KEN 107 THE ANNUAL REPORT on THE HEALTH, SANITARY CONDITION, &c., &c., of the Paridh of St. Mary Abbotts, KENSINGTON, FOR THE YEAR 1880, by T. ORME DUDFIELD, M.D., Medical Officer of Health HUTCHINGS & CROWSLEY, LIMITED, PRINTERS, FULHAM ROAD, S.W. and henry street, st. john'S wood, n.w. 1881. TABLE OF CONTENTS. pace Prefatory Remarks on Parochial, Metropolitan, and National Death- rates in 1880 5 Registration District, " Kensington."—What it includes. 7 „ Sub-Districts " Kensington Town," and " Brompton " 7 „ „ Differences in the, in respect of Relative Proportions of Rich and Poor, &c. 7 Wards, Parochial Division into 8 Kensington, Population and Rateable Value of, 1801-81 9 „ Vital Statistics, &c.; Summary of, for 1880 9 Zymotic Diseases, General Remarks on the " Seven Principal" 12 „ „ Number of Deaths from the „ „ 13 „ „ Death-rate from : Kensington, London, England and Wales . 14 Scarlet Fever 15 „ Cases Illustrating Modes of Spread of 15 „ Cases of, Removed to Hospital under Justice's Order 19 „ Provident Dispensaries, and their Influencs on the Spread of 20 Diphtheria . 21 Measles 21 Whooping-Cough 21 Fever: Typhus, Enteric, and Simple-Continued 22 Diarrhcea 23 Small-Pox, Continuation of History of Present Epidemic of (1876-81) 24 Fclham Small-Pox Hospital, The Year's Work at (1880) 26 „ „ Principal Contributory Parishes sending Cases to, in first half of 1881 (foot note) 26 „ „ Ambulances and Ambulance Service 28 „ „ The Indictment against 30 „ ,, Local Government Board Enquiry respecting 30 „ „ Legal Proceedings to Close 31 Small-Pox Hospitals, Action of Nuisance Authority in Fulham, St. Pancras, and Islington, and of Kensington Guardians, with respect to provision of District Accommodation 32 Small-Pox Hospitals : Are Local Hospitals desirable ? 35 „ „ Proceedings of Nuisance Authority in Paddington, and Willesden 35 ii CONTENTS. page Hampstead Small-Pox Hospital Case, Appeal (No. 2,) Result 36 „ „ „ Appeal (No. 1,) Proposed prosecution of 37 Infectious Diseases, Prevention of the Spread of 38 „ „ Information of Existence of, How obtained 38 „ „ Legislation necessary to ensure Disclosure of 40 „ „ Increased Facilities for Removal of Cases of 41 „ „ Interruption of Education resulting from: Action of London School Board ; Report by Society of Medical Officers of Health 42 „ „ " Compulsory Notification" of, required 44 „ „ „ „ in Operation in certain Towns and Boroughs 45 „ „ „ „ Action of Vestry; Medical Officers' Report, &c. 46 „ „ „ „ Memorandum thereon sent by Vestry to Metropolitan Nuisance Authorities with Invitation to Meet in Conference 49 „ „ „ „ Conference of Vestries and District Boards of Works : Resolution adopted 52 „ „ „ „ Action of Society of Medical Officers of Health with reference to 54 „ „ „ „ British Medical Association 55 „ „ „ „ Metropolitan Asylum Board 56 „ „ „ „ Metropolitan Poor Law dians' Association 56 „ „ „ „ Deputation of Vestries and other Bodies to Local Government Board 57 Hospital Accommodation for the Infectious Sick 58 „ „ Practical Solution of Difficulties of, by lishment of Extra-mural Convalescent Camp Hospitals 58 Hospital Accommodation, increased by Ships fitted up by Asylum Board 61 „ „ supplemented by the Provision of an Ambulance Service by the Board 62 Census of 1881 . 63 Population; Number of Inhabited Houses, &c. 64 „ of Sub-Districts, Wards, and Ecclesiastical Divisions 65 „ Relative Proportions of Males and Females, &c., &c. 65 „ Rateable value. Increase in 25 years, and in 10 years 67 „ Estimated in 1880 67 Marriages and Marriage-Rate 69 CONTENTS. iii page Births and Birth-Rate 69 Deaths and Death-Rate, at Ages ; Periods of the Year; in Sexes ; among Illegitimate Children ; in Sub-districts, &c., &c. 70 Deaths, Special causes of 74 Public Institutions, Deaths at 82 Parish Infirmary 82 Brompton Consumption Hospital 83 St. Joseph's House 84 Deaths "Not certified" 84 „ „ Action of Society of Medical Officers of Health with reference to 85 Inquests held in 1880, Particulars with respect to . 85 „ Why so many become necessary 87 Violence, Deaths from 87 Meteorology of the Year 87 Vaccination in 1880 88 „ Officers'Report; House to House Visitation, &c. 89 „ Statistical Evidence of; Protection afforded by 90 „ The Alleged Dangers of; 91 „ Animal: Government Calf-Lymph Station 92 „ Bill of Government (withdrawn) 93 Sanitary Work of the Year. Some account of the Legal Proceedings, &c. 94 Slaughter-Houses, Summary of Report on the Licensed 96 „ „ Proceedings on Licensing day for 98 „ „ Refuse of: The Butchers' Memorial 99 Cowsheds, The Licensed 100 „ „ Report on, by the Sanitary Committee 100 „ ,, The Refuse of 102 „ „ The Action of the Magistrates in Special Sessions with reference to the Licensing of 102 „ „ Present requirements at the . 103 Dairies, Cowsheds, and Milkshops "Order," 1879 105 Cattle Diseases, "Foot and Mouth" 106 „ „ "Unwholesome Food" 107 Pleuro-Pneumonia 108 Trichinosis 108 Glanders 110 House Refuse, Collection of 111 Stable Refuse, Non-removal of, &c. 112 Refuse, Trade, House, Stable and Cowshed : Report on Collection, Removal, and Disposal of, by the Society of Medical Officers of Health 113 Bakehouses 120 Necessary Accommodation (Public Urinals, &c.) 120 Baths and Wash-houses, Public 121 Mortuary, Public 121 iv CONTENTS. page Coroner's Court, Proposed 121 Disinfection of Houses, Bedding, Clothing, &c., after Infectious Diseases 122 Water Supply 122 „ Summary of Professor Frankland's Report on the 123 „ „ Colonel Bolton's „ 126 „ The Companies and the Government: "The Agreements " 128 Gas, Result of Tests for ascertaining the Illuminating Power and Purity of the 129 „ Supply of, for Street Lighting 130 Conclusion 131 APPENDIX. STATISTICAL AND OTHER TABLES. Table 1.—Estimated Population in 1880 and ten previous years 1870-79 : Number of Inhabited House: Gross numbers of Births, Deaths, and Marriages 134 „ 2.—Birth and Death Rates : Deaths of Children, and Deaths in Public Institutions, 1880 and 1870-79 135 „ 3.—Deaths Registered from all Causes in 1880 136 „ 4.—Deaths from Seven Principal Zymotic Diseases: Pulmonary Diseases, Tubercular Diseases; Wasting Diseases of Infants, Convulsive Diseases of Infants (Gross numbers); Proportions of to 1000 deaths and to 1000 population 137 „ 5.—Deaths in 1880 and 1870-79 from the Seven Principal Zymotic Diseases; Parish; Metropolis, England and Wales. 138 „ 6&6a.—Sanitary Work, Summaries of . 139-40 „ 7 & 8.—Comparative Analysis of Mortality in London and Kensington from certain classes of diseases; Death rates and percentages of deaths, at ages; from Violence and in Public Institutions, &c., &c. 141-2 „ 9.—Localities where fatal cases of the most important of the Zymotic Diseases occurred in 1880 143-4 „ 10.—Vaccination Officer's Annual Return 145 „ 11.—Slaughterhouses, Localities of, and Names of Licensees 146 „ 12.—Cowsheds „ „ „ 147 TWENTY-FIFTH ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH, BEING FOB THE YEAR 1880. To the Vestry of the Parish of St. Mary Abbotts, Kensington. Gentlemen, I propose to place before you in this Annual Report the vital statistics of the parish for the registration year 1880 which terminated on the 1st January, 1881. The ordinary sanitary statistics will, as usual, be compiled for the parochial year, which terminated on the 25th March, 1881. Other matters calling for notice will be dealt with as occasion may require. The vital statistics will be calculated on an estimated population of 159,700, at the middle of 1880, this number being arrived at on data furnished by the recent Census. The year was on the whole a salubrious one, as judged by the death-rate; but, as we shall see, it was characterised by somewhat extreme rates at different periods. The gross number of deaths was 2,884, fewer by 108 than in 1879, (a period of 53 weeks), and 160 below the corrected decennial average. This total includes 99 of non-parishioners that took place at the Brompton Consumption Hospital, as well as a not inconsiderable number at the parish Workhouse, and at St. Joseph's bb 6 House, and at other smaller "public institutions," which are retained in our vital statistics by way of compensation for the deaths of parishioners at public institutions and elsewhere outside the parish. It also includes the deaths of parishioners at the Fever and Small pox Hospitals of the Metropolitan Asylum District. The death-rate was 18 per 1,000 persons living, or 1.1 below the rate in 1879, and the decennial average. The Metropolitan rate was 22.2 per 1000, and 0.8 per 1000 below the mean rate in the previous ten years. The rate in all England and Wales was 20.6 per 1,000. The subjoined table shews the death-rate in Kensington for the last 8 years as compared with that of the whole Metropolis, and of the several divisions thereof as mapped out by the RegistrarGeneral, and of England and Wales. Death-rate. 1880. 1879. 1878. 1877. 1876. 1875. 1874. 1873. Kensington 18.0 19.1 20.3 17.3 19'5 19.4 19.5 18.3perl,000 London 22.2 23.3 23.5 21.9 22.3 23.7 22.5 22.5 „ W. Districts l9.9 22.4 21.6 19.1 21.0 22.1 20.9 20.5 „ North „ 21.2 22.7 22.3 21.8 21.4 22.3 21.8 21.2 „ Central „ 23.2 25.2 24.9 24.1 24.0 26.0 25.6 25.0 „ East „ 24.3 25.8 24.9 24.4 24.0 25.5 25.4 25.2 „ South „ 22.8 24.2 24.2 21.3 22.1 25.0 21.5 22.0 „ England Wales20.6 10.8 21.7 20.4 21.0 22.8 22.3 21.1,, The Registrar-General, referring in his Annual Summary for 1880 to the Metropolis generally, states, that "only on five other occasions within the last forty years has so low a death-rate (as 22.2 per 1,000) been recorded, viz.: in 1850, 1856, 1872, 1876, and 1877; and it will be noted that of these six years of low mortality, no less than four occurred in the last decennium." He adds that "the decennium which closed with the year 1880 was one of lower mortality in London than any of the preceeding decennial periods, for which trustworthy data are forthcoming." The second half of the decennium also had a lower mortality than the first. "These facts," he says, are "strong evidence that the sanitary efforts of recent years have not been unfruitful," evidence strengthened by the fact that'' the saving of life was almost entirely due to diminished mortality from causes whose destructive activity is especially amenable to sanitary interference, namely, the socalled zymotic diseases." 7 Registration District and Sub-Districts. Before proceeding any further it may be desirable to say a few words with respect to the "Registration District" and "SubDistricts" in which we are locally interested. "Kensington" is the title of a "registration district" (No. 1 on the Registrar-General's list), which comprises not only the parish of Kensington, but also the parishes of Paddington, Fulham, and Hammersmith. The subjoined table shows the relative areas of the component parishes, and other particulars relating to the Census years, 1871 and 1881. Area in Statute Acres. Inhabited houses. Increase 10 years. Population. Increase in 10 years. 1871 1881 1871 1881 Kensington 2,190 15,735 20,103* 4,368 120,299 162,924 42,625 Paddington 1,251 11,847 13,613 1,766 96,813 107,098 10,285 Fulham 1,716 3,469 5,812 23,350 42,895 Hammersmith 2,287 6,719 10,543}6,167 42,691 71,916}48,470 Registration Sub-Districts.—For registration purposes Kensington is unequally divided into two "sub-districts," viz., "Kensington Town," (hereinafter for brevity designated "Town,") and "Brompton." The area of the Town sub-district according to the Registrar-General, is 1,497 acres, of Brompton, 693 acres,—total 2,190 acres. In your Vestry's Annual Report, the total acreage is given as 2,245. The population of the Town sub-district at the middle of 1880, was about 117,860, of Brompton, 41,840. The Town sub-district includes some important open spaces, e.g., Kensal Green Cemetery, Holland Park, and fields at Notting Barn Farm, which are rapidly being covered with houses. The Brompton subdistrict, in which the builder has been active of late years, many of the new houses being of a palatial character, includes within its boundaries the West London or Brompton Cemetery. The sub-districts present considerable differences which should always be borne in mind in any comparison of their vital statistics. Speaking generally the rich and well-to-do form a large proportion of the population of Brompton, whilst in the Town sub-district there is *The number 20,103 is taken from the Census return. The rate books show 20,705 occupied and rated premises, many of which presumably do not afford living or sleeping accommodation and therefore would not be enumerated at the Census. 8 a large and increasing percentage of persons of the poorer classes. The poor in Kensington, however, have one advantage over the poor in some other parts of the Metropolis, in that they live in well-built houses obviously intended for occupation by a superior class of people, miles of streets of such houses being now inhabited by persons who in the older parts of the Metropolis find shelter in dwellings that by comparison might be described as squalid. But rents are high, and high rents, where the poor dwell, mean overcrowding, which is sure in the long run to increase the death-rate wherever it exists. That the overcrowding I have long suspected is going on, may be seen in the section on "Population." This state of things has already, I fear, led to a greater variation in the rate of mortality in different sections of the parish than should rightly prevail. The ultimate effect of the overcrowding, unless a remedy should be found, and of this I see no prospect, will be to cause the death-rate of Kensington to approximate more and more closely to the Metropolitan rate. The Parish of Kensington is for some local purposes divided into "Wards." The subjoined table shows the acreage of the wards, their population, and the number of inhabited houses, etc., in 1871 and 1881. Name ofWard Area in Atatute Acres Inhabited houses. Increase in 10 years Population Increase in 10 years 1871 1881 1871 1881 St. Mary Abbotts 846 4,781 6,573 1792 35,696 48,604 12,908 Holy Trinity Brompton 439 3,224 3,936 712 22,128 26,746 4,618 St. John, Notting hill, and St. James Norland. 905 7,730 9,594 1,864 62,475 87 574 25,099 The increase in the number of " Inhabited houses," is not quite so large as it appears. The description "inhabited house" on the rate books is applied to rated premises, and, under the provisions of the Act for the Quinquennial Valuation of Property, many properties have been separately rated since 1871 that were rated together prior to the passing of the Act. The rateable annual value of property in the wards in 1871, was, St. Mary Abbotts, £823,992; Holy Trinity, £246,716; and St. John and St. James, £365,012. In 1881 the returns for the first and second wards, which cannot now be given separately, show a rateable 9 value of £1,078,512, increase, £497,804; for St. John and St. James, of £501,704, increase £136,692. me subjoined hgures show the growth of the parish in population and wealth, since the beginning of the 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 70,108 590,711 1865 1871 120,299 817,326 1870 1881 (April) 162,924 1,648,187 (April) 1881 SUMMARY OF VITAL STATISTICS, 1880. The year 1880 was, on the whole, a healthy one, but the early part of it was characterized by severe weather which left its mark on the vital statistics indicated by a sharp rise in the rate of mortality in January and February, the deaths of aged persons, and the deaths at all ages from chest diseases having been excessive. The mean temperature of the air during the four weeks ended January 31st, was 31.7 Fahr., or 7.6 below the decennial average. The death-rate for the month (23.6) was 2.8 per 1000 above the average: seventy-three persons died at 60 years of age and upwards; and from chest diseases (excluding phthisis) there were so many as 108 deaths, including 71 from bronchitis. There was nothing extraordinary in this mortality, however, regard being had to the weather; for, as I have frequently pointed out, long continued severe cold, especially when associated with fogs, is always followed by a rise in the death-rate and by an excessive senile mortality, the most frequent cause of death being bronchitis. In February the mean temperature of the air was 410,6, or 2.5 above the average, and yet the death-rate, Metropolitan and local, exhibited a considerable increase even as compared with January, and on the decennial average— an increase dependent on the severe weather, cold and foggy, which had prevailed, especially at the end of January—for the effects of past severe weather are felt long after the commencement of a beneficial change. The successive weekly returns showed this very clearly in an increased death-rate, and especially in the fatal 10 prevalence of the diseases of the respiratory organs. The deaths of persons aged 60 and upwards in the month of February were 95, and the deaths from chest diseases were 101, including 70 from bronchitis. The Metropolitan death-rate for the first week of February was 48.1 per 1000, a higher rate than had been recorded since the cholera epidemics of 1849, 1854, and 1856; and in this week the deaths from diseases of the respiratory organs, numbering 1,557, exceeded the corrected weekly average by upwards of 1,100. The Metropolitan death-rate for the month (34) was 9 per 1000 in excess of the decennial average, and 7 per 1000 higher than the rate in January. The Kensington death-rate exhibited an increase of 3.4 per 1000 only, on the decennial average, and 1.4 per 1000 on the January rate. The mean temperature in March was 3°.l above the average, and the deaths of aged people, and of people at all ages from chest diseases, were about as many below the average as they had been above the average in January and February; thirty-eight deaths only having been caused by these diseases, and only 39 persons having died at 60 and upwards. The death-rate in the parish and the Metropolis respectively was 3.l and 3.5 per 1000 below the decennial average, and 7'3 and 12.6 per 1000 below the rate in February. This remarkable decline in the death-rate was due in part to the clear bright weather that had set in; but it was due in part also to the fact that the deaths of aged people, and of persons at all ages from chest diseases, had previously been excessive—many persons who would have succumbed to these diseases week by week as the winter progressed, in ordinary circumstances, having been cut off prematurely owing to the unusual inclemency of the weather in January, the untoward combination of severe cold and dense fogs. In the following four weeks ended April 24th, cold winds having been prevalent, and notwithstanding the temperature had been 1°.3 above the average, there was an increase of 19 in the deaths of aged persons above 60, and of 12 from chest diseases. In the next period of four weeks ended May 22nd, the death-rate fell to 15, or 3.5 per 1000 below the decennial rate. In the following four weeks to June 23rd, the death-rate was 0.5 below the average; the mean temperature, 55°.7, corresponding with 11 the decennial average; the comparative coolness of the weather, conjoined with a considerable rainfall, combining to defer the commencement of the summer scourge, infantile diarrhoea. There was only one death from diarrhœa in the four weeks: the number rose to 10 in the following month ended July 17, the mean temperature having then risen to 61°.3, the death-rate meanwhile continuing slightly below the average. In the four weeks ended August 14th, the death rate being average, and the mean temperature, (62°.5) 0°.6 below average, there was a great increase in diarrhœal disease, the deaths from this cause being 44. This heavy mortality, however, was compensated by a low rate from chest diseases, which caused only 15 deaths. The deaths from diarrhœa declined in the four weeks ended September, to 30, although the mean temperature had risen to 640.l, 20.9 above the average; the deaths from chest diseases were only 17, and the death-rate was 3.1 per 1,000 below the average, the result of continued genial weather. With a decline of mean temperature to average, (54°.8) in the four weeks ended October 9th, there was a further fall in the number of deaths from diarrhoea, viz., to 13, a rise in the number of deaths from chest diseases to 22, the local death rate being average, (14.9), and 5.1 per 1,000 below the Metropolitan rate. In the three remaining periods of four weeks each, completing the year, the death-rate was below the average, the approach of the wintry season with its cold days and frosty nights, being marked by customary effects in the reduced mortality from diarrhcea, and the increased fatality of chest diseases. In my last monthly report I had to chronicle a death-rate nearly 3 per 1,000 below the average, a very favourable condition due to the prevalence of mild and genial weather, with freedom from fogs, such as is rarely experienced in December. "Seasonable weather" we had not: the weather socalled, viz., hot in summer and cold in winter, is the reverse of "healthy" weather, although the two terms seem to be in the popular vernacular, synonymous. The Metropolis generally was in good case, the death-rate being 5.3 per 1,000 below the decennial average. The fatality of chest diseases was much below what is usual at the end of the year, the deaths from these diseases having been no fewer than 903 below the corrected average in the four last weeks of the year. 12 THE ZYMOTIC DISEASES. Having said so much by way of general introduction, I now propose, before entering into details on the subject of population, births, deaths, etc., to consider specially the sickness and mortality from the principal diseases of the Zymotic class, and subjects naturally arising out of this topic. The "Class" of diseases called Zymotic, comprises four "Orders." The first order, "Miasmatic," includes, among others, the diseases which the Registrar-G-eneral calls" the seven principal diseases of the zymotic class," still classing under the generic term "fever" the three distinct fevers, "Typhus," "Enteric," and "Simple continued." These diseases have a high interest for sanitarians, being of a more or less preventable character: it is the custom, moreover, to regard the death-rate from them, and the proportion of deaths from them as compared with deaths from all causes, as an index of the sanitary condition of a district. But, without underrating the importance of this relation it needs be said that there are limitations to the applicability of the test which must be borne in mind if we would draw sound conclusions. What I mean can be best explained by an illustration or two founded on our own local observations within the last few years. Thus Measles was very fatal in 1878 ; the deaths were far above the average: it was, so to speak, the zymotic disease of the year. In 1879, on the other hand, the deaths from Measles were below the average; but the reduced mortality—evidence of the diminished prevalence of the disease, was almost the corollary of the excessive prevalence and fatality of the malady in the previous year. In saying this, I do not, of course, ignore the fact that one epidemic of a zymotic disease may be more severe than another; still less am I forgetful of the fact that the fatality of an epidemic is largely influenced by the means taken, rathe neglect to take means, to limit the spread of infection. Diarrhoea may be cited as an illustration of quite another kind. The mortality from this disease among infants was excessive in 1877; the mortality in 1878 was far below the average; but the diminished mortality in the second year had no relation to the excessive mortality in the first: the conditions were altogether different. The summer season of 1878 was cold and wet: in a cold and wet summer the mortality from infantile diarrhoea is always low, just as it is always high when the summer is hot and dry, as it was in 1877. 13 But the conditions that were so favourable to infantile life in respect of diarrhoea in 1878, were very unfavourable to life, both in the young and in the aged, in respect of another class of diseases, viz., the pulmonary, the mortality from which throughout the year was excessive, as it always is in cold and wet seasons. These and like circumstances must be kept steadily in view if we would draw sound conclusions from a high or a low rate of prevalence of this or that disease, or class of diseases, especially in relation to the sanitary condition of a district. Subject to corrections for climatic conditions, and for high rates in previous years, the concurrence of a low general death-rate with a low zymotic rate furnishes just grounds for satisfaction; and as the general and the zymotic rates were both below the average in 1880, to that satisfaction we are fairly entitled. It need hardly be said that a persistently high rate of mortality from zymotic diseases is always a subject for serious consideration; but, as we shall see in due course, Kensington has hitherto been in the happy position of having a death-rate from these diseases much below that of the Metropolis generally. The subjoined table sets out necessary particulars of the mortality from the principal zymotic diseases in 1880, together with the decennial average, &c.:— Diseases. Sub-districts. In Hospital. Totals. Totals in 1880. Decennial Average. Town. Brompton. (uncorrected). (corrected). Small-pox 1 2 8 11 22 33.7 38.7 Measles 74 1 .. 75 60 65.4 75.2 Scarlet Fever 69 14 22 105 51 66.5 76.4 Diphtheria 21 1 .. 22 27 17.2 19.7 Whooping Cough 75 20 ... 95 93 83.6 96.1 Typhus Fever 1 3 .. 4 1 37.7 43.3 Enteric Fever 17 7 .. 24 14 Simple continued Fever 4 1 .. 5 8 Diarrhoea 111 17 .. 128 71 123.4 141.3 373 66 30 469 347 427.5 491.3 From the above table we learn that the deaths from scarlet fever and diphtheria were in excess of the corrected decennial average, that the deaths from measles and whooping cough were average, and that the deaths from small-pox, fever, and diarrhoea were below average. The deaths from these zymotic diseases were 122 more than in 1879, 104 fewer than in 1878, and 22 below the corrected decennial average. As usual, the deaths in the Brompton sub- 14 district were relatively fewer in proportion to population than in the Town sub-district. The increase of 122 over the number in 1879, moreover, belongs almost entirely to the Town sub-district. The deaths were equal to 162 per 1,000 deaths from all causes, and to a rate of 2.9 per 1,000 persons living, as against 3.7 per 1000, the rate in all London, the decennial average being 3'0 per 1,000 in Kensington, and 3'9 per 1,000 in London. By way of comparison it may be mentioned that in all England and Wales the deaths from the Zymotic diseases were 156 in each thousand deaths, the rate being 3.1 per 1,000 persons living in 1881, and the decennial average being 3'4 per 1,000. The Registrar-General, speaking of the Metropolis as a whole, states that of each 1,000 deaths, 170 were assigned to one or other of the chief zymotic diseases; this proportion corresponding with the average for the decennium, but being much lower than the proportion in any of the three previous decennia, in which it was successively 209, 213 and 213. This fact and the fact that the general mortality in the decennium 1871—80 was the "lowest on record," are cited by the Registrar-General in evidence, that "the sanitarv efforts of recent vears have not been unfruitful." The following table shows the distribution of deaths in Kensington from zymotic diseases in 13 periods of four weeks, corresponding to my monthly reports. PERIOD. DISEASES. Four weeks ended Small Pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Typhus Fever. Enteric Fever. Simple continued Fever. Diarrhoea. Jan. 31, 1880 1 ... 7 2 8 1 3 1 3 Feb. 28 „ 1 4 2 1 13 2 1 ... 3 Mar. 27 ,, ... 8 7 5 10 ... ... ... 3 April 24 „ ... 5 7 ... 16 ... 1 ... 3 May 22 ,, .. 7 1 1 10 ... 2 ... 4 June 19 „ .. 6 6 1 7 ... 3 1 1 July 17 .. 15 4 2 8 ... ... ... 10 Aug. 14 „ 1 13 5 2 4 ... 2 1 44 Sept. II „ ... 4 6 1 2 ... ... ... 30 Oct. 9 ... 2 4 2 2 ... 4 1 13 Nov. 6 ... 3 15 3 2 ... 3 ... 6 Dec. 4 ... 6 10 1 1 .. 2 1 2 Jan. 1, 1881 ... 2 9 1 12 ... 3 ... 6 15 From the above table we learn that measles was most fatal in the eight weeks, June 19th to Aug. 14th; scarlet fever in the last quarter of the year, and whooping cough in the first half. Diarrhœa as an infantile disease prevails in summer and autumn, the fatality being proportional to the heat of the weather, but less when hot weather is accompanied with rain. The fatal cases of small-pox were all in the Brompton sub-district. The deaths in hospitals are not included in the table. I now proceed to make a few observations on each of the several diseases, and first with respect to Scarlet Fever, which was the most severe epidemic disease of the year, some 466 cases having been recorded, viz., 225 in that portion of the parish north of Uxbridge Road, commonly called the north sanitary district, and 221 in the south sanitary district, which comprises the remainder of the parish south of Uxbridge Eoad. Of the 105 deaths from this disease, 22 took place in the hospitals of the Metropolitan Asylum District, to which about 150 cases were removed; and the remaining 83 in the parish, viz., 69 in the Town registration sub-district, and 14 in Brompton,—17, 14, 18, and 34, in the four quarters respectively. Many cases were concealed, especially in the northern district, only 50 cases having been removed to hospital from that district, as compared with 100 from the south district, in which district moreover, there were many cases not calling for removal. No intimation of the existence of the disease was received in respect of the great majority of the cases that ultimately proved fatal until after death, and then only from the sub-district registrars after the registration of death. A few cases may be cited in illustration of ways in which infectious diseases are spread. Scarlet fever is spread frequently by exposure of the sick when peeling, and this exposure may be quite unintentional—due to ignorance, as in the following instances: There were five cases in one house, one of them being a child, who, so it was alleged, was not known to have had scarlet fever. This child was sent 16 regularly to a crowded "dispensary" waiting room, to fetch medicines for other members of the family, while his skin was peeling. All these eases were of a mild type, and were thought to be of no importance, but it cannot be too strongly insisted on, that the mildest case may have the most serious consequences for the individual in the long run, and is capable of spreading the disease in its most virulent form. Again:— Two children in one family attended school regularly while peeling : they had had a slight illness, the nature of which appeared not to have been suspected until on a more severe case occuring medical advice was sought, and the disease was recognised as scarlet fever. In another instance A man engaged as a porter in delivering parcels, went about his work while actively peeling, in ignorance, real or pretended, of the nature of a smart illness he had recently passed through. In the same house this man's nephew was found to be peeling, but the child's mother protested her ignorance of the nature of a previous indisposition from which he had suffered. Again and again parents refused to allow then sick children to be sent to hospital: child after child would be stricken; all seemed to go well for a time, but too frequently in the end the parents had occasion to regret their obstinacy, the last case proving fatal. In one instance the illness was concealed in a family of three children until one of them died;- the remaining two children were subsequently taken ill and died. There were two well marked cases of "mediate" infection, viz.— One through a washerwoman who conveyed the disease in her clothing to a child at a house where she worked, and the other through a governess just arrived from Germany, who conveyed the disease in her clothing to her pupils. Sometimes there was an attempt to conceal the nature of the illness even after death had taken place, as in a case certified as "febris rubra; cerebral softening There had been six cases of scarlet fever in the house. The death of the sixth case, above referred to, led to the discovery of the outbreak, on the registration of the death. The fifth and sixth cases had been under the care of a private medical practitioner, the first four had been attended by the medical officer of a public or quasi-public dispensary. The disease had been in existence many weeks when the house was first visited,—the four patients were convalescent, but no effectual measures had been taken for disinfecting the house, clothing, bedding, etc., and we should not have had an opportunity of getting the place disinfected, had no.t a 17 death occurred. Not long before the death from, "febris rubra," there had been another death in the house from " measles; pneumonia," and as this very infectious disease "measles" did not spread, we may reasonably surmise that the supposed measles was really scarlet fever. The following cases are instructive:— At a house in Talbot Grove a child—member of a family of six persons occupying the basement—was attacked with scarlet fever on or about September 11th, and the case was concealed until after two other children in the same family fell ill on the 1st and 2nd October respectively. These three children were removed to hospital October 5th. On this day a child—member of a family of five persons occupying the parlour floor—was seized, but the parents refused to allow her to be removed to hospital. On the 6th and 7th October two children in a third family of nine persons occupying the first floor fell ill, and they were removed to hospital on the 12 th. A married woman—member of a family of six persons occupying the top floor—was stricken on the 17th October, and she refused to go to hospital. Her infant fell ill on or about the 19th, and died on the 22nd, the case having been concealed until after the registration of the death. On the 8th of November a youth of 17—member of the third family (first floor), was attacked, and he died on the 19th. This youth had been employed all the time the disease was in the house by a family near Notting Hill High Street ; and in this family two children fell ill of scarlet fever on the 28th and 29th September respectively. It is an open question whether the lad conveyed the disease to these children in his clothing, living as he did in an infected house, or whether he contracted the malady from the children or from sick people in the house where he lived ? At a house in Lancaster Road the disease continued many weeks, the parents refusing to allow removal of the children to hospital. The first four cases in one family, between the 11th and the 25th August, were concealed. There was an interval of one week between the first and the second ease, quite long enough for preventive measures. The fifth and sixth cases were in another family, and the sixth case was the fatal one. A woman, who lived at Blechyenden Street, was in the habit of visiting at this house frequently, and the children of the two families played together. The result was the illness of three children of the family in Blechynden Street and the death of one of them. The existence of the outbreak in the latter family was revealed only on the registration of the death of the third and last case. At Oxford Mews there was an outbreak—four cases in one family. The interval between the first and second cases was 24 days. Six days after the second case the third began, and it proved fatal. A fourth case, of an adult, occurred ten days subsequently. The parents refused to let the children go to hospital. On the 6th October, a case of scarlet fever was reported at a house in Albion Place. The mother denied the truth of the report. Visitation in the street, same day, led to discovery of two cases at adjoining houses, and nine days later a second case was discovered in one of these houses. The house first 18 visited was again inspected on the 1st November; and the child who was declared on 6th October to be free from illness was found to be dead, and it then came out that the illness had commenced on the 27th September. The death of this child was not registered until the 8th day. On the same day four concealed cases were discovered in the very next house to that where the death had occurred. Another group of cases, at a house in Wheatstone Road, might be cited in illustration of the evils attendant on keeping the sick at home under circumstances which preclude the possibility of isolation. In this group, as in others, it was the last person to be attacked who succumbed to the malady. I refer to the cases, however, for an illustration of another character :— Wheatstone Road was a private street, and one of a group which I had brought under the notice of the Works, &c. Committee, as requiring to be "made up." The medical gentleman who certified the death referred it to "malignant scarlet fever, 21 days," and appended to his certificate the following observation : " Another death of preventable disease in this unhealthy street abounding in decayed vegetable and animal matter soddened in filth." Now it may be freely admitted that the state of the roadway was unsatisfactory, and, in fact, I had so reported it; but it was scarcely reasonable to attribute the death to such a cause, seeing that there had been a case of scarlet fever in the same house and family some ten days before the deceased was taken ill. If the death was " preventable,'-' it could only have been prevented by the removal of the first case to hospital— a course that might have preserved the deceased from the malady, but this course was objected to by the parents and by the medical attendant alike. Other cases subsequently occurred in the same house, and the last of them was that of the deceased child's father, a railway clerk, who fell ill and died within 7 days, leaving a widow and six children. The certifying medical practitioner again appended a remark to his certificate, viz., that" the roads, &c., are in a dangerous state as regards sanitary matters," as if to imply that the fatal attack was due to the condition of the roads rather than to the previous occurrence of four cases of scarlet fever in the house, all under his charge, and not one of which would he allow to be removed. As illustrations of the regardlessness of people in respect of the spread of infection, two cases may be mentioned. In the first oase, a child lay ill in bed of scarlet fever, and in the same room, when the Inspector called, there were no fewer than four adults besides the mother, viz., the child's grandmother, two other women, and a soldier. In the second case, in the same house, an adult brother of the patient, himself in the employ of a greengrocer, was found eating his dinner in the sick room. It is hardly possible that this very infectious disease should not have been spread by the folly of these people; and what made their conduct the more reprehensible was the fact that there was not 19 any occasion in either case why another room should not have been employed for the reception of visitors, or for the use of healthy members of the family. Two children were removed to hospital under Justice's order (Sec. 26, The Sanitary Act, 1866). They were living with two other children and their parents—the father was a stable-man—in a single room. The sick children had been attended by a medical practitioner who keeps a "Provident" Dispensary, and who certified that their removal to hospital would be "improper" and was "unnecessary." But as there were numerous other persons living in the same house, adults and children, I could not adopt this view of the case ; and, accordingly I took the requisite measures to remove the children without loss of time. The law allows a magistrate to make an "Order" for the removal of a person to a hospital at the cost of the "nuisance Authority," on a certificate signed by a duly qualified medical practitioner, and on proof that the sufferer is "without proper lodging or accommodation:" This power would be more often exercised, but that it appears to have been decided that the fitness of the lodging or accommodation should be judged by the wants of the sufferer, rather than with any reference to the safety of the remaining inmates of the same house. It would be far better were it otherwise, as the spread of disease from one family to another in a house, without actual contact of sick with healthy people, is of frequent occurrence, so that the lodging or accommodation of the sick was obviously not "proper," judged from the standpoint of the healthy.