KEN 110 THE ANNUAL REPORT on THE HEALTH, SANITARY CONDITION, &c., &c., of the Parish of St. Mary Abbotts, KENSINGTON, FOR THE YEAR 1883, by T. ORME DUDFIELD, M.D., (President of the Society of Medical Officers of Health,) Medical Officer of Health. London : PRENTICE & MONSON, PRINTERS, 47, UPPER THAMES STREET. 1884. TABLE OF CONTENTS. page. Prefatory Remarks on Death-rate—Parochial, Metropolitan, and National, in 1883 9 Registration District, "Kensington:" What it includes 11 ,, Sub-Districts ; " Kensington Town " and "Brompton" 11 Wards, Division of Parish into 12 Kensington, Population and Rateable Value of ; 1801-83 12 Vital Statistics, in 1883 ; Summary of 13 Zymotic Diseases, General Remarks on the " Seven Principal " 17 ,, ,, Number of deaths from the „ „ 20 „ „ Death-rate from : in Kensington, in London, and other large Towns, and in England and Wales 20 ,, ,, In Kensington; Monthly Return of deathsfrom 21 Measles 21 Wnooping-Cough 22 Scarlet Fever 22 Diphtheria 24 Fever 25 „ Typhus 25 „ „ Meningitis from over-pressure at school, mistaken for 26 „ Enteric, Local outbreak of 27 „ Simple continued 27 Diarrhœa 27 Small-pox 28 Western District (late Fulham) Hospital 29 Fulham Hospital Case 29 4 PAGE. Hampstead Hospital Case 31 Hospitals Commission, Action of Managers of Asylums Board, to give effect to the Recommendations of 31 Small-pox Hospital Accommodation 31 Ship-Hospitals 31 Hospital for Small-pox to be provided at Darenth 32 Fever Hospital Accommodation 33 Ambulance Service 34 Ambulance Station, Western District 35 Ambulance Steamers 35 Wharves or Landing Places 35 Removal of Patients, Arrangements for the 36 Depauperisation of Medical Relief 36 Need of Increased Facilities for reception of Patients 36 Asylums Board should be a Sanitary Authority 37 Hospitals for Infectious Diseases, The use and influence of 38 Fulham Hospital, New Enquiry by Mr. W. H. Power with regard to 39 „ „ Some facts with regard to the Epidemic of Small-pox in the district of, in 1884 40 Cholera, Precautions against 43 ,, Diseases Prevention (Metropolis) Act, 1883, Arrangements made by the Asylums Board under the: 44 ,. Duties of Local Authorities (Vestries, See.) under Diseases Prevention Act, 1856 45 ,, Outbreak of, in France (July, 1884) 45 ,, Memorandum by Medical Officer of Local Government Board, with reference to precautions against 45 Notification of Infectious Diseases 46 ,, „ Deputation to the Local Government Board 47 ,, ,, Views of President of the Local Government Board, on 48 ,, „ Bill to provide for 49 „ „ Should be provided for by a Government Bill 49 Voluntary Notification, Existing sources of 50 „ The beneficial results of 52 Increased Facilities for removal of the Infectious sick 55 Regulations of Asylums Board with regard to the removal of the infectious sick; important new arrangements 57 Interruption of Education at Elementary Schools, resulting from prevalence of Infectious Diseases 58 5 PAGE. Population : Of Sub-Districts, Number of Inhabited Houses, &c. 59 „ Relative Numbers of Males and Females in the: at different ages, in parish, and in sub-districts . . 61 Rateable Value, &c. : Increase of, in 27 years and in 12 years 62 Marriages, and Marriage Rate 63 Births, and Birth-rate 64 Deaths, and Death-Rate, in whole Parish and in Sub-Districts, at ages; periods of the year; in sexes; among illegitimate children under five years, &c. 65 Infantile Mortality 65 Death Rate, Monthly : Monthly mean Temperature, &c. 67 Death, Summary of causes of (Table) 67 Death, Assigned causes of 68 ,, „ Zymotic Diseases 69 „ „ „ ,, (Septic: Puerperal Fever) 70 „ „ Parasitic „ 71 „ Dietic 72 „ ,, Constitutional Diseases 72 „ „ „ „ (Tubercular) 73 „ „ Developmental „ 74 „ ,, Local Diseases 76 „ „ Violent Deaths 79 Public Institutions, Deaths in 80 ,, ,, Parish Infirmary and Workhouse 80 „ ,, Outlying Public Institutions 82 „ „ St. Joseph's House 82 ,, „ Consumption Hospital, Brompton 82 „ ,, Marylebone Infirmary, Notting Hill 83 Deaths " Not Certified" 83 Inquests 84 „ Violent Deaths 84 „ Why so many become necessary 85 Meteorology 86 Vaccination in 1883 87 „ Officer's Report 87 ,, Evidence furnished by Medical Officer to Local ,, Government Board, as to the Protection afforded by 87 „ Animal; Calf Lymph 90 Sanitary 91 6 PAGE. Nuisances Removal Acts, Committee appointed to carry out the 91 ,, „ Magisterial action with reference to the 91 ,, „ Digest of, and Digests of other Acts pared by Local Government Board and issued with circular letter to Sanitary Authorities 92 „ ,, Work of Sanitary Inspectors under the 92 Offensive Businesses : Proposal to schedule ' Marine Stores' under Slaughter Houses Act, Sec. 3 94 ,, ,, The Views of the Metropolitan Board of Works with regard to proposal 95 „ ,, A Judicial decision on the subject (Passey v. Oxford Local Board) 97 Slaughter Houses, The Licensed 97 Cowsheds, The Licensed 99 Dairies, Cowsheds, and Milkshops Order of 1879 99 Public Health (Dairies, &c.) Bill, 1883 100 Bakehouses : Vestry made Local Authority with respect to, by the Factory and Workshop Act, 1883 101 „ The regulation of, by bye-laws 103 Houses Let in Lodgings, Regulations with respect to, as adopted by the Vestry 106 Refuse, Removal of: Recommendations by the Society of Medical Officers of Health with reference to 113 „ House, Removal of : Dust-bins should be abolished 114 „ Stable: Difficulty of obtaining periodical removal of 115 Necessary Accommodation, Public Urinals, &c. 116 Public Baths and Wash-houses, A site obtained for 117 Mortuary, Public, Remarks with regard to the 117 Coroner's Court 120 Disinfection 122 Water Supply, Report on, by Professor Frankland 122 „ „ ,, Sir Francis Bolton (Water Examiner) 126 „ Deterioration of, in dirty cisterns 129 Waste-pipes of cisterns, The Medical Officer of the Local Government Board recommends abolition of 130 „ Communications addressed by the Vestry to the Local Government Board, to the Vestriesandtothe Waterworks Companies, with reference to 131 7 PAGE. Gas, Results of examinations for ascertaining the illuminating power and purity of the 134 „ Supply of, for street lighting 136 „ Excessive pressure complained of: a proper subject for enquiry 136 Conclusion 136 APPENDIX. STATISTICAL AND OTHER TABLES. Table 1. Estimated Population in 1883 and ten previous years, 1873-82 ; Number of Inhabited Houses; Gross numbers of Marriages, Births, and Deaths 141 ,, 2. Birth Rate and Death Rate; Death rates of Children, Deaths in Public Institutions, 1883, and 1873-82 142 ,, 3. Deaths Registered from all Causes in 1883 143 ,, 4. Deaths from Seven Principal Zymotic Diseases; Pulmonary Diseases; Tubercular Diseases; Wasting Diseases of Infants; Convulsive Diseases of Infants; Gross numbers, and Proportion of to 1,000 deaths and to 1,000 population 144 ,, 6. Deaths in 1883 and in 1873-82 from the Seven Principal Zymotic Diseases: in the Parish, in the Metropolis, and in England and Wales 145 „ 6 & 6a. Sanitary Work, Summaries of 146-7 „ 7 & 8. Comparative Analyses 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. 148-9 „ 9. List of streets where fatal cases of the more important of the Zymotic Diseases occurred in 1882 160 „ 10. Vaccination Officer's Annual Return 151 „ 11. Slaughterhouses, Licensed; and Names of Licensees 152 „ 12. Cowsheds „ „ „ 153 TWENTY-EIGHTH ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH, BEING FOR THE YEAR 1883. To the Vestry of the Parish of St. Mary Abbotts, Kensington. Gentlemen, In the following report the vital statistics have been compiled for the registration year ended December 29, 1883, and the sanitary statistics for the parochial year ended March 25, 1884. The vital statistics are calculated upon an estimated population of 168,000, a number arrived at, mainly, on data furnished by the census of 1881. The year 1883 was a singularly healthy one; the deaths registered were 2,615 only, and 565 below the corrected decennial average. In this total there are included 160 deaths which took place at outlying public institutions, i.e., special and general hospitals &c.: the deaths of non-parishioners at public institutions within the parish are excluded. The 2,615 deaths were equal to an annual rate of 15.5 per 1,000 persons living—the lowest on record, it being 2.8 below the decennial average, 4.9 below the London rate, (20"4) and 4'0 below the rate in England and Wales (19.5). B, 10 The London death-rate was 2.1 below the decennial average, and the lowest on record. The rate in England and Wales, 1.3 below the decennial average, was, with the exception of 1881, (16.9) the lowest recorded in any year since civil registration was established in 1837. The subjoined table shows the annual death-rate, per 1,000 persons living, in Kensington, in each of the last eleven years, and, for the sake of comparison, the rate in the Metropolis and its several districts, and the rate in all England:— Death Rate 1883. 1882. 1881. 1880. 1879. 1878. 1877. 1876. 1875. 1874. 1873. Kensington 15.5 16.2 16.6 17.8 18.8 20.2 17.3 19.5 19.2 19.4 18.3 London 20.4 21.4 21.2 21.7 22.6 23.1 21.5 21.9 23.5 22.4 22.4 W.Districts 19.5 19.9 19.6 19.8 20.9 21.6 19.2 20.9 22.2 20.9 20.6 North ,, 19.1 19.7 20.6 20.8 21.5 22.0 21.5 22.1 22.1 21.7 21.1 Central ,, 23.2 23.9 23.2 23.4 26.0 25.1 24.2 24.1 26.2 25.6 25.1 East „ 24.1 25.3 24.2 24.3 25.5 25.0 24.5 23.9 25.7 25.5 25.2 South „ 19.4 20.7 20.5 21.3 21.8 23.0 20.5 21.2 23.3 21.0 21.7 England and Wales 19.5 19.6 18.9 20.5 20.7 21.6 20.3 20.9 22.7 22.2 21.0 In his Annual Summary the Registrar-General states that "the extremely low death-rate (in London) was in great part attributable to the comparatively equable temperature that prevailed throughout the year, there having been neither excessive cold in the winter months nor great heat in the summer, so that the mortality both from diseases of the respiratory organs, and from disorders of the bowels, was far below the average." Again, "had the deaths in 1883 equalled the average annual number in the preceding decade 1873-82, corrected for increase of population, 6,726 persons would have died in the year, who, as it was, were alive at its close." The death-rate in the "Outer Ring" of London Suburban districts, with a population slightly exceeding a million persons, was 16.7. The rate in 27 great towns (exclusive of London), having an aggregate population of over millions persons was 22.5, ranging from 17.9 at Bristol, to 27.6 at Manchester. In 50 other large urban districts with an estimated population of nearly 2,700,000 persons, the aggregate rate was 20.4, ranging from 15.4 at Barrow-inFurness (population 56,000), to 26T at Ashton-under-Lyne (population 37,600). 11 Having premised so much by way of introduction it will be well, before proceeding further, to say a few words with respect to the Registration District and Sub-Districts, in which we are locally interested. " Kensington " is the title of a Superintendent Registrar's District, No. 1 in the Registrar General's London list, which comprises the parishes of Kensington and Paddington. The subjoined table shows the relative areas-of the two parishes, and other particulars relating to the census years 1871 and 1881. Area in Statute Acres. Inhabited houses. Increase in 10 years. Population. Increase in 10 years. 1871. 1881. 1871. 1881. Kensington 2,190 15,735 20,103* 4,368 120,299 163,151 42,852 Paddington 1,251 11,847 13,187 1,340 96,813 107,098 10,285 Registration Sub-Districts. For registration purposes Kensington parish is unequally divided into two "sub-districts," viz., "Kensington Town," hereinafter for brevity designated "Town," and "Brompton." The Town sub-district, according to the Registrar-General, has an area of 1,497 acres, and Brompton, 693 acres; total, whole parish, 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 1888 was about 124,000, and that of Brompton 44,000; total, whole parish, 168,000. The Town sub-district still includes some open spaces, e.g., Holland Park, and fields at Notting Barn Farm, the latter, however, are now 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, is now nearly covered. The West London or Brompton Cemetery is in this sub-district, and the Kensal Green Cemetery in the Town sub-district: both, unfortunately, are still in active use. The sub-districts present considerable differences which have to be borne in mind in any comparison of their vital * 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. B3 12 statistics. In Brompton the rich and well-to-do form a large proportion of the population, whilst in the Town subdistrict there is a considerable and increasing percentage of persons of the poorer classes. The poor in Kensington, however, possess one advantage over the poor in some other parts of the Metropolis, in that for the most part they live in well-built houses obviously intended for occupation by the lower middle class, miles of streets of such houses being now inhabited by a class of persons who, in the more ancient parts of the Metropolis, find shelter in dwellings that by way of comparison might be called squalid. 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 of Ward. Area in StatuteAcres. Inhabited houses Increase in 10 years. Population. Increase 10 years. 1871. 1881 1871. 1881. St. Mary Abbotts 846 4,781 6,573 1,792 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 & St. James Norland 905 7,730 9,594 1,864 62,475 87,574 25,099 The rateable annual value of property in the several wards in 1871, was St. Mary Abbotts, £323,992; Holy Trinity £246,716; St. John and St. James, £365,012: total, whole parish, £935,720. In 1881 the returns show for the first and second wards, which cannot now be given separately, a rateable value of £1,078,512 (increase, £507,804); for St. John and St. James, of £501,704 (increase £136,692): total, whole parish, £1,580,216 (increase £644,496). The subjoined figures will be found interesting as marking the development 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 70,108 444,030 1863 1871 120,299 975,046 1873 1883 (July) 168,000 1,711.683 (April) 1883 13 SUMMARY OF VITAL STATISTICS, 1883. The first fact to be remarked is that, as already mentioned, the Kensington death-rate in 1883 was lower than in any other year of which we possess the vital statistics. And this lower death-rate was due, not to exceptional causes operating at particular periods, but to a good average condition of the public health from the beginning to the end of the year; for in every one of my ordinary reports, thirteen in number, each covering a period of four weeks, I had the satisfaction of recording a rate below the decennial average. The mortality from the "principal diseases of the zymotic class," as a whole, was, as we shall see, far below the average; but the deaths from diphtheria and enteric fever were slightly in excess, and the deaths from whooping cough considerably above the average. The mortality from whooping cough was evenly spread throughout the year, and the same may be said of enteric fever, there having been no marked general autumnal increase, although there was a smart local outbreak to which reference will be made later on. There was one death only from small-pox. Scarlet fever was little prevalent. The deaths from diarrhoea were less than two-thirds the average number corrected for increase of population, and of the 80 deaths from this cause, 48 were registered in eight weeks (24th—31st; June 16th to August 11th). Of the 39 deaths from measles 33 occurred in the second half of the year. In only one period of four weeks (November 3 to December 1), did the deaths from the principal diseases of the zymotic class exceed the average, and then by two only. The death-rate during the first four weeks of the year was 18.7 per 1,000, the decennial average being 20.7: it was 2.2 below the Metropolitan rate, (20.9) this being 3.8 below the decennial average. The deaths from the principal diseases of the zymotic class were 21 (including seven from enteric fever), or 10 below the decennial average: mean 14 ature 41°.6 F being 3°.3 above the average. There were numerous deaths from puerperal fever at this time, a localized outbreak to which reference will be made later on. In the second period (5th—8th weeks; January 28 to February 25), the death-rate, 14.9, was 6.3 below the average: the Metropolitan rate, 20.5, was 5.6 below the average, and 5.6 above the Kensington rate. To the "unseasonable" mildness of the weather, and to the copious rains from which in a sense we may be said to have "suffered," the preservation of many lives, and the consequent lowness of the death-rate, may be ascribed. In this month the deaths from the principal diseases of the zymotic class were 13, or 17 below the average: mean temperature 42°.2, or 3°.l above the average. In the third period (9th-12th weeks; February 25 to March 24), somewhat severe weather, (the temperature was 5°.3 below the average), there was a rise in the rate of mortality resulting principally from an increase in the number of deaths of young children from pulmonary and other diseases. Nevertheless the death-rate, 17 per 1,000, was 3.2 below the decennial average and 6'0 below the Metropolitan rate, which moreover, was 1.2 below the average. The deaths from the principal diseases of the zymotic class were 11, being 18 below the average: mean temperature 36°.6; average of ten years, 41.9. In the fourth period (13th-l(5th weeks; March 25 to April 21), the effects of previous severe weather were shown by a considerable rise in the death-rate due to an increase in the number of deaths of young children and aged people, and of persons at all ages from diseases of the respiratory organs. In these weeks the deaths of children under five were 22 more than in the preceding month, and 45 more than in the penultimate month. But although the total deaths showed an increase of 27 over the preceding month, the number was 20 below the corrected decennial average. The death-rate, 19.1, highest recorded in 1883, was 1.5 per 1,000 below the 15 average, and 6.1 below the Metropolitan rate (25.2) which, however, was 1.2 above the average. The deaths from the principal diseases of the zymotic class were 14, being 16 below the average: mean temperature 44°.8; average of ten years, 45.6. In the fifth period (17th-20th weeks; April 22 to May 19), the death-rate fell to 13.5, being 4.0 below the average, and 7.3 below the Metropolitan rate (20.8) which was 0.5 below the average. The deaths from the principal diseases of the zymotic class were 11, just half the average: mean temperature 48°.8; average of ten years, 49°.8. In the sixth period (21st-24th weeks; May 20 to June 16), there was a slight rise in the death-rate—to 14.7, but it was 1.9 below the average, and 3'8 below the Metropolitan rate, (18.5), this being 0.9 below the decennial average. The deaths from the principal diseases of the zymotic class were 13, being 19 below the average: mean temperature 58°.1; average of ten years, 55.2. In the seventh period (25th-28th weeks; June 17 to July 15), the death-rate fell to 12.9, being 2.7 below the decennial rate, and 6.7 below the Metropolitan rate (19.6) which was about average. The deaths from the principal diseases of the zymotic class were 26 below the average. The mean temperature in this period 61°.3, was the same as the decennial average, and the deaths from diarrhoea, which had been 4 in the preceding period, rose to 22, as against 2 in the corresponding weeks in 1882, when the temperature was 59°.2, and the weather rainy. The corrected decennial average number of deaths from diarrhoea for these weeks is 16. At this time a good deal of anxiety was occasioned by an outbreak of cholera in Egypt, fears having been entertained lest the disease should extend to Europe and to England : happily the event did not justify these fears. The subject will be referred to again. In the eighth period (29th-32nd weeks; July 15 to August 11), the deaths from diarrhoea further rose to 26, the mean 16 temperature, meantime, having fallen to 58.3, (4.1 below the decennial average). The death-rate, moreover, rose to 14.8, but it was 2.7 below the decennial rate, and 5.5 below the Metropolitan rate; this, again, being 2'3 below the decennial average. The deaths from the principal diseases of the zymotic class (39), which in the previous period had been six only below the corrected decennial average, were during the period under notice, as many as 21 below the average (60), notwithstanding the prevalence of infantile diarrhoea. In the ninth period (33rd-36th weeks; August 12 to September 8), the deaths from diarrhcea (10) were 20 below the average. The death-rate declined to 13.8, being 1.3 below the decennial average, and 3.8 below the Metropolitan rate (17.6), this again being 2.4 below the decennial average (20.0). The deaths from the principal diseases of the zymotic class (21) were 19 below the average (40): mean temperature 60°.9; average of ten years, 60°.7. In the tenth period (37th-40th weeks; September 9 to October 6), the death-rate fell to the lowest point touched in 1883, the remarkably low rate of 10.7 per 1,000 having been recorded: it was 3.7 below the decennial average (14.2), and 6.0 below the Metropolitan rate (16.7), this being 2.1 below the average. The deaths from diarrhcea were two only, and the deaths from the principal diseases of the zymotic class (12), were 11 below the average: mean temperature 55°.2; average of ten years, 55°.0. In the eleventh period (41st-44th weeks; October 7 to November 3), the death-rate rose to 14.9: but it was 1.2 below the decennial average, and 4.0 below the Metropolitan rate (18.9), which was 2.l below the average (21.0). The deaths from the principal diseases of the zymotic class were 22, or two below the average: there were four deaths from enteric fever, the disease being prevalent in the south west of the parish: mean temperature 50°.6; average of ten years, 51°.2. 17 In the twelfth period (45th-48th weeks; November 4 to December 1), the death-rate further rose to 16.6, but it was 2.7 below the decennial average (19.3), 5'0 below the Metropolitan rate (21.6), this, moreover, being 2.0 below the decennial average (23.6). The deaths from the principal diseases of the zymotic class were 27, or two above the average, this being the only occasion in the year on which the average was reached: measles and scarlet fever were the causes of 9 and 7 deaths respectively. The nearer approach to the end of the year was marked, as usual, by an increasing mortality from chest diseases, the total deaths from these causes, which had been 24, 17, and 37 in the three previous periods, rose to 63, including bronchitis, 45 : the mean temperature which in the previous period had been 50°.6, fell to 43°.4, but was l°.l above the average of ten years. In the thirteenth and last of the four-weekly periods, (49th-52nd weeks, December 2-29), the rate of mortality, 17.3, was 3.2 below the average, and 4.0 below the Metropolitan rate (21.3), which, moreover, was 4.2 below the decennial rate (25.5). Measles and whooping cough were the causes of 7 and 6 deaths respectively; the total deaths from the principal diseases of the zymotic class being 21, or 9 below the average. The deaths from chest diseases further rose to 65, including bronchitis 40, the mean temperature (40°.7) having further declined to the extent of 2°.7, but being 2°.4 above the decennial average. THE ZYMOTIC DISEASES. Before entering into details with respect to population births, deaths, &c., I propose to consider 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 in the Registrar-General's classification of the "causes of death" 18 six "Orders." The first and second Orders, ("Miasmatic" and "Diarrhoeal"), include the diseases which the RegistrarGeneral calls "the seven principal diseases of the zymotic class," still grouping under the generic term "Fever" the three distinct fevers, "Typhus," "Enteric," and "Simple continued." These "seven" diseases have a high interest for sanitarians, arising out of their more or less preventible character; it being customary, moreover, to regard the absence or the prevalence of them, as the case may be, as a test of the sanitary condition of a district. But, without under-rating the importance of this test, there are limitations to its applicability which must be borne in mind if we would draw sound conclusions. What I mean may be best explained by an illustration or two founded on our own local experiences within the last few years. Thus Measles was very fatal in 1874 and 1876; the deaths were far above the average; it was the zymotic disease that gave a special character to those years. In 1875 and 1877, on the other hand, the deaths from Measles were below the average; but the lower mortality—evidence of the diminished prevalence of the disease—was due to the excessive prevalence and fatality of the malady in the preceding years. 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 measures taken, or the neglect to take measures, for limiting the spread of infection. Again; the rate of mortality in the Metropolis from whooping cough in 1881 was the lowest on record; it is not surprising to find, therefore, that in 1882 the disease was excessively fatal. Diarrhcea may be cited as an illustration of quite another kind. The mortality from this disease amongst infants was excessive in 1878; the mortality in 1879 was much below the average; but the diminished mortality in the second year had no relation to the excessive mortality in the 19 first: the conditions were altogether different. The summer in 1879 was cold and wet, and, as always happens in these circumstances, the mortality from infantile diarrhoea was low, just as it is always high when the summer is hot and dry, as it was in 1878. Per contra, it may be observed that the conditions that were so favourable to infantile life in respect of diarrhoea, in 1879, were very unfavourable to life, both in the young and in the aged, in respect of another group of diseases, the pulmonary, the mortality from which throughout the year was excessive, as it always is in cold and wet seasons. Again; the significance of a high rate of prevalence of enteric fever may vary widely in different circumstances : the disease may be constantly present in one district as the result of drainage defects, or a polluted water supply; in another district its introduction may be due to an accidental pollution of water, or to a specifically contaminated milk supply—and the same observation in regard to milk applies equally in the case of scarlet fever also. These and like circumstances must be kept in view if we would draw right conclusions from a high or a low rate of prevalence of diseases, particularly in relation to the sanitary condition of a district. Subject to corrections for local and climatic conditions, and for high rates in previous years, the concurrence of a low zymotic and a low general death rate, furnishes just ground for satisfaction; and as the general and the zymotic rate in Kensington were both lower in 1883 than in any previous year on record, we are fairly entitled to that satisfaction. It need hardly be said, on the other hand, that a persistently high rate of mortality from zymotic diseases is always a subject for serious consideration. Kensington, as we shall see in due course, has hitherto been in the happy position of having a death-rate from these diseases much below that of the Metropolis generally. 20 The subjoined table* sets out necessary particulars of the mortality from the principal zymotic diseases in 1883, together with the decennial average, &c.:— Disease. SubTown. districts. Brompton. In Hospitals. Total. Totals in 1882. Decennial Averaere. Town. Brompton. Uncorrected. Corrected for Increase of Population. Small-Pox 0 0 1 0 1 .. 20.7 22.5 Measles 34 3 2 0 39 77 69.6 75.7 Scarlet Fever 17 5 5 1 28 62 54.8 59.6 Diphtheria 18 2 2 2 24 25 19.6 21.3 Whooping Cough 38 6 0 0 44 119 93.1 101.2 Typhus Fever 2 0 0 0 2 1 3.3 3.3 Enteric „ 16 9 4 1 30 25 23.6 25.6 SimpleCond. ,, 1 2 0 0 3 6 6.8 7.4 Diarrhœa 69 9 2 0 80 61 113.1 123.0 195 36 16 4 251 376 404.6 439.6 From the above table, we learn that the deaths from the "seven principal diseases of the zymotic class" were 125 fewer than in 1882, and 188 below the corrected decennial average. As usual, the deaths in the Brompton sub-district were relatively fewer, in proportion to population, than in the Town sub-district. The deaths were equal to 96 per 1,000 deaths from all causes in Kensington, (Metropolis, 134), and to a rate of 1.5 per 1,000 persons living, (Metropolis, 2.7), the decennial average being 2'6 in Kensington, and 3.5 in London. By way of comparison it may be mentioned that in England and Wales the deaths from these diseases were 112 in every thousand deaths: the rate was 2.2 per 1,000 persons living, the decennial average being 3'0 per 1,000. In the 27 large Towns grouped by the Registrar-General with the Metropolis, the zymotic death-rate was 2.8per 1,000, ranging from TO in Norwich to 4.3 in Newcastle, and in the 50 large Towns coming next in order of importance after the 28, it averaged 2.4 per 1,000; the highest rate, (5.8 per 1,000), being recorded at Dudley, and the lowest rate, (0.8), at Hastings. * The figures in the table do not tally with those in the Registrar-General's Annual Summary, because deaths of non-parishioners at public institutions within the parish are excluded, whilst deaths of parishioners in outlying public institutions are included. 21 The following table shows the distribution of deaths, from the several diseases, of Kensington people, in 13 periods of four weeks, corresponding to my monthly reports:— PERIOD. DISEASES. Total. Uncorrected Averages ten years, 1873-82. Four weeks ended Small-Pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Typhus Fever. Enteric Fever. Simple Continued Fever. Diarrhoea. Jan. 27 .. 2 5 3 1 .. 7 .. 3 21 30 Feb. 24 .. 1 1 1 5 .. 5 .. .. 13 30 Mar. 24 .. .. .. 1 6 .. 1 .. 3 11 29 April 21 .. 3 .. 4 5 .. 2 .. .. 14 30 May 19 .. .. 3 .. 4 .. 3 .. 1 11 22 June 16 .. .. 1 4 3 .. .. 1 4 13 31 July 14 .. .. 1 .. 2 .. 1 .. 22 26 31 Aug. 11 1 3 3 1 4 .. 1 .. 26 39 60 Sept. 8 .. 6 .. 1 2 .. 1 .. 10 21 40 Oct. 6 .. 2 1 4 2 .. 1 .. 2 12 23 Nov. 3 .. 6 4 2 3 .. 4 1 2 22 24 Dec. 1 .. 9 7 2 1 1 2 1 4 27 25 Dec. 29 .. 7 2 1 6 .. 2 .. 3 21 30 1 39 28 24 44 2 30 3 80 251 405 I now proceed to make a few observations with regard to each of the above-mentioned diseases. Measles. The deaths were 39, about half the decennial average: 33 were recorded in the second half of the year, and 36 took place in the Town sub-district. The deaths from this cause in 1882 were 76, the same as the decennial average. In the majority of the fatal cases, some intercurrent disease, e.g., pneumonia, bronchitis, etc., a complication of the original malady, was the immediate cause of death. Little care is taken by parents among the poorer classes to prevent the spread of measles; it is considered as inevitable as teething, and they reason that there is less trouble in the long run if all the children have the complaint at one time. It must, however, be admitted that it is difficult to prevent measles from spreading, it being highly infectious from an early stage, if not from the beginning. 22 The circumstances, moreover, in which the poor in London live—several families occupying one house and using a common staircase—almost preclude the possibility of isolation. More care, perhaps, might be taken to protect the sufferers against the secondary affections, which, as already stated, are generally the immediate causes of death. Whooping-Cough which was the cause of 119 deaths in 1882, proved fatal to 44 persons only last year, all but 6 in the Town sub-district; the corrected decennial average being 101. Reference was made, above, to the little care taken by parents in the humbler walks of life, to prevent the spread of measles: the observation is perhaps even more generally true in regard to whooping-cough, the danger of this always distressing malady being unappreciated by the poor, who,.in the engrossing struggle for existence, find little time to devote to the care of their children in respect of an ailment which they have come to regard as at once inevitable and not very serious. Often enough the fatal event comes as a surprise, being due to some complication, e.g., convulsions or bronchitis, the secondary causes of many deaths : few deaths, indeed, are returned from whoopingcough alone. In some instances, intercurrent diseases, of the chest for example, are unavoidable, but they are often the result of want of care in the treatment of the little sufferers— though I would by no means imply that such want of care proceeds from indifference, still less from unkindness. The little ones are not, perhaps cannot be, confined to a single room, kept at an even temperature: they catch cold ; the "cold" and the "cough" are not differentiated ; medical treatment is not sought until the child is obviously very ill, and, when it is obtained, the patient is but too frequently beyond the reach of help. Scarlet Fever was the cause of 28 deaths, against 62 in 1882, the corrected decennial average being 60. Of the 28 deaths 22 belong to the Town sub-district, and 6 only to Brompton. Six of the deaths took place in hospitals, to 23 which 90 out of 231 recorded cases were removed for treatment. Of the 231 recorded cases 154 belonged to that part of the parish north of Uxbridge Road, and 77 to the remainder of the parish south of that road. The recorded cases in 1882 were 319. In many instances the occurrence of the disease was concealed until recovery had taken place, when the cases were reported in order to obtain gratuitous disinfection; and frequently when the existence of the disease became known at an early period, we were unable to persuade parents to consent to the removal of their children to hospital. In some cases, when it was too late, the refusal came to be lamented. A certain number of patients were well isolated at home, and their removal to hospital was deemed unnecessary, but proofs were not wanting that, even when the patients had what might be fairly described as " proper lodging and accommodation," due care was not taken to prevent the spread of the disease, unless it be the fact that no amount of care suffices to prevent its spread when once it has found admittance into a susceptible family. In not a few instances, where removal was obviously necessary to security, the greatest difficulty was experienced in obtaining the parents' consent, but in no case did we have recourse to the compulsory powers of removal, such as they are, which the Sanitary Act of 1866 confers. It need hardly be said that most of the cases were of children, usually of school age, and 86 of the sufferers had been attending school up to the time of the attack. Every effort was made, by co-operation with school-teachers and visitors, &c., to prevent the disease from spreading, and no child was allowed to go to school from an infected house. The existence of the disease was revealed often by the registration of a death, and it is the fact that its spread was commonly the result of keeping patients at home under circumstances that rendered nugatory any attempts at isolation. From time to time cases come to light which help to 24 explain the apparently mysterious spread of infectious diseases. For instance, one of the sanitary inspectors received information of an outbreak of scarlet fever in the family of a verger at a church, the man continuing his daily duties as usual: he would not allow the children to go to hospital, so I communicated with the clergyman, who required him to take lodgings away from home. In another instance two children of a letter carrier had been ill for several weeks: the cases were concealed, and the man was about to resume duty, on their recovery, when the Sanitary Inspector happened to hear that a third child was ill, and on revisiting the house, shortly after he had left it, having been led to believe there was no other case, he found a sick girl concealed in another room. Children from this house were attending school, and the Inspector saw a young school girl nursing one of the sick children. The illness in this family should have been reported to me by the Medical Officer to the Post Office, in conformity with the requirements of the instructional circular issued by the Department, to which I made reference in my last annual report (page 74), but I only received intimation of the illness when our services were required for disinfection. The Inspector, however, was informed that the Medical Officer, who had certified, so as to enable the letter carrier to remain off duty, and receive pay, week by week, did not visit the house, (another doctor being in attendance), until the two children were reported to be well; and then it was that he communicated with me with regard to the disinfection: the third case, above referred to, had been kept from his knowledge likewise. Diphtheria, which was unusually prevalent in London in 1883, was the registered cause of 24 deaths in Kensington, 3 above the corrected decennial average'• 20 in the Town sub-district and 4 in Brompton. Not all deaths classified to diphtheria are really caused by diphtheria: cases of scarlatina anginosa, are sometimes erroneously certified as diphtheria ; and we had illustrations of the fact in 1883. On the other 25 hand, it sometimes happens that true diphtheria is not recognised in the primary stage: the nature of the disease does not become known until paralysis supervenes. Cases of croup, again, are sometimes described as diphtheria, and vice versa. Diphtheria, it may be added, does not often show a disposition to become epidemic, or even endemic, in the metropolis. Occasionally, however, when the disease occurs as a result of insanitary conditions, it will spread in the family : thus, for instance, there were five cases in a family living in rooms over a stable at Ruston Mews, Notting Hill, the first case being due to defective drainage, and the following cases to infection. The first case was concealed and fatal: its existence became known upon the registration of death only, and it was found impossible to persuade the parents to let the other children—for all the sufferers were children under fourteen—be removed to the parish infirmary. The Asylums Board, it may be mentioned, do not treat diphtheria in their hospitals. Fever.