KEN 105 THE ANNUAL REPORT on THE HEALTH, SANITARY CONDITION, &c., &c., of the Parish of St. Marn Abbotts, KENSINGTON, FOR THE YEAR 1878, by T. ORME DUDFIELD, M.D., Medical Officer of health HUTCHINGS AND CROWSLEY, PRINTERS, 123, FULHAM ROAD, SW. AND HENRY STREET, ST. JOHN'S WOOD, N.W. 1879. CONTENTS. PAGE. Prefatory Remarks 5 Death-rates (1873-8), Parochial and Metropolitan 7 Registration District ("Kensington") and Sub-Districts, what they comprise 7 Zymotic Diseases, The Seven Principal 8 „ Whooping-cough 8 „ Diarrhoea 9 „ Scarlet Fever 10 „ Diphtheria 11 "Fever" 11 „ Measles 11 „ Small Pox, Epidemic of 12 Fulham Hospital—Still an object of suspicion, on insufficient grounds 15 „ „ Its work during the year 19 "Hampstead Hospital Case," The 21 Hospital Accommodation for Non-pauper Infectious Sick 22 „ „ Conference of Vestries, &c., on 22 „ „ Deputation to Local Government Board with respect to 24 (See Addendum, page 81, for result of Conference). "Disqualification by Medical Relief," A Bill to remove 26 Ambulance Service 29 (See Addendum also, page 82). Infectious Diseases, Prevention of the spread of 29 „ „ Information of the existence of, how obtained 30 Population of Kensington in 1878 (estimated) 32 „ of Sub-districts; relative proportion of the sexes; number of inhabited houses, &c. 32 Kensington, Evidences of the growth, wealth, &c., of (1801-79) 33 Marriages and Marriage-rate 33 Births and Birth-rate 33 Deaths and Death-rate (at ages and periods, and of the sexes) 34 Deaths, Special causes of 37 Public Institutions, Deaths at 43 Inquests, Facts about 45 „ Why so many are necessary 47 Deaths not certified 48 iv CONTENTS. PAGE. Glanders, Outbreak of at Colville Mews 48 „ Breaches of the Law relating to 50 „ Inquest on a Woman who died of 51 „ Action of " Local Authority" in relation to the Outbreak of 52 Meteorology 54 Vaccination 55 Sanitary Work 56 Slaughter Houses, The Licensed 56 Cowsheds „ 57 „ Report of Works, &c., Committee, on the 57 „ „ „ „ Further, showing the result of the action of Vestry for the improvement of 59 "Dairies, Cowsheds, and Milk-shops Order of l879," The 60 „ „ Regulations as to 61 Bakehouses 64 Dust Removal 65 Manure (Stable), Non-removal of 65 "Offensive Matter," Removal of 66 Necessary Accommodation—Public Urinals 67 Legal Proceedings 67 Convictions under Dairies, &c., Order 68 „ for keeping Swine 68 „ for " transmitting" infected clothing 69 Richmond Gardens, Proceedings under Torrens' Act 70 Mortuary, Public 70 Disinfection 71 Baths and Washhouses 72 Lodging Houses, Proposed Regulations for 72 Water Supply 73 Gas 79 Conclusion 80 ADDENDUM. "The Poor Law Act, 1879,"—makes provision for Hospital treatment of Infectious Diseases (non-paupers), Metropolitan Ambulance Service, &c., &c. 81 APPENDIX. Statistical and other Tables, I—XII 83 TWENTY-THIRD ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH, BEING FOR THE YEAR 1878. To the Vestry of the Parish of St. Mary Abbotts, Kensington. Gentlemen, The year 1878 occupies an unfavorable position in respect of the vital statistics of our parish, especially as compared with 1877. The latter year was remarkable for a very low death-rate, viz., 17.3 per 1,000 persons living, or 2.2 per 1,000 below the decennial average (19.5). The death-rate of 1878, 20.3 per 1,000 in an estimated population of 153,600, was 0.8 above the average, and 3.0 per 1,000 above the rate in 1877. The deaths registered in the parish, and at the hospitals of the Metropolitan Asylums Board, in 1877, were only 2,624, being 272 fewer than the number in 1876 (2,896); but in 1878 the deaths were 3,120, or 226 more than in 1876, and 496 more than in 1877. These totals include in each case the deaths of nonparishioners at the Hospital at Brompton for Consumption and Diseases of the Chest, which are reckoned in our vital statistics by way of compensation for the unknown number of deaths of parishioners at hospitals and other places beyond the limits of the parish. The Metropolitan death-rate, which in 1877 was 21.9per 1,000, and 4.6 per 1,000 above the rate in Kensington, rose to 23.5 in 1878, being 3.2 per 1,000 only above that of Kensington. As the decennial death-rate in the Metropolis was 3.6 per 1,000 above that of Kensington, it would appear at first sight that the state of the public health of our parish, as guaged by the death-rate, was relatively worse last year B 2 6 than that of the Metropolis generally; but at the least it cannot be deemed to have been so unfavorable as the rise of 3.0 per 1,000 above the low death-rate of 1877 might seem to indicate,—seeing that the rise in the Metropolitan death-rate was only 1.6; because the rate in 1877 was 2.2 per 1,000 below the decennial average, while that of the Metropolis was only l.3 per 1,000 below the average. A death-rate much below the average one year, is nearly sure to be followed by a rate above the average in the next or following year; and, therefore, though it may be well to refer to the fluctuations in the rate from year to year, it would be unwise to attach too much importance to them, whether they represent an elevation or a depression of the wave of mortality. The healthiness of a district must be judged by the decennial rate. It may be here mentioned, in passing, and in some sort as an illustration of the above remarks, that in 1877 the deaths from the "seven principal diseases" of the zymotic class were far below our decennial average, while in 1878, they were considerably above that average. Only 339 in the former year, they sprung up to 573* in the latter. There is some little satisfaction in noting, however, that the increase in the number of deaths from these maladies in 1878, was not due to the prevalence of the more serious members of the class, but to the unusual fatality of two infantile diseases, viz., whooping cough and diarrhoea, which were the causes of 185 and 181 deaths respectively. The excess of deaths from these two diseases alone (233) exactly accounts for the rise from 339 deaths from the "seven principal diseases of the zymotic class" in 1877 to 573 in 1878. The Unusual fatality of these two diseases raised the " zymotic death-rate" to 3.7 per 1,000 living, which is considerably above the decennial average (3.2), and not much below the rate, in 1878, for the whole Metropolis (4.1). It accounts likewise for the high rate of infantile mortality throughout the year, the deaths of children under five years having numbered 1,429, including 823 of infants in the first year of life; whereas, in 1877, only 1,040 children died under five years, including 648 under one year, numbers considerably below the average. Particulars with reference to the deaths from zymotic diseases, and the causes of deaths generally, will be furnished latter on. * These totals include the deaths at the Hospitals of the Metropolitan Asylums Board. 7 The subjoined table shows the relative rates of mortality in all London and the several great divisions thereof, and in our own parish, during the last six years :— Death-rate. 1878. 1877. 1876. 1875. 1874. 1873. Kensington 20.3 17.3 19.5 19.4 19.5 18.3 per 1,000. London 23.5 21.9 22.3 23.7 22.5 22.5 „ West Districts 21.6 19.1 21.0 22.1 20.9 20.5 „ North „ 22.3 21.8 21.4 22.3 21.8 21.2 „ Central „ 24.9 24.1 24.0 26.0 25.6 25.0 „ East „ 24.9 24.4 24.0 25.5 25.4 25.2 „ South „ 24.2 21.3 22.1 25.0 21.5 22.0 „ Registration Sub-Districts.—As usual, there was a great difference both in the general and in the zymotic death-rate of the two registration sub-districts, into which the parish is unequally divided, viz., "Kensington Town" and "Brompton," and much to the advantage of the latter. The former district, hereinafter for brevity called the "Town," comprises that portion of the parish north of Kensington Road, and a portion south of that line. It has an area of 1,497 acres, and it had an estimated population of 114,100 at the middle of 1878. The area of "Brompton;" is 693 acres, and its estimated population was 39,500. The Town sub-district includes important open spaces, as Holland Bark, Kensal Green Cemetery, and fields in the vicinity thereof, which are now being rapidly covered with houses. The Brompton sub-district, in which the builder has been very busy during the last few years—many of the new houses being of a palatial character— comprises within its boundaries the West London or "Brompton" Cemetery. The two sub-districts differ widely in respect of the social status of their inhabitants. Speaking generally the rich and well-to-do form a large proportion of the population in "Brompton," the "poor" being few in number; while in the Town sub-district, especially in the northern part of the parish, the poor constitute a large and an increasing percentage of the population. The poor in Kensington, however, have one advantage over the poor in some other parts of the Metropolis, especially at the East end, viz., that they live in houses obviously intended for a superior class: miles of streets of such houses being now inhabited by 8 persons who, in the older parts of the Metropolis, find shelter in dwellings that by comparison might be described as squalid. Rents are high, as might be expected, and there is a good deal of overcrowding, which leads me to fear that ere long, unless a remedy be provided, of which I do not see any present prospect, the Kensington rate of mortality may approximate more nearly to the Metropolitan rate than heretofore. The propriety of dividing the "Town" sub-district, which is exceptionally large and populous, is under the consideration of Authorities at the present time.* At present, as before stated, the "Town" and " Brompton" sub-districts make up the parish of Kensington; but "Kensington" as a "registration district"—the parish and the district being often confounded—comprises a great deal more; viz., the parishes of Paddington, Fulham, and Hammersmith. The subjoined figures show the relative proportions of Kensington parish, and the other parishes comprised in the registration district of Kensington:— Area in statute acres. Inhabited houses, 1871. Population, 1871. Kensington 2,190 15,735 120,299 Paddington 1,251 11,847 96,813 Hammersmith 2,287 6,719 42,691 Fulham 1,716 3,469 23,350 For some parochial purposes Kensington parish is divided into wards. The subjoined figures show the acreage of the several wards, and other particulars of interest which relate to the census year, 1871. Name of Ward. Area in statute acres. Inhabited houses, 1871. Population, 1871. Rateable annual value of property 1871. Holy Trinity, Brompton 439 3,224 22,128 £246,716 St. John, Notting Hill and St. James, Norland 905 7,730 62,475 £365,012 St. Mary Abbotts 846 4,781 35,696 £323,992 2,190 15,735 120,299 £935,720 THE SEVEN PRINCIPAL ZYM0TIC DISEASES. Whooping Cough in point of fatality heads the list of the diseases of the Zymotic class, having caused 185 deaths in 1878, of which 164 * The projected division of the sub-district was not carried out; other arrangements for the convenience of the parishioners having been made. 9 belong to the Town registration sub-district, and 21 to Brompton. The victims of this malady are infants and young children; death, when it happens, being usually the result of some intercurrent complication, as disease of the breathing organs. It is scarcely too much to say that many deaths from whooping cough are "preventible"—the fatal complication, e.g., pneumonia, bronchitis, &c., being due to exposure of the patient. It is a good rule to confine children to the house, and indeed to one room, during the more acute stages of whooping cough, but in the homes of the poor it is often found quite impracticable to do so. The children of the poor furnish a large proportion of the fatal cases; and it is observable that scarcely more than one death in nine occurred in the Brompton registration sub-district, which is largely inhabited by the wealthier part of the community; children moreover being relatively lewer in number in this sub-district. Diarrhœa comes next after whooping-cough in the order of fatality, having been the cause of 181 deaths, of which only one-ninth (20) occurred in the Brompton registration sub-district. Diarrhœa as a factor in the mortality returns is an infantile disease, and a disease peculiar to hot weather, the time of year at which it prevails in its most fatal form being determined by the temperature. Heat appears to be a direct exciting cause of the malady, and it has been noticed that diarrhoea is always fatally prevalent when the Thames water attains a temperature much above 60º Fahr. The Registrar-General in his 29th "Weekly Return" (July 20), referring to this subject, said—"The Thames temperature which had been 60° rose in the last week of June to 65°, in the three following weeks it was 68, 66, and 67, The weekly deaths from diarrhœa and simple cholera, which had been 23, rose to 78, 156, 256, and 349 in the corresponding weeks." He added the following significant remark:—"The deaths from diarrhoea are differently distributed in the fields of the water companies; thus the deaths in the last four weeks were 786 in the districts supplied with Thames and Lea waters, whereas the deaths in the districts supplied with water drawn from the chalk by the Kent Company were 19. Out of the same population the deaths in the former were to the deaths in the latter as 3 to 1." It may be mentioned that the Kent Company's water, obtained from deep wells, attains a maximum temperature of about 58o Fahr. only, and has a range of about 13º Fahr., whereas the river 10 waters have a range of double that extent. Other causes, however, contribute to the production of diarrhoea, among which may be cited artificial feeding. It is difficult to preserve milk from undergoing change in hot weather, and the heat, which generally "turns the milk" acid, simply, not seldom in the close atmosphere of crowded rooms, is the cause of a putrid change. No doubt want of attention to the condition of the feeding bottle is also an important factor in the chain of causation, as the slightest collection of sour matter in any part of the apparatus leads to speedy change in the milk. Not uncommonly, moreover, ignorant mothers allow the milk to remain in the bottle in the hot bed, till it is wanted: or feed their children on farinaceous and other indigestible foods, which disorder the bowels and almost infallibly cause diarrhoea. The disease, once set up in young infants at this season of the year, is apt to prove intractable, more especially when the cause to which it is due continues in operation. The disease, again, is at first thought too lightly of, and in many instances medical aid is not sought until the patient has become so much reduced as to be beyond the power of restoration under the circumstances in which the children of the poor are brought up; and I say the children of the poor, because it is among the children of the poorer classes that the disease prevails in its most fatal form. Scarlet Fever.—The deaths from scarlet fever 77, viz., 8 in Brompton, 62 in the Town sub-district, and 7 in the hospitals, were below the average. The disease seems to have assumed a tolerably mild form, as a rule, throughout the year; but two or three groups of severe and fatal cases in single houses occurred, amply illustrating the danger poor persons incur by keeping cases of scarlet fever at their homes where it is impossible to isolate them. It is often done because the individual case is mild (it is then called Scarlatina, which is only Scarlet Fever put into Latin); but it cannot be too generally known that the mildest cases frequently prove the most serious in the long run, because, owing possibly to want of care during convalescence, they are often followed by those sequelce—kidney disease, dropsy, &c., by which life is ultimately cut short after a more or less prolonged period of illness and suffering. Many an adult succumbs in what should be the prime of life to "Bright's disease," the foundation of which had been laid in a "mild" attack of Scarlatina. 11 The mildest case, moreover, is a source of danger to all, children especially, who come within the area of its infective power, being capable of conveying the disease in its worst form. Great obstacles, however, are experienced in persuading parents to allow their children to go to the hospital when suffering from scarlet fever, though such removal is, on an average of years, more necessary for the security of the public than the removal of cases of small-pox. The disease, however, is not so loathsome to look upon as small-pox, and from its comparative frequency does not inspire the same dread. Diphtheria.—The deaths from this disease (20) were above the average, and all occurred in the Town sub-district. In more than one case the disease was imported. The victims were mostly young children. Measles.—The deaths from measles, 54 in 1877, were 53 in 1878, the uncorrected decennial average being 65. Only three of the deaths were in the Brompton sub-district. Fever.—The deaths grouped by the Registrar-General under the common heading, "Fever," are due to one of three several diseases, viz., Simple Continued fever, Enteric (or Typhoid) fever, and Typhus fever. The deaths last year, as registered, were 31, the uncorrected decennial average being 41. Typhus Fever.—Three deaths were registered from this cause,— all in the Town sub-district: there was good reason, however, for questioning the accuracy of the diagnosis. I entered fully into this subject in respect of two of the cases in my last Annual Report (page 10), the deaths having occurred at the beginning of the year; it only remains now, therefore, to notice the third case; that of a child aged three years, the patient of an unregistered practitioner. I thoroughly investigated this case, with the result of assuring myself that, whatever may have been the nature of the fatal disease, it was not typhus. It may have been enteric fever, but more probably it was a case of tuberculosis, ending with convulsions. There had been no previous case in the house, and there was no subsequent case; nor was there anything in the condition of the house or family to account for the occurence of 12 typhus fever; no reference to this disease, moreover, having been made by the practitioner during the continuance of the illness. Enteric Fever.—Twenty-four deaths were registered from this disease, of which 10 occurred in Brompton, a large and unusual mortality for that sub-district. I dealt fully witn the subject of enteric fever in my last annual report (page 11), in connection with a sharp endemic, which, commencing in November, 1877, was prolonged until the end of January, 1878, and caused eight deaths at home or in hospital. The localities at which fatal cases occurred are shown in Table 9 (Appendix). I am not able to throw much light on these cases, qua causation. A few, however, certainly six, were imported, and in one or two others there appeared reason to doubt the validity of the diagnosis; as, to quote but one example, in the case of a lady whose death was attributed to "disease of the valves of heart, three years; typhoid fever, 56 days; acute pulmonary phthisis, 40 days," the case probably being an instance of that sharp febrile disturbance, associated with acute tuberculosis, which is occasionally mistaken for specific fever. Simple Continued Fever.—The deaths from this disease were four in number, of which one occurred in the Brompton sub-district. SMALL-POX. Small-Pox, which began to be epidemic at the close of 1876 is still, at the middle of 1879, more or less prevalent in the Metropolis generally, and in some parts of the parish; our efforts to cope with the disease and to stamp it out not having had the success they deserved, seeing how much time and labour has been consumed in the endeavour. This is not to be wondered at, however, the migration of families in which the disease makes its appearance, and the concealment of cases, amply accounting for its spread in the parish, and from one parish to another. The force of the epidemic has been very unequal, and sometimes we have been deluded with the hope that it was about to cease, a hope again and again dashed by the occurence of fresh and unlooked-for outbreaks. The fluctuations of the disease, and the relative prevalence of it in the parts of the parish north and south of the Uxbridge Road; 13 and between November, 1876, and the end of June, 1879, are shown in the subjoined table (compiled from my Monthly Reports):— Date of the Monthly Report. No. of Cases Reported. No. of Cases under 15 years of age Ditto over 15 No. of Cases Sent to Hospital. Treated at home North South of Uxbridge Road. 1876. No. 10. Nov. 15 13 5 8 12 1 4 9 14. Dec 13 36 14 22 22 14 28 8 1877. 15. Jan. 10 40 20 20 24 16 30 10 1. Feb. 7 43 14 29 34 9 24 19 2. Mar. 7 26 12 14 24 2 15 11 3. April 4 24 7 17 22 2 18 6 4. May 2 39 17 22 32 7 23 16 5. „ 30 43 21 22 38 5 29 14 6. June 27 50 20 30 28 22 40 10 7. July 25 43 21 22 25 18 38 5 8. Aug. 22 39 10 29 17 22 32 7 9. Sept. 19 12 3 9 7 5 9 3 10. Oct. 17 19 16 3 7 12 12 7 11. Nov. 14 11 4 7 4 7 8 3 12. Dec. 12 5 1 4 1 4 3 2 13. (to) 31 5 0 5 1 4 4 1 1878. 1. Feb. 6 8 3 5 6 2 7 1 3. Mar. 5 10 1 9 5 5 10 — 4. April 3 16 2 14 6 10 15 1 5. May 1 57 8 49 7 50 47 10 6. „ 29 55 23 32 21 34 35 20 8. June 26 23 8 15 7 16 18 5 9. July 24 6 2 4 - 6 4 2 10. Aug. 21 1 - 1 - 1 1 - 11. Sept. 18 - - - - - - - 12. Oct. 16 - - - - - - - 13. Nov. 13 1 — 1 1 — 1 — 14. Dec. 11 — — — — — — — 15. Dec. 28 2 — 2 — 2 1 1 1879. 1. Feb. 5 7 1 & — 7 2 5 2. Mar. 5 11 2 9 2 9 9 2 3. April 2 28 3 25 13 15 18 10 4. „ 30 27 4 22 — 27 25 2 5. May 28 10 1 9 2 8 7 3 6. June 25 28 8 20 2 26 24 4 Totals 738 251 487 370 368 541 197 The cases recorded between June 26th, 1878, and June 25th, 1879, were 121 only, as compared with 303, in the previous twelve 14 months. Of these 121 cases, 20 occurred North and 101 South of the Uxbridge Road: 21 were under, and 100 were over, 15 years of age; 92 of the sufferers were removed to Hospitals and 29 were treated at home. The disease made its appearance in 93 streets and in 108 houses. The deaths in the registration year 1878 were 24, viz., 8 at the homes of the sick (3 in the Town sub-district and 5 in Brompton) and 16 at the Hospitals. During the present epidemic, as in the previous one in 1871-2, which was of shorter duration, the prevalence of the disease was mainly confined to the northern parts of the parish in the first instance, and subsequently to the southern parts. It has persisted for a longer period in the south during the present epidemic, and I am bound to believe that it has done so owing to the re-introduction of infection from adjoining parishes, especially Fulham, where according to the report of the Medical Officer of Health, very many cases have been concealed and kept at home. Some cases no doubt are so effectually concealed that we never hear of them at all, and in other instances the presence of the disease is made known only on the registration of a death. In a case of recent occurrence an outbreak was concealed for some time by the supression of the "primary disease" in a medical certificate of the cause of death; a death really due to small-pox, having been attributed to the secondary cause only, viz., congestion of the lungs. In a few instances the first case in a family was of so trivial a nature as to have been mistaken for chicken-pox, the mistake not being discovered until too late to prevent the spread of the disease, nor in fact until the occurrence of second cases (one or two of them fatal) left no room for doubt. In several instances there was exposure of the sick in public places and in public conveyances—but with what evil consequences can only be surmised. On the whole we have not much reason to be dissatisfied with the amount of success that has attended our efforts to get the sick removed to hospitals; though objections have been raised in a few instances, sometimes because the case was of so trifling a character, and sometimes because of the severity of the illness. It is not easy to say which class of cases does the greater public harm, the lighter in which it is difficult to keep the "sick" at home for the period requisite for complete recovery, so as to prevent them from spreading the disease; or the more severe in which a large amount of infective matter is thrown off by the skin, lungs, &c., to the great danger of the other inmates of the house. 