* In several instances the last child to be attacked in a family died, and these deaths were strictly preventable and would have been prevented, had the parents taken good advice and allowed the children first attacked to be removed to the hospital. The great majority of the sick naturally were children, and many of them had been in attendance at school until they were taken ill. Some cases were reported by Officers of the School * This subject is dealt with fully in the section on Compulsory Notification of Infectious Diseases. 20 Board, Teachers and Visitors; but several of the cases reported on suspicion turned out to be not ill of fever, parents having been misinformed, or having deceived the Visitor. Deceit may have been practised to excuse the children's absence from School, or to screen parents from prosecution; but in several cases it was stated that a ("Provident") Dispensary Doctor had at a first attendance—and often there was but one attendance—expressed the opinion that a certain case was, or would prove to be, one of scarlet fever; and even when the case continued under treatment and did not turn out to be infectious, the error was not corrected, and the child was kept an unduly long time away from school. Facts of this sort which came to my knowledge led me to comment on the so-called "Provident Dispensaries" and their Influence on the Spread oF Infectious Diseases in connexion with a discussion with regard to them, which took place in one of the medical journals. These institutions, if they may be so termed, are not dispensaries at all in the commonly accepted sense, but simply private business speculations. They have not proved of any benefit in this parish in the way of preventing the spread of infectious disease, e.g., by increasing facilities for the poor obtaining medical advice at a cheap rate. On the contrary, many cases of illness have occurred in connexion with these establishments which, but for their existence, would have come under the observation of the District Poor-Law Medical Officers, and would have been removed to hospital. We have not received information of illness from their proprietors, nor can I say that they have shown any great anxiety to further the efforts of the Inspectors to remove cases to hospital when discovered, but rather the reverse. It was reported, moreover, that in some instances at least, the medical assistance rendered to sick children was of a purely nominal character—the mother having to report progress at the Dispensary from time to time when fetching fresh supplies of medicine. In one period of four weeks 17 out of 52 cases in the North district were "Dispensary" patients; three of them died, and not one of them was removed to hospital, nor was one of the cases reported till concluded. 21 Diphtheria.—The mortality from Diphtheria was above the corrected average (19.7), the deaths having been 21 (20 in the Town sub-district, and only one in Brompton) 8, 2, 5, and 6 deaths in the four quarters respectively. The fatal cases were mostly of children; several were imported cases. It would be well if provision were made on the medical certificate of the cause of death for information to be given in the event of an infectious disease having been imported. Such information would often be of value to the sanitary authority of the district whence the patient came, and the district in which the death takes place would be relieved of an imputation on its sanitary arrangements. Measles.—The deaths from Measles were 75, corresponding with the corrected average, viz., 74 in the Town sub-district, and only one in Brompton—13, 25, 26, and 11 in the four quarters respectively. The deaths were mostly of the children of persons in the humbler ranks of life; and it is open to question whether, in some instances at least, the complicating malady may not have been due to a want of that care which is necessary to guide children safely through an attack of measles. Sufferers from this complaint have more or less disturbance of the respiratory organs, which are ready to take on inflammatory action under an amount of exposure borne with impunity in health. There is no reason to assume intentional want of care on the part of mothers in the management of children suffering from measles ; but the disease is regarded too lightly: it is even thought a good thing to let it run through a family; and not uncommonly children are purposely exposed to infection, while rarely is any great trouble taken to isolate the sick. It must be admitted, however, that the disease is intensely catching, and is, of all the so-called preventable diseases one of the most difficult to prevent, being infectious probably from the appearance of the first symptoms —running from the eyes and nose, sneezing, etc., about three days before the characteristic rash appears on the skin. Whooping Cough.—The deaths from Whooping Cough, 95 in number corresponded practically with the corrected average (96.1), 75 of them occurred in the Town sub-district, and 20 in Brompton. The deaths in the four quarters respectively were, 34, 33, 12, and 16. Sixty-seven of the deaths were of children under five years of cc 22 age, of whom 31 were less than one year old. Whooping Cough by itself is not a very frequent cause of death, the disease usually proving fatal through complications which too often arise from want of proper care in the management of the sick. This disease is too lightly regarded by parents in the humbler ranks of life. Children must have it, they think, and they take little pains either to prevent the attack or to guide the little sufferers through what is one of the most painful and distressing of infantile complaints. FEVER. The deaths from the three diseases grouped under this head were 33, ten less than the corrected average, but ten more than in 1879. Typhus.—The deaths attributed to this intensely infectious disease were 4, of which 3 were registered in the Brompton subdistrict. The cases were carefully investigated, with the result of convincing me that the diagnosis was in error. The first case was that of an old lady at Wharfdale Street, West Brompton, who was removed into this parish not long before her death, being very ill at the time. Her usual medical adviser, who had been in attendance till within a few days of her death, assured me that the complaint was not typhus, but simply inflammation of the lungs; her family were not told she had typhus, no precautions were taken to prevent the spread of the disease, if it were typhus; and it did not spread. The second, third, and fourth cases were of young children, at Princes Road, Notting Hill; at South Row, Earl's Court; and at Stanhope Mews East, respectively. No second case occurred in either of these localities. Enteric Fever.—The deaths from this disease were 24, as compared with 14 in 1879; 17 of them were registered in the Town sub-district, and 7 in Brompton : the quarterly numbers being 4, 6, 4, and 10. Several of the cases were imported, notably one of a female student at Observatory Avenue, another of a military student at Holland Park Terrace, and a third of a young lady at Cromwell Road, whose illness originated on the Continent. One death of a child aged 6 ascribed to gastric fever; bronchitis, was, by the 23 Registrar-General classified to enteric fever. The certifying Surgeon however, informed me that by "gastric fever" he did not intend to imply "enteric fever." He had seen the patient once only, viz., on the day she died. Another case of supposed enteric fever was that of a very unhealthy man at Princes Road, Notting Hill, who had long suffered from scrofulous ulcers of the feet. The true cause of this death probably was pyemia—the symptoms assuming a "typhoid" character. Another doubtful case was that of a gentleman aged 74, at Fawcett Street, West Brompton, who had been ailing a long time, congestion of the lungs being the immediate cause of death. The age of this patient excludes the probability of enteric fever, and the same remark applies in respect of the case at Gledhow Gardens, of a gentlemen aged 84, whose death was certified as due to typhoid fever; bronchitis. No mention of 'fever' appeared to have been made during the progress of the illness in any of these doubtful cases. There was an outbreak of enteric fever at Cornwall Mews traceable to a previous case in the family prior to their removal from Brighton. There was another severe outbreak—five cases—in a family residing at Fenelon Road. There had been two casae of illness previously in another family in the same house, one of them fatal, the registered cause of death being diphtheria. It is probable that the first case in the larger group was due to poisoning by sewer gas, and as no precautions were taken to prevent the spread of the disease, which was alleged to be non-infectious, the occurrence of the subsequent cases is sufficiently explained. A fatal case at St. Mark's Road, Notting Hill, was popularly ascribed to effluvia from a distant manure heap in an adjoining field, on which offal from a slaughter house had been deposited: but there were sanitary defects in the house of the deceased adequate to account for the illness, if it were enteric fever. It was very doubtful, however, whether the disease was one of specific fever at all; the cause of death as registered being "low or typhus fever," terms by no means synonymous and not at all corresponding to enteric fever. Simple continued Fever.—The deaths from this disease were 5, viz., 4 in the Town sub-district and 1 in Brompton. Diarrhea, which caused only 71 deaths in 1879, was fatal to 24 128 persons in 1880; but even this large number was 14 below the corrected average. Only 17 of the deaths occurred in the Brompton sub-district. The quarterly numbers were 9, 10, 93, and 16, respectively. One hundred and twenty four of the deaths were of children under five years of age, including 97 under one year. The fatality of infantile diarrhoea in summer, to whatever specific cause due, is mainly a matter of temperature. In hot and dry summers the disease is terribly fatal, whereas in cold and wet summers, as in 1879, the mortality is small. Ninety-seven of the deaths occurred in the 16 weeks between June '20th and October 9th, viz., 10, 44, 30, and 13, in four several periods of four weeks each. SMALL POX. This disease, which had been absent from our midst in the latter part of 1879, re-appeared at the beginning of 1880, just as it did at the beginning of 1879. In my first report for 1880 (dated Feb. 4th, page 3), I had to note the occurrence of seven cases, one (fatal) in the north of the parish, and six in the south. Two of these were of servant girls, a third case was imported from Paris, two were children in attendance at St. Matthias' School, and the last case was an adult brother of one of the children. Two of the cases were treated at home, at Childs Place, and gave rise to a further outbreak in that part of the parish. A few cases were imported, and there were not wanting instances of that exposure of the sick, voluntary or unintentional, to which in all probability the spread of the disease is largely due in the locality of a hospital. The following is one such case:—A servant, at Redcliffe Gardens, was taken ill, August 27th, and being unable to do her work she was sent to her friends at South Street, St. Mark's. She went to a general hospital for advice on the 31st, and was directed to attend again on September 2nd. On the 1st, however, feeling worse, she went in a cab to the Parish Infirmary, and was found to be suffering from small pox; she was sent at once to Fulham hospital in the ambulance. The cab was not disinfected, having driven off before the nature of the case was discovered. Two children were subsequently admitted into the hospital from the house in South Street—a boy, who was sent in the ambulance, and a girl who walked in. Among the imported cases was one of a mail who contracted the disease at his place of work in Bethnal Green. There had been numerous cases in one street in that Parish, four of them fatal, and it was stated that the malady was extensively spread from a dead body, a concealed case, over which a species of (English) wake had been held. There were fifty cases of the disease recorded during the year, viz., seven in the district north of Uxbridge Road and 43 in the remainder of the parish south of that Road. Of the seven cases in the north five were removed to hospital, and of the 43 in the south 35 were removed. Eight out of the 11 deaths took place in hospital, and of the eight deaths in hospital four were of unvaccinated persons. At the end of 1880 the disease again broke out in a far more virulent form: the cases being both more numerous and more severe; and the epidemic continues in full force at the present time (June 1881). The fluctuations of the epidemic, and the relative prevalence of the disease in the parts of the parish north and south of Uxbridge Eoad respectively, between November, 1878, and the end of June, 1880, were set out in a table at page 20 of my annual Report for 1879. In continuation of that table I subjoin similar particulars relating to the period between June, 23rd, 1880, and June 22nd, 1881, 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. Removed to Hosptl. Treated at Home. North South o f Uxbridge Road 1880. No. 7, July 21 2 1 1 - 2 2 - 9, Aug. 18 2 — 2 — 2 1 1 10, Sept. 15 6 2 4 1 5 3 3 13, Dec. 8 1 — 1 — 1 1 - 1881. No. 1, Feb. 2 14 2 12 4 10 14 — 2, Mar. 2 36 3 33 4 32 33 3 3, Mar. 30 36 8 28 17 19 32 4 4, Aprl.27 52 17 35 16 36 39 13 5, May 25 48 9 39 17 31 35 13 6, June 22 68 22 46 29 39 52 16 Total 265 64 201 88 177 212 53 Totals previously recorded 803 270 533 380 423 595 208 Grand Total 1068 334 734 468 600 807 261 26 FULHAM HOSPITAL. I submit, as usual, some observations on the work done at Fulham Hospital during the year, compiled from the report of the Mr. R. D. R. Sweeting, the Resident Medical Superintendent. On the 1st January, 1880, there were 22 patients remaining in the hospital; the admissions during the year were 315; the discharges, 237; the deaths, 48, leaving 52 cases under treatment at the end of the year, of which 37 were convalescents, and 15 acute uncompleted cases. Of the 315 admissions, 55 were convalescents from other hospitals, and 260 were acute cases—252 of these being undoubted cases of small-pox. Three patients walked in. Of the fatal cases 23 were vaccinated, (all imperfectly), and 25 were unvaccinated. The total mortality was at the rate of 16.21 per cent. Of 257 completed cases 195 were vaccinated, and 62 were unvaccinated. The per centage mortality amongst the vaccinated was ll.79, and among the unvaccinated 40'32. Doubtful cases are reckoned amongst the "vaccinated;" 25 per cent. of the cases "doubtful as to vaccination" died, thus swelling the per centage mortality in this class. Of the contributory parishes, Islington sent in the largest number, 64, Fulham followed with 45 cases; and then Kensington, 38; St. Pancras, 34; St. George's Union, 21; St. Marylebone, 10; Chelsea, 9; Wandsworth and Clapham, 8, etc., etc. The largest number of admissions was in February, (61), the smallest number in October, (4), and November, (5). By way of comparison it may be stated that the number of patients sent in during the first half of the year 1881, by the chief contributory parishes was as follows: Fulham and Hammersmith, 205; Kensington, 193; Chelsea, 108; Islington, 250; St. Pancras, 80; and Hackney (to middle of April), 67; Holbom, 143; Strand, 35; St. Giles, 84; and St. George's Union, 86; Bethnal Green, 56; Whitechapel (to end of April), 12, and Mile-end Old Town, 34; Paddington, 41, and Marylebone, 89; Wandsworth, 23, and Westminster, 22, etc. It should be mentioned that for a short time the hospital was restricted to the use of patients from the borough of Chelsea, on the ground that the accommodation available was not more than sufficient for the needs of the constituent parishes, viz., Fulham and Hammersmith, Kensington and Chelsea. The restriction had the 27 effect of masking to some extent the prevalence of the epidemic in other parishes, as judged by the number of admissions into the hospital, yet the above figures shew that the parish of Islington, in which parish there is no small pox hospital, sent more patients to Fulliam than any parish in the vicinity of the hospital. Some of the contributory parishes did not send all their cases to the hospital. Fulham is credited with having sent in more doubtfully vaccinated cases than any other parish. Only 10 persons with good vaccination marks were admitted, and of these not one died. As showing the importance of infant vaccination, it is mentioned that the percentage mortality amongst the unvaccinated under five years of age, was almost double that of those over five. Among 112 "discrete" cases, thoroughly modified by vaccination, there was but one death: more than a third of the "confluent" cases died; seven out of eight of the "petechial," and all the 9 "hemorrhagic." Of 25 cases admitted in the months of September, October, and the beginning of November, seven were of the ''malignant'' form. The average duration of stay in the hospital amongst the fatal cases was about 4½ days, amongst the vaccinated, 35.62 days, and amongst the unvaccinated, 46.73 days. Mr. Sweeting states that he can fully corroborate the point to which I have often called attention, viz., "that the bulk of the Kensington cases consists of servants (chiefly female,) whose infection can in many cases be distinctly traced to exposure to infectious influences, e.g. a visit to an infected house on the social Sunday out." He adds that "the history of infection of every case within a mile of the Hospital has been gone into, and a record kept," so that he hopes to be able to lay before the Asylum Board many curious and striking facts in the report for the current year. During the year 50 patients were placed on the "dangerous list 33 of these were visited by 48 persons, who made altogether 76 visits. Only one of the visitors was subsequently admitted with small-pox, but she was obviously infected prior to her first visit. As it has been supposed that there is indiscriminate visiting of patients, the above statement is reassuring. Mr. Sweeting remarks that "it is needless to point out that the visiting is reduced to the smallest possible limits, due regard being, however, paid to the feelings and sentiments of the relatives of patients." Forty-four fresh members of the hospital staff were re-vaccinated. 28 One unsuccessful case was attacked with small-pox, on the 12th clay after entering, but passed through a mild illness. It having been alleged that the boasted immunity from small-pox of hospital nurses, was due to the fact that the nurses are chosen from former patients who have had small-pox, Mr. Sweeting states, that "since Fulham Hospital has been opened no nurses have been chosen from former patients," and that "out of 94 nurses engaged, only 11 had suffered from small-pox before they entered the service of the Institution." Out of 22 nurses engaged in 1880, only 3 had ever suffered from small-pox. AMBULANCES. Reference is made to an order of the Committee, under which "all the ambulances are now disinfected by the hospital gate porter before leaving the premises," instead of some of them being allowed to be done by their own attendants as heretofore; but Mr. Sweeting urges the desirability of the ambulance service being provided by the Managers themselves, as recommended by Dr. Stevenson, the Medical Officer of Health for Paddington. It may be here mentioned that the 16th section of the PoorLaw Act, 1879, confers on the Asylum Board power to provide Ambulances for the conveyance of the infectious sick to the hospitals. At present the Managers require ambulances only for the conveyance of sick or convalescent cases from one hospital to another.* In some parishes both the Vestry (Nuisance Authority) and the Guardians (Poor-Law Authority) provide ambulances: in others the Vestry or the Guardians alone. There being some 39 Nuisance Authorities and 30 Boards of Guardians it would appear that a not inconsiderable saving might possibly be effected should the Managers find it practicable to give effect to the section—replacing the existing arrangements by a uniform system of ambulances connected with the several hospitals, five in number. A strong motive for the adoption of this plan is supplied by the complaints that have been made by inhabitants on the route to the * Since this was written the Board have provided an Ambulance Service for the conveyance of patients to the hospital ship moored off Deptford, a step that may be regarded as precursory to the adoption of Dr. Stevenson's recommendation. 29 hospital that the drivers stop at public houses to refresh on the return journey.* To obviate any necessity for their so doing they are now regaled with bread and cheese and beer, while the ambulance is undergoing disinfection within the hospital precincts. The Managers are well aware of the objectionable practice alluded to, and they have more than once, and quite lately again at my instance, addressed the several Boards of Guardians on the subject, and done everything in their power to put an end to it. But as their Clerk stated, when replying to my representations, the drivers are not the servants of the Board and they have no control over them. The Managers would have this control if the ambulances were their property and the drivers their servants. I communicated with Sir E. Y. Henderson, the Chief Commissioner of Police, and a parishioner living on the common hospital route, asking for the assistance of the police in detecting and exposing the practice of loitering. Sir Edmund expressed willingness that the police should do what they could, but the local Superintendents to whom he referred my letter, saw practical difficulties in the way, the chief one being that the police had no means of identifying ambulances, or of distinguishing them from other vehicles of similar build, many ambulances having been constructed so as to resemble private carriages. Nevertheless, the police subsequently did good-service in other districts in reporting offenders. Mr. Sweeting concludes his interesting report with some remarks on the necessity of an isolation ward for "doubtful" cases, and for cases other than small-pox, but too ill to be sent back, and therefore of necessity admitted into the hospital. I cannot conclude this notice of Mr. Sweeting's work without an acknowledgment of his courteous readiness to afford me information on every occasion, and the occasions on which I have troubled him in respect of Kensington cases have not been few. * The view has been entertained that the officers and servants of the hospital may spread infection by their clothing. In a monthly report (No. 7, 1878, page 52) I quoted the rules framed for preventing such an occurrence. The Nurses, whose duties are of a disagreeable, often loathsome, nature, get considerable indulgences in the way of leave of absence. I ventured to suggest to the Chairman of the Hospital Committee, whether some greater restriction might not be placed on the leave of Nurses, who possibly would be willing to submit to longer periods of confinement, if alternated with longer holidays, from time to time ? 30 THE INDICTMENT AGAINST FULHAM HOSPITAL. In my last annual report I dwelt at length on "the indictment" against the hospital, viz.—"The charge against the hospital of being the cause of the prevalence of small-pox in the surrounding parishes," and I gave numerous histories showing how the disease had been spread. I could have added largely to those histories on the present occasion, but it is needless, the Local Government Board having resolved to make an enquiry into the allegations against the hospital, and having appointed Dr. Thome Thorne with Mr. W. H. Power to conduct the enquiry. Dr. Thorne made known his appointment and duties in a letter to the medical practitioners in the Borough of Chelsea, which includes the parishes of Kensington, Chelsea, Fulham, and Hammersmith, in the following terms:— 19th January, 1881. "Under the instructions of the Local Government Board, I am engaged in an enquiry relating to the use and influence of Hospitals for Infectious Diseases ; and in connexion with this investigation I am desirous of ascertaining whether such hospitals are, and if so, by what means, instrumental in causing the spread of infection in the localities in which they are situated. At the present moment I am engaged with my colleague, Mr. W. H. Power, in procuring information on this point as regards the Metropolitan Asylum District Hospital at Fulham, where cases of small-pox are under treatment, and I shall feel much indebted to you if you will kindly give me the names and addresses of any persons whom you may have met with suffering from small-pox within a radius of one mile of the hospital since Christmas Day last, and also if you will, during the next three months, give me similar information as regards any such cases which may come under your notice quite irrespective of any presumed source of contagion." I obtained the insertion of Dr. Thome's letter in the local newspapers, and I did everything in my power, personally and through the Sanitary Staff, to assist the gentlemen to whom the enquiry had been deputed. The desirability of the enquiry cannot be questioned and the enquiry can hardly fail to be productive of valuable results, provided only there has been no concealment of cases. It is to be regretted that, through an oversight, information was not asked respecting cases of "Chicken-Pox," for we have evidence that in numerous instances a severe case of small-pox followed what was supposed to be a case of chicken-pox, but what really was a mild case of modified small-pox. In connexion with such an 31 enquiry the investigation of cases of this sort would probably be fruitful in valuable results. We await the publication of the Report, which, whatever its conclusions, cannot fail to be interesting, and to throw important light on a quœstio vexata. LEGAL PROCEEDINGS TO CLOSE FULHAM HOSPITAL. At the present time (June) legal proceedings are pending the object of which is to close Fulham Hospital against cases of smallpox. It is to be hoped that the medical case for the defence will be got up better than in the Hampstead Hospital Case. The complainants are landowners and others who feel aggrieved and allege nuisance detrimental to their interests. In this connexion the following "case," submitted by the Fulham Board of Works to eminent counsel, and their "opinion" thereon, will be read within terest, the object of the Board in stating the case being to ascertain their locus standi, with a view to proceedings by themselves, as the Nuisance Authority, to shut up the hospital as Hampstead hospital has been shut up. Case.—"The District Board wish to be advised: 1—Whether the Poor Law Board had any power under the Act of 1867, to make the whole of the Metropolis into one District, when the Act evidently contemplated the formation of separate districts for the different parts of the Metropolis. 2—Whether the Asylum Board can be prevented from continuing the present Hospital as a receptacle for patients from other parts of the Metropolis, and if so, what steps the District Board should take for that purpose. 3—Whether the Asylum Board can be prevented from increasing, in a populous neighbourhood like Fulham, its accommodation for small-pox patients, even if it cannot be prevented from receiving the present number. 4—Whether the District Board, as the Sanitary Authority or otherwise, has the power to take any (and if so what) proceedings against the Asylum Board to prevent such continuance or extension of hospital accommodation, and increased importation into the district of small-pox patients as proposed ? Opinion.—We have given this case our most careful consideration, and have arrived at the following opinion: 1—Though the Act, we think, contemplated the formation of the Metropolis into more than one District we are not prepared to say the Poor Law Board went beyond their power, in taking the course they did. Had they made two Districts they would have been clearly within the law, and the mischief complained of by the Fulham Board of Works would have remained the same, and probably any action now taken by the Fulham Board, on the theory suggested, would result in the Poor Law Board adopting this course. 2 and 3—The recent judgment of the House of Lords in the case of the Metropolitan Asylum Board v. Hill and others, has decided that the Asylum Board are in no 32 different position from private individuals in respect of their right to do anything that is a nuisance. It was also held in that case that to bring sick persons into a neighbourhood under circumstances which caused any spread of disease was a nuisance, even though the spread of disease was less than i t would have been if the patients had been left in their own houses, in the neighbourhood surrounding such houses. We are of opinion therefore, that if it can be shown that the use of the Hospital at Fulham has caused a spread of disease in the neighbourhood, either by the direct spread of disease from the Hospital, or from the transit of the patients, then there is a legal nuisance, and an injunction could be obtained by any neighbouring land-owner whose land was rendered less healthy, to restrain them from continuing so to use the Hospital; a fortiori, an injunction could, under the same circumstances, be obtained to prevent them increasing it. 4—The District Board could not, as the Sanitary Authority, bring an action against the Asylum Board, but they might, should the increase of small-pox patients in the Hospital, or the spread of the disease from the present number amount to a nuisance, proceed by indictment against the Managers of the Metropolitan Asylum Board ; we think, however, there would be some prejudice against criminal proceedings in such a case, and in our view, the neighburing owners, rather than the District Board, are the persons who can most safely move in the matters (Signed) Farrer Herschell, Hy. M. Bompas, R. J, Biron. Temple, March 12th, 1881. It is somewhat remarkable that the Fulham Board, entertaining views hostile to the continuance of the hospital, should have asked the Asylum Board to grant them the loan of a portion of the site for the purpose of erecting thereon an additional hospital for the special use of the parishes of Fulham and Hammersmith. DISTRICT HOSPITAL ACCOMMODATION. Proceedings of the Fulham Board of Works.—The Fulham Board have been very energetic in their efforts to provide local accommodation for their sick. At the time when the hospitals were full, the Board set up a tent hospital one night, on a "public street" called Imperial Road, abutting on the Thames, near the railway bridge between Chelsea and Battersea stations on the West London Extension Railway. Proceedings were instantly taken against the Board by the Gas Light and Coke Company, in deference to the panic of their employes. The hospital 33 was so distant from human habitations, that the opposition to it on the ground of nuisance failed utterly; a site more free from objection on the score of danger to the public, could hardly have been conceived. The Board, however, had been guilty of a trespass, and on this technical ground they had no answer to the application made by the Company to the Master of the Rolls, and they had to submit to an order to remove the hospital so soon as the then inmates should have recovered, and to agree not to place any fresh patients in the hospital. The Board then proceeded to acquire a site at Little Wormliolt Scrubbs, near the Latymer Road Station on the Hammersmith and City Railway. But here again they were opposed by the residents in the locality, although the nearest house was some hundreds of yards distant. Trespass could not be alleged in this instance, and the opposition on the ground of probable "nuisance" collapsed. The Board, however, agreed not to provide accommodation for more than fifty patients, without giving notice to the complainants. The necessity for erecting the tents has not arisen at the present time. The Board, I understand, obtained permission to make some provision for cases of small-pox, in the ample grounds of the Guardians at the Fulharn Union Workhouse. Action of the Kensington Board of Guardians.—In our own parish the Guardians of the Poor were desirous of making provision for cases that could not be received for want of room at Fulham, or other hospitals of the Managers. The Local Government Board had intimated to the Guardians ths necessity of making such provision, and had enquired of them, as of every other Board of Guardians, and of every Vestry and District Board of Works, (the Nuisance Authorities), what steps they proposed to take in the emergency? at the same time urging them to do something; and pointedly, in the case of the Nuisance Authorities, calling their attention to their duty to make such provision, under the 37th section of the Sanitary Act, 1866. The Guardians at once arranged, with the approval of the Local Government Board, to make provision for opening their hospital at Mary Place, in the Potteries, Notting Dale, at a time moreover when there were several cases kept at home in that neighbourhood, owing to the block at Fulham and other hospitals. No sooner did this become 34 known, than persons interested in the locality, applied for and obtained an injunction to restrain the Guardians from using the hospital for the reception of small-pox cases, although the buildings at Mary Place might be deemed to be, and have been used as, a supplementary " workhouse." Action of St. Pancras Vestry.—At about the same time the St. Pancras Vestry desired to provide a temporary tent hospital some miles distant from their parish, on land adjoining the parochial cemetery at Finchley, and they did so, though not without threats of legal proceedings to restrain their intended action by injunction. This Vestry took the somewhat remarkable step of officially congratulating the plaintiffs in the cause celebre, "Hill others v. the Managers," on their success in obtaining the injunction against the Hampstead Hospital, and they invited other Vestries, etc., to join -with them in opposing, so far as they could, the further prosecution of the appeal (No. 1) by the Managers to the House of Lords, for a new trial of the "Hampstead Hospital Case"— action on their part intelligible, seeing that the hospital is, comparatively speaking, in their near neighbourhood, and that they are enabled to obtain beds for then sick by sending them across London, through Kensington, to Fulham Hospital. Eighty patients have been admitted to the hospital from St. Pancras, between January 1st and June 30th, 1881.* Proceedings of Islington Vestry.—A proposal was made to open the Holloway Workhouse, belonging to the City of London Guardians, for the reception of small-pox cases, at the time when the hospitals of the Managers were full. The proposal was strongly opposed by the Islington Vestry, who waited on the Managers to enforce their objections. They had to confess, however, that although they had many cases of small-pox in their district, they had made no provision for the treatment of them,* and that they had sent many patients to the hospitals of the Managers out * Since the Report has been in type the St. Pancras and Islington Vestries have provided Tent Hospitals at Finchley, the former for 5° patients, at a cost of about £2,500, and the latter for 123 patients, at a cost of some £4,000. But not many patients have hitherto (July) been admitted into these hospitals. of the parish, viz., across London to Fulham. The number of Islington cases received into Fulham during the first half of 1881, was 250.* I have thought it right to refer to these matters to shew the difficulties that surround the attempts to provide hospital accommodation for small-pox, (for no such difficulty exists in respect of other infectious diseases), and to shew that the difficulty is about equally great, whether the attempt to provide accommodation be made by the Managers or by the Nuisance Authorities. The difficulty arises mainly on the ground that neither authority has a statutory right to create a "nuisance" by setting up a hospital so as to depreciate the property of adjoining owners. And if the Managers, with their apparently large powers under the Metropolitan Poor Act, 1867, and with practically unlimited funds at their disposal, having the command of the Metropolitan purse through the "common poor fund," have been unable to do what is necessary for the public safety, what prospect is there of a Vestry succeeding? As I stated in my fifth Report for 1881, (May 25, page 46), ''special legislation is imperatively called for to enable the Asylum Board to carry on their important duties, subject to proper precautions so as to avoid danger to health and injury to property, without unreasonable interference on the part of individuals." The need for such legislation is now universally felt, and the subject is receiving the careful attention of the Managers, and of the Local Government Board. In my third Report for 1881, (March 30, page 24), I asked the question— Abe Local Hospitals desirable ?—the question whether it is desirable that each Nuisance Authority should provide a hospital for the sick of its own district, under the provisions of the 37th section of the Sanitary Act, 1866 ? This question has been carefully considered on more than one occasion by committees of your Vestry, and decided in the negative. With this decision I have fully concurred, and I see no reason to alter my opinion. It is my * In the two weeks ended June nth, Islington sent 61 patients to Fulham Hospital, by far the largest number contributed by any one parish, and only 13 less than the cases from the four parishes forming the Borough of Chelsea. 