VIII 61 LEN 113 THE ANNUAL REPORT ON THE HEALTH, SANITARY CONDITION, &c., &c., OF THE Parish of St. Mary Abbotts, KENSINGTON, FOR THE YEAR 1886, BY T.ORME DUDFIELD,M.D., Medical Officer of health. PRINTED BY HUTCHINGS AND CROWSLEY, LIMITED, 123, FULHAM ROAD, SOUTH KENSINGTON S.W.; AND HENRY STREET, ST. JOHN'S WOOD. N.W. 1 8 8 7. THE ANNUAL REPORT ON THE HEALTH, SANITARY CONDITION, &c., &c., OF THE Parish of St. Mary Abbotts, KENSINGTON, FOR THE YEAR 1886, BY T.ORME DUDFIELD, M.B., Medical Officer of health. PRINTED BY HUTCHINGS AND CROWSLEY, LIMITED, 123, FULHAM ROAD, SOUTH KENSINGTON S.W.; and henry street, st. john's wood, n.w. 1 8 87. TABLE OF CONTENTS. PAGE Prefatory Remarks on Death-Rate—Parochial, Metropolitan, Urban, and National 9 Registration District, "Kensington" 12 „ Sub-Districts: "Kensington Town," and "Brompton" 13 Wards, Division of Parish into 13 Kensington, Population and Rateable Value of; 1801-1887 14 Vital Statistics in 1886, Summary of 14 Zymotic Diseases, General Remarks on the "Seven Principal" 20 „ „ Number of Deaths from the „ „ 22 „ „ Death-rate from; in Kensington, in London, and other large Towns, and in England and Wales 23 „ „ In Kensington : Monthly Returns of Deaths from 23 Small-Pox, in Kensington and Londobn 24 Measles 25 Scarlet Fever 26 „ „ Alleged dissemination of, by Milk of Diseased Cows 29 „ „ Views of Dr. Buchanan, Mr. Power, and Dr. Klein 30 „ „ „ (Divergent) of Professors Brown and Axe 32 Diphtheria 34 „ Need of Hospital Accommodation for Sufferers from 36 Whooping-Cough 37 Fever 38 Diarrhœa 38 Cholera: Precautionary Measures against 38 Hydrophobia: Rabies Order of 1886 39 Hospital Accommodation for Small-Pox 40 Action of Asylums Board to give effect to the recommendations of the Hospitals Commission by providing Ship and Camp Hospitals, &c. 40 „ Managers propose to erect Permanent Hospital at Darenth: Local Government Board objects 40 „ Reports of Sub-committees of Asylums Board on the subject of proposed permanent Hospital 42 2 PAGE Fever Hospital Accommodation 43 Views of the Royal Commission 43 „ Requirements of the Metropolis, amply supplied at present 43 „ North Western Hospital (Hampstead), closed 45 „ Western Hospital (Fulham), Improvements at 45 Hospital Ships 46 „ Note on Medical Inspection of 48 Asylums Board: Number of patients treated in Hospitals of, in 1886 49 Table shewing Quarterly and Total Admissions of Small-Pox and Fever Patients at the Hospitals, from each Parish and Union, and population of the several Districts, etc. (1886) 50 Clinical Instruction: Hospitals utilised for purpose of 52 Darenth Camp Litigation closed 52 Ambulance Service, The Asylums Board 53 „ „ Annual Report of the Committee 53 „ „ River Steamers 54 „ „ Wharves 55 „ „ Metropolitan, a desideratum soon to be supplied 55 „ „ Objectionable employment of public vehicles for conveyance of the Infectious Sick: Action of Police Authorities, and of Asylums Board 56 „ „ Views of the Medical Officer of Health: dorsed by the Asylums Board 57 Non-Pauper Infectious Sick; Hospital Provision for 58 Poor Law Act, 1879. The Poor Law Act, 1879, allows of contracts between Asylums Board and Sanitary Authorities for treatment of the Infectious Sick 59 „ The Act in abeyance : Patients admitted to Hospitals, in 1884, freely and without payment 59 „ The Managers of Asylums Board seek and obtain authority, in 1884, to enter into contracts with Sanitary Authorities under provisions of the Act 60 „ Sanitary Authorities in many instances decline to enter into contracts with the Managers 60 „ Vestry's objection to the proposed contract system: Principles on which it is based 61 „ Vestry recommends that all charges in connection with Medical Relief in Hospitals be borne upon a Common Sanitary Fund 61 „ Sanitary Authorities in London confer (in 1881) and agree in regard to the principles upon which Vestry's objection to contract had been based 62 „ Society of Medical Officers of Health concurs 63 „ Important new departure by Asylums Board 63 3 PAGE Poor Law Act, 1879—continued. „ Mode of admission of Patients to Hospitals, under Poor Law Board's Order of 1875 64 Asylums Board seek power to admit Patients of all classes, without the order of a Relieving Officer, upon the certificate of any Registered Medical Practitioner 65 Notification of Infectious Diseases (Compulsory) 66 „ Model Clause drafted by Select Committee of House of Commons, to provide for 67 „ Bill to provide for, introduced in the House of Commons, in 1883 68 „ Views of the President of the Local Government Board on 68 „ Provided for in Local Acts 69 „ Provision for in Regulations for Houses let in Lodgings, or occupied by members of more than one family 69 „ Voluntary; Existing sources of information 70 „ „ Beneficial results of, evidenced by decline in prevalence and fatality of certain diseases 72 „ „ Tables shewing mortality from principal zymotic diseases before and after introduction of, and provision of Hospitals. 72 „ „ Action of Public Authorities (Postal and Police), with reference to 75 Interruption of Education at Elementary Schools, resulting from prevalence of Infectious Diseases 80 Population of Sub-Districts, Number of Inhabited Houses, &c. 81 „ Relative Numbers of Males and Females, at different ages, in parish, and in sub-districts, in 1881 (Tables) 82 „ Rateable Value, and Inhabited Houses, Increase of, since 1856 83 Marriages and Marriage Rate 84 Births and Birth Rate 84 Deaths and Death Rate 85 Infantile Mortality 86 „ Among Illegitimate Children 86 Senile Mortality 87 Death Rate at Different Age-Periods (Table) 87 „ Mean Temperature, etc., Monthly 88 Death, Summary of causes of (Table) 88 Death, Assigned Causes of 89 „ Specific Febrile or Zymotic Diseases 90 „ „ „ Venereal Diseases 90 „ „ „ Puerperal Fever 91 „ Parasitic Diseases 91 4 PAGE Death, Assigned Causes of continued. Dietetic Diseases 91 „ „ Alcoholism 91 Constitutional Diseases 92 „ „ „ Cancer 92 „ „ „ Tubercular 93 „ Developmental Diseases 95 „ Local Diseases 95 „ „ Nervous System, Diseases of 96 „ „ Circulatory „ 96 Respiratory „ „ 96 „ Digestive „ „ 97 „ Urinary „ „ 97 „ „ Reproductive„ „ 98 „ Violent Deaths 98 „ Ill-delined and Not Specified Causes of 98 Public Institutions, Deaths in 99 „ Parish Infirmary and Workhouse 99 „ Outlying Public Institutions 101 St. Joseph's House 101 Consumption Hospital, Brompton 102 „ Marylebone Infirmary, Notting Hill 102 "Not Certified" Deaths 102 Inquests 103 „ Deaths from Violence ; Accidental and Suicidal 103 „ Why so many become necessary 105 Meteorology 105 Vaccination 106 „ Officer's Report for 1885 106 „ Evidence furnished by Medical Officer to Local Government Board, as to the Protection afforded by 106 „ Animal; Calf Lymph 109 Sanitary Work in 1886 110 Sanitary, Nuisances Removal, and other Cognate Acts, Report on, by the Law and Parliamentary Committee 110 Housing of the Working Classes 112 Underground Rooms 112 „ Construction of Drains 113 Inspection of Drains 113 „ Vestry may cause work to be done at Owner's expense 113 „ Vestry's mode of procedure 113 Rules with respect to House Drainage 113 „ Metropolitan Board have power to make Bye-laws 114 5 PAGE Sanitary and Nuisances Removal Acts—continued. „ Public Conveniences 114 „ Drinking Fountains 114 Private Mews, Courts, &c., Paving and Drainage of 114 „ Consumption of Smoke 115 „ Manure and other Refuse Matter: Periodical Removal of 115 „ Infectious Disease Hospital: Ambulances 115 „ Disinfecting Chamber 115 Defective Enforcement of Sanitary Law 115 „ Amendment of the Law; Summary Powers needed 116 „ Supplementary Observations 117 Sanitary, Nuisances Removal, and other Cognate Acts, Joint Report by the Law and the Works Committees as to the best means to be adopted for carrying, out the (approved) recommendations of the Law Committee:— 118 „ With respect to the Metropolitan Board of Works 118 „ With respect to the Vestry 118 „ With respect to the Finance Committee 118 „ With respect to the Law and Parliamentary Committee 119 „ With respect to the Wharves and Plant Committee 119 With respect to the Works, Sanitary, and General Purposes Committee 119 „ With respect to the Representatives of the Vestry on the Metropolitan Board of Works 119 „ With respect to the Clerk to the Vestry 120 „ With respect to the Surveyor 120 „ With respect to the Sanitary Inspectors 121 „ With respect to the Home Secretary and the President of the Local Government Board 122 „ With respect to the Members for the Borough 122 Nuisances Removal Acts: Committee appointed to carry out Provisions of the 123 „ Legal Proceedings: Increased facilities afforded by the Justices 123 „ Sanitary Inspectors, Work of 124 „ Justices' Orders 125 Water Supply: The cutting-off powers of the Companies 125 „ Inconsistent legislation in regard to 125 „ The Medical Officer's Views in regard to 126 „ Bill to Limit and Regulate the Powers of the Companies 127 „ Bill of Metropolitan Board of Works with reference to. thrown out 127 Bills in Parliament 128 Joint Reports by Public „ Beer Adulteration (No. 2)Analyst and Medical Officer 128 „ Butter Substitutes of Health. 6 PAGE Bills in Parliament—confirmed. Sanitary Registration of Buildings Report by Medical „ Sanitation of Houses (Metropolis) Officer of Health 131 Offensive Businesses 132 „ Brick-burning, Nuisance arising from 132 Marine Stores „ „ 133 „ „ Metropolitan Board of Works requested to schedule the business under the provisions of the Slaughter Houses (Metropolis) Act, 1874 133 „ The Views of the Board on the subject 133 „ A Judicial Decision (Passey v. Oxford Local Board) 134 „ Tallow Melting (Tucker's Factory) 134 „ Fat Extracting 135 Slaughter Houses 135 Cowsheds 136 Dairies, Cowsheds, and Milkshops' Order of 1885, Metropolitan Board of Works, as Local Authority, makes new Regulations under provisions of 137 Public Health (Dairies, etc.) Bill of 1883; Provisions of, Incorporated in Contagious Diseases (Animals) Act, 1886 139 Bakehouses 143 Refuse: Recommendations by the Society of Medical Officers of Health with reference to disposal of 145 „ House, Removal of: Nuisance from Dustbins improperly used 146 „ „ Dustbins should be abolished 147 „ „ „ often placed in positions difficult of access; Accidents to dustmen resulting 147 „ Stable 147 „ Trade, Removal of 148 „ „ Views of the Law and Parliamentary Committee with reference to 149 „ „ Views of the Wharves and Plant Committee with reference to 149 „ „ Action of the Vestry with reference to 149 „ „ The Law on the Subject of 150 „ „ The Views of the Medical Officer of Health 151 Amendment of Sanitary Law Required 151 „ With reference to exposure of infected clothing 151 „ With reference to eggs unfit for food 153 Metropolitan Main Drainage „ Metropolitan Board of Works decides to deal with sewage at the Outfalls by Chemical Precipitation of the Solid 7 PAGE Metropolitan Main Drainage—continued. Matters, and when necessary, by Deodorisation of the Effluent, followed by immediate discharge into the River, contrary to the Recommendation of the Royal Commission in favour of a System of Land Filtration of the Effluent, prior to its discharge into the River 154 Round Pond (Kensington Gardens): Nuisance complained of as arisiug in process of cleansing 157 Necessary Accommodation: Public Urinals, &c. 158 Public Baths and Washhouses: approaching completion 159 Washhouses, apart from Baths: A public want 159 Mortuary, Public: Observation with reference to the 159 „ Views of the Royal Commission with reference to 160 „ Particulars of 100 consecutive Applications for mission to deposit bodies at 160 Coroners' Court: A Public Want 161 Disinfection 161 Houses Let in Lodgings, &c., The Law relating to 162 „ Regulations for, made by the Vestry 163 „ Procedure under Regulations, especially with reference to Registration 164 „ Unfounded apprehensions of Owners and Keepers of Houses let in Lodgings, with reference to effect of Registration 164 „ Instructions to Sanitary Inspectors with reference to Inspection of 165 Housing of the Working Classes : Report of the Royal Commission; Housing of the Working Classes (England) Act, 1885; Public Health (Metropolis)Bill, 1885 165 Water Supply, Abstract of Report on, by Professor Frankland 166 „ „ „ „ The Water Examiner 171 „ „ Deterioration of, in Dirty Cisterns 177 „ „ Waste Pipes of Cisterns: Medical Officer of Local Government Board recommends Abolition of 178 „ „ Communications addressed by the Vestry to the Local Government Board, to the Vestries and to the Companies with reference to 178 Gas, Results of Examinations for ascertaining the Illuminating Power and Purity of the 180 „ Supply of, for Street Lighting 182 „ Excessive pressure complained of 182 Conclusion 183 8 APPENDIX. STATISTICAL AND OTHER TABLES. Table I. Estimated Population in 1886, and ten previous years, page 1876-85; Number of Inhabitated Houses, and of Marriages, Births, Deaths, &c. 187 ., II. Birth Rate and Death Rate; Death Rates of Children; Deaths in Public Institutions, in 1886 and 1876-85 188 „ III. Deaths Registered from all Causes in 1886 189 „ IV. Deaths from the Seven Principal Zymotic Diseases; and from Pulmonary Diseases; Tubercular Diseases; Wasting Diseases of Infants, and Convulsive Diseases of Infants: Gross and Proportional Numbers 191 ,. V. Deaths in 1886, and in 1876-85, from the Seven Principal Zymotic Diseases: in the Parish, in the Metropolis, and in England and Wales 192 „ VI. Summary of Inspectors' Reports of Sanitary Work completed in the year 1886-7 192 „ Via. Summary of Monthly Returns of Work done by the Sanitary Inspectors in the year 1886-7 194 „ VII. Death Rates, General and Zymotic; Kensington and London; and Proportion of Deaths from Zymotic Diseases to Total Deaths, in 1886 and 10 previous years 195 „ VIII. Comparative Analysis of the Mortality in London and Kensington in 1886; Percentage of Deaths under one year to Births registered; and percentages of deaths, under one year, and at 60 and upwards, from the principal Zymotic Diseases, and from violence; of inquest cases, and of deaths at public institutions, to total deaths 196 „ IX. Localities where fatal cases of the more important of the Zymotic Diseases occured in 1886 197 ., X. Vaccination Officer's Annual Return (1885) 199 .. XI. Slaughter-houses, Licensed : and name of Licensees 200 XII. Cowsheds „ „ 201 THIRTY-FIRST ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH, BEING FOR THE YEAR 1866. To the Vestry of the Parish of St. Mary Abbotts, Kensington. Gentlemen, The vital statistics in the following report are for the registration year ended January 1st, 1887, and the sanitary statistics are for the parochial year ended March 25th, 1887. The vital statistics are calculated upon an estimated population of 173,500, a total arrived at on data furnished by the census of 1881, corrected as far as practicable by the number of inhabited houses at the middle of 1886. The deaths registered were 2,756, being 12 below the actual number in 1885, and 259 below the decennial average, corrected for increase of population. The death rate (15.9 per 1,000) was 0.2 below the rate in 1885, and 1.4 below the decennial average. It was 4.0 below the rate in London, as a whole (19.9), and 3.4 below the rate in England and Wales (19.3). But while the death rate in Kensington shows a decrease of 0.2 per 1,000, as compared with 1885, the death rate in London shows an increase of 0.2 above that in 1885, which was the lowest, on record. The rate in England and Wales (19.3) shows a rise of B 10 0.3 per 1,000, compared with 1885; but with the two exceptions of 18.9 in 1881, and 19.0 in 1885, was the lowest recorded in any year since civil registration began in 1837. The subjoined table shows the annual death rate per 1,000 persons living, in each of the last eleven years, in Kensington, in London, as a whole, and in all England:— Death Rate. 1886. 1885 1884. 1883. 1882. 1881. 1880. 1879. 1878. 1877. 1876. Kensington 15.9 16.1 15.1 15.5 16.2 16.6 17.8 18.8 20.2 17.3 19.5 London ... 19.9 19.7 20.3 20.4 21.4 21.2 21.7 22.6 23.1 21.5 21.9 W. Districts 19.2 19.2 19.2 19.5 19.9 19.6 19.8 20.9 21.6 19.2 20.9 North „ 18.1 18.5 19.1 19.1 19.7 20.6 20.8 21.5 22.0 21.5 22.1 Central „ 23.6 23.0 23.8 23.2 23.9 23.2 23.4 26.0 25.1 24.2 24.1 East „ 23.3 22.5 23.0 24.1 25.3 24.2 24.3 25.5 25.0 24.5 23.9 South ,, 19.1 18.5 19.8 19.4 20.7 20.5 21.3 21.8 23.0 20.5 21.2 England & Wales 19.3 19.0 19.6 19.5 19.6 18.9 20.5 20.7 21.6 20.3 20.9 The Registrar-General, in his "Annual Summary of Births, Deaths, and Causes of Death in London," speaks of 1886 as "a year of remarkably low rates; the marriage rate being the lowest on record, the birth rate the lowest since 1850, and the death rate (19.9) lower than in any previous year, excepting 1885" (19.7). He adds that the "marked decline in the death rates of recent years," for the decline has been continuous since 1882 (21.4), " has been doubtlessly in some part due to the decline in the birth rate, which must have materially diminished the proportion of children under five in the total population. Had the birth rate in the successive five years 1882-86 been equal to the birth rate in the ten years 1871-80, there would have been, as nearly as can be estimated, some 50,000 more children under five living in 1886, and as the mortality in this first life-period is high, the general death rate would have been raised, and at a rough estimate, would have been about 20.4 instead of being as it was 19.9. It would still, therefore, have been exceptionally low." In a table appended to the above observations, the Registrar-General shows diminution or excess of deaths in 1886, compared with annual deaths in 1876-85, corrected for increase of population, from which we learn that there was a marked diminution in the number of deaths from all the principal zymotic diseases, diarrhœa diseases excepted, and a diminution in deaths, 11 among other causes, from erysipelas (161), phthisis and tubercular diseases (1,195), diseases of nervous system (759), diseases of respiratory system (665), and "all other causes" (1,161), the total diminution being 8,178. On the other hand, there was an excess under six heads—viz., diarrhoeal diseases (720), cancer (194), premature birth (218), diseases of circulatory system (742), diseases of urinary system (203), and suicide (36). The excess (2,113) being deducted from the diminution, a balance of diminution and excess shews a net diminution of 6,065. It is shewn further that as regards cancer, premature birth, diseases of the circulatory system, and diseases of the urinary system, the increased mortality has been continuous for some years, not in London only but throughout the country generally. The increased fatality of diarrhoeal diseases is accounted for by "the hot weather that prevailed through the summer, the mean temperature for each month from July to October inclusively having been considerably above the previous average." So with regard to the diseases which shew diminished mortalities; "here, also, most of the changes are not peculiar to the year 1886, but are parts of a change that has been going on for a considerable time," for, in regard to 11 out of 17 causes named, "there was also a diminution in each of the three preceding years—viz., under scarlet fever, typhus, simple continued fever, enteric fever, erysipelas, phthisis and tubercular diseases, diseases of the nervous system, diseases of the respiratory system, accident, murder. This persistency of decrease," it is added, "affords fair grounds for expectation that the diminution under, at any rate, some of these headings will be permanently maintained." The death rate in the "Outer Ring" of Suburban Districts, with a population slightly exceeding a million persons, "did not exceed 17.0, and was 0.5 below the rate in the preceding year." The rate in twenty-seven large towns, excluding London, having an aggregate population close on four millions, was 20.1, ranging between 17.1 in Brighton, and 28.9 in Preston, without correction for differences between one town and another in regard to the age and sex distribution of their respective populations. B 2 12 With such correction, Brighton shews a death rate of 17.6, and Preston one of 31.1. In fifty other Town Districts of considerable size, and containing in the aggregate a population of nearly three millions, the death rate was 19.9 per 1,000, and exactly the same as that of London—the recorded death rates ranging from 14.7 in Gloucester, and 14.8 in Hastings, to 26.5 in Merthyr Tydfil. The death rate in England and Wales as a whole was, as already stated, 19.3 per 1,000. In twenty-four of the largest European cities, having an estimated population of more than ten millions of persons, the mean rate of mortality was 27.2 per 1,000, and exceeded by 6.3 the mean rate in the twenty-eight largest English towns dealt with, and having an aggregate population of over nine millions. The lowest death rates were 21.4 in Christiania, and 21.9 in Stockholm; the rates in the other towns ranged upwards to 35.0 in Marseilles, 37.8 in Buda-Pesth, and 38.0 in Trieste. The rate of mortality in Paris was 24.6 against rates ranging between 28.6 and 23.5 in the five preceding years, and exceeded by as much as 4.7 per 1,000 the rate recorded in London. Having premised so much by way of general introduction, it will be well, before proceeding to deal with the statistics of our own parish, to say a few words with respect to the REGISTRATION DISTRICT AND SUB-DISTRICTS, in which we are locally interested. "Kensington," prior to 1st January, 1885, was the title of a. Registration District, No. 1 on the Registrar-General's list, comprising the parishes of Kensington and Paddiugton. Since that date the parish of Kensington has been constituted a separate Registration District, and is numbered 1b. It contains 2,190 acres according to the Registrar-General; but in your Vestry's Annual Report the area is given as 2,245 acres. In 1871 the 18 enumerated houses were 15,735, in 1881, 20,103: increase, 4,368. In 1871 the population was 120,299; in 1881, 1(53,151: increase, 42,852. At the middle of 1886 the inhabited houses were some 21,500 and the estimated population 173,500. Registration Sub-Districts.—For registration purposes the parish is unequally divided into two sub-clistricts, "Kensington Town," hereinafter for brevity designated "Town," and "Brompton." The Town sub-district comprises an area of 1,497 acres, the area of Brompton being 693 acres. The population of the Town sub-district at the middle of 1886 was about 127,800, and that of Brompton 45,700. The Town sub-district still includes some open spaces, as Holland Park and Xotting Barn Farm. The Brompton sub-district, in which the builder has been busy 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: the Kensal Green Cemetery is in the Town sub-district. These cemeteries, it is to be regretted, are still in active use. The sub-districts present marked differences, which must be borne in mind in any comparison of their vital statistics. In Brompton the rich and well-to-do form a large proportion of the population, whilst in the Town sub-district there is a considerable and probably an increasing percentage of persons of the poorer classes. The poor in Kensington, however, are better off in one respect than the poor in some other parts of the Metropolis, in that, for the most part, they live in houses fairly well-built and obviously intended for occupation by the lower middle class; miles of streets of such houses being now inhabited by persons of a class who in some of the older parts of the Metropolis live in dwellings that by comparison might be termed "squalid." 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. 14 Name of Ward Area in Statute Acres. Inhabited houses. Increase in 10 years. Population. Increase in 10 years. 1871. 1881. 1871. 1881. St. Mary Abbotts 846 4,781 6,573 1,792 35,696 48,831 13,135 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 as follows:—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 for the first and second wards, which cannot now be given separately, show a rateable value of £1,078,512 (increase, £507,804); the rateable value of St. John and St. James being £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 1881 163,151 1.580,216 1881 1886 (July) 173,500 1,846,647 (April) 1887 SUMMARY OF VITAL STATISTICS, &c. The year 1886, regarded from the health point of view, was a satisfactory one, the rate of mortality having been, as already stated, 2.0 per 1,000 below the decennial average, and 0.2 below the rate in 1885. In eleven of my four-weekly reports, I had to record a rate lower than the decennial average (vide Table at page 23). In two months only was the rate above the average— viz., 0.1 per 1,000 in February, and 4.5 per 1,000 in March; the rate in the latter (23.2) being the highest in the year, and due to seven weeks of continuous cold weather, which had the effect of largely augmenting the number of deaths of aged persons, and of persons at all ages from diseases of the respiratory 15 system. The mortality from the principal diseases of the zymotic class was also considerably below the average, and this is true of every one of the diseases excepting diphtheria, which was slightly in excess. There was not one death, moreover, from small-pox or typhus fever, and only 11 from scarlet fever, and the same number from enteric fever (vide Table at page 22). The death rate in the first four weeks of the registration year (ended January 30th) was 18.6 per 1,000 persons living, and 2.0 below the decennial average; it was also 4.0 below the Metropolitan rate, this in turn being 1.6 below the average. The deaths from the principal diseases of the zymotic class were 15 only, and 13 below the corrected decennial average. Measles was the cause of 7 deaths. One non-fatal case of small-pox, probably imported, was recorded. This disease was at low ebb in London, only 18 cases having been admitted at the Asylums Board Hospitals in the four weeks, and only 22 cases being under treatment at the end of January. The mean temperature of the air was 35°.2 Fahr., and 2°.6 below the means in the corresponding weeks in the previous ten years. In the second four-weekly period (5th-8th weeks, January 31st to February 27th) the death rate rose to 19.1 per 1,000, and was 0.1 above the average, but 5.4 below the Metropolitan rate, this being 0.2 below the average. The deaths from the principal diseases of the zymotic class were 28, and included 8 from measles, and 12 from whooping cough. The mean temperature was 34°.0, and 7°.2 below the average. Probably it was the coldest February on record; nevertheless, the rate of mortality in the Parish, and in the Metropolis as a whole, was not above the decennial average. In the third period (9th-12th weeks, February 28th to March 27th) the rate of mortality further rose to 23.2 per 1,000—the highest in 1886—being 4.5 above the decennial average, but 5.0 below the Metropolitan rate, which was 5.1 above the decennial average. The deaths from the principal diseases of the zymotic class were 25, the same as the corrected decennial average. Seventeen of these deaths were due to whooping cough, and 6 to measles. The 16 mean temperature was 38°.3, and 3°.7 below the average. In the first of the four weeks the deficiency was 9°.0, in the second week 10°.6, and in the third week 4°.5, while in the fourth week the temperature was 9°.0 in excess. The effects of seven weeks of continuous cold were painfully visible in the rise of the death rate, due to an excessive fatality from diseases of the respiratory organs, especially among aged persons and young children. These diseases were the causes of 119 deaths in the four weeks, or 40 in excess of the corrected decennial average. The deaths of persons at 60 and upwards were 102, the corrected average being 66 only. One hundred and six children died under the age of five years. In the Metropolis, as a whole, it may be added, the deaths from diseases of the respiratory organs in the four weeks were no fewer than 1,317 in excess of the corrected average. It will be seen that in subsequent months a low rate of mortality prevailed, consequent on what may be described as the premature cutting-oil* of many lives that would have gradually passed away under more normal conditions of winter temperature. In the fourth period (13th-16th weeks, March 28th to April 24th) the rate of mortality fell (from 23.2) to 15.7 per 1,000, being 4.2 below the decennial average, and 4.3 below the Metropolitan rate, which in turn, again, was 3.9 below the average. The deaths from the principal diseases of the zymotic class were 28 (seven below the average)—viz., diphtheria 4, and whooping cough 19. The mean temperature was 46°.0 and 0°.9 above the average. The figures relating to mortality, as set out in my Report, contrasted very favourably with the corresponding figures in the previous Report, the deaths under five being 76, against 106; and the deaths at 60 and upwards being 66, against 102; while the deaths from diseases of the respiratory organs were only 44 as compared with 119. A similar improvement was shewn for the Metropolis as a whole in the weekly returns of the Registrar General. In the fifth period (17th-20th weeks, April 25th to May 22nd) the rate of mortality further declined to 15.2 per 1,000, being 1.2 below the decennial average and 2.9 below the Metropolitan 17 rate, which was 2.9 below the average. The deaths from the principal diseases of the zymotic class were 24 (two below the average), including 10 from whooping cough, the mortality from which had reached its highest point (19 deaths) in the previous month. In the month under consideration there were again four deaths from diphtheria; one of these occured in a house let furnished, which was found to be in an unsatisfactory sanitary condition. An infant and a lady sent from this house to the country subsequently sickened and died from diphtheria. The mean temperature was 51°.9, and 2°.7 above the average. In the sixth period (21st-24th weeks, May 23rd to June 19th) the rate of mortality further fell to 11.6 per 1,000 (the lowest recorded during the year), being 5.3 below the decennial average, and 3.9 below the Metropolitan rate, which was 3.7 below the average. The deaths from the principal diseases of the zymotic class were 11 only, and 24 below the corrected decennial average, the deaths from whooping cough being only 3. The mean temperature was 55°.3, and 0°.9 below the average. In the seventh period (25th-28th weeks, June 20th to July 17th), the rate of mortality rose to 12.8 per 1,000, being 2.4 below the decennial average, and 5.1 below the Metropolitan rate, this being 1.6 below the average. The deaths from the principal diseases of the zymotic class were 20 (19 below the average), measles, whooping cough, and diarrhoea being accountable for 5, 4, and 8 deaths respectively. The mean temperature was 62°.6, and 1°.1 above the average. In the eighth period (29th-32nd weeks, July 18th to August 14th) the rate of mortality further rose to 15.4 per 1,000, but was 1.7 below the decennial average, and 5.2 below the Metropolitan rate, which was 1.6 below the decennial average. The deaths from the principal diseases of the zymotic class were 40, but 18 below the average. Measles and whooping cough were the causes of 6 and 4 deaths respectively. Diarrhœa, which in the previous month had caused 8 deaths, was fatal to 27 persons, two at advanced ages, and 25 of children under five, including 21 infants under one year. The deaths attributed to diarrhoea and 18 dysentery in the Metropolis in the four weeks, were 1,424, and exceeded the corrected average by 230. Of these deaths, 1,117 were of infants under one year of age. The mean temperature was 61°.4 and 0°.7 below the average. In the ninth period (33rd-36th weeks, August 15th to September 11th) the rate of mortality fell to 14.0 per 1,000, being 0.2 below the decennial average, and 33 below the Metropolitan rate, this being 1.8 below the decennial average. The deaths from the principal diseases of the zymotic class were 33, and two below the average, 25 being due to diarrhœa, including 20 of infants under one year, and 3 between one and two years. A death from "cholera" (after 24 hours illness) was that of a boy aged 12, who had had severe diarrhœa attacks on former occasions, and who was alleged to have eaten an indefinite quantity of fruit, possibly unsound or unripe, prior to the fatal attack. The deaths from diarrhoea and dysentery in the Metropolis, in the four weeks, were 806, including 579 infants under one year, and exceeded the average by 130. Scarlet fever was prevalent in the Metropolis and was increasing: the admissions at the Asylums Board Hospitals in the four weeks were 196, and 400 cases were under treatment, September 11th, an increase of 130 compared with August 14th The disease was not virulent, the mortality being much below average. A non-fatal imported case of smallpox was recorded. Practically the Metropolis was free from this disease. The mean temperature was 62°.7 and 2°.7 above the average. In the tenth period (37th-40th weeks, September 12th to October 9th) the rate of mortality further fell to 13.1 per 1,000, being the same as the decennial average, and 3.8 below the Metropolitan rate, which was 1.0 below average. The deaths from the principal diseases of the zymotic class were 23 (three above the average), including 15 from diarrhœa, or six above the corrected decennial average. Eleven of the 15 deaths were of infants under one year, and three were of children between one and two years. The deaths from diarrhoea and dysentery in the Metropolis fell in the four weeks to 498 (compared with 1,424 19 and 806 in the two previous four-weekly periods), but were 198 above the average. Scarlet fever was still increasing in the Metropolis, the cases in the hospitals at the end of September being 461, and the admissions in the month 256. The mean temperature was 57°.6 and 2°.9 below the average. In the eleventh period (41st-44th weeks, October 10th to November 6th) the rate of mortality rose to 14.6 per 1,000, but was 0.6 below the decennial average, and 2.3 below the Metropolitan rate, this being 3.2 below the average. The deaths from the principal diseases of the zymotic class were 9, the smallest number recorded in 1886, and 14 below the average. Diarrhœa was the cause of five deaths. The admissions of scarlet fever cases in October (305) were higher than in any month during the seven previous years, having been most nearly approached in September, 1882, in which month the number of admissions was 250. The admissions of enteric fever cases during October were also higher than in any month since October, 1881: neither of these diseases, however, was prevalent in Kensington. Scarlet fever cases in hospitals on November 6th were 543, the admissions in the four weeks having been 273. The type of the disease was still mild, the weekly number of deaths (26) being 34 below the corrected decennial average. The mean temperature was 50°.2 and 2°.4 above the decennial average. In the twelfth period (45th-48th weeks, November 7th to December 4th) the rate of mortality further rose to 16.3, but was 1.3 below the decennial average, and 2.4 below the Metropolitan rate, this being 3.3 below the average. The deaths from the principal diseases of the zymotic class were 13, and 9 below the average. Diphtheria was the cause of five deaths. One death only was caused by diarrhoea. Scarlet fever cases in the Asylums Board hospitals were 571 on December 4th, as against 543 on November 6th, but the admissions in the four weeks were only 238 against 273 in the previous four weeks. The mean temperature was 41°.7 and 1°.2 below the average. The weather had been severe and foggy, and the accustomed results ensued—increased 20 mortality among aged people and among persons of all ages from diseases of the respiratory system. In the thirteenth and last period (49th-52nd weeks, December 5th to January 1st, 1887) the rate of mortality was again 16.3 per 1,000, being 1.9 below the decennial average, and 4.8 below the Metropolitan rate, this being 2.4 below the average. The deaths from the principal diseases of the zymotic class were 16 (nine below the average), including 9 and 5 from measles and whooping cough respectively. Scarlet fever was shewing symptoms of decline at this period, the cases in hospitals at the end of the year being 496, against 543 on November 6th, and 571 on December 4th; whilst the admissions in the four weeks were 162 only, against 278 and 288 in the two previous four-weekly periods. Neither in respect of cases or of deaths in Kensington was there any excess recorded in my several monthly reports. The mean temperature was 36°.4 and 2°.4 below the average, but notwithstanding the increased severity of the weather, the deaths from diseases of the respiratory organs (68) were not so numerous as in the previous month, when they were 70, including 50 from bronchitis. THE ZYMOTIC DISEASES. Before entering into details with respect to population, births, deaths, etc., 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's-General's arrangement of the "causes of death," six "Orders." The first and second Orders ("Miasmatic" and "Diarrhœa"), include the diseases which the Registrar-General describes as "the seven principal diseases of the zymotic class," grouping, as he does, under the generic term "Fever," the three distinct fevers, "Typhus," "Enteric," and "Simple Continued." These zymotic diseases have a high interest for sanitarians, arising out of the fact that they are admittedly of a more or less 21 preventible character; it being customary, moreover, to regard the absence or the prevalence of certain of them as a test of the sanitary condition of a district. But, without underrating the importance of this test, it must be said that there are limitations to its applicability to be borne in mind in drawing inferences from mere numbers. 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 the result of an excessive prevalence and fatality of the malady in the preceding years. In saying this, I must not be thought to ignore the fact that one epidemic of a zymotic disease may be more severe than another; or that the fatality of an epidemic disease may be influenced by the measures taken, or the neglect to take any measures, to check 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. In our own parish the large total of 185 deaths from this disease, in 1878, followed the minimum return of 34 in the previous year. Diarrhœa 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 1879 had no relation to the excessive mortality in 1878. The conditions were altogether different: the summer of 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 summer is hot and dry, as happened in 1878. Again, the significance of a high rate of prevalence of enteric fever varies widely in different circumstances. This disease may 22 be constantly present in a district as a result of drainage defects, or of a polluted water supply; whilst in another district its introduction may be wholly accidental, as when due to casual pollution of water, or to a specifically contaminated milk supply introduced from without. These and like circumstances must be kept in view if we would draw sound conclusions from a high or low rate of prevalence of zymotic diseases, particularly in relation to the sanitary condition of a district. Subject to corrections for local circumstances, for climatic influences, and for high rates in previous years, the concurrence of a low zymotic death rate, and of a low general death rate, furnishes just ground for satisfaction; and as the general rate and the zymotic rate were both below the average in Kensington in 1886, we are entitled to the enjoyment of that satisfaction. It need hardly be said that a persistently high rate of mortality from zymotic diseases furnishes matter for serious consideration. Kensington, as we shall see, has hitherto been fortunate in having a death rate from these diseases much below that of the Metropolis generally. The subjoined Table sets out necessary particulars of the mortality from the principal zymotic diseases in 1886, together with the decennial average, etc.:— Disease. Sub-Districts. In Hospitals. Total. Decennial Average. Uncorrected. Corrected for Increase of Population. Town. Brompton. Town. ton Small-pox — — — — — 25.8 27.9 Measles 50 6 - - 56 69.6 75.3 Scarlet Fever 3 5 1 2 11 47.6 51.5 Diphtheria 20 5 2 3 30 19.1 20.7 Whooping Cough 58 24 — — 82 95.8 103.7 Typhus Fever — — — — — 1.8 1.9 Enteric Fever 5 4 2 — 11 22.6 24.4 Simple Continued Fever - - - - - 4.6 4.9 Diarrhœa 72 18 — — 90 104.3 112.9 208 62 5 5 280 391.2 423.2 From the above Table we learn that the deaths from the "seven principal diseases of the zymotic class," which were 81 fewer than in 1885, were also 147 below the corrected decennial 23 average. As usual, the deaths in the Brompton sub-district (67) were fewer in proportion to population than in the Town subdistrict, but not to the same extent as in previous years. These deaths were equal to 101.6 per 1,000 deaths from all causes in Kensington (Metropolis, 135), and to a rate of 1.6 per 1,000 persons living (Metropolis, 2.7); the decennial average being 2.4 in Kensington, and 3'3 in London. In England and Wales the deaths from these diseases were, 117 in each 1,000 deaths; and the rate was 2.2 per 1,000 persons living, the decennial average being 2.8 per 1,000. In the 27 large Towns grouped by the Registrar-General with the Metropolis, the zymotic death rate was 2.9 per 1,000, ranging from 1.6 in Huddersfield to 5.6 in Preston; while in the 50 large Towns coming next in order of importance after the 27, it averaged 2.5 per 1,000, the highest rate (5.3 per 1,000), being recorded at St. Helens and Ystrodyfodwg. and the lowest rate (0.6) at Southport. The following Table shows the distribution of deaths in Kensington from the principal zymotic diseases registered in thirteen four-weekly periods, corresponding to my monthly reports:— PERIOD. DISEASES. Four weeks ended Small-pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Typhus Fever. Enteric Fever. Simple Continued Fever. Diarrhœa. Total. Jan. 30. 1886 ... 7 1 2 3 ... ... ... 2 15 Feb. 27, „ ... 8 3 3 12 ... 2 ... ... 28 Mar. 27. „ ... 6 1 1 17 ... ... ... ... 25 April 24, „ ... ... ... 4 19 ... ... ... ... 23 May 22 „ ... 5 1 4 10 ... 1 ... 3 24 June l9. „ ... 1 ... 1 3 ... 2 ... 4 11 July 17. „ ... 5 l 1 4 ... 1 ... 8 20 Aug. 14, „ ... 6 l 1 4 ... 1 ... 27 40 Sept. 11, „ ... 2 ... 3 2 ... 1 ... 25 33 Oct. 9, „ ... 3 2 2 ... 1 ... 15 23 Nov. 6, „ ... ... 1 2 1 ... ... ... 5 9 Dee. 4. „ ... 4 ... 5 2 ... 1 ... 1 13 Jan. 1, 1887 ... 9 ... 1 5 ... 1 ... ... 16 Totals ... 56 11 30 32 ... l1 ... 90 280 24 I now proceed to make a few observations with regard to each of the above-mentioned diseases. Small-pox, it will be observed, does not appear in the list as a fatal disease in 1886. Three cases, however, two in the Town sub-district and one in Brompton, were recorded, one of them being an imported case, treated in the patient's home, and the other two cases having been removed to hospital. The recorded cases in the two previous years were 177 and 181 respectively. Small-pox was very little prevalent in the Metropolis, as a whole, in 1886. The deaths were only 24, shewing a diminution of 1,194 deaths, compared with annnal deaths in 1876-85 corrected for increase of population. These deaths (24) were "fewer—not merely relatively to the population, but absolutely—than in any year since the present system of civil registration began; the years which most nearly approached this minimum being 1875 (46 deaths), 1874 (57 deaths), 1878 (113 deaths), and 1883 136 deaths). The mean annual mortality from this disease in the six years as yet elapsed of the current decennium was 0.24 per 1,000, and lower than in any previous decennium." The Registrar-General, from whose Annual Summary the preceding quotation is taken, states that London. "in spite of the disadvantage it suffers from its perpetually shifting population, and its comparative neglect of vaccination, has improved its position in regard to small-pox among the great towns since 1861-70. But the case is otherwise if London be compared with the aggregate provinces—i.e., the whole of England and Wales without London itself—for while the provincial rate has fallen very greatly, the London rate has lagged behind, so that the difference has become wider and wider." It having been suggested that this may be attributable to the opening of the Metropolitan Hospitals in 1871, the Registrar-General states that "an examination of the successive rates shows that the increase in the difference between the London and the provincial rates dates from a time long anterior to the opening of 25 the hospitals, and, if successive decennia be compared with their immediate predecessors, was indeed greater in the decennium 1861-70, which preceded the opening of these hospitals, than in 1871-80, the decennium which followed it. Whatever, therefore, may be the cause why London does not improve in its relation to small-pox to the same extent as the provinces, it is something that came into operation long before the hospitals were opened." Granting this, I have no doubt, in my own mind, that the diminution in small-pox mortality in the Metropolis, last year, was due largely to the perfected system of removing the sick direct from their homes to the Ship Hospitals, situated as these are outside the London registration District—a system which, as your Vestry is aware, was instituted upon my recommendation made to the Asylums Board and the Local Government Board in 1881. In evidence of the success of the Asylums Board in effecting the removal of the sick from London, it may be mentioned that 19 of the 24 deaths from small-pox occurred at the Hospital Ship at Dartford. Of the remaining five deaths, two occurred at the London Small-pox Hospital at Highgate, and three only in private houses—viz., one each in Marylebone, Camberwell, and Deptford. The Hospital Ship "Atlas," it may be mentioned, was in use throughout the year, but the patients in the latter half of the year were few in number. Measles.—The deaths in 1886 from measles were 56 (six only in Brompton), or just half the number recorded in 1885, and 19 below the corrected decennial average. Fifty-two of the deaths occurred under five years, including 7 under one year. The disease appears to have prevailed in a moderate degree throughout the year, seeing that in two only of my thirteen four-weekly reports, it did not appear as a cause of death. In the majority of the fatal cases, some intercurrent disease—of the respiratory organs usually—complicating the original malady, was the immediate cause of death. Comparatively little care is taken by parents among the poorer classes to prevent spread of measles: not regarding it as a serious disease, and considering it inevitable as 26 teething, they naturally enough hold it to be less trouble, in the long run, if all the children have the complaint at one time. It must be allowed, however, that it is difficult to prevent measles from spreading, the disease being highly infectious from an early stage, if not from the commencement of the attack. The circumstances, moreover, in which the poor live in London—two or more families generally occupying one house and using a common staircase—almost preclude the possibility of isolation. But more care might be taken to protect the sufferers against secondary affections, which, as already stated, are, as a rule, the immediate causes of death. The London mortality from measles was somewhat below the average of the previous decennium, but, as the Registrar-General tells us, the fall was "not much more than could be explained by the diminished proportion of children under five in the population, owing to the continuously low birth rate." Scarlet Fever.