15 FULHAM HOSPITAL. About 139 cases of small-pox were removed to the hospitals of the Managers of the Metropolitan Asylum's Board during the year, of which 5 went to Hampstead, 2 to Stockwell, and 132 to Fulham. The question, Whether the latter hospital is a source of direct infection, and, therefore, a danger to the locality in which it is situated? has from time to time been debated as warmly as ever. I say "from time to time," because when an outbreak of small-pox occurs in the district the question is debated: and when the disease is absent from the district nothing is heard about the matter, though the hospital may have been steadily continuing its career of usefulness. Debated, moreover, I am bound to add, without any evidence having as yet been produced to support the indictment against the hospital, and without any reference to the value of the hospital as a place of safe isolation for the sick. "There are cases of small-pox in the district the origin of which we don't know: there is a small pox hospital not half-a-mile away: therefore the spread of the disease must be due to the hospital;"—is a not unfair exposition of the "reasoning" on which the hospital has been condemned (in all sincerity I believe) by many persons. But the mode of spread of the disease is not often mysterious to those who, being brought daily into contact with the sick, have opportunities of tracing cases to their origin; and although cases have occurred of which the origin has not been traced, the cases are so numerous in which the course of infection has been tracked, from house to house, to the primary case in a given group, as to satisfy well-informed persons that the comparatively few cases in which the source of infection has not been traced would, in all probability, if the facts were known, admit of an equally rational explanation. Speaking from experience, I am able to say that it is often a difficult matter to extract the truth with respect to the previous movements of the sufferers. Actual untruth in some cases, a withholding of facts in others, is too common. In many a case where the Sanitary Inspector, under the heading in his report book, "supposed origin of the infection," has been obliged to write "unknown," the apparent mystery has received quick and satisfactory solution as the result of enquiries made under more favourable circumstances in the hospital itself. The able and 16 courteous Medical Superintendent has acquainted me with many illustrations of this fact; hut, as he intends to publish his experience shortly, it would not be fair to detract from the interest of his work by any partial and imperfect statement in this place. I may mention, however, that the recurrence of the Easter festival having brought its thousands of holiday-makers into the immediate vicinity of the hospital, viz., at Lillie Bridge and Stamford Bridge running grounds, the opportunity was deemed a good one for endeavouring to ascertain what basis, if any, there might be for suspicion against the hospital; aud, accordingly, I wrote a letter in the following terms to the Lancet and the British Medical Journal, and it was inserted conspicuously in both papers on the 26th April. "The question whether the Small-Pox Hospital at Fulham may not be a danger to the locality by direct infection, still agitating the public mind, I have been requested by the Kensington Vestry to ask you to permit me to draw the attention of the profession to the fact that, on the 4th, 5th, 11th, 14th, and 15th days of April, many thousands of people were congregated in the immediate vicinity of the hospital, viz., at the Lillie Bridge or at the Stamford Bridge running-grounds. The Vestry are of opinion that, if there be any basis for the belief that the hospital is a source of danger to the public by direct infection, the fact should become manifest on such occasions as those referred to. They appeal, therefore, to medical men in town and country, for detailed information should cases of small-pox come under their notice, which, due regard being had to the known period of incubation, may be reasonably supposed to have originated from infection on the dates and at the places named." To this letter I did not receive one reply. A fresh outbreak occurred at Brompton at the end of 1878, corresponding with a general recrudescence of the disease throughout the Metropolis, as shown by the cases admitted into the Hospitals; the local prevalence of the disease, however, being explained by the existence of numerous unguarded centres of infection at that very time. As will be seen by reference to the previous table, there had been only one known case of the disease, and that in the north of the 17 parish, during a period of three or four months, viz., from August to November, 1878. But, in December, a concealed and fatal case occurred at Seymour Place, Fulham Road. Between that date and the end of January, 1879, eight other cases occurred, and of these five were treated at home, one at Pelham Street (fatal), three at Richmond Road (two of them fatal), and one at Ifield Road (also fatal). Thus, to say nothing of "concealed" cases of which we subsequently obtained information (there were two consecutive cases in one room at Sumner Mews, the continuance of the disease extending over many weeks), we had six local centres of infection at the very commencement of the fresh outbreak- at a time moreover, when for many weeks we had flattered ourselves that our efforts to eradicate the disease had at last been crowned with success. It happened moreover, as it nearly always does when an epidemic disease first breaks out, that the first cases were not reported. Unless death ensues weeks may elapase before an epidemic disease is known to exist. Such was the case at the beginning of this great epidemic at Islington in 1876, and such was the case at the beginning of the last outbreak in Brompton, which is still progressing. So soon as we knew that the disease had re-appeared in the parish our efforts were again directed to the isolation of the sick in hospital, not with complete success at any time, and least of all at first, and thus the disease got a good hold in the district. As soon as cases began to flow freely into the hospital persons aware of that fact, but ignorant of what had gone before, jumped to the conclusion that the hospital—our greatest ally in measures for coping with the epidemic, was in fact the means by which the disease was originated and spread. In my second report for 1879 (dated March 5th), 1 recorded eleven cases—including the two at Sumner Mews referred to above as having been concealed, until our services were required for the disinfection of the sick room. The remaining nine cases were removed to the hospital after more or less loss of time, due to delay in diagnosis or in reporting the cases, but they had established several other centres of infection. In the third report (dated April 2nd), 28 cases were recorded, of which 15 occurred in the south district: and in the fourth report (April 30th), 27 cases, all in the South district. In the fifth report (May 28th) the known cases fell to 10, eight in the 18 south district, and in the sixth report (June 25th) the last report that will be referred to here, the cases rose again to 28, of which 25 were in the south district. The streets that successively became infected were the following:— Moreton Gardens, Childs Place, Adrian Terrace, Redcliffe Street, Shaftesbury Terrace, Kramer Mews, Ifield Road, Finborough Road, Fenelon Road, Redcliffe Mews, Tregunter Road, Yeoman's Row, Pembroke Square, Redcliffe Gardens, Warwick Terrace, Cathcart Road, Ashley Cottages, Queen's Gate Gardens, Redcliffe Square, Glos'ter Road, Coleherne Road, Cromwell Road, Earl's Court Road, &c., &c. It will be apparent to those who know the district, that many of the above streets are far away from the hospital, and are separated from it by other streets in which, so far as we know, the disease has not made its appearance. One remarkable fact must not be overlooked, viz., the frequency of the instances in which a female domestic servant was the only person ill in a house. In the great majority of instances there was but one case in a house, and in a considerable number of these, the single sufferer was a servant; in most of such cases, moreover, the symptoms first showed themselves on or very near Sunday, at a period when they would have been expected to develope, on the assumption that the disease had been contracted on the previous Sunday week when the sufferer was enjoying her "Sunday out." In one month alone out of a total of 27 cases—one to a house—no fewer than 12 were of female domestic servants. Granting the hospital to have been the source of infection in these cases, by what law of selection can it be explained, how it happened that one only of several servants, and no other member of the household should have been stricken? The opponents of the hospital have not hitherto offered an explanation of the fact, but we know that in many of these instances, the disease has been traced to exposure to infection at the homes of the sufferers. Artizans and labourers came next in order of frequency as the victims in the recent outbreak. The number of children attacked was relatively small as it has always been, within my experience, in the Brompton district. The comparative freedom of the northern parts of the parish from the disease, during the progress of the epidemic in the first half of the current year, has been somewhat remarkable. There were six cases in one house,—one died at home, the others were removed; there were 19 several cases in another house, of whom one died in hospital, and the others were well isolated at home. The remaining cases, few in number, were single cases. It seemed as if the disease had no particular tendency to spread in the district, which, earlier in the epidemic, when Brompton was free, had been severely stricken, and where re-vaccmation had been practised to a relatively large extent. I shall conclude my remarks on this subject with a brief resume of some of the work, &c., of Fulham Hospital during 1878, as set out in Dr. Makuna's annual report. On the first day of the year there were 15 convalescent patients remaining under treatment, transferred from the Stockwell Hospital. On the 6th January, a sick man walked in from Fulham, and on the 25th the hospital was re-opened for acute cases. By the 21st February the number of patients had reached 156, and on April 21st there were 252 cases, the maximum number since the opening of the hospital in March, 1877. By the end of May—the admissions had become fewer week by week—the number had declined to 187; on July 21st there were 72 cases, and on the 28th September only 3. Between the 28th September and the 31st December the number rose slowly to 20. Here we see the first flow of the wave, the full force of which has hardly been expended yet, though from time to time it has seemed about to ebb. And it corresponds with that new outbreak in the Brompton district, of which it was the evidence and the outward sign; and not, as some imagine, the cause. The number of patients in the hospital is seen to rise and fall just as the cases out of doors increase or diminish. If the timid and the ignorant (using the term in no unbecoming sense) will invert the order of occurence of the events we can but regret it, and endeavour with how little soever of success to set them right. There were 1,109 admissions in all during the year, of which 766 were acute cases, and 343 were convalescents transferred from Hampstead and Stockwell. There were 134 deaths; 20 cases remained under treatment at the end of the year, and 970 persons had been discharged. There were 121 deaths out of 727 completed cases, equal to 16.64 per cent. Of 569 vaccinated persons 48 died, or 8*43 per cent. Of 158 unvaccinated persons 73 died or 46.20 per cent. Fifty-five children under five years were admitted, 21 had been vaccinated and 34 had not. Only one of the vaccinated children 20 died, a boy who had six 'indifferent' marks of vaccination; but on admission he was emaciated, ill-fed, had sore eyes, and he suffered from lung disease. Nineteen of the un-vaccinated children died, or 55.88 per cent. Seventy-five of the 399 male patients died (=18.48 per cent.), and 46 of the 328 female patients (10.97 per cent.) The average period of the illness in hospital of the fatal cases was 7.73 days, but four of the patients died within 24 hours after their admission, 11 within 48 hours, and 10 within 72 hours. The average stay in hospital of un-vaccinated persons was 52 days; of vaccinated persons with good marks, 35 days; ditto with traces of marks, 41 days. Among the cases there were admitted from Fulham 191 of whom 42 were unvaccinated. Kensington 132 „ 19 „ Chelsea 116 „ 27 „ Wandsworth and Clapham 90 „ 28 „ St. George's, Hanover Square 76 „ 14 „ Of 34 unvaccinated children Fulham supplied 11, Chelsea 10, St. George's 4, and Wandsworth 4, and Kensington 1. These statistics must be regarded as relatively favourable in respect of our own parish, qua vaccination. The percentage of deaths of children was 36.36. Above five years it was 43.54 per cent. of unvaccinated cases, and 8.57 of the vaccinated. Of the sick who had "good marks" of vaccination 1.24 per cent. died. Of those with "indifferent marks" 9.53 per cent. died. Of those with "traces of marks" 20.96 per cent. died, while among the "unvaccinated" the mortality was 46.20 per cent. So much for the quality of the vaccination; the influence of quantity is shown by the fact that the per centage of deaths where there was 1 mark was 16.83 per cent. 2 marks „ 6.79 „ 3 „ „ 6.25 „ 4 „ „ 6.52 „ 5 „ „ 6.25 „ In all vaccinated cases 9.53 Persons who have been thoroughly vaccinated are described as "vaccinized." There were 22 such cases—12 above 16 years of age; 21 four of these cases were hardly to be called small-pox, so trivial were the symptoms, and 19 out of the 24 required no treatment. Since the opening of the hospitals in 1877 there have been employed on the staff 157 officers, nurses, servants, and porters, of whom 23 had previously had small-pox. One house servant, whose word was taken for her re-vaccination, contracted the disease. Of 133 who were revaccinated two only suffered from small-pox, and that in a very mild form. The report by the Medical Superintendent contains much further interesting matter to repay perusal, but for which I cannot find room here. I shall only add that the Hospital "Pavilions" are singlestory buildings, well ventilated, with abundant light and air, being surrounded by nicely laid-out gardens. The hospital site has an area of 6½ acres. "THE HAMPSTEAD SMALL-POX HOSPITAL CASE." The opposition to the continued existence of Fulham Small-Pox Hospital was not a little stimulated by the apparently successful result of the action brought by Sir Rowland Hill and others against the Managers of the Metropolitan Asylums Board, in respect of the Hampstead Hospital—the verdict having been adverse to the Managers on all points. Mr. Baron Pollock, who tried the cause, left the following questions to the jury:—1. Was the hospital a nuisance occasioning damage to the plaintiffs, per se? 2. Was the hospital a nuisance per se, or by reason of patients coming to or going from the hospital? 3. Assuming that the defendants were by law entitled to erect and carry on a hospital, did they do so with all proper reasonable care and skill with reference to the plaintiffs' rights? 4. Assuming that the defendants were by law entitled to erect and carry on this particular hospital, did they do so with all proper reasonable care and skill with reference to the plaintiffs' rights? 5. Did the defendants use proper care and skill with respect to the ambulances? And on all these questions the verdict was adverse to the defendants, though the jury admitted that everything had been done that could have been done relating to the internal management of the hospital. c2 22 It would be difficult to exaggerate the mischief that might ensue to the prejudice of the public health if this verdict should stand; and as the verdict appeared to be against the weight of evidence, as it certainly is contrary to public policy, I ventured to express a hope, at the time, that it might be reversed on a new trial. An application was in due course made for a new trial, and gave rise to a long and able argument before the Court of Queen's Bench, with the result that, subject to the decision of the Court of Appeal on certain legal questions, the rule for a new trial was made absolute, the Lord Chief Justice, moreover, having laid down the questions that are to be submitted to the jury. HOSPITAL ACCOMMODATION FOR CASES OF INFECTIOUS DISEASE. The subject of hospital accommodation for persons suffering from infectious diseases has engaged a good deal of attention during the year having at length, as I stated in my last annual report, been taken up by many of the Nuisance Authorities of the Metropolis acting in concert; but no satisfactory solution of the difficulties by which it is beset has hitherto been arrived at. The Limehouse District Board of Works, which has honorably distinguished itself by the part it has taken in endeavouring to bring about a settlement, invited the Vestries and District Boards to appoint delegates to confer on the subject, and several meetings were held; your Vestry having been one of the authorities represented at the conference. Indeed it is not too much to say that the action that had been taken by your Vestry in past years, and with which the other Vestries, &c., appeared not to have been previously acquainted, had a very important influence on the proceedings of the conference, which practically gave effect to the views your Vestry had on several occasions enunciated, and had reaffirmed in a set of propositions framed for the guidance of your Vestry's delegates (vide Annual Report for 1877—page 22). In my last annual report I detailed the proceedings of the conference down to July, 1878, set out the resolutions that had been adopted, and stated that the conference had been adjourned until the month of October. At the meeting held in October a great impetus was given to the proceedings by an excerpt from one of my monthly reports (No. 12, 23 1878. Oct. 16th—page 82, et seq.), which had been reprinted by order of your Vestry for the use of the delegates, and in which I had mentioned a case bearing on the hospital treatment of infectious diseases, that had cropped up in the Tower Hamlets Registration Court. It appeared that— "Sometime in March the child of a householder contracted small-pox, and that 'the sanitary authority of the district insisted on her being removed to Homerton Hospital,' which is legally a pauper establishment. On this ground one of the political parties—it boots not which, for the question is above party— objected to the man's vote. It was contended on the one side that the 'relief' afforded to the man by the maintenance of his child in a hospital supported by the poor rate was 'parochial' relief; while on the other side it was contended that the fact of the removal of the child having been compulsory rendered the objection null. The opposing party, however, argued that poor relief, whether voluntary or compulsory, was still poor relief, and was, legally, fatal to the claim. The Revising Barrister at first held that there was a great distinction to be drawn between a man who of his own free will sought parish relief and one who had it forced on him against his will, as appeared to be the case here; but ultimately he decided that such relief was to all intents and purposes parochial relief, notwithstanding that it was afforded against the will of the recipient. But in order to disqualify the voter for the franchise, the Revising Barrister said it must be shown that parish relief had been afforded to a child under sixteen years of age, and evidence on this point was not before the court. He further held that the payment of the cost of the child's maintenance from the district rate would not have been sufficient to disqualify the claimant, hut that clear proof must be given that it came from the poor rate. He decided to retain the name of the claimant on the list."* It was generally felt by the delegates that the occurrence of the above case could not fail to have a good effect in furthering the object * It appeared subsequently that the child was eight years of age only, and that the expense of her maintenance was borne by the Guardians out of the poor rate. The householder therefore saved his vote, not on the merits of the case, but simply owing to the failure on the part of the objector to produce the evidence which was necessary in order to his disqualification. 24 the conference had in view, by calling attention to a practical injustice in the working of an otherwise beneficent Act (The Metropolitan Poor Act, 1867); and that Parliament could scarcely do otherwise than remove an anomaly that had been so glaringly illustrated. At this third meeting of the Conference, the Resolutions adopted were as follow (1.) "That a memorial be prepared and presented to the Home Secretary, in accordance with the terms of the resolution passed at the last meeting of the Conference;" and (2.) "That a Committee be appointed to prepare such memorial, and arrange for its presentation by a deputation." Referring to these resolutions, I ventured in my Report for Nov. 13th (No. 13, page 95), to express my hope that the right hon. gentleman, should he consent to receive the deputation (the question belonging to the Local Government Board) would have his attention called to the necessity of depauperising the "relief" afforded in the "infectious diseases hospitals," by a short Act or a clause, framed on the model of the 26th section of the Vaccination Act (30 and 31 Vic. cap. 84) in some such words as these:—" It is hereby declared that the surgical or "medical assistance and the maintenance incident to the treatment of any "person in a union or parish, hereafter removed to a hospital provided "for the isolation and treatment of persons suffering from any infec"tious diseases, shall not be considered to be parochial relief or charitable "allowance to such person, or his parent, and no such person or his "parent shall by reason thereof be deprived of any right or privilege, "or be subject to any disability or disqualification:" and I further expressed my belief that it would be sound policy to make no distinction of persons in a matter of this kind, and not to compel any one to pay for the assistance afforded by the hospital. Accommodation of a superior or more private character might be provided for persons who are able and willing to pay, at the "London Small-pox Hospital" and the "London Fever Hospital." In March this year, a large and influential deputation waited on the President of the Local Government Board; the Home Secretary having, as I anticipated, referred the Committee to Mr. Sclater Booth. Mr. Lindsay, a member of your Vestry, had been chosen by the Delegates to give expression to their views; the main object of the Conference, as it ultimately took shape, being to induce the 25 ment to obtain Parliamentary powers to enable local sanitary authorities and the Managers of the Metropolitan Asylums Board, to enter into contracts for the treatment of non-pauper cases of infectious disease at the hospitals of the Managers. The President intimated his willingness to do this during the current session, in a Poor-Law Amendment Bill*; but he reminded the deputation that what they had now asked him to do he had endeavoured to do in 1877, viz., in the "Public Health (Metropolis) Bill," which was defeated by the opposition of the Vestries and District Boards of Works. The President expressed his opinion that admission into the hospitals should not entail loss of political status on the recipients of relief, but that their franchise should be saved by their paying for their maintenance, &c., while in the hospital. To this view I venture to express my dissent; but I have so frequently expressed my conviction of the injustice of compelling or persuading sick people to go into the hospital to ensure their isolation for the protection of the public, and then making them pay for the "relief" so afforded; and your Vestry have so fully endorsed my views, that I need do no more now than refer to the subject. I may just mention in passing, however, that if the Vestries had power conferred on them to contract with the Managers, under section 37 of The Sanitary Act, 1866, the charges for the patients sent into the hospitals by the Vestries would be borne upon the general rate, and the recipients of "relief" thus afforded would not be pauperised. No doubt power will be given to the Vestries, &c., to recover from the persons so relieved the cost of their maintenance and treatment in the hospitals: presumably, however, this power will be exercised with discretion so as not to endanger the success of efforts to stamp out disease by the isolation of the sick in the hospitals. The President referred to the possibility of there being established at some future time a "Common Sanitary Fund" for the Metropolis, and I entertain no doubt that this plan, which, as your Vestry are aware, I have also long advocated, furnishes the most hopeful prospect of a successful issue to our efforts to make proper provision for dealing effectually with the treatment of infectious diseases. I venture to think much good will ultimately come of the labours of the Conference, and that common action on the part of the Vestries will tend to smooth away the difficulties which at present beset the subject. * Vide Addendum, page 81, for some account of "The Poor Law Act, 1879," by which Mr. Sclater Booth has redeemed the promise made to the Deputation. 