30 duty, however, to state that a different view appears to have been taken by the Paddington Vestry, and by the Willesden Sanitary Authority, these bodies having proposed to your Vestry to join with them in providing a hospital for, say, 50 small-pox cases. I could not advise concurrence in this scheme, which would involve great outlay without corresponding advantages. The Poplar District Board of Works provided a hospital at West Ham, at a cost of £18,000, but did not even proceed so far as to furnish it, and they are now anxious to get the Asylum Board to take it off their hands. I believe your Vestry came to a sound decision in recommending that the Asylum Board should be empowered and encouraged to make provision of hospital accommodation for all cases of infectious disease occurring within the Metropolis, and requiring to be removed from home for the purpose of isolation.* THE HAMPSTEAD HOSPITAL CASE. As amatter of interest to your Vestry as a "Nuisance Authority," responsible for carrying out the Sanitary Acts, the recent decision of the House of Lords in this celebrated cause is deserving of notice. There were two appeals, and that which has now been decided was the Appeal (No. 2) by the Managers of the Asylum Board for a reversal of the injunction restraining them from using the hospital in such a manner as to create a nuisance to the plaintiffs in the original cause, or either of them. The plaintiffs did not receive the injunction originally prayed for restraining the Managers from using the building as a hospital for small-pox, &c.; the practical effect of the injunction, however, as it stands, and confirmed as it now is by the highest Court of Appeal, will probably be to close the hospital permanently against the reception of the sick for whom it was provided. An incidental result of the decision, moreover, will be the encouragement of aggrieved persons to persevere in attempts to close other hospitals; and of this we have an example in our midst, for since the decision, representatives of an Association *Report of Special Purposes Committee (20th March, 1877), on a reference of a circular letter from the Asylum Board on the subject of hospital accommodation. The Law and Parliamentary Committee had previously come to a similar conclusion on a similar reference. The subject is dealt with at length in my Annual Report for 1876-77, published in October, 1,877. 37 originally formed with the view of restricting Fulham Hospital for the use of the Borough of Chelsea, have commenced proceedings with a view to closing the hospital altogether. The first decision of the House of Lords having been adverse to the Managers the question arose whether they should proceed with the other Appeal (No. 1), which is for a new trial of the cause without the condition attached by the Court of Appeal below, in granting a new trial, viz., that the Managers should pay a certain portion of the plaintiffs' costs? The General Purposes Committee of the Board have reported, advising "that the Solicitors be directed to proceed" with this Appeal; the Managers have, by the casting vote of their Chairman, decided on taking this step, and the President of the Local Government Board has signified his approval of their decision, not improbably because it relieves the Board from the responsibility of taking action in the matter, e.g., by promoting fresh legislation. It has been stated that the prosecution of the Appeal (No. 1) will not involve a large expenditure; the Court of Queen's Bench, moreover, has expressed an opinion that there ought to be a new trial; the Court of Appeal is also in favour of a new trial, but on condition of the Managers paying certain costs to which they object, and against which (as a condition of a new trial) they have appealed. The Managers are certainly placed in a delicate position by the decision of the House of Lords, for, as the Chairman of the Committtee is reported to have said,'' the finding of the jury is a standing verdict against them, giving encouragement to everybody to attack them," whereas "if this verdict were set aside by an order for a new trial, their position would assume a totally different character." The Times, referring to the decision of the House of Lords, remarks that "the public are chiefly concerned to know whether, as a matter of scientific fact, a hospital for small-pox, however well conducted, is necessarily a source of infection in its neighbourhood, and therefore a nuisance, not at common law, but in the special sense defined by the Sanitary Acts as being something injurious to health? . . . Throughout the various appeals and counter-appeals in connexion with the Hampstead Hospital, this essential question has been kept in the background; " the evidence given " by certain medical men that in their opinion the hospital was a source of D D 38 danger to the dwellers in the vicinity . . . was of a somewhat conjectural kind, based rather upon surmise than upon well-ascertained facts, and nothing was brought to rebut it on the part of the defence in consequence of an agreement having been arrived at between the Counsel on both sides that they would not address themselves to this element of the case." It is alleged that the Asylum Board "strong in the exercise of what they believed to be their legal rights, had not been sufficiently careful of the rights of others, and that they had, as a matter of fact, created what was clearly a nuisance at common law and in the ordinary acceptation of the term." The final decision of the House of Lords is that "in so doing they were acting in excess of their powers"; the trial therefore raised what is described as an "accidental question." Should there be a new trial, the essential question whether a small-pox hospital is a nuisance per se ? is likely to receive consideration, and it is desirable that this question should be settled. PREVENTION OF 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 illness—information that would be of the greatest value, particularly at the commencement of an epidemic when the first cases are often mild, and, therefore, not fatal. It has been my constant endeavour to increase our sources of such information, and it may not be out of place here to state what progress has been made:— 1. By virtue of an arrangement entered into between your Vestry and the sub-district registrars, I receive notice of every death from the graver infectious diseases (small-pox, scarlet fever, diphtheria, typhus, enteric and simple continued fevers), within a few hours after registration. It may be observed that when a death has occurred from an infectious disease there is always a probability of finding cases of illness in the same house or in the locality, and such discovery not unfrequently results from the Sanitary Inspector's visit. 39 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 disease that come within their cognizance, and generally these are cases that have been, or are about to be, removed to the hospitals of the Metropolitan Asylum District, 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 request of the Committee of Management. 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 treated at home by medical men attached to so-called "provident dispensaries." 4. Medical men favour me occasionally with information of cases, especially when they desire assistance in order to get the patients (e.g., domestic servants) removed to hospitals; or when they want the assistance of the disinfecting staff. 5. In my annual report for 1877,I referred to what I thought to be an important step that had then lately been effected through the action of the London School Board, which, at my request, had instructed the Superintendents of Divisions throughout the Metropolis to desire the "Visitors" to report to the several Medical Officers of Health all cases of infectious disease that should come to their knowledge in the discharge of their official duties which take them frequently into the homes of the poorer classes. To facilitate the transmission of this information by the Visitors, your Vestry authorized me to prepare a form for their use. This was done; but I must say, that hitherto, the resolution of the Board has not been attended with the hoped for results. The Board, moreover, at one time, showed a disposition to 40 recede from the position they had taken up, for on my calling their attention to the omission on the part of the Visitors to report cases, the "divisional members," to whom my communication had been referred, simply agreed that the Visitors should report cases when they had reason to suppose that no duly qualified medical man was in attendance. "When a duly qualified medical man has charge of a case, they are not prepared to do more than take steps for seeing that proper precautions are taken at the Schools." This decision, if final and acted upon, would be regretable, as I am sure the Visitors could render us essential assistance by giving effect to the original instructions of the Board. Two out of seven Visitors officiating in Kensington have supplied information of a not inconsiderable number of cases during the past year. 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 report 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 concealed 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 regretable state of affairs is legislation to ensure the compulsory disclosure of the occurrence of infectious diseases, a subject which is fully dealt with further on. 41 Increased Facilities for Removal to Hospital of Infectious Sick.—Having had occasion to meet the House Committee of the Board of Guardians in November, I took advantage of the opportunity to invite a continuance of the valuable assistance the Guardians had so long rendered to your Vestry, and my Department, in getting sufferers from infectious disease, and willing to go to hospital, removed by their staff of Officers; and I pointed out the desirability of having all such cases removed, at any cost, and on strictly economical grounds, viz.: as a mode of preventing the spread of infectious diseases, and therefore of saving the rates which it is one of the functions of the Guardians to administer. I submitted, that, if the Guardians would instruct their officers not to apply for payment for the maintenance of persons in the hospitals, especially as many parents, at the instance of the Inspectors, consented to the removal of their children simply for the sake of isolation, and therefore with the object of preventing the spread of disease, the efforts of my Department in this direction would be greatly facilitated. It had come to my knowledge that in some cases the expectation of having to pay for maintenance of children in hospital had acted as a deterrent when parents were otherwise willing to let patients be removed—although these were so little "ill," as not on account of their own state of health to require hospital treatment, however necessary their isolation might be on sanitary grounds. The Guardians at once complied with the request I had ventured to make, and caused an instructional letter to be addressed by their clerk to the several Relieving Officers in the following terms:— "The Guardians having recently had urged upon them by the "Medical Officer of Health the importance of facilitating "in every way possible, the immediate removal to hos"pitals of cases of infectious disease, have directed me "to instruct the Relieving Officers to abstain generally "from taking any steps for obtaining paymen incases "sent to the Metropolitan District Fever and Small pox " Hospitals." 42 INTERRUPTION OF EDUCATION RESULTING FROM INFECTIOUS DISEASE. In my 12th Report for 1880 (November 10th, page 72) I wrote as follows:— "The evil resulting from infectious disease by interference with education is deserving of attention at the hands of the School Board lor London. It has been publicly asserted that children are allowed to go to school from houses where scarlet fever is known to exist: but this is not my experience, and we have co-operated earnestly with the officers of the Board to arrest the spread of disease by preventing children going to school from infected houses. Thus it has happened that owing to the refusal of parents to send their children to hospital, and the occurrence of case after case in a house—at intervals of weeks, it may be—the house has remained infected for a very long time, the education of whole families of children being interrupted even for months. And yet all the while convalescing children may have been running about the streets spreading infection. It is, moreover, too much the habit even with some professional men to regard "mild" cases too lightly, as if such cases were as little dangerous to others as they are to the sufferers themselves. It is not long since that a certificate was given that children might go to school from a certain house, there "being no infection," owing to the mildness of an illness; but the next we heard from that house was of the death of a child who had contracted the disease from the aforementioned "mild" case. This "mild" case commenced on 26th September, and the authority to attend school was given 18th October. The second child died on the 22nd October, after eight days illness, and therefore had been attacked on the 14th October, or four days prior to the date of the certificate of freedom from infection." It is satisfactory to know that this question has lately received considerable attention at the hands of the School Board for London, by which it was in the spring of the present year referred to two of the members, viz., Dr. B. W. Richardson, F.R.S., and Professor Gladstone, F.R.S., who conferred with the Society of Medical Officers of Health thereon. These gentlemen thought the Society would 43 have been able to lay down some rales for the guidance of teachers, to enable them to recognize infectious diseases, and they asked for an expression of opinion as to the length of time children suffering from this or that infectious disease should be kept away from school? The Council, to which the matter was referred, carefully considered a set of questions that had been drawn up embracing the topics discussed between the Deputation and the Society, and ultimately presented a Report, which having been adopted by the Society may be fitly reproduced here, the subject being one of undeniable importance in a sanitary point of view. "The Council beg to report that they have considered the question referred to them of the best means to be adopted to prevent the spread of infectious diseases by children attending School Board Schools, and have also had the advantage of discussing this subject with B. W. Richardson, Esq., M.D. F.R.S. and Professor Gladstone F.R.S., members of the School Board. The points mainly to be considered are : a. The course to be adopted for preventing children suffering from infectious disease attending school during any period of their illness, from the moment they are first attacked until the time when they are free from infection. b. The necessity of preventing children attending school, who are not themselves suffering from illness, but who come from houses where they are more or less closely associated with infectious persons, and who therefore are themselves possible carriers of infection. With regard to the first point the Council think that it is impossible to convey to a person not possessing medical knowledge, the information that would be necessary to enable the teachers in schools to recognise the symptoms of infectious diseases in their early stages. But they are of opinion, that if a child be ill from any cause it is desirable for his own sake, as well as often for the sake of other children, that his attendance at the school, should at once be discontinued by direction of the teacher. Moreover, if a child be away from school for more than a few days on account of illness, it is desirable that the cause of his absence should be investigated by a medical practitioner, and that the teacher should in such a case require the production of a medical certificate, stating the cause of the child's absence, and his fitness to return, before he is allowed again to present himself at the school. Again, if a child is known to have been absent from school through an attack of an infectious disease, it is especially necessary that medical testimony should be produced that the child and his clothes, as well as the house from which he comes, are free from infection before he is allowed to return. 44 No definite time can be stated during which such a child should be absent from school, seeing that the periods of infectiousness not only vary in the different acute diseases, but that each disease has itself a very variable duration of infectiousness: a medical examination therefore, can alone form the basis on which an opinion can be founded as to the time when a child who has recently suffered from infectious disease, is free from infection. The Council are of opinion that all cases of infectious disease should be immediately reported to the Medical Officer of Health, but they desire to point out that the duty of investigating suspicious cases, and it should be remembered that these constitute the majority of those in which a School Board teacher would be interested, can only be properly performed by a medical practitioner. With regard to the second point, that of the necessity of preventing children attending school, who are not themselves suffering from illness, but who come from homes where they are more or less closely associated with infectious persons, the Council think that no child living in a house with an infectious person ought to be permitted to attend school unless such child be living in rooms having a staircase different from that leading to the rooms of the infected person, and that in all other ways have no relation with the latter." The report was adopted by the Society, with the addition of the following paragraph:— "The Society wish to point out that if a law for the compulsory notification of infectious diseases were passed, the difficulties to which Dr. Richardson and Professor Gladstone have called attention, would be greatly diminished. The Society would therefore invite Dr. Richardson and Professor Gladstone to bring this subject under the notice of the School Board, with a view to requesting that Board to co-operate with the Society, and Sanitary authorities generally, in seeking for legal powers to compel the notification of cases of infectious diseases." COMPULSORY NOTIFICATION OF INFECTIOUS DISEASES. I have on several occasions in my annual reports, referred to the necessity of a registration of infectious diseases ; and in my last annual report I specially noticed the fact that the city of Edinburgh had obtained legislative powers for the compulsory disclosure of cases of infectious disease.* As the Edinburgh Act makes it "The Edinburgh Municipal and Police Act, 1879," Sec. 208. 45 obligatory on medical practitioners to disclose cases coming under their cognizance, there was a doubt how it would work, and some friction, it was feared, would occur in the relations of the Medical Officer of Health with his professional brethren. From a statement published by Dr. Littlejohn, the Medical Officer, it appears that these fears have not been justified by the event, but that, according to the general testimony, the scheme has worked well, and to the public advantage. "Our experiment," he says, "has been a great success. No complaints have reached us from the medical profession, who have loyally assisted the authorities in carrying out what was feared to be an unworkable and objectionable clause. The information as to the existence of infectious disease has been prompt and effectual, which, I am convinced, would not have been the case had we trusted in great part to a poor ignorant population to supply it To the Health Department the intimations have proved of great service. enabling us to arrive at the true cause of outbreaks of infectious diseases, and thus prevent their spread." Encouraged by the successful results of legislation, not only at Edinburgh, but more particularly in certain English towns and boroughs, to wit—Huddersfield, Bolton,† Burton-on-Trent, Nottingham, Jarrow, Llandudno, Warrington, Blackburn, Norwich, Rotherham, Blackpool, Leicester, Derby, Lancaster, Oldham and Preston, the Corporation of Dublin took up the question which had been brought under their notice by the Lord Mayor, who had received a deputation representing the Irish Branch of the British Medical Association and the medical profession generally in Dublin, to lay before him, as Chairman of the Public Health Committee, the necessity of introducing a Bill in Parliament with the view of making it compulsory to notify to the Sanitary Authority in Dublin the presence of infectious disease in any house; and at a meeting † The Medical Officer of Health of Bolton, in his Report for 1880, states that the compulsory notification of infectious diseases in that borough during fifteen months, has given every satisfaction, and proved of immense value in limiting the spread of contagion. The cases reported amounted to 1,646, including 18 of small-pox, 702 of scarlet fever, 5 of diphtheria, 102 of typhoid fever, 17 of typhus, etc. But Bolton has no infectious disease hospital ! 46 held at the latter end of 1880, the Corporation adopted the following resolution, viz.:— "That the Council strongly approve of the principle of the notification to "the sanitary authority of the existence of dangerous infectious disease, "and consider such notification most necessary in this city. That the "Lord Mayor, and such members as think fit to accompany him, do "seek an interview with the Chief Secretary, to request him to introduce "a permissive Bill for the purpose, applicable to all Ireland, or to give "the support of the Government to such a Bill, if introduced by the "Lord Mayor and other members. That it be referred to a committee "of the whole House to prepare suggestions to lay before the Chief "Secretary as to the mode of carrying out the proposal, with power to "consult with the gentlemen of the medical profession who waited on "the Lord Mayor, with a view to joint action, and, if considered desi"rable, a joint deputation." In the result a Bill was introduced into the House of Commons during the current session, but whether it can be carried through, in the present state of public business, is doubtful. Several English towns and boroughs have Local Bills for the same purposes, now under the consideration of the legislature. The Vestry's action in the matter.—Having called attention to the above important question in my 12th and 13th reports for 1880, (Nov. 10th and Dec. 8th, page 73 and page 82,) your Vestry resolved to take it into special consideration at the meeting to be held on Dec. 22nd: I thereupon lost no time in placing myself in communication with the Medical Officers of Health of the seventeen English towns and boroughs which had already obtained local Acts (inter alia) for the compulsory notification of infectious diseases, and I submitted a summary of the information thus obtained, in a Special Report dated Dec. 22nd, (No. 14, page 85). At the same time I drew attention to a defect in the 26th section of the Sanitary Act, 1866, which provides for the removal to hospital, by justice's order, of infectious sick persons who are "without proper lodging or accommodation," a defect which has often defeated the object of the section, and baffled the efforts of medical officers to get suitable cases removed to hospital, on the ground that the lodging, etc., was sufficient for the accommodation, although notoriously inadequate for the isolation, of the sick. It 47 had been decided that "the fitness of the lodging or accommodation should be considered in relation to the wants of the sufferer, rather than with any reference to the safety of the remaining inmates of the house," and thus we were "often prevented removing cases eminently in need of isolation." And I showed how this defect had been remedied in the Warrington Local Act, 1878, which requires that the sick person, if he is to be treated at home, must have "lodging or accommodation" such as to enable him" to be properly isolated, so as to prevent the spread of disease, or to be properly treated:" failing which conditions the Corporation may give notice to the head of the family requiring the sick person to be removed forthwith to the hospital, and in case of refusal on his part, may appeal to the justice for an "order" in conformity with the provisions of the 26th section of the Sanitary Act, 1866, as amended in the terms of the local Act. I suggested as a practical way of giving effect to my views— (1) That powers should be sought to ensure the disclosure of the graver diseases only of the zymotic class, viz., cholera, small pox, scarlet fever, diphtheria, typhus and typhoid fevers. (2) That the registered medical practitioner should be required "forthwith," i.e., as soon as he becomes aware that his patient is suffering from any one of the scheduled diseases, to fill up and sign a certificate setting out the facts, and to be given to the occupier of the house. (3) That the duty of reporting the illness, and of transmitting the doctor's certificate to the Nuisance Authority "without delay," should be imposed on the occupier of the house. (4) That an amendment of the 26th Section of the Sanitary Act, 1866, in the terms or to the effect of the Warrington Act, should be applied for, so as to ensure that every case of infectious disease which cannot be "isolated" and treated at home without danger of the spread of the disease to other inmates in the same building, should be removed to a hospital. The time is ripe for these concessions, for it is well known that the Local Government Board are favourable to the principles they 48 involve, having encouraged the passing of the Acts referred to, and which would never have become law without their concurrence. The only question, therefore, that remained was, How should we set to work to accomplish the object in view? I submitted that the first step should be to endeavour to unite the "Nuisance Authorities" (Vestries and District Boards of Works) in support of a scheme by inviting them to send delegates to a "Conference" to be held at a convenient season, and at a central place, to consider the whole subject, including the question of depauperising the relief given to the sick in the infectious disease hospitals. I suggested that a brief statement of the case and of the grounds of action should be prepared, and that when the Nuisance Authorities were invited to send delegates to the conference a sufficient number of copies of such statement should be supplied, so that one might be sent to every Vestryman and every Member of a District Board. Thus each authority would be in a position, and delegates would come prepared, to consider the subject on its merits. Lastly, assuming a successful issue to the conference, I proposed that the delegates should apply to the President of the Local Government Board to receive a deputation to submit whatever resolutions they should have come to; and that other public bodies known to sympathise with the views herein expressed, should be asked to join with the delegates in a combined deputation—such bodies, among others, as the Society of Medical Officers of Health, the British Medical Association, &c., &c. After debate on the day in question, December 22nd, 1880, continued at the following meeting, January 19th, 1881, the following resolutions were unanimously agreed to, on the proposition of C. H. Campbell, Esq., J.P., viz.:— 1. That this Vestry approve the principle of compulsory intimation to the Public Health Authority of all cases of such diseases as Small-pox, Scarlet Fever, Diphtheria, Typhus, Typhoid Fever, and Cholera. 2. That this Vestry do invite the other Vestries and District Boards of the Metropolis to unite with them in an effort to obtain the necessary legislation on the subject, and with that view, to depute delegates to represent them at a Conference to be held at an early date, at this Town Hall, or some other convenient place. 3. That the Medical Officer of Health be requested to draw up, in the name of this Vestry, a concise Memorandum on the whole subject, and 49 that a sufficient number of copies of such memorandum be printed to supply a copy to each Vestryman or Member of a Board of Works throughout the Metropolis. In accordance with the foregoing resolution I prepared the subjoined Memorandum, which was approved by your Vestry, and a sufficient number of copies were printed and forwarded to the several Vestries and District Boards, together with a letter inviting them to appoint Delegates. MEMORANDUM on COMPULSORY NOTIFICATION OF INFECTIOUS DISEASES; A necessary Amendment of Section 26, Sanitary Act, 1866; and Hospital Treatment of Infectious Diseases, &c. The attention of the Vestry has been directed to the difficulty of checking or preventing the spread of epidemic infectious diseases, such as small-pox, scarletfever, &c., &c. This difficulty arises mainly from the concealment of the sick which is so commonly practised, it not being obligatory on Medical men, or the occupiers of houses, rooms, &c., or on the sick themselves, to report the occurrence of illness to the "Nuisance Authority:" the result being that an epidemic of a dangerous infectious disease like small-pox may begin and continue for days or even weeks—until, in fact, a death has taken place and the cause of death has been registered—without its existence becoming known to the Authority whose duty it is to take measures for the public safety. It is somewhat strange that the law should take more thought for the beast that perisheth than for man; for the concealment of sickness that is practised with impunity when human health and life are interested, is not tolerated when the health of animals, representing property, is concerned. The cattle owner is required under heavy penalties, strictly enforced, to report without delay any outbreak of infectious illness among his stock to the Local Authority under the Contagious Diseases (Animals) Act, 1878. During the continuance of such illness, moreover, the premises on which it occurs are declared to be an "infected place," and are under the control of the Local Authority, which has power to prevent the removal of infected animals, and generally to take whatever steps may be necessary for preventing the spread of disease. Is it too much to ask that the law should extend to the protection of human life some of the care which it takes in respect of animals for the preservation of property ? The effort to secure this protection, so far as it can be secured by the compulsory disclosure of the occurrence of cases of certain infectious diseases, has been successfully made under Local Acts of Parliament, by the Health Authorities of the following English Towns and Boroughs, viz., Huddersfield, Bolton, Burton 50 on-Trent, Nottingham, Jarrow, Llandudno, Warrington, Blackburn, Norwich, Rotherham, Blackpool, Leicester, Derby, Lancaster, Oldham, and Preston. The city of Edinburgh obtained similar powers in 1879; and not to speak of Towns, &c. in England, the Authorities of which are now applying to Parliament for Local Acts, Mr. E. Gray, the Member for County Carlow, has, at the instance of the Irish branch of the British Medical Association, given notice of a Bill, which it is hoped will shortly secure for the whole of Ireland the advantages now enjoyed by the above-mentioned places. The British Medical Association, comprising thousands of medical practitioners, is favourable to legislation, and the assistance given by Government in the passing of the Local Acts furnishes conclusive evidence of the favour with which the principle they involve is regarded by the Central Sanitary Authority. The Vestry desire to initiate a movement for obtaining through that Authority similar powers for the Nuisance Authorities of the Metropolis, powers which they believe to be absolutely necessary for the proper discharge of their duty, and for the protection of their constituents. Without entering into details it may be stated that the "Local Acts" referred to require some person, usually the medical man in attendance, or the occupier or other person where no medical man has been called in, to report to the Nuisance Authority the occurrence of infectious illness in any inmate of a building used for human habitation—the medical certificate or declaration (for which a small fee is payable) setting out the name and address of the sick person, the nature of his illness, and the name of the occupier of the house or room, &c. The system has worked well, and has not been attended with greater difficulties than might have been expected from its novelty. The testimony obtained by the Vestry goes to show that it has had the effect of diminishing the amount of infectious disease, especially in those Towns where hospitals for the sick have been provided—for however useful the mere disclosure of illness may be, as enabling the Health Authority to take measures for preventing the spread of disease, the system is robbed of half its value by failure to provide hospitals for those sick persons who cannot be properly isolated at home. It often happens, however, that persons who cannot be isolated at home refuse to go to hospital, the Vestry, therefore, while inviting the Vestries and District Boards of the Metropolis to combine for the purpose of securing, by legislation, the compulsory disclosure of all cases of certain dangerous infectious diseases, propose also to submit to the Conference the desirability of such further legislation as may be required for the compulsory removal of the sick to a hospital, when necessary. This may be effected by an amendment of section 26 of "The Sanitary Act, 1866," empowering any Justice, by order, on a certificate signed by a legally qualified medical practitioner, to direct the lemoval to a hospital, at the cost of the Nuisance Authority, of any person suffering from any dangerous infectious disorder, and being without proper lodging or accommodation enabling him to be properly isolated so as to prevent the spread of disease, or to be properly treated.. To give effect to the 26th section, a hospital for the reception of the sick must be provided within the district of the Nuisance Authority (in other words, within the district of the Metropolis,) and this the Nuisance Authorities, separately or in combination, have power to provide under section 37. Practically, however, the hospitals of the Metropolitan Asylum District are available, and the Nuisance Authorities may (under section 15 of the Poor Law Amendment Act, 1879) 51 contract with the Managers for the reception of "non-paupers," and they may recover the cost incurred by them in the maintenance and treatment of the persons in hospital; but the Vestry, being strongly of the opinion that isolation of the sick, as the means necessary for checking the spread of disease, should be paramount to all other considerations, propose to invite the Conference to consider—Whether the time has not arrived for giving effect to the view they have long entertained that the cost of maintaining infectious sick persons in hospital— persons, that is, isolated for the public good—should be defrayed out of a common fund levied on the Metropolis, as the fire brigade expenses are defrayed ? and Whether the assistance thus rendered to the sick in hospital should not, like public vaccination, be exempted by special enactment from the disabilities consequent on the receipt of parochial relief, even in the case of patients removed to hospital by the Poor Law Authority? In provincial towns which possess local acts and infectious disease hospitals, the authorities have power to require payment for maintenance and treatment of the sick, but the Vestry learn on good authority that the tendency grows stronger day by day, not to enforce such payment, but rather to consider the public safety, secured by the isolation of the sick, an adequate return for the outlay incurred. It would often be unreasonable to enforce payment for maintenance in hospital. It is notorious, for instance, that in many cases of what formerly was the most loathsome and most virulent of infectious diseases, small-pox, the complaint is so wonderfully modified by vaccination and re-vaccination, that the "sufferers," though most dangerous to all unprotected persons with whom they may come in contact, can scarcely be described as "sick," and are under no necessity of submitting to confinement, excepting from a sense of duty, and, as the law requires, for the public safety. This being so, the Vestry hope that the Conference will adopt the view of this subject which the Vestry submitted to the Conference on "Hospital accommodation for non-paupers," held at the Cannon Street Hotel in 1878, viz., that "no compulsory payment should be exacted from persons who are removed to hospital for the sake of isolation." Practically this view is now acted on to a large extent, for the Managers of the Asylum Board freely admit all comers sent by the Guardians of the Poor—and in some parishes (Kensington is one of them) nearly every patient is removed through the agency of the Guardians, no claim being made for repayment of expenses, the Guardians being animated by a view of the supreme importance of isolating the sick at any cost. The Vestry have reason to believe that the same spirit animates the Nuisance and Poor Law Authorities of the Metropolis generally, repayment of expenses being rarely, if ever exacted; and they desire to see the sanction of law accorded to what has now grown into a well-established practice. The Memorandum concluded by stating that should the foregoing views meet with the approval of the Conference the Vestry believed that the desired results might be obtained by the adoption of certain resolutions, which were ultimately agreed to, and will be found below in the report of the proceedings of the conference. 52 The invitation forwarded to the Nuisance Authorities was very satisfactorily responded to, and on the 23rd of March the first and the only meeting of THE CONFERENCE was held at the Town Hall, under the presidency of Maior-General Boileau, R.E., F.R.S. The meeting was largely attended, delegates from some 24 (out of 37) Vestries and District Boards being present, together with 23 Medical Officers of Health, including six from districts not otherwise represented. The proceedings were brief and characterized by a singular unanimity attributable, probably, to the step taken by your Vestry in forwarding the "Memorandum" and the draft resolutions, to every member of a Vestry or of a District Board of Works throughout the Metropolis, the result being that the delegates came to the Conference thoroughly informed on the subjects for discussion, and their judgment approving the action taken, and the advice tendered by your Vestry, all the resolutions were passed without a single dissentient in the following terms:— "That this conference of Vestries and District Boards of Works is of the opinion— 1. That in the interests of public health, and to enable Nuisance Authorities to discharge the duty of checking and preventing the spread of infectious diseases, such as small-pox, scarlet fever, &c., provision should be made by legislative enactment to secure the compulsory disclosure to the said Authorities of all cases of such diseases immediately after their occurrence. 2. That the provisions of the 26th Section of the Sanitary Act, 1866 (Section 124, Public Health Act, 1875), are insufficient for the protection of the public health, and should be so amended as to empower any justice to direct the removal to a hospital, within the district of a Nuisance Authority, of any person suffering from any dangerous infectious disorder, and being without proper lodging or accommodation which would enable him to be properly isolated so as to prevent the spread of disease to other inmates of the same house, or to be properly treated. 