—The deaths from the three diseases grouped as "fever," were 35, viz., 28 in the Town sub-district, and 12 in Brompton; the decennial average, corrected for increase of population, being 36.3. Typhus. Two deaths from this highly infectious disease were registered, viz., that of a manufacturer of parquet flooring, aged 54, at Lancaster Road, after five days illness, and that of a school girl, aged 12, at St. Ervan's Road, Notting Hill. I was unable to obtain any definite information as to origin in the first case: the circumstances of the second case were peculiar, and strongly suggestive of error in diagnosis. The deceased was a daughter of an upholsterer, being a "half-time" pupil at Buckingham Terrace Board School, and lived in service at Hammersmith. She was sent home unwell November 1, and next day was taken to a private "Dispensary." She was subsequently attended at home by the "Dispensary" doctor till she died, on the 7th, having been visited five times in as many days. The doctor, 26 who had said nothing about typhus during the illness, refused to certify the cause of death, and called for an inquest, because, in some former case, in connection with the same "Dispensary," I had felt it my duty to express doubt as to the accuracy of a diagnosis of typhus. A post-mortem examination was held, and after hearing the medical evidence the jury returned a verdict of death from "typhus." No precautions were taken to prevent the disease from spreading, for even after the post-mortem the father was not informed of the supposed nature of the illness, and only became aware of it at the inquest. I communicated with the Medical Officer of Health for Hammersmith, who informed me there had not been any case of typhus at the house where the deceased had resided. I thought it probable the child had died from brain trouble, e.g., Meningitis, for her father stated that she was much excited and anxious in connection with an approaching school examination, and that, until she became delirious, on the third day preceding death, she constantly engaged in calculations, recitations, &c. Some of her school fellows were allowed to see and kiss her body after death, but no ill consequences resulted, nor did any other case of typhus occur in the house or locality. This case, as narrated in my fourteenth report, (December 3, 1883, page 125), attracted some attention in connection with a question then agitating the public mind, viz., whether educational "over-pressure," under the stringent provisions of the new code, might not be acting injuriously upon dull and backward children ? It happened curiously enough, that the death of another girl of the same age, and a pupil of the same school, was in the same report referred to as having been certified from "over application to study—Meningitis." The report was forwarded to the Vice-President of the Council, and I was informed that an enquiry was made by an Officer of the School Board, who arrived at the conclusion that the deaths were not due to "over-pressure;" but what sort of an enquiry he made, or what were his qualifications for making such enquiry, or how he arrived at his conclusion, I do not know. 27 Enteric Fever was the registered cause of 30 deaths, 20 in the Town sub-district and 10 in Brompton; five occurred in hospitals: 12 took place in the first eight weeks of the year. The disease was scarcely so prevalent as usual in the autumn; but there was a local outbreak of considerable importance ; the district particularly affected being south of Kensington Road, and west of Earl's Court Road. The cases in this outbreak, 29 in number, were in 19 houses in 12 streets: the sufferers included 12 of children under 11 years of age, 7 of persons between 14 and 20, and 10 of persons above 20. The disease was restricted to houses of well-to-do people, and there were not wanting grounds for suspicion that in the great majority of the cases it might have been spread through the agency of milk : the cases, however, were singularly few in proportion to the number of persons receiving milk from the same dairy. Every facility for investigation was placed at my disposal, and most diligent enquires were made in different parts of the country, but without anything being revealed to throw light on the origin of the outbreak ; which, moreover, excepting perhaps in one or two instances, did not appear to be explicable by sanitary defects in the infected houses. House to house visitation was made, and numerous medical men, hospital authorities, medical officers of health, &c., were communicated with, but to little purpose. The endemic speedily died out, but it was the cause of five deaths. Simple continued Fever was the cause of 8 deaths, two of them in the Brompton sub-district. Diarrhoea.—The deaths from diarrhoea, 80 in number, were 43 below the decennial average corrected for increase of population ; 71 of them took place in the Town subdistrict, and 9 in Brompton; 58 were registered in twelve weeks ended September 8. As usual, the deaths were chiefly of young children, viz., 74 under five years of age, including 65 under one year. Excepting in 1879, when the deaths were 71, and in 1882, when the deaths were 61 C 2 28 only, such a low rate of mortality from diarrhoea has not been recorded for many years: it was the result of the generally low temperature that prevailed in the summer months. The immediate causation of this infantile scourge has never been clearly made out: it is hoped that the enquiry delegated by the Local Government Board to their Inspector, Dr. Ballard, will ultimately throw light on the subject. Small-Pox.—Eight cases only of small-pox were recorded during the year, viz.:—three in the district north of Uxbridge Road, and five in the remainder of the parish south of that road : two of the cases were imported. Six of the sufferers were removed to Hospital; in one case removal was not necessary, and in the remaining case, that of a housekeeper at Hyde Park Gate, the patient left the parish. This case led to a second in the same house, the only fatal case in 1883, the sufferer having died in hospital. She was a lady's maid, and evidently contracted the disease from the housekeeper who had been visited, at her place of service, and at the mistress's request, by a medical man, who formed the opinion that she was not suffering from any infectious complaint. Two days later, however, the patient called at the doctor's house and he then recognised small-pox, told her of the fact, and advised her to send to the parochial authorities, on her return home, in order that she might be removed to hospital. Unfortunately the doctor did not communicate with the family nor with me, and the woman left the house on the same day, for Hammersmith, it is alleged, and in an omnibus, without saying one word about the nature of her illness: she could not be traced. The lady's maid stated in hospital, that the housekeeper had had spots upon her body like her own, and the doctor, when questioned admitted that the housekeeper was suffering from small-pox. The lady's maid, doubtless, was infected before the diagnosis in the first case was made, nevertheless it is to be regretted that the doctor did not acquaint the lady of the house with the nature of the illness, for there is no knowing what mischief 29 may have resulted from the housekeeper's wilful infraction of the law: it is certain that at an epidemic period such an exposure might have led to a wide diffusion of small-pox. WESTERN DISTRICT (LATE FULHAM) HOSPITAL. No case of small-pox was admitted into this hospital in 1883, but the use of it for cases of fever was continued throughout the year. From the report of Mr. Sweeting, the Medical Superintendent, we learn that on December 31, 1882, there remained 101 patients: during 1883, 236 were admitted, 273 discharged, and 21 died, leaving 43 under treatment at its close. Of the admissions 197 were of scarlet fever, 18 of enteric fever, 13 of typhus fever, and 8 of other diseases. Of the 21 deaths, 15 were from scarlet fever, 2 from intercurrent measles in scarlet fever cases, 3 from enteric fever, and one from inflammation of the kidneys. The mortality from scarlet fever was 6'7 per cent, and from enteric fever, 14.6 per cent. Kensington contributed the largest number of cases; 44 per cent. of the whole number, Fulham coming next with 30 per cent. Of the scarlet fever cases, 58 per cent were under 10 years of age. The mortality, greater amongst males than females, was heaviest in those under five years of age. No deaths from typhus fever occurred; 5 cases only were treated; the remaining cases were transferred to another hospital. The average duration of stay in the hospital of scarlet fever cases, was 78 days, and of enteric fever cases, 72 days. During the year 34 patients were placed upon the visiting list, of whom 21 died. They were visited by 78 visitors, who paid altogether 258 visits. It is to be presumed that the visitors escaped infection, as not one of them was subsequently admitted with fever. The Fulham Hospital Case.—The litigation in this case has been terminated by a compromise, a sum of money having been paid to the plaintiffs. The Deed of 30 ment provides that 75 "mixed,'" or 50 severe or confluent cases of small-pox may be treated in the hospital at one time, but is understood that the managers will not receive more than 40 at any one time if they can help it. The hospital site, I understand, is to be divided, the larger, southern, portion containing five pavilions, (150 beds), will ultimately be a fever hospital: the smaller portion, three pavilions, with certain additional buildings, will be a small-pox hospital. A wall running from east to west will separate the two hospitals, as far as practicable: each hospital will, I presume, have an assistant Medical Officer under the direction of the Medical Superintendent in charge of both hospitals. Not being myself a convert to "aerial infection" theory as developed in Mr.Power's report on this hospital, I should not fear the reception of fifty severe cases of small-pox, provided due care in administration, to prevent spread of infection, were observed; but considering that not a half—barely a quarter—of 50 severe cases were in the hospital when the "notable outburst" occurred in January, 1881, the upholders of that theory may well look forward with apprehension to the practical realization of the new arrangements which, however, have been sanctioned by the Plaintiffs in the action, and are based on the recommendations of the Hospitals Commission. The injunction having been dissolved, patients can be admitted from any distance, but the hospital will be utilized chiefly for the Western districts, and especially for the parishes of Kensington, Chelsea, Fulham, and Hammersmith.* Considerable improvements, by the provision of permanent accommodation for nurses, and for administrative purposes generally, are being carried out at the hospital. New entrances also are in course of construction, and altogether the establishment, when finished, will be of a very complete character. * The Hospital was re-opened May 17th, 1884, for the reception of small-pox cases. Vide page 38 31 The Hampstead Hospital Case.—The long and costly litigation in this cause celebre has been terminated by a compromise entered into between the Asylums' Board and the principal plaintiff, whose property has been purchased by the Managers, who will be at liberty to treat a fixed number of small-pox cases in the hospital, presumably the same number as at Fulham, i.e., 75 mixed, or 50 severe or confluent. A much needed improvement has been effected, by the purchase of a right of way to the hospital, along the Fleet Road, and the approach to the hospital, which previously was unsatisfactory, is now all that could be desired. HOSPITALS COMMISSION. In my last annual report (pages 28-43 inclusive), I referred to the recommendations of the Royal Commission for making provision of hospital accommodation for the infectious sick, and generally for dealing with epidemic diseases. I propose now to state what has since been done by the Managers of the Asylums Board, with the view of giving effect to the recommendations : and first as regards Small-pox Hospital Accommodation. The Commission urged the desirability of hospitals being provided for smallpox cases in isolated situations on the banks of the Thames, of in floating hospitals on the river itself. The Managers have provided both, for in addition to the Atlas which can make up more than two hundred beds on an emergency, they have purchased the twinship Castalia which has been adapted for the reception of about 200 patients. These vessels with their tender, the Endymion, are moored at Long Reach, and opposite the moorings the Managers have purchased upwards of eight acres of land for laundry, mortuary, and general purposes, and have erected a pier and landing stage. This land is within a short distance of Darenth Asylum, in the grounds of which, it will be remembered, a camp hospital for convalescent small-pox cases 32 was erected and carried on with remarkable success in the summer of 1881. The Managers have also purchased the "Gore Farm Estate," about 135 acres, in the immediate vicinity of Darenth Asylum, and on a part of it they established, in March 1884, a camp hospital, to meet a great emergency, there having been a very considerable increase in the number of small-pox cases in the eastern district of the metropolis. But the Managers intend to make permanent provision for convalescent small-pox cases on this site, and they have matured arrangements for the erection of a hospital, a step rendered necessary by the restrictions imposed on them by the compromises already referred to, in regard to the North Western and Western Hospitals, and by the recommendation of the Commission that not more than 30 to 40 small-pox cases should be treated at one time in any hospital within the metropolitan area. During the epidemic of 1881, the Managers had accommodation at their disposal in the metropolis for 1,000 small-pox cases, and the camp hospital at Darenth provided for about 650 cases; 1,650 beds in all, the maximum number occupied at any one time in the course of that not very extraordinary epidemic. The Managers as at present situated, and apart from the camp, possess accommodation for 650 cases only, viz.:—250 beds in hospitals on land, (fifty in each of the five existing hospitals), and about 400 on shipboard, so that there would be a deficiency to the extent of about 1,000 beds in the event of an average epidemic. To supply this deficiency, the Managers propose, with the sanction of the Local Government Board, to erect a hospital for 1,000 patients in ten groups of buildings, each to afford accommodation for 100: six only of the groups to be erected in the first instance, but with all the administrative buildings necessary for the complete hospital. Each of the groups will be subdivided into four wards of 25 beds each, with a day room, &c., and infirmary accommodation 33 will be provided for 60 patients in two large wards of 24 beds each, and two small wards, or isolation rooms, of six beds each, for the treatment of cases of erysipelas or other complications occasionally attendant upon small-pox. The permanent provision, already made or contemplated, falls short of the requirements of the metropolis as estimated by the Hospitals Commission, who were of opinion that there should be sites and buildings which could without difficulty be made capable of receiving 2,100, or by special exertion 2,700, small-pox patients. The sites are adequate in mere acreage, as on the land at Darenth any necessary number of tents could be pitched on an emergency; but the Local Government Board have judiciously suggested for the consideration of the Managers the desirability of an endeavour being made to secure an additional site, to the west or south west of the metropolis, which would be available for an additional hospital for convalescent smallpox patients, in view of the exigencies of a serious epidemic, and taking into account the necessities of London as a whole. Fever Hospital Accommodation. The Commission were of opinion that there should be sites and buildings which could be made capable of receiving 8,000 fever patients. " Of the 3,000 cases those in the earlier stages, probably about half, should be provided for in the near neighbourhood of London; the other half—the convalescents—in two or three country hospitals." The beds now available for treatment of fever cases at the five existing hospitals are about 1,050, the recommendation of the Commission, that these hospitals should " become in the main fever hospitals," having been carried into effect. These hospitals the Commission thought it probable would, "with the aid of another hospital which appears to be indispensable for the east of London, fully accommodate all the cases requiring London treatment." The Managers resolved in the first instance to give effect to the recommendation to provide another hospital for the 34 east of London, and the sanction of the Local Government Board was accorded to the proposal, but the Managers afterwards rescinded the resolution, and with the approval of the Board they have acquired about 36 acres of land, known as the Chaseville Park estate, at Winchmore Hill, nine miles north east from Charing Cross, on which they propose to erect a hospital, mainly for convalescing and convalescent fever cases; but they have not pledged themselves to exclude acute cases, should the London accommodation prove inadequate at any time. Whether the Metropolis will be sufficiently provided with accommodation for acute cases without an additional hospital, time only can show, but there can be no doubt as to the need of a country retreat for convalescents, such as the " Northern District Hospital" will supply. This hospital has been designed to provide for about 500 patients in buildings similar to those to be erected for convalescent small-pox cases at Darenth: but, unlike Darenth, it is intended to be in permanent occupation, and it is expected to relieve the pressure upon the other hospitals north of the Thames. It is probable that the Managers will ultimately decide upon purchasing a site for convalescing fever patients south of the river, so as to carry out the recommendations of the Hospitals Commission, as it is obviously neccessary, if we are to be prepared against all emergencies, that there should be hospitals or, at the least, sites on which to make temporary provision for patients in the acute, and in the convalescent, stages, and so situated, moreover, as to be accessible from all parts of the Metropolis north and south of the Thames. Ambulance Service. — The Hospitals Commission recommended that "the hospital authorities should have the entire control of the ambulances, by which all other modes of conveyance should be as far as possible superseded." In order to give effect to this recommendation, the Managers have taken steps with the view of providing ambulance stations at three of their London hospitals, powers for this 35 purpose having been conferred on them by section 16 of the Poor Law Act, 1879. The station in connection with the Western District Hospital, with which we are more immediately concerned, is approaching completion, and will provide stabling for 15 horses, coach-house for 15 ambulances, together with all necessary accommodation for drivers, nurses, &c., on a site 220 feet by 76 feet. The Managers, desirous of obtaining ambulances of the best possible construction, offered prizes for designs, and finally made choice of a pattern which it may fairly be hoped will prove satisfactory. Ambulance Steamers.—The "Red Cross," specially constructed for the conveyance of small-pox patients to the ship hospitals, and to the camp, is now in use, and a second and larger vessel is in process of construction. A river steamer has been purchased for temporary use, and will probably be made available ultimately, for conveying recovered patients from the hospitals on the home journey. Wharves.—By section 6 of the Diseases Prevention (Metropolis) Act, 1883, the Managers were empowered to obtain land, with approaches, &c., for three wharves or landing places within the metropolis, and one beyond the metropolis, to facilitate the conveyance of the sick to land or ship hospitals down the river. Effect has been given to this enactment by the purchase of land as follows:—A site at Rotherhithe, ("Acorn Wharf "), for the service of the southern districts of the metropolis, and a site at Blackwall, (" Brown's Wharf,") for the service of the north-east district. Negotiations are in progress for the purchase of a site near Wandsworth Bridge, to serve as a transfer depot for the use of the Western districts, including Kensington. The land at Long Reach, off which the hospital ships are moored, is the fourth or extra metropolitan site. At each wharf a pier has been, or will be, erected, from alongside which patients will be taken from the land ambulances to the steamers, and at which convalescents will disembark on their return 36 home from the ship hospitals or camp. Under the arrangements matured by the Managers, the treatment of a small-pox patient may be said to commence at the moment of removal, for he is taken charge of at the bedside by a skilled nurse, who attends upon him in the ambulance and in the steamer. Hitherto, the service so carefully organized, has worked well, and it must be allowed to be a great improvement on that which, in the course of a short time, it will have entirely superseded. Large as are the expenses being, or to be, incurred, it will probably be felt that the Managers have exercised a sound discretion in making provision for all contingencies, quietly and systematically, while as yet there was no serious epidemic: they have been found prepared and so panic has been avoided now that the emergency has arisen. It is almost superfluous to add, perhaps, that the Managers have been hampered, more or less, at every stage of their proceedings, through local opposition, based generally on fears that hospitals, ambulance-stations and wharves alike, must needs depreciate the value of adjacent property and injuriously affect the health of the inhabitants. Subject to proper precautions being adopted I do not think the latter danger is likely to arise, and the first named will probably turn out to be ill-founded. From what has already been stated it will appear, that when the arrangements in progress, or contemplated, shall have been completed, the Managers will have provided a sufficiency of hospital accommodation for infectious diseases for all classes of the population. It is to be remembered, moreover, that by the Diseases Prevention (Metropolis) Act, 1883, the relief to be afforded in the Managers' Hospitals will not pauperise the recipients of it, for I hold it impossible that the provisions of section 7 should not be made permanent. It only remains, therefore, to contrive arrangements for facilitating the admittance of patients without the formalities which now frequently interpose delay when delay 37 is so dangerous. I contended so far back as 1875, that the certificate of any duly qualified medical man should be accepted as evidence of the nature of a dangerous infectious disease, (e.g., small-pox, scarlet fever, enteric fever, &c.), and I am of opinion that the Medical Officer of Health, equally with the Relieving Officer, should be authorised to sign the order for the admittance of a patient.* To all practical intents and purposes the Managers are now a sanitary or quasi-sanitary authority, acting for the whole Metropolis, and arrangements should be concerted for bringing them into close and definite relations with the local sanitary authorities, the vestries and district boards, with a view of facilitating the admittance of the patients, who, as already explained, will be transferred to the hospitals in the Managers' own ambulances. And this without the necessity of contracts between the Managers and Sanitary Authorities, (under the Poor Law Act, 1879), for the maintenance and treatment of non-paupers; for the hospitals, although conducted by a Poor Law Authority, are no longer pauper establishments. Certain expenses incurred by the Managers in the treatment of the sick, viz., for maintenance, clothing, &c., are at present repayable by the Guardians of the parish or union from which the patients are admitted, and it can matter nothing whether such repayments are made by the Guardians, as Poor Law Authority, or by the Vestry as Sanitary Authority. So long, however, as the elective Managers are chosen by the Guardians exclusively, it will probably be found convenient to continue the existing arrangements, but I need hardly say that I concur in the recommendation of the Hospitals Commission, which indeed merely endorsed my views, long ago sanctioned by your Vestry, that the sanitary authorities should be represented at the Board. I am strongly of opinion, however, that it will * Shortly after this portion of the report was in type, more than I had ever ventured to ask, was conceded by (he new arrangements of the Asylums Board, as set out in the " Regulations for the removal of cases of small-pox and fever by the land and river ambulances." The subject is referred to again further on. 38 ultimately be found desirable, qua provision of hospital accommodation, to make the Board a purely sanitary authority, and to treat the Metropolis as one District, throwing every expense to be incurred by the Managers on a metropolitan common fund. I submitted a recommendation to this effect to the Managers, in the early part of 1877, in a communication subsequently reprinted in my Annual Report for 1876-7, (at page 14), under the heading, "Hospital accommodation for the non-pauper infectious sick." THE USE AND INFLUENCE OF HOSPITALS FOR INFECTIOUS DISEASES. In my last Annual Report, (pp 47-65 inclusive) I discussed under the above heading, the question raised by Mr. W. H. Power's Report on Fulham Hospital, whether the poison of small-pox can be transmitted unchanged through the atmosphere so as to infect susceptible persons at considerable distances? So momentous are the issues involved in a correct solution of this question, which, practically, Mr. Power has answered in the affirmative, that I thought it my duty to state the grounds on which I had ventured to doubt the accuracy of Mr. Power's conclusions, and to express a hope that his views would not be generally accepted as correct, without further investigation and more decisive evidence than any as yet forthcoming. The opportunity for such further investigation has already arrived, and the duty of making it has devolved upon Mr. Power. In March, of the present year, an epidemic of small-pox, commenced in the eastern districts, and the extension of the disease westward, necessitated the reopening of Fulham Hospital at the middle of May. Towards the end of June, a considerable number of small-pox cases having occurred in the Borough of Chelsea, the Local Government Board directed Mr. Power to resume enquiry respecting the 39 tribution of the disease, in the constituent parishes, Chelsea, Kensington, and Fulham, including Hammersmith. Mr. Power, thereupon, appealed to the Medical profession for precise information of all small-pox, in the districts above mentioned, since the commencement of the present year, (1884), such information to include the facts as to each case, mild or severe. Mr. Power's further report will be awaited with interest, none the less because he will have had the opportunity of testing the validity of his own conclusions with full knowledge of the objections raised thereto by those who have felt themselves unable to accept, as proved, the theory of distant aerial infection. The new inquiry, however, will be conducted under circumstances differing considerably from those of 1881, inasmuch as not more than fifty cases may now be treated in the Hospital at any one time, whereas in 1881 as many as 300 beds were continuously occupied for weeks together. The great bulk of the 300 patients, it is true, were in the stage of convalescence which is not regarded by Mr. Power as being infective in any thing like the same degree as the acute stage, if at all: still, there were as many as 80 acute cases in the wards at one time and over a considerable period. It is noteworthy, however, that when these acute cases were at a maximum there was no marked prevalence of small-pox in the "special area," (a circle of a mile radius having the Hospital for its centre), it being the fact, moreever, that when the "notable outbreak" of January, 1881, took place, there were not more than fifteen acute cases in Hospital, only 55 of such cases in all having been admitted in a period of five weeks, ending Jan 17th, which was the last of the five days on which the persons were infected, whose illnesses, commencing Jan. 26-30, (inclusive), made so strong an impression on the mind of Mr. Power. It was this smallness of numbers at the critical time, that led me to submit to the Royal Commission the view that, if the aerial infection theory as developed by Mr. Power were true, "a 40 hospital, however small, must be a public danger, even at a distance of 1000 feet and upwards ; " and that the attempt to stay the plague would be all but hopeless under the land-hospital system. In these circumstances, the very cautious scheme of the Commission, which contemplates the retention of some 30 or 40 acute cases in each of the Town hospitals, could not be justified—still less, the compromise of litigation, under the terms of which the Managers are at liberty to receive into the Fulham Hospital as many as 50 " severe or confluent " cases at one time. In each epidemic of small-pox since 1877, when the hospital was first used, there had been some cases in the "special area " prior to the admission of any considerable number of patients, as my monthly reports show. Curiously enough, the disease was later in making its appearance in the special area in 1881, when hospital cases accumulated more rapidly than in any previous year. In the present year, when the hospital cases have been fewer than ever before, the reverse, as I shall show, has been the case. I do not propose in the present report to enter in a controversial spirit into the question of aerial infection, and I have made the above remarks solely by way of introduction to a statement of known facts with regard to small-pox prevalence in the days prior to, and immediately succeeding, the re-opening of the hospital, (May 17), with the view of showing, that whatever may be the influence of small-pox hospitals on surrounding districts, Fulham Hospital could not have originated the Borough epidemic in 1884, inasmuch as the disease had appeared in many streets before the hospital was opened, and some three-score of cases had been recorded while as yet there were not ten cases in the wards. The cases recorded in Kensington in the twenty weeks ended May 17, on which day the hospital was re-opened, were 12, five north and seven south of Uxbridge-road.* In *There were about as many cases in Chelsea, but none in Fulham, apparently, prior to this date. 41 the next four weeks, ended June 14th, the recorded cases were 38, 10 north and 28 south of Uxbridge-road. The 10 cases in the north district occurred in eight houses, in eight streets; the 28 cases in the south district, in 24 houses, in 22 streets, nine of the patients being domestic servants. By June 14th, 44 cases had been admitted into the hospital, 26 from Kensington, 10 from Fulham, and 8 from Chelsea. Fifteen Kensington cases were infected in four days, May 19-22, the atmospheric conditions on those days being as follows:—wind easterly for the most part, and blowing therefore, in the direction of Fulham; horizontal movement of air below the average of 16 years, to the extent of 90, 69, 119, and 15 miles per diem, on the four days respectively; temperature 54°. 