—This disease, which was the cause of seven deaths only in 1885, proved fatal to eleven persons in 1886—seven of them in the Town sub-district. Of the eleven deaths three occurred in hospitals, to which 63 out of 100 recorded cases were removed for treatment. Of the 100 cases 42 belonged to North Kensington—viz., that part of the parish north of Uxbridge Road; and 58 to South Kensington—the remainder of the parish south of that road. The recorded cases in the three preceding years respectively were 231, 202, and 110. In 1884 the cases in North and South Kensington respectively were 75 and 127; in 1885 they were 42 and 68, so that in each of the last three years the disease appears to have been most prevalent in the southern half of the parish. As usual, the occurrence of the disease was concealed in several instances until recovery had taken place, and the cases were then reported only with the object of obtaining disinfection at the public expense. In other cases, when the existence of the disease became known at an early period, parents refused to allow their children to be removed to hospital. A certain number of home patients were, to all appearance, 27 properly isolated, and the removal of them to hospital was deemed unnecessary; but proofs were not wanting that, even when the sufferers had what might be fairly described as "proper lodging or accommodation," due care could not have been taken to prevent spread of the disease; unless, indeed, it be the fact that no amount of care suffices to prevent it from spreading when once it has found admittance into a family of susceptible persons. In not a few instances, when removal was obviously necessary to security, the greatest difficulty was experienced in obtaining the parents' consent, but in no case was recourse had to the compulsory powers of removal, such as they are, which the Sanitary Act of 1866 confers. The cases were generally of children of school age. No child was knowingly allowed to go to school from an infected house. The existence of the disease was revealed occasionally by the registration of a death, and its spread was not seldom the result of keeping patients at home under circumstances that rendered nugatory any attempt at isolation. The following cases are cited as illustrations of modes of spread of scarlet fever, and as evidence of the necessity for an Act providing for the notification of Infectious Disease:— A child fell ill in November, 1884; the illness was concealed with the result that, one after another, every member of the family, man, wife, and three children, were attacked; but the illness was not disclosed until the middle of January, and then only upon the registration of the death of a child, the fourth case in order of attack. A death was registered in January from Laryngitis. It turned out that the child had really had scarlet fever, and six other cases in the same family immediately following were removed to hospital. Seven cases occurred in one family, all of the children save one, at ages ranging from 24 downwards. The first case was that of a child who had attended a day school in another parish. Two of the seven cases proved fatal 28 at home, and two cases were removed to hospital. Two other pupils in another family had been previously removed to hospital suffering from scarlet fever, and subsequently two more pupils belonging to a third family were attacked. A child being taken ill, was allowed to mix freely with the children of another family in the adjoining house, the result being that all of them, four in number, contracted the disease. In three cases, in as many families, scarlet fever was contracted at the seaside and imported into the parish. A case, recorded in October, was the child of a School Board visitor, and there appeared to be good grounds for suspecting that the father's clothing had been the medium of infection, he having had occasion, in discharge of his official duties, to visit at houses where the disease existed. The child was treated at home, and the visitor was relieved from duty until the medical attendant was able to give him a clean bill of health. The School Board, I may mention, do not allow children to attend school from houses where scarlet fever exists, even though there be no illness in the families to which the excluded children belong, and naturally therefore they do not allow a visitor to be on duty while there is infectious illness in his family. It may be doubted, however, whether it would not be to the public advantage to find a temporary lodging for the visitor in such a case rather than let him remain at home idle for so many weeks, supposing he is, as in the above case, unwilling to avail himself of the means of isolation provided at the public expense. Scarlet fever was to a certain extent epidemic in London, in the latter part of the year, but it did not assume a severe type, and the deaths were 688 only, or 1,452 fewer than the decennial average, corrected for increase of population. These deaths give a rate of 29 017 per 1,000 living, and in the preceding year the rate was only 0.18—rates far lower than those previously recorded. "The great decline in the mortality from this disease in 1885 and 1886," we are told by the Registrar-General, "was not peculiar to London, but was shared by the whole of England and Wales, but not in an equal degree; for the London rate was again below that of the rest of the country as has very commonly been the case in late years." The suggestion that the "comparative immunity of London from scarlet lever may not impossibly be due to the greater amount of provision it enjoys for isolation by means of public hospitals, and the increasing use made of such means of isolation, finds further support in the increased proportion borne by the hospital deaths to the total mortality." This proportion has risen from 7 per cent. in 1878 to 22'7 in 1886. The decline in scarlet fever mortality in 1885-86 was due partly to a "diminished prevalence of the disease, and partly to the disease having assumed a milder form," a conclusion inferred from the "diminution of the case-mortality in the hospitals," which, 111 per 1,000 in 1880, fell in 1885-86 to 81 and 84 respectively, a fall of 21 per cent.; the death rate from it having fallen by 78 per cent. It has been mentioned that the admissions of scarlet fever cases during the month of October (305) were higher than in any month during the past seven years, having been most nearly approached in September, 1882, in which month the number of admissions was 250. As a consequence, the Managers, at their meeting on November 20th, authorised the Ambulance Committee to make, if necessary, additional accommodation for fever patients by the re-opening of either of the hospitals then closed, or by such other means as they might deem expedient; but the necessity did not arise. SCARLET FEVER DISSEMINATED BY MILK OF DISEASED COWS. In my last Annual Report, I stated that scarlet fever had recently acquired a new interest for sanitarians as the result of 30 an outbreak in certain districts in London and at Hendon, enquiry into which had led Mr. W. H. Power, Medical Inspector to the Local Government Board, to believe that the disease might be of bovine origin; and, after describing the symptoms of the cow disease which was the supposed cause of the outbreak, I mentioned that the services of Dr. Klein had been called in, and that that gentleman was engaged in a study, at the Brown Institution, of the pathology of the disease. Dr. Klein's report strongly supports the views expressed by Mr. Power, which, moreover, approved themselves to Dr. George Buchanan, the Medical Officer to the Local Government Board, who in his report on the subject remarks that:— "In its own province, Dr. Klein's report is as important and interesting a.s Mr. Power's, and its more immediate significance lies in the complete harmony between the conclusions obtained from Mr. Power's etiological researches, and the influences, as to communicability and other characters of the Hendon cow-disease, that follow from pathological enquiry. By the inoculation into calves, either directly of the discharges from cow-ulcers, or indirectly of sub-cultures of those discharges artifically prepared, Dr. Klein has succeeded in producing now local, now general disease in the calf; disease having unmistakable affinities, under some conditions, with the Hendon cow-disease; under other conditions, with scarlatina in the human subject:—on the one hand, ulcers on the skin of the calf anatomically identical with the ulcers on the teats of milch cows; on the other hand, general disease in the calf, at first of inconspicuous nature, but passing on to serious changes in the internal organs, more particularly in the kidneys of the calf; the more characteristic of these changes being anatomically identical with those resulting in the human subject from the operation of the scarlatina poison." It may be added that Dr. Klein, after complete study of the cow-disease, found that "as regards the feeding capacity of affected animals—their milking power, and their body temperature, nothing abnormal could be detected;" and herein lies a danger to the public, inasmuch as it will be difficult to satisfy cowkeepers that there can be anything serious the matter with cows in such circumstances; so that they will be likely, until instructed and convinced, to continue to mix and sell the milk of cows affected with the specific contagious disease in question, in ordinary course of 31 business, despite the provision in the Dairies Order which is directed to prevent the milk of diseased cows being mixed with other milk, or sold or used as human food. Singularly enough, however, Dr. Klein's investigations appear to prove that the milk itself, as found in the cow's udder, is not infective. The germs which produce the human disease appear to be carried down to the pail in the act of milking, by pressure of the milker's hands on the sores on the teats, in the form of scales and exuded lymph; just as the "peeling" skin of the hands of a person convalescing from scarlet fever might be rubbed off, in the act of milking, and fall into the pail, and so give rise to scarlet fever in consumers of the unboiled milk. Once in the pail the infective matter—whether derived from the cow, in the one case, or from the milker, in the other case—finds in the milk a fluid adapted for the "cultivation," or multiplication by development and growth, of the specific organism, a small quantity of which, from a single cow, may suffice to contaminate the mixed milk of a dairy, and to infect great numbers of susceptible persons. It is quite unnecessary to expatiate on the importance of the subject, and it is satisfactory to know that the Medical Officer to the Board proposes that a portion of the grant annually made by Parliament for the scientific purposes of the Board shall be allotted to further study of the relations that exist between human scarlatina and diseases of animals. We can all concur, moreover, in the view of Mr. Power and Dr. Klein's reports, expressed by Dr. Buchanan, that "they will properly form a starting-point for fresh observation and experiment by all who have the opportunity of investigating the new and promising fields of research that are opened by the recent experiences of Hendon." The connexion between localised outbreaks of scarlet fever and the consumption of milk had been well established by repeated experiences, but previous to Mr. Power's enquiry the dissemination of the disease, through milk, had been attributed to the contamination of the milk by the introduction of scarlatina poison of human origin, either from the milker's hands or by 32 absorption when the milk had been stored in an infected place —a condition of things entirely different to that prevailing at Hendon, where there was no suspicion of scarlatina among the employes at the Dairy, and where the sanitary arrangements appear to have been quite satisfactory. It may be asked, then, how are we to guard against the spread of scarlet fever if it be true, as there is good ground for suspecting, that the disease of the cow in the Hendon outbreak was related to that of man as cause is to effect? Well, consumers may make themselves secure by following the oft-repeated advice to boil their milk. For the rest, we must trust to the good sense of milk producers, who in these days, when sanitary knowledge is permeating all classes, may be expected to take an increasing interest in the preservation of the health of their stock; and, above all, to the strict performance of their duty by Local Authorities and their officers, who are responsible for the due carrying out of the provisions of the Dairies, Cowsheds, and Milkshops Order, which enable them to "make regulations for prescribing precautions to be taken by purveyors of milk against infection or contamination," and which enacts that "if at any time disease exists among the cattle in a dairy or cowshed the milk of a diseased cow therein—(a) shall not be mixed with other milk, and (6) shall not be sold or used as human food." After the report was in type, I received from the Agricultural Department of the Privy Council Office, a Report by Mr J. Wortley Axe (Professor of Pathology at the Royal Veterinary College, and Consulting Veterinary Surgeon to the British Dairy Farmers' Association) dealing with the eruptive cow-disease referred to, in which reasons are advanced for doubting whether the disease has the relation to human scarlatina which Mr. Power's inquiry and Dr. Klein's study of the pathology had led them to entertain. Professor Axe's report, which bears the imprimatur of Professor Brown, Professional Officer of the Department, treats of the malady as being at once common, well 33 known among farmers, and innocuous. The facts cited are intended to prove that the milk of other dairies infected by cows from the same herd as those which infected the Hendon cows, was supplied to the public, at the same time, and in various localities, in ordinary course of trade, without any evil effect (but, it may be added, contrary to the provisions of the Dairies Order cited above). The conclusion arrived at, therefore, is that the London epidemic of scarlatina in December, 1885, due doubtless to the consumption of the Hendon milk, "had its origin in some obscure source connected with the Dairy by channels which inquiry has failed to reveal." But it must be added that Professor Axe does not appear to have seen the incriminated herd, his inquiry having been made after the period in question, and his conclusion deduced from the statements of persons who may not unfairly be regarded as parties interested in minimising the gravity of the conclusions arrived at by Mr. Power and Dr. Klein. And what is even more strange, considering Professor Axe's professional position at the Veterinary College, he does not refer to the pathology of the cow-disease, which, however, he admits to be contagious, and to have the power of protecting its victims from a second attack. Mr. Power and Dr. Klein admittel all that the Professor now asserts of the apparently harmless character of the malady as it affects the cow—absence of constitutional disturbance, etc.—but while Dr. Klein shows that the inoculated disease in calves is followed by pathological changes in the viscera identical with those found in fatal human scarlatina, Professor Axe is silent on the point. The disease, "eruption of the the teats," he states, is spoken of among the dairy-farmers (but can it be the same disease?) as "cow-pox"; it is transmissible to man, by inoculation, in the form of vesicles (vaccinia), but is" incapable of communicating scarlatina or other epidemic fever." Professor Brown states truly in his letter to the Lords of the Council, introducing Professor Axe's report, that "the last link in the chain of argument, constructed by Mr. Power and Dr. Klein," viz., proof that inoculation with the matter from the ulcers of the cow-disease will produce human scarlatina, is wanting. 34 Nevertheless, it will probably be accepted as a fact, by the medical profession, until stronger disproof than any Professor Axe has at present supplied, that the cow-disease at Hendon caused the scarlatina epidemic of December 1885, which furnished the occasion for Mr. Power's enquiry. Diphtheria, which was the registered cause of 22 deaths in 1885, was fatal to 30 persons last year; 22 in the Town subdistrict and 8 in Brompton, the corrected decennial average number being 20.7. Twenty of the deaths occurred among children between 1 and 5 years, and only three of them at ages above 15. Five of the deaths took place in general hospitals. In two instances the cause of death was not registered as diphtheria, the nature of the disease not having been recognized until a second illness in the same family, unmistakably diphtheritic, threw light on the nature of the previous case. In regard to London as a whole, I had to report that in 1885 the mortality from diphtheria was in excess: the deaths were 896. Last year the deaths from this cause were only 846, and 87 below the corrected average. In Kensington the mortality from diphtheria has been increasing for some years, and in 1886 the deaths (30) were more numerous than in any year in the preceding decennium (vide Table V., Appendix). I cannot account for this increase, which, however, may possibly he apparent rather than real, and due to greater accuracy in diagnosis. This explanation seems the more probable, as the disease has not hitherto exhibited any tendency to spread or become epidemic. Diphtheria was the only one among the principal diseases of the zymotic class which shewed a mortality in excess of the corrected decennial average. One case only, so far as I am aware, was imported—viz., from a town in the Isle of Wight, where, in the autumn, there was a sharp outbreak. It is probable that some of the cases registered as diphtheria were really cases of croup, or even of scarlatina anginosa. But against such cases must be placed certain cases of diphtheria not recognized as such, of which we had instances. Sometimes the specific character of an apparently simple throat affection does not become apparent 35 until paralysis supervenes, this being one of the more serious sequels of diphtheria. I subjoin a list of the fatal cases, which are nearly all the cases of which we possess any information. Such information, moreover, as we do possess fails to throw any satisfactory light on the question of origin of the several cases. Daughter of an auctioneer, aged 21 months. Certified as Membranous Croup. Daughter of an auctioner, aged 3½ years. Died at Westminster Hospital. Certified as Diphtheria. Son of a coachman, aged 6 years. Son of a laundryman, aged 3 years. Daughter of a carpenter, aged 1 year. Died at St. Mary's Hospital. Daughter of a draper, aged 3 years. Carman, aged 26 years. Son of a fruiterer, aged 2 years. Son of a schoolmaster, aged 13 months. Certified as " Ulceration of the Throat and Suffocation." Son of a schoolmaster, aged 3 years. Son of an Indian civil servant, aged 2 years.* Coachman, aged 50 years. Son of a labourer, aged 3 years. Died at King's College Hospital. Son of a coachman, aged 2 years. Daughter of a captain, H.M.S., aged 8 years. Son of a hairdresser, aged 2 years. Died at King's College Hospital. Son of a solicitor's clerk, aged 3 years. Died at St. George's Hospital. Son of a plumber, aged 12 years. Son of a lodginghouse-keeper, aged 6 years. Daughter of a carpenter, aged 4 years. † * From the house where this death occurred, I was informed that an infant and a lady were sent into the country for safety. Both subsequently sickened and died of diphtheria. The house was found on inspection to be in an unsatisfactory sanitary condition. It had been taken as a furnished house. † There were three other non-fatal cases in the family. The existence of the disease became known upon registration of the death. 36 Daughter of a Knight, aged 16 years. Daughter of a coachbuilder, aged 4 years. Daughter of an upholsterer, aged 6 years. Daughter of an Irish peer, aged 10 years. * Daughter of a licensed victualler, aged 3 years. Daughter of a tobacconist, aged 3 years. Daughter of a fruiterer, aged 4 years. Daughter of a tailor, aged 19 months. Son of an engine driver, aged 5 years. Son of a cabman, aged 3 years. Hospital Provision for Diphtheria.—Reference was made above to the fact that five of the 30 deaths from diphtheria took place in General Hospitals. The cases had been removed to the hospitals in question, simply because the Managers of the Asylums Board are not authorised by the Order of the Local Government Board to admit to their hospitals persons suffering from this disease. The Managers being willing to receive such cases, and applications for their admission having been made to them from time to time, they put themselves into communication with the Local Government Board on the subject. The Board, doubting its power under the Metropolitan Poor Act, 1867, to authorise the Managers to admit cases of diphtheria, consulted the Royal College of Physicians with regard to the question Whether persons suffering from diphtheria cm be regarded as patients suffering from "fever" within the meaning of section 69 of the Metropolitan Poor Law Act, 1867? and the opinion of the President of the College, Sir William Jenner, was given in the following terms:— "If the words in the Act had been 'for patients suffering from fevers,' I should most certainly have considered Diphtheria to be included under the term 'Fever,' but the separation of Small-pox from Fevers seems to signify that the word 'Fever' was intended to include only fevers of a special type, those cases, that is to say, to which the word 'Fever' is specially applied, as Scarlet fever, Typhus fever, and Typhoid fever." In these circumstances it appeared to the Local Government Board to be desirable that, if cases of Diphtheria were to be admitted to * An imported case from the Isle of Wight. 37 the Fever Hospitals of the Managers, there should be express legislation for the purpose, and the Board stated that the question whether legislation on the subject should be proposed would receive their consideration. That such consideration should result in legislation for the purpose is much to be desired, it being often difficult to obtain admittance at General Hospitals for patients suffering from diphtheria, however necessary removal may be for the sake of the patients and of other inmates of the same room or house. Whooping Cough, the cause of 98 deaths in 1885, proved fatal in 1886 to 82 children, all under five years of age, and 35 under one year:—58 in the Town sub-district, and 24 in Brompton; the corrected decennial average being 103. Sixty-one of the deaths were registered during the first 20 weeks of the year, the remaining 21 deaths being spread over 32 weeks. Reference has already been made to the indifference of parents in regard to the spread of measles in their families. The observation is perhaps even more generally applicable in regard to whooping cough; the danger of this always distressing malady being unappreciated by the poor, who, in the engrossing battle of life, pay scant attention to an ailment which they deem at once inevitable and seldom dangerous. Often enough, when the disease ends fatally, the event comes as a surprise, due, as it commonly is, to some secondary disease—of the respiratory organs, or of the nervous system—for few deaths are registered from whooping cough alone. These secondary diseases cannot always be prevented; but the occurrence of bronchitis or pneumonia, for instance, is often owing to want of care in the management of the sufferers. The little ones are not, perhaps cannot be, confined to the house, even in winter; 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. As in the case of measles, the London mortality from whooping-cough was somewhat below the average of the previous decennium, but the fall was not much more than could be 38 explained by the diminished proportion of children under five in the population, owing to the continuously low birth rate. Fever.—No death was registered either from Typhus Fever or from Simple Continued Fever, while the deaths from Enteric Fever were only eleven in number—one more than in 1885, and less than half the corrected decennial average (24.4). Seven of the deaths were registered in the Town sub-district, and four in Brompton. Two of the deaths took place in hospitals, to which thirteen patients were removed. The recorded cases were 24; twelve in North Kensington and twelve in South Kensington, the Uxbridge Road being the dividing line. The deaths in London from enteric fever in 1886, shew a diminution of 320, compared with annual deaths in 1876-85, corrected for increase of population. But the disease appears to have been prevalent beyond the average in the autumn, inasmuch as the admissions at the Asylums Board Hospitals were more numerous in October than in any month since October 1881. Diarrhœa was the cause of 90 deaths, 72 in the Town subdistrict, and 18 in Brompton. This number was four in excess of the number in 1885, but fewer by 22 than the corrected decennial average. Eighty-three of the deaths were of children under five, including 71 under one year. Of the total number, 67 were registered in twelve weeks, July 18th—October 9th inclusive. The deaths from diarrhoea in London generally, were 720 in excess of the corrected decennial average, this increased mortality being due to the hot weather that prevailed throughout the summer, the mean temperature for each month from July to October inclusively, having been considerably above the previous average. Cholera.—Only one death from English Cholera was registered in the course of the year. Outbreaks of Asiatic Cholera, however, in different parts of Europe, kept attention alive to the possibility of this country being invaded by that fell disease at any time. It is satisfactory, therefore, to know that the sanitary survey of the outports, which the Medical Department of the Local Government Board has been prosecuting for some time past, has made satisfactory progress, and issued in much improvement 39 in our first line of defence. As regards the Metropolis, we were, probably, never so well prepared against a danger the gravity of which no one pretends to undervalue; for, as I have shewn in former reports, should cholera threaten to invade us, the Local Government Board would instantly call into operation the several Diseases Prevention Acts. Thereupon a complete system of hospital accommodation would be provided—by the Metropolitan Asylums Board in the first instance—while the Local Authorities, Vestries and District Boards, would be armed with power to provide subsidiary hospitals, as well as refuges for the healthy, taken from infected houses. By medical visitation of their several districts, moreover, and by provision of medicine, &c., in cases of diarrhoea, the Local Authorities would be enabled to do all that the requirements of the emergency dictate, and so complete the second line of defence for the security of our vast population. HYDROPHOBIA. Much alarm was caused throughout the Metropolis by an unusual prevalence, in 1884, of hydrophobia, which led to publication, by the Chief Commissioner of Police, of an order for the muzzling of dogs when allowed to go at large, or not led so as to be "under proper control." At the end of 1885 this muzzling order was withdrawn, and dogs were allowed to go free as usual. During the time that the order was in force, wandering dogs were seized by the police and destroyed if not owned. Many thousands were so destroyed. A new "Order in Council," dealing with the subject and known as "The Rabies Order, 1886," has been issued. It transfers the duty of preventing the spread of Rabies from the police to the " ocal authority," under the Contagious Diseases (Animals) Act, 1878—the authority for London, except the City, being the Metropolitan Board of Works, whose half-dozen of inspectors will have, in addition to their other multifarious duties, to see to the due carrying out of such regulations as the Board may think fit to frame. The Board cannot be accused of unwillingness to undertake any duty cast upon them by the Legislature, but 40 it may be doubted whether they would not rather have been excused this "obnoxious duty," as it was described by one of the members in moving a reference of the Order in Council to the Works Committee. Parliament, in devolving the duty upon the Board, has placed Rabies in the same category with pleuropneumonia in cattle, glanders in horses, and swine fever—the amending Act passed last June (Clause 8) having extended the definition of "animal," which now includes any kind of four-footed beasts: and "Rabies," being now classed as a "contagious disease," under the new Order, the owner or person having charge of any dog suffering therefrom is required to give notice to the. police. The Order also provides that the Local Authority may make any such regulations as they see fit for the muzzling of dogs, or for keeping them under proper control, and for the seizure and disposal of stray dogs, or dogs not muzzled or not under proper control. No dog regulations have been made at present. It will probably be deemed satisfactory in the circumstances that, the new Order notwithstanding, the provisions of the Dogs Act, 1871, still remain in operation, and may be acted upon by the police. SMALL-POX HOSPITAL ACCOMMODATION. The Royal Commission, in one of their "practical recommendations," proposed that provision should be made of sites and buildings which could without difficulty be made capable of receiving 2,100, or by special exertion 2,700, small-pox patients. The actual accommodation falls very far below the smaller of these totals, consisting as it does of some 400 beds at the Hospital Ships, and 60 beds, in all, at three London Hospitals, to which Ambulance Stations are attached—beds for exceptional patients, and which the Asylums Board will not suffer to be occupied except in case of urgent necessity. The Gore Farm Estate, comprising some 135 acres at Darenth, is available upon emergency for any probable demand for accommodation. The Managers proposed to erect on this site a permanent hospital, to contain ultimately one thousands beds, mainly for convalescent patients. The plans 41 of the buildings were formally approved by the Local Government Board in July, 1884, and it was anticipated that by this time the construction of the hospital would have been well advanced. But the Board have seen reason for changing their views, and are now entirely opposed to the scheme for building a permanent hospital, while willing to sanction the necessary expenditure for the construction of wooden huts, which they believe to be well suited for the purpose. The Managers, on the other hand, are still of opinion that wood is an objectionable material, and as there appears no immediate prospect of an agreement, the construction of any hospital will probably be deferred until necessity arises. Having experience of the rapidity with which temporary provision can be made for housing patients at Darenth, we may view with equanimity the present deadlock, knowing that the site is always available, and that as regards building it is only a question of money—a good deal of money, indeed, as it has been shewn that the outlay on the establishment of the last temporary camp was about one half the amount of the estimated cost of the proposed permanent hospital. It follows, meanwhile, from what has been said, that the Ships furnish our only immediately available hospital accommodation for small-pox patients, and even these a considerable section of the Managers have endeavoured to close, in conformity with advice tendered by the Local Government Board. In the past year the Ships proved adequate to the wants of the Metropolis, and as the Managers are persevering in their resolve to remove every small-pox patient out of London, when removal can be effected with. safety to the patient—and happily this is usually the case—there is reason to believe that hospital accommodation in the future will not be necessary to anything like the amount provided in the epidemics of recent years. The action of the Local Government Board, nevertheless, is somewhat difficult to understand, for not only did the Board, as already mentioned, and so long ago as July, 1884, sanction the erection of the permanent hospital at Darenth, but they also suggested the desirability of an endeavour by the Managers to obtain a site to the west or south-west of the Metropolis which should be C 42 available for an additional hospital for convalescent patients— having in view the probable exigencies of a fresh epidemic, and taking into account the requirements of London as a whole.* After the report was in print, the Asylums Board, being so much divided with regard to the necessity and the character of the proposed permanent hospital, appointed, through the General Purposes Committee, which comprises the whole of the Managers, two sub-committees, from among the majority and the minority respectively, to consider and report on the communication from the Local Government Board, and with instructions to submit alternative schemes, with the arguments in favour of each. The minority sub-committee (chairman, Bev. G. A. M. How) reported in terms substantially identical with the views of the Local Government Board, while the majority sub-committee (chairman, Captain Douglas Galton), considering that the Local Government Board had vetoed the only suitable site on the estate—viz., the upper plateau—and, holding the lower plateau, where the existing huts stand, to be unsuitable for a hospital, declined to recommend the Managers to erect any additional accommodation on the site of the camp. The Managers referred the two reports to the Small-pox Hospital Committee for consideration, the committee being empowered to take professional advice as to the practicability and advisability of carrying into effect the suggestions of the minority sub-comnrttee, the chairmen of the two sub-committees being added to the committee for the purposes of this reference. The Managers also transmitted the reports to the Local Government Board in reply to their communications on the subject, dated 24th August and 5th January. The Board, under date 16th May, acknowledging receipt of copies of the two reports, stated that * In my monthly reports for 1886—viz., No. 2, page 13, No. 6, page 39, No. 9, page 60, and No. 13, page 92, the subject of small-pox hospital accommodation was fully discussed, especially in connection with the divergence of views manifested in the correspondence between the Local Government Board and the Metropolitan Asylums Board. 43 they would be glad to be informed as soon as any decision had been arrived at thereon. Here the matter rests—for the present. FEVER HOSPITAL ACCOMMODATION. The Royal Commission recommended provision of sites and buildings capable of accommodating 3,000 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 other country hospitals." The beds now available at the five London hospitals are nearly 1,400 in number, the recommendation of the Committee that these Hospitals should "become in the main Fever Hospitals" having been carried into effect. These hospitals, the Commission thought, 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." With a view to give effect to the recommendation of the Commission, the Managers originally intended to provide another hospital for East London. This intention was subsequently abandoned and a site was obtained at Winchmore Hill, nine miles north-east from Charing Cross, on which the "Northern Hospital" for 500 patients has been erected. It was designed mainly for convalescing and convalescent fever cases; but acute cases will not be excluded should the London accommodation prove inadequate at any time. The total provision of fever hospital accommodation, therefore, is now nearly 1,900 beds, a number that falls far short of the recommendation of the Commission. "On the other hand," as we are told by the Asylums Board, "the number of fever patients annually under treatment at any one time during the past year, though in advance of those of the eight previous years, has not exceeded 742," so that, as it is further stated, "up to the present time the recommendation that the Managers should provide for 3,000 fever patients has not been justified by subsequent experience." C 2 44 Having regard to the notable decline of fever mortality already referred to elsewhere, a result as it would seem of improved sanitation, and therefore likely to be progressive, we may reasonably hope that the existing accommodation will suffice for the requirements of the Metropolis. The Northern Hospital has not yet been opened, but it would seem desirable that it should be utilised as a sanatorium for convalescents, and I think it would be sound policy to provide a similar institution south of the Thames. At present the Managers appear disposed to defer the opening of the new Hospital till such time as the Board may have "obtained power to open these Hospitals to all classes of the population, including paying patients." It has been proposed to utilise the hospital for the reception of the imbecile children now housed at Darenth Asylum, so as to free that building for use as a permanent small-pox hospital, but the Managers have not deemed it proper to entertain the proposal. "By certain shiftings of the usual allocation of patients," the Managers have "contrived that three hospitals, the Eastern, South Eastern, and Western, have sufficed for the requirements of the past year." But it is considered desirable that in future —at least for a part of the year when fever is most prevalent— "the three hospitals permanently open should be supplemented by a fourth." There are Ambulance Stations contiguous to the three hospitals named, and as they are most conveniently situated for supplying the necessary accommodation they will be retained for permanent use. The North Western Hospital, it is probable, will be utilised as a supplementary hospital for acute cases when required, and also for convalescents, unless necessity should arise for opening the Northern Hospital as a convalescent hospital for the relief of the other three hospitals permanently open. Meanwhile, the Managers have obtained the sanction of the Local Government Board to close the South Western Hospitals, the district in which they are situated being within moderate distance of the South Eastern and Western Hospitals. It is clear from what has gone before that the existing accommodation is largely in excess of the present demand, there being no reason, moreover, 45 as already intimated, for anticipating any great increase in the demand, inasmuch as the ever increasing success attending the efforts of the Managers to promote the speedy removal of patients from their homes may he expected to have a tendency to diminish the prevalence of disease. NORTH-WESTERN (HAMPSTEAD) HOSPITAL. This hospital was closed on the 30th January, and has not been re-opened. It was arranged at the time of closure that enteric fever cases arising in the district should be removed to the Western Hospital; but effect could not be given to this arrangement owing to the demands made on the "Western Hospital for the admittance of scarlet-fever patients. The long-continued closure of the North-Western Hospital and the closure of the Southwestern Hospital affords striking evidence of the remarkable freedom of the Metropolis from "fever." The probable future application of this (North-Western) hospital has already been alluded to in the preceding section. WESTERN HOSPITAL. The Managers have considerably improved this hospital by the execution of works necessary for the adaptation of two of the fever wards for the more convenient and, economical treatment of the different classes of fever, and, for the provision of isolationwards for cases of doubtful or faulty diagnosis. It has been found necessary to reconstruct the drainage, which was unsatisfactory, having been put in without due care and consideration when the hospital was hurriedly run up in 1877 to meet the demands for accommodation for small-pox patients. The hospital has been in use throughout the year, and in the latter half was almost exclusively restricted to scarlet fever. So great, in fact, was the pressure arising from the prevalence of that disease, in some of the parishes and unions allocated to the Hospital, that arrangements were made for conveying cases arising in certain of these districts to the 46 Eastern (Homerton) Hospital or the South-Eastern (Deptford) Hospital, and ultimately the Managing Committee had to deny admittance to enteric fever altogether. The Hospital Committee taking into consideration the possibility that they may be called upon at any time to admit small-pox patients, and deeming the existing accommodation unsuitable, have proposed (May 1887) to the Managers to build two small hospitals upon a plan suggested by Dr. Burdon Sanderson, a member of the Royal Commission of 1882, with the object of purifying the infected air passing from the hospital, by burning it, so as to minimise the risk of infection being conveyed to persons outside the building. The proposal, which does not appear to have been very favourably entertained, was referred to the General Purposes Committee. Dr. Sanderson's plan is illustrated opposite page 310 in the Report of the Commission. HOSPITAL SHIPS. The Hospital Ships were open throughout the year, but happily there was little occasion for them during the greater part of it, when admittance of small-pox patients was limited to the Atlas. Great efforts were made by a section of the Managers—acting in conformity with advice tendered by the Local Government Board— to close the ships and to treat sporadic cases of small-pox in the Town Hospitals. It was thought that money might be saved by taking this step—an opinion for which there does not seem to be much foundation. But the majority of the Managers, having regard to the doubtful state of the question as to the causation of outbreaks of disease in the vicinity of small-pox hospitals, were firm in their resolution to continue the practice of removing patients to the Ships, a practice the beneficial results of which are (as I think) apparent in the remarkable reduction in the number of cases and the practical freedom, during many months, of the Metropolis from the disease. Granting the relation, which I believe to exist, between the removal of small-pox patients out of London and the comparative freedom of London from small-pox, it cannot be 47 doubted that the maintenance of the Ships in constant readiness for an outbreak is justifiable on the ground of economy. For not only has it been shewn that little saving in expenses would be effected by closure of the Ships—a saving, moreover, that would probably be out-balanced by the expenses incident to the opening of wards in the Town Hospitals—but it must be obvious, to all who have considered the question, that the first outlay in keeping the Ships in readiness, and sending the sick out of London, is insig. nificant compared with the cost of even a slight epidemic which might otherwise ensue. A somewhat extraordinary proposal was submitted to the Managers to close the Atlas and Castalia (the latter ship was closed at the time), and to treat sporadic cases on board the administrative ship Kndymion, in two wards, one for males, and one for females. The Hospital Ships' Committee, to which the proposal was referred, reported adversely to it, pointing out that " the saving that would be effected by its adoption is insignificant, whilst to give effect to it would involve the breaking up of the existing accommodation provided for the Staff on the Kndymion, only to be restored immediately upon an outbreak of small-pox; unless, indeed, additional nurses should be engaged to attend upon patients in separate cubicles, as severe cases cannot be left without constant supervision." Either plan, the Committee stated, would lead to increased expenditure, while the conversion of an administrative ship, whereon the staff sleep, the meals are cooked, and the Committee meetings are held, into an infectious Hospital, would be a violation of the principle hitherto rigidly insisted on of keeping the staff quarters distinct from the patients. The Committee, regarding the proposition as only a modification of the idea to close the Hospital Ships altogether in non-epidemic times, refer to previous resolutions ot the Managers not to take this step, which they considered would involve the retention of a staff of officers for the reception and treatment in the London Hospitals of comparatively few cases of small-pox, cases that could be treated more satisfactorily and more economically under one administration in the Hospital Ships. Moreover, to treat patients, however few in number, in the London 48 hospitals would be “ a retrogressive and most unfortunate step, and a marked reversal of the policy deliberately adopted by the Managers.” In conclusion, they expressed " a strong hope that, in the interests of the public health of the metropolis, the Managers will adhere to the decisions they have on several occasions come to in favour of maintaining the Hospital Ships on their present footing.” The report was received, and the proposal—against which your Vestry, on my advice, sent an earnest protest—may be considered as dropped by common oonsent. MEDICAL INSPECTION OF THE HOSPITAL SHIPS, &c. It may be mentioned that, by the courtesy of the Asylums Board, and on the recommendation of the Hospital Ships’ Committee (of which Rev. C. Darby Reade, M.A., J.P., was Chairman), the Metropolitan Medical Officers of Health had an opportunity, in July, of inspecting the Wharves, the Ambulance Steamers, and the Hospital Ships, together with the several buildings for administrative and other purposes, erected opposite the Ships on land acquired by the Managers under the provisions of the Diseases Prevention (Metropolis) Act, 1883. Anything more perfect in its way, or better adapted for safeguarding the Metropolis against small-pox, by securing isolation of the sick, could hardly be conceived. There was but one opinion among the Medical Officers present—viz., that the work of the Managers, in this regard, is of the greatest value to the Metropolis, and that the Managers will do well to persevere in their resolution to remove every case of small-pox to the Hospital Ships, “ unless the condition of the patient be such that the journey down river would be dangerous to life or prejudice the patient's chauce of recovery.” This resolution the Managers have acted upon now for many months, and with complete success, seeing that not for many years has the Metropolis been so free from small-pox as during this period, when every land hospital has been practically closed against smallpox patients. 