26 In looking forward to a new system, however, I would wish to bear my testimony to the efficiency of the present system, so far as it has been illustrated in this parish, and it affords me pleasure to state that owing to the cordial support your Vestry's officers have received from the Guardians and their officers, no difficulty has been experienced of late years in obtaining the removal of suitable cases to the hospitals. Indeed I am not sure that any system is likely to surpass the present one in convenience, for the organization of the Poor-Law service, with a relieving officer and a medical officer in every district of the parish has answered well in practice, and could only be improved, probably, by one modification, viz., by the acceptance of the certificate of any registered medical practitioner as evidence of the nature of an infectious disease—a step, whereby, in many cases, delay in removal would be avoided, and the District Poor-Law Medical Officer would be spared a needless visit to the bedside of the sick person. Should your Vestry be compelled to take up the work now so well done by the PoorLaw officials, it will probably be found necessary to appoint a special officer to perform the functions of the relieving officer, and I am confident it will be found necessary to receive the certificate of any duly qualified medical man as evidence of the nature of the disease. It may reasonably be hoped that by the time we have a "Common Sanitary Fund" for the maintenance of the infectious sick, we shall also have a law to compel the disclosure of cases of infectious disease. When this reform shall have been achieved, and concealment can no longer be practised with impunity, we may hope to be able to combat diseases like small-pox and scarlet fever with more success than we can at present boast. "DISQUALIFICATION BY MEDICAL RELIEF." "The Tower Hamlets case" mentioned in the previous section, and to which I referred to in my Monthly Report for October 16th (No. 12, 1878, page 85), excited considerable stir—my report having been quoted and commented on in many influential organs of public opinion. And well it might, for the case brought us face to face at last with a contingency I had long foreseen, and against which your Vestry had endeavoured to provide. It added another difficulty, as I pointed out, to those which already beset us in our efforts to induce —or, as some would say, "compel"—people suffering from infectious 27 diseases to go into the hospitals. The task of persuasion—for that is the form of "compulsion" employed in ninety-nine cases out of the hundred—has always been a difficult one, and if to any other reasons that may disincline a man to go, or send his children, into an hospital, he should find himself liable to be branded as a "pauper," and to be disfranchised for doing his duty towards his family and his neighbours, we may well tremble at the prospect before us, viz., of having to deal with infectious diseases in the crowded houses of the poor rather than in hospitals, where alone, as a rule, such cases can be securely isolated; for I do not think men would be willing to sacrifice their political rights even to secure gratuitous hospital treatment. In some districts the "non-pauper" sick are removed by the sanitary authority, the expenses of maintenance being paid out of the district rate. In other districts, as in this parish, hundreds of cases have been removed by the Guardians, and the charges have been borne upon the poor rate. In every such case, when the recipient of relief is a voter—whether as a householder or as a lodger—it is in the power of his political opponents to object to his vote in the Revising Barrister's Court, and who shall say this will not be done now that attention has been drawn to the subject ? As the law stands there is only one way of meeting the difficulty, if it should be raised, viz., by an arrangement under which the sanitary authority should recoup the Guardians for their expenditure—by a payment, that is, from the district rate to the poor rate, or, as I have put it, by the transfer of money from one pocket to another ! The question having been raised, however, it should be settled in some way; and the only way, I believe, in which it can be equitably and permanently settled, is the way your Vestry have indicated—viz., by depauperising "relief" afforded in the infectious diseases hospitals. To obviate the recurrence of such cases, a Bill was introduced into the House of Commons by Sir Charles Dilke, Mr. Rathbone, and other members. Your Vestry addressed the President of the Local Government Board in support of this Bill, petitioned the House of Lords in its favor, and invited the co-operation of the other Vestries and District Boards. The Society of Medical Officers of Health, at my instance, petitioned in favor of the Bill, and I myself submitted to the President of 28 the Local Government Board, as well as to the Lord President of the Council, and other Peers, a statement of the reasons for which I thought the Bill entitled to support. In the result, the Bill passed through the House of Commons, notwithstanding the opposition of the Government, but having been utterly ruined by amendments moved by the Duke of Richmond in Committee of the House of Lords, its promoters thought it best to abandon the measure lest by its presence in the Statute Book it should lead to a false notion that the question had been settled, and thus discourage legislation at a more favorable time. It is not a little remarkable that, while both parties in the State appear agreed as to the necessity of protecting men against the consequences of voluntary exposure of themselves to contagious disease, viz., by locking up "unfortunate" women when in an infective state, and this at the public expense, neither party should be able to recognize the propriety of protecting the general public against involuntary exposure to infection from small-pox, &c., viz., by removing the restrictions against the free admission of poor persons into rate-supported hospitals, when such persons are willing to enter them for the sake of isolation. At the present moment, as already stated, no person having the electoral privilege, whether householder or lodger, can go, or send a child, into one of the hospitals of the Metropolitan Asylums Board, without incurring the risk of losing his franchise: should a political opponent think fit to object to his vote, it must be struck off the list. But though such objection has only been made in one case hitherto, to my knowledge, and, though it is not very probable that such objections will ever be generally made, (if they were the hospitals would be little used, the infectious diseases would spread, and after a time a sensible modification of existing legislation would be effected ! ) yet any man, voter or otherwise, who avails himself of the hospital, even at the instance of the Sanitary Authority, and solely for the benefit of the community, thereby becomes, legally, a pauper. And yet the same man may have all his family vaccinated and re-vaccinated at the public cost, paid out of the poor rate, without incurring the stigma of pauperism, the sole object of such free vaccination being to protect the individual and the community, as far as possible, against the danger of small-pox! When the public understand the bearings of this question judicious legislation must follow, and the hospital treatment of small-pox will be 29 put on the same footing as the operation of vaccination; for no ratepayer of ordinary intelligence would object to a trifling increase of his rates, practically inappreciable, to secure protection against infectious disease, unless he valued the health and the lives of his family less than the preservation of his property, which he insures against the contingency of destruction by fire by voluntary payments for insurance, in addition to a compulsory rate in support of a fire brigade.* Ambulances.—The subject of ambulance-provision was raised in an effective way during the year by the publication of a Report by my colleague, the Medical Officer of Health for Paddington, in which he showed that in some districts many and serious irregularities exist in connection with the housing and the use of the vehicles employed for the conveyance of the infectious sick to the hospitals. The leading recommendation, however, contained in the Report did not meet with universal acceptance, for the Managers of the Metropolitan Asylums Board demurred to the proposition that they should supply the conveyances, the horses, and the drivers—first because they have 110 power to do as suggested, and secondly because the plan would lead to a large, and as they thought, unnecessary increase of expenditure. The remaining recommendations are substantially complied with in our parish, the Guardians of the Poor having provided separate and well-constructed carriages for small-pox and fever cases respectively; and the sick being placed in the charge of a paid attendant who lives at the workhouse, in special isolated quarters adjoining the ambulance sheds; he, moreover, being responsible for the cleanliness and disinfection of the vehicles.† PREVENTION OP THE SPREAD OF INFECTIOUS DISEASES. Is one of the chief duties appertaining to the office I hold; and it is one which constantly engages the attention of all the officers in my Department. A difficulty with which we have to contend is the want of information of the occurrence of non fatal cases of illness; and it has been my constant endeavour to increase our sources of such information. In "The Poor Law Act, 1879," the Government have made an attempt to deal with the question treated in this section (vide Addendum, page 81. † '"The Poor Law Act, 1879," enables the Metropolitan Asylums Board to provide ambulances (vide Addendum, page 82)* 3° It may not be out of place to state here what progress has been made:— 1. By virtue of an arrangement entered into between your Vestry and the sub-district registrars of deaths, seven years ago, I duly receive notice of all deaths from the graver infectious diseases (small-pox, scarlet fever, diphtheria, typhus, enteric and simple continued fevers), within a few hours after they have been registered. It may be observed that when a death has occurred from an infectious disease there is always a probability of finding other cases of illness in the same house or in the locality, and such discovery not unfrequently results from the Sanitary Inspector's visit. Now and then the registration of a death has been unduly delayed—sometimes probably with the object of temporary concealment of the cause of death. It would be well if registration within a limited period, say twenty-four hours, were made compulsory. 2. The Relieving Officers, by direction of the Board of Guardians, report all cases of infectious diseases that come under their cognizance, and generally these are cases that have been, or are about to be, removed to the hospitals of the Metropolitan Asylums Board, admission to which (practically denied to no person) can only be obtained on the order of a relieving officer, or the master of a workhouse. 3. Similar information is given by the Resident Medical Officer of the Kensington Dispensary, by direction of the Committee of Management; but we seldom hear of sickness through any similar institution; and it is a matter of regret that many cases that ought to be removed to the hospitals are kept at home, and treated by medical men attached to so-called " provident dispensaries." 4. Medical men favour me occasionally with information of cases, and more especially when they desire assistance in order to get the sufferers (e.g., domestic servants) removed to hospitals. 5. In my last annual report I referred to what I thought to be a somewhat important step in advance that had then lately been effected by the action of the London School Board, which at my request, had instructed the Superintendents of Divisions through- 3i out the Metropolis to desire the "Visitors" to report to the several Medical Officers of Health any cases of infectious disease that might come to their knowledge in the discharge of their official duties, which take them constantly into the homes of the poorer classes. To facilitate the transmission of this information by the "Visitors," your Vestry authorised me to prepare a form for their use, which has been done. I must say, however, that hitherto the resolution of the Board has not been attended with the hoped for results, very few cases having been reported, and those a long time back. 6. Clergymen and District Visitors not unfrequently report cases of sickness. 7. The Resident Medical Officers of St. George's and St. Mary's Hospitals have on many occasions reported the admission of cases, or the application of inadmissible cases of illness from houses in this parish. 8. Occasionally anonymous communications are the source of information, for I have not felt at liberty to disregard such communications, which have generally proved accurate. In one or other of these several ways cases come to our knowledge; but, all told, they form only a small percentage of total cases, as proved by the fact that the great majority of fatal cases remain unknown till after registration of death—a fact from which it is a fair inference that a still larger proportion of non-fatal cases never come to our knowledge at all. The only remedy for this regrettable state of affairs is legislation to ensure the compulsory disclosure of the occurrence of infectious diseases. The only question among sanitarians is, Who should be the informant? As a rule the information will have to come, directly or indirectly, from medical men. In those cases, and they are not few, where either no medical aid is sought, or where unregistered practitioners are employed, the information, if supplied at all, must come from the head of the family or from the ''occupier" of the house. Where there is a duly qualified medical man in attendance it would suffice to require that he should give a certificate showing the nature of the complaint whicli it should then be the duty of the head of the family, or the occupier of the house, to forward without delay to the sanitary 32 authority, as is done now in respect of the medical certificate of the cause of death for registration. This is the plan recommended by the Society of Medical Officers of Health, and it is I believe the course adopted in those boroughs where under Local Acts, the disclosure of such cases has already been enforced. Having regard to the relations of doctor and patient, it is useless to expect that the desired information will be at all generally given by medical men until it is made their duty as law-abiding citizens, to supply it; and even then the exaction should be made as little onerous as possible, whether or not the public service thus rendered by the giving of such certificates is recognized by the payment of a suitable fee. POPULATION, INHABITED HOUSES, &c. The population of the parish estimated to the 1st of July, 1878, was 153,600, the increase for the year being 2,600, viz., 1,500 the natural growth, representing the excess of births over deaths; the remaining 1,100 being due to immigration. The estimate of population is based on the number of inhabited houses (19,719—an increase of 389 in the year) multiplied by the average number of persons per house (7.8), ascertained at the last census. It is almost impossible eight years after a census, and in a parish which is growing rapidly, though irregularly, to estimate with accuracy the population of the several registration sub-districts, or the relative number of the sexes, but, subject to correction at a future date, I shall assume the population of "Kensington Town" sub-district to be 114,10 ), and that of "Brompton" 39,500; also that the males (whole parish) number 62,520, and the females 91,030—an excess of the gentler sex of not less than 28,560. The subjoined table shows the relative numbers of the sexes, in groups of ages, at the census, 1871. AGES OP MALES AND FEMALES, 1871. All Ages. Under 5 5 to 15 15 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 to 95 95 and upwds. Males, 48977 7065 10198 8948 8317 5963 4339 2464 1270 378 33 2 Females, 71322 7147 11527 16585 14203 9080 6241 3768 2000 667 97 7 Total, 120299 14212 21722 25533 22520 15043 10580 6232 3270 1045 130 9 33 The numerical preponderance of the female sex may he accounted for by the concurrence of a variety of causes, including (1) the large proportion of female domestic servants in the population; probably not less than ten per cent.; (2) numerous girls' schools; (3) popularity of the parish as a place of residence with unmarried ladies, widows, &c., and (4), the superior longevity of women. The density of the population is about 70 persons per acre, making no allowance for ground uncovered by buildings, the extent of which I am not able to estimate with accuracy.* But independently of open spaces like Holland Park and the cemeteries at Brompton and Kensal Green, there is still a considerable amount of land available for building purposes, especially at Notting Hill. The subjoined table exhibits at a glance some of the evidences of the growth of Kensington during the present century:— The Year. Population. Rateable value of Property. The Year. 1801 8,556 £75,916 1823 1821 14,428 93,397 1833 1841 26,834 142,772 1843 1851 44,053 257,103 1853 1861 70,108 375,333 1860 1871 120,299 590,711 1865 1876 148,000 817,326 1876 1879 (July) 156,200 1,379,196 (April) 1879 MARRIAGES. The number of marriages celebrated in 1878 was 1.331, viz.— By the Church 1,084 At Roman Catholic places of worship 76 An Nonconformist „ „ 64 At the Superintendent-Registrar's office 107 Total 1,331 The marriage rate (i.e., number of persons married to 1,000 population) was 17.3. The marriage rate in England and Wales in 1877, was 15.8, the lowest rate since, 1817, about the time of the Irish famine. The gross number of marriages in Kensington increased from 1,131 in 1871 (when the population was 121,500) to 1,417 in 1876, (estimated population 148,000). The number fell in 1877 to 1,411, and in 1878 to 1,331, though in the latter year the population had increased to 153,600; striking evidence of the much complained-of commercial depression. BIRTHS AND BIRTH-RATE. Four thousand six hundred and seven births were registered in 1878, (males 2,320, and females 2,287): in the Town sub-district, 3,719, and In the "Report of the Vestry" the recoverable is pat at 350 acres. 34 in Brompton 888. The birth-rate (whole parish) was 30 per 1,000, as compared with a Metropolitan rate of 36.2 per 1,000. The rate in the Brompton sub-district was only 22.4, that in the Town sub-district being 32.5 per 1,000. There was one birth to 33.3 persons living; the males born were as 101.5 to 100 females, the relative per-centage of births being, males 50.5, females 49.5. The illegitimate births, were 220 in number, or 4.3 per cent. of total births. Of the illegitimate births, 192 took place in the Town sub-district, which includes the parish workhouse. At this institution out of 119 births 89 were of illegitimate children. The decennial birth-rate in Kensington (1868-77) was 31.9 per 1,000. The subjoined table shows the quarterly number of births of each sex registered:— Kensington Town Sub-District. Brompton Sub-District. Grand Total. Males. Females. Total. Males. Females. Total. 1st Quarter 513 503 1016 128 122 250 1266 2nd „ 468 450 918 105 129 234 1152 3rd „ 477 446 923 104 102 206 1129 4th „ 437 425 862 88 110 198 1060 Total 1,895 l,824 3,719 425 463 888 4,607 The regular decrease in the number of births from the first quarter to the last is somewhat remarkable. DEATHS AND DEATH-RATE. The deaths registered exceeded the number in 1877 by no fewer than 496, and they exceeded the corrected decennial average by 136. The gross number (whole parish) was 3,097: males 1,524, females 1,573; in the Town sub-district 2,408, and in Brompton 599. The death-rate, whole parish, was 20.3 per 1,000 persons living (0.8 above the decennial average), equal to one death to 49.5 of the population. The Metropolitan rate was 23.5 per 1,000. After making the necessary corrections by distributing the deaths at the parish infirmary, which is in the Town sub-district, and at the Consumption Hospital, which is in the Brompton sub-district (the, 101 deaths of non-parishioners at the latter institution being retaind in our vital statistics by way of compensation for deaths of parishioners outside the parish), the estimated death-rate 35 in the Town sub-district was 22 per 1,000, and in the Brompton subdistrict 14.9 per 1,000. The sex death-rate was, males 24.3, and females 17.2 per 1,000, figures which agree pretty accurately with the proportionate death-rates in 1871 (males 22.3, females 15.7 per 1,000), in respect of which year we have accurate information as to the relative numbers of the sexes. There was one death to 49.5 persons living: one to 41, males; and one to 58, females. The infantile mortality was high, the deaths under 5 years of age being 1,429, equal to 46.3 per cent. on total deaths, and to 31 per cent. on births registered. The deaths under 1 year were 823, equal to 26.5 per cent. on total deaths, and to 17.8 per cent. on births registered. These numbers and per centages are considerably in excess of the corresponding figures for 1877, and are also above the corrected averages. By way of comparison it may be added that the deaths under five years and under one year respectively, in the whole Metropolis were equal to 43.4, and 25.6 per cent. on total deaths; and to 28.2 and 16.4 on births registered. The deaths in Kensington and in London at 60 years of age and upwards were equal to 21.2 and 20.3 per cent. on total deaths respectively, the gross number in Kensington being 657. The deaths of iilegitmate children under five years of age were 151, equal to nearly 70 per cent. on the number of illegitimate births registered. The subjoined table shows the quarterly number of deaths of each sex registered:— Kensington Town Sub-district. Brompton Sub-district. Grand Total. Males. Females. Total. Males. Females. Total. 1st Quarter 329 327 656 72 95 167 823 2nd „ 303 306 609 85 71 156 765 3rd „ 287 278 565 52 82 134 699 4th „ 336 332 668 60 82 142 810 Totals 1,255 1,243 2,498 269 330 599 3,097 The deaths in the first and last, or the winter, quarters (1,633), considerably exceeded the deaths in the two intermediate, or the summer, quarters (1,464), the excess being 169. The temperature of the air during the winter and summer quarters, respectively, was 41°5 and 57°7 Fahr. 36 The subjoined table shows the death-rate in 13 periods, corresponding to my monthly reports, and the average temperature of the air:— Date of Report. Death-rate per 1,000 living. Mean Temperature of the air. For Five weeks to Feb. 2, 1878. 24.5 40.4 Four „ March 2 20.1 43.2 „ „ „ 30 19.6 41.5 „ „ April 27 22.9 47.3 „ „ May 25 18.0 55.5 „ „ June 22 18.2 56.1 „ „ July 20 20.3 66.5 „ „ Aug. 17 19.9 63.4 „ „ Sep. 14 17.0 60.9 „ „ Oct. 12 15.2 54.8 ,, „ Nov. 9 17.6 45.5 „ „ Dec. 7 22.3 38.9 Three „ ,, 28 26.1 30.8 Averages 20.3 49.6 The detailed causes of death are set out in Table 3 (Appendix), in 13 divisions, according to age. The ages at death (excluding the deaths of non-parishioners at the Brompton Consumption Hospital), were as follows:— Deaths under 1 year of age 823 „ between 1 and 2 years 314 „ „ 2 „ 5 „ 271 „ „ 5 ,, l5 „ 137 „ „ 15 „ 25 „ 114 „ „ 25 „ 35 „ 155 „ „ 35 „ 45 „ 193 „ „ 45 „ 55 „ 219 „ „ 55 „ 65 „ 249 „ „ 65 „ 75 „ 285 „ „ 75 „ 85 „ 191 „ 85 „ 95 „ 41 „ ,, 95 and upwards 3 37 The following table shows the number of deaths due to the chief great classes of diseases:— Kensington Town Sub-District. Brompton Sub-District. Total. Deaths per 1,000 living. Deaths Per 1,000 Deaths. Zymotic diseases (all) 555 79 634 4.1 212 Constitutional „ 498 107 605 3.9 196 Local „ 1105 238 1343 8.6 434 Developmental „ 279 63 342 2.2 111 Deaths from Violence 52 11 63 0.4 16 SPECIAL CAUSES OP DEATH. Class 1.—ZYMOTIC DISEASES. The class of diseases called Zymotic comprises four Orders, and the total deaths were 634, exclusive of 23 that took place in the hospitals belonging to the Metropolitan Asylums Board. Order 1. Miasmatic.— The deaths from the "seven principal diseases" of the zymotic class (to adopt the customary phraseology, although nine diseases, including the three varieties of "Fever" are comprised in this definition), were 543 in number. To this total 23 deaths that took place in the hospitals of the Asylums Board must be added, viz., 16 from small-pox and 7 from "fever," thus raising the total to 566. Of the deaths registered as occurring in the parish, 476 took place in the Town Sub-District and 67 in Brompton, as follows:— Town. Brompton. Total.* Small-pox 3 5 8 Measles 48 3 51 Scarlet Fever 60 8 68 Diphtheria 22 0 22 Whooping Cough 165 22 187 "Fever" (31) Typhus 3 0 3 Enteric 14 9 23 Simple continued 3 2 5 Diarrhœa 158 18 176 Total 476 67 543 * These figures differ slightly from those in the Registrar-General's Annual Summary, which shows a total of 548. d 2 38 This total is considerably above the corrected decennial average (495), but in the previous year the deaths from the same diseases (339) were far below the average. The death-rate from these diseases was 3.7 per 1,000 living in the whole parish: 4.3 in the Town sub-district, and 1.8 in Brompton. The rate in all London was 41. The deaths in Kensington were equal to 181 per 1,000 deaths, the proportion in all London being 175. The proportion of deaths from the same diseases to deaths from all causes in England and Wales in 1877 was 135— an unusually low rate.* Among other diseases of the Zymotic Class, Croup was the cause of 17 deaths, 14 under five years of age—16 in the Town sub-district and 1 in Brompton. Erysipelas occasioned 8 deaths; 6 in the Town sub-district and 2 in Brompton. Three of the deaths were of children under five years. Puerperal Fever (Metria) was the registered cause of 6 deaths, all in the Town sub-district; five of the deaths were of women between 25 and 35 years of age. It may be here mentioned that 14 deaths were ascribed to Childbirth (all but 1 in the Town sub-district); 5 between 15 and 25 years; 5 and 4 respectively in the next two decades. Thus 20 deaths, according to the registration returns, were due to the diseases and accidents incident to parturition, or rather less than 0'5 per cent, on the live births—about half the usual rate of mortality from these causes. Metria. it may be added, is a specific disease of a highly contagious character, affecting women in the puerperal state. Rheumatism was the cause of 10 deaths ( 2 of them in Brompton), all but one of persons above 5 years of age. The more immediate cause of death in these cases, usually, is disease of the heart. Sometimes heart-complication proves fatal in the course of an attack of rheumatic fever: more commonly, however, the secondary disease proves fatal at a later period of life; and it is probable that a considerable percentage of the deaths returned as due to heart disease might, be comprised under the head of rheumatism, and would be, if the history of the illness could be traced from the commencement. Order 2. Enthetic Diseases.—The only fatal disease in this order was Syphilis, which occasioned 17 deaths; 14 of them in the first year of life, and 2 in the second. Only 1 death from this cause was registered in the Brompton sub-district. The number of deaths ascribed to Syphilis is greater than usual, though it would probably be found to be * For some account of the mortality from the "seven principal diseases of the zymotic class" vide page 8 et, seq. 34 understated if all the facts were known. One death of a child 12 months old was registered as "Syphilis (Vaccine), 7 months." Without questioning the accuracy of the diagnosis as to the nature of the fatal disease, there appears good reason for doubting whether vaccination had anything to do with the illness. At any rate a careful inquiry made with the assistance of the vaccination officer led to no positive result, for I could not learn whether any other children had been vaccinated from the same child as the deceased, or whether the lymph from the arm of the deceased had been employed for vaccination. The case occurred in private medical practice. Order 3.—Dietic Diseases.— Eight deaths were attributed to the diseases in this order, viz , Purpura and Scurvy, 2, and Alcoholism, 6. Five of the deaths attributed to drink occurred in the Town sub-district. The registered cause of death in three cases was delirium tremens, and in other three intemperance. Many deaths really due to the abuse of alcohol appear on the registers as having been caused by diseases which doubtless had been set up or aggravated by drink. Order 4.—Parasitic Diseases.— Nine deaths in the first year of life (six of them in the Town sub-district) were due to Aphtha (Thrush), the only fatal disease named in this order. Class 2.