8 Fahr., barometer 30.03 in., no ozone; no rain; degree of humidity 62, complete saturation being represented by 100. On June 14 there were 23 cases in hospital, but not more than 10 cases had been in the wards at the date of infection of any of the 40 cases. Eleven of the 40 cases were infected before the hospital was opened, in addition to any Chelsea and Fulham cases, and to the 12 Kensington cases recorded prior to that event. It may be further mentioned, that in the four weeks, June 15-July 12, there were 52 cases recorded in Kensington, 30 north and 22 south of Uxbridge-road, (not one of them within the quarter-mile central circle of the special area), and that the total of cases admitted into the hospital by July 12, was 127 viz., from Kensington 61, from Fulham and Hammersmith 38, and from Chelsea 28. Of these 127 cases 30 only were in hospital July 12, all or nearly all of the remainder, (97), having been transferred to the Hospital Ships or Hospital Camp. The maximum number of patients in hospital on any one day was 32. The 52 Kensington cases occurred in 33 houses, in 28 streets: in 22 of the streets there had been no previous case. Eight of the 22 patients in the south district, were female domestic servants.* On * In the next fortnight, July 12-25, there were only three cases in Kensington, all north of Uxbridge Road, and two of them infected by a previous case, d 42 July 4, there were 1,378, and on July 18 only 1172, cases in hospital including nearly one thousand in the Camp. The maximum number in the epidemic of 1881 was 1650, viz., 1000 in land and ship hospitals, and 650 in Camp. I am indebted to Mr. Sweeting, the Medical Superintendent of the hospital, for an analysis of the admissions, showing the position in relation to the hospital, of the houses newly invaded by small-pox, after Mr. Power's plan, the special area being divided into zones. From this it appears that between May 17-July 12—so far as hospital patients are concerned— the disease invaded 103 houses, of which 146 are in the special area and 57 beyond the special area, or more than one mile from the hospital. Of the 46 houses in the special area, 2 are in the ¼ mile central circle, 20 in the mile ring, 20 in the mile ring, and 4 in the outer or ¾1 mile ring. By July 12, the hospital having been open 8 weeks, one case only, (that of an unvaccinated girl), had been recorded in Ifield Road, the street in Kensington nearest to the hospital. The facts as to age-distribution of cases are much the same as in previous epidemics, many children having been attacked in the district north of Uxbridge road, and few in the south district. In the south district, on the other hand, female domestic servants, as usual, formed a large proportion, (31.5 per cent.), of total cases. The well-to-do classes have been little affected; artizans, &c., have suffered more than common labourers or the poorest classes. With few exceptions the cases have been removed to hospital, several of the patients having walked in. There were other cases of exposure, particulars of which are recorded in my monthly reports. Occasionally the disease was spread owing to modified cases of small-pox having been mistaken for chicken-pox: a few cases were imported. Eight patients were admitted from one house and at one time—the fruits of a concealed case. This quantity of small-pox, it may be added, did not lead to the spread of the disease in the poor street whence it was removed, although seven of the cases 43 were in the house for two days, five of them for four days, three of them for five days, two of them for eight days, and one of them for nine days. CHOLERA. Three deaths were registered from English Cholera. One of them, which caused very unnecessary alarm, was that of a homeless man of intemperate habits, who died after a few hours illness at the parish infirmary, having been removed in a moribund state, after some regrettable but unavoidable delay, from a stable at Notting Hill. The death took place in July, at a time of anxiety due to the prevalence of Asiatic Cholera in Egypt, and to fear lest the disease should be imported into this country. A great sensation was excited by the reports of the case in the daily papers, and I was credibly informed that it was the immediate cause of arrivals from England being quarantined in Spain and Portugal. The Local Government Board took active measures in view of the possible introduction of Cholera at the time mentioned, and although nothing occurred to justify the fears that had been aroused, we had satisfaction for the trouble and expense incurred, in the evidence afforded of our preparedness for instant action in case of an outbreak. The Board issued in the first place two "Orders" with a covering explanatory letter for the guidance of Port Sanitary Authorities, who of necessity constitute the first line of defence, and subsequently they communicated with all other sanitary authorities throughout the kingdom. At the instance of the President a conference was held between the Medical Officer of the Board and the Metropolitan Medical Officers of Health, the conclusions arrived at being, that, to safeguard the metropolis against Cholera, " increased attention should be devoted by sanitary authorities and their officers to the ordinary means for improving the sanitary condition of the several districts," and that "the attention of the Local Government Board should be D 2 44 called to the necessity of careful supervision of the sources of water supply in the rivers, and of the storage reservoirs, &c."; on the ground that if cholera should be imported into the metropolis it might be spread, as on a former occasion, through the agency of the water companies. The "Diseases Prevention (Metropolis) Bill," of which I gave a full account in my last annual report, (page 66), became law in August, its nominal object being to make "better provision as regards the Metropolis for the isolation and treatment of persons suffering from cholera and other infectious diseases." Section 2 constitutes the Managers of the Asylums Board, equally with the Vestries and District Boards, a "Local Authority" under the Diseases Prevention Act, 1855, and enables them to utilize their buildings, ambulances, staff, &c., for the execution of powers and duties conferred or imposed on them under both the Acts. Immediately after the passing of the Act the Managers undertook to provide a limited amount of temporary hospital accommodation for patients of both sexes, and for the whole Metropolitan area, irrespective of parochial boundaries. They not merely agreed to utilize any of their buildings, ambulances, &c., and to arrange for the temporary use of empty buildings, or of small plots of land whereon to erect huts, to be under the charge of their own officers, but they also negotiated arrangements with the governing bodies of general hospitals, and with Boards of Guardians, for the employment of such spare accommodation in Hospitals, Workhouses and Infirmaries, as could be made available either for the reception of patients in infected district, or for the accommodation of ordinary inmates of such establishments who could be transferred to cholera-free districts so as to furnish room for the sick in the vacated buildings in cholera-stricken districts. Many of the Boards of Guardians, as well as the governing bodies of voluntary hospitals, signified their willingness to co-operate with the Managers in making the needful provision of hospital accommodation: the Metropolis,therefore, 45 would have been found in better case than in any previous epidemic, had cholera unhappily reached our shores. The design in these proposed arrangements was to constitute the Managers a first line of defence, only, for instant action on the appearance of the disease; for it was distinctly intimated that they would not undertake the exclusive provision of hospitals, and the Local Government Board clearly laid it down that the course the Managers were prepared to adopt, would in no way absolve the sanitary authorities from the duty imposed on them by the Diseases Prevention Act, 1855, should it become necessary by "Order" to put in force the provisions of that Act. In other words the Vestries and District Boards would have had to provide hospitals for the sick in their several districts, as well as places of refuge for the as yet unattacked inmates of infected houses, when the sick could not be removed to hospital, whether from the gravity of the illness, or owing to the want of accommodation within one mile, which is held to be the furthest distance to which a cholera patient can be properly removed. The regulations issued by the Board in 1866, it may be remembered, imposed on the Vestries, as "local authorities," the duty of making arrangements for the prevention and treatment of the disease, including the medical visitation of poorer houses for the purpose of detecting cholera and diarrhœa, the supply of medical attendance and nursing, and of medicines and disinfectants. The expenses incurred by the Managers form a charge upon the Metropolitan Common Poor Fund. [Addendum, July, 1884. Asiatic Cholera broke out at Toulon, France, in June, and shortly afterwards appeared at Marseilles. In view of the probability of the disease being conveyed to this country, the Local Government Board, (under date, July 8th), forwarded for the information of your Vestry, as sanitary authority, copies of a Memorandum prepared by their Medical Officer, on the "precautions to be taken against the infection of Cholera." The 46 dum is substantially the same as that sent out in July, 1888. In view of all eventualities the Board were desirous that your Vestry's attention should be again called to the question of taking such measures of precaution as the sanitary condition of the parish might demand. I may mention that in a special report, (No. 9, July 25), on "Precautions against Cholera," I dealt with the subject in 1883, and pointed out what I conceived to be the relative duties devolving upon the central authority, (Local Government Board), the local authority, (your Vestry), the representatives of the law, (the Justices), and the people themselves, in the dreaded emergency. In concluding that report I said, and I now repeat, that individual householders might render invaluable service by reporting to your Vestry whatever nuisances may come to their knowledge, or under their observation, and not less by carrying into effect, each in his own house and family, the advice submitted to each one in Papers respectively entitled—(a) Suggestions for Preventing the spread of Infectious Diseases; (b) General Sanitary Notice, and (c) Precautions against Cholera. I have already, (at page 44), described the arrangements the Asylums Board made in 1883, for providing hospital accommodation for cases of Cholera in all parts of the metropolis, should the disease unhappily come amongst us. A conference between the Medical Officers of Health and Representatives of the General Purposes Committee of the Board, proposed by the Committee, was held July 17," with a view to the consideration of several points which arise in connection with the carryingout of the Diseases Prevention (Metropolis) Act, 1883, and upon which unity and uniformity of action seem to be advisable."] COMPULSORY NOTIFICATION OF INFECTIOUS DISEASES. In several of my Annual Reports I have referred to the need of legislation to secure immediate information to 47 Sanitary Authorities of the occurrence of illness from some of the more dangerous infectious diseases; and in the Report for 1880, (page 44), I gave a full account of the steps that had been taken by means of legislation, in the shape of "Local Acts," to secure such notification in certain provincial towns and boroughs. The subject was continued in my Report for 1881, (page 40), and I stated that, as the desirability of the extension of such legislation in the shape of a Public Act was generally acknowledged, it only remained for the Government to introduce a measure for the purpose of securing notification. In the Session of 1882, several Private Bills providing for "Police or Sanitary Regulations" were introduced at the instance of provincial Corporations, and referred to a Select Committee, of which Mr. SclaterBooth, an ex-President of the Local Government Board, was the Chairman. In their Report on the "Sanitary Regulations "the Committee stated, with respect to "Notification," that they had "little difficulty in forming the opinion that the time had arrived when provisions of law on this subject may be sanctioned, at least in the more important Urban Sanitary Districts." Encouraged by this report Mr. Hastings,who was a member of the Committee, with Sir Trevor Lawrence, Dr. Farquharson and Mr. Brinton, introduced a Bill in the Session of 1883, "To provide for the better Notification of Infectious Diseases," drawn on the lines sketched by the Committee in a "Model Clause," which will be found at page 44 of my Annual Report for 1881. Without entering into details I may state that the Bill proposed to throw upon the householder, and upon the medical attendant, equally, the duty of notifying cases to the Medical Officer of Health—the so called "dual system." The gentlemen named are active members of the Social Science Association, the Health Section of which body has taken a prominent part in promoting legislation to secure Notification. The Bill was, in fact, the Bill of the Association, which, moreover, organized a Deputation to the Local 48 Government Board in support of it. The deputation comprised, in addition to members of the Association, numerous medical and other persons known to take an interest in the question. The President, Sir Charles Dilke, in his reply, said that there was no difference of opinion at the Board as to the advantageous nature of the powers asked for where they were possessed. The evidence from the various localities where they had been worked was ample on that head. They were not, however, quite ready to adopt the Bill, or to support it in its existing form, there being great fear, in going at all in advance of public opinion, of producing reaction. They would be disposed to agree to general legislation in some form, legislation to facilitate the application of the desired provisions by local authorities. The Bill went beyond this, and it was not the opinion of the Board that the time had yet come to give universally the compulsory powers proposed, by absolute legislation. After a few years' experience of the working of such provisions in the districts where they had been applied, and in the other districts which would try them very shortly; then, after investigation, the matter might be extended still further. The Board were disposed to give local authorities who want compulsory powers, the means of dealing with infectious diseases at once, without the necessity of applying for a local Act; either by means of a general Act, which they could bring into force themselves, or else by giving them power to make bye-laws for that purpose.* *The Medical Officer of the Board in his Annual Report for 1881-2 wrote on this subject as follows: "Seeing how greatly the usefulness of Sanitary Action in respect of infectious diseases must depend upon early knowledge of its presence, I have had no hesitation in advising that this power, (i.e. of obtaining immediate information of the existence of infectious disease in any house), might properly be possessed by any Sanitary Authority who wanted it, and who, having made adequate arrangements for securing isolation and disinfection for the district, was prepared to put to effectual use the knowledge which a system of disease-notification would afford." It may be remembered that the Select Committee on "Sanitary Regulations," (House of Commons, Session 1882), recommended that,"in any future amendment of the Public Health Act, powers," (i.e., to secure "notification,") " should be extended to all Urban Sanitary Authorities, or at least that means should be devised for clothing them with such powers on application." 49 The President expressed his willingness to support a proposition to refer the Bill to a Select Committee. The Bill was strongly opposed on the second reading, and the House having been counted out the measure was dropped for the Session. Prior to the reception of the deputation, the President had received a so-called "Vigilance Association," which desired to enlist his influence in opposition to the Bill, on the ground of its interference with the "liberty of the subject," indifferent or oblivious to the fact, that the most democratic communities are precisely those which are the most stringent in exercising such interference with individual liberty when it is necessary for the general good. The President subsequently received the Parliamentary Bills Committee of the British Medical Association, who urged "That the local authorities should not have the power of imposing the duty of compulsory notification on medical practitioners." The Committee in taking this step, was acting upon a resolution carried, at the Jubilee Meeting of the Association, held at Worcester in 1882, to the effect:— "That this meeting earnestly desires compulsory notification of infectious diseases, but it wishes to express its opinion that the compulsion to notify should be placed upon the householder, as his duty as a citizen, and not upon the doctor." Urgently as compulsory notification may be required, it is probable we shall have to wait for a more settled state of political affairs before the Government can be expected to deal with the subject. Meanwhile it is well to be reminded that the Sanitary Authorities of London have expressed themselves unequivocally in favour of the principle of notification, and with pardonable satisfaction it may be mentioned that their action was taken under the lead of your Vestry.* * Vide Annual Report for 1882, page 69 et seq. 50 VOLUNTARY NOTIFICATION OF INFECTIOUS DISEASES. Prevention of the spread of infectious diseases being a chief duty appertaining to my office, constant efforts have been made to obtain, by "voluntary notification," information of the occurrence of such diseases, and it will not be out of place here to mention the sources from which such information is now obtained. 1. By virtue of ail 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. When a death from an infectious disease has occurred, 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. Occasionally the registration of a death is unduly delayed—sometimes, apparently, with the object of temporary concealment of the cause of death: it would be well, therefore, 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 the graver infectious diseases that come within their cognizance, and generally these are cases that have been, or are about to be, removed to the hospitals of the Asylums Board, admission to which, (although practically denied to no person), can only be obtained at present 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. 4. Medical men favour me occasionally with information of cases, especially when they desire assistance in order to get patients, (e,g., domestic servants), removed to hospitals; or when they want the assistance of the disinfecting staff. 5. The Chief Commissioner of Police has instructed Divisional Surgeons that on the occurrence of infectious disease being reported in the residence of a police officer, the Medical Officer of Health is to receive due notice of the fact, and a few such cases have been notified. 6. The Postal Authorities have taken a similar step, having intimated to the numerous medical officers of the department throughout the country, that if in their several districts it be not already the rule to give notice of infectious diseases to the Sanitary Authority, it would be well that such a rule should be introduced in the case of Post Office Servants. * This rule has been relaxed in operation, since the above portion of the report was in type, Vide page 57. 51 A few cases have been notified, but the rule appears to have been not very strictly carried out. 7. In my annual report for 1877 I referred to an important step then lately 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 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, the resolution of the Board, hitherto, has not been attended with all the hoped-for results. The Board, moreover, at one time, showed a disposition to 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, would have been regrettable, the Board, however, has recently passed a resolution directing Teachers also, to inform the Medical Officer of Health of the case of any child excluded from the school on account of its showing symptoms of an infectious disease, or of its coming from a house where an infectious disease exists. The result of this new departure will be awaited with interest. Some of the teachers in our part of the Chelsea Division, I may mention, had occasionally reported cases, as a result of an application I made to all of them in 1879, at which time I furnished them with printed forms for the purpose. 8. Clergymen, and District Visitors, occasionally report cases of sickness. 9. The Resident Medical Officers of St. George's and St. Mary's Hospitals report the admission of cases, or the application of inadmissable cases, of infectious illness from houses in this parish. 10. Occasionally anonymous communications are the source of information, for I have not felt at liberty to disregard such communications, which have frequently proved accurate. In one or another of these ways some hundreds of cases come to our knowledge in the course of every year. How many never get reported at all it is impossible to say, but from the fact that the majority of the fatal cases are concealed until after registration of death, it may be inferred that unrecorded cases of recovery are numerous. 52 The Results of Voluntary Notification.—With the view of informing myself upon this point, I have recently investigated the statistics of mortality for twenty-four years, in respect of the "principal diseases of the zymotic class;'' comparing the total number of deaths in the first half-period, (1859-70), before I entered upon the duties of Medical Officer, with the number in the second half-period, (1871-82), during which we have had the inestimable advantage of hospital accommodation. The results of the investigation are set out in the following tables, showing the number of deaths of Kensington people, (at home and in hospitals), in two periods of twelve years, respectively, from the diseases in question. First period (1859-70); without notification and without hospitals:— Diseases. 1859 1860 1861 1862 1863 1864 1865 1866 1867 1868 1869 1870 Totals. Small Pox 11 18 2 0 49 5 18 10 29 4 6 8 160 Measles 42 29 53 30 83 100 52 40 19 84 27 70 629 Scarlet Fever 53 86 57 110 89 90 31 28 35 170 106 198 1053 Diphtheria .. .. .. .. .. .. .. .. .. .. 9 14 23 WhoopingCough 11 56 37 54 22 56 37 28 68 34 71 55 529 Fever 17 25 32 51 54 60 77 33 46 52 42 46 535 Diarrhœa 72 35 66 24 54 63 104 112 78 113 108 154 983 Totals 206 249 247 269 351 374 319 251 275 457 369 545 3912 Yearly average. .326 Second period (1871-82); with voluntary notification and with hospitals:— Diseases. 1871 1872 1873 1874 1875 1876 1877 1878 1879 1880 1881 1882 Totals. Small Pox 120 68 1 0 0 8 84 24 24 11 55 0 395 Measles 64 43 38 121 23 128 54 53 60 75 67 77 803 Scarlet Fever 95 29 10 32 83 59 31 77 51 105 36 62 670 Diphtheria 11 14 11 26 23 17 10 20 26 22 8 25 213 WhoopingCough 72 77 44 45 107 124 34 185 93 95 85 119 1080 Fever 48 42 41 52 29 36 27 33 23 33 31 32 427 Diarrhœa 129 110 145 112 107 126 99 181 71 128 101 61 1370 Totals 539 383 290 388 372 498 339 573 348 469 383 376 4958 Yearly average. .413 53 Summary of preceding tables with corrections for increase of population:— Diseases. Actual number of Estimated No. of Deaths in 2nd period, 1871-82, corrected for increase of population. Increase (corrected) in 2nd period, 1871-82 Decrease (corrected in 2nd period. 1871-82. Nett decrease (corrected) representing estimated saving of lives in 2nd period, 1871-82 Deaths in 1st period 1859-70. Deaths in 2nd period 1871-82. Small Pox 160 395 261 134 .. .. Measles 629 803 1029 .. 226 .. Scarlet Fever & Diphtheria 1076 883 1761 .. 878 .. Whooping Cough 529 1080 865 215 .. .. ''Fever 535 427 875 .. 448 .. Diarrhœa 983 1370 1608 .. 238 .. 3912 4958 6399 349 1790 1441 The average population in the first period of twelve years, (1859-70), was 90,000, and in the second period, (1871-82), 147,300. It will be noticed that after making correction for increase of population there was an increase in the number of deaths, in the second period, in respect of two diseases, small-pox and whooping-cough. Of whooping-cough I shall only say that it is one of the diseases of which we rarely hear until it has proved fatal, its occurrence never being notified. Small-pox, on the other hand, is more frequently notified than any other disease, and yet the deaths show an increase of 134. This disease, however, was severely epidemic in four years out of the twelve, (1871-82), whereas in the first period of twelve years, twice only did the annual number of deaths exceed twenty. Measles exhibits a decrease, although, like whooping-cough, it is not notified; but I am not aware that we are entitled to claim any credit for the reduced mortality. The diminished diarrhœal mortality may be attributed, in considerable measure, to the coldness of recent summers, and may therefore be regarded as accidental. It is when we come to scarlet-fever and enteric fever, that the real grounds for satisfaction appear, these being the diseases which admit—the latter of mitigation by improved sanitary arrangements, and the former of control by speedy isolation of the sick in hospitals. And what do we find? That the deaths from "fever" in the second period were 108 fewer than in the first period, without correction for increase of population, and 448 fewer after such correction; the reduction in respect of scarlet fever being, without 54 correction, 388, and with correction, no fewer than 1053. But it will be observed that in the first ten years of the first period no deaths from diphtheria were recorded, although the table commences in 1859, the year in which diphtheria was first registered as a separate disease. I am unable to account for the omission, there being no records extant, except upon the somewhat improbable assumption that no deaths from diphtheria were registered in Kensington in those ten years. I have thought it fair, therefore, to bracket scarlet fever and diphtheria, in the two periods, respectively, for comparison; and thus, adding the deaths from diphtheria, only 23 in the first period, and so many as 213 in the second period, to the deaths from scarlet fever, we observe in the second period an absolute reduction of 193 in the number of deaths from the two diseases, the reduction corrected for increase of population being 878. Taking the "seven" principal diseases of the zymotic class together, there appears a corrected reduction in the number of deaths in the second period of no fewer than 1441. In other words, had the rate of mortality from these diseases been the same in the second period, 1871-82, as in the first period, 1859-70, there would have died 1441 persons in the twelve years more than did die; or 120 per annum—the difference between the actual annual average number, (413), and the number corrected for increase of population, (533). The zymotic death rate, I may add, which in 1859-70 was 3.6 per 1,000 persons living, fell to 2.8 per 1,000 in 1871-82; the deaths from these diseases, moreover, which in 1859-70 were 18 per cent. of total deaths, were only 15.4 per cent. in 1871-82. Other causes doubtless, besides notification, contributed to bring about this satisfactory result, and we must not forget, as regards enteric fever, that this disease, under improved sanitary arrangements, has "continuously and notably declined in England during recent years." Chief among these causes, and one, in my judgment, even superior 55 in efficacy to notification, is the provision of hospital accommodation by the Asylums Board, under the provisions of the Metropolitan Poor Act, 1867. So highly, indeed, do I value this provision, that, were I offered a choice between hospitals and notification, I should unhesitatingly choose hospitals; for this reason, among others, that provision of hospital accommodation leads, almost inevitably, to voluntary notification; whereas, even compulsory notification has comparatively little value if hospital accommodation be wanting. Increased Facilities for Removal of the Infectious Sick.—In 1880 the Board of Guardians manifested their desire to promote the removal of cases, by instructing the Relieving Officers to abstain generally from taking any steps for obtaining payment in cases sent to the Metropolitan District Fever and Small-pox hospitals. The carrying out of these instructions has been attended with the happiest results, not a single case having since been prevented from going to hospital, on grounds of inability or unwillingness to pay for maintenance and treatment. Having always held that the removal to hospital of the nonisolated infectious sick, at whatever cost to the public, is justifiable on economical grounds, it is a source of satisfaction to me to know that this view is shared by the Guardians equally with your Vestry. Practically, moreover, nothing is lost in money through the enlightened action of the Guardians; for, as the result of an enquiry made in view of the Conference of Sanitary Authorities held at the Town Hall in March, 1881, I ascertained that less than £60 had been paid to some twenty Boards of Guardians, in respect of 79 patients who contributed something towards their own maintenance, out of 3,100, the number of patients removed to hospitals in a little less than one year. Objection had been raised to the principle of "free hospital treatment," on the ground that many patients contributed towards their maintenance a sum considerable in the aggregate, it being contended, also, that patients able to pay should be made to 56 pay. Even had this been the case, and I have shown that it is not, sanitarians, who know the terrible consequences that so often result from the home-treatment of infectious diseases when the sick cannot be isolated, would have been ready to justify a sacrifice in money rather than imperil life. It was more difficult to satisfy the representatives of the ratepayers— those who hold the strings of the public purse—of the good policy of such a course, but the facts and figures I submitted to the Conference brought conviction, and it was resolved unanimously, "that payment for the assistance given in hospitals to persons removed thereto for isolation, by the Sanitary or the Poor Law Authority, should not be enforced," and, "that the giving of such assistance should not entail on the recipient the loss of any social or political status." By the passing of the Diseases Prevention (Metropolis) Act, 1883, relief in the hospitals has been depauperised. The Hospitals Commission, moreover, recommended, (in 1882), that "it is desirable in the public interest to attract to the hospitals, even by the bribe of gratuitous treatment, all who will go thither;" thus completely justifying the views for which I have so long contended. The above enlightened step for promoting the removal of infectious cases, as a means of protecting the community, is not the only one for which we are indebted to the Guardians. The Asylum Board Hospitals, as is well known, are poor law institutions, although, as mentioned above, admittance into them no longer pauperises the recipients of assistance, few of the patients, moreover, being of the pauper class. For some years, as I have before stated, I have contended that the medical certificate of a duly registered practitioner should be accepted as evidence of the nature of an infectious disease, (small pox, scarlet fever, &c.), in the case of a patient proposed to be removed to an asylum-hospital, and that the medical officer of health should be authorized to make the necessary "order " for the reception of the patient. In the 57 Order of the Local Government Board, relatingto admission of patients, the certificate of a district or workhouse medical officer, and the order of a relieving officer, or a master of a workhouse, are alone recognized. Although my efforts in this direction appeared to produce little result, the discussidn to which they gave rise, from time to time, was doing good, and paving the way to a better state of things. In our own parish, as a result, a practice grew up, with the tacit approval of the guardians, of accepting a properly authenticated certificate of any registered medical man, as evidence of the nature of an infectious illness, without waiting to obtain the confirming certificate of the district medical officer. By this plan several hours were sometimes saved in effecting the removal of a patient. A still more notable step, in the same direction, but equally informal, had just been taken by the Ambulance Committee of the Asylums Board, to which I cannot refer without unfeigned satisfaction, as it concedes even more than I had ventured to ask, and will bring about the removal of infectious cases with the utmost attainable rapidity. The committee, determined that no avoidable delay should take place, have resolved to receive any case of small-pox or fever into a Board-Hospital, upon the direct application of any duly registered medical practitioner, and without a previous order from a relieving officer. Applications are required to be made at the chief offices of the Board, Norfolk Street, Strand, by telegram, during the hours telegraph offices are open, on week-days only. The offices are in telephonic communication with all the hospitals, and immediately on receipt of a telegram an order is sent to the Superintendent of the Ambulance Station of the district, who, within a few minutes, despatches an ambulance with a nurse to remove the patient. The details of the scheme are set out in the "Regulations of the Board for the removal of cases of small-pox and fever by the Land and River Ambulances," (June 21,1884). Information of cases so admitted is sent to the Clerk of the E 58 guardians, and I have suggested that information should be forwarded to the medical officer of health also, in order that he may take proper measures for disinfection, &c. Such an admirable plan was impossible of execution while the ambulance arrangements were under the control of numerous local authorities, but it became practicable when the Board decided to undertake the duty of removing the sick over the entire district of the Metropolis. In this connexion I may mention that the Western District Ambulance Station, adjoining the Hospital at Fulham, being now in use, applications for removal of cases to that hospital between the hours of 8 p.m. and 8 a.m., and all day on Sunday, are required to be sent to the Ambulance Superintendent direct. To facilitate the working of the new system, I have suggested to the Guardians the desirability of their offices being placed in direct telegraphic or telephonic communication with the Ambulance Station, and with the chief offices of the Board, and this suggestion