! Iif- THE ANNUAL REPORT on the HEALTH, SANITARY CONDITION, &c., &c., of the Parish of Mary Abbotts, KENSINGTON, FOR THE YEAR 1887, by T. ORME DUDFIELD, M.D., Medical officer of Health, ===== PRINTED BY J. WAKEHAM AND SON, 4, BEDFORD TERRACE, KENSINGTON; And 116, UXBRIDGe Road, ShepheRd's Bush, W. 1888. THE ANNUAL REPORT on the HEALTH, SANITARY CONDITION, &c., &c., of the Parish of St.Mary Abbotts, KENSINGTON, FOR THE YEAR 1887, by T. ORME DUDFIELD, M.D., Medical officer of Health, PRINTED BY J. WAKEHAM AND SON, 4, BEDFORD TERRACE, KENSINGTON And 116, Uxbridge Road, Shepherd's Bush, W. 1888. TABLE OF CONTENTS. pagb 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 14 Kensington, Population and Rateable value of; 1801-1888 14 Vital Statistics, 1887, Summary of 14 Zymotic Diseases, General Remarks on the " Seven Principal " 21 „ „ Number of Deaths from the ,, ,, 28 ,, „ Teath-rate from ; in Kensington, in London and other large Towns, and in England and Wales 23 „ „ Monthly Returns of Deaths from, in Kensington 24 Small-Pox, in Kensington and London 24 Measles 26 Scarlet Fever 27 „ „ Illustrations of Modes of Spread of 28 ,, „ The Epidemic of,in London 30 ,, ,, Statistical Returns, relative to 32 „ ,, Tabular Annual Return of cases of, 1879-87 33 ,, „ Tabular Monthly Return of cases of, 1879-87 34 „ „ Alleged dissemination of, by Milk of Diseased Cows 35 „ „ Views of Dr. Buchanan, Mr. Power, and Dr. Klein 35 „ „ „ (Divergent) of Professors Brown and Axe 37 „ „ ,, . „ of Piofessor Crookshank 38 „ „ Precautions against spread of, by Milk 39 Diphtheria 40 „ Need of Hospital Accommodation for Sufferers from 41 Whooping-Cough 42 Fever 43 Diarrhcea 43 Cholera, Precautionary Measures against 44 ii. PAGE Metropolitan Asylums Board, The Work and Proceedings of the 45 „ ,, The future of, as Infectious Hospital- providing Authority 46 Infectious Disease Hospital-Question and the Vestries 49 ,, ,, Local, Neither necessary nor desirable 50 Non-Pauper Infectious Sick 52 „ Hospital provision for 52 Poor Law Act, 1879 (section 15) allows of contracts between Asylums Board and Sanitary Authorities for treatment of the Infectious Sick 53 ,, The origin of Section 15 53 ,, The Section in abeyance ; Patients admitted to Hospitals, in 1884, freely and without payment 53 „ The Managers of Asylums Beard seek and obtain authority, in 1884, to enter into contracts with Sanitary Authorities under provisions of the Act 54 „ Sanitary Authorities in many instances decline to enter into contracts with the Managers 54 „ Vestry's objection to the proposed contract system: Principles on which it is based 55 ,, Vestry recommends that all charges in connection with Medical Relief in Hospitals be borne upon a Common Sanitary Fund 55 ,, Sanitary Authorities in London confer (in 1881) and agree in regard to the Principles upon which Vestry's objection to contract had been based: Deputation to the Local Government Board 56 „ Society of Medical Officers of Health concurs 57 „ Important new departure by Asylums Board 57 „ Mode of admission of Patients to Hospitals under Poor Law Board's Order of 1875 58 „ Asylums Board apply for power to admit Patients of all classes, without the Order of a Relieving Officer, upon the certificate of any Registered Medical Practitioner 59 „ Asylums Board adopt Regulations to facilitate admission of Patients upon application of Registered Medical Practitioners 59 , Local Government Board issue an Order to facilitate admission of Patients, under which the certificate of any Registered Medical Practitioner is accepted as evidence of the nature of the Disease 60 „ Forty per cent. of the Patients admitted without an Order from a Relieving Officer 61 iii. PAGE Non-Pauper Infectious Sick (Continued). ,, Local Government Board willing to promote Legislation to enable Asylums Board to admit Patients to Hospital upon the application of any registered Medical Practitioner 61 „ Society of Medical Officers of Health and Sanitary Institute approve action of the Asylums Board 62 „ Regulations (New) of the Asylums Board for the Removal of Patients 63 „ Mode of Admission of Patients to Hospital 64 „ Status of Hospital Patients ; Erroneous views with reference to 65 ,, The question of Payment for, in Hospital 68 Hospitals and the Sanitary Acts, re Compulsory Removal of the Sick who are without Proper Lodging or Accommodation 69 Small-pox Hospital Accommodation 70 „ Views of the Royal Commission 70 ,, Action of Asylums Board to give effect to the recommendations of the Commission by raising Total Accommodation to 1,200 Beds. 70 ,, Permanent Hospital to be erected at Darenth 71 ,, Hospital Ships; Proposal to close them rejected 73 Fever Hospital Accommodation 74 „ Views of the Royal Commission 74 „ „ Justified by exigencies of Scarlet Fever Epidemic 75 ,, Plaistow Hospital Hired, Temporary Huts Provided 75 „ Northern Hospital at Winehmore Hill opened 75 ,, Asylums Board provided 2,700 beds for Scarlet Fever Patients, of which 2,600 were occupied atone time 75 Western Hospital (Fulham) alleged to be inadequate for the needs of the West District; Proposal to enlarge 76 Asylums Board: Number of Patients treated in Hospitals of, in 1887 77 Table shewing Quarterly and Total Admissions of Small-pox and Fever Patients at the Hospitals, from each Parish and Union, in 1887, and population of the several Districts, etc., in 1881 78 Western Hospital Admissions at in 1887 80 Clinical Instruction : Hospitals utilized for purpose of. 80 Ambulance Service of the Asylums Board: 81 ,, „ „ Stations 81 „ „ „ Wharves 81 ,, „ ,, River Service 82 ,, ,, ,, Annual Report of the Committee 82 „ „ Metropolitan: A Desideratum 85 iv. PAGE Ambulance Service of the Asylums Board (Continued). , ,, Objectionable employment of Public Vehicles for conveyance of the Infectious Sick : Action of Police Authorities, and of Asylums Board 85 , „ Views of the Medical Officer of Health endorsed by the Asylums Board 86 „ „ Asylums Board willing to be the Ambulance viding Authority for London 87 Notification (Compulsory) of Infectious Disease 88 ,, History of the Question 89 ,, Conference of Sanitary Authorities in 188] 90 ,, Views of Society of Medical Officers of Health, the Asylums Board, Ac. 91 „ Deputation to Local Government Board in 1881 91 „ What came of the Deputation 92 ,, Views of the Medical Officer to the Local Government Board ; of the British Medical Association, and of the Royal Commission on Infectious Disease Hospitals 93 „ Views of the Select Committee of the House of Commons on Sanitary Regulations (1882) ; Model Clause drafted 93 „ Provided for in Local Acts 94 „ Bill to provide for, introduced in 1883 94 „ Views of the Local Government Board 94 ,, Views of the Select Committee on Sanitary Regulations, Session of 1887 95 „ Fresh Effort tc obtain Compulsory Powers, initiated by the Vestry in 1887 95 ,, Memorandum on the subject, Prepared by Medical Officcr of Health and widely circulated 96 „ President of the Local Government Board requested to bring in a Bill : Asylums Board and Sanitary and Poor Law Authorities invited to support Vestry's request 97 „ Society of Medical Officers of Health and Sanitary Institute endorse Vestry's action 98 ,, Action of the Asylums Board 98 ,, Action of Sanitary Authorities 99 ,, Provincial Opinion on the Subject 99 „ Looal Government Board make enquiry into the working of the System in the Provinces 100 ,, President of Local Government Board in favour of the System 102 „ Bill introduced " Public Health (Prevention of Infectious Diseases) &c." from the operation of which, if passed into law, the Metropolis would be excluded 102 V. PAGE Notification (Compulsory) of Infectious Disease (Continued). „ The Vestry protests against exclusion of Metropolis from operation of the proposed Act 103 „ The question in abeyance 103 Voluntary Notification in Kensington : Existing sources of information 104 „ „ Recent Action by the Vestry to promote 105 ,, „ Beneficial results of, evidenced by decline in prevalence and fatality of certain Diseases 107 „ „ . Tables showing mortality from Principal Zymotic Diseases, before and after introduction of system and provision of Hospitals 107 Interruption of Education at Elementary Schools, resulting from prevalence of Infectious Diseases 110 Report of the Royal Commission on Infectious Disease Hospitals: Its Recommendations, and the extent to which they have been realized ill A Retrospect, 1856-1887 : The Fruits of Sanitation 113 Population of Sub-Districts, Number of Inhabited Houses, &c 115 ,, Relative Numbers of Males and Females, at different ages, in Parish, and in sub-Districts, in 1881 (Tables) 110 „ Rateable Value, and Inhabited Houses, Increase in, since 1856 117 Marriages and Marriage Rate 118 Births and Birth Rate 110 Deaths and Death Rate 119 Infantile Mortality 120 „ ,, Among Illegitimate Children 120 Senile Mortality 121 Death Rate at Different Age-Periods (Table) 121 „ Mean Temperature, etc., Monthly 122 Death, Summary of causes of (Table) 122 Death, Assigned Causes of 123 „ „ Specific Febrile or Zymotic Diseases 124 ,, „ Venereal Diseases 124 „ „ Puerperal Fever 125 „ Parasitic Diseases 125 ,, Dietetic Diseases 125 „ „ „ Alcoholism 125 „ Constitutional Diseases 126 Cancer 126 „ „ Tubercular 127 vi. PAGE Death, Assigned Causes of (Continued). ,, Developmental Diseases 129 „ Local Diseases 129 „ „ Nervous System, Diseases of 129 „ „ Circulatory ,, „ 130 „ „ Respiratory ,, „ 131 ,, ,, Digestive „ „ 131 „ „ Urinary „ „ 132 „ „ Reproductive „ „ 132 „ Violent Deat s 132 „ Ill-Defined and Not Specified Causes of 133 Public Institutions, Deaths in 133 ,, ,, Parish Infirmary and Workhouse 133 „ „ Outlying Hospitals, &c. 135 „ ,, St. Joseph's House 135 ,, ,, Consumption Hospital, Brompton 136 ,, ,, Marylebone Infirmary, Notting Hill 136 Deaths " Not Certififd," in Kensington 136 ,, „ The subject of, considered generally 137 „ ,, The position and duties of Coroners and their Officers in relation to 139 Inquests 139 ,, Deaihs from Violence : Accidental, Suicidal, Homicidal 141 ,, Why so mam become necessary 142 Meteorology 143 Vaccination ... ... ... ... ... 143 ,, Officer's Report for 1886 ... ... ... 143 ,, Evidence furnished by Medical Officer to Local Govern- ,, ment Board, as to the Protection afforded by ... 144 „ Animal; Calf Lymph... ... ... ... 147 Sanitary Work, etc., in 1887 ... ... ... ••• 148 Sanitary, Nuisances Removal, and other Cognate Acts, Report on, by the Law and Parliamentary Committee 148 „ Housing of the Working Classes ... ... ... 150 „ Underground Rooms ... ... ... ... 150 ,, Construction of Drains ... ... ... 150 „ Inspection of Drains ... ... ... ... 150 „ Vestry may cause work to be done at Owner's expense ... 151 „ Vestry's mode of procedure ... ... ... 151 ,, Rules with respect to House Drainage ... ... 151 „ Metropolitan Board have power to make Bye-laws ... 161 ,, Public Conveniences ... . . ... ... 151 vii. PAGE Sanitary and Nuisances Removal Acts (Continued). „ Drinking Fountains 152 „ Private Mews, Courts, &c., Paring and Drainage of 152 ,, Consumption of Smoke 152 „ Manure and other Befuse Matter : Periodical Removal of 153 „ Infectious Disease Hospitals; Ambulances 153 „ Disinfecting Chamber 153 ,, Defective Enforcement of Sanitary Law 153 ,, Amendment of the Law; Summary Powers needed 154 „ Supplementary Observations 155 „ 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:— 15G ,, With respect to the Metropolitan Board of Works 156 „ With respect to the Vestry 156 „ With respect to the Finance Committee 157 ,, With respect to the Law and Parliamentary Committee 157 ,, With respect to the Wharves and Plant Committee 157 ,, With respeot to the Works, Sanitary, and General Purposes Committee 157 ,, With respect to the Representatives of the Vestry on the Metropolitan Board of Works 158 „ With respect to the Clerk to the Vestry 158 ,, With respect to the Surveyor 158 ,, With respect to the Sanitary Inspectors 159 „ With respect to the Home Secretary and the President of the Local Government Board 161 „ With respect to the Members for the Borough 161 „ The Metropolitan Board of Works recognize importance of Vestry's Recommendations, but are not prepared to promote legislation 162 Bills in Parliament 162 „ ,, Housing of the Working Classes 162 ,, ,, Housing of the Working Classes (London) 164 ,, ,, Public Health (Prevention of Infectious Diseases), &c., (See also page 102) 165 „ „ Local Government (England and Wales) 165 „ ,, Scheme of Sanitary Administration for London ; Suggestions by Medical Officer of Health 166 Water Supply Legislation: The Clerkenwell Vestry suggest amendment of the Law to deprive the Companies of the power to cut-off for waste 170 viii. PAGE Water Supply Legislation (Continued). „ The Subject of the Companies cutting-off powers considered : Water Companies (Regulation of Powers) Act, 1887 171 „ Inconsistencies of existing Law in relation to 171 „ . Vestry's views on the subject 172 Offensive Businesses 174 ,, Tallow Melter 174 „ Fat Extractor 174 „ Marine Stores 174 „ ,, Metropolitan Board of Works requested by Vestry to schedule the business, under the provisions of the Slaughter Houses (Metropolis) Act, 1874 175 „ The views of the Board 175 „ A Judicial Decision (Passey v. Oxford Local Board) 176 Conveyance of Offensive Surstances through Streets 176 ,, Circular Letter from the Metropolitan Board of Works 176 „ Nuisance arising from Fish and Poultry Offal 177 „ „ Blood 178 ,, ,, Bones 178 „ „ Kitchen Stuff 178 „ ,, Greengrocers' Refuse 179 „ ,, Cowshed Refuse 179 „ ,, Stable Manure 179 „ ,, House Refuse 180 ,, Steps taken for preventing Nuisance from 180 „ Bye-laws required for the purpose 182 ,, The subject of " Filth Removal " dealt with by Medical Officer of Health in 1878, and subsequently 182 „ Society of Medical Officers of Health : The views of the 183 ,, Subject may possibly be dealt with, with a view to Prevention of Nuisance, under Sec. 53 of Sanitary Act, 186& 185 „ Action of the Poplar Board of Works, and of the Greenwich Vestry, with reference to 186 ,, Vestry's reply to the Metropolitan Board's Letter 187 ,, Metropolitan Board take no action 189 Brick Burning: Nuisance arising from 189 „ „ Judicial Decisions with reference to 189 „ „ Legislation required for dealing with 191 Food Adulteration.—Boracic Acid as a so-called "Food Preservative :" Joint Report by Public Analyst and the Medical Offioer of Health 191 ix. PAGE Nuisances Removal Acts : Committee appointed by Vestry for carrying out the provisions of the 194 „ „ Legal Proceedings: Increased Facilities afforded by the Justices 194 ,, „ Sanitary Inspectors, The work of the 195 Slaughter Houses, Licensed 196 Cowsheds, Licensed 197 Dairiej, Cowsheds, and Milkshops' Order, 1885 : Regulations of the Local Authority (Metropolitan Board) 198 „ „ Registrations of Premises under the 200 Public Health (Dairies, &c.) Bill, 1883 201 Contagious Diseases (Animals) Aot, 1886, confirms Metropolitan Board in position of " Local AuthorityObjections stated 202 Bakehouses, Regulation of: Further Legislation necessary 204 Refuse, Removal of, and Nuisance arising from (see also p. 176) 206 ,, House: The Work of "Dust" Collection and Removal 207 „ „ Dust Bins improperly used 207 ,, „ Metropolitan Board requested to promote Legislation to abolish Dust Bins 208 „ „ The Board makes inquiry, but takes no other action 209 ,, ,, Daily Collection of from Moveable Receptacles : A Desideratum 209 ,, ,, Difficulty and Expense of finding " Shoots" always on the increase 210 „ ,, Vestry resolves to remove all Refuse out of London and purchases land at Purfleet in Essex, for a Dust and Slop Depot 210 „ Stable, should be collected by Vestry 211 ,, Trade, Removal of 211 ,, ,, Views of Law and Parliamentary Committee 212 „ ,, Views of Wharves and Plant Committee 212 „ ,, Vestry's action with reference to 212 ,, „ The Law on the subject of 213 Necessary Accommodation : 215 „ „ Public Urinals 215 „ ,, Public House Urinals; Vestry's action with reference to 215 Underground Rooms : The Law, and the Duties of District Surveyors, with reference to 218 Public Baths and Washhouses Opened : Washhouses apart from Baths, a Desideratum 219 Mortuary, Public : Observations with reference to the 219 „ Views of the Hospitals Royal Commission 220 „ Particulars with reference to Bodies admitted to 221 X. PAGE Coroner's Coubt, provided by Vestry at Town Hall 221 „ „ Insufficient use of : Inquests still frequently held at Public Houses 222 Post-Mortem Examinations at Private Houses, Objectionable 223 Disinfection 224 Houses Let in Lodgings, Regulations for; Proceedings under Sanitary Act, 1866 224 „ ,, Vestry's Instructions for the guidance of the Sanitary Inspectors 227 Housing of the Working Classes : Report of the Royal Commission 227 ,, Public Health (Metropolis) Bill, 1885 228 ,, Housing of the Working Classes (England) Act, 1885 228 Landlords, The Liabilities of: Important Legal Decision 228 Metropolitan Main Drainage 230 ,, Metropolitan Board of Works decides to deal with sewage at the Outfalls by Chemical Precipitation of the Solid Matters, and, when necessary, by Deodorization 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 230 Meteopolitan Sewage : Deodorization of 231 „ „ „ Sir Henry Roscoe's Reports on the 231 „ „ „ Views of the Vestry on the 240 Water Supply, Abstract of Reports on, by Professor Frankland 241 „ „ „ „ The Water Examiner 246 ,, „ Deterioration of, in Dirty Cisterns 252 „ ,, Waste-Pipes of Cisterns: Medical Officer to Local Government Board recommends Abolition of 253 „ ,, Communications addressed by the Vestry to the Local Government Board, to the Vestries and to the Companies with reference to 253 Gas, Results of Examinations for ascertaining the Illuminating Power and Purity of the 255 „ Proposed New Standard for ascertaining the Illuminating Power of 257 ,, Supply of, for Street Lighting 258 „ Excessive pressure complained of: the Remedy suggested 258 Conclusion 259 XI. APPENDIX. STATISTICAL AND OTHER TABLES. PAGE Table I. Estimated Population in 1887, and ten previous years, 1877-86: Number of Inhabited Houses, and of Marriages, Births, Deaths, &c. 263 „ II. Birth Rate and Death Rate ; Death Rates of Children: Deaths in Public Institutions, in 1887 and 1877-86 264 „ III. Deaths Registered from all Causes in 1887 265 ,, 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 267 ,, V. Deaths in 1887, and in 1877-86 from the Seven Principal Zymotic Diseases : in the Parish, in the Metropolis, and in England and Wales 268 „ VI. Summary of Inspectors' Reports of Sanitary Work completed in the year 1887-8 269 „ Via. Summary of Monthly Returns of Work done by the Sanitary Inspectors in the year 1887-8 270 ,, VII. Death Rates, General and Zymotic, in Kensington and London; and Proportion of Deaths from Zymotic Diseases to Total Deaths, in 1887 and 10 previous years 271 „ VIII. Comparative Analysis of the Mortality in London and Kensington in 1887 ; 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 272 ,, IX. Localities where fatal cases of the more important of the Zymotic Diseases occurred in 1887 273 „ X. Vaccination Officer's Annual Return (1886) 275 „ XI. Slaughter-houses, Licensed: and names of Licensees 276 „ XII. Cowsheds „ „ „ 277 THIRTY-SECOND ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH, BEING FOR THE YEAR 1887. 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 December 31st, 1887; the sanitary statistics being for the statutory year ended March 25th, 1888. The vital statistics are calculated upon an estimated population of 175,000, a total arrived at on data furnished by the census of 1881, corrected as far as practicable by the number of inhabited houses. The deaths registered were 2,872, being 116 above the number in 1886, and 104 below the decennial average, corrected for increase of population. The death rate (16.4 per 1,000) was 0.5 above the rate in 1886, and 0.5 below the decennial average. It was 3.2 below the rate in London, as a whole (19.6), and 2.4 below the rate in England and Wales (18.8). But while the death rate in Kensington shows an increase of 0'5 per 1,000, as compared with 1886, the death rate in London shows a decrease of 0.3 from that in 1886, which was b the lowest on record. The rate in England and Wales, moreover, shows a decrease of 05 per 1,000, compared with 1886, and 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:— 1887. 1886. 1895. 1884. 1883. 1882. 1881. 1880. 1879. 1878. 1877. Kensington 16.4 15.9 10.1 15.1 15.5 16 2 16.6 17.8 18.8 20.2 17.3 London 19.6 19.9 19.7 20.3 20.4. 21.4 21.2 21.7 22.6 23.1 21.5 W. Districts 19.0 19.2 19.2 19.2 19.5 19.9 19.6 19.8 20'9 21.6 19.2 North ,, 17.8 18.1 18.5 19.1 19.1 19.7 20.6 20.8 21.5 22.0 21.5 Central ,, 26.0 23.6 230 23.8 23.2 23.9 23.2 23.4 26.0 25.1 24.2 East ,, 22.5 23.3 22.5 230 24.1 25.3 24.2 24 3 25.5 25.0 24.5 South ,, 18.6 19.1 18.5 19.8 19.4 20.7 20.5 21.3 21.8 23.0 20.5 England & Wales 18.8 19.3 19.0 19.6 19.5 19.6 18.9 20.5 20.7 21.6 20.3 The Registrar-G eneral, in his Annual Summary of Births, Deaths, and Causes of Death in London," speaks of 1887 as " a year of remarkably low rates ; the marriage rate and the death rate being each the lowest on record, and the birth rate the lowest since 1849." Referring to the low death rate in 1886, the Registrar-General made an observation, equally true in regard to the still lower death rate in 1887, to the effect that the " marked decline m 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." The RegistrarGeneral, as usual, has prepared a table showing diminution or excess of deaths in 1887, compared with annual deaths in 187786, corrected for increase of population, from which we learn that there was a marked diminution in the number of deaths from 11 small-pox (1,132), scarlet fever (518), whooping cough (261), and " fever " (461), and an excess from measles (459), diphtheria (180), and diarrhoeal diseases (478). There was a diminution in deaths, among other causes, from phthisis and tubercular diseases (2,015), diseases of nervous system (929), diseases of respiratory system, including croup (1,834), and "all other causes " (1,843), the total diminution being 9,198. On the other hand, there was an excess under several heads—viz., cancer (302), premature birth (197), diseases of circulatory system ( 708), diseases of urinary system (192), and suicide (22). The excess (2,538) being deducted from the diminution, a balance of diminution and excess shows a net diminution of 6,660. It is shown 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 from diarrhoeal diseases is " attributable to the long spell of hot weather in the third or summer quarter, in which the mean temperature was 10.1 above the average for the ten years 1877-86." So with regard to the diseases which show diminished mortalities; here, also, most of the changes are not peculiar to the year 1887, but are parts of a change that has been going on for a considerable time, for, in regard to the thirteen causes named, " there are no fewer than ten under which there was also a diminution in each of the four next preceding years—viz., under scarlet fever, typhus, simple continued fever, enteric fever, phthisis and tubercular diseases, diseases of the nervous system, diseases of the respiratory system, accident, murder, and the aggregate of other causes. 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 around London, with a population slightly exceeding a million persons, after correction for the County Lunatic Asylums, " did not exceed 15.9, against 16.5 in the preceding year." The B 2 12 death rate in "Greater London," which is co-extensive with the Metropolitan and City Police Districts, was 18'9 against 19 3 in 1886, The death rate in twenty-seven Cities and Boroughs, having an aggregate population exceeding five millions, was 21.6, ranging from 169 in Brighton, and 17.1 in Derby, to 27.9 in Preston, and 28.7 in Manchester, without correction for differences between one town and another in regard to the age and sex distribution of their respective populations. With such correction, Brighton shows a death rate of 17.3, Derby 17.8, Preston 30.3, and Manchester 31.9. In fifty other Town Districts of considerable size, and containing in the aggregate a population of nearly three millions, the death rate in the year was 19.0 per 1,000, ranging from 12.4 in Maidstone, and 13 3 in Burton-on-Trent, to 23.8 in Stockport, and 24.9 in Wigan. The death rate in England and Wales as a whole was, as already stated, 18.8 per 1,000. In twenty-live of the largest European cities, having an estimated population of more than eleven millions of persons, the mean rate of mortality was 25.1 per 1,000, and exceeded by 4.3 the mean rate in the twenty-eight largest English towns including London, having an aggregate population of more than nine millions. The lowest death rates were 19.9 in the Hague, 20.8 in Geneva, and 20 9 in Brussels, ranging upwards to 30.0 in Prague, 30.1 in Trieste, and 32.0 in Buda-Pesth. The rate in Paris was 23'4, and was lower than in either of the two preceding years, although it exceeded the rate in London by 3.8 : the deaths referred to Measles, Typhoid Fever and Smallpox considerably exceeded the numbers returned in 1886. Having premised so much by way of general introduction, it will be well, before proceeding to deal in detail 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. 13 " 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 Paddington. Since that date the purish 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 enumerated houses were 15,735, in 1881, 20,103; increase, 4,368. 1n 1871 the population was 120,299 ; in 1881, 163,151 ; increase, 42,852. At the middle of 1887 the inhabited houses were some 21,566, and the estimated population 175,000. Registration Sub-Districts. —For registration purposes the parish is unequally divided into two sub-districts, " 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 1887 was about 128,500, and that of Brompton 46,500. The Town sub-district still includes some open spaces, as Holland Park and NottingBarn 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, Government property, is in this subdistrict ; the Kensal Green Cemetery, in private ownership, in the Town sub-district. These cemeteries, it is to regretted, are still in active use : the former certainly ought to be closed. 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 14 lower middle class : miles of streets of such houses are 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. Name of Ward. Area in Statute Acres. Inhabited 1871. houses. 1881 Increase in 10 years. Population. Increase in 10 years. 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 1,711,495 1883 1887 (July) 175,000 1,876,043 (April) 1888 SUMMARY OF VITAL STATISTICS, &c. The year 1887, regarded from a health point of view, was not so satisfactory as its immediate predecessors, the rate of 15 mortality, 16'4 per 1,000—although 0.5 below the decennial average—having been higher than in any preceding year since 1881, when it was 16.6 per 1,000. In seven of my thirteen four-weekly reports I had to record a rate above the decennial average, the excess ranging from 0.2 per 1,000 in October to 2.0 per 1,000 in March; the rate in this month (20.9) being the highest in the year, the lowest rate (11.3) having been recorded in the month of September. The mortality from the principal diseases of the zymotic class was also above the corrected decennial average, for the first time since 1880 ; the deaths from measles, diphtheria, and diarrhoea being in excess, those from small-pox, scarlet fever (which was nominally epidemic) and from "fever " being below the average. There was one death only (of an imported case) from small-pox, no death from typhus fever, and only eleven deaths from enteric fever (vide Table at page 23). The death rate in the first four weeks of the year (ended January 29th) was '20.8 per 1,000 persons living, and 0.7 above the decennial average; it was, however, 1.9 below the Metropolitan rate (22.7), this being 1.3 below the average. The deaths from the principal diseases of the zymotic class were 31 , and 6 above the corrected decennial average. Measles, whooping cough, and diphtheria were the causes of 14, 9, and 4 deaths respectively. The deaths of young children (93 under five years of age) and of aged persons (94 at 60 years and upwards) were largely in excess, the deaths from chest affections (87, including 64 from bronchitis), being especially numerous : these results were due to severity of weather, fog, &c. The mean temperature of the air was 35°.6 Fahr. and 2°.l below the means in the corresponding weeks in the previous ten years. In the second four-weekly period (5th-8th weeks, January 30th to February 26th), the death rate fell to 1 8.3 per 1,000, and was 0.4 below the average and 0.7 below the Metropolitan rate (19.0), this being 5.5 below the average. Thedeathsfrom the principal diseases of the zymotic class were 32 and 8 above the 16 decennial average. They included 13, 7, and 4 from whooping cough, measles and diphtheria, and 2 from scarlet fever and enteric fever respectively. The weather in this period continued cold, but the state of public health was better than in January (the improvement being greater in London, as a whole, than in Kensington), the deaths of aged persons and from chest diseases having fallen considerably. The mean temperature of the air was 39º.1 and lº.5 below the decennial average. In the third four-weekly period (9th-12th weeks, February 27th to March 26th), the death rate rose to 20.9, the highest recorded in the year, being 2.0 above the decennial average and 0.3 above the Metropolitan rate (20.6), which was 3.1 below the average. The enhanced mortality was due to the prevalence of low temperature and cutting winds, the effects of these maleficent conditions being an increase of deaths from chest diseases (81 against 63 in the previous four weeks), and among the aged (83 at 60 and upwards against 74) and among young children (101 under five against 89). The deaths from the principal diseases of the zymotic class were 31 and 8 above the average, including 16, 10, and 3 from measles, whooping cough and diphtheria. The mean temperature was 36º.4 and 5º.4 below the average. In the fourth period (13th-16th weeks, March 27th to April 23rd), the death rate fell to 15.0 per 1,000, being 4.3 below the decennial average and 3.9 below the Metropolitan rate (18.9), which was 4.6 below the average. The deaths from the principal diseases of the zymotic class were 24, two below the average, including 12 and 8 from measles and whooping cough, and one each from diphtheria and enteric fever. The deaths from the diseases of the respiratory system were 54 only, against 81 in the previous four weeks; whilst the deaths of children under five, and of persons at 60 and upwards, were 75 and 59 respectively, against 101 and 83. The mean temperature was 44°.4 and 0º.7 below the average. 17 In the fifth period (17th-20th weeks, April 24th to May 21st) the death rate was 15.1 per 1,000, 0.9 below the decennial average, and 3.8 below the Metropolitan rate (18.9), this being 1.8 below the average. The deaths from the principal diseases of the zymotic class were 25, being one above the corrected average. The only death in 1887 from small-pox occurred in this period: the victim was a gentleman living in Bolton Gardens, the disease having been contracted in Paris. The deaths from measles and whooping-cough were 12 and 5 ; from scarlet fever and diphtheria 2 and 3, respectively. Scarlet fever was on the increase in the Metropolis at this time; the patients in the hospitals on May 21st were 437, and the admissions in the four weeks 238, against 121 in the preceding four weeks. Sixteen cases were recorded in Kensington. The mean temperature was 47°.9, and 1º.8 below the average. Tn the sixth period (21st—24th weeks, May 22nd to June 18th) the death rate rose to 16.0 per 1,000, and was 0.4 above the decennial average, but 19 below the Metropolitan rate (17.9), which was 0.9 below the average. The deaths from the principal diseases of the zymotic class were 29, one above the corrected average, including 14 from measles, 5 each from diphtheria and whooping-cough, and 3 from scarlet fever. The mean temperature was 57°.5 and 1°.2 above the average. In the seventh period (25th—28th weeks, June 19th to July 16th) the death rate fell to 15.6 per 1,000, and was l.0 above the decennial average, but 3.0 below the Metropolitan rate (18.6), this being 0.7 below the average. The deaths from the principal diseases of the zymotic class were 50, and 14 above the corrected average. Diarrhcea (mainly, as usual, amongst infants) was very prevalent at this time, and was the cause of 25 deaths in the four weeks, the corrected average number being 14. Measles and whooping cough were the causes of 12 and 3 deaths respectively ; scarlet fever and diphtheria 4 each; enteric fever 2. Scarlet fever was now becoming epidemic in London: the cases in the Asylums Board Hospitals, on July 16th, were 518, and the 18 admissions in the four weeks 260. Still the deaths (75) were relatively few, being 47 below the corrected average number in the corresponding weeks in the previous ten years. Thirty-one cases were recorded in this parish. The mean temperature was 65°.l and 3°.7 above the average. In the eighth period (29th—32nd weeks, July 17th to August 13th) the death rate further rose to 17.2 per 1,000, being 0.8 above the decennial average, but 6.4 below the Metropolitan rate (23.6), which was 1.9 above the average. Our high rate was due to diarrhoea, which caused 58 deaths (24 in excess of the corrected average) out of 76 attributable to the principal diseases of the zymotic class. Measles and whooping-cough were the causes of 3 and 10 deaths, scarlet fever and diphtheria of 2 each, and enteric fever of one. Out of 232 deaths 111 were of infants under one year, the cause of death in 50 cases being diarrhcea. The deaths from diarrhcea in London generally during these four weeks were 1,848, and 681 in excess of the corrected average. No fewer than 1,508 of the cases were of children in the first year of life. The epidemic of scarlet fever was progressing, the cases in the Asylums Board Hospitals on August 13th being 646—increase in the four weeks, 128—and the admissions 353, against 238 in the previous month. The recorded cases in this parish were 14 only. The mean temperature was 640.5 and 2°.8 above the average. In the ninth period (33rd—36th weeks, August 14th to September 10th) the eath rate fell (from 17'2) to 13.4 per 1,000, being 0.6 below the decennial average, and 4.8 below the Metropolitan rate (18.2), which was 0.6 below the average. The deaths from the principal diseases of the zymotic class were 35, including 17 from diarrhoea, 2 and 7 from measles and whooping-cough, 5 and 3 from scarlet fever and diphtheria, and one from enteric fever. The deaths from diarrhoea in the Metropolis in these weeks were 746, being 55 in excess of the corrected average. The scarlet fever epidemic at this date had begun to assume somewhat disquieting proportions: the deaths in 19 the four weeks were 151, and 24 in excess of the corrected decennial average. The cases in the Asylums Board Hospitals on September 10th were 1,035, against 646 on August 13th, an increase of 389. The admissions in the four weeks were 634, or 281 more than in the previous month. The recorded cases in Kensington were 55. The mean temperature was 59°.7, and 0o.6 below the average. In the tenth period (37th—40th weeks, September 11th to October 8th) the death rate further fell to 11.3 per 1,000 (the lowest rate recorded in the year), being 1.7 below the decennial average and 3.9 below the Metropolitan rate (15.2), which was 2.6 below the average. The deaths from the principal diseases of the zymotic class were 20, including 11 from scarlet fever, the largest number recorded in 1887. Whooping-cough was the cause of 4 deaths, diphtheria and measles of 1 each, and diarrhcea of 3. The recorded cases of scarlet fever were 115, the largest number in any month in the year. On October 8th there were 1,759 cases in the Asylums Board Hospital (increase in the four weeks 724), and the admissions in the four weeks were 986, or 352 more than in the previous four-weekly period. The deaths were 181, and 7 above the corrected decennial average. Apart from this epidemic, the state of the public health was satisfactory. I was able to report, as regards our own parish, that " the deaths from the zymotic diseases were fewer than in any previous month in the year,'' that " the deaths from diseases of the respiratory system were exceptionally few, the deaths of young children fewer than in any previous month, and the deaths of persons over 60 years of age, with one exception, the fewest recorded in the year." The mean temperature was 520.2 and 20.7 below the average. In the eleventh period (41st—44th weeks, October 9th to November 5th), the death rate rose (from 11.3) to 15.3, being 0.2 above the decennial average, but 4.5 below the Metropolitan rate, which was average. The deaths from the principal diseases of the zymotic class were 19 (the smallest total in the year) including 6 from scarlet fever, 4 each from measles and 20 whooping cough, and 2 from enteric fever. In this month diphtheria was absent from the list of fatal diseases for the only time in 1887. The recorded cases of scarlet fever were 92. The cases in the Asylums Board Hospitals had further risen on November 5th to 2,516, showing an increase in the four weeks of 757. The admissions were 1,208 against 986 in the previous month, increase 222. The deaths in London were 243, and 15 above the corrected decennial average. The mean temperature was 43°.2 and 4°.6 below the average. In the twelfth period (45th—48th weeks, November 6th to December 3rd) the death rate further rose to 18.1 per 1,000, or 0.7 above the decennial average, but it was 2.8 below the Metropolitan rate (20.9), which was 07 below the average. The deaths from the principal diseases of the zymotic class were 20, including 6 and 2 from measles and whooping cough, 4 and 6 from scarlet fever and diphtheria respectively. Sixty-four cases of scarlet fever were recorded. The cases in the Asylums Board Hospitals showed a slight increase, viz., from 2,516 on November 5th to 2,562 on December 3rd. But the admissions were 825 only, against 1,205 in the previous four-weekly period —decrease 383. The deaths were 209 and 26 fewer than the corrected decennial average. The mean temperature was 40°'3 and 20.3 below the average. In the thirteenth and last four-weekly period (49th52nd weeks December 4th-31st) the death rate fell (from 18.1) to 15.8 per 1,000 being 2.5 below the decennial average and 4.6 below the Metropolitan rate (20.4) this being 3.0 below the average. The deaths from the principal diseases of the zymotic class were 24, viz., 5 and 6 from measles and whooping-cough, 4 each from scarlet fever, diphtheria, and diarrhoea, and one from enteric fever. Thirty-four cases of scarlet fever were recorded. The cases in the Asylums Board Hospitals on the last day of the year were 2,046, a decrease of 516 since December 3rd. The admissions in the four weeks were 592, against 825 in the preceding month : decrease 233. The deaths were 154 and 39 below the corrected decennial average. The mean temperature was 370.3 and lo.0 below the average. 