49 It is to be regretted that the work of the Board in connection “with the treatment of persons suffering from infectious disease is not better known. It is a very great work, and one of the highest importance to the well-being of the inhabitants of this great city, as those best know who, as Health Officers or otherwise, are best acquainted with it. Here is just one fact, viz:— that at the close of 1885 the River Ambulance Service had conveyed, in 23 months, no fewer than 11,060 small-pox patients to the Hospital Ships—the greatest number in one day being 104 —irrespective of 10,076 recovered persons who were brought back to the London Wharves. We in London, perhaps, hardly think enough of these things. Strangers are differently affected. It is not long ago that a deputation, civic and medical, came from Paris to study the hospital system of the Managers. The Paris correspondent of the Standard subsequently stated that Dr. Nicaise, a member of the deputation, in conversation with him, expressed his judgment on the Darenth Camps and the Hospital Ships, that " they were the realisation of a dream of perfection." The success of these institutions is naturally gratifying to me, the plan of removing small-pox patients out of London having been adopted upon my advice (in 1881) during Mr. JDodson's Presidency of the Local Government Board. Reference to the great work done by the Asylums Board may fitly be completed by stating that during the year 1886, there were admitted at the several hospitals 2,298 patients, including small-pox, 136, scarlet fever, 1,806, typhus fever, 8, and enteric fever, 356. The numbers admitted in the previous year were 8,253, including the large total of 6,391 from small-pox. The scarlet fever patients in 1885 were 1,394, typhus fever 54, and enteric fever 226. The latest published statistics show for smallpox, amongst the vaccinated, a case-mortality of 8 per cent., and amongst the unvacciuated, 51 per cent. The rate in scarlet fever in 1885 was 9.31; that of enteric fever 17'62. The following Table supplies information of considerableinterest. Table shewing Quarterly and Total Admissions of Small-pox and Fever Patients at the Asylums Board Hospitals in 1886, and Population of the several Parishes, Unions, and Districts in 1881. Parishes, Unions, etc. Small-pox. Total Scarlet Fever. Total Enteric Fever. Total Grand Total. Small-pox and Fever. Population. 1st Qtr. 2nd Qtr. 3rd Qtr. 4th Qtr. 1st Qtr 2nd Qtr. 3rd Qtr. 4th Qtr. 1st Qtr. 2nd Qtr. 3rd Qtr. 4th Qtr. Western District. Kensington 1 ... 1 ... 2 13 13 12 23 61 1 2 5 4 12 75 163,251 Fulham 4 1 ... 1 6 7 12 21 31 71 ... 1 2 11 14 91 114,839 Paddington 1 3 ... ... 4 5 8 4 19 36 1 1 ... 1 3 43 107,218 Chelsea ... 1 ... ... 1 4 3 5 22 34 1 ... ... 1 2 37 88,128 St. George's 2 7 ... ... 9 8 9 36 44 97 ... ... ... 2 2 108 149,748 Westminster ... ... ... ... ... ... 2 5 8 15 ... 1 ... ... 1 16 370 46,549 669,633 Northern District. St. Marylebone 6 2 3 ... 11 13 8 20 42 83 1 ... 2 4 7 101 154,910 St. Pancras 2 4 3 ... 9 7 12 40 72 131 1 3 2 4 10 150 236,251 Hampstead ... ... ... ... ... ... ... 1 1 2 ... ... ... ... ... 2 45,452 Islington 7 4 2 ... 13 10 6 21 43 80 14 3 7 24 48 141 282,865 Hackney ... ... ... 1 1 12 9 61 98 180 3 3 6 17 29 210 604 186,462 905,947 Central District. St. Giles and St. George ... ... ... ... ... 2 3 3 10 18 ... 3 1 5 9 27 45,382 Strand 3 3 2 2 4 8 ... ... 1 1 12 33,582 Holborn 3 3 1 ... 7 18 20 46 56 140 2 1 10 9 22 169 151,835 London, City of ... 2 ... ... 2 3 5 18 2 28 ... ... ... 2 2 32 240 57,439 282 238 Eastern District. Shoreditch ... ... ... ... ... 8 14 13 16 51 2 ... 10 9 24 75 126,591 Bethnal Green ... 1 2 ... 3 2 2 14 18 36 2 4 6 17 29 68 126,961 Whitechapel ... 5 ... ... 5 13 15 28 18 74 ... ... 4 3 9 88 71,363 St. George's-in-the-East 2 1 ... ... 3 11 11 18 12 52 2 ... 3 2 7 62 47,157 Stepney ... ... ... ... ... 2 13 15 17 47 ... ... 2 10 12 59 58,243 Mile End Old Town 1 1 2 5 5 10 22 3 1 3 5 12 35 105,613 Poplar 1 7 1 ... 9 6 9 5 9 29 3 ... 7 6 16 54 441 156,510 692,438 Southern District. St. Saviour's ... 17 ... ... 17 7 13 28 23 71 5 1 1 6 13 101 195,164 St. Olave's 2 1 1 ... 4 7 9 9 10 35 ... 1 4 1 6 45 134,632 Lambeth ... 8 ... ... 8 11 20 61 88 180 1 1 2 6 10 198 253,699 Wandsworth and Clapham 1 2 1 ... 5 18 12 18 36 84 4 9 6 14 33 122 210,434 Camberwell 4 3 ... ... 7 4 7 63 21 95 2 ... 1 7 10 112 186,593 Greenwich 4 2 ... ... 6 6 4 6 9 25 1 ... 4 5 10 41 131,233 Woolwich ... ... ... ... ... 1 ... ... ... 1 ... 1 1 2 3 80,845 Lewisham ... ... ... ... ... 5 2 10 3 20 ... ... ... 1 1 21 643 73,337 1,265,937 40 78 15 3 136 207 246 588 765 1806 49 41 89 177 356 2298 In addition to cases in Table, 8 of typhus were admitted, as well as numerous cases of other diseases. N.B.—The names o£ Parishes and Unions in which hospitals are situated are printed in dark type, and those adjacent to hospitals in italics. 52 CLINICAL INSTRUCTION. The Managers, desirous of making their hospitals available for clinical instruction, upon conditions embodied in a report dated February, 1886, and as contemplated by Section 29 of the Metropolitan Poor Act, 1867, have obtained from the Local Government Board the necessary authorisation, and registered practitioners are now appointed, with the status of assistant medical officer, the period of residence being limited to three months. The arrangement is a very advantageous one, seeing how greatly the opportunities of medical students for studying infectious diseases have been restricted, not to say annihilated, as regards small-pox, scarlet fever, etc., by exclusion from general hospitals of sufferers from these diseases. DARENTH CAMP LITIGATION. Reference may be made to the failure of the plaintiff's appeal in this case (Fleet v. the Managers) by the unanimous decision of the Lords Justices, Cotton, Fry, and Bowen, who did not even call upon the respondents, but dismissed the application with costs, upon the ground that the Camp, which it was sought to close, was “ no appreciable injury to the healthiness of the .plaintiff's property.” The Managers, therefore, may hold themselves free to utilise their Gore Farm Estate for the treatment of small-pox, should necessity arise, and whether it should ultimately be decided to erect a permanent hospital, as the Managers prefer, or to fall back on wooden huts, as the Local Government Board suggest, a question already referred to at page 39. ASYLUMS BOARD AMBULANCE SERVICE. The recommendation of the Royal Commission, that the Asylums Board should have " entire control of the ambulances, by which all other modes of conveyance should be as far as possible superseded," has been carried out by the establishment of Ambulance Stations at three of the Managers' Hospitals 53 (Eastern, South-Eastem, and Eastern), under the provisions of Section 16, Poor Law Act, 1879. Small-pox patients are taken down the river in Ambulance Steamers, specially built or fitted for the purpose, embarking at Wharves which the Managers were authorised to provide by Section 6 of the Diseases Prevention (Metropolis) Act, 1883. Kensington patients are removed by the ambulance staff at the Western Station, where provision has been made for 15 horses, coach-houses for as many vehicles, together with all necessary accommodation for drivers, nurses, etc. Between 8 a.m. and 8 p.m., on week-days, cases for removal are reported at the Managers' Central Offices, these being in telephonic communication with the Station. During the night, and on Sunday, application for a patient's removal is forwarded direct to the Ambulance Station. Erom a report made by the Committee for the Western Hospital, we learn that the number of patients removed since the opening of the Western Station in May, 1884, to the end of April, 1885, amounted to 2,369. Owing to the great distance between the Western Hospital and the districts allotted to it, and the South (late Acorn) Wharf, at Botherhithe, to which the patients are at present sent for embarcation, the number of miles travelled by the ambulances is excessive. This will be obviated when the West Wharf shall have been been brought into use. BEPOBT OF THE AMBULANCE COMMITTEE. Arrangements in connexion with the transit of the sick, between home and hospital, and back again, are under the control of a special Committee of the Asylums Board, whose first report, issued in March, 1886, is of singular interest. As regards Biver Ambulance Service, it appears that between 9th February, 1884, when patients were for the first time taken to the Hospital Ships, and the close of 1885, some 11,060 were removed to Long Beach. The Committee report with justifiable satisfaction that this large number of persons “ of both sexes and all ages, for the most part in physical suffering, and many helpless from disease,” were 54 “ carried in all weathers and throughout all seasons of the year, and to a great extent during the hours of darkness, without detriment to the patients, and without accident or mishap to any person whatsoever.” In their second annual report, for 1886, the Ambulance Committee again refer with justifiable satisfaction to the “ entire freedom from casualty involving personal injury, with which the transport of patients, both by land and water, has been accomplished.” In consequence of the cessation of the smallpox epidemic the number of patients removed during the year fell to 2,478, “ a figure which may be taken as an approximate indication of the work likely to be required, under present conditions, in any year when small-pox is not prevalent in the metropolis.” RIVER AMBULANCE SERVICE. The Managers possess in their three Ambulance steamers, Red Cross, Maltese Cross and Albert Victor, together with the steam pinnace Swallow and the steam launch Marguerite, a fleet equal to all probable demands. The demands, however, as indicated by number of admissions, are very unequal at different periods of the year. Thus the Ambulance Committee inform us that on the first day of January there were only 351 patients in the Managers' Hospitals : so that on the 30th of that month the North-Western Hospital was closed. The number of admissions continuing at. a low rate during the first half of the year, the Managers were induced, on the 31st July, to stop the admission of patients to the South-Western Hospital, thus concentrating the whole of the Fever patients in the Eastern, South-Eastern, and Western Hospitals. In August, however, " the admissions began to increase at an alarmingly rapid rate, the total number of patients rising from 257 in July to 394 in August, 513 in September, 638 in October, 734 in November, and culminating with 742 on the 1st December, after which date to the end of the year the number declined." The Managers authorised the Committee, in October, to make additional provision for Fever patients by re-opening the North-Western or the South-Western Hospital, if necessary, but the Committee, anticipating that the highest 55 numbers would be reached in November, contrived, by " various shiftings of the usual allocation of patients, to provide sufficient accommodation until the critical period had passed and the numbers began to decline. The necessity for opening a fourth Hospital was thus avoided." WHARVES. The Managers have acquired or constructed three Wharves for the embarcation of patients, etc., named respectively, North, South, and West. The North Wharf is at Blackwall, the South Wharf at Rotherhithe. The West Wharf, at Fulham, near Wandsworth Bridge, at which Kensington Small-pox cases will embark for the voyage to Long Reach, but which is intended for the accommodation of the Western District generally, as a place of embarcation for the infectious sick, en route to the Hospital Ships, is now complete— a pier, porter's lodge, receiving house, and river wall having been erected. A pier-master and an assistant pier-man have been placed in charge of the wharf, which hitherto it has not been found necessary to use. METROPOLITAN AMBULANCE SERVICE. A DESIDERATUM. The Ambulance Service for the whole of London is now, practically, in the hands of the Asylums Board. There are few private ambulances, and it is difficult to effect the removal of cases of small-pox to the Highgate Hospital, or of Diphtheria to general hospitals, persons suffering from this disease not being admissible at the Managers' Hospitals. The result of this state of things is that public vehicles are occasionally used for the conveyance of the infectious sick. Such user is not unlawful, provided that the person hiring or using the vehicle gives notice of the condition of the sufferer to the owner or driver, who may refuse to convey the sick person until he shall have been indemnified for costs and expenses incurred by so doing—viz., for disinfection, loss of time, etc. 56 As a rule, cabs which have been used for the conveyance of infected persons to hospitals are stopped and disinfected. At the London Fever Hospital the number of the cab is taken and the police are made acquainted with the facts. Difficulty having sometimes been experienced in getting the vehicle disinfected, the Assistant Commissioner of Metropolitan Police lately put himself in communication with the several Sanitaiy Authorities, enquiring if the Vestry or District Board would be prepared to disinfect public conveyances upon application, and if so, upon what terms and where ? It was suggested also that a certificate should be given to the cabman that the vehicle had been disinfected, so that he might be in a position to satisfy the police when enquiry should be made of him. The several Authorities accepted the duty proposed to be laid upon them, agreeing to disinfect and certify, either without charge, or on payment of a nominal fee. A similar communication having been addressed to the Metropolitan Asylums Board, and referred to the Ambulance Committee, the Committee reported, after consultation with the Chief Surgeon of Metropolitan Police (Dr. MacKellar) and the Chief Inspector of the Public Carriage Office, to the effect that— “ They are not prepared to recommend the Board to offer facilities for the disinfection of public vehicles which may have been used for the conveyance of persons suffering from infectious disorders.* “ In the first place, they are of opinion that public vehicles do not admit of efficient disinfection, owing to the nature of the padded linings and other upholstery used in their construction. “ Further, even if truthful certificates of efficient disinfection could be given, the grant of such certificates would tend to encourage an increased use of public vehicles for the conveyance of infectious cases. The employment of any public vehicle for such a purpose is obviously most undesirable, and, in the judgment of your Committee, ought to be prohibited by law. “ In these views it is believed that Dr. MacKellar fully concurs. He, moreover, pointed out that the proprietors and drivers were generally very averse to such an employment of their vehicles; and he gave * Nevertheless, as a matter of fact, infected cabs are detained at the hopitals and disinfected 57 your Committee much valuable information as to the difficulties experienced by persons of the non-pauper class in seeking to obtain the removal of infectious patients. “ The removal of persons of all classes suffering from infectious disorders should, in the opinion of your Committee, be the duty of a public authority; and your Committee regret that, possessing as the Managers do the piachinery for the prompt and economical removal of such cases, they do not appear to have power to use their Ambulances for persons other than those contemplated by the Poor Law Act of 1879. “Your Committee therefore recommend that the Assistant-Commissioner be informed, in reply to his letter of the 10th November— (a) “That the Managers are not prepared to undertake the tion of public vehicles, as they are of opinion that such disinfection cannot be effipiently performed owing to the usual construction of those vehicles ; (b) “That the Managers consider that the conveyance of infectious cases by public vehicles should be prohibited by law ; (e) “hat the Managers already possess the machinery for the prompt and economical removal of infectious cases, but do not at present appear to have power to use their Ambulances for other cases than those contemplated by the Poor Law Act of 1879; and (d) “That the Managers will be willing to co-operate with the Commissioner of Police, with the view of obtaining for the Board the power to undertake the general removal of infectious cases in the Metropolis.” The report was adopted by the Board. I quite concur in the view that “ conveyance of infectious cases by public vehicles should be prohibited by law,” but before effect can be given to such a proposition, provision should be made for the conveyance of infectious cases by the Managers, or other constituted authority, in public ambulances. In the absence of a proper service of public ambulances great difficulty is experienced in obtaining a suitable carriage for the conveyance of an infectious private patient, and hence the improper and dangerous practice of using public vehicles. Animated by a sense of the danger of this practice, I put myself into communication with the Board, 12th December, 1884, writing as follows:— 58 “ The Ambulance Service of London is now practically in the hands of the Metropolitan Asylums Board. There are scarcely any private Ambulances; and if, for example, a person suffering from small-pox desires to be removed to the Highgate Hospital, or a person with enteric fever or diphtheria, to a general hospital, there is the greatest difficulty in obtaining means of carriage. “ This being so, I beg to suggest for the consideration of the Managers whether it would not be practicable to place disengaged ambulances at the service of the medical profession and Medical Officers of Health for the conveyance of such cases—either with or without payment? The cases are few. and this is the cause of the difficulty, for if the cases were numerous demand would create supply, ambulances would be provided, and there would be no need for this communication.” The Managers in their reply stated that they were “ not yet in a position to undertake the removal of any cases of infectious disease beyond those which are to be received into hospitals under their own control.” Commenting in my Annual Eeport for 1884 (page 86) on this reply, I said, “ I do not doubt that the Managers will, in course of time, recognise the desirableness, and, I may say, the propriety of doing what I suggested.” The time has now arrived, and although the Managers appear to doubt whether they “ have power to use their ambulances for other cases than those contemplated by the Poor Law Act of 1879,” yet as they are willing to take steps for obtaining “ the power to undertake the general removal of infectious cases in the Metropolis,” I cannot see any reason why they should not at once, as I recommended, “ place disengaged ambulances at the service of the medical profession and Medical Officers of Health for the conveyance of such cases.” It is quite certain that no one would raise objection to their so doing, by which means the improper use of public vehicles would at once be put a stop to, pending time and opportunity for legislation, to give effect to the present views of the Board. HOSPITAL ACCOMMODATION FOR “NON-PAUPERS.” In several of my monthly reports, within the last two years, I have had occasion to refer to the proceedings of the Asylums 59 Board with reference to the proposed Agreements with the Vestries and District Boards in the Metropolis, for the reception and treatment at the Managers' Hospitals of so-called nonpauper patients, for which provision was made by section 15 of the Poor Law Act, 1879. The subject being important, and the Managers having manifested a disposition to settle it in a satisfactory manner, I think it well to recall the circumstances out of which it arose, and to explain, upon the ground of historical interest, the position of affairs as they stood when I last referred to the subject in my eleventh monthly report (November 8th, 1886, page 74). It may be said, then, that prior to the passing of the abovenamed Act, the Managers had no legal power to receive “ nonpaupers ” at their hospitals. But they did admit, without question, whatever patients were sent by relieving officers; so that, in parishes and districts where (as in this parish) a good understanding prevailed between the Vestry or District Board and the Poor Law Guardians, the Sanitary Authority had no difficulty in obtaining admission orders for other than strictly pauper patients. But in parishes and districts where the Guardians refused to remove “ non-paupers,” the Sanitary Authority was placed in a difficulty, there being, practically, no hospitals, other than those of the Asylums Board, available for the reception of such cases. Certain Vestries and District Boards, placed in this difficulty, and being desirous of arranging with the Managers for the admission of “ non-pauper ” cases, made representations to the Local Government Board with the view to enabling legislation. A deputation, moreover, waited upon the Board, in March, 1879, with reference to the subject (Mr. Lindsay, a member of your Vestry, being spokesman), the result being the passing of the 15th Section of the Poor Law Act, 1879, above referred to, by which the Managers were authorised, with the sanction of the Board, to enter into contracts with any of the Metropolitan “ Nuisance Authorities.” But the section was not put into operation, and as time went on, the restrictions with regard to admission of patients were tacitly allowed to fall into abeyance. To such an extent 60 indeed that, in the summer of 1884, when small-pox was rife in the Metropolis, patients were admitted upon the application not only of Medical Officers of Health and Sanitary Inspectors, but also upon the application of private medical practitioners ; and this not merely without a previous “ order” by a relieving officer, but also, in many instances, without such order even following; the admission of the cases being simply notified to the several Poor Law Authorities by the Clerk to the Board. In October of the same year (1884), however, the Managers—for whatever reason— decided to exercise the powers of the Act, and placed themselves in communication with the several Sanitary Authorities. The proposal was that the Vestries, &c., should enter into contracts with the Managers for the admission of “ non-pauper ” patients, upon the “ order ” of Medical Officers of Health, and a form of agreement was subsequently forwarded, the Local Government Board having previously given its required sanction to the proposal. In a report by the Committee for General Purposes, the result of the negotiations with the several Vestries, &c., is set out, shewing that 86 of them had replied; 14 were willing to enter into tlis proposed agreement as suggested, while 15 declined to enter into agreement for various reasons; 7 sent replies which were of an ambiguous or argumentative character, and 4 gave no definite replies. The Managers thereupon adopted the recommendation of the Committee to send a synopsis of the replies to the Local Government Board, with an intimation that, “ as it is optional with the Vestries, &c., whether they will avail themselves of the powers conferred by section 15 of the Poor Law Act, 1879, the Managers do not see how they can take any further action in the matter unless and until the Local Government Board shall see fit to obtain from Parliament such additional powers as will render compulsory instead of optional the conditions of the section in question.” Your Vestry was one of those which declined to enter into the proposed agreement. The reasons for refusal were set out, in detail, in my Annual Report for 1884 (pp. 101—117 inclusive). The grounds of your Vestry's action were communicated to 61 the Managers and to the Local Government Board, and also to the several Vestries and District Boards, by many of which they were entirely approved. The failure of the Managers' proposal may perhaps not unfairly be ascribed to the results of these proceedings. It may be well, therefore, in this place, to recall the principles that your Vestry had adopted with reference to the hospital treatment, &c., of the infectious sick—not merely before the issue of the Managers' proposal in 1884, but anterior to the passing of the Poor Law Act, 1879, as set out in a communication addressed to the Sanitary Authorities, the Managers, and the Local Government Board in November, 1884. They were as follows :— (a) That the Managers of the Metropolitan Asylums Board should be powered to make adequate provision of hospital accommodation for infectious disease for all classes of the population in need of such accommodation. (b) That patients should be admitted into the Managers' Hospitals upon certificates signed by any duly qualified medical practitioner. (c) That as the hospitals of the Managers have been established for the common good at the public cost, no compulsory payment should be exacted from persons whom the Sanitary Authority may deem it necessary or expedient to remove to the hospitals for the purpose or isolation. (d) That all expenses incident to the maintenance and treatment of such persons in the hospitals should be defrayed out of a Common Sanitary Fund, the Metropolis being treated for the purpose as a single district; and (e) That steps should be taken to alter, by Act of Parliament, the stitution of the Board, by severing its connection with pauperism, in so far as relates to the treatment of infectious disease, and by providing for the election of a certain proportion of the Managers by the several Sanitary Authorities, i.e., the Vestries and District Boards of Works. Your Vestry, when communicating the above views to the Managers, invited them (and.not for the first time) to “ Consider the greater simplicity and superior advantages of the plan of throwing the entire expenditure incurred by the Board, in the hospital treatment of infectious 62 diseases, upon a Metropolitan Fund, as compared with that of contracts with individual Sanitary Authorities as proposed, under the provisions of the Poor Law Act, 1879,” and suggested “ the desirability of legislation to give effect to such plan.” There was all the more ground for this request, seeing that at the great Conference of Sanitary Authorities held in the Town Hall in March, 1881,—which was presided over by that distinguished member of your Vestry, the late Major-General Boileau, R.E., F.R.S., the following resolution was unanimously adopted, some 30 out of a total of 39 Sanitary Authorities being represented thereat, viz.:— “ That the admission into hospitals, for the purpose of isolation, of persons suffering from infectious disease, and being without proper lodging or accommodation, is eminently desirable in the interests of the public and should be encouraged ; that payment for the assistance given in hospitals to such persons removed thereto for isolation, by the Nuisance or the Poor-Law Authority, should not be enforced ; that the giving of such assistance should not entail on the recipients the loss of any social or political status, and that the cost of hospital treatment of such infective sick persons should be made a charge on the Metropolitan Common Poor Fund.” The above resolution was (on April 23, 1881,) submitted to the President of the Local Government Board by a deputation comprising delegates of the Vestries and District Boards (not one of these Authorities dissenting), supported by the Council of the British Medical Association, the Society of Medical Officers of Health, the Public Health Section of the Social Science Association, and the National Health Society, the late General Boileau being spokesman. Subsequently to the joint action of the Vestries and District Boards above referred to, the views which your Vestry had been the first to expound, several years previously, to the effect that admission to infectious disease hospitals should not pauperise the sick, found expression in section 7 of the Diseases Prevention (Metropolis) Act, 1883, which, once and for ever, depauperised the relief given in the Managers' Hospitals. 63 It may be mentioned that the Medical Officers of the Metropolis, who have no object to serve apart from the preservation of public health, are unanimous in their views on this question, views which have lately found expression in a report by the Council of the Society of Medical Officers of Health, wherein it is maintained that— “ Every possible facility should be afforded for the admission to the hospitals of the infectious sick, and that as no attempt has been made to define ' non-pauper ' from other cases (presumably owing to the difficulty attending any such definition), and as dangerous delays would inevitably result from conflict of opinion, between poor-law and sanitary authorities, as to the status of candidates for admission to the hospitals, the wiser and better course would be, some arrangement whereby all rate-supported hospitals should be freely open, without payment, to all classes of the community, without distinction; that orders for admission should be given by Medical Officers of Health as well as by Relieving Officers; that the certificate of any registered medical practitioner should be accepted as evidence of the infectious character of the illness and of the patient's fitness for removal, and that all charges incurred in the maintenance of the hospitals should be defrayed out of the Metropolitan Common Poor Fund, until such time as the hospitals themselves shall have been transferred to a properly constituted central sanitary authority.” AVhat action the Local Government Board will take with reference to the Managers' communication referring to their disposal the question, as raised by section 15 of the Poor Law Act, 1879, remains to be seen; but the Managers themselves, in the early part of the current year, took a great stride in advance of their former views, having, in fact decided “ that application be made to the Local Governrnen Board for, or to obtain, authority for the Managers to remove all persons suffering from fever or small-pox whose removal shall be applied for by duly qualified (registered) medical practitioners ”— a new departure which will involve the concession of free treatment of the sick, for which I have been contending now for many years. 64 The conditions which at present regulate the admission of patients at the various infectious hospitals under the Board's control, are specified in the Order of the Local Government Board, dated the 10th February, 1875. The patient, called “ pauper” in the Order (but admission no longer pauperises), is admitted upon an order filled up and signed by a Relieving Officer, or a Master of a Workhouse, of the union or parish from which he is sent to the Asylum ; the said order being accompanied by a certificate signed by the Medical Officer either of the Workhouse or District, as the case may be (Article 3). In a valuable report prepared by the Ambulance Committee for the guidance of the General Purposes Committee, which comprises the whole Board, it is pointed out that the above Article and others “were framed in view of arrangements essentially different from those now in force.“ Reference is made to the fact that previous to 1881, in which year the Ambulance system of the Board was brought into working, patients were brought to the hospitals in parish ambulances, “ and it was at the door of the hospital that their contact with the Asylums Board commenced." Now, however, " the door of the ambulance carnage has taken the place of the door of the hospital," and the hospital officials have " no choice but to receive as patients all persons brought in by the ambulances of the Managers." The parish ambulances, moreover, have for the most part ceased to exist. Formerly they were, in some cases at least, available for the removal of " non-pauper " patients. After their abolition Nuisance Authorities were wont to apply to the Managers for the removal of their patients. " To these applications the Managers, in the first instance, declined to accede." But in 1883 the Managers acceded to a request by the Port Sanitary Authority for permission for the Board's ambulances to be used on the receipt of a telegraphic request from the Port Medical Officer, without previous application being made to the Relieving Officer; the Port Sanitary Authority agreeing to pay the cost of maintenance, etc., of all patients removed. A similar application made by the Fulham Board of Works was subsequently acceded to. In 1884, when small-pox was prevalent, and upon the 65 receipt of urgent representations from various public authorities, the Managers, “ convinced of the hopelessness of coping with the disease by any other means, countenanced the practice of removing cases upon the application of the officials of Nuisance Authorities ” —under circumstances very fully set out in my Annual Report for that year—“ a step the wisdom of which has never been challenged.” The Managers are now prepared to go a great deal further. For very sufficient reasons they decline to admit a patient to the Ambulance without the production of a medical certificate, but they are "by no means satisfied that any useful purpose is now served by the intervention of the Relieving Officer as an admitting, or rather removing, authority, while" (as I pointed out in the above-mentioned report) " . the necessity of obtaining his order prior to removal, if insisted on in every case, would prevent some cases from being removed at all, and in many others must interpose a delay prejudicial to the patient, distressing to his friends, and dangerous to the health of the locality." The Managers now recognise the fact that " delay means largely increased expense to the Ambulance Service," while " the performance of a formal and unnecessary function entails waste of valuable time on the Relieving Officer." And having regard to the fact that " it has in practice been found impossible for the Managers to distinguish between ‘ pauper ’ and ‘ non-pauper ’ patients," and to the benefits to be derived from the early isolation of cases of infectious disease, the Managers, as already stated, have unanimously resolved to "apply to the Local Government Board for, or to obtain, authority to remove all persons suffering from fever or small-pox whose removal shall be applied for by duly qualified (registered) medical practitioners ; the practice of at once communicating the removal of every patient to the Clerks of Guardians being of course continued." This decision will afford the greatest satisfaction to all concerned in sanitary administration. To myself it is peculiarly gratifying that views which, when I first published them, were deemed extreme, have now been so fully accepted by the Board. But it is no great matter for surprise, the Managers 66 having always shewn a desire to do their utmost for the preservation of the public health, and having never hesitated to reconsider, and if need be reverse, previous decisions, when once convinced that by so doing they would more effectually serve the great end for which they were appointed. The resolution referred to was moved by Six E. H. Gurrie, to whose energetic action in 1884 we were indebted for facilities which enabled us to obtain immediate admission for patients suffering from small-pox, and for all the benefits to the Metropolis thence proceeding. The new departure, however, is, I understand, mainly due to the initiative of Mr. Scovell, Chairman of the Ambulance Committee, who has found a zealous coadjutor in the Rev. C. Darby Reade, M.A., J.P., one of the Kensington Managers, who has recently retired from the Chairmanship of the Hospital Ships Committee, after four years of arduous service, in which he has seen the system of direct removal of small-pox patients from their homes to the Ships, carried to perfection, with the happiest results to the health of the Metropolis. At the present writing (April), the Local Government Board have not replied to the Managers' application, and it is impossible to say what their immediate decision will be. I do not doubt, however, that ultimately, if not at once, the application will be granted. And then—under arrangements for free admittance of the infectious sick upon the application of sanitary officials and registered medical practitioners, as proposed—we may fairly assume that the Metropolitan Hospital system, including the Ambulance Service, regarded in the light of a provision against epidemics, will be all that can be desired for the protection of the public health. COMPULSORY NOTIFICATION OF INFECTIOUS DISEASES. In previous Annual Reports reference was made to the need of legislation to provide for the compulsory notification of infectious disease, and in the report for 1880 (page 44) I described what had been done in the shape of " Local Acts," to provide for notification in provincial towns and boroughs. The subject was continued in 67 my Report for 1881 (page 40), wherein I stated that, as the desirability for 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. Sclater-Booth, an ex-President of the Local Government Board, was 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 most important Urban Sanitary Districts," and they framed a " Model Clause " which has since been incorporated in divers Local Acts as follows:— “I. Iii order to secure that due notice be given to the Corporation of any inmate of any building used for human habitation who is suffering from any infectious disease, the following provisions shall take effect (that is to say):— 1. If any such inmate be suffering from any infectious disease the occupier or the person having the charge, management or control of such building (or if such occupier or person be prevented by reason of such disease, then the person in charge of such inmate) shall so soon as he shall become aware of the existence in any such inmate of any such disease forthwith give notice thereof to the Medical Officer of Health at his office. 2. If such inmate be not a member of the family of such occupier or person, the head of the family (resident in such building) to which such inmate belongs, or if there be 110 such head, or if such head be prevented bv illness, then such inmate (unless prevented by reason of such disease or of youth) shall, on becoming aware of the existence in such inmate, or in his own person, as the case may be, of such disease, forthwith give notice thereof to such occupier or person; 3. The Corporation shall provide and supply gratuitously to every registered medical practitioner resident or practising in the Borough who shall apply for the same, forms for the certificate or declaration to be made by such medical practitioner of the particulars hereinafter mentioned in relation to such cases according to the form set forth in the Second Schedule to this Act; 68 4. Every medical practitioner attending on or called in to visit such inmate shall on becoming aware that such inmate is suffering from any infectious disease, forthwith fill up, sign and deliver or send to the Medical Officer of Health at his office a certificate or declaration stating, according to the form so prescribed, the name of such inmate, the situation of such building, the name of such occupier or person, and the nature of such infectious disease from which in the opinion of such medical practitioner such inmate is suffering; 5. The Corporation shall pay to every registered medical practitioner who shall in pursuance of this section duly make and give any such certificate or declaration, a fee of two shillings and sixpence for each such certificate or declaration in respect of cases occurring in his private practice and a fee of one shilling for each such certificate or declaration in respect of cases occurring in his practice as a medical officer to any public body or institution; 6. And any person who shall wilfully offend against this enactment shall for every such offence be liable to a penalty not exceeding forty shillings.” Encouraged by the Report of the Select Committee, Mr. Hastings, who had been a member of it, 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 of the model clause. The Bill proposed to throw upon the householder, and upon the medical attendant, equally, the duty of reporting cases to the Medical Officer of Health—the so-called " dual system." A deputation waited upon the Local Government Board in support of the Bill, the principle of which has been accepted by Governments of both political parties, and has the unanimous approval of the Medical department of the Board. The President, on that occasion, signified willingness to agree to general "legislation to facilitate the application of the desired provisions by local authorities, but he said the Board were of opinion that the time had not 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, he thought the matter might be extended still further. Meanwhile the Board were disposed to give local authorities who wanted compulsory powers, the means of dealing with infectious 69 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 byelaws for that purpose. The President expressed his willingness to support a proposition to refer the Bill to a Select Committee: the Bill, however, was opposed on the second reading, and the House, having been counted-out the measure was dropped for the Session, and has not been re-introduced. Beyond the fact that Parliament has signified its continued approval of the principle of notification, by passing the “Model Clause” in certain Local Acts, nothing has to be added to the above statement; and although compulsory notification is urgently required, it is evident that we shall have to wait for a more settled state of political affairs before the present, or any future, Government will be prepared to deal with the subject in a general Act. Meanwhile it is well to remember that the Sanitary Authorities in London have expressed themselves unequivocally in favour of the principle of notification, their action having been taken under the lead of your Vestry.* The Metropolitan Asylums Board,it maybe added, are entirely in agreement with the Sanitary Authorities as to the necessity for notification, and their great influence will, doubtless, be exercised at the proper time in support of the desired legislation. It is noteworthy that, in Regulations framed for the registration of houses let in lodgings, or occupied by members of more than one family, “Notification of infectious diseases” is required to be given to the Medical Officer of Health by the “keeper” and by any lodger in a “registered house”—under section 47 of the Sanitary Law Amendment Act, 1874, which provides for “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 (i.e., Sanitary Act, 1866), or of the Acts mentioned therein.” Your Vestry, having made Regulations under the above Acts, and deeming it unreasonable that there should be one law for the * Vide Annual Eeport for 1882, page 69 et seq. 70 rich and another for the poor, requested the President of the Local Government Board, under date March 9,1885, to take measures for obtaining for Sanitary Authorities the necessary powers to enable them to secure notification. Either by a general Act embodying the Model Clause of the Select Committee, or by an Act to give such Authorities the means of obtaining the powers without the necessity of applying for a Local Act; which might be done, as above stated, by a general Act which they could bring into force themselves, or by the power of making bye-laws. The Board promised “attention,” and there the matter dropped. VOLUNTARY NOTIFICATION OF INFECTIOUS DISEASES. Whilst awaiting the advent of a system of compulsory notification of infectious diseases, constant efforts have been made, since my appointment in 1871, to obtain, by “voluntary notification,” information of the occurrence of such diseases, and it will not be out of place here to recapitulate the sources from which information is now received. 1. By virtue of an arrangement entered into between your Vestry and the sub-district registrars, in 1871, I receive notice of every death from the graver infectious diseases (small-pox, scarlet fever, diphtheria, typhus, enteric and simple continued fevers), immediately 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, made, as it is, without loss of time. (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 twentyfour hours, were made compulsory.) 2. The Relieving Officers, by direction of the Board of Guardians, report cases of dangerous infectious disease that come to their knowledge, and generally these are cases that have been, or are about to be, removed to the hospitals of the Asylums Board. 3. The Asylums Board report small-pox and fever cases admitted into their hospitals, by sending immediate notice of each case to the local Medical Officer of Health. They also forward, weekly, to every Medical Officer of Health in the Metropolis, a complete list of admissions to their land and river hospitals during the previous seven days. 71 4. The Resident Medical Officer of the Kensington Dispensary reports infectious cases, which he is not allowed to treat in the homes of the poor when they cannot be properly isolated. 6. Medical men occasionally report cases, especially when they desire assistance to get patients [e.g., domestic servants) removed to hospital ; or when they require the aid of the disinfecting staff. 6. 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. 7. The Postal Authorities have intimated to the medical officers of the Department 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. 8. In my annual report for 1877 I referred to a resolution of the London School Board directing the Superintendents of Divisions throughout the Metropolis to instruct the “Visitors” to report to the several Medical Officers of Health cases of infectious disease coming to their knowledge in the discharge of their official duties. The Board subsequently passed a resolution directing Teachers, also, to inform the Medical Officer of Health of the case of any child excluded from School on account of its showing symptoms of an infectious disease, or coming from a house where an infectious disease exists. A few such cases have been reported, but on the whole the results of my efforts to promote notification through the School Board organisation have not realized expectations. 9. Clergymen and District Visitors occasionally report cases of sickness. 10. The Resident Medical Officers of St. George's and St. Mary's Hospitals report the admission of cases, or the application of inadmissible cases, of infectious illness, from houses in this parish. 11. Occasionally, anonymous communications are the source of information, for I have not felt at liberty to disregard such communications, which have frequently proved to be accurate. In one or another of the above ways some hundreds of cases come to my knowledge in the course of every year. How many never get reported at all it is impossible to say; but from the fact that many fatal cases of infectious disease, other than small-pox, are concealed until after registration of death, it may be inferred that unrecorded cases of recovery are numerous. 72 THE RESULTS OF VOLUNTARY NOTIFICATION OF INFECTIOUS DISEASES. With the view of ascertaining the probable results of a system of compulsory notification, I have made an investigation of the results of voluntary notification as practised in this parish. Taking the statistics of mortality for twenty.four years, in respect of the “principal diseases of the zymotic class,” I compared the 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 advantage of hospital accommodation. The results of the investigation are set out in the following Tables. First period of twelve years (1859.70); without notification and without hospitals:— Number of Deaths Annually. 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 Whooping Cough 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 Diarrhoea 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 Second period of twelve years (1871.82); with voluntary notification and with hospitals:— Number of Deaths Annually. 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 Whooping Cough 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 Diarrhoea 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 The average population in the first period of twelve years (1859.70), was 90,000, and in the second period (1871.82), 147,300. 73 Summary of preceding Tables, with corrections for increase of population:— Diseases. Actual number of Deaths in 1st period (1859.70). Actual number of Deaths in 2nd period 1871.82. 