-CONSTITUTIONAL DISEASES. The second great class in the Registrar General's tables, viz., Constitutional diseases, comprises the causes of 605 deaths; 498 in the Town sub-district, and 107 in Brompton—122 above the number registered in 1877. This class includes two Orders, viz , (1) diathetic diseases, 101 deaths; and(2) tubercular or scrofulous diseases (including phthisis) 504 deaths. Order 1. Diathetic Diseases.—101 deaths.— The fatal diseases were Gout (4), Dropsy (9), Cancer (79), Cancrum oris (4), and Mortification (5). Twenty of the deaths occurred in the Brompton sub-district, including 18 due to cancer. Order 2. Tubercular.— Total deaths 504, viz., 417 in the Town sub-district, and 87 in Brompton. Scrofula and Tuberculosis occasioned 59 deaths; 8 in Brompton. Tabes mesenterica (popularly called "consumption of the bowels") 61 deaths—3 in Brompton. Phthisis 299 deaths, 238 in the Town sub-district, and 61 in Brompton. Hydrocephalus (water on the brain), and Tubercular meningitis 85 deaths— 15 in Brompton. As usual the deaths from these diseases were 40 disproportionately more numerous in the Town sub-district. In Table 3 (Appendix) the deaths of non-parishioners at the Brompton Consumption Hospital. 101 in number, are excluded. Some particulars with respect to these deaths, however, are given at page 45. It may be observed that many of the deaths of young children ascribed to such causes as premature birth, atrophy and debility, convidsions, &c., are probably due primarily to the scrofulous taint, whether inherited or simply induced by want of care, or of suitable food, light, air, &c. Seventy-eight of the deaths in this order occurred in the first year of life, 58 in the second, and 33 between two and five, making a total of 169 deaths of children under five years. The deaths in later life occurred as follows:—Between 5 and 15 years, 37; 15 and 25, 53; 25 and 35, 76; 35 and 45, 74; 45 and 55, 64; 55 and 65, 23; 65 and upwards, 8. The deaths from tubercular diseases in 1877 were less than in 1876 by nearly 100; but the deaths from the same diseases last year exceeded the number in 1876 by about 30, and those in 1877 by 130. The quarterly numbers of deaths were 127, 134, 125, 118, or 245 in the cold or winter quarters, and 259 in the warm or summer quarters. Class 3.—LOCAL DISEASES. This great class of diseases accounts for more than 40 per cent. of the registered deaths. It is sub-divided into eight Orders, agreeing with the systems or organs of the body affected, all of which will be noticed in turn. The deaths from the diseases in this class, 1,343 in all, were as usual relatively fewer in Brompton sub-district (238) than in the Town sub-district (1,105). More than a third of the deaths (459) were of children under five years. Order 1. Nervous System.—The diseases of the nervous system caused 315 deaths, viz., 261 in the Town sub-district, and 54 in Brompton; 103 were of children under five. The fatal diseases as registered were:—Cephalitis (inflammation of the brain) 4, Apoplexy 86 (of which 17 in Brompton), Paralysis 41 (13 in Brompton), Insanity 2, Epilepsy 16 (7 in Brompton), Brain disease 75 (of which only 9 in Brompton), and Convulsions—a symptom in many infantile diseases rather than a disease in itself—91, and only 7 of them in Brompton. Of the 91 deaths from convulsions, 89 were of children under five; 69 having occurred in the first, and 16 in the second year of age. Apoplexy and Paralysis—diseases of the later periods of life—were the causes of nine deaths under 35 years of age; of two between 35 41 and 45; of 19, 34, 44, and 16 in the four following decades; three deaths from apoplexy were of persons between 85 and 95 years of age. Order 2. Organs of Circulation.—Total deaths 202; five under 5 years of age, and 31 in the Brompton sub-district. The fatal diseases were Pericarditis 5, Aneurism 9, and "Heart Disease" 188, viz., 159 and 29 in the Town and Brompton sub-districts respectively. Thirtythree of the deaths were of persons between 5 and 35 years of age. In the five consecutive decades above 35, the deaths were respectively 23, 34, 36, 44, and 20. Six deaths were of persons between 85 and 95, and one death occurred at upwards of 95. Order 3. Respiratory Organs.— The deaths from the diseases of the respiratory organs were 636 (nearly 100 more than in 1877), 532 in the Town sub-district, and 104 in Brompton; 331 of the deaths were of children under five. The deaths in the four quarters respectively were 207, 141, 71, and 217. Eight of the deaths were returned as caused by Spasm of the Glottis—but as these were mostly of infants found dead in bed, it may not unreasonably be questioned whether at an examination made hours or even days after death, there would be found any evidence of such a condition as spasm? In the absence of other apparent cause of death, the pre-existence of spasm of the glottis may have been inferred. Laryngitis was the cause of 9 deaths; Bronchitis and Pneumonia were the causes of 336 and 219 deaths respectively—total 555, of which 91 only occurred in Brompton. Other diseases were Pleurisy 7, Asthma 15, and Lung Disease 42. Of the deaths from bronchitis and pneumonia 294 occurred under five years of age, and 194 above 55; only 67 deaths were of persons between 5 and 55. The diseases of the respiratory organs are most fatal at the extremes of life, and in cold wintry weather. Of the 636 deaths 424 took place in the first and fourth or winter quarters, and only 212 in the second and third or summer quarters. Order 4. Digestive Organs.—The deaths from the diseases of the organs principally concerned in the process of digestion, were 99, of which 21 occurred in the Brompton sub-district Fifteen of the deaths were of children under five. Among other affections of these organs Liver disease, Jaundice, and Hepatitis were the causes of 29, 15, and 8 deaths respectively; Peritonitis, Enteritis, and Gastritis of 11, 8, and 4; Ulceration of the Intestines and Ileus of 9 and 6. Order 5. Urinary Organs.—Total deaths 65, of which 24 were in the Brompton sub-district. Thirty-eight of the deaths were caused by 42 Bright's Disease (Nephria), 14 of them in Brompton. Cystitis (inflammation of the bladder), and "Kidney disease" were each the cause of 9 deaths. Other diseases;—Nephritis 3 deaths, Diabetes 2, Calculus (stone) 4. Order 6. Organs of Generation.—Total deaths 7. Diseases, Ovarian Dropsy 3, and Uterus disease 4. Order 7. Organs of Locomotion.—Six deaths from "Joint disease." Order 8. Integumentary System.—Thirteen deaths. From Phlegmon (abscess), 5, Ulcer 7, and " Skin disease " 1. Class 4.—DEVELOPMENTAL DISEASES. This class of diseases contains four orders, and comprises the diseases (1) of children, (2) of adults, (3) of old people, and (4) of nutrition. The total deaths were 342, of which 242 were of children under five, and 63 occurred in Brompton. Order 1. Diseases of Children.—"Premature Birth" led to the termination of existence in 60 infants under one year, while Cyanosis, Spina Bifida, and "other malformations" account for the deaths of 8, 1, and 4, deaths respectively. Thirty-nine deaths were ascribed to Teething; 22 in the first year, 15 in the second, and 2 between 2 and 5 years. Order 2. Diseases of Adults.—Childbirth was the cause of 14 deaths, of which only one was in Brompton. Order 3. Diseases of Old People.—"Old Age," is the only "disease" in this order. Total deaths 79 (10 of them in Brompton), viz., 2 between 55 and 65, 18 between 65 and 75; 40 between 75 and 85; 17 between 85 and 95; and 2 above 95. Order 4. Diseases of Nutrition.—Total deaths from Atrophy and Debility, the only diseased condition named, 137: 130 occurred under five years, including 119 under one year. Twenty-nine of the deaths took place in the Brompton sub-district. Class 5.—VIOLENT DEATHS, &c. Sixty-three deaths are distributed over the four orders comprised in this class, of which 11 belong to Brompton. Order 1. Accident or Negligence.—Total deaths 55, including fractures and contusions, 20; burns and scalds, 6; poison, 4; 43 tion, 19; drowning, 1; and "otherwise," 5. Of the deaths from suffocation 16 occurred in the first year of life. Thirty of the deaths in this order were of children under five, and 10 of the deaths were registered in the Brompton sub-district. Order 3. Homicide.—One death of an infant, registered cause (without explanation), "Murder." Order 4. Suicide—Five deaths; 3 by Poison, and 2 by Wounds. Two "sudden deaths" were registered, the causes of which were not ascertained; and 5 deaths come under the heading " Causes not specified or ill-defined." DEATHS AT PUBLIC INSTITUTIONS. The only "large public institutions" in the parish at present, are (1) the Parish Infirmary and Workhouse, situated in the Town registration sub-district, (2) the Hospital for Consumption and Diseases of the Chest, located in Brompton, and (3) St. Joseph's House, a Roman Catholic home for the poor, situated in the Portobello Road. This house contains about 250 aged persons of both sexes, and there died therein last year 34 persons, viz., 16 males and 18 females, mostly of very advanced age, and from the ordinary diseases of senility. The Barracks, the various homes, nurseries, &c., do not furnish a sufficient number of deaths in the aggregate to call for any special reference in this place. The deaths registered at the three principal public institutions named above were equal to 13.2 per cent. on total deaths in the parish—the equivalent proportion in London generally being 18.4' per cent. The Parish Infirmary and Workhouse. I am indebted to Dr. Whitmore, the Medical Superintendent of the Infirmary and the Medical Officer to the Workhouse for the statistics of mortality at these important institutions. The deaths registered last year were 284, viz., males 136, and females 148. The quarterly numbers of deaths were 56, 49, 73, and 106—162 in the winter and 122 in the summer quarters. The deaths were 61 more than in 1877, a difference due to a considerable increase in the numbers of the sick admitted into the Infirmary, and to the severe winter of 1878, which proved very fatal to aged people. The ages at death were as follow:—Under one year 27; between one year and sixty 139; sixty and upwards 118. Of the deaths in the 44 latter group 62 occurred between 60 and 70 years of age; 36 between 70 and 80; and 18 between 80 and 90. Two females died of "old age" at 90 and 92 years respectively. Five inquests were held during the year, the verdicts returned being "Disease of the heart, accelerated by cold;" a woman of 73 found destitute in the streets; "Tabes mesenterica," a child of eight months erroneously supposed to have died of starvation; "Suffocation, accidental," a child of three days old; "Rupture of the Intestinea male of 69; "Pneumoniaan epileptic man of 24. The causes of death may be grouped as follows Under 1 Year. Between 1 and 60. 60 and upwards. Total. Diseases of the Nervous System 2 20 27 49 Diseases of the Circulatory System 0 12 6 18 Diseases of the Respiratory System 5 14 36 55 Diseases of Abdominal Viscera 0 4 5 9 Measles 2 4 0 6 Croup 0 1 0 1 Whooping-cough 3 14 0 17 Enteric Fever 0 1 0 1 Erysipelas 0 0 1 1 Dysentery 0 1 0 1 Diarrhœa 2 7 7 16 Syphilis 1 0 0 1 Gout 0 0 1 1 Dropsy 0 3 1 4 Cancer 0 0 4 4 Gangrene 0 3 9 12 Phthisis 0 38 4 42 Scrofula 0 5 3 8 Atrophy 7 6 0 13 Want of Breast Milk 2 0 0 2 Premature Birth 2 0 0 2 Childbirth 0 2 0 2 Ulcer 0 2 4 6 Abscess 0 2 1 3 "Old Age" 0 0 8 8 Suffocation 1 0 0 1 Unknown 0 0 1 1 27 139 118 284 45 The Hospital for Consumption and Diseases of the Chest.— The deaths at this institution were 107, viz., 57 males and 50 females: 29 in the first quarter, 31 in the second, 23 in the third, and 24 in the fourth; or about an equal number in the winter and summer quarters respectively. All but six of the deceased were non-parishioners. This hospital, widely and favorably known, is less strictly a Metropolitan hospital than many others, drawing patients as it does from many even distant parts of England. Of the 107 persons who died there in 1878, rather more than half (58) had previously been resident in London proper, 24 came from other than Metropolitan counties, and the remaining 25 came from the suburbs, or " greater London." The ages at death were as follows:- Between 10 and 20 years, 14; 20 to 40 years, 77; 40 to 60 years, 16. The causes of death as registered, were—In 86 cases, Phthisis (Consumption) alone; in 12 cases phthisis with complications affecting the heart, the lungs, or the bowels. Heart disease was the cause of 7 deaths. Aortic disease and Diabetes each caused one death. INQUESTS. The "cause of death "in 176 cases (males 101, females 75) was returned by the coroner (inquests), and was ascertained in 120 instances by examination after death. Inquests were held on 60 infants under one year of age, or more than one-third of the whole number. There were 11 inquests on children between one and two years, and 13 on children between two and five, so that 84, or nearly half the inquests were held on the bodies of children under 5. Between 5 and 20 years there were 12 inquests, 52 between 20 and 60 years, and 28 above 60 years. The apparent ground for holding an inquest was the "suddenness" of the death in 92 cases; the finding of the dead body in 47 cases*; "violence" in 32 cases; sundry other causes, 5 cases. The verdicts returned may be classified thus:— Diseases of the brain and nervous system (apoplexy, paralysis, convulsions, &c.) 29 Diseases of the heart and circulatory system 45 Diseases of the lungs and respiratory system 19 Diseases of the bowels 2 Carried forward 95 * In 22 of these 47 cases the dead body was "found in bed:" most of these 22 cases were "violent deaths" of infants suffocated or " overlaid." 46 Brought forward 95 Tubercular or Scrofulous diseases 8 Diarrhœa 3 Croup 1 Spasm of the Glottis 7 Syphilitic cachexia 1 Intemperance 1 Sunstroke 1 "Sudden" 1 "Found dead" 3 Accident 49 Violence {Suicide 5} 55 Wilful Murder 1 176 VIOLENT DEATHS. The violent deaths were caused as follows:— Run over accidentally By a wagon or cart 3 5 By a railway train 2 Falls From windows 2 12 „ the roof of a house 1 „ ladders 3 into areas 3 from a bed 1 downstairs 1 from a railway 1 Suffocation, accidental, of infants 16 „ of an adult by fumes of a portable stove 1 Scalds 4 Burns 2 Drowning 1 "Injury" 2 "Neglect at birth" 2 Poisoning Accidental. By sweet spirits of nitre 1 4 „ Chlorodyne 1 „ Chloral 1 „ Santonin (given for the cure of "worms") 1 Carried forward 49 47 Brought forward 49 Suicide By poison, viz:— By rat-poison 1 5 „ chloral 1 „ oil of vitriol 1 By pistol shot wounds 2 Wilful Murder (no particulars given) 1 55 WHY SO MANY INQUESTS ARE NECESSARY. I have felt it my duty in several annual reports to remark on the evidence afforded by many inquest-returns of the obviously culpable neglect of parents to obtain medical assistance for their sick children, which is patent on the very face of the verdicts,—for people do not die "suddenly" of inflammation of the lungs, bronchitis, and other visceral diseases; that is, not without obvious and continued symptons of serious illness, proclaiming the necessity of recourse to medical assistance. The evidence of this kind of neglect is just as marked as ever in the returns for the past year, and so long as parents are allowed to neglect the health, and practically to sacrifice the lives, of their children with impunity, such neglect is likely to continue. There is no excuse for parents now-a-days, for apart from the gratuitous medical aid obtainable at hospitals and dispensaries, to say nothing of the Poor Law Medical Service, there are now so many so-called "Provident Dispensaries," where some sort of medical attention may be obtained by the outlay of a few pence, that it is surprising any child should be allowed to die of diseases such as I have named, without having been seen by a medical man, even though assistance should have been sought only at the last, and with a view to certification of the cause of death and consequent avoidance of the scandal of a verdict which is almost conclusive proof of parental neglect. The inconsistency of Coroners' Juries is remarkable, for on the one hand they have branded religious persons of the sect called the "peculiar people" with the stigma of a verdict of "manslaughter," for refusing, on conscientious, though mistaken, interpretation of Holy Scripture, to "send for the doctor" to a child sick unto death; while on the other hand, they allow parents who can lay little or no claim to the possession of common humanity to escape scot free, though guilty of the same offence, without the same or any palliative excuse. If parents of this 48 latter class were to "be treated like the members of the sect above named, the scandal would be soon diminished, if not removed. DEATHS "NOT CERTIFIED." Forty-five deaths were returned as "not certified," i.e., the deceased had been attended in their last illness by unregistered practitioners. All but a very few of the deceased were the patients of one practitioner who upon the production of a diploma of a foreign University, was lately admitted to a "modified" examination by one of the licensing bodies, and having "passed" is now a "duly registered medical practitioner." In two instances, the return made was "no medical attendant," these cases, of course, being irrespective of those in which, because there had been no medical attendant, inquests were held. In 9 cases of infants who died, some of them at so late after birth as one month, a midwife was the only professional attendant, and this happened in more than one case under circumstances in which the neglect to obtain proper medical assistance was really almost inexcusable. Two children died from want of proper attention at birth. All included, the deaths were 58, which were either "not certified," or where there was "no medical attendant," or no other professional attendant than the midwife. GLANDERS. A death from this terrible malady occurred in March (1879) at a stable in Colville Mews, the victim being a child aged 15 months. A sister of the deceased, a young woman of eighteen, contracted the malady, was removed to St. Mary's Hospital, in Paddington parish, and died there. On investigating the circumstances of the first death I found that glanders had existed for many weeks at two out of three stables occupied by a cab-proprietor in the above-named "private" mews. Ten horses had been removed from the stables, some of them had died, others had been killed, and the remainder had been conveyed alive through the streets to the knacker's. There were two or three ill at the date of my visit, one of them suffering from farcy. The construction of all the premises was found to be bad, for the living rooms are approached through the stable (which, practically, is unventilated) by an open 49 staircase, up which the foul air of necessity ascends. It was not quite clear in what manner the child first attacked contracted the disease. The mother fancied a horse might have snorted the morbid secretion from the nostrils on the child in her arms as she was going up or down stairs, but it seemed more probable that the infection had been conveyed in vitiated air. The second case may have been due to contagion, for the young woman—a servant out of place, and not long at home, had occasionally nursed the baby, whose neck was extensively ulcerated. The father of the children had nothing to do with the horses, and there was no reason to suppose that any member of the family had been in contact with them or had approached them nearer than the use of the staircase had rendered necessary. I gave notice of the disease in the horses to the Privy Council (Veterinary Department), to the Metropolitan Board of Works (the "Local Authority" under the Contagious Diseases (Animals) Act, 1878), and to the Police. The premises were immediately visited by the officers of the local authority, and on the following day three horses were destroyed, and two others were destroyed subsequently. The stables were disinfected and put under surveillance until all danger of further spread of the disease was at an end. I also communicated the death of the child to the Coroner for Western Middlesex, who, however, did not deem it necessary to hold an inquest; but Dr. Hardwicke, the Coroner for Central Middlesex, to whom I reported the death of the second patient, at the hospital, appreciating the importance of the case decided at once to hold an inquest. Before stating the result of the enquiry it may be as well to refer to the law relating to glanders and farcy, which is comprised in "The Contagious Diseases (Animals) Act, 1878, and "The Animals' Order of 1879, by Her Majesty's Privy Council"; the "Local Authority" for all London, the City excepted, being, as already stated, the Metropolitan Board of Works. By section 8 of the Order, horses are "deemed to be animals" and "glanders and farcy to be diseases for the purposes" of certain clauses of the Act, including clause 31, which makes it the duty of the owner of a horse affected with glanders or farcy to give immediate "notice" of the fact to the Police. The same clause requires the owner to keep the diseased animal separate from animals not so affected. Section 10 of the Order requires the Local Authority to 50 lish notice by placards, handbills, or otherwise, of the existence of glanders or farcy in any stable, building, or other place, and to continue such publication during the existence of the disease, and until the place has been cleansed and disinfected. Movement or exposure of diseased horses on a highway or thoroughfare is forbidden by section 18 of the Order (sub-section d); and movement and exposure of dung, fodder, or litter which has been in contact with or used about a diseased horse (except under license of the Local Authority, after everything moved has been disinfected,) is forbidden by section 20. The 19th section empowers the Inspector or other officer of the Local Authority to sieze an exposed horse, and if the same is found to be affected with glanders or farcy, to have it slaughtered. Section 21 empowers the Local Authority to cause the carcase of any horse that has died of glanders or farcy, or has been slaughtered in consequence of being affected with either of these diseases, to be buried as soon as possible in its skin (which is first to be so slashed as to make it useless), and to be covered with quick-lime and not less than six feet of earth. Or the Local Authority may (if authorised by license from the Privy Council) cause the carcase to be disinfected, and afterwards removed to an approved place, there to be destroyed by heat or by chemical agents. From the information I procured, it appeared that the law had not been complied with in several respects, e.g.— 1. Notice of horses affected with glanders or farcy had not been given to the Police. 2. Glandered horses had not been kept separate from horses not affected. 3. Glandered horses had been exposed on public highways and thoroughfares. 4. Carcases of glandered horses had not been buried or destroyed. 5. Carcases of glandered horses had been removed to a knacker's premises at Wandsworth without authority. 6. Dung had been exposed and removed contrary to the Order. 7. Glandered and other horses, in considerable numbers, had been slaughtered at Blechynden Mews contrary to the provisions of "The Slaughter Houses (Metropolis) Act, 1874," clause 2 of which Act imposes a heavy penalty for the offence 51 of "establishing anew" within the limits of the Act, "the business of a knacker," which term (in the definition clause' 12) is stated to mean "a person whose business it is to slaughter any horse, ass, or mule, or any cattle, sheep, goat or swine, which is not kided for the purpose of its flesh being used for butchers' meat." On the 12th April the Coroner opened his enquiry, but very little information was forthcoming on that occasion. I therefore suggested an adjournment and that all the persons who had in any way been connected with the diseased horses should be subpoenaed to give evidence. At the adjourned inquest, the Privy Council and the Local Authority were both represented; and, clothed with the authority conferred on me by your Vestry I was, by the courtesy of the Coroner, enabled to elicit from the several witnesses facts which created a strong impression on the public mind, but which, being now matter of notoriety, need not be dwelt on here. Suffice it to say that, notwithstanding the tergiversation of some of the witnesses, who had previously given me information, the non-compliance with the law, as laid down in the Contagious Diseases (Animals) Act, and in the "Animals Order" of the Privy Council, in all the respects above stated, was substantially proved. I was enabled, moreover, to show that an unauthorised business of a "knacker," on an extensive scale, had been carried on for a long time at Notting Hill by Mr. Tedder, a horse-dealer—who had purchased the diseased animals, which he had taken to his own premises and there pole-axed them, and who had removed carcases thence, and from Colville Mews, to the premises of a licensed horse slaughterer at Wandsworth, whose books proved that he had already in the present year received more than eighty dead horses from Mr. Tedder. It was elicited from unwilling witnesses, moreover, that on an average three or four horses a week had been killed by this person. The licensed horse slaughterer admitted that the flesh of glandered horses is habitually cooked and sold for cat's meat; that the fat is melted down for sale (but for what purposes it is used he "did not know"); and that the skins are sent to the fellmo ger in the ordinary way of business. The "Order" of the Privy Council, as before stated, provides for the destruction of the entire carcase by heat or chemical agents, or for its burial. 5^ It seemed to me that the facts brought out in the course of the enquiry would hare justified a verdict of manslaughter. The actual verdict returned, however, was in the following terms:— " We, the jury, find that Emily Susan Hulbert was found dying and did die in St. Mary's Hospital from the mortal effects of glanders contracted at No. 16, Colville Mews, Kensington (her sister having previously died from the same disease). The jury are further of opinion that the provisions of the Contagious Diseases (Animals) Act, 1878, with reference to the outbreak of glanders and to the treatment and disposal of the carcases of horses suffering from such disease, have not been duly carried out. " It further appears that the provisions of the Slaughter Houses (Metropolis) Act, 1874, have been violated by carrying on trade by unlicensed knackers. '• The jury further desire that the facts given in evidence may be brought before the Privy Council, and that steps be taken to avoid if possible, the occurrence of such accidents in future." Proceedings were subsequently instituted by the Local Authority against the proprietor of the glandered horses, for not giving notice of the disease to the Police, as required by the Act; and he was fined in the full penalty of .