21 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-General's arrangement of the "causes of death," six "Orders." The first and second Orders ("Miasmatic" and "Diarrhceal") 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 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 necessary 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 prevalent in 1885, the deaths being considerably above the average ; it was the zymotic disease that gave a special character to the year. In the year 1886, on the other hand, the deaths from measles were below the average ; but the lowered mortality, regarded as evidence of the diminished prevalence of the disease, was the result of its excessive prevalence and fatality in the preceding vear. 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 severity of an epidemic may be influenced by the measures taken, or the neglect to take any measures, to check the spread of infection. Again, the rate of 22 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. Diarrhcea may be cited as an illustration of quite another kind. The mortality from this disease, amongst infants, was excessive in 1878 ; the mortality in 1879 was much below the average ; but the diminished mortality in 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 diarrhcea was low ; just, as it is always high when the 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 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 it is 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 a 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, with a low general death rate, furnishes just ground for satisfaction For some years past the general rate and the zymotic rate have both been below the decennial average in Kensington But in 1887 it was otherwise, for although the general death rate was below, the zymotic death rate was rather above the average. It need hardly be said that a persistently high rate of mortality from zymotic diseases furnishes matter for serious consideration. Kensington, 23 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 1887, together with the decennial average, etc. :— Disease. Sub-districts. In Hospitals. Total. Decennial Average. Corrected Town Brompton. Town Brompton. Uncorrected for increase of Population. Small-pox – 1 – – 1 250 26.8 Measles 84 22 2 — 108 62.4 66.8 Scarlet Fever 21 1 19 3 44 42.8 45.8 Diphtheria 27 5 6 2 40 204 21.8 Whooping Cough 83 3 — — 86 91.6 98.0 Typhus Fever — – – — — — 1.5 1.6 Enteric Fever 1 6 1 3 11 210. 22.4 Simple Continued Fever 2 — — — 2 40 4.3 Diarrhcea 108 13 2 1 124 100.7 107.8 326 51 30 9 416 369.4 395.3 It appears, then, that the deaths from these diseases were 21 above the corrected decennial average. They were also 126 more than in 1886. As usual, the deaths in the Brompton sub-district (60) were fewer in proportion to population than in the Town sub-district, and even to a greater extent than in immediately preceding years. The total deaths were equal to 144.8 per 1,000 deaths from all causes in Kensington (Metrolis, 154.3), and to a rate of 2.4 per 1,000 persons living (Metropolis, 3.0); the decennial average being 2.2 in Kensington, and 3.2 in London. In England and Wales the deaths from these diseases were 121.9 in each 1,000 deaths; and the rate was 2.3 per 1,000 persons living, the decennial average being 2.7 per 1,000. In the 27 Cities and Boroughs grouped by the RegistrarGeneral with the Metropolis, the zymotic death rate was 3.2 per 1,000, ranging from 1.25 in Halifax to 4.86 in Manchester; while in 50 other large Town Districts it averaged 2.25 per 1.000, the highest rate (4.89 per 1,000), being recorded at Warrington, and the lowest rate (0.8) at Southport. 24 The following Table shows the distribution of deaths in Kensington from the principal zymotic diseases registered in thirteen four-weekly periods, corresponding with my monthly reports :— PElRIOD DISEASE. Four Weeks ended Small-pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Typhus Fever. Enteric Fever. Simple Continued Fever. Diarrhoea. ./ Jan. 29,1887 ... 14 1 4 9 ... ... 1 2 31 Feb. 26, ,, ... 7 2 4 13 ... 2 ... 4 32 Mar. 26 ,, ... 16 ... 3 10 ... 1 ... 1 31 April 23, ,, ... 12 ... 1 8 ... 1 ... 2 24 May 21, „ ... 12 2 3 5 ... ... ... 2 25 June 18, ,, ... 14 3 5 5 ... ... 1 1 29 July 16, „ ... 12 4 4 3 ... 2 ... 25 50 Aug. 13, „ ... 3 2 2 10 ... 1 ... 58 76 Sept. 10, „ ... 2 5 3 7 ... 1 ... 17 35 Oct. 8, ,, ... 1 11 1 4 ... ... ... 3 20 Nov. 5, ,, ... 4 6 ... 4 ... 2 ... 3 19 Dec. 3, ,, ... 6 4 6 2 ... ... ... 2 20 Dec. 31, ,, ... 5 4 4 6 ... 1 ... 4 24 Totals 1 108 44 40 86 ... 11 2 124 416 I now proceed to make a few observations with regard to each of the above-mentioned diseases. SMALL POX. Small Pox was the cause of one death only, that of a gentleman who contracted the disease in Paris. Only one other case (also imported) was recorded during the year. The recorded cases in the three previous years were 177, 181, and 3 respectively. Small-pox was almost entirely absent from the Metropolis in 1887. The deaths were nine only, shewing a dimunition of 1,194 deaths, compared with annual deaths in 1877-86 corrected for increase of population. These deaths in both years were fewer—not merely relatively to population, but 25 lutely—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), 1873 (113 deaths), 1883 (136 deaths), and 1886 (24 deaths). The mean annual mortality from this disease in the seven years as yet elapsed of the current decennium was 0.20 per 1,000, and lower than in any previous decennium. The RegistrarGeneral, in his Annual Summary for 1886,stated 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 RegistrarGeneral 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 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 that the diminution in small-pox mortality in the Metropolis, last year and in 1886, was largely due 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 are aware, was initiated upon my recommendation made to the Asylums Board and the Local Government Board in 1881, c 26 MEASLES. Measles.—The deaths from measles in 1887 were 108 (22 of them in Brompton,) being nearly double the number (56) recorded in 1886, and 40 above the corrected decennial average. Ninety-six of the deaths occurred under five years of age, including 23 under one year. The disease was more or less prevalent throughout the year, seeing that it appeared in each of my thirteen four-weekly reports as a cause of death. The deaths, however, in the first half of the year (82) were more than thrice as numerous as in the latter half. 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, considering it, moreover, to be inevitable as teething, they naturally enough rather prefer that all of the children should have it at one time. We must allow, 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. An outbreak at Notting Hill, involving seventeen (known) cases in four families, and two deaths, was due to infection carried to a children's party of thirty by a child supposed to be suffering from a cold, but who had an eruption, diagnosed and treated as measles on the following day. Four of the children, in one family, came from Ealing. A child, who came from Croydon, subsequently infected three other children in the same family in that town. 27 The Registrar-General remarks that " a very insignificant proportion of the deaths from measles occur in hospitals, and the tendency on the part of the public to estimate the prevalence of a disease merely by the pressure to which it subjects hospital authorities is well illustrated by the fact that while much alarm was felt as to scarlet fever, which was in reality less than averagely prevalent, no such general alarm was felt as to measles which was more than averagely fatal." The deaths from measles were 2,894, being exactly double the fatality from scarlet fever, 1,447. SCARLET FEVER. This disease, which was the cause of seven and eleven deaths in 1885 and 1886 respectively, proved fatal to 44 persons in 1887—forty of the deaths belonging to the Town sub-district. Of the 44 deaths 22 occurred in hospitals, to which 316 out of 465 recorded cases were removed for treatment. Of the 465 cases 240 belonged to North Kensington—viz., that part of the parish north of Uxbridge Road; and 225 to South Kensington —the remainder of the parish south of that road. The cases in the four preceding years respectively were 231, 202, 110, and 100. The disease was epidemic in the latter half of 1887; the cases recorded being being 389 against 76 in the first half of the year. Last year, as usual, the occurrence of scarlet fiver 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 some instances, moreover, when the existence of the disease became known at an early period, parents refused to allow their children to be removed to hospitals, these cases however being far less numerous than in preceding years. A certain number of home patients were, to all appearance, properly isolated, and the removal of them to hospital was deemed unnecessary; but proof was not wanting that, even when the sufferers had what might be fairly described c 2 28 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 a few instances, when removal was obviously necessary to security, 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 patients were generally 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 in several instances the result of keeping patients at home under circumstances that rendered nugatory any attempt at isolation. The following cases are cited in illustration of modes of spread of scarlet fever, and as evidence of the necessity for an Act providing for the notification of Infectious Disease, a subject to be dealt with later on. Scarlet fever broke out in a family living in a Mews, three children being successively attacked, the first on August 7th. The malady was pronounced to be " rose-rash," and no precautions were enjoined. While the children were actively " peeling," two of them visited their father, who was butler at a large house in South Kensington, the occupants of which were from home. The children, moreover, were allowed to play in the Mews with their schoolfellows, the result being that four other families became infected. In one family two children were attacked simultaneously on August 17th, the cases being concealed. A case occurred in each of two other families on the 21st August, and these likewise were concealed, and a case on the 2nd September in a fifth family. Nothing was heard of any of these cases until Sunday, September 4th, when the first-mentioned (three) cases were found to be actively " peeling," but the parents would not allow the children to be removed. Four of the remaining cases, in three families, were removed, but in one case, in another family, the parents refused to allow removal. Here, then, we had eight cases in one Mews, seven of which presumably might have been prevented by removal of the first case. A police-constable, having a wife and a family of five children, was placed in charge of a mansion at South Kensington. About four weeks before the family were to return to town—a family comprising several children—scarlet fever attacked four of the caretaker's children. The 29 disease assumed a mild form, and no doctor was consulted. An examination was coming on at a local school, amongst the pupils at which scarlet fever had been very prevalent, and as it was important to whip-up absentees, attention was directed to the fact—after nearly four weeks—of the absence of one of the constable's children whose attendance was desired. The School Board Visitor found the current address of the family (who had migrated from the Mews referred to above as furnishing so many cases of scarlet fever), and, on calling at the house, was informed that the absence of the children was due to scarlet fever. On the house being visited, it appeared that the servants of the occupier had already returned, and that the family were to follow on the next day. The constable and his family were to go home, and did go home, the sick children in a public vehicle (number unknown), on the day when visited. The occupier had been kept in ignorance of the illness, and but for the prompt action of the Inspector, in telegraphing, he would have brought his family to a house reeking with infection. The constable, it may be mentioned, continued on duty throughout the illness, but was taken off duty as soon as the Divisional Surgeon became acquainted with the facts. The constable should have reported the outbreak at once, in conformity with Police Orders (vide my Annual Report for 1882, page 75). If he had done so, he would have been relieved from duty ; the children would have "been removed ; the occupier would have been informed; the house would have been disinfected —in a word, everything would have been done to secure the safety of all parties, and presumably the constable would have lost the advantages of his position as caretaker. Some of the children it may be added had attended school after the disease broke out in the family. Two cases occurred in the family of a lodger. The first, beginning on August 18th, was concealed, the result being a second case a few days later. The landlady of the house knew nothing of the illness until her own child was attacked on the 3rd September. All three cases were removed to hospital on 5th September. In another house there were four concealed cases. The first case began on the 19th August, the child dying on the 23rd. Upon visitation of the house—as a result of the registration of the death—three other children were found to be ill, having been successively infected. In another house there were four cases in two families. The first case began on the 16th August, two other children in the same family being successively attacked. Another case occurring a few days later, in another family, was reported, after some delay, visited, and removed. The illness of the other three children was then ascertained, and they also were removed to hospital. In another house a child was attacked on August 9th, two others fell ill on the 16th and 24th respectively. The child last attacked died, and registration of the death led to discovery of the other cases, which, however, were not removed, consent of the parents being withheld. 30 In another house four cases occurred successively in two families. All were removed to hospital, but the three cases in one of the families were the result of delay in removal of the first case in the other family. In the above groups 23 cases were secondary, all or most of which might, presumably, have been prevented by early notification and removal. SCARLET FEVER IN LONDON. More or less epidemic throughout the year, scarlet fever did not assume a severe type, and the deaths, 1,447 only, were 518 fewer than the corrected decennial average. In the latter half of the year, notably after the prorogation of Parliament, the public mind was considerably exercised by the daily publication in the newspapers of the number of cases admitted to the Asylums Board Hospitals, and there can be no doubt that the exaggerated fears to which such publication gave occasion operated injuriously to the interests of the trading community - by keeping families out of town throughout the winter months. There was not anything to justify the scare which undoubtedly existed, and for which, in a sense, certain of the Managers were more or less responsible. The leading members of the Board, seeing clearly that the ordinary accommodation would be inadequate to meet the growing demands for admission, arising in no small degree from the increasing confidence in which the hospitals are held, proposed to open the "Northern" Hospital at Winchmore Hill, which had been erected for the very purpose to which it was proposed to apply its wards. But the party of "economy" successfully opposed the proposal again and again. Meanwhile the discussions at the Board's meetings had been copiously reported, and the country generally was led to believe in the existence of an unprecedented crisis which had no foundation in fact. The mischief done by the delay, moreover, was to the interests of trade rather than those of public health, as before said, for after all the hospital was opened in time. The pressure of public opinion, endorsing 31 the views of the leading Managers, supported as these were by the somewhat tardily given advice of the Local Government Board, soon silenced the opposition, and thenceforth accommodation was provided, as required, by the erection of '' huts" in the grounds of some of the hospitals—the work being carried out with much celerity, and at no small expense, so that not a single patient was denied admission. The Managers, moreover, with a boldness which elicited the approval of all competent authorities, threw open the doors of their hospitals, removing thereto large numbers of patients, upon the application of medical practitioners, without the formality of an order by a relieving officer. The Local Government Board raised no objection to this proceeding—contrary as it was to their Order regulating the admission of patients, which necessarily follows closely the provisions of law. The Board even facilitated the practice by issuing, at the request of the Managers, an Order which legalised the certificate of the private medical practitioner as evidence of the nature of the disease—a concession of value, for which I had pleaded eleven years previously. But, as we shall see, the Board stated that, as the law stands, they have no power to comply with an application "for authority for the Managers to remove all persons suffering from fever or small-pox, whose removal shall be applied for by duly qualified medical practitioners." The type of scarlet fever was, as I have said, mild, the case-mortality in the Hospitals being low. In Kensington the mortality in respect of known cases was 9.4 per cent., a rate in excess of the true proportion as many cases doubtless occurred of which we had no information. Still, we have reason to believe that notification is much more general now than in byegone years. Thus, comparing 1887 with 1880, we note that the number of cases recorded was the same in both years, but the case-mortality in 1880 (22.5 per cent.) was more than double that in 1887; and the only conclusion at which we can arrive is that in 1880 the concealed cases must have been considerably more numerous than in 1387. The deaths in 32 London from this cause in 1880 were more than twice as numerous as in 1887, and yet we had then no such alarm. The reason is not far to seek. People did not use the hospitals seven years ago as they do now. The bulk of the sick were kept at home. Most of the deaths occurred in private houses, and so there was no particular strain on the hospitals to awaken public attention to the epidemic. Take our local experience by way of illustration. In 1887 our home treated cases were 316 out of 466 cases recorded, only 150 cases having gone to hospitals; whereas in 1887 the home treated cases were only 149, the cases removed to hospital being 316—an exact reversal of the figures of 1880. The percentage of removals, which in the latter year was 32, had risen in 1887 to 68. The percentage of deaths in hospitals, which was 21 in 1880, rose to 52 in 1887. And what is true of Kensington cases is no doubt true in the main in regard to cases in all of the other Metropolitan districts. STATISTICAL RETURNS. The Asylums Board addressed a circular letter to the Vestries and District Boards, in October, making application for information to enable them to ascertain " the extent, as compared with previous years, to which scarlet fever had been prevalent during the year " in the several districts, their object being to form " as correct an estimate as possible of the accommodation to be provided in future" for cases of this disease. The reason for inquiry was " the difficulty of obtaining reliable information on the subject in the absence of any system of notification of infectious disease"—a difficulty enhanced, perhaps, by the fact that although " the numbers of patients under treatment in the hospitals " were in October " more than double the numbers under treatment at any one time during the past ten years," yet " the mortality . . . was below, rather than above, the general average." It was reasonably assumed, however, that as the deaths in the hospitals " form, year by year, an increasing percentage of the total number of deaths, . . . the numbers in the hospitals had also assumed a correspondingly increased proportion of the total number of persons attacked in the Metropolis." 33 At the request of your Yestry I drew up the desired information, iu the form of the subjoined Tables, which are selfexplanatory :— Statistics op Scarlet "Fever, in Kensington in 1887 and in Eight* Previous Yeabs. The Year. No. of Recorded Cases. Total Number of Recorded Cases. Percentage of Removals to total Recorded Cases. Deaths. Total Deaths. Percentage of Deaths. Percentage of Deaths to Recorded Cases. Deaths in London from Scarlet Fever. Treated at Home. Removed to Hospital. At Home. In Hospitals At Home. In Hospitals 1887 149 316 465 68 21 23 44 48 52 9.4 1447† 1886 37 63 100 63 8 3 11 73 27 11.0 688 1885 68 42 110 38 5 2 7 72 28 6.3 707 1884 115 87 202 43 11 7 18 61 39 9.0 1444 1883 141 90 231 40 22 6 28 79 21 12.0 1989 1882 199 120 319 40 51 11 62 82 18 19.4 2004 1881 177 110 287 39 30 8 38 79 21 13.2 2108 1880 316 150 466 32 83 22 105 79 21 22.5 3073 1879 174 103 277 37 41 10 51 80 20 18.4 2706 * The returns prior to 1879 are incomplete. †The corrected decennial average number of deaths from Scarlet Fever in Kensington was 46, and in London 1,975; so that, the epidemic notwithstanding, the mortality in 1887 was below the average. 34 Scarlet Fever Cases Recorded in Kensington in 1887, and in Eight Previous Years*, in Thirteen Four-Weekly Periods. The Year. Weeks. 1-4 Weeks. 5-8 Weeks. 9-12 Weeks. 13.16 Weeks. 17-20 Weeke. 21-24 Weeks. 25-28 Weeks. 29-32 Weeks. 33-36 Weeks. 37-40 Weeks. 41-44 Weeks. 45-48. Weeks. 49-52. total. 1887 10 8 9 5 16 12 31 14 55 115 92 64 34 465 1886 10 17 7 4 4 7 3 4 8 13 11 9 3 100 1885 7 12 12 3 9 8 11 9 9 12 7 3 8 110 1884 21 23 11 17 10 29 17 5 2 24 4 19 20† 202 1883 21 6 5 9 22 26 10 14 5 19 37 30 27 231 1882 19 18 14 6 23 11 15 21 28 31 53 38 42 319 1881 24 31 18 27 18 14 17 16 18 33 24 30 17 287 1880 34 19 29 39 35 23 17 17 31 46 59 58 59 466 1879 18 12 9 9 13 11 9 11 35 22 28 74 26 277 Average 18.2 16.2 12.7 13.2 16.7 15.7 14.4 12.3 21.2 35.0 35.0 32.6 25.2 245† * The returns prior to 1879 are incomplete. †Return comprises five weeks. ‡Without correction for increase in population. 35 SCARLET FEVER ALLEGED TO BE DISSEMINATED BY THE MILK OF DISEASED COWS. In my Annual Report for 1885 I stated that scarlet fever had recently acquired a new interest for sanitarians, as the result of an outbreak in certain districts in London and at Hendon, inquiry into which had led Mr. W. H. Power, Second Assistant Medical Officer 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, subsequently presented, confirmed the views expressed by Mr. Power, which, moreover, were approved by Dr. George Buchanan, Medical Officer to the Local Government Beard, who in his observations on the subject remarked that:— " In its own province, Dr. Klein's report is as important and interesting as 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 artificially 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 affocted animals, their milking power, and their body 36 ture, nothing abnormal could be detected and herein, as I pointed out, " lies a danger to the public, inasmuch as ic will be difficult to satisfy cow keepers 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 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 went to show that the milk itself, as found in the cow's udder, is not infective. The germs which produce the human disease are, in his view, conveyed to the pail in the form of scales and exuded lymph, in the act of milking, by pressure of the milker's hands on the sores on the teats ; just as the " peeling" skin of the hands of a person convalescing from scarlet fever, may be (and often has been) rubbed off, and fall into the pail in the act of milking, so giving rise to scarlet fever in susceptible 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 so to infect great numbers of susceptible persons. It is 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 regarding 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 37 investigating the new and promising fields of research that are opened by the recent experiences of Hendon." But the views of the investigators have not remained without challenge, the first note of which was sounded in 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 as supposed with the eruptive malady now commonly spoken of as the " Hendon cow-disease." Professor Axe's report, which bears the imprimatur of Professor Brown, C.B., Professional Officer of the Agricultural Department of the Privy Council, treats of the malady as being at once common, well known among farmers, innocuous, and having no relation to human scarlatina. He cites facts to prove that milk from 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, without evil effect, but, it may be added, contrary to the provisions of the Dairies Order. The conclusion therefore arrived at by him was 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 did not see the incriminated herd during the critical period ; his inquiry came subsequently, and his conclusion being deduced from the statements of persons who may not unfairly be regarded as interested in minimising the gravity of the deductions arrived at by Mr. Power and Dr. Klein. Professor Axe, moreover, makes no reference 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 had already admitted all that the Professor asserts of the apparently harmless character of the malady as it affects the cow ; but while Dr. Klein shows that the inoculated disease in calves is followed 38 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 teats," he tells us, is spoken of among the dairy-farmers (but can it be the same disease ?) as "cow-pox"; and, while admitting that it is transmissible to man, by inoculation, in the form of vesicles ([vaxinia), he says that it is "incapable of communicating scarlatina or other epidemic fever." Thus the subject was left at the date of my last Annual Report, but being one of undeniable importance to the agricultural world and to the general public, a further investigation has since been made, at the instance of the Agricultural Department of the Privy Council, by Professor Crookshank, of the Bacteriological Laboratory, King's College, who has arrived at the conclusion that the bovine disease, of which he has seen numerous examples, is " cow-pox," of which, he states, there are spurious varieties which afford no protection against small-pox. As the outcome of his investigations, which are described in the principal medical journals of 17th December, 1887, he states his conviction that the disease he has investigated is identical with the " Hendon cow-disease " ; that this was not scarlatina in the cow ; ihat the milk of cows affected with the disease does not produce scarlet fever in man ; and that in the Hendon milk " the source of infection was from some hitherto unascertained human source." At a discussion at the Pathological Society on Professor Crookshank's paper (reported in the medical journals of December 24th), Dr. Klein took up the view that the disease which the author of the paper had investigated (presumably cow-pox) was not the " Hendon cow disease." It is not probable that the matter will end here. Meanwhile, what is of present interest is the fact that Professor Crookshank appears to have lighted on a case of " the true Jennerian cow-pox " transmitted from the cow to man, the lymph of which, moreover, has " produced in calves typical vaccinia so that we may hope to have 39 obtained, as an incidental result of an altogether interesting investigation, the means of renewing our sources of vaccine supplies from the animal whose milder form of the disease is capable of affording almost perfect protection against the virulent small-pox of man. 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 above referred to, the dissemination of the disease through milk had always been attributed to the contamination of the milk by the introduction of scarlatinal poison of human origin ; either from the milker's hands or by 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 satisfactory. It may be asked, then, how are we to guard against the spread of scarlet fever, if it be true 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, 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 (b) shall not be sold or used as human food." 40 DIPHTHERIA. Diphtheria, which was the registered cause of 30 deaths in 1886, was fatal to 40 persons, 20 males and 20 females, in 1887, 33 in the Town sub-district and 7 in Brompton, the corrected decennial average number being 22. Twenty of the deaths occurred among children between 1 and 5 years, three under 1 year, eleven between 5 and 12 years, and six at ages above 16 years. Nine of the deaths took place in public institutions. The deaths in London in 1886 from diphtheria (846) were 87 below the corrected average. Last year the deaths, 961, were 180 in excess of the average. The RegistrarGeneral states that the registered mortality from diphtheria has been considerably higher in each of the last six years, 1882-87, than in any previous years since 1864, while during the six years themselves the rate has remained almost constant. In Kensington the mortality from diphtheria has been increasing for some years, and in 1887 the deaths (40) were more numerous than in any year in the preceding decennium (vide Table V., Appendix). I cannot account for this increase, which to some extent may possibly be 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. It is probable that some of the cases registered as diphtheria were really cases of croup, or even of scarlatina anginosa. Sometimes, on the other hand, the specific character of an apparently simple throat affection does not become apparent until paralysis supervenes —this being one of the more serious sequelae of diphtheria. There was a localised outbreak in Stratford Road and Radley Mews, at the beginning of the year—in five families, in as many houses; the cases being nine and the deaths five. To one of the houses the disease appeared to have been imported by a ser vant from a distant parish, and in another house, where three cases occurred, the disease was probably due to defective sanitary conditions. 41 HOSPITAL PROVISION FOR DIPHTHERIA. Reference was made above to the fact that nine of the 40 deaths from diphtheria took place at public institutions, usually 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 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, in 1886. The Board, doubting their 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 can be regarded as patients suffering from "fever" within the moaning of section 69 of the Metropolitan Poor Law Act, 1867 ? The opinion of the President of the College, Sir William Jenner, was given in the following terms:— "If the words of the Act had been 'for patients suffering from fever,' 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 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. After waiting eighteen months the Managers have recently resolved to direct the attention of the Board again to the subject. That the promised consideration may result in necessary legislation, is much to be desired, it D 42 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. Whooping Cough, the cause of 82 deaths in 1886, proved fatal in 1887 to 86children, all but 2 under five years of age, and 33 under one year. All the deaths save three were in the Town sub-district. The corrected decennial average is 98. Fifty of the deaths were registered during the first 24 weeks of the year, the remaining 36 deaths being spread over 28 weeks (vide Table at page 24.) 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, and the danger of this always distressing malady being unappreciated by the poor, who, in the engrossing struggle 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, being due commonly to some secondary disease— of the respiratory organs, or of the nervous system: 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. The deaths in London from whooping cough (2,928) were 261 fewer than the decennial average; but the disease was unusually prevalent during the greater part of the year. "The saving of life was entirely in the earliest months, the mortality 43 having been very greatly below the average for each of the first twenty weeks. Then there was a change in the figures: the mortality rose above the average and continued to be in excess to the very end of the year." Our local experience, as before shewn, was different, the mortality having been greatest in the early part of the year. FEVER. No death was registered from Typhus Fever, and only two from Simple Continued Fever, the deaths from Enteric Fever, moreover, being only eleven, the same number as in 1886, and just half the corrected decennial average (22.4). Two only of the deaths were registered in the Town sub-district, and nine in Brompton. Four of the deaths took place in hospitals, to which fifteen patients were removed. The recorded cases were 27; ten in North Kensington (all of which were removed to hospital) and seventeen in South Kensington, the Uxbridge Road being the dividing line. The deaths in London from enteric fever in 1887 shew a diminution of 247, compared with annual deaths in 1877-86, without correction for increase of population. There were only 18 deaths from typhus, and 48 from simple and ill-defined fever. "The deaths from these diseases and enteric fever, which year by year have been decreasing, fell still further in number in 1887, and amounted only to 672, whereas had the proportion to the population been as high as the previous decennial average, the number of deaths would have been 1,134. Thus the mortality from these continued fevers was no less than 41 per cent. below the decennial average." DIARRHŒA. DiarrhŒa was the cause of 124 deaths, 110 in the Town sub-district, and 14 in Brompton. This number was thirty- d 2 44 four in excess of the number in 1886, and exceeded the corrected decennial average by sixteen. One hundred and seven of the deaths were of children under five, including 95 under one year. Of the total number, 100 were registered in twelve weeks, Juue 19th to September 10th inclusive. The deaths from diarrhoea in London generally were 478 in excess of the corrected decennial average, this increased mortality being attributable to the long spell of hot weather in the third or summer quarter. DiarrhŒa was prevalent in an epidemic form in the Metropolis in the winter of 1886-7, many persons having been severely prostrated by sudden onset of the complaint, attended with cramps, sickness, and other symptons simulating English Cholera. I heard of numerous cases in this Parish, but not of any fatal case. I was unable to explain the cause of the epidemic, nor was light thrown upon the subject in the medical journals which took note of the facts. 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 outposts, 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 in our first line of defence. The annual recurrence of this disease, moreover, in the parts indicated, does not now excite the same alarm as in past times, it being well understood that cholera is a malady that may be prevented, or its extension minimised, by good sanitation, and this country being not only prepared to deal with imported cases, but, as it is hoped, in such a condition that if the disease should be accidentally introduced, there would be no great 45 danger of a general epidemic. Extensive outbreaks in the past have been due, usually, to a polluted water supply, a danger against which the Metropolis is better guarded than formerly, but one against which it is impossible to obtain complete security whilst the supply is obtained from rivers. 