3. That the admission into hospitals for the purpose of isolation of persons suffering from infectious diseases, and being without proper lodging or accommodation, is eminently desirable in the interests of the public and should be encouraged; that payment for the assistance given in hospitals to such persons removed thereto for isolation by the Nuisance or Poor-Law Authority should not be enforced; that the giving of such 53 assistance should not entail on the recipients the loss of any social or political status; and that the cost of hospital treatment of such infective sick persons should be made a charge on the Metropolitan Common Poor Fund. 4. That the President of the Local Government Board be asked to receive a Deputation to present the foregoing resolutions, and make request that he would be pleased to bring under the notice of the Government the desirability of taking measures for giving effect to them by legislation. 5. That copies of the foregoing resolutions be forwarded to the several Vestries and District Boards of Works; the Commissioners of Sewers for the City of London; the Council of the British Medical Association; the Council of the Society of Medical Officers of Health; the Council of the Social Science Association; the Managers of the Metropolitan Asylum District; and the Boards of Guardians in the Metropolis; that each of the several Vestries and District Boards of Works, should they approve the resolutions, be requested to appoint two gentlemen to take part in the deputation to the President of the Local Government Board, and that the other bodies above referred to, be invited to co-operate with the deputation in order to secure the objects embraced in the resolution." With reference to the subject of the third resolution, objection had been made in some quarters to the acceptance of the principle of free hospital treatment which your Vestry had adopted, on the ground that many persons sent to the hospitals of the Managers of the Asylum District contributed sums considerable in the aggregate towards their maintenance, &c. To settle this question, I made enquiry of the Clerks of the Boards of Guardians, some 30 in number, "What number of persons had been removed to the hospitals from the 25th March, 1880, to date? What number of such persons had contributed to their maintenance in hospital ? and What was the gross amount of such contributions?" I received replies from 20 unions and parishes, showing that 3,100 cases had been removed within the period specified, and that the sums contributed by 79 patients amounted to only £58 10s. 1d., thus entirely confirming the view I had expressed, that "repayment of expenses is rarely, if ever, exacted," and, as I think, justifying the desire of the Conference in passing the resolution to see the sanction of law accorded to what has now grown into a well-established, and, as I believe, judicious practice. Comparatively few cases are removed by the Nuisance Authorities, who, moreover, have no power to recover the costs incurred in the maintenance, etc., of the sick, except in special circumstances under the provisions of Sec. 15 of the Poor Law Amendment Act, 1879,—this section, however, being practically a dead letter. e e 54 Action of the Society of Medical Officers of Health.— It may not be out of place to mention here that I brought the subject of the foregoing resolutions under the notice of the Society of Medical Officers of health on the 18th March, and that the Society, by an unanimous vote, resolved as follows:— i. "The Society adheres to the views it has previously expressed with respect to notification of infectious diseases to Sanitary Authorities, and re-affirms the resolutions passed in December, 1876, viz.:— (a) 'That in the opinion of the Society, whenever a case of infectious disease occurs in any house or vessel, it should be a legal obligation on the person in¬charge of the house or vessel, or on the person in charge of the case, to report the fact to the Sanitary Authority without delay. (b) "That it should be a legal obligation on every Medical practitioner in attendance on any such case, to give immediate written information respecting its nature to the occupier or other person responsible for reporting it to the Sanitary Authority.' 1. "The Society sees no reason to depart from its recorded opinion that the hospital treatment of infectious diseases should be dissevered from any relation with pauperism, and re-affirms the views on the subject expressed in a Report of the Council adopted April 20th, 1877, and in the resolution of the Society passed in November, 1878. [The Report of the Council expressed agreement 'with the opinion of the Managers of the Asylum Board that adequate provision for the isolation and treatment of epidemic infectious diseases in the Metropolis does not exist; and under existing circumstances the Society endorses the conclusion that such provision could be best made in a comprehensive and systematic manner by one central authority acting for the whole Metropolis. As regards the constitution of the authority and the administration of the infectious disease hospitals, the Society is of opinion that such hospitals, regarded in the light of a sanitary provision for the advantage of the general population, should be completely dissevered from any relation with pauperism.'] The resolution referred to was as follows:— (c) "That this Society is of opinion that the assistance afforded to the sick in hospitals for the treatment of infectious diseases, and aid given for other sanitary purposes, ought not to be considered to be pauper relief, and that this is a matter to which the attention of the Local Government Board should be directed. 55 3. "The Society, recognizing the necessity for isolating in hospitals persons ing from infectious disease who have not proper lodging or accommodation enabling them to be properly treated at home, and isolated so as to prevent the spread of disease to other persons in the same house, affirms the desirability of an extension of the powers contained in the 26th section of the Sanitary Act, 1866 (124th section of the Public Health Act, 1875), so as to secure the removal to hospital of the infective sick not possessed of lodging or accomodation enabling them to be properly treated and isolated. 4. "The Society empowers the Council to bring the above resolutions under the notice of the President of the Local Government Board, in such manner and at such time, during the current Session of Parliament, as they may deem expedient." Action of the British Medical Association.—I may further state that having been invited to attend a meeting of the Parliamentary Bills Committee of the British Medical Association, on the 11th March, called to consider an exhaustive report by the Chairman of the Committee, Mr. Ernest Hart, dealing with the provisions of Bills now before the House of Commons, and promoted by the Health Authorities of Aberdeen, Barrow-in-Furness, Birkenhead, Bradford, Reading, Salford, and Stalybridge, for the purpose of obtaining the compulsory notification powers, and sundry others, including, in several instances, the increased powers of removal referred to in the second resolution of the Conference. I availed myself of the opportunity to bring under the notice of the Committe the desirability of depauperising hospital relief in cases of infectious sickness, and of affording such relief in suitable cases without enforcing payment from the sulferers; the result being that the Committee, and the Medical Officers present by invitation, agreed unanimously to the following resolution, which corresponds with the third resolution of the Conference, viz.:— "That the admission into hospitals, for the purpose of isolation, of persons suffering from infectious diseases, is eminently desirable in the interests of the public, and should be encouraged; that payment for the assistance given in hospitals to persons so suffering should not be enforced; that the giving of such assistance should not entail on the recipients the loss of any social or political status where their admission into hospital is certified by as being desirable on the ground of difficulties of isolation, and that the cost of hospital treatment of the infective sick should be made a charge on the public funds of the Sanitary Authority." 56 It may be mentioned that subsequent to the Conference, viz., at a meeting held May 28th, the Managers of the Metropolitan Asylum District directed a communication to be made to the Local Government Board, to the effect (inter alia) that in their opinion " provision should be made in any new Act for the compulsory notification of any infectious or contagious disease, in every class of the community to the respective Sanitary Authorities." At a meeting on the 29th April, of the Metropolitan Poor Law Guardians' Association also, after the reading of a paper by Mr. Rutherglen, Clerk to the Kensington Guardians, on "The difficulties as to isolation and treatment of cases of Small-pox and Fever in the Metropolis," it was resolved unanimously (inter alia). "That the Government be asked to include (in a proposed Act) provision for the Compulsory Notification of Infectious Diseases, for the compulsory removal to hospital of persons suffering from such diseases, for whom proper isolation and treatment cannot otherwise be obtained, and for the 'non-pauperization' of recipients of this kind of relief." It is difficult to imagine what further evidence can be wanted to satisfy the Local Government Board of the ripeness of the time, and of public opinion for such legislation as is here contemplated. The result of the Conference was communicated to the Sanitary Authorities, a copy of the resolutions being forwarded, together with a request that each authority approving "the principles laid down in the first three resolutions would be good enough to appoint two of their members to take part in the proposed deputation to the President of the Local Government Board." The resolutions were also sent, for information, to the several Boards of Guardians. They were sent also to the Society of Medical Officers of Health, to the Council of the British Medical Association, to the Social Science Association, and to the National Health Society, together with a letter of invitation to those Bodies to join in the deputation to the President of the Local Government Board. The invitations were accepted by the several Societies, and the President having been communicated with, appointed the 23rd of April for the reception of 57 THE JOINT DEPUTATION, the proceedings at which were briefly reported in the daily newspapers, and fully in the British Medical Journal for May 7th, (at page 744). It may suffice here to say that the deputation was introduced by Mr. G. Hastings, M.P., for East Worcestershire (the son of the Founder of the British Medical Association), and Dr. Farquharson, M.P., for West Aberdeenshire, gentlemen well known for the interest they take in Sanitary matters : and that the resolutions were spoken to by Major General Boileau, F.R.S., for the Sanitary Authorities; by Dr. Alfred Carpenter, J.P., for the Council of the British Medical Association; by Dr. Bristowe, F.R.S., for the Society of Medical Officers of Health; by Mr. Michael, Q.C., for the Social Science Association; and by Mr. Ernest Hart for the National Health Society. As an expression of opinion from the official, the professional and the general-public point of view respectively, nothing could well have been more impressive than this deputation, or more weighty than the statements and arguments brought under the President's notice; and whether legislation follow this year or next, or even later, it is difficult to imagine that it can ever be necessary to say or do more than has now been said and done, in evidence of the bent of public opinion on this question. Some disappointment was felt that the reply of the President was not more definite and satisfactory; Mr. Dodson having simply promised to give the subject his best consideration. There was more reason for this general reply, perhaps, than was quite apparent at the time, Mr. Dodson seemingly being of opinion that the "notification" would be of little use unless hospital accommodation could be provided. The decision of the House of Lords rejecting the Appeal of the Asylum Board, (No. 2) in the Hampstead Hospital case was fresh in men's minds, as well as the attempts that had been made to prevent the establishment of other hospitals to meet the demands created by the rapid extension of the small-pox epidemic. 58 Mr. Dodson stated that in his view the "hospital question was underlying" the whole of the subjects brought under his notice, and he pressed for definite information on the provision of HOSPITAL ACCOMMODATION for the infectious sick. At the request of the deputation I gave that information, to the effect inter alia that infectious disease hospitals should not be unduly multiplied in large centres of population; that convalescent and mild cases of small-pox might be safely removed into the country; that if such cases were so removed the existing hospitals would suffice for cases too ill to be removed to any considerable distance, and which therefore must of necessity be provided for in town; and that the difficulty in which the Managers found themselves placed would vanish if provision could be made for the reception of convalescent and mild cases outside London. These views were approved by the deputation, and it is satisfactory to know that they commended themselves to the judgement of the President, and led to results which, as they will have an important bearing in the future on this question of hospital accommodation, are deserving of record. I may premise by stating that I had long felt that the solution of the hospital difficulty, so far as the treatment of small-pox is concerned, was to be sought in the removal out of London of as many cases as could be safely removed. On the 1st March I had brought this subject under the notice of the Asylum Board, in the form of a letter, suggesting that "light cases and convalescents" should be removed out of London, because if this were done "the existing hospital accommodation would probably suffice for the requirements of the Metropolis." "We know," I continued, "what a large number of cases there are whose isolation is necessary only for the public good, and that many other cases more severe at first, soon arrive at a stage when they might safely be removed to a distance from Town if Sanatoria existed for their reception. The hospitals get choked with mild cases and by the necessary detention of convalescents; whereas, I think, it might be better to restrict the use of them for ' bad cases,' and for other cases so long only as 59 they require medical treatment." The idea in my mind was expressed in my Report, dated April 27th 1881, (No. 4, page 35,) viz., that the Asylums Board should "provide huts or double marquees which might be erected on open sites in a very brief space of time for the reception of mild cases of modified small-pox, and for convalescent cases." The want of hospital accommodation for cases of small-pox was brought under the notice of the Council of the Society of Medical Officers of Health, on the 21st April; and the Secretary (Dr. Vinen) on that date addressed a letter to the Managers, as follows:— "I am desired by the Society of Medical Officers of Health to draw your attention to the large number of cases of small-pox at present detained in the houses of the poor in most of the Metropolitan parishes for want of accommodation in the hospitals under the management of your Board. Whilst a large number of convalescents and slight cases of small-pox are retained in the hospitals, it appears to the Society of Medical Officers of Health that room might be obtained for the reception of a considerable number of cases now treated at home by establishing a temporary hospital or hospitals in some open spaces in the suburbs of London, to which slight cases and convalescents could be removed. The Society begs also to express its opinion that in the proposed hospitals for the reception of such cases there is no necessity for providing so large a cubic space for each patient as is at present allowed in the existing hospitals, by which the accommodation would be much increased." The above letter was forwarded to the President of the Local Government Board by the Managers, shortly after their meeting, held on the 1st May, and no doubt had its due weight. I had taken care moreover to state at the deputation that the views I expressed on the hospital question, were held by the Medical Officers of Health of the Metropolis generally. On Saturday, May 7th, the Local Government Board addressed a letter to the Managers of the Asylum Board impressing on them "the necessity of endeavouring to meet the existing pressure by acquiring some open space or spaces on which temporary buildings may be erected for convalescent cases. The Board," the letter continues, "do not doubt that sites of the kind indicated might be obtained within a moderate distance of the Metropolis; and if the buildings were sufficiently removed from any thoroughfare, and no 60 dwelling houses were adjacent, it does not appear to the Board that the Managers need be apprehensive of any successful attempt to interfere with their proceedings, provided that proper precautions are taken with respect to the removal of the patients going to and fro." With the view to avoid delay in seeking for sites, the Board advised the Managers to utilize their spare land adjacent to the imbecile asylum at Darenth for the erection of tents and huts for the reception of convalescent cases.* On Monday, 9th May, the Managers met to consider the above letter (which is given in extenso in the Minutes of the Board, page 135), and a report dated 9th May, by the "Committee for Darenth Schools and Asylum," as follows:—"Haying regard to the alarming increase of the epidemic of small-pox, and to the relief which would be afforded to the existing hospitals by the provision of a temporary establishment for convalescent patients, your Committee, at the request of the Chairman and Yice-Chairman of the Board, have had under consideration the question of the erection of tents upon the land at Darenth, and are of opinion that accommodation can be provided for the reception of at least 800 convalescents without detriment to the health of the imbecile patients already located there." The Managers thereupon resolved unanimously, "That, subject to the sanction of the Local Government Board, the Committee for Darenth Asylum be authorised to erect, on the site at Darenth, tents for convalescent small-pox patients; to obtain such furniture, bedding, etc., as may be required without advertising for sealed tenders, and to make all other arrangements that may be necessary for the reception of patients." The sanction of the Local Government Board was at once given; the work of providing the necessary accommodation was undertaken without loss of time, with the immediate effect of relieving the pressure on the existing hospitals, which have since proved adequate to meet the requirements of the Metropolis. I have referred at some length to this interesting movement, because it shows how the difficulty that " underlies " the matters * The suggestion to use the grounds at Darenth, originated, I am informed, with Sir E. H. Currie, the Chairman of the Darenth Committee. 61 submitted by the Deputation to the President may be solved—has, indeed, been already solved; and because this solution of the difficulty appears to justify a further direct appeal, which I propose should shortly be made by the leaders of the Deputation to the President, for a more decided reply to the application made to him for legislation for the compulsory notification of infectious diseases, for better provision for the isolation of infected persons, and for the "depauperisation" of the relief offered to the sick in infectious disease hospitals. Moreover, as I have always been opposed to the provision of local or district infectious disease hospitals, I may be pardoned for thinking the advice I have submitted to your Vestry has now been justified by the event, for if the several sanitary authorities had provided hospitals as they were urged to do by the Local Government Board, we might have muddled on for some time longer, until the danger of multiplying possible centres of infection had compelled a change of policy, or until the law had stepped in to close the hospitals—supposing the Sanitary authorities had been permitted to get so far as to establish them. Judging, however, from what took place in the adjacent parish, Fulham, it may be doubted whether the Sanitary authorities would ever have got so far as to erect even tent hospitals, for wherever the attempt has been made to provide local hospitals, the inhabitants of the district have taken measures to obtain an injunction to restrain the proposed action of the Sanitary authority. The immediate difficulty in respect of hospital accommodation has thus been surmounted, but special legislation is imperatively called for to enable the Asylum Board to carry on their important duties, subject to proper precaution so as to avoid danger to health and injury to property, without unreasonable interference on the part of individuals. I need not pursue this subject, however, as the need for such legislation is now universally felt, and the subject is receiving attention at the hands of the Managers and of the Local Government Board. ADDENDUM.—The Asylum Board subsequently took steps to increase hospital accommodation by borrowing two ships, Atlas and Endymion, from the Admiralty, which, after being fitted up, at great cost, as hospital and administration ship 62 tively, and moored off Deptford, at the old hospital ship, Dreadnought's moorings, were opened for the reception of cases at about the middle of July, at a time, therefore, when there were plenty of beds available in the hospitals on shore. The Managers appear, in this matter, to have acted under pressure of the Local Government Board, which must be held responsible for the very great expense incurred—needlessly incurred, as it appears, the hospital-ship scheme having been initiated subsequently to the opening of Darenth Convalescent Camp Hospital, an event which effectually put an end, for the time being, to the difficulty of finding accommodation for acute cases in the permanent land hospitals. But to resume:— The Atlas provides 180 beds in three wards, one on each deck. Wharf premises known as "Potter's Ferry,' have been secured for the embarkation of patients, on the north side of the river, opposite Greenwich Pier. The patients are shipped from the ambulances on to a barge specially prepared for their reception, and which is towed to the ship by a steam launch. The Managers have further provided an Ambulance Station at George Street, London Fields, in the parish of Hackney, a position central to the several parishes allocated to the ship. Here are placed the horses and ambulances, and staff of drivers, &c., for the transfer of patients from their homes to the wharf, as well as a resident staff of nurses, &c.—all the employes being accommodated on the premises, thus preventing contact with the public. The station is placed in telephonic communication with the Offices of the Board in Norfolk Street, whence a message will be sent to the station directing the removal of a case as soon as it has been reported, by telegram, by the parochial officer. The ambulance will, accompanied by a nurse, proceed to the address of the patient, who will be conveyed direct to the wharf for removal to the ship. Arrangements have been made for the burial of the dead to take place from Homerton Hospital. It remains to be seen whether wooden ships are as well adapted for the treatment of small-pox as their advocates believe. POPULATION, INHABITED HOUSES, &c. In my last Annual Report, referring to the probable population of Kensington I remarked that it was difficult, if not impossible, to estimate, with accuracy, the population of "sub-districts," and "the relative numbers of the sexes, nine years after a census, and in a parish which had developed at once largely and irregularly." The estimate, however, had to be made, and I assumed that the population of the parish in July, 1880, was not less than 158,850, giving reasons at the same time for the opinion that it might have been taken to be 161,450, but that I preferred an understatement to 63 any risk of exaggeration in a favourable sense. I now find, as the result of THE CENSUS, that the population in July, 1880, could not have been less than 159,700 persons, which number is taken throughout this Report as the basis of calculation of birth and death rates, &c. My estimate was sufficiently near the actual to justify, so far as I can judge at present, the retention of the statistics of the decade; but this is a question that I shall have further and better opportunities of considering when the details of the census shall have been published. It may be mentioned that the parish was divided for the Census into 70 or 80 blocks, each of which was placed in the charge of an Enumerator. The return made by the Enumerator shews the number of houses in the block, the number of "heads of families," and the population stated in males and females. A transcript of the information thus condensed would have been of value for statistical purposes, and to enable me to ascertain the death-rate in much more minute sub-divisions of the parish than is practicable otherwise, as the weekly returns are simply for the two registration sub-districts. At my request your Vestry made application to the Registrar-General to sanction an arrangement whereby such information might have been obtained from the registrars "for purely statistical purposes." But although the granting of this request would not have delayed the returns by the registrars to the head office by a single hour, the Registrar-General declined to allow the information to be supplied "for any purpose whatever." The unrevised figures of the Census, as presented to your Vestry by Messrs. Barnes and Hume, the registrars for the Town and Brompton Sub-districts respectively, are set out in the subjoined tables. 64 REGISTRAR'S SUMMARY, CENSUS, 1881, KENSINGTON TOWN SUB-DISTRICT. Shewing the number of inhabited Houses, and Population; Ecclesiastical Districts, Wards—Civil Parish and Borough. Aprl.4th,1881 Ecclesiastical Parish. Inhabited Houses. Total Population. Mems. Division 1 All Saint's, Notting Hill 2,434 23,991 The remainder of Nos. 2. 4, 9 and 10 is situated in other Civil Parishes. 2 Part of St. Clement's, Notting Dale 1,399 14,908 3 St. George's, Campden Hill 1,048 9,273 4 Part of St. James's Norland 878 7,432 5 St. John's, Notting Hill 935 6,488 6 St. Mark's, Notting Hill 1,310 11,320 7 St. Michael's 423 3,137 8 St. Peter's, Notting Hill 1,161 7,804 9 Part of St. Andrew's and St. Philip's, Kensal Town 479 7,319 10 Part of St. John's, Kensal Green 20 117 The remainder of Nos. 12, 13, and 14 is in the Brompton Sub-dietrict. 11 St. Mary Abbot, Kensington 2,210 17,014 12 Part of St. Barnabas', Kensington 981 6,351 13 Part of St. Philips, Earl's Court 506 3,511 14 Part of St. Stephens', South Kensington 202 1,462 13,986 120,127 Division of Wards. Part of Town Ward St. John & St. James' (Notting Hill) Ward 4,392 32,553 9,594 87,574 13,986 120,127 Kensington Town portion of the Civil Parish of Kensington and of the Borough of Chelsea 13,986 120,127 Division of Sexes Males. 49,958 Females. 70,169 Total population 120,127 65 BROMPTON SUB-DISTRICT. April 4th, 1881. Inhabited Houses. Total. Population. Brompton Sub-district 6,117 42,797 Division of Wards— Part of Town Ward 2,181 16,051 Brompton Ward 3,936 26,746 6,117 42,797 Division of Sexes Males. 15,318 Females. 27,479 Total population 42,797 From the above tables we learn that the population on the 4th of April, 1881, was 162,924, the decennial increase being 42,625 or 35.4 per cent. This is less than half the percentage increase (73) in the decennium 1861-71, but the numerical increase is less by only 8,400. Of this increase 16,445, or 38.6 per cent. is natural, representing the excess of births over deaths; the remainder, 36,180 (61.4 per cent.) representing the balance of immigration over emigration. The 162,924 persons comprised: Males, 65,276 and females, 97,648; the excess of females, which had been 22,345 in 1871, having increased in ten years to 32,372, and being 20,211 in the Town sub-district, and 12,161 in Brompton. The population of the Town sub-district increased from 91,645 to 120,127, or by 31 per cent.; and that of Brompton from 28,654 to 42,797, or by nearly 50 per cent. The number of inhabited houses, 15,712, in 1871, according to the Census returns, increased to 20,103 in 1881, or 28 per cent. The average number of persons to a house, which was nearly 7.7 in 1871 had increased to 8.1 in 1881. The proportions to a house were in the Town sub-district 8.6, and in Brompton, 7. In the Ward of St. John and St. James', the increase per house was from 8.1 (nearly) to a little over 9.1 persons. These figures prove that I did not err in supposing that the northern portion of the parish was becoming overcrowded (vide page ). The density of population in 1871 was 55 to an acre; 61 in the Town sub-district, and 66 41 in Brompton. In 1880 it was 73 to an acre, whole parish, 79 in the Town sub-district, and 60 in Brompton. There is an apparent discrepancy between the Census return and the rate books as to the number of inhabited houses. In 1871 the Census return gave the number of inhabited houses as 15,712, the rate books' total being 15,181; the explanation of the difference being that only rated properties are recognized in the rate books as "inhabited dwellings," whereas the registrars properly include under that description any house containing inhabitants, e.g., houses unlet, but occupied by caretakers, &c. In 1881 the Census return of inhabited houses is only 20,103, whereas the rate books give the number as 20,679. Thus in 1871, the rate books showed 531 fewer inhabited houses than the Census return, whereas in 1881 they show 576 more, so that comparing the figures of the two Censuses the rate books appear to have gained on the registrar's returns by no fewer than 1,107 entries. I am not sure that I can quite explain this discrepancy. It appears however, that the registrars count as a house such a building, e.g., as the model lodging houses in the Mall, Notting Hill, which are rated as 48 houses; and as seven houses the extensive buildings in seven blocks, known as "Campden Houses" in Peel Street, Campden Hill, which are rated as 133 houses. There are some large houses let out in "flats" in the Brompton district also, and separately rated. But these buildings and flats account for a difference of only about 220 in the number of "houses." I am not able to state how many "empty" houses contained inhabitants as "caretakers." It is supposed that the balance is to be accounted for by the alteration in the mode of rating properties, rendered necessary by the Act for the Quinquennial Valuation of the Metropolis, many properties, stables and others, that were formerly rated in combination with houses, etc., being now separately assessed. The Metropolis Local Management Act, which brought your Vestry into existence, came into operation on the 1st of January, 1856, or, twenty-five years ago. The subjoined figures, therefore, showing the growth of the Parish in the quarter-centuxy, may not be without interest at the present time. 67  1856. 1880. Gross Increase of 25 years. Estimated number of Inhabited Houses 7,600 20,700 13,100 Population 57,000 160,000 103,000 Rateable Value of Property £308,000 £1,455,084 £1,147,084 The increase within the last ten years, in all respects, is not inconsiderable, as the subjoined figures will show:— 1871. 1881. Increase in 10 years. Estimated Number of Inhabited Houses, July 15,394 20,800 5,406 Population July 121,300 164,000 42,700 Rateable Value £935,720 £1,648,187 £712,467 These figures, demonstrating a transcendent growth, speak for themselves; nevertheless, attention may be called to the fact that in the quarter-century the rateable value of property became more than quintupled, and that in the last decade the mere increase was double the total in 1856. The population and the number of inhabited houses increased nearly threefold in 25 years; the increase in the last decade alone attaining the proportions of a large city. In the nature of things the material growth of the parish must cease ere many years shall have passed, and there must be an arrest to the increase of population, for there will be no further room for additional buildings. Property, however, will probably continue to increase in value long after the population shall have become comparatively stationary, and even now the rateable value of property has attained such proportions as to be exceeded by that only of the cities of London, Liverpool, Manchester and Bristol. But to resume. Calculating upon the basis of the Census, I estimate the population of the Town sub-district at the middle of 1880, at 118,180, and that of Brompton at 41,520. In my 68 "annual summary," published in January last, I assumed the numbers to be 118,000 and 40,850, inclining however to the "belief that the population of Brompton might be understated." I credited the female sex with a majority of only 29,450, whereas it must be now assumed that this sex predominated to the number of 31,700, the males numbering, 64,000, and the females 95,700. The redundancy of females is explicable in a large measure by the fact that in this parish, as in all rich parishes, there are numerous female domestic servants. There are many girls schools in Kensington also; and probably a considerable number of boys, in excess of the number of girls, go from home to school, and so would be out of the district when the Census is taken. The superior longevity of women becomes a factor of no mean importance as years go by, in increasing the disproportion in the relative numbers of the sexes, and some of which, moreover, may be fairly ascribed to the influences of fashion and healthfulness, which tend to make the parish a favourite place of residence with many unmarried and widowed ladies. The subjoined table shows the numbers of the sexes at different ages in 1871; the materials for a corresponding return based on the Census of 1881 is not yet forthcoming. AGES OF MALES AND FEMALES, 1871. All Ages. U nder 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 The density of the population varies greatly no doubt in different parts of the parish, but taking the parish as a whole, and making no allowance for open spaces, the density is about 71.1 persons to an acre. It is probable that the open spaces available for building purposes—Holland park and land at Notting Barn farm, etc, do not now exceed 250 acres. Other open spaces that cannot 69 be built upon, are the Cemeteries at Kensal Green and at West Brompton. The number of inhabited houses at the middle of 1880 was 20,700 showing an increase in the 12 months of 487. MARRIAGES AND MARRIAGE RATE. The number of marriages in 1880 were 1,483. Of these there were celebrated By the Church 1,199 At Roman Catholic places of worship 91 At Nonconformist places of worship 50 At the Superintendent Registrar's Office 143 Total 1,483 The marriage rate, i.e., persons married to 1,000 population, was 18.5. It will be seen on reference to Table 1, Appendix, that the marriages in 1880, although 55 more than in 1879, were only 66 above the number in 1876, notwithstanding that the population had increased by many thousands. Nevertheless the marriage rate is considerably above that of the country generally, 15 per 1,000. Despite the high marriage rate, Kensington has a low birth rate, resulting from that disproportion in the relative numbers of the sexes, to which reference has already been made. BIRTHS AND BIRTH RATE. Four thousand six hundred and five live births were registered in 1880, viz., males, 2,328, and females, 2,277: in the Town subdistrict, 3,748, and in Brompton, 857,—the same number as in 1878 notwithstanding an increase in population to the extent of 6,100, and 185 fewer than in 1879. The decrease in the Town sub-district was 109, and in Brompton 76. The birth-rate, 28'9 per 1,000, was considerably below the Metropolitan rate, 36.2; and that of all England and Wales, 34.5; also being 2.5 per 1,000 below the decennial rate. The rate in the Town sub-district was f f 70 31.4, and in Brompton 21 per 1,000. There was one birth to every 34.6 persons living, and 102.2 births of males to 100 of females. The illegitimate births were 186, 170 of them having been registered in the Town sub-district, which includes the parish workhouse, at which, out of 136 births, about 40 were illegitimate. The illegitimate births in the parish formed nearly 4 per cent. of total births. The subjoined table shows the quarterly numbers of births registered of each sex, and in the sub-districts. KENSINGTON TOWN BROMPTON Sub-district. Males. Sub-district. Grand Total. Males. Females. Total. Females. Total. 1st Quarter 475 506 981 108 108 216 1,197 2nd „ 489 488 977 101 118 219 1,196 3rd „ 434 423 857 110 105 215 1,082 4th „ 496 427 923 115 92 207 1,130 1,894 1,844 3,788 434 423 857 4,605 Additional particulars respecting births, birth-rates, etc., for the decennium, are contained in Tables 1 and 2, Appendix. DEATHS AND DEATH-RATE. The deaths in 1880 were 2,884, viz.: 2,854 registered in the parish; Town sub-district, 2,258; Brompton, 596; and 30 in the hospitals of the Metropolitan Asylum District. The total includes 99 of non-parishioners at the Brompton Consumption Hospital, and 33 at St. Joseph's House, Notting Hill, retained in the statistics to compensate for the deaths of parishioners that may have taken place at hospitals and elsewhere outside the parish. The deaths were fewer by 108 than in 1879, a year that included 53 weeks : they were also 175 below the corrected decennial average. The death-rate of the entire parish was 18.0 per 1000; 1.1 per 1000 below the decennial rate; 4'2 per 1000 below the Metropolitan rate; and 2.6 below the rate in England and Wales. The rate in the sub-districts, after distribution of deaths in public institutions, proportionately to population, was, Town, 21.1; 71 Brompton, 14.2 per 1000; the rate for the male sex being 221, and for the female sex, 15.3 per 1000. There was one death to every 45.2 males, and 65.1 females respectively; and, taking the entire population into account, one death to every 55.3 persons living. The deaths of children always bear a high ratio to total deaths: last year the deaths under five years were 1,219, about the same number as in 1879, equal to 42.3 per cent. on total deaths, and to 26.5 per cent. on registered births. There were 719 deaths under one year—about the same number as in 1879—equal to 25 per cent. on total deaths, and to 15'6 on registered births. The deaths at 60 and upwards were 656, or 43 less than in 1879, and equal to 22.7 per cent. on total deaths. By way of comparison it may be stated that in the Metropolls, as a whole, the deaths under five were 49.7 and 27.2 per cent. and under one year 25.7 and 15.8 per cent., on total deaths, and registered births respectively; while the deaths at 60 and upwards were equal to 20'9 per cent. on total deaths. The deaths of illegitimate children under five were 85, equal to 47.4 per cent. on registered illegitimate births: all but three of them occurred in the Town sub-district. Of the 85 children only 21 outlived the first year, and of these 21, 17 died in the second year. The causes of death were scrofulous or tubercular diseases, including atrophy and debility 25; premature birth 4, lung disease 10, brain disease 8, diarrhoea 12, measles 7, other diseases, some ill defined, 19. Most illegitimate children probably are brought up by hand feeding and by strangers: the evidence of improper feeding and of the want of due parental care is sufficiently apparent in the above list of diseases. The cause of 11 out of the 85 deaths formed the subject of enquiry in the Coroner's Court, but only two of the deaths were directly referable to violence, and this of an accidental nature. The verdict in two eases was an open one, "found dead." In the case of a third child found dead in a garden, the Coroner deemed it unnecessary to hold an inquest. 