is now receiving their consideration. I communicated the above information as to the removal of cases to the medical men throughout the parish, and supplied them with copies of a suitable form of certificate, &c. I also informed them that your Vestry would reimburse the cost of the telegraphic application for removal in the case of any patient unable, through poverty, to pay for it. Interruption of Education at Elementary Schools resulting from the prevalence of infectious diseases. —It is customary at Board and other elementary schools, to refuse admission to children from houses where infectious disease exists, even when the rejected children are not members of the family affected. The propriety of this practice is beyond question, and to its existence we may reasonably ascribe the fact that on no occasion has it been found necessary, in this parish, to close a school on account of the prevalence of infectious disease among the pupils. The "notification of infectious disease," when it shall have been secured by legislation, and the increased powers of 59 removal to hospital of non-isolated cases of infectious sickness, for which Sanitarians are asking as a correlative measure, will probably have the desired effect of limiting the occasions on which it will become necessary to close schools on account of epidemics, e.g., of scarlet fever. Sanitary authorities under the provisions of the new Education Code* have greater powers than they formerly possessed of closing schools—powers which it need hardly be said should be used with great care and discretion. It has been my constant endeavour to obtain the assistance of school teachers, and this plan has often been attended with excellent results. The regrettable fact connected with the existence of infectious diseases, in relation to education, is the length of time during which children, themselves in good health, but living in infected houses, are often kept away from school, to the curtailment of the short period devoted to education ; and yet at the same time they may be meeting their school fellows at play, thus to a certain extent neutralizing the precautions taken at school. It is obvious that fresh and even stringent legislation is needed to enable us to cope with this difficulty, viz., for the compulsory removal of the sick when necessary to secure isolation. POPULATION, INHABITED HOUSES, &c. The population of Kensington, estimated to the middle of the year, was in round numbers, 168,000 : males 67,830, and females 100,670; excess of females, 33,340. The population of the Town sub-district was, approximately, 124,000, and of the Brompton sub-district 44,000. The natural increase during the year, represented by the excess of births over deaths registered, was 1,615: an estimated further *"The Managers must comply with any notice of the Sanitary Authority of the district in which the school is situated, requiring them for a specified time, with a view to prevent the spread of disease, either to close the school, or to exclude any scholars from attendance, subject to an appeal to the Department, if the Managers consider the notice to be unreasonable." E2 60 crease of 935 represents the balance of immigration over emigration; total increase, 2,550. It is always difficult to estimate with accuracy the number of persons living in a large and populous place like Kensington, still in the process of growth. The best available test, perhaps, is the number of inhabited houses: if these show an increase, an increase in the number of people may be inferred, and vice versa. In July, 1883, there were some 21,030 occupied and rated premises, an increase of 122 as compared with July, 1882. The number of persons to a house at the census in April, 1881—taking the return of houses from the rate-book—was 7'89, a number which multiplied by 21,030 gives 167,819 as the population estimated to July. In places having a stationary population, e.g., parishes which have no available building land, and which are not undergoing obvious depopulation, as by the pulling down of the houses of the poor to make room for mansions, warehouses, &c., the birthrate may serve as a guide in estimating a population. But this test is of little practical avail in a place like Kensington. We shall see, moreover, that with a constantly-increasing population, not merely our birth-rate, but the absolute number of births also has declined considerably of late years, fewer children having been born last year than in 1874, when the population was smaller by thirty thousand. The most remarkable feature, however, in connection with the population of Kensington, one, moreover, which, to a large extent, accounts for the small and diminishing birthrate, is the inordinate excess of females. It was thought astonishing when the census of 1871 revealed a majority of 22,000 females, but that majority has now grown to upwards of 33,000. The excess is due in no slight degree to the fact that, Kensington being a rich parish, a very large number of female domestic servants are employed. It is almost needless to say that females are in excess in the general population: in London the excess is about 13 per cent., in Kensington it is about 50 per cent. 61 The subjoined Tables show the relative numbers of persons of each sex at the Census 1881, grouped according to age, (a) in the entire parish, (b) in the Kensington Town Sub^district, and (c) in the Brompton Sub-district. (a) ENTIRE PARISH. All ages. Under Five Years. 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. All ages. Females 97,700 8753 15361 23391 19789 12606 8339 5472 2901 965 115 8 97,700 Females. Males 65,451 8832 13501 12452 10793 8397 5549 3619 1748 502 58 - 65,451 Males. Excess of Females. 32,249 —79 —1860 10939 8996 4209 2790 1853 1153 463 57 8 32,249 Excess of Females. Total of both sexes 163,151 17585 28862 35843 30582 21003 13888 9091 4649 1467 173 8 163,151 Total of both sexes (b) KENSINGTON TOWN SUB-DISTRICT. All ages. Under Five Years. 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. All ages. Females 70,134 6952 12141 15640 13453 8996 6031 3968 2168 701 79 5 70,134 Females. Males 50,007 6969 10986 9205 7936 6404 4099 2669 1310 386 43 - 50,007 Males. Excess of Females. 20,127 —17 —1155 6435 5517 2592 1932 1299 858 315 36 5 20,127 Excess of Females. Total of both sexes 120,141 13921 23127 24845 21389 15400 10130 6637 3478 1087 122 5 120,141 Total of both sexes (c) BROMPTON SUB-DISTRICT. All ages. Under Five Y ears. j 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 upwads. All ages. Females 27,566 1801 3220 7751 6336 3610 2308 1504 733 264 36 3 27,566 Females Males 15,444 1863 2515 3247 2857 1993 1450 950 438 116 15 - 15,444 Males. Excess of | Females. 12,122 —62 —705 4504 3479 1617 858 554 295 148 21 3 12,122 Excess of Females. Total of both sexes 43,010 3664 5735 10998 9193 5693 3758 2454 1171 380 51 3 43,010 Total of both sexes 62 Kensington is still in process of development by building, but to a very moderate extent compared with past years— 1861-70 for example. Owing to the increased and ever increasing value of property, its rateable value rises higher and higher, and out of proportion to the actual increase in the number of houses. The following table brought up to date exhibits the growth and wealth of our great parish since the Metropolis Local Management Act came into operation in 1856:— Estimated number of Inhabited Houses (as per rate books) 1856 1883 Gross Increase in 27 years. 7,600 21,030 13,430 Population 57,000 168,000 111,000 Rateable Value of Property £308,000 £1,711,495 £1,403,495 The increase in all respects, within the last twelve years, the period over which my official experience extends, is not inconsiderable, as the subjoined figures will show. Estimated number of Inhabited Houses, July, (as per rate books) 1871 1883 Increase in 12 years. 15,395 21,030 5,635 Population 121,000 168,000 47,000 Rateable Value £935,720 £1,711,495 £775,775 The above figures demonstrate a transcendent growth and speak for themselves; nevertheless, attention may be called to the fact that in little more than a quarter of a century the rateable value of property more than quintupled and that in the last twelve years the mere increase was double the total in 1856. The population and the number of 63 inhabited houses increased nearly threefold in 27 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, and there will bean arrest to the increase in population, for there will be no room for additional houses; but property in some parts of the parish will probably continue to increase in value long after the population shall have become comparatively stationary. Even now the rateable value has attained such proportions as to be exceeded by that of the cities of London, Liverpool, Manchester, and Bristol only. At present the population of Kensington is to that of London about 1 to 23½ and the rateable value 1 to 16½. MARRIAGES AND MARRIAGE RATE. The marriages in 1883 were 1,616, or 143 more than in 1882. Of these there were celebrated— By the Church (76.9 per cent. of total marriages) 1,243 At Roman Catholic places of worship - - 107 At other Nonconformist places of worship - 76 At the Superintendent Registrar's Office - - 190 Total 1,616 The marriage rate, i.e., persons married per 1,000 of the population, was 19.5. The marriage rate in the country generally was 15.4 per 1,000, against 14.4, 14.9, 15.1, and 15.4 in the four preceding years. The marriage rate declined steadily from 17.6 in 1873 to 14.4 in 1879, which was lower than any previous year on record: since 1879 the recovery has been slow, but continuous. The marriage rate in London, in 1883, was 17.8, a lower rate, the Registrar General states, than any previously recorded, the nearest to it having been 18.0, which was the rate in 1879. The marriage rate 64 reached its highest point in 1865, when it was 22'3, and gradually declined from that date, though with some fluctuations, until in 1883, as before mentioned, it had fallen to 17'8. BIRTHS AND BIRTH RATE. The births of 4,230 children were registered in 1883; males, 2,162; females, 2,068: 3,374 in the Town sub-district, and 856 in Brompton, the total being 97 below the number in 1882, and 735 below the decennial average corrected for increase of population. For so small a number of births, we have to go back to 1873, when the population was some 33,000 smaller than in 1883. The birth rate was only 25.2 per 1,000; 4.4 below the decennial average; (27.2 in the Town sub-district, and 19.4 in Brompton), being 8.7 per 1,000 below that of the Metropolis generally, (33.9), and 8.0 per 1,000 below that of all England and Wales, (33.2). There was one birth to every 39.7 persons living, and 104 male births to 100 of females. The illegitimate births were 203; males 107, females 96, and of these 186 took place in the Town sub-district, which includes the parish workhouse, at which institution, out of a total of 147 births—males 82, and females 65—121 were illegitimate. The illegitimate births in the parish formed 4.8 per cent of total births. The subjoined table shows the quarterly numbers of births of males and females, in each of the sub-districts:— Males. Kensington Town Sub-district. Brompton Sub-district. Grand Total Whole Parish. Females. Total. Males. Females. Total. 457 455 912 135 109 244 1156 461 424 885 118 100 218 1103 392 400 792 99 98 197 989 409 376 785 92 105 197 982 1719 1655 3374 444 412 856 4230 Additional particulars respecting births and birth rates during the decennium 1873-82, are set out in Tables 1 and 2 (Appendix). 65 DEATHS AND DEATH RATE. The deaths in 1883 were fewer by 76 than in 1882, and some 565 below the decennial average corrected for increase of population. The total was 2,615, viz., 2,115 in the town sub-district and 500 in Brompton. One hundred and sixty of the deaths, (119 in the town sub-district and 41 in Brompton), occurred at hospitals without the parish. The death-rate, whole parish, was 15.5 per 1,000, the lowest on record, being 0.7 below the rate in 1882, (16.2), of which I had the same satisfactory observation to make in my last annual report. It was 2.8 per 1,000 below the decennial average rate, (18.3); 4.0 per 1,000 below the rate in England and Wales, (19.5), and 4.9 per 1,000 below the metropolitan rate, (20.4), this, moreover, being 2.0 per 1,000 below the decennial average, (22.4). The rate was 16.5 per 1,000 in the Town sub-district, and 12.9 per 1,000 in Brompton. In the male sex it was 18.7, in the female sex 13.4 per 1,000. There was one death to every 64.2 persons living; 1351 females died out of 100,670, (or one in 74.5), and 1264 males out of 67,330, (or one in 53.3). The rate in the female sex was the same as in 1882, but the rate in the male sex was 1.8 per 1,000 lower. INFANTILE MORTALITY. The deaths of young children always bear a high ratio to total deaths, but in 1883 the ratio was lower than usual. The deaths under five years, 982, (132 fewer than in 1882), were equal to 37.5 per cent. on total deaths, and to 23.2 per cent. on births registered; the relative percentages in the Metropolis generally, being 41.6 and 25.1. Under one year of age there were 601 deaths, or 34 less than in 1882, equal to 22.9 per cent. on total deaths, and to 14.3 per cent. on births registered: the relative percentages in the Metropolis generally, being 24.1 and 14.6. The deaths of illegitimate children under five years of age were 78, (in 1882, 114), equal to 38.4 per cent. on births 66 registered as illegitimate: all but 7 of them occurred in the Town sub-district. Of the 78 children, only 14 outlived the first year, and of these 10 died in the second year. The causes of death as registered were, scrofulous and wasting diseases, 19 deaths; want of breast milk, debility, 2; premature birth, 5; thrush, 1; diseases of the digestive system, 3; diseases of the lungs, 14; diseases of the brain, 12, (including convulsions, 10); zymotic diseases, 10; (viz: measles, 2; scarlet fever, 1; and diarrhœa, 7); syphilis, 8; and violence, 4; (suffocation, 3; run over by a cab, 1). A large proportion of illegitimate children are brought up by hand, and by strangers: the evidence of improper feeding, and absence of maternal care, is sufficiently apparent in the above list of diseases. At sixty years of age and upwards there were 699 deaths, 80 more than in 1882, equal to 25.5 per cent. on total deaths, the proportion in all London being 21.6 per cent. The deaths in the first and fourth, or colder, quarters of the year, exceeded the deaths in the second and third, or warmer, quarters by 251: in 1880, 1881, and 1882, respectively, the difference was 240, 120, and 355, in favour of the warmer quarters. The subjoined table shows the quarterly numbers of deaths, of parishioners, males and females, in each of the subdistricts, including those that occurred at Hospitals outside the parish. Males. Kensington Town Sub-district. Brompton Sub-district. Grand Total Whole Parish. Females. Total. Males. Females. Total. 268 316 584 69 91 160 744 240 248 488 61 66 127 615 241 236 477 55 35 90 567 278 288 566 52 71 123 689 1027 1088 2115 237 263 500 2615 The Births were, Males 2162 the Deaths, Males 1264 Females 2068 Females 1251 Total 4230 2615 Deaths Total 2615 1615 Excess of Births over Deaths 67 The subjoined table shows the death rate in each of 13 periods of four weeks, corresponding with my monthly reports; and the mean temperature of the air:— DATE OF REPORT. Death-rate per 1,000 living. Decennial Average. Mean Temperature of the Air. In 1883. Decennial Average Above or below Average. For four weeks to Jan. 27, 1883 18.7 20.7 41.6 38.3 + 3.3 „ „ Feb. 24, „ 14.9 21.2 42.2 39.1 + 3.1 ,, ,, ,, ,, Mar. 24, ,, 17.0 20.2 36.6 41.9 — 5.3 ,, ,, ,, ,, April 21, „ 19.1 20.6 44.8 45.6 — 0.8 ,, „ „ „ May 19, „ 13.5 17.5 48.8 49.8 — 1.0 ,, ,, ,, ,, June 16, ,, 14.7 16.6 58.1 55.9 + 2.2 ,, ,, ,, ,, July 14, „ 12.9 15.6 61.3 61.3 — ,, ,, ,, ,, Aug. 11, ,, 14.8 17.5 58.3 62.4 — 4.1 ,, ,, ,, ,, Sept. 8, ,, 13.8 15.1 60.9 60.7 + 0.2 ,, ,, ,, ,, Oct. 6, ,, 10.7 14.2 55.2 65.0 + 0.2 ,, ,, ,, ,, Nov. 3, ,, 14.9 16.1 50.6 51.2 — 0.6 ,, ,, ,, ,, Dec. 1, ,, 16.6 19.3 43.4 42.3 + 1.1 ,, ,, ,, ,, Dec. 29, ,, 17.3 20.5 40.7 38.3 + 2.4 Averages (whole year) 15.5 18.3 49.4 49.4 The subjoined table is a summary of Table 3 (Appendix) showing the numbers of deaths of parishioners in 1883, in each class and order, according to the Registrar-General's re-arranged classification:— I. SPECIFIC FEBRILE OR ZYMOTIC DISEASES No. of Deaths. 1. Miasmatic diseases 171 2. Diarrhœal 82 3. Malarial ,, 4. Zoogenous ,, 5. Venereal „ 28 6. Septic ,, 39 320 II. PARASITIC DISEASES 6 III. DIETIC DISEASES 18 IV. CONSTITUTIONAL DISEASES 602 V. DEVELOPMENTAL DISEASES 161 VI. LOCAL DISEASES 1. Diseases of Nervous system 288 2. Diseases of Organs of Special Sense 5 3. Diseases of Circulatory system 179 4. Diseases of Respiratory system 585 6. Diseases of Digestive system 156 6. Diseases of Lymphatic system 1 7. Diseases of Glandlike Organs of uncertain use 1 68 8. Diseases of Urinary system 83 9. Diseases of Reproductive system a. Diseases of Organs of Generation 15 b. Diseases of Parturition 3 10. Diseases of Locomotive system 2 11. Diseases of Integumentary system 4 1,321 VII. VIOLENCE 1. Accident or Negligence 40 2. Battle 3. Homicide 1 4. Suicide 10 5. Execution — 51 VIII. ILL-DEFINED AND NOT SPECIFIED CAUSES 136 Total 2,615 ASSIGNED CAUSES OF DEATH. Having already, (at page 20), treated of the deaths from the "principal diseases of the zymotic class," I now proceed to give some particulars of the mortality from the remaining diseases, but before doing so it is right to mention that the classification of the causes of death in the "Weekly Returns" of the Registrar-General was considerably modified at the beginning of 1882. "The list of causes, in its new form," as the Registrar-General stated in his Annual Summary for that year, "is an abbreviation of the much more detailed list which has been drawn up for use in the 'Annual Reports of Births, Deaths, and Marriages in England,' and which has been compiled in general accordance with the classification of the Royal College of Physicians. The London deaths, though they are only classified by the abridged list in the Weekly Return, and in the Annual Summary, will be afterwards classified by the full list in the 'Annual Report of Births, Deaths, and Marriages in England.'" Table 3 in my reports, prior to 1882, was framed upon the lines of the less abridged list of the causes of death contained in the Annual Summary, and it was the basis, to a large extent, of all the other tables. As it was not possible to accept the more abridged list contained in the Annual Summary for 1882, but, at the same time, desirable to frame table 3 in close 69 accordance with the more detailed list drawn up for use in the Annual Report, I placed myself in communication with the Registrar-General's Department, and having been favoured with a copy of the new classification, I brought the subject under the notice of the Society of Medical Officers of Health, who decided to revise the tables which they had framed for the sake of uniformity, some ten years previously. Tables 1 to 6, (Appendix), therefore, will be found to differ considerably from similarly numbered tables in annual reports prior to 1882, in which year I adopted the new forms settled by the Society. With these preliminary remarks, I pass on to deal with the remaining diseases included in the "Class" of Specific Febrile or Zymotic Diseases, which comprises six "Orders," the first and second "Miasmatic," and "Diarrhœal," including the diseases already dealt with. Order 3, "Malarial Diseases," includes Remittent Fever and Ague, and Order 4, Zoogenous diseases, includes Cowpox and effects of vaccination, hydrophobia, glanders, splenic fever, &c., but no deaths were registered from any of these causes. Order 5, "Venereal Diseases," includes syphilis,gonorrhœa, and stricture of the urethra. Syphilis was the only fatal disease in 1883, the deaths registered being 23—viz., 22 in the Town sub-district, and 1 in Brompton: 17 of the deaths were of infants under one year of age. If the truth were known, it would probably appear that this Protean malady was accountable, directly or indirectly for a much larger number of deaths. Order 6, Septic Diseases. This order comprises Erysipelas, Pyemia, Septicemia, and Puerperal Fever, the total deaths registered being 33. Erysipelas was the cause of 10 deaths, all in the Town sub-district, and 4 of them of children under one year of age. Pycemia and septicemia were the causes of 3 deaths, two of them in the Brompton sub-district. 70 Puerperal Fever was the registered cause of 26 deaths, all but 5 in the Town sub-district. Seven of the deaths were of women between 15 and 25 years of age, 14 between 25 and 35, and 5 between 35 and 45. In addition to these 26 deaths, 3 deaths, two of them in the Town sub-district, were registered as having occurred in "childbirth," as against 9 in 1882. The distinction between these two classes of cases is, that whilst puerperal fever is a specific and communicable disease; deaths registered as caused by childbirth simply, are, so to say, accidental, a common cause being haemorrhage ("flooding"). The total deaths registered as having been caused by the diseases and accidents associated with parturition, 29, (10 more than in 1882, and 15 more than in 1881), were equal to 0.68 per cent. on registered live births. [Among the deaths from Puerperal Fever there were three in the practice of a midwife. One took place at St. Mary's Hospital after a horrible illness extending over three months; the other two had been previously registered within a few days of one another, upon the certificates of two medical men who had been called in by the midwife; each, however, being in ignorance of what had taken place in the practice of the other. These medical gentlemen discontinued midwifery practice for many weeks through fear of spreading the disease, and each cautioned the midwife to do the same, but she did not. A fourth case occurred in her practice; it did not prove fatal, but the victim passed through a long and serious illness. The occurrences above referred to did not come to my knowledge till after the death and burial of the two first cases. I lost no time in calling upon the midwife and putting a stop to her practice. When the third death took place, and the body having been removed from St. Mary's Hospital to the previous residence of the deceased in this parish, I reported the particulars to the Coroner, who held an inquest, and the jury returned a verdict of manslaughter against the midwife, who was subsequently 71 charged at the Hammersmith Police Court. The facts of all four cases were brought by your Vestry to the knowledge of the Public Prosecutor, and by him they were submitted to an eminent criminal lawyer who formed the opinion that there was no ground for taking proceedings against the midwife. The Public Prosecutor, therefore, refused to take up the case, and when the midwife was charged, the conduct of the prosecution was left in the hands of the police. The Magistrate, however, having certified that it was a case in which the police should have legal assistance, the Public Prosecutor had no alternative but to intervene. The "prosecution" was entrusted to the learned counsel who had previously been consulted by the Public Prosecutor, and had arrived at the conclusion that there was no case, and as submitted, the Magistrate had no alternative but to dismiss the charge. He, however, called counsel's attention pointedly to the circumstance that, to all appearance, another of the cases was much stronger and more suitable for prosecution, and enquired whether the Public Prosecutor would take it up? The learned counsel, in reply, only remarked that that case was not then in question, and it was not heard of again. The history of this sad affair was very fully set out in several of my monthly reports, and in a special report, (No. 6, May 21, page 45), I gave a summary of the proceedings at the Police Court, &c. The only satisfactory result of the proceedings, was, that the midwife, conscious of her wrong doing, and fearing that further action might be taken ; having, moreover, lost her business, owing to the strong feeling excited against her among the married women in her usual field of practice, quitted the parish.] Class 2.—Parasitic Diseases. Includes Thrush and other vegetable parasitic diseases; 6 deaths, 4 of them in the Town district, and 5 under 1 year of age, and "Worms, Hydatids, and other animal parasitic 72 diseases," no deaths having been registered from these latter causes. Class 3.—Dietic Diseases Were the causes of 18 deaths, 12 of them in the Town subdistrict. Want of breast milk was the cause of 8 deaths. To Scurvy no death was assigned. Chronic alcoholism and delirium tremens were the registered causes of 8 and 2 deaths respectively; eight of them in the Town sub-district. It is scarcely necessary to say that, if all the deaths due, directly and indirectly, to the immoderate use of intoxicating liquors could be ascertained, "Alcoholism" would occupy a much more prominent position in the" Bills of Mortality; "but many deaths due to the abuse of alcohol get registered, and therefore are classified to visceral and degenerative diseases, secondary in their character, but which have been caused or aggravated by "drink." Man's ingenuity in the discovery of alcohol is accountable for a large share of the misery of his race. "Drink" is the fruitful parent of vice and crime, as well as being the cause of much bodily sickness, mental trouble, moral degradation, ruin, and many premature deaths: it fills our prisons and workhouses, our asylums and hospitals, our cemeteries, and, though happily to a decreasing extent, our National Exchequer! Class. 4—Constitutional Diseases. This important class comprises the causes of 602 deaths (=23 per cent, of total deaths): including 129 of children under the age of 5 years; 485 in the Town sub-district, and 117 in Brompton. Rheumatic Fever and Rheumatism of the heart caused 13 deaths; Rheumatism 7. In many fatal cases of rheumatic fever the immediate cause of death is disease of the heart arising in the course of the malady; and of the deaths from heart disease at later periods of life, not a few might justly be ascribed to 73 rheumatism as the primary cause, though the connexion may have been overlooked, or is not recognised in the medical certificate of the cause of death. In the new classification deaths due to rheumatic disease involving the heart are distinguished from ordinary rheumatism without such complication. Gout was the cause of 5 deaths and Rickets of 2. Cancer, (Malignant disease), was accountable for 128 deaths; 103 in the Town sub-district, and 25 in Brompton. The deaths from cancer appear to be on the increase, the numbers in the previous nine years having been 67, 74, 69, 88, 79, 95, 90, 112, and 92. The deaths in the Brompton sub-district are usually, but were not in 1883, more numerous proportionally to population than in the relatively poorer Town sub-district. Cancer, in fact, is quite as prevalent in well-to-do people, more prevalent, perhaps, than amongst the poorer classes. The parts of the body most commonly affected are the viscera or internal organs; in women, the uterus and the breast; the malady, moreover, being most common in later life. One hundred and nine of the deaths took place at ages above 45. It may be well to mention that in Table 3, (Appendix), the deaths of persons who had cancer are classified to cancer irrespective of the question whether any other disease was named in the medical certificate, and of the question whether cancer was the immediate cause of death. Purpura, Hemorrhagic diathesis, caused three deaths; Ancemia, Chlorosis, and Leucocythemia, 4 deaths; Glycosuria, Diabetes mellitus, 13 deaths, 7 of them in the Brompton subdistrict. The remaining diseases in this Class belong to the group generically known as Tubercular, and they are amongst the most important with which sanitarians have to deal, the degree to which they prevail in a given district being regarded, in some sort, as a test of the healthiness or otherwise of the people. Generally hereditary, these diseases are nevertheless susceptible of 74 considerable amelioration under improved hygienic arrangements. Scrofula is unknown in Hygieapolis! Sunlight and pure air; efficient drainage and its corollary, a dry sub-soil; good food, warm clothing, and temperance in all things, are powerful antidotes to the bane of tubercle, which is fostered by squalor and dirt, by cold and nakedness, by vice and intemperance, by the want of the proper necessaries of life, by over-crowding in ill-constructed, unventilated, and sewagetainted 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, it has been the custom to say, are usually traceable to the influence of heredity, but modern researches, which have thrown great light on the origin of tubercle, raise a presumption that tuberculosis may be an infectious disease, a specific fever of slow progress with a veiled resemblance to other specific eruptive fevers; and we are encouraged to hope that a remedy may ultimately be found for this great scourge of the human race. Tubercular diseases were the registered causes of 425 deaths viz., 847 in the Town sub-district, and 78 in Brompton; 122 of the deaths being of children under 5 years of age. The numbers in the four quarters of the year respectively were 117, 103, 106 and 99; 216 in the winter and 209 in the summer quarters. Occasionally "phthisis" is returned as the cause of death in the earliest infancy, a period of life at which the tubercular diathesis is usually manifested by diseases of other parts of the body, e.g., brain and bowels, rather than of the lungs. Such deaths are classified in Table 3, with those properly certified as due to tuberculosis and other forms of scrofula, the. total being 33, of which 19 occurred under 5 years of age, including 6 registered in the Brompton sub-district. Tabes mesenterica, popularly known as "consumption of the bowels," was the cause of 48 deaths, 3 of them in Brompton, and 46 under 5 years of age. Tubercular meningitis and Hydrocephalus, (waterton the brain), were the causes of 67 deaths, 12 of them in Brompton, and 75 57 under 5 years of age. Phthisis, popularly known as "decline," or "consumption," was the cause of 277 deaths, 12 of them between 5 and 15 years of age; and 263 between 15 and 65, viz., 40, 75, 69, 51, and 28, in the five decades respectively: two deaths were registered at ages over 65. The quarterly numbers were 76, 69, 65. and 67; of the total, 220 belong to the Town sub-district and 57 to Brompton. The deaths from tubercular diseases generally, were disproportionately more numerous in the Town sub-district, less than a fifth having occurred in Brompton, which contains more than a fourth of the population, a fact which may be explained, in part, by the relatively small proportion of children, and of the poorest classes, in this sub-district. It is probable that the deaths ascribed to these causes do not comprise all the deaths really due to diseases indicating the tubercular diathesis, and that many deaths of young children classified to such causes as premature birth, atrophy, debility, convulsions, &c., are primarily due to the scrofulous taint. In many instances other diseases, e.g., of the lungs, as bronchitis, pneumonia, &c., are associated with phthisis in medical certificates of the cause of death, but all such associated diseases are disregarded in Table 3 : when phthisis is returned the death is classified to that heading, it being assumed that the tubercular diathesis was underlying the other disease or diseases, being in fact the primary cause of death. Class 5.—Developmental Diseases. In this class, Premature birth is the assigned cause of 61 deaths; Atelectasis of 7, and Congenital malformation of 13. Old age was the registered cause of 80 deaths; all but one at ages over 65. Between 75 and 85 there were 40 deaths, and 22 at ages above 85. The total deaths in this class were 161, viz., 124 in the Town sub-district, and 37 in Brompton. 76 Class 6.—Local Diseases. The diseases in this Class, containing eleven Orders, named after the systems or organs to which the diseases relate, were accountable for 1321 deaths, or 50 per cent. of the deaths from all causes: 1065 were registered in the Town subdistrict, and 256 in Brompton; 415 were of children under five years of age. 1. Nervous System.—Diseases of the nervous system were the registered causes of 288 deaths, (as against 260 in 1882), viz., 222 in theTown sub-district, and 66 in Brompton: 87 under five years of age. The quarterly numbers were 86, 61, 66 and 75. Inflammation of the brain or membranes was the cause of 17 deaths; Insanity and General Paralysis of the insane of 8; Epilepsy of 10; Disease of spinal cord, paraplegia and paralysis agitans of 11;" Other diseases of nervous system " of 29. The principal diseases, however, were apoplexy,softening of brain, hemiplegia, and brain paralysis, which together account for 137 deaths, 35 of them in Brompton, and 126 at ages above 45. Convulsions was the cause of 70 deaths, all under 5 years of age, and 17 only in Brompton, irrespective of the deaths referred to epilepsy. Convulsions as a cause of death is frequently associated, in medical certificates, with definite diseases, and with "teething." The convulsions being a symptom only, such deaths are classified to the primary diseases named, or to dentition, as the case may be. Laryngismus stridulus, (spasm of the glottis), included in the new classification with diseases of the nervous system, was the registered cause of 6 deaths, all under five years of age ; but as the children were generally "found dead in bed," it is probable that the title has little more meaning than "want of breath," as a cause of death; and indeed want of breath is the cause of death when death results from spasm of the glottis. In the absence of other apparent cause of death, the pre-existence of spasm of the glottis may have been inferred, but it is quite possible, to say the least of it, that some of 77 the children had been "overlaid," i.e., suffocated—a remark equally applicable to deaths attributed to convulsions, when the deceased persons have been found "dead in bed." The cause of death in such cases—whether spasm of the glottis or convulsions be returned, can be only guessed at when the child has not been seen to die, for examination after death would not disclose the occurrence of spasm, during life, and there is no pathological condition which would enable one to say positively that a child had suffered, still less that it had died, from convulsions. 2. The second Order comprises the Diseases of the Organs of Special Sense, (e.g., of ear, eye, nose); five deaths were classified to these causes. 3. Circulatory System.—The deaths due to diseases of the organs of circulation, heart and blood vessels, were 179, as against 158 and 167 in the two preceding years: 150 were registered in the Town sub-district, and 29 in Brompton; 3 only were of children under five years of age. The quarterly numbers were 49, 39, 34 and 57. To specified forms of disease, 65 deaths were assigned, viz., Pericarditis 6; Acute endocarditis 1; Valvular diseases of heart 51; Aneurism 6; Embolism, Thrombosis 1: Other diseases of heart, nature not specified, caused 113 deaths; other diseases of blood vessels, one death. 