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 shown 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. METROPOLITAN ASYLUMS BOARD. The work and proceedings of the Asylums Board, at all times of importance to all concerned in sanitary administration within the metropolis, acquired additional interest in 1887 by reason of the steps taken by the Managers to make the Hospitals more than ever a refuge for the infectious sick in need of © isolation. Accommodation, as we shall see, has been provided, or is in course of preparation, adequate to the needs of the population; and, during the recent epidemic of scarlet fever, beds were placed at the disposal of registered practitioners, as well as sanitary officials and resident medical officers of General Hospitals, whose applications for the admission of patients, subject only to compliance with the Board's Regulations, were invariably complied with The Board indeed have become in 46 practice the Central Hospital Authority for London in regard to infectious diseases, and right well do they discharge the duties of the position. No authoritative statement of their work, year by year, is published, and it again affords me satisfaction to be the medium for conveying the requisite information, which will involve frequent reference to the views and proceedings of your Vestry and other Sanitary Authorities. THE FUTURE OF THE METROPOLITAN ASYLUMS BOARD. At a meeting of the Managers in October, Dr. J. H. Bridges, Poor Law Inspector, expressed his satisfaction that the Board was "working in the direction of what he hoped it would become, viz., the Hospital-providing Authority for all poor people of London not paupers." This sentiment was received with applause, a fact which must be taken to mark a further advance by the Board in the direction of that goal to which I have for many years urged the Managers to aspire. It is not to be supposed that Dr. Bridges was, in the above utterance, expressing his merely personal predilections. He spoke, doubtless, with a full sense of official responsibility, and we may conclude that the Board which he represents is no dissatisfied spectator of the process of evolution by which the Asylums Board is being transformed into a Central Authority, acting for the whole Metropolis, to provide, "in a comprehensive and systematic manner," hospital accommodation for all classes in need of isolation. The subject is not a new one. It was carefully considered by the Managers themselves in February, 1877, when they took counsel with the Sanitary Authorities and with the Medical Officers of Health. Expressing "the belief that adequate provision for the isolation and treatment of epidemic diseases in the Metropolis'' did not exist, the Managers arrived at the following conclusions:— (a) "That such provision could be best made in a comprehensive and systematic manner by one Central Authority acting for the whole Metropolis, not only for pauper patients, but for other classes desirous of Hospital accommodation, 47 (b) "That such Central Authority should not be merely a Department of Poor Law Administration, but should have the powers of the Sanitary Acts conferred upon it. (c) "That either the Board should be merged into such Central Authority or should itself be that Authority, in which case its constitution should be altered and adapted to its enlarged duties and responsibility." A Conference of the Sanitary Authorities was held at the Cannon Street Hotel, June 16th, 1878, upon the invitation of the Limehouse Board of Works, "on the subject of provision of Hospital accommodation for persons suffering from Infectious Diseases and at an adjourned meeting held 16th July, the delegates unanimously adopted a resolution, which in March, 1879, was presented by a deputation to the President of the Local Government Board, as follows:— "That in the opinion of this Conference, many almost insurmountable obstacles present themselves to the carrying out by the Vestries and District Boards of the Metropolis, of the powers conferred upon them by the 37th Section of the Sanitary Act, 1866, and it is further of opinion that it is desirable that provision should be made by Act of Parliament for one Authority, acting for the whole Metropolis, to provide Hospital accommodation for nonpauper persons suffering from Infectious Disease, and is further of opinion that such Authority should be as far as possible representative." The main object of the Conference, as it ultimately took shape, was to induce the Government to obtain Parliamentary powers to enable Local Sanitary Authorities to enter into contracts with the Asylums Board for the reception of non-pauper patients at the Managers' Hospitals—powers which were subsequently conferred by section 15 of the Poor Law Act, 1879. the section in question was allowed to remain a dead letter for a lengthened period, but in 1884 the Managers desired to put it into operation, a course that, under circumstances referred to elsewhere, was resisted by many Sanitary Authorities, and above all by your Vestry— the great conference, held at the Town Hall, meanwhile (in 1881), having unanimously committed the said Authorities to the principle of free admission to the Hospitals of all persons whose isolation was necessary to the public safety. 48 So much for the doings of the Sanitary Authorities acting in concert. Your Vestry's proceedings in the matter take precedence in point of time, dating from receipt of a circular letter from the Local Government Board (2nd January, 1877), in which the several Authorities were urged to provide hospital accommodation for the non-pauper sick under the 37th section of the Sanitary Act, 1866. Your Special Purposes Committee presented a report on this letter, 17th January, 1877, submitting "that it is inexpedient and unnecessary for the Vestry to provide hospital accommodation, seeing that the whole of the cases can be so easily dealt with by extending the powers of the Metropolitan Asylums Board, so as to enable them to provide for all persons in the Metropolis suffering from small-pox or other infectious disease, and requiring isolation in hospitals.". Upon consideration of the February communication from the Asylums Board, your Vestry concurred in the conclusions (a) (b) (c) above quoted, but further urged "that the expenses of persons not being paupers, admitted into the hospitals upon the recommendation of Vestries and District Boards, should be defrayed out of a Metropolitan Rate or Common Fund." My own views were fully set out in a report to your Vestry, dated January 10th, 1877, and in a subsequent communication to the Managers. They were to the effect that the Managers should " go on as heretofore providing accommodation for all comers that the cost of patients admitted upon the application of the Nuisance Authority should be borne by a Metropolitan Rate or Common Fund, and that relief in hospitals should be placed upon the same footing as public vaccination—i.e., should not pauperise. If these conditions were not admissible, I said that I would prefer " severance of the connection between poor-law administration and the hospital treatment of infectious diseases, by the constitution of a Central Authority (on the plan of the Metropolitan Board of Works), to be elected by the Vestries and District Boards of Works, and having power to provide accommodation for all persons whose isolation in hospitals is necessary for 49 venting the spread of disease." A detailed exposition of my views is contained in my Annual Report for 1876-7 (at pp. 14-17). These views found little favour eleven years ago, hut gradually Medical Officers of Health and Local Sanitary Authorities alike have adopted them, and I venture to predict that ere long they will be formally accepted by the Managers, with the sanction of the Local Government Board, and that the Asylums Board will become de jure what it is de facto, the Authority for providing free hospitals for all infectious persons in need of isolation. THE VESTRIES AND THE HOSPITAL QUESTION. When the Chairman of the Asylums Board proposed in the autumn to open the Northern Hospital, scarlet fever being epidemic, reference was made, not for the first time, to the alleged "laches'' of the Sanitary Authorities, who were blamed for not having provided Hospitals for "non-paupers." Some of the Managers indeed were for rejecting these cases, upon "economical" grounds, and under the impression that exclusion of them would put an end to the difficulty created, through want of accommodation, which arose solely from the refusal, by a temporary majority of the Board, to utilize an actually existing hospital. The old complaint was made that people who could pay did not pay for their treatment, it being forgotten, as usual, that if payment were enforced many of the patients would not go to hospital, but, by being kept at home, would spread disease to the common danger. Among Sanitary Authorities, from those at the Local Government Board downwards, there is now little question regarding the wisdom of free hospital treatment. The Times (December 6) in a leader referring to the epidemic, and dealing generally with the question of admission of all classes who desire to participate in the benefits afforded by the hospitals, expressed in felicitous terms views identical with those advocated by me any time these dozen years. The Hospitals are supported by and for the benefit 50 directly or indirectly, of the ratepayers, and the payment of rates should entitle to the protection, by isolation of the sick, which they afford. ARE LOCAL HOSPITALS NECESSARY OR DESIRABLE. Upon no subject, perhaps, has more unwisdom been uttered than upon that of local hospitals for the " nonpauper " infectious sick, for whom it is said the Sanitary Authorities should make provision. Constant reference has been made to the permissive powers conferred on the Nuisance Authori ties by sec 37 of the Sanitary Act, 1866, to provide hospitals " for the reception of the sick," and blame has been freely bestowed on those Authorities for their neglect to do so. But,as I have so often pointed out, the necessity for local hospitals was superseded by the enactment of the Metropolitan Poor Act, 1867, under the provisions of which hospitals adequate for the requirements of the population have been erected by the Asylums Board; the whole Metropolis for this purpose being constituted a single "District." It is admitted that from the very beginning these "pauper" hospitals have furnished accommodation out of all proportion to the needs of the "pauper" class. Substantially they have been regarded and used as hospitals for the poor of all classes. The only blot upon them was that admission nominally pauperised the patients. This blot was removed in 1 883, by the Diseases Prevention (Metropolis) Act of that year. Now, had the Sanitary Authorities built hospitals and taken in all "non-paupers," the first and enduring effect would have been to empty the "pauper" hospitals. The said Authorities might possibly have obtained power to take over the hospitals, and so provided for all the infectious sick. But there exists no means of compelling them to unite for the purpose. The work, moreover, can be properly done by a Central Authority only, and the only body at present existing capable of exercising the powers of a Central Authority is the Asylums Board ; and admirably—as regards provision of hospitals—have they done the work entrusted to them, The only 51 alternative to the use of the Managers' Hospitals would have been the provision of another set of Local or District Hospitals by the forty Sanitary Authorities, acting singly or in such combinations as could have been voluntarily brought about under the provisions of the Act of 1866. And this is the course, apparently, that the "economists" at the Asylums Board would have the Sanitary Authorities take. It would be interesting to calculate the amount saved to the Metropolis by the success of the opposition which your Vestry,at my instance, invariably opposed to the proposal—even when, as in January, 1877, it was recommended by the Local Government Board to each local authority, small-pox being widely prevalent at the time. Had Local Hospitals been provided they must have been made adequate for the reception of all cla sses of patients, fever and small-pox, and they must have been large enough to provide for the maximum needs of the several districts. The cost of building—say twenty hospitals, would have been great, and the cost of maintenance, if the hospitals were to be kept in constant readiness for use, would have been considerable. So far from "economy" resulting from the multiple-hospital system, there cannot be a doubt that it would have involved such an immensely enhanced expenditure,in first cost and annual outlay, as would have brought down endless reproaches upon the Authorities who had been so imprudent as to obey the (permissive) letter of the law when there was so obvious and common-sense an alternative in the system which is actually in use and works so well. The same ratepayers, as I have before observed, would have had to pay for both sets of hospitals; and if they have complained—not without reason in the past—of the expense entailed on them by the action of the Asylums Board, what would they have said had expenditure been needlessly increased, to an indefinite extent, by the suggested action on the part of the Vestries and District Boards? There is another consideration not to be lost sight of, moreover; viz., that any attempt to erect a number of local hospitals would have been opposed, thus leading to still further expense by costly litigation. Nobody is better informed on this subject than the Managers, by whom the accuracy of the statement, after their 52 own dear-bought experience, will not be questioned. The Board last year opened a new hospital at Winchmore Hill, and were at once threatened with legal proceedings in the event of acute cases being sent thereto! I shall conclude these observations with an extract from my report dated 10th January, 1877, only premising that the views I then expressed—not for the first time —are now generally accepted, and have, with so many other of my recommendations, since received the sanction of the high authority of the Hospitals Commission in their "Practical Recommendations" (1882). "The work" (of hospital provision, I wrote) "can be done more cheaply, more speedily, and more efficiently by one Central Board than by numerous Local Sanitary Authorities. The hospitals once built, moreover, and a skeleton staff of doctors, nurses, and other officers provided, we should be prepared for any epidemic, and should be spared the periodical recurrence of panics. On the. other hand, if Vestries and District Boards provide local hospitals, not only will the first outlay be great, but each hospital will require a staff of officers, got together with much expense, and with difficulty, only to be scattered at the close of the epidemic—and probably, after all, the hospitals will not be wanted, unless the beds in the Poor Law Hospitals should remain untenanted !" Much more might have been said on the subject, but it is unnecessary, for whatever theoretical objections may be made to the hospital system as it is worked (and we know that it is not worked altogether in accordance with the letter of the law), there can be no doubt that the public interests are studied in practice to the highest degree, and that in an informal way a machinery for dealing with infectious disease has been brought into operation in this Metropolis, which is at once honourable to those responsible for its creation, advantageous to the people, and the admiration of foreign nations. HOSPITAL ACCOMMODATION FOR "NON-PAUPERS." In several of my monthly reports, within the last three years, I have had occasion to refer to the proceedings of the 53 Asylums 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 non-pauper patients, for which provision was made by section 15 of the Poor Law Act, 1879 The subject being important, and the Managers being anxious to settle it upon a satisfactory basis, I think it well, upon the ground of historical interest, to recall the circumstances out of which it arose, and to explain the present position of affairs. It may be said, then, that prior to the passing of the above-named Act, the Managers had no legal power to receive "non-paupers" 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 indeed that, 54 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 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., was set out, showing that 36 out of 39 had replied: 14 were willing to enter into the proposed agreement; 15 for one reason or another declined; 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 among the dissentient authorities on grounds set out in my Annual Report for 1884 (pp. 101—117 55 inclusive), and which were communicated to the Managers, and the Local Government Board, and also to the several Vestries and District Boards, by many of which they were formally approved. The failure of the Managers' proposal may perhaps not unfairly be ascribed to the results of this action. It may be well, therefore, in this place, to re-state the views 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 the 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 empowered 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 of 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 (c) "That steps should be taken to alter, by Act of Parliament, the constitution 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 these 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 56 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 Conference of Sanitary Authorities held in the Town Hall in March, 1881,—which was presided over by the late Major-General Boileau, R.E., F.R.S.,—the following resolution was unanimously adopted, some 30 out of the 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." This 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, 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 fust 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. 57 It may be here mentioned that the Medical Officers of Health, who have no object to serve apart from the preservation of public health, are unanimous in their views on this question. The latest expression of their views is contained in a report by the Council of the Society of Medical Officers of Health (November, 1886), 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 an 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." The Local Government Board took no definite action with reference to the Managers' communication referring the question, as raised by section 15 of the Poor Law Act, 1879, to their disposal; but the Managers themselves, March 6th, 1887, decided "that application be made to the Local Government 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, if carried into effect, will, it may be hoped, involve the concession of free treatment of the sick, for which I have been contending now for many years. Here it may be explained, that the conditions which until recently regulated the admission of patients at the various infectious hospitals under the Managers' control are specified in the E 58 Order of the Local Government Board, dated 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 Hospital; 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), or latterly, by any other registered medical practitioner. In a valuable report prepared by the Ambulance Committee of the Asylums Board, 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 carriage 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." In 1884, however, when small-pox was prevalent, and upon the 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 set out in my Annual Report for that year— "a step the wisdom of which has never been challenged." The Managers are now 59 prepared to go much further. For an obvious reason 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 the Managers now see (what I pointed out in my report for 1884) that the "necessity of obtaining the Relieving Officer's 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, moreover, 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 smallpox 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." With the view to facilitate the admission of patients without unnecessary delay, the Managers had long been content to accept the certificate of any legally qualified medical practitioner combined with the order of a relieving officer. In June last they went a step further by the adoption of new "Regulations for the Removal of Small-pox and Fever Patients," which were framed so as to allow of the admission of patients upon the direct application of Medical Officers of Health, Medical Practitioners, and Sanitary Inspectors, subject E 2 60 to the production of a medical certificate stating "the name, age, and full address of the patient, from what disease suffering, and in cases of fever, the particular kind of fever;" thus doing what they had asked authority to do, knowing doubtless that it was not in the power of the Local Government Board to comply with their request. The Board raised no objection to the judicious action taken, in disregard of law, by the Managers; action which had consequences immediate and decisive, for no fewer than 40 per cent. of the cases admitted to the hospitals during the six months ended September 29th, 1887, were admitted without an order of a Relieving Officer. The Local Government Board, replying (in July) to the Managers letter, announced that "with a view to facilitate the removal of infectious cases they had issued an Order by which the certificate of any registered medical practitioner was legalised for the admission of any such person admitted to hospital upon the order of a Relieving Officer," a course I had suggested in November, 1875. The Order, however, makes no reference to the request of the Managers for authority to admit patients upon the application of Medical Practitioners, although it was known to the Board that such applications had been made and complied with more or less frequently since 1884, and especially during the recent epidemic of scarlet fever. The Managers, therefore, being unwilling to let the matter rest thus, resolved (October 8th):— "That the attention of the Local Government Board be directed to the fact that application was made to them on the 6th March last, 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 medical practitioners; and, inasmuch as the Order received on the 8th July only partially gives effect to this recommendation, they be urged to further consider that portion of the Ambulance Committee's report of the 31st January last, which directs attention to the inconvenience and delay often occasioned by the intervention of the relieving officer." The Board, in reply, intimated that they were of opinion that they were not empowered to issue an Order such as that suggested, and pointed out that the existing Regulations 61 authorised the Medical Superintendents to receive any persons who, when they present themselves for admission, are in such a condition that it would be dangerous to refuse admission. The Board's letter was referred to the General Purposes Committee, which comprises all the Managers; and it was pointed out that the Board must have overlooked the fact that the Regulations had reference only to persons who might present themselves at the hospital gates, and not to patients who, as in the great majority of instances, were conveyed in the Managers' ambulances. The Committee, therefore, recommended that the Managers should remind the Local Government Board that 40 per cent. of the patients recently admitted had been admitted without an order from a relieving officer, and that the Managers must, therefore, again seriously impress upon the Board the expediency and, indeed, the absolute necessity of taking steps without further delay to obtain from Parliament such powers as would directly authorise the Managers to remove to their hospitals all persons suffering from fever or small-pox, whose removal should be applied for by duly qualified medical practitioners. The report was unanimously adopted, and the Committee was authorised to seek a conference with the President of the Local Government Board on the subject. The Conference took place, and under date 16th December the Board stated, "with reference to the existing provisions under which patients suffering from fever or small-pox are admitted into the asylums provided by the Managers," that "they are of opinion that they are not empowered to confer upon the Managers, by any regulations which they could issue, the powers which the Managers desire," as mentioned above. "Having regard, however, to the difficulties which the deputation brought under the attention of the President, the Board will consider the question with a view to legislation in the coming Session, if circumstances should admit of it." Meanwhile, of course, the Managers continue to admit patients upon the application of medical practitioners. 62 I may add that the matter being one of public importance, and with a view of strengthening the hands of the Managers in their application to the Local Government Board, I brought it before the Society of Medical Officers of Health and the Council of the Sanitary Institute in October. Both bodies passed an identical resolution in the following terms:— "That this (Society or Council) has observed with satisfaction the efforts recently made by the Metropolitan Asylums Board to facilitate the admission of infectious cases to their hospitals, by removing patients upon the application, not only of Sanitary Officials, but also of duly qualified medical practitioners; and with regard to the request of the Managers to the Local Government Board 'for or to obtain authority for the Managers to remove patients upon the application of medical practitioners,' trusts that the desired authority will be conferred or obtained by the Local Government Board." It was ordered by both bodies that a copy of the above resolution be forwarded to the President of the Local Government Board, to the Asylums Board, and to the several Vestries and District Boards. Personally I note with satisfaction the proceedings of the Asylums Board in this matter, having regard to the difference between the Managers and myself thereon in July, 1884, resulting from the circular letter I then issued to medical men in this parish, in which I stated that the Managers would remove patients upon their application, subject to careful compliance with certain reasonable conditions as to the mode of making application, medical certificate, etc. There is now complete agreement between the Managers and myself with regard to the subject, and I look forward hopefully to the time when the Local Government Board shall have obtained powers to enable the Managers to do legally that which they are now doing, with public advantage, and with the Board's cognizance, but without express authority. That the desired powers will ultimately be conferred upon the Managers I entertain no doubt. And then, under arrangements for free treatment of the infectious sick, we shall have in the Hospital and Ambulance service, regarded in the light of a provision against epidemics, all that can be desired for the protection of the public health. 63 REGULATIONS FOR THE REMOVAL OF SMALL-POX AND FEVER PATIENTS. I have referred above to the increased facilities afforded by the Managers for the removal of the infectious sick, viz., upon the application of Medical men, Hospital Surgeons, and Sanitary Officials, new regulations having been framed by the Board, in June, 1887, with the obvious, if not expressed, intention of giving effect to their resolution to facilitate the admittance to their hospitals of patients suffering from infectious disease, without unnecessary formalities. Regulations 2 and 3 read as follows:— "2 Every application (i.e., for admission) must state the name, age, and full address of the patient, from what disease suffering, and in case of fever the particular kind of fever and also the name of the person making the application, and the Parish he represents. "Applications which do not give these particulars will be referred back to the applicant for the required information to be furnished. "3. The Medical Certificate or Order (i.e., of a Relieving Officer or Master of a Workhouse) for the admission of the patient must be handed to the nurse in charge of the Ambulance. Should neither of these documents be handed to the nurse, the patient will not be removed." Regulation 3 was necessary for the security of the Board and its officers; Regulation 2 provides, so far as public officials— Medical Officers of Health, Sanitary Inspectors, etc.— are concerned, all the facilities that could be desired. Under this regulation we are now enabled to (and do) remove patients without troubling the Relieving Officer for his order, or the District Medical Officer for his certificate. The certificate of anv registered medical man is now accepted, legally (as in 1875 I proposed that it should be), as evidence of the nature of the disease, and any person suffering from an infectious disease is now admitted to hospital upon the "application" of a registered medical practitioner, provided that the requirements of Regulation 2 are complied with and the medical certificate is forthcoming. 64 The Local Government Board, as already stated, cannot give the desired authorisation for admitting patients informally, but, doubtless, the Managers are satisfied that the Board will not object to the admirable system which they have adopted, and for which the Metropolis is indebted, in no slight degree, to your Vestry's action—a system which places London at the head of all great cities in regard to facilities for isolating infectious persons in hospitals: the hospitals themselves, and the ambulance service by which the patients are transported, being second to none, whether regard be had to the accommodation provided or to the speed and comfort with which the sick are removed. THE MODE OF ADMISSION OF PATIENTS TO THE HOSPITALS. This question came before the Managers in the autumn last year, and the information supplied shows that there is considerable variety of practice in the different districts, for while in some of them all of the admissions are upon the orders of the Poor Law Officials, in others patients are exclusively admitted upon the application of the Sanitary Authorities. The Chairman of the Board, referring to 1,200 patients received in the six weeks ended September 24th, stated that the cases admitted on the application of the Poor Law Officials were 720, or 60 per cent. of the whole; the applications by the Sanitary Officials being 349, or 29 per cent. Officials at general hospitals had sent in 103 patients or 8.5 per cent., while 25 patients, or 2 per cent., had been admitted upon the application of private medical practitioners*. Owing to this variety in the mode of *The Asylums Board have recently (May) published a return showing the number of cases admitted into the Board's Hospitals, between the 1st April, 1887, and the 31st March, 1888, a total of 7,614. Of this number 4,761 (=63 per cent.) were admitted with, and 2,853 (=37 0 per cent.) without an Order of a Believing Officer or Master of a Workhouse. The following numbers of patients were removed in the Managers' Ambulances:—Upon application by Poor-Law Officers, 4,348 (=57.2 percent.); by Sanitary Officials,2,129 (=27.9 per cent.); by Officials of General Hospitals, 761 (=10.0 per cent.); by private Medical Practitioners,211 (=2.8 per cent.); 111 persons were received from District Schools in Parish Ambulances (=1.5 per cent.); and 53 patients ( =0.7 per cent.) presented themselves at the Hospitals. 