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. Small Pox 160 395 261 134 … … Measles 629 803 1029 … 226 … Scarlet Fever& 1076 883 1761 … 878 … Diphtheria Whooping Cough 529 1080 865 215 … … “Fever” 535 427 875 … 448 … Diarrhœa 983 1370 1608 … 238 … 3912 4958 6399 349 1790 1141 It will be observed 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 a disease 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 in the second period (1871.82), whereas in the first period of twelve years (1859.70), 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, unless as a general result of improved sanitary conditions. The diminished diarrhceal mortality is attributable to the coldness of the summer season in several of the years in the second period, 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 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,” mainly enteric 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 ; and that the D 74 scarlet fever deaths were fewer by 383, without, correction, and with correction, by 1,053. It will be observed that in the first ten years of the first period no deaths were recorded from diphtheria, although the Table commences in 1859, the year in which diphtheria was first classified and registered as a disease separate and distinct from scarlet fever. 1 am unable to account for the omission, there being no records extant, except upon the improbable assumption that no deaths from diphtheria took place in Kensington in those years. I have thought it fair, in any case, to bracket scarlet fever and diphtheria in the two periods, respectively, for comparison ; and thus, adding the deaths from diphtheria, 23 in the first period, and 218 in the second period, to the deaths from scarlet fever, we have in the second period an absolute reduction of 193 in the deaths from the two diseases, the reduction corrected for increase of population being 878. Comparing the mortality from the “seven principal diseases of the zymotic class ” in the two periods, we arrive at a corrected reduction in the number of deaths, in the second period, of no fewer than 1,441. 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 in the second period of twelve years 1,441 persons more than did die, or 120 per annum. The zymotic death rate, I may add, which in 1859.70 was 8'6 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 formed 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 in efficacy to notification, is the provision of hospital accommodation by the Asylums Board, under the powers of the Metropolitan Poor Act, 1867. So highly, indeed, do I value this provision, that, were I offered a choice 75 “between hospitals and notification, I should unhesitatingly choose hospitals; for this reason, among others, that the existence of hospitals leads, almost inevitably, to voluntary notification; whereas even compulsory notification has comparatively little value if such means of isolation does not exist. PUBLIC AUTHORITIES AND NOTIFICATION OF INFECTIOUS DISEASES. In my Annual Report for 1882 I referred to a letter which I had myself addressed to the Postmaster.General, with reference to the desirability of instructions being given to Postal District Medical Officers and Postal employes to notify the occurrence of infectious disease in such employes. The letter arose out of an outbreak of scarlet fever in the family of a letter carrier, involving the occurrence of seven cases and three deaths in one house. The illnesses extended over a period of two months, during which the letter carrier was off duty. The facts of the outbreak were known to the Department, but 110 report of it having been made to me, the first intimation I received of the existence of the disease was on the registration of a death. The occurrence of other similar cases in the families of persons connected with the Police and Postal services, subsequently gave rise to a correspondence between your Vestry and the public authorities referred to. Prior to the time in question it appeared that the Chief Commissioner had issued a Memorandum on the subject, as follows:— “ Sick: Infectious Diseases, March 7, 1882.—On the occurrence of infectious disease in the residence of a police.officer, the Divisional Surgeon is to visit the premises to verify the fact, and to see that the parish authorities receive due notice, so that the rooms and their contents be properly disinfected. A report from the Divisional Surgeon is also to be submitted—Whether, in his opinion, the case ought to be removed to the Fever Hospital ? “ The diseases to be recorded as infectious are small.pox, typhus, scarlet fever and diphtheria. In cases where the Divisional Surgeon thinks it necessary that a police.officer, in whose residence infectious disease has broken out, should be absent from duty, leave will be allowed by the Commissioners on the Divisional Surgeon's certificate from week to week.” D 2 76 As the result, apparently, of the communication I made to the Chief Commissioner in October, the following (second) Memorandum was issued in November:— Sick: Infectious Diseases.—Referring to Police Orders, 7tli March last, under this head.—On the occurrence of infectious disease being reported in the residence of a police.officer, the Divisional Surgeon is to see that the Medical Officer of Health receives due notice, as well as all other Parish Authorities.” And finally a third Memorandum was issued in January, 1883, as follows “Sick: Infectious Diseases.—Referring to Police Orders, 7 th of March last, under this head.—When the Divisional Surgeon reports in accordance with that Order that he considers a member of a police. officer's family ought to be removed to the Fever Hospital, the case is to be reported to the Parochial Authorities. Certificates of admission to the Fever Hospital a,re to be issued to police.officers only.” The second Memorandum required the occurrence of an infectious disease in the residence of a police.officer to be reported to the Medical Officer of Health, irrespective of the question whether the sick person was, or could be, properly isolated. By the third Memorandum, such report, in respect of a member of the family, appears to be required only when the Divisional Surgeon is of opinion that the sick person ought to be removed to hospital; the Divisional Surgeon apparently being relieved from the obligation to report cases when the sick (in his opinion) can be safely treated at home. I am under the impression that the Divisional Surgeons are now required to report all such cases. In a letter received from the Postal Authorities (July, 1883), expression was given to "an anxious desire to meet as far as may be the wishes of the Vestry" and it was stated that "the Department never loses an opportunity of inculcating upon its servants how important it is that in cases of infectious and contagious diseases in their families they should remove the sick to hospital.” Copies of three notices, which “have been placed in the hands of every post office servant having infectious or contagious disease in his house,” were enclosed, one of them having been issued “early in the present year to the numerous medical officers of the Department throughout the country, in which they have been in. 77 structed, that if in their district it be not already the rule to give notice of such disease to the Sanitary Authority, it would be well that such a rule should be introduced in the case of post office servantsand another, also issued in 1883, “indicating how, so far as the metropolitan district is concerned, admission to hospital can best be secured and the removal of the sick effected. As regards compulsion, however, which would seem to be suggested in Dr. Orme Dudfield's letter of the 30th October last, this the Department is not prepared to employ.” The letter having been considered by the Works, Sanitary and General Purposes Committee, my suggestion was adopted, that your Vestry should be recommended to request the Postmaster.General to issue an instruction to the numerous Medical Officers of the Department, to give notice to the Sanitary Authority of the existence of dangerous infectious disease in the persons or families of post office servants, no such notice having hitherto been given or received; and this was done accordingly. Very little information, however, has reached me, in regard to illness in the families of letter carriers, etc., since the date of the correspondence, July, 1883. My attention was redirected to the subject by the occurence, a short time back, of scarlet fever in the families of three postmen, information of which was withheld from me until the services of your Vestry's disinfecting staff were called into requisition at the termination of the respective illnesses. Such being the facts, I wrote to the Chief Medical Officer to the Post Office, recalling attention to the correspondence that had taken place in 1882.3 when, as above stated, "the co.operation of the Post Office Authorities in measures to secure the isolation of cases of infectious illness occuring in the families of post office employes “was solicited by your Vestry, together with the assistance of the Authorities” to facilitate the removal of the sick to hospital when they cannot be safely treated at home." I also stated that— “Within the current month only, I have received information of three cases of scarlet fever in the families of three postmen. . . . Probably I should not have heard of either case had not the services of the 78 Vestry's officers, for disinfecting purposes, been required. It is eminently desirable that information of such cases should be forwarded to me at the commencement of the illness, and I shall be obliged if you will give directions to ensure that result in future cases.” To this letter I received a reply, dated 23rd March,as follows:— ‘The enquiry into the cases of Scarlet Fever mentioned in your letter of the 3rd current, has taken more time than I at first expected it would require. It appears that in neither of the cases quoted was direct notification made to you, the Medical Officer of Health of the Parish in which the sick relatives of the postal employes resided. The Medical Officers of this department have forms supplied to them for the purpose, and they are recommended to make use of them; but, as you have been informed through your Vestry clerk, Mr. G. C. Harding, in the Secretary's letter, dated July 20th, 1883, the Department is not prepared to employ compulsion in this matter; indirectly, however, and as you have observed in the 3rd clause of your letter, you were indebted to the care and vigilance of the Postal Medical Officers of the respective districts for a knowledge of the existence of the cases of contagious illness in question." The statement that 1 was "indebted to the care and vigilance of the Postal Medical Officers of the respective districts for a knowledge of the existence of the cases of contagious illness in question,” must be received with the qualification that the information was not given till it could not well be deferred any longer, and that it was not given in conformity with the instructions issued in 1883; it being unreasonable to suppose that the Post Office Authorities intended their medical officers to conceal the existence of infectious disease until recovery, or that report of the existence of such disease when the patient had recovered, could be regarded as giving effect to an “anxious desire to meet as far as may be the wishes of the Vestry,” viz., for “co.operation in measures to secure the isolation of cases,” and for “assistance to facilitate” (not by compulsion) “the removal of the sick to hospital when they cannot be safely treated at home.” Your Vestry not deeming the Chief Medical Officer's letter satisfactory, directed my monthly report (No. 3., March 28th, 1887), dealing with the question, to be forwarded to the Postmaster.General (Mr. Raikes), together with a communication requesting that he would be so good as to consider as to the desirability of issuing 79 an Instruction to the Postal Medical Officers and Postal employes, providing for immediate information to be given to Sanitary Authorities of the existence of infectious disease in the families of such employes. “The Vestry, as a Sanitary Authority,” it was stated, “is anxious to obtain such information, with a view to the discharge of its duty, in checking and preventing the spread of infectious disease—viz., by necessary supervision of the patient, during illness, when the patient is kept at home, and by measures for disinfection, after the patient's death or recovery.” Attention was called to the fact, by reference to the correspondence in 1883, that the Postal Authorities were “at one in principle with the Vestry, in regard to these matters, and regret was expressed that “the judicious recommendations of the Postal Authorities then issued to Medical Officers “had not been carried into effect. It was, therefore, suggested that” alike in the public interest, and in the interest of Postal employes themselves, positive instructions should take the place of recommendations, instructions similar to those issued by the Commissioners of Police in like circumstances.” To the above communication a reply was received from one of the Assistant Secretaries of the Department in the following terms:— “General Post Office, “Sir, “April 28th, 1887. “I am desired, by the Postmaster General to reply to your letter of the 15th instant, written to him by direction of the Vestry of the Parish of St. Mary Abbotts, Kensington. “Confining himself to the particular Parish over which your Vestry holds jurisdiction, Mr. Raikes directs me to state that the omission to communicate with the Local Sanitary Authority in the cases of Scarlet Fever mentioned in Dr. Orme Dudfield's printed Report, appears to have been due to inadvertence, and he feels assured, now that the attention of the Department's Local Medical Officers has been called to the matter, that the notification of the existence of infectious disease in the families of Post Office Servants residing in the Kensington District will for the future be punctually made. “As regards the suggestion that positive instructions should take the place of recommendations, I am to state that it is the experience of this Department that in dealing with gentlemen of education, who are 80 presumably striving to do their duty, recommendations—and even the mere expression of a wish, on the part of those who have the right to express one—are more efficacious than peremptory commands. “If, therefore, the Department proceeds by means slightly differing from those suggested in the letter now under reply, Mr. Raikes trusts your Vestry will not conclude from that circumstance that he does not cordially approve of the cause which they have at heart, or that he will not endeavour to promote it by every means in his power." It is to be hoped that the officers and employes of the Department will in future pay more respect to the wishes of the Authorities than they have done during the last four years. INTERRUPTION OF EDUCATION AT ELEMENTARY SCHOOLS RESULTING FROM THE PREVALENCE OF INFECTIOUS DISEASE. It is the practice at Board and other elementary schools to refuse admission to children from houses where infectious disease exists, even when the excluded 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 it has never 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 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 have greater powers under the provisions of the Education Code of 1883., than they formerly possessed, to close schools—powers which it need hardly be said should be used with great care and discretion. It has always been my endeavour to obtain the co.operation of school teachers in . “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.” 81 respect of infectious disease existing among their pupils, and then. help has often proved very serviceable. A regrettable fact connected with the existence of infectious disease, in relation to education, is the length of time during which children living in infected houses, but in good health themselves, have to be kept away from school, to the curtailment of the short period devoted to education; and although they may at the same time be meeting their school.fellows at play, thus to a certain extent neutralising the precautions taken at school. It is obvious that fresh and even stringent legislation is needed to enable us to cope with a difficulty of this sort.viz., an Act for the compulsory removal of the sick when such removal is necessary to secure isolation POPULATION, INHABITED HOUSES, &c. The population of Kensington, estimated to the middle of the year was, in round numbers, 173,500 (=79.2 per acre); males, 69,750, and females, 103,750; excess of females, 34,000. The population of the Town sub.district was, approximately, 127,800, and that of the Brompton sub.district 45,700. The natural increase during the year, represented by the excess of births over deaths registered, was 1,393: an estimated further increase of 107 represents the excess of immigration over emigration; total increase, 1,500. It is always difficult to estimate with accuracy the number of persons living in a large and populous place still, like Kensington, 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. At the present time of writing, however, I have no very reliable information as to the number of inhabited houses. Probably they were about 21,500 at the middle of the year. In places with stationary population the birth.rate may serve as a guide in estimating a population. But this test is of little practical avail in a parish like Kensington, where, as we shall see that, with a constantly increasing population, not merely the birth.rate, but the absolute number of births also, has “constantly declined in recent years” (vids Tables T. & II. Appendix). 82 The subjoined Tables show the relative numbers of persons of each sex, at the Census of 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 32,248 Excess of Females. Total of both sexes 163,151 17.585 '28862 35843 30582 21003 13888 9091 4649 1467 173 8 163,151Total 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 15540 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 27,127 17 1155 6435 5517 2592 1 932 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 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 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 83 Kensington is still in process of development by building, but at a moderate rate compared with past years—1861.70, for example. Owing to the increased value of property, its rateable value in recent times has risen out of proportion to the increase in the number of houses. The following Table, brought up to date, exhibits the growth of the Parish since the Metropolis Local Management Act came into operation in 1856:— 1856. 1886. Gross Increase in 30 years. Estimated number of Inhabited Houses (as per rate books) 7,600 21,500 13,900 Population 57,000 173,500 116,500 Rateable Value of Property £308,000 £1,833,599 £1,525,599 The above figures may well be said to speak for themselves: nevertheless, attention may be called to the fact that in 30 years the rateable value of property almost sextupled, and that in the last 15 years the mere increase was nearly treble the total in 1856. The population trebled, and the number of inhabited houses increased nearly threefold, in 30 years, the increase in the last decade alone attaining the dimensions of a large city. The rateable value of the parish is exceeded by that of the cities of London, Liverpool, Manchester, and Bristol only, The population of Kensington is to that of London about 1 to 24, and the rateable value 1 to 16½. The increase in all respects within the last fifteen years, the period over which my official experience extends, is not inconsiderable, as the subjoined figures will show. 1871. 1886. Increase in 15 years. Estimated number of Inhabited Houses (as per rate books) 15,395 21,500 6,105 Population 121,000 173,500 52,500 Rateable Value £935,720 £1,833,599 £897,879 84 MARRIAGES AND MARRIAGE RATE. The marriages in 1886 were 1,605 and 125 more than in 1885. Of these there were celebrated— By the Church (76'9 per cent, of total marriages) . 1,235 At Roman Catholic places of worship 127 At other Nonconformist places of worship 64 At the Superintendent Registrar's Office 179 Total 1,605 The marriage rate, i.e., persons married to 1,000 inhabitants, was 18.5. The marriage rate in the country generally was 14.1 per 1,000, and showed a further decline from the steadily decreasing rates in the four preceding years: it was 1.1 below the mean annual rate in the ten years, 1876.85, and was lower than the rate recorded in any year since 1837. The marriage rate in London was 16.6, the lowest rate as yet recorded; the three next lowest, moreover, being those recorded in the three immediately preceding years, 1883.4.5, in which the rates were successively 17.9, 17.6, and 16.9. BIRTHS AND BIRTH RATE. The births registered in 1886 were 4,149—males, 2,137, and females, 2,112; in the Town sub.district, 3,378, and in the Brompton sub.district, 771. The births in 1885 were 4,032, or 117 below the number last year, in which the births, 670 below the decennial average corrected for increase of population, were fewer by 33 than in 1873, when the population was smaller by 47,000 than in 1886. The birth rate in Kensington, considerably lower than the London rate (32'3), and that of England and Wales (32.4), has been declining since 1867, when it was 33.1 per 1000. In 1886 it was 23.9, being 3.7 below the decennial average. The rate in the Town sub.district was 26.4 and in Brompton 17'0. There was one birth to 41.8 inhabitants and 101'2 births of males to 100 of females. The births of illegitimate children were 190 (15 fewer than in 1885), viz., males 94 and females 96. Of these births 171 were registered in the Town 85 sub.district, which includes the parish workhouse, at which institution out of 127 births (males 60, females 67) 103 (including 10 stillborn) were illegitimate. In the parish generally, the illegitimate births formed 4.5 per cent, of total births, as against 4"8, 42, and 5.8 in 1883.4.5 consecutively. For particulars respecting annual number of births and birth rates in the decennial period, 1876.85, see Tables I. and II., Appendix. DEATHS AND DEATH BATE. The deaths registered in 1886, inclusive of 183 at outlying public institutions, but exclusive of deaths of non.parishioners at intra.parochial public institutions, were 2,756, or 259 below the decennial average corrected for increase of population: 2,178 of the deaths belong to the Town sub.district, and 578 to the Brompton sub.district. The death rate, whole parish, was 15.9 per 1,000, compared with 15.5, 15.1, and 16.1 in the three preceding years; being 1.4 below tliejdecennial average and 4.0 below the London rate (19.9); this, moreover, being 1.7 below the average, and only 0.2 above the rate in 1885, which was the lowest on record. It was 3'4 below the rate in England and Wales (19.3); this being 0.4 above the rate in 1881, the lowest on record. The rate in the Town sub.district was 17.0 and in Brompton 12.6, as against 17'4 and 12.4 in 1885. The rate in the male sex was 19.1, and in the female sex 13"7 per 1,000, as against 19'2, and l4.0 in 1885. There was one death to every 62'9 inhabitants, as against one to 62.1 in 1885. Out of 69,75 ) males, 1,331 died, equal to one in 524, as against one in 52.0 in The subjoined Table shows the quarterly numbers of births of males and females in each of the sub.districts. Kensington Town Sub.district. Brompton Sub.district. Grand Total. Whole Parish. Males. Females. Total. Males. Females. Total. 1st Quarter 452 427 879 94 118 212 1091 2nd „ 446 375 821 103 108 211 1032 3rd „ 442 415 857 86 86 172 102!) 4th „ 418 403 821 96 80 176 997 1758 1620 3378 379 392 771 4149 86 1885, whilst only 1,425 females died out of 103,750, or one in 72.8, as against one in 74.4 in 1885. The deaths in the first and fourth, or colder quarters, exceeded those in the second and third, or warmer quarters, by 320 : in the six preceding years the difference in favour of the warmer quarters was 240, 120, 355, 251, 132, and 22, consecutively. INFANTILE MORTALITY. The deaths of young children always bear a high ratio to total deaths. In 1886 this ratio was lower than in some recent years. The deaths under five years were 1,029 (545 in the first and fourth quarters, and 484 in the second and third quarters), compared with 1,114, 982, 1,034, and 1,085 in the four preceding years; being equal to 37'3 per cent, on total deaths, and to 24"8 on births registered: the equivalent percentages for the whole Metropolis were 41.7 and 25.7. Under one year of age the deaths were 636 (compared with 635, 601, 689, and 653 in 1882.3.4.5 consecutively), and were equal to 23.0 per cent, on total deaths, and to 15'4 per cent, on registered births; the equivalent percentages for the whole metropolis being 25'8 and 15'9. The deaths of illegitimate children under five years of age were 104 (of which 92 were registered in the Town sub.district), as against 114, 78, 80, and 86 in the four preceding years, and were equal to 54.7 per cent, on births registered as illegitimate. Of these 104 children only 25 outlived their first year, and 23 died in the second year of life. The causes of death, as registered, were atrophy, debility, inanition, 29 ; premature birth, 4 ; tubercular diseases, 26; zymotic diseases, 18 (diarrhoea, 8; measles, 8; whooping.cough, 1; enteric fever, 1); brain disease, 2 ; syphilis, 3; lung diseases, 8; convulsions, 8; wilful murder, 2; teething, epistaxis, injuries at birth, and want of attention at birth, 1 each. Illegitimate children are commonly brought up by hand, under the charge of strangers. The evidence of improper feeding. and of the lack of maternal care is apparent enough in the above iist of fatal diseases. 87 Senile Mortality.—At sixty years of age, and upwards, there were 747 deaths, as against 619, 699, 607, and 736 in the four preceding years, or 27.1 per cent. on total deaths, the .equivalent percentage in London being 23.5. The Death Rate per 1,000 persons living, at different periods of life, was as follows:— 1886. 1885. 1884. Under Five years of age 55.0 58.4 56.3 Five and under 15 3.2 2.9 3.4 Fifteen „ „ 25 3.1 2.8 3.1 Twenty.five „ 35 5.5 5.4 5.0 Thirty.five „ 45 9.5 9.7 9.8 Forty.five „ 55 14.8 16.3 18.0 Fifty.five „ 65 29.5 27.6 24.7 Sixty.five „ 75 65.8 63.2 58.1 Seventy.five „ 85 144.9 142.7 127.5 Eighty.five and upwards 338.0 340.3 202.1 The subjoined Table shews the quarterly numbers of deaths of parishioners, males and females, in each of the sub.districts, including those that occurred at outlying public institutions (vide page 101,):— Kensington Town Sub.district. Brompton Sub.district. Grand Total. Whole Parish. 1st Quarter Males. 342 Females. 319 Total. 691 Males. 73 Females. 106 Total. 179 870 2nd „ 221 234 455 60 77 137 592 3rd „ 238 254 492 73 61 134 626 4 th „ 2«3 277 540 61 67 128 668 1064 1114 2178 267 311 578 2756 The Births were, Males 2137 The Deaths were, Males 1331 Females 2012 Females 1425 Total Births 4139 Total Deaths 2756 2756 Deaths 1393 Excess of Births over Deaths. The subjoined Table shows the rate of mortality and the mean temperature of the air in each of thirteen periods of four weeks corresponding with my monthly reports. 88 Date of Report. Death Rate per 1000 persons living. Mean Temperature of the Air 1886. Ten years, 1876.85. 1886. Decennial Average. Above or below average For four weeks to Jan. 30, 1886 186 20.6 35.2 37.8 — 2.6 „ „ Feb. 27, „ 19.1 19.0 34.0 41.2 — 7.2 „ „ Mar. 27, „ 23.2 18.7 38.3 42.0 — 3.7 „ „ April 24, „ 15.7 19.9 46.0 45.1 + 0.9 „ „ May 22, „ 15.2 16.4 51.9 49.2 + 2.7 „ „ June 19, „ 11.6 16.9 55.3 56.2 — 0.9 „ „ July 17, „ 12.8 15.2 62.6 61.5 + 11 „ „ Aug. 14, „ 15.4 17.1 61.4 62.1 — 0. 7 „ „ Sept. 11, „ 14.0 14.2 62.7 60.1 + 2.6 „ „ Oct. 9, „ 13.1 13.1 57.6 54.7 + 2.9 „ „ Nov. 6, „ 14.6 15.2 50.2 47.8 + 2.4 „ „ Dec. 4, „ 16.3 17.7 41.7 42.9 — 1.2 „ „ Jan. 1, 1887 16.3 18.2 36.4 39.0 — 2.6 Averages whole year 15.9 17.3 48.6 49.3 The subjoined Table, a summary of Table 3 (Appendix) shews the numbers of deaths of parishioners in 1886, 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 190 2. Diarrhceal 91 3. Malarial „ — 4. Zoogenous „ — 5. Venereal „ 22 6. Septic „ 29 332 II. PARASITIC DISEASES 1 III. DIETETIC DISEASES 21 IV. CONSTITUTIONAL DISEASES 609 V. DEVELOPMENTAL DISEASES 158 VI. LOCAL DISEASES 1. Diseases of Nervous system 302 2. Diseases of Organs of Special Sense 1 3. Diseases of Circulatory system 163 4. Diseases of Respiratory system 630 5. Diseases of Digestive system 176 6. Diseases of Lymphatic system — 7. Diseases of Glandlike Organs of uncertain use — 89  No. of Deaths 8. Diseases of Urinary system 84 9. Diseases of Reproductive system a. Diseases of Organs of Generation 18 b. Diseases of Parturition 15 10. Diseases of Locomotive System — 11. Diseases of Integumentary system 5 - 1,394 VII. VIOLENCE 1. Accident or Negligence 62 2. Battle — 3. Homicide 4 4. Suicide 8 5. Execution — - 74 VIII. ILL.DEFINED AND NOT SPECIFIED CAUSES 167 Total 2,756 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 deal with the mortality from the remaining diseases; but before doing so I think it 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 some of the other Tables. As it was 90 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 accordance with the more detailed list drawn up for use in the Annual Report, the Society of Medical Officers of Health revised certain Tables, which, at my instance, they had framed for the sake of uniformity, some ten years previously, and ultimately settled the forms of Tables 1—6 inclusive, as they appear in the Appendix. It results, therefore, that these Tables will be found to differ to some extent from similarly numbered Tables in the annual reports prior to 1882. With this explanation I pass on to deal with the remaining diseases included in Class 1.—Specific Febrile or Zymotic Diseases. This class comprises six "Orders;" the first and second, "Miasmatic" and "Diarrhoeal," 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, cC.c.; but no deaths were registered from any of these causes. Order 5, Venereal Diseases, includes Syphilis, Gonorrhoea, and Stricture.of the Urethra. Syphilis was the registered cause of 21 deaths, as against 15 and 26 in 1884.5. All but one of these deaths occurred in the Town sub.district: 17 of them were of children under five years of age. If the truth could be ascertained, it would probably appear that this Protean malady was accountable, directly or indirectly, for a number of deaths much in excess of the record. There was one death from stricture of the urethra. Order 6, Septic Diseases. This order comprises Erysipelas, Pyaemia, Septicemia, and Puerperal Fever, the total deaths registered being 29, against 33 and 40 in 1884.5. Erysipelas was the cause of 7 deaths only, against 26 in 1885, and all in the Town sub.district. One of the deaths was of a child under one year of age. 91 Pyamia and Septicemia were the causes of 3 deaths ; all in the Town sub.district. There were 7 deaths from these causes in 1885. Puerperal Fever was the registered cause of 19 deaths, against 26, 14, and 7 in 1883.4.5; 13 of them in the Town sub. district. Six of the deaths were of women between 15 and 25 years of age, eleven between 25 and 35, and two between 35 and 45. In addition to these 19 deaths, fifteen deaths, all of them in the Town sub.district, were registered, as having occurred in "childbirth," as against 3, 7, and 9 in the three preceding years. Puerperal fever is a communicable disease depending on "blood poisoning," whereas other causes of death connected with childbirth, are, so to say, accidental, e.g., haemorrhage ("flooding"). The deaths registered as having been caused by diseases and accidents associated with parturition (34) were equal to 5.8 per 1,000 live births, against 4 per 1,000 in 1885. Class 2.—Parasitic Diseases Includes Thrush and Other Vegetable Parasitic Diseases, one death: and "Worms, Hydatids, and other Animal Parasitic Diseases,"no death. Glass 3.—Dietetic Diseases Were the causes of 21 deaths, 16 of them in the Town sub. district. Want of breast milk was the cause of one death. To Scurvy no death was assigned. Delirium tremens was the cause of ten deaths (against two in 1885), and Chronic alcoholism of a like number of deaths, against four in 1885. Of these 20 deaths 15 were registered in the Town sub.district. It is scarcely necessaiy, perhaps, to remark that, if all the deaths due, directly and indirectly, to the immoderate use of intoxicating liquors could be ascertained, "Alcoholism" would occupy a more prominent position in the "Bills of Mortality"; but many deaths due to the abuse of alcohol get certified, and therefore are classified, to visceral and degenerative diseases, caused or aggravated by "drink." Man's ingenuity in the discovery of alcohol is 92 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 of many premature deaths: it fills our prisons and workhouses, our asylums and hospitals, our cemeteries, and, though happily to a largely decreasing extent, our National Exchequer ! Class 4.—Constitutional Diseases. This important Class comprises the causes of 609 deaths (=22 per cent, of total deaths); including 170 of children under the age of 5 years: 480 of the deaths were registered in the Town sub.district, and 129 in Brampton. Rheumatic Fever and Rheumatism of the Heart caused 11 deaths, six of them in the Brampton sub.district; Rheumatism, four deaths, all in the Town sub.district. In fatal cases of rheumatic fever the immediate cause of death, not unfrequently, is disease of the heart arising in the course of the malady; and of the deaths certified from heart disease at later periods of life, not a few might properly be ascribed to rheumatism as the primary cause. But the connexion between the two diseases is either overlooked or, it may be, unknown to the certifying practitioner. In the new classification, deaths due to rheumatic disease involving the heart are distinguished from deaths due to rheumatism without such complication. Gout was the cause of 4 deaths, all in the Town sub.district, and Rickets of 3. Cancer, Malignant Disease, was accountable for 128 deaths; V6 in the Town sub.district, and 32 in Brampton. Cancer appears to be on the increase in the country generally: possibly, however, some portion of the increase in deaths classified to this cause may be due to more accurate diagnosis. The deaths in Kensington from this cause in the previous ten years, were 69, 88, 79, 95, 90, 112, 92, 128, 117 and 119. Deaths from cancer are usually more numerous, proportionally to population, in the Brampton sub.district, than in the relatively poorer Town sub. district. Cancer, in fact, is quite as prevalent, probably even more prevalent, amongst well.to.do people, than in the poorer 93 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 for the most part one of later life. One hundred and nine of the deaths took place at ages above 45. It is right to mention that in Table 3 (Appendix) the deaths assigned to cancer have been classified to cancer irrespective of the question whether any other disease was named in the medical certificate, or whether cancer was the immediate cause of death. Puerpura, Ilcemorrhagic Diathesis, was the cause of two deaths; Leucocythesmia was the cause of one death; Glycosuria, Diabetes Mellitus, was the cause of 1.6 deaths, 12 of them in the Town sub.district. The remaining diseases in this Class belong to the group known as Tuberculab, 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 population. Generally hereditary, these diseases are nevertheless susceptible of considerable amelioration under improved sanitary arrangements. Scrofula is unknown in Hygieapolis. Pure air and sunlight, efficient drainage and its corollary, a dry subsoil; good food, warm clothing, and temperance in all things, are powerful antidotes to the bane of tubercle, which is fostered by dirt and squalor, 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 sewage. tainted houses, and, in a word, by whatever is inimical to the maintenance of a typical condition of health. The cases that occur amongst the well.to.do classes are frequently traceable to the influence of heredity; modern researches, however, 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 : we are encouraged to hope, therefore, that a remedy may ultimately be found for this great scourge of the 94 human race. Tubercular diseases were the registered causes of 440 deaths, viz., 354 in the Town sub.district, and 86 in Brompton ; 164 of the deaths being of children under 5 years of age. The numbers in the four quarters of the year respectively, were 105, 95, 121, and 119; 224 in the winter and 216 in the summer quarters. In a few instances " phthisis " was returned as the cause of death in earliest infancy, a period of life at which the tubercular diathesis commonly manifests itself in other parts of the body than the lungs; e.g., brain, bowels, etc. Such deaths have been classified, in Table 3, with those certified from "other forms of tuberculosis, scrofula,"the total, being 68 (of which 51 occurred under 5 years of age), including 15 registered in the Brompton sub.district. Tabes Mesenterica, popularly known as " consumption of the bowels," was the cause of 52 deaths; including five only in Brompton; 50 of them under five years of age, and 39 under one year. Tubercular Meningitis and Hydrocephalus (water on the brain), were the causes of 74 deaths, 15 of them in Brompton, and 62 under five years of age. Phthisis, popularly known as "decline," or "consumption "was the cause of 246 deaths; 6 of them between 5 and 15 years of age, and 225 between 15 and 65; viz., 37, 66, 64, 33, and 25, in the five decades consecutively : fourteen deaths were registered at ages over 65. The quarterly numbers were 64, 56, 62, and 64. Of the total, 195 belong to the Town sub.district and 51 to Brompton. The deaths from tubercular diseases were, as usual, but not to the customary extent, disproportionately more numerous in the Town sub.district than in Brompton; less than a fifth of them 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 tubercular diseases do not comprise all of the deaths originating in the tubercular diathesis, and that many deaths of children classified to premature birth, atrophy, debility, convulsions, &c., were primarily due to the scrofulous taint. In numerous instances some other disease, e.g., of the lungs, as bronchitis, pneumonia, 95 &c., was associated with phthisis in medical certificates of the cause of death; but all such associated diseases have been disregarded in the preparation of Table 3, for when phthisis was returned the death is classified to that heading, it being assumed that the tubercular diathesis was underlying the other disease, and was in fact the primary cause of death. Class 5.—Developmental Diseases. In this Class the total deaths were 158, viz., 117 in the Town sub.district, and 41 in Brompton. Premature Birth was the assigned cause of 56 deaths; Atelectasis of 4; and Con. genital Malformation of 13. Old Age was the registered cause of 85 deaths at ages over 65 : between 75 and 85 there were 46 deaths, and 28 at 85 and upwards. 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 1,394 deaths, or 50.6 per cent, of the deaths from all causes; 1,105 were registered in the Town sub.district, and 289 in Brompton ; 360 were of children under five years of age. 1. Nervous System.—Diseases of the nervous system were the registered causes of 302 deaths (against 288, 259, and 288 in 1883.4.5), viz., 253 in the Town sub.district, and 49 in Brompton : 85 of the deaths were of children under five years of age. The quarterly numbers were 93, 69, 67, and 73. The fatal diseases were Inflammation of Brain or Membranes, 15 deaths; Apoplexy, Softening of Brain, Hemiplegia, Brain Paralysis, 159 (28 in Brompton, and 139 at ages over 45); Insanity, (ieneral Paralysis of the Insane, 1; Epilepsy, 13; Convulsions, 74 (all, save one, under five, and 50 under one year); Laryngismus Stridulus (spasm of glottis), 3 (under one year); Disease of Spinal Cord, Paraplegia, Paralysis Agitans, 14; Other Diseases of Nervous System, 23. Convulsions as a cause of death is frequently associated, in medical certificates, with definite diseases, 96 and with "teething." The convulsions being a sympton only, such deaths are classified to the primary disease 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, is not infrequently the assigned cause of death of children "found dead in bed." The name of the disease has much the same meaning as "want of breath," which, indeed, is the cause of death 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 in some of the cases the children had been "overlaid," i.e., suffocated—a remark equally applicable to deaths attributed to convulsions, in the case of children 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 cannot prove the occurence 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). One death only was registered. 3. Circulatory System.—The deaths due to diseases of the organs of circulation, heart and blood vessels, were 163 against 179, 196, and 170 in 1883.4.5 : 124 were registered in the Town sub.district, and 39 in Brompton. The quarterly numbers were 56, 31, 43, and 33. To specified forms of disease 55 deaths were assigned, viz., Pericarditis, 3; Valvular Diseases of Heart, 33; Aneurism, 9; Embolism and Thrombosis, 2. Other Diseases of Heart caused 108 deaths, and Other Diseases of Blood Vessels 8 deaths. 4. Respiratory System.—The deaths from the diseases of the chest, phthisis being excluded, were 630; or 17 more than in 1885, and 22.8 per cent. of total deaths. Of this number 517 97 were registered in the Town sub-district, and 113 in Brompton. The quarterly numbers were 280, 100, 63, and 187 ; 467 in the first and fourth, or colder quarters, and 163 in the second and third, or warmer quarters. The deaths Under five years of age were 223 = 35.4 per cent. (against 47.7 and 41.1 in 1884-5); and at 55 and upwards, 267 = 42.4 per cent. of the whole number; (against 33 and 42 per cent. in 1884-5). These diseases are thus seen to be most fatal at the extremes of life. The prevalence of them varies considerably in different years, depending on the degree 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 fatal diseases were Laryngitis, 3 deaths ; Croup (transferred in the new classification from " miasmatic" diseases), 22; Emphysema, Asthma, 13; Bronchitis, 423; Pneumonia, 122; Pleurisy, 13 ; Other Diseases of Respiratory System, 34. Bronchitis and Pneumonia, therefore, were accountable for 545 deaths, including 286 under five years of age, and 87 registered in Brompton. 5. Digestive System.—The diseases of the various organs concerned in digestion were the causes of 176 deaths ; 43 of them under five years of age ; 124 in the Town sub-district, and 52 in Brompton. In the new classification, Dentition is included in this Order ; it was the cause of 14 deaths under five, 5 of them under one year. Sore Throat, Quinsey (the latter disease transferred in the new classification from "miasmatic" diseases), was the cause of 2 deaths; Diseases of Stomach, 18; Enteritis, 18; Obstructive Diseases of Intestines, 27; Peritonitis, 26. Ascites was the cause of three deaths ; Cirrhosis of Liver, 24 ; Jaundice and Other Diseases of Liver, 34; Other Diseases of Digestive System, 10. 6. Diseases of Lymphatic System {e.g., of Lymphatics and of Spleen). No death registered. 7. Diseases op Gland-like Organs of Uncertain Use (e.g., Bronchocele, Addison.s Disease). No death registered. 8. Diseases of Urinary Organs.—Of the 84 deaths assigned to these causes, 56 were registered in the Town sub- 98 district, and '28 in Brompton; three were of children under five years of age. The diseases were, Nephritis, 6 deaths ; Bright's Disease (Albuminuria), 28 ; Diseases of Bladder or of Prostate, 13 ; Other Diseases of Urinary System, 37. 9. Diseases of Reproductive System.—(a) Of Organs of Generation : Male Organs, no deaths ; Female Organs, 18 ; (b) Of Parturition, 15 deaths, viz., from Placenta Prcevia (flooding), 1, Puerperal Convulsions, 1, Other accidents of Childbirth, 13. 10. Diseases of Bones and Joints.—No death. 11. Diseases of Integumentary System.—Five deaths— viz., Carbuncle, Phlegmon, 3 ; Other Diseases, 2. Glass 7. —Deaths from Violence. Seventy four deaths, including 28 under five years of age, (22 under one year) are distributed over the four Orders comprised in this Class ; 11 of them belong to the Brompton sub-district. 1. Accident or Negligence.—Total deaths 58, including 5 in Brompton, and 25 under five years of age; viz., from Fractures and Contusions, 28 ; Gunshot Wounds, 1; Burn, Scald, 4; Poison, 2 ; Drowning, 1 ; Suffocation, generally of infants " overlaid," 18, including 17 under one year ; Otherwise, 4. 2. Homicide.—Murder, four deaths, including three ot infants of unknown parentage under one year. 3. Suicide.—Of the 12 suicidal deaths, 5 took place in the Town sub-district. Poison was the lethal agent in 4 cases ; Cut, Stab, 3 ; Gunshot Wound, 3; Hanging, and a fall, one each. • Class 8.—Deaths from Ill-defined and not Specified Causes. This Class has acquired increased importance in the new classification, owing to the transfer of a certain number of illdefined causes of death from other positions in the old classification. It includes the causes of 167 deaths ; 134 under five years of age, and 138 and 29 in the Town and Brompton subdistricts, respectively. The diseases named are—Dropsy, 4 99 deaths; Debility, Atrophy, Inanition, 122, (all but two under five years, and 108 under one year) ; Mortification, 7 ; Abscess, 1; Hemorrhage, 4; Causes not specified or ill-defined, 19. 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 gwasi-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, largely from Ireland; but the Registrar-General does not class it as a "public institution." The deaths of non-parishioners at the Marylebone Infirmary, Notting Hill (404), and at the Brompton Consumption Hospital (130), 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 (417), at the Brompton Consumption Hospital (4), and at outlying institutions (183), were 604, or 21'9 per cent, on total deaths, the percentage proportion of deaths in public institutions in the Metropolis generally being 20"7. The Parish Infirmary and Workhouse.—I am indebted to Mr. H. Percy Potter, Medical Superintendent to the Infirmary, and Medical Officer to the Workhouse, for the statistics of mortality at these important institutions, the former being, to all intents and purposes, as indeed its name implies, a hospital; it contains over six hundred beds. The deaths registered at these institutions in 1886 were 417, compared with 273, 307, 322, 273 and 355 in the five previous years, and were equal to 15'0 percent. on total deaths. Mr. Potter informs me that the actual deaths in the year were 410, the quarterly numbers being 140, 81, 102 and 87 ; so that 227 deaths occurred in the first and fourth (or cold) quarters, and 183 in the second and third (or 100 warm) quarters. The deaths of males were 219 and of females 181. The ages at death were, under one year 65 (32 in 1885), between one year and 60 years 184 (157 in 1885); and at 60 years and upwards, 161 (177 in 1885). Two inquests were held : in one of the cases the death was due to "natural causes" (apoplexy); in the other case the death was caused by " a fall" (fractured ribs). Summary of Causes of Death. Under one year. Between one year and Sixty. Sixty and upwards. Total. Nervous System, Diseases of (including Apoplexy, Epilepsy and Convulsions) 5 23 25 53 Circulatory System, Diseases of Respiratory ,, ,, (including Phthisis) 1 3 14 77 10 65 25 145 Digestive System, Diseases of 1 12 9 22 Urinary ,, ,, — 10 7 17 Measles 4 8 — 12 Diarrhoea 4 2 — 6 Erysipelas — — 4 4 Septicaemia — 1 1 2 Syphilis — 4 — 4 Tubercular Diseases (excluding Phthisis) 42 13 55 Cancer — 7 8 15 Premature birth 5 — — 5 Diseases and accidents of childbirth — 7 — 7 Tumours — 1 2 3 Privation — 2 — 2 Hemorrhage — 1 — 1 Gangrene — — 4 4 Cancrum Oris — 1 — 1 Injuries — 1 — 1 Old age — — 26 26 65 184 161 410 101 Outlying Public Institutions, etc.