4. Respiratory System.—The deaths from the diseases of the chest, phthisis being excluded, were 585, 24 fewer than in 1882, and equal to 22'3 per cent. on total deaths. Of this number 483 were r-egistered in the Town sub-district, and 102 in Brompton. The quarterly numbers were 197,145, 69, and 174: 371 in the first and fourth, or colder quarters, and 214 in the second and third, or warmer quarters. The deaths under five years of age were 264,=45 per cent., and at 55 and upwards 211,=36 per cent. of the whole number. These diseases are thus seen to be most fatal at the extremes of life; but the prevalence of them varies considerably in different years, depending mainly on the degree 78 of cold in winter, and the general character of that season: they are always most fatal when fog, especially "London fog," is associated with low temperature. The several diseases are Laryngitis 5 deaths; Croup, (transferred in the new classification from miasmatic diseases), 30; Emphysema, Asthma, 10; Pleurisy, 17; Bronchitis, 367; Pneumonia, 124; and Other diseases of the respiratory system, 32. Bronchitis and Pneumonia therefore, and they often occur together, were accountable for 491 deaths, (including 216 under five years), and of this number 78 only were registered in Brompton. 5. Diseases of Digestive System.—The diseases of the organs concerned in digestion were the causes of 156 deaths; 122 in the Town sub-district, and 34 in Brompton; 48 of them under five years of age. In the new classification, Dentition is included in this Order; it was the cause of 29 deaths under five, 15 of them under one year. Sore throat and Quinsy, (the latter disease transferred in the new classification from miasmatic diseases), were the causes of 5 deaths. Diseases of Stomach of 15 deaths; Enteritis of 14; Obstructive diseases of intestines of 17, and Peritonitis of 12. Cirrhosis of Liver was the registered cause of 20 deaths; Jaundice and other diseases of Liver of 35, and Other diseases of digestive system of nine. 6. Diseases of Lymphatic System, e.g., of Lymphatics and Spleen; no deaths were registered from these causes, and only one death from 7. Diseases of Gland-like Organs of Uncertain Use (e.g., Bronchocele, Addison's disease). 8. Diseases of Urinary Organs.—Of the 83 deaths assigned to these causes, 68 were registered in the Town sub-district and 15 in Brompton: two only were of children under five years of age. The diseases were, Nephritis, 14 deaths; Bright's disease, (Albuminuria), 38; Diseases of the bladder, or of the prostate, 10, and Other diseases of urinary system, 21. 79 9. Diseases of Reproductive System.—(a) Of organs of generation : male organs, no deaths; female organs, 15: (b) Of parturition 3 deaths, viz., from Placenta prcevia, (flooding), 2, and Other accidents of childbirth, 1. 10. Diseases of Bones and Joints.—Arthritis, ostitis, periostitis, caused two deaths. 11. Diseases of Integumentary System, 4 deaths, viz., Carbuncle, Phlegmon, 2; "Other diseases," 2. Class 7.—Deaths from Violence. Fifty-one deaths, including 21 under five years of age, are distributed over the four Orders comprised in this class; 13 of them belonging to the Brompton sub-district. 1. Accident or Negligence.—Total deaths 40, including 9 in Brompton, and 20 under five years of age, viz., from Fractures and Contusions, 15; Bum, Scald, 3; Poison, 2; Drowning, 2; Suffocation, generally of infants " overlaid," 16, including 14 under one year; " Otherwise,'' 2. 2. Homicide.—Murder, 1; of a newly born child, by some person unknown. 3. Suicide.—Of the 10 suicidal deaths, seven occurred in the Town sub-district, and 3 in Brompton. Poison was the lethal agent in 5 cases; Hanging in 2; Cut, Stab in 2; Pistol shot wound in 1. Class 8.—Deaths from Ill-defined and. not Specified Causes.—This class has assumed great importance in the new arrangement, owing to the transfer of a large number of diseases from other positions in the old classification; the causes of 136 deaths, 118 and 18 in the Town and Brompton sub-districts respectively, including 108 under five years of age, are embraced in it, viz -.—Dropsy, 1; Debility, Atrophy, Inanition, 108, (all under five years, and 93 under one year); Mortification, 2; Abscess, 8; and Hemorrhage, 1; Causes not specified or ill-defined, 16. 80 DEATHS IN PUBLIC INSTITUTIONS. The only " large public institution" within the parish in which we are directly interested, is the Parish Infirmary and Workhouse, situated in the Town sub-district. There are several minor public, or quasi-public institutions, but, with one exception, they do not furnish occasion for special notice. The excepted institution is St. Joseph's. House, Portobello Road, Notting Hill—a Roman Catholic Home for aged poor persons of both sexes, brought from various parts, principally from Ireland; but the Registrar General does not regard it as a public institution. The deaths of non-parishioners at the Marylebone Infirmary, Notting Hill, (446), and at the Brompton Consumption Hospital, (116), are excluded from our statistics, but will furnish occasion for a few remarks later on. The deaths of parishioners registered at the Parish Infirmary and Workhouse, (322), and at out-lying institutions, (160), were 482, or 18.4 per cent. on total deaths, the percentage proportion of deaths in public institutions in the Metropolis generally being 20.6. The addition of the deaths at the Marylebone Infirmary, and Brompton Hospital to those at the Parish Infirmary, would raise the percentage in Kensington to 33.7. The Parish Infirmary and Workhouse.—I am indebted to Mr. H. Percy Potter, Medical Superintendent of the Infirmary, and Medical Officer of the Workhouse, for the statistics of mortality at these important institutions; the former being, to all intents and purposes, as its name implies, a hospital; it contains over 600 beds. The deaths, 322* in number, were equal to 12.3 per cent. on deaths registered in the parish; they were 15 in excess of the total in 1882, (307), and 49 in excess of the total in 1881, (273). The deaths comprised 164 of males, and 158 of females, the quarterly totals being 102, 72, 67, and 81; so that 183 deaths occurred in the first and last (or cold) quarters, and 139 in the second *The number registered in 1883, was 318; other four occurring at the end of December were not registered until the beginning of January, 1884. 81 and third (or warm) quarters. The ages at death were, under one year, 39; between one and sixty, 151; at sixty and upward, 132. Two inquests were held; the causes of death being "violent," viz: male, aged 4 days, found dead in bed, suffocation; and male, aged 22, injury to head. CAUSES OF DEATHS. Under one year. Between one year and sixty. Sixty and upwards Total. Nervous System, Diseases of 0 10 30 40 Circulatory Organs, „ 0 8 15 23 Respiratory „ „ 7 78 53 138 Abdominal Viscera „ 0 5 0 5 Urinary Organs „ 0 10 7 17 Joints (Hip) „ 0 1 0 1 Measles 1 4 0 5 Enteric Fever 0 1 0 1 Erysipelas 0 2 2 4 Diarrhœa 0 0 2 2 Cholera 0 1 0 1 Croup 0 1 0 1 Whooping Cough 0 1 0 1 Septicæmia 0 1 0 1 Diphtheria 1 0 0 1 Syphilis 3 6 0 9 Parametritis 0 1 0 1 Puerperal Eclampsia 0 1 0 1 Convulsions 6 1 0 7 Want of Breast Milk 3 0 0 3 Cancer 0 12 15 27 Tabes Mesenterica 12 2 0 14 Scrofula 0 1 0 1 Premature Birth 4 0 0 4 Old Age 0 0 6 6 Stomatitis 0 1 0 1 Diabetes 0 1 0 1 Gout 0 1 0 1 Leucocythemia 0 0 1 1 Purpura 0 0 1 1 Asthenia 2 0 0 2 Injury to Head 0 1 0 1 Totals 39 151 132 322 82 Outlying Public Institutions.— By virtue of an arrangement entered into between your Vestry and an official in the department of the Registrar General, I have been supplied, during the past year, with a return of the deaths of Kensington people in public institutions outside the parish. In Table 3, all such deaths, 160 in number, are included, and consequently all deaths of non-parishioners at Brompton hospital—heretofore included in our vital statistics by way of compensation for an unknown number of deaths of parishioners occurring outside the parish — have been excluded. The 160 deaths occurred in the following institutions, viz: St. George's Hospital 42 St. Mary's 44 Middlesex ,, 10 Charing Cross „ 5 University College „ 4 St. Bartholomew's,, 3 St. Thomas's „ 3 London ,, I Guy's 1 West London „ 4 Cancer „ 4 Brompton Consumption Hospital, (south branch) 4 North London Consumption Hospital 1 Western District, (Fulham) Hospital 10 South Western District, (Stockwell),, 1 Childrens' Hospitals 7 Queen Charlotte's Hospital, and St. John's Maternity Home (children 4) 5 Bethlehem Hospital 3 Military Hospital, Westminster 3 St. Raphael's Hospital 1 Homeopathic ,, 1 St. Peter's Home, Kilbum 2 Paddington Workhouse 1 Total 160 St. Joseph's House.—The deaths at this institution, which are included in Table 3 (Appendix) were 28, viz.: males 12 and females 16; all at ages over 60, seventeen of them at ages over 70. Fifteen of the deceased had come from Ireland, seven from the provinces, six belonged to London. The causes of death were: diseases of the heart and lungs, 15: of the brain, including paralysis, 4; cancer, 3; albuminuria, 2 ; other diseases, 4. The Hospital for Consumption and Diseases of the Chest.—The deaths at this institution, or rather in that part of it situated in Kensington, a new hospital having been built on the south side of Fulham Road, in the parish of Chelsea, were 121, viz.: males 76, and females 45: 21, 29, 42, and 29 in the four quarters of the year respectively. The ages at death were: under 20 years, (youngest 13), 21; 83 between 20 and 40, 75; between 40 and 60, (oldest 57), 25. Five of the deaths were of parishioners, and are included in Table 3 (Appendix). Seventy-three of the deceased had previously resided in the Metropolis; 18 in the suburbs or Metropolitan counties, and 30 in more distant parts of the country. The causes of death as registered, were; Phthisis (consumption or decline) alone, in 93 cases; Phthisis associated with other forms of tubercular disease in 3 cases, and with lung diseases in 7 cases; other visceral diseases, chiefly of the heart and lungs, in 18 cases. Marylebone Infirmary, Notting Hill.—At this institution, which is larger than the parish infirmary, 446 deaths of non-parishioners were registered, but they are not included in Table 3 (Appendix). They comprised males 238, and females 208; 233 of the deceased were aged 60 and upwards, and 8 were under five years, including 7 under one year of age. Six deaths from zymotic diseases, and 6 from violence, were registered ; inquests were held in nine cases. DEATHS NOT CERTIFIED. Twenty deaths, (0.76 of all deaths registered), were returned as "not certified," the deceased persons not having been attended in their last illness by any registered medical practitioner. The proportion of not certified deaths in London was 1.22 per cent. In three cases, unregistered male practitioners had been in attendance upon the deceased, and in two cases, (infants), midwives: in the remaining 15 cases there had been "no medical attendant." The ages of the deceased were :—under 1, 6; between 1 and 5, 2; between 5 and 60, 6; 60 and upwards, 6. The causes of death, as registered, were:—wasting and debility of infants, 2; premature birth, 2; injury during birth, 1; old age, 4; whooping cough and diarrhoea, 1 each; epilepsy and convulsions, one each; phthisis, 1; diseases of the lungs, 3; sprained ankle, 1; "unknown," (one of a child found dead in a public place), 2. 84 The subject of uncertified deaths has, on more than one occasion, engaged the attention of 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 indefensible is the responsibility cast on the Coroner's Officer of making a preliminary enquiry, and of being the de facto judge in a doubtful case whether an inquest should be held. The Society, at my instance, adopted the following further 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 forty-five inquests, 113 in the Town subdistrict, and 32 in Brompton, were held in the year, the subjects being males 83, and females 62; 58 were under five years of age, including 40 less than a year old, and 27 were persons aged 60 and upwards: the cause of death in 111 instances was ascertained by post-mortem examination. The Deaths from Violence were 51, of which 13 belong to the Brompton sub-district. The grounds for holding inquests were, usually, either the suddenness of death, 85 or the fact that death has been caused by violence. In many cases it was stated that the deceased had been "found dead," in bed or otherwise. The causes of death may be classified as follows:— Deaths caused by disease 94 Accidental deaths 40 Suicidal „ 10 Homicidal „ 1 145 The diseases may be classified thus:— Diseases of the brain and nervous system 27 „ „ organs of respiration and circulation 55 Zymotic diseases 4 Other diseases 8 The violent deaths were caused as follows:— Accident: Suffocation, (14 of infants one year) 16 Poison, (Chloral and Chloroform) 2 Drowning 2 Falls, under various circumstances 5 Scalded 3 Run over by train 3, by cab 1 4 Thrown from cart 3 Kicked by horse 2 Hemorrhage from neglect at birth 1 Otherwise 2 Suicide: By hanging 2 By poison 5 By cut throat 2 By pistol shot 1 Wilful Murder : (of newly born infant) 1 Among the deaths described as "sudden," there were, as usual, many from ordinary and curable visceral diseases, and it is impossible to resist the conviction that the neglect to 86 obtain medical assistance for the deceased was culpable, inasmuch as the illnesses must often have extended over many days, and been attended with obvious symptoms of a more or less serious and painful nature. The mere finding of the "cause of death" in such cases, seems scarcely to satisfy the requirements of justice, considering that the death of any person—but particularly of one very young or very aged —from such diseases as pneumonia, bronchitis, &c., when there has been no medical attendance, raises a presumption of neglect which would justify a verdict of "manslaughter," just as much as in the case of the "peculiar people," who, whilst treating their sick with care in other respects, refuse, on so-called "conscientious" grounds, to employ medical assistance, and who, as a consequence of such refusal, death having ensued, have on several occasions been found guilty of manslaughter. METEOROLOGY. The mean temperature of the air at Greenwich in 1883 was 490.4 Fahrenheit, the same as the average of 42 years; the means of the four quarters respectively being 40o.0, 53°.0, 590.5, and 44°.9. The highest reading by day (85°.1) was registered in the week ending August 25th, and the lowest reading by night (20°.6) in the week ending March 24th; the means of the highest weekly readings by day, in the four quarters respectively, being 51.9, 71.0, 75.9 and 56T, and of the lowest readings, by night, 28.9, 37.6, 46.2, and 35.9. The hottest week in the year was that which ended July 7th, (64.3), and the coldest week that which ended March 10th (33.8). August was the hottest month, mean temperature 61.9, and March the coldest, mean temperature 36.1. May was characterised by the greatest range in temperature, viz.: 50.7—from 81.0 to 30.3, whilst February exhibited the smallest range, viz.: 24.3—from 55.2 to 30.9. The dryness of the atmosphere, i.e., the difference between dew-point temperature and air-temperature was 5.8; the same as the 87 average of 42 years. Rain fell on 173 days, the total amount registered in the year being 21.90 inches, the average of 42 years being 22.59 inches. Most rain fell in September, 3.82 inches, and least in August 0.72. The means of the readings of the barometer were 29.784 inches; the means of December 29.983, and of September 29.648, being respectively, highest and lowest. VACCINATION. Table X (Appendix) is a return respecting the vaccination of children whose births were registered in 1883, and for it I am indebted to Mr. Shattock, the Vaccination Officer, whose energetic discharge of the duties of his appointment it is my pleasing duty, yearly, to recognise. The return shows a loss of 4.0 per cent. in the cases, as against 4.4 and 3.3 in the two previous years, in column 10, indicating loss "from removal of children to places out of parish unknown, or which cannot be reached, and cases not having been found." In the Metropolis, as a whole, the loss considerably exceeds the loss in Kensington. It is due to the Guardians of the Poor— the authority responsible for carrying out the Vaccination Acts—to say that they cordially support their officer in the discharge of his duty. With regard to the protection against small-pox afforded by vaccination—differing in degree as this does according as the operation is more or less perfectly performed—it should be unnecessary to say anything in these days; but the perverse pertinacity with which a noisy, if not considerable, minority decry this most beneficent of medical discoveries, shows no sign of abatement; the teaching of its opponents, moreover, being of a sort to oppose the masses to the continuance of the wise compulsion enforced by Parliament. Hence it becomes a duty, year by year, to refer to the subject, and I do not hesitate to refer again to the pregnant facts submitted to the Local Government Board by their 88 Medical Officer, Dr. Buchanan, in his report for 1881. Dr. Buchanan, first of all, refers to the relative mortality from small-pox in the vaccinated, and in the unvaccinated, inhabitants of London, which formed the subject of a memorandum which he submitted to the Board in June, 1881, and containing the following table:— Comparative Small-pox Death Rates among Londoners, Vaccinated and Unvaccinated respectively, for the 52 weeks ended 29th May, 1881. Death rate of people of subjoined ages. Per million of each age of the vaccinated class. Per million of each age of the unvaccinated class. All ages 90 3,350 Under 20 years 61 4,520 Under 5 years 40½ 5,950 But mainly he limits the scope of his further enquiry on the subject, to the mortality from small-pox among children under the age of ten years, for the sufficient reason that the limit embraces the period within which vaccination has been efficiently compulsory. The population of London under ten was 916,784 on census night, 1881, of whom, in round numbers, 55,000 were unvaccinated, and 861,000 were vaccinated. In 1881 some 782 small-pox deaths occurred among the 55,000 unvaccinated, as against 125 among the vaccinated. "Upon equal numbers of the two classes, therefore, the mortality from small-pox among the unvaccinated, was about a hundredfold the mortality from small-pox among the vaccinated. This degree of protection was given to children under 10, by the average current vaccination of London."* * "The power of a thorough vaccination to protect against death from smallpox," (it is stated), "is at least ten times greater than the power of much that passes under the name of vaccination." 89 "If the London children under 10 who were unvaccinated, had had the protection which the current vaccination gives, not 782 of them, but at the outside nine, would have died of small-pox during the year. "If the 861,000 vaccinated children had died at the rate of the 55,000 unvaccinated, we should not now be considering 125 small-pox deaths, and how they can be reduced, but we should be confronted with an additional 12,000 and more deaths from small-pox, occurring during the year in the London population under 10 years of age." This "great saving of children from death by small-pox can only have been due to vaccination, and largely to the operation of vaccination law." It must be remembered, moreover, that the mortality of small-pox in vaccinated children, small though it be, is unduly high, for the reason, doubtless, that so much of the vaccination which passes current is imperfect, there still being many medical men who systematically evade the spirit of the law, and disregard the teachings of experience, as summed up in the instructions issued by the Board for the guidance of public vaccinators. A prime condition of vaccination, "successful" from the official standpoint, is the production of four typical vesicles; but we are told that there is a "form of private vaccination that offers itself in competition with public vaccination, and which parades its inefficiency as a reason for its acceptance by ignorant people. Its professors say to young mothers, 'Do you come to me and I won't hurt your baby; I'll make only one place on its arm, not four, as those public vaccinators do.'" It will excite little surprise, therefore, that—the vaccination being done in almost equal proportions by public vaccinators and private practitioners—the proportion of deaths from smallpox, among children under ten, is far greater among the patients of private practitioners, than among children vaccinated by the public vaccinators; and this despite reasons, to which Dr. Buchanan refers, which might fairly lead us to G 90 expect a quite different result, were it not for the admittedly superior average quality of vaccination as performed by public vaccinators. Here, then, we have a record of the "saving of 12,000 lives, by vaccination, to children under ten years of age" in the one year, 1881, when the total mortality from small-pox did not amount to one-third of the mortality in the epidemic of 1871. This saving of life is, I believe, justly attributed to the operation of the Vaccination Acts of 1867 and 1871. It only needs further to be mentioned that in the "two periods of ten years immediately preceding 1871, 59 and 54 per cent., or more than half, of the total small-pox mortality was borne by children under five years old," whilst "now, only 28 per cent., little more than a quarter of the total small-pox mortality, falls upon such children," a clear indication of the greater success with which the law of compulsory vaccination is now carried out. Animal Vaccination—Calf Lymph.—A common objection to "arm to arm" vaccination is based on the fact that as the lymph is passed through the human system, it may transmit disease: the dangers attending the use of humanised lymph, however, are very trifling, and practically, almost inappreciable. Nevertheless, and it being desirable to remove, as far as possible, every obstacle to vaccination, it is satisfactory to know that the Local Government Board have made arrangements to give people the option of having their children vaccinated with calf-lymph at the public vaccination stations. The Government, moreover, supplies medical practioners with "stock" lymph to enable them to start a series of vaccinations, leaving them to keep up their supplies afterwards—if they can. The use of calf lymph is common on the Continent, and the system of animal vaccination has been carried to great perfection at Brussels under the direction of M. Warlomont, who forwards regular supplies of lymph to this country, tubes and charged ivory points being 91 purchasable at a moderate rate. A station, moreover, has been established by a private medical practitioner in the Marylebone Road, for the supply of calf lymph, and at which persons can be vaccinated direct from the calf. SANITARY. Committee for carrying out the Nuisances Removal Acts.—With the view of accelerating proceedings in cases of nuisance, your Vestry decided, in February of the current year, to appoint the Works, Sanitary, and General Purposes Committee, to be a Committee to receive notices, take proceedings, and in all respects, execute the Nuisances Removal Act, for England, 1855, and all Amending Acts. The Committee meets for the purposes of the Acts once a week, and notices are issued upon the immediate authority of the Committee, which simply reports its proceedings to your Vestry. Summonses continue to be heard by the Justices sitting in Petty Sessions at the Vestry Hall. It were to be desired that the Justices would place Sanitary cases at the commencement, instead of, as heretofore, at the end of the agenda for the day, so that the several Inspectors might be set free early to proceed about their ordinary work. The business rarely occupies any considerable length of time, but on many occasions the entire staff of Inspectors has been detained till 2 or 3 p.m., waiting for their cases to come on. I have no doubt that the Justices would pay every regard to an application on the subject by your Vestry. They would also, I believe, consent to hold a mid-monthly sitting, if requested, for hearing sanitary cases. Their duties in this department of judicial work have increased considerably, owing to the Cheslea Vestry and the Fulham District Board of Works having to some extent followed the example of your Vestry in bringing their business before the Court. It is interesting to know that the magistrates in the Tower Hamlets Division, have recently G2 92 agreed to take up this description of judicial work, and to hold a fortnightly meeting for the purpose. At present, I believe, they take Bethnal Green cases only. Application was made to me by the magistrate to whose initiative this action is due, to know how the system worked in Kensington, and it afforded me much satisfaction to be able to speak so favourably of the results. It would be well if the Justices in every Division would follow this example: they might render good service in measures for improving the public health by the removal of nuisances, &c. The Local Government Board and Sanitary Authorities.—It will not be out of place here to mention that with the view of informing sanitary authorities on the extent and limitations of their powers, the Local Government Board, issued in December, a valuable circular letter dealing with "Dwellings of the Labouring Classes in the Metropolis," and accompanied by (a) Digest of provisions as to Removal of Nuisances, (Metropolis). (b) Digest of the Artizans and Labourers' Dwellings Acts, (Mr. Torrens's Acts). (c) Digest of the Artizans and Labourers' Dwellings Improvement Acts, (Sir R. Cross's Acts). (d) Digest of Labouring Classes' Lodging Houses Acts. The Board at the same time issued circulars with regard to the Regulation of Houses let in lodgings, and with regard to the Regulation of Bakehouses under the Factory and Workshop Acts. These subjects will be referred to at a subsequent part of this report. The Work of the Sanitary Inspectors.—Tables VI and VIa (appendix) contain a summary of the work of the Sanitary Inspectors during the year ended March 25, 1884. Ninety-eight summonses were taken out for offences, 93 principally under the Nuisances Removal Acts, against 104 and 78 in the two preceding years. Orders were made by the Magistrates in nearly every instance for giving effect to the Notices previously served on the defendant persons, upon whom, as the law stands, no further penalty could be inflicted than payment of costs to the extent of one or two shillings only, however serious or long continued the nuisance. Under the provisions of Section 96 of the Public Health Act, 1875, which does not apply to the Metropolis, the Justices have power by their Order to inflict a penalty not exceeding five pounds, on the person on whom the Order is made, together with all costs. It is to be desired that the same power should be conferred on Courts of Summary Jurisdiction in London. At present they can punish for contempt of Court only, viz.: for disobedience of the order of the Court. In three cases penalties were inflicted for this offence; but the amount was paid in one case only. Probably if there were power to inflict penalties for offences under the Nuisances Removal Acts, disregard of the Local Authority's notices, which implies continuance of nuisance with consequent injury to health, to say nothing of the trouble and loss of time imposed upon officers, would be of less frequent occurrence. That the cases are proper to be brought before the Justices would appear from the fact that dismissal of a summons is a very rare occurrence. Orders were made as follows:—To lay on water to premises, 5; for the provision of new, or the repair of existing, cisterns, 13; for the abolition of waste-pipes in connexion with drains, 4; for the repair of defective fittings to water closets and supply of water to same, 30; for the construction, or amendment, including trapping and ventilation of drains, sinks, &c., 33; for the repair of defective rain water pipes, 3; for the provision of new, or repair of old, dustbins, 10; for the cleansing and reparation of dirty, unwholesome, and dilapidated houses, &c., 61, &c. Summonses have regard, usually, to "Premises in such a state as to be a nuisance or injurious to health," 82 being of this 94 ter. Last year, however, proceedings were taken in several cases for the abatement of nuisances arising from the accumulation or deposit of offensive matters on vacant land. In every instance the requisite Order was made; once a penalty of forty-shillings was inflicted and in one case an Order to prohibit the recurrence of the nuisance was granted. A good deal of trouble had been occasioned previously in efforts to prevent or remove nuisances on the lands in question, (building sites), but with little effect, there being no power to compel owners to enclose. One summons only was taken out for breach of the regulations with regard to the periodical removal of manure, the Justices being unwilling to enforce payment of the penalty which the law authorises the "Nuisance Authority" to fix for the disobedience. On three several occasions proceedings were taken against one person to secure the removal of animals so kept as to be a nuisance or injurious to health, the animals being cats and dogs of all ages and both sexes. Once the defendant was mulct in costs to the extent of four shillings, a prohibitory order also being made, but the Order was nullified by a change of residence.* Offensive Businesses.—Some of the more important legal proceedings related to the premises of a marine store dealer, i.e., rag and bone shop. Numerous complaints had been received during the hot weather of the stenches arising from the collection and storage of fat and other animal matters in a putrid condition on these and similar premises. As an illustration of the serious character of the nuisance, I quote from a report by the Sanitary Inspector on certain premises in Warwick Road. There was, he says, a "fearful stench emanating from a shed at the back of the house, caused by a large accumulation of putrid fat, bones, rabbit skins, and the refuse that had been collected from numerous kitchens. There were about 25 tubs full of fat, which was in * In the present year further proceedings were taken, and a Prohibitory Order granted. This was appealed against, but the decision of the Magistrates was upheld. 