65 cation, the Chairman thought it would be difficult for the officials to form a correct idea of what the numbers of scarlet fever cases yet to come in might be. But with deference, I submitted (in my tenth report, October 12, p. 111) that the difficulty would be rather to predict the extent of the epidemic. The patients, whether sent in by the Poor Law Authority or by the Sanitary Authority, belong substantially to the same class, the variety in mode of application being mainly a question of practice, depending on substitution of one authority for another in certain districts. Be this as it may, a state of affairs has now been brought about which may well and reasonably satisfy all who take an interest in the sanitary welfare of the Metropolis. THE STATUS OF HOSPITAL PATIENTS. On various occasions statements have been made by Managers of the Asylums Board, Poor Law Guardians, and others, to the effect that many patients enter the hospitals who are able, and ought to be made, to pay for the relief afforded. That now and again such cases may occur I am not concerned to deny, but I am confident that the cases are fewer than might be supposed from the general character of the statements referred to. It is said, for instance, that four-fifths of the patients (80 per cent.) are not "paupers," and some years back a statement was made that 90 per cent. of the patients had not previously been in receipt of parochial relief. This may be true, but it does not follow that the patients were able to pay. Infectious disease is a serious calamity iu any circumstances. Its occurrence frequently deprives the bread-winner of work, and compels him, often against his instincts, to allow his child to be removed to hospital, that he may not lose the means of living for himself and family and thus possibly become a veritable ''pauper." Relief in hospitals no longer pauperises, otherwise it might truly be said that a large proportion of the persons who make use of 66 the hospitals are ''potential paupers"—that is, they are persons who, although able to pay their way in ordinary circumstances, are disabled by an outbreak of infectious disease in their families or themselves. Single persons, for example, male or female, living by service of whatever kind, who, while quite capable of supporting themselves in health or in ordinary sickness, are obliged to have recourse to hospitals when suffering from infectious disease. But apart from considerations of this sort, it must be obvious that it is just as important for the public welfare to isolate the infectious sick in hospitals as it is to pump water on a house on fire. More important, indeed, in the view of those who are disposed to value life and health above property. And there are people who consent to go to hospital, or allow their children to be sent, as an act of duty towards their neighbours, that they may not become the means of spreading disease. Removal, in a word, is effected by persuasion, and because it is for the public good. Would it be reasonable to try to make people pay in such circumstances ? They certainly would not pay; and the result would be that, the sick being kept at home, centres of infection would be multiplied. Then, when an epidemic had attained unmanageable dimensions, there would be an unanimous outcry for a free and open hospital system. Year by year the proportion of infectious cases admitted to the hospitals has been increasing, and to this fact, in large measure, is due the gratifying decrease in mortality from scarlet fever and typhoid fever elsewhere referred to. Statements of this kind are simple truisms to the initiated, but they are not matter of common knowledge; and it would seem that they are unknown to some of the Managers, very properly concerned in the economical administration of the affairs of the Asylums Board. The true economy in relation to infectious disease is to stamp it out as quickly as possible, and at whatever necessary cost. With all deference, be it said, moreover, that one fails to see why the Managers should concern themselves in the matter. Their drafts are duly honoured by the Boards of Guardians; and if the Vestries were their bankers the funds would come out of the 67 same ratepayers' pockets. Suppose that the Vestries were called upon to pay for the patients whom, as a matter of convenience and to avoid delay, they remove to hospital —the patients being the same people, whom otherwise the Guardians would remove— is it conceivable that they, as Sanitary Authorities, having medical advisers, would throw any difficulty in the way of isolation of the sick, by raising question of payment? It is now getting to be known throughout the country generally, that people will not pay for relief in Infectious Disease Hospitals, and that the demand for payment simply has the effect of preventing the hospitals from being used, much to the public disadvantage. But I repeat that, from one cause and another few of the people who use the hospitals are really in a position to pay. Probably Kensington is the richest parish in London, not to say in England, and here, if anywhere, we might expect that the sick would be able to pay. But what are the facts, as to the status of hospital patients ? I examined the record with regard to one hundred consecutive cases, and this is what 1 found: six were adults and ninety-four were children under 16. The 6 adults were described as domestic servants (2), draper's assistant, laundry assistant, wife of a paper hanger, and errand boy. The parents of the 94 children were described as follows:— Labourer 23 Laundress 2 Painter 9 Zinc Worker 1 Cabman 6 Stonemason 1 Coachman 5 Plumber 1 Porter 4 Plasterer 1 Police Officer 3 Coachpainter 1 Paper-hanger 3 Farrier 1 Sweep 3 Wheelwright 1 Single Woman 3 Hatter 1 Gasfitter 2 Hawker 1 Gilder 2 Soldier 1 Printer 2 Omnibus Conductor 1 Valet 2 Roadman 1 Shoemaker 2 Tailoress 1 Gardener 2 Charwoman 1 Carman 2 Caretaker 1 Horsekeeper 2 — Widow 2 Total 94 68 It is probable that "80 or 90 per cent." of these persons had not previously been "in receipt of parochial relief," but I repeat that it does not follow, therefore, that they were "able to pay" for hospital treatment. The Managers themselves, as a body, are recognizing not merely the duty, in the interests of public health, of admitting all comers, but the fact that few of their patients are able to pay. The subject came under their notice in March of the current year, when it was stated that the facts would show that not five per cent. of those thus admitted were of a class who could pay, and that not ten. per cent had friends who could pay part of their cost—statements well borne out by our experience in this "rich" parish, as set out above. It was further stated that the admissions had greatly benefited the Metropolis, in removing the feverstricken from among the population—a fact the accuracy of which will not be questioned by anyone conversant with the subject, but of which the importance is perhaps scarcely realized even now by a not inconsiderable section of those concerned in the "medical relief'' of the infectious sick. PAYMENT FOR NON-PAUPER CASES IN HOSPITALS. Certain charges incurred in the treatment of the sick in hospital are borne, in the first instance, by the Poor-law Authority of the Unions and Parishes from which the cases are removed, be the patients paupers or not. Not so very long ago, the Asylums Board desired to contract with the Yestries and District Boards for the reception and treatment of non-paupers: their proposal, however, not proving acceptable, fell through, under circumstances set forth in another place (vide page 54). As a rule, the Guardians pay for the cases sent in by the Sanitary Authorities or by medical men, without demur, but some little time back the Board of Guardians of St. Saviour's Union made objection to pay the cost of maintenance of a child admitted into one of the hospitals, presumably at the request of the Sanitary Authority, 69 and without an order from an officer of the Union. The Guardians referred the matter to the Local Government Board, who in due course informed the Guardians that they "could not doubt that the course which was taken in the case referred to," i.e., in removing the patient to hospital for isolation, "was desirable in the interest of the public health," and that they "could not advise them to raise any question as to their liability to repay the cost of the maintenance of the patient." The Board, moreover, reminded the Guardians that" the expense . . . . is one which is a charge on the Metropolitan Common Poor Fund, and is not borne by the Union." The Local Government Board having forwarded to the Asylums Board copy of their letter addressed to the St. Saviour's Guardians, the said letter (with covering letter) was ordered to be entered on the Minutes, a motion hostile to the principle of free treatment taking the form of a proposed reference of the letter to the General Purposes Committee, having been made, and defeated by 26 votes to 3. With reference to this case it may be pointed out that if the cost of the child's maintenance had been repaid by the Sanitary Authority it would have fallen upon the local ratepayers. Contending, as I have done, successfully so far, for free treatment of patients in the hospitals, I should be glad to see my proposal to throw all charges for maintenance and otherwise upon the Common Poor Fund directly, adopted, so as to obviate irritating differences, such as the above, between tho Poor Law and the Sanitary Authority respectively. THE HOSPITALS AND THE SANITARY ACTS. A Justice is enabled—sec. 26 Sanitary Act, 1866—by order, on a certificate signed by a duly registered medical practitioner, to direct the removal of any person suffering from a dangerous infectious disease, and being without proper lodging or accommodation, to a hospital "within the district" of the Nuisance Authority. It is in the power of the Local Government Board to issue an Order, under section 51 of the Sanitary Law 70 ment Act, 1876, declaring the Managers' Hospitals to be within a convenient distance of any of the sanitary districts in the Metropolis for the purpose of the section first cited. Upon the issue of such an Order every hospital named therein "shall be deemed to be within the district" of the named Sanitary Authority. The Board have not issued an Order hitherto, but it is desirable that such an Order should be issued (although the occasions are few on which it is found necessary to exercise the compulsory powers of removal), seeing that the hospitals are only six in number, while the Sanitary Districts are forty. Certain of the Sanitary Authorities whose districts are more or less remote from the hospitals, having made application to the Board to issue an Order, their communications were referred by the Board to the Asylums Board for "any observations that the Managers may desire to offer upon this question." The Managers having considered the question stated that they "had no observations to offer . . . . although they would be prepared to carry out any instructions which the Local Government Board may issue in reference to the section of the Act referred to"—an important proviso, seeing that before any person can be removed to a "hospital for the reception of the sick" by justice's order, "the consent of the superintending body of such hospital " must be obtained. SMALL-POX HOSPITAL ACCOMMODATION. The Royal Commission (of 1882), 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. But 71 the Gore Farm Estate, comprising some 135 acres at Darenth, is always available upon emergency for the erection of huts, tents, &c., equal to any probable demand for accommodation. The Managers proposed to erect on this site a permanent hospital, to contain ultimately one thousand beds, mainly for convalescent patients. The plans were formally approved by the Local Government Board in July, 1884, and it was anticipated that by this time the hospital would have been built. But the Board seeing reason for changing their views, opposed the scheme for building a permanent hospital, being willing however to sanction the necessary expenditure for the construction of wooden huts, which they considered to be well suited for the purpose. The Managers, on the other hand, adhered to their opinion that wood is an objectionable material for the construction of a small-pox hospital. But this was not the only ground of difference between the two Authorities, for while the Board desired that a permanent hospital should be erected on the site of the North and South Camps, the Managers had decisively condemned that site as unsuitable, and chosen another, higher up, described as the "plateau site," in a secure and sheltered position, which they considered in every way preferable. Owing to these differences no steps were taken towards the erection of the hospital in 1887, but at the meeting of the Managers, held September 24, a communication was read intimating that the Board would not further press their objections to the plateau site, and giving consent to the use of brick in the construction of the so-called "hut-hospital." The differences being thus happily composed, it is not necessary to refer to them any further than to mention that in my monthly reports I summarised the correspondence, as it proceeded, and the reports of subcommittees appointed by the Managers. Fortunately, moreover, owing to the almost absolute freedom of the metropolis from small-pox, there has been no need hitherto for the proposed hospital, which is to contain accommodation for six hundred convalescing small-pox patients, with administrative building capable of serving one thousand 72 The plans having been approved by the Managers, and the assent of the Local Government Board obtained, the Small-Pox Hospitals Committee were authorised, in January of the current year, to invite tenders upon specifications to be prepared by the Architects. The Committee in their report stated that their efforts had been " directed to the preparation of plans for a hospital which, whilst it provides accommodation suitable in character and adequate in dimensions, shall be erected, maintained and administered at a mimimum cost." They claim moreover, to have been "so far successful that the present plans, although providing for the same number of patients, and for the same possible increase as that previously (in 1884) considered, are estimated to cost but little more than half the amount then contemplated." This, however, is "partly due to the proposed retention of the Infirmary and Laundry at the South Camp." The delay, therefore, is seen to have been productive of nothing but good, for a better site has been obtained, through the persistency of the Managers, whilst the utmost economy of construction will have resulted from the action of the Local Government Board, who, in their letter of assent, state that ''the estimated cost of the buildings, which, according to the plans submitted (and approved) in 1884, it was then proposed to erect for the purpose of the hospital, was £116,000, whereas the cost of carrying out the new plans, including the extensive utilisation of the existing buildings remaining from the North and South Camps," which will "form an essential feature of the proposed new hospital,'' is estimated at £66,142. The accommodation to be provided is, for males 250, females and children 350, in two groups of five and seven huts respectively, each hut providing for 50 beds. The hospital has been designed for convalescing patients no longer needing medical treatment or nursing ; and it is proposed to utilise the Camp buildings for Infirmary purposes. Two infirmary wards will be removed from the North Camp to the South Camp, where there will then be eight infirmary wards affording accommodation for 128 beds in all. The laundry is to be retained for use of the Hospital and 73 Infirmary alike, the kitchen for the Infirmary only. Mess rooms and dormitories for the female staff will be provided by adaptation of existing buildings, which will, with slight alteration, afford similar accommodation for the laundry staff; other buildings, after removal, being set apart for the use of the kitchen staff, nurses, and ward servants. Numerous other reconstructions and adaptations are also contemplated—all of which are set out in the architects' report—the cost being included in the above estimate. When the new hospital shall have been constructed, the available accommodation will provide—in town, on the river, and at Darenth—for some 1,200 patients, or less than half the maximum indicated by the Royal Commission. But huts can be rapidly extemporised to any required extent in case of emergency. Moreover, it may be anticipated, as the Managers will remove every small-pox patient out of London, when removal can be effected with safety—and, happily, this is usually the case—that hospital accommodation in the future will not be required to the amount provided during recent epidemics. The Hospital Ships.—A proposal was pressed upon the Asylums Board, notably by the Islington Board of Guardians, and supported by a section of the Managers who had warrant for their proceedings in advice tendered by the Local Government Board, to close the Hospital Ships, the Guardians believing that money would be saved if the sporadic cases of small-pox, which occur between epidemic periods, were treated in the London Hospitals, instead of being taken down the river. The money saving would not be considerable in any case, and certainly not so large as has been supposed, for it would be necessary to make provision at three hospitals (the Eastern, the South-Eastern, and the Western), for the reception of sporadic cases of small-pox, and it is not probable that the expense of maintaining the necessary staff, for the male and female wards, in these hospitals, would fall far short of the cost of maintaining the ships in a state of constant readiness, now that the expenditure of the Managers appears to be governed by strict economy. It has to be remembered, moreover, that on F 74 every occasion when small-pox has been treated in the town hospitals, the disease has spread around those hospitals, with the effect that for many years, until patients were taken direct to the Ships, small-pox was rarely, if ever, absent from the Metropolis. The existence of the disease entailed heavy expenditure in maintenance of the Hospitals in London, and of the Ships at Long Reach, as well as of the Camps at Darenth, to say nothing of the money value of an annual average number of precious lives, upwards of 1,000, sacrificed to the loathsome disease. Since it has been the rule to take the sick out of London altogether, a plan which I proposed in 1881, the epidemic, which was chronic before, has practically ceased. If this result is due to the fact of removal, which has been made possible by the existence of the Ships, no better investment of public money was ever made. The subject came before your Yestry, and a communication was forwarded to the Managers in opposition to the proposal to close the Ships, a proposal to which happily a large majority of the Board was opposed. The Managers have kept steadily to their resolution to remove to the Ships all cases of small-pox, when such removal is not likely to prove prejudicial to the patient's prospect of recovery. Extravagant outlay, properly so described, is to be condemned, but it is true economy to be prepared for any emergency, and, in my opinion, the Local Government Board did wisely in making the suggestion, a few years ago—but it has not been carried out hitherto—that the Managers should endeavour to obtain a site to the west or south-west of the Metropolis, which should be available for an additional hospital for convalescent patients—having in view the possible exigencies of au epidemic, and taking into account the requirements of London as a whole. 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." 75 The beds available at the five London hospitals, at the date of my last annual report, were about 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 obtained at Winchmore Hill, nine miles north-east from Charing Cross, on which the "Northern Hospital" for between 400 and 500 patients has been erected. The total provision for fever is now nearly 1,900 beds, a number that falls far short of the recommendation of the Commission. "On the other hand,'' as we were told by the Asylums Board in May last year, "the number of fever patients annually under treatment at any one time during 1886, though in advance of those of the eight previous years, has not exceeded 742," so that, as it was 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." The recommendation of the Commission, however, has been justified by the experience of 1887, when the requirements of the epidemic of scarlet fever obliged the Managers to re-open the hospitals that had been closed, exhausted the accommodation at all the town hospitals, compelled them to hire the Plaistow Hospital at West Ham, and to open the new Northern Convalescent Hospital at Winchmore Hill, and necessitated the erection of temporary huts at the Eastern, the SouthEastern, and the South-Western Hospitals, as well as at the Northern Hospital, where at one time upwards of 700 patients were accommodated. In all some 2,700 beds were provided by the Managers, the maximum number of patients at one time being about 2,600. What happened in 1887 may happen again, for the very satisfactory reason that the Managers' Hospitals have F 2 76 attained a popularity certain to lead to increased use of them in the future by people in need of isolation ; the fact being that the strain was due in large degree to the greater proportion of the sick removed to hospital as compared with previous years. Evidence of this fact is furnished, as regards our own parish, by the figures set out in the Table at page 33. The experience of 1887 accentuates the necessity for additional accommodation as recommended by the Commission, and the matter should be taken in hand while the temporary huts remain. The outlay in erecting these huts was probably almost sufficient to defray the cost of a brick hospital. But the "party of economy at the Asylums Board are averse to building. They thought the Northern Hospital unnecessary, and successfully opposed its use for some weeks, after the necessity had become apparent enough to other persons; and having qua this subject become a majority at the Board in the autumn, they would have persisted even longer in their opposition but for the pressure put upon them by the Local Government Board, and the remonstrances of the exponents of public opinion. WESTERN (FULHAM) HOSPITAL. At a Board meeting in February, 1888, the General Purposes Committee were instructed to consider and report to the Managers as to how far it may be practicable to increase the accommodation for fever patients at the several Hospitals, and at the meeting of the Managers on the 21st April, they submitted a memorandum received from the Western Hospital Committee, respecting the necessity of providing further accommodation for fever patients at that Hospital—a course which would involve the acquisition of additional land, available to the north or the south of the site, as no further accommodation can be provided on the existing site. The Hospital contains at present only 252 beds, and ''the experience gained during the late prevalence of scarlatina shows that it is not large enough to receive all the cases arising in the districts allotted to it, inasmuch as after the Hospital was filled, cases that should 77 have been admitted had to be taken—in 1887—to other Hospitals" to the number of 355*—a course which " necessarily occasioned great loss of time and waste of labour, as well as an increased expense to the Ambulance Department." The Committee point out that ''the administration of the Hospital is very expensive pro rata with the number of patients, and that the present staff with a few additional nurses and other subordinate officers would be sufficient for a Hospital twice the size." Therefore, and "taking into account the large and increasing population of the district, as well as the increasing use made of the Hospitals," the Committee consider it advisable to add considerably to the existing accommodation, and they submit that beds should be provided for at least 400 fever cases, irrespective of those to be allotted to small-pox. The General Purposes Committee recommended that the Memorandum be forwarded to the Local Government Board "with the view to the attention of the President being especially directed thereto in connection with a recent resolution of the Managers regarding the compulsory acquisition of additional land adjacent to the existing sites of the Infectious Hospitals of the Board." There can be no doubt that it would tend to economy if provision were made for as many patients at each hospital as can be properly accommodated. The Report of the General Purposes Committee was adopted by the Managers. Reference to the work of the Asylums Board as the Hospital Authorities may fitly be completed by stating that in 1887, cases were admitted at the several hospitals as follows:—smallpox 63, scarlet fever 5,933, typhus fever 38, enteric fever 500, "other diseases," 66; total, 6,600. The numbers admitted in the previous year were 2,298. In 1885 the admissions were 8,253, including 6,391 suffering from small-pox; scarlet fever patients being 1,394, typhus fever 54, and enteric fever 226. The following Table supplies information of considerable interest with respect to the admissions in 1887:— *Of these 355 cases, 152 were sent to the Novth-Western (Hampstead) Hospital, 79 to the South-Western (Stockwell), 106 to the South-Eastern (Deptford), and 18 to the Eastern (Homerton). Table shewing Quarterly and Total Admissions of Small-Pox and Fever Patients at the Asylums Board Hospitals in 1887, and Population of the several Parishes, Unions, and Districts in 1881. Parishes, Unions, &c. Small-Pox. Total. Scarlet Fever. Total. Enteric Fever. Total. Grand Total. Small-Pox and Fever. Population in 1881. 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 5 29 115 165 314 2 1 3 5 11 326 163,251 Fulham ... ... ... ... ... 18 40 67 92 217 2 5 2 2 11 228 114,839 Paddington 1 ... ... 1 2 32 18 55 128 233 ... ... 1 2 3 238 107,218 Chelsea ... ... ... ... ... 6 17 45 90 158 2 2 6 12 22 180 88,128 St. George's 1 ... ... ... 1 27 32 95 113 267 ... ... 4 4 8 276 49,748 Westminster 1 ... 2 ... 3 8 4 28 43 83 ... ... 2 1 3 89 1337 46,549 669,633 Northern District. St. Marylebone ... ... ... ... ... 24 40 165 146 375 2 ... 4 5 11 386 154,910 St. Pancras ... ... ... 2 2 25 26 90 148 289 1 ... 2 4 7 298 236,251 Hampstead ... ... ... ... ... 11 4 9 12 36 ... ... ... ... ... 36 45,452 Islington ... ... ... ... ... 24 28 76 134 262 4 4 16 22 46 308 282,865 Hackney ... 5 ... 1 6 20 25 61 117 223 6 3 20 30 59 288 1316 186,462 905,947 Central District. St. Giles and St. George ... ... ... ... ... 4 8 16 63 91 2 2 ... 3 7 98 45,382 Strand ... ... ... ... ... 8 5 20 27 60 ... ... 2 ... 2 62 33,582 Holborn ... ... ... 1 1 52 37 159 161 409 2 2 9 13 26 436 151,835 London, City of ... ... ... ... ... 6 14 25 26 71 ... ... 1 ... 1 72 668 57,439 282,238 rn District. Shoreditch ... ... ... ... ... 20 17 46 112 195 4 2 11 18 35 230 126,591 Bethnal Green ... ... 1 1 2 21 7 50 95 173 6 7 7 4 24 199 126,961 Whitechapel 2 ... ... 5 7 8 17 59 58 142 ... ... 1 1 2 151 71,363 St. George's-in-the-East 2 ... 1 4 7 7 14 21 29 71 4 ... ... 7 11 89 47,157 Stepney 1 ... ... 1 2 7 7 26 34 74 4 ... 1 8 13 89 58,243 Mile End Old Town ... ... ... 1 1 2 8 27 60 97 1 3 3 7 14 112 105,613 Poplar 1 3 1 6 11 2 7 23 39 71 2 1 12 12 27 109 979 156,510 692,438 Southern District. St. Saviour's ... ... 1 2 3 18 57 123 190 388 4 4 7 8 23 414 195,164 St. Olave's ... ... ... 3 3 7 12 75 81 175 2 ... 2 15 19 197 134,632 Lambeth ... ... ... 1 1 39 59 221 306 625 1 5 7 10 23 649 253,699 Wandsworth and Clapham ... ... ... 1 1 19 35 120 245 419 6 5 13 20 44 464 210,434 Camberwell ... ... ... ... ... 30 17 51 168 266 1 ... 4 13 18 284 186,593 Greenwich ... ... 1 ... 1 6 19 22 39 86 5 ... 5 5 15 102 131,233 Woolwich 1 7 ... ... 8 ... ... 5 6 11 ... ... 1 10 11 30 80,845 Lewisham ... ... ... ... ... 7 3 26 16 52 ... ... 1 3 4 56 2196 73,337 1,265,937 10 16 7 30 63 463 606 1921 2943 5933 63 46 147 244 500 6496 6496 In addition to cases in Table, 38 of typhus were admitted, viz., 9, 7, 5, and 4 from St. Saviour's, Camberwell, Whitechapel, and Chelsea; 3 each from St. Giles', Bloomsbury, and Stepney; 2 from Bethnal Green; and one each from City of London, St. Olave, St. George's East, Poplar, and Islington; 66 cases of "other diseases" were admitted through error in diagnosis. 80 The Admissions at the "Western Hospitals in 1887 were 1,185, viz:—940 from the Parishes and Unions in the West District, and 245 from other districts. These latter cases were admitted while the North-Western (Hampstead) Hospital and the South-Western (Stockwell) Hospital were closed. For economical reasons, and not being required, the North-Western Hospital was closed in January, 1886, and not re-opened until August, 1887, upon the supervention of the Scarlet Fever epidemic. In like manner the South-Western Hospital was closed in August, .1886, and re-opened in September, 1887. The Managers have recently (April) closed this Hospital again, the epidemic being at an end; some of those, however, who were opposed to the opening of the Northern Hospital preferred that that institution should be closed instead. Their views happily did not prevail, and it is clearly desirable that the Northern Hospital should be in permanent use as a Convalescent Home, especially for children recovering from fever. 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, obtained from the Local Government Board the necessary authorisation, and registered practitioners are now eligible to be appointed,with the status of assistant medical officer, the period of residence being limited to three months. The arrangement is prospectively advantageous, seeing how greatly the opportunities of medical students for studying infectious diseases have been curtailed, not to say annihilated, as regards small-pox, scarlet fever, etc., by exclusion from general hospitals of sufferers from these diseases. But young medical men have not shown that desire to avail themselves of the advantages which might have been expected. 81 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 (Eastern at Homerton, South-Eastern at Deptford, and Western at Fulham), 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. 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. WHARVES. The Managershave 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, in the event of an epidemic of small-pox, Kensington patients will embark for the voyage to the hospital ships at Long Reach and the hospital at Darenth, but which is also intended for the accommodation of the Western District generally, has long since been completed. But hitherto it has not been found necessary to bring it into use. Owing to the great distance between the Western Hospital and the districts allocated to it, and the South Wharf, at Rotherhithe, to which the patients are at present sent for embarcation, the number of miles travelled by the ambulances is excessive. 82 RIVER AMBULANCE SERVICE. The Managers possess in their three Ambulance steamers, Bed 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, and, of course, in different years. REPORT 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 River 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 Reach. The Committee reported 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 "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 referred with justifiable satisfaction to the "entire freedom from casualty involving personal injury, with which the transport of patients, both by land and water, had 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" (the Committee then thought) 83 "may be taken as an approximate indication of the work likely to be required, unier present conditions, in any year when small-pox is not prevalent in the Metropolis." The Committee's third report, for 1887, as they say, "presents a marked contrast to that of the preceding year, and, so far as the number of fever patients removed to hospital, is unprecedented in the history of the Board." The cases removed were 6,394 in number; but, as usual, the work was unevenly distributed : the average daily removals during the first six months were only 6.7, against a daily average of 29.1 in the second half of the year. "The number of removals" is "heaviest in the late hours of the day—indeed many having been effected between 12 p.m. and 3 a.m.," the result being " much extra expense and inconvenience to the Ambulance service and disturbance of the sleep of the patients in the hospital wards by the entrance of fresh cases during the night." In addition to the first removal of acute cases of fever (6,394) from homes to hospitals, there were 3,093 removals of convalescents, viz., 1,793 to the Northern and other Hospitals, 1,088 of recovered cases from the Northern Hospital to Town Hospitals for discharge, and 212 from Hospitals to homes, making a total of 9,487 Fever patients removed by the Ambulances of the Board. By judicious measures for the removal of patients to the Convalescent Hospital at Winchmore Hill, the work was effected with great economy; the cost of each patient's removal averaging only one shilling and sevenpence for horse hire and driver's wages, although the distance to be traversed is considerable, the hospital being about nine miles from Charing Cross. The lowest number of patients removed in any one month was 165, in March; the highest number of Fever patients removed was 1,361, in October. Scarlet fever was the prevalent disease of the year, and beds for 2,700 patients were provided, the maximum number occupied at one time being 2,611. The position of affairs was often "critical" owing to the "rapid influx of patients," but all 84 difficulties were overcome, not one patient being refused admission. One hundred and six patients certified to be suffering from small-pox were removed. "They were taken in the first instance to one of the Town Hospitals, and those found to have small-pox were conveyed to the Hospital Ships : 44 cases, however, were found not to have the disease, and were sent back to their homes." "The number of small-pox admissions increased during the latter months of the year," the cases being generally "traceable to infected persons arriving in London." "Information as to the probable cause of an outbreak coming to the knowledge of the Committee was at once communicated to the Medical Officer of the District concerned," and "this no doubt materially assisted in the success of the measures taken to prevent the spread of the disease. Outbreaks occurred in 17 out of 30 Parishes and Unions comprising the Metropolitan (Poor Law) District, but did not in any instance assume serious proportions." The Steamers, Redcross, Maltese Cross, Albert Victor, Swallow (steam pinnace), and Marguerite (steam launch), were all employed in turn, and ran in the aggregate 5,802 miles. The cost of the river service was nearly £5,000, that of the land service being about £6,000. Referrine; to the cost of the River Service, the Oommittee observe that " the justification for this expenditure cannot be sought in work actually performed, so much as in the maintenance in constant readiness for immediate expansion of an organisation the value of which, in the event of a small-pox epidemic arising, cannot be exaggerated, and which could not then be established without serious delay, and only by an extravagant outlay." The Committee report "considerable delay in the removal of patients still caused by the intervention of the Relieving Officer," and note with satisfaction that this subject is " receiving the serious attention of the Local Government Board." The work of the department, though so much greater in extent than in the preceding year, was unattended with any 85 accident affecting the safety or comfort of a patient. No higher praise can be awarded to the Committee, or to the superior officers who, " by their vigilant maintenance of discipline, or to the subordinates, who, by their careful and steady conduct, contributed to this result," than is implied in this simple statement of fact. 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 at present unlawful, provided that the person hiring or using the vehicle gives notice 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. 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 h iving sometimes been experienced in getting the vehicle disinfected, the Assistant Commissioner of Metropolitan Police placed himself in communication with the several Sanitary 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 86 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,—and in the result the Assistant Commissioner was informed: (a) "That the Managers are not prepared to undertake the disinfection of public vehicles, as they are of opinion that such disinfection cannot be efficiently performed owing to the visual construction of those vehicles; (b) "That the Managers consider that the conveyance of tious cases by public vehicles should be prohibited by law; (c) "That 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." 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 must 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 a mbulances 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, suggesting for the consideration of the Managers, ''whether it would not 87 be practicable to place disengaged ambulances at the service of tbe medical profession and Medical Officers of Health for the conveyance of such cases—either with or without payment" ? The cases (I added) "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 Report for 1884 (page 86) on this reply, I said, "I do not doubt that the Managers will, in course of time, recognize the desirableness, and, I may say, the propriety of doing what I suggested." The time has now arrived, the Managers having recently (April, 1888) adopted a report on the subject by the Ambulance Committee, in which they observe that "The Managers cannot, with their present powers, undertake the removal of all infectious cases; but taking into consideration the various circumstances under which, owing to the absence of specially provided vehicles, infection may be and undoubtedly is spread in the Metropolis, and believing that a large proportion of patients requiring such conveyances would be found to be in a position to pay any reasonable charge for such service, your Committee are of opinion that it would be in the interests of the public health if some Central Authority were empowered to undertake the conveyance of all persons suffering from infectious disorders within the Metropolitan District, with power to make such charges as might appear to it reasonable for such conveyance and to recover payment thereof. The Asylums Board having the appliances necessary for the purpose, are in the opinion of your Committee the Authority able to do this work with economy and efficiency, and your Committee recommend that these views be submitted to the Local Government Board." 