—By virtue of an arrangement between your Vestry and one of the officials in the Registrar-General's Department I receive weekly a return of the deaths of Kensington parishioners occurring in public institutions and other places outside the Parish. In Table 3 (Appendix) all such deaths, 183 in number, are included. St. Joseph's House, Pobtobello Road.—The deaths at this quasi-public institution are included in Table 3 (Appendix). They were 37 in number : males 14 and females 23. All of the deaths occurred at ages over 60 ; 11 of them at ages over 80. Seventeen of the deaths were of persons who had been imported from other Metropolitan parishes ; eight of the deceased had previously resided in Ireland, one in Scotland, two on the continent, and five in the Provinces; three were stated to be parishioners ; the previous residence in one case was not stated. The causes of death were : diseases of the nervous system, 9 ; The deaths occurred in the following institutions, viz.— St. Mary's Hospital 53 Lock Hospital 1 St. George's „ 34 Western District Hospital 4 Charing Cross ,, 6 St. Raphael's Hospital 3 King's College „ 6 St. Gabriel's Home 2 St. Thomas's ,, 5 St. Thomas's Home 1 Middlesex „ 5 St. Elizabeth's Home 2 Westminster ,, 5 ,, Hospital 1 St. Bartholomew's „ 4 Children's Hospital (Paddington) 11 West London ,, 4 „ (Victoria, Chelsea) 2 UniversityCollege,, 3 Guy's „ 2 Hoxton House Asylum 1 London ,, 1 Camberwell „ „ 1 Brompton Consumption Hospital Chelsea Workhouse Infirmary 1 (south branch) 3 Paddington ,, „ 1 Chest, Hospital for Diseases of 1 Hampstead ,, ,, 1 Throat ,, „ 1 Fulham „ „ 2 Heart ,, ,, 1 Homoapathic Hospital 1 Women ,, ,, 1 Public Baths, Whitechapel 1 Paralysis Hospital, National 1 Public carriage, In a 1 Cancer Hospital (Chelsea) 5 Temperance Hospital 1 Queen Charlotte's Hospital 4 Total 183 102 diseases of the respiratory and circulatory systems, 18 ; cancer, 8 ; old age, 2 ; diarrhoea, liver disease, rheumatism, Bright's disease, and bed-sores, 1 each. The Hospital foe Consumption and Diseases of the Chest.—The deaths at this institution, or rather in that part of it—the original hospital—situated in Kensington, (a 'South Branch " having been established on the further side of the Fulham Road, in the parish of Chelsea) were 134, viz. : males, 80, and females, 54. Four of the deaths were of parishioners, and are included in Table 3 (Appendix), the remaining deaths, of non-parishioners, are excluded from that Table. Marylebone Infirmary, Notting Hill.—At this hospital, which is under the control of the Guardians of the Poor of the Parish of St. Marylebone, and is even larger than our own Parish Infirmary, 404 deaths of non-parishioners were registered, all of which are excluded from Table 3 (Appendix). DEATHS NOT CERTIFIED. Twenty-five deaths (against 20,10, and 12 in the three preceding years) were returned as not having been certified, either by a registered medical practitioner or by a coroner. The proportion of uncertified deaths to total deaths was, in Kensington, 0*8 per cent.; in London, 1*2 per cent.; in England and Wales, 3"4 per cent. None of the deaths uncertified in Kensington occurred in the practice of unregistered male practitioners. Six of the deaths were registered on the information of midwives. Three of the deceased persons had been out-patients at hospitals. In the remaining cases there appears to have been no medical attendance: the cases were reported to the Coroner, who did not deem it necessary to hold inquests. The causes of death, as registered, were: in six cases each, diseases of heart, lungs, &c., and premature birth ; in seven cases, affections of the nervous system (including convulsions 3); in two cases, whooping cough ; and in one case each, phthisis, anaemia, burns, and " unknown." 108 The subject of uncertified deaths having some time since engaged the attention of the Society of Medical Officers of Health, the following resolution was adopted:— "That all cases of uncertified deaths should be reported by the local registrar of births and deaths to the Coroner, who should, when there is no primd facie ground for holding an inquest, direct such cases to lie investigated by a registered medical practitioner.'" It had been suggested that the duty of making the proposed 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 uncertified deaths, the least defensible is that which makes the Coroner's Officer de facto judge, in a doubtful case, whether an inquest should be held. The Society, at my instance, adopted the following resolution bearing on the subject:— "That 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 fifty-one inquests were held on parishioners: 109 in the Town sub-district, 22 in Brompton, and 20 at outlying public institutions (hospitals) to which the deceased had been removed. The subjects were males 91 and females 60; the age, at death being, under five years, 55, including 38 under one year; between 5 and 60 years, 69 ; at 60 years and upwards, 27. The cause of death in 96 cases is stated' to have been ascertained by post-mortem examination. Several of the subjects of inquestwere illegitimate children, including six newly born (and presumably non-parishioners), abandoned in the streets, etc. The Deaths prom Violence were 74, of which 11 belong to the Brompton sub-district. The grounds for holding inquests are, usually, the suddenness of death, or the fact that death had been caused by violence. In many cases the Coroner's returns shew that the deceased persons had been " found dead," in bed or otherwise. 104 The causes of death may be classified as follows Deaths caused by disease 77 Violent deaths— Accidental 58 Suicidal 12 Homicidal 4 74 151 The fatal diseases may be classified thus Diseases of the brain and nervous system, including " convulsions " 22 Diseases of the organs of respiration and circulation 46 Other visceral diseases 2 Tubercular diseases 2 Zymotic ,, (Diarrhoea) 2 Spasm of Glottis 2 Teething 1 77 The violent deaths were as follows:— Accident: Suffocation (including 17 of infants under one year) 18 Poison 2 Burns 4 Gunshot wounds 1 Drowning - 1 Fractures and Contusions, 28—viz.— Run over 4 Falls under various circumstances 24 28 Otherwise 4 Suicide: By hanging 1 By poison 4 By cut (stab) 3 By gunshot wounds 3 By a fall 1 Homicide: Wilful murder 4 74 105 The suicidal deaths comprise eight of males and four of females ; two of the latter by poison (belladonna and carbolic acid), and one each by hanging and drowning. The homicidal deaths were of a man who was fatally injured by a stone thrown at him in the street, and three newly-born children cast out in public places—presumably non-parishioners and illegitimate. Among the deaths described as . sudden,. there were, as usual, many from curable visceral diseases, and there must have been culpable neglect of the deceased, in that medical attendance had not been procured, although the illnesses extended over many days, and could not have failed to be marked by 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; . equally as in the case of the . peculiar people,. who, whilst treating their sick with care in other respects, refuse, 011 mistaken .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 1886, was 480.7 Fahrenheit, 0.1 above the average of 115 years, but 0.7 below the average of 45 years : the means in the four quarters respectively were, 36.5, 52.5, 61.2, and 44.6. The highest reading by day (89.8) was registered in the week ended July 10th, and the lowest reading by night (16.5) in the week ended January 9th. The means of the highest weekly readings by day, in the four quarters respectively, were 64.1, 85.6, 89.8, and 79.2 ; and of the lowest readings by night, 16.5, 29.1, E 106 40.3, and 17.3. The hottest weeks in the year were those which ended July 10th and September 4th, (mean temperature, 66.5), and the coldest week that which ended March 13th (mean temperature, 31.9). July was the hottest month, (mean temperature, 63.0): and February the coldest (mean temperature, 36.7). May exhibited the greatest range in temperature, viz., 49.8:— from 78.9 to 29.1 ; and February the smallest range, viz., 27.2:— from 47.8 to 20.6. The dryness of the atmosphere, i.e., the difference between the dew-point temperature and air temperature, was 5.7, or 0.6 below the average of 45 years. Rain fell on 163 days, the total amount registered in the year being 24.21 inches, 1.85 less than the averages of 72 years. Most rain lell in May (4.23 inches), and least in June (0.44). The means of the readings of the barometer were 29.734 inches ; the means of February 29.945, and of January, 29.475, being respectively highest and lowest. The relative proportion of wind was : north, 67 ; east, 88 ; south, 100 ; and west, 110. VACCINATION. Table X. (Appendix) is a return respecting vaccination in 1885, compiled by Mr. Sliattock, the Vaccination officer, whose energetic discharge of the duties of his appointment it is always a pleasing duty to recognize. The return shows a loss of 4.6 percent. in the cases, against 4.0 and 3.9 in the two preceding years, . 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 is somewhat greater than in Kensington. In England and Wales, as we learn from the annual report of Dr. George Buchanan, Medical Officer to the Local Government Board, . the returns give evidence of about 95 per cent, of the infantile population having received the benefits of vaccination within the first year . after their birth ; it follows that the infant population is made up of .19 vaccinated to each unvaccinated individual.. With regard to the protection against small-pox afforded by vaccination—differing in degree as this does according as the 107 vaccination is more or less " successful "—it should be unnecessary to say anything; but the pertinacity with which some misguided persons still decry the most beneficent of medical discoveries' shows no sign of abatement, and as their teaching is calculated to prejudice the general public against the wise compulsion authorized by law, I do not hesitate to refer again to the pregnant proofs of the efficacy of vaccination, as a protection against small-pox, contained in the annual report for 1881 of the Medical Officer to the Local Government Board, lately republished. Dr. Buchanan refers, in the first place, 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 from which I extract the following Table:— Comparative Small-pox Death Rates among Londoners, }~accinated 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 1,520 Under 5 years 40½ 5,950 Mainly, however, Dr. Buchanan 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, e 2 108 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 ten, by the average current vaccination of London." * " If the London children under ten 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 can they be reduced, but we should be confronted with an additional 12,000 and more deaths from smallpox, occuring during the year in the London population under ten 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 from 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, as we are informed, medical men who systematically evade the spirit of the law, and disregard the teachings of experience, as summed up in 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 * " 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." f Primary vaccination only is compulsory in England. In Germany, revaccination, ever since 1874, has been compulsory during the "school period" of children's lives ; the result being that, " duriug the ten years last past Germany has not only experienced smaller death rates by small-pox than ever before, but even lias passed from a position of inferiority to England into a position of distinct superiority as regards its immunity from the disease. ... In the large towns (since 1874). small-pox death rates have become actually trivial." 109 vaccination that offers itself in competition with public vaccina-, tion, 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 is not surprising, therefore, to learn that although vaccination is done in about equal proportions by public vaccinators and private practitioners, the proportion of deaths from small-pox, among children under ten, is far greater among the patients of private practitioners than among children taken to public vaccinators ; and this, despite reasons, to which Dr. Buchanan refers, which might fairly lead us to expect a different result, were it not for the admittedly superior average quality of public vaccination. 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 ; a saving of life, justly, I believe, 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.—An objection to "armto-arm " vaccination is based on the fact that, as the lymph is passed through the human system, it may become the means of transmitting enthetic disease. This danger, however, though by no means to be disregarded, appears to be slight, and in practice almost inappreciable, seeing that Dr. Buchanan states that he " cannot learn of communication of syphilis in vaccination being actually effected once in a million of vaccinations." Nevertheless, and it being desirable to remove every impediment to the 110 full acceptance of vaccination, it is satisfactory to know that theLocal Government Board have made arrangements for affording to parents the option of having their children vaccinated with calflymph at the public vaccination stations. The Government, moreover, supplies medical practitioners with "stock" lymph from the calf to enable them to start a series of vaccinations. 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, his tubes and charged ivory points being procurable at a moderate price. Stations, moreover, public and private, have been established in London at which persons can be vaccinated direct from the calf. This direct vaccination is highly successful at the Government Stations, an average of 988 vesicles resulting from 1,000 insertions of calflymph. " This rate of success," Dr. Buchanan observes, " is nowise to be had when the lymph " (human or animal) "is used in any preserved condition." Preserved lymph, indeed, is said to he attended with perfectly successful results, in the Army Medical Department, in only 40 per cent. of cases ; in 34 per cent. failure is complete, while in 26 per cent. " modified vaccine pustules " (probably a very imperfect protection) are obtained. The "keeping" qualities of calf-lymph are at present matter of observation by the Directors of the Animal Vaccine Station. In face of the above statement, however, it is obvious that the protective power of vaccination cannot be fully and universally obtained, ex* cepting by the use of lymph taken direct from a vesicle, whether human or animal. SANITARY WORK OF THE YEAR. Before entering upon customary details of the work of the Inspectors, under the Nuisances Removal and other Acts, allusion may be made to the " Special Report on Sanitary, Nuisances Hemoval, and other cognate Acts," by the Law and Parliamentary Committee, resulting from an enquiry, on reference by your 111 Vestry, "Whether the provisions of the various Acts have been and are being enforced by the Vestry as fully as the circumstances of the Parish demand, and if not, to advise as to the steps it is desirable to take for their better enforcement; and also whether any amendment of the law may appear necessary?" The first step taken by the Committee was to obtain reports from the Surveyor and the Medical Officer of Health, " with respect to any special matters which in their judgment have not hitherto received, but which should receive, the attention of the Vestry." The reports of the said officers, in the result, formed the basis of the Committee's enquiry and report, and with that report, which was unanimously adopted by your Vestry, were published and widely circulated. It will suffice here, therefore, to say, for my own part in the matter, that attention was frankly called to all of the points which appeared to require consideration, whether regard were had to failure to exercise existing powers or to need for additional powers. The Committee expressed their views on each point raised and made valuable suggestions in regard to " better enforcement " of the law, and to the need for " amendment of the law." Their conclusions, however, were reassuring, for they found that " the Acts referred to are, up >11 the whole, satisfactorily administered in Kensington," and that the Acts themselves are also fairly sufficient, delect taking the form rather of difficulty in putting the law into speedy operation than in the terms of the law itself. My report dealt, in sections, with the following subjects:— 1. The housing of the working 14& 15 Vic., c. :S4 ; 29 Vic., c. , 28 ; 30 Vic., c. 28. classes. 2. Underground rooms. 18&19 Vic., c. 120, s. 103, p. 57 ; 25 & 26 Vic., .. 102, s. 62, p. 195* : 18 & 19 Vic., c. 122, s. 23, p. 283. 55. Construction of drains. 18 & 19 vic., c. 120, s. 79, p.106. 4. Inspection of drains, &c. 18 & 19 Vic ., c.120,s.82, p..44 5. Vestry to cause work to be done at 18 & 19 Vic.,'' 12_c- ss- £!- 81, 85. pp. 4o ; & 25 & 26 owner's expense. Vic., c. 102, s. 64, p. 196. * The •' page " referred to is in " Woolrych.' 2nd edition. 112 6. Vestry's mode of procedure. 180f„19 VlnCo' e' cio' s* I4'A'r J L 613 ; s. 12, p. 612 ; & s. io. p. 613. 7. Rules with respect to house drain- ls & 19 Vic., c. 120, aa.73,76, 1 pp. 40, 41 ; s. 83, p. 45. age, &c. 8. Power of Metropolitan Board of 18 & 19 Vic., c. 120, s. 202, p. r 124 ; s. 138, p. 82. Works to make Bye-laws, &c. 25 & 26 Vic.,c. 102, s. 83, p. 209. 9. Public conveniences. 18 & 19 Vic., c. 120, s. 88, p. 47- 10. Drinking fountains. 25 & 26 Vic., c. 102, s. 70, p. 199. 11. Paving and drainage of private 18 & 19 Vic., c. 120, s. 100, p. 66. „ 25 & 26 Vic., c. 102. ss. 80, 81, mews, courts, &c. p. 208. 12. Consumption of smoke. 29 & 30 Vic., c. 90, s. 19, p. 643. 13. Periodical removal of manure, 29 & 30 Vic., c. 90, s. 53, p. 654. 25 & 26 Vic., c. 102, s. 95. p. 216. and other refuse matter. 18 & 19 Vic.,c. 120,s. 202. p.124. 14. Trade refuse. 18&19 Vic.,c. 120,s. 128, p. 71. 15. Infectious disease hospit als: 29 & 30 Vic., c. 90, s. 22, p. 645. . , , 46 & 47 Vic., c. 35, s. 5. Ambulances. 16. Disinfecting chamber. 29 & 30 Vic., c. 90,s. 23, p. 645. 17. Defective enforcement of Sanitary 25 & 26 Vic., c. 102, s. 64, p. 196. Law. 18. Amendment of the Law: Sum-Various Acts. mary powers needed. The Committee reported, in substance, on the several subjects, as follows:— 1. The Housing of the Working Classes is a " question that can be dealt with satisfactorily" only by a metropolitan authority having power to put Lord Shaftesbury's Acts into operation. This view was subsequently sustained by the action of Parliament, which by Section 1 of the Housing of the Working Classes (England) Act, 1885, authorised the Metropolitan Board of Works to adopt the Acts if one of Her Majesty's principal Secretaries of State approves of such adoption. 2. Underground Rooms.—The Committee take note of Clause 61, Public Health (Metropolis) Bill, 1885, which proposed to transfer the powers now exercised by the District Surveyor to the Sanitary Lispector, and recommend, pending 113 lation on the subject, that enquiry be made by the Inspector with regard to the rooms scheduled by the District Surveyor, "with a view .. . . to such action by the Vestry as the circumstances of each case may seem to warrant." 3. Construction of Drains.—The Committee recommend the Vestry to encourage the practice of construction of drains outside the house to junction with the sewer, by their own officers. 4. Inspection of Drains, etc.—The Committee doubt whether the Vestry have power to recover the cost of opening up drains of private houses for inspection, even when the drains are found to be defective, and recommend an amendment of sec. 85 Metropolis Management Act to confer such power. 5. Vestry to cause Work to be done at Owner's Expense.—The Committee advise that the powers of sections 73, 81, and 85 of above cited Act, be exercised by the Vestry, and drainage work, etc., carried out by the Surveyor at owner's expense, when the Vestry's Notice is not complied with. The " powers " referred to are comprehensive, and cover practically all structural sanitary requirements. 6. Vestry's Mode of Procedure (under Nuisances Removal Acts)..—The Committee recommend that in all suitable cases an Order should be obtained to prohibit the recurrence of the nuisance, and that when the Justices' Order for the abatement of the nuisance is disobeyed, the officers of the Vestry should enter upon the premises in order to abate the nuisance, at the cost of the owner or occupier. 7. Rules with respect to House Drainage, etc.—The Committee recommend that certain " Instructions," adopted by the Vestry (February 11th, 1885) for the guidance of the Sanitary Inspectors, in regard to the sanitary arrangements of "Registered Houses," be carried out in respect of all other houses wherein, on examination, sanitary improvements are found to be necessary.* * See " Instructions " in later section, " Regulations for Houses let in Lodgings," etc. 114 8. Metropolitan Board's power to make Bye-laws with reference to House Drainage Arrangements.—The Committee heing of opinion that the power might be exercised with advantage, recommend that the attention of the members representing the Vestry be called to the subject, with a view to their advising the Board to exercise the powers conferred by the Act. 9. Public Conveniences.—The Committee refer to the willingness of the Vestry to add to existing accommodation to any necessary extent, and to the difficulty of obtaining sites for urinals, etc., free from objection on the part of adjoining occupiers of inhabited houses. Local opposition alone has prevented the Vestry from adopting the recommendations of sites made by the Works, Sanitary, and General Purposes Committee. (The Medical Officer of Health had reported that " such accommodation being unmistakably a public want, too much weight should not be attached to local objections, as the provision of a suitable retiring place must obviously be less objectionable than the nuisances it is designed to prevent; it being found in practice, moreover, that local objections quickly die away when once the urinal has been brought into use.") 10. Drinking Fountains.—The Committee concurring that power to provide means for supplying the public with drinking water may be advantageously extended to very wide limits, and not deeming it requisite to erect costly fountains, recommend that the object in view should be attained, in the first instance, by attaching a simple apparatus to the several standpipes for street watering, about sixty in number. 11. Paving, etc., of Private Mews, Courts, etc.—The a Committee, being of opinion that the Vestry have power to pave, drain, etc., and to recover the cost from the owners of abutting premises, recommend that the Surveyor and the several Inspectors be requested to submit to the Works, Sanitary, and General Puiposes Committtee, from time to time, a list of places suitable to be dealt with under the provisions of the Act. 115 12. Consumption of Smoke.—Any fireplace or furnace not properly consuming its own smoke, being a statutory " nuisance," the Committee recommend that the several Inspectors be instructed to report offences under the Act, with a view to proceedings for the abatement of the nuisance, and prosecution in suitable cases. 18. Periodical Removal of Manure and other Refuse Matter, etc.—-The Committee recommend tbat the Sanitary Inspectors be instructed to take proceedings for recovery of penalties in case of neglect or default to comply with the requirements of the Vestry's " Notice." They think it possible that section 85 may be wide enough to enable the Vestry by " Notice" to secure periodical removal of " refuse matter " of offensive trades, and recommend that steps be taken to give practical effect to this view. They further recommend that the attention of the representatives of the Vestry on the Metropolitan Board of Works, be requested to the question, Whether the Board's power to make bye-laws for "works of cleansing and of removing and disposing of refuse," may not be exercised so as to assist the Vestry in securing the removal of refuse of an offensive nature ? 15. Infectious Disease Hospitals : Ambulances.—The Committee concurring in the view that the Hospitals and Ambulances of the Asylums Board adequately provide for the needs of the Parish, make no recommendation, but take note of the duties that would devolve upon the Vestry should the Local Government Board issue an Order bringing the Diseases Prevention Act, 1885, into operation, e.g., in the event of an epidemic of cholera. 16. Disinfecting Chamber.—The Committee see no reason for providing a chamber while the plan of disinfection by contract continues to work satisfactorily. 17. Defective Enforcement of Sanitary Law.— [The Medical Officer of Health had called attention to defective enforcement of the provisions of law relative to abatement of nuisances, and to execution of sanitary works ; there being, as the law stands, no means of obtaining speedy abatement of a nuisance, and no penalty for the offence of creating a nuisance. The only 116 penalty is for (contempt of court by) disobedience of the Justices Order after summons ; this, moreover, being rarely inflicted to an adequate extent. Hence the need for the Vestry's interference, as recommended by the Committee, in sections 5 and 6, under the Nuisances Removal and the Metropolis Management Acts.] The Committee are of opinion that all proper cases involving infringement of the law should be brought before the Justices, who will no doubt exercise their judgment in each case ; especially if the importance of assisting the Vestry in efforts to improve the health of the Parish be brought prominently to their attention. 18. Amendment of the Law.—Summary Powers Needed. — [The Medical Officer of Health had reported upon the need for additional powers, "imposing on the Nuisance Authority a Statutory Duty to proceed in a summary manner to abate nuisances and to carry out works of sanitary construction .... as well as power to the Justices to inflict a penalty for the offence of causing a nuisance." He urged the duty of putting existing laws into force " firmly and upon principle " in every suitable case, on the ground that there would be no temptation to disregard the Vestry's Notices when it became known that nuisances would be abated, and sanitary works executed, at the cost of negligent or defaulting owners or occupiers. He also referred to the need of amendment of the law in regard to water supply; and to the propriety of constituting the Sanitary Authority as " Local Authority" for all purposes save making of bye-laws, under the Dairies, Cowsheds, and Milkshops Order of 1885, and under the Slaughter Houses (Metropolis) Act, 1874.] The Committee note that by section 7 of the Public Health (Metropolis) Bill,. 1885, it was proposed to empower the Justices to inflict a penalty, on the person liable, for the offence of causing a nuisance, as recommended in the report of the Medical Officer, and that the Medical Officer's view that "a statutory duty" should be imposed on Sanitary Authorities, requiring them to execute 1 the powers entrusted to them, has been imposed by section 17 of the Housing of the Working Classes (England) Act, 1885. 117 The Committee concur, in regard to the necessity, for amendment of the law in relation to the Water Supply question ; and with reference to the Dairies, Cowsheds and Milkshops Order, and to the Regulations framed under the Slaughterhouses Act, they refer to the fact that the Vestry have, on various occasions, fully endorsed the views of the Medical Officer, and have urged other Sanitary Authorities to support their efforts to obtain amendment of the law. After dealing with " Recommendations" contained in the Surveyor's Report, which treated of " matters which can only indirectly be deemed of a sanitary nature, viz., by tending to prevent the creation of nuisances," the Committee, in " supplementary " observations, refer to the need for legislative enactment to provide for " notice to be given to the Sanitary Authority when it is intended to alter the drainage of an existing house 01* building," They would be glad to see some such machinery, for adapting the law to the requirements of the times, available in London, as that contained in the Public Health Act, 1875 ; enabling the Sanitary Authority to make and alter bye-laws for carrying out necessary provisions in regard to construction and drainage of houses. The Committeee refer to the need of a " Consolidating Act bringing to a focus the scattered enactments on sanitary and administrative matters," and "note with satisfaction that such a codification, so far as Sanitary and Nuisances Removal Acts are concerned, was contemplated by the Public Health (Metropolis) Bill, 1885, introduced in August, 1885, by the then Prime Minister, Lord Salisbury." They observe that, as the said Bill " will finally clear the Statute Book of 14 statutes, all of which are already repealed as regards the rest of England, it cannot fail to prove very useful to sanitary authorities and officials alike, should it ultimately become law." The Committee conclude their report with a reference to the necessity for "a similar measure dealing with the Metropolis Management and Building Acts." 118 At a meeting held on February 10th, your Vestry referred the Report to the Law and Parliamentary Committee, and to the Works, Sanitary, and General Purposes Committee respectively; with a view to their advice "as to the best means to be adopted for carrying out the recommendations." The said Committees, having carefully considered the Reference, submitted, in April, a joint report as follows :— 1. WITH RESPECT TO THE METROPOLITAN BOARD OF WORKS. A communication should be addressed to the Board, calling their attention to the need for the consolidation of the Metropolis Management and Buildings Acts, and for certain amendments of, and additions to, the existing Acts. e.g.:— The Metropolis Management Act, 1855. Jntpection of Drains (Sec. 85).—The Vestry should have power to charge the owner or the occupier of a house with the costs of opening up a drain for inspection under section 82 when, as the result of such inspection, the drain is found to be in a defective condition. Alteration of Drainage (Sec. 7H).—Notice should be given to the Vestry when it is proposed to alter the drainage of an existing house or building, so that a system of drainage which has been sanctioned by the Vestry may not be altered without the consent of the Vestry. New Buildings.—In respect of the supervision of new buildings, and of all works appertaining thereto, amendment of the Metropolis Management and Building Acts is necessary, and such amendment should follow upon the lines of the Public Health Act, 1875, and amending Acts. Bye-Laws.—The Vestry should have power to make and alter Bye-laws, with the sanction of the Metropolitan Board of Works, for carrying out necessary provisions in regard to the construction and drainage of houses, etc. Some such machinery as that contained in the Public Health Act, 1875, and amending Acts, is required for adapting the law to the requirements of the times in respect of such matters. 2. WITH RESPECT TO THE VESTRY. A special meeting should be called for the purpose of rescinding the resolution of the Vestry of 19th July, 1882, relating to sanitary surveys of houses for owners or occupiers. 3. WITH RESPECT TO THE FINANCE COMMITTEE. The Committee should be requested to advise as to the appointment, upon commission or otherwise, of a person or persons to collect moneys accruing due, from time to time, for works executed on behalf of owners or occupiers, or otherwise payable to the Vestry. Probably this duty could be efficiently carried out by the several rate collectors. 119 4. WITH RESPECT TO THE LAW AND PARLIAMENTARY COMMITTEE. The Committee should be requested to prepare— (а) A form to be sealed by the Vestry, for giving authority to each of the Sanitary Inspectors to enter upon premises for the purpose of opening up drains for inspection under Section 82 of the Metropolis Management Act, 1855; and (b) Forms of notices necessary to give effect to the recommendations contained in the Report with reference to proceedings ordered to be taken under the provisions of the Metropolis Management (and other) Acts. 5. WITH RESPECT TO THE WHARVES AND PLANT COMMITTEE. The Committee should be requested to make arrangements for the removal of trade refuse, upon the application and at the cost of owners or occupiers of houses, etc., and take steps to put a stop to the illicit removal of such refuse for pecuniary presents made to the dustmen, a practice alleged to be now common in this parish. 6. WITH RESPECT TO THE WORKS, SANITARY, AND GENERAL PURPOSES COMMITTEE. The Committee should be requested— (a) To give the necessary directions for carrying into effect the mendations contained in the Report, so far as they relate to acts directed by the Vestry to be done, and to instructions necessary to be given to the several officers of the Vestry ; (b) To take into consideration the question of the cleansing and lating of sewers ; (c) To see that, so far as practicable, all drains in streets shall be structed by the Vestry, from the sewer to the back line of footway, with the consent and at the cost of the owner or occupier, and that the supervision of all drain-work by the Vestry shall be as complete as possible, and in accordance with the law as laid down in s. 76 of the Metropolis Management Act, 1855 ; and (d) To instruct the Surveyor to make a report to them on this subject, setting out his views as to the practicability of giving full effect to the recommendations contained in the Report. 7.- WITH RESPECT TO THE REPRESENTATIVES OF THE VESTRY ON THE METROPOLITAN BOARD OF WORKS. A communication should be addressed to the several members representing the Vestry on the Metropolitan Board of Works, requesting their attention to the recommendations contained in the Report of the Law and Parliamentary Committee and in this Report, in order that they may address fitting representations to the Board. 120 8. WITH'RESPECT TO THE CLERK OF THE VESTRY. He should prepare a form of Notice for the periodical removal of refuse matter other than manure, from premises, and take all such measures as may be necessary for giving effect to the recommendations of the Law and Parliamentary Committee, contained in their Report relating to the subject. He should apply for and obtain an order of the Justices for the prohibition of the nuisance in every case in which such Order would be likely to prevent the recurrence of the nuisance, as provided for by Sections 12-14, inclusive, of the Nuisances Removal Act, 1855. He should report that the Justices' Order, whether for abatement, discontinuance, or prohibition of a nuisance, has been served upon the defendant without loss of time, a.nd that he has taken steps to enforce, as far as practicable, any penalties that may have been incurred through disobedience of the J ustices' Order. He should proceed immediately to recover the costs of works executed by the Surveyor when that officer's intervention becomes necessary in consequence of disobedience to the Vestry's Notice under the Metropolis Management Acts, or of the Order of the Justices under the Nuisances Removal Acts. 9. WITH RESPECT TO THE SURVEYOR. The Works, Sanitary and General Purposes Committee Should give the Surveyor such Instructions as may be necessary for carrying into effect the recommendations contained in the Report, viz.:— To construct as far as practicable, all drains in streets, including new streets, from the sewer to the back line of footway, with the consent and at the cost of the owner or occupier. To supervise as completely as possible all drain work executed in accordance with the provisions of Sec. 76, Metropolis Management Act, 1855. To carry out, at the cost of the owner or occupier, structural works specified in the Vestry's Notice, when such notice is not complied with by the owner or occupier under the Metropolis Management Act, 1855 (ss. 73, 81, and 85). To carry out any structural works specified in, or necessary with a view to compliance with, the Orders of the Justices for the abatement of nuisances, when the said Orders are not obeyed within the time limited therein. To submit from time to time to the Works, &c., Committee a list of private mews, courts, etc., suitable to be paved and drained, in order that the necessary directions may be issued for giving effect to the opinion of the Law and Parliamentary Committee, that the Vestry have power to cause such work to be done at the cost of the owners of abutting premises. 121 To submit, from time to time, to the Works, &c., Committee suitable sites for Public Conveniences. To report to the Works, &c., Committee as to the practicability and the cost of giving effect to the recommendation for providing means for supplying the public with drinking water, by attaching a simple apparatus to the several standpipes for street watering. 10. WITH RESPECT TO THE SANITARY INSPECTORS. The Works, Sanitary and General Purposes Committee should give the several Sanitary Inspectors such instructions as may be necessary for carrying into effect the recommendations contained in the Report, viz. :— To enquire and report to the Works, &c., Committee on all matters contained in the ha If-yearly reports of the District Surveyors relating to underground rooms, with a view to such action by the-Vestry as the circumstances of each case may seem to warrant. To take steps to obtain the Vestry's Notice requiring the execution of necessary works under the provisions of the Metropolis Management Acts in all suitable cases. To report to the Clerk, when applying for a summons under the Nuisances Removal Acts, whether the case is one in which it is necessary to ask the Justices for an Order to prohibit the recurrence of the nuisance. To give the necessary information to the Clerk to enable liim to enforce, as far as practicable, whatever penalties may have been incurred through disobedience of the Justices' Order. To inform the Surveyor when it becomes necessary for that officer, in case of disobedience to the Vestry's Notice under the Metropolis Management Acts, or disobedience of the Order of the Justices under the Nuisances Removal Acts, to enter upon the premises to execute structural works for giving effect to the Vestry's Notice or to remove or abate a nuisance. To enter upon the premises to remove or abate the nuisance at the cost of the owner or occupier when the Order of the Justices is not obeyed within the time limited therein. To act in the inspection of all houses upon the " Instructions" with respect to drainage, ventilation of drains, water supply, etc., adopted by the Vestry (February 11th, 1885) for the guidance of the Inspectors in respect of Registered houses, when on examination sanitary improvements are found to be necessary. To submit from time to time to the Works, &c., Committee a list of private mews, courts, etc., suitable to be paved and drained, in order that the necessary directions may be issued for giving effect to the opinion of the Law and Parliamentary Committee, that the Vestry have power lo cause such work to be done at the cost of the owners of abutting premises. 122 To submit from time to time to the Works, &c. Committee. suifable sites for Public Conveniences. To report to the Works, &c., Committee offences under clause 3, section 19, of the Sanitary Act, 1866. which relates to nuisances caused bychimneys of manufactories, bakehouses, etc., which do not consume their own smoke, with a view to proceedings being taken for the abatement of the nuisance, and the enforcement of penalties in suitable cases. To report to the Works, &c., Committee all cases in which the requirements of the Vestry's Notice for the periodical removal of manure or other refuse matter from mews, stables, or other premises, are not. complied with, so that in suitable cases proceedings may be taken for the recovery of the penalty prescribed by section 53 of the Sanitary Act, 1866. 11. WITH RESPECT TO THE SECRETARY OF STATE FOR THE HOME DEPARTMENT AND THE PRESIDENT OF THE LOCAL GOVERNMENT BOARD. A communication should be addressed to the Home Secretary and to the President of the Local Government Board, urging the desirability of a consolidation of the several Sanitary and Nuisances Removal Acts, as contemplated by the Public Health (Metropolis) Bill, 1885, and of a consolidation of the Metropolis Management and Building Acts. Copies of the Report of the Law and Parliamentary Committee, dated 8t.h January, 1886, and of this Report should be forwarded with the said communication. 12. WITH RESPECT TO THE MEMBERS REPRESENTING NORTH AND SOUTH KENSINGTON IN PARLIAMENT. Copies of the Reports and of the communication referred to in the previous section should be sent to the Members for North and South Kensington, who should be requested to take advantage of any fitting opportunity to impress upon the Government, the desirability of consolidating and amending the several Statutes. The Report of the Law and Parliamentary Committee, it may be added, was forwarded, together with the supplementary report of t he Joint Committee, and the reports of the officers of the Vestry, to the several Vestries and District Boards, and met willt considerable approval. The documents were forwarded to the Metropolitan Board of Works also, and gave rise to a correspondence on the various matters dealt with. A communication, final for the present, was received from the Clerk to that Board in April of the present year, couched in the following terms:— 123 "The Board has had under consideration your letter of the 14th February last, referring to the previous correspondence between the Board and the Vestry of Kensington, with respect to certain recommendations made by a Committee of the Vestry for amendment of the Metropolis Local Management Acts, and expressing the hope of the Vestry that some or all of the proposed amendments may be inserted in one of the Board's Bills now before Parliament, or that the Vestry may be informed of the Board's objections to the proposals. "In reply, I am directed to inform you, that the Board, while fully recognizing the importance of the suggestions contained in the ably prepared documents transmitted with your former letter, regrets that, in view of the wide range of subjects which are sought to be dealt with, it is not prepared at the present time to promote legislation in the direction indicated." COMMITTEE FOR CARRYING OUT THE NUISANCES REMOVAL ACTS. With the view of accelerating proceedings in cases of nuisance, your Vestry decided, in February, 1885, 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 in due course reports its proceedings to your Vestry. Summonses continue to be heard by the Justices sitting in Petty Sessions at the Vestry Hall. In my last Annual Report, I remarked that it was " much to be desired that the Justices should place sanitary cases at the top, instead of, as heretofore, at the bottom of their agenda, so that the several Inspectors might be set free at a reasonable hour to go about their ordinary work. Sanitary cases rarely occupy much of the time of the Court, but on many occasions all of the Inspectors have been detained till 1 or 2 p.m., waiting for their cases to be called on. As a rule the Justices meet once a month only. A fortnightly meeting for the hearing of sanitary cases would be very useful." I am happy to state that the Justices have lately arranged to meet weekly for the purpose of dealing with sanitary 124 cases, and that they now give precedence to our cases as suggested. The duties of the Justices in this branch of judicial work have increased considerably, other Local Sanitary Authorities having to some extent followed the example of your Vestry in bringing their cases before the court. THE WORK OF THE SANITARY INSPECTORS. Tables VI. and VIa. (Appendix) contain a summary of the work of the Sanitary Inspectors during the year ending March 25th, 1887. Ninety-nine * summonses were taken out for offences under the Nuisances Removal Acts, against 98, 89 and 80, in the three preceding years. Orders were made by the Justices in every instance, for giving effect to Notices previously served on the defendant persons; upon whom, as the law at present stands, no penalty can be inflicted, however serious or long continued the nuisances for which they are responsible. 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 upon whom the Order is made, together with all costs. The same power should be conferred upon Courts of Summary Jurisdiction in London, t At present the Justices can punish for contempt of Court only, viz., by a penalty not exceeding ten shillings per diem, during continuance of disobedience to their Order. If the Justices had power to inflict a penalty for offences under the Nuisances Removal Acts, disregard of the Local Authority's Notice, 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 infrequent— *This number is irrespective of 44 summonses under the Sale of Food aud Drugs Act, 24 in cases of obstruction, and 2 in cases of disobedience of Justices' Orders. †Provision was made for enabling the Justices to inflict a penalty, in the Public Health (Metropolis) Bill, 1885, but there was not time to pass the measure, which, however, is certain, sooner or later, to be re-introduced. 125 always supposing the power were exercised. That the cases are proper to be brought before the Justices is obvious from the fact that dismissal of a summons is a rare occurrence. Orders were made last year inter alia for the execution of works, as follows:— To provide a supply of water to water closets 33 To repair and cleanse defective fittings to ditto 19 To repair, cleanse, and whitewash walls of rooms 60 To provide new or repair existing dustbin 19 To repair roofs, etc., of houses 11 To repair or provide cover to cistern 14 To trap drains, gullies, or sinks 46 To disconnect waste-pipes of cisterns, sinks, baths, etc., from drains 22 To repair, cleanse, or unstop defective or choked drains 4 To repair defective paving and drainage of yard, washhouse, etc. 24 To improve ventilation and lighting of houses 3 In two cases penalties—one shilling per diem for 47 days, and half-a-crown per diem for 25 days-—were inflicted for disobedience of the Justices' Orders. A penalty to the amount of twenty shillings was imposed in one case for disobedience to an order prohibiting the keeping of swine. WATER SUPPLY. The Cctting-off Powers of the Companies. In dealing with the question of water supply in my Annual Report for 1882 (pp. 117-126), I recited the powers of the companies, referring especially to the power to cut off water for nonpayment of water rents, and I urged that the companies should be left to their remedy for the recovery of debts like other traders. My views on the subject have strengthened with lapse of time and accumulated experience. The law, however, remains in its original unsatisfactory state,, notwithstanding recommendations for 126 its amendment by the Royal Commission on the Housing of the Working Classes. And although a house without a supply must be in a state of nuisance, the companies are under no obligation to give notice to the Sanitary Authority of cutting off, unless, where there is constant supply, the service has been discontinued because the "fittings" are not of the "prescribed" character. Oddly enough, absence of the prescribed fittings, which entitles the company to cut off the water, constitutes a statutory nuisance within Section 11 and Sections 12 and 19 (inclusive) of the Nuisances Removal Act for England, 1855, and is " presumed to be such as to render the premises unfit for human habitation," even although the premises may be supplied with water : but. should the premises have been deprived of water by the act of the company for non-payment of the rate, the law has nothing to say to the matter, and the Nuisance Authority may be, and often is, left in ignorance of the fact for weeks together. Moreover, when proceedings are taken for restoration of.supplyj supposing the Vestry's'notice be disregarded, it is within the discretion of the Justices to make such Order as they think fit, and to decide, should their Order be disobeyed, whether or no the house is " unfit for human habitation," and ought or ought not to be closed. Looking at the water companies' powers from a sanitary point of view it seems to me reasonable—while the law is in its present unsatisfactory state—that a company should demand payment of the rate in advance, in the case of a bad tenant, and take proceedings to enforce payment prior to the expiration of the period covered by the demand note, so that no necessity for cutting off the water may arise. 