95 a putrid state, and alive with maggots. Besides these there were several sacks, baskets, &c. full of the most offensive fat, bones, &c." The stench from this place was perceptible at a distance of a hundred yards, and your Vestry's surveyor stated that the street in the vicinity was undermined with rat-runs directed to the premises. A notice was served for the removal of the stuff, and it was removed quickly, but even after thorough washing of the premises there remained a very offensive smell, caused no doubt by the bad state of the brick floor which held a quantity of the fat, &c.; the tubs also being saturated with fat. Further proceedings were subsequently taken to obtain an Order for the prohibition of the nuisance. So numerous were the complaints that, after due consideration, the Works, Sanitary, and General Purposes Committee recommended, and your Vestry directed, "that the attention of the Metropolitan Board of Works be directed to the serious character of the nuisance caused by the collection of putrid animal matters at marine stores, and that they be requested to consider as to the desirability of the business of a 'marine store dealer,' being declared an 'offensive business' under the provisions of the Slaughter Houses (Metropolis) Act, 1874, Section 3." It was felt that public advantage would result from the action recommended to be taken, for if the business were scheduled under the Act, we should be able to secure a proper construction of the premises where it is carried on, proper impermeable receptacles for the collection, storage, and removal of the fat, &c., and frequent, if not daily, removal of it from the premises. Incidentally, moreover, the nuisancewould be diminished, for if the business were subjected to needful supervision, the proprietors would impress on vendors, domestic servants for the most part, the necessity of submitting their "perquisites" for sale in a more wholesome condition. The Board, however, did not adopt the views submitted by your Vestry, for in their reply they stated that "the businesses to which the Act of 1874 refers, are businesses 96 which include processes of manufacture of a more or less offensive character, and that it does not appear to the Board that the mere collection of a mass of refuse matter into one place is a 'business' within the meaning of the 3rd Section of the Act." But among "offensive" businesses already scheduled are those of "bone boiler," "tallow melter," and "fat extractor," the staple articles of which are obtained largely from "rag and bone shops." The "processes of manufacture," moreover, in boiling bones, in melting tallow, in boiling hog-wash, &c., to extract fat, are not very obvious, and in any case the bye laws for the regulation of these "businesses" do not allow collections of bones, fat, &c., to remain exposed, polluting the air, on the premises. Why, then, should such matters be allowed to remain exposed, and to pollute the air in the neighbourhood of the stores where they are originally collected, and which are far more numerous than the "manufactories?" The Board was of opinion that a nuisance such as that brought under their notice "should be dealt with under the Nuisances Removal Act," which, they say, was "intended to apply to such cases." Doubtless: it was also intended to apply to the cases of the "offensive businesses" now regulated under the Slaughter Houses Act, in respect of which the Board is the Local Authority: but in practice it was found impossible to deal effectually with nuisances arising in the conduct of those businesses under the general Act, and so a special Act was passed. The Board, evidently, were unaware how difficult it is to deal with recurring trade nuisances under the Nuisances Removal Act: whilst no one knows better that there is little difficulty in preventing nuisance when the "offensive businesses" are conducted subject to bye-laws with appropriate penalties for offences. In properly constructed premises, in chambers without openings to the external atmosphere, and in covered impermeable receptacles, bones, fat, &c., can be stored without nuisance; and it is to be regretted that the Board did not see their way to secure these 97 requisites, by declaring a marine store business to be an "offensive business " within the meaning of the Act. Shortly afterwards, at a time when I supposed the question of principle had been decided adversely to my views, by the expression of the Board's opinion, with which the Law and Parliamentary Committee expressed their concurrence, it came to my knowledge that in an appeal case, Passey (Appellant), v. Oxford Local Board, (Respondents), Lord Chief Justice Cockburn and Mr. Justice Lopes had decided that the business of "bone and rag merchant" is an "offensive trade," of the same nature with those specified in Section 112 of the Public Health Act 1875, which is based upon, and substantially corresponds with, the 3rd Section of the Slaughter Houses (Metropolis) Act 1874. In my last report for 1883, (No. 15, December 31, page 136), I gave an outline of the above mentioned appeal case as reported in the Local Government Chronicle, (January 10, 1880, page 27), together with the terms of the judgment; and in view of the importance of the matter, the decision of the judges, moreover, being entirely accordant with my views, I recommended a reference to the Law and Parliamentary Committee to advise whether a further communication should not be addressed to the Metropolitan Board of Works, requesting them to again consider the subject with the above case before them? The Committee in their report simply recommended "that proceedings be taken as heretofore under the Nuisances Removal Act, as occasion may arise, the Committee not being prepared to advise that any further steps be taken at present as to the control of such businesses." The report was adopted and for the time, therefore, the question has collapsed. THE LICENSED SLAUGHTER HOUSES. The licensed slaughter houses, which in 1874 were 56 in number, are now only 24, viz., 15 in the district north of Uxbridge Road, and 9 in the remainder of the parish south 98 of that road. The names of the licensees, and the localities of the licensed premises, are set out in Table XI (appendix). The several premises were inspected, in July, by the Works, Sanitary, and General Purposes Committee, who found them to be in "good structural condition, and, as a rule, well kept." There were some striking exceptions to the rule, however, and the Committee were compelled to recommend proceedings against two of the licensees for offences against the bye-laws. The Magistrates did not convict even in the worst case, although the offence was practically admitted by the defendant as well as proved in evidence. At some of the slaughter houses, business appears to have been almost discontinued: compared with byegone years very little slaughtering was seen to be going on. Wherever animals were found in the lairs the Committee observed with satisfaction that, in accordance with a frequently repeated recommendation, water had been provided for their use. Altogether, the state of matters in regard to the slaughter houses has undergone a great improvement since the passing of the Act in 1874; nevertheless, I am still of opinion that private slaughter houses should give place to public abattoirs, and that the dead meat trade should be encouraged to the utmost possible extent. It would be well, moreover, looking at the matter from the public health point of view, could facilities be increased for bringing the consumer into direct relations with the purveyor of frozen meat imported from our colonies. This meat, which generally is excellent in quality and condition, is sold, but too often, under false colours, and at an unfairly high price, as English meat. It may be mentioned that the business of a slaughterer of cattle has not been established anew in Kensington since the passing of the Act, and that the number of private slaughter houses in the Metropolis, which in 1874 was 1,420, had fallen, in October 1883, to 809, and this without any evidence forthcoming to show that inconvenience had arisen to the public, 99 or that the supply of sound meat had been in any way curtailed, as a consequence of the large reduction. THE LICENSED COWSHEDS. The licensed cowsheds are 15 in number, viz., 9 in the district north of Uxbridge Road, and 6 in the remainder of the parish south of that road. The names of the licensees, and the localities of the licensed premises, are set out in Table XII (appendix) The several premises were inspected, in July, by the Works, Sanitary, and General Purposes Committee, and were "found in fairly good sanitary condition." The sheds, which in the aggregate are licensed for the keeping of 189 cows, contained 126 cows only, at the time of inspection. DAIRIES, COWSHEDS, AND MILKSHOPS ORDER OF 1879. Sanitary Supervision of Dairies, Cowsheds, &c.— The Metropolitan Board of Works is the "Local Authority" under this Order, which "provides for the registration of all persons carrying on the trade of cow-keeper and purveyor of milk, etc.," and under which upwards of 16,000 registrations or transfers of registration, have been effected since the Order first came into operation. We learn from the Board's Annual Report, that during 1883, there were in the Metropolis 895 cowkeepers, keeping upwards of 10,000 cows in 1171 cowsheds. There were 231 dairies, and 1,941 shops exclusively confined to the sale of milk and dairy produce; milk was sold at 4,421 general shops also, and kept for sale in 516 dwellings, where there was no shop. The total number of places at which cows were kept and milk sold in the metropolis was 8,285. The Board, in the Annual Report for 1882, stated that "in the larger dairies and milk stores much improvement has 100 taken place, and they are generally in a satisfactory condition ; and in the small shops where milk is sold there has been considerable improvement in point of cleanliness, and in the separation from the place of storage, of substances likely to contaminate the milk." PUBLIC HEALTH, (DAIRIES, &c.) BILL, 1883. In my last Annual Report I referred to the "Public Health, (Dairies, &c.) Bill," introduced by the Government, with the object of placing the supervision of dairies, cowsheds, &c., under the Sanitary Authorities, it having been found, by experience, that in many parts of the country the "Dairies, &c. Order, 1879," framed by the Privy Council under Section 34 of the "Contagious Diseases, (Animals) Act, 1878," was practically a dead letter, owing to the general failure by "Local Authorities," (mostly county Magistrates), to appoint proper officers to inspect dairies and cowsheds, and generally to carry out the provisions of the Order.* This Bill was to have transferred to the Local Government Board, the powers of the Privy Council, with regard to cowsheds, dairies, and milk shops, ~ including the power of making "Orders." Had it passed, the Metropolitan Board of Works would have continued to be the "Local Authority" for the Metropolis, outside the city; an objectionable arrangement seeing that the Board have no Medical Officer and no proper sanitary staff. Under the auspices of your Vestry, a strong opposition to this part of the Bill was raised, it having been urged that while it would be well to give the Board power to frame the bye-laws for the regulation of dairies and cowsheds &c., so as to secure uniformity, the duty of carrying out the bye-laws and generally of supervising dairies, cowsheds, &c., should be intrusted to the Vestries and the District Boards; these bodies, without exception, having * The "Local Authorities" for Middlesex, and part of the County of Surrey, are deserving of honourable mention, for having appointed special officers to carry out the provisions of the Order. 101 Medical and Sanitary officers well accustomed to the work. The views of your Vestry were in complete accordance with those of the Society of Medical Officers of Health, who, at a former time, had passed a resolution to the effect— "That 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, the Medical Officers of Health, and the Sanitary Inspectors of the respective districts." Communications were addressed to the Lord President of the Council, to the President of the Local Government Board, and to the Vestries and the District Boards, with the object of preventing the perpetuation of the error involved in placing the supervision of cowsheds and dairies under the Metropolitan Board. Whether they would have been attended with the desired success it boots not now to enquire, for, owing to pressure of business, the Bill could not be persevered with, and I am informed, on good authority, that, as a result of opposition to the measure, coming from north of the Tweed, it is not intended to deal with the subject in the current session, although the necessity for legislation, upon the lines of the Bill of last year, has been fully admitted by the Vice President of the Council, and by the Local Government Board. BAKEHOUSES. In the last three or four of my annual reports I have had occasion to deprecate the transfer of the duty of supervising bakehouses, from the sanitary authority to Factory Inspectors, effected by the repeal of "The Bakehouses Regulation Act, 1863," by "The Factory and Workshop Act, 1878." How this came about it is needless now to enquire: suffice it to say that, as I pointed out in my last report, (pages 133-148), when I dealt very fully with the subject, systematic inspection of bakehouses in the metropolis—as a whole—fell 102 into abeyance. The Factory Inspectors were too few to take up the duty, which the Sanitary Authorities, as a rule, had ceased to perform; these, moreover, no longer having a statutory power of entry; the result being that many of the bakehouses fell into a deplorable state of neglect, as testified by the reports of the factory inspectors themselves. Happily, the representations addressed to the Government, to which I referred in my last report, together with the statements of the Chief Factory Inspector himself, satisfied the Government that an error had been committed in taking away from the sanitary authority the right to exercise a sanitary supervision over these establishments; and so, in the last days of the session of 1883, an Act was passed, ("Factory and Workshop Amendment Act, 1883"), by which the legislation of 1878 was revoked, and their former position was restored to the Vestries and District Boards, who are now the "local authority," so far as relates to cleanliness, ventilation, overcrowding, and other sanitary conditions of bakehouses, with powers to enforce sections 3, 33, 34 and 35 of the "Factory and Workshop Act, 1878." The recommendations of your Vestry went considerably beyond the point reached by the new Act, being substantially in agreement with the views I had set out in my annual report for 1881, when I said— "What really is required is a proper 'Bakehouse Regulation Act,' providing for the licensing of bakehouses, and conferring on Sanitary Authorities the power, which they should be obliged to exercise, of regulating the trade by bye-laws, uniform for the Metropolis, dealing with— (1) The position and construction, including lighting and ventilation of bakehouses. (2) The periodical cleansing of them; and (3) The materials and utensils employed in the manufacture of bread." But, however desirable that the above recommendations should be carried out, it was felt to be useless to press for their adoption by Parliament last year. I took the oppotunity, nevertheless, of drawing the attention of the Local Government Board to the imperfections of the Bill, and it 103 is to be hoped that at a convenient season a more complete measure may be introduced. Happily, the public and the operatives are in complete agreement with sanitary officials as to the necessity of thorough supervision of bakehouses by the sanitary authority. In our own parish, control over the bakehouses by your Vestry had never been wholly lost, as I felt it my duty to instruct the sanitary inspectors to visit them periodically, as a part of their routine work; and therefore, although there is much to desire in regard to the position and the arrangements generally of the premises,—for few of them were built for use as bakehouses,—yet, on the whole, sanitary conditions have been fairly maintained, and when the powers now possessed by your Vestry shall have been fully exercised, there will remain, I hope, little cause for complaint. This subject of bakehouse regulation had often been under the consideration of the Society of Medical Officers of Health, and upon the passing of the new Act the Society prepared "Suggestions for Regulations with respect to Bakehouses," for the guidance of local authorities. The Acts do not expressly authorise the making of regulations, but it was felt that much good would result should local authorities see fit to adopt the regulations for the guidance of their officers, and communicate them to the proprietors of bakehouses, as an indication of the requirements of the Acts. This course was followed by your Vestry: the Regulations have been printed in large type, and mounted on cardboard, and a copy has been supplied to each bakehouse proprietor in this parish. The Regulations are as follows:— REGULATIONS. 1. Every Bakehouse shall be kept in a cleanly state, and free from effluvia arising from any drain, privy, water-closet, or other nuisance. The floors shall be carefully swept at least once every 24 hours, and the sweepings shall be immediately placed in an impermeable covered receptacle, and removed from the bakehouse at not longer intervals than every seven days. 104 2. All the inside walls of the rooms of the bakehouse, and all the ceilings or tops of such rooms, and all the passages and staircases of the bakehouse, shall either be painted with oil, or varnished, or lime-washed. Where painted with oil or varnished, there shall be three coats of paint or varnish, and the paint or varnish shall be renewed once at least in every seven years, and shall be washed, with hot water and soap, once at least in every six months. Where lime-washed the lime-washing shall be renewed once at least in every six months. The cleansing should be done in the months of April and October. 3. The troughs and all the utensils used in the making of bread and pastryshall be kept scrupulously clean. 4. A place on the same level with the bakehouse, and forming part of the same building, shall not be used as a sleeping place. (a) Unless it is effectually separated from the bakehouse by a partition extending from the floor to the ceiling. (b) Unless there be an external glazed window of at least 9 superficial feet of area, of which at the least 4½ superficial feet are made to open for ventilation. 5. No water-closet, earth-closet, privy, or ash-pit shall be within, or communicate directly with, the bakehouse. 6. Any cistern for supplying water to the bakehouse shall be separate and distinct from any cistern for supplying water to a water-closet. 7. No drain or pipe for carrying off faecal or sewage matter shall have an opening within the bakehouse, and every sink-waste, or other pipe used for carrying off surface water within the bakehouse, shall be efficiently trapped and disconnected from any drain. 8. Every Bakehouse shall be efficiently lighted, shall be ventilated so as to render harmless all gases and dust, and shall not be overcrowded while work is carried on therein. 9. Every Bakehouse shall be used for the purposes of the trade only. 10. No animal shall be kept in the bakehouse on any pretence whatever. 11. No person suffering, or who has recently suffered, from any infectious disease shall be permitted to enter the bakehouse, or take part in the manufacture or sale on the premises, of bread, biscuits or confectionery. 1'2. The owner or occupier of a bakehouse shall give immediate notice to the Medical Officer of Health of any case of infectious disease occurring on the same premises as the bakehouse. PENALTIES. Every bakehouse in which there is a contraventiou of Sections 3, 33, and 34 of the Factory and Workshop Act, 1878, which provide for the 105 sanitary condition and cleansing of the bakehouse, shall be deemed not to be kept in conformity with the Act, and the occupier thereof is liable for default to a fine not exceeding ten pounds. The use of a bakehouse for sleeping purposes, or of a room on the same level as the bakehouse, insufficiently separated from it and insufficiently ventilated and lighted, is punishable under the 35th Section of the same Act by a fine not exceeding Twenty Shillings for the first offence, and of a sum not exceeding Five Pounds for every subsequent offence. An infringement of the 15th Section of the Factory and Workshop Act, 1883, which prohibits— A direct communication between a water-closet, earth- closet, privy, or ash-pit, with the bakehouse; The supply of water to a bakehouse from a cistern also supplying a water-closet; The opening into a bakehouse of a drain currying off faecal or sewage matter; is punishable by a fine not exceeding Forty Shillings, and a further fine not exceeding Five Shillings for every day during which the infringement is continued after a conviction. It only remains to add, that the number of bakehouses in this parish is 146; 83 of these being in the district north of Uxbridge Road, and 63 in the remainder of the parish south of that road. REGULATIONS WITH REGARD TO HOUSES LET IN LODGINGS, &c. The Sanitary Act, 1866, Section 85, enables the Local Government Board, on the application of a Nuisance Authority, by Notice to be published in the London Gazette, to "declare the following Enactment to be in force in the district of such Nuisance Authority, and from and after the publication of such notice the Nuisance Authority shall be empowered to make Regulations for the following matters: that is to say:— 1.—For Fixing the Number of Persons who may occupy a House, or Part of a House, which is Let in Lodgings, or occupied by Members of more than One Family. 2.—For the Registration of Houses thus let or occupied in Lodgings. 3.—For the Inspection of such Houses, and the keeping of the same in a cleanly and wholesome state. H 106 4.—For enforcing therein the provision of Privy Accommodation and other appliances and means of cleanliness, in proportion to the number of Lodgings and Occupiers, and the cleansing and ventilation of the Common Passages and Staircases. 5.—For the cleansing and lime-whiting at stated times of such premises." The Sanitary Law Amendment Act, 1874, Section 47, enables regulations made under the 35th Section of The Sanitary Act, 1866, to extend to "Ventilation of rooms, Paving and drainage of premises, The separation of the sexes, and to Notices to be given, and precautions to be taken in case of any dangerously infectious or contagious disease, under the powers of this Act, or of the principal Act, or of the Acts therein mentioned." The Nuisance Authority may provide for the enforcement of the regulation by penalties, but regulations are not of any validity unless and until they shall have been confirmed by the Local Government Board. At the meeting held November 21st, your Vestry resolved unanimously, "with reference to the large and increasing number of houses which are let in lodgings, or occupied by members of more than one family, and to the necessity in the interest of public health of sanitary supervision of such houses," to take steps for carrying out the provisions of the above sections of the Sanitary Acts. The subject had been under consideration in 1878, when the Sanitary Department was reorganized and the staff enlarged, and in an exhaustive report on the work of the Department, the Special Purposes Committee recommended (inter alia) that the provisions of the Acts be put in force by the making and carrying out of Regulations, &c. No action was taken upon this part of the Committee's report at the time; but in the following January (1879) your Vestry referred it again to the Committee, to consider the steps necessary to be taken for carrying out the above recommendation. The Committee resolved, in April, to defer the further consideration of the subject, pending an inquiry 107 they requested me to make with regard to towns and places where the powers of the Acts had been exercised. Meanwhile I had brought the subject under the notice of the Society of Medical Officers of Health, and the Society, after full deliberation, had resolved "(1) That the Acts (viz., Sanitary Act, 1866, section 35, and the Sanitary Law Amendment Act, 1874, section 47) are practicable; (2) That it is desirable they should be put into operation in London and other large towns; (3) That it is desirable to have a uniform code of regulations for the Metropolis, and (4) That it is advisable the Society should undertake the framing of such a code." The Council of the Society, to which the matter was referred, requested me to draft a code. and the draft so prepared having been approved by the Council, and subsequently by the Society, it was sent to nearly two hundred medical officers of health in different parts of England, and suggestions by way of amendment were invited. All such suggestions having been duly considered, the Council finally submitted the draft, as amended, to the Society, by which it was approved, and in May, 1879, the regulations were published "for the guidance of Urban Sanitary Authorities." I brought these proposed regulations under the notice of the Special Purposes Committee, and on the 17th June, 1879, they reported, recommending that "the regulations proposed by the Society of Medical Officers of Health" be adopted and forwarded to the Local Government Board for sanction. This report was referred back by your Vestry. As I have already stated, I had been requested in April, 1879, to ascertain to what extent the Acts had been adopted in other Metropolitan parishes, and throughout the country generally, and the result of my enquiries having been to show that the Acts had been adopted in very few places only, whether Metropolitan or Provincial, and that in the majority of such places the provisions had been carried out in a somewhat perfunctory manner, the Committee finally advised your Vestry H2 108 (in July), that it was not expedient to adopt the Acts at that time. The Committee were influenced to some extent, in coming to this decision, by a statement that the Board had under consideration the desirability of framing model bye-laws for the guidance of sanitary authorities, the issue of which it was thought desirable to await. Model regulations for "Houses let in Lodgings" were issued by the Board in the following year (1880), framed with regard to Section 90 of the Public Health Act, 1875, (38 and 39 Vict., c. 55). The provisions of that section are practically identical with those of sec. 35 of the Sanitary Act, 1866, and sec. 47 of the Sanitary Law Amendment Act, 1874, which were incorporated in the general Act of 1875, from the operation of which the Metropolis is expressly excluded. But the regulations were not quite suitable for the circumstances of the Metropolis, and your Vestry took no further action in the matter at that time. At the close of the year 1883, the Local Government Board, by notice published in the London Gazette, declared the provisions of the Acts to be in force in all parts of the Metropolis, and they issued model Regulations, 39 in number, for the guidance of the Vestries and District Boards, which had not already made regulations. Your Vestry referred the Board's communication and the model regulations to the Works, Sanitary, and General Purposes Committee, and the Committee having prepared a code of regulations which was adopted by your Vestry, it was forwarded to the Board for their sanction. At the present writing, (July), the sanction of the Board has not been accorded to the proposed regulations which are as follows:— regulations. for houses or parts of houses, which are let in lodgings, or occupied by members of more than one family. Made by the Vestry under, and in pursuance of. The Sanitary Act, 1866, and The Sanitary Law Amendment Act, 1874, at a meeting held on 109 the 13th day of February, 1884; and confirmed according to Law by the Local Government Board on the -day of-, 1884. INTERPRETATION OF TERMS. In these Regulations the following words and expressions shall have the meanings hereinafter respectively assigned to them, unless the context otherwise requires : that is to say, "Registered House."—A house, and all the premises appurtenant to such house, registered under section 35 of The Sanitary Act, 1866. "Owner."- Any person receiving the rent of a registered house from the keeper or any lodger on his own account, or as trustee or agent for any other person, or as receiver or sequestrator appointed by the High Court of Justice, or under any order of the Court, or who would receive the same if the property were let to a tenant or tenants. "Keeper."—The registered occupier of a registered house, or the person liable to pay the rent of the owner; or the rent receiver or his appointed agent, when the whole house is let in tenements. “Lodger."—A person to whom any room or rooms in a registered house may have been let as a lodging or for his use or occupation. "Vestry."—The Vestry of the Parish of St. Mary Abbotts, Kensington, being the "Nuisance Authority " under The Sanitary Act, 1866. "Inspector."—Any person specially appointed by the Vestry. "Office." (of the Vestry, of the Medical Officer of Health, and of the Inspector).—The Town Hall, Kensington High Street, W., where all notices required to be given to the Vestry, or to the Medical Officer, or to the Inspector by the owner or keeper of, or any lodger in, a registered house, must be addressed. REGISTRATION. 1. A house or part of a house let in lodgings or occupied by members of more than one family may be registered by the order of the Vestry at its discretion, and any house so registered—hereinafter referred to as a "registered house" — shall continue to be registered until otherwise ordered by the Vestry notwithstanding any change in the ownership or tenancy thereof, if the house continue to be let in lodgings. Notice of such registration shall be given to the owner of the registered house, together with a copy of these regulations. Notice shall also be given to the keeper, together with two copies of these regulations, one of which copies shall by him be affixed, and kept affixed, to some conspicuous part of the house where it may be seen by every lodger. One month after such notice of registration these regulations shall come into force. 110 NUMBER OF LODGERS. 2. The minimum space for each adult in any room in a registered house occupied only as a sitting room, or occupied only as a bed room, shall not be less than 300 cubic feet; and in any room occupied as a bed room only not less than 400 cubic feet. In fixing the number of persons that may lawfully occupy any room two children under the age of 12 years may be counted as one adult. The number of persons who may lawfully occupy the several rooms in a registered house shall be specified on a card, which shall be a copy of the register, and shall be given to the keeper, and by him shall be shown to every lodger. The card shall be preserved in a legible condition, and it shall be produced to the Inspector on application. SEPARATION OF THE SEXES. 3. The keeper of a registered house, and any lodger therein, shall not suffer more than two persons of opposite sexes, if above the age of 12 years, to occupy the same sleeping room. DRAINAGE. 4. The owner of a registered house shall keep all drains and drainage apparatus in proper working order and good sanitary condition, so as to preserve the house in a wholesome state, to the satisfaction of the Vestry. PRIVY ACCOMMODATION. 6. The owner of a registered house shall provide and maintain privy accommodation in the proportion of one properly constructed water-closet for every twelve adults* lawfully occupying the house. Every watercloset shall be provided with a properly fitting door, and all requisite fastenings, and with all requisite water supply apparatus, and with a sufficient supply of water so as effectually to cleanse the same, either from a service or flushing box, or from a cistern independent of the cistern provided for the general water supply of the house, and with adequate means of ventilation into the outer air. The soil-pipe shall be of impervious material and made air-tight at the joints and shall be ventilated to the satisfaction of the Vestry. The keeper of a registered house shall cause every water-closet to be ventilated and kept in a cleanly and wholesome condition. WATER SUPPLY. 6. Unless the registered house has a constant supply of water, the owner shall cause it to be provided with a cistern, or cisterns, of a capacity adequate for the supply of not less than 12 gallons of water daily for every adult* lawfully occupying the house, and shall maintain and keep *Two children under 12 years of age may be counted as one adult. 1ll the same in proper repair: every cistern shall be properly placed above ground, constructed of impervious material, covered with a properlyfitting lid, and provided with an overflow or warning pipe, which shall not be connected with any soil-pipe, house drain, or common sewer. The keeper of the registered house shall cause every cistern to be kept covered, and to be cleansed at least once every two months, and shall exercise due care to preserve the water from contamination. ASH-PIT. 7. The owner of a registered house shall cause it to be provided with a properly constructed ash-pit, properly covered, and fitted with a slide or doors, and placed in the best practicable position to the satisfaction of the Vestry, so as not to be a nuisance or foul the drinking water, and shall maintain and keep the same in proper repair: the ash-pit shall be of sufficient size to contain the ashes, and refuse of the house accumulated within the space of one week. The keeper of a registered house shall cause the ash-pit to be kept in a cleanly and wholesome condition and covered, and the doors thereof to be kept closed. The ash-pit shall be emptied at least once in every week and no filth or wet refuse shall be thrown therein. The keeper shall allow the contents of the ash-pit to be removed on application by any properly-appointed dustman.* CLEANLINESS. 8. The owner of a registered house shall cause the walls and ceilings of every room and of the staircases, passages, water-closets and out-houses thereof, to be thoroughly stopped, cleansed, and, where not papered, well and sufficiently whitewashed or coloured, when necessary or when required by the Vestry. He shall strip papered walls of any room after the occurrence therein of any dangerously infectious or contagious disease or when required by the Vestry. The keeper of a registered house shall cause the passages and staircases thereof, and the floor of every room and the walls, woodwork, and windows thereof, to be cleansed when necessary, so that the same may be kept at all times in a cleanly and wholesome condition. VENTILATION. 9. The owner of a registered house shall provide all requisite means for the ventilation of the rooms, passages, and staircases thereof, to the satisfaction of the Vestry. *Notice of omission by the dustman to empty the ash-pit on the appointedday of the week should be forwarded by the keeper of the registered house to the Inspector, at his office, without delay. Every keeper and lodger is advised and requested to burn all vegetable and other offensive refuse as far as practicable. 112 The keeper of a registered house shall cause every room therein, and the passages and staircases thereof, to be thoroughly ventilated daily to the satisfaction of the Inspector. WASH-HOUSE, CELLAR, YARD, AND AREA. 10. The owner of a registered house shall cause every wash-house, cellar, yard and area thereof to be properly paved and drained to the satisfaction of the Vestry, and shall lime-whiten the walls of the wash-house, cellar, yard and area, when necessary, or when and as required by the Inspector. The keeper of a registered house shall cause every wash-house, cellar, yard and area to be properly swept and thoroughly cleansed when necessary, or when required by the Inspector, and shall not allow any accumulation of rags, bones or other offensive refuse, or the accumulation of any matter or thing so as to interfere with the good Sanitary condition of the premises, or with the proper lighting and ventilation of the house. DUTIES OF LODGERS. 11. Every lodger in a registered house shall comply with the regulations numbered 2, 3, 8, and 9, so far as they relate to cubic space, to separation of the sexes, and to cleansing and ventilation of rooms under his control: and every lodger having the exclusive use of a water-closet, a water cistern, an ash-pit, a wash-house, a cellar, a yard or an area, shall comply with the regulations numbered 5, 6, 7 and 10 so far as they relate to the keeping clean and wholesome of such water closet, water cistern, ash-pit, wash-house, cellar, yard or area. INFECTIOUS DISEASES. 12. The keeper of a registered house shall give immediate notice in writing to the Medical Officer of Health, or to the Inspector, and verbal notice to every lodger, when anyone therein is ill or dead of small-pox, typhus, typhoid fever, scarlet fever, diphtheria, cholera, or any other dangerously infectious or contagious disease, and he shall carry out without delay all measures for disinfection which the Medical Officer or the Inspector may direct. Every lodger in a registered house shall give immediate notice in writing to the keeper and to the Medieal Officer of Health, or to the Inspector when anyone is ill or dead of small-pox, typhus, typhoid fever, scarlet fever, diphtheria, cholera, or any other dangerously infectious or contagious disease in any room occupied by him, and he shall carry out without delay all measures for disinfection which the Medical Officer or the Inspector may direct. 113 animals. 13. The keeper of a registered house, or any lodger therein, shall not suffer any animal to be kept in any part thereof, under his control, so as to render the house unclean or unwholesome, or so as to be a nuisance or injurious to health, and the keeper and every lodger shall remove any animal improperly kept forthwith, on receiving a notice to that effect from the Inspector. INSPECTOR.—POWER OF ENTRY. 14. The keeper of, and every lodger in, a registered house shall give to the Vestry and to the Inspector all such information and assistance as may be required for the registration of the house, and for the purpose of carrying out these regulations, and shall allow such house and every part thereof to be inspected by the Inspector, on his application, at any hour; and any owner, keeper, lodger, or other person refusing to admit him, or obstructing him in the execution of his duty, shall be deemed to be guilty of an offence against this regulation. PENALTIES. 15. Every person who offends against any of the foregoing regulations shall be liable, on conviction before a Court of Summary Jurisdiction, to a penalty not exceeding forty shillings, together with the costs of proceedings, for any one offence, with an additional penalty not exceeding forty shillings, for every day during which a default in obeying such regulations may continue. REFUSE. Great difficulty is 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 was appointed to consider the subject. The report of the Committee was printed in my Annual Report for 1880 (page 114). The conclusions at which they arrived may be summed up as follows:— 1. Trade Refuse.