88 The Hoard had enquired (February 3rd, 1887), "Whether, in the event of the Managers undertaking to effect the removal of all cases of infectious disease occurring in the Metropolis, they could do so without incurring the expense cf providing another ambulance station, and what additional staff would be required by them ? " to which the Managers replied that "no other ambulance station would be necessary, and that the only additional staff required would be drivers and stablemen in proportion to the increased number of applications for removal." The report of the Committee having been adopted they were empowered to seek an interview with the President of the Local Government Board on the subject. COMPULSORY NOTIFICATION OF INFECTIOUS DISEASE. In my ninth monthly Report, dated 12th September, 1887 (page 80), I wrote on this subject as follows:— " The facts (cited in the report) relating to the spread of scarlet fever show the necessity for a General Act providing for immediate notice to be given to the Sanitary Authority of the occurrence of infectious disease. There is now no difference of opinion among Sanitarians as to the necessity for such a measure; the only difference that exists is as to the proper mode of carrying the principle into effect. Many provincial towns have obtained the requisite powers. In some of them the duty of reporting the illness devolves upon the medical attendant; in others upon some member of the family of the sick person; occasionally both the doctor and the parent are required to notify the illness—the so-called 'dual system'—aud in every case a small fee is payable to the medical man for his certificate. Theoretical objections have been raised to the system of Notification, and especially to the obligatory nature of the duty cast by legislation upon the medical attendant. But in practice the system has worked well, and with far less friction than was anticipated. It is very unfortunate that Loudon should be without the protection afforded to many minor towns. The necessity for legislation is acutely felt in epidemic times like the present, which seems a suitable one for directing the attention of the Local Government Board to the subject, with a view to the introduction of a measure next session. We know that the Board is favourable to the principle which is approved by its medical advisers, 89 in the sanitary and poor law departments alike, and there can be no doubt that any moderate measure would receive favourable consideration from both Houses of Parliament. In this connexion it may be mentioned that in 1882 a Select Committee of the House of Commons, of which Lord Basing (then Mr. Sclater-Booth), an ex-president of the Local Government Board, was chairman, not only reported that they had ' little difficulty in forming the opinion that the time had arrived when provisions of law on this subject (notification) may be sanctioned, at least in the more important Urban Sanitary Districts,' but also framed a 'model clause' which has since been incorporated in divers local Acts, and the terms of which are set out in my last Annual Report, at page 67. The Asylums Board we know to be well disposed to promote legislation in this direction. To what extent the forty Sanitary Authorities of the Metropolis are prepared to go in the matter I am not able to state ; but there is no doubt as to the advice they will receive from the Medical Officers of Health, should the subject be brought under their notice. It seems to me very desirable that a communication should be addressed to the several Vestries and District Boards, so as to elicit their opinions, with a view to combined action by an appeal to the Government to procure a general Act, or an Act limited to the Metropolis. Should such an application be made unsuccessfully, I trust that your Vestry, either alone, or in conjunction with others, may be disposed to take the necessary steps to obtain a 'Local Act,' in the terms, with necessary modifications, of the 'Model Clause.' " I have reproduced the above passage because it had the desired result of re-opening the question of Compulsory Notification, and was productive of action which promises to bear fruit in the near future. But before stating what form that action took I think it desirable to submit a resume of the proceedings taken under the leading of your Vestry, in 1881, when the matter was first taken vigorously in hand by the Metropolitan Sanitary Authorities. In my monthly Reports for November and December, 1880, I had referred, not for the first time, to the necessity for legislation to secure Notification, and in January, 1881, your Vestry, on the motion of Mr. C. H. Campbell, J.P., unanimously adopted a resolution approving "the principle of compulsory intimation to the Public Health Authority of all cases of such diseases as small-pox, scarlet fever, diphtheria, typhus, typhoid, and cholera." G 90 By a further resolution the several Vestries and District Boards were invited to send delegates to a Conference, with a view to joint action to promote legislation; and a Memorandum on the subject, which I had prepared, was sent to every member of each of the Sanitary Authorities, together with draft resolutions, so that these bodies might decide upon the course proper to be taken, with full knowledge of the views of vour Vestry. The Conference was held March 23rd, 1881, twenty-four Vestries and District Boards being directly represented by delegates, and other six by their Medical Officers of Health. Twenty-three Medical Officers of Health were present. The Conference unanimously adopted the drafted resolution on Notification as follows:— "That, in the interests of Public Health, and to enable Nuisance Authorities to discharge the duty of checking and preventing the spread of Infectious Diseases, such as Small-Pox, Fever, &c., provision should be made by legislative enactment to secure the Compulsory disclosure to the said Authorities of all cases of such Diseases immediately upon their occurrence." The other proposed resolutions, in favour of free hospital treatment of infectious diseases, depauperisation of medical relief in infectious disease hospitals, and maintenance of the hospitals out of the Common Poor Fund, were also unanimously adopted by the Conference, and it may be said, by way of parenthesis, that all of the objects sought to be obtained have now been secured, practically, save only Compulsory Notification of Infectious Diseases. Copies of the resolutions were directed to be forwarded to the several Vestries and District Boards, to the Commissioners of Sewers, to the Council of the British Medical Association, to the Council of the Society of Medical Officers of Health, to the Council of the Social Science Association, to the Managers of the Metropolitan Asylums Board, and to the several Boards of Guardians. The Vestries and District Boards were invited to appoint delegates to take part in a deputation to the Local Government Board to present the resolutions; the other 91 bodies named being invited to co-operate with the Sanitary Authorities with a view to securing the objects embraced in the resolutions. The subject of Notification had been considered by the Society of Medical Officers of Health, in view of the proposed Conference, and a resolution as follows adopted:— "That in the opinion of the Society, whenever a case of infections disease occurs in any house or vessel, it should be a legal obligation on the person in charge of the house or vessel, or on the person in charge of the case, to report the fact to the Sanitary Authority without delay. "That it should be a legal obligation on every Medical Practitioner in attendance on any such case, to give immediate written information respecting its nature to the occupier or other person responsible for reporting it to the Sanitary Authority." It may be added that, subsequently to the Conference, a meeting of the Metropolitan Poor Law Guardians Association (29th April, 1881), after hearing a paper by Mr. Rutherglen, Clerk to the Kensington Guardians, on "The difficulties as to isolation and treatment of cases of small-pox and fever in the Metropolis," unanimously resolved: — "That the Government be asked to include " (in a proposed Act) "provision for the compulsory notification of Infectious Diseases." And on May 28th of the same year, the Asylums Board directed a communication to be made to the Local Government Board, to the effect that, in their opinion, "Provision should be made in any new Act for the compulsory notification of any infectious or contagious disease, in every class of the community to the respective Sanitary Authorities." But to resume: The deputation waited upon the President of the Local Government Board (Right Hon. J. G. Dodson), 23rd April, 1881. It was introduced by Mr. G. Hastings, M.P., and Dr. Farquharson, M.P. The resolutions were spoken to by the late Major-General Boileau, R.E., F.R.S., for the Sanitary Authorities; by Dr. Alfred Carpenter, J.P., for the Council of the British Medical Association; by Dr. Bristowe, F.R.S., for the Council of the Society of Medical G 2 92 Officers of Health; by Mr. Michael, Q.C., for the Social Science Association (Public Health Section); and by Mr. Ernest Hart, for the National Health Society. As an expression of opinion from the official, the professional, and the general public point of view respectively, nothing could well have been more impressive than this great deputation, or more weighty than the statements brought under the President's notice. Nothing, however, to appearance, could well have been more discouraging than the President's reception of the deputation, followed by the stereotyped promise to give the matter his best consideration. But, quite unexpectedly, it may be added, results of vital importance to the health of the Metropolis were the almost accidental outcome of the meeting. The President had spoken of Notification as of little value unless hospital accommodation were provided. The hospital question, he said, was underlying the whole of the subjects brought to his notice—at a time when all available accommodation had been exhausted, and multitudes of small-pox patients were lying in their own homes, acting as so many centres of infection. He pressed, therefore, for definite information "How was the emergency to be met?'' At the request of the deputation, I stated my views to the effect that small-pox patients should be removed out of London altogether. This plan, almost immediately afterwards recommended by the President to the Asylums Board, was by that body carried into effect, with remarkable energy and with lasting benefit to the Metropolis. The Conference then appeared to be a failure. But good seed had been sown; public attention had been drawn to the subject of Notification, which was advocated in a leader in the Times ; and although nearly seven years were to elapse before your Vestry should again take it up, much discussion helped to enlighten public opinion and prepare the way for legislation. Meanwhile, utterances of weight were not wanting. Thus, Dr. George Buchanan, the Medical Officer to the Local 93 ment Board, in his Annual Report for 1881-2, had expressed his views on the subject in the following terms:— "Seeing how greatly the usefulness of sanitary action in respect of infectious disease must depend upon early knowledge of its presence, I have had no hesitation in advising that this power (i. e., of obtaining immediate information of the existence of infectious disease in a house) might properly be possessed by any Sanitary Authority who wanted it, and who, having made adequate arrangements for securing isolation and disinfection for the district, was prepared to put to effective use the knowledge which a system of diseasenotification would afford." In the same year (1882) the British Medical Association, at its Jubilee Meeting, held at Worcester, passed a resolution in favour of compulsory notification, and the Hospitals Commission endorsed the principle in their Report, in the following terms:— "We think that every person suffering from an infectious disease, or those in charge of him, or, if these neglect their duty, the occupier of the house in which the sick person is residing, or, if he is a pauper, his medical attendant, should be required by law to notify the nature of the disease to the Medical Officer of Health so soon as they or any of them are aware of it; and that in the case of non-paupers, the medical attendant should, if it is inexpedient to impose any further obligation on him, be similarly required by law to furnish the sick person, or those in charge of him, with a certificate of the nature of the disease, in the form which we have already suggested, to be by them communicated to the Medical Officer of Health. On every certificate so communicated a small fee should be paid to the medical man who signed it." But most important of all, perhaps, is the action taken by the House of Commons in the Session of the same year (1882), when the Select Committee on "Sanitary Regulations" stated in their Report that they had "little difficulty in forming the opinion that the time had arrived when provisions of law on the subject (of Compulsory Notification) may be sanctioned, at least in the more important Urban Sanitary Districts." The Committee, moreover, framed a Model Clause providing for Notification, in Local Acts, and recommended that, in any future amendment of the Public Health Acts, powers to secure Notification should be extended to all Urban Sanitary Authorities, or at least that means should be devised for 94 ing them with such powers on application. In that Session (1882), and in every subsequent Session, the Model Clause was inserted in Local Acts, provisions of a similar nature having been incorporated in preceding Local Acts, so that, in all, some forty-eight towns, with a population exceeding four millions, now possess the desired powers, In the Session of 1883, a general Bill "To provide for the better Notification of Infectious Diseases" was introduced by private Members. This Bill was drawn upon the lines of the Model Clause, the duty of reporting cases to the Medical Officer of Health being thrown upon the medical attendant and the householder equally—the so-called "dual system." A deputation having waited upon the Local Government Board in support of the Bill, the President signified his willingness to agree to general legislation to facilitate the application of the desired provisions by Local Authorities, but he said that the Board were of opinion that the time had not yet come to give universally the compulsory powers proposed,by absolute legislation. The Board, in other words, were prepared to give Local Authorities who wanted compulsory powers, the means of dealing with infectious diseases, at once, without the necessity of applying for a Local Act—either by means of a general Act which they could bring into force themselves, or else by giving them power to create bye-laws 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, it was dropped. No similar measure of a general character had been introduced by private Members, and the Board had done nothing in the matter up to the close of 1887. But year by year the subject has been before Parliament; for in every Session the House of Commons has ordered the appointment of a Committee to consider "all Private Bills promoted by Municipal and other Local Authorities, by which it is proposed to create powers relating to Police and Sanitary 95 Regulations which deviate from, or are in extension of, or are repugnant to the General Law," including powers for Compulsory Notification. The Select Committee appointed in the Session of 1887, in their Special Report on the Bills referred to them, state that: — ''The Committee have readily sanctioned the insertion in the Bills of the Model Clauses or some of them" (including those relating to Notification), " originally drafted under the instructions of preceding Committees, and approved by more than one Parliament. These Clauses have had the merit of introducing a considerable degree of uniformity into special legislation. They have now been adopted by a lar ge number of Municipal Corporations and other Local Authorities, and have stood the test of experience. The Committee have not been made aware of a single ease in which these clauses have led to complaint from the inhabitants of any borough or district to which they have been applied. The Committee once more, therefore, submit to the House, as was submitted in Reports by former Committees, whether the time has not arrived for enacting in a general measure those . . . sanitary provisions." The clauses, I may add, are set out in full in Appendices Nos. 2 and 3 to the Special Report, dealing respectively with "Notification of Disease" and "Provisions as to dealing with Infectious Disease." Such, then, in brief, is the history of the question, and thus matters stood, in the latter half of 1887, when the epidemic of scarlet fever was pursuing its course. And who can doubt that it would have been well, having regard to the difficulty Sanitary Authorities experienced in dealing with that epidemic, for want of information, had the Local Government Board procured legislation in the sense of the recommendations of the Conference of 1881? But regrets are useless, and the time for renewed action seemed favourable. So, at least, I thought in making the report placed at the head of these observations (page 88), and so your Yestry decided. It was right, moreover, that the body which had brought about the Conference and the Deputation of 1881 should be to the fore in the new effort. This effort was initiated by the passing, on October 5th, 96 of the following resolutions, upon the recommendation of the Works, Sanitary and General Purposes Committee, to which my report, submitted to your Vestry on September 21st, had been referred, viz.:— "That Compulsory Notification of Infectious Disease, enforced by legislative enactment, would be conducive to the interests of the public health, tending as it would to check and prevent the spread of infectious disease, by promoting isolation in the homes of the sick, and removal of the sick to hospital, when necessary, and also by securing the opportunity for speedy disinfection of infected houses, clothing, bedding, etc. "That the President of the Local Government Board be asked to bring in a Bill, General or Local (Metropolitan), to provide for Compulsory Notification of Infectious Disease. "That the Metropolitan Asylums Board and the several Vestries and District Boards be invited to co-operate with the Vestry by endorsing its application to the Local Government Board." The matter was remitted to the Committee to carry out the resolutions, and at the request of your Vestry I prepared, for the information of the Managers of the Metropolitan Asylums Board, and the several Vestries and District Boards of Works, a Memorandum setting out the reasons for Compulsory Notification, the views of sanitary experts, and the proceedings of the Conference held at the Town Hall in 1881, when a Resolution affirming the desirability of Compulsory Notification was unanimously adopted. A copy of the Memorandum was sent (in October) to each of the Managers of the Asylums Board, and to every member of a Vestry or a District Board of Works, and a communication moreover was addressed to the Asylums Board and to the several Vestries and District Boards of Works (and also to the Boards of Guardians), inviting those bodies to ''Take into consideration the (above cited) Resolution of the Conference of 1881, and to endorse the application to the President of the Local Government Board to bring in a Bill, General or Local (Metropolitan), to provide for Compalsory Notification, which the Vestry propose to make." 97 The letter addressed to the President was as follows:— "Sir, "I am instructed by the Kensington Vestry to inform you that, having recently had fresh experience of the ill results arising from the want of early information of the occurrence of Scarlet Fever, they have come to the conclusion that the time has arrived for making a renewed effort to promote legislation with a view to the Compulsory Notification of Infectious Diseases generally. "The Vestry, knowing that the Local Government Board are favourable to the principle, and being of opinion that the subject is one that can be dealt with effectually by the Government only, have further instructed me respectfully to request that you would be pleased to take into your consideration the desirability of bringing in a Bill, next Session, General or Local (Metropolilan) to provide for Compulsory Notification. This subject, I am to state, was fully considered by the Sanitary Authorities of the Metropolis at a Conference held at this Town Hall, in March, 1881, when the following resolution was unanimously adopted:— " 'That in the interest of public health, and to enable Nuisance Authorities to discharge the duty of checking and preventing the spread of infectious diseases, such as small-pox, fever, &c., provision should be made by legislative enactment to secure the compulsory disclosure to the said Authorities of all cases of such diseases immediately upon their occurrence.' "The proceedings of the Conference are set out in a Memorandum, which the Vestry have requested their Medical Officer of Health to prepare; and in two recent reports, Nos. 9 & 10, dated respectively September 12, and October 12, by the Medical Officer, copies of all of which are herewith enclosed for your information. ''I have, etc." A communication was also addressed, same date, to the several Vestries and District Boards, in which it was stated that your Vestry had "not thought it necessary at present to propose a further Conference on the subject, the expression of the views of the Sanitary Authorities in 1881 having been unanimous, and there being no reason for supposing that those views had undergone any change." It was suggested, therefore, that each Board should pass a Resolution re-affirming the necessity for Compulsory Notification, and forward the same to the Local Government Board, 98 A like communication was sent to the Metropolitan Asylums Board, the Managers, moreover, having been kept informed of your Vestry's proceedings through my monthly reports, a copy of which had been regularly forwarded to each member of the Board. Here it may be mentioned that I brought the subject to the attention of the Society of Medical Officers of Health at the Annual Meeting held on Friday, October 21st, with the result that the following Resolutions were unanimously adopted:— "(1) That in the opinion of this Society, compulsory notification of Infectious Diseases enforced by legislative enactment would be conducive to the interests of public health, tending, as it would, to check and prevent the spread of Infectious Diseases by promoting isolation in the homes of the sick, and by removal of the sick to hospital when necessary, and also by securing the opportunity for speedy disinfection of infected houses, clothing, bedding, &c. "(2) That this Society, having been informed that the Kensington Vestry have requested the President of the Local Government Board to bring in a Bill, General or Local (Metropolitan), to provide for compulsory notification, do address a communication to the Board in support of the said request, and that a communication intimating its approval of the principle of compulsory notification be addressed to the Metropolitan Asylums Board, and to the several Vestries and District Boards, together with a request that they would be pleased to support the Kensington Vestry's application to the Local Government Board." The Society's resolutions were forwarded to the Asylums Board on the same day as the subject was to come before the Board on 22nd October, when, upon the motion of Mr. Acworth, the General Purposes Committee were directed "To consider the propriety of addressing a communication to the Local Government Board, urging that Board to take the necessary steps for the extension to the Metropolis of the system of compulsory Notification of Infectious Disease . . . with power, should they see fit, to address such a communication . . . and to communicate on the subject with the several Boards of Guardians, Vestries, and District Boards of Works." The Committee,which comprises the whole of the Managers, met on the 25th October, and on the next day a letter was *The Council of the Sanitary Institute, on 27th October, upon my motion, unanimously adopted identical resolutions. 99 addressed by the Clerk, to the Local Government Board, as follows:— "Sir, "I am instructed by the Managers of the Metropolitan Asylums District to request you to bring to the notice of the President of the Local Government Board, the fact that the system of compulsory notification of infectious disease, the adoption of which was strongly recommended in the Report of the Commissioners appointed to enquire respecting Small-Pox and Fever Hospitals, has not yet been extended to the Metropolis. "I am at the same time instructed to point out that in the absence of accurate information, it is almost impossible for the Metropolitan Asylums Board, more especially at the commencement and at the close of an epidemic, to make arrangements at once satisfactory and economical, for the prompt removal and proper accommodation of patients, and to request the Local Government Board to take steps at the earliest possible moment to obtain from Parliament legislation providing for the adoption of this system in the Metropolis, "I am, etc." The letter, like that of your Vestry, simply received formal acknowledgment. It only remains to slate that with few exceptions the Vestries and District Boards endorsed the action of your Vestry by passing, and forwarding to the Local Government Board, resolutions in favour of the principle of Notification, and requesting the President to introduce a Bill during the current Session. The Wandsworth District Board especially, did good service by requesting their Medical Officers of Health to obtain information regarding the working of the system in the towns where it is in operation. The results of their inquiry have been tabulated, and now form a valuable synopsis of information that cannot fail to be useful, and convincing to the mind of any unprejudiced person as evidence of the success of the system. PROVINCIAL OPINION. Provincial Opinion found adequate expression, March 8th last, at the Annual Meeting of the Association of Municipal Corporations (President, Mr. Wm. Woodall, M.P.; Treasurer, 100 the Lord Mayor of London), when the subject was fully debated, there being a large attendance of delegates from England and Wales, and the meeting being held in the Council Chamber of the Guildhall, by permission of the Lord Mayor, on behalf of the Corporation. The Mayor of Salford moved a resolution; "That a memorial be presented to the Local Government Board, praying them to introduce, or to give active support to a Bill for the compulsory notification of infectious disease, and that the Council be requested to give effect to this resolution." In the course of the discussion, Dr. Tindal Robertson, M.P, (Brighton), referring to the objection by the people of Brighton to a proposed Local Bill, said they "did not oppose a general system of notification applied to the whole country." The mover of the resolution referred to the immunity of Salford from infectious diseases, due to notification. Mr. Picton, M.P., observed that his town, Leicester, guarded against small-pox almost entirely by notification. Mr. Powell, M.P. (Wigan), stated that in conjunction with Mr. Hastings, M.P., he had drafted a Bill dealing with the subject, and it would be introduced in the House of Commons on the first available opportunity. With that view he thought it would strengthen the hands of the promoters of the measure if the motion of the Mayor of Salford were amended, so as to promise assistance to private members who might introduce the Bill. He said that if the Bill was introduced by himself and Mr. Hastings, it would be with the sanction and under the co-operation of the Government, and if the measure did not become law. it would be "a deliberate disgrace to the Legislature." The motion was passed, amended as suggested by Mr. Powell. THE ACTION OF THE LOCAL GOVERNMENT BOARD. The communications addressed to the Board were not without effect, for towards the close of the year they forwarded a circular to the Local Authorities of the Towns, &c., where the system is in force enquiring: 101 (1) "How many cases of each of the specified diseases were notified to the authority; (a) in the year 1886; and (b) during the first eleven months of 1887. (2) "What procedure is adopted on the receipt of the notification. (3) "Whether it is believed that to any considerable extent there has been a failure to give the requisite notification. (4) "What are the practical difficulties, if any, which have arisen in connection with the system; (5) "What is believed to be the general result as regards the limitation of the spread of Infectious Disease, and (6) "In what points, if any, the system appears to require amendment." The Board also desired to be furnished with information as to the expense attending the working of the system, and also with any observations and suggestions which the Sanitary Authority thought might be of assistance in the consideration of the subject generally. At the present writing, I do not know the results of the Board's inquiry, which may be assumed to have been instituted on the advice of the Medical Department. But as the Board will naturally be influenced in any decision they may come to by the counsels of their Medical Officer, it may be well, in conclusion, to repeat that Dr. Buchanan considers that ''power of obtaining compulsory information of the existence of infectious disease in a house" may properly be "possessed by any Sanitary Authority who wanted it, and who having made adequate arrangements for securing isolation and disinfection for the district, is prepared to put to effective use the knowledge which a system of disease-notification would afford." The metropolis is admirably endowed with means of isolation; disinfection is efficiently carried out, and a large majority of the 102 Sanitary Authorities, as we have seen, "want" compulsory notification, and doubtless would "put to effective use the knowledge which the system would afford." It is reasonable to hope, therefore, that the desired power will be conferred. That Parliament would be asked to take the subject into consideration was inferred from a speech made by the President at Sheffield on 30th January last, in which he said "that it was now for the Government to consider whether an Act compelling the notification of infectious disease should not be passed for the whole country," and that "if he could see his way to bring in a Bill of that kind, he should endeavour to do so." This satisfactory announcement, it may be mentioned, closed observations upon the epidemic of small-pox then in progress at Sheffield—an epidemic which would have been more manageable had the system of compulsory notification been in force. Hitherto (May) the Government have not taken any action in the matter in Parliament, but Mr. Hastings, Mr. Francis Powell, and other members, introduced a Bill entitled "Public Health (Prevention of Infectious Diseases), &c.," which was ordered to be printed 20th March last. It is described as a "Bill to amend the Public Health Act, 1875, so as to make further provision for the prevention of Infectious Diseases, and for other purposes," and the preamble states it to be "expedient to amend the provisions of the Public Health Act, 1875, so as to provide for the notification and more effectual prevention of Infectious Diseases," and the "Act" is to be "construed as one with the Public Health Act, 1875." The Public Health Act, 1875, does not apply to London, and the Bill as drafted would exclude the Metropolis from its operation. Your Vestry, therefore, communicated more than once with Mr. Hastings, calling his attention to this fact, and expressing a desire that the measure should be made applicable to London. At the present writing, however (June 21st), no reply has been received, nor has the Bill been read a second time. 103 The Bill, I may mention, is drawn in the terms of the "Model Clauses," which are set out as Appendices Nos. 2 and 3 to the Special Report of the Select Committee of 1887, dealing respectively with "Notification of Disease," and "Provisions as to Dealing with Infectious Disease." Your Vestry's Law and Parliamentary Committee considered the clause with reference to Notification on the 6th January last, and reported their opinion that "the provisions are admirably adapted for, and should be made applicable to the Metropolis." The Committee moreover "considered the reference by Vestry as to the advisability of organizing a deputation to the Local Government Board on the subject" of a Bill, and expressed the opinion that "at the present time such a deputation would be premature." The Report of the Committee was adopted. Should the Bill be passed, the Local Government Board may declare its provisions to be in force in the whole or any part of the district of a local authority, "on the application of any local authority, or of persons rated to the relief of the poor, the assessments of whose hereditaments amount at least to one-tenth of the net rateable value of the district of such authority—after local inquiry by Order, to be published in such manner as the Local Government Board may direct." As usual the House has ordered "That the Committee of Selection do appoint a Committee, to whom shall be referred all Private Bills promoted by Municipal and other Local Authorities, by which it is proposed to create powers relating to Police and Sanitary Regulations which deviate from, or are in extension of, or are repugnant to the General Law." Mr. Hastings has been elected Chairman of the Committee. But I presume that the Bill will not be referred to this Committee, as it cannot be described as a Private Bill, nor is it promoted by Municipal or other Local Authorities. The practically important questions are Whether the Bill has been introduced, as Mr. Francis Powell said it would be, "with the sanction and under the co-operation of the Government"? and, Whether it will be made applicable, if passed, to the Metropolis? 104 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 and enteric fever), 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 it may be mentioned 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, were registration within a limited period, say twenty-four hours, made compulsory. 2. The Relieving Officers, by direction of the Board of Guardians, report oases 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 to the local Medical Officer of Health. They also forward, weekly, a complete list of admissions to their land and river hospitals during the previous seven days. 4. The Resident Medical Officer of the Kensington Dispensary reports infectious eases, which he is not allowed to treat in the homes of the poor. 5. Medical men occasionally report eases, 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. 105 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 report for 1877 I referred to a resolution of the London School Board, adopted upon my recommendation, 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 Officers 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. 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 tion for I have not felt at liberty to disregard such communications, which have frequently proved to be accurate. In one way or another some hundreds of cases come to my knowledge in the course of the year. How many never get reported at all it is impossible to say; but from the fact that sometimes fatal cases of infectious disease are unheard of until after registration of death, it may be inferred that unrecorded cases of recovery are numerous. RECENT ACTION BY THE VESTRY TO PROMOTE VOLUNTARY NOTIFICATION. A considerable stimulus to voluntary notification was given in October by your Vestry's adoption of certain recommendations made, at my suggestion, by the Works, Sanitary, and General Purposes Committee, in continuation of those relating to Compulsory Notification, already referred to at page 88. The Committee, thinking it desirable to make an effort to increase our knowledge of the occurrence of cases of scarlet fever, which was epidemic at the time, recommended:— H 106 "That . . . registered medical practitioners in the parish be invited to notify to the Medical Officer of Health the occurrence of oases of Scarlet Fever, Enteric Fever, Typhus Fever, Diphtheria, and Small Fox, and that they be informed. "(1) That the Vestry will pay to every registered medical practitioner who shall duly notify. any such case a fee of two shillings and sixpence. "(2) That the Vestry will pay a fee of two shillings and sixpence, in addition to the cost of telegram, in respect of any case that shall have been removed to hospital, upon the direct application and certificate of any such medical practitioner." The Committee were ''empowered to take the necessary steps for giving effect to the above resolutions," which I communicated to all registered practitioners, under cover of a circular letter accompanied with the necessary forms. In order that nothing might be wanting to the success of the scheme (the latter part of which had become possible only through the action of the Asylums Board in admitting patients to their hospitals upon the application of medical practitioners) your Vestry adopted a further recommendation of the Committee to the effect:— "That upon discovery of any person suffering from infectious disease, and willing to be removed to hospital, the several Sanitary Inspectors be authorised to obtain a medical certificate of the nature of the illness, as a necessary preliminary to the removal of the patient, and to pay a fee of two shillings and sixpence for the certificate, it being understood that the patient will be removed upon the application of the Inspector, a course whereby valuable time will be saved." A considerable number of cases have been reported under this arrangement, and others have been removed to hospitals upon the application and certificate of medical practitioners. As regards small pox, concealment is rarely practised, the desire to obtain isolation in hospital being very general, and I am glad to state that there is a growing recognition of the desirability of notification in respect of "fevers," which doubtless is, in large measure, due to increasing willingness of the poorer classes to avail themselves of the means of isolation provided by the Metropolitan Asylums Board. This fact, so far as concerns scarlet fever, is clearly demonstrated by the figures set out in the Table at page 33. 107 THE RESULTS OF VOLUNTARY NOTIFICATION OF INFECTIOUS DISEASES. With the view of ascertaining the probable results of a system of compulsory notification, I 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 Diarrhœa 72 35 66 24 54 63 104 112 78 113 108 154 983 Totals 206 249 247 269 351 374 319 251 275 457 369 545 3912 Yearly Average 326 Second period 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 188.1 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 Diarrhœa 129 110 145 112 107 126 99 181 71 128 101 61 1370 Totals 539 383 290 388 372 498 339 573 348 469 383 376 4958 Yearly Average 413 The average population in the first period of twelve years (1859-70), was 90,000, and in the second period (1871-82), 147,300. H2 108 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 ... Diarrhoea 983 1370 1608 ... 238 ... 3912 4958 6399 349 1790 1441 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, smallpox 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 diarrhœal mortality is attributable to the coldness of the summer season in several of the years in the second period, and may therefore be regard 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 109 the first period, without correction for increase of population, and 448 fewer after such correction; and that the 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. I 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 213 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 1,411. 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 3.6 per 1,000 persons living, fell to 2.8 per 1,000 in 1371-82; the deaths from the diseases, moreover, which in 1859-70 formed 18 per cent, of total deaths, were only 15.4 per cent, in 1871-82. The improvement still goes on, for the rate fell in the quinquennium 1883-87 to 1.9 per 1,000 living, and the deaths were only 11.8 per cent, of total deaths. Other causes, doubtless, besides notification, contributed to bring about this satisfactory result, and we must not forget, as 110 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 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. INTERRUPTION TO 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 nonisolated 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 * "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." 