£20 (with costs) in each of two cases. It appeared to have been felt that he had been sufficiently punished for his offence by the loss of property and by the penalties inflicted (which, however, it has been stated, were paid by a subscription among his horse-owning friends), and this feeling perhaps explains why no steps were taken to bring him to account for the other offences of which he had presumably been guilty. Your Yestry, however— sharing my conviction that some notice should have been taken of the doings of the horse dealer, for it was evident that if he had not interposed between the owner of the horses and the licensed "knacker," the existence of glanders must have become known much sooner, and the fatal results of the outbreak might have been avoided— requested the Local Authority to take proceedings against him under section 3 of the Slaughter Houses (Metropolis) Act, 1874, for " establishing anew'' the business of a knacker. The Board in their reply having expressed their opinion that Mr. Tedder, the person in question, is not a knacker, and had not 53 established the business of a knacker within the meaning of the Slaughter Houses (Metropolis) Act, 1874, and, therefore, they did not feel it necessary to take proceedings as suggested, your Vestry, on the recommendation of the Special Purposes Committee, requested the Board to reconsider their decision, and in support of this application reminded them that, according to the 12th section of the Act, "knacker" means a person whose business it is to slaughter horses, &c.," and that by section 13 of the Act, a business is deemed to be established anew if it is removed from any one set of premises to any other premises. It was stated to be capable of proof—(1) That Mr. Tedder had been accustomed to slaughter horses in great numbers at his premises in Blechynden Mews: (2) That he had entered upon the occupation of the said premises since the passing of the said Act; and (3) That he holds no license under section 94 of the 25th and 26th Vict., c. 102 (Metropolis Local Management Amendment Act), for the keeping or using of any place in the parish of Kensington for the purpose of killing horses. "Thus" (your Vestry's communication continued) "as Mr. Tedder slaughters horses without a license, and at a place not licensed for the slaughtering of horses, and as he did not occupy the said place at the passing of the Slaughter Houses (Metropolis) Act, the Vestry consider that his proceedings are in contravention of the law. Agreeing with the Board that it is desirable to put a stop to the illicit slaughtering of horses, as it tends to spread disease by keeping the occurrence of cases of glanders, &c., from the knowledge of the Board, the Vestry hopes that the Board may yet see their way to proceed against Mr. Tedder, and put a stop to his unlawful business." The Board subsequently intimated to your Vestry, that if evidence were forthcoming to prove that Mr. Tedder had slaughtered horses in considerable numbers, and that he had entered upon the occupation of his premises since the passing of the Act, they would institute proceedings as suggested. But, as they stated at the same time that Mr. Tedder had now wholly discontinued his unlawful business—which appeai-ed to be the case, and the object of your Vestry's interposition had thus been effected—the matter was not further pressed. I may perhaps be pardoned for mentioning here that "The Lords of the Council" tendered me their thanks for the action I took in cone 2 54 nection with the above outbreak and enquiry, and intimated that the matter was in "course of strict investigation by direction of their Lordships." Investigation was indeed necessary as there is but too much reason to fear that the provisions of the law for the suppression of glanders had been systematically broken or evaded for a long time; for, on it becoming known that rigorous proceedings would be taken against offenders (as the Home Secretary and the Privy Council alike desired), the police received notice of diseased horses to an extent far above the previous average, the Inspector for the district having informed me (at the end of July) that he was having horses destroyed at the rate of more than 20 in a month. In several cases, moreover, the authorities discovered diseased horses in respect of which they had not received notice, and proceedings against the owners having been instituted, the maximum penalty of £20 was inflicted in each case. It only remains to state that, having made a careful inspection of the stables in Colville Mews, I came to the conclusion that the living rooms, were unfit for human habitation, and I gave a certificate to that effect to your Vestry, in conformity with the provisions of the Artizans' and Labourers' Dwellings (commonly known as Torrens') Act. Your Vestry's Surveyor subsequently made a report on the premises, showing what alterations, &c., were necessary to fit the rooms for habitation, and the owner at once consented to make them, and he will have to make similar alterations in other stables in the same mews.* METEOROLOGY. The mean temperature of the air at Greenwich in 1878 was 490.6 Fahr., or 00.3 in excess of the average of 39 years. The averages for the four quarters were 41°.5, 540.6, 60°.8 and 41°.6. The highest reading by day (86°.8) was taken in the week ending June 26, and the lowest reading by night (120.2) in the week ending December 28. The hottest week in the year was that which ended June 26 (mean temperature 70°.7); and the coldest that which ended Dec. 14th (mean temperature 28°.4). The dryness of the atmosphere (i.e., the difference between the dew-point temperature and air temperature) was 50.8; * In connection with the outbreak of Glanders, the attention of the Vestry was directed to the dangerous and unseemly practice of carrying dead horses through the streets, with the head hanging out, in open and exposed vehicles . and the Vestry requested the Metropolitan Board of Works to frame a regulation under the Slaughter houses (Metropolis) Act. 1874, to compel knackers to provide properly enclosed vehicles for the removal of carcases. The Board, while recognizing the impropriety of the practice referred to, and the desirability of pulling a stop to it, doubled their power to do as requested; but premised to make a communication. to the knackers, with a view of carrying out the views of the Vestry. 55 average of 38 years, 50.7. The mean reading of the barometer was 29.751 inches. The rain-fall was 29.2 inches, the average in 39 years being 24.3 inches. Rain fell on 166 days. VACCINATION. It gives me pleasure to present in the Appendix (Table X) the "Returns respecting the Vaccination of Children whose Births were registered in 1878," for which I am indebted to Mr. Shattock, the Vaccination Officer, whose energy and success in the performance of the duties of an important office it has always afforded me satisfaction to recognize in my annual reports. The Local Government Board do not call for a final report on the vaccination in any given year until twelve months after the completion of that year, as a certain proportion of the cases cannot be fully accounted for in a less time, The present return therefore having been furnished to the end of June only, is not final as to the vaccination in 1878, but even were it so it would be considered satisfactory and probably up to the average of the Metropolis generally. The final reports on vaccination in Kensington have for some years held almost, if not quite, the first position for "results," i.e., as showing the smallest number of "cases not accounted for." No alteration has been made in the arrangements for free public vaccination since the publication of my last annual report, in which I referred to the then recent abolition of the "Station" at Brompton; I am informed, however, that there has been no falling off in the number of primary vaccinations in that part of the parish. During the year 1,845 infants were vaccinated at the public stations, viz., 1,324 at Notting Hill and 521 at Hornton Street, the "Town" station. There has been little done in the way of re-vaccination even in Brompton—notwithstanding the intermittent prevalence of small-pox; not even in the houses where the disease has existed. Altogether there were 169 re-vaccinations, viz., 29 in the North district, when small-pox was almost entirely absent in 1878, and 140 in the combined Southern district. It would seem desirable that some arrangement should be made to facilitate re-vaccination in the houses where the disease appears, as, e.g., by the provision at the public expense of fresh "lymph" in tubes for the use of the district medical officer, who is authorised to vaccinate 56 and re-vaccinate in houses where small-pox exists, and is entitled to payment for his work the same as a "public vaccinator." SANITARY WORK. The principal items of the sanitary work of the Inspectors are set out in Tables VI and VIa (Appendix.) A not inconsiderable part of the work of the Inspectors, however, scarcely admits of tabulation, many sanitary improvements being carried out on their advice without the necessity of recourse to forms, notices, or other legal proceedings, all of which take up time just when the object is to get nuisances abated, &c., without delay. Rut when persuasion fails, and recourse must be had to the forms of the law there can be no doubt that it is the duty of an Inspector to proceed with the utmost despatch; rigour is then not only the best policy but in the end it is also the kindest. The difficulties that beset legal proceedings, however, tend to cool the ardour of Sanitary Inspectors in having recourse to magisterial assistance. I trust the plan recently sanctioned by your Vestry of authorising the Inspectors to issue a 'preliminary notice' immediately on the discovery of a nuisance will be attended with good results, and will frequently render unnecessary recourse to the more formal statutory notice by your Vestry, which necessarily involves more or less loss of time. LICENSED SLAUGHTER-HOUSES. The slaughter-houses are now 29 in number, viz., 20 north and 9 south of Uxbridge Road (vide Table XI, Appendix). The business of a slaughterer of cattle has not been "established anew" in Kensington since the passing of the "Slaughter Houses (Metropolis) Act, 1874." One license has lapsed, there having been no application for a renewal: the premises were very unfit for the business, so that the discontinuance of it is a clear sanitary gain. All the licensed premises were inspected by your Vestry's Works, Sanitary, and General Purposes Committee prior to the renewal of the licenses, and their report was published with my monthly Report (No. 11), Sept. 18th, page 74. The Committee had occasion to complain of the neglect by several of the licensees to give that careful attention to the carrying out of the regulations (e.g., Nos. 5, 10, and 16) essential for the prevention of nuisance. A copy of the Committee's report was forwarded to the several licensees, and their attention was called to the necessity of a 57 strict compliance with the provisions of the law. In several of the worst cases proceedings were taken for breaches of the regulations, and penalties ranging from £3 to £5 were imposed. LICENSED COWSHEDS. The licensed cowsheds are 26 in number, 18 north and 8 south of Uxbridge Road, (vide Table XII, Appendix). In my last annual report, having already in previous reports enlarged on the reasons for placing cowsheds and dairies under regulation by bye-laws, I referred to the progress that had been made, and more particularly to the powers then lately conferred on the Privy Council by the "Contagious Diseases (Animals) Act, 1878," (sec. 34), by which they are enabled to issue Orders for the registration of cowsheds and dairies, and for a variety of purposes in connection therewith. The probability that the cowsheds (and dairies) would soon be made subject to regulations gave an increased interest to the annual inspection of the licensed premises, to which your Vestry's Works, Sanitary, and General Purposes Committee devoted great attention at numerous meetings, both prior to the licensing day and subsequently,—several cases having been adjourned for the completion of necessary sanitary improvements. Your Committee reported in substance as follows:— "In view of the probability that ere long Bye-Laws may be framed by the Local Authority under the above mentioned Act, your Committee have not thought it desirable to recommend the adoption, at this time, of any active steps in furtherance of those improvements of the cowsheds, which their former reports have shown to be necessary, and which, year by year, have been in progress "There is one point in connection with the cowsheds, however, which cannot well be deferred any longer, viz., the question of cubic space, and it seems the more necessary to deal with it now as the subject is not mentioned in the Act. For several years your Vestry have required that in the case of premises newly licensed for the keeping of cows, a minimun of 800 cubic feet per cow should be provided, and the Justices have in every such case given effect to the views of your Vestry by limiting the number of cows that may be kept. Your Vestry in May last decided that the time had arrived when in the sanitary interests of the public an equal amount of cubic space per head should be provided in all cowsheds, and due notice of your Vestry's views was given to the several licensees: your Committee therefore paid particular attention to the subject in the course of their inspection. They found considerable variation in the amount of space actually provided, not so much for the cows found on the several premises (for some of the sheds were not half full), as in the provision made for a maximum number of cows which might at any moment be stalled in the sheds. Having regard to this maximum number, the amount of cubic space actually provided in one or two sheds falls as low as from 300 to 400 cubic feet per cow. 58 "Your Committee were much struck with the small allowance of standing room (floor-space) allowed to the cows in some of the sheds, and they are of opinion that this is a matter that needs attention, for in several instances they found the cows standing very uncomfortably on the edge of the stalls, their hoofs overhanging the channel; while in other cases the animals had great difficulty in lying down, through being so much cramped for room. In any bye-laws that may be framed hereafter for regulating the structure of cowsheds, this question of floor space should not be overlooked. The flooring of many of the sheds is very defective in point of material, condition, &c., and the mangers likewise. "With respect to the general condition of the sheds, it was on the whole very fair, though many of them are in want of whitewashing. The temperature and the condition of the atmosphere varied much, some of the sheds being hot, close, and oppressive; but in a few, where there is fixed through ventilation, the temperature was cool, and the air was sweet and pleasant. Some cowkeepers appear to be governed in the management of their cows by the opinion that a high temperature conduces to the secretion of a larger quantity of milk, and this may be so; but it is more than probable that in such a case quality is sacrificed in order to secure quantity, and thus the consumer becomes a sufferer from a hot and illventilated cowshed. It being the opinion of your Committee that a cool temperature and efficient ventilation contribute to keep the cows healthy, the attention of the "local authority" should be drawn to the subject whenever the Privy Council shall have authorised the making of bye-laws, one of which might very properly provide for keeping a thermometer in a specified place in each shed. "At a few of the cowsheds a considerable quantity of dung was observed; and it would appear from the reports of the sanitary inspectors that the removal of dung, &c., is not always effected with the proper regularity, though every cowkeeper engages, as a condition of the renewal of his license not being opposed by the Vestry, "to have all solid manure removed from the premises at least three times in every week, before 8 o'clock in the morning." As there is at present no penalty for default, the due execution of this engagement depends simply on the good faith of the licensee, or, it may be, on the obedience of his employes. "The sheds vary much in point of suitability of site, construction, &c. With few exceptions the premises have not been designed for the use to which they are applied, and many of them are unsuitable, being nothing more than the ground floor of stables, the upper portions of which are sublet as dwelling rooms to private families. In other cases the shed is ceiled, the loft being used for storing fodder. In all these examples the shed is more or less hot, badly lighted, and offensive, owing to the difficulty of ventilating it in an adequate manner. Your Committee are strongly of opinion that the shed should in all cases be open to the roof; and that in addition to fixed ventilation in the roof, there should, wherever it is practicable, be through ventilation over the heads of the cows. They were very favourably impressed with the satisfactory results attending the employment of pan-tiles in the formation of the roof, especially where the tiles are fixed without mortar, for while the rain is effectually excluded, an abundance of fresh air is admitted, apparently without draught, and with obvious advantage to the health of the cows. A few of the sheds stand in their own yards, and it is desirable that every cowshed should have a yard, in which the dung pit should be built. In two cases the dung pit is within the shed itself—there is no other place for it—and in 69 numerous other instances the dung is stored in ordinary pits, constructed for stable manure in mewses, and which are totally unsuitable for the purpose. "Provision should be made for storing the fodder outside the shed, and the grain-pit should never be within the shed, where now, as a rule, it is found." In a subsequent Report (dated Jan. 7th, 1879, and published as an appendix to my 15th Report for 1878 at page 114) your Committee stated the results of their attendance before the Magistrates on the annual licensing day, and two adjournments thereof, in substance as follows:— "The views of your Vestry as to the necessity of giving each cow a fixed minimum amount of cubic and floor space, or, in other words, for limiting the number of cows to be kept in the several sheds, and for the improvement of the ventilation of certain of the sheds—those especially which are not open to the roof—were duly laid before the court, which, by its decisions, gave effect to them in nearly every instance. The Magistrates endorsed the opinion of your Vestry that the number of cows permitted to be kept in any shed should be specified on the license, and while in respect of most of the old sheds (viz., by limiting the number of cows to the maximum fixed by your Vestry) they adopted the "800 cubic feet" rule, which for some years they have acted on in the case of newlylicensed sheds, they declined in other instances to be bound by a hard and fast line, upon the ground that it would not be right to interfere suddenly with a man's business by reducing the number of his cows much below what he had been accustomed to keep. In most of these excepted cases, however, the Justices announced their intention of requiring the number of cows kept to be reduced next year, in conformity with your Vestry's recommendations. "In several cases, the Justices refused to renew the license until the flooring of the loft over the shed, and which separated it from the roof of the premises, had been removed; and your Committee have satisfaction in reporting that not only has a great improvement in ventilation, &c., been thus effected in several of the sheds, but also that the licensees themselves more or less frankly admit the fact though it is alleged that the cooler and better ventilated condition of the sheds has had the effect of diminishing the supply of milk by the cows—a not unmixed evil, perhaps, from the consumers point of view ! "For the reasons stated in their previous report, your Committee did not think it advisable to deal with any other questions than those of space and ventilation this year. In these respects a good work has been successfully begun, and next year your Committee hope to see it carried still further, either by regulations to be framed by the Metropolitan Board of Works (as "Local Authority" under sec. 34 of the Contagious Diseases (Animals) Act, 1878) or, if necessary, by the independent action of your Vestry "The Justices laid down a rule that horses are not to be kept in the sheds; in other words that cowsheds should be used as cowsheds only, and not as stables, &c.; a view your Vestry had long ago adopted. 60 "DAIRIES, COWSHEDS, AND MILK SHOPS ORDER, 1879." The first Order by Her Majesty's Privy Council under the above title, and made under the provisions of The Contagious Diseases (Animals) Act, 1878, was issued in February. It was revoked in July, and another Order in an improved form issued in its place. The Order provides for the Registration of Cowkeepers and Dairymen, and it is now not lawful for any person to carry on the trade of a cowkeeper, dairyman, or purveyor of milk unless he is registered as such under the Order, viz., with the "Local Authority." (The Local Authority under the Act, in London—the city only excepted, is the Metropolitan Board of Works, hereinafter referred to as the Board.) It is not lawful, moreover, for a cowkeeper or dairyman to begin to occupy any "building" for the purpose of the trade without first giving one month's notice in writing to the Local Authority of his intention so to do, nor until he first makes provision for the lighting, ventilation (including air space), cleansing, drainage, and water supply of the same, to the "reasonable satisfaction" of the Local Authority. Nor is it lawful for any person following the trade to occupy any building, whether so occupied at the making of the Order or not, if, and so long as the lighting, ventilation, &c., are not such as are necessary or proper (a) for the health, &c., of the cattle (b) for the cleanliness of milk vessels, and (c)for the protection of the milk against infection and contamination. Of course the necessity of obtaining a license for premises intended to be used as a cowshed in the Metropolis is not superseded by the Act or the Order. The Order authorises the Board to make regulations for " prescribing and regulating" the cleansing of dairies, cowsheds, milkstores, milkshops, and milk vessels; and it directs that the milk of diseased cows may not be mixed with other milk; nor be sold or used for human food; nor be sold or used as food for swine or other animals until it has been boiled. The Order forbids a cowkeeper, dairyman, &c., to take part, or allow any person to take part, in carrying on his business while he or any such person is suffering from a "dangerous infectious" disease, or has recently been in contact with a person so suffering; and the cowshed, dairy, &c., may not be. used for any purpose incompatible with the 61 proper preservation of the cleanliness of the premises and of the milk vessels, or in any manner likely to cause contamination of the milk therein. I have thought it desirable to give the above resume of the Order as an introduction to a few observations on the Regulations, &c., framed by the Local Authority, and now in force throughout the Metropolis. And first I would remark that, although the 34th section of the "Contagious Diseases (Animals) Act, 1878," which authorises the Privy Council to make the Order, enables the Council to endow the "Local Authority" with power to frame regulations for "prescribing and regulating the lighting, ventilation, cleansing, drainage, and water supply of dairies and cowsheds," the Couucil have given the Local Authority power to make regulations for "prescribing and regulating" the "cleansing" only, of dairies, cowsheds, milk shops, and milk vessels; and the Middlesex magistrates have actually confined themselves to making two simple regulations for this purpose The Order enables the Local Authority to "prescribe" but not to make regulations for the "lighting, ventilation, drainage, and water supply" of cowsheds, dairies, &c., and this the Board (and the Surrey magistrates also) have done, as well as they were able, by setting out the "Provisions which it is necessary shall be made in all dairies and cowsheds," in compliance with the sections 6 and 7 of the Order. The "Regulations" of the Board, therefore, consist, firstly, of certain "Provisions for lighting, ventilation, drainage, and water supply," which may be regarded as a standard of what the Board will require for its "reasonable satisfaction;" and, secondly, of "Regulations" proper as to the "cleansing of dairies, cowsheds, and milk shops. These Regulations, so far as they go, are such as are reasonable, and the due carrying-out of them cannot fail to be attended with good results. But further interest attaches to the "Provisions for lighting, ventilation, cleansing, drainage, and water supply of dairies and cowsheds," which, though falling short—perhaps unavoidably—of sanitary require ments, nevertheless present some valuable features; e.g.