— The Nuisance Authority should have power to collect, remove, and dispose of the trade refuse of butchers, fishmongers, poulterers, greengrocers, etc., at the reasonable cost of the producers. 114 The collection of such refuse should be made in the early morning, and the removal effected in specially constructed vehicles: if practicable the refuse should be utilized; otherwise it should be destroyed by fire. 2. House Refuse.—In view of the increasing distance to brickfields, house refuse will have to be dealt with by fire in specially constructed apparatus of the "Destructor" type, by which its bulk may be reduced some 75 per cent., the resulting product moreover, being at once innocuous, and useful for road making and other purposes : the refuse should be collected daily, and "dust-bins" abolished. 3. Stable and Cowshed Refuse.—The Nuisance Authority should have power to collect the refuse at the reasonable cost of the owner: cowshed refuse daily, in vehicles designed to prevent slopping and effluvium nuisance: stable refuse periodically, the refuse, meanwhile, to be stored in suitable receptacles—paved, drained, and enclosed within iron racks, above ground. 4. Conclusion.—Legislation is necessary to give effect to the above recommendations, and to compel railway and canal companies to carry refuse from towns at a reasonable, while remunerative, rate. HOUSE REFUSE. The collection of ashes, and miscellaneous refuse, from upwards of 20,000 houses, over an area of 2,200 acres, and to the extent of 34,000 loads in a single year, is no light task, and complaints of neglect by the dustmen were habitual when the work was carried out under the contract system. So frequent, indeed, did complaints become at last, that your Vestry, desirous of satisfying the legitimate requirements of the parishioners, determined, in 1877, to abolish the contract system altogether, and to undertake dust-collection with an ample staff and plant. The results have justified the change: the work has ever since been done in an increasingly satisfactory manner; complaints are rare, and applications, even, for the removal of ashes, are now comparatively few. Sometimes, moreover, when your Vestry, or the dustmen have been censured for supposed neglect, it has turned out on enquiry that domestic servants were to blame; such excuses as that the hour of the dustman's call was "inconvenient"; or that "the steps had just been cleaned"; being deemed sufficient for the perpetuation of a nuisance. 115 And nuisance, it may be averred, arises almost solely from the improper use of the receptacle by the deposit therein of animal and vegetable refuse, of which it maybe 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 again in 1883. A strong effort has been made to systematise the work of dust-collection by dividing the parish into districts, and by providing for the inspection of the dust-bins, and for supervision of the "dusting-gangs." A systematic call is now made at every house once a week, and further improvement is scarcely possible until the whole abominable system of dust-harbourage shall have given place to the only rational practice of daily collection from moveable receptacles deposited in the early morning on the footway, ready for the call of the dust cart. Delay in the removal of ashes, at present, arises not unfrequently from the exceedingly inconvenient position of the receptacle, e.g., in a deep area, to which there is practically no access save by ladders—a short one on the foot pavement, and a longer one in the area. Apart from the question of danger to the dustmen in the use of the ladders, it is a question whether your Vestry should not insist on some more satisfactory provision being made, as by steps and an area gate, giving safe and convenient access to the receptacle ? In some cases where there are steps, householders actually refuse to allow the gate to be unlocked, thus wilfully endangering the safety of the unfortunate dustmen. STABLE REFUSE. For several years I have felt it my duty to draw your Vestry's attention to the removal, or rather to the nonremoval, 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, 116 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 not with uniform success, the offenders having usually been able to satisfy the Magistrates of their inability to perform the duty required of them. 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 cleared, farmers being too busy to send their carts into town, or, when they do, to allow them to stay to collect the refuse. The refuse, nevertheless, has value, if it could only be got on to the land without undue cost. The quantity made in this large parish, with its 150 mews, is very great, and of an aggregate value probably more than sufficient to pay for collection and removal from London. It is a question, whether your 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 all cases, were it understood that the "Regulations" would be enforced. 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. PUBLIC URINALS. There are only ten public urinals in this great Parish, a very inadequate number, and no public water closets save at the rear of the Vestry Hall. Your Vestry's powers to provide such "necessary accommodation" are ample, but difficulty has been experienced in giving effect to the provisions of the 117 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," Owing to the opposition raised by inhabitants in the neighbourhood of the sites selected for such proposed erections, 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 have been erected: there is one at Shepherd's Bush Green. Should the system be found to work satisfactorily,means will doubtless be found to overcome any legal difficulties that may appear to stand in the way of its extension. PUBLIC BATHS AND WASHHOUSES. The Commissioners have recently obtained an Act enabling them to purchase the site at Notting Hill, to which I referred in my last report as being suitable for the purpose. It is to be hoped, therefore, that we shall see next year the realization of our long delayed hopes for the provision of Baths and Wash-houses. I am of opinion that great good might be effected by the provision of a number of buildings, on a modest scale, in different parts of the parish, to which the poor might resort for the purpose of washing clothing, and that the question of public wash-houses might with advantage be separated from that of public baths. MORTUARY. The Mortuary in the Parish Churchyard, at the rear of the Vestry Hall, was opened in July, and in the first year nearly fifty bodies were deposited. The Mortuary 118 comprises two chambers, one for infectious, and the other for non-infectious, bodies, separated by a "place provided for post-mortem examinations." This "place" is designed "for the reception of dead bodies for and during the time required to conduct any post-mortem examination ordered by the Coroner," who "may order the removal of the body for carrying out such post-mortem examination, and the re-removal of such body, such costs of removal and re-removal to be paid in the same manner, and out of the same fund as the costs and fees for post-mortem examinations when ordered by the Coroner." (Sanitary Act, 1866, sec. 28.) The Coroner has ordered the removal of several bodies, and now appears desirous of availing himself of the Mortuary, which is highly convenient for himself and for Medical witnesses who have to make postmortem examinations. In congratulating your Vestry upon the completion of the handsome and appropriate building now dedicated to public use, I may, perhaps, be allowed to recall the fact that in my first annual report, for the year 1871, I drew attention to the need of a mortuary. Shortly afterwards a Special Committee was appointed to consider how this want might be supplied. The Committee devoted much time to the subject, but were ultimately obliged to report that they could not obtain a site. In my annual report for 1873 I first referred to the Parish Churchyard as a suitable site, but the suggestion was not approved by the then senior Churchwarden. Gradually, however, the idea of placing the Mortuary in this position grew into favour, and was ultimately accepted as the solution of the site-difficulty. A question has been raised, whether one Mortuary is ufficient ? Without committing myself to a final answer to this question I would point out that the Mortuary site is central, and at no very great distance from any part of the parish. It is the fact, moreover, that, once a body has to be removed, the cost is much, if not quite, the same, whether 119 the distance be a hundred yards or a couple of miles. I could not recommend your Vestry, therefore, to entertain the question of a second mortuary until the present building has been proved to be of insufficient capacity, or inconvenient in position. It is a real difficulty to get people to avail themselves of the accommodation furnished by a mortuary; this difficulty, however, I have always felt would be, to a certain degree, overcome by the sacred associations connected with the site on which the Mortuary is placed. I trust the building will be used more and more every year, and that it will prove a benefit to our poorer parishioners, who are now often condemned, in following an unwise custom, to retain their dead for many days in rooms occupied by the living. Few, absolutely, as were the bodies admitted during the first year many of the cases were of a nature to prove the necessity, and to justify the provision, of the mortuary. In course of time the advantages of the institution must come to be more and more appreciated and larger use of it will then be made. If only medical men and clergymen would inculcate the propriety of removal of the dead to the mortuary in suitable cases, there would be no cause of complaint on the score of its disuse. Much might be done if medical men would give the certificate necessary in respect of infectious bodies, and bodies in an offensive condition from decomposition, so as to enable a Justice to order the removal of such bodies to the mortuary, under Section 27 of the Sanitary Act, 1866. Medical men highly appreciate the facilities offered by the mortuary when they have to make post-mortem examinations; and well they may, the inconvenience of making such examinations in private houses being well known, and the objections to the practice in the homes of the poor very serious. Mortuary Keeper's Residence:—Some inconvenience has resulted from the difficulty, hitherto insuperable, of finding lodgings for the Mortuary Keeper within a reasonable 120 distance of the Mortuary. With a view to enable him to be always at hand when wanted, the Works, Sanitary, and General Purposes Committee negotiated a preliminary agreement with the Churchwardens, for obtaining a site on the Churchyard adjoining the Mortuary, whereon to erect a lodge for the keeper. A faculty would have been necessary to give effect to this agreement, and this the Churchwardens were willing to apply for. Nothing, unfortunately, came of the matter, your Vestry having declined to accede to the terms of the Churchwardens which involved a payment of money by way of compensation for the land. The money was to have been expended in placing the Churchyard in proper order. It is to be desired that an arrangment should yet be made with the Churchwardens, to secure the site if the matter is still open to negotiation. The Churchyard, however, has been put in order by a charge upon the Poor rate, which the parishioners pay, and it is probable that the rate will be further charged with the cost of keeping it in decent condition. Nothing, therefore, has been saved, but much has been lost, in point of public convenience, by the failure of the negotiations with the Churchwardens. These gentlemen approached the consideration of the subject in so friendly a spirit that I would fain hope they will still be found willing to co-operate with your Vestry for the public advantage in this matter, especially as the improvement they were so desirous of effecting has been brought about at the public cost, although not out of the rates controlled by your Vestry. CORONER'S COURT. It is now very generally the practice to provide in connection with a mortuary, a building in which the Coroner can hold his Court, thus rendering it unnecessary for the holder of that ancient and dignified office, to have to resort to a public house for the needful accommodation. But this step seemed unnecessary in Kensington, as there are rooms 121 at the Vestry Hall, to which the mortuary is adjacent, convenient and suitable for the purpose. Accordingly, the Works, Sanitary, and General Purposes Committee authorized me to communicate with the Churchwardens, who, as trustees of the Vestry Hall, kindly consented to place a room at the disposal of the Coroner whenever required, on due notice being given, and subject to the payment which the Coroner is authorized to make, and does make, for such accommodation provided elsewhere for the same purpose. About 150 inquests are held annually in the Parish, and the majority of them, probably, could be held at the Vestry Hall, were it the pleasure of the Coroner, in whose power it is, as already mentioned, to order bodies to be removed to the "place provided for post.mortem examinations," when such examination is necessary. In such cases—about two. thirds of the whole number—it would seem a natural thing, for a judge, for such the Coroner is, to hold his Court in a public building ; but, for whatever reason, the Coroner continues to hold inquests at public houses. On more than one occasion juries have recently complained of being taken to public houses in the discharge of their duties, and have expressed a desire that the Coroner would hold his court at the Vestry Hall. Jurymen have also complained that, because they live in the vicinity of the mortuary, they have been summoned to serve on inquests held on bodies removed from a distance to the mortuary. The Coroner stated that a jury should, for obvious reasons, be summoned from the locality where the death took place, and this no doubt is a right view of the matter. The objection was anticipated, and it is one that could be easily overcome by the Coroner's officer, viz.:—by his making a judicious selection of jurymen from different parts of the parish, and so arranging his list as not to have to call with undue frequency upon any person to serve on a jury. I 122 DISINFECTION. During the year ended March 25th, 1884, a large number of infected articles of clothing, bedding, furniture, &c., were satisfactorily disinfected by the contractor at the cost of your Vestry, the owners being too poor to bear the expense. The weight of the articles was more than 9 tons : their number 4,015 ; and the cost of the process £181. Two hundred and sixty rooms in 215 houses were disinfected with sulphurous acid by your Vestry's officer, no charge being made in the majority of instances. Many rooms were disinfected by the contractor, aswell as numerous parcels of clothing, bedding, &c., at the cost of persons able to pay. WATER SUPPLY. Professor Frankland's Report.—Believing it desirable that your Vestry, as the body responsible in this great parish for carrying into effect the provisions of sanitary legislation, should receive the best information on all points connected with the water supply, a subject of great importance in relation to the public health, it has been my custom, year by year, to summarise the reports prepared annually by Professor Frankland, for the Registrar.General, and by Colonel Sir Francis Bolton, R.E., the " Water Examiner," appointed under the Metropolis Water Act, 1871. I do so again. Dr. Frankland deals mainly with the quality of the water in its chemical and microscopical aspects, and in respect to its fitness for dietetic and domestic purposes ; he being, as is well known, adverse to riparian sources of supply: while Sir Francis 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 the consumer—in a word, to whatever relates to the collection, filtration, storage, and distribution of the water. London is mainly supplied from the rivers Thames and Lea, 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 123 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 in 1883 was 28.4 gallons. Dr. Frankland is consistent in his preference of "deep well water," taking it as the standard of purity in comparative observations on the waters generally. In a previous report he described 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," he said, 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." He considered that it would be a valuable boon to London 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 "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 19.9 ; of the Kent Company's water 28.0 ; and of the Colne Valley Company's water only 7.1 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, about eighty times as much, (for soap), as it costs when conducted on a large scale by a water company. The only water suitable for washing delivered in London during the past year was that of the Colne Valley Company, which was rendered soft by Clark's process before distribution. All waters, save artificially prepared distilled water, contain more or less " solid matter." A large proportion of this solid matter, consists of mineral salts which are unobjectionable in drinking water, but they render thewaterhard. A small proportion of the solid matter on theotherhand is organic. Small quantities of vegetable organic matter are not objectionable in drinking water, but the organic matter in river water, which receives sewage, may at any time become dangerous to health. The task of banishing sewage pollution from the river, is regarded as hopeless. The deep.well waters delivered by the Kent Company and by the Tottenham Board of Health, contained the largest proportions of solid matter ; but the deep well.water, derived from the same source, and supplied by the Colne Valley Company, contained little more than one.third the quantity found in the river waters, and little more than one.fourth of that in the I 2 124 Kent Company's water ; this comparative freedom from saline matters being attained by adding a small quantity of slaked lime to the water before it leaves the Company's works. All the water supplied to the Metropolis would be improved by being submitted to the same (Clark's) process. The organic impurities found in the river waters, derive their importance, as already intimated, from being chiefly of animal origin. Last year the amount of organic matter was exceptionally small. Owing to the careful filtration to which the river water is now subjected, together with the improved means of storage at the command of the Companies, it being no longer necessary to impound the worst flood waters, and to the action of the conservators, the average quality of the water supplied has become better year by year, and more uniform throughout the year. The river Lea water was better last year than that drawn from the Thames. Of Thames derived waters, the Chelsea Company supplied the best, the West Middlesex Company the worst, a strange reversal of former experiences. Deep.well waters undergo such a prolonged, exhaustive, and inimitable natural filtration through great thicknesses of porous strata, as to render it extremely unlikely that any suspended organic matter known to be prejudicial to health, should have escaped removal. Hence these waters are "uniformly pure and wholesome." The following table exhibits the proportional amounts of organic elements, (organic carbon and organic nitrogen), in the waters of the Companies which supplv Kensington, the Kent Company's water being used as The standard of purity for comparison :— Name of Company. Maximum. Minimum. Average. Kent 1.5 0.9 11 Chelsea 4.7 2.0 3.1 Grand Junction 5.3 2.4 3.4 West Middlesex 5.7 2.0 3.7 Dr. Frankland states that the water drawn from the Thames was of better average quality than in any previous year, excepting 1870, since his analyses were first made in 1875. But he adds that with the proportion of organic matter at its minimum, there is no certainty that the water does not contain the germs of zymotic disease, there being no guarantee against such morbific matters gaining access to the river, and there being nothing in the subsequent treatment to which the river water is subjected by the Companies that will ensure the removal of matters of this description. He is informed that, on this account, several of the Companies themselves are now impressed with the necessity of ultimately abandoning the rivers Thames and Lea as sources of water supply, and some of them have already completed works for utilizing subterranean waters which have undergone natural filtration through great thicknesses of gravel and 125 sand, whilst others are sinking deep.wells in the chalk. Unfortunately the protection which is provided by the common law to rivers is at present denied to subterranean waters, which may be polluted to any extent without remedy. Such sources of pure water should be carefully protected by law. 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 340.0 Fahr., viz., from 370.6 in March to 710.6 in July. The deep.well water sent out by the Kent Company varied in temperature from 380.l in March to 590.9 in June (range 210.8). The deep.well waters remain of an agreeable coolness in summer when the river waters become warm and unpalatable. 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, and a great improvement over former years, the examinations being made monthly :— Number of Occasions. Name of Company When clear and transparent. When slightly turbid. When turbid. When very turbid. Chelsea 11 1 0 0 West Middlesex 11 1 0 0 Grand Junction 9 3 0 0 The deep.well waters were clear and transparent on every occasion save one. When examined under the microscope the sediment deposited by turbid water, on standing, is generally found to contain living and moving organisms. The occurrence of such organisms is now much rarer than formerly. The annexed table shows the results of such microscopic examinations during the past fourteen years:— Name of Company Number of occasions when living organisms were found. 1869 1870 1871 1872 1873 1874 1875 1876 1877 1878 1879 1880 1881 1882 1883 Chelsea 3 2 2 3 2 5 4 4 1 0 2 0 0 0 1 West Middlesex 0 0 0 0 0 0 0 0 0 1 2 0 0 0 0 Grand Junction 4 1 1 2 3 6 7 3 3 3 1 3 3 0 1 The subjoined table shows the annual averages of each determination, and thus summarises the average results of the analysis of the waters supplied by the local Companies during the year; the Kent Company's water being taken as a standard for comparison. The numbers in this table relate to 100,000 parts of the waters, but may be converted into grains per imperial gallon by multiplying them by 7 and then moving the decimal point one place to the left. 126 Name of Company. Temperature in Centigrade Degrees. Total Solid Matters. Organic Carbon. Organic Nitrogen. Ammonia. Nitrogen as Nitrates and Nitrites. Total combined Nitrogen. Chlorine. Total Hardness. Proportional amount of organic Elements, that in the Kent Company's Water during the 9 years ending Dec., 1876, being taken as 1.. 11.9 27.12 .156 .030 .ooo 193 .223 1.5 19.1 3.1 West Middlesex 12.7 27.76 .184 .033 .ooo .206 .238 1.5 19.7 3.7 Grand Junction 12.2 28.07 .164 .034 .ooo .199 .233 1.5 19.9 3.4 12.1 41.71 .050 .015 .ooo 470 .484 2.6 28.0 11 The Water Examiner's Report.—I turn now to the Annual Report of Colonel Sir Francis Bolton, R.E., which contains much information of general interest relating to the water supply. Sir Francis Bolton, it should be mentioned, makes monthly inspections of the Metropolitan waterworks, filter beds, reservoirs, &c.: he examines the quality of the water, both at the intakes and after filtration at the works, and he reports monthly the results of such inspections and gives all other necessary information and particulars respecting each of the water companies. One of the most important of his duties is to ascertain whether or not the requirements of Section 4 of the Act of 1852 are complied wiih, viz., that " every Company shall effectually filter all water supplied by them within the metropolis before the same shall pass into the pipes for distribution." The effectual filtration of river water depends, he says, upon— 1. A sufficient area of properly constructed filter beds, constantly clean, and fresh sanded from time to time as the original thickness is reduced. 2. The rate of filtration being controlled and limited to a certain speed. 3. The water delivered into the filter beds having been previously stored in subsiding reservoirs, and the capacity of these reservoirs being such as to avoid the necessity for the intake of turbid and muddy water during the time of extraordinary and heavy floods, which tend to foul and choke the filters. The rate of filtration should not exceed 540 gallons per square yard of filter bed each 24 hours, or 2£ gallons per 127 square foot per hour, which, for all practical purposes, may be considered as a standard. The average rate of filtration per square foot of filtering area per hour of the local companies is West Middlesex, li, Grand Junction and Chelsea, If: the requirements of the Act in this respect, therefore, are fully carried out. The filter beds are formed as follows:— West Middlesex. Harwich sand, 2ft. 3in.; Barnes sand 1ft. ; gravel screened to different sizes, and arranged in layers 2ft. 3in. Total thickness 5Jft. Grand Junction. Harwich sand, 2ft. 6in.; Hoggin, 6in. ; fine gravel, 9in. coarse gravel, 9in.; boulders, 1ft. Total thickness, 5Jft. Chelsea. Thames sand, 3ft. 3in. ; shells, See., 3in. ; gravel, 4ft. 6in. Total thickness, 8ft. It avails little, however, that the water is well filtered if it is allowed, as it so frequently happens, to deteriorate in the cisterns of the consumers through the uncleanly condition of those receptacles, and the connection of them with the drains through the medium of "waste.pipes," which the Companies only have the power to abolish under the provisions of the fourteenth water regulation.. The remedy no doubt is a " constant supply;" but as we shall have to wait for this, I would again urge that the Companies should be compelled to exercise their powers, or that the Vestries and District Boards should have co.ordinate authority with the Companies to enforce the regulations. Meanwhile, the attention of house.holders cannot be too frequently drawn to the necessity of such abolition of waste.pipes, and of periodical cleansing of the cisterns for storing potable water, which, moreover, should be properly covered to exclude light and dirt, and so situated that the water may be kept cool in summer without being in danger of freezing in winter. The stop valve should be fixed outside the premises to prevent . Vide, Regulation 14, page, 131. 128 damage to the house in case of pipes burst by frost or other causes. When constant supply is given a screw down draw. off tap should be affixed on to the rising main, or service pipe, so that drinking and cooking water may be drawn therefrom without the intervention of cisterns, which are required for washing, flushing, baths and similar purposes. The quantity of water supplied daily, 290, 195, and 298 gallons per house, by the Grand Junction, West Middlesex, and Chelsea Companies respectively, was super.abundant, and indicates great waste, amounting as it does, in the three districts respectively, to 32.22, 26.11, and 38.01 gallons per head of the population. The " intake " of the Chelsea Company is at West Molesey; of the others, at Hampton Court. The Grand Junction supply is supplemented from gravel beds at Hampton, the company having a complete system of underground collection of water on about 20 acres of land, and being able during times of flood to raise 12 million gallons of water per day that has passed through the natural beds of granite and sand which are characteristic of the neighbourhood. The state of the water in the Thames during the months of January, February, and parts of March, October, November, and December, was generally bad; and the water that had to be taken in by the Companies was much polluted, and very difficult to filter. The solid impurities in suspension, chiefly consisting of clay, marl, and chalk in a very finely divided state, can be got rid of only by long subsidence previous to filtration. The storage reservoirs appear to be adequate for the purpose. The following particulars, are derived from Sir Francis Bolton's report, in respect of the local Companies:— Storage and Filtration.—No new works have been found necessary by the Companies the existing means being sufficient to meet all requirements at all times of the year. Constant Supply.—I have no means of ascertaining to what extent the constant supply has been extended to houses in this parish ; but the follow ing facts relating to the subject in the districts of the Companies in which we are interested may be acceptable. The West Middlesex Company are 129 giving constant supply to all new estates and buildings, and where new services are laid down constant supply is made compulsory by the Company; 2,860 houses were put on constant supply during the year and in May 1884, the number of houses on constant supply was 15,702 out of a total of 63,370. The Grand Junction Company in May 1884 were giving constant supply to 30,612 houses, out of a total of 48,130: the increase during the year 1883 was 8,158, and the system has been extended to North Kensington and new estates at Notting Hill. The reservoirs at Kew Bridge and Camp. den Hill have been connected with the main of the East London Company in order to insure a supply of water from the works of that company at Sunbury, in case of accident or emergency. The Chelsea Company in May 1884, were giving constant supply to 3,807 houses (increase during the past year, 664), out of a total of 32,587, and are fully prepared to extend the system as required ; but judging from the few applications made for such supply, there appears to be no desire in the public authorities, or private individuals, in this, or either of the other districts, for the constant service: all new estates, and new lines of streets are being so supplied. By way of contrast, and to show how backward the Western Companies are in this matter of constant supply, as compared with the Companies in the East of London, where the Companies have taken the initiative, it may be mentioned that the East London Waterworks Company now give constant supply to 117,493, out of a total of 142,605 houses supplied by them, and containing an estimated population of 1,069,537 persons. Considerable advance was made during the past year in London as a whole in extending the constant supply; 237,826 of the total number of 664,440 houses supplied, being now on constant service. The number of miles of streets containing mains constantly charged, and on which hydrants for fire extinguishing purposes could at once be fixed, in the districts of the local Companies are, West Middlesex, 81 ; Grand Junction, 62; and Chelsea, 70. The Companies are ready to affix hydrants on the mains whenever required to do so. In the Metropolis there are now fixed 6,555 hydrants, the total length of mains being 916 miles : the increase, in mains, during 1882 being 87¼ miles, and in number of hydrants, 392. Deterioration of Water in Dirty Cisterns.