111 possessed to close schools—powers which it need hardly be said should be used with discretion. It has always been my endeavour to obtain the co-operation of school teachers in respect to infectious disease occurring in school children, and their help has often proved very serviceable. A regretable fact connected with the occurrence 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 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. REPORT OF THE ROYAL COMMISSION ON INFECTIOUS DISEASE HOSPITALS. The Commission presented their Report in 1882, and its influence is still at work in moulding the sanitary administration of the Metropolis to the shape indicated in several of the preceding sections. In that weighty document, as I stated in my Annual Report for 1882, I find the justification for "nearly every principle in dealing with infectious disease that I had advocated, chiefly in reports to your Vestry," during the ten years preceding the appointment of the Commission, and I instanced the following, among other of their "Practical Recommendations":— 1. Compulsory Notification. 2. Compulsory Removal when necessary. 3. Unity in Hospital administration, and representation of Sanitary Authorities on the Hospital Board. 112 4. Separation of Hospital treatment from all connexion with parochial relief; or, in other words:— (a) Abolition of distinction of pauper and non- pauper in respect of the treatment of infectious disease. (b) Free hospital treatment of infectious disease. 5. Paying wards for those who desire special or separate accommodation. 6. Provision of additional Hospitals in London, with skeleton staff of doctors, nurses, and other officers, capable of extension, so as to cope with all emergencies. 7. Provisions of Hospitals in the country for removable cases of small-pox, and for the reception of convalescent hospital-treated cases of other infectious diseases. 8. Transference of Vaccination to the Hospital, or Central Sanitary Authority. Parliamentary sanction has yet to be obtained for giving legal effect to the greater number of the above recommendations; some of them, however, are already carried out in practice. The principle of the main recommendation, moreover, that which may be said to be at the root of nearly all of the others—to wit, compulsory notification, has, as before stated, found expression in numerous Local Acts, and has been approved by the authorities who have the best right to be heard on the subject. The time, therefore, must surely be at hand when success shall crown the labours of years, and give to the public the additional security afforded by the disclosure of infectious disease with all its attendant results. 113 A RETROSPECT. Reform of Local Government being to all appearance imminent, it will not be out of place to review, in a very few sentences, the results, as they are indicated by the state of the public health, attained under the system initiated in 1856, by the passing of the Metropolis Management Act, 1855, supplemented as that Act has been by others entitled "Sanitary" and "Nuisances Removal"—not forgetting the Acts under which the Thames has been embanked, and the Metropolis provided with efficient main sewers, and a fairly satisfactory water supply. The effects of these and other minor Acts, carried out as they have been by the Metropolitan Board of Works, and by the several Vestries and District Boards, are apparent enough in the reduced death-rate by which London compares favourably with the great cities of the civilized world. The statistics at my command go back to 1841, and I find that in the three quinquennial periods—1841-5, 1846-50, and 1851-55, the death-rate in London was 24.2, 25.4, and 24.8 per 1,000 persons living; or for the fifteen years prior to the passing of the Metropolis Management Act, 24.8 per 1,000. In the following fifteen years, 1856-70, the rate had fallen to 23.9 the rate in the three five-yearly periods being—in 1856-60, 22.7; 1861-65,24.4; and 1866-70, 24.3. In the next fifteen years, 1871-85, the average rate fell to 21.3 per 1,000; the rate in the three successive periods being—in 1871-75, 22.9; in 1876-80, 22.2; and in 1881-85, 20.7. In 1886 the death-rate was 19.9; and last year, 1887, it was 19.6, the lowest recorded since the present system of civil registration began. It is almost needless to say that this remarkable decline implies the saving of tens of thousands of lives, to say nothing of myriad illnesses prevented ; or that it will serve as a monumental record of the good effects of the sanitary legislation and administration of the last 32 years, long after the existing system of local government shall have undergone more or less drastic revision. 114 I regret that it is not in ray power to furnish a similar return showing the results of the administration of the Acts in this parish. But there are no statistics for the period antecedent to 1856, and the figures relating to 1856-60 are unreliable. The statistics for the 27 subsequent years may be relied on, and these years may be grouped for comparison into quinquennial periods. The death-rate, then, in the five years. 1861-65, was 20'3 per 1,000 persons living; that in 186670 being 20.2 per 1,000. In 1871 upon my appointment a more vigorous sanitary administration was organized by your Yestry, which soon began to produce good results, for in the quinquennium, 1871-75, the death rate fell to 18.9, and in the next five years, 1876-80, to 18.7. A still larger decline characterized the quinquennium, 1881-85, the death rate in those years being 15.0 per 1,000 only. If to these five years we add 1886—87, it will appear that the death rate in the last septennial period (1881-87) was 16.1 per 1,000, In Kensington, as in London, a remarkable and eminently satisfactory improvement in the public health has taken place in regard to "preventible" diseases; those, namely, of the zymotic class. This improvement has been largely due to the legislation of 1866 ("The Sanitary Act") and 1867 "The Metropolitan Poor Act ") the Metropolis having been provided under the last-named Act with a magnificent system of Hospitals for Infectious Diseases, organized by the Metropolitan Asylums Board. So far as I am able to ascertain, the saving of life in this parish in the 17 years, 1871-87, as shown by the reduced rate of mortality ill those years compared with the rate in the ten years, 1861-70, is close upon six thousand, the average rate having fallen from 20.2 per 1,000 in 1861-70, to 18.8 in 1871-80, and to 16.1 in 1881-87. Some portion of this result may be fairly credited to the labours of your Vestry's Sanitary Department. 115 POPULATION, INHABITED HOUSES, &c. The population of Kensington, estimated to the middle of the year was, in round numbers, 175,000 (=80 per acre); males, 70,500, and females, 104,500: excess of females, 34,000. The population of the Town sub-district was, approximately, 128,500, and that of the Brompton sub-district 46,500. The natural increase during the year, represented by the excess of births over deaths registered, was 1,069: an estimated further increase of 431 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 reliable information as to the number of inhabited houses as compared with previous years since the census of 1881. Probably they were about 21,566 at the middle of the year. In places with stationary population the birth-rate may serve as a guide in estimating the 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 (vide Tables I. & II. Appendix). The most remarkable feature, however, in connection with the population of Kensington, one, moreover, which, to a large extent, accounts for the small and diminishing birth rate, is the inordinate excess of females. It was thought surprising when the Census of 1871 revealed a majority of 22,00 Ofemales; the majority now probably exceeds 34,000. Females are in excess in the population generally; in London the excess is about 13 per cent., in Kensington it is nearly 50 per cent. 116 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 32,249 Excess of Females. Total of both sexes 163,151 17585 28862 35843 30582 21003 19888 9091 4649 1467 173 8 163,151 Total of both sexes (b) KENSINGTON TOWN SUB-DISTRICT. All Ages. Under Five Years. 5 to 15. 15 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 to 75. 75 to 85. 85 to 95. 95 and upwards. All Ages. Females 70,134 6952 12141 15640 13453 8996 6031 3968 2168 701 79 5 70,134 Females. Males 50.007 6969 10986 9205 7936 6404 4099 2669 1310 386 43 - 50,007 Males. Excese of Females 27,127 —17 1155 6435 5517 2592 1932 1299 858 315 36 5 20,127 Excess of Females. Total of both sexes. 120,141 13921 23127 24845 21389 15400 10130 6637 3478 1087 122 5 120,141 Total of both sexes (c) BROMPTON SUB-DISTRICT. All Ages. Under Five 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 117 Kensington is still in process of development by building, but at a moderate rate compared with past years—1861-70, for example. 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. 1887. Gross Increase in 31 years. Estimated number of Inhabited Houses (as per rate books) 7,600 21,566 13,966 Population 57,000 175,000 118,000 Rateable Value of Property £308,000 £1,846,647 £1,538,647 The increase in all respects within the last sixteen years, the period over which my official experience extends, is not inconsiderable, as the subjoined figures will show. 1871. 1887. Increase in 16 years. Estimated number of Inhabited Houses (as per rate books) 15,395 21,566 6,171 Population 121,000 175,000 54,000 Rateable Value £935,720 £1,846,647 £910,927 The above figures may well be said to speak for themselves: nevertheless, attention may be called to the fact that in 31 years the rateable value of property has sextupled, and that in the last 16 years the mere increase was treble the total in 1856. The population more than trebled, and the number of inhabited houses increased nearly threefold, in 31 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. 118 MARRIAGES AND MARRIAGE RATE. The marriages in 1887 were 1,561 and 44 fewer than in 1886. Of these there were celebrated— By the Church (73.5 per cent. of total marriages) 1,147 At Roman Catholic places of worship 146 At other Nonconformist places of worship 60 At the Superintendent Registrar.s Office 208 Total 1,561 The marriage rate, i.e., persons married to 1,000 inhabitants, was 17.8. The marriage rate in the country generally was 14.2 per 1,000, being 0.l above the rate in 1886 (which was the lowest on record since the commencement of civil registration in 1837), but 0.8 below the mean rate in the ten years 1877-86. The marriage rate in London was 16.2, the lowest rate yet recorded; the four next lowest, moreover, being those recorded in the four immediately preceding years, 1883-6, in which the rates were successively 17.9, 17.6, 16.9, and 16.6 per 1,000. BIRTHS AND BIRTH RATE. The births registered in 1887 were 3,941—males, 2,016, and females, 1,925; in the Town sub-district, 3,202, and in the Brompton sub-district, 739. The births in 1886 were 4,149, or 208 above the number last year, in which the births, 785 below the decennial average corrected for increase of population, were fewer by 100 than in 1872, when the population was smaller by 47,600 than in 1887. The birth rate in Kensington, considerably lower than the London rate (31.7), and that of England and Wales (314), has been declining since 1868, when it was 33.1 per 1,000. In 1887 it was 22.5, being 4.5 below the decennial average. The rate in the Town subdistrict was 24.9 and in Brompton 16.0. There was one birth to 44 inhabitants and 104.7 births of males to 100 of females. The births of illegitimate children were 188 (2 fewer than in 1886), viz., males 114 and females 74. Of these births 174 119 were registered in the Town sub-district, which includes the parish workhouse, at which institution out of 126 live births (males 67, females 59), 103 were illegitimate. In the parish generally, the illegitimate births formed 4.7 per cent. of total births, as against 4.8, 4.2, 5.8 and 4.7, in 1883-4-5-6 consecutively. 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 428 428 856 103 113 216 1072 2nd ,, 406 389 795 110 72 182 977 3rd ,, 4th ,, 410 396 378 367 788 763 89 74 81 97 170 171 958 934 1640 1562 3202 376 363 739 3941 For particulars respecting annual number of births and birth rates, in the decennial period, 1877-86, see Tables I. and II., Appendix. DEATHS AND DEATH RATE. The deaths registered in 1887, inclusive of 213 at outlying public institutions, but exclusive of deaths of non-parishioners at intra-parochial public institutions, were 2,872, or 104 below the decennial average, corrected for increase of population: 2,321 of the deaths belong to the Town sub-district, and 5.51 to the Brompton sub-district. The death rate, whole parish, was 16.4 per 1,000, compared with 15.1, 16.1, and 15.9 in the three preceding years; being 0.5 below the decennial average and 3.2 below the London rate (19.6); this, moreover, being 1.7 below the average (21.3) and the lowest on record. It was 2.4 below the rate in England and Wales (18.8), also the lowest on record. The rate in the Town sub-district was 18.0, and in Brompton 11.8, as against 17.0 and 12.6 in 1886. The rate in the male sex was 20.0, and in the female sex 14.0 per 1,000, as against 19.1 and 137 in 1886. There was one death to every 60.9 inhabitants, 120 as against one to 62.9 in 1886. Out of 70,500 males, 1,410 died, equal to one in 50.0, against one in 52.4 in 1886; whilst only 1,462 females died out of 104,550, or one in 71.4, against one in 72.8 in 1886. The deaths in the first and fourth, or colder quarters, exceeded those in the second and third, or warmer quarters, by 272. In the seven preceding years the difference in favour of the warmer quarters was 240, 120, 355, 251, 132, 22, and 320 consecutively. INFANTILE MORTALITY. The deaths of young children always bear a high ratio to total deaths. In 1887 this ratio was rather higher than in immediately preceding years. The deaths under five years were 1,129 (568 in the first and fourth quarters, and 561 in the second and third quarters), compared with 1,114, 982, 1,034, 1,085, and 1,029 in the five preceding years; being equal to 39.3 per cent. on total deaths, and to 28.6 on births registered: the equivalent percentages for the whole Metropolis were 42.8 and 26.4. Under one year of age the deaths were 680 (compared with 635, 601, 689, 653, and 636 in 1882-3-4-5-6 consecutively), and were equal to 23.7 per cent. on total deaths, and to 17.2 per cent. on registered births; the equivalent percentages for the whole Metropolis being 24.3 and 15.8. The deaths of illegitimate children under five years of age were 104, males 57, females 47 (of which 95 were registered in the Town sub-district), as against 114, 78, 80, 86, and 104 in the five preceding years, and were equal to 55.2 per cent. on births registered as illegitimate. Of these 104 children only 29 outlived their first year, and 17 died in the second year of life. The causes of death, as registered, were atrophy, debility, inanition, 17; premature birth, 11; tubercular diseases, 14; zymotic diseases, 22 (diarrhoea, 11; measles, 8; whoopingcough, 3); syphilis, 6; lung diseases, 19; convulsions, 3; injuries at birth, 2; thrush, 2; spasm of glottis, enteritis, erysipelas (after vaccination), blood poisoning in utero), 121 abscess, skin disease, suffocation and "want of breath," one 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 list of fatal diseases. Senile Mortality.—At sixty years of age, and upwards, there were 773 deaths, as against 619, 699, 607, 736, and 747 in the five preceding years, or 27.0 per cent. on total deaths, the equivalent percentage in London as a whole being 22.5. The Death Rate per 1,000 persons living, at different periods of life, was as follows:— 1887. 1886. 1885. 1884. Under Five years of age 60.0 55.0 58.4 56.3 Five and under 15 3.4 3.2 2.9 3.4 Fifteen „ ,, 25 2.8 3.1 2.8 3.1 Twenty.five „ 85 4.4 5.5 5.4 5.0 Thirty.five „ 45 10.0 9.5 9.7 9.8 Forty.five „ 55 15.5 14.8 16.3 18.0 Fifty.five „ 65 32.5 29.5 27.6 24.7 Sixty.five „ 75 61.2 65.8 63.2 58.1 Seventy.five ,, 85 151.6 144.9 142.7 127.5 Eighty.five and upwards 367.8 338.0 340.3 202.1 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:— Kensington Town Sub.district. Brompton Sub.District. Grand Total. Whole Parish. Males. Females. Total. Males. Females. Total. 1st Quarter 321 369 690 81 94 175 865 2nd 275 252 527 70 64 134 661 3rd „ 4th „ 257 265 522 60 57 117 639 294 288 582 52 73 125 707 1147 1174 2321 263 288 551 2872 The Births were, Males 2016 The Deaths were, Males 1410 Females 1925 Females 1462 Total birth s 3941 Total deaths 2872 2872 Deaths 1069 Excess of Births over Deaths. I 122 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. Date of Report. Death Rate per 1,000 persons living. Abave or below Decennial Average Mean Temperature of the Air. 1887 Decennial Average Above or below Decennial Average 1887. 10 years 1877-86. For four weeks to Jan. 29, 1887 20.8 20.1 + 0.7 35.6 37°.7 —2°.l Feb. 26. ,, 18.3 18.7 —0.4 39.1 40.6 —1.5 Mar. 26. ;, 20.9 18.9 +2.0 36.4 41.8 -5.4 Apl. 23. „ 15.0 19.3 —4.3 44.4 45.1 —0.7 May. 21. „ 15.1 16.0 —0.9 47.9 49.7 —1.8 June 18. „ 16.0 15.8 +0.4 57.5 56.3 +1.2 July 16. „ 15.6 14.6 + 1.0 65.1 61.4 + 3.7 Aug. 13. „ 17.2 16.4 +0.8 64.5 61.7 +2.8 Sep. 10. „ 13.4 14.0 —0.6 59.7 60.3 -0.6 Oct. 8. „ 11.3 13.0 —1.7 52.2 54.9 —2.7 Nov. 5. „ 15.3 15.1 +0.2 43.2 47.8 —4.6 Deo. 3. 18.1 17.4 +0.7 40.3 42.6 —2.3 Dec. 31. „ 15.8 18.3 —2.5 37.3 38.3 —1.0 Average whole year 16.4 16.9 47.8 49.1 The Subjoined Table, a summary of Table 3 (Appendix) shews the numbers of deaths of parishioners in each Class and Order, according to the Registrar-General's le-arranged classification. I. SPECIFIC FEBRILE OR ZYMOTIC DISEASES. No. of Deaths. 1. Miasmatic diseases 298 2. Diarrhœal ,, 125 3. Malarial ,, 2 4. Zoogenous „ 1 5, Venereal ,, 19 6. Septic ,, 35 480 II. PARASITIC DISEASES 4 III. DIETETIC DISEASES 13 IV. CONSTITUTIONAL DISEASES 571 V. DEVELOPMENTAL DISEASES 170 VI. LOCAL DISEASES 1. Diseases of Nervous system 289 2. Diseases of Organs of Special Sense 5 123 3. Diseases of Circulatory system 20 4. Diseases of Respiratory system 649 5. Diseases of Digestive system 172 6. Diseases of Lymphatic system — 7. Diseases of Gland like Organs of uncertain use — 8. Diseases of Urinary system 72 9. Diseases of Reproductive system a. Diseases of Organs of Generation 4 b. Diseases of Parturition 13 10. Diseases of Locomotive system 6 11. Diseases of Integumentary system 9 1,419 VII. VIOLENCE 1. Accident or Negligence 60 2. Battle — 3. Homicide 5 4. Suicide 6 5. Execution - VIII. ILL-DEFINED AND NOT SPECIFIED CAUSES —— 71 144 Total 2,872 ASSIGNED CAUSES OF DEATH. Having already (at page 21) 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 deaths 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 I 2 124 was the basis, to a large extent, of some of the other Tables. As it was not possible to accept the more abridged list contained in the Animal 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 in Class 1.—Specific Febbile or Zymotic Diseases. This class comprises six "Orders;" the first and second, "Miasmatic" and "Diarrhceal," 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 and Splenic Fever. The deaths registered were two from Remittent Fever and one from Erysipelas following Vaccination. Order 5, Venereal Diseases, includes Syphilis, Gonorrhoea, and Stricture of the Urethra. Syphilis was the registered cause of 17 deaths, as against 15, 26, and 21 in 1884-5-6. All but one of these deaths occurred in the Town sub-district: 13 of them were of children under one year 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 considerably in excess of the record. There were two deaths from stricture of the urethra. Order 6, Septic Diseases. This order comprises Erysipelas, Pyœmia, Septicaemia, and Puerperal Fever, the total deaths registered being 35, against 33, 40, and 29 in 1884-5-6. Erysipelas was the cause of 11 deaths, against 26 and 7 in 1885-6; nine of them in the Town sub-district. Four of the deaths were of children under one year of age. 125 Pyaemia and Septicemia were the causes of 7 deaths; 6 of them in the Town sub-district. There were 7 and 3 deaths from these causes in 1885-6. Puerperal Fever was the registered cause of 17 deaths, against 26, 14, 7, and 19 in 1883-4-5-6; 14 of them in the Town sub-district. Two of the deaths were of women between 15 and 25 years of age, seven between 25 and 35, and eight between 35 and 45. In addition to these 17 deaths, thirteen deaths, eleven of them in the Town sub-district, were registered as having occurred in "childbirth," as against 3, 7, 9, and 15 in the four preceding years. Puerperal fever is a communicable disease depending on "blood poisoning," whereas other causes of death connected with child-birth are, so to say, accidental, e.g., hemorrhage ("flooding''). The deaths registered as having been caused by diseases and accidents associated with parturition (30) were equal to 7.6 per 1,000 live births, against 5.8 per 1,000 in 1886. Class 2.—Parasitic Diseases Include Thrush and other Vegetable Parasitic Diseases, two deaths; and "Worms, Hydatids, and other Animal Parasitic Diseases,” two deaths. Class 3.—Dietetic Diseases Were the causes of 13 deaths, 12 of them in the Town subdistrict. To Want of breast milk and Scurvy no death was assigned. Delirium tremens was the cause of four deaths, against ten in 1883, and Chronic alcoholism of nine deaths, against ten in 1886. Of these 13 deaths 12 were registered in the Town sub-district. It is scarcely necessary, 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 accountable for a large share of the 126 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 decreasing extent, our National Exchequer! Class 4.—Constitutional Diseases. This important Class comprises the causes of 571 deaths (=20 per cent. of total deaths), including 128 of children under the age of 5 years; 441 of the deaths were registered in the Town sub-district, and 130 in Brompton. Rheumatic Fever and Rheumatism of the Heart caused 10 deaths, three of them in the Brompton sub-district; Rhaumatism, one death. 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 12 deaths, seven of them in the Town sub-district, and Rickets of six. Cancer, Malignant Disease, was accountable for 117 deaths; 84 in the Town sub-district, and 33 in Brompton. Cancer appears to be on the increase in the country generally: possibly, however, some portion of the increase in c eaths classified to this cause may be due to more accurate diagnosis. The deaths in Kensington from this cause in the previous ten years were 88, 79, 95, 90, 112, 92, 128, 117, 119, and 128. Deaths from cancer are usually more numerous, proportionally to population, in the Brompton sub-district, than in the relatively poorer Town subdistrict. Cancerrin fact, is quite as prevalent, probably even more prevalent, amongst well-to-do people, than in the poorer 127 classes. The parts of the body most commonly affected are the viscera or internal organs: in women, the uterusand the breast; the malady, moreover, being for the most part one of later life. Ninety-seven of the deaths took place at ages above 45, and 18 between 35 and 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. Purpura, Hœmorrluxgic Diathesis, was the cause of one death, Ancemia, Chlorosis, and Leucocythcemia were the causes of six deaths. Glycosuria, Diabetes Mellitus, was the cause of 20 deaths, 13 of them in the Town sub-district. The remaining diseases in this Class belong to the group known as Tubercular, and they are amongst the most important with which sanitarians have to deal; the degree to which they prevail in a given district being regarded, in some sort, as a test of the healthiness or otherwise of the 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-todo 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 128 encouraged to hope, therefore, that a remedy may ultimately be found for this great scourge of the human race. Tubercular diseases were the registered causes of 393 deaths (against 440 in 1885), viz., 317 in the Town sub-district, and 76 in Brompton; 121 of the deaths being of children under 5 years of age. The numbers in the four quarters of the year respectively, were 108,86 100, and 105: 213 in the winter and 186 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 42 (of which 22 occurred under 5 years of age), including 5 registered in the Brompton sub-district. Tabes Mesenterica, popularly known as "consumption of the bowels," was the cause of 48 deaths; including five only in Brompton; 47 of them under five years of age, and 32 under one year. Tubercular Meningitis and Hydrocephalus (water on the brain), were the causes of 63 deaths, 16 of them in Brompton, and 51 under five years of age. Phthisis, popularly known as "decline," or "consumption," was the cause of 240 deaths; 9 of them between 5 and 15 years of age, and 215 between 15 and 65; viz., 36, 53, 54, 45, and 27, in the five decades consecutively; fifteen deaths were registered at ages over 65. The quarterly numbers were 64, 53, 59, and 64. Of the total, 190 belong to the Town sub-district, and 50 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 129 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, &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 170, viz., 130 in the Town sub-district, and 40 in Brompton. Premature Birth was the assigned cause of 58 deaths: Atelectasis of 5; and Congenital Malformation of 9. Old Age was the registered cause of 98 deaths, 96 of them at ages over 65: between 75 and 85 there were 45 deaths, and 35 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 1,419 deaths, or 49.4 per cent. of the deaths from all causes; 1,135 were registered in the Town sub-district, and 284 in Brompton; 414 were of children under five years of age. 1. Nervous System.—Diseases of the nervous system were the registered causes of 289 deaths (against 288, 259, 288, and 302 in 1883-4-5-6), viz., 228, in the Town sub-district, and 61 in Brompton; 76 of the deaths were of children under five years of age. The quarterly numbers were 86, 77, 47, and 79. The fatal diseases were Inflammation of Brain or Membranes, 15 deaths; Apoplexy, Softening of Brain, Hemiplegia, Brain Paralysis, 161 (40 in Brompton, and 148 at ages over 45); Insanity, General Paralysis of the Insane, 2; Epilepsy, 14; Convulsions, 64 (all, save 2, under five, and 45 under one year); Laryngismus Stridulus (spasm of glottis), 4 (3 under one year); Disease of Spinal Cord, Paraplegia, Paralysis Agitans, 9; Other Diseases of Nervous System, 20; 130 sions as a cause of death is frequently associated, in medical certificates, with definite diseases, and with ''teething." The convulsions being a symptom only, such deaths are classified to the primary 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 occurrence of spasm during life, and there is no pathological condition which would enable one to say positively that a child had suffered, still less that it had died, from convulsions. 2. The second Order comprises the Diseases of the Organs of Special Sense (e.g., of Ear, Eye, Nose). Five deaths were registered from these causes. 3. Circulatory System.—The deaths due to diseases of the organs of circulation, heart and blood vessels, were 200 against 179, 196, 170, and 163 in 1883-4-5-6: 150 were registered in the Town sub-district, and 50 in Brompton. The quarterly numbers were 62, 37, 38, and 63. To specified forms of disease 54 deaths were assigned, viz., Pericarditis, 7; Acute Endocarditis,3; Valvular Diseases of Heart, 28; Aneurism, 13; Embolism, and Thrombosis, 3. Other Diseases of Heart caused 142 deaths, and other Diseases of Blood Vessels, 4 deaths. 131 4. Respiratory System.—The deaths from the diseases of the chest, phthisis being excluded, were 649; or 19 more than in 1886, and 22.5 per cent. of total deaths. Of this number 547 were registered in the Town sub-district, and 102 in Brompton. The quarterly numbers were 262 and 180 in the first and fourth, or colder quarters, and 131 and 76 in the second and third, or warmer quarters. The deaths under five years of age were 278=42.7 per cent. (against 47.7, 41.1 and 35.4 in 1884-5-6); and at 55 and upwards, 271=41.7 per cent. of the whole number (against 33, 42 and 42.4 per cent. in 1884-5-6). These diseases are thus seen fo 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, 12 deaths; Group (transferred in the new classification from "miasmatic" diseases), 19; Emphysema, Asthma, 13; Bronchitis, 422; Pneumonia, 140; Pleurisy, 10; Other Diseases of Respiratory System, 33. Bronchitis and Pneumonia, therefore, were accountable for 562 deaths, including 236 under five years of age, and 88 registered in Brompton. 5. Digestive System.—The diseases of the various organs concerned in digestion were the causes of 172 deaths; 45 of them under five years of age; 124 in the Town subdistrict, and 48 in Brompton. In the new classification, Dentition is included in this Order; it was the cause of 15 deaths under five, 8 of them under one year. Sore Throat, Quinsy (the latter disease transferred in the new classification from "miasmatic" diseases), was the cause of 1 death; Disease of Stomach, 15; Enteritis, 26; Obstructive Diseases of Intestines, 13; Peritonitis, 18. Cirrhosis of Liver was the cause of 25 deaths; Jaundice and Other Diseases of Liver, 43; Other Diseases of Digestive System, 16. 6. Diseases of Lymphatic System (e.g., of Lymphatics and of Spleen). No death registered. 132 7. Diseases of Gland-like Organs of Uncertain Use (e.g., Bronchocele, Addison's Disease). No death registered. 8. Diseases of Urinary Organs.—Of the 72 deaths assigned to these causes, 57 were registered in the Town subdistrict, and 15 in Brompton: two were of children under five years of age. The diseases were Nephritis, 15 deaths; Bright's Disease (Albuminuria),26; Diseases of Bladder or of Prostate, 4 ; Other Diseases of Urinary System, 27. 9. Diseases of Reproductive System.—(a) Of Organs of Generation: Male Organs, no deaths; Female Organs, 4. (b) Of Parturition, 13 deaths, viz., from Abortion, Miscarriage, 1; Placenta Prœvia (flooding), 1; Puerperal Convulsions, 3; Other accidents of Childbirth, 8. 10. Diseases of Bones and Joints.—Six deaths. 11. Diseases of Integumentary System.—Nine deaths. Class 7.—Deaths from Violence. Seventy-one deaths, including 29 under five years of age (20 under one year), are distributed over the four Orders comprised in this Class; 8 of them belong to the Brompton subdistrict. 1. Accident or Negligence.—Total deaths 60, including 6 in Brompton, and 25 under five years of age; viz., from Fractures and Contusions, 32; Burn, Scald, 6; Poison, 1; Drowning, 1; Suffocation, generally of infants "overlaid," 19 (including 15 under one year) ; Otherwise, 1. 2. Homicide.—Five deaths, including, from want of attention at birth, two newly-born infants of unknown parentage, 3. Suicide.—Of the six suicidal deaths, 4 took place in the Town sub-district. Poison was the cause of death in two cases; Hanging in 2; Gunshot Wound and Drowning in one each. 133 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 144 deaths; 111 under five years of age, and 127 and 17 in the Town and Brompton subdistricts, respectively. The diseases named are—Debility, Atrophy, Inanition 105 deaths (all but one under five years, and 98 under one year); Mortification, 5; Tumour, 2; Abscess and Hœmorrhage, 3 each; Causes not specified or ill-defined, 26. DEATHS IN PUBLIC INSTITUTIONS. The only "large public institution" within the parish, in which we are directly interested, is the Parish Infirmary and Workhouse, situated in the Town sub-district. There are several minor public, or quasi-public, institutions; but, with one exception, they do not furnish occasion for special notice. The excepted institution is St. Joseph's House, Portobello Road Notting Hill—a Roman Catholic Home for aged poor persons of both sexes, brought from various parts, 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 (375), and at the Brompton Consumption Hospital (69), 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 (391), at the Brompton Consumptive Hospital (4), and at outlying institutions (213), were 608, or 21.2 per cent. on total deaths, the percentage proportion of deaths in public institutions in the Metropolis generally being 21. 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 134 deaths registered in 1887 were 391, compared with 273, 307. 322, 273, 355 and 417 in the six previous years, and were equal to 13.6 per cent. on total deaths Mr. Potter informs me that the actual deaths in the year were 404, the quarterly numbers being 119, 92, 82 and 111; so that 230 deaths occurred in the first and fourth (or cold) quarters, and 174 in the second and third (or warm) quarters. The deaths of males were 218 and of females 186. The ages at death were, under one year 50 (65 in 1886), between one year and 60 years 195 (184 in 1885). and at 60 years and upwards 159 (161 in 1886). Two inquests were held: in both cases death was caused by falls, in one instance suicidal, the deceased being temporarily insane. Summary of Causes of Deaths. diseases. Under 1 year. Between 1 year and 60. 60 and upwards. Total. Nervous System, Diseases of (including Apoplexy, Epilepsy, and Convulsions) 4 14 31 49 Circulatory System, Diseases of ... 14 15 29 Respiratory System, Diseases of (including Phthisis) 7 88 66 161 Digestive System, Diseases of 1 13 7 21 Urinary System, Diseases of ... 7 2 9 Tubercular Diseases (excluding Phthisis) 22 13 ... 35 Measles 1 16 ... 17 Diphtheria ... 2 ... 2 Whooping Cough 1 ... ... 1 Scarlatina (born with) 1 ... ... 1 Rötheln ... 1 ... 1 Erysipelas ... 4 1 5 Septicæmia ... 1 ... 1 Syphilis 4 3 ... 7 Cancer ... 9 8 17 Puerperal Mania ... 1 ... 1 Gout ... ... 2 2 Rheumatism ... 1 ... 1 Privation ... 1 ... 1 Asthenia ... ... 1 1 Apnœa 4 ... ... 4 Bone Disease ... 3 ... 3 Gangrene ... ... 2 2 Alcoholism Chronic ... ... 2 2 Delirium Tremens ... 2 ... 2 Premature Birth 2 ... ... 2 Want of Breast Milk 1 ... ... 1 Diabetes ... 1 ... 1 Senile Decay ... ... 22 22 Injury 2 1 ... 3 50 195 159 404 135 Outlying Public Institutions, Etc.—By virtue of an arrangement between your Vestry and a gentleman in the office of the Registrar-General, 1 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, 213 in number (against 183 in 1886) are included. The deaths occurred in the following institutions, viz.— St. Mary's Hospital 63 St. George's „ 31 St. Bartholomew's ,, 5 University College „ 6 West London ,, 6 Brompton Consumption Hospital (south branch) 6 St. Thomas's Hospital 4 Westminster ,, 3 Middlesex ,, 3 Guy's 2 Charing Cross ,, 2 London „ 1 London Temperance Hospital 3 German ,, 1 Royal (Waterloo Road) „ 1 Alexandra ,, 1 Homceopathic ,, 1 Western District „ 23 South-Western ,, 4 South-Eastern ,, 1 Northern ,, 1 London Fever ,, 1 Lock Hospital ,, 1 Cancer (Fulham Road) 5 Children's (Paddington) „ 5 ,, Great Ormond St. „ 3 ,, Victoria ,, 2 Queen Charlotte's „ 5 Lying-in (St. John the Divine) 1 Bethlem 1 Camberwell House Asylum 2 National for Paralysis 1 Epilepsy for (Portland Terrace) 1 Throat (Golden Square) 1 Paddington Workhouse Infirmary 6 Chelsea ,, „ 1 Holborn ,, 1 Wandsworth ,, „ 1 St. Peter's Home (Kilburn) 2 St. Elizabeth's ,, 2 St. Raphael's ,, 2 Medical and Surgical (Fitzroy Square) 1 213 Deaths from Infectious Diseases occurred as follows:— Western District Hospital 20; other Hospitals of Asylums Board 5; London Fever Hospital 1; St. Mary's Hospital 4; (Diphtheria); St. George's Hospital 2 (Diphtheria); West London Hospital 1 (Enteric Fever); and Victoria Hospital for Children 1 (Enteric Fever). The deaths at Queen Charlotte's Hospital, at the Lying-in Hospital of St. John the Divine, and at the Lock Hospital, were of infants born in those institutions. St. Joseph's House, Portobello Road.—The deaths at this quasi-public institution are included in Table 3 (Appendix). They were 30 in number: males 14 and females 16. All of the deaths save one occurred at ages over 60; 23 of them at 136 ages over 70. Seventeen of the deaths were of persons who had been imported from other Metropolitan parishes ; seven of the deceased had previously resided in Ireland, and three in the Provinces ; three were stated to be of parishioners. The causes of death were : diseases of the heart and lungs, 17; diseases of the nervous system, 6; old age, 2; phthisis, cancer, ague hernia and kidney disease, 1 each. Two deaths from phthisis, of girls aged 14 and 15 respectively, were registered at St. Elizabeth's Home, another Roman Catholic Institution, also in Portobello Road. The Hospital for 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 farther side of the Fulham Road, in the parish of Chelsea), were 73, viz.: males, 38, and females, 35. 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. The Hospital, it may be added, was closed for repairs during the last third of the year. 