72 The subjoined table shows the quarterly numbers of deaths of males and females in each of the sub-districts Kensington Town Males. Brompton Grand Total, whole Sub-district. Sub-district. Males. Females. Total. Females. Total. Parish. 1st Quarter 317 339 656 103 101 204 860 2nd „ 273 259 532 56 72 128 660 3rd „ 258 260 518 64 65 129 647 4th „ 254 298 552 68 67 135 687 1,102 1,156 5,258 291 305 596 2,854 The deaths in the first and fourth or colder quarters (1,547), exceeded the number in the second and third, or warmer quarters (1,307), by 240. The excess belongs mainly to the first quarter which was very fatal to aged people by reason of the inclement weather which prevailed, especially in the month of January. The subjoined table shows the death-rate in 13 periods of four weeks, corresponding with my Monthly Reports, and the mean temperature of the air DATE OF REPORT. Death-rate, per 1000 living, 1880. Decennial Average Mean temperature of the air, 1880. Decennial Average Temperature above or below Average. For four weeks to Jan. 81, 1880 23.6 20.8 31.7 39.3 — 7.6 „ „ „ „ Feb. 28, „ 25.0 22.6 41.6 39.1 + 2.5 „ „ „ „ Mar. 27, „ 17.7 20.8 44.6 41.5 + 3.1 „ „ „ „ -A.pl. 24, „ 19.2 21.5 47.0 45.7 + 1.3 „ „ „ „ May 22, „ 15.1 18.6 47.0 49.4 — 2.4 „ „ „ „ June 19, „ 16.2 16.7 55.7 55.7 — „ „ „ „ July 17, „ 16.3 16.7 61.1 61.3 — 0.2 „ „ „ „ Aug. 14, „ 19.2 19.1 62.5 63.1 — 0.6 „ „ „ „ Sep. 11, „ 14.0 17.1 64.1 61.2 + 2.9 „ „ „ „ Oct. 9, „ 14.9 14.9 54.8 55.2 — 0.4 „ „ „ „ Nov. 6, „ 16.3 17.1 43.0 48.3 — 5.3 „ „ „ „ Dec. 4, „ 18.2 20.6 43.4 41.2 + 2.2 „ „ „ „ Jan. 1, 1881 18.2 21.1 43.0 37.5 + 5.5 Averages (whole year) 18.0 19.1 49.2 49.1 The subjoined summary of the "causes of death" shows the number of deaths in 13 groups, according to age at death, and the number of deaths resulting from the diseases in each "class," according to the Registrar General's classification.— (For details, vide Table III., Appendix.) DEATHS REGISTERED FROM ALL CAUSES DURING THE YEAR 1880. (Exclusive of the Deaths of non-parishioners at the Brompton Consumption Hospital.) CAUSES OF DEATH. AGES. Total deaths under Five. Grand Total sub-districts. 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. Kensington Town. Brompton. (classes) I. ZYMOTIC DISEASES 195 105 98 58 22 16 14 13 12 14 5 2 1 398 555 472 83 II. CONSTITUTIONAL DISEASES 81 46 40 36 53 72 83 64 51 33 8 4 ... 167 571 461 110 III. LOCAL „ 242 100 82 27 23 39 100 121 169 211 137 23 ... 424 1274 1023 251 IV. DEVELOPMENTAL 183 13 5 ... 3 6 5 1 2 8 40 15 3 201 284 240 44 V. VIOLENT DEATHS 14 6 4 3 6 8 6 5 2 1 ... ... 20 55 46 9 CAUSES NOT SPECIFIED OR ILL-DEFINED 4 2 3 ... ... 1 ... 1 2 2 1 ... ... 9 16 16 ... 719 266 234 125 104 140 210 206 241 270 192 44 4 1219 2755 2258 497 73 74 SPECIAL CAUSES OF DEATH. CLASS 1. ZYMOTIC DISEASES. Having already (at page 12) treated of the deaths from the principal diseases of the Zymotic class, I now proceed to offer some observations on the mortality from the remaining diseases included in the first order in this "class," viz., Miasmatic. Croup was the registered cause of 16 deaths, 13 in the Town sub-district, 3 in Brompton, and 10 under five years of age. The deaths in 1879 from this cause were 25. It is satisfactory to note the reduction in 1880, as I had occasion in my last annual report to observe that this disease appeared, like diphtheria, to be on the increase of late years. The deaths from diphtheria, however, as we have seen were again in excess of the average. Erysipelas was the cause of 24 deaths, 3 under five years of age, as compared with 9 in 1879. Only one of the deaths occurred in the Brompton sub-district. Puerperal Fever (Metria) was the registered cause of 13 deaths, 10 in the Town sub-district, and 3 in Brompton. The numbers in the five previous years were 13, 6, 12, 6 and 6. The deaths were of women between 15 and 25, 4; between 25 and 35, 6; and between 35 and 45, 3. There were also 13 deaths ascribed to child-birth, viz., 2 between 15 and 25 years, and 6 and 5 in the two following decades respectively. The distinction between the two classes of cases is this, that while Metria is a specific and highly contagious disease, deaths from 'childbirth' simply, may be regarded as mainly due to accidental causes, e.g. hemorrhage, ("flooding,") etc. The total deaths registered as having been occasioned by, or occurring in, childbed, were 26, equal to 0.5 per cent. on registered births. Rheumatism was the cause of 16 deaths—12 of them in the Town sub-district, and 14 above five years of age. In many of the fatal cases of Rheumatism the immediate cause of death is heart 75 disease, arising in the progress of the malady. Not a few of the deaths registered from "heart-disease" simply, might be properly classified to "rheumatism" as "primary cause," the foundation of the more important affection having been laid years before, it may be, in an attack of rheumatic fever. Pyaemia, a fatal condition of blood-poisoning, was the cause of 4 deaths, 3 of them in the Town sub-district. Order 2. Enthetic Diseases.—Syphilis was the cause of 13 deaths, 11 in the Town sub-district, and 2 in Brompton; 12 in the first year of life, and 1 in the second. The deaths due directly or indirectly to this disease, were probably more numerous : some deaths due to it, we may reasonably believe, get registered under other headings year by year. It is a truly Protean disease, and lies at the root of many secondary diseases. There was one death from Stricture of the Urethra. Order 3. Dietic Diseases.—Thirteen deaths were due to the diseases included in this order, viz., Privation, 2; Want of breastmilk, 4; Purpura and Scurvy, 1, and Alcoholism, 6. All the deaths ascribed to the abuse of alcohol occurred in the Town subdistrict, the registered cause in one case being delirium tremens, and in five intemperance. If all the diseases and all the deaths due, directly or indirectly, to the misuse of alcoholic stimulants could be traced to their source, the sum total would be very great. Many deaths really due to the abuse of alcohol get registered as having been caused by secondary diseases set up, doubtless, or aggravated by "drink." Man's ingenuity in the discovery of alcohol is accountable for a large part of the misery of his race. Alcohol is a fruitful source of vice and crime, as well as being the cause of much bodily sickness, and of many premature deaths. Drink fills our hospitals and asylums, our prisons, our workhouses, and our national exchequer. Order 4. Parasitic Diseases.—Eleven deaths, 10 of them in the first year of life, and 10 in the Town sub-district were due to Aphtha (Thrush). 76 CONSTITUTIONAL DISEASES. The second great Class in the Registrar-General's Tables, viz., Constitutional Diseases, comprises the causes of 571 deaths, 44 below the number recorded in 1879: 461 in the Town sub-district, and 110 in Brompton. One hundred and sixty-seven of the deaths were of children under five. The Class includes two Orders, viz., (1) diathetic diseases, 104 deaths, and (2) tubercular or scrofulous diseases, including phthisis, 467 deaths. Order 1. Diathetic Diseases.—The deaths from the diseases comprised in this order, 104 in number, viz., 78 in the Town sub-district, and 26 in Brompton, were, Gout, 2; Dropsy, 6; Mortification, 6; and Cancer, 90. Twenty-five of the deaths from Cancer were registered in the Brompton sub-district. This disease appears to be on the increase: the deaths registered in the previous six years respectively having been 67, 74, 69, 88, 79, and 95. It should be explained that the deaths of all persons who have suffered from cancer, in any form, are classified to that disease, irrespective of any other disease from which they may have suffered, and of the question whether death was immediately due to cancer. The majority of the deaths from cancer occur in advanced life, the disease being most prevalent in the aged, having regard to the number of persons living in groups of ages. Eighty-six of the deaths occurred at ages over 35, 49 of them between 55 and 75 years. The parts of the body most commonly affected are the viscera or internal organs; very frequently, in women, the uterus and the breast. The deaths in the four quarters, were 26, 22, 24 and 18 respectively. Order 2. Tubercular.—The diseases included in this order are among the most important with which sanitarians have to deal, and the degree to which they prevail may be regarded in some sort as a test of the healthiness or otherwise of a population. Generally of an hereditary character, these diseases are nevertheless susceptible of considerable amelioration if not, like some others, of ultimate extirpation under improved hygienic conditions. Scrofula is unknown in Hygeiapolis! Sunlight and pure air; 77 efficient drainage and its corollary a dry soil; good food, warm clothing, and temperance in all things, are powerful antidotes to the bane of tubercle, which is fostered by the opposites—by filth and squalor, by cold and nakedness, by vice and intemperance, by the want of the proper necessaries of life, by overcrowding in illconstructed, unventilated, and sewage-tainted houses, and, in a word, by whatever is inimical to the maintenance of a typical condition of health. The cases that occur in the well-to-do classes of society are usually traceable to the influence of heredity. The diseases in this order were the registered causes of 467 deaths, viz., 383 in the Town sub-district, and 84 in Brompton; 165 of the deaths being of children under 5 years of age. The numbers in the four quarters respectively, were 130,135,116 and 86:—216 in the winter, and 251 in the summer quarters. It is not uncommon to have "phthisis " returned as the cause of death in the earliest infancy, a period at which tubercular disease usually manifests its presence in other organs than the lungs. Such cases have been classified to scrofula and tuberculosis, the deaths from which were 42; 84 in the Town district, and 8 in Brompton, 26 of them having occurred under five years of age. Tabes mesenterica popularly known as "consumption of the bowels," was the cause of 64 deaths, 3 of them in Brompton, and all but three of children under five years of age. Hydrocephalus (water on the brain), and Tubercular meningitis were the causes of 89 deaths, (17 in Brompton) 72 of them of children under five. Phthisis, the form of the disease known as "decline" or "consumption," was the cause of 272 deaths, irrespective of 99 deaths of non-parishioners at the Consumption Hospital, dealt with later on. Of the 272 deaths, 216 occurred in the Town sub-district, and 56 in Brompton. The quarterly numbers of deaths were 79, 76, 68, and 49 respectively. Six of the deaths occurred under five years of age, 9 between 5 and 15; 47 between 15 and 25; 69 between 25 and 35; 67 between 35 and 45; 48 between 45 and 55; 21 between 55 and 65; and 5 between 65 and 75. The deaths from tubercular diseases were disproportionately numerous in the Town sub-district, scarcely more than a fifth of the whole number having occurred in Brompton, the population of which is more than a fourth of that of the parish generally. This fact may be explained by the relatively smaller number of children and of the poor in Brompton. It is 78 probable that many of the deaths of young children ascribed to such causes as premature birth, atrophy and debility, convulsions, etc., are primarily due to the scrofulous taint. Frequently other diseases, especially of the lungs (bronchitis, pneumonia, etc.), are associated with phthisis in certificates of death, but all such associated diseases are disregarded: when phthisis is returned, the death is invariably classified to that disease. CLASS 3.—LOCAL DISEASES. This great class of diseases is accountable for 1,284 deaths (viz., 1,033 in the Town, and 251 in Brompton), or about 44'6 per cent. of total deaths : 424 of the deaths were of children under five. The class comprises 8 orders, according to the system of organs affected. Order 1. Nebvous System.—Diseases of the nervous system caused 316 deaths (19 more than in 1879), including 113 of children under five years. Two-hundred-and-fifty-seven of the deaths were in the Town sub-district, and only 59 in Brompton— a disproportion in favour of the latter sub-district as great as that previously referred to in relation to tubercular diseases. Cephalitis —inflammation of the substance of the brain, as meningitis, already referred to, is of the coverings of the brain, was the cause of 7 deaths. "Brain disease" was returned in 62 instances (8 of them in Brompton), insanity in two, and epilepsy in eight. Apoplexy and paralysis, for the most part diseases of the later periods of life, were the causes of 80 and 44 deaths respectively. Of these 124 deaths 25 occurred in Brompton, and 109 were of persons above 45 years of age. Convulsions—a symptom in many diseases, rather than a disease, of infancy was returned as the cause of 107 deaths, only 19 of them in Brompton. All but two of these deaths were of children under five years, 80 of them occurred in the first year. Convulsions as a cause of death, is frequently returned in connection with specified diseases, and especially with "teething." The convulsions being a symptom only, the deaths in these circumstances are classified to the primary diseases named, or to dentition as the case may be. The 79 quarterly numbers of deaths from all diseases of the nervous system, were 85, 87, 64 and 80 respectively. Order 2. Organs of Circulation.—Total deaths, 148; 116 in the Town sub-district, and 32 in Brompton; under five years of age, 1. The fatal diseases were Pericarditis, 2; Aneurism, 5; ''Heart Disease, etc.," 141. The quarterly numbers of deaths were 39, 39, 29 and 41 respectively. Of the 141 deaths due to "heart disease," there was one of a child under five, and 16 of persons between 5 and 35: in the decennium 35-45, there were 18 deaths; between 45 and 55, 26; between 55 and 65, 26; between 65 and 75, 40; between 75 and 85, 13, and one at 85. Order 3. Respiratory Organs.—The deaths from "chest diseases "were 595, viz.:—482 in the Town sub-district, and 113 in Brompton. The deaths under five were 283, nearly 48 per cent. Seven deaths were returned from spasm of the glottis, but as these were mostly of infants "found dead in bed," it may be questioned whether an examination made, possibly, two or three days after death, would have disclosed 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. It is quite possible, to say the least of it, that some of the children had been "overlaid"; the same remark being applicable to cases in which death is attributed to "convulsions," when the deceased have in like manner been "found dead in bed." Laryngitis was the cause of 1 death, Pleurisy of 6, Asthma of 11, and "Lung Disease, etc.," of 48. The principal diseases, Bronchitis and Pneumonia caused 400 and 122 deaths respectively: total 522; of which 97 (less than one-fifth) occurred in Brompton. Of these 522 deaths, 260 were of children under five, and 188 of persons above 55 years of age. The diseases of the respiratory organs are thus seen to be most fatal at the extremes of life. They are also most prevalent in cold, inclement wintry weather. Of the 595 deaths last year—the quarterly numbers being 267, 110, 58 and 160:—427 took place in the first and fourth or winter quarters, and 168 only in the second and third or summer quarters. 80 Order 4. Digestive Organs.—The diseases of these organs were the causes of 121 deaths, viz.:—99 in the Town, and 22 only in Brompton. Nineteen were of children under five years, including 3 from Jaundice of the newly born. Liver Disease heads the list with 46 deaths (11 in Brompton), being followed by Jaundice 13, Enteritis 9, Peritonitis 15, etc. Order 5. Urinary Organs.—The deaths in this order were 72 (17 in Brompton), only one being of a child under five. Thirtyseven of the deaths were due to Bright's Disease (Nephria or Albuminuria). Among other causes of death were Kidney disease, 22; Cystitis, 4; Nephritis, 2; Diabetes, 6; and Stone, 1. Order 6. Organs of Generation.—Deaths 9, viz:—Ovarian Dropsy, 6 ; Uterus disease, etc., 3. Order 7. Organs of Locomotion.—Deaths 2, Synovitis and Joint disease, etc., each one. Order 8. Integumentary System.—The deaths from the diseases of the skin were 11, viz: Phlegmon (Abscess), 7 ; Skin disease, etc., 4. CLASS 4.—DEVELOPMENTAL DISEASES. This class contains four orders, and comprises diseases (1) of children, (2) of adults, (3) of old people, and (4) of nutrition. The deaths were 285 (50 in Brompton), including 201 of children under five years of age. Order 1. Diseases of Children.—The total deaths were 89, viz., 77 in the Town sub-district, and 12 in Brompton, all having taken place under five years of age. The list is headed by "Premature Birth" 55 deaths, 8 of them in Brompton. Teething is accountable for 23 deaths, (3 in Brompton), convulsions being the immediate cause of death in many of the cases. Cyanosis or malformation of the heart was the cause of 4 deaths. 81 Order 2. Diseases of Adults.—The only cause of death under this heading is Childbirth, which proved fatal to 13 women (see Puerperal Fever). Order 3. Diseases of Old People.—Under this heading we have "Old Age" only, the cause of 68 deaths above 55 years. In the four decennia between 55 and 95, the deaths were respectively 2, 8, 40, and 15. Three deaths took place at 95 and upwards. Order 4. Diseases of Nutrition.—Atrophy and Debility. The deaths, 115 (including 19 in Brompton), were of 112 children under five, 102 in the first year; and of two persons between 15 and 25, and one between 45 and 55 years. CLASS 5.—VIOLENT DEATHS, &c. Fifty-five deaths (20 under five years) are distributed over the four orders comprised in this class, 9 of them belonging to the Brompton sub-district. Order 1. Accident or Negligence.—Total deaths, 42 (5 in Brompton), viz.: Fractures and Contusions, 19; Wounds, 3; Suffocation, 12, all of infants under one year; Burns and Scalds, 3; Poison, 3; Drowning, 2. Order 2.—Homicide. One death. Order 4. Suicide.—Twelve deaths (4 in Brompton), viz., by Poison, 2; by Drowning, 2; by Wounds, 5; by Hanging, 2; and Otherwise, 1. Nine deaths, 7 in the Town sub-district, and 5 of them under five years of age, are classified to causes not specified or ill-defined. Several of these "causes" are not really "ill-defined," but they fall to this place as there is none other found for them in the Registrar- General's Classification. 82 DEATHS AT PUBLIC INSTITUTIONS. The "large public institutions" in Kensington, are the Parish Infirmary and Workhouse in the Town sub-district, and the Hospital for Consumption and Diseases of the Chest at Brompton. There are numerous minor public or quasi-public institutions, but, with one exception, they do not furnish occasion for notice here. The exception is St. Joseph's House, Portobello Road, Notting Hill— a Roman Catholic institution, containing some 250 aged poor persons of both sexes, brought from all parts. The Marylebone Infirmary, at Notting Hill, for the sick poor chargeable to the rates of that parish, now completed, will be opened this month (June), and will henceforth appear among our large public institutions. The deaths registered at the Workhouse, the Brompton Hospital, and the Hospitals of the Metropolitan Asylum District, were 369, or 12.8 per cent. on total deaths, the percentage proportion of deaths in public institutions in the Metropolis generally being 18'0. The Parish Infirmary and Workhouse.—I am indebted to Dr. Whitmore, late Medical Superintendent of the Infirmary and Medical Officer of the Workhouse, for the statistics of the mortality at these institutions. The deaths were 236, males 115 and females 121. The numbers in the four quarters respectively were 75: 57: 55 and 49:—124 in the cold and 112 in the warm half of the year. The ages at death were as follows:—Under 1 year, 33; between 1 and 60,115; at 60 and upwards, 88. Between 60 and 70 the deaths were 46; between 70 and 80, 34; at 80 and upwards, 8. The greatest age at death was 88; bronchitis proving fatal to a female in the first quarter, and brain disease to a male in the fourth quarter, at that age. Five inquests were held, viz., on a male, age 66, verdict, "sudden, syncope, want of food;" on a male, age 28, verdict, "sudden, disease of heart, want of food"; on a male, age 76, and a female, age 62, verdict, "sudden, disease of lungs"; and on a female, aged 10 weeks, verdict, "found dead in bed, convulsions." During the year erysipelas of a severe type, and generally idiopathic, was prevalent, and was the cause of a considerable number of deaths. 83 The causes of death may be grouped as follows:— Under one year. Between one year and sixty. Sixty and upwards. Total. Nervous System, Diseases of 4 16 23 43 Circulation, Organs of „ 0 10 7 17 Respiration, „ „ 2 18 24 44 Abdominal Viscera „ 0 5 4 9 Measles 5 2 0 7 Diphtheria 0 2 0 2 Whooping Cough 1 4 0 5 Enteric Fever 0 1 0 1 Erysipelas 0 5 11 16 Rheumatism 0 1 0 1 Diarrhoea 3 1 1 5 Pyaemia 0 0 1 1 Syphilis 1 0 0 1 Want of Breast Milk 1 0 0 1 Delirium Tremens 0 1 0 1 Dropsy 0 1 1 2 Cancer 0 2 6 8 Mortification 0 0 3 3 Scrofula 1 1 0 2 Tabes Mesenterica 10 4 0 14 Phthisis 0 40 4 44 Premature Birth 4 0 0 4 Spina Bifida 1 0 0 1 Abortion 0 1 0 1 Lupus 0 0 1 1 Old Age 0 0 2 2 33 115 88 236 The Hospital for Consumption and Diseases of the Chest. —The deaths at this institution were 103—males 58, and females, 45; 23, 22, 29, and 29 in the four quarters respectively; 52 in the winter, and 51 in the summer, half of the year. The ages at death were:—under 20 years (youngest 13), 14; between 20 and 40, 76; between 40 and upwards (oldest 57), 13. Four of the deaths were of parishioners. Fifty-six of the deceased had previously 84 resided in the Metropolis, 14 in the suburbs or Metropolitan counties, 30 in more distant parts of the country, and one each in Wales, Orkney, and Russia respectively. The causes of death as registered, were Phthisis (consumption or decline) alone, in 81 cases, and with other visceral diseases in 9 cases; diseases of the heart, &c., in 2 cases; diseases of the lungs in 5 cases; and other diseases in 6 cases. St. Joseph's House.—The deaths at this institution were 32, viz., males 13, and females 19: all at ages over 60. The fatal diseases were—of the heart, 3; of the lungs, 1; of the kidneys, 7; of other viscera, 3; of the nervous system, including paralysis, 13; and various, 5. DEATHS NOT CERTIFIED. Sixteen deaths were returned as "not certified," the deceased having been attended in their last illness by unregistered practitioners. The number is smaller than in years prior to 1879, owing to the fact of two previously unregistered practitioners having obtained a single medical qualification, and become registered under the Medical Act, 1858. Only five of the deceased had been attended by persons professing to have medical knowledge, e.g., as "unqualified" assistants to medical men, &c.; the remaining 11, mostly infants a few hours or days old, having been attended by midwives. In nine other cases there had been "no medical attendant" in the last illness. Several of the deaths were reported to the Coroner, but no inquest was thought necessary. In one case, not previously alluded to, the cause of death was stated to be "unknown." It was that of a male child, aged about one week, whose body was "found exposed at Chepstow Villas, and was taken to the workhouse. The Coroner declined to hold an inquest." Of the above 26 cases, four were adults, viz., gentleman aged 50, alleged cause of death, disease of the heart; widow, aged 84, natural decay; needlewoman, aged 47, hemorrhage from lungs; and girl, aged 18, consumption. The registered causes of the remaining deaths were—premature birth, debility, exhaustion and inanition, in 12 cases; convulsions, 6; small pox, diarrhœa, 85 thrush, and abscess, each 1. The uncertified deaths were only 0.9 of total deaths, a very small proportion. Referring to England and Wales, the Registrar-General states that 4.7 per cent. of the total deaths in 1879 were not certified; the proportion in London as a whole being only 1.4 per cent. The subject of uncertified deaths has, on more than one occasion, been discussed by the Society of Medical Officers of Health, and in December, 1880, the Society, on the recommendation of the Council to which the subject had been referred for consideration, adopted the following resolution— "That all cases of uncertified death should be reported by the local registrar of births and deaths to the Coroner, who should, when there is no prima facie ground for holding an inquest, direct such cases to be investigated by a registered medical practitioner." It had been suggested that the duty of making the investigation should devolve on the Medical Officer of Health, as a part of his ordinary work, but the Society did not adopt this view. Of all the unsatisfactory arrangements connected with the subject of uncertified deaths, perhaps the most unsatisfactory is the responsibility cast on the Coroner's officer of making a preliminary enquiry, and of being the de facto judge whether an inquest should be held in any given doubtful case. The Society at my instance adopted the following resolution bearing on the subject:— "That in the opinion of this Society, the present system of investigation of deaths referred to a Coroner, viz., by an officer having no special qualification for the discharge of the duty, is unsatisfactory." INQUESTS. One hundred and seventy-two inquests were held during the year, 21 in Brompton and 151 in the Town Sub-district; on male persons, 100, and females, 72; the cause of death having been G G 86 ascertained by post mortem examination in 112 instances. Eightyfive of the deceased were children under five, 53 being less than one year old: 65 were aged between 5 and 60 years, and 22 were above 60. The "Violent Deaths" were 60 and of these 58 are accounted for as inquest cases. The suddenness of death is put forward as the ground for holding the inquest in 75 cases; in 33 cases the deceased were found dead, in bed or otherwise. The reason for an inquest having been held does not appear in respect of some 6 cases. The verdicts may be classified as follows:— Death due to disease 109 „ „ privation 2 „ „ unknown cause, " found dead" 3 Acccidental deaths 44 Suicidal „ 13 Homicidal 1—58 172 The diseases may be classified thus:— Diseases of the brain and nervous system (including apoplexy 11 and convulsions 20) 37 Diseases of the respiratory organs (including spasm of the glottis 6) 26 Diseases of the circulatory organs 28 „ „ other viscera 3 Debility 3, diarrhoea 2, scarlet fever 1, Dropsy 1, Hernia 2 9 Congenital malformation of the heart 3 Various 3 The Violent Deaths were caused as follows:— Accident.—Poison; opium 1, chloral 2, chlorodyne 1 4 Suffocation (infants under one) 12 Drowning 2 Choking 1 Falls, under various circumstances 13 Wounds 3 87 Blows on head (causation not discovered) 2 Kick by horse 2 Crushed in a folding bedstead 1 Burns (1) and scalds (2) 3 Run over by railway engine 1 Suicide. —By poison (prussic acid and chlorodyne) 2 By wound of throat 4 By stabs 1 By pistol wound 1 By hanging 4 By fall from window 1 Manslaughter 1 Of 60 violent deaths in the parish 9 occurred in Brompton. Among the cases described as "sudden," "found dead," &c., there were, as usual, many of persons who had died from ordinary and curable visceral diseases ; and it is impossible to resist the conviction that there had been culpable neglect on somebody's part in the failure to obtain medical assistance for the deceased; for the illnesses must have extended over many days, and been attended with obvious symptoms of a more or less serious and painful nature; and there would have been no occasion for inquests had medical certificates been forthcoming. The mere return of the cause of death by a jury in such cases seems to me scarcely to meet the requirements of justice, considering that the death of any person—but particularly of one very young or very aged—from a disease like pneumonia or bronchitis, when there has been no medical treatment, raises a presumption of neglect which would justify a verdict of "manslaughter," quite as much as in the case of the "peculiar people," who, whilst treating their sick with care in other respects, refuse on mistaken conscientious grounds, to employ medical assistance. METEOROLOGY. The mean temperature of the air at Greenwich in 1880 was 4°·49 Fahr., or 0°·1 below the average of the forty years, 1841-80. The averages of the four quarters respectively were 39°.8, 52°·8, 61°·3 and 43°'7. The highest reading by day (87°·5) was taken in the week 88 ending May 29th, and the lowest reading by night (17°'2) in the week ending January 31st; the highest reading in each of the four quarters being 62°·4, 87°·5, 87°·2, and 63°·3; and the lowest 17°·2, 31°·5, 41°·5, and 25°·0 respectively. The hottest week in the year was that which ended Sept. 4th (67°·3), and the coldest that which ended January 31st (29°'2). The dryness of the atmosphere, i.e., the difference between the dew point temperature and air temperature was 5°·0, the average of 40 years being 5°·5. The rainfall was 29·68 inches, the average of 40 years being 24·7 inches. The means of the readings of the barometer were 29·87 inches; the means of February, 29'634, and of January, 30·204, being respectively lowest and highest. VACCINATION. Table X (Appendix), is a return respecting the vaccination of children whose births were registered during the year 1880, and for it I am indebted to Mr. Shattock the Vaccination Officer, whose energetic discharge of the duties of his appointment it has always afforded me great pleasure to recognize. The return shows a loss of only 3.5 per cent. of the cases which is better than usual, even for Kensington, the loss in 1879 having been 4 and in 1878 5 per cent. It must be remembered, moreover, that the present return is, after all, only preliminary, the Local Government Board allowing vaccination officers a period of twelve months (expiring in February) for the presentation of a final return, in order that the statement, in respect of the children born in any given year, may be rendered as complete as practicable. I believe I am correct in stating that the "loss" in the column indicating "removal of children to places out of the parish unknown, or which cannot be reached, and cases not having been found," averages, in different years, from 6 to 9 per cent. in the Metropolis generally, so that the Kensington return is fully 4 per cent. better than the average. It is but what is fairly due to the Guardians of the Poor, who are the authority for carrying out the Vaccination Acts, to state that they omit no opportunity of giving effect to the law. During the current year they have adopted all practicable means, by house to house visitation, by posters, handbills, advertisements, circulars 89 to medical men, &c., to induce the public to bring up children for vaccination, and to encourage the revaccination of persons over 12 years of age, who have not previously been revaccinated. Mr. Shattock, in an interesting report, dated June 29th, 1881, has set out the results of the house-to-house visitation. It appears that three hundred and fifty-eight streets were canvassed, containing 8,500 inhabited houses, and 28,939 children in 11,136 families. Of 573 unvaccinated children discovered, 304 were found to have been born in other parishes, but by migration had escaped the Vaccination Officers of those parishes: of 269 cases of children born in Kensington the majority would have been dealt with in the usual course; in 27 cases, however, the births had not been registered, and in a few instances births had been falsely registered. In every instance discovered of a child between the ages of 14 years and three months, unprotected by vaccination, notice was at once served upon the parent or person having the custody of the child, requiring compliance with the law within 14 days. In many instances attempts were made to evade by removal, but on the case being followed the law was complied with. The 573 unvaccinated cases are thus accounted for—564 have been successfully vaccinated, one was found "unfit;" four have been lost sight of, and four were at the date of the report, under proceedings to secure compliance with the Act. "The law making no provision for house-to-house visitation, parents' statements had to be accepted," and that these statements were not always to be relied on is proved by the fact that "in numerous instances after stating that all the children had been vaccinated, the mother attended at the station to have one or two children vaccinated, fearing the consequences of her untruthful statements being found out." The good effects of the energetic proceedings of the Guardians and their officer are seen in the fact that in 18 weeks 3,283 vaccinations and re-vaccinations were done, as against an average of 720 during a similar period. Very many thousand circulars addressed to "heads of families" in the richer parts of the parish, led to the re-vaccination of large numbers of domestic servants. It is said, however, that "mechanics and the labouring classes are apparently careless "about re-vaccination, • even when small-pox has broken out in the house." To facilitate 90 re-vaccination the Guardians opened a temporary night station at Cathcart Road, in the south district, and made provision for late attendance at the public station in the north district. Proceedings were taken in two cases against married women for offences under the Births and Deaths Registration Act, viz., false statements given to the Registrar on the occasion of registering a birth, the object of falsifying the Register being to evade the vaccination of children. In the first case the woman was convicted, but the judge, whose opinions on the vaccination question are pronounced, imposed the nominal punishment of two days imprisonment, the offender being at once discharged. In the other case the offender pleaded guilty, and having been severely censured by the judge, was liberated on her entering into recognizances to come up for judgment when called upon. The Protection afforded By Vaccination.—As bearing on the question of the protective power of vaccination and re-vaccination, reference may be made to a circular letter, issued in October, 1879, by the Managers of the Metropolitan Asylum District, in which they summed up the experience acquired in the hospitals by the Medical Superintendents of the several small-pox hospitals under the control of the Board. The Managers state that "the observations of these gentlemen confirm former opinions on the subject, and establish beyond doubt the mitigating influence in small-pox cases of successful primary vaccination, and the preventive powers of efficient re-vaccination." It is needless to quote at length the valuable statistics furnished : but it may suffice to state that the mortality was 8.8 per eent. of the vaccinated, and no less than 44.4 per cent. of the unvaccinated, the observations extending to a total of 15,171 cases, treated in the hospitals in the epidemic which began in 1876. It is added, that "no case of small-pox has come within the cognizance of either of the Medical Superintendents, of any person who had been efficiently vaccinated, and successfully re-vaccinated. Moreover, the nurses and servants employed from time to time at the various hospitals during the epidemic, have enjoyed almost absolute immunity from infection; and the few—some half-dozen among nearly one thousand—who contracted the disease, whilst discharging their duties, had from 91 some cause or other escaped re-vaccination before entering the wards." The conclusion is, that if vaccination and re-vaccination were successfully accomplished at the proper times, small-pox "instead of being, as it is at present, a common and extremely fatal disease, would be a comparatively rare one, and so little fatal that few if any deaths would result from it." An interesting and valuable memorandum by Dr. Buchanan, Medical Officer of the Local Government Board, on the present prevalence of small-pox in London among vaccinated and un-vaccinated persons respectively, published as a Parliamentary paper, has been extensively re-produced and commented on in the public press. It tells the same story of the protective power of vaccination and re-vaccination, in another way, and may be read with advantage by all who are sceptical on the subject. The Alleged Dangers of Vaccination.—The question whether vaccination—I will not say carefully performed, but performed as it is without selection of cases—is attended with any, and if so what dangers ? is an interesting one, which can be solved in part only, by reference to the death registers. I have heard of only one somewhat severe case of erysipelas in connexion with the public vaccination in this parish in 1880—although many children were vaccinated at the same time with the child in question. Two deaths were recorded during the year, in the medical certificates concerning which reference was made to vaccination as a cause of death. In the one case the certificate was as follows:—"Vaccination, two years: Erysipelas, blood poisoning, and gangrene;" the certifying Surgeon being the same gentleman on whose certificates in respect of cases of scarlet fever I had to animadvert at page 19. Not much importance probably will be attached to this case. The other death was that of an infant fourteen weeks old, which was certified as being due to "erysipelas from vaccination, twelve days." The facts of this case appear to be as follow:—The child when eight weeks old was vaccinated on July 6th, being in a good state of health, and the vaccination 92 followed the ordinary course. About a week after the crusts had fallen from the arm—at a time, therefore, when the operation had to all appearance terminated successfully, the arm became red and swollen. Subsequently the same side, and later, the other arm and various parts of the body and legs, became inflamed in patches, and the skin of the reddened parts afterwards desquamated or peeled. The child was taken to a medical man on the 30th July; was seen by him at his surgery from time to time until the 14th August, and died 16th August—six weeks, less one day, after vaccination. Now there can be no reasonable doubt that this case was one of erysipelas, and the disease would appear to have been in existence 17 days, or 5 days longer than stated in the certificate of death; but having regard to the fugitive character of the inflammation—the time of its first onset, and the circumstances in which it made its appearance, viz., a week after the crusts had fallen; it may fairly be assumed that the erysipelas was an example of the variety known as "idiopathic," which comes on without the previous occurrence of wound or other injury, and was therefore, altogether independent of the vaccination. Many children were vaccinated at the same time and place with the deceased, but there was no other case of erysipelas. Animal Vaccination—Calf Lymph.