—To ensure "sufficient ventilation or air space for the health and good condition of the cattle; an adequate provision of floor and cubic space is enjoined, the air space being "at least 800 cubic feet in respect of every animal 62 . the height of the shed in excess of 16 feet" not being taken into account in estimating the cubic space. I need hardly remind your Vestry that 800 cubic feet of air space is the standard amount adopted by your Vestry, and which for some years has been exacted by the Justices in respect of new cowsheds in this parish. Henceforth the requirements of your Vestry in this important particular will have to be carried out in all sheds, and the rule will apply throughout the Metropolis. Among other important "provisions" are those relating to the paving of the sheds with "impervious material" sloped to the drain, &c.; and to the erection, outside the shed, of properly constructed receptacles for receiving dung and litter, and for storing any brewers' grains intended for the animals, and also for a proper water supply. But the prescribed (minimum) quantity of water* (12 gallons for each cow lawfully kept) is insufficient for giving due effect to the regulation for "cleansing" the shed, though the regulation injudiciously limits the compulsory cleansing to "once a day." The "provisions" for the lighting, paving, water supply, &c., of dairies are good as far as they go, and if properly carried out will prove useful for securing the milk against contamination, &c. Already we have been enabled to test the sanitary value of the Order in Council in one respect, viz., by successfully prosecuting a dairyman under the section (9) referring to the prevention of contamination of milk. (Vide page 68). It may be conceded that the Regulations are not all that could be desired, and it will be apparent on the face of them that they do not carry out all the powers contemplated in the 34th section of the Act. The reason, however, is plain. The Privy Council have permissive power to make "Orders" as they "think fit" for certain specified "purposes, or any of them:'' among others "for authorising a local authority to make regulations" for the purposes named in the section, "or any of them," and as a matter of fact the Council have thought fit to limit the powers to be conferred on local authorities by the order within narrow bounds. The Metropolitan Board of Works have done as much, perhaps, as could be expected, under the circumstances, to give effect to the intentions of the legislature in the "Regulations " lately issued, and the * The daily supply of water by the Companies averages 30 gallons per head of the population. 63 Surrey Magistrates, who are the Local Authority for the county of Surrey, as before stated, have followed suit. It is to be regretted, however, that the Middlesex Magistrates should have taken so narrow a view of their duties under the Act and the Order, and—thus setting an example which is but too likely to be followed by other Provincial (especially rural) Local Authorities—contented themselves with framing two meagre "regulations for prescribing and regulating the cleansing of dairies and cowsheds" (under clause 7 of the Order), and not have adopted any "standard of requirements" for the guidance of their officers (whomsoever these may be); so that it will be difficult for interested persons to know what is necessary to be done for the "reasonable satisfaction" of the Local Authority in respect of the lighting, ventilation, drainage, and water supply of the dairies and cowsheds in extra-metropolitan Middlesex. The probability, therefore, is that nothing will be done, and that numerous dairies and cowsheds, from which London obtains a large part of its milk supply, may, for the present at least, remain in statu quo ante. It would not be difficult to suggest particulars in respect of which the regulations of the Metropolitan Board of Works might be mademore efficacious in accordance with the highest requirements of sanitary science. But even as they are, I have no doubt they will lead to considerable improvement in our cow-sheds. The regulations, and those framed by the Surrey Magistrates, are based on a code of "proposed bye-laws for regulating Metropolitan and Urban cowsheds and dairies," published in 1876 by the Society of Medical Officers of Health. I trust I may be pardoned for referring to the circumstances under which the subject came before the Society. Having in two papers read in 1874 and 1875, dealt with the subject of the slaughter-houses and contributed in some slight degree, as I hope, to the improvement of those establishments by promoting the formation of a code of good bye-laws, and by striving in this parish to get the bye-laws carried out in the letter and in the spirit, I then turned my attention to the subject of the cowsheds, and in December, 1875, I read a paper thereon before the Society. In this paper I first gave formal expression to those views on the subject of dairies and cowsheds, with which your Vestry are so well acquainted, pointing out "the considerations which in my judgment called for the intervention of the law." I stated we had 64 evidence that "disease in man may be caused through the agency of milk: (1) By insanitary conditions in the cowshed or in the dairy, viz., by the absorption by the milk of sewer gas, or the products of excremental decomposition: (2) By the pollution of water: (3) By the use of improper or unwholesome food for the cows: (4) By disease derived from the employes in the cowshed or dairy; (5) By disease affecting the cows themselves." I stated, moreover, the proper subjects of bye-laws, viz.: (1) The position, construction, and sanitary condition of the sheds, including' questions of cubic and floor space, lighting, ventilation, drainage, paving, &c.: (2) Everything relating to the health and management of the, cows, including quarantine arrangements, the isolation of sick animals, the quality and the storage of the food: (3) The sanitary condition of the dairy, and of the vessels used for receiving, storing and distributing milk; and the health of the persons engaged in the conduct of the business." In a draft code of "proposed bye-laws" I dealt with all these subjects, and having in view the importance of getting "uniform regulations," I suggested the desirability of power being conferred on the Metropolitan Board of Works to enable the Board as "Local Authority" to form a code of bye-laws. The Society referred my paper and proposed bye-laws to the Council, and ultimately adopted the bye-laws in the form in which they appeared in my Annual Report for 1876. I cannot conclude this section of my report without expressing my sense of the valuable support your Vestry, and notably the Works, Sanitary and General Purposes Committee, have invariably accorded me in my efforts not only to improve our own licensed cowsheds, but also to bring all cowsheds and dairies under regulation by byelaws. Without that support, and the adoption of a standard, which has been as far as possible enforced in our local cowsheds, I could have done little.; and it is but just, while putting on record a sketch of some of the steps by which a great sanitary improvement has been effected, that due credit should be awarded to your Vestry for the leading part you have taken in bringing about a settlement of the question. BAKEHOUSES. The special duties that devolved on the officers of your Vestry under the Bakehouses Act were transferred on the 1st of January, 1879, to 65 Government Inspectors under the operation of the Factory and "Workshop Act, 1878. Nevertheless, as a part of their ordinary work, the Sanitary Inspectors have regularly visited the bakehouses, and there can he no doubt that a continuation of these periodical inspections is desirable in the interests of public health. The bakehouses are about 125 in number, 71 north and 54 south of Uxbridge Road. DUST REMOVAL. The collection of ashes and other refuse from our 20,000 houses and other rated dwellings has been carried out on the whole very satisfactorily during the past year, the complaints having been few in number as compared with the old "contract" times.* The one thing needful for complete success is a systematic call at every house on a given day in each week. But it should be understood that if, through the default of domestics or other cause for which your Vestry's servants cannot be held responsible, the receptacle is not emptied on the proper day, no further attention can be given until the same day in the following week. There is good reason to believe that the annoyance to which householders are exposed from the supposed neglect of the dustman not seldom arises from the refusal of servants to allow the dust to be taken away at an "inconvenient" time. Also, that complaint of nuisance in connection with dust-bins is generally due to the improper use of these receptacles for the storage of vegetable refuse (which should be first dried at the back of the kitchen fire and then burned), and even of animal matter—bones, meat, pot-liquor, &c. It may be deemed a fair question whether those who thus mis-use the dust-bin, and then complain of your Vestry's "neglect," should not be held responsible for the creation of a recurring nuisance? REMOVAL (OR NON-REMOVAL) OF STABLE MANURE. In former annual reports I have referred to the nuisances arising from the neglect of the owners of horses to remove with sufficient frequency and regularity the contents of dung pits, in conformity with the regulations of your Vestry, which require the pits to be emptied three times a week, viz., on alternate days; though as a matter of fact the refuse is removed far less frequently and at irregular intervals. I * Vide Table VIa. (Appeudix.) 66 also suggested the desirability of your Vestry undertaking the removal of the manure, &c., as the law permits you, with the sanction of the owner, which probably it would not be difficult to obtain if it were understood that the penalties for non-compliance with the regulations would be enforced. The addition of the manure would give value to other refuse matter as slop, dust, &c., and as it is most desirable on sanitary grounds that the regulations should be carried out strictly, I trust steps will be taken to give effect to my suggestion. That stable refuse has an appreciable value is obvious, for a tender has been accepted for the purchase of the stuff from your Vestry's wharves and depots for one year, for the sum of £70. There are nearly 150 mews in this parish, and the value of the stable refuse must be very great in the aggregate, though the produce of a single stable can be of little worth to the proprietor or his coachman. I cannot but believe therefore that it would pay to collect the stuff as proposed, and at the least I would urge a fair trial of the plan under the direction and supervision of the Wharves and Plant Committee. Proceedings were taken in a few instances against offenders for systematic neglect to remove accumulations of manure, &c., and in two instances a fine of twenty shillings was inflicted. In other cases, however, the magistrates required the defendants to pay the costs only (one shilling!) although the offence had been glaring and continuous. The reason given for this leniency was that the penalty imposed by the Act under which your Vestry's regulations had been framed, viz. twenty shillings a day, is "too high"—a matter for which, however the magistrates cannot be held responsible, their duty being simply to carry out the law. REMOVAL OF OFFENSIVE MATTER. The subject of the conveyance of offensive matter through the parish has engaged a good deal of attention. The greater part of such matter comes from stables and cowsheds, the refuse from cowsheds being, as a rule, taken to Chelsea and barged away on the river. The licensee of a cowshed, when he gives your Vestry notice of his intention to apply to the Justices for a renewal of his license, pledges himself to remove al1 manure. &c., from his shed three times in the week, and before eight o'clock in the morning. From time to time, however, the Inspectors have had occasion to report dung-carts going river-wards 67 too late in the day, and they have cautioned the drivers and the cowkeepers also. One of two courses may be suggested by way of trying to put a stop to the annoyance. The renewal of the license of offending cowkeepers may be opposed, or proceedings may be taken to enforce a penalty under the 219th section of "The Kensington Improvement Act," which relates to the "conveying of offensive matter at improper times." But before this can be attempted, your Vestry must frame regulations and fix certain hours within which only it shall be lawful to remove "offensive matters," and this is about to be done by the Law and Parliamentary Committee. It is doubtful, however, whether your Vestry have any power to interfere in the matter complained of;—that is, whether the carting of cow-dung through the streets after, say 9 or 10 o'clock in the morning, is an offence at law any more than the carting of stable manure? Over the hours for the removal of the latter we. have no control, though the state in which it is sometimes carted is very offensive; but with respect to the removal of manure from licensed cowsheds, we can at the least bring moral force into operation in order to prevent annoyance to parishioners. The whole question is a wider one than appears at first sight, for "regulations" might possibly be made to apply to the conveyance of "offensive matter" of many descriptions, e.g., the refuse from slaughter-houses, fishmongers', poulterers', and greengrocers' premises, marine stores, &c. NECESSARY ACCOMMODATION. No progress has been made during the year in this matter; not one additional urinal having been provided to supplement the very insignificant number already in existence. All admit the necessity of public accomodation for both sexes; but the difficulty has been to provide sites free from personal objection. Thanks to the public spirit of one ratepayer, and subject to an arrangement with the governmental authorities, ail urinal will shortly be erected where it is much needed, viz., in High Street, Notting Hill, west of Palace Gardens. LEGAL PROCEEDINGS. Recourse was had to legal proceedings to enforce the orders of your Vestry somewhat more frequently than usual during the past year. If "notices" were rigidly followed up, the necessity of going into 68 Court would in course of time seldom arise. But the law's delays are very harassing to public officers, whose valuable time is often wasted in fruitless attendance at the Police Court. Owing to the number of "charges," the slowness of the proceedings, and repeated adjournments, there is much delay in getting serious nuisances, dangerous to health, and it may be to life, abated with the requisite speed. Magistrates, moreover, ignoring the fact that much time has been unavoidably taken up in complying with legal forms before an appeal is made to them, too often allow an unreasonably long period for the execution of sanitary works that might be carried out in a few hours, or a day or two at most. I am inclined to think it would be a good plan were your Vestry to exercise your powers under the Sanitary Acts, and to carry out necessary works at the cost of the parties liable, laying an embargo on the 'rent' to recoup the cost of the work done and the necessary supervision. Dairies, &c., Order, 1879.— Proceedings were taken against a dairyman, under sec. 9 of this Order, for allowing his wife to take part in the conduct of his business while she was nursing members of her family suffering from an infectious disease. When the dairy was visited the proprietor, two of his grown-up children also, and two lodgers were found to be suffering from small-pox; and it transpired that one of the dairyman's children had already died from this disease, though in the medical certificate of the cause of death reference was made to the secondary disease only (congestion of the lungs). The wife of the dairyman and the wife of one of the lodgers were attending to the business of the shop in the intervals of their ministrations in the sick chambers. The dairyman had thus rendered himself liable to a penalty of £20, but as all the sick persons had consented to go to the hospital, the Order in Council, moreover, being a recent one, with which it was possible the dairyman was not well acquainted—he also having suffered heavily in pnrse and person from the outbreak—the magistrate took a lenient view of the case, and mitigated the penalty to twenty shillings. Conviction for Keeping Swine on "Prohibited" Premises.— The defendant (since deceased) was the only person in "the Potteries" who had persisted in keeping pigs on prohibited premises. She had been fined on several occasions, and was once more mulct in a penalty of forty shillings. The practice of keeping swine as a regular business 69 is now at an end in Kensington, though a few pigs are still found from time to time in some of the private mewses in this parish—not in styes, hut running loose and foraging on vegetable refuse, &c. Generally the pigs are removed as soon as a notice is served on the owner, and that is as soon as they are discovered by the Inspector; but this is not always the case, and proceedings were taken in two cases some time ago, with a view to get rid of pigs in Lonsdale and Ledbury Mewses. The magistrate, however, dismissed the summons in both cases, and congratulated the defendants on having discovered how to keep pigs without creating a nuisance, and without cost, the animals, it being alleged, subsisting on the food which fell under the mangers, and which otherwise would have been wasted. Should a suitable case arise, I am of opinion that the question should be again tried. Reference has already been made (at page 57) to the fact that several licensees of Slahghter-houses were fined for breaches of the bye-laws; and to convictions for disobedience of your Vestry's regulations for the periodical removal of stable manure (page 66.) Conviction fob Transmitting Infected Clothing.—Proceedings were taken to try whether a stop might not be put to the dangerous practice of laundresses carrying on their business while members of their families are suffering from an infectious disease? The case arose in this way.—A boy contracted small-pox, and was nursed at home in a front parlour by his mother and his aunt, who carried on the business of a laundry in the basement of the house. The parents refusing to let the boy go to hospital, were forbidden to carry 011 the business, or to send home the customers' linen until it had been disinfected. The business was carried on as usual, however, and the linen having been sent home without previous disinfection, the question arose whether the linen had been "exposed to infection" so as to make the "transmission" of it an offence under section 38 of The Sanitary Act, 1866? The case received a very attentive hearing from Mr. Bridge, who in giving his judgement said, that although he was not prepared to go so far as to say that a laundry, where the premises were large, could not be carried on with safety, even though there might be a case of infectious disease in the house, the presumption in fact and in common sense was that there was danger in the practice. It was clearly a duty owing by a laundress to the public to discontinue her business immediately on a dangerous infectious disease occurring in her house, and not to send to the homes of her customers things that had been exposed to infection, as in the case under consideration. He held that from the subtle nature of the infection, from the relative position f 2 70 of the sick room and the laundry, and from the communication established between the two by the movements of the boy's relatives, there had been an exposure of the washed things to infection: those things were sent home without previous disinfection, and the offence was such an one as the section contemplated. This, however, being a first case, and the Vestry not wishing to press the matter heavily against the defendant, he should impose a mitigated penalty; but, having regard to the great importance of the subject in a public point of view, he desired to state that, while each case that might be brought before him would be dealt with on its merits, he should not hesitate in any future case, when the offence was fairly brought home, to inflict the full penalty of five pounds. Richmond Gardens.—The wretched and dilapidated group of houses lying back from New Street, Brompton, which bears this delusive title, had long been a source of considerable trouble to the Inspector of the district. During 1878 the tenants lived rent free, no owner appearing on the scene, and day by day the houses and back offices fell into a more and more unwholesome and dilapidated condition. It appeared useless to serve notices for the abatement of nuisances under the circumstances, I, therefore, gave a certificate under Torrens' Act to the effect that the houses were unfit for human habitation. Your Vestry's surveyor inspected them, and submitted a report of the works necessary to make them fit for habitation. Your clerk, however, was unable to find an owner on whom to serve copies of our reports, and as a dernier ressort he applied to the Magistrate at the Hammersmith Police Court for an order to close the houses. The magistrate refused to grant an order, and directed summonses to be taken out against the "owner," and to be affixed to the premises. This was done without effect, until suddenly a claimant turned up and at once took steps to eject the tenants, thus substantially complying with our requirements. MORTUARY. "A public mortuary is still among the sanitary desiderata in Kensington, but negotiations are in progress, the issue of which will probably have the effect of removing the opprobrium from this important parish of being without a suitable temporary resting place for the dead—necessary alike for the convenience of poor parishioners to whom such accommodation would often prove a great boon, and for the reception of the bodies of unknown persons who may die or be killed in the public streets. Hitherto, in such cases of sudden or 71 accidental deaths of unknown persons, the bodies have been deposited in the Workhouse mortuary. This, however, is not a suitable place; and the use of it, moreover, is objected to by the Board of Guardians. Several years ago a Committee was appointed to give effect to the resolution of your Vestry to provide a mortuary, but nothing came of the labours of the Committee, as it was found impracticable to obtain a site. There is one site, however, which has always appeared to me superior to all others, viz., the disused Parish Churchyard, at the rear of the Vestry Hall; and it is highly satisfactory to me to know that the overtures which have now at length been made by your Vestry to the Churchwardens for a grant of that site, have been met by those gentlemen in a public spirit, which encourages the belief that, if no unforseen obstacles should arise, we may hope before very long to see the building of a mortuary taken in hand." In the above terms, strictly applicable to the present state of affairs, I referred in my annual report last year to the subject of a public mortuary. Some little progress, however, has since been made, for at a conference between your Vestry's Works, Sanitary and General Purposes Committee and the Churchwardens, held this year, the latter assented in principle to the proposition for the erection of a mortuary on the disused burial ground attached to the Parish Church, the exact site and the extent of the proposed buildings, moreover, having been provisionally settled. Your Vestry subsequently requested Mr. Walker, the Architect of the New Vestry Hall, to prepare a design and plans for the mortuary, to be submitted to the Churchwardens for approval in accordance with their request. The matter now awaits their decision, which I doubt not will be conformable with the true interests of the living, and with due respect for the dead. DISINFECTION. During the parochial year ended March 25th, 1879, a large number of articles of bedding, clothing, furniture, &c., were disinfected, mostly at the cost of your Vestry, by Messrs. Wellan & Co., the contractors, the process having become necessary on account of infectious diseases; the weight of the articles was 167 cwt., their number 3822, and the cost of disinfecting them £161 0s. 0d. Large as this outlay may appear, it is probably less than would have been incurred had your Vestry provided a 72 disinfecting chamber and the necessary staff. An establishment once provided must be kept up, irrespective of the prevalence of infectious diseases, whereas, under the present system, we pay only for results. The work has been well done and without leaving room for suspicion that any disinfected articles had retained infective power. Your Vestry's officer to whom the duty has been delegated disinfected 222 rooms in 183 houses during the year. No charge is made to the poor; but a small fee is required from those who are in a position to pay, to cover the expense of the process. BATHS AND WASH-HOUSES. One step in advance has been taken during the year to give effect to the sanction of the Local Government Board enabling your Vestry to adopt the Acts for providing baths and wash-houses. Commissioners have been elected and negotiations have been opened for the purchase of a site at Notting Hill. REGISTRATION, &c., OF "LODGING HOUSES." The question of making application to the Local Government Board to declare the enactment contained in the 35th section of the Sanitary Act, 1866, and other Acts extending the same, to be in force in this parish, was under the consideration of the Special Purposes Committee for several months, having been referred to them for reconsideration by your Vestry towards the close of 1878.