1 see no reason, moreover, why the companies should not be endowed with the same facilities for recovering their water rentals as a " nuisance authority ' for the recovery of its rates, and these are simplicity itself. Water companies, howeyer, are naturally enough unwilling to be at the trouble of taking legal proceedings, although the cost would fall on the defaulting person, when they can so easily put the "screw" on their " tenants " and make the Sanitary Authority, in effect, their 127 agents for compelling payment of their dues. With the view of rectifying this unsatisfactory state of affairs, the Earl of Camperdown brought into the House of Lords a Bill for regulating the powers of water companies, its main object being to take away the power of cutting off the water from a house, the occupier of which had not paid his water rate. After enquiry by a Select Committee the House passed the Bill, which, however, was opposed in the Commons, and ultimately dropped. In the current Session a Measure entitled "Water Companies (Regulation of Powers) Bill" described as "A Bill to limit the powers of the Water Companies to cut off the Tenants' Water Supply where the rate is paid by the landlord," has been introduced in the Lower House, and your Vestry have petitioned the House in its favour. If passed into law, it would prevent the recurrence of such a scandal, from the cutting off of the water supply of a whole street of tenements, as occurred in 1885 at Hayden's Mews. It would also give effect to the views on the subject set out in my Special Report on that case, views which were endorsed by your Vestry; and it would carry out, I believe, in a satisfactory manner, the principle of Lord Camperdown's Bill. The new measure makes provision, as I have long recommended, for treating the water rate as a debt to be recovered—primarily, after notice to pay—from the occupier, who is entitled to deduct the amount paid to the Company out of the rent then due, or that may next become due, from him, when the owner and not the occupier is liable by law or agreement with the Company to t 13 payment of the rate, which is to be a charge on the dwelling house in priority to all other charges affecting the premises. METROPOLITAN WATER SUPPLY. The Metropolitan Board of Works resolved, October 30th, 1885, to authorise their Parliamentary Committee to prepare a bill "to extend the operation of the 144th section of the Metropolis Management Act, 1885, so as to enable the Board to submit to Parliament a Bill dealing with the water supply of 128 London." The committee thought it desirable that the scope of the Bill should be somewhat extended, so as to make it clear that the Board should have power to incur any necessary expenditure in opposing Bills relating to the supply of water in or near the metropolis. A draft Bill was prepared accordingly, and the committee, in submitting the same, recommended (the Board agreeing) " that when the proper time arrives leave be sought to bring in the Bill as a public Bill, and that the committee be empowered to take all necessary measures for promoting its passage through both Houses of Parliament." The Bill having been approved by the Board, was duly introduced in the House of Commons. It soon became manifest, however, that the government was not disposed to give the Board facilities to acquire power to deal with the question of water supply; the Home Secretary, following in the wake of the Home Secretary of the preceding Liberal Government, taking the view that the water supply of London is a question that can be properly dealt with only by a municipality, the creation of which, within any definable time, appears less probable now than it was two years ago. The Bill was thrown out upon the second reading. BILLS IN PARLIAMENT. At the request of the Law and Parliamentary Committee, Mr. Cassal, Public Analyst, and myself, drew up the following observations on two Bills brought before Parliament in the current session, both of which may be considered of more or less importance in a public health point of view:— Beer Adulteration (No. 2). " The object of this Bill, of which, so far as it goes, we approve, is to secure the imposition of a penalty for selling Beer containing other ingredients than Malt and Hops, without giving notice to the purchaser by a legible notice conspicuously posted in the bar or other place of sale. The only definition of Beer which it is possible to adopt in the present state of the law is this—that it is ' a fermented saccharine infusion to which has been added a 129 wholesome hitter;' but, as popularly understood, Beer is an infusion of Malt and Hops, and people imagine that they are buying such an infusion, when they buy Beer. We do not say that there is any radical objection to the substitution of other ingredients in common use for Malt and Hops, so long as those ingredients are wholesome, but we do consider that, if such substitutes are employed, the fact should be published. In other words, the buyer should know, and he should be informed, what he is buying. " Wa believe that it would be a great boon to the public if they could rely on all occasions upon obtaining a sound and pure infusion of Malt and Hops when they ask for and drink Beer. The extract of Malt contains a variety of substances, organic and mineral, believed to be valuable for their dietetic properties, and it is utterly fallacious to suppose that the only object of using Malt is to obtain the sugar necessary for fermentation ; and that, therefore, the complete or partial substitution of various sugars for Malt is a proceeding capable of producing the same ultimate results. Similar remarks may be made as regards Hop extract; and that the substitution of other bitter principles is objectionable, there cannot be any doubt. "We believe, therefore, that the effect of this Bill would tend considerably to secure the production and sale of a better article, and that consequently it would not improbably result in diminishing drunkenness, and in lessening the tendency to drinking, and that a considerable national benefit might ensue. " We may add that limits of Alcoholic strength, below which the different classes of Beer should not be allowed to fall, might with advantage have been fixed, and included in the measure before us, as well as a limit for the amount of salt in Beer." Butter Substitutes. "This Bill defines Butter as an article produced from unadulterated milk or cream unmixed with any other fatty or oleaginous substance whatsoever, and 'Margarine' or 'Oleo-Margarine,' as any imitation of Butter whatsoever, or any compound of 130 Butter with animal fat, or any compound of Butter and animal or vegetable oil. It provides, under a severe penalty for default, for the distinct branding, by all importers, manufacturers, or sellers, of the word 'Margarine,' in letters not less than one inch in length, on all packages of this butter substitute, and for the Registration by the Clerk to the Union of all manufactories of Margarine in the United Kingdom, and for these manufactories to be accessible for inspection by the Inspectors under the Sale of Food and Drugs Act. "The Bill further provides under heavy penalties, for the invoicing of Oleo-Margarine as such, by manufacturers and wholesale dealers, and for information to be given to purchasers byretail dealers in this article, as to what they are buying, and for proceedings to be taken under Sections 20 to 28 of the Sale of Food and Drugs Act, 1875. "There can be no doubt that fraud is practised when ' Butterine ' is sold as Butter. But Butterine, honestly made, with all proper care, and free from unwholesome ingredients, is probably a more wholesome article of food than some samples of Butter that find their way into the market. Here again, however, the public are fully entitled to know what it is that they are buying, and the sale of Butterine as Butter should be punishable by a severe penalty. The substitution of the words ' Margarine' or ' OleoMargarine ' would probably do something to check the sale of Butter-substitutes as Butter, if under the penalties of the " Sale of Food and Drugs Act" the seller was compelled to mark every packet or parcel with those words, as provided in the proposed measure. At the same time, it should be remembered, in this connection, that the sale of mixtures in place, and under the name of the pure article, has not been very greatly checked by the provisions of the Sale of Food and Drugs Act, which make it incumbent upon the seller to affix a notice to each package to the effect that the article is a mixture. "We feel that precautions should be taken, by supervision during the process of manufacture, to ensure the use of perfectly sound and wholesome fats in the production of Butter-substitutes. 181 This appears to be partially provided for by the 4th Section of the proposed measure ; but we do not consider that the duties to be undertaken by the Inspectors under the Sale of Food and Drugs Act with regard to these manufactories, are sufficiently defined in the section referred to. We consider further that under the 10th Section, the Inspectors under the Sale of Food and Drugs Act should have been included. "We are disposed to regard the proposed Bill as a step in the right direction, although we are of opinion that it is only by a much larger extension and application of the principles of the Sale of Food and Drugs Act that the fraud in question and other similar frauds can be adequately dealt with." I also prepared a memorandum upon two other Bills in Parliament, as follows :— "Sanitary Registration of Buildings.—This Bill has been materially modified since its introduction last Session. The central feature of the present measure appears to be deserving of approval, providing as it does for the registration of public and quasi-public buildings, in order to secure that such buildings shall be put and kept in a proper sanitary condition. The buildings specified are school, college, hospital, asylum, hotel, lodginghouse ; and Clause 11 provides that such buildings shall not be used permanently or temporarily unless and until a " Sanitary Certificate " has been deposited with the " Sanitary Registration Authority," and a " Sanitary Registration Certificate " has been issued in accordance with the provisions of the " Act." The Local Authorities charged with the administration of the Public Health Acts are to be the Sanitary Registration Authorities in their respective areas. The Sanitary Certificate is to be given by persons duly licensed in sanitary practice by the Local Government Board. This provision (clause 7) appears to me wholly objectionable. I am of opinion that if such a measure should ever become law, the proper persons to be authorised to issue sanitary certificates are the duly qualified officers of the respective Sanitary Authorities." 132 "Sanitation of Houses (Metropolis).—A Bill under this title, prepared and brought in by Mr. Dixon Hartland, provides for a scheme of sanitary construction and inspection of houses which may fairly be called Utopian. It might also be described as a Bill to supersede existing Sanitary Authorities—and Medical Officers of Health also. It enacts the creation of a ' Sanitary Board ' of twelve members ' who shall be selected from the Sanitary Institute of Great Britain, the Royal Institute of British Architects, and the Association of Municipal and Sanitary Engineers,' and the division of the Metropolis into seventy districts, each to be under the control of a sanitary surveyor, to whom the local surveyors and the sanitary inspectors are to be subordinate. The duty of the Sanitary Board is ' to define the duties of the sanitary surveyors and inspectors, and to form a court of appeal between the said sanitary surveyors and the public,' and to examine and appoint sanitary surveyors, etc. They are also to ' approve and license all sanitary apparatus and fittings to be used in carrying out the provisions of the Act.' The directions for every class of work are minute, and of the most paternal description. No room for doubt in any difficulty need arise if only owners and occupiers, local surveyors and inspectors, will be content to walk in the leading-strings provided for their guidance. The Bill is not likely to become law. It may be mentioned that the Works, Sanitary, and General Purposes Committee, having considered this measure, expressed an opinion that ' the changes in the sanitary arrangements ' proposed ' are not an improvement on the present system ;' that the ' important duties' proposed to be devolved upon the ' Sanitary Board ' should be ' under the supervision and control of the recognised public bodies, and that the transfer of such duties to a small Special Board is not advisable.' " OFFENSIVE BUSINESSES. Nuisance from Brick Burning.—During the summer 01 1886, as in previous years, complaints were made by several 133 ratepayers in regard to stenches, especially in the early morning hours, almost invariably supposed to be due to sewer gas. The real cause, however, was brick-burning in localities, for the most part, beyond the limits of the Parish. The reality of the nuisance is not open to question, and the law is strong enough to put a stop to it, but the process is tedious and costly, as was proved in two important actions decided in the course of the year 1885. Marine Stores.—Every year, during the hot weather, complaints are received in regard to the stenches arising from the collection and storage of bones, fat, and other animal matters in a putrid condition on the premises of so-called " marine store dealers." Your Vestry, having found it difficult to prevent recurrence of nuisance from this cause, under the Nuisances Removal Acts, resolved, in 1883, to direct the attention of the Metropolitan Board of Works to the subject, and to request them to consider the desirability of declaring the business of a " marine store dealer " an " offensive business," under the provisions of the Slaughter-houses (Metropolis) Act, 1874, Section 3. It was felt that if the business were scheduled under the Act, 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 offensive matters from the premises, might be secured. The Board, however, did not adopt your Vestry's view of the matter, stating in its reply that " the businesses to which the Act of 1874 refers, are businesses which include processes oi manufacture of a more or less offensive character;" and that " the mere collection of a mass of refuse matter into one place " is not a " business " within the meaning of the 3rd Section of the Act. But among "offensive" businesses named in the Act 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 melting tallow, and in boiling bones or hog wash to extract fat, are not very obvious; and, it must be added, the bye-laws for the 134 regulation of these "businesses" expressly forbid collections of bones, fat, &c., to be kept and exposed on the premises so as to pollute the air. Such collections should not be allowed to remain exposed in the neighbourhood of the stores where they are gathered for the purposes of the scheduled " businesses," and which are so much more numerous than the " manufactories." The Board was of opinion that the nuisance brought under its notice " should be dealt with under the Nuisances Removal Act," which it said, truly enough, was "intended to apply to such cases."- This Act was also intended to apply to the "offensive businesses" now regulated under the Slaughter-houses Act, in respect of which the Board is the "Local Authority." In practice, however, 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. There is difficulty in dealing with recurring trade nuisances under the Nuisances Removal Act; but experience has proved it easy to prevent nuisance when "offensive businesses" are conducted subject to bye-laws with penalties for offences. One point has been made clear since the correspondence above referred to—viz., that the business of a bone and rag merchant is ejusdem generis with the businesses named in the Slaughterhouses Act, and those scheduled by the Board since the passing of that Act. The point was settled in Passey (Appellant) v. Oxford Local Board (Respondents), Lord Chief Justice Cockburn and Mr. Justice Lopes having ruled 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 framed upon the lines of the 3rd Section of the Slaughter-houses (Metropolis) Act, 1874. The only businesses coming under the statutory description "offensive," other than that of a "slaughterer of cattle," carried on in this parish, are those of tallow melter and fat extractor. Tallow Melting.—Tucker's Factory, in the High Street, is the only one in Kensington, and it must be confessed that the 135 efforts of the proprietor to prevent effluvium-nuisance have not been altogether successful, as complaints are made from time to time by inhabitants in the vicinity. The complaints are referred to the Metropolitan Board, the local authority in regard to offensive businesses. The Board, in the Annual Report for 1886, states that "the improvement in the manner of conducting the businesses" (of soap boiler and tallow melter) " has been continued during the past year, and it has not been necessary to take proceedings for the enforcement of the bye-laws in any case; " a statement which I suspect would be traversed by many persons residing in Kensington Square, Cheniston Gardens, etc. Fat Extracting.—Two businesses are carried on in Tobin Street, Notting Dale. They give rise, more or less, to effluviumnuisance, notwithstanding improved arrangements and care on the part of the proprietors. But the people living thereabout are not of a particularly squeamish character, and do not often complain. The Metropolitan Board, referring to this trade and that of a fat melter, reports that " these businesses have been generally well conducted during the year." SLAUGHTER-HOUSES. The licensed slaughter-houses, which in 1874 were 54 in number, are now only 22, viz., 13 in North Kensington (i.e., the district north of Uxbridge Road), and 9 in South Kensington (i.e., the remainder of the parish south of Uxbridge 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 thom to be " in a satisfactory condition." Comparatively little slaughtering is now carried on, and on some of the premises none at all, the licenses being kept up with the view of maintaining the value of the premises. Wherever animals were found in the lairs, it was observed that, in accordance with a recommendation by the Committee, a supply of water had been provided. Altogether, the state of affairs has 136 undergone much improvement since the passing of the Slaughterhouses (Metropolis) Act, 1874; it is desirable, nevertheless, that private slaughter-houses should give place to public abattoirs, and that the dead meat trade should be encouraged to the utmost. It would be well, moreover, looking at the matter from a publichealth point of view, could facilities be increased for bringing consumers into direct relations with the importers of frozen meat—mutton especially. This meat, excellent in quality and condition, is often sold by retail dealers at an unfairly high price as English meat, to which, so far as my experience goes, it is in no way inferior. The licensed premises have been systematically visited throughout the year by the several Inspectors, although, as it is scarcely necessary to mention, your Vestry have no statutory right of control over the slaughter-houses; the position of "local authority " for all London (the City excepted) having been vested by the Legislature in the Metropolitan Board of Works. It is desirable that this Board should be a local authority for making regulations, so as to secure uniformity for the whole Metropolis, but the Sanitary Authorities should have concurrent powers to enable them to enforce the provisions of the regulations. The business of a slaughterer of cattle has not been "established anew" in Kensington since the passing of the Act. The number of private slaughter-houses in the Metropolis, which in 1874 was 1,429, had fallen, in October, 1886, to 775. Few businesses have been established anew during the twelve years the Act has been in operation. COWSHEDS. The licensed cowsheds are 14 in number; 9 in North Kensington, and 5 in South Kensington. 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 137 mittee, and were "found in a satisfactory coiidition." The sheds are licensed for the keeping of 185 cows, but contained 107 only at the time of inspection. The several premises have been systematically inspected throughout the year, although your Vestry have no statutory powers in regard to them, the Metropolitan Board being the " Local Authority" in respect of cowsheds, as explained in the two following sections. DAIRIES, COWSHEDS, AND MILIvSHOPS ORDER OF 1885. The 34th section of the Contagious Diseases (Animals) Act, 1878, provides for the registration of persons carrying on the trades of cowkeeper and purveyor of milk ; for regulating the lighting, ventilation, cleansing, drainage and water supply of dairies and cowsheds; for securing the cleanliness of milk stores, milksliops, and milk vessels ; and for protecting milk against infection and contamination. The Metropolitan Board of Works is the "Local Authority" for the purposes of the Act in the Metropolis, the City only excepted. Under the provisions of the 34th section, the Privy Council framed "The Dairies, Cowsheds, and Milkshops Order of 1879," which enabled the Local Authority to make regulations for the purposes above indicated. This Order was superseded in 1885 by a fresh Order, which came into operation in August. The new Order differs from its predecessor mainly in its more strict provisions designed to prevent spread of infectious disease through the agency of milk. But it also enlarges the powers of the Local Authority to make regulations for securing proper construction of registered premises. Of this power the Board immediately took advantage by framing new regulations, which are superior, in several respects, to the old ones; and, if carried out loyally, should be effectual to prevent the spread of disease by milk produced in London ; or by country milk—provided it is uncontaminated on arrival in town. The importance of this reservation will be obvious in view of an epidemic of scarlet fever, referred to at page 29, which might have been pre- F 138 vented had the cowkeeper, whose milk was the cause of the outbreak, strictly complied with the requirements of the Order, section 15, which reads as follows:— "If at any time disease exists among the cattle in a dairy or cowshed, or other building or place, the milk of a diseased cow therein— "(a) Shall not be mixed with other milk, and "(b) Shall not be sold or used for human food." Section 13 enables the Local Authority to make regulations "for the inspection of cattle in dairies an important provision in view of accumulating evidence of the transmissibility of certain bovine diseases to man. Section 8 requires provision to be made in every cowshed for the lighting and the ventilation, including air space, and for the cleansing, drainage, and water supply thereof, such as may be necessary " for the health and good condition of the cattle therein." Section 9 forbids any person (master or servant) suffering from a dangerous infectious disorder, or having recently been in contact with a person so suffering, " to milk cows, or to handle vessels used for containing milk for sale', or in any way to take part or ass: st in the conduct of the trade or business of the cowkeeper or dairyman, etc. ... so far as regards the production, distribution, or storage of milk .... until all danger of the communication of infection to the milk, or its contamination, has ceased." » Proceeding upon these powers the Board in their new Regulations require every seller of milk "immediately on any outbreak of infectious or contagious disease within the building or upon the premises in which he keeps milk, or amongst the persons employed in his business, to give notice of such outbreak to the Board; .... to remove all milk for sale, and all utensils for containing milk for sale, from such building ; and to cease to keep milk for sale, or to sell milk, in such building, until the same has been disinfected and declared by the Medical Officer of Health for the District to be free from infection." The Regulations further provide for the preservation of milk from contamination by "gases 139 or effluvia arising from sewers, drains, gullies, cesspools, or closets, or by any offensive effluvia from putrid or offensive substances," etc. We learn from the Board's Annual Report that since the Order of 1879 came into operation, upwards of 24,500 registrations, or transfers of registration, have been effected, and that there are now some 9,000 registered premises in the Metropolis, including those of 780 cowkeepers, who keep nearly 10,000 cows. In the larger dairies and milk stores, it is stated, " much improvement has taken place, and they are generally in a satisfactory condition while 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." It is a somewhat extraordinary fact, which may be considered satisfactory or otherwise, that proceedings under the Dairies Order had to be taken in four cases only during the year "—viz., in one case for neglect of the regulations, and in three cases against persons who carried on the sale of milk without complying with the requirements of the Order as to registration. PUBLIC HEALTH (DAIRIES, etc.) BILL. In a previous Report I referred to the " Public Health, (Dairies, etc.) Bill," introduced by Government in 1883, with the object of placing the supervision of dairies, cowsheds, etc., under the Sanitary Authorities, it having been found that in many parts of the country the " Dairies, etc., Order of 1879," was practically a dead letter, owing to the 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.* The object of the Bill was (among other things) to transfer to the Local Government Board the powers of the Privy Council with regard to cowsheds, dairies, and milk shops, *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. F 2 140 ing the power of making "Orders." Had the Bill passed, the Metropolitan Board of Works would have continued to be the "Local Authority" for the Metropolis, outside the city—an objectionable arrangement. Under the auspices of your Vestry, a strong opposition to this part of the Bill was raised, upon the ground, that, while it was desirable to give the Board power to frame bye-laws for the regulation of dairies and cowsheds, so as to secure uniformity, the duty of carrying out the bye-laws, by supervision of cowsheds, dairies, etc., should be entrusted to the Sanitary Authorities—i.e., the Vestries and the District Boards; these bodies having Medical Officers and Inspectors accustomed to the work. The views of your Vestry accorded with those of the Society of the Medical Officers of Health, as expressed by 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 Sanitary Authorities, the Medical Officers of Health, and the Sanitary Inspectors of the respective districts." Communications were addressed to the Lord President of the Council, the President of the Local Government Board, and the several Vestries and District Boards, with the view to obtaining modification of the Bill in the sense above indicated. The Bill, however, was dropped, but its main provisions have been re-enacted in the Contagious Diseases (Animals) Act, 1886, a fact which did not come to my knowledge until too late to be of any service. This is much to be regretted. The question obviously is not understood by those who had the conduct of the measure, otherwise so great a mistake as that of placing the sole legal control over dairies, cowsheds, and milkshops, in the hands of the Metropolitan Board, to the exclusion of Sanitary Authorities, could hardly have been perpetuated. The Board have no medical adviser, and but a very limited staff of inspectors—seven, I believe, for all London; and these officers, moreover, are responsible for inspection of premises where explosives are stored, as well as of the premises where " offensive 141 businesses," scheduled under the Slaughter Houses (Metropolis) Act, 1874, are carried on. The premises registered under the Dairies, &c., Order of 1885 alone, are, as already stated, some mine thousand in number. The District of the Inspector for Kensington embraces Paddington, St. George's, Hanover Square; St. Margaret and St. John, Westminster; Hammersmith, Fulham, and Chelsea. The Vestries and District Boards, by their fifty-four Medical Officers of Health, and some liundred-and-fifty Sanitary Inspectors, have no statutory right of entry upon any of the premises. What power the Sanitary Authorities possess in respect of cowsheds depends wholly upon their ability to oppose the renewal of a license if the business is not conducted to theii' satisfaction. Dairies, milk stores, and milkshops are no more under the control of the Sanitary Authorities than other occupied premises. They have no right of entry unless in the case of nuisance or suspected nuisance. Under the arrangement proposed by your Vestry, for giving to the Sanitary Authorities co-ordinate power of inspection, with authority to enforce the regulations, the sanitary staff in every district in the Metropolis would have been made legally available in the supervision of all registered premises. Referring to the new Order, the "Chief Officer of the Special and Sanitary Branch, Metropolitan Board of Works," in a paper read by him before the Society of Medical Officers of Health,* prior to the introduction of the Bill (now an Act), described the " provisions " of the Order as " very valuable," and such as " would go far towards giving milk that protection " which is necessary, " if the Executive Authority had been placed in the right hands in all cases." But, " until the Sanitary Authority is made the authority under the Act, in the manner proposed by the Public Health (Dairies) Bill, introduced by the Government into Parliament, in the session of 1883 " (and as provided for in the new Act), he did " not look forward to valuable results under the powers given, except in towns," where, as before intimated, the Sanitary Authority is the Local Authority, excepting in the Metropolis itself. *"On the Protection of Milk from Contamination, etc." The Paper is the joint production of Mr. A. Wynter Blyth, Medical Officer of Health for Marylebone, and Mr. Alfred Spencer, the Chief Officer referred to. 142 It is admitted that the cowsheds in the Metropolis have been much improved since the first Dairies Order was issued in 1879, mainly because the regulations, which the Metropolitan Board was authorised to make, established, for the first time, something like a standard in regard to structural and other requirements, power to make regulations being then for the first time conferred. But this good result is due, in part at least, to the work of the Medical Officers and the inspecting staff of the several Sanitary Authorities, taking advantage of the existence of the regulations, although having no statutory power under them or under the Order. This position of affairs will be recognised as all the more extraordinary, in presence of the fact that by the fresh regulations made by the Metropolitan Board, under the Order of 1885, dairymen and cow-keepers are required to notify (to the Board) the occurence of cases of infectious disease on registered premises. That some use might be made of the information thus obtained, the Board has consented, on the advice of the Society of Medical Officers of Health, to give notice to the Medical Officers of the several districts, of the occurrence of such illnesses, which the registered persons are bound under penalty to report; and Regulation 29 actually forbids resumption of business " in such (registered) building until the same has been disinfected and declared by the Medical Officer of Health for the district to be free from infection." The Board in return has requested that similar information coming to the knowledge of the Medical Officer, may be communicated to it, and also that the Medical Officer and the Sanitary Inspectors should be authorised to make known to the Board any premises used for storage and sale of milk which have not been registered. Acting on my suggestion, moveover, the Board has supplied a local list of registered premises to the Sanitary Authority in each district; and this may incidentally prove useful, although, as I have already said, the Sanitary Authority have no statutory power, no right of entry upon the premises. Excepting as regards the one matter dealt with above, the passing of the new Act is subject for congratulation, for the 143 vision of Dairies, Cowsheds, &c., is eminently a sanitary matter proper to be placed in the hands of the Sanitary Authorities and under the control of the Local Government Board by its Medical Department as Central Sanitary Authority. Much credit is due, for improvements effected upon registered premises, to the Metropolitan Board of Works, as Local Authority, and to their " Chief Officer," who has brought exceptional ability and energy to bear upon the discharge of his duty under the Order—one only of multifarious duties devolving upon him—and who has always maintained amicable relations with Medical Officers of Health, and always receives their suggestions with courtesy and consideration. My objection is to the negation of principle, so far as the metropolis is concerned, involved in the new legislation, which is in no slight degree the outcome of representations made to the Govermental Authorities by the Medical Officers of Health, and especially by the Society of Medical Officers of Health, who were the first to frame " model " codes of regulations for dairies, cowsheds, &c., and for slaughterhouses also ; the drafting of which, I may mention, devolved upon myself in connection with papers which I read before the Society, before the passing of the Slaughter-houses Act in 1874, and before the passing of the Contagious Diseases (Animals) Act in 1878, which was followed by the issue of the Dairies, &c., Order in 1879. BAKEHOUSES. In a previous report I had occasion to deprecate the transfer of the duty of supervising bakehouses from the Sanitary Authority to the Factory Inspector, under the provisions of " The Factory and Workshop Act, 1878, " by which " The Bakehouses Regulation Act, 1863," was repealed. The effect of the transfer was to put an end to systematic inspection of bakehouses in the Metropolis as a whole; for the Factory Inspectors were too few in number to take up the duty which the Sanitary Authorities, as a rule, ceased to perform; the result being that many of the 144 bakehouses fell into a deplorable state of neglect, as testified by reports of the Factory Inspectors themselves. Happily, the representations addressed to the Government by the Society of Medical Officers of Health and others, endorsed as they were by the admissions and recommendations of the Chief Factory Inspector himself, convinced the Government that the Act of 1878 qua bakehouses was a mistake ; and so it came - to pass that, by the enactment of the " Factory and Workshop Amendment Act," in the last days of the Session of 1883, the Vestries and District Boards were restored to their former position, and they are now the " Local Authority," so far as relates to cleanliness, ventilation, overcrowding, and other Sanitary conditions of bakehouses, with power to enforce Sections 3, 33, 34 and 35 of the " Factory and Workshop Act, 1878." Your Vestry had previously made recommendations to the proper authorities, which went considerably beyond the point reached by the new Act, and were in substantial agreement with views set out in my annual report for 1881, in which I stated that— "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 tion, of bakehouses; (2) The periodical cleansing of bakehouses ; and (3) The materials and utensils employed in the manufacture of bread." That such a measure is desirable will hardly be contested, but it was felt to be useless to press for any alteration in the Bill of 1883 ; for, owing to the lateness of the period at which the measure was introduced, it could not be passed, except in its original form. I took the opportunity, nevertheless, of drawing the attention of the Local Government Board to the shortcomings of the Bill, and it is hoped that a more complete and satisfactory measure may hereafter be introduced, for even the operative bakers, recognise the necessity for thorough supervision of bakehouses by the Sanitary Authority. It may be mentioned that your Vestry's 145 control over bakehouses in this Parish was never wholly lost, the sanitary inspectors having, in accordance with my instructions, continued to inspect them during the interregnum (1879-83) as before. Although, therefore, there is still much to desire, in regard to position and structural arrangements of the premises— few of which were designed for their present use—sanitary conditions have, on the whole, been fairly maintained. Upon the passing of the Act the Society of Medical Officers of Health prepared " Suggestions for Regulations with respect to Bakehouses," for the guidance of local authorities. There is no .express authority for making regulations, but it was felt that good would result should local authorities see fit to adopt regulations •framed in accordance with the provisions of the Acts, for the guidance alike of their officers and of the proprietors of bakehouses. This course was followed by your Vestry, and the Regulations, printed in large type, and mounted on cardboard, have been supplied to each bakehouse proprietor in this parish. It only remains to add, that the number of bakehouses in the Parish is 149; 84 in North Kensington, and 65 in South Kensington. REFUSE. The prevention of nuisance from accumulations of offensive matters, coming under the general description " Refuse," is a matter of no little practical difficulty. The difficulty, common to .nil parts of the Metropolis, is not likely to be surmounted without legislative interference.* Some few years since, I brought the subject under the notice of the Society of Medical Officers of Health, with the result that a Special Committee was appointed, whose report, unanimously adopted by the Society, was printed in my Annual Report for 1880 (page 114). The conclusions .arrived at by the Society were 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. *The subject is dealt with in a report by the Law and Parliamentary Committee, vide page 115. 146 The collection of such refuse should be made in the early morning, and its removal effected in specially constructed vehicles ; if practicable the refuse should be utilised ; 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 maybe 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 u dustbins" 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 21,000 houses, spread over an area of 2,200 acres, and to the extent of 38,000 loads in a single year, is no light task. That it is on the whole satisfactorily performed, may be inferred from the fewness of complaints, which, it may be said, were legion when the work was in the hands of contractors. Comparatively few as the complaints now are, a not inconsiderable proportion of them results from the refusal of domestic servants to allow the refuse to be removed when the periodical call is made. Nuisance, in the sanitary sense, need not arise, even from a full dustbin ; when it occurs, it is due to improper use of the receptacle, by the deposit therein of animal and vegetable matters, of which it may be said that the former has an appreciable value, and should be utilised, while the latter admits of being burned, after drying, on the kitchen fire. A notification to this effect was left at every house in the Parish in 1873, and again in 1883. The work of dust collection has been systematised by division of the parish into districts, and provision has been made for inspection of dustbins and oversight of the "dusting gangs." A 147 call is now made at every house once a week, and further improvement is scarcely possible until the objectionable practice of refuse harbourage shall have given place to the only rational system of daily collection from moveable receptacles deposited in the early morning on the footway, ready for the cart. Delay in removal was formerly due, not unfrequently, to the inconvenient position of the dustbin ; as, for instance, in an area, to which there was no access save by ladders over the railings. In some instances where there were steps householders have been known to refuse to allow the gate to be unlocked, thus wilfully endangering the safety of the unfortunate dustmen, more than one of whom have been impaled on the spikes of area railings. Such an accident cannot happen again, your Vestry having issued instructions, upon the recommendation of the Wharves and Plant Committee, forbidding the use of ladders, and requiring that access be given to the dustbin through the house when necessary. A constantly increasing difficulty is experienced in finding convenient, i.e., accessible, "shoots" for house refuse; to the deposit of which within their boundaries the Sanitary Authorities of contiguous districts naturally object. The refuse, moreover, has little value now that building operations are being prosecuted upon so limited a scale in, or within easy distance of, the Parish, and other districts being able to supply the brickmakers' wants. Your Vestry have appointed a Committee, now sitting, to consider as to the practicability of conveying the refuse to the country, for agricultural purposes, and await with interest the result of the Committee's enquiry. STABLE REFUSE. I have frequently had occasion to draw attention to nuisances arising from the non-removal of stable refuse. "Notice" has been given "for the periodical removal of manure and other refuse matter," under the provisions of Section 53 of the Sanitary Act, 1866, which prescribes a penalty of twenty shillings a day for default; and yet one of the most frequent causes of complaint by 148 parishioners, and the most common of recurring nuisances, arises, from the neglect of this obligation. Proceedings have been taken occasionally to recover penalties, but not with much success, defendants having usually been able to satisfy the Justices of their inability to perform the duty required of them. The difficulty generally originates with the coachman, who will not give the refuse away, while the farmer will not pay for it. At certain seasons there is, no doubt, a difficulty in getting the receptacles cleared, farmers being too busy to collect the refuse, which has value for manurial and other purposes. The quantity made in this large Parish, with its 177 mews, is great, and of an aggregate value, sufficient, probably, to pay for collection and removal. 1 am of opinion that your Vestry should undertake the work of collection and removal, as the law allows, "with the sanction of the owner." The necessary sanction would be obtainable, probably, in the great majority of cases, were it understood that the requirements of the law would be enforced. The statutory "notice" requires manure to be removed "every alternate day," but twice a week in summer, and once a week in winter, would probably suffice for practical requirements, were the manure stored in properly constructed receptacles above ground. TRADE REFUSE. I11 a special report made by me, March 13, 1885, on Sanitary Nuisances Removal, and other cognate Acts,* in connection with an enquiry referred to the Law and Parliamentary Committee (April 9, 1884), I stated that:- "The Vestry have power, and indeed are required when called upon, to remove the refuse of any trade, etc., upon the application and at the cost of the owner or occupier of any house, etc.," and I added that "the section (referred to) would apply in the case of trades which lead to the production of 'refuse' of an offensive character ; " but, "for a well known reason, this power is not exercised as fully as it might be." * Vide page 111. 149 The Law and Parliamentary Committee in their report recommended "That stringent measures be taken by the Wharves and Plant Committee to put a stop to the practice on the part of the dustmen of removing trade refuse for a pecuniary present, a practice which is reported to prevail extensively, and which is detrimental to the interest of the Vestry, who are entitled to payment for the service in question." Subsequently, in a further report, "as to the best means for carrying out the recommendations" contained in the previous report, the Committee advised, and your Vestry agreed, that— "The Wharves and Plant Committee should be requested to make arrangements for the removal of trade refuse, upon the application and at the cost of owners or occupiers of houses, etc., and take steps to put a stop to the illicit removal of such refuse for pecuniary presents made to the dustmen, a practice alleged to be now common in this parish." The Wharves and Plant Committee, having taken the subject into consideration, made the following recommendation, which was adopted by your Vestry, at the meeting held October 20th last, viz.:- "That the attention of the Inspectors of Nusances and the Dust Foremen be called to the large amount of trade refuse removed without being paid for; and that the Inspectors and Foremen be directed to give the matter special attention, and report to Inspector Gaylard any and every case coming under their notice, so that payment may be demanded for removal, of such refuse ; and that the dustmen be cautioned against the removal of trade refuse without reporting same to the Foremen." The carrying out of the above order entailed a large amount of work on the part of the Sanitary Inspectors, and, for a time greatly interfered with the discharge of their ordinary and more important duties. On some days the Inspectors had to traverse large portions of their extensive districts to call upon tradesmen whose "refuse" the dustmen had refused to remove; and to little purpose, seeing that in the majority of instances the persons waited upon declined to pay for the removal of the refuse. In exceptional instances, when arrangements for payment had been made, Inspector Gaylard was taken away from his duties, which lie in the North-West District, to collect the agreed sums, quite insignificant in total amount. 