—One of the most common objections to "arm to arm" vaccination is based on the fact that the lymph is passed through the human system, and therefore, it is said, may transmit disease. The dangers attending the use of humanized lymph, however, are so trifling as to be practically inappreciable. Nevertheless, and as it is desirable to remove, as far as possible, every objection which stands in the way of vaccination, it is satisfactory to learn that the Local Government Board have made arrangements for establishing a station for the supply of "calf-lymph." The first step will be to find a case of natural cow-pox (the small-pox of the cow), and from the vesicles which usually appear on the udder, to innoculate a calf. This once done, there will be practically no difficulty in getting a supply of calves, week by week, to keep up the stock of lymph. It is not intended 93 to produce the disease in the calf by the use of humanized lymph. The object the Government have in view is the same as in respect of humanized lymph, viz., to supply medical practitioners with ''stock'' lymph to enable them to start a series of vaccinations, leaving them to keep up their supplies, if they can, afterwards. Presumably, facilities will be given to enable persons who object to the use of humanized lymph to have their children vaccinated with calf lymph. It may be mentioned that the use of animal lymph is common on the Continent, and the system has been carried to great perfection at Brussels under the direction of M. Warlomont, who sends supplies to this country regularly, and whose tabes of lymph and charged ivory points can be purchased at a moderate rate. A station, moreover, has been established by a private medical practitioner in the Marylebone Road, where persons can be vaccinated direct from the calf. It is to be hoped, therefore, that so much having been done to remove possibly reasonable objections, the agitation promoted by anti-vaccinators will gradually dimmish, if not completely subside. The Government Vaccination Bill.—In connexion with the subject of vaccination, reference must be made to a retrograde step by the Government, which, if it had taken effect, might have led to small-pox becoming a common disease in the future, as it was in the now-distant past. It was a proposed concession to the antivaccinationists, in the form of a Bill (" Vaccination Acts Amendment Act") to enact that "no parent of a child shall be liable to be convicted for neglecting to take, or to cause to be taken, such child to be vaccinated, or for disobedience to any order directing such child to be vaccinated, if either (a) he has been previously adjudged to pay the full penalty of twenty shillings for any of such offences with respect of such child; or (b) he has been previously twice adjudged to pay any penalty for any of such offences in respect of such child." Had this Bill became law, any parent who objected to vaccination would have been enabled, at the cost of a few shillings, to escape the performance of what is by most reasonable persons regarded as a duty equally owing to society at large and to his own offspring. Under the existing law penalties are multiple, i.e., a parent may be fined again and again (inter alia) for neglecting to have his child 94 cinated, and for disobeying the order of a magistrate requiring him to have his child vaccinated: and although the multiplication of penalties, rendered necessary by contumacy, may seem to savour of "persecution," experience proves that it is really the only means of securing the vaccination of the children of contumacious parents, and of those who would deny their children the protection of vaccination, were it not for fear of the consequences of setting the law at defiance. But had the Government proposition been adopted, anti-vaccinationists would soon have had their way, for were the operation to cease to be compulsory, in the sense in which it is now compulsory, it would practically become optional, and thus, year by year, an ever-increasing number of persons would exist in our midst, who, being themselves unprotected by vaccination, and, therefore, intensely liable to small-pox, would become the means in any future epidemic of spreading the disease indefinitely. The disease itself, moreover, instead of appearing from time to time epidemically, as it does now, would always be in our midst, as in the pre-vaccination days. Many Sanitary and Poor Law Authorities, following your Vestry's initiative, Petitioned the House against the measure the introduction of which served the useful purpose of showing how strong public opinion is in favor of vaccination, and of the quasicompulsory law. The opposition was too powerful to be resisted: the Bill was withdrawn, and it is satisfactory to know that the Government have no intention of re-introducing the measure. SANITARY WORK. Tables VI and VIa (Appendix) summarise the chief items of Work done by the Sanitary Inspectors during the year. A not inconsiderable part of their work, however, scarcely admits of tabulation, many sanitary improvements being carried out at their instance, and under their supervision, without recourse to forms which take up time, and are, indeed, unnecessary when an owner or occupier is ready and willing to abate a nuisance or effect a desired improvement. The statement as to the "number of houses inspected" applies to primary inspections only. When a nuisance is found to exist and it is not at once abated, repeated inspections may be required—as 95 many as six, when it becomes requisite to take out a summons. In cases of infectious disease treated at home under circumstances which seem likely to endanger the spread of disease, through the omission of proper precautions, numerous visits are usually paid to the infected house, for which it has not been customary, until lately, to take credit. The total of "sanitary orders" issued comprises none of the cases in which work has been done by the owner or occupier at the request of the Inspector. During the last three years the abatement of nuisances has been much accelerated by the plan of serving "preliminary notices" upon the parties liable, immediately on discovery. These notices appear to be well nigh as effectual as the more formal notice which, previously, it had been the rule to serve after the nuisance had been reported to the Works, Sanitary, and General Purposes Committee, and your Vestry had confirmed the recommendation of the Committee. When the notice is not complied with recourse is had to a summons before a magistrate, a step which when necessary should always be taken with the least possible delay. In my last Annual Report I had to observe that " the difficulties which beset legal proceedings, i.e., at the Police Court, tend to cool the ardour of Sanitary Inspectors in having recourse to magisterial aid." I am able to bear witness to a great improvement in this respect, for acting upon a recommendation I made in 1878, your Vestry have authorised proceedings before the magistrates sitting at the Vestry Hall—an arrangement by which much time has been saved, besides securing in nearly every instance the object in view. We have cause to be grateful to the magistrates for their willingness to take our cases, adding considerably as they do to the time devoted by them to the administration of justice; and for the useful work they have done by their decisions in helping forward sanitary improvement. Daring the year ended March 25th, 1881, summonses were issued in 74 cases, and "Orders" for giving effect to your Vestry's requirements were made by the Justices in nearly every instance. Frequently one summons covered several requirements, as might be inferred from the amount of work carried out under the "orders'. In connection with water supply, orders for providing it were made in five cases; and for repairs to cisterns, &c. in 11 cases. In 21 cases orders were made to provide or connect the water 9fi service of closets. For cleansing and white-washing houses there were made 22 orders; for the repair of defective roofs of houses, &c. 12 orders; ditto of privies, 3 orders; for the provision or repair of dustbins 11 orders; for cleansing repairing, or trapping drains, 10 orders; for abolishing the waste pipe in a cistern, one order. In several instances further proceedings had to be taken on account of the parties' failure to comply with the Justices' orders. In some of these the Justices dealt very leniently with the disobedience, but in a few cases they inflicted substantial penalties. For offences under the Slaughter Houses Bye Laws, there were two convictions, a penalty of £3 and costs being inflicted in each case. For allowing offensive accummulations of manure contrary to your Vestry's regulations for the periodical removal of the same, an order for removal, and the payment of one shilling costs was made in two instances. THE LICENSED SLAUGHTER-HOUSES. The licensed slaughter-houses are 29 in number, viz., 20 north and 9 south of Uxbridge Road (Vide Table XI, Appendix, for localities of premises and names of licensees). The several premises were carefully inspected by several members of your Vestry, at whose request I submitted a Special Report in July (No. 8, page 37). On the whole there has been a very considerable improvement in the condition of the Slaughter-houses within the last few years, and I suppose it is now about as satisfactory as we can expect it to be, seeing that with one or two exceptions the premises were not constructed for the purpose to which they are applied, and that the localities are mostly unsuitable for carrying on the business. The day when London will be provided with public abattoirs, such as are to be found in several provincial cities, seems to be as distant as ever, having been indefintiely postponed by the compromise involved in the passing of the Slaughter-houses (Metropolis) Act, 1874. From time to time, since that event, material improvements have been effected at the instance of the Local Authority (Metropolitan Board of Works) on representations which were made by your Vestry. In 1878 the attention of the Board was directed to the unsatisfactory character of the traps used in slaughter-houses for trapping the drains,— 97 "bell" traps being at that time in general use; and to the fact that when the cover of a bell trap is removed, any quantity of blood, manure, &c. can be let off into the drains. Your Vestry expressed the opinion that a bell trap could not be deemed an "appropriate trap" in conformity with the 16th Bye Law; and the Board took steps to induce the licensees to adopt the syphon trap and to cover the gully with a fixed grating. The majority of the licensees at once complied with the request of the Board. In July, however, it was found that there were still five slaughterhouses having none other than bell traps, and that in other five the gratings were not fixed. A further representation to the Board having been made, the attention of the licensees was again drawn to the matter, and the defect was, in some cases, remedied prior to the licensing day in October. Your Vestry had also called attention more than once to the absence or insufficiency of the provision for watering animals in the lairs, the result being that some of the licensees subsequently fitted troughs, whilst others provided buckets, to supply the defect, It was felt, however, that provision should be made at every slaughter-house for watering the animals by the erection of permanent troughs connected with the cistern by means of piping and tap, and the attention of the Board was again called to the subject. With respect to the vessels for containing "offal, garbage, filth, blood, and manure,' it had to be observed that sufficient care is not taken to keep them clean; and that in some instances the vessels were either without covers, or were so much out of shape at the rims that, the lids not fitting, it was impossible to cover them properly. In more than one instance the vessels when in use were left uncovered, the lids either hanging up against the wall or lying on the floor. With respect to the disposal of offal, &c., the arrangements were by no means satisfactory in certain cases. It appeared that several butchers conveyed the vessels to a field near to Wormwood Scrubbs, and there deposited the blood, offal, &c., on manure heaps. Occular demonstration was had of the nuisance thus created; the stench, moreover, emitted by the refuse being perceptible at a great distance. The Bye-laws require that offal, blood, &c., should be deposited in covered vessels and removed from the premises within 24 hours, or before the same 98 shall have become offensive; it was probably never contemplated that the contents of the vessels would be disposed of in the objectionable manner above mentioned. Your Vestry directed a letter to be written to certain of the licensees, urging the necessity of greater care in complying with the provisions of Bye-laws 5 and 10 for the prevention of nuisance, and took steps to put a stop to the nuisance in the field above-mentioned. Licensing Day:—The views of your Vestry with respect to the trapping of drains and the supply of water in the lairs were brought under the notice of the Justices at the Special Sessions for licensing, October 5th, the results being that the Justices impressed on the licensees the propriety of providing a permanent water supply, and that the licenses, in certain cases, were granted conditionally on the drainage being put into proper order, conformably with your Vestry's interpretation of the 16th Bye-law, and this was subsequently done. One of the licensees, referring to the letter addressed to him by your Vestry, expressed his willingness to comply with the regulations, but complained of the difficulty experienced in getting offal, blood, &c., taken away regularly, and of the expense he had been put to in the endeavour. The Justices appeared to think it reasonable that your Vestry should, as suggested, assist the butchers in this matter: but it was explained that not only is it no part of the duty of your Vestry to undertake the removal of refuse from slaughter-houses, but that no application for such assistance had been made. As things are at present, moreover, it would be impracticable; but should "Fryer's Destructor" be adopted by your Vestry, and prove successful in operation, it might be possible in the future to undertake the destruction, if not the collection, of offal, blood, &c., at the cost of the licensees, though it is open to question whether such valuable animal matter should be destroyed '? there being reason for believing that by systematized arrangements its storage, removal and utilization might be effected without nuisance. For compliance with the regulations, nothing more is required than that offal, blood, &c., should be removed from the "premises;" but the conveyance of "offensive matters" through the streets is an important question materially affecting the comfort, not to say 99 the health, of the people, and your Vestry have referred it to the Law and Parliamentary Committee to frame a bye-law for regulating such conveyance, under the provisions of the "Kensington Improvement Act." There must be a very large amount of refuse, coming under the definition "offensive matter" and requiring to be removed daily, in an extensive parish like this, and it would be a great boon to tradesmen, among others, if some arrangement could be effected for its periodical removal. All the licenses were granted, no opposition having been raised in any case; but a ratepayer appeared before the Justices to complain of a nuisance at one of his houses in Portland Road arising from blood and manure from a slaughter-house in Princes Mews, at the rear, welling up through the drain in the back area, the drain having become choked by these offensive matters, which had been allowed to pass into the drain, instead of beingput into covered vessels for removal, as required by Regulation 5. The Justices animadverted severely on the negligence displayed by the licensee, and they were informed by your Clerk that in the event of such a thing happening again your Vestry would doubtless take proceedings for breach of the Regulations. Slaughter-House Refuse.—Shortly after the licensing day the licensees carrying on business in the Borough of Chelsea presented a memorial to your Vestry, in which it was stated that "For some time the trade has laboured under the greatest difficulty with regard to the removal of offal and manure from the different slaughter-houses, and as this difficulty is on the increase," they wished that your Vestry "would take some immediate steps to arrange for carts to call at the slaughter-houses in the early part of the morning, and convey the refuse to some proper place where it can be deposited." The memorial was referred to the Works, Sanitary, and General Purposes Committee, by which its consideration was postponed until the sub-committee, appointed to visit Leeds for the purpose of seeing "Fryer's Destructor" in operation, should have presented their report, an event we are now (in June) looking 100 forward to with considerable interest. The subject of "trade refuse" is further dealt with at page 113 in a report thereon by the Society of Medical Officers of Health. At the date of the passing of the Slaughter-Houses (Metropolis) Act 1874, the number of private slaughter-houses in the Metropolis was 1429. At the end of 1880 the number had become reduced to 90S by the gradual abolition of the least suitable of the licensed premises. LICENSED COWSHEDS. The licensed cowsheds are 23 in number, viz., 15 in the district north of Uxbridge Road, and 8 in the remainder of the Parish south of that Road (vide Table XII. Appendix, for localities of premises and names of licensees). The several sheds were as usual inspected by the Works, Sanitary, and General Purposes Committee, from whose report the following excerpts are taken. Referring to the "Provisions" of the Regulations framed by the Metropolitan Board of Works (Local Authority, under the Contagious Diseases Animals Act, 1878,) the Committee observed that— "Not one of the provisions is more important than that which requires that ' every cow-shed shall be well paved with Stourbridge or other impervious brick, or other impervious material, set with cement, properly bedded on concrete, with a proper slope towards a gully-hole; and although the Board required the paving of several of the sheds to be re-constructed, more or less, to bring them into conformity with the Regulations, it is scarcely too much to say that, with here and there an exception, this regulation has not been carried out. The paving of many of the sheds is irregular, and, beyond slight reparation it has undergone no improvement in the majority. Speaking generally, the paving is usually of bricks which are not impervious; the bricks are not set in cement; the jointing is more or less defective, and it is probable that in nearly all cases the paving is not bedded on concrete. "Provision 7 of the Regulations, moreover, requires the drains to be trapped by an 'appropriate' trap, and the gully-hole to be covered with a fixed or locked grating, &c. In the majority of the sheds the trap is of the 'bell' pattern, which cannot be deemed 'appropriate' for a cow-shed any more than for a slaughter-house. 'Gratings' over the gully-holes are the exception rather than the rule, and the covers, of whatever character, are usually removeable. The same 'provision' requires the gully-hole, 'where practicable,' to be 'outside the shed.' Should the paving be re-constructed in conformity with the provision of the regulation, viz., 'with a proper slope,' it would be 'practicable,' generally, to place the gully-hole outside 101 the shed; a desirable improvement, for now the gully is usually in the channel, within reach of the hoofs of the cow, and thus the grating is liable to get broken, and it is often obstructed with excrement, &c. "With respect to 'air space' your Committee saw nothing to lead them to modify the opinion of your vestry that anything short of 800 cubic feet per cow would be insufficient; and they learnt with regret that the Local Authority had authorised one of the licensees to keep an increased number of cows, beyond the number for which the license was marked by the Justices, thus reducing the air space to 600 cubic feet for each animal, the floor space, moreover, being below the prescribed amount.* Of the shed in question it cannot be said that, 'taking into consideration the position and construction of the shed, there are perfectly satisfactory means of ventilation,' but quite the contrary; and if there is one shed in the parish where the 800 feet for each cow, as regards the greater part of the premises, ought to be insisted on, this is the one. The shed is close to the rear of houses, the inhabitants of which complain of effluvia issuing therefrom. "The third ' Provision' requires 'for each cow kept in one stall a superficial space of at least 8 feet by 4 feet; and for two cows kept in one stall a superficial space of 8 feet by 7 feet.' Your Vestry had previously adopted a width of 7 feet 6 inches for a double stall; but in several of the sheds the space now existing in double stalls is even less than 7 feet. A question has arisen whether the length of the stalls should be reckoned from the front or the back of the ' water-trough' or manger ? In certain sheds some of the stalls are considerably less than 8 feet in length from the front of the trough, and the cows appear cramped for standing room. It seems reasonable to believe that the 8 feet length was intended to include the standing room independently of the manger; the requirements in respect of the water-trough being the subject of a distinct provision, viz., No. 9. " Provision 5, for 'covering the inner walls, doors, and woodwork of the sheds with hard, smooth, and impervious material to a height of at least 5 feet from the floor,' has been generally carried out; viz., by covering the walls with cement, and painting the woodwork with ' indestructible ' or silicate paint. In some cases, only the wall in front of the cows has been covered with cement. " The ventilation of some of the sheds appeared to be insufficient, even in summer weather. It must naturally be more defective when windows and doors are closed. The same remark applies to the lighting. " Some of the licensees consider it desirable to keep the shed hot, others prefer a cool atmosphere. Your Committee, basing their opinion on the ventilation of the sheds partly, at least, on the effects produced on their own sensations, are decidedly in favor of the cool sheds as compared with those that are hot and stuffy. On the whole, however, both ventilation and lighting have been considerably improved. * The attention of the Local Authority having been drawn to this matter, it was explained that their action was taken "in ignorance of the fact that the Justices had limited the number of cows to be kept in the sheds," and the matter wasset right at the Special Licensing Sessions in October.—T. O. D. H H 102 "With a view, apparently, to proper cleansing by flushing, Provision 8 of the Regulations requires the water-tank to be 'so placed that the bottom thereof shall be not less than six feet above the floor level.' It requires further that the tank shall be 'provided with piping for conveying the water to the cow-shed; 'while Provision 9 requires piping to be laid on to the trough or manger. At some of the sheds the cistern is much lower than the prescribed level. In nearly all the sheds piping is laid on to the sheds and to the troughs, but in some cases the supply-pipe of the trough was found defective, in others it appeared to be not used. In more than one instance the trough was improperly constructed, in part, of wood, instead of being wholly formed of, or covered by impervious material. "The grain-pit is required to be 'properly drained,' but in many sheds the (bell) trap is so placed as that it must either get choked or be dry; and in the latter case instead of carrying off liquid it would admit foul air from the main drain and sewer. In some instances the dung-pit adjoins the grainpit, and where the party-wall is not effectually lined on either side with cement there is danger of percolation from one to the other. Some of the dung-pits are not drained, and at several sheds there is no properly constructed dung-pit; at others, again, no properly constructed grain-pit. In several sheds the grain-pit communicates directly with the shed, contrary to Provision 6 of the Regulations." Cowshed Refuse.— Speaking generally, it must be acknowledged that the cowsheds are better kept than they formerly were ; more care and punctuality, however, are required in removing the manure through the streets, the vehicles used being unfit for the purpose, and giving rise to effluvium nuisance in transitu. This subject is further dealt with at page 114 in a report thereon by the Society of Medical Officers of Health. Licensing Day.— Prior to the licensing day a copy of the Committee's Report was forwarded to each of the Magistrates of the Kensington Division. All the licenses were renewed, only one license being opposed by inhabitants in the locality, on the ground of nuisance; but some of the Magistrates having inspected the shed granted the license, the proprietor having promised to do everything in his power to prevent annoyance to his neighbours. The licensing day was marked, nevertheless, by important incidents deserving of notice in this place. In Special Reports on the cowsheds in 1879, your Vestry's Works, Sanitary, and General Purposes Committee entered fully into the question of cubic or "air space," and while expressing regret that the local authority 103 (Metropolitan Board of Works) should have recognised a low standard of air space—viz., 600 cubic feet per cow—in certain exceptional cases, they noted with satisfaction that the magistrates in the Kensington Division had in nearly every instance insisted on the full minimum of 800 cubic feet per cow in Kensington cowsheds, moved thereto by their conviction of the reasonableness of your Vestry's views, which had been brought under their notice from time to time. The Bench had for several years adopted the 800 cubic feet standard in the case of all sheds newly licensed in Kensington, and at the Sessions in October, 1879, they announced that the cases dealt with exceptionally on that occasion would be brought under the general rule in 1880. It affords me much satisfaction to report that, not only did the magistrates give effect to this their decision in respect of Kensington cowsheds, but that they also extended the rule over the entire Division, which includes the parishes of Fulham, Hammersmith, and Chelsea. Instead of granting a license, as heretofore, for such a number of cows as the proprietor of the premises desired to keep, or as the "Local Authority," or the Vestry, or the District Board of Works might be pleased to approve, the magistrates ascertained the cubical contents of each shed, and dividing this total by 800, arrived at the proper number of cows for which the shed should be licensed, and marked that number on the license. The important question of cubic or air space may now, therefore, be considered settled, so far as this Division is concerned, and it can hardly be doubted that the example set by the magistrates here will sooner or later (and the sooner the better) be followed in all the other Divisions of this great metropolis. Present Requirements.— Many alterations and improvements are still necessary at some of the cowsheds to bring the structural condition of them into conformity with the provisions of the byelaws. The most serious question, and one that your Vestry have hitherto left in the hands of the Board, relates to the paving of the sheds. The seventh "provision" of the regulations requires that ''every cowshed shall be well paved with Stourbridge or other impervious brick, or other impervious material, set with cement, properly bedded on concrete, with a proper slope towards a gulley-hole," and it must be said that with a very few exceptions, this "provision" has 104 not been carried out, and that if it were to be carried out, it would involve the repaying of most of the sheds with new material, for, with here and there an exception, the material of the existing pavements is not impervious. Your Vestry called the Board's attention to this "provision" in August, and the Board, in a letter dated 15th October, intimated that "such provisions are only intended as a standard or guide—having no legal force beyond what is given by section 6 of the Dairies, Cowsheds, and Milkshops Order of July, 1879." The sixth section, it may be mentioned, makes it "unlawful for any person following the trade of a cowkeeper to occupy as a cowshed any building if, and as long as, the lighting and the ventilation, including air space, and the cleansing, drainage, and water supply thereof, are not such as are necessary or proper (a) for the health and good condition of the cattle therein and (c) for the protection of the milk therein against contamination." The Board have framed their regulations under the "Order," and the Order is authorised by the 34th section of the Contagious Diseases (Animals) Act, 1878, which enables the Privy Council "from time to time" to make orders (inter aliaJ "for prescribing and regulating the lighting, ventilation, cleansing, drainage, and water supply of cowsheds," and "for authorising a local authority to make regulations for the purposes aforesaid." Sections 60 and 61 of the Act provide that any person who does anything in contravention of an Order in Council, or of a regulation of a local authority, will be guilty of an offence against the Act, and be liable to a penalty not exceeding twenty pounds." The question therefore, is whether the 6th regulation referred to goes beyond the powers conferred on the Board by the Order framed by the privy Council under the Act ? In my opinion it does not, and I should think no one acquainted with the subject would question the necessity of the "provision" of a sloped and impervious flooring to secure the proper drainage and cleansing of the cowshed; the preservation of the health of cattle kept therein day and night for months together; and the protection of the milk therein against contamination from foul emanations from a subsoil reeking with accumulated filth. It is to be hoped, in any case, that the Board and the Sanitary Authorities will co-operate to secure obedience to the provisions of 105 the regulations. Should difficulties arise, through unwillingness of individuals to comply with the requirements, the intervention of the Justices may be invoked with confidence, as it is in their power to refuse the license, i.e., if they are not satisfied of the fitness of a shed in a sanitary point of view, and should they feel unable to impose the penalty for breach of the regulations. They have repeatedly refused, at the request of a Sanitary Authority, to renew a license until the Authority had notified the removal of defects which had provoked opposition. It may be mentioned that it is not lawful for any person to begin to occupy any building as a cowshed without first giving one month's notice in writing to the Local Authority of his intention to do so, and he cannot so occcupy any building for the purpose of a cowshed unless, and until, he first makes provision, to the reasonable satisfaction of the Local Authority, for the lighting and ventilation, including air space, and the cleansing, drainage, and water supply, of the same, nor unless the lighting, ventilation, &c., are such as are necessary and proper for the health and good condition of the cattle therein. THE DAIRIES, COWSHEDS AND MILKSHOPS ORDER, 1879. Eight thousand and three persons have been registered under the "Order" in London to the end of 1880: of whom 1,044 were occupiers of licensed cowsheds, the remainder being dairymen or milk sellers only. It is a curious circumstance that the carrying out of so important an Order should have been entrusted as a rule to bodies which have no sanitary machinery. Thus in the Metropolis (City excepted) the Metropolitan Board of Works is the "Local Authority," and in the provinces the county magistrates, by virtue of the provisions of the Contagious Diseases (Animals) Act, 1878. The Board in London have delegated the duty of inspection of cowsheds and dairies to a very limited number of 106 officers who have multifarious duties to perform under other Acts ; and in the counties the magistrates, almost universally, have entrusted the duty, to what little extent it is carried out, to the police. Arrangements such as these are not calculated to ensure the results intended by the legislature, and they do not meet with the approval of sanitarians to whose representations the 34th section of the Act and the Order itself may be said to be due. These unsatisfactory arrangements formed the subject of discussion at a Meeting of the Society of Medical Officers of Health, held in December, 1880, when the following resolution was unanimously adopted:— "That in the opinion of this Society it is desirable, having regard to the more effectual prevention of the spread of zymotic disease by the agency of milk, that the special sanitary supervision and inspection of cowsheds, dairies, and milk shops should be entrusted to the Local Authorities, to the Medical Officers of Health, and the Sanitary Inspectors of the respective districts." CATTLE DISEASES. Cattle Diseases, "Foot and Mouth" (Eczema epizootica).— In connexion with the subject of cowsheds reference may be here made to this cattle disease, which has been very prevalent in the country, many large districts having been "proclaimed." Several cowsheds in London were declared " infected places," including three in Kensington, and the Metropolitan Board of Works, as Local Authority, under the Contagious Diseases (Animals) Act, 1878, and the Dairies, Cowsheds, and Milkshops Order, July, 1879, addressed a letter to the Medical Officers of Health of the Metropolis, directed to the question of enforcing the 8th section of the above-named order, which prohibits the sale or use of the milk of a diseased cow for human food—considering it desirable to assist the Medical Officers of Health in preventing the dissemination of disease by means of "contaminated milk." The Board arranged to report the occurrence of cases, and also when the 107 sheds were free from the disease. The 8th section of the Order as already intimated, prohibits the use of the milk of a diseased cow for human food; and that prohibition should be enforced in respect of this disease; but there is considerable doubt whether the milk of a cow suffering from foot-and-mouth disease is capable of conveying any disease to man—the evidence on which the assertion that it can do so is based being of questionable value, and there being plenty of evidence that such milk has been used by children without apparent injury to health. The secretion of milk rapidly falls off moreover, and soon ceases with the increase of febrile disturbance. In any case, however, as cattle proprietors are compelled under heavy penalties to report the outbreak of disease, there is little fear of "contaminated milk" being produced in London cowsheds. The "Local Authorities" under the Act, and the Order in the provinces, moreover, are so keenly alive to the necessity of checking the spread of animal infectious diseases, that they are little likely to neglect any precautions for giving effect to the 8th section of the Order. One could wish, for the sake of humanity, that they were equally careful to enforce the following section, which makes provision against contamination of milk by prohibiting any peron suffering from an infectious disease, or having been in contact with a person so suffering, from taking part in the conduct of the business of a cowkeeper or a dairyman. But as the local authorities almost universally have confided the execution of the order to the police, there is small prospect at present of this important 9th section receiving the attention necessary for the public protection. Cattle being property, are much better looked after, as the law stands, than man, in respect of the prevention of the spread of infectious diseases. The occurrence of such diseases must be reported, infected animals being isolated and quarantined, if not at once slaughtered. Unwholesome Food.— The question whether the flesh of cattle affected with foot and mouth disease is fit for food, or whether it falls within the category "diseased, unsound, or unwholesome" food, has been much debated, and may be conveniently referred to here. Diverse opinions have been expressed, 108 but on the whole it must be admitted that the evidence of its unfitness is weak and ill supported by facts; and as a matter of fact no objection is made to the sale of the meat for human food. Many persons knowing the rapid loss of condition and the consequent depreciation in value of cattle allowed to pass through the disease, have the affected animals killed in the earliest stage. In the later stage it would hardly pay to kill them for food: it may be assumed, therefore, that if the meat of animals affected with this disease is sent to market at all it will be in the earliest stage of the complaint, before any changes affecting it injuriously have taken place—not that I am aware of any ill consequence arising from the use of the meat at any stage of the disease. Pleuro-Pneumonia.— A still more interesting question in connection with the subject of "diseased" meat may be here referred to, viz., whether the flesh of animals affected with "lung-plague" (pleuro-pneumonia) is fit for food ? The Special Purposes and Sanitary Committee of the Metropolitan Board of Works, the Local Authority for the Metropolis (outside the City) under the Contagious Diseases (Animals) Act, 1878, have recently resolved no longer to allow the flesh of cattle slaughtered by their direction, to be sold for human food, as previously had been the custom, at the discretion of the Board's Inspectors. Without pretending to decide the question of the fitness of such meat for human consumption—although I am inclined to believe that the observation expressed above, in respect of the fitness for food of the flesh of animals affected with foot-and-mouth disease, might be applied with safety in this case also—I may say that it was an anomaly that the sale of it, which had often entailed fine and even imprisonment on the vendors in the City, had a quasi legal sanction outside the City boundaries. The desirability of assimilating the practice all over London was unquestionable: and it is so far satisfactory that, in making such assimilation, the benefit of any doubt that may have existed should have been given to the consumer.