* The section enables the Nuisance Authority to frame regulations—subject to the sanction of the Local Government Board—for the registration, inspection, &c. of houses let in lodgings or occupied by members of more than one family, of which there must be some thousands in this parish. Before coming to a decision on the subject, the Committee requested me to ascertain to what extent the Act had been adopted in other parishes in the Metropolis and throughout the country generally; and the result of my enquiries having been to show that the Act had been adopted in very few places, either metropolitan or provincial, and that in the majority of such places the provisions of the section had been carried out for the most part in a somewhat perfunctory manner, the * The Committee had dealt with the subject on a previous occasion. Vide Annual Report of the Medical Officer of Health for the year 1877 (page 51), 73 Committee advised your Vestry that it did not appear expedient at the present time to make the necessary application to the Local Government Board. The Committee were influenced to some extent in coming to this decision by a statement that the Board had under consideration the desirability of framing model regulations for the guidance of Sanitary Authorities, the issue of which it was thought desirable to await. At about the same time that the Committee began to consider this subject I had brought the provisions of the Acts under the notice of the Society of Medical Officers of Health, which, after full consideration, resolved (1) That the Acts are practicable; (2) That it is desirable they should be put into operation in London and other large towns; (3) That it is desirable to have an uniform code of regulations for the Metropolis; and (4) That it is advisable the Society should undertake the framing of such a code. The Council of the Society, to which the matter was referred, requested me to draft a code; and the draft so prepared, having been approved by the Council, and subsequently by the Society, it was sent to nearly two hundred medical officers of health throughout the kingdom, suggestions by way of amendment, &c., being invited. All such suggestions having been duly considered, the Council finally submitted the draft, as amended, to the Society, by which it was approved; and, in May last, the regulations were published "for the guidance of Urban Nuisance Authorities." I brought these proposed regulations under the notice of the Special Purposes Committee, by which they were approved, and with a view to their being submitted to the Vestry for adoption. But, as before stated, the Committee, on learning to how slight an extent the 35th section of the original Act had been carried out during the thirteen years it had been in existence, thought it right to advise your Vestry not to proceed any further in the matter at the present time. WATER SUPPLY. The water supply of Kensington is in the hands of three Companies (West Middlesex, Chelsea, and Grand Junction), which obtain water from the Thames above tidal influence, viz., at Hampton, Ditton, and Molesey. 74 Professor Frankland, F.R.S., in his annual report to the RegistrarGeneral on the monthly analysis of the waters supplied by the Metropolitan Water Companies during 1878, furnishes valuable information, which I propose to summarise as usual. The average daily supply by the eight Companies was nearly 130 million gallons. Of this, quantity the Professor says 65 million gallons were often much polluted with organic matters of animal origin; 56 million gallons were occasionally so polluted, but much less intensely; whilst only 8 million gallons were uniformly delivered in a pure and wholesome condition:—the water, namely, supplied by the Kent and Colne Valley Companies, and by the Tottenham Board of Health; which, drawn from deep wells, was uniformly wholesome throughout the year, and of most excellent quality for dietetic purposes. It is not a little interesting to note that of the waters supplied from the Thames the Chelsea Company delivered the best—for it is not many years since this Company occupied a position not very dissimilar to that assigned to the Grand Junction Company in 1878, namely, that of distributing the worst. The average condition of the river waters distributed to London was exceptionally bad—they have seldom been so intensely polluted as in 1878, owing, doubtless, to the more frequent scouring out of the sources of pollution of the Thames and Lea by floods. Referring to the "organic elements" which constitute the pollution specially alluded to, the late Rivers Commissioners in their report on the domestic water supply of Great Britian, express an opinion that "potable water which contains organic matter, even only partially derived from animal sources, should not yield much more than 0.1 part of organic carbon in 100,000 parts of water," whereas the "organic elements" in the river waters, consisting chiefly of "organic carbon" at the maximum of pollution, greatly exceeded the standard. Only once since Dr. Frankland commenced his observations on Thames water had it been so much polluted by organic matter as during 1878. The river was often in high flood even in summer, and much filthy matter, ordinarily retained in sewers and cesspools during the summer months, was swept into the river. The Lea water was superior to the Thames; nevertheless, in June and December it also was unsuitable for dietetic purposes; but the New River Company supplied the water of this river in much better condition than the East London Company. 75 The following table shows the proportions of organic elements (organic carbon and organic nitrogen) in the waters supplied by the local Companies during the year; the Kent Company's water being taken as a standard of comparison;— Source. Company. Maximum. Minimum. Average. Deep Wells Kent 1.8 0.85 1.3 River Thames West Middlesex 5.9 2.9 4.2 Chelsea 5.2 2.9 4.0 Grand Junction 7.8 3.1 4.4 The evidence of "previous animal contamination" in the river waters is of importance, owing to the likelihood of morbific matter derived from animal excreta being carried down the rivers and distributed to the consumers. Owing to the floods the river waters were often so much polluted as to be extremely difficult to filter, whilst the deep, well waters, having been exhaustively filtered and purified by percolation through great thicknesses of porous strata, maintained their usual brilliancy and purity. The following table shows the results of observation as to the degree of efficiency of filtration of Thames water by the Local Companies, the examinations being made monthly:— Names of Companies. Number of occasions. When clear and transparent. When slightly turbid. When turbid. When very turbid. West Middlesex 11 1 0 0 Grand Junction 8 3 1 0 Chelsea 11 1 0 0 When examined by the microscope the sediment deposited by turbid water, on standing, is almost always found to contain numbers of living and moving organisms. The subjoined table shows how often such organisms were noticed in the water supplied by the local Companies at the monthly examinations during 1878:— Names of Companies. Number of occasions when moving organisms were found. 1869. 1870. 1871. 1872. 1873. 1874. 1875. 1876. 1877. 1878 West Middlesex 0 0 0 0 0 0 0 0 0 1 Grand Junction 4 1 1 2 3 5 7 3 3 3 Chelsea 3 2 2 3 2 7 4 4 1 0 76 The Chelsea Company's water takes precedence of that of the West Middlesex Company, which has hitherto borne the palm for comparative excellence, but in 1878, for the first time in ten years, was once "slightly turbid," and was once found to contain "living and moving organisms." Among other advantages enjoyed by the consumers of deep well water, uniformity in the temperature of the water is not the least. The temperature of such water even in the hottest weather never interfered with its palatability. The range of temperature was only 11°2 Fahr., the maximum temperature in July, August, and September being 56°1, and the minimum in February 44°9. The temperature of the Thames water on the contrary varies considerably: during 1878 the range was 29°0 Fahr., viz., from a minimum 39°7 in January and December to a maximum of 68°5 in July. At the latter temperature the water tastes vapid and disagreeable. All the waters were harder in 1878 than in 1877, and the only water delivered in London fit for washing was that of the Colne V alley Company, which is softened by Clark's process before distribution, and is thus rendered suitable for washing, whilst its excellence for dietetic purposes is not thereby impaired. All hard water must be softened before it can be used for washing linen; and when it is softened in detail by the laundress the operation costs for an equal volume of water at least eighty times as much as it costs when conducted on a large scale by a water company. The average hardness of the Thames water as delivered was 20°3 or parts in 1878, as against 19°5 or parts in 1877: that of the softened water of the Colne Valley Company being 7.3 or parts. Of the solid matters contained in the water by far the larger proportion is saline and harmless when the water is used for dietetic purposes, and a large part of this may be removed by the softening process already referred to. It is the organic substances—a small proportion of the total solid matters—that are objectionable and are dangerous to health, consisting as they do to a great extent of the excreta of men and animals. The most important constituents of organic matters are carbon and nitrogen, and these are therefore the expression of the relative quantity of organic impurity present in the waters. The river was much more polluted by organic matters than it was in 1877, and in the months of January, May, June, July, September, November and December, it was so much polluted as to be unfit for dietetic purposes. 77 The subjoined table, shows the average for 1878 of solid impurity, &c., the numbers relating to 100,000 parts of each water:— Name of Company. Temperature in Centigrade Degrees. Total Solid Matters. Organic Carbon. Organic Nitrogen. Ammonia. Nitrogen as Nitrates and Nitrites. Total combined Nitrogen. Chlorine. Total Hardness. Proportionate amount of organic elements, that in the Kent Company's Water being taken as 1. Kent 11.8 43.50 .064 .015 0 .484 .499 2.51 28.4 1.3 West Middlesex 11.6 28.64 .216 .039 0 .178 .226 1.56 20.2 4.2 Grand Junction 10.5 291.1 .233 .038 0 .181 .219 1.55 20.2 4.4 Chelsea 11.0 28.12 .205 .030 0 .173 .204 1.57 20.0 4.0 The monthly Reports issued during the past year by Colonel Bolton, R.E., the "water examiner," contain as usual much interesting information with reference to the state of the Thames at the several intakes; to the apparatus for filtration and supply; and to the subject of constant supply, &c. Two of the local Companies, viz., West Middlesex and Chelsea are now able to supply effectually filtered water in ample quantity to their respective districts—having large reservoir capacity for subsidence, and being able to avoid taking in water during floods. The Grand Junction Company is constructing additional impounding and subsiding reservoirs at the intake at Hampton with the same object in view, and they are also increasing and improving their filter beds at Kew, so that ere long it is expected they will be enabled to supply water of the same quality with the other Companies. With reference to filtration it appears that the rate should not exceed 540 gallons per square yard of filter bed each 24 hours, and at this rate filtration is said to be effectual. The filter beds, composed of varying thicknesses of different sorts of sand, shells, and of gravel screened to different sizes, and arranged in layers, have a total depth of about five feet. As regards constant supply, not much progress has been made. The West Middlesex Company, however, are stated to be giving constant supply to a number of houses on the application of the owners, and to be fully prepared to extend the system as required. This Company is 78 also compelling constant supply to be received on all new estates and buildings, under the Metropolis Water Acts and Regulations, including the South Kensington and Earl's Court Estates; and when "all-new" services are laid down constant supply is made compulsory by the Company. The Chelsea Company are giving a constant supply to a portion of their district—mostly outside Kensington; but the Grand Junction Company have not yet moved in the matter. Should the Public Authority (Metropolitan Board of Works) see fit to exercise their right to demand constant supply it will of course be given, that is if the conditions by which the system is limited are complied with. But it appears that in some districts where the Companies have been earnest in their endeavours to enfore constant supply, they have had to put pressure on landlords, &c., to induce them to make the requisite alterations in the fittings. It would be well if the water Companies could be induced to exercise the powers they possess under Regulation 14, which reads as follows:— "No overflow or waste pipe other than a 'warning-pipe' shall be attached to any cistern supplied with water by the Company, and every such overflow or waste pipe existing at the time when these regulations come into operation shall be removed, or at the option of the consumer, shall be converted into an efficient 'warning-pipe' within two calendar months next after the Company shall have given to the occupier of, or left at the premises in which such cistern is situate, a notice in writing requiring such alteration to be made." The Companies, however, are too busy in looking after their trade interests to concern themselves much about the health of the people, which would be materially benefitted by the substitution of "warning or overflow pipes," made to discharge innocuously in the open, for waste pipes—connected, as these often are, with the house drain—the effect being pollution of the water by absorption of poisonous effluvia from the sewers, &c., to the danger of the health of the consumers. Could we abolish the waste pipe and ensure due attention to cleansing of properly constructed and properly placed cisterns, and have the water softened by Clark's process, there would be perhaps little practical objection to the present sources of supply. In practice, however, cisterns are often bad in construction, inconveniently placed if not inaccessible, and, from sheer neglect and want of covering, are allowed to fall into a condition of dirtiness little suspected, but which cannot fail to be a 79 source of ill health to water drinkers, especially in hot summer weather It is of little avail that the Companies supply effectually filtered water if it is to be spoiled so soon as it enters the domestic receptacle, which is often disregarded as though cleanliness were of no account. The only remedy for this state of things is constant supply and abolition of cisternage. GAS. The subjoined tables from the quarterly reports of the Chief Gas Examiner exhibit at a glance the chief results (averages) of the daily testings of the gas supplied by the Gas Light and Coke Company made at Kensal Green, and examined at the testing station, 123, Ladbroke Grove, NottingHill. Sulphuretted hydrogen, an impurity which is not tolerated in any degree, was absent on every occasion when the gas was tested; and ammonia was seldom found in the gas, and then only in fractional amount far below the permitted maximum. 1. With respect to the illuminating power. The maximum, minimum, and average illuminating power in standard sperm candles was as follows:—(Statutory standard, " sixteen candles.") Maximum. Minimum. Average. Quarter ended March 31st 19.5 16.2 17.5 Quarter ended June 30th 19.7 16.5 17.7 Quarter ended September 30th 19.5 16.0 17.4 Quarter ended December 31st 19.3 16.3 17.6 Averages, whole year 19.5 16.2 17.5 On no occasion during the year was the illuminating power lower than the prescribed standard. 2. As regards purity. Grains of sulphur per 100 cubic feet of gas. (Permitted maximum, 20 grains in summer, 25 in winter.) Maximum. Minimum. Average. Quarter ended March 31st 22.8 9.8 15.8 Quarter ended June 30th 21.2 2.8 9.0 Quarter ended September 30th 37.4 6.0 11.3 Quarter ended December 31st 33.0 10.8 19.1 Averages, whole year 28.6 7.3 13.8 The average in respect of sulphur impurity was considerably better than required by the Acts in the first quarter; the maximum on one 8o occasion in the second quarter was exceeded (21.2 grains), but tbe accuracy of the return is disputed. In the third quarter there was an excess of sulphur on two occasions, the maximum being far above the Parliamentary allowance: and there was a smaller excess on several occasions in the fourth quarter, the accuracy of the official returns of the gas examiner, however, being disputed by the Company. No complaint was made by private consumers, during the year, so far as I know, with respect to the illuminating power of the gas, and I believe your Vestry's Superintendent of street lighting is satisfied with the quality of the gas as supplied to the public lamps. The burners now in use in the street lamps consume 4.5 cubic feet of gas per hour, whereas the old burners consumed only three feet per hour, but notwithstanding this increased consumption (50 per cent.) and the consequent better illumination of the public thoroughfares, the cost is not greater than formerly under the system of a fixed annual payment per lamp. In concluding my report I have the pleasurable duty once again of tendering my best thanks to the parochial officers generally for the cordial assistance I have received from them in carrying out the work of my department. The registrars of births and deaths, the vaccination officer, and the officers of the Guardians have on all occasions manifested the utmost readiness to co-operate with me, each in his own sphere of work, in measures for promoting the public health. The members of the sanitary staff, moreover, have shown an earnest desire to cany out thoroughly the onerous and responsible duties of their position, and I gladly bear testimony to their zeal and diligence. It only remains for me to express my grateful acknowledgments to your Vestry for the confidence you have ever reposed in me, and which has been of such essential assistance to me in carrying out the duties of my office. I am, gentlemen, Your obedient servant, T. ORME DUDFIELD, M.P, Medical Officer of Health. Vestky Hall, Kensington, July, 1879. 81 ADDENDUM. HOSPITAL TREATMENT OF INFECTIOUS DISEASES. At page 25 (ante) I referred to a promise made by the President of the Local Government Board to a Deputation, consisting of delegates from London Vestries and District Boards of Works, represented by Mr. Lindsay as their spokesman, to deal with the subject of hospital treatment of infectious diseases in a "Poor Law Amendment Bill" during the then current session. Mr. Sclater Booth has redeemed this promise, and by an Act* passed on the last day of the session the Metropolitan Asylums Board are now enabled, with the approval of the Local Government Board, to contract with any Vestry, &c., in the Metropolis (as the "local authority" acting in the execution of the Nuisances Removal Act, 1855, &c.) for the reception and maintenance in the hospitals of the Managers of any person suffering from any dangerous infectious disorder within the district of any such Vestry, &c.; and any person received into an hospital by virtue of any such contract, under the 15th section of the Act, will be deemed to be maintained in such hospital by the Vestry, &c., with whom the contract is made. It is further enacted that any expenses incurred by the Vestry, &c. (local authority), for the maintenance of any person under this section shall be deemed to be due from such person to the local authority, and may be recovered by the local authority from him or his representatives at any time within six months after his discharge from such hospital. The powers thus given to the sanitary authority to contract for the maintenance in hospitals of non-paupers, is a round-about way of depauperising the relief afforded to such persons in the, hospitals belong, ing to the Managers, which are essentially pauper establishments. The power given to the sanitary authority to recover from the sick person or his representatives the expenses incident to his treatment in the hospital may possibly be found useful in occasional instances ; but, put plainly, it amounts to this—that the sanitary authority, having for the protection of the public health, succeeded in getting a person to consent to be isolated in a pauper estab ishment, side by side with paupers, may upon his discharge therefrom, or on his death occurring, proceed to recover from him or his representatives the costs incurred by them—on his account doubtless, but for the protection of the public rather than for the safety of the patient himself. If this power should be at all generally exercised by the Vestries, &c., it would more than neutralise any benefit likely to accrue from (he discretion they now have to contract with the Managers for the reception and maintenance of non-paupers. It is therefore to be hoped that in any district where such power is * The short title of the Act is " The Poor Law Act, 1879." 82 exercised very great care will be taken, so that payment may be exacted of those only who are well able to pay, and who may have sought the assistance of the Yestry, &c., in the removal of their sick. There is, however, really no reason why any person so situated should seek the assistance of the sanitary authority at all, for it is quite certain that the expenses incurred at any one of the hospitals belonging to the Managers in the treatment of a case of fever or small-pox, would, in a majority of instances, unless the patient died very speedily after admittance, considerably exceed the charge made at the London Fever Hospital, or at the London Small-Pox Hospital (which are not pauper establishments), viz., two guineas and four guineas, respectively, per case, irrespective of the duration of the patient's illness. The 14th section of the Act seems to have been dosigned to afford the means of doing the same for rural sanitary districts that the 15th will do for the Metropolis if carried out, viz., depauperise relief in "infection hospitals," as it enables the Guardians of any Union, who are also the sanitary authority, to transfer any hospital or building for the reception of persons suffering from infectious diseases, vested in them as guardians under the Acts relating to the relief of the poor, so that it shall be vested in them as the rural sanitary authority of the union. In urban districts, where the sanitary authority is distinct from the poor law authority, the admittance of patients into hospitals supported out of the rates does not entail pauperisation. Ambulances (vide page 29).—The 16th section of the Act confers on the M etropolitan Asylums Board power to provide ambulances for the conveyance of the infectious sick to the hospitals belonging to the managers ; and all expenses incurred by them in the execution of this section, to sucli extent as the Local Government Board may sanction, will be paid out of the Metropolitan Common Poor Fund. At the present time, and in some parishes and districts of the Metropolis, the Vestries, &c., possess ambulances as well as the Boards of Guardians; in others (as in Kensington) the Guardians alone possess ambulances; and there may be some in which the Vestries, &c., only possess ambulances. As there are 39 sanitary authorities within the Metropolis and 30 Boards of Guardians, it would appear that should the Managers see fit, and find it practicable, to give effect to this section, a considerable economy might possibly be effected by substituting for the present scattered arrangements an establishment of ambulances connected with the existing hospitals, which are only five in number. rlhe subject will in due time, I have no doubt, receive that careful attention from the Managers which its importance demands. August, 1879. T.O. D. APPENDIX. jNote.—The forms for Tables I.—VI. were framed by the Society of Medical Officers of Health with the object of securing uniformity of Statistical returns TABLE 1. Estimated population of Kensington at the middle of the year 1878, and in 10 previous years; number of inhabited houses; Births, Deaths, and Marriages (gross numbers). Year. Estimated Population.* Number of Houses. Registered Births. Deaths † Marriages. 1878. 153,600 19,719 4,607 3,120 1,331 1877 151,000 19,330 4,648 2,624 1,411 1876 148,000 18,944 4,499 2,896 1,417 1875 143,500 18,444 4,478 2,783 1,346 1874 138,000 17,667 4,356 2,696 1,311 1873 133,000 16,920 4,128 2,439 1,243 1872 127,403 16,206 4,041 2,225 1,132 1871 121,500 15,394 3,804 2,360 1,131 1870 116,350 15,279 3,705 2,473 892‡ 1869 111,350 14,654 3,625 2,267 891‡ 1868 106,350 14,029 3,522 2,232 984‡ Average ot 10 years, 1868-77. 129,645 16,668 4,086 2,499 „ Notes.—Population at Census, 1871, 120,234. Average number of persons per house at Census, 1871, 7.8. Area of Parish in Statute Acres, 2,190. * The population is estimated to the middle of the year. Between 1868 and 1871 inclusive, a yearly addition has been made to the population based on the known increase between the Censuses of 1861 and 1871. The same principle has been adopted with regard to the number of inhabited houses, in the absence of specific information oil the subject, such as has been forthcoming since 1871. Some of the figures in this and subsequent Tables differ from those in former reports, as the result of a revision of the estimated population, based upon the best attainable information. The population at tha Census, 1861, was 70,108. † The actual number of deaths registered in the Parish was 3,097, and it includes 101 deaths of non-parishioners, which are retained as a compensatory allowance for the deaths of parishioners that may have taken place in general hospitals, &c., out of the Parish. The total, 3,120, is made up by the addition of 23 deaths of parishioners fr<>m small-pox and " fever," that took place at the hospitals of the Metropolitan Asylums Board. ‡ The returns of marriages for the years 1868-70, do not include those that took place at the Superintendent Registrar's Office, concerning which I have no information. G 2 TABLE II. Showing Birth and Death Rate : Deaths of Children, and Deaths in Public Institutions in 1878 and 10 previous years. The Year. Births per 1000 of the population. Death Rate per 1000 living. Deaths of Children under 1 year per cent, to Total Deaths. Deaths of Children under 1 year per cent, to Registered Births. Deaths of Children under 5 years per cent, to Total Deaths. Deaths in Public Institutions 1878 300 20.3 26.5 17.8 46.3 414* 1877 30.8 17.3 25.3 13.9 40.8 354 1876 32.9 19.5 26.6 17.1 44.6 338 1875 31.2 19.4 25.0 15.6 40.3 338 1874 31.7 19.5 28.5 17.5 45.4 252 1873 31.4 18.3 27.0 15.9 40.0 272 1872 32.1 17.4 28.9 15.6 44.2 264 1871 31.3 19.4 25.0 15.0 41.6 252 1870 32.1 21.2 24.0 16.4 42.9 330 1869 32.5 20.3 † † † 313 1868 33.1 21.0 † † † 303 Average of 10 Years, 1868-77. 31.9 19.3 26.3 15.9 42.4 301 * Viz. The Workhouse (284), the Hospital for Chest Diseases at Brorripton (107), and the Infectious Diseases Hospitals (2-3). + No information. Not®.—The Calculations in this Table are made on the gross number of deaths registered without deduction of those of n on-parishioners at TABLE III. Deaths Registered from all causes during the year 1878- (The Deaths of non-parishioners at the Brompton Consumption Hospital are not included in this Table. Vide Report, page 45.) CAUSES OF DEATH. AGES. Total deaths unaer Five. Grand Total. sub-distriots. Under 1. 