—The Local Government Board sometime ago addressed a circular letter to Nuisance Authorities in the Metropolis, stating that the Water Examiner had drawn their attention to the serious deterioration which water frequently undergoes, after delivery, by being kept in impure cisterns, and enclosing an 130 extract from one of his reports of the examination of the water supplied by the Companies. Sir Francis Bolton's observations were directed (1) to the deterioration of the water by the dirty and uncovered condition of the cisterns ; (2) to the need for frequent cleansing of cisterns ; and (3) to the misplacing of the cistern, where there is but one, and that one situated over a water closet, and having communication with the drains by means of the waste pipe. The importance of the subject is undeniable; and your Vestry's Sanitary Inspectors have standing instructions to inspect the cisterns of every house visited, where practicable. It is the fact, however, that cisterns are often so placed as to be inaccessible to inspection or for cleansing : often there is but one cistern, and it is commonly placed immediately over a water.closet, as stated by Sir Francis Bolton. With respect to the improper placing of a cistern we have no power to interfere, but the Water Companies might, if so minded, do something to remedy the evil complained of, under the 13th Regulation, which provides that : " Every cistern . . . . shall be . . . properly covered and placed in such a position that it may be inspected and cleansed." I need hardly remind your Vestry that the subject of water supply has constantly engaged my attention ; or that the matters referred to in the Water Examiner's above mentioned report have always formed the subject of comment in my Annual Reports. I was glad therefore that the subject had attracted the attention of the Local Government Board, and I ventured to suggest the desirability of a reply being sent to the Board's communication, directed to calling their attention to the necessity of such an alteration in the law as would give Nuisance Authorities co.ordinate power with the companies to enforce the regulations, and so give effect to the views of the Water Examiner. This was done but without effect. Abolition of Waste.Pipes. — In the Memorandum by 131 the Medical Officer of the Local Government Board, on the subject of Precautions against Cholera, previously adverted to at page 45 it was advised that " any connexions of waste. pipes of cisterns with drains should be severed." As this advice was entirely in agreement with the views of your Vestry, advantage was taken of the opportunity it afforded to draw attention, once again, to the imperfections of the law and of the water regulations, which do not allow of Sanitary Authorities carrying out the recommendations of the Board's Medical Officer. Communications were forthwith addressed to the Board, to the Vestries and District Boards, and to the local Waterworks Companies. The Board was informed that your Vestry was sensible of the value of the advice given, and fully concurred with the Water Examiner, that if Regulation 14 were " carried out in its integrity," it would " prevent contamination of the water from the gases generated by sewage." Request, therefore, was made that the Board should take steps to secure the severance of all connexions of waste.pipes with drains by urging the Companies to put Regulation 14 into immediate and general operation by serving the required notice on consumers.. Should the Companies refuse or neglect, the Board was asked to consider as to the desirability of bringing in a Bill to confer on Sanitary Authorities power to enforce the regulation. The Sanitary Authorities were requested to support your Vestry's action in the matter by addressing a similar communication to the Board and by recommending the several Water Companies to put the regulation in force, and thereby bring about a much needed and important sanitary improvement. . Regulation 14. " No overflow or waste.pipe other than a ' warning.pipe ' shall be attached to any cistern supplied with water by the Company, and every such overflow or waste.pipe existing at the time when these Regulations come into operation shall be removed, or at the option of the consumer shall be converted into an efficient ' warning.pipe,' within two calendar months next after the Company shall have given to the occupier of, or left at the premises in which such cistern is situate a notice in writing requiring such alteration to be made. 132 The Water Companies were reminded that the most effectual plan for giving effect to the advice of the Board was by their serving notice on the consumers to cut.off waste. pipes in conformity with the provisions of Regulation 14; and, " having regard to the danger of a polluted water supply, especially at a time when the introduction of Cholera was possible, and to the probability that should Cholera spread in the Metropolis it will be,as on a former occasion, through the water supply, " the great importance of taking steps without loss of time to carry the said regulations into effect," was pressed upon the attention of the several Companies. I may here mention, by way of parenthesis, that I endeavoured, some years ago, to stimulate the local Companies to exercise their power to abolish waste.pipes. I was given to understand that the Chelsea Company— at the time they were short of water, prior to the construction of their new works at West Molesey— had taken steps to abolish waste.pipes, with a view to economise consumption, but I failed to get the West Middlesex and Grand Junction Companies to move in the matter. The views expressed by the Secretaries were to the effect that the Companies, being trading bodies, did not care to offend their customers: the regulation was intended to prevent waste of water, simply, and as they had plenty of water they didn't care about the waste. I failed also in the attempt to convince the Secretaries that the Commissioners, in framing regulation 14, must have had in view the removal of a dangerous nuisance. It may be added that under the regulations for the construction of drainage to new houses, which have been enforced for some time past in this parish, waste.pipes are not allowed to have direct communication with the drains. But to resume. The Local Government Board subsequently addressed a communication to the Water Companies on the subject, and these in turn prepared circular notices, (in varying terms), which were left at every house in the districts of the several 133 Companies, and in which attention was drawn to the excellent advice upon the subject of cleansing and covering of cisterns, and cutting.off waste.pipes, which from time to time, the Water Examiner embodies in his reports. In every circular the 14th Regulation was quoted in its entirety. It is impossible to say how much or how little good may have been effected as a result of the trouble the Companies took in the matter it; is impossible, moreover, not to regret that the Companies did not go one step further and issue the required "notice" upon every householder, to cut off all connexions of waste.pipes of cisterns with drains, as they had been urged to do, and thus effect an important sanitary reform. It is very much to their interest to do so, as I believe many of the complaints of bad water which arise from time to time are due to the dangerous connections of waste.pipes with drains, and that if these were abolished the Companies' water would be in greater repute. Waste pipes, we are told will be abolished when constant supply is given, but for this, large portions, in fact the bulk, of the parish will still have to wait a long time, as the Companies appear to be unwilling to move in the matter any faster than the necessities of the constant system require. Meanwhile, Sir Francis Bolton continues to reiterate monthly his sound advice to householders—and there is now some prospect of it reaching them, as it has been arranged that an abstract from his reports shall be printed on the back of the Companies' collectors rate.papers, and the collectors will be instructed by the Companies to " report immediately any bad cases they may discover, (but how should they discover any ?), in order that the assistance of the Sanitary Authorities may be drawn thereto." Sir Francis Bolton points out that if the conditions contained in the Regulations were observed by consumers and by local, {i.e. nuisance or sanitary), authorities, as well as by the Water Companies, many of the evils complained of would be prevented. Doubtless compliance with the 134 tion should be enforced on consumers, but I have not been able to ascertain that the Local Authority has the power which, by implication, Sir Francis Bolton appears to credit them with ; and as for the Companies, we are likely enough still to have occasion to complain, as in former years, that, as a rule, they do not, and will not, systematically enforce the regulations, excepting for their own trading purposes. Nothing short of an epidemic of cholera will suffice to bring about universal compliance with the advice of the Water Examiner, viz., by the exercise of the powers possessed by the Water Companies under Regulation 14. GAS. The subjoined tables, based on the quarterly reports of the Chief Gas Examiner, summarise the principal results (averages), of the daily testings, at the 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 maximum, minimum, and average illuminating power in standard sperm candles was as follows, (statutory standard, sixteen candles):— Maximum. Minimum. Average. Quarter ended March 31st 17.5 16.6 17.0 Quarter ended J une 30th. 17.7 16.5 17.1 Quarter ended September 30th 17.5 16.7 17.0 Quarter ended December 31st 17.6 I6'6 17.0 Averages, whole year 17.6 16.6 17.0 The minimum did not on any occasion fall below the Parliamentary Standard, and the average was considerably above the standard. 2. With respect to purity. Sulphuretted hydrogen was not present in the gas at any time, and the proportion of sulphur in any other form was always considerably below the limit fixed by the Acts of Parliament. 135 Grains of sulphur per 100 cubic feet of gas. Permitted maximum—17 grains in 100 cubic feet, between April and October, and 22 grains between October and April. Maximum. Minimum. Average. Quarter ended March 31st. 10.9 6.3 8.2 Quarter ended June 30th 9.7 6.2 8.1 Quarter ended September 30th 11.7 7.9 8.1 Quarter ended December 31st 10.0 6.0 6.4 Averages, whole year 10.6 6.4 7.9 Do. 1882 14.7 7.7 10.6 With regard to Ammonia, a valuable residual product of gas manufacture, the limit allowed by the Acts of Parliament, (4 grains in 100 cubic feet of gas), was not reached on any occasion. The Chief Gas Examiner is quite independent of the Company ; it is satisfactory, therefore, to note that his reports of the testings are so favorable. No complaint was received from any private consumer in respect of the illuminating power of the gas, and I understand that Mr. Philip Monson, your Vestry's Superintendent of Street Lighting, is satisfied with the quality of the gas as supplied to the public lamps. The burners now in use 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 gas was employed, consumed only 3 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. Great complaints, however, are made by private consumers, who allege, and justly, I believe, that however much the price of gas may go down, (the shareholders profits going up pari passu), the actual annual payment for gas increases. The reason, doubtless, is that proper apparatus for controlling the consumption of gas is not applied either at the meter or in connexion with the individual 136 burners. And as it is, unquestionably, to the pecuniary interest of the Company, to supply the gas at an excessive, rather than at a low or medium pressure, for then more gas passes through the meter and has to be paid for, as gas consumed, to say nothing of the cost of cleansing dirty ceilings, I would again beg to recommend that systematic records of pressure, at all hours of the day and night, and at several points of the Company's district within the parish, be obtained. It would be well, moreover, that Mr. Monson should prepare, and your Vestry circulate, directions to consumers, as to the best way of limiting the consumption of gas and of burning it to the greatest advantage. I might say a good deal on this subject but it is not in my department, and as in Mr. Monson your Vestry has an officer, both able and willing to advise consumers to their advantage, I venture to hope that his services may be enlisted in their behalf. Conclusion.—It now only remains for me to discharge the pleasing duty of thanking those who have contributed by their assistance to whatever success may have attended the work of my Department in the past year. Of the sympathetic co.operation of the Board of Guardians I have already spoken, and it would be impossible to overrate the importance of the assistance rendered by them, and their officers, in measures for preventing the spread of infectious diseases. The sub.district Registrars, Messrs. Barnes and Hume, and the Vaccination Officer, Mr. Shattock, have, as usual, very willingly complied with all my requests for information. The members of the Sanitary Staff have discharged their numerous duties with zeal, intelligence, and success. My thanks, are justly due to your Vestry for a continuance of the confidence and support which I have never failed to receive, and which have enabled me to carry out with 137 faction the duties appertaining to my office, and to superintend the working of a Department the importance of which is every year more fully recognised by the general public. I am, Gentlemen, Your obedient Servant, T. ORME DUDFIELD, M.D., Medical Officer of Health. Town Hall, Kensington, July, 1884. [appendix tables.] K APPENDIX. Note.— The forms for Tables I. — VI, were compiled by the Society of Medical Officers of Health with the object of securing uniformity in Statistical Returns. 141 TABLE I. Shewing the Population, Inhabited Houses, Marriages, Births, and Deaths for the Year 1883, and 10 years preceding. The Year. Estimated Population* No. of Inhabited Houses. + Marriages. Registered Births. DEATH Total all Ages. Under One Year. Under Five Years. In Pnb. lie Institutions. 1883. 168,000 21,030 1,616 4,230 2,615+ 601 982 483§ 1882 165,450 20,908 1,474 4,327 2,691 635 1,114 403 1881 163,540 20,666 1,461 4,400 2,726 644 1,067 437 1880 161,462 20,700 1,483 4,605 2,884 719 1,219 369 1879 158,316 20,240 1,428 4,790 2,992 722 1,218 424 1878 154,305 19,719 1,331 4,607 3,120 823 1,429 410 1877 151,360 19,330 1,411 4,648 2,625 648 1,040 420 1876 148,338 18,944 1,417 4,499 2,896 771 1,305 338 1875 144,488 18,444 1,346 4,478 2,786 686 1,119 338 1874 138,616 17,667 1,311 4,356 2,696 762 1,188 352 1873 132,826 16,915 1,243 4,182 2,439 656 979 272 Average of 10 yrs. 1873 1882. 151,870 19,035 1,390 4,489 2,785 706 1,167 376 Population at Census 1861, 70,108; 1871, 120,234; 1881, 163,151. Average Number of Persons in each house at Census in 1871, 7'6 ; in 1881, 8.1. Area of Parish 2,190 acres. Number of Persons to an acre (1883) 76.6. * For statistical purposes the population is estimated to the middle of the year, on the basis of the rate of increase ruling between the two preceding Census periods, checked by the known number of inhabited houses, and by the average number of persons per house, as ascertained at the preceding Census. †Mean of number on rate books in April and October yearly. + Inclusive of deaths of parishioners at public institutions outside the parish, and exclusive of the deaths of non.parishioners at public institutions within the parish. § Viz.: at the Parish Infirmary and at outlying public institutions, including the Asylum Board's hospitals. TABLE II. Shewing the Annual Birth Rate and Death Rate; Death Rates of Children, and Proportion of Deaths in Public Institutions in a Thousand Deaths, for the year 1883 and 10 years preceding. The Year Birth Rate per 1000 of the Population. Death Rate per 1000 of the Population. Deaths of Children under 1 year: per 1000 of Registered Births. Deaths of Children under 1 year: per 1000 of Total Deaths. Deaths of Children under 5 years : per 1000 of Total Deaths. Deaths in Public Institutions : per 1000 of Total Deaths. 1883 25 2 15 5 143 229 375 184* 1882 26.1 16-2 146 236 413 149 1881 26.9 16.6 146 236 391 160 1880 28.5 17.8 156 249 422 128 1879 80.2 18.8 150 241 407 133 1878 29.8 20.2 178 263 458 132 1877 30.7 17.3 132 246 396 135 1876 30.3 19.5 171 266 450 117 1875 30.9 19.2 153 246 401 121 1874 31.4 19.4 174 282 440 131 1873 31.4 18.3 156 270 402 116 Average of 10 years 1873-1882. 29.6 18.3 156 253 418 132 * Includes deaths of Parishioners at outlying Public Institutions, but excludes deaths of non-parishioners at Brompton Consumption Hospital and Marylebone Infirmary, Notting Hill. In the years 1873-82 the deaths at Brompton Consumption Hospital are included as compensation for an unknown number of deaths of Parishioners at outlying Public Institutions. TABLE III. Deaths Reg1stered from all causes 1n the year 1883. (Exclus1ve of the Deaths of Non-Par1sh1oners at Publ1c Inst1tut1ons w1th1n the Par1sh, but 1nclus1ve of the deaths of Par1sh1oners at Publ1c Inst1tut1ons outs1de the Par1sh.) CAUSES OF DEATH. AGES. Years of Age. Grand Total All Ages sub-d1str1cts. 0 to 1. 1 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 and upward Kensington Town. Brompton. (classes). I. SPECIFIC FEBRILE or ZYMOTIC DISEASES ..2 103 25 17 23 13 10 7 5 2 3 215 320 270 50 II. PARASITIC DISEASES 5 1 .. .. .. .. .. .. .. .. 6 6 4 2 III. DIETIC DISEASES 8 .. .. .. 1 4 5 .. .. .. .. 8 18 12 6 IV. Const1tut1onal D1seases 61 68 33 47 86 89 89 77 33 18 1 602 484 ..8 V. DEVELOPMENTAL DISEASES 80 .. 1 .. .. .. .. 1 17 40 80 124 37 VI.Local D1seases 225 190 38 34 66 90 135 1 ss 140 21 415 1321 1065 256 VII. Death from V1olence 18 3 4 3 4 5 8 2 .. .. 21 51 38 13 VIII. Death from 1ll def1ned and not Spec1f1ed causes 93 15 2 1 4 3 7 4 2 3 2 108 136 ..8 18 602 380 103 102 184 204 254 281 253 203 49 982 2615 2..5 500 I. SPECIFIC FEBRILE or ZYMOTIC DISEASES 1. Meamat1c D1seases Small-pox Vacc1nated .. .. .. .. .. .. .. .. .. .. .. .. .. .. Unvacc1nated .. .. .. .. 1 .. .. .. .. .. .. .. 1 .. 1 No Statement .. ...... .. .. .. .. .. .. .. .. .. ...... .. .. .. Measles 4 31 3 .. .. .. .. .. 1 .. .. 35 39 36 3 Scarlet Fever 3 17 .. .. .. .. .. .. .. .. .. 20 28 22 6 Typhus .. .. .. 1 .. .. .. .. .. 2 2 .. Whoop1ng Cough 16 26 2 .. .. .. .. .. .. .. .. 42 .. 38 6 D1phther1a 2 14 5 1 1 .. 1 .. .. .. .. 16 24 20 4 S1mple Cont1nued or Illed1f1ned fever .. .. .. 2 .. .. .. .. .. .. 1 3 1 2 Enter1c or Typho1d Fever .. 1 6 7 3 4 6 2 .. .. 1 .. 30 20 10 Other M1asmat1c D1seases .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 2.—D1arrheal D1seases. S1mple Cholera 1 .. .. 1 .. .. .. .. .. .. .. 1 2 2 .. D1arrhoea, Dysentery 65 9 .. .. 1 .. .. 1 2 2 74 80 71 9 3- Malar1al D1seases. Rem1ttent Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Ague .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 4.—Zoogenous D1seases. Cowpox, and effects of Vacc1nat1on .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ..Other D1seases (e.g. Hydrophob1a, Glanders, Splen1c Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 5.—Venereal D1seases. Syph1l1s 17 4 .. 1 .. .. 1 .. .. .. .. 21 23 22 1 .. .. .. 3 .. 2 .. .. .. .. 6 4 1 6.—Sept1c D1seases. Erys1pelas 4 .. .. .. 1 .. .. 2 3 .. .. 4 10 10 .. Pyæm1a Sepr1cæm1a .. .. .. .. 1 .. 1 1 .. .. .. .. 3 1 2 Puerperal Fever .. .. .. 7 14 5 .. .. .. .. .. .. 26 21 5 ..2 103 25 17 23 13 10 7 5 2 3 215 320 270 50 II. Paras1t1c D1seases Thrush, and other Vegetable Paras1t1c D1seases 5 1 .. .. .. .. .. .. .. .. .. 6 6 .. 2 Worms, Hydat1ds, and other An1mal Paras1t1c D1seases. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. III.D1st1c D1seases 5 1 .. .. .. .. .. .. .. .. .. 6 6 4 2 Want of Breast M1lk-Starvat1on 8 .. .. .. .. .. .. .. .. .. .. 8 8 4 4 Scurvy .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Chrome Alcohol1sm .. .. .. .. 1 3 4 .. .. .. .. .. '8 6 2 Del1r1um Tremens .. .. .. .. .. 1 1 .. .. .. .. .. 2 2 .. 8 .. .. .. 1 4 5 .. .. .. .. 8 18 12 6 IV. Const1tut1onal D1seases Rheumat1c Fever, Rheumat1sm of the Heart .. 1 2 1 5 2 2 .. .. .. .. 1 13 9 4 Rheumat1on .. .. .. .. .. 1 .. 2 1 2 .. .. 7 6 1 Gout .. .. .. .. .. 1 1 .. 1 1 1 .. 5 4 1 R1ckets 1 1 .. .. .. .. .. .. .. .. .. 2 2 2 .. Cancer, Mal1gnant D1sease .. 1 1 .. 3 14 31 41 24 13 .. 1 128 103 25 Tabes Mesenter1ca 29 17 2 .. .. .. .. .. .. .. .. 46 48 45 3 Tubercular Men1ng1t1s, Hydrocephalus 21 36 10 .. .. .. .. .. .. .. .. 57 67 65 12 Phrh1s1s .. .. 12 10 75 69 51 28 2 .. .. .. 277 220 57 Other formus of Tuberculos1s Scrofula 8 .. 5 6 1 1 .. 1 .. .. .. 19 33 227 6 Purpura, Hæmorrhag1c D1athes1s .1 .. 1 .. .. .. .. 1 .. .. .. 1 3 2 1 Anaem1a, Chloros1s, Leucocythsm1a 1 1 1 1 2 4 3 1 Glycosur1a, D1abetes MeU1tus 1 1 '2 3 4 2 13 6 7 Other const1tut1onal D1seases .. .. .. .. .. .. .. 1 1 129 2 2 ..8 V. DEVELOPMENTAL DISEASES. Premature B1rth 61 .. .. .. .. .. .. .. .. .. .. 61 61 49 12 Atelectas1s 7 .. .. .. .. .. .. .. .. .. .. 7 7 6 1 Congen1tal Malformat1on 12 .. 1 .. .. .. .. .. .. .. 12 13 9 .. Old Age .. .. .. .. .. .. .. 1 17 40 22 .. 80 60 20 80 .. 1 .. .. .. .. 1 17 40 22 80 161 124 37 VI. Locl D1seases 1. D1seases of Nervous System Inflammat1on of Bra1n or Membranes .. 3 4 3 3 2 1 1 3 17 15 2 Apoplexy,soften1ng of Bra1n, Ham1pleg1a,Bra1n Paralys1s .. .. .. 2 3 6 22 35 40 26 3 .. 137 102 35 Instan1ty,General Paralys1s of the Insance .. .. .. .. 3 1 2 .. 1 8 2 "1 2 2 1 2 1 .. .. 10 8 2 Convols1ons 47 23 .. .. .. .. .. .. .. .. .. 70 70 53 17 Laryng1smus Str1dulus (spasm of Glott1s) 4 2 .. .. .. .. .. .. .. .. .. 6 6 4 2 D1seases of sp1nal cord, parapleg1a, paralys1s Ag1tans .. .. .. .. 1 2 1 -2 .. 1 .. .. .. 7 4 Other D1seases of Nervous System 1 7 .. .. .. 2 5 4 8 2 .. 8 29 27 2 2.—D1seases of Organs of Spec1al Sense. (e.g. of Ear, Eye, Nose) .. 2 1 .. .. 2 .. .. .. .. .. 2 6 4 1 3. D1seases of C1rculatory System. Per1eard1t1s 1 .. 1 .. 2 .. 1 1 .. .. .. 1 6 6 .. Acute Endocard1t1s .. .. .. .. .. 1 .. .. .. .. .. .. 1 1 .. Valvolar D1seases of Heart .. .. 1 1 .. .. 8 14 15 80 1 51 41 10 Other D1seases of Heart .. 2 9 6 8 9 16 22 31 10 1 2 ..3 ^0 « 4 17 Embol1sm, Thrombos1s .. .. .. .. .. .. .. 1 .. .. .. .. 1 1 .. Other D1seases of Blood Vessels .. .. .. .. .. 1 .. .. .. .. .. .. 1 1 .. 4. D1seases of Rep1ratory System Larung1rls 1 2 1 .. .. .. 1 .. .. .. .. 3 5 3 2 Croup 2 22 6 .. .. .. .. .. .. .. .. 24 30 23 7 Emphysema Asthma .. .. .. .. .. 1 1 3 3 2 .. .. 10 7 7 Bronch1t1s 68 ' !j 14 45 1g 165 317 Pneumon1a 28 23 6 7 8 12 10 9 96 pleur1sy 2 57 ? Other D1seases of Resp1ratory System 6 8 2 3 3 .. 2 5 3 ll 32 25 ! 5.—D1seases of D1gest1ve System. Dent1on 15 14 Sore Throat,' Qu1nsey' 1 2 1 '1 .. .. 23 D1seases of Stomach 1 .. •J Enter1t1s ? 2 '{ 1 | 2 1 2 2 t 14 10 5 Obstruct1ve D1seases of Intest1ne 2 j _ J 5 : Jo 4 Per1ton1t1s 1 .. .. Asc1tes •* 4 2 2 1 1 12 .. 1 C1rrhos1s of L1ver 1 '1 6 5 6 "1 -1 20 18 Jaudn1ce and other D1seases of L1ver 5 ' I 5 8 5 6 35 9 Other D1seases of D1gest1ve Sfystem 2 1 .. 4 1 1 3 7 2 6,-D1seases of Lymphat1c System. (e.g. of Lymphat1cs and of Spleen) .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 7.- D1seases of Glandl1re organs of Uncerta1n use (e.g. Bronchocele, Add1son's D1sease) .. .. .. .. .. .. 1 .. .. .. .. .. 1 .. 1 8 D1seases of Uh1nary System Nephr1t1s .. 1 2 g 2 14 Br1ght's D1seases Album1nur1a .. 8 D1sease of Bladder or of Prostate .. 3 5 Other D1seases of the Ur1nary System .. 1 .. .. "1 '5 3 8 2 '1 21 1s •3 9.—D1seases of Reproduct1ve System. A.of organs of Generat1on Male Organs Female Organs .. "1 1 2 .. 2 .. .. b. Of Partur1t1on. .. 15 8 7 Abort1on M1scarr1age .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Convuls1ons .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Placenta Prev1a, Flood1ng .. .. .. .. 2 .. .. .. .. .. .. .. 2 '1 -1 Other Acc1dents of Ch1ldb1rth .. .. : .. .. 1.. D1seases of Bone and Jo1nts Car1es, Necros1s Arthr1t1s, Ost1t1s Per1ost1t1s 1 .. .. '2 Other D1seases of Bones and Jo1nts .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ... D1seases of Inteoumentary System Carvuncle , Phelegmon .. .. .. 1 .. .. .. .. 1 .. .. Other D1seases of Integumentary System 2 .. .. .. 2 2 2 .. 225 190 38 34 66 90 135 188 194 140 21 415 1321 1065 266 VII. DEATHS FROM VIOLENCE 1.—Acc1dent or Negl1gence. Fractures and Contus1ons Gunshot Wounds 15 13 2 Cut, Stab Burn, Scald .. Po1son .. 1 2 3 2 1 Drow1ng .. 1 .. 2 .. .. 2 2 Suffocat1on .. -1 1 .. .. Otherw1se .. .. .. 2 14 2 2.—Hom1c1de. Manslaughter Murder •1 .. .. .. .. 1 .. '1 3.—Su1c1de. Gunshot wounds Cut,stab 1 1 Po1son .. .. .. 1 2 .. 2 1 1 Drown1ng 1 2 1 .. 5 4 1 Hang1ng " .. .. .. Otherw1se .. .. .. .. .. .. 2 .. 4.—Execut1on. Hang1ng .. .. .. .. .. .. .. .. 18 3 4 3 4 5 8 4 2 .. .. 21 51 38 13 VIII. Death from 1ll def1ned AND NOT SPECIFIED CAUSES. Dropsy .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Deb1l1ty, Atrophy, Inan1t1on 89 12 .. 2 1 .. 1 .. .. 1 101 108 1 150 Mort1f1cat1on •[ 15 Tumour I] " 1 2 2 Abscess ' j '3 '1 1 'g '• Haemorrhage 8 Sudden Death (Cause not ascerta1ned) Causes not spec1f1ed or Ill-def1ned '3 -1 "1 '1 •2 *6 .. '1 .. 1! '3 1e 13 3 93 15 2 1 4 3 7 4 2 3 2 108 136 ..8 18 CAUSES OF DEATH. I I 1 to 5. 5 to 15. 15 to 25. — 1 — 1 1 J 65 to 75. I 1 Tot^nder Years of Age. je. Ke^gton | Brompton. AGES. sub-d1str1cts. 144 TABLE IV. Shewing the Number of Deaths at all ages in 1883, from certain groups of Diseases, and proportions to 1000 of Population, and to 1000 deaths from all causes ; also the number of deaths of [nfants under one year of age from other groups of Diseases, and proportions to 1000 Births and to 1000 Deaths from all causes under one year. Division I. (Adults). Total Deaths. Deaths per 1000 of Population at all ages. Deaths per 1000 of Total Deaths, at all ages. 1. Principal Zymotic Diseases 251 1 .5 96 2. Pulmonary Diseases 590 3.5 225 3. Principal Tubercular Diseases 360 2.1 133 Division 11. Infants under One Year). Total Deaths. Deaths per 1000 of Births. Deaths per 1000 of Total Deaths under One Year. 4. Wasting Diseases. . 158 37 262 5. Convulsive Diseases 83 22 138 NOTES. 1. Includes Small-pox, Measles, Scarlet Fever, Diphtheria, Whooping-cough, Typhus Fever, Enteric (or Typhoid) Fever, Simple Continued Fever and Diarrhoea. Twenty of the deaths occurred in Hospitals outside the Parish. 3. Includes Phthisis, Scrofula, Tuberculosis, Rickets, and Tabes. 4. Includes Marasmus, Atrophy, Debility, Want of Breast Miik, and ture Birth. 5. Includes Hydrocephalus, Infantile Meningitis, Convulsions, and Teething. (In Table III Hydrocephalus and Infantile Meningitis are classified with tubercular diseases, Convulsions with diseases of the nervous system, and Teething with diseases of the digestive system.) 145 TABLE V. Shewing the Number of Deaths from the principal Zymotic Diseases, in the 10 years, 1873 to 1882, and in the year 1883. Diseases. 1873. 1874. 1875. 1876. 1877. 1878. 1879. 1880. 1881. 1882. Annual average of 10 years, 1873.1882. Proportion of Deaths to 1000 Deaths in 10 years, 1873.1882. 1883. Proportion of Deaths to 1000 Deaths in 1883. Small.pox 1 0 0 8 84 24 24 11 55 .. 20.7 7.4 1 .3 Measles 38 121 23 128 54 53 60 75 67 77 69.6 25.0 39 15.0 Scarlet Fever 10 32 83 59 31 77 51 105 38 62 54.8 19.6 28 10.7 Diphtheria 11 26 23 17 10 20 26 22 8 25 18.8 6.7 24 91 Whooping Cough. 44 45 107 124 34 185 93 95 85 119 93.1 33.4 44 16.9 Fevers. Typhus 6 9 2 3 2 3 1 4 2 1 3.3 .1 2 .7 Enteric 27 28 21 27 20 26 14 24 22 25 23.4 8.4 30 11.5 Simple Continued 8 15 6 6 5 4 8 5 5 6 6.8 2.4 3 11 Diarrhœa 145 112 107 126 99 181 71 128 101 61 1131 40.6 80 30.6 Totals. . Kensington . 290 388 372 498 339 573 348 469 383 376 403.6 1436 251 959 London 11385 11230 13411 12565 12292 14734 12256 13681 13811 13553 12891 160 10801 134 England & Wales 70402 88200 82332 75506 66558 84624 62020 82537 58239 69734 74015 142 58972 112 146 TABLE VI. Inspectors' Report of the Sanitary Work completed in the year 1888-4. Sanitary Districts.* No. of Complaints received dnring the year. No. of Houses, Premises, &c. inspected. No. of Re-inspections of Houses, Premises, &c. Results of Inspection. House Drains. Water-Closets. Dust Bins. Water Supply. Miscellaneous. Orders issued for Sanitaiy Amendments of Houses and Premises. Houses, Premises, &c., Cleansed, Repaired, Whitewashed, & c Houses Disinfected after illness of an Infectious Character. Repaired, Cleansed, Trapped, See. Ventilated. Repaired, See. Supplied with Water. .... New provided. New provided. Repaired, Covered, &c. Cisterns (new) erected. Cisterns Cleansed, Repaired, and Covered. Waste-pipes connected wilh Drains,& c . abolished. No. of Lodging Houses registered under 35th Section of the " Sanitary Act, 1866." if Dust Removal—No. of Communications received and attended to. Removal of Accumulatious of Dung, Stagnant Water, Animal and other Refuse. Animals Removed, being improperly kept. Regularly Inspected. Legal Proceedings : i.e., Summonses Bakehouses Licensed Cowsheds. Licensed Slaughter-houses. N.W. 47 1279 1079 502 149 42 104 25 49 100 6 41 2 13 61 32 .. 393 120 39 37 8 11 62 N.E. 70 1345 1269 416 183 73 184 9 234 169 8 10 30 9 62 19 .. 531 90 2 46 1 5 20 Centrl. 60 1299 1774 354 266 44 53 191 22 62 3 47 75 8 47 96 .. 406 21 15 24 2 7 3 South 112 2024 1668 154 630 40 133 111 100 79 3 4 87 4 151 61 .. 508 114 1 39 4 2 25 Totals 289 5247 5790 1726 1228 199 474 336 405 410 20 102 194 34 321 208 .. 1838 345 1 " 146 15 25 110 * 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. +his Act has not yet been put into operation. § The actual complaints of neglect made by letter were 58. † Inclusive of proceedings, in 9 cases, under the Food and Drugs Adulteration Act, the Inspector for the North-west District being the Inspector under the Act, and in 22 cases of " obstructions, &c.," on and over the public ways. h-i •<1 TABLE VIa Summary of Monthly Returns of Work, &c., done by the Sanitary Inspectors, 1883-4. Date of Report. Houses Inspected. Mews Inspected. Slaughter Houses Inspected. Cowsheds Inspected. Bakehouses Inspected. Offensive Trades Inspected. Sanitary Notices Issued. Removal of Dust, Ashes, &c., Letters of Request 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. N.W. N.E. c. s. N.W. N.E. c. s. N.W. N.E. c. s. Ap.21,1883 82 134 128 171 103 254 78 207 2 4 6 8 7 2 3 16 7 15 15 9 12 7 15 3 50 31 19 30 55 82 18 66 Ap.21,1883 May 19 ,, 115 101 136 180 105 255 88 202 7 6 6 8 4 5 6 18 2 29 14 8 7 20 16 7 24 42 24 41 51 59 39 39 May 19 „ June 16 „ 135 121 78 182 102 248 52 196 9 4 6 8 10 4 2 17 18 15 13 7 23 29 13 5 39 49 38 45 77 62 37 79 June 16 „ July 14 „ 100 88 147 99 288 212 11 14 7 8 2 16 6 31 3 38 11 9 35 60 66 57 54 69 69 July 14 „ Aug. 11 „ 108 125 18 61 101 283 14 100 15 7 2 2 12 3 2 6 12 12 11 1 30 8 14 6 49 26 4 15 35 51 31 68 Aug.ll „ Sept. 8 „ 142 8 108 154 120 56 67 228 9 7 8 6 5 2 2 13 16 11 4 10 2 13 10 30 14 68 39 41 42 57 32 Sept. 8 ,, Oct. 6 „ 25 86 153 146 25 324 61 167 9 13 7 8 6 2 2 14 4 31 6 4 4 30 11 3 14 25 63 33 6 29 24 16 Oct. 6 „ Nov. 3 „ 78 102 135 121 86 248 59 175 7 6 8 9 6 2 4 9 13 1 8 6 22 5 16 6 62 32 36 30 3 16 24 25 Nov. 3 ,, Dec. 1 „ 68 128 125 200 63 254 72 163 2 3 4 9 8 1 1 13 4 32 11 7 12 28 12 5 44 27 9 44 15 16 19 19 Dec. 1 „ Dec. 29 „ 73 77 53 130 119 253 52 197 2 9 10 7 1 1 5 15 12 14 16 8 17 10 19 4 23 21 6 16 10 25 9 25 Dec. 29 „ Jan.26,1884 127 114 158 178 134 254 80 201 12 6 8 9 12 1 5 14 21 23 10 1 24 25 17 2 42 30 46 32 20 46 23 22 Jan.26,1884 Feb.23 „ 125 116 149 178 120 251 80 207 10 8 7 9 3 1 2 15 5 20 2 1 14 14 2 2 37 20 15 24 10 12 40 15 Feb.23 „ Mar. 22 „ 101 145 68 176 126 252 46 194 7 4 6 8 5 1 3 12 15 26 7 4 18 25 6 3 47 39 26 39 14 37 15 33 Mar. 22 „ Totals 1279 1345 1309 2024 1303 3220 749 2449 102 91 78 98 87 27 37 178 135 249 124 63 231 214 154 65 502 416 354 454 394 531 405 508 Totals. 148 TABLE VII. Showing the Death rate per 1000 persons living : the annual rate per 1000 from the " seven " principal Diseases of the Zymotic class ; and the proportion of Deaths from these Diseases to total Deaths in Kensington and all London, in 1883, and in ten years preceding. 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. 1873 18.3 22.5 290 2.1 3.3 118 149 1873 1874 19.4 22.5 388 2.8 3.3 144 147 1874 1875 19.2 23.7 372 2.5 3.9 133 164 1875 1876 19.5 22.3 498 3.3 3.6 171 162 1876 1877 17.3 21.9 339 2.2 3.5 129 160 1877 1878 20.2 23.5 573 3.7 4.1 183 175 1878 1879 18.8 23.3 348 2.2 3.3 116 143 1879 1880 17.8 22.2 469 2.9 3.7 162 170 1880 1881 16.6 21.2 383 2.3 3.6 140 172 1881 1882 16.2 21.4 376 2.2 3.5 140 163 1882 AVERAGES OF TEN YEARS. 18.3 22.4 403 2.6 3.5 143 160 AVERAGES OF TEN YEARS. 1883 155 204 251 1.5 27 96 134 1883 TABLE VIII. Comparative Analysis of the Mortality in all London and in Kensington in 1888. LOCALITY. Annual Death Rate per 1000 living from all causes. Annual Death Rate per 1000 living from seven 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 seven principal Zymotic diseases. From Violence. Registered upon information of the Coroner. (Inquests.) Registered at Public Institutions. London 20.4 2.7 145 24.1 216 13.4 3.7 7.2 20.6 Kensington 15.5 1.5 14.3 22.9 25.5 95.9 1.5 5.5 18.4* * Viz.:—At the Parish Infirmary and at outlying institutions. Inclusive of the deaths of non.parishioners at the Brompton Consumption Hospital and the Marylebone Infirmary, the percentage would be 40*0, or 33*7 if the deaths of parishioners at outlying institutions were excluded. 149 150 TABLE IX. Showing the principal Localities in which Fatal Cases of the Zymotic Diseases occurred in 1883. KENSINGTON TOWN REGISTRATION SUB-DISTRICT. LOCALITY. DISEASE S. LOCALITY. DISEASES. LOCALITY. DISEASES. Small-pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. FEVER. | Diarrhoea. | | Total. | Small-pox. | Measles. Scarlet Fever. | Diphtheria. "Whooping Cough. FEVER. | Diarrhoea. | | Total. Small-pox. I Measles. Scarlet Fever. Diphtheria. Whooping Cough. FEVER. Diarrhoea. | Total. | Typhus. Enteric. | Sim.Con | Typhus. | Enteric. Sim Con Typhus. Enteiic. Sim.Con.l Bangor Street .. 1 .. .. 1 .. .. .. 4 6 Golborne Road .. l 1 .. .. .. .. .. .. 2 Rillington Place .. .. 1 .. 1 .. .. .. .. 2 Basing Road .. .. 1 .. 1 .. .. .. .. 2 Hazlewood Crescent .. l 2 .. .. .. .. .. .. 3 Ruston Mews .. .. .. 2 .. .. .. .. .. 2 Bevigton Road .. 1 .. .. •2 .. .. .. 2 5 Infirmary (The) .. 5 .. 1 1 1 8 St. Clement's Road i i 2 Blagrove Road .. .. 1 .. .. .. .. .. .. 1 Kensington High Street .. .. .. .. .. .. 1 1 .. 1 St. Ervan's Road .. .. .. .. .. 1 2 .. .. 3 Blechynden Street .. 2 1 .. 2 .. .. .. 2 7 „ Park Road. .. 1 1 .. .. .. .. .. .. 2 St. James' Street .. .. .. .. .. .. 1 .. .. 1 Blenheim Crescent .. .. .. 1 .. .. .. .. .. 1 Ladbroke Grove Road. .. .. .. .. 1 .. 1 .. .. 2 St. Katherine's Road .. .. .. .. 1 .. .. 4 5 Branstone Street .. .. .. .. .. .... 1 .. .. 1 Lancaster Road .. 1 .. .. 1 1 .. .. .. 3 Scarsdale Villas .. .. .. 1 .. .. .. .. 1 2 Buckingham Terrace .. .. .. 2 .. .. .. .. 1 3 Ledbury Road .. .. .. 1 1 .. .. .. 2 Silchester Terrace .. 2 .. .. .. .. 1 .. .. 3 Chepstow Place .. .. .. 1 .. .. .. .. .. 1 Lockton Street .. .. 1 .. .. .. .. .. 1 2 Southam Street .. .. .. .. 2 .. .. .. 3 5 Villas .. .. 1 .. .. .. .. .. .. 1 Manchester Road .. 1 .. .. 2 .. .. .. 1 4 Swinbrook Road .. .. .. 1 .. .. .. .. .. 1 Chesterton Road .. .. 1 .. .. .. .. .. 2 3 Martin Street .. 2 .. .. .. .. .. 2 4 Testerton Street .. 1 .. 1 .. .. .. .. 1 3 Cornwall Road .. 1 .. 1 2 .. 1 .. .. 5 Norland Square .. .. .. .. .. i .. .. I Victoria Gardens .. .. 2 .. .. .. .. 2 Crescecent Road .. .. .. 1 .. .. 2 3 Pembridge Place .. .. .. 1 .. .. .. .. .. 1 Walmer Road .. .. 1 3 .. 1 .. 2 7 Elgin Crescent .. .. 1 .. .. .. .. .. .. 1 Pembroke Place West .. .. .. .. .. 1 .. .. .. 1 Wellington Mews .. .. .. 1 .. .. .. .. .. 1 Eldon Road .. .. .. 1 .. .. .. .. .. 1 Portobello Road .. .. .. .. .. .. 2 .. 2 4 Western Terrace .. .. .. .. .. .. .. 3 3 Faraday Road .. .. .. .. 1 .. .. .. 1 2 Potteries .. 3 1 .. .. .. .. .. 3 7 Wornington Road .. .. .. 2 1 1 1 5 .. ..• .. .. 1 .. .. .. 1 2 .. .. .. .. .. .. .. .. BROMPTON REGISTRATION SUB-DISTRICT. Adrian Terrace .. .. .. .. .. .. 1 .. 1 2 Fopstone Road .. .. .. .. .. .. 1 .. .. 1 Richmond Road .. .. .. .. 2 .. .. .. 1 3 Ashburn Plaxe .. .. .. .. 2 .. 1 .. .. 3 Finborough .. .. .. .. .. .. 1 .. 1 Seymour Place .. .. .. 1 .. .. .. .. .. 1 Childs Street .. .. .. .. 2 .. 1 .. .. 2 lexham Garden .. .. .. .. .. .. 1 .. .. 1 Shaftesbury Terrace .. .. 1 .. .. .. 1 .. .. 2 Clifton Place .. .. .. .. .. .. 1 .. .. 1 Nevern Road .. .. .. .. .. .. ..1 1 Sloane Place .. .. 1 .. .. .. .. 1 2 Cromwell Crescent .. .. .. .. .. .. 1 .. .. 1 Queen Street 2 2 Warwick Road 1 .. 1 Earl's Court Square .. .. .. .. .. .. 1 .. .. 1 Redeliffe Square .. .. .. .. .. .. 1 •• 1 Yeoman's Row .. 1 .. .. .. .. .. .. 1 151 TABLE X. PARISH OF ST. MARY ABBOTTS, KENSINGTON Return respecting the Vaccination of Children whose Births were Registered in 1883. 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 shewn by Report Book) of Column 10 Successfully vaccinated. Column 11. Column 13 Dead. Un-vaccinated. Postponement by Medical Certificate. Removal to District the Vaccination Officer of which has been duly apprised. 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 1883 1 2 3 4 5 6 8 9 10 .. 1st January to 30th June ) Kensington Town 1779 1558 5 .. 136 7 8 65 .. Brompton 462 398 3 .. 38 .. 2 21 .. 1st July to 31st Dec. ) Kensington Town 1586 1330 4 .. 152 30 2 68 .. Brompton 402 339 .. 31 11 .. 18 3 Total 4229 3625 12 357 48 12 172 3 152 TABLE XI. LICENSED SI AUGHTER-HOUSES. SOUTH OF UXBRIDGE ROAD. LOCALITY. LICENSEE. 1, Church Street, Kensington Mr. Blott 11, Peel Place, Silver Street- „ Osborn The Mall, Silver Street- „ Wright 183, Brompton Road - Mrs. French 60, Kensington High Street - Mr. Evans 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 195, Clarenden road „ Rea 10, Edenham Mews „ Goddard 2, Ledbury Mews- „ French Lonsdale Mews - „ Green 50, Princes Road - „ Parratt 10, Princes Mews- „ Short 10, Princes Yard - „ Coles Clarendon Mews - „ Colley 41, Princes Place - „ Grant 23, Norfolk Terrace „ Harris 61, Silchester Road „ Crawforth 235, Walmer Road „ Van Royal Crescent Mews - „ Brooker Ditto ditto „ Down 153 TABLE XII. LICENSED COWSHEDS. SOUTH OF UXBRIDGE ROAD. LOCALITY. LICENSEE. 5, St. Mark's Road, Fulham Rd. Mr. Cotching Newland terrace (rear of) „ Tisdall Stratford Road ,, Clarke Addison Cottage, Lome Gds. ,, Glenie Newcombe Street - ,, Lunn Earl's Court Road (rear of 117) ,, Thorne NORTH OF UXBRIDGE ROAD. 1, Ledbury Mews - 187, Walmer Road 235, Walmer Road 47, Tobin Street, Notting Dale 12, Blechynden Mews 14, Ditto ditto - 23, Bramley Road 27, Queen's Road, Norlands - Elm Cottage, St. Mark's Road Mr. Liddiard „ Arnsby „ Van „ Skingle, Jun. „ Burton „ Copperwheat ,, Tame „ Williams „ Bowyer