* Whilst on the subject of diseased meat reference may be made to Trichinosis, the name given to a rare, but very dangerous * Since the Report has been in type I have learned that the Resolution of the "Special Purposes and Sanitary Committee," to the effect stated in the text, has not been carried out: therefore the "anomaly" continues.—T. o. D. 109 malady, produced in man by eating the raw or insufficiently cooked flesh of swine in which the disease exists. The disease is most common in America, and is known as swine fever or hog cholera. It consists essentially in the presence of innumerable parasitic worms rolled up in microscopic balls in the muscles, and presenting the appearance of minute specks in the line of muscular fibres—the parasite being known as trichina spiralis. There was considerable alarm in the early part of the current year owing to the alleged excessive prevalence of the disease in American pigs, and consequently in American pork and bacon—for the preparation of pig meat as ham, bacon, pork, &c., does not kill the parasite, nothing short of thorough cooking being effectual for this purpose. The disease is more common in Germany than elsewhere, consequent on the habit of the people of eating raw meat in the form of ham, sausages, &c. The French Government forbade the importation of American bacon, pork, &c., on the ground that some cases of trichinosis had occurred, and that it was impossible to examine with the microscope all parcels of imported meat. The Local Government Board in this country issued a circular letter to Health Authorities (and your Vestry among the number,) calling their attention to this question, and urging that the Medical Officers of Health and the Sanitary Inspectors should use special vigilance in carrying out their inspection in relation to the descriptions of meat referred to ; and the Medical Officer of the Board (Dr. Geo. Buchanan) prepared an interesting memorandum on the subject, to go with the circular letter. It may be satisfactory to state that Dr. W. Sedgwick Saunders, the Medical Officer of Health of the City of London, who has unequalled opportunities of investigation in the Smithfield Dead Meat Market, reported to the Commissioners of Sewers that he had examined numerous samples of meat, specially selecting those that, from their appearance, poorness, &c., seemed most likely to be infested, without in any case discovering the parasite. The Local Government Board, it should be added, expressly stated that they had no information of the existence of the disease in Great Britain ; but while trusting that the prevalence was not to be apprehended, they did but exercise a judicious prudence in recommending special precautions to be taken in regard to the matter, and particularly where foreign pork and bacon were concerned. I 110 have only to add that it is extremely desirable to avoid the use of underdone (and still more of raw) pig meat in any form, and that special precautions should be taken to very thoroughly cook, and, even, to "overdo," such meat. Subject to such precautions, even trichinous meat might be used without producing the dangerous disease in question, although, as a matter of prudence, any suspicious meat should be instantly destroyed. GLANDERS. I referred in my last Annual Report to the subject of glanders in horses, a disease that had attracted considerable attention owing to a serious outbreak at Colville Mews which led to two deaths of parishioners; owing, moreover, to the actual prevalence of the disease in your Vestry's stables, and to the alleged extensive prevalence of the disease in the parish. We have heard but little of the subject, locally, during the past year; no further outbreak happily having occurred in your Vestry's stables: but it would appear from the Annual Report of the Metropolitan Board of Works that many horses have been destroyed on account of glanders, and the related disease, farcy. There is ground for believing, however, that the apparently increased frequency* of the disease is due to the fact that the prosecutions instituted by the Board, and the infliction of maximum penalties by the Magistrates, have led to an early disclosure of cases, rather than to any actual increase. In January, 1881, I received information that a member of the family of horse copers, who had been mixed up with the Colville Mews outbreak, had taken premises in Royal Crescent Mews, and was slaughtering glandered horses there. It turned out on enquiry that horses, whether glandered or not, had been slaughtered on the premises in contravention of the provisions of the Slaughter Houses (Metropolis) Act, 1874, but upon the premises being visited by the police at my request they were found to be empty, the tenant having taken alarm and decamped. * "The number of cases of glanders (573) and farcy (426) reported on by the Board's Veterinary Inspectors in 1880, is larger than in any previous year." Annual Report of Metropolitan Board of Works 1ll HOUSE REFUSE. The collection of dust and ashes, and miscellaneous refuse from upwards of 20,000 houses, in an area of more than 2,000 acres, is no light task, and complaints of neglect were habitual when the work was carried out under the contract system. So frequent, indeed, did complaints become at last, that a desire to satisfy the legitimate requirements of the parishioners in respect of the removal of house refuse, had its due influence in determining your Vestry, in 1877, to abolish the contract system altogether, and undertake the collection with an ample staff and plant. The result has justified the decision, for the work has been done in an increasingly satisfactory manner: complaints are now rare, and even applications for removal of the dust are comparatively few in number. Oftentimes, moreover, when the dustmen, or your Vestry, get censured for alleged neglect, it turns out on enquiry that the domestic servants are to blame—the hour of the dustman's call is "inconvenient"; or "the steps have just been cleaned"; such excuses, or some other excuse equally valid from a servant's point of view being deemed sufficient justification for the perpetuation of a nuisance. And nuisance always arises from the improper use of the receptacle by the deposit therein of animal and vegetable refuse; of which it may be said that the former has an appreciable value, and should be utilized, while the latter admits of being burned on the kitchen fire. A notification to this effect was left at every house in the parish in 1873, and subsequently repeated, not, I fear, with any conspicuously good result. A strong effort has been made to systematise the work of dust collection by dividing the parish into districts, and providing for the inspection of dust bins and for supervision of the "dustinggangs." The one thing needful for success is a systematic call at every house once a week. Hitherto the rule, or at any rate the order, has been that a dust cart should go through each street once a week on a given day, and that a call should be made at each house once a fortnight. If the plan of a weekly call could be organised, it should be understood that if, through default of domestic servants, or any other cause beyond the control of your Vestry, the receptacle is not emptied on the appointed day, no further attendance could be given in the same week. 112 It may be mentioned that a dust-bin properly placed, and used properly, is not a "nuisance" perse—becomes, indeed, little more than an inconvenience even when full; and that it is not fair that dustmen should be exposed to needless risk of health and to annoyance resulting from misuse of the receptacle. It is a fair question, indeed, whether those who misuse the dust-bin, and then complain of your Vestry's "neglect," should not be held responsible for the creation of a recurring nuisance ? The subject of house refuse is further dealt with at page 114 in a report thereon by the Society of Medical Officers of Health. STABLE REFUSE. For several years I have felt it my duty to draw your Vestry's attention to the subject of the removal, or rather the wow-removal of stable refuse. Regulations have been framed and published enjoining "periodical removal of manure, etc.," by the owners under the provisions of The Sanitary Act, 1866, which prescribes a penalty of twenty shillings a day for default. But still the most frequent cause of complaint by parishioners, and the most frequent of recurring nuisances, arises from the neglect of this obligation. Proceedings have been taken occasionally to enforce the regulations, but with little success, the offenders having usually been able to satisfy the Magistrates that the duty required of them was beyond their power to perform. The difficulty not seldom originates with the coachman who will not give the refuse away, while the farmer or his carter will not pay for it. At certain seasons, e.g., hay-making time and harvest, there is a real difficulty in getting the receptacles cleansed. The refuse nevertheless has value, if it could only be got to the land without undue expenditure. The quantity of refuse made in the stables in this large parish, with its 150 mewses is very great, and of an aggregate value, probably, more than sufficient to pay for the cost of collection and removal from London. It is a question whether vour Vestry should not undertake such collection and removal as the law allows, "with the sanction of the owner," a sanction which would be cheerfully given in many instances, and which, probably, it would not be difficult to obtain in most cases, if it were understood that the " Regulations" would be enforced. 113 The regulations require that the manure should be removed "every alternate day." Twice a week in summer, and once a week in winter would probably suffice for all practical requirements in ordinary cases, if the manure were stored in properly constructed receptacles above ground. Owing to inclement weather in the early part of the present year,—snow having fallen in large quantities and remained long on the ground, the removal of manure was suspended for a lengthened term, with the usual result of a crop of complaints from residents in the vicinity of the mewses. The nuisance was all the greater as the manure had been spread to enable coachmen and others to exercises their horses, the effect being that the straw had become crushed and sodden, and thus rendered more offensive than usual. When collected after the thaw much of the filthy stuff was piled up against empty stables, there being no room for it in the pits, etc., at occupied stables, and thereby the responsibility of its removal was so shifted, that in many instances your Vestry had to send carts into mewses and take it away. Acting on my suggestion, your Vestry circulated a special handbill calling upon the proprietors of stables to remove the accumulated manure without delay, and intimating that proceedings for the recovery of penalties under the regulations would be taken in case of default. The ordinary machinery by means of market garden carts utterly broke down in the emergency, and it was many weeks before the parish was restored to its ordinary condition in respect of stable manure ; and this, as I have said, is by no means satisfactory. A very large portion of the time of the Sanitary Inspectors is taken up in the endeavour to keep the several districts fairly clear of manure, time which in different circumstances would be more profitably occupied in other directions. This subject is further referred to in a special report thereon by the Society of Medical Officers of Health, in the following section. TRADE, HOUSE, STABLE & COWSHED "REFUSE." In previous sections, viz., "Slaughter Houses" (page 96); "Cowsheds" (page 102); "House Refuse" (page 111) ; and "Stable Refuse" (page 112); I have referred to the difficulties 114 experienced in preventing nuisance from accumulations of offensive matters coming under the general description refuse. The difficulty is common to all parts of the Metropolis, and calls for legislative interference for its abatement. With a view to such steps being taken I brought the subject under the notice of the Society of Medical Officers of Health in 1880, the result being that a special Committee, consisting of the Medical Officers of Health for the City (Dr. W. Sedgwick Saunders); St. Pancras (Mr. Shirley Murphy); Marylebone (Mr. Wynter Blyth); and Kensington, with Dr. Alfred Carpenter, of Croydon, was appointed to consider and report— "On the best and most convenient ways of dealing with animal and vegetable trade refuse, e.g., from slaughter houses, fishmongers, poulterers, and greengrocers shops, &c., with a view to its collection, removal, and ultimate disposal, whether by utilization or destruction." On the suggestion of Dr. W. Sedgwick Saunders, the subject of house refuse was added to the reference, and at a later time, when I had had recent and very acute experience of the difficulties of the manure question (vide page 113), the reference was still further enlarged by the addition of "stable and cowshed refuse In due course the Committee, which did me the honour to appoint me their Chairman, presented a report, which having been considered by the Society at a meeting specially called for the purpose in June this year, was unanimously adopted as follows:— Report of the Society of Medical Officers of Health. " The Committee appointed to consider— 1. The best and most convenient method of dealing with animal and vegetable trade refuse (e.g. from slaughterhouses, fishmongers, poulterers, greengrocers' shops, etc.), with a view to its collection, removal, and ultimate disposal, whether by utilization or otherwise; 2. The collection and disjwsal of house refuse; and 3. The collection and disposal of stable and cowshed refuse, 115 Beg to report as follows:— "1. With respect to trade refuse. The Metropolis Local Management Act (18 & 19 Vict. cap. 120, sect. 128) entitles the owner or occupier of any house or land to require the "scavenger" to remove the refuse of any trade, manufacture, or business, etc. on payment of a reasonable sum by way of compensation; but the Nuisance Authority, which by its own staff, or by its ' contractor' is the 'scavenger,' has at present no power to remove trade refuse, whatever its nature or condition, excepting on the requisition of the owner or occupier as aforesaid. The Committee, however, are of opinion that, as the refuse of slaughter-houses and the refuse of the trades of fishmonger, poulterer, greengrocer, etc. (being of animal or vegetable origin and liable to decomposition), would, if not speedily removed from the premises, become a "nuisance and injurious to health," the Nuisance Authority should have power, as well as obligation, to collect, remove, and dispose of such refuse, and should receive reasonable compensation for so doing. "In the City of London the Nuisance Authority (Commissioners of Sewers) do, as a matter of fact, collect trade refuse—animal and vegetable—receiving payment; and the Committee are informed by the Medical Officer of Health that the Commissioners have under consideration a scheme for its profitable utilization—a scheme which is the more likely to succeed as the Commissioners will have to deal with large and regular supplies. It is open to question whether the Nuisance Authority in a district not having public markets could profitably utilize limited quantities of animal refuse directly ; but posbibly a scheme might be arranged for this purpose through the agency of establishments where "offensive trades " are carried on under the provisions of the Slaughter-houses (Metropolis) Act, 1874. "In any case the refuse should be collected daily in the early morning hours, and conveyed in properly constructed covered receptacles, or in vehicles expressly adapted for the prevention of effluvium nuisance. Failing an arrangement for utilization, 116 each district should provide the means of destroying animal refuse. It appears doubtful whether vegetable refuse could be properly utilized in London by the process of ' carbonisation,' but the destruction of such refuse by fire could be effected without difficulty or nuisance. "2. With respect to the collection and disposal of house refuse. It is almost superfluous to observe that the Committee cannot approve of the refuse being deposited in large heaps or 'tips' in or near towns or inhabited dwellings : its use for levelling land for building purposes is now very properly forbidden by the bye-laws regulating the foundations of buildings,* and its destruction in the open air, creating an intolerable nuisance, is impractable. "The refuse, moreover, is not without value—the 'breeze,' for instance, being almost indispensable to the brickmaker. The value, however, has decreased of late years, for the growth of London has led to the production of the refuse in larger amount, while the increased distance to the brickfields has greatly increased the cost of carriage. "Formerly contractors were willing to pay large sums for the privilege of removing the contents of dust bins. Now they invariably receive payment. The expense to the Nuisance Authority, however, is not so great as it would be were not the refuse capable of utilization for various trade purposes. Of these, the manufacture of bricks is the most important; and it is, perhaps, not to much to say that the diligence of the contractor in carrying out his contract is governed to no inconsiderable extent by the season of the year and by the demands of the brickmaker, so that the dust bins are apt to be neglected when their contents are not in requisition in the brickfield. "The Committee consider, however, that the removal of house refuse ought not to depend upon its pecuniaiy value, * Vide Bye-laws made on Oct. 3rd, 1879, by the Metropolitan Board of Works, under the provisions of the Metropolis Management and Buildings Act, 1878, sec. l6, 117 but should be regarded from the sanitary rather than the commercial point of view, and they are of opinion that the time is at hand when the Nuisance Authority will have to adopt the process of refuse-destruction by fire, in specially constructed apparatus, such for instance as is in operation at many great provincial centres of population, e.g., Birmingham, Leeds, Manchester, Warrington, etc.* The mere reduction in bulk resulting from this process (some 70 to 80 per cent.) is in itself a great gain, so that in the event of no practicable means of utilizing the products of combustion—slag and dust being found, the quantity of perfectly innocuous matter to be disposed of would be relatively small. This is a very important factor in the case having regard to the limited facilities for water carriage, and to the exhorbitant, not to say prohibitory, cost of railway carriage. The slag, however, is useful for making up roads ; and ground into powder and mixed with lime it makes a valuable mortar, which in the provincial towns finds a ready sale at a remunerative price. "The combustion apparatus might be made available for the destruction of vegetable refuse and of infected articles ; and probably it would suffice for the destruction of small quantities of animal refuse, failing any scheme for its ' utilization.' "The Committee, in concluding this section of their report, desire to place on record their disapproval of the present system of storing house refuse in "dust-bins," in close proximity to dwelling houses, a system unjustifiable on sanitary principles and productive of nuisance at every stage. Legal provision should be made for the daily removal of the refuse in covered carts, and to facilitate collection the refuse should be deposited in suitable receptacles which should be placed evenmorning on the pavement in front of the house. " 3. With respect to stable and cow-shed refuse. The Nuisance Authority has power under the 53rd section of the Sanitary Act, 1866, to make regulations for the ' periodical removal' by the owner of manure, etc., and an ample penalty, * "Fryer's Destructor" may be mentioned as the best known form of such apparatus for the " destruction" of refuse by fire."—T.O.D. I I 118 twenty shillings per day, is provided for default. Nevertheless, where regulations exist they are rarely carried out strictly, for this reason, among others, that it is found difficult to get the Justices to inflict the penalties for neglect or default. "Of late years the difficulty of procuring the removal of the refuse has considerably increased, owing to the growth of London and the greater distances to the fields and market gardens. Formerly stable manure was in request by market gardeners, who paid a good price for it. Now, horse owners generally have to pay for its removal, or at best to give it away. It is often difficult, moreover, to get it removed on any terms, for, as a rule, it is conveyed in vehicles returning from the markets; and at certain seasons of the year, e.g., hay-making and harvest time, it is practically impossible to get the farmers to send their carts so regularly as is necessary for compliance with the regulations. "'With the permission of the owner,' the Nuisance Authority may collect the refuse : but the Committee are of opinion that the Nuisance Authority should have the same right everywhere as in the City of London,* to collect it when the owner is in default, and to charge him for so doing. There is good ground for believing that many horse owners would be glad to be relieved of the difficulty and responsibility of their position under the 'regulations,' and would be willing to pay a reasonable compensation to the Nuisance Authority to cover the cost of the removal of the refuse. The penalties for default of compliance with the regulations should be rigorously enforced against persons who fail to come to an arrangement with the Nuisance Authority. Less difficulty is experienced in enforcing the removal of cowshed refuse, this being further provided for by regulations framed under the 'Dairies, Cowsheds, and Milkshops Order, 1879;' the Nuisance Authority, moreover, being able to bring pressure to bear on offenders on the occasion of the annual application for the renewal of the cowshed license. * City of London Sewers Act, 1851, 14 and 15 Vict., cap. 91, sec. 8. 119 The cowkeeper being thus compelled to incur the expense of removing his shed refuse regularly, would probably welcome any scheme whereby, without increased outlay, this duty would be taken off his hands by the Nuisance Authority. "The refuse of cowsheds should be removed within specified hours in the early morning, in vehicles specially constructed so as to prevent slopping and effluvium nuisance. It would be found difficult in some districts to remove stable refuse within the same hours, and the necessity for so doing would be less, provided it were found practicable to abolish sunken dung-pits, in which manure rapidly ferments and decomposes, giving rise to intolerable nuisance when the receptacle is emptied, and also in the passage of the cart through the streets. Were the plan universal of employing properly paved and drained receptacles enclosed within iron racks above the surface of the ground, so as to dry the refuse by air currents, its removal might be effected at any period of the day without offence, provided it had not been kept too long in the stable or in the receptacle itself, so as to become rotten and offensive. "The Committee having in the second and third sections dealt with the 'collection' of house and stable refuse, have now only to express their conviction that legislation will be found necessary to solve the difficulty attending the ultimate "disposal" of such refuse, viz., by imposing on canal and railway companies the obligation of conveying it from towns in boats or vans, expressly contrived for the avoidance of nuisance, and at a rate for carriage which, while fairly remunerative, shall not be oppressive to the ratepayers—power to settle the rate, in case of dispute, to be vested in the Railway Commissioners or some similar tribunal having an equitable jurisdiction." It may be mentioned that the Society directed the above report to be forwarded to the Sanitary Authorities of the Metropolis : and to those Members of Parliament likely to take an interest in the subject. 120 BAKEHOUSES. The special duties formerly devolving on your Vestry's officers under the provisions of the Bakehouse Act were transferred in the year 1879, to Government Inspectors appointed under the provisions of the Factory and Workshops Act, 1878. The Sanitary Inspectors, nevertheless, have continued to exercise a considerable amount of supervision over the bakehouses as a part of their routine work, and I have no doubt that a continuation of thenperiodical visitations is desirable in the interests of the public. There are about 133 bakehouses in the parish, 81 north and 52 south of Uxbridge Road. PUBLIC URINALS. The only step to increase "necessary accommodation" taken during the year was by the provision of a well-designed building in the Churchyard, at the rear of the Vestry Hall, absolutely necessary for the prevention of filthy nuisances adjoining the flank of the Town Hall on one of the chief approaches to the Parish Church. Your Vestry's powers to provide such accommodation are ample, but difficulty has been experienced in giving effect to the provisions of the 88th section of the Metropolis Management Act, which enables the Nuisance Authority to "provide and maintain urinals, water closets, and like conveniences (for both sexes) in situations where they deem such accommodation to be required, &c." Your Vestry's Works, Sanitary, and General Purposes Committee, to which the subject was referred, have indicated several situations where it is admitted such accommodation is required; but the opposition raised by inhabitants in the neighbourhood of the selected sites has always proved insuperable. A proposition was made by a private individual firstly, and afterwards by a Company, to provide chalets for the convenience of the public as a commercial speculation, but the Law and Parliamentary Committee having reported that your Vestry have no authority for placing obstructions in the public streets the matter fell through. In some other parishes the scheme has been entertained favourably, and chalets are about to be erected; we can, therefore, but await with patience and hope the issue of an interesting experiment. 121 PUBLIC BATHS AND WASH-HOUSES. No steps have been taken since the publication of my last report to give effect to the resolution of your Vestry in favour of the establishment of public baths and wash-houses. MORTUARY. Referring to the need of a Mortuary, and to the steps that had been taken to give effect to the resolution of your Vestry to provide one, I stated in my last report that plans prepared by your Vestry's architect had been approved by the Churchwardens, and that your Vestry had completed an agreement with the Churchwardens settling the conditions on which a building should be erected, as I had recommended, in the disused Parish Churchyard; and I expressed a hope that in my next (the present) Annual Report I might have the privilege of congratulating your Vestry on a successful issue to long continued efforts to supply this much needed sanitary want. I regret that I may not have this pleasure, for the matter appears not to have materially advanced beyond the stage at which it had arrived a twelvemonth ago, and "the next step" still is, as it was, then "to obtain a faculty" for the erection of the proposed building.* CORONER'S COURT. I have in former reports animadverted on the unseemly necessity the Coroner is placed under of holding inquests in public houses, having no proper Court. When the hoped-for Mortuary shall have been provided, I trust there will be no difficulty in making an arrangement for obtaining the use of the Vestry Hall as a Coroner's Court. The large room has been altered for the convenience of the Divisional Magistrates, who meet in it periodically; and the alterations have been made so judiciously that the room * On the 16th July the necessary fifteen days' notice of the application for a "faculty" was posted at the principal entrance to the Parish Church, as the law directs, and I am informed that no person appeared in opposition to the granting of the faculty* 122 is perfectly adapted, and is really admirably suited in all respects, not forgetting the essential one of position, for the purpose indicated. DISINFECTION. During the year ended March 25th, 1881, a large number of infected articles of bedding, clothing, furniture, &c., were satisfactorily disinfected by the contractors, mostly at the cost of your Vestry, the owners being too poor to bear the expense. The weight of the articles disinfected at the public cost, was about 14 tons: their number, 5650, and the cost of the process, £280 10s. Od. Large as this outlay may appear, it is probably less than would have been incurred had your Vestry been possessed of a disinfecting chamber, and the necessary staff for working it. An establishment and staff would have to be maintained in working order almost irrespective of the amount of infectious disease existing, whereas, under the present system, we pay only for work done; all infected articles, moreover, being cleansed as well as disinfected. Three hundred and thirty-three Rooms in houses were disinfected with sulphurous acid by your Vestry's Officer. No charge was made in the great majority of instances; a small fee, however, to cover the cost of the process, having been charged to those in a position to pay. Many rooms in addition were disinfected by the contractor. WATER SUPPLY. PRofessor Frankland's Report.— I have always thought it desirable that your Vestry, as the body responsible in this great parish for carrying into effect the provisions of sanitary legislation, should receive, year by year, the best and latest available information on all points connected with the water supply, a very important question in relation to the public health, and it has been my custom, therefore, to summarise the report prepared annually by Professor Frankland, for the Registrar-General. Of late years I have been enabled to furnish, in addition, a summary of interesting facts supplied in monthly reports by Colonel Bolton, R.E., the "Water Examiner," underthe "Water 123 Act, 1871." Dr. Frankland's report deals mainly with the quality of the water in its chemical and microscopical aspects, and in relation to its fitness for dietetic and domestic purposes; he being, as is well known, adverse to riparian sources of supply: whereas Colonel Bolton's observations have reference inter alia to the condition of the water in bulk at the intakes, and to its physical qualities when delivered to consumers—in other words, to the machinery for collection, subsidence, filtration, storage, and distribution. London is mainly supplied from the rivers Thames and Lea, and the New River; but a considerable and increasing quantity of water is obtained from deep wells sunk in the chalk, not only by the Companies which obtain their entire supply from that source, but also by some of the old Companies, which thus supplement their intake of river water. The average daily volume supplied per head of population was 34 gallons. This is greatly in excess of what is required, and indicates waste. Dr. Frankland is as emphatic as ever in his commendation of "deep well water," and takes it as the standard of purity in comparative observations on the waters generally. He describes it as being "delicious and wholesome" and uniformly excellent for dietetic purposes; maintaining that in the interests of temperance and public health it should, as soon as possible, be substituted for that portion of the Metropolitan supply which is drawn from polluted rivers. This "pure spring water," moreover, is "everywhere abundant in the Thames basin: in dry seasons it constitutes the sole supply of the Thames and the Lea, and even after the most protracted drought, more than 350,000,000 gallons of it daily flow over the weir at Teddington, whilst a further very large volume of it joins the Thames lower down." At present the inhabitants of the Metropolis, generally, can only use it after it has been mixed with the excrements of a large population, and used for the washing of vast quantities of filthy rags in paper mills, and of linen in laundries. It would be a most valuable boon to London, he thinks, if even a small fraction of this prodigal supply could be collected, preserved from irremediable pollution, and distributed to those portions of the Metropolis which are not at present supplied with such water. The principal objection to it is its hardness, but this is an objection easily surmounted by "Clark's process"—the addition of slaked lime, a process equally applicable to all waters supplied to the Metropolis. The "hardness" of water represents the weight of carbonate of lime, or its equivalent of other soap-destroying substances, found in 100,000 parts of water. The average hardness of the Thames water delivered in London last year was 20°.2; of the Kent Company's water 26.6; and of the Colne Valley Company's water only 6°.3. "All hard water must be softened before it can be used for washing linen: when it is softened in detail by the laundress, the operation costs, for an equal volume of water, at least eighty times as much (in soap and soda) as it costs when conducted on a large scale by a water company." The only water fit for "washing" delivered in London during the past year was that of the Colne 124 Valley Company, which was softened before distribution by the process above mentioned. All waters, save artificially prepared distilled water, contain more or less "solid matter." The solid matter in river water is composed of a variety of substances, by far the largest proportion being entirely harmless when the water is used for dietetic purposes, but a small proportion consists of organic substances, which are always objectionable, and at times are dangerous to health. The average proportion of total solid matter was rather less than in 1879. The deep-well waters delivered by the Kent Company and by the Tottenham Board of Health, contained the largest proportions of these matters; but the deep-well water supplied by the Colne Valley Company contained less than one-half the quantity found in the river waters, and less than one-third of that found in the Kent and Tottenham waters: this comparative freedom from saline matters being attained, as already explained, by adding a small quantity of slaked lime to the water before it leaves the Company's works. The organic impurities derive their importance from being, to a great extent, of animal origin. They are found in the river waters, which last year were often much polluted, so that, even after efficient filtration, Dr. Frankland deemed them in some measure fit to drink only during the months of May, June and July. Never since these analyses have been made had the Thames water been so much polluted by organic matter as in 1880. The nearest approach to this degree of pollution was reached in the year 1872, but at this time the several companies were provided with far less efficient apparatus for filtration than at present, so that the actual pollution of the unfiltered Thames water during the last year must have been even still more strikingly in excess of that of previous years. Owing to the flooded condition of the river, even in summer, much filthy matter from sewers, cesspools, and cultivated fields was swept into it during those periods of the year when they are usually kept back through the absence of heavy rain. No practicable amount of storage capacity could have prevented the supply of such water during the last three years. The water is becoming year by year less suitable for domestic use. These "noxious organic matters" are "in suspension," but in such a finely divided state as to render their removal by artificial filtration through sand impossible. There is thus no protection against the distribution of them in polluted river water. Deep-well water, on the other hand, has undergone such a prolonged and exhaustive filtration through great thicknesses of porous strata, as to render it extremely unlikely, if not impossible, that any portion of the organic matter still remaining in it should be of this objectionable character. Hence the deep-well waters are "uniformly pure and wholesome." Of the river water abstracted from the Thames, the best average supplies were furnished by the Chelsea and West Middlesex Companies. Not many years ago the supply by the Chelsea Company was one of the worst, owing to the unsatisfactory position of their intake—at Seething Wells—and to deficiency of storage reservoirs. Stimulated by the complaints of their customers the Company removed their intake to West Molesey, undertaking extensive works at a large outlay, and now they are enabled to supply water even superior in quality to that of the West Middlesex Company, which for several years was at the head of the Companies drawing their supplies from the Thames, but which in 1880 showed the highest maximum as well as the lowest minimum of pollution. 125 The following table shows the amount of organic matter in the water of the Companies which supply Kensington, the Kent Company's water being taken as the standard of purity for comparison:— Name of Company. Maximum. Minimum. Average. Kent 1.0 1.0 1.0 Chelsea 5.7 3.1 4.3 West Middlesex 8.4 2.2 4.8 Grand Junction 7.4 2.4 5.0 The organic elements consist chiefly of organic carbon, and the maximum pollution in the river waters greatly exceeded the standard, which is—0.l part of organic carbon in 100,000 parts of potable water. A marked and undeniable advantage of spring water is its evenness of temperature. The range of temperature of river waters is considerable, and last year in the water of the Thames, as delivered by five of the Companies, it amounted to 270 Fahr., viz., from 410 in February to 68° in August. The water, therefore, was unpleasantly cold in winter whilst it was unpalatably warm in summer. The deep-well water delivered by the Colne Valley Company ranged through 140 Fahr., and that supplied by the Kent Company through 5°4 Fahr. only, viz:—from 520 Fahr. in January to 570 Fahr. in September. The transparency or otherwise of water is ascertained by its appearance in a tube two feet in length, and is expressed in arbitrary terms settled by common agreement, as in the following table, which shows the degree of efficiency of filtration of Thames water as supplied by the Companies in this parish, the examinations being made monthly:— Number, op Occasions. The transparency or otherwise of water is ascertained by its appearance in a tube two feet in length, and is expressed in arbitrary terms settled by common agreement, as in the following table, which shows the degree of efficiency of filtration of Thames water as supplied by the Companies in this parish, the examinations being made monthly:— Name of Company. When clear and transparent. Number of OccasioNs When very turbid. When slightly turbid. When turbid. Chelsea 11 I 0 0 West Middlesex 8 4 0 0 Grand Junction 6 5 I 0 The deep-well waters were clear and transparent on every occasion. When examined under the microscope the sediment deposited by turbid water on standing, is generally found to contain living and moving organisms. During the year these organisms were observed in the Grand Junction Company's water on three occasions. Batch7-442 The annexed table shows the results of such microscopic examinations during the past twelve years:— Name of Company. Number of occasions when living organisms were found. 