1 to 2. 2 to 5. 5 to 15. 15 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 to 75. 75 to 85. 85 to 95. 95 and upwards. Keiwngtonl Town. Brompton. (classes) I. ZYMOTIC DISEASES 243 119 135 49 18 17 14 9 14 6 9 1 ... 497 634 555 79 II. CONSTITUTIONAL DISEASES 79 59 35 41 55 77 83 87 47 30 11 1 ... 174 605 498 107 III. LOCAL 258 113 88 40 32 50 86 118 181 226 128 22 1 459 1343 105 238 IV. DEVELOPMENTAL 213 21 8 2 6 5 5 2 2 19 40 17 2 242 34? 279 63 V. VIOLENT DEATHS 26 1 5 5 3 4 5 2 5 4. 3 ... 32 63 52 11 CAUSES NOT SPECIFIED OR ILL DEFINED. 4 1 ... ... ... 2 ... 1 ... ... ... ... ... 5 8 7 1 823 314 271 137 114 155 193 219 249 285 191 41 3 1409 2995 2496 499 I. ZYMOTIC DISEASES. Order 1.—miasmatic. Varicella ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 1 1 ... Small-pox ... 1 ... 1 1 ... 3 1 ... 1 ... ... ... 1 8 3 5 Measles 14 21 13 3 ... ... ... ... ... ... ... ... ... 48 51 48 3 Scarlet Fever (Scarlatina) 3 12 35 17 ... 1 ... ... ... ... ... ... ... 60 68 60 8 Diphtheria ... l' 11 9 1 ... ... ... ... ... ... ... ... 12 22 ... Quinsy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Croup 2 4 8 2 1 ... ... ... ... ... ... ... ... 14 17 16 1 Whooping-cough 75 51 54 6 ... ... ... ... ... ... 1 ... ... 180 187 165 22 Typhus ... ... 1 ... 2 ... ... ... ... ... ... ... ... 1 3 3 ... Enteric or Typhoid Fever 1 ... ... 5 11 4 ... 1 1 ... ... ... ... 1 23 14 9 Simple continued Fever 1 ... 1 ... ... ... 1 1 1 ... ... ... ... 2 5 3 2 Erysipelas 3 ... ... ... ... ... 1 1 2 1 ... ... ... 3 8 6 2 Puerperal Fever (Metria) ... ... ... ... 1 5 ... ... ... ... ... ... ... ... 6 6 ... Carbuncle ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Dysentery 1 ... 1 ... ... ... ... 1 ... 1 ... ... ... 2 4 4 ... Diarrhœa 115 26 10 2 ... 2 1 3 6 3 8 ... ... 151 176 158 18 Simple Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ague ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 1 ... Remittent Fever ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 1 ... Rheumatism ... 1 ... 3 ... 2 2 ... 1 ... ... 1 ... 1 10 8 2 Other Zymotic Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pyaemia ... ... ... ... ... 2 2 ... 1 ... ... ... ... 5 4 1 Order 2.—enthetic. Syphilis 14 2 ... ... ... 1 ... ... ... ... ... ... ... 16 17 16 1 Stricture of Urethra ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Hydrophobia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Glanders ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Order 3.—dietic. Privation ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Want of Breast Milk 4 ... ... ... ... ... ... ... ... ... ... ... ... 4 4 4 ... Purpura and Scurvy 1 ... ... ... ... ... ... ... 1 ... ... ... ... 1 2 1 1 Alcoholism (a Del. Tremens ... ... ... ... ... ... 2 1 ... ... ... ... ... ... 3 2 1 Alcoholism b Intemperance ... ... ... ... ... ... 22 ... 1 ... ... ... ... ... 3 3 ... Order 4.—parasitic. Thrush 9 ... ... ... ... ... ... ... ... ... ... ... ... 9 9 6 Worms, &c ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 243 119 135 49 18 17 14 9 14 6 9 1 497 634 555 79 II. CONSTITUTIONAL DISEASES. Order 1.—diathetic. gout ... ... ... ... 1 ... ... ... 2 1 ... ... ... ... 4 3 1 Dropsy ... 1 ... 3 ... 1 1 1 1 1 ... ... ... 1 9 8 1 Cancer ... ... 1 ... 1 ... 7 22 18 18 11 1 ... 1 79 61 18 Cancrum Oris (Noma) 1 ... 1 1 ... ... 1 ... ... ... ... ... ... 3 4 4 ... Mortification ... ... ... ... ... ... ... ... 3 "2 ... ... ... ... 5 5 ... Order 2.—tubercular. Scrofula and Tuberculosis 14 14 10 13 3 2 1 1 ... 1 ... ... ... 38 59 51 8 Tdbes Mesenterica 31 23 4 2 ... ... 1 ... ... ... ... ... ... 58 61 58 3 Phthisis ... 1 1 14 46 73 71 63 23 7 ... ... ... 2 299 238 61 Hydrocephalus and Tubercular Meningitis 33 20 18 8 4 1 1 ... ... ... ... ... ....... 71 85 70 15 79 59 35 41 55 77 83 87 47 30 11 1 174 605 498 107 III. LOCAL DISEASES. Order 1.—nervous system. Cephalitis ... 1 ... 1 ... ... 1 ... 1 ... ... ... ... 1 4 4 ... Apoplexy ... 1 1 1 1 3 1 13 27 26 9 3 ... 2 86 69 17 Paralysis ... ... 1 ... 1 ... 1 6 7 18 7 ... ... 1 41 28 13 Insanity ... ... ... ... ... 1 1 ... ... ... ... ... ... 2 1 1 Chorea ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Epilepsy ... 1 ... 2 2 2 3 2 ... 2 2 ... ... 1 16 9 7 Convulsions 69 16 4 2 ... ... ... ... ... ... ... ... ... 89 91 84 7 Brain Disease, &c 5 ... 4 5 4 1 3 12 18 14 8 1 ... 9 75 66 9 Order 2 -organs of circulation Pericarditis ... ... 1 2 ... 1 ... 1 ... ... ... ... ... 1 5 5 ... Aneurism ... ... ... ... 1 1 1 3 2 1 ... ... ... ... 9 7 2 Heart Disease, &c. 2 ... 2 9 7 12 22 30 34 43 20 6 1 4 188 159 29 Order 3.—respiratory organs. Spasm of the Glottis 5 1 2 ... ... ... ... ... ... ... ... ... ... 8 8 7 1 Laryngitis 2 2 1 ... 1 1 ... ... 1 1 ... ... ... 5 9 7 2 Bronchitis 92 47 24 3 1 2 3 14 39 55 46 10 ... 163 336 280 56 Pleurisy ... ... 1 1 ... 1 1 2 ... ... ... ... 1 7 4 3 Pneumonia 53 39 39 6 9 7 13 9 13 16 14 1 ... 131 219 184 35 Asthma 1 ... ... ... ... ... 3 3 2 3 3 ... ... 1 15 13 2 Lung Disease, &e. 15 3 4 ... ... 2 3 2 5 .3 5 ... ... 22 42 37 5 Order 4.—digestive organs. Gastritis ... ... ... 1 ... ... 1 ... 1 1 ... ... ... ... 4 3 1 Enteritis 2 1 ... 1 1 2 ... 1 ... ... ... ... ... 3 8 7 1 Peritonitis ... ... 1 1 ... 1 2 2 ... 4 ... ... ... 1 11 9 2 Ascites ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ulceration of Intestines 1 ... ... ... l ... 3 1 ... 1 2 ... ... 1 9 8 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 ... Heus ... ... ... ... ... 1 1 ... 2 '2 ... ... ... ... 6 3 3 Intussusception 2 ... ... ... ... ... ... ... ... ... ... ... ... 2 2 1 Stricture of Intestines ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Fistula ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Stomach Disease, &c. ... ... ... ... ... ... ... 1 ... 4 ... ... ... ... 5 4 1 Pancreas Disease, &c ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Hepatitis ... ... ... ... ... 2 '3 2 ... 1 ... ... ... ... 8 6 2 Jaundice 7 ... ... ... l ... ... ... 2 4 1 ... ... 7 15 13 2 Liver Disease, &c ... ... ... ... 1 1 5 5 10 5 1 1 ... ... 29 22 7 Spleen Disease, &c. ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 1 1 ... Order 5.—urinary organs. Nephritis ... ... ... ... ... 1 ... ... ... 2 ... ... ... ... 3 2 Ischuria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Bright's Disease (Nephria) ... ... 1 1 ... 6 8 6 8 5 3 ... ... 1 38 24 14 Diabetes ... ... ... ... ... ... ... ... ... 2 ... ... ... ... 2 1 1 Calculus (Stone) ... ... ... ... ... ... ... 1 1 2 ... ... ... ... 4 2 2 Cystitis ... ... ... ... ... ... ... 1 1 3 4 ... ... ... 9 5 4 Kidney Disease, he. 1 ... 1 ... 1 1 2 ... ... 2 1 ... ... 2 9 7 2 Order 6.—organs op generation. Ovarian Dropsy ... ... ... ... ... ... 1 1 ... ... 1 ... ... ... 3 2 1 Uterus Disease, &c. ... ... ... ... ... 1 3 ... ... ... ... ... ... ... 4 3 1 Order 7.—organs op locomotion. Synovitis (Arthritis) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Joint Disease, St c. ... ... 4 ... ... ... ... 1 1 ... ... ... ... 6 6 ... Order 8.—integumentary system. Phlegmon 1 1 ... ... ... ... ... ... 1 2 ... ... ... 2 5 4 1 Ulcer ... ... ... ... ... ... 1 1 2 2 1 ... ... ... 7 7 ... Skin Disease, &c. ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 258 113 88 40 32 50 86 118 181 226 128 22 1 459 1343 1105 238 IV. DEVELOPMENTAL DISEASES. Order 1.—diseases of children. Premature Birth 60 ... ... ... ... ... ... ... ... ... ... ... ... 60 60 49 11 Cyanosis 7 ... 1 ... ... ... ... ... ... ... ... ... ... 8 8 6 2 Si»ina Bifida 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 8 Other Malformations 4 ... ... ... ... ... ... ... ... ... ... ... ... 4 4 1 3 Teething 22 15 2 ... ... ... ... ... ... ... ... ... ... 39 39 33 6 Order 2.—diseases of adults. Paramenia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Childbirth (see Puerperal Fever) ... ... ... ... 5 5 4 ... ... ... ... ... ... ... 14 13 1 Order 3.—diseases of old people. Old Age ... ... ... ... ... ... ... ... 2 18 40 17 2 ... 79 69 10 Order 4.—diseases of nutrition. Atrophy and Debility 119 6 5 2 1 ... 1 2 ... 1 ... ... ... 130 137 108 29 213 21 8 2 6 5 5 2 2 19 40 17 2 242 342 279 63 V. VIOLENT DEATHS, &c. Order 1.—accrdent or negligence. Fractures and Contusions 2 ... j 3 2 3 2 1 2 1 3 ... ... 3 20 17 3 Wounds ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Buruns and Scalds 1 1 3 ... ... ... ... ... ... 1 ... ... ... 5 6 6 ... Poison ... ... 1 1 ... ... 1 ... 1 ... ... ... ... 1 4 2 2 Drowning 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 1 1 ... Suffocation 16 ... ... ... ... 1 1 1 ... ... ... ... ... 16 19 15 4 Otherwise 4 ... ... 1 ... ... ... ... ... ... ... ... ... 4 5 4 1 Order 3.—homicide. Murdei and Manslaughter 1 ... ... ... ... ... ... ... ... ... ... ... 1 1 1 ... Order 4.—suicide. Wounds: Gunshot, Cut, Stab ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... 2 1 1 Poison ... ... ... ... ... ... 1 ... 1 1 ... ... ... ... 3 3 ... Drowning ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Hanging ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Otherwise ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Order 5.—execution. Hanging ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Violent Deaths (not classed) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Sudden deaths (cause unascertained) 1 ... ... ... ... ... ... ... 1 ... ... ... ... 1 2 2 ... 26 1 5 5 3 4 5 2 5 4 3 ... ... 32 63 52 11 Causes not specified or iU defined 4 1 ... ... ... 2 ... 1 ... ... ... ... ... 5 8 7 1 CAUSES OF DEATH. Under 1. 1 to 2. 2 to 5. 5 to 15. 15 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 to 75. 75 to 85. 85 to 95. 95 and upwards. Total deaths under Five. Grand Total, Sensing- tonTown. Brompton AGES. pq_ Sub-Districts TABLE IV. Showing Total Deaths from certain classes of Diseases and rate o: mortality therefrom, &c. Diseases. Total Deaths. Deaths per 1000 of Population. Proportion of Deaths to 1000 Deaths. 1. Seven Principal Zymotic Diseases 566 3.7 181 2. Pulmonary (other than Phthisis) 636 4.1 204 3. Tubercular 419 2.7 135 4. Wasting Diseases of Infants (under 5) 194 1.2 62 5. Convulsive Diseases of Infants [under 5) 199 1.2 64 NOTES. 1. Includes Small Pox, Measles, Scarlet Fever, Diphtheria, Whoopingcough, "Fever," and Diarrhœa. 3. Includes Phthisis, Scrofula, and Tabes, 4. Includes Atrophy, Debility, Want of Breast Milk and Premature Birth. 5. Includes Hydrocephalus, Infantile Meningitis, Cbnvulsions and Teething. TABLE V. Showing the number of Deaths in 10 years, 1868-77, from the seven principal Zymotic Diseases, and the number in 1878, &c. Disease. 1868 1869 1870 1871 1872 1873 1874 1875 1876 1877 Annual Average 10 years 1868-77. Proportion of deaths to 1000 Deaths in 10 years, 1868-77. 1878 Proportion of Deaths to 1000 Deaths, 1878. Smallpox 4 6 8 120 68 1 0 0 8 84 29.9 11.9 24 3.8 Measles 84 27 70 64 43 38 121 23 128 54 65.2 26.1 53 17.1 Scarlet Fever 170 106 198 95 29 10 32 83 59 31 81.3 32.5 77 24.6 Diphtheria * 9 14 11 14 11 26 23 17 10 13.5 5.4 20 6.4 Whooping Cough . 34 71 55 72 77 44 45 107 124 34 66.3 26.5 185 59.8 "Fever" 52 42 46 48 42 41 52 29 36 27 41.5 16.1 33 10.5 Diarrhœa 113 108 154 129 110 145 112 107 126 99 120.3 49.2 181 58.8 Total, Kensington 457 369 545 539 383 290 388 372 498 339 418 167.7 573 181.0 Total, London 14,925 17,431 16,476 19,455 12,699 11,385 11,230 13,411 12,565 12,365 14,192 183 14,734 175 TOTAL, ENGLAND & "WALES, For 10 years,1867—76* 1867 1868 1869 1870 1871 1872 1873 1874 1875 1876 Average 1867 76 10 years. 1867—76 1877 1877 72,587 97,352 90,380 100,497 103,801 91,743 89,286 88,200 82,332 75,506 89,168 178 66,558 133 * Not separately registered. †ke Totals for England and Wales are for the ten years 1867-76, compared with. 1877, the latest year of publication. TABLE VI. Inspectors' Report of the Sanitary Work completed in the year ended March 25th, 1879. Sub-districts. No. of Complaints received during the year. No. of Houses and Premises, &c., inspected. Results of luspection. House Drains. Privies and W.C.'s. Dust Bins. W ater Supply. Miscellaneous. Orders issued for Sanitary Amendments of Houses and Premises. Houses, Premises, &c., Cleansed, Repaired and Whitewashed. Houses Disinfected after Infectious Diseases. Repaired, Cleansed, &c. Trapped or Ventilated. Repaired, Covered, &c. Supplied with Water. New provided. New provided. Repaire 1, Covered, &c. Cisterns (new) erected. Cisterns Cleansed, Repaired and Covered. No. of Lodging Houses registered under 35th Clause of Sanitary Acts, 1866.* No. of Dust Complaints received and attended to. Removal of accumulations of Dung, Stagnant Water, Animal and other Refuse. Removal of Animals, &e., improperly kept. Regularly Inspected. Other Proceedings, e.g. Legal Proceedings. Bakehouses. Licensed Cowsheds. Licensed Slaughter-houses. N.W. 512 1202 485 408 24 176 114 62 81 4 32 53 8 66 ... 1222 74 32 34 10 11 26 N.E. 473 1252 446 373 32 119 62 33 52 2 27 61 6 79 ... 917 56 17 42 8 9 4 Centrl. 412 1142 400 263 29 97 59 45 49 3 29 45 16 52 ... 852 60 11 27 4 7 6 South 439 1164 416 295 98 112 84 52 63 4 38 62 19 71 ... 1055 52 3 22 4 2 4 Totals 1836 4760 1747 1339 183 504 319 192 245 13 126 221 49 268 ... 4046 242 63 125 26 29 40 * This Act has not been put into operation. TABLE Via. Summary of Monthly Returns of Sanitary Work, &c., done by the Inspectors. Date of Report. Houses Inspected. Mewses Inspected. Slaughter Houses Inspected. Cowsheds Inspected. Bakehouses Inspected. Offensive Trades Inspected. Sanitary Notices Issued. Removal of Dust, Ashes, &c., Letters of Request received.† Date of Report. District. District. District. District. District. District. District. District. n.w. n. e. c. s. n.w. n. e. C. s. n.w. n. e. c. s. n.w. n. e. C. s. n.w n. e. c. s. nw N e c. s. n.w. n e C. S. m.w. n. e. c. s. May 1,1878 99 99 44 43 21 22 14 14 8 10 6 2 7 9 6 2 21 21 10 9 3 3 0 0 49 50 21 20 100 80 99 93 May 1,1878 May 29 „ 102 96 95 58 27 19 10 16 8 8 3 3 6 6 3 2 14 12 10 7 2 3 0 0 22 47 15 8 128 114 76 116 May 29 „ June 26 „ 92 104 102 86 25 23 16 32 7 8 4 2 8 7 2 0 26 22 9 11 6 4 3 0 44 73 67 42 78 128 92 114 June 26 „ July 24 „ 94 86 102 114 12 22 14 29 7 8 5 2 11 10 6 3 12 16 11 9 6 3 4 2 43 59 52 66 143 150 107 98 July 24 „ Aug. 21 „ 86 92 91 93 20 18 12 28 8 9 5 2 8 12 5 3 17 12 14 13 3 6 2 1 23 36 26 34 54 25 51 35 Aug. 21 „ Sept. 18 „ 72 114 68 87 12 17 9 22 6 8 3 2 9 10 5 3 10 16 11 14 3 4 2 0 18 3 20 16 39 28 32 25 Sept. 18 „ Oct. 16 „ 93 127 82 104 19 23 9 29 17 12 15 2 18 16 16 6 19 21 14 17 5 2 3 0 53 27 36 33 26 46 36 44 Oct. 16 „ Nov. 13 „ 98 131 94 107 27 25 19 24 12 9 8 2 28 26 22 7 22 19 12 16 6 4 2 0 47 35 31 43 49 34 25 38 Nov. 13 „ Dec. 11 „ 104 129 128 j 117 26 23 17 28 11 7 7 2 15 11 14 3 27 22 14 19 3 5 4 0 54 31 34 49 136 64 54 70 Dec. 11 „ Jan. 8,1879 89 96 101 91 25 32 28 22 10 8 7 2 12 10 6 3 29 37 13 21 1 3 2 0 16 21 12 15 174 95 144 179 Jan. 8, 1879 Feb. 5 „ 92 87 83 94 27 38 22 34 8 9 7 2 9 11 5 3 31 25 8 17 4 3 2 0 46 27 33 33 107 62 58 102 Feb. 5, „ March 5 „ 97 69 84 88 24 39 26 38 9 6 7 2 8 10 5 3 29 43 10 14 1 2 2 0 35 29 30 28 99 56 43 65 March 5 „ April 2 „ 84 22 68 82 26 16 22 34 8 3 6 2 10 7 5 3 22 6 17 16 4 0 3 1 35 8 23 29 89 35 45 76 April 2 „ Totals. 1202 1252 1142 1164 291 317 218 350 119 105 83 27 149 145 100 41 279 272 153 183 47 42 29 4 485 446 400 416 1222 917 852 1055 Totals. * The Sanitary Districts are (1) North-west, (2) North-east, (3) Central, (4) South. + The actualcom plaints of non-removal during the year were only (by letter) 13, viz., 2, 7, 2, & 2, in the four district. TABLE VII. Showing the Death rate per 1,000 persons living; the annual rate of Mortality per 1,000 living from the "seven' srincipal Zymotic Diseases ; and the proportion of Deaths from these Diseases to the total Deaths in Kensington and in all London in 1878, and in the ten years, 1868-77. The Year. Deaths per 1000 living. Total Deaths from seven Zymotic diseases, Kensington. Annual rate of Mortality per 1000 living from seven Zymotic Diseases. Proportion of Deaths to 1000 Deaths from seven Zymotic diseases. The Year. Kensington. London. Kensington. London. Kensington. London. 1868 21.0 23.6 457 4.2 4.7 208 200 1868 1869 20.2 24.6 369 3.3 5.5 164 227 1869 1870 21.2 24.1 545 4.6 5.1 222 213 1870 1871 19.1 24.7 542 4.4 6.0 233 242 1871 1872 17.0 21.4 390 3.0 3.8 181 179 1872 1873 18.3 22.5 290 2.1 3.3 119 149 1873 1874 19.5 22.5 388 2.8 3.3 144 147 1874 1875 19.4 23.7 372 2.5 3.9 133 164 1875 1876 19.5 22.3 498 3.3 3.6 172 162 1876 1877 17.3 21.9 339 2.2 3.5 129 160 1877 average of ten years. 19.2 23.1 419 3.2 4.2 170 184 average of ten years. 1878 20.3 23.5 573 3.7 4.1 183 175 1878 TABLE VIII. Comparative Analysis of the Mortality in all London and in Kensington, in 52 weeks, ended 28th December, 1878. LOCALITY. Annual Death Rate per 1000 living from all causes. Annual Death Rate per 1,000 living from principal Zymotic diseases. Per centage of Deaths under 1 year to Births Registered. Per Centage of Deaths to Total Deaths. Under 1 year of age. At 60 years of age and upwards. From Zymotic diseases. From Violence. Registered upon information of the Coroner. (Inquests.) Registered at large Public Institutions. London 23.5 4.1 16.4 28.7 20.3 17.5 3.9 6.7 18.4 Kensington 20.3 3.7 17.8 26.5 21.2 18.3 2.1 5.8 13.2 TABLE IX. Showing the Principal Localities in which fatal cases of the principal Zymotic Diseases occurred in 1878. KENSINGTON TOWN REGISTRATION SUB-DISTRICT. Locality. DISEASES. Locality. DISEASES. Locality. DISEASES. Small Pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Fever. Total. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Fever. Diarrhœa. Total. Small Pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Fever. Diarrhoea. Total.  Typhus. Enteric. Sim. Con. Diarrhoea Typhus. Enteric. Sim. Con. Typhus. Enteric. Sim. Ton. Abingdon Road ... ... ... ... 1 ... ... ... 1 2 Hazlewood Crescent 2 ... ... 1 ... ... 1 1 5 Prince of Wales Terrace ... ... ... ... ... ... 1 ... 1 2 Absalom Road ... ... ... ... 1 ... ... ... 3 4 Heine Terrace ... 1 ... ... ... ... ... ... 1 Rackham Street ... ... ... ... ... ... ... 2 2 Acklam Road ... ... ... 2 1 ... ... ... ... 3 High St., Notting Hill ... ... ... 2 ... ... ... ... 2 Rillington Place ... ... ... 1 ... ... ... ... 1 Addison Road ... ... ... ... ... 1 ... ... ... 1 Holland Mews ... ... ... 2 ... ... ... 1 3 St. Ann's Road ... 2 1 ... 1 ... ... ... 6 10 Terrace ... ... ... ... ... ... ... 1 1 2 „ Villas Road ... 1 ... ... ... ... ... ... 1 St. Clement's Road ... ... ... ... ... ... ... ... 2 2 Admiral Place ... ... ... 1 ... ... ... ... 1 2 Hursrway Street ... ... ... 1 ... ... ... 2 3 St. Ervan's Road ... ... 2 ... 1 ... ... ... 5 8 All Saints' Road ... 1 ... ... 2 ... ... ... 1 4 Hyde Park Gate ... ... ... ... ... 1 ... ... 1 St. George's Road ... 1 4 1 ... 1 ... ... 1 8 Appleford Road ... ... 3 ... 1 ... ... ... ... 4 Infirmary (The) ... ... ... 17 ... 1 ... 14 8 St. James' Place ... ... ... 1 ... ... ... ... ... 1 Angola Mews ... ... ... 1 1 ... ... ... ... 2 James Street ... ... ... 2 ... ... ... ... 2 St. Katherine's Road ... ... ... ... 1 ... ... ... 3 4 Arundel Gardens ... ... 1 ... ... ... ... ... ... 1 Johnson Street 1 ... ... 1 ... ... ... 1 3 St. Luke's Mews ... ... ... ... ... 1 ... ... ... 1 Ball Street 1 ... 2 ... 2 ... ... ... 5 Kensington Pk. Garden ... ... ...... ... 1 ... ... 1 St. Mark's Road ... ... 2 ... ... ... ... ... ... 2 Basing Road ... ... 1 ... ... ... ... ... ... 1 „ „ „ News ... ... 1 ... ... ... ... ... 1 Sander's Row ... ... 1 ... ... ... ... ... ... 1 Blechynden Street ...4 4 ... 3 ... ... ... 2 13 „ „ Road.. ... ... ... 2 ... ... ... ... 2 Sheffield Terrace ... ... ... ... ... ... 1 ... ... 1 Bramley Road ... 2 ... ... 3 ... ... ... 1 6 Ladbroke Grove Road.. l 2 ... 1 ... ... ... ... 4 Silchester Road ... 4 3 1 ... ... ... ... 2 1 Bransford Street ... ... 1 ... ... ... ... ... 1 Ladbroke Road ... 2 ... ... ... ... ... 1 3 Silchester Street ... 1 ... ... ... ... ... ... 1 2 Calverley Street ... ... 1 1 ... ... ... 2 4 Lancaster Road ... ... ... 3 ... ... ... 2 5 „ Terrace ... ... 1 ... 1 ... ... ... 1 3 Campden Street ... ... 1 1 1 ... ... ... 1 4 Lansdowne Road ... ...... ... ... ... ... ... 2 2 Southam Street ... 1 1 4 ... ... ... 4 l Clarendon Road ... ... 1 3 2 ... ... ... ... 6 Latimer Road ... 3 ... ... ... ... ... 1 4 Stanford Road ... ... ... 1 ... ... ... ... ... 1 Connaught Terrace ... ... ... ... 2 ... ... ... 1 3 Ledbury Mews ... ... ... 2 ... ... ... ... 2 Stoneleigh Street ... 1 ... ... ... ... ... ... 1 2 Convent Gardens ... ... ... ... 2 ... ... ... 1 3 Lockton Street ... ... ... 3 ... ... ... ... 3 Sutton Street ... ... ... ... ... ... 1 ... ... 1 Cornwall Gardens ... ... 1 ... ... ... ... ... 1 Lonsdale Road l ... ... 1 ... ... 1 1 4 Swinbroke Road ... ... 2 ... 5 ... 1 ... 2 10 „ Road ... ... 1 ... ... ... ... ... ... 1 Manchester Street 3 ... ... 4 ... ... ... 3 10 Testerton Street ... 1 1 ... 4 ... ... ... 3 9 Crescent Street ... 2 3 1 2 ... ... ... 5 13 Martin Street 1 ... ... ... ...... ... 1 2 Thresher's Cottages ... 1 ... ... ... ... ... ... 1 2 Dartmoor Street ... ... ... ... 2 ... ... ... 2 4 Mary Place ... ... 1 1 ... ... ... 1 3 Tobin Street ... 1 1 ... 1 ... ... ... 1 4 De Yere Gardens ... ... ... ... ... ... ... 1 ... 1 Norfolk Terrace ... ... ... 2 ... ... ... ... 2 Treverton Street ... ... ... ... ... ... ... 1 1 2 Earl's Court Road ... ... ... ... 2 ... ... ... 1 3 Peel Street ... 1 ... 1 ... ... ... 2 4 Lxbridge Street ... ... ... ... ... ... ... 2 2 Edenham Street ... ... ... ... 1 1 ... ... 1 3 Pembroke Place ... ... ... ... ... ... 4 4 Waimer Road ... 4 2 l 1 ... ... ... 4 12 Edinboro' Road ... ... 1 ... ... ... ... ... 1 Petersham Terrace ... ... ... ... ... ... ... ... ... Warwick Gardens ... ... ... 1 ... ... ... ... ... 1 Edwardes Terrace ... ... ... ... ... 1 ... ... 1 Phillimore Mews ... ... ... ... 1 ... ... 2 Wilby Mews ... ... ... ... 2 ... ... ... ... 2 Ernest Street ... ... ... ... 2 ... ... ... 1 3 Portland Road ... 2 ... 2 ... ... ... ... 7 Western Terrace ... ... ... ... 2 ... ... ... ... 2 Golborne Gardens ... ... ... ... 1 ... ... ... 4 5 Portobello Road ... 2 ... 8 ... 1 5 18 William St., Notting Hill ... ... ... ... 1 ... 1 ... ... 2 „ Road ... ... 1 1 ... ... ... ... 2 4 Princes Road ... 3 ... 2 ... ... ... 6 1 Wornington Road ... ... ... ... 4 ... ... ... 1 5 BROMPTON REGISTRATION SUB-DISTRICT. Adrian Terrace 1 ... ... ... 2 ... ... ... ... 3 Finboro' Road l 2 ... ... ... ... ... ... 3 Pembroke Road ... ... 1 ... ... ... ... ... ... 1 Ashley Cottages ... ... ... ... 3 ... ... ... 1 4 Fulham Road ... 1 ... ... ... ... ... ... 1 Redcliffe Road ... ... ... ... ... ... 1 ... ... 1 Brompton Road ... ... ... ... ... ... 1 ... 1 2 Gledhow Terrace ... ... ... ... ... 1 ... ... 1 Richmond Road ... ... ... ... ... ... 1 ... ... 1 Bute Street ... 1 ... ... ... ... ... 1 1 3 Gloucester Road ... ... ... ... ... 1 ... ... 1 Seymour Place 1 ... ... ... 2 ... ... ... ... 3 Child's Place ... ...... ... ... ... 1 ... 1 2 „ Terrace ... 1 ... ... ... ... ... 1 Shaftesbury Road ... ... ... ... 1 ... ... ... 1 2 Coleherne Road ... ... 1 ... ... ... ... ... ... 1 Hogarth Road 1 ... ... ... ... ... ... ... 1 Walgrave Road ... ... ... ... 2 ... ... ... 1 3 Cromwell Road ... ... ... ... ... ... 1 ... ... 1 Ifield Road 1 1 ... 2 ... 2 1 7 „ Terrace ... ... ... ... ... ... 1 ... ... 1 Fenelon Road ... ... ... ... 2 ... ... ... ... 1 Montpelier Row ... ... ... 1 ... ... ... ... 2 Y eoman s Row ... ... ... ... ... ... ... ... 1 3 TABLE X. PARISH OF ST. MARY ABBOTTS, KENSINGTON. Return respecting the Vaccination of Children whose Births were Registered during the year 1878. date. Registration Sub-Districts comprised in Vaccination Officer's District. Number of Births returned in Birth List Sheets. Number of these Births duly entered in Columns 10, 11, and 13 of the Vaccination Register (Birth List Sheets) viz: Number of these Births which are not entered in the Vaccination Register, on account, as shown by Report Book, of Column in Successfully Vaccinated. Column 11. Column 13 Dead Un.vaccinated. Postponement by Medical Certificate. Removal to Districts, the Vaccination Officer of which has been duly apprized. Removal to places unknown, or which cannot be reached, and cases not having been found. Cases still under proceedings by summons and otherwise. Insusceptible of Successful Vaccination. Had Small-pox. 1 2 3 4 5 6 8 9 10 1st January to Kensington 3722 3069 15 372 40 16 194 16 31st Dec. Brompton 889 763 3 1 73 10 7 26 6 Totals 4611 3832 18 1 445 50 23 220 22 TABLE XI. LICENSED SLAUGHTER HOUSES. SOUTH OF UXBRIDGE ROAD. LOCALITY. LICENSEE. 6, Church Street, Kensington Mr. Stimpson 11, Peel Place, Silver Street „ Andrews The Mall, Silver Street „ Wright 183, Bronipton Road „ French 60, Kensington High Street „ English 15, High Street, Notting Hill „ Short 133, Ditto ditto „ Candy 6, Addison Terrace, ditto „ Beall 35, Earl's Court Road „ Matson NORTH OF UXBRIDGE ROAD. 13, Archer Mews Mr. Bawcombe 20, Bolton Mews „ Smith 195, Clarendon Road „ Rush 10,Edenham Mews „ Gibson Tavistock Mews,Portobello Road ,, Hughes 8, Vernon Mews, Portobello Road „ Young 196. Portobello Road „ Scoles Ledbury Mews „ French Lonsdale Mews „ Olney 50, Princes Road, Notting Hill „ Parratt 10, Princes Mews, Notting Hill „ Cole 10, Princes Yard ditto „ Coles Clarendon Mews ditto „ Colley 41, Princes Place ditto „ Pickworth 23, Norfolk Terracc „ Matthews 61, Silchester Road „ Matthews 235, Walmer Road „ Van Mary Place, Notting Dale „Nind Royal Crescent Mews „ Macpherson Ditto ditto „ Down TABLE XII. LICENSED COW-SHEDS. SOUTH OF UXBRIDGE ROAD. LOCALITY. LICENSEE. 7, The Mall, Notting Hill Mr. Edwards St. Mark's Road, Fulham Road „ Starr Melbury Road „ Tisdall Newland Terrace „ Tisdall Warwick Road „ Pool Stratford Road „ Clarke Addison Cottage, Lome Gardens „ Lyons Newcombe Street „ Lunn NORTH OF UXBRIDGE ROAD. 2, Portobello Terrace Messrs. Ross & McCulloch 191, Portobello Road „ Hughes and Son 207, Portobello Road Aylesbury Dairy Company 3, 4, 5, Angola Mews Mr. Jennings 4, 5, 6, Wornington Mews „ Jones Ledbury Mews „ Liddiard 187, Walmer Road „ Arnsby 235, Walmer Road „ Van 47, Tobin Street, Notting Dale „ Bedgood 12, Blechynden Mews „ White 14, ditto „ Copperwheat 15, ditto „ Salisbury 3, 4, & 5, Archer Mews „ Skingle 23, Bramley Road „ Tame 27, Queen's Road „ Williams 49, Tavistock Crescent „ Minter Elm Cottage, St. Mark's Road „ G. Attfield Clarendon Road „ Brumbridge