150 The subject is important, and was deserving of the attention which your Vestry and the Committee bestowed upon it; for in the interest of public health, it is eminently desirable that the Sanitary Authority should undertake the removal of " refuse " matters; especially such, of animal or vegetable origin, as may become, if kept too long on the premises, injurious to health ; the refuse, for example, of the trades of fishmonger, poulterer, greengrocer, etc. It is the fact, however, that the Sanitary Authority has no statutory power to remove trade refuse save by arrangement with the producer. The law on the subject is contained in the Metropolis Management Act, sec. 128, and reads as follows:- "In case any scavenger be required by the owner or occupier of any house or land to remove the refuse of any trade, manufacture, or business, or of any building materials, such owner or occupier shall pay to the scavenger a reasonable sum for such removal, such sum, in case of dispute, to be settled by two Justices." The following (129th) section provides for the settlement by two Justices of any dispute as to what should be considered "refuse," in case of difference of opinion between the owner or occupier of any house and the scavenger—an important point. It has been held, for instance that ashes from coals burned in the furnace of a steam engine for sawing wood are " refuse of trade, manufacture, or business." In another case it was decided that a Vestry is bound to remove whatever it would be mischievous and injurious to health to retain on the premises, but not to remove such refuse as old boots and shoes, old coal scuttles, tin canisters, etc. The latter decision is a strange one, for it is hardly likely that a bootmaker would have "old boots and shoes" on his premises, or an ironmonger "old coal scuttles and tin canisters," requiring removal as "trade refuse," and such articles in a private house would not come under the description " refuse of trade, manufacture, or business," but might rather be regarded as "rubbish" which the Nuisance Authority is required (by section 125) to collect and remove. In a case tried at a police court the 151 magistrate decided that paper and miscellaneous matters, the sweepings of a theatre, did not constitute "trade refuse" and the District Board was required to remove the collection without payment, presumably as "dirt or rubbish." It has already been shown that, although there is no obligation on the part of the tradesman to have his " refuse " removed by the scavenger, the Vestry (as "scavenger") may be "required," by the owner or occupier, to remove the refuse—a somewhat onesided arrangement. In the interests of public health it were to be desired that the producer of trade refuse of an offensive sort should be compelled to employ the services of the public scavenger for its removal. But, at present, it is exactly the offensive refuse that the Vestry are not called upon or expected to remove— viz., that produced by butchers, fishmongers, fried-fish dealers, poulterers, &c., who pay substantial sums for the removal of their refuse, which is effected, not seldom, in a manner calculated to give rise to nuisance. Greengrocers' refuse has been largely removed by the dustmen with the "ashes." One main reason for the difficulty experienced by the Inspectors in making arrangements with tradesmen arose out of "difference of opinion" as to what should be considered "refuse." I felt it to be undesirable that the time of the Inspectors should be diverted from their proper duties to work of this character, but the difficulty was not of long continuance, for the resistance to payment was so strong that, in practice, all attempts to enforce it had to be abandoned—much to the satisfaction doubtless of refuse producers and of the dustmen—and matters drifted back to the position which is considered "unsatisfactory." INFECTED CLOTHING, ETC. The question of exposure of infected clothing came before your Vestry towards the end of the year. As some misconception appears to exist with reference to the subject, it may be as well to explain how the matter stands and the action your Vestry have 152 taken with reference to it in bygone times. The law is contained in section 38 of The Sanitary Act, 1866, and is as follows "Any person who without previous disinfection gives, lends, sells, transmits or exposes any bedding clothing, rags, or other things which have been exposed to infection from any dangerous infectious disorder shall, on conviction of such offence before any justice, be liable to a penalty not exceeding five pounds." The above words follow others, dealing with the wilful exposure of "any person suffering from any dangerous infectious disorder, without proper precaution against spreading the said disorder, in any street, public place or public conveyance." But in the words relating to exposure of infected things, no reference is made to locality. It may therefore be open to question whether, by reason of the context, or by simply reading on, the exposure must be in "a street, public place or public conveyance," to constitute an offence under the section, and whether exposure of infected clothing, on the body of the wearer, in a shop ; or the exposure of infected bedding, &c., in a backyard or garden, can be deemed to be an infraction of the law. Many years ago, I brought the question generally before your Vestry at a time when small-pox was prevalent, and I cited instances in which men had gone to their daily employment, after sleeping in the same room with their children ill of this disease, and wearing in "street, public place or public conveyance," clothing which, having been all night in the sick room, was reeking with infection. I also cited instances of exposure of infected bedding in backyards of bouses, respecting which complaint had been made by adjoining occupiers. I was desirous of having a test case taken with the view of ascertaining whether the section was wide enough to cover such exposure of infected things, and your Vestry referred the subject to the Law and Parliamentary Committee for their opinion. The Committee reported that, in their opinion, the section was not intended to apply to the exposure of infected clothing worn by a person not being himself ill of the infectious disease; and, with respect to bedding, &c., that the exposure contemplated was in a public place and not in a private garden. So that, as I remarked in my Annual Report for 1876 (page 26), while deferring to the views 153 of the Committee, though unconvinced— "If any person conveyed through a street a coat or dress that had been for ever so short a time exposed to infection in a sick room, he would be liable to the penalty (prescribed by the Act); but it would seem that a person may with impunity wear, in public places, a suit of clothes that had been for an entire night exposed to infection in the same sick room. The danger is as great in the one case as in the other. Again, if any person ' moves or exposes ' in a public place any infected bedding, &c., unless in course of transmission, under proper precautions, to a disinfecting chamber, he is liable to a penalty. But it would seem that he may with impunity expose that same bedding in a backyard, over the dwarf walls of which the winds impartially disseminate the poison it contains in every direction." The law is still in the same state as in 1876, and no attempt has been made, to my knowledge, to determine whether exposure of infected clothing on the bodies of healthy persons, or of infected bedding, &c., in backyards close to adjoining houses, is an offence coming within the provisions of the section. Your Vestry, however, decided that, in the event of a suitable case occurring the question should be tried. EGGS UNFIT FOR FOOD. A communication from the Clerkenwell Vestry, relating to eggs exposed for sale and condemned by a Magistrate as unfit for food, was referred to the Law and Parliamentary Committee. The Vestry stated that they were compelled to forego proceedings in consequence of eggs not being specially mentioned in the Act (26 & 27 Vict., cap. 117); that they had communicated with the Local Government Board requesting them to take steps to procure an amendment of the law on the subject, and they requested your Vestry to take a similar course. The Committee recommended your Vestry to communicate with the Board in the manner suggested, but the recommendation was not adopted. In the course of the discussion on the subject I was appealed to for an opinion, which I gave to the effect that if the particular instance, of seizure of 12,000 eggs, which gave rise to the Clerkenwell 154 Vestry's communication, were to be taken as a typical case, I should concur in the propriety of power to prosecute being applied for, or, in other words of the addition of the word "eggs" to the list of foods (meat, poultry, game, flesh, fish, fruit, vegetables, corn, bread, flour) named in the Act, because there could be no reasonable doubt that the person who was selling the eggs which were seized knew that they were unfit for food. There is a difficulty in the matter, however, because "bad" eggs cannot be detected off-hand, and bad eggs may be innocently commingled with good ones in a consignment of professedly "new-laid." It would nevertheless be reasonable to include this valuable article of food in the list of foods scheduled in the Act, so that, in cases like the one mentioned above, bad eggs might be seized; it being morally certain that no prosecution would be undertaken by a Sanitary Authority, and surely no conviction would be obtained, unless the facts were such—viewed as circumstantial evidence—as to satisfy the magistrate that the person who exposed for sale or sold the bad eggs must have been cognizant of their unfitness for food. The Clerkenwell case is in point, for it was the exceptionally low price at which the eggs were being sold which drew the attention of the Vestry's officer and led to the seizure; but under what authority I know not. The public ought to be protected against a wholesale injury of this kind. Meanwhile, there would appear to be a remedy, for it has been decided that to expose for sale, or have posession of with intent to sell, things unfit for human food is a common law nuisance, and the Clerkenwell Vestry might have taken proceedings upon that ground. METROPOLITAN MAIN DRAINAGE. The attention of the Metropolitan Board of Works has necessarily been occupied from time to time with the question of sewage disposal at the main drainage outfalls; and two reports thereon, which should have considerable interest for all concerned 155 in the sanitary administration of London and the riverian districts, were presented to the Board in the Autumn of 1885, by its Works and General Purposes Committee—viz., On the disposal of the sewage of the Metropolis; and On the treatment of sewage at main drainage outfalls. The Committee reported, November 27th, 1885, that "by chemical precipitation a good effluent water could be obtained, and that they were pursuing their enquiries as to the best method of dealing with the residue or sludge." As the result of long-continued and practical experiments, conducted by Mr. Dibdin, the chemist to the Board, to whose aid Dr. Dupre was subsequently called, the Committee came to the conclusion that " chemical precipitation of the solid matters held in suspension in the sewage can be effected by the addition of various reagents, but that no practical advantage accrues from the addition to the sewage of more precipitating matters than are really necessary for facilitating the natural tendency to solid deposit." It was found that the sewage can be sufficiently clarified by the addition of 3'7 grains of lime, and 1.0 grain of protosulphate of iron (green vitriol) to each gallon of sewage, and by subsidence in settling tanks during a period of from one to two hours ; the effect, being, besides the removals of the solids, that "the grosser odours of the sewage are destroyed, and the foul and offensive appearance removed.'' The conclusions arrived at by the Committee, and the chemist to the Board, were submitted to four eminent chemists, Sir F. A. Abel, Dr. Odling, Dr. Williamson, and Dr. Dupre, who reported as the result of experiment, that while the treatment by lime and iron " does exert a distinctly purifying effect upon the liquid part of the sewage," the effluent, nevertheless, "retains a sufficiently unpleasant odour to prohibit its being discharged into the river, during warm weather, at all states of the tide but that "the addition of manganate of soda and sulphuric acid, or other suitable oxidising agent," to the effluent, "would so far deodorise and purify that effluent as to allow of it being afterwards discharged into the river throughout the year at all states of the tide." This supplementary treatment, however, would be unnecessary during great part of the year, when the river water 156 and the sewage are cool, and the latter much diluted by rainfall. When necessary, the addition of manganate of soda, in some proportion, ranging between 0.5 and 1.5 grains of the crude commercial manganate to one gallon of the effluent, together with sulphuric acid corresponding to about one-third of the manganate used, suffices to deodorise and purify the effluent to such an extent as to render its discharge into the river unobjectionable at all states of the tide. The chemists recommended that the treatment by lime and iron be carried on throughout the year, and that when the effluent is to any appreciable extent offensive it be treated with the manganate. So successful has this plan proved, and so greatly have the Board succeeded in reducing the cost of the manganate (viz., from £40 to £11 per ton), that, in the view of the Board, which, however, is by no means universally accepted, the necessity for costly land filtration of the effluent, as recommended by the Royal Commission on Metropolitan Sewage Discharge, to ensure the removal of all odour and the possibility of "secondary fermentation," no longer exists. In order to prevent nuisance within the metropolis, arising from the discharge of offensive gases from sewer ventilators, the Board are now applying at numerous stations manganate of soda and sulphuric acid to the sewage as it flows through the main sewers. It is expected that this plan will ensure the arrival of the sewage at the outfalls in a deodorised condition, and thus assist in the production of a satisfactory effluent. The Committee devoted much attention to the further question of the "collection and disposal of the sludge" resulting from the precipitation process, and by means of a 30 inch press dealt with 1,787 tons of sludge, which yielded 523 tons of "cake." It has been ascertained that this cake cannot be burned without nuisance, except at an expense that would be prohibitory. It is evident, therefore, that if the wet sludge is not removed from the works, by farmers and others, for manurial purposes, the alternative must be, either to raise up low lying land with the cake—87 acres to a depth of three feet annually—or to take the sludge or cake out to sea. With a view of ascertaining the expense of the latter course, the Board 157 have arranged for the construction of a suitable vessel. It is also proposed, as an experiment, to offer the pressed and unpressed sludge to persons who may desire it, free of cost, so as to ascertain to what extent it may be disposed of by this means. Sludge not so disposed of will be sent in lighters out to sea, both in the liquid and in the cake condition, in order to ascertain the cost and effect of this mode of getting rid of it. The question of the disposal of sewage, it need hardly be said, is one of great magnitude, it being estimated that on an average 150,000,000 gallons are daily carried down to the outfalls, giving rise to the production of 3,000 tons of sludge, which, when pressed, would leave 850 tons of cake. The Board adopted the report of the Committee, and referred it back with a view to preparation of the necessary plans and estimates for carrying it into effect. This decision, which amounts practically to a refusal to adopt the recommendations of the Report of the Royal Commission, has been severely criticised by outside authorities on the question, and has met with condemnation, the justice of which time only can determine, and will determine,seeing that the Board have taken steps for carrying the scheme into effect. THE ROUND POND. There was a considerable outcry during the summer months against the authorities responsible for the management of the parks, on account of their proceedings in draining the Round Pond in Kensington Gardens, preparatory to removing the accumulated mud of a century—the object being to fill up the; bottom to such an extent as to make the pond a safe place for skating—a process which necessarily gave rise to a good deal of stink. It being not unnaturally supposed, by many persons, that Kensington Gardens is in Kensington Parish, your Vestry were deemed in some degree responsible for the nuisance created, granting it to have continued longer than necessary, or upon the supposition that it might have been prevented. The Round Pond, however, like the Palace itself, is in the Hamlet of Knightsbridge, an outlying part of the parish of St. Margaret's, Westminster. Few complaints reached me directly. One gentleman, indeed, living in 158 South Kensington, in a letter addressed to me, attributed his daughter's illness, from typhoid fever, to the malodourg proceeding from the mud, which, after drying in heaps, was spread as manure on the grass. Unsightly and objectionable as was the appearance of things, I could not admit the probability that the mud was the cause of illness ; nevertheless, I forwarded the letter to the Medical officer of Health to the Westminster District Board of Works. It is not necessary for me, perhaps, to say anything further on the subject, especially as all acknowledge the necessity for what was done; and as the quasi-official defence of the means and time selected for carrying out the work, which appeared in the Times, satisfied most persons that if to be done at all, it could hardly have been done in any other way, or at any other season of the year. The season, indeed, was highly favourable, for without a hot sun and continuous dry weather the work must necessarily have been attended with great difficulties, and extended over a period much longer than was actually occupied in its performance. The heavy rains that occurred subsequently to the spreading of the dried and, to a large extent, pulverised, mud on the grass, soon caused it to disappear, and assisted in producing a much improved crop of grass. NECESSARY ACCOMMODATION. There are only thirteen public urinals in the Parish—a very inadequate number—and no public water-closets, except at the rear of the Vestry Hall. Section 88, Metropolis Management Act, enables the Vestries and District Boards to " provide and maintain urinals, water closets, and like conveniences, for both sexes, in situations where they deem such accommodation to be required;" but your Vestry's efforts to provide this necessary accommodation have frequently been thwarted by local opposition. A proposition to erect "châlets" as a commercial speculation is now under consideration; and should it be carried into effect, the result of the experiment will be awaited with interest. Accommodation, it may be added, is provided at about 160 public-houses. 159 PUBLIC BATHS AND WASH-HOUSES. The Baths and Wash-houses, at the junction of Lancaster and Silchester Roads, Notting Hill, are now in an advanced stage towards completion, and will probably be opened before the close of the year. For the majority of parishioners, certainly, the site will not be found sufficiently central for bathing; and obviously it is too remote for washing purposes. The same objections would apply to any single site in the Parish. I am of opinion that much good might be effected by the provision of buildings, on a modest scale, in different localities, to which the poor might resort for the purpose of washing clothing. The question of public washhouses might with advantage be separated from that of public baths. MORTUARY. The Mortuary in the Parish Churchyard, at the rear of the Yestry Hall, was opened in July, 1883; in the first year 37 bodies were deposited; in the second year 77; in the third year 100; and in the fourth year 97. The building comprises two chambers, for infectious and non-infectious bodies respectively, separated by a "a place provided for post-mortem examinations," which is highly convenient, and much appreciated by medical practitioners. 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; the costs of such 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 now frequently orders the removal of bodies, but at your Vestry's charge. The present demands made upon the Mortuary amply justify the expense incurred in its erection. As time passes the institution will probably be even more appreciated and used; especially 160 should medical men and clergymen see fit to inculcate the propriety of removal of the dead, in suitable cases. Medical men can by certificate secure the removal of an infectious body, or of a body in an offensive condition from decomposition, on the Order of a Justice, under Section 27 of the Sanitary Act, 1866. The Royal Commission on the Housing of the Working Classes recommended provision of additional mortuaries. What, however, is more required, at present, is power to compel removal of the dead to existing mortuaries, when necessary. The Commissioners recognize this fact by the further recommendation that " in the event of a death from infectious disease the body should forthwith be removed to a mortuary in cases where it would otherwise be retained in a room used as a dwelling by others." They think it desirable, moreover, "that in any case where the body lies in a room which is used by other persons, it should, in the same manner, be removed" (Report, p. 31). Inquiry having been made as to the proportion of bodies admitted at the Mortuary on the request of friends, to those brought in by the police, or removed on the order of the Coroner, the subjoined statement was prepared with regard to 100 bodies consecutively deposited. BODIES ADMITTED. 1. At the request of relatives of the deceased 30 2. At the request of Undertakers (bodies principally of parishioners removed from hospitals) 18 3. At the request of the Coroner (Inquest cases)- Cases of sudden death 15 Cases of violent death 3 — 18 4. Brought in by the Police Found dead 19 Accident cases 7 Suicides 5 — 31 5. Deaths due to infectious disease 3 100 161 In nearly one-half of the above cases post-mortem examinations were made by authority. Mortuary Keeper's Residence.—In a previous report I had occasion to refer to inconvenience from difficulty in finding lodgings for the Mortuary Keeper within a reasonable distance of the Mortuary. That officer has now secured a house adjoining the building. CORONER'S COURT. It is now generally the practice to provide a Court for the Coroner in connection with the Mortuary, so as to obviate the necessity of holding inquests in public-houses. This step seemed to me unnecessary when plans for the Mortuary were under consideration, there being rooms at the Yestry Hall suitable for the purpose. Accordingly, the Works, Sanitary, and General Purposes Committee authorized me to communicate with the Churchwardens, who, as trustees of the Yestry Hall, 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 authorised to make, and does make, for such accommodation provided elsewhere for the same purpose. About 150 inquests are held in the Parish annually, most of which could be conveniently held at the Vestry Hall. But none of them are held there, the Coroner protesting his inability to comply with the requirement of the Churchwardens, that application should be made for the room prior to the issue of notices to jurymen, witnesses, etc. It is, nevertheless, impossible to resist the conviction that if the Coroner and those who have the control of the building would but pull together, the wish of your Vestry and, I may say, of parishioners summoned on juries, that inquests should be held at the Vestry Hall, would soon be realised. DISINFECTION. During the year ending March 25th, 1887, a large number of infected articles, clothing, bedding, etc., were satisfactorily 162 infected 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 116 cwts : their number over 2,900, and the cost of the process £112 12s. 2d. One hundred and four rooms in 83 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, as well as numerous parcels of clothing, bedding, etc., at the cost of the owners. REGULATIONS FOR HOUSES LET IN LODGINGS. Exercising a power conferred by the Sanitary Law Amendment Act, 1874, the Local Government Board at the close of 1883, by notice published in the London Gazette, declared the enactments of Section 35 of the Sanitary Act, 1866, and Section 47 of the Sanitary Law Amendment Act, 1874, to be in force in all parts of the Metropolis. The first-named Section empowers a Nuisance Authority 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 ; 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, enables regulations made under the above-mentioned section of the Sanitary Act, 1866, to extend to Ventilation of rooms, Paving and drainage of premises, The separation of the sexes, and 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 Acts therein mentioned. 163 The nuisance Authority may provide for the enforcement of the regulations by penalties; but regulations are not of any validity unless and until they shall have been confirmed by the Local Government Board. Your Vestry, having previously resolved to put the Acts in operation, framed Regulations which, having been confirmed by the Local Government Board, are now in force ; and under them some 1,500 houses in the poorest streets in the parish have been registered. The work of registration, however, was suspended in August last upon the illness of the temporary assistant in the clerical department of my office, and has not been resumed, the illness of the assistant in question having incapacitated him for work, and the appointment not having as yet been filled up. The Nuisance Authority, it may be mentioned, is under no obligation to make (or having made, to enforce) regulations for all of the purposes specified in the Acts, and I am of opinion that for a considerable time to come the most important part of our work will be" to put into operation the regulations which provide:- "For the inspection of houses, and the keeping of the same in a cleanly and wholesome state; "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; "For the ventilation of rooms; "For the paving and drainage of premises; and " For notices to be given, and precautions to be taken in case of any dangerously infectious or contagious disease." In isolated cases, when overcrowding is found to exist, it will be easy to measure rooms, so as to enforce the provisions of Regulation 2, which prescribes the air space to be allowed for each person, according to age; and, in like manner, should any glaring instance of indecent occupation come to light, it will be easy to enforce Regulation 3, which relates to the "separation of the sexes." 164 These views, which I submitted in my first Monthly Report for 1886, commended themselves to your Vestry, sharing with me the opinion that omission to press inquisitorial enquiries in regard to personal matters, as to "number, age, and sex o the occupants of each room used for sleeping," etc., would tend to facilitate the application of the sanitary provisions of the regulations. The information proposed to be obtained by such enquiries would have had little and evanescent value; for "lodgers" are a migratory class and "particulars" correct when obtained, cease to be so on any and every change in tenancy. It may be mentioned that notice of your Vestry's intention to register certain houses has proved distasteful to "landlords," and some of them have "stated in writing reasons why the house should not be registered;" but almost without exception the "reason" stated has simply been "objection" to registration, based usually on a mistaken supposition that by registration the "registered house" would become a "common lodging-house," subject to police inspection, and stigmatised in a manner likely to diminish its letting value.* It is hardly necessary to say that these evils are purely imaginary. The register is a quasiprivate document: no intimation of registration is given excepting * The Vestry's "notice" to the landlord of intention to register might have prevented such a mistake. It is as follows:—"Sanitary Act, 1866, 29 & 30 Vic., cap. 'JO, sec. 35; and Sanitary Law Amendment Act, 1874, 37 & 38 Vic., cap. 89, sec. 47.—I have to inform you that the Vestry propose to Register the house described as of which you are the landlord,' in conformity with the provisions of the above-cited Acts. 1 forward herewith a copy of the Regulations made by the Vestry, and confirmed by the Local Government Board, for Houses let in lodgings, and Registered. On page 2 you will find a Summary of the sections of the Acts referring to the subject. To prevent mistake, I am to inform you that the registration of a house will not make it a Common Lodging House under the provisions of the Common Lodging Houses Acts, which are administered by the Police Authorities; that there will be nothing affixed to the house to indicate that it is registered; and that so far from any disadvantage attaching to a house because it is registered, the Vestry are of opinion that the fact of registration may rather be expected to add to the value of the house, by proving that it is in good sanitary condition. Should you, after the above explanation, desire to state, for the information of the Vestry, any reasons "why the above described house should not be registered, you will please do so (in writing) within fourteen days." 165 to the parties immediately interested; to wit, the "owner," the "keeper" (i.e., the occupier; but in the case of a tenementhouse the "owner" is "keeper," also), and the lodgers. So far from registration injuring property, I believe it will come to be regarded as a guarantee that the house is in good sanitary condition, viz. : when time shall have permitted the carrying out of your Vestry's "Instructions" for the guidance of the Sanitary Inspectors in regard to the sanitary arrangements of registered houses, which require them to see:- 1. That all cisterns are periodically cleansed and properly covered ; 2. That all waste pipes from sinks, cisterns, baths, &c., be disconnected and empty themselves over, or, preferably, near surface gratings, and outside the house where practicable ; 3. That the drains under all such gratings be efficiently trapped; 4. That the paving of yards be laid to a fall towards such gratings, with the joints of such paving grouted or pointed in Portland cement or other impervious material ; 5. That all drains be trapped from the Sewer outside the wall of the house next the Sewer; Note.— Where convenient or practicable an intercepting chamber with a closefitting cover and an air-pipe should be recommended. 6. That all house drains are air-tight ; Note.— Where there is reason for believing that any house drain is imperfect, notice must, if necessary, be given to the Surveyor, who will provide workmen for opening it up for examination.. 7. That all special soil pipes beair-tight at the joints, and carried, full diameter, above the roof, at a safe distance from windows and chimney tops ; 8. That all rain-water-pipes used as soil pipes be air-tight at the joints. Note.—The use of "combined soil and rain-water-pipes'' is a bad arrangement and should be discountenanced. These Instructions, adopted February llth, 1885, were by your Vestry, on Febuary 10th, 1886, directed to be observed " in respect to all other houses wherein on examination sanitary improvements are found to be necessary." HOUSING OF THE WORKING CLASSES. In connection with the subject of registration of houses let in lodgings reference was made, in a previous annual report, to the 166 Report of Her Majesty's Commissioners for enquiring into the Housing of the Working Classes. The labours of the Commission have hitherto borne little fruit —probably because of the disturbed state of the political world, which takes little heed of questions which concern health and life merely. The report itself did scant justice to the work of the sanitary authorities, which, though carried on under pressure of many difficulties, has had the effect of making London the cleanest, best paved, best drained, best lighted, safest, and healthiest of great cities. The outcry against the existing system of local self-government is largely factitious, being raised at convenient seasons by those who desire to promote the creation of a "municipality," against which per se I have nothing to say. The outcry being for the time useless is now seldom heard. The present Prime Minister, Lord Salisbury, brought in a Public Health (Metropolis) Bill in the Session of 1885, which, as a measure for consolidating, with some few useful amendments, existing scattered statutes, fourteen in number—all bearing more or less on the question under consideration—would have proved serviceable. But there was not time to pass the Bill, which, moreover, is not likely to be reintroduced in the current Session. The Housing of the Working Classes (England) Act, 1885, to which I adverted in my last report, is a well-intentioned measure, which, however, has not bome much fruit hitherto. Nevertheless it is not without value, containing as it does powers which, when the times are less out of joint, may be found useful for promoting some of the objects it was intended to subserve. WATER SUPPLY. Professor Frankland's Report.—It being desirable that your Vestry, as Sanitary Authority, should be well informed on the subject of water supply, one of great importance in relation to public health, it has been my custom to summarise the reports prepared annually by Professor Frankland, for the RegistrarGeneral, and by the official "Water Examiner," under the 167 Metropolis Water Act, 1871. Dr. Frankland, who is adverse to riparian sources of supply, deals mainly with the quality of the water in its chemical and microscopical aspects, and in regard to its fitness for dietetic and domestic purposes; the observations of the Water Examiner have reference to the condition of the water in bulk at the intakes; to its physical qualities when delivered to the consumer; and, in a word, to whatever concerns collection, subsidence, filtration, storage, and distribution. London is supplied mainly 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 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 1886 was 28'6 gallons. Dr. Frankland is consistent in his preference for "deep well water," taking it as the standard of purity in his comparative observations on the supplies of the different companies. In a previous report he described this water 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 the water is its hardness, but this is an objection easily surmounted. The "hardness" of water represents the weight of carbonate of lime, or its equivalent of other mineral ingredients, found in 100,000 parts of water. The average hardness of the Thames water delivered in London last year was 19°.2; of the Kent Company's water 29°.4 ; and of the Colne Valley Company's water 4°.5 only. The hardness of the waters is of no consequence in respect of their fitness for drinking purposes: the superiority of a soft water like that of the Colne Valley Company, however, comes into play and becomes a matter of first importance in nearly 168 all the industrial uses of water. Thus in the washing of linen the economy effected by the use of soft water is very great indeed, for since it is indispensable to have soft water for this purpose, if the water employed is initially hard it must be softened, either by means of carbonate of soda or by the expenditure of a larger quantity of soap. By far the most economical method of softening water is by means of lime (Clark's process) which can be carried out on the largest scale, at a cost of about one-eightieth part of that which the use of extra soap entails on the consumer. The only water which is well fitted for washing and industrial purposes generally, is that of the Colne Valley Company, which in its natural state is hard like that of the Kent Company, but which by treatment with lime has its hardness reduced before delivery to less than one-sixth of its original amount. The hardness of the river supplies is also capable of similar reduction. A small proportion of the solid matter in water is always organic in nature, and this, although quite insignificant as regards its absolute amount, is yet of the greatest importance when its possible origin is taken into consideration. The rivers receive above the intakes of the Companies a certain amount of animal matter, derived partly from sewers, cesspools, and sewage works, and partly from manured land. Such animal substances may at any time be accompanied by matters capable of producing zymotic disease ; and, although the treatment which the water subsequently receives at the hands of the Companies is calculated greatly to diminish the risk of such morbific matter reaching the consumer, its entire removal is not guaranteed. It is, therefore, satisfactory to know that most of the Companies are making serious efforts to diminish the volume of water taken directly from the streams. It is desirable, however, that this action of the water Companies should be supplemented by the enforcement of the laws prohibiting the discharge of sewage into the Thames and Lea." "The amount of organic matter was very moderate during the months of March, May, June, July, August, September, October, and November, whilst during the remaining four months, and especially in December, the proportion was considerably greater. The average proportion of organic matter present in the deep well water, almost uniformly small in quantity throughout the year, was less than one-third as great as that found in the Thames, and less than half of that present in the water of the Lea. The real superiority of the deep well water, moreover, is not fully indicated by these figures, for the process of filtration to which the deep well water has been subjected in traversing the porous strata from which it has been derived, is far more exhaustive than can be effected by the sand filtration to which the river waters are submitted." 169 The following table exhibits the proportional amounts of organic elements (organic carbon and organic nitrogen) in the waters of the Companies which supply Kensington; the Kent Company's water being used as the standard of purity for comparison:- Name of Company. Maximum. Minimum. Average, Kent 0.9 0.4 0.6 Chelsea 4.7 1.5 3.1 Grand Junction 6.7 1.6 3.1 West Middlesex 4.7 1.9 3.1 "The average proportion of organic matter in the waters supplied by the (local) Companies is thus seen to be identical, but much more uniformity is observable in the case of the water of the Chelsea and West Middlesex Companies, which are provided with extensive storage reservoirs, than in the case of the Grand Junction Company, who in consequence of the very limited storage capacity they possess are less independent of floods in the river. This Company has, however, within the last few years constructed very important works, by means of which much of the water which they obtain is subjected to natural filtration in the gravel beds adjoining the Thames, and it is doubtless in consequence of this improved method of filtration that they have been enabled to supply water of perfectly clear appearance even when the river was in a very impure and flooded state." It may be added that the maximum amount of organic matter in the Thames-derived waters was less than in any previous year, excepting 1884 only. This greater freedom from an excessive proportion of organic matter results from the protective measures which have from time to time been adopted by the water Companies. The amount of "combined nitrogen," Dr. Frankland stated in a previous report, "constitutes the whole evidence exhibited by the various waters, of the nitrogenous organic substances which they have in the past received, as well as of those which they still retained at the time when the analyses were made. In river waters the quantity of this total combined nitrogen undergoes considerable reduction during the warmer months, owing to the presence of active vegetable life in these waters, under favourable conditions of temperature. It was stated in a former report that several of the Companies 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 underground waters which have undergone natural filtration through great thicknesses of gravel and sand, whilst others are sinking deep-wells in the chalk. In 1884 it had to be remarked that the protection provided by the common law to rivers was denied to subterranean sources of water, which, it appeared, as the result of a decision by Mr. Justice Pearson in an important case (Ballard v. G 170 Tomlinson), might be polluted or poisoned to an unlimited extent without legal redress. Happily, in the interests of public health, this judgment was afterwards unanimously reversed in the Court of Appeal. A marked and undeniable advantage of spring water is its uniformity of temperature. The mean temperature of the Companies' waters is practically identical, but the fluctuations in temperature, according to the season of she year, are much more marked in river than in deep-well water. The latter remains refreshing and palatable in summer, whilst on the other hand, the risk of frozen pipes is greatly diminished in winter The range of temperature in the water of the Thames, as delivered by five of the Companies last year, amounted to 32°.4 Fahr., viz., from 36°.0 in March to 68°.4 in July. The deep-well water furnished by the Kent Company varied in temperature from 52°.9 in December to 56°.3 in July, a range of 3°.4 only. The past year," Dr. Frankland states. "has been particularly favourable for studying the resources of the Metropolitan Water Supply. For, owing to the exceedingly variable nature of the weather experienced, the quality of the water in the rivers suffered far greater fluctuations than during the two previous years, in which the meteorological conditions were in many respects exceptional. For the past year, however, the rainfall was considerably above the average during the months of January, May, and December, whilst in the remaining months it was almost invariably below; thus, during no less than a fourth part of the year, the conditions were unfavourable to the purity of the river supply. Notwithstanding the prevalence of these unfavourable conditions during such a considerable fraction of the year, it is especially noteworthy that every sample of water collected from the mains in the Metropolis and submitted to examination, was clear, bright, and free from turbidity. . . . The high efficiency of treatment and consequent general improvement in the quality of the river portion of the Metropolitan water supply, which has been conspicuous for several years past, has therefore been more than maintained during the year 1886." The improvement effected in the river water by filtration, revealed by the determinations of the relative numbers of micro-organic spores or germs present in a given volume of the raw and filtered waters, is very striking. These determinations are made by Dr. Percy Frankland, and the results show that whilst the unfiltered Thames water exhibited, by gelatine cultivation, on an average. 2,219 germs per cubic centimetre, the filtered water contained only 38. which corresponds to a reduction of 98.3 per cent. 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 has become exceedingly rare in late years, and last year, presumably, was altogether wanting none of the waters being turbid on any occasion. 171 The subjoined table shows the annual averages of each determination and thus summarises the average results of the analysis of the water 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. 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., being taken as 1°. Chelsea 10°.8 27.84 .149 .032 0 .227 .259 1.7 18.8 3.1 West Middlesex 11°.8 28.01 .151 .033 0 .236 .269 1.7 19.0 3.1 Grand Junction 10°.9 28.39 .158 .028 0 .236 .264 1.8 19.3 3.1 Kent 12°.6 42.69 .029 .009 0 .491 .500 2.5 29.4 0.6 The Water Examiner's Report.—The post of Water Examiner, so long held by the late Colonel Sir Francis Bolton, R.E., has recently been filled by the appointment of MajorGeneral A. de C. Scott, R.E., to whose courtesy I am indebted for an early copy of the Annual Report of the Water Examiner for 1886, which General A. de C. Scott refers to as "a brief statement, without comment, of facts on record, as nearly as possible in the form adopted by the late Sir F. Bolton, and deduced from the materials collected at his instance." On this report and on the report for March, 1887, by General A. de Scott, the following remarks on the water supply of the Metropolis are mainly founded. The duties of Water Examiner, it may be remarked, are multifarious and important. He makes monthly inspections of the several Metropolitan waterworks, filter beds, reservoirs, &c.; examines the quality of the water, both at the intakes and after filtration at the works, and reports, monthly, the results of such inspections and examinations to the Local Government Board. Upon him rests the responsibility of seeing that G 2 172 the requirements of Section 4 of the Metropolis Water Act of 1852 are complied with—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, according to Sir F. Bolton, upon:— 1. A sufficient area of properly constructed iilter beds, constantly cleaned, 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 2½ gallons per square foot per hour. Filtration ought to be effectual at this rate, which, for all practical purposes, may be considered as a standard. Effectual filtration is greatly facilitated by previous subsidence." The average rate of filtration, per square foot of filtering area, in gallons per hour, by the several local companies in 1886, was as follows:—West Middlesex, 1½; Grand Junction, 15/6; and Chelsea, 1¾. 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. Sin.; Barnes sand, lft.; gravel screened to different sizes, and arranged in layers, 2ft. 3in. Total thickness, 5½ft. Grand Junction.—Harwich sand, 2ft. 6in.; Hoggin, 6in.; fine gravel, 9in.; coarse gravel, 9in.; boulders, lft. Total thickness, 5½ft. Another and more modern kind of filter is used by this Company made up of sand, 2ft., fine gravel, 9in., pipe drains, 3in. Total, 3ft. Chelsea.