1869 1870 1871 1872 1873 1874 1875 1876 1877 1878 1879 1880 Chelsea 3 2 2 3 2 s 4 4 I 0 2 0 West Middlesex 0 0 0 0 0 0 0 0 0 I 2 0 Grand Junction 4 I I 2 3 5 7 3 3 3 I 3 The subjoined table shows the annual averages of each determination, and thus summarizes the average results of the analysis of the waters supplied by the local 126 name of Company. Temperature in Centigrade Degrees. Total Solid Impurity. Organic Carbon. Organic Nitrogen. Ammonia. Nitrogen as Nitrates and Nitrites. Total combined Nitrogen. Chlorine. Total Hardness. Proportional amount of organic elements, that in the Kent Company's Water during the 9 years ending 1876 being taken as 1. Chelsea 11.3 28.02 .212 .042 .001 175 .218 1.5 20.1 4.3 West Middlesex 12.5 28.36 .243 .043 .001 .210 .253 1.5 20.0 4.8 Grand Junction 11.2 2870 .248 .048 .001 .188 .237 1.5 20*0 5.0 Kent 12.7 43 05 .079 .015 .001 .427 .442 2.5 26*6 1.6 Having thus summarised Dr. Frankland's views—reproducing in the consumers' interests, as in duty bound, the strictures on river water of what may be considered the official report, it is only fair to state that river water is not without its defenders and advocates. Among these, Dr. Meymott Tidy stands conspicuous, and he has summed up all, perhaps, that can be said in its favour in a paper read before the Chemical Society in May, 1880, and printed in the Society's transactions. He contends that dangerous organic matter is rapidly destroyed through the operation of natural laws when introduced into running streams, and gives numerous experiments to prove his point. "Reviewing all the facts," he submits— "1. That when sewage is discharged into running water, provided the primary dilution of the sewage with pure water is sufficient, after the run of a few miles, the precise distance of travel being dependent on several conditions, the removal of the whole of the organic impurity will be effected. 2. That whatever may be the actual cause of certain diseases, i.e., whether germs or chemical poisons, the materies morbi which finds its way into the river at the sewage outfall, is destroyed together with the organic impurity after a certain flow." Colonel Bolton's Reports.— I now turn to Colonel Bolton's reports, which from time to time supply a variety of interesting 127 information in connection with the water supply : and first with reference to Storage, &c.— The West Middlesex Company, he states, having large reservoir capacity for subsidence, avoid taking in water during floods, and they have increased the storage capacity of their subsiding and unfiltered water reservoirs at Barnes by nearly 35 million gallons, raising the total to 91 million gallons. Nevertheless they are about to construct an additional reservoir to contain 24 million gallons, and two filter-beds of one acre each. The Grand Junction Company have constructed much-needed additions of impounding and subsiding reservoirs near to the intakes at Hampton, and are constructing additional filters at these works capable of filtering 4 million gallons per day. The addition to, and reconstruction of, the existing filters at the Kew Bridge Works have greatly improved this Company's supply. The Chelsea Company have completed their works, and now the intake of the subsiding reservoirs at Molesey is closed when the river is in bad condition. This Company's power of supply is in excess of the demands of their district, and they are enabled to supply effectually filtered water at all times. Filtration.— Great improvements have been effected of late years in respect of filtration; and water is now taken in at Hampion and Molesey where it is usually in far better condition than lower down, as, for example, at Seething Wells, where, till lately, the Chelsea Company had their intake. The rate of filtration of water should not exceed 540 gallons per square yard of filter-bed each 24 hours, and at this rate filtration should be effective. The materials of filters are mainly sand, shells, and gravel (increasing in coarseness towards the bottom) arranged in layers of different thicknesses. Domestic Pollution of Water.— The efforts of the Companies to supply wellfiltered water are frequently neutralised by the neglect of householders, who allow their cisterns, &c., to fall into a filthy state. Water, moreover, often undergoes very dangerous pollution, of which the householder maybe all unconscious, viz.:— through the "waste pipe" being connected with the house-drain, and consequently with the sewer, to which it becomes a ventilator. Foul air is thus admitted within the covered receptacle, and becoming absorbed by the water confers on it qualities of a deleterious character, so that it may in favouring circumstances be the means of spreading disease. No more familiar example can be quoted than typhoid fever, endemics of which have been traced to the pollution of water in the domestic cistern. It is to be regretted that the Water Companies generally should have failed in their duty to the public by neglecting to exercise their power, under the "14th regulation,"* to cause the abolition of the waste-pipe universally. The Chelsea * The 14th regulation reads as follows:— "No overflow or waste-pipe other than a 'warningpipe' 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." A very desirable sanitary reform would be achieved if co-ordinate powers were granted to "nuisance authorities" to enable them to put this regulation into force; and it would be well worth enquiring whether such co-ordinate powers might not be obtained by making application to the Government in the manner prescribed by the Metropolis Water Act, 1871 ? 128 Company alone, in the western part of the Metropolis, have to any appreciable extent given effect to the regulation. The "Metropolitan Authority" (Board of Works) have not interfered for the protection of the public—having practically ignored the regulations from the first. Nor have the Local Government Board taken any steps in the matter, although for years the Water Examiner called their attention, in his monthly reports, to^thejmportance of carrying out this particular regulation. Referring to the deterioration of the water after leaving the Companies' mains by the dirty state of the cisterns, rarely cleaned out and frequently uncovered, often placed over the water-closet and not seldom in close proximity to the dust-bins and other deposits of filth and garbage, Colonel Bolton remarks that the only remedy for this state of affairs will lie in the establishment of the Constant Supply system, and the consequent total abolition of these unfit receptacles. Constant Supply.— To obtain a constant supply of water was supposed to be a principal object of the Act of 1871, and Colonel Bolton states that considerable advance has been made in extending the system to the Metropolis. The West Middlesex Company have 7,878 houses so supplied out of a total of 56,965 in their district ; the Chelsea Company 1,691 out of 30,656 ; and the Grand Junction Company none apparently, in their town district : this Company supplies 43,443 houses, of which 3,555, in their country district, have constant supply. In other words there are in the districts of the Companies in which we are locally interested, about 13,000 houses on constant service out of a total of nearly 131,000, or about 10 per cent. ; an increase of 6 per cent, within the year. The East London Company, on the other hand, to quote but one, and the strongest case, by way of comparison, has nearly 106,000 houses on constant service out of 129,000. The western parts of the Metropolis are deplorably behind in this matter, and speaking generally, it may be said that constant service has been given only on estates built over since the passing of the Act, on which the intermittent service could not be lawfully introduced. The West Middlesex, Grand Junction, and Chelsea Companies respectively, according to their own published statements, supplied 166, 248 and 239 gallons daily, on an average, to each house in their districts. These quantities are in excess of the public needs, and the fact of so much water having been supplied implies waste, which would be almost entirely avoided by the adoption of the Constant Supply system. It will be remembered that the late Government entered into certain "Agreements" with the several Water Companies for the purchase of their property, and that the then Home Secretary introduced a Bill for giving effect to the Agreements and for creating a "Water Trust." Great objection was raised against the enormous price proposed to be paid to the Companies, amounting to some twenty millions in excess of the prime cost of their Works. The present Government, therefore, remitted the subject to a Select Committee of the House of Commons, which reported adversely to the "Agreements," which have now fallen 129 through. The question of the Water Supply of the Metropolis, consequently, remains where it was before the negotiations between the late Government and the Companies. It is not improbable that the subject will be taken into consideration by the Government at an early date. GAS. The subjoined tables from the quarterly reports of the Chief Gas Examiner exhibit at a glance the principal results (averages) of the daily testings, at Ladbroke Grove Station, of the " common gas," manufactured at Kensal Green by the Gas Light and Coke Company. 1. With respect to illuminating power. The minimum, and average illuminating power in standard sperm candles was as follows (Statutory standard, sixteen candles) :— Maximum. Minimum. Average. Quarter ended March 31st 19.1 15.6 17.0 Quarter ended June 30th 18.7 16.5 17.2 Quarter ended September 30th 18 9 16.9 17.9 Quarter ended December 31st 18.7 16.1 17.2 Averages, whole year 18.8 16.3 17.3 With the exception of two occasions during the first quarter the minimum illuminating power of the gas was invariably above the requirements of the Acts of Parliament. 2. With respect to purity. Sulphuretted hydrogen was not present in the gas at any time, and the proportion of sulphur in any other forms than this was always below the limits of the Acts of Parliament. Grains of sulphur per 100 cubic feet of gas. Permitted maximum—20 grains in summer, 15 grains in winter. Maximum. Minimum. Average. Quarter ended March 3let 13.2 6.1 9.4 Quarter ended June 30th 13.3 6.7 10.2 Quarter ended September 30th 14.6 6.6 11.1 Quarter ended December 31st 18.4 7.8 10.7 14.9 6.8 10.4 130 The above figures show a considerable improvement on the averages for 1879. Ammonia, a valuable residual product of gas manufacture, appeared but rarely, and then only in small quantity, far below the limits of the Acts of Parliament (4 grains in 100 cubic feet of gas). It would be well if an arrangement could be effected to obtain systematic records of pressure at all hours of the day and night, and at several points in the Company's District within the Parish. No complaint was received from any private consumer in respect of the illuminating power of the gas in 1880, and I understand that Mr. Philip Monson, your Vestry's Superintendent of Street Lighting, is satisfied with the quality of gas as supplied to the public lamps. The burners now in use are calculated to consume gas at the rate of 4'5 cubic feet per hour, whereas the burners formerly in use, originally provided when Cannel was employed, consumed only three feet per hour; but notwithstanding the increased consumption of gas (50 per cent.) and the consequent improvement in the lighting of the public thoroughfares, the cost is not greater than under the old system of a fixed annual payment per lamp. Conclusion.— It now only remains for me to discharge the pleasing duty of expressing my obligation and my thanks to those who have so materially contributed by their assistance to whatever of success may have attended the work of my Department during the past year. It would be impossible to over-rate the value of the sympathetic co-operation of the Board of Guardians ard their officers in every department, in measures for preventing the spread of infectious diseases. The Sub-district Registrars (Messrs. Barnes and Hume), and the Vaccination Officer (Mr. Shattock), have always been found ready and willing to supply whatever information I may have required. The members of the sanitary staff have discharged their numerous and important duties with zeal and efficiency. That 131 their work is not unattended with danger we have had evidence in the past year, and it was with much gratification I observed the liberal and spontaneous way in which your Vestry compensated one of them for personal suffering and a heavy bereavement arising out of the faithful discharge of duty. My own grateful thanks are due for continued manifestation of your Vestry's appreciation of my efforts to carry out the duties of my office, and in superintending the work of a Department the importance of which is becoming every year, and not in this parish only, more fully recognised by the general public. I am, Gentlemen, Your obedient servant, T. ORME DUDFIELD, M.D., Medical Officer of Health. Offices, Town Hall, Kensington, June, 1881. APPENDIX Note.— 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. K K TABLE 1. Estimated population of Kensington at the middle of the year 1880, and in ten previous years; number of inhabited houses; Births, Deaths, and Marriages (gross numbers). Year. Estimated Population.* Number of Inhabited Houses. Registered Births. Deaths. Marriages. 1880. 159,700 20,700 4,605 2,884+ 1,483 1879 156,250 20,210 4,790 2,992 1,428 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 2,786 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 127,400 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^: Average of 10 years, 1870-9 138,860 17,811 4,305 2,661 1,264 Notes.— Population at Census, 1861, 70, 108; 1871, 120, 234; 1881, 162,924. Average number of persons per house at Census, 1871, 7.8; at Census, 1881, 8.1. Area of Parish, 2,190 Statute Acres (according to Registrar-General). * The population is estimated to the middle of the year. † The actual number of deaths registered in the Parish was 2854, and it includes 99 deaths of non-parishioners at the Brompton Consumption Hospital, 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, 2,884, is made up by the addition of 30 deaths of parishioners from small-pox and "fever," that took place at the hospitals of the Metropolitan Asylum District. ‡ The return of marriages for the year 1870 does not include those that took place at the Superintendent Registrar's Office, concerning which I have no information. TABLE 1 1. Showing Birth and Death Rates; Deaths of Children; and Deaths in Public Institutions in 1880, 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 at Public Institutions 1880 289 180 25 0 156 42 3 369* 1879 30.6 19.1 24.2 15.1 40.8 423 1878 30.0 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 321 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 Average of 10 Years, 1870.9. 31.4 19.1 26.1 15.9 42.6 323 * Viz. The Workhouse (236), the Hospital for Chest Diseases at Brompton (103), and the Infectious Diseases Hospitals (30). Note.—The calculations in this Table are made on the gross number of deaths registered, without deduction of those of non.parishioners in public institutions. Vide Report, page 82). TABLE III. Deaths registered from all causes during the year 1880. (Exclusive of the Deaths of non-parishioners at the Brompton Consumption Hospital. Vide Report, page 77). CAUSES OF DEATH. AGES. Total " deaths under Five. Total. sub-DISTRICTS. Under 1. 1 to 2. 2 to 5. 5 to 15. 15 to 25. i 25 to 85. 35 to 45. 45 to 55. 55 to 65. 65 to 75. 75 to 85. 85 to 95. 95 and upwards. Kensington Town. Brompton. (classes) I. ZYMOTIC DISEASES 195 105 98 58 22 16 14 13 12 14 5 2 1 398 555 472 83 II. CONSTITUTIONAL DISEASES 81 46 40 36 53 72 83 64 51 33 8 4 ... 167 571 461 110 III. LOCAL 242 100 82 27 23 39 100 121 169 211 137 23 ... 424 1274 1023 251 IV. DEVELOPMENTAL 183 13 5 3 6 5 1 2 8 40 15 5 201 284 240 44 V. VIOLENT DEATHS 14 6 4 3 6 8 6 5 2 1 ... ... 20 55 46 9 CAUSES NOT SPECIFIED OR ILL-DEFINED 4 2 3 ... ... 1 ... ... 2 ... 1 ... ... 9 16 16 ... 71 266 234 125 104 140 210 206 241 270 192 44 4 1219 2755 2258 497 I. ZYMOTIC DISEASES. Order 1.—miasmatic. Varicella ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Small-pox 1 1 ... ... ... 1 ... ... ... ... ... ... 2 3 1 2 Measl 28 27 10 9 ... 1 ... ... ... ... ... ... ... 65 75 74 1 Scarlet Fever (Scarlatina) 4 11 45 19 3 ... ... 1 ... ... ... ... ... 60 83 69 14 Diphtheria 4 6 11 1 ... ... ... ... ... ... ... ... 10 22 21 1 Quinsy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Croup 4 2 "4 6 ... ... ... ... ... ... ... ... ... 10 16 13 3 Whooping-cough 31 34 22 7 1 ... ... ... ... ... ... ... ... 87 95 75 20 Typhus ... ... 1 2 ... ... ... ... 1 ... ... ... ... 1 4 1 3 Enteric or Typhoid Fever ... 1 1 3 8 5 1 ... 2 1 ... ... 2 24 17 7 Simple continued Fever 1 1 1 1 ... ... 1 ... ... ... ... 2 5 4 1 Erysipelas 2 ... 1 ... 1 ... 2 3 5 4 4 1 1 3 24 23 1 Puerperal Fever (Metria) ... ... ... ... 4 6 3 ... ... ... ... ... ... ... 13 10 3 Carbuncle ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Dysentery ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 2 ... Diarrhoea 97 21 6 ... ... ... 1 ... 1 1 ... 1 ... 124 128 111 17 Simple Cholera ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 2 2 Ague ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 1 ... Remittent Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Rheumatism ... 1 1 1 1 4 3 2 3 2 16 12 4 Other Zymotic Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pyaemia ... ... ... ... 1 ... ... ... 1 2 ... ... ... ... 4 3 1 Order 2.—enthbtic. Syphilis 12 1 ... ... ... ... ... ... ... ... ... ... ... 13 13 11 2 Stricture of Urethra ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... Hydrophobia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Glanders ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Order 3.—dietic. Privation ... 1 ... ... ... ... ... ... ... 1 ... ... ... 1 2 2 Want of Breast Milk 4 ... ... ... ... ... ... ... ... ... ... ... ... ... 4 ... 1 Purpura and Scurvy 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 1 Alcoholism a Del. 1 remens ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... b Intemperance ... ... ... ... ... ... 2 3 ... ... ... ... ... ... 5 5 ... Order 4.— parasitic. Thrush 10 ... ... 1 ... ... ... ... ... ... ... ... ... 10 11 10 1 Worms, &c ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 195 105 98 58 22 16 14 13 12 14 5 2 1 398 555 472 83 II. CONSTITUTIONAL DISEASES. Order 1.—diathetic. Gout . ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... 2 1 1 Dropsy 1 ... 1 ... ... ... 1 1 1 ... 1 ... 1 6 6 ... Cancer ... ... ... ... 1 2 12 15 26 23 8 2 ... 1 90 65 25 Cancrum Oris (Noma) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Mortification ... ... ... ... ... ... ... ... 2 3 ... 1 ... ... 6 6 ... Order 2.—tubercular. Scrofula and Tuberculosis 13 6 7 8 3 ... 4 ... 1 ... ... ... ... 26 42 34 8 Tabes Mesenterica 39 17 5 3 ... ... ... ... ... ... ... ... ... 61 64 61 ... Phthisis 2 4 47 ... 67 48 21 5 ... ... ... 6 272 216 56 Hydrocephalus and Tubercular Meningitis 28 20 24 15 2 ... ... ... ... ... ... ... ... 72 89 72 17 81 46 40 36 53 72 83 64 51 33 8 4 ... 167 571 461 110 III. LOCAL DISEASES. Order 1.—nervous system. Cephalitis ... ... 2 ... 1 ... 2 ... 1 ... ... 1 ... 2 7 5 2 Apoplexy ... ... ... ... 1 2 7 11 13 25 20 1 ... ... 80 65 15 paralysis ... ... ... ... ... ... 5 7 8 10 11 3 ... ... 44 34 10 Insanity ... ... ... ... ... ... ... ... ... 2 ... ... ... ... 2 1 1 Chorea ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Epilepsy ... ... ... 2 ... 1 2 1 1 ... ... ... 14 10 ... Convulsions 80 15 10 2 ... ... ... ... ... ... ... ... 105 107 19 Brain Disease, &o. 2 1 3 4 1 1 9 5 12 17 6 1 6 62 54 8 Order 2.—organs op circulation. Pericarditis ... ... 1 ... ... ... 1 ... ... ... ... ... ... 1 2 2 ... Aneurism ... ... ... ... ... 1 ... 2 2 ... ... ... ... ... 5 5 ... Heart Disease, &c. ... ... 1 4 2 10 18 26 26 40 13 1 ... 1 141 109 32 Order 3.—respiratory organs. Spasm of the Glottis 5 2 ... ... ... ... ... ... ... ... ... ... ... 7 7 7 ... Laryngitis ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... Bronchitis 94 59 41 2 2 4 15 21 42 55 53 12 ... 194 400 321 79 Pleuris ... ... ... ... ... 1 1 2 ... ... ... ... ... ... 6 5 Pneumonia 27 19 20 5 4 4 6 11 12 8 5 1 ... 66 122 104 18 Asthma ... ... ... ... ... ... ... ... ... ... 3 ... ... ... 11 9 2 Lung Disease, &c. 14 1 ... i 2 2 6 4 8 4 ... 2 ... 15 48 35 13 Order 4.—digestive organs. Gastritis ... ... ... ... ... ... 1 1 1 2 ... ... ... ... 5 5 ... Enteritis 3 ... 2 ... 1 ... 1 2 ... ... 5 9 g 1 Peritonitis 1 ... ... ... 3 2 3 3 2 ... 1 ... ... 1 15 12 3 Ascites ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... Ulceration of Intestines ... ... ... ... ... ... ... 1 ... 1 ... ... ... 2 2 ... Hernia ... ... 1 ... ... ... ... 1 3 1 ... ... ... ... 8 6 2 Ileus ... ... ... ... ... ... 1 1 2 3 ... 1 ... ... 8 5 3 Intussusception 1 1 ... 2 ... ... ... ... ... ... ... ... ... 2 ... ... ... Stricture of Intestines ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Fistula ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Stomach Disease, &c. 3 2 ... ... 1 ... ... ... 1 1 ... ... ... 5 8 8 ... Pancreas Disease, &c ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Hepatitis ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 ... Jaundice 3 ... ... ... 1 1 ... ... 3 3 2 ... ... 3 ... 11 2 Liver Disease, &c. 2 ... ... ... ... 4 7 10 ... 11 2 ... ... 2 46 35 11 Spleen Disease, &c. ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 ... Order 5.—urinary organs. Nephritis ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... 2 1 1 Ischuria ... ... ... ... ... ... ... ... ... ... ... ... ... ... Bright's Disease (Nephria) ... ... ... 2 1 3 4 9 8 7 3 ... ... ... 37 28 9 Diabetes ... ... ... ... ... ... 1 ... 1 2 2 ... ... ... 6 ... Calculus (Stone) ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 ... Cystitis ... ... ... ... ... ... ... ... ... ... 2 ... ... ... 4 4 ... Kidney Disease, &c. ... ... 1 1 ... 1 1 ... 4 9 5 ... ... 1 22 15 7 Order 6.—organs op generation. Ovarian Dropsy ... ... ... ... ... ... ... 3 1 1 1 ... ... ... 6 1 5 Uterus Disease, &c. ... ... ... ... ... ... 1 ... 2 ... ... ... ... ... 3 2 1 Order 7.—organs op locomotion. Synovitis (Arthritis ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... 1 Joint Disease, &c. ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... 1 Order 8.—integumentary system. Phlegmon 4 ... ... ... ... ... 3 ... ... ... ... ... ... 4 7 7 ... Ulcer ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Skin Disease, 2 ... ... ... ... ... ... ... 1 1 ... ... ... 2 4 4 ... 242 100 82 27 23 39 100 121 169 211 137 23 424 1274 1023 251 IV. DEVELOPMENTAL DISEASES. Ord.fr 1.—TITSRASRS of children. Premature Birth 55 ... ... ... ... ... ... ... ... ... ... ... ... 55 55 47 cyanosis 4 ... ... ... ... ... ... ... ... ... ... ... ... 4 4 1 Spina Bifida 7 ... ... ... ... ... ... ... ... ... ... ... 7 7 7 Other Malformation ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Teething 15 5 3 ... ... ... ... ... ... ... ... ... ... 23 23 20 3 Order 2.—diseases op adults. Paramenia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Childbirth (see Puerperal Fever) ... ... ... ... 2 6 5 ... ... ... ... ... ... ... 13 9 4 Order 3.—diseases op old people. Old Age ... ... ... ... ... ... ... ... 2 8 40 15 3 ... 68 55 13 Order 4.— DISEASES OF nutrition. Atrophy and Debility 102 8 2 ... 1 ... ... 1 ... ... ... ... ... 112 114 99 15 183 13 5 ... 3 6 5 1 2 8 40 15 3 201 284 240 44 V. VIOLENT DEATHS, &c. Order 1.- Accident or Negligence Fractures and Contusions 1 ... 2 3 2 1 2 3 3 1 1 ... ... 3 19 16 3 Wounds ... ... 1 ... ... ... 2 ... ... ... ... ... ... 1 3 ... Burns and Scalds ... ... 2 ... ... ... ... ... ... ... ... ... ... ... 3 3 ... Poison ... ... 1 ... ... 2 ... ... ... ... ... ... ... ... 3 2 1 Drowning ... ... ... l ... ... ... ... ... ... ... ... ... ... 2 2 ... Suffocation 12 ... ... ... ... ... ... ... ... ... ... ... ... 12 12 11 1 Otherwise ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... * Order 3.—homicide. Murder and Manslaughter ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 1 ... Order 4.—suicide. Wounds: Gunshot, Cut, Stab ... ... ... ... ... 2 ... 3 ... ... ... ... ... ... 5 2 3 Poison ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 2 1 1 Drowning ... ... ... ... ... ... ... ... 1 1 ... ... ... ... 2 2 ... Hanging ... ... ... ... ... 2 ... ... ... ... ... ... ... 2 2 ... Otherwise ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 1 ... Order 5.—execution. Hanging ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Violent Deaths (not classed) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Sudden Deaths (Cause unascertained) 14 ... 6' 4 3 6 8 6 5 2 1 ... ... 20 55 46 ... Causes not specified or ill U define 4 2 3 ... ... 1 ... 1 2 2 1 ... ... 9 16 16 ... 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 Kensing- on Town. Brompton. AGES. Sub-Districts * Order 2, comprising Violent Deaths in battle, is omitted as inapplicable to the civil population. TABLE IV. Showing Total Deaths from certain groups of Diseases and rate oi Mortality therefrom, &c. Diseases. Total Deaths. Deaths per 1,000 of Population. Proportion of Deaths to 1,000 Deaths. 1.—Seven Principal Zymotic Diseases 469 2.8 162 2.—Pulmonary Diseases (other than Phthisis) 595 3.7 206 3.—Tubercular Diseases 378 2.3 131 4.—Wasting Diseases of Infants (under 5) 171 1.0 59 5.—Convulsive Diseases of Infants (under 5) 219 1.3 76 NOTES 1.—Includes Small-pox, Measles, Scarlet Fever, Diphtheria, Whooping Cough "Fever" and Diarrhoea. Thirty of the deaths took place in Hospitals). 3.—Includes Phthisis, Scrofula, and Tabes. 4.—Includes Atrophy and Debility, Want of Breast Milk, and Premature Birth. 5.—Includes Hydrocephalus and Infantile Meningitis, Convulsions and Teething. (In Table III, Hydrocephalus and Infantile Meningitis are included with Tubercular Diseases, raising the total deaths in Order 2 of Class '2 " Constitutional Diseases" to 467.) TABLE V. Showing the number of Deaths in 10 years, 1870-9, from the principal Zymotic Diseases, and the number in 1880, &c. Diseases. 1870 1871 1872 1873 1874 1875 1876 1877 1878 1879 Annual Average 10 years 1870-79. Proportion of deaths to 1000 Deaths in 10 years, 1870-79. 1880 Proportion of Deaths to 1000 Deaths, 1880. Small-pox 8 120 68 1 0 0 8 84 24 24 33.7 12.6 11 3.8 Measles 70 64 43 38 121 23 128 54 53 60 65.4 24.5 75 26.0 Scarlet Fever 198 95 29 10 32 83 59 31 77 51 66.5 25.0 105 36.5 Diphtheria 14 11 14 11 26 23 17 10 20 26 17.2 6.5 22 7.6 Whooping Cough 55 72 77 44 45 107 124 34 185 93 83.6 31.4 95 33.0 "Fever" 46 48 42 41 52 29 36 27 33 23 37.7 14.1 33 11.4 Diarrhœa 154 129 110 145 112 107 126 99 181 71 123.4 46.5 128 44.4 Totals,Kensington 545 539 383 290 388 372 498 339 573 348 427.5 160.6 469 162.7 Totals, London 16,476 19,455 12,669 11,385 11,230 13,411 12,565 12,365 14,734 12,256 13,654 173 13,681 170 TOTALS, 100,497 103,801 91,743 89,286 88,200 82,332 75,506 66,558 84,624 62,020 84,456 163 82,537 156 ENGLAND & WALES' TABLE VI. Inspectors Report of the Sanitary Work completed in the year ended March 25th, 1881. Sanitary districts.*' No. of Complaints received during the year. No. of Houses, Premises, &c., inspected (irrespective of re-inspections) Results of Inspection. House Drains. Privies and W.C.'s. Dust Bins. Water Supply. Miscellaneous. Orders issued for Sanitary Amendments of Houses and Premises. Houses, Premises, &c., Cleansed, Repaired, Whitewashed, &c. Houses Disinfected after illness of an infectious character. Repaired, Cleansed, Trapped, &c. Ventilated. Repaired, &c. Supplied with Water. New provided. New provided. Repaired, Covered, &c. Cisterns (new) erected. Cisterns Cleansed, Repaired and Covered. Waste-Pipes connected with Drains, &c., abolished. No. of Lodging Houses registered under 35th Section of "The Sanitary Act, 1866."† Dust Removal.—No. of Communications received and attended to.§ Removal of accumulations of Dung, Stagnant Water, Animal and other Refuse. Animals Removed being improperly kept. Regularly Inspected. Other Proceedings, e.g. Legal Proceedings.‡ Bakehouses. Licensed Cowsheds. : Licensed Slaughter-houses. N.W. 179 1763 536 259 76 140 21 30 129 4 29 37 19 86 20. ... 335 339 6 36 10 11 37 N.E. 215 990 305 159 72 93 45 105 138 2 10 34 6 62 31 ... 588 228 ... 45 5 9 14 Centrl. 158 1065 440 197 120 83 165 30 88 ... 67 61 47 50 42 ... 807 91 ... 30 5 7 17 South 377 1882 878 654 96 47 43 57 95 8 33 116 31 88 39 ... 1209 598 2 22 3 2 15 Totals 929 5700 2159 1269 364 363 274 222 450 14 139 248 103 286 132 ... 2939 1256 8 133 23 29 83 The North-East and North-West Districts are north of the centre of Uxbridge Road; to the East and West of Ladbroke Grove, and Ladbroke Grove Road respectively; the Central and South Districts are south of Uxbridge Road. † This Act has not been put into operation. § The actual complaints of neglect or non-removal, made by letter, were 62. ‡ Irrespective of proceedings (in 8 cases) under the Food and Drugs Adulteration Act: the Inspector for the North-West District being the Inspector under the Act. TABLE VIa. Summary of Monthly Returns of Work, &c., done by the Sanitary 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 Bequest received and attended to. 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. NE c. S'. N. W. N. E. C. S. N.W. N. E. C. S. Ap. 24,1880 155 129 113 101 58 253 73 82 19 10 14 8~ 15 6 18 16 21 19 20 42 25 19 14 3 49 33 47 93 41 30 60 90 Ap. 24,1880 May 32 ,, 172 66 72 120 44 244 63 100 9 11 8 8 8 9 10 16 11 26 14 40 11 20 9 2 33 12 29 84 23 23 45 96 May 22 „ June 19 „ 193 98 111 108 57 245 66 96 12 10 9 8 12 5 9 16 12 17 13 44 16 18 22 3 57 34 42 88 44 43 46 93 June 19 „ July 17 „ 81 64 74 139 35 241 77 88 7 11 9 8 12 8 14 16 3 14 14 34 10 19 2 15 15 25 74 24 52 75 87 July 17 „ Aug. 14 „ 170 39 52 89 61 165 47 70 21 23 23 6 23 19 14 12 5 30 6 17 22 20 10 2 19 12 14 36 27 65 68 96 Aug. 14 „ Sept. 11 „ 56 42 45 100 43 201 80 95 14 6 9 8 2 6 9 12 12 15 36 6 17 18 4 9 9 15 42 19 38 74 90 Sept. 11 „ Oct. 9 „ 138 92 96 144 64 240 82 113 11 4 10 8 10 5 7 12 26 13 12 40 20 5 12 7 51 22 37 81 6 37 64 97 Oct. 9 „ Nov. 6 „ 178 93 127 133 72 212 67 104 16 16 6 7 7 10 8 7 15 28 7 27 23 16 10 4 50 71 48 53 6 54 65 89 Nov. 6 „ Dec. 4 „ 84 61 96 179 94 66 64 123 8 8 8 8 7 4 10 10 3 ... 6 15 12 ... 6 3 74 9 69 64 26 35 58 3 Dec. 4 „ Jan. 1,1881 128 30 19 146 61 157 58 105 21 8 7 6 10 5 6 7 27 ... 8 28 14 ... 5 4 32 7 25 47 28 41 64 99 Jan. 1, 1881 Jan. 29, „ 104 42 48 148 68 245 52 117 4 3 4 8 1 8 8 11 3 32 6 ... 18 23 5 3 45 15 24 49 30 47 63 80 Jan. 29, „ Feb. 26 „ 168 99 102 236 79 245 69 110 8 11 8 8 11 10 4 12 8 12 4 ... 26 1 4 4 77 27 43 80 36 76 65 91 Feb. 26, „ March 26 „ 136 135 110 239 95 250 80 134 9 7 6 6 8 8 5 11 7 32 3 ... 24 23 6 3 25 39 22 87 25 47 60 118 Mar. 26, „ Totals. 1763 990 1065 1882 831 2764 878 1337 159 128 121 97 126 103 122 158 141 235 128 323 227 162 140 44 536 305 440 878 335 588 807 1209 Totals. 141 TABLE VII. Showing the Death-rate per 1,000 persons living; the annual Rate of Mortality per 1,000 living, from the "seven" principal Zymotic Diseases ; and the proportion of Deaths from these Diseases to total Deaths in Kensington and all London in 1880, and in ten years, 1870-9. 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. 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 1878 20.3 23.5 573 3.7 4.1 183 175 1878 1879 19.1 23.3 348 2.2 3.3 116 143 1879 averages of ten years. 19.0 22.9 428 3.0 3.9 163 173 averages of ten years. 1880 18.0 22.2 469 2.9 3.7 162 170 1880 142 TABLE VIII. Comparative Analysis of the Mortality in all London and in Kensington, in 1880. LOCALITY. Annual Death Rate per 1000 living from all causes. Annual Death Rate per 1,000 living from 7 principal Zymotic diseases. Percentage of Deaths under 1 year to Births Registered. Percentage 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 ... 22.2 3.7 15.8 25.7 20.9 17.0 3.3 6.5 18.0 Kensington ... ... 18.0 2.9 15.6 25.0 20.9 16.2 2.0 6.1 12.8 TABLE IX. Showing the principal Localities in which Fatal Cases of the Chief Zymotic Diseases occurred in 1880. KENSINGTON TOWN REGISTRATION SUB-DISTRICT. Locality. DISEASES. Locality. DISEASES. Locality. DISEASES. Small Pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Fever. Diarrhœa. Total. Small Pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Fever. Diarrhoea. Total. Small Pox. Measles Scarlet Fever. Diphtheria. Cough. Fever. Diarrhœa. Total. Enteric. Typhus. Sim. Con. Enteric. Typhus. | Sim. Con. Enteric. Typhus Sim. Con. Acklam Road ... ... 1 ... ... ... ... ... ... 1 Holland Park Road ... ... 1 ... ... ... ... ... ... 1 St. Clement's Boad ... 2 ... ... l ... ... ... 4 7 Admiral Place ... ... ... ... ... 1 ... ... 1 2 ,, „ Terrace ... ... ... ... ... 1 ... ... ... 1 St. Ervan's ,, ... 1 1 ... 2 ... ... ... ... 4 Albion Place ... ... 1 ... ... ... ... ... ... 1 Hornton Street ... ... 1 ... ... ... ... ... ... 1 St. James's Place ... 1 ... 1 ... ... ... ... ... 2 Appleford Road ... ... ... 1 1 ... ... ... 1 3 Hurstway Street ... 1 ... ... ... ... ... ... 3 4 St. Katherine's Road ... 1 2 ... ... 1 ... ... 2 6 Bangor Street ... 2 1 ... ... ... ... 1 5 9 Infirmary (The) ... 7 ... 2 5 1 ... ... 5 20 St. Mark's ... ... ... ... ... 1 ... 1 ... 2 Basing Road ... ... ... ... ... 1 ... ... ... 1 Kensington-pk.gds. Ms. ... ... 1 ... 2 ... ... ... ... 3 St. Michael's Gardens ... ... 1 ... ... ... ... ... ... 1 Bevington Road ... ... 1 ... 2 ... ... ... ... 3 Lancaster Road ... 2 2 ... ... ... ... ... 3 7 Silchester Road ... ... 1 ... ... ... ... ... 3 4 Blechynden Street ... 1 5 ... ... 1 ... ... 1 8 Linden Gardens ... ... ... ... ... 1 ... ... ... 1 „ Street ... ... 1 ... 1 ... ... ... ... 2 Bramley Road ... 1 1 ... ... ... ... ... l 3 Manchester Road ... 2 ... ... ... 1 ... ... 1 4 „ Terrace ... ... 1 ... ... ... ... ... ... 1 Branstone Street ... ... ... ... ... ... ... ... ... 1 „ Street ... ... 1 ... 1 1 ... ... 4 7 Southam „ ... 5 1 ... ... ... ... ... 1 7 Britannia Terrace ... ... ... ... ... 1 ... ... ... 1 Newcombe Street ... ... 1 ... ... ... ... ... 1 2 Stanley Gardens ... ... ... 1 ... ... ... ... ... 1 Brunswick Gardens ... ... 1 ... ... ... ... ... ... 1 Norfolk Terrace ... ... l ... ... ... ... ... ... 1 Swinbroke Road ... 1 1 2 1 1 ... ... ... 6 Church Walk ... ... 1 ... ... ... ... ... ... 1 Norland Terrace ... ... 1 ... ... ... ... ... ... 1 Sylvester Mews ... ... ... 1 ... ... ... ... ... 1 Clarendon Road ... ... ... ... 4 ... ... ... ... 4 Observatory Avenue ... ... ... ... ... 1 ... ... ... 1 Talbot Grove ... ... 2 ... ... ... ... ... 1 3 Connaught Terrace ... ... ... 1 1 ... ... ... ... 2 Oxford Gardens ... ... 1 ... ... ... ... ... 1 2 Tavistock Crescent ... ... 1 ... ... ... ... ... 1 2 Cornwall Road ... ... 1 ... 2 ... ... ... 1 4 „ Mews ... ... 1 ... ... ... ... ... ... 1 Thomas Mews ... ... 1 ... ... ... ... ... 1 2 Crescent Street ... 1 1 ... ... ... ... ... 2 4 Pembridge Mews ... ... ... 1 ... ... ... ... ... 1 Tobin Street ... 2 1 ... 1 ... ... ... 1 5 Dawe's Mews ... ... 1 ... ... ... ... ... ... 1 Pembroke ,, ... ... 1 ... ... ... ... ... ... 1 Vicarage Gardens ... ... ... 1 ... 1 ... ... ... 2 Denbigh Terrace ... ... ... 1 ... ... ... ... ... 1 Portland Road ... 2 l ... 12 ... ... ... 1 6 Victoria ,, ... ... 1 ... ... ... ... ... ... 1 Durham Place ... ... ... 1 ... ... ... ... ... 1 Portobello Road ... ... 5 3 1 1 ... ... 3 13 Walmer Road ... 7 4 ... 2 ... ... ... 7 20 Elgin Mews ... ... 2 ... ... ... ... ... ... 2 Princes ... 1 1 ... ... 1 1 ... 3 8 Western Terrace ... ... ... 1 ... ... ... ... ... 1 „ Road ... ... ... ... ... 1 ... ... ... 1 Queen's Gate.Ter.Mews ... ... ... 1 ... ... ... ... ... 1 Wheatstone Road ... 3 4 ... 1 ... ... ... 2 10 Gloucester Road ... ... 1 ... 1 ... ... ... ... 2 Royal Crescent ... ... 2 ... ... ... ... ... ... 2 William St., Nott. Dale ... 2 ... ... ... ... ... ... 3 5 Golborne Road 1 ... ... ... 2 1 ... ... 1 5 Russell Road ... ... ... 1 ... ... ... ... ... 1 Wornington Rd., N. sec. ... 2 5 ... 1 ... ... ... ... 8 Gordon Place ... ... 1 ... ... ... ... ... ... 1 St. Ann's Road ... 2 ... ... ... ... ... ... 4 6 Wornington Road ... ... 2 ... 1 ... ... ... 2 5 BROMPTON REGISTRATION SUB-DISTRICT. Alfred Place ... ... ... ... ... 1 ... ... ... 1 Cromwell Road 1 ... ... ... 1 1 ... ... ... 3 North Row ... ... ... ... 1 1 ... ... ... 2 Ashburn Mews ... ... 1 ... ... ... ... ... 1 1 Earl's Court Gardens ... ... l ... 1 ... ... ... ... 2 Queen's Gate ... ... 2 ... ... ... ... ... ... 2 Bute Street ... ... 1 ... ... ... ... ... ... 1 „ Road ... ... 1 ... ... ... ... ... ... 1 Redcliffe Square ... ... 1 ... ... ... ... ... ... 1 Child's Place 1 ... ... ... ... ... ... ... ... 1 Fawcett Street ... ... ... ... ... 1 ... ... ... 1 Rich Terrace ... ... ... ... ... 1 ... ... ... 1 „ Street ... ... ... ... ... 1 ... ... ... 1 Fenelon Road ... ... ... 1 ... ... ... ... ... 1 Sloane Place ... ... 1 ... ... ... ... ... ... 1 Clyde Street ... ... ... ... ... 1 ... ... ... 1 Foulis Terrace ... ... l ... ... ... ... ... ... 1 Wallgrave Terrace ... ... 1 ... ... ... ... ... ... 1 Courtfield Gardens ... ... 1 ... ... ... ... ... ... 1 Gledhow Gardens ... ... ... ... ... 1 ... ... ... 1 Warwick Road ... ... ... ... 3 ... ... ... ... 3 Cromwell Crescent ... ... 1 ... ... ... ... ... ... 1 1 Field Road ... ... l ... ... ... ... ... 1 2 Yeoman's Row ... ... 1 ... ... ... ... ... ... 1 TABLE X. PARISH OF ST. MARY ABBOTTS, KENSINGTON. Return respecting the Vaccination of Children whose Births were Registered during the year 1880. 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 10 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. 1880. 1 2 3 4 5 6 8 9 10 1st January to 30th June Kensington Town 1994 1724 5 ... 171 8 7 77 2 Brompton 452 405 6 ... 26 1 ... 12 2 1st July to 31st Dec. Kensington Town 1796 1526 11 ... 177 11 4 63 4 Brompton 424 381 2 ... 28 ... 3 10 ... Total 4066 4036 24 ... 402 20 14 162 8 145 146 TABLE XI. LICENSED SLAUGHTER-HOUSES. SOUTH OF UXBRIDGE ROAD. LOCALITY. LICENSEE. 6, Church Street, Kensington Mr. Stimpson 11, Peel Place, Silver Street „ Osborn The Mall, Silver Street „ Wright 183, Brompton Road Mrs. French 60, Kensington High Street Mr. 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 Rd. „ Hughes 8, Yernon Mews, Portobello Rd. „ Young 196, Portobello Road ,, Sheard Ledbury Mews „ French Lonsdale Mews „ Olney 50, Princes Road, Notting Hill ., Parratt 10, Princes Mews ditto „ Cole 10, Princes Yard ditto „ Coles Clarendon Mews ditto ,, Colley 41, Princes Place ditto Barber 23, Norfolk Terrace „ C. F. Matthews 61, Silchester Road „ E. Matthews 235, Walmer Road ,, Van Mary Place, Notting Dale „ Nind Royal Crescent Mews „ Macpherson Ditto ditto „ Down 147 TABLE XII. LICENSED COWSHEDS. 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 ,, Glenie Newcombe Street „ Lunn NORTH OF UXBRIDGE ROAD. 191, Portobello Road Messrs. Hughes and Sons 3, 4, 5, Angola Mews Mr. Jennings Ledbury Mews „ Liddiard 187, Walmer Road „ Arnsby 235, Walmer Road „ Van 47, Tobin Street, Notting Dale „ Squires 12, Blechynden Mews „ White 14, ditto „ Copperwheat 15, ditto „ Bedgood 3, 4, & 5, Archer Mews „ Skingle 23, Bramley Road „ Tame 27, Queen's Road, Norlands ,, Williams 49, Tavistock Crescent „ Minter Elm Cottage, St. Mark's Road „ Attfield Clarendon Road „ Briimbridge