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, 375 deaths of non-parishioners were registered, all of which are excluded from Table 3 (Appendix). DEATHS NOT CERTIFIED. Twenty deaths (against 20, 10, 12 and 25 in the four 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, 0.7 per cent., and in London, l.2 per cent. In England and Wales the proportion was, 3.3 per cent., having, it may be added, steadily declined from 4.7 per cent. in 1879. None of the 20 137 deaths (males 9, females 11) uncertified in Kensington occurred in the practice of unregistered male practitioners. Four of the deaths are stated to have been registered on the information of midwives. One of the deceased persons had been an outpatient at a hospital. In the remaining cases there appears to have been no medical attendance. The several cases were duly reported to the Coroner, who did not deem it necessary to hold inquests. The causes of death, as registered, were: in six cases, diseases of heart, lungs, &c.; in five cases premature birth (including convulsions 3); in four cases, old age ; and in one case each, phthisis, tuberculosis, convulsions, hemorrhage (17 days after delivery of a child), and one unknown. Twelve of the deceased were adults (five of them 60 years of age and upwards), while of the remaining eight, seven were under one year and one was in the second year of life. The attention of the Metropolitan Sanitary Authorities was recently called to the subject of uncertified deaths, by the Vestry of St. James, Westminster, that body being of opinion that "no death should be registered unless the cause thereof is certified either by a qualified Medical Practitioner or by the Medical Officer of Health for the District, or by the Coroner upon inquisition." If it is meant that the Medical Officer of Health should, as a part of his duty in that capacity, inquire into and, if practicable, certify the cause of death, I for one should respectfully prefer not to come under any such obligation. It was stated that "at present three to four per cent. of the total deaths are not certified ai all;" and this is true, but the percentage varies within wide limits. It is about 1.0 per cent. in London; under one per cent. in Kensington; ranging upwards to 7 per cent. in Wales (8.6 in North Wales), where probably certification is often unattainable; because. by reason of the inaccessibility of the place of death, or remoteness from a doctor's residence, medical attendance cannot be procured. In such cases, which, I believe, constitute a large proportion of the total number, the suggested duty would be altogether k 138 impossible of performance. It would take up too much time to deal exhaustively with the subject, but I may further remark, speaking now from my experience in this parish, that of the 20 or 25 uncertified deaths that occur annually, nearly all are referred to the Coroner, and registration of death takes place only after the Coroner's decision that inquisition is not necessary. The inquiry by Coroners' officers no doubt is not Satisfactory, and in many cases like those in which inquisition is now held, it is probable that inquiry by an expert, such as a Medical Officer of Health, would save the time of Coroners and jurors, and some expense to the rates—if his decision that there was no necessity for inquest were accepted. In this case the Medical Officer would practically become "Coroner's Officer," as the St. James's Vestry propose. If suitably remunerated for his task, he might reasonably be authorised to inquire, in the first instance, into the cause of all uncertified deaths; and to certify in proper cases, referring all such as were due to actual or suspected violence to the Coroner. Any such change would require legislation to give it effect, but it may be doubted whether the legislature would entrust, to any individual, powers of such an exceptional nature. In the case of deaths not certified, but registered after report to the Coroner, it cannot be doubted that inquiry and report by a Medical Officer would be more satisfactory than that by a Coroner's Officer, and could be obtained were provision made for payment of a suitable fee. Presumably, the deaths "not certified" in mountainous districts are not even referred to a Coroner. In some of the manufacturing towns there is, I understand, much "medical" practice by unregistered practitioners, upon whose information, probably, many deaths are registered*; registration being required by law, which medical certification is not; excepting in the case of patients who have been duly attended in their last illness by a registered practitioner. I am of opinion that when death ensues in the case of persons attended by *The percentage of uncertified deaths last year, to total deaths, was 5.0 in Liverpool, 5.4 in Oldham, 5.9 in Sheffield, and 7.0 in Halifax. 139 unregistered practitioners, some inquiry should be made, and probably the fear of inquisition would tend to limit such practice, which, as a very general rule, cannot be to the public advantage. The subject of uncertified deaths has engaged the attention of the Society of Medical Officers of Health on many occasions, and some years ago this Society passed the following resolution, viz.:— "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 primâ facie ground for holding an inquest, direct such cases to be investigated by a registered medical practitioner." It had been suggested that the duty of making the proposed investigation should devolve on the Medical Officer of Health as a part of his ordinary work, but the Society did not approve this view, the adoption of which would impose on the Medical Officer an onerous and responsible duty, seeing that "uncertified" deaths include all "inquest cases," as well as those described as "not certified." Of all the unsatisfactory arrangements connected with uncertified deaths, it was felt that the least defensible is that which makes the Coroner's Officer de facto judge, in a doubtful case, whether an inquest should be held, and 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 qualifications for the discharge of the duty, is unsatisfactory." It follows as a corollary to this proposition that the firstinstance inquiry should be made by an expert. INQUESTS. One hundred and fifty-eight inquests were held on parishioners, 119 in the Town sub-district, 21 in Brompton, and 18 at outlying public institutions (hospitals) to which the K 2 140 deceased had been removed, sixteen of them from the Town sub-district. The subjects were males 87 and females 71; the age at death being, under five years, 60, including 40 under one year; between 5 and 60 years, 80; at 60 years and upwards, 18. The cause of death in 108 cases is stated to have been ascertained by post mortem examination. Eight of the subjects of inquest were illegitimate infants, including two "newly-born" and abandoned in the streets. The Deaths from Violence were 71, of which 7 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 Coroners' returns shew that the deceased persons had been "found dead," in bed or otherwise. The causes of death may be classified as follows:— Deaths caused by disease 87 Violent deaths— Accidental 60 Suicidal 6 Homicidal (including want of attention at birth 2) 5 — 71 158 The fatal diseases may be classified thus:— Diseases of the brain including convulsions 19 Diseases of the heart and lungs . 42 Other visceral diseases 5 Tubercular diseases (including phthisis) 5 Syncope 7 Zymotic diseases (scarlet fever and Diarrhœa) 2 Spasm of glottis 2 141 Syphilis, Erysipelas, Congenital malformation, Atelectasis, and Debility (one each) 5 87 The violent deaths were classified as follows: Accident: Suffocation (in bed) including 15 infants under one year 16 Choked with food (man, 50, and young children 2) 3 Burns (4), Scalds (2) 6 Drowning 1 Fractures and contusions, 32—viz.— Run over 5 Falls, under various circumstances 18 Injuries inflicted by horses 5 Other injuries 4 32 Hydrophobia 1 Corrosion by carbolic acid, causing pneumonia 1 Suicide: By hanging 2 By poison 2 By drowning 1 By pistol shot wound 1 Manslaughter 5 71 The Suicidal Deaths comprise three of each sex. The three females, aged respectively 45,43 and 24, killed themselves by drowning, pistol shot wound, and poison (aconite liniment); 142 the cause of death in the three males, aged respectively 63, 45 and 40, being hanging in two cases, and poison (laudanum) in one case. The Homicidal Deaths were of a female child aged 3 (by what means is not stated,), a female aged 32, on whom some unknown person procured miscarriage, a female aged 48, knocked down by a horse, and two newly-born children from "want of attention at birth." Among the deaths described as "sudden," "found dead," etc., 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, on 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. The inquest cases in Kensington were equal to 5.5 per cent. of the total deaths, the rate in the Metropolis being 7.4 per cent. and in England and Wales 5.6 per cent. The reported deaths from different forms of violence were equal to 2.5 per cent. of the deaths from all causes in Kensington, 3.7 per cent. in the Metropolis, and 3.3 per cent. in England and Wales. 143 METEOROLOGY. The mean temperature of the air in Greenwich, in 1887 was 47°.8 Fahrenheit, 0'8 below the average of 115 years and 1.4 below the average of 45 years: the means in the four quarters respectively were, 37.3, 51.6, 61.0, and 41.3. The highest reading by day (92.2) was registered in the week ended July 9th, and the lowest reading by night (15.5) in the week ended January 8th. The means of the highest weekly readings by day, in the four quarters respectively, were 53.5, 79.4, 84.2, and 57.8; and of the lowest readings by night, 24.7, 32.8, 40.9, and 28.0. The hottest week was that which ended July 9th (mean temperature, 69.3), and the coldest week that which ended March 19th (mean temperature, 31.4). July was the hottest month, (mean temperature, 66.5): and January the coldest (mean temperature 35.0). August exhibited the greatest range in temperature, viz., 48.5:—from 89.5 to 41.0; and December the smallest range, viz,, 30.1:—from 54.l to 24.0. The dryness of the atmosphere, i.e., the difference between the dew-point temperature and air temperature, was 6.7, or 2.5 below the average of 45 years. Rain fell on 141 days, the total amount registered in the year being 19.86 inches, 5.36 less than the averages of 72 years. Most rain fell in November (3.78 inches), and least in February (0.53). The means of the readings of the barometer were 29.840 inches; the means of February 30.145, and of November, 29.530, being respectively highest and lowest. The relative proportion of wind was: north, 100; east, 74; south, 83; and west, 108. VACCINATION. Table X. (Appendix) is a return respecting vaccination in 1886, compiled by Mr. Shattock, the Vaccination Officer, whose energetic discharge of the duties of his appointment it is always a pleasing duty to recognise. The return shows a loss of 5.4 per cent. in the cases, against 4.0, 3.9, and 4.6 in the three preceding years, "from removal of childrea to places out of parish unknown, or which cannot be reached, and cases not 144 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 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, Vaccinated and Unvaccinated respectively, for the 52 weeks ended 29th May, 1881. Death rate of people of subjoined ages. Per million of each age of the vaccinated class. Per million of each age of the unvaccinated class. All ages 90 3,350 Under 20 years 61 4,520 Under 5 years 40½ 5,950 145 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, therefore, the mortality from small-pox among the unvaccinated was about a hundredfold the mortality from smallpox 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 they can be reduced, but we should be confronted with an additional 12,000 and more deaths from small-pox, occurring during the year in the London population under 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.''† *''The power of a thorough vaccination to protect against death from small-pox "(it is stated) "is at least ten times greater than the power of much that passes under the name of vaccination." † 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, "during the ten years last past Germany has not only experienced smaller death rates by small-pox than ever before, but even has 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." 146 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 vaccination that offers itself in competition with public vaccination, and which parades its inefficiency as a reason for its acceptance by ignorant people. Its professors say to young mothers, 'Do you come to me, and I won't hurt your baby; I'll make only cne 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 147 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 "arm to-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 full acceptance of vaccination, it would be satisfactory to know that the Local Government Board had made arrangements for affording to parents the option of having their children vaccinated with calf-lymph at the public vaccination stations.* The Government at present only 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, whence regular supplies of lymph are forwarded to this country, 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 calf-lymph. "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 be attended with perfectly successful results, in the Army Medical Department, in only 40 per cent. of cases; in 34 per cent. failure is * This option will henceforth be given at the Vaccination Stations in Kensington, the Guardians having made arrangements for a supply of fresh calf-lymph weekly, on the days appointed for Vaccination. 148 complete, while in 26 per cent. "modified vaccine pustules'' (probably a very imperfect protection) are obtained. In face of the above statement, it is obvious that the protective power of vaccination cannot be fully and universally obtained, excepting 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, I shall again refer to the ''Special Report on Sanitary, Nuisances Removal, and other cognate Acts," by the Law and Parliamentary Committee, resulting from an enquiry, on reference by your Yestry, "Whether the provisions of the various Acts have been and are being enforced by the Yestry 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 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 Yestry." These reports, in the result, formed the basis of the Committee's enquiry and report, and with that report, which was unanimously adopted by your Yestry, 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 149 Acts referred to are, upon the whole, satisfactorily administered in Kensington," and that the icts themselves are also fairly sufficient, defect taking the form rather of difficulty in putting the law into speedy operation than in the terms of the law itself. My report dated March 13th, 1885, dealt, in sections with the following subjects:— 1. The housing of the working classes. 2. Underground rooms. 3. Construction of drains. 4. Inspection of drains, &c. 5. Vestry to cause work to be done at owner's expense. 6. Yestry's mode of procedure. 7. Rules with respect to house drainage, &c. 8. Power of Metropolitan Board of Works to make Bye-laws, &c, 9. Public conveniences. 10. Drinking fountains. 11. Paving and drainage of private mews, courts, &c. 12. Consumption of smoke. 13. Periodical removal of manure, and other refuse matter. 14. Trade refuse. 15. Infectious disease hospitals : Ambulances. 16. Disinfecting chamber. 14 & 15 "Vie., c. 34; 29 Vie., c. 28; 30 Vie., c. 28. 18 & 19 Vie., e. 120, s. 103, p. 57; 25 & 26 Vie., c. 102, a. 62, p. 195*; 18 & 19 Vie., e. 122, s. 23, p. 283. 18 & 19 Vie., c. 120 s. 79, p. 43. 18 & 19 Vie., c. 120, a. 82, p. 44. 18 & 19 Vie., c. 120, ss. 73, 81, 85, pp. 39, 44, 45; & 25 & 26 Vie., c. 102, s. 64, p. 196. 18 & 19 Vic., c. 121, a. 14, p. 613; s. 12, p. 612; & s. 13, p. 613. 18 & 19 Vie., c. 120, ss. 73, 76, pp. 40 41; a. 83, p. 45. 18 & 19 Vic., c. 120, a. 202, p. 124; s. 138, p. 82. 25 & 26 Vic., c. 102, s. 83, p. 209. 18 & 19 Vie., c. 120, s. 88, p. 47. 25 & 26 Vie., c. 102, s. 70, p. 199. 15 & 19 Vic., c. 120, s. 100, p. 56, 25 & 26 Vie., c. 102, ss. 80, 81, p. 208. 29 & 30 Vic., c. 90. s. 19, p. 643. 29 & 30 Vic., c. 90, a. 53, p. 654. 25 & 26 Vic., c. 102, s. 95,p. 216. 18 & 19 Vie., c.120, s.202,p. 124. 18 & 19 Vic., c. 120, s. 128, p.71. 29 & 30 Vic., c. 90, s. 22, p. 645. 46 &47 Vic., c. 35, a. 5. 29 & 30 Vie., c. 90, a. 23, p. 645. * The "page" referred to is in "Woolrych," 2nd edition. 150 17. Defective enforcement of tary Law. 18. Amendment of the Law; mary powers needed. 25 & 26 Vic., c. 102, s. 64, p. 196. Various Acts. The Committee reported, in substance, on the several subjects as follows:— 1. The Housing of the Working Classes is a "question that can he 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, authorized 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 Inspector, and recommend, pending legislation 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 Yestry 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, 151 5. Yestry 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. Yestry'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 Yestry 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 Yestry (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.* 8. Metropolitan Board's power to make Bye-laws WITH REFERENCE TO HoUSE DRAINAGE ARRANGEMENTS.— The Committee being of opinion that the power might be exercised with advantage, recommend that the attention of the members representing the Yestry 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 * See "Instructions" in subsequent section, "Regulations for Houses let in Lodgings," etc. 152 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 Yestry 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 Peivate Mews, Couets, etc.— The 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 Purposes Committee, from time to time, a list of places suitable to be dealt with under the provisions of the Act. 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. 153 13. Periodical Removal of Manure and other Refuse Matter, etc.—The Committee recommend that theSanitary 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 53 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 theattention 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 penalty is for (contempt of court by) disobedience of l 154 the Justices' Order after summons; this, moreover, being rarely inflicted to an adequate extent. Hence the need for the Yestry's interference, as recommended by the Committee, in sections 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 for 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 the powers entrusted to them, has been imposed by section 17 of 155 the Housing of the Working Classes (England) Act, 1885. 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 Slaughter-houses Act, they refer to the fact that the Yestry 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 or 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 Committee 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, and now, Prime Minister, Lord Salisbury. They observe that, as the said Bill" will finally clear the Statute Book of 11 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 repoit with a reference to the necessity for "a similar measure dealing with the Metropolis Management and Building Acts." L 2 156 At a meeting held on February 10th, 1886, 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, 1886), 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. Inspection of Drains (Sec. 85).—The Yestry should have power to charge the owner or the occupier of a house with the cost 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. 76).—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. Neit) Buildings.—In respect of the supervision of new buildings, and of all works appertaining thereto, amendment of the Metropolis Management and Buildings Acts is necessary, and such amendment should follow upon the lines of the Public Health Act, 1875, and amending Acts. Bye Laics.—The Vestry should have power to make and alter Bye-laws, with the sanction of the Metropolitan Board of Works, for carrying out necessary provions 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. 157 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 money, 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. 4. WITH RESPECT TO THE LAW AND PARLIAMENTARY COMMITTEE. The Committee should be requested to prepare— (a) A form to be sealed by the Yestry, 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— (а) To give the necessary directions for carrying into effect the recommendations 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 ventilating of sewers; (c) To see that, so far as practicable, all drains in streets shall be constructed 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 158 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. 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, and that he has taken steps to enforce, as far as practicable, any penalties that may have been incurred through disobedience of the Justices' 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.;— 159 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. To submit from time to time, to the Works, &c., Committee suitable sites for Public Conveniences. To report to the Works, etc., 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, etc., Committee on all matters con" tained in the half-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. 160 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 him 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, etc., 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. To submit from time to time to the Works, etc., Committee suitable sites for Public Conveniences. To report to the Works, etc., Committee offences under clause 3, section 19, of the Sanitary Act, 1866, which relates to nuisances caused by chimneys 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, etc., 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. 161 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 Buildings Acts. Copies of the Report of the Law and Parliamentary Committee, dated 8th 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 the Joint Committee, and the reports of the officers of the Vestry, to the several Vestries and District Boards, and met with 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 was received from the Clerk to that Board in April, 1887, couched in the following terms:— "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. 162 "In reply, I am directed to inform you, that the Board, while fully recognising 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.' What the Board ''might have" done this year, 1888, it is useless to speculate. But in view of their (apparently) pending extinction under the provisions of the Local Government (England and Wales) Bill, the Board have not thought it well, and have received no encouragement to promote legislation this session. Practically, then, almost nothing has come of the labours of the Committee. The importance of their work is admitted, the desirability of legislation to give effect to their recommendations is recognized. That the matters dealt with may not be lost sight of, I have felt it my duty again to reproduce the report in abstract, as above. BILLS IN PARLIAMENT. At the request of the Law and Parliamentary Committee, Mr. Cassal, Public Analyst, and myself drew up reports on certain Bills then before Parliament. They wore the Beer Adulteration Bill (No. 2), which was rejected by the House of Commons, and the Butter Substitutes, which passed into law. I also reported upon Bills entitled Sanitary Registration of Buildings and Sanitation of Houses (Metropolis), both of which failed to get passed (vide Annual Report for 1886, pp. 128—132). In. the current Session, your Vestry having requested my attention to the provisions contained in the Housing of the Working Classes Bill and the Housing of Working Classes (London) Bill, I submitted observations as follows:— Housing of the Working Classes.— Certain "Amendments of General Law" are proposed. Thus Clause 2 provides for a fine on owner of dwelling for disobedience of justices order requiring abatement, &c., of nuisances, the fine being "in addition to any daily penalty to which the owner may be liable" for such disobedience. The existing penalty of (not more than) 163 ten shillings a day during continuance of disobedience, would be adequate if duly enforced; but, speaking in regard to the Metropolis, I should think of more importance than the proposed additional fine, a power possessed by Courts of Summary Jurisdiction, outside London, under the Public Health Act, to inflict a penalty not exceeding five pounds, upon the person liable for the creation of a nuisance. Clause 3 imposes an obligation on Vestries and District Boards to make bye-laws respecting lodging houses under section 35 of the Sanitary Act, 1866. Bye-laws have now been made in all, or nearly all, parishes and districts in London. To what extent they are carried out is another question. Clause 4 relates to inspection of Cellar Dwellings (underground rooms) in the Metropolis, and proposes to enable a Vestry to authorise their officers to inspect such places, and to have powers of entry the same as District Surveyors. The Public Health (Metropolis) Bill brought in by the Marquis of Salisbury, in the Session of 1885, proposed to transfer the powers of the District Surveyor in regard to cellar dwellings, &c., to the Inspector of Nuisances. Clause 5, referring to section seven of the Housing of the Working Classes Act, 1885—which makes it the duty of a local authority to put in force their powers to secure a proper sanitary condition of all premises within their district—and to the fact that "there is no provision in that Act for enforcing the said enactment," would confer power on the Local Government Board (after local enquiry) to dissolve the defaulting local authority and to direct a fresh election of members, at which members of the dissolved authority would be ineligible, unless, in the case of any particular person or persons, the Board should otherwise direct. Such a power, if ever conferred, will certainly not be put in motion, as here proposed, "on a written representation to the Board, signed by (at least) six ratepayers, to the effect that the local authority have failed to do their duty," etc. 164 Clause 6 (Amendment of Artizans and Labourers Dwellings Improvement Acts, 1875 to 1885), is directed to the question of compensation, and is designed to remedy defects in the Acts which have made the application of them so costly. There being no scope for these (Cross's) Acts in this parish, we are interested'in the proposed amendments (which appear to be sufficient and reasonable) only as contributors to the Metropolitan Consolidated Rate, out of which all charges incurred in the execution of the Acts are defrayed. Your Yestry petitioned Parliament against this Bill. Housing of the Working Classes (London).— The following summary of the Bill, which appeared in the Times, contains all necessary information, there being no probability of the measure passing into law this Session The powers which the Bill would confer on the 'local authority' are those of buying, selling, letting, hiring, and laying out land, and also of building. One object for which these powers might be exercised would be to provide suitable dwellings inside or outside the Metropolitan area for the use of the population engaged in the industry of that area. A second object would be to provide lodgings, baths, wash-houses, halls, or other structures for the use, convenience, or health of the population; and another would be to provide open spaces for the same purpose. Finally, land might be acquired within the Metropolitan area or within five miles of it, which in the judgment of the local authority ought to be acquired 'with a view to the expansion of the population.' The 'local authority' to which these powers are intrusted by the Bill is to be any representative body elected by the inhabitants which may be established in the future by Parliament. Meanwhile its duties would be performed by seven Commissioners, three of whom would be paid, and all appointed by the President of the Local Government Board. Compulsory powers of acquiring land are conferred by the Bill ; and it is left to the Local Government Board to decide in each case, after local inquiry, whether there are any valid objections 165 to carrying out the local authority's resolution to acquire any lands compulsorily. Failing agreement, the amount of the compensation would be ascertained by the County Court Judge, where the total claims in respect of one property are under £1,000, and in other cases by a judge of the High Court. In assessing the compensation the Bill directs that there shall be no addition for compulsory purchase, but that there shall be an allowance for cost and trouble of removal, reinvestment, or other special circumstances. When a person who is thus dispossessed is affected in his business, the direction is that regard be paid to the prospect of other premises being obtained for the business, but that in no case is more than one year's net profits to be awarded. Further provisions of the Bill are that vacant land is to be rated at 4 per cent. on the sum which the land would sell for; and that unoccupied houses are to be subject to rates just as if they were occupied, and half of these additional rates are to go towards the purposes of the Bill. Besides conferring borrowing powers on the local authority, the Bill would enable it, when it obtains the consent of the Local Government Board, to add a penny in the pound to the landlord's property-tax for the purposes of the Bill. In all works executed under the Bill attention is to be directed towards providing for the poorer classes the best available accommodation at the lowest rent." Your Yestry petitioned Parliament against this Bill also. Public Health (Prevention of Infectious Disease).— "A Bill to amend the Public Health Act, 1875, so as to make further provision for the prevention of Infectious Diseases, and for other purposes," is really a Bill for Notification of Infectious Disease, upon which I submitted a full report (No. 4., April 23, 1888, page 40). Although the Bill as drawn does not apply to the Metropolis, the subject with which the Bill deals has already been sufficiently considered (vide pages 88—103 inclusive.) Local Government (England and Wales).—Upon this Bill, which materially affects the question of Local Govern- 166 merit in the Metropolis, I also reported, on April 23, as follows:— " London, as defined under the Metropolis Management Act, is to be created a county, and governed by a County Council, to be directly elected by the ratepayers. The County Council •will take over the powers, duties, and liabilities of the Metropolitan Board of Works, which will cease to exist, and certain powers now possessed by the Corporation, and various powers at present exercised by the Secretary of State, the Board of Trade, and the Local Government Board, as set out in schedules appended to the Bill. The County Council will have the appointment of Public Analysts. Its functions as a Sanitary Authority will be those, mainly, now possessed by the Metropolitan Board of Works under the Contagious Diseases (Animals) Act, the Slaughter Houses (Metropolis) Act, &c.—functions which, elsewhere than in London, are at present exercised by the municipal authorities and local boards, and will in future be carried on by their successors, the ' District Councils.' "The Bill does not touch the Vestries and District Boards of Works, but Mr. Ritchie intimated the intention of the Government to deal with them at some future time, by amalgamating them, within certain defined areas, as ' large District Councils with large and important administrative functions.' The County Council will be enabled to transfer to District Councils any powers or duties transferred to the County Council by the Act, so that it is probable that the District Councils of the future in London will be entrusted with the carrying out of the sanitary duties now discharged by the Metropolitan Board. No new sanitary powers appear to be conferred upon the County Council, but they will exercise certain powers of control, now discharged by central authorities, e.g., under the Burials Act, the Gas and Waterworks Facilities Acts, the Electric Lighting Acts, the Baths and Washhouses Acts, &c., among others. The County Council will also exercise the powers of the Local Government Board, under sections 189 and 191 of the Public Health Act (which does not at present apply to London), with regard to 167 the qualifications, &c., of Medical Officers of Health. But the County Councils appear to have no power to appoint Medical Officers of Health, excepting in London, where, under Cross's Acts (Artizans and Labourers' Dwellings Improvement Acts) they can appoint such officers, but only for the purpose of carrying those Acts into effect. " Regarded from the public health point of view, the scheme of the Bill is not all that could be desired, but provisions which might well have been included, powers which might well have been granted, have for the time been withheld for fear of the ill consequences likely to arise from overloading the machine at starting.' The controlling powers given to the County Councils on other than sanitary matters are considerable, and Mr. Ritchie anticipates that ' at some future time it may be desirable to cast upon them powers even more extensive.' " Having regard to Sanitary Administration,it is to be regretted that the powers and duties of the Metropolitan Asylums Board, so far as regards the provision of Hospitals for Infectious Diseases, should not have been transferred to the County Council. In corporate towns the municipal body is the sanitary authority, and has power to provide hospitals for the infectious sick, and this power will remain to their successors, the District Councils. Nominally, the Vestries have similar power in London, but with such an adequate and admirable system of hospitals as we possess, under a central authority, the Asylums Board, it would be an iniquitous waste of money were they to attempt to duplicate those establishments. It is true that relief afforded to the sick in them does not pauperise the recipients now, as it did formerly; but, legally, the Managers have been brought into existence to deal with the pauper class only, and any connection with pauper government is undesirable in measures designed for the prevention of infectious disease. " Objection has been made that Poor Law administration has not been transferred to the County Council, but such an addition to the otherwise onerous duties of the Council is undesirable. There seems to me scope, in London, for separate administration in 168 regard to Educational and Poor Law matters equally. But Sanitary administration in its fullest sense—including vaccination and registration, might with advantage be placed under the control of the County Council, the executive business being carried out upon identical lines by the District Councils. " The subject is not new to me, having been fully dealt with in my presidential address delivered before the Society of Medical Officers of Health, in 1883, wherein I pointed out that the unity of Sanitary administration, so necessary to efficiency, might be brought about in either of two ways : (1) by sweeping away the existing Sanitary authorities and creating a new authority to rule over an undivided London ; or (2), the present local machinery being retained, a Central Board might be established—to take charge of all great matters affecting the Metropolis as a whole ; to lay down the principles on which Sanitary administration should be carried out, by framing byelaws, &c., and generally to exercise a supervising control over the work entrusted, under the Local Management Acts, to the Vestries and District Boards. Such Central Board,' I said, would be, as it were, legislative in its functions, the local boards executive, and thus substantial unity might be attained with a minimum of change.' A copy of the address was, by desire, placed in the hands of every member of the Vestry, and it may be remembered that I expressed my preference for the second of the courses above indicated, finding it difficult to believe that a system which has worked so well, and conferred so many benefits on the Metropolis, should be cast aside in order to give trial to a new, a vast, and a doubtful experiment such as that involved in the adoption of the first course.' I proposed that 'the new authority (regarding it as I did purely from the sanitary standpoint) should take over, among other duties, those now discharged by the Asylums Board with regard to hospital provision, &c., together with the hospitals and ambulances ; that it should have power to acquire, on equitable terms, the property of the water companies ; that it should be the vaccination authority ; and in addition to medical and other officers 169 concerned with public vaccination, that it might be clothed with powers to appoint coroners and registrars of births, deaths, &c. The provision or control of cemeteries might not unreasonably be one of its functions.' I expressed an opinion that only one entirely new department would have to be created-—that, namely of Public Health,' and 1 sketched a scheme of Sanitary administration, in which the central authority (County Council) and the local sanitary boards (District Councils) would have their allotted part, working together for the promotion of the public health, to which end, after all, all the work of local administration mainly tends, whether it be drainage, paving, lighting, water supply, scavenging, or what else. Under a system thus providing for unity in sanitary government, there would be no waste of labour, no contrarieties in the action of different local authorities; but everything necessary for the public welfare, baths and washhouses, mortuaries, disinfecting chambers, public conveniences for both sexes, abattoirs, markets, &c., would be provided, not haphazard, but on a uniform and consistent plan—while by suitable bye-laws, bakehouses, and trades and businesses resulting in the production of offensive refuse, or other form of nuisance, could be regulated, the central authority framing the bye-laws, the duty of inspection and immediate control devolving on the several local authorities. " The Bill does not realize these views, but it does at least create a machinery which, by judicious extension from time to time, may bring about a practical scheme of sanitary administration which will have the effect of making London more than ever an example of what may be done to improve the health, the comfort, and the safety of those whose fate it is to live in the great cities of the world."