—Thames sand, 4ft. 6in.; shells, &c., 3in.; gravel, 3ft. 3in. Total thickness, 8ft. The filtering basins are lined with brickwork or concrete, and contain layers of sand and firm and coarse gravel arranged in descending order. The water passes vertically downwards, and 173 is collected by pipe and brick drains laid on the floors of the basins and led by conduits to the well of the pumping-engine. The thickness of this filtering media ranges from eight feet in the case of the Chelsea Company to two feet nine inches in that of the Grand Junction Company. The thickness of the upper layer of sand, which is the most effective of the layers, varies from two feet to four feet six inches. The sand becomes clogged, in course of time, and then the upper layer is scraped and removed. Renewals of sand take place periodically as the layer becomes reduced below an assigned minimum. The West Middlesex Company is spoken of as prominent "in respect of the uniformity in the quality of its water," probably due to the fact that it "uses to an exceptionable extent for filtering purposes sand from Harwich and its neighbourhood, which is remarkably fine and uniform in grain." But filtration avails little if the water is allowed, as frequently happens, to be fouled in the cisterns ; whether through the uncleanly condition of those receptacles or by the connection of them with drains through the medium of "waste-pipes," which the Companies only have the power to abolish, viz., under the provisions of the 14th water regulation, which reads as follows:— 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." Sir Francis Bolton remarked that— The particular object of the above regulation is to prevent the waste of water ; but if the overflow-pipe is brought outside the house, and the end left exposed to the air, instead of being carried into the drain, as is often the case, it will effect an object of far greater importance, by getting rid of the poisonous effluvia and gases from the drains; which would otherwise ascend through the pipe, and not only be partly absorbed by the water in the cistern, but be partly mixed with the air in the houses, thereby becoming a cause of fever and disease." 174 These remarks are just, and therefore I would again urgethat the Companies should be compelled to exercise their power, or that the Vestries and District Boards should have co-ordinate authority, to enforce the regulation. Meanwhile, the attention of householders cannot be too frequently drawn to the necessity for abolition of waste-pipes, and periodical cleansing of cisterns for storing potable water. Cisterns, moreover, should be properly covered so as to exclude light and dirt; and so placed that the water may be kept cool in summer, without being in danger of freezing in winter. When "constant supply" is given, a screwdown draw-off tap should be affixed to the rising main, or service pipe, so that drinking and cooking water may be drawn therefrom, fresh and uncontaminated, without the intervention of cisterns, which are required for washing, flushing, baths, and similar purposes. A stop-valve should be fixed outside the premises, to prevent damage to the house, in case of pipes burst by frost or other causes. The quantity of water supplied by the Grand Junction, West Middlesex and Chelsea Companies, respectively, last year, averaged 35, 29 and 37 gallons daily per head of the population. The "intake" of the Chelsea Company is at West Molesey ; the intakes of the other Companies at Hampton. 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 the time of flood, to raise 12 million gallons of water per day that has passed through the natural beds of gravel and sand which are characteristic of the neighbourhood. The state of the water in the Thames during the month of January, was bad, in February fair, in March good, April and May indifferent, June fair, July, August and September good, October fair, and remainder of year indifferent. It need hardly be added that polluted water is 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 fitration. 175 The fact that the impurity of the water in the river is so largely increased during periods of flood, renders it of great importance that there should be sufficient provision of subsidence and storage reservoirs to enable the necessary daily supplies to be delivered during such periods, while keeping the intakes closed. The position of the several Companies varies in this respect very considerably. The following statement shows the number of days' supply, represented by the capacity of the reservoirs for unfiltered water, belonging to each of the local Companies:—Chelsea 14; West Middlesex 8 ; Grand Junction 4. It must be mentioned, however, that the Grand Junction Company's resource, during floods, of pumping from the gravel beds adjoining the Thames is practically equivalent to an addition to their provision of storage reservoirs. For sake of comparison it may be added that the East London Company has capacity for 16½ days' supply. The same Company is stated to be conspicuous by its advance in work for improving the water supply of its district in other respects. Dr. Percy Frankland continued in 1886 his biological experiments by the process known as gelatine-plate cultivation, from which it appears that the average reduction in the micro-organisms (bacteria) present in the unfiltered water of the Thames, effected before delivery to the consumers, amounted to no less than 96.5 per cent, a striking evidence not only of the importance, but also of the efficiency, of filtration as practised by the several Companies. The following particulars with respect to the local Companies may be of interest:— Storage and Filtration.—No new works have been found necessary by the Chelsea Company, the existing means being sufficient to meet all requirements at all times of the year. The West Middlesex Company have constructed two additional filters at Barnes, of about one acre of area in each. The Grand Junction Company have connected their reservoirs at their Kew and Campden Hill Works with the main of the East London Company, and made connection of mains in other localities, so that the one Company can assist the other in case of emergency arising from fracture of a main, etc. 176 Constant Supply.—I have no means of ascertaining to what extent constant supply has been extended to houses in this parish, but the following facts with reference to the several districts may be acceptable. The West Middlesex Company are giving constant supply to all new estates and buildings, and where new services are laid down constant supply is made compulsory by the Company, on outside stop valves being fixed ; 1,165 houses were put on constant supply during the year, the number of houses on constant supply being 20,493 out of a total of 68,486. The Grand Junction Company were giving constant supply to 40,298 houses out of a total of 52,794 ; the increase during the year 1886 was 2,965. The system has been extended to North Kensington. The Chelsea Company were giving constant supply to 5,160 houses (increase during the past year. 398), out of a total of 34,251. This Company is the only one of the eight Metropolitan Water Companies which has given no notice of its intention to substitute a constant for an intermittent supply under the provisions of the Act of 1871. Judging from the few applications made for constant supply, there appears to be little desire on the part of the public authorities, or private individuals, in any of the districts, for the continuous service; but all new estates and new lines of streets are being so supplied voluntarily. By way of contrast, and to show how backward the Western Companies are in the matter of constant supply, as compared with the Companies in the East of London, it may be mentioned that the East London Waterworks Company now give constant supply to 137,238, out of a total of 156,588 houses supplied by them, and containing an estimated population of 1,174,410 persons. The percentage of house supplies on the constant system in each local Company's district, in March 1887, was Chelsea, 15 per cent. ; West Middlesex, 30 per cent.; and Grand Junction, 77 per cent. In the East London District the percentage is as high as 87. But considerable advance was made during the past year in London as a whole, in extending the constant supply: 345,043, out of the total number of 719,906 houses supplied, being now on constant service; an increase of 24,765. 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 was, in December, West Middlesex, 107¼; Grand Junction, 82½ ; and Chelsea, 74½. The Companies are ready to affix hydrants on the mains whenever required to do so. In the Metropolis there were 9,343 hydrants only, the total length of mains being 1,171½ miles. The increase, in mains, during 1886, was 38½ miles, and in number of hydrants, 893. 177 "Subsequent to the passing of the Act of 1871, the Water Companies have incurred a considerable expenditure, amounting altogether to £3,890,124, for the improvement of the water supply, both in quantity and quality, by extending the storage capacity of their reservoirs, and increasing their areas of filtration, as well as by providing for the requirements of constant supply, by the construction of high service reservoirs for filtered water, the laying of mains and the addition of powerful machinery to their works. These measures have tended to improve the supply of water to the Metropolis. The total expenditure of the Companies on works, improvements, &c., to the end of 1886 amounts to £13,865,122, of which £237,202 was expended during the past year." Deterioration of Water in Dirty Cisterns.—The Local Government Board, some three or four years ago, addressed a circular letter to Sanitary 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 they sent an extract from one of his reports on the examination of the water supplied by the Companies. Sir F. Bolton's observations were directed (1) to the deterioration of water resulting from 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 frequently not only situated over a watercloset, but also having communication with the drains by means of the waste pipe. The importance of the subject is undeniable, and, with the view to removal of defects, your Vestry's Sanitary Inspectors have standing instructions to inspect the cisterns of every house visited, where practicable. It is a fact, however, that cisterns are frequently so situated as to be inaccessible for inspection and cleansing alike; often, moreover, there is but one cistern, and that one over a water closet, as stated by Sir F. Bolton. The Sanitary Authority has no control over the placing of cisterns, but the Water Companies, might, if so minded, remedy the evil 178 complained of, viz., 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." All that relates to water supply has great interest for me, and the deterioration of water in dirty cisterns has been frequently referred to in my reports. I was glad, therefore, that the subject had been brought to the notice of the Local Government Board, to whose communication a reply was sent, calling their attention to the necessity for such an alteration in the law as should give Sanitary Authorities co-ordinate power with the companies to enforce the regulations, and so enable them to give effect to the views of the (late) Water Examiner. The Board, however, took no action in the matter. Abolition of "Waste-Pipes.—In a Memorandum by the Medical Officer to the Local Government Board, on "Precautions against Cholera," adverted to in my Report for 1883, it was advised that " any connections of waste-pipes of cisterns with drains should be severed." This advice being accordant 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. Communications were addressed to the Board, to the Vestries, and to the local Waterworks Companies. The Board was informed that your Vestry were 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 connections of waste-pipes with drains, by urging the Companies to put Regulation 14 into immediate and general operation, viz., 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 the necessary power to enforce the regulation. The Sanitary Authorities were invited to support your Vestry's action by addressing a similar communication to the 179 Board, and by recommending the Companies to put the 14th Regulation in force, and thereby bring about a much needed sanitary improvement. Many of them did as requested. 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 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 ever spread in the Metropolis, it would be, as on a former occasion, through the water supply, the great importance of taking steps without loss of time to carry the said regulation into effect," was pressed upon the attention of the several Companies. The Local Government Board subsequently addressed a communication to the Companies on the subject of Regulation 14, and these in turn prepared circular notices, which were left at every house in the several districts. In every circular the regulation was quoted in its entirety. Attention was drawn to the excellent advice, upon cleansing and covering of cisterns, and cutting-off of waste-pipes, which, from time to time, the late Water Examiner embodied in his reports. A good deal of trouble and expense was thus incurred—with what effect it is impossible to say; it is however to be regretted that the Companies did not go one step further and give the "notice" to every householder, to cut off all connections of waste-pipes of cisterns with drains, as they had been urged to do ; and thus, at no further expense to their shareholders, and at little cost to individual householders, effect an important sanitary reform. It would have been to their interest; for many of the complaints respecting the water supply are due to the connections of waste-pipes with drains, and if this source of contamination were abolished, the Companies' water would be held in greater repute. We are told that waste-pipes will be abolished when constant supply is given; but for this, large portions, in fact the bulk, of the parish, will still have long to wait. Sir F. Bolton continued 180 to reiterate in his monthly reports, to the very last, sound advice which might have done good if only it could have been impressed on every individual householder; pointing out, as he did, that it the conditions contained in Regulation 14 were observed by consumers and by local (i.e., nuisance or sanitary) authorities, as well as by the Companies, many of the evils complained of would be prevented. Compliance with the regulation, doubtless,, should be enforced upon consumers, but the Local Authorities have not the power with which, by implication, Sir F. Bolton credited them; 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 regulation, excepting for their own trading purposes. I fear that nothing short of an epidemic of cholera will suffice to bring about compliance with the advice of the late Water Examiner—viz., by the exercise of the power possessed by the Water Companies under Regulation 14. GAS. The subjoined Tables, based on the quarterly reports of theChief Gas Examiner, summarise the principal results (averages) of the daily testings at the Ladbroke Grove Station of the " common gas," manufactured by the Gas Light and Coke Company at their Kensal Green Works, and supplied in this Parish. 1. With respect to illuminating power. The maximum, minimum, and average illuminating power, in standard sperm candles, the statutory standard being sixteen candles, was as follows:— Maximum. Minimum. Average. Quarter ended March 31st 17.5 16.1 16.9 Quarter ended June 30th 18.1 16.5 16.9 Quarter ended September 30th 17.3 16.5 16.9 Quarter ended December 31st 18.5 16.8 17.7 Averages, whole year 17.8 16.5 17.1 181 It appears from these results that the illuminating power of the gas at the Station was above the Parliamentary standard. But it was stated, in the Annual Report of the Metropolitan Board of Works for 1884—and as the result of testing with a portable photometer—that there are parts of London the inhabitants of which do not always get their gas of the quality which it was thought had been secured to them by Act of Parliament; the gas having been frequently found to be inferior in lighting power to the prescribed standard, sometimes by as much as one candle. There is no way of preventing this, the companies in default being subject to no forfeiture or penalty, as they are when the gas is shown to be defective at the regular testing places. The above facts point to the necessity for an alteration of the law. The gas referees, it was stated, approve of the testing of gas by means of a portable photometer; and the Metropolitan Board of Works have advised the Board of Trade that statutory power should be obtained for that mode of testing, so that gas companies may be liable to forfeitures for gas which the portable photometer shews to be defective in lighting power. The Metropolitan Board also suggested the expediency of an alteration in the standard of light prescribed by the statutes. The statutory standard is obtained by burning a sperm candle of six to the pound, at the rate of 120 grains an hour; and the gas is required to be of such lighting power as to produce, when consumed at the rate of five cubic feet an hour, a light equal to that produced by sixteen such candles. A Committee, appointed by the Board of Trade, has reported adversely to the continuance of the use of the sperm candle as a standard, it having been proved that, in spite of all the precautions taken to secure uniformity in the manufacture of the candles, there remained considerable variation in their lighting power. In the Report of the Metropolitan Board for 1886, no reference is made to the important matters dealt with in the above paragraph. 2. As regards purity. The gas was free from sulphuretted hydrogen throughout the year; and the quarterly average quantity of other sulphur compounds with which the gas was charged, was 182 considerably below the permitted amount; the maximum not having been attained on any occasion. Grains of sulphur per 100 cubic feet of gas ; the Parliamentary limit being 17 grains in 100 cubic feet during the months from April to October, and 22 grains from October to April. Maximum. Minimum. Average Quarter ended March 31st 13.4 7.4 9.8 Quarter ended June 30th 12.0 8.0 9.7 Quarter ended September 30th 14.5 7.1 10.2 Quarter ended December 31st 11.5 6.7 8.7 Average, whole year 12.8 7.3 9.6 Ammonia, a valuable residual product of gas manufacture, was present in the gas in slight quantities, more or less frequently throughout the year; but never in anything like the quantity permitted by the Acts of Parliament—viz., four grains in 100 feet of gas. The Chief Gas Examiner being independent of the Company, it is satisfactory to note that his reports on the daily testing of the gas are favourable. No complaint was received by me during the year 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 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. Notwithstanding the increased consumption of gas (50 per cent.), and the consequent improvement in the lighting of the public thoroughfares, the cost, owing to reduction in price, is less than under the old system of a fixed annual payment per lamp. Great complaints, however, are made by private consumers, who allege that, although the nominal price of gas may go down (the shareholders' profits go up pari passu) the actual annual payment for gas is always increasing; the reason probably being that no means are adopted for controlling 183 consumption, either at the meter or in connection with the several burners. It is to the interest of the Company to maintain high pressure; for then more gas is passed through the meter, and has to be paid for by the unfortunate consumer ; who, moreover, is put to heavy charges for cleansing ceilings fouled by unconsumed gas and smoke. I would, therefore, once again recommend that automatic records of pressure, at all hours of the day and night, and at several points in the Company's district within the parish, be obtained. I would further recommend that Mr. Monson be requested to prepare, and that your Vestry should circulate halfyearly, on the back of the rate-call papers, information shewing how gas may be burned with greatest effect and minimum consumption." This subject might easily be enlarged upon, but as your Vestry have in Mr. Monson an officer able and willing to advise consumers to their advantage, I content myself with expressing a hope that his services may be enlisted in their behalf. It now only remains for me, in conclusion, to offer my thanks to all who have contributed by their assistance to whatever success may have attended the work of my Department during the past year. I have already had occasion to refer to the co-operation of the Board of Guardians. It would be impossible to over-value the services rendered by them, through their officers, in measures for preventing the spread of dangerous infectious disease—viz., by securing the speedy removal of the sick. The sub-district Registrars, Messrs. Barnes and Hume, and the Vaccination Officer, Mr. Shattock, have, as usual, readily complied with my applications for information on subjects connected with their several duties. * In the course of a discussion in the Vestry, on the Gas question, a member advocated the use of "governors" to ensure economy of consumption, by equalisation of pressure, thus preventing "blowing." He stated that he had effected a saving of 56,000 feet of Gas, in value nearly £8, in a single year, by using a governor, the total cost of which was £5 10s. A profitable business might be done by letting out " governors," payment for hire to be in the form of a liberal percentage on the money value of the gas saved by their use. 184 The Sanitary Inspectors have discharged their onerous, and in some respects perilous, duties with zeal, intelligence, and success. To Mr. Budman, the Sanitary Clerk, I am much indebted, among other things, for assistance rendered in passing this Beport through the press. But above all, my thanks are due to your Vestry for continuance of confidence which, now for sixteen years, has enabled me to carry out, with pleasure and satisfaction, the duties of an office, and to superintend the work of a Department, the importance of which, I believe, is now generally recognised. I am, Gentlemen, Your obedient servant, T. ORME DUDFIELD, Medical Officer of Health. Offices : Town Hall, Kensington, W., June, 1887. APPENDIX. Note.—The forms for Tables I.—VI. were arranged by the Society of Medical Officers of Health, with the object of securing uniformity in Statistical Returns. 187 TABLE I. Shewing Population, Inhabited Houses, Marriages, Births, and Deaths in 1886, and ten preceding years. The Year. Estimated Population* No. of Inhabited Houses† Marriages. Registered Births. Deaths. Total all Ages ‡ Under One Year. Under Five Years. In Public Institutions § 1886 173,500 21,500 1,605 4149 2,756 636 1,029 604 1885 172,000 21,420 1,480 4,032 2,768 653 1,085 561 1884 170,000 21,290 1,498 4,394 2,638 678 1,020 439 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 148,316 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 Average of 10 yrs. 1876-85. 160,277 20,424 1,459 4,453 2,795 689 1,147 428 Population in 1861, 70,108 ; 1871, 120,234 ; 1881, 163,151. Average Number of Persons to each house at Census: in 1871, 7.6 ; in 1881, 8.1. Area of Parish, 2,190 acres. Number of Persons to an acre (1886), 792. * 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 Censal 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 numbers on rate books in April and October yearly. ‡ Inclusive of the deaths of parishioners at public institutions outside the parish, but 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 Asylums Board hospitals. 188 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 1886 and ten preceding years. The Year. Birth Rate per 1,000 of the Population. Death Rate per 1,000 of the Population. Deaths of Children under 1 year ; per 1,000 of Registered Births. Deaths of Children under 1 year ; per 1,000 of Total Deaths. Deaths of Children under 5 years ; per 1,000 of Total Deaths. Deaths in Public Institutions ; per 1,000 of Total Deaths. 1886. 23.9 159 154 230 373 219* 1885 23.4 16.1 161 236 392 202 1884 25.8 15.1 156 261 392 166 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 30.2 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 Average of 10 years 1876—1885. 27.6 17.3 153 246 409 150 * 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 1876-83 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 Registered from all causes in the year 1886. (Exclusive of the Deaths of Non-Parishioners at Public Institutions within the Parish, but inclusive of the Deaths of Parishioners at Public Institutions outside the Parish.) CAUSES OF DEATH. AGES. Total under Five Years of Age. Grand Total all Ages. SUB-DISTRICTS. 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 upwards. Kensington Town. Brompton. (classes). I. SPECIFIC FEBRILE or ZYMOTIC DISEASES 128 134 16 12 14 8 4 4 7 4 1 262 332 258 74 II. PARASITIC DISEASES ... 1 ... ... ... ... ... ... ... ... ...... 1 1 1 ... III. DIETETIC DISEASES 1 ... ... 1 3 7 6 2 1 ... ... 1 21 16 5 IV. CONSTITUTIONAL DISEASES 98 72 29 46 80 77 62 66 55 21 3 170 609 480 129 V. DEVELOPMENTAL DISEASES 71 2 ... ... ... ... ... ... 11 46 28 73 158 117 41 VI. LOCAL DISEASES 201 159 48 53 78 104 136 197 236 150 32 360 1394 1105 289 VII. DEATHS FROM VIOLENCE 22 6 2 4 4 13 8 6 7 1 1 28 74 63 11 VIII. DEATHS FROM ILL DEFINED AND NOT SPECIFIED CAUSES 115 19 3 ... 2 5 5 8 6 4 ... 134 167 138 29 636 393 98 116 181 214 221 283 323 226 | 65 1029 2756 2178 578 I. SPECIFIC FEBRILE or ZYMOTIC DISEASES. 1.—Miasmatic Diseases. Small-pox Vaccinated ... ... ... ... ... Unvaccinated ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... No Statement ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 7 46 3 ... ... ... ... ... ... ... ... 53 56 50 6 Scarlet Fever ... 7 4 ... ... ... ... ... ... ... ... 7 11 4 7 Typhus „ ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough 35 47 ... ... ... ... ... ... ... ... ... 82 82 58 24 Diphtheria ... 21 6 1 1 ... 1 ... ... ... ... 21 30 22 8 Simple Continued or Ill-defined Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric or Typhoid Fever ... 1 2 3 ... 2 2 1 ... ... ... 1 11 7 4 Other Miasmatic Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2.—Diarrhœal Diseases. Simple Cholera ... ... 1 ... ... ... ... ... ... ... ... ... 1 1 ... Diarrhoea, Dysentery 71 12 ... ... ... ... ... ... 4 3 ... 83 90 72 18 3.—Malarial Diseases. Remittent Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4.- Zoogenous Diseases. Cowpox, and effects of Vaccination ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases (e.g., Hydrophobia, Glanders, Splenic Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5—Venereal Diseases. Syphilis 14 ... ... 1 2 1 1 2 ... ... ... 14 21 20 1 Gonorrhoea, Stricture of the Urethra ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 6.—Septic Disease. Erysipelas 1 ... ... ... ... 1 ... 1 3 ... 1 1 7 7 ... Pyaemia, Septicæmia ... ... ... 1 ... 2 ... ... ... ... ... ... 3 3 ... Puerperal Fever ... ... ... 6 11 2 ... ... ... ... ... ... 19 13 6 128 134 16 12 14 8 4 4 7 4 1 262 332 258 74 II. PARASITIC DISEASES. Thrush and other Vegetable Parasitic Diseases ... 1 ... ... ... ... ... ... ... ... ... 1 1 1 ... Worms, Hydatids, and other Animal Parasitic Disease ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 1 1 ... III. DIETETIC DISEASES. Want of Breast Milk—Starvation 1 ... ... ... ... ... ... ... ... ... ... 1 1 1 ... Scurvy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chronic Alcoholism ... ... ... 1 2 3 2 1 ... ... ... 10 6 4 Delirium Tremens ... ... ... ... 1 4 5 ... ... ... ... ... 10 9 1 1 ... ... 1 3 7 6 2 1 ... ... 1 21 16 5 IV. CONSTITUTIONAL DISEASES. Rheumatic Fever, Rheumatism of the Heart ... ... 1 1 3 1 2 1 2 ... ... ... 11 5 6 Rheumatism ... ... ... ... 1 ... ... 1 1 1 ... ... 4 4 ... Gout ... ... ... ... ... ... ... 1 2 1 ... ... 4 4 ... Rickets ... 3 ... ... ... ... ... ... ... ... ... 3 3 2 1 Cancer. Malignant Disease ... 2 1 1 4 11 24 32 34 16 3 2 128 96 32 Tabes Mesenterica 39 11 2 ... ... ... ... ... ... ... ... 50 52 47 5 Tubercular Meningitis, Hydrocephalus 31 31 11 ... 1 ... ... ... ... ... ... 62 74 59 15 Phthisis ... 1 6 37 66 64 33 25 12 2 ... 1 246 195 51 Other forms of Tuberculosis Scrofula 27 24 8 7 1 ... ... ... 1 ... ... 51 68 53 15 Puerpura, Hæmorrhagic Diathesis 1 ... ... ... ... 1 ... ... ... ... ... ... 2 2 ... Anæmia, Chlorosis, Leucocythæmia ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 ... Glycosuria, Diabetes Mellitus ... ... ... ... 4 ... 2 6 3 1 ... ... 16 12 4 Other Constitutional Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 98 72 29 46 80 77 62 66 55 21 3 170 609 480 129 V. DEVELOPMENTAL DISEASES. Premature Birth 56 ... ... ... ... ... ... ... ... ... ... 56 56 41 15 Atelectasis 4 ... ... ... ... ... ... ... ... ... ... 4 4 3 1 Congenital Malformation 11 2 ... ... ... ... ... ... ... ... ... 13 13 9 4 Old Age ... ... ... ... ... ... ... ... 11 46 28 ... 85 64 21 71 2 ... ... ... ... ... ... 11 46 28 73 158 117 41 VI. LOCAL DISEASES. 1- Diseases of Nervous System. Inflammation of Brain or Membranes ... 2 6 4 1 1 ... ... ... ... ... 2 15 12 3 Apoplexy, Softening of Brain, Hemiplegia, Brain Paralysis 1 2 ... 5 1 11 21 29 62 25 2 3 159 131 28 Insanity, General Paralysis of the Insane ... ... ... ... 1 ... ... ... ... ... ... ... 1 1 ... Epilepsy ... 1 ... 3 4 2 2 ... ... ... ... 1 13 13 ... Convulsions 50 23 1 ... ... ... ... ... ... ... ... 73 74 69 5 Laryngismus Stridulus (Spasm of Glottis) 3 ... ... ... ... ... ... ... ... ... ... 3 3 3 ... Disease of Spinal Cord, Paraplegia, Paralysis Agitans ... 1 ... 1 ... ... 2 3 3 4 ... 1 14 10 4 Other Diseases of Nervous System 1 1 1 1 2 5 2 4 3 3 ... 2 23 14 9 2.-Diseases of Organs of Special Sense (e.g.,of Ear, Eye, Nose) ... ... 1 ... ... ... ... ... ... ... ... ... 1 1 ... 3.-Diseases op Circulatory System. Pericarditis ... ... 1 ... ... 1 ... 1 ... ... ... ... 3 3 ... Acute Endocarditis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Valvular Diseases of Heart ... ... 1 ... 4 4 5 8 9 2 ... ... 33 20 13 Other Diseases of Heart ... 1 6 5 8 10 19 22 24 12 1 1 108 86 22 Aneurism ... ... ... ... ... 4 2 3 ... ... ... ... 9 8 1 Embolism, Thrombosis ... ... ... ... ... ... ... ... 1 1 ... ... 2 2 ... Other Diseases of Blood Vessels ... ... ... 1 ... 1 2 1 1 2 ... ... 8 5 3 4.-Diseases op Respiratory System. Laryngitis 1 ... 2 ... ... ... ... ... ... ... ... 1 3 2 1 Croup 4 15 3 ... ... ... ... ... ... ... ... 19 22 18 4 Emphysema, Asthma ... 1 ... 1 ... 1 2 5 3 ... ... 1 13 8 5 Bronchitis 82 71 8 5 9 11 24 52 79 64 18 153 423 360 63 Pneumonia 17 20 7 7 10 14 14 13 9 8 3 37 122 98 24 Pleurisy 1 1 2 ... 1 4 1 1 1 1 ... 2 13 7 6 Other Diseases of Respiratory System 11 3 2 ... 1 3 4 4 4 1 1 14 34 24 10 5.—Diseases of Digestive System. Dentition 5 9 ... ... ... ... ... ... ... ... ... 14 14 13 1 Sore Throat, Quinsey 1 ... ... 1 ... ... ... ... ... ... ... 1 2 2 ... Disease of Stomach 6 ... ... 2 1 1 3 1 2 2 ... 6 18 10 8 Enteritis 8 2 1 2 ... ... ... ... 2 2 ... 10 18 13 Obstructive Disease of Intestine 1 1 1 2 2 1 2 8 5 4 ... 2 27 22 5 Peritonitis 1 ... 2 4 4 6 3 3 1 2 ... 1 26 16 10 Ascites ... 1 ... ... ... ... 1 ... ... 1 ... 1 3 2 1 Cirrhosis of Liver ... ... ... ... 1 4 7 7 4 1 ... ... 24 14 10 Jaundice, and other Diseases of Liver 6 ... ... 2 5 1 3 5 11 1 ... 6 34 27 7 Other Diseases of Digestive System 1 1 1 ... ... 2 1 2 1 1 ... 2 10 5 5 6.- Diseases of Lymphatic System (e.g., of Lymphatics and of Spleen) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 7.—Diseases of Glandlike. Organs of Uncertain Use. (e.g., Bronchocele, Addison's Disease) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 8.- Diseases of Urinary System Nephritis ... 1 ... ... 1 j 1 ... 1 ... 1 1 6 4 2 Bright's Disease Albuminuria ... ... 1 1 2 2 8 7 2 4 1 ... 28 11 17 Disease of Bladder or of Prostate ... 1 ... 1 ... ... ... 5 2 1 3 1 13 9 4 Other Diseases of the Urinary System ... 1 1 ... 8 4 5 10 3 4 1 1 37 32 5 9.—Diseases of Reproductive System. a. Of Organs of Generation. Male Organs ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Female Organs ... ... ... 1 4 5 1 3 3 1 ... ... 18 12 6 b. Of Parturition. ... ... Abortion,Miscarriage ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Convulsions ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... Placenta Prævia, Flooding ... ... ... ... 1 ... ... ... ... ... ... ... 1 1 ... Other Accidents of Childbirth ... ... ... 3 7 3 ... ... ... ... ... ... 13 13 ... 10.- Diseases of Bones and Joints. Caries, Necrosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Arthritis, Ostitis, Periostitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of Bones and Joints. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 11.- Diseases of Integumentary System Carbuncle, Phlegmon ... ... ... ... ... ... ... ... ... 2 1 ... 3 1 2 Other Diseases of Integumentary System 1 ... ... 1 ... ... ... ... ... ... ... 1 2 2 ... 201 159 48 53 78 104 136 197 236 150 32 360 1394 1105 289 VII. DEATHS FROM VIOLENCE. 1.—Accident or Negligence. Fractures and Contusions 2 3 1 2 3 4 3 4 5 ... 1 5 28 26 2 Gunshot Wounds ... ... ... 1 ... ... ... ... ... ... ... ... 1 1 ... Cut, Stab ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Burn, Scald ... 3 ... ... ... 1 ... ... ... ... ... 3 4 4 ... Poison ... ... ... ... ... j 1 ... ... ... ... ... 2 1 1 Drowning ... ... ... ... ... 1 ... ... ... ... ... ... 1 1 ... Suffocation 17 ... 1 ... ... ... ... ... ... ... ... 17 18 18 ... Otherwise ... ... ... ... ... 1 1 1 1 ... ... ... 4 4 ... 2.—Homicide. Manslaughter ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Murder 3 ... ... ... ... 1 ... ... ... ... ... 3 4 3 1 3.—Suicide. Gunshot Wounds ... ... ... ... 1 1 ... ... ... ... ... ... 3 1 2 Cut, Stab ... ... ... 1 ... 1 1 ... ... ... ... ... 3 2 1 Poison ... ... ... ... ... 2 2 ... ... ... ... ... 4 2 2 Drowning ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Hanging ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 Otherwise ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... 1 4.—Execution. ... ... Hanging ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 22 6 2 4 4 13 8 6 7 1 1 28 74 63 11 VIII. DEATHS FROM ILL-DEFINED AND NOT SPECIFIED CAUSES. Dropsy ... 1 ... ... ... ... ... 1 ... 2 ... 1 4 2 2 Debility, Atrophy, Inanition 108 12 1 ... ... 1 ... ... ... ... ... 120 122 105 17 Mortification ... ... ... ... ... ... ... 1 4 2 ... ... 7 7 ... Tumour ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Abscess 1 ... ... ... ... ... ... ... ... ... ... 1 1 1 ... Hemorrhage 4 ... ... ... ... ... ... ... ... ... ... 4 4 4 ... Sudden Death (Cause not ascertained) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Causes not specified or Ill-defined 2 6 2 ... 2 4 5 6 2 ... ... 8 29 19 10 115 19 3 ... 2 5 5 8 6 4 ... 134 167 138 29 CAUSES OF DEATH. 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 Total under Five Years of Age. Grand under Five Years of Age. Kensington Town. Brompton. AGES. SUB-DISTRICTS. 191 TABLE IV. Shewing the number of Deaths at all ages in 1886 from certain groups of Diseases, and proportions to 1,000 of Population, and to 1,000 Deaths from all causes; also the number of Deaths of Infants under one year of age from other groups of Diseases, and proportions to 1,000 Births and to 1,000 Deaths from all causes under one year. Division I. (Adults). Total Deaths. Deaths per 1,000 of Population at all ages. Deaths per l,000 of Total Deaths, at all ages. 1. Principal Zymotic Diseases 280 1.6 101 2. Pulmonary Diseases 630 3.6 229 3. Principal Tubercular Diseases 369 2.1 134 Division II. (Infants under One Year). Total Deaths. Deaths per 1,000 of Births. Deaths per 1,000 of Total Deaths under One Year. 4. Wasting Diseases 165 39 259 5. Convulsive Diseases 86 21 135 NOTES. 1. Includes Small-pox, Measles Scarlet Fever, Diphtheria, Whooping-cough, Typhus Fever, Enteric (or Typhoid) Fever, Simple Continued Fever and Diarrhoea. Thirty-seven of the deaths occurred in Hospitals outside the Parish. 3. Includes Phthisis, Scrofula, Tuberculosis, Rickets, and Tabes. 4. Includes Debility, Atrophy, Inanition, Want of Breast Milk, and Premature 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). 192 TABLE V. Shewing the Number of Deaths from the Principal Zymotic Diseases in the ten years 1876-85, and in the year 1886. Diseases. 1876. 1877. 1878. 1879. 1880. 1881. 1882. 1883. 1884. 1885. Annual Average of ten years 1876-85 Proportion of Deaths to 1000 Deaths in ten years 1876-85. 1886. Proportion of Deaths to 1000 Deaths in 1886. Small Pox 8 84 24 24 11 55 0 1 26 25 *25.8 9.2 0 0 Measles 128 54 53 60 75 67 77 39 32 111 69.6 24.9 56 20.3 Scarlet Fever 59 31 77 51 105 38 62 28 18 7 47.6 17.1 11 3.9 Diphtheria 17 10 20 26 22 8 25 24 17 22 19.1 6.8 30 10.9 Whooping-Cough 124 34 185 93 95 85 119 44 81 98 95.8 34.3 82 30.0 Typhus Fever 3 2 3 1 4 2 1 2 0 0 1.8 0.7 0 0 Enteric Fever 27 20 26 14 24 22 25 30 26 12 22.6 8.0 11 3.9 Simple Continued Fever 6 5 4 8 5 5 6 3 4 0 4.6 1.7 0 0 Diarrhœa 126 99 181 71 128 101 61 80 110 86 104.3 37.3 90 32.6 TOTALS. . Kensington 498 339 573 348 469 383 376 251 314 361 391.2 140.0 280 101.6 London 12565 12392 14734 12256 13681 13811 13553 10801 13629 11261 12868 158.0 11121 135.0 England &Wales 75506 66558 84624 62020 82537 58239 69734 58972 71762 57726 68767 132.0 62859 117.0 193 TABLE VI. Inspectors' Report of the Sanitary Work completed in the year 1886-7. Sanitary Districts.* No. of Complaints received during the year. No. of Houses, Premises, &c., inspected. No. of Re-inspections of Houses, Premises, &c. Results of Inspection. House Drains. Water-Close ts. Dust Bins. Water Supply. Miscellaneous. Notices issued for Sanitary Amendments of j Houses and Premises. Houses, Premises, &c., Cleansed, Repaired, Whitewashed, &e. Houses Disinfected after illness of an Infectious Character. Repaired, Cleansed, Trapped, &c. Ventilated. Repaired, &c. I Supplied with Water. New provided. New provided. Repaired, Covered, &c. Cisterns (new) erected. Cisterns Cleansed, Repaired, and Covered. Waste-pipes connected with Drains, &c., abolished. No. of Lodging Houses registered under 35th Section of the "Sanitary Act, 1866." § Dust Removal—No. of Communications received and attended to. f Removal of Accumulations of Dung, Stagnant Water, Animal and other Refuse. Animals Removed, being improperly kept. Regularly Inspected. Legal Proceedings: i.e., Summonses. ‡ Bakehouses. i Licensed Cowsheds. Licensed Slaughter-houses. N.W. 30 1195 1179 337 174 28 77 60 53 65 3 24 37 15 97 9 198 421 65 3 38 6 8 94 N.E. 57 1154 1403 442 254 29 231 14 266 163 3 7 21 7 46 16 212 466 40 45 2 5 36 Centrl. 45 1294 2316 300 197 22 166 83 21 187 17 17 24 12 6 10 164 353 20 2 22 2 7 16 South 134 2149 1722 342 337 48 106 47 36 80 3 4 26 16 91 44 242 697 178 7 43 3 2 23 Totals 266 5792 6620 1421 962 127 580 204 376 495 26 52 108 50 240 79 816 1937 303 12 148 13 22 169 * The North-East and North-West Districts lie north of the centre of Uxbridge Road, to the East and West of Ladbroke Grove and Ladbroke Grove Road respectively (North Kensington): the Central and South Districts are south of Uxbridge Road (South Kensington), †The actual complaints of neglect made by letter were 11. ‡ Inclusive of proceedings, in 44 cases, under the Food and Drugs Adulteration Act, all the Inspectors being Inspectors under the Act; in 24 cases of "obstructions," on and over the public ways ; and in two cases of disobedience of the Justices' Orders. § The total number of Houses on the Register is, in round figures, 1,500. 194 TABLE VIa. Summary of Monthly Returns of Work, &c., done by the Sanitary Inspectors, 1886-7. 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. 8. 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. 1886, Ap. 24 93 122 59 187 111 232 47 195 9 7 4 8 2 3 12 4 28 3 2 5 29 6 1 33 38 15 34 51 62 31 86 Ap. 24, 1886 „ May 22 113 90 120 163 110 248 85 184 9 9 4 8 6 4 4 12 10 27 6 2 20 24 12 7 31 61 31 29 71 61 46 59 May 22 „ „ June 19 108 109 90 209 123 250 79 216 16 6 4 8 11 2 2 12 14 17 4 3 19 10 9 7 40 57 18 29 35 57 24 77 June 19 ,, „ July 17 78 73 157 191 107 248 96 220 9 8 4 7 6 3 2 12 16 26 7 ... 24 30 5 6 22 34 17 43 49 , 34 40 100 July 17 „ „ Aug. 14 23 52 100 45 28 284 93 53 ... 27 23 2 1 18 17 3 4 31 11 ... 3 36 10 2 11 47 2 11 22 47 30 21 Aug. 14 „ „ Sept. 11 115 24 24 108 156 60 25 110 9 4 ... 6 6 2 1 10 18 13 ... ... 24 6 7 1 42 3 6 16 13 3 18 21 Sept. 11 „ „ Oct. 9 92 124 81 203 107 248 75 161 7 4 4 9 7 2 3 11 25 32 4 4 32 32 12 2 16 38 29 33 16 38 19 49 Oct. 9 „ „ Nov. 6 92 95 132 173 116 247 79 204 16 7 3 8 6 1 2 12 4 16 5 3 44 24 15 5 22 41 29 31 15 41 18 24 Nov. 6 „ „ Dec. 4 78 80 137 184 108 253 96 222 9 8 9 8 9 3 4 12 11 27 6 ... 39 26 17 4 26 16 25 24 12 16 10 27 Dec. 4 „ 1887, Jan. 1 87 86 67 169 117 249 88 199 10 7 1 8 7 4 1 12 13 18 10 9 30 12 8 1 20 8 12 16 16 8 18 29 Jan. 1, 1887 ,, Jan. 29 88 86 110 158 112 251 94 211 8 6 8 8 7 1 2 13 10 43 14 37 12 32 10 8 20 13 27 20 68 13 76 119 „ 29 „ „ Feb. 26 122 112 137 180 106 250 70 209 11 4 7 7 5 4 4 12 12 20 8 6 32 18 24 2 22 34 27 27 34 34 15 39 Feb. 26 „ „ Mar. 26 106 101 80 179 113 252 87 208 5 9 9 8 6 3 4 12 13 25 6 1 21 24 18 8 32 52 62 29 19 52 8 46 Mar. 26 ,, Totals 1195 1154 1294 2149 1414 3072 1014 2392 118 106 80 95 77 19 49 145 151 323 84 67 305 303 153 54 337 112 300 342 421 466 . 353 697 Totals. 195 TABLE VII. Shewing the Death Rate per 1,000 persons living: the Annual Rate per 1,000 from the principal Diseases of the Zymotic class; and the proportion of Deaths from these Diseases to total Deaths, in Kensington and in all London, in 1886, and in ten preceding years. The Year. Deaths per 1,000 living. Total Deaths from seven principal Zymotic diseases, Kensington. Annual rate of Mortality per 1,000 living from seven principal Zymotic Diseases. Proportion of Deaths to 1,000 Deaths from seven principal Zymotic Diseases. The Year. Kensington. London. Kensington. London. Kensington. London. 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 1883 15.5 20.4 251 1.5 2.7 96 134 1883 1884 15.1 20.3 314 1.8 2.7 119 164 1884 1885 16.1 19.7 361 2.1 2.7 130 140 1885 AVE RAGES OF TEN YEARS, 1876-85. 17.3 21.6 391 2.4 3.3 138 158 AVERAGES OP TEN YEARS, 1876-85. 1886 15.9 19.9 280 1.6 2.7 101 135 1886 196 TABLE VIII. Comparative Analysis of the Mortality in all London and in Kensington in 1886. LOCALITY. Annual Death Rate per 1,000 living from all causes. Annual Death Rate per 1,000 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 Coroners. (Inquests.) Registered at Public Institutions* Uncertified causes of Death. London 19.9 2.7 15.9 25.8 235 13.5 3.5 7.2 20.7 1.2 Kensington 15.9 1.6 15.4 23.0 27.1 10.1 2.7 5.5 21.9 0.9 *Yiz.—Parish Infirmary, Brompton Consumption Hospital, so far as relates to Deaths of Parishioners therein, and outlying Public Institutions, i.e., General and Special Hospitals, including the Hospital Ships. TABLE IX. Showing the Localities in which Fatal Cases of some of the Principal Zymotic Diseases occurred in 1886. KENSINGTON TOWN REGISTRATION SUB-DISTRICT. Locality. DISEASES. Total. Locality. DISEASES. Total. Small Pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Fever. Diarrhoea. Small Pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Fever. Diarrhoea. Typhus. Enteric. Sim.Cont. Typhus. Enteric. Sim.Cont Absolom Road ... ... ... ... ... ... ... ... 2 2 Lionel Mews ... 2 ... ... ... ... ... ... ... 2 Acklam Road ... 1 ... 1 1 ... ... ... ... 3 Lonsdale „ ... 3 ... ... ... ... ... ... ... 3 Adair Road ... 1 ... ... ... ... ... ... 2 3 Melon Place ... ... ... ... 3 ... ... ... ... 3 Admiral Mews ... ... ... 1 ... ... ... ... ... 1 Norland Square ... ... ... ... ... ... 1 ... ... 1 Ball Street ... ... ... 1 1 ... ... ... ... 2 Peel Street ... ... ... ... 2 ... ... ... ... 2 Bangor Street ... ... ... ... ... ... ... ... 2 2 Pembridge Mews ... ... ... 1 ... ... ... ... ... 1 Basing Road ... ... ... 1 ... ... ... ... ... 1 Pembroke Road ... ... ... 1 ... ... ... ... ... 1 Bevington Road ... 1 ... ... 1 ... ... ... 1 3 Portland Road ... ... ... ... 1 ... ... ... 2 3 Bosworth Road ... ... ... ... ... ... 1 ... 2 3 Portobllo Road ... 2 ... ... 3 ... ... ... 6 11 Chesterton Road ... ... ... 2 ... ... ... ... 1 3 Pottery Lane ... ... ... ... 2 ... ... ... ... 2 Convent Gardens ... 2 ... ... ... ... ... ... 1 3 Queen's Gate Terrace ... ... ... ... ... ... 1 ... ... 1 Cornwall Road ... ... ... 1 1 ... ... ... ... 2 „ Road ... ... ... ... 2 ... ... ... 1 3 Crescent Street ... ... ... ... ... ... 1 ... 1 2 Roseland Place ... ... ... 1 ... ... ... ... ... 1 Denbigh Terrace ... ... ... 1 ... ... ... ... ... 1 St. Ann's Road ... ... ... ... ... ... ... ... 2 2 Faraday Boad ... ... ... 1 3 ... ... ... 1 5 Si. Clement's Road ... 1 ... ... ... ... ... ... 2 3 Golborne Road ... ... ... 1 ... ... ... ... ... 1 St. Ervan's Road ... 1 ... ... ... ... ... ... ... 1 Golden Mews ... 2 ... ... ... ... ... ... ... 2 St. James's Square ... ... ... 1 ... ... ... ... ... 1 Holland Park ... ... ... 1 ... ... ... ... ... 1 St. John's Place ... 1 ... ... 2 ... ... ... ... 3 ,, ,, Gardens ... ... 1 ... ... ... 1 ... ... 2 St. katherine's Road ... ... ... ... 2 ... ... ... 4 6 ,, „ Terrace ... ... 1 ... ... ... ... ... ... 1 Southam Street ... 2 1 ... 2 ... ... ... 2 7 Hornton Place ... ... ... 1 ... ... ... ... ... 1 Stratford Road ... ... ... 1 ... ... ... ... 1 2 Hurstway Street ... ... ... ... 1 ... 1 ... 2 4 Swinbrook Road ... ... ... 1 4 ... ... ... ... 5 Infirmary (The Parish) ... 9 ... ... ... ... ... ... 3 12 Tavistock Crescent ... 2 ... ... ... ... ... ... ... 2 Inverness Gardens ... ... ... 1 ... ... ... ... 3 4 „ Road ... ... ... 1 1 ... ... ... ... 2 Ladbroke Grove Road ... ... ... ... ... ... ... ... 2 2 Vernon Mews (Cholera) ... ... ... ... ... ... ... ... 1 1 Lancaster Road ... 2 ... ... ... ... ... ... 3 5 BROMPTON REGISTRATION SUB-DISTRICT. Ashley Cottages ... ... ... ... ... ... ... ... 2 2 Hooper's Court ... ... ... ... ... ... 1 ... 1 2 Bute Street ... ... ... ... 3 ... ... ... ... 3 Ifield Road ... ... 2 1 2 ... ... ... 4 9 Brompton Road ... ... ... ... ... ... 1 ... 1 2 Middle Street ... ... ... 1 ... ... ... ... ... 1 Childs Street ... ... ... 1 ... ... ... ... ... 1 Redcliffe Road ... ... 2 ... ... ... ... ... ... 2 Coleherne Mews ... 2 ... ... ... ... ... ... ... 2 Seymoyr Place ... 1 ... ... 1 ... ... ... ... 2 Courtfield Gardens ... ... 1 ... ... ... ... ... ... 1 South Street ... ... ... ... ... ... 1 ... ... 1 Drayton Gardens ... 1 1 ... ... ... ... ... ... 2 Stanhope Gardens ... ... ... ... ... ... 1 ... ... 1 Earl's Court Road ... ... 1 1 West Cromwell Road ... ... 1 ... ... ... ... ... ... 1 Glendower Place ... ... ... 1 ... ... ... ... ... 1 Yeoman's Row ... 1 ... ... 1 ... ... ... ... 2 Hogarth Place ... ... ... 1 ... ... ... ... ... 1 199 TABLE X. Return respecting the Vaccination of Children whose Births were Registered in 1885.* DATE. Registration Sub-Districts comprised in Vaccination Officer's District. Number of Births returned in Birth List Sheets. 1 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. 1885. 1 2 3 4 5 6 8 9 10 1st January to 30th June Kensington Town 1689 1446 7 1 151 12 4 68 ... Brompton 412 364 4 ... 34 2 ... 7 1 1st July to 31st Dec. Kensington Town 1558 1311 5 ... 160 11 3 66 2 Brompton 397 344 1 ... 25 5 2 19 1 Toatal 4056 3465 17 1 370 30 9 160 4 *The return for 1886 is not yet complete. 200 TABLE XI. LICENSED SLAUGHTER-HOUSES. SOUTH OF UXBRIDGE ROAD. LOCALITY. LICENSEE. 6, Church Street, Kensington Mr. Blott 11, Peel Place, Silver Street „ Osborne 25, Silver Street „ Wright 183, Brompton Road „ Joyce 60, Kensington High Street „ Evans 15, High Street, Notting Hill „ Short 133, ditto ditto „ Candy 20, Addison Terrace, ditto „ Austin 35, Earl's Court Road „ Matson NORTH OF UXBRIDGE ROAD. 13, Archer Mews Mr. Bawcombe 195, Clarendon Road „ Rea 10, Edenham Mews „ Goddard 2, Ledbury Mews „ Sanson Lonsdale Mews „ Green 10, Princes Yard „ Coles Clarendon Mews „ Colley 41, Princes Place „ Grant 23, Norfolk Terrace „ Comes 61, Silchester Road „ Crawford 235, Walmer Road „ Van 4, Royal Crescent Mews „ Brooker 8, Ditto ditto „ Down 201 TABLE XII. LICENSED COWSHEDS. SOUTH OF UXBRIDGE ROAD. LOCALITY. LICENSEE. 5, St. Mark's Road, Fulham Rd. Mr. Cotching Newland Terrace (rear of) „ Tisdall Addison Cottage, Lome Gardens „ Glenie Campden Street (Yard in) „ Lunn Earl's Court Road (rear of 117) „ Cross NORTH OF UXBRIDGE ROAD. 5, Ledbury Mews Mr. Liddiard 187, Walmer Road „ Amsby 285, Walmer Road „ Van 17, Tobin Street „ Squire 12, Blechynden Mews „ Burton 14, Ditto ditto - „ Copperwheat 23, Bramley Road „ Tame 41, St. Mark's Road ,, Humfrey Portobello Road (rear of 209) Aylesbury Dairy Company