* * It is hardly necessary perhaps, to mention that ray comments were based on the Bill in the form in which it was introduced by the President of the Local Government Board, M 170 WATER SUPPLY. The Cutting-off Powers of the Companies. This subject was recently brought under the notice of the Metropolitan Sanitary Authorities in a communication from the Clerkenwell Vestry calling attention to " The question of the power of Water Companies, under Section 32 of the Metropolis Water Act, 1871, to cut-off water from houses which are under the constant supply system, if the fittings are in such a state as to occasion waste of water, the Sanitary Authorities being then set in motion under Section 33." The Vestry, referring to the Act passed last Session " modifying the Companies' power to cut-off water from premises for non-payment of the Water Rate," submitted " that in the interests of public health it is highly desirable that a similar amendment of the law should take place in regard to cutting-off water in consequence of waste," and suggested " that, in lieu of the water being cut-off, power should be given to the Water Companies" (by whom, in fact, it is already possessed, when constant supply is given), " or the Sanitary Authorities, to carry out the necessary works, and recover the costs from the owners." The Vestry invited the co-operation of the Sanitary Authorities " in endeavouring to obtain such an amendment of the law." This subject of "cutting-off" has received consideration repeatedly in my Monthly and Annual Reports, and was fully dealt with in my Annual Report for 1882 (p. 117-26), in which I drew attention to the arbitrary power possessed by the Companies to cut off the supply "as a coercive measure to obtain payment of the rate." This power, in regard to houses let in tenements, and when the owner is liable for payment of the water rate, has been taken from the Companies by the Water Companies (Regulation of Powers) Act, 1887, described as " an Act to limit the powers of the Water Companies to cut off the Tenant's Water Supply when the Rate is paid by the 171 Landlord." The Act, in the cases to which it applies, makes provision 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 next may become due, from time to time, when the owner and not the occupier is liable by law, or agreement with the Company, for the payment of the rate, which is a charge on the dwelling-house in priority to all other charges affecting the premises. Obviously this power cannot be made to apply in regard to houses the water rate of which is payable by the occupier. But, as I suggested in 1882, " the Company should be left to their remedy for the recovery of a debt like other traders," in such cases, and should not be allowed to cut off the supply, for the reason that water, being " a prime necessary of life, the absence of a proper supply in an inhabited house constitutes a serious nuisance," dangerous to health, and should not be allowed. With this branch of the question the Clerkenwell Vestry did not deal, and in their circular letter they simply made the modest proposal that the Companies should not be allowed to cut off " in consequence of waste." The Companies have powers beyond what are implied in the proposal, for they may cut off, where constant supply is given, in case of the " absence of the prescribed fittings;" and also when, by reason of defective fittings, there is waste, misuse, undue consumption, or contamination of water. But the Companies very rarely, in my experience, cut off on these accounts. I say this confidently in respect of their powers under the Water Act of 1871, with regard to " prescribed fittings," because in such case they are required by the said Act to give notice to the Nuisance Authority, and not more than a dozen such notices have been made to your Vestry in as many years. The Companies are under no obligation to give notice to the Nuisance Authority when the cutting-off is for non-payment M 2 172 of the rate; hut occasionally such notice is given, and then the law is put in motion to obtain a renewal of supply; your Vestry's officers thus becoming, practically, the agents of the Companies to enforce payment of the rate. Referring to these anomalies, I observed, in my Report for 1882, that it is " an unreasonable thing that a Water Company should have the power of cutting-off the supply because, to take an extreme case as an example, an iron pipe is used where a lead pipe should have been used ; or because a lead pipe is used of less weight per lineal yard than the Regulations require. ... In such a case," I added, " the Company would be required to give your Vestry 'notice,' the ' nuisance' being 'presumed to be such as to render the premises unfit for hum in habitation,' although water may flow into the cistern ; and yet they are under no obligation to give such notice when they have cut-off the water to compel payment of a debt, a step whereby nuisance is actually created." I adhere to the opinion then expressed that notice should be given in every case, but more especially that the Companies should not be allowed to cut-off at all, but should be endowed with ample power to recover payment of the rate, which, moreover, they can insist on having paid in advance. The subject is of so much importance that I may remind your Vestry that in my second and third Monthly Reports for 1882 (February 1st and March 1st, p. 6 and p. 13) I recommended that the attention of the Local Government Board be directed to the need of further legislation (inter alia) to take away the power of the Companies to cut-off water from premises, substituting therefor such other powers to enable the Companies to recover rates, or make good fittings, &c., as to the wisdom of Parliament should seem sufficient and equitable. These Reports were referred to the Works, Sanitary, and General Purposes Committee, who after much consideration reported as follows (a) " That the Water Companies should be requested, if they are not by law required, to give the Vestry notice in every case when they have cut-off the supply of water from inhabited premises from whatever cause. 173 (d) " That the sections of the Acts conferring on the Water Companies the power of cutting-off the water from premises should be repealed, etc." [The clauses (b) and (c) related to the 14th Regulation, which provides for the abolition of waste-pipes connected with drains, etc.; the Committee recommending, as I had proposed, that the Nuisance Authority should have power, by an amendment of the Regulation, " to abolish waste-pipes, and to enforce the Regulations having a sanitary bearing," the Companies having allowed the 14th Regulation to remain practically a dead letter. 1 The Committee further recommended that their Report (e) " Together with the legal questions raised in the Beports of the Medical Officer 0f Health, dated February 1st and March 1st, 1882, respectively, be referred to the Law and Parliamentary Committee for consideration as to the best way of giving effect to the recommendations contained in such Beports. (/) " That upon receipt of a report from the Law and Parliamentary Committee on the subject, a communication be sent to each Vestry and District Board of Works in the Metropolis, with a request that they would appoint three of their members to attend a Conference upon the whole subject of Water Supply, at some convenient date, for the purpose of taking such action in the matter as maybe deemed expedient." The Report of the Committee was adopted by your Vestry, but no action was taken upon it, and the matter remains in statu quo ante, excepting so far as to cutting-off powers, as modified by the Act of 1887, above mentioned. Referring to the circular letter of the Clerkenwell Vestry, it seemed to me that their proposal was of too limited a character to necessitate general action on the part of the Sanitary Authorities of the Metropolis, but I am of opinion that the time has arrived for carrying into effect the recommendations of the Works, Sanitary, and General Purposes Committee as set out in their Report above cited. 174 OFFENSIVE BUSINESSES. 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 Melter. — " Tucker's Factory," in High Street, is the only one in Kensington, and it must be confessed that the efforts of the Company to prevent effluvium-nuisance have not been successful, as Well-founded 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, who are anxious, but have hitherto failed, to remove the causes of complaint. The Board, in the Annual Report for 1887, states that "the improvement in the manner of conducting the businesses" (of soap boiler and tallow melter) '' has been continued during the past year, but it has been necessary to take proceedings for the enforcement of the bye laws in four cases," Tucker's factory not being one of the four. Fat Extractor.—A business of this description is carried on in Tobin Street, Notting Dale, another having been discontinued in 1887. The business gives rise to more or less effluvium-nuisance, notwithstanding improved arrangements and care on the part of the proprietor. But the people living thereabouts are not of a particularly squeamish nature, and do not often complain. The Metropolitan Board, referring to this trade and that of " fat melter," reports that " these businesses have been generally well conducted during the year." Marine Stores.—Every year, during the hot weather, complaints are received in regard to stenches arising in the collection and storage of bones, fat, and other animal matters in a putrid condition on the premises of " marine store dealers." Your Vestry, having found it difficult to prevent recurrence of 175 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 ia carried on, proper impermeable receptacles for the collection, storage, and removal of the fat, &c,., and frequent, if not daily, removal of offensive matter 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 of 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 regulation cf 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 17b " 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 diffiulty in dealing with recurring trade nuisances under the Nuisances Removal Act; but experience has proved it comparatively 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 Slaughter-houses Act, and those scheduled by the Board since the passing of that Act. The point was settled in Passey (Apellant) 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. CONVEYANCE OF OFFENSIVE SUBSTANCES THROUGH STREETS. That the representations made to the Metropolitan Board of Works, referred to in the preceding observations, have not been without effect is testified by the subjoined circular letter received by your Vestry in November :— " Dear Sir, The Special Purposes and Sanitary Committee of the Board have under consideration the question of the nuisance caused in the collection, and conveyance through the streets of the Metropolis, of offensive substances, such as fish offal, blood, kitohen stuff, and other refuse. It has been represented to the Board that the existing provisions in the Nuisances Removal Acts, and in the Local Management Acts, bearing upon the matter, do not enable the Looal Sanitary Authorities to deal authoritatively aud effectively with the nuisance, 177 and that additional legislative powers are necessary. The Committee are quite satisfied that serious nuisance does arise from this source, but before recommending the Board to take any steps for obtaining an amendment of the law, they are desirous of ascertaining the views of the several Vestries and District Boards of the Metropolis on the subject, especially as the Committee understand that in some districts the Local Authority has succeeded in effecting the removal of offensive substances without nuisance. " The Committee have, therefore, instructed me to request your Board to be good enough to furnish the following information :— 1. Whether nuisance is experienced in your district in the collection of offensive material, and in its conveyance through the streets, and, if so, the nature and extent of the nuisance. 2. If your Board have taken any steps for preventing nuisance from this source, and, rf so, what steps, and with what results. 3. Under what statutory provisions you have acted, and if you consider such provisions adequate to the purpose of preventing nuisance. " The Committee will be glad to receive any information which your Board may be good enough to afford them during the present month, as they propose to report on the subject early in December. I am, c&c., J. E. WAKEFIELD, Clerk to the Board." Recognizing the importance of the communication, I made a Special Report on the subject (17th November) dealing with the subject, as follows :— " Nuisance is experienced in this Parish in ' the collection of offensive material, and in its conveyance through the streets and in its storage prior to removal. "Fish (and Poultry) Offal.—In regard to this refuse, perhaps the most offensive of all, the arrangements appear to be wholly unsatisfactory arising in large measure from the fact that there is no systematic collection of it. The fishmongers experience much trouble in getting rid of it, and cannot place dependence on the collectors, who, nevertheless, are paid for their sei vices. The offal appears to be collected in part for boiling-down for pigs' focod; it is also removed in manure carts, then presumably, finding it is way on to the land. As a i 78 rule, it is collected daily, and mostly in the latter part of the day. It is rarely stored in impermeable covered vessels, and as it rapidly decomposes, effluvium results. This is most complained of at hay-making and harvest time, when the manure collectors are less regular in their visits. The storage vessels are not removed — simply emptied, and the receiving vessels, mostly of wood, and the carts themselves, are offensive at the commencement of the day's work—the nuisance naturally being greatest in hot weather, both at the time of emptying the trade receptacles, and during passage of the carts through the streets, the tubs being usually covered with sacking only. " Blood.-—With blood may be grouped the other refuse matters from slaughter-houses, and with regard to these matters I am able to report comparative absence of cause for complaint —as a result of bye-laws, well conceived and fairly carried out under substantial penalty for default. The various matters are stored in impermeable covered receptacles, in which, as a rule, they are, as they ought to be, removed from the premises, double sets of receptacles being provided. " Bones may be mentioned here, though not named in the Board's letter. The nuisance from these is great, especially in hot weather, and it may exist on every butcher's premises. Bones, from which the flesh has been stripped, are stored usually in uncovered receptacles awaiting the periodical call of the collecting vehicle. The vehicles themselves are offensive, and as they load up they become every hour more objectionable to smell and sight, as they make their fetid progress through the streets. " Kitchen Stuff.—Under this head I include waste-fat, bones, hare and rabbit skins, &c., all of which find their way to ' Marine Stores.' Skins are generally removed before they become very offensive, but even in regard to these there is by no means freedom from complaint, Bones and fat are generally offensive in warm weather, being often allowed to accumulate in considerable quantities, pending the periodical 179 call of the collecting vehicle. These matters are stored in open wooden tubs, which arc emptied direct into the vehicle, or into receptacles, all of which are usually offensive, empty or full. Bones go to the bone boilers, fat to the fat melters and soap boilers, and naturally the collectors do not call without hope of receiving an adequate quantity, making it worth their while. Bones are conveyed out of the parish, and a good deal of fat probably, but within the boundaries there are two melting establishments, which demonstrate the difficulty— even under good bye-laws fairly carried out—of preventing nuisance in the conduct of a naturally ' offensive ' business. "Other Offensive Substances."—Greengrocers' Refuse is not seldom the cause of complaint, arising largely out of the difficulty of getting it removed—such refuse, moreover, being naturally most abundant in summer, when it more speedily decomposes. It is often put into dung-pits, where, under the influence of heat, it ferments, and soon becomes offensive, adding considerably to the nuisance arising in the removal of stable manure. " Cowshed Refuse.—The dung from cowsheds, to which sometimes sour grains are added, is a cause of complaint, being removed in filthy vehicles, which are often leaky, and allow of dropping in the streets. Under the operation of the Board's Regulations for Cowsheds, the refuse is removed with greater frequency than formerly, but cow-dung in its passage through the streets is almost always objectionable. " Stable Manure is frequently allowed to remain too long in the receptacles, and when these are underground covered pits the nuisance in removal—at the time of collection, and in the progress of the vehicles through the streets—is very great, and is a frequent cause of complaint. The nuisance varies widely in different localities, according to the use made of straw as litter. In gentlemen's stables, the straw is changed frequently, and when the used litter is stored in iron cages on a paved and 180 drained surface, there is practically no nuisance in storage or removal. But people less favourably circumstanced use the litter day after day, until it becomes fairly rotten before being deposited in the ' dung-pit '; and then, naturally, the nuisance is great—in the pit itself, in the act of collection, and in conveyance through tlie streets—greatest also in hot sveather (when, moreover, it is difficult often to get it removed),and in proportion to the time of detention. Of late years, peat moss has come into use as litter (sawdust, also, to some extent), and in the act of collection, this is extremely offensive from disengagement of ammonia. There is, however, little nuisance while the moss is undisturbed, or in conveyance through the streets. " House Refuse. —The storage, collection, and removal of house refuse is an undoubted cause of serious nuisance, which can be prevented only by a system of storage in impermeable covered receptacles, and frequent if not daily removal in properly constructed vehicles.* This duty should, in my opinion, be undertaken everywhere, as in Kensington, by the Sanitary Authority itself. '' Your Vestry have ' taken steps for preventing nuisance' from the storage of offensive substances by instructing the Sanitary Inspectors to visit regularly the premises where ' offensire trades ' are carried on ; using the word ' offensive' not merely in the statutory sense of the Slaughter Houses Act, but in regard to all businesses the conduct of which gives rise to the production of refuse substances that may become offensive. In this way much has been done, and is being done, but at the cost of considerable time that might well be spent in other work. Much of the nuisance, as already intimated, in regard to offensive substances of animal origin, occurs at the time of collection and in conveyance through the streets; with which, * It may be mentioned that the Vestry have lately requested the Metropolitan Board of Works to " take steps to procure an amendment of the law whereby it is obligatory that an ash-pit or dust-bin be provided to every house, and an enactment that dust-bins be abolished and movable receptacles substituted."—(Vide Section on "House Refuse.") 181 so far as I know, we have no power to deal; but efforts have been constantly made to minimise cause for complaint by promoting removal before the substances in question have become offensive from decomposition. " When necessary 'to prevent nuisance from these sources,' proceedings have been taken under the provisions of the Nuisances Removal Acts for the abatement of nuisance on premises, the powers being adequate ; but no penalty attaches to the creation of a nuisance. True, an Order prohibiting the recurrence of a nuisance may be obtained, and breach of the Order entails a daily penalty during continuance of the disobedience —a penalty of no great amount, however, and reducible at the discretion of the Justices. The machinery, moreover, is cumbrous, the incident delay tedious and objectionable. The statutory provisions therefore cannot be deemed ' adequate to the purpose of preventing nuisance.' " 'Notice' has been given by your Vestry for the 'periodical removal of manure or other lefuse matter from mews, stables, and other premises," under section 53 of the Sanitary Act, 1866, which specifies as the penalty for default twenty shillings for every day; and were the penalty a fixed one it would be adequate to enable the Sanitary Authority to enforce its requirements ; but it is reducible at the discretion of the Justices, and when proceedings have been taken, either no penalty has,been inflicted or, usually, so small a penalty as to have no deterrent effect. " For breach of the Slaughter House Regulations there is a fixed penalty of three pounds, and to this fact in large measure it is due that the Regulations have been so well carried out and that offences are now so rare. It was the success of the Slaughter Houses Act, dealing as it does with offensive businesses which could not be effectively controlled under the Nuisances Removal Acts, that induced your Vestry, upon my recommendation, to apply to the Board to declare the business of a Marine Store Dealer an 'offensive business' under the Act, under circumstances already referred to at page 175, 182 To conclude, then, there can, I think, be no doubt that ' the representations made to the Board ' that the existing provisions in the Nuisances Removal Acts and in the Local Management Acts, bearing upon the matter, do not enable the Local Sanitary Authority to deal authoritatively and effectively with nuisance ' arising from the storage, the collection, and the removal of offensive substances, are well founded, and that 'additional powers are necessary.' The Board is satisfied that ' serious nuisance does arise ' from the source in question, and I trust it will come to the conclusion, at which your Vestry long since arrived, that the matter can be dealt with effectively only by bye-laws, entailing an adequate and fixed penalty for offences—bye-laws made by the Board, under their existing powers, or under fresh powers to be obtained from Parliament; bye-laws the carrying out of which should be entrusted to the Local Sanitary Authorities. Such bye-laws with respect to offensive substances of animal origin should make provision with regard :— (1) To storage vessels, which should be of metal, impervious and covered. (2) To removal in iron tank vans (but it would be better to provide for the removal of the storage vessels themselves). (3) To time of daily removal (in the evening); and (4) To measures for disposal of the refuse. " It, is open to consideration whether the duty of removing all offensive substances should not be devolved upon the Sanitary Authority, at the reasonable cost of the producers thereof." I may here mention that in a Special Report on " Filth Removal," dated July 24, 1878—a Report originating in complaints with regard to the conveyance of offensive matters through streets in the day time—I dealt with this question, and 183 your Vestry referred ray Report to the Law and Parliamentary Committee, with a view to the making of a " Bye-law regulating the time for the removal of offensive matter through the streets" under the powers conferred by section 219 of the Kensington Improvement Act. The question, however, dropped out of sight, and the bye-laws adopted by your Vestry, in July, 1882, contain no reference to it. Meanwhile, I had reported to your Vestry on ''the difficulty experienced in preventing nuisance from accumulations of offensive matters coming under the general description Refuse," a difficulty " common to all parts of the Metropolis, and calling for legislative interference for its abatement " (Annual Report for 1880, page 114). And with a view to steps being taken to obtain legislative enactment, I had brought the subject under the notice of the Society of Medical Officers of Health (in 1880) the result being that a Special Committee was appointed to consider and report :— " On the best and most convenient ways of dealing with animal and vegetable trade refuse, e.g., from slaughter-houses, fishmongers', poulterers', and greengrocers' shops, etc., with a view to its collection, removal, and ultimate disposal, whether by utilization or destruction." Subsequently the reference was enlarged by the inclusion of house refuse, stable refuse and cowshed refuse. In due course the Committee, over which I presided, presented a report, which, after careful consideration, was unanimously adopted, and will be found in my Annual Report for 1880 (page 114). With regard to Trade Refuse such as "the refuge of slaughter-houses and the refuse of the trades of fishmonger, poulterer, greengrocer, etc." (being of animal or vegetable origin and liable to decomposition), the Society was of opinion that " the Nuisance Authority should have power as well as obligation to collect, remove, and dispose of such refuse, and 184 should receive reasonable compensation for so doing." And " in any case the refuse should be collected daily in the early morning hours, and conveyed in properly constructed covered receptacles, or in vehicles expressly adapted for the prevention of effluvium nuisance." Passing over the Society's recommendations with regard to House Refuse—a subject now under the consideration of a Special Committee of your Vestry—it may be stafed, with respect to stable and cowshed refuse, that the Society urged that ''the Nuisance Authority should have the same right everywhere, as in the City of London, to collect such refuse when the owner is in default, and to charge him with the cost of so doing;" the "default" being noncompliance with the Regulations which the Authority possesses power to frame under the 53rd section of the Sanitary Act, 186(3, for the " periodical removal " of manure, etc., by the owner. Regulations have been framed under the Dairies Order of 1885, for the removal of cowshed refuse, and it is now done pretty regularly. With regard to this refuse, however, the Society intimated that it "should be removed within specified hours in the early morning, in vehicles specially constructed so as to prevent slopping and effluvium nuisance." Reference was made to the greater difficulty of getting stable refuse removed within the same hours, and to the fact that " the necessity for so doing would be lessened, provided it were found practicable to abolish sunken dung-pits, in which manure rapidly ferments and decomposes, giving rise to intolerable nuisance when the receptacle is emptied, and also in the passage of the cart through the streets. Were the plan universal of employing properly paved and drained receptacles, enclosed within iron racks above the surface of the ground, so as to dry the refuse by air currents, its removal might be effected at any period of the day, .without offence, provided it had not been kept too long in the stable, or in the receptacle itself, so as to become rotten and offensive.'' The Society, in conclusion, expressed its conviction that " legislation will be found necessary to solve the difficulty attending the ultimate 'disposal' of Refuse—viz., by imposing 185 on canal and railway companies the obligation of conveying it from towns in boats or vans expressly contrived for the avoidance of nuisance, and at a rate for carriage, which, while fairly remunerative, shall not be oppressive to the ratepayers—power to settle the rate, in case of dispute, to be vested in the Railway Commissioners, or some similar tribunal having an equitable jurisdiction." The Report of the Society was forwarded in 1881 to the several Sanitary Authorities of the Metropolis, and to many members of Parliament who, it was thought, might be likely to take an interest in the subject—but nothing came of it. In 1883, as already mentioned, I directed your "Vestry's attention to nuisances from " stenches arising from the collection and storage" (I might have added removal also) *' of fat and other animal matters in a putrid condition" on the premises of marine store dealers. The representations made by your Vestry to the Metropolitan Board at that time had no effect, but the Board is now " quite satisfied that serious nuisance does arise from this source," i.e., in the "collection and conveyance through the streets of offensive substances," including " kitchen stuff and other refuse," and that " additional legislative powers are necessary." Whether this is so or not, I may remind your Vestry that in a Special Report on " Sanitary, Nuisances Removal, and other Cognate Acts " (dated March 13th, 1885), made at the request of the Law and Parliamentary Committee, I called attention to what I deemed to be latent powers vested in the Board (under section 202 of the Metropolis Local Management Act, 1855), enabling it to make bye-laws for " works of cleansing and of removing and disposing of Refuse"—powers which Vestries do not possess, unless inferentially under the 53rd section of the Sanitary Act, 1866. This section, as I stated, gives " the power . . . .to require the periodical removal of refuse N 186 matter from premises," and it is a question whether it may not " extend to the case of ' other refuse' than that from stables, and to ' other premises ' than ' mews, stables, etc.'— e.g., to the refuse matter of the trades, and on the premises of fishmongers, poulterers, greengrocers, etc.'' The Committee, in their report submitted to and adopted by your Vestry in February, 1886, stated that they thought it "probable that the terms of the section might be wide enough to enable your Vestry 'to give notice' to secure the periodical removal of ' offensive refuse matter' " of the trades mentioned, and recommended that "proceedings be taken to give practical effect to this opinion." Under the provisions of the section quoted, the Poplar District Board of Works have given notice for the periodical removal of offensive substances such as fish offal, which is largely produced in the locality, and is collected by a manure manufacturer, who pays, something to the fish curers for the privilege. This being as I thought, one of the instances referred to in the Board's letter of a " local authority succeeding in effecting the removal of offensive substances without nuisance,'' I referred to the Annual Report for 1886-7, of Mr. F. M. Corner, the Medical Officer of Health for the South District of Poplar, in which it is stated that " The difficulties attending the removal of offal from fishmongers without a serious nuisance being created has not been entirely overcome by the arrangements of Messrs. and others; many complaints having been received during the year. The vans alone, in passing along the streets, have been noticed as offensive, but the worst evil attends the opening of the vans for the reception of the fishmongers' collections. The stench from the decomposing fish is so disgusting that something further should be tried for its prevention." Mr. Corner later on informed me that "the nuisance is not done away with by the arrangements of the best of the Vanners; the open tank and tipping at the door, the leaving open the door, to level down the offal, and the neglect to keep receptacles clean, all conduce to just complaints from 187 persons near." And he favoured me with a report on the Collection and Conveyance of Fish Offal, made by the Sanitary Inspector appointed by his Board to inspect Manufactories, which emphasizes the necessity for regulation of the business by bye-laws, and confirms my view that the offal should be removed in the storage vessels. But I subsequently learned that the "local authority " particularly referred to in the Clerk's letter (page 176) was the Greenwich Board, whose method, it is stated, has been "entirely successful." That Board, it appears, "has a duplicate set of closed metal receptacles. They leave daily at the various premises a clean receptacle, and remove the full one to their depot, which is in a suitable position. Here the smaller receptacles are emptied into one large one, and are then cleansed. A farmer removes daily the larger receptacles to his land, cleanses them, and next day takes back the empty and removes the full vessels, and so on.'' Now admitting for the sake of argument that this method is successful, it must be obvious that the Greenwich Board has no power to enforce its observance. Personally, therefore, and so far as existing law is concerned, I am more disposed to rely on the Metropolitan Board's powers to make Bye-laws for " works of cleansing and of removing and disposing of refuse" already adverted to, but I am of opinion that it would be a simpler and better course for the Board to obtain "additional legislative powers " should it still be of opinion that the offensive businesses referred to cannot be regulated under the provisions of the Slaughter Houses (Metropolis) Act, 1874. The Clerk's letter and my report having been duly considered by your Vestry, the following reply was sent under date, 12th December:— n 2 188 " Conveyance of Offensive Substances theough Streets. " Sir, " In reply to your circular letter, dated 11th ult., I am directed by the Vestry of Kensington to state for the information of the Special Purposes and Sanitary Committee of the Metropolitan Board of Works :— "1. That nuisance is experienced in this Parish in the storage, and in the collection of offensive material, and in its conveyance through the streets. The nuisance is due to stench, and is co-extensive with the trades, &c., which give rise to the production of refuse of an offensive nature. Commonly, moreover, the nuisance is aggravated by the objectionable character and condition of the vehicles used for conveying the offensive material. " 2. That the Vestry have taken steps for preventing nuisance in the storage of offensive material by instructing their Inspectors of Nuisances to visit regularly the premises where ' offensive trades' are carried on, with the result of ameliorating the nuisance by promoting, as far as practicable, regularity in the removal of the refuse ; and on some occasions proceedings have been taken for the abatement of nuisances arising from delay in the removal of offensive material. The Vestry have not taken steps for preventing nuisance in the collection and conveyance through Streets of offensive material other than as above stated. " 3. That the Vestry have proceeded in the cases indicated, under the Nuisances Removal Acts, the Sanitary Act, 1866, and the Slaughterhouses (Metropolis) Act, 1874. The Vestry do not consider the provisions of the Nuisances Removal Acts adequate to the purpose of preventing nuisance. There is no penalty for the offence of committing a nuisance, and it is not always easy to satisfy the Justices of the reality of the nuisance. The proceedings, moreover, entail delay, and any conviction is subject to appeal to Quarter Sessions. As regards proceedings under the Sanitary Act, 1866, which have been taken to enforce penalities for failure to comply with the Vestry's Notice, 1 for the periodical removal of manure or other refuse matter from Mews, Stables, or other premises,' the Vestry's efforts have been to a large extent nugatory owing to the reluctance of the Justices to inflict adequate penalties for default ; and also owing to the fact that the Vestry have no power to remove such refuse matter at the cost of the Owner thereof, nor without his consent. " The provisions of the Slaughterhouses (Metropolis) Act, 1874, under which the dealing with offensive material of certain trades is regulated by Bye-laws, are adequate, so far as they go, to the purpose of preventing nuisance. " I am to add that the success of the Board's Regulations made under the provisions of this Act, suggests to the Vestry the course most likely to succeed in preventing nuisance in connection with the storage, the collection and the conveyance of offensive material through streets, viz.: by the creation of Bye-laws to regulate in these respects, the Trades, &c., which involve the production of refuse of an offensive character. 189 " By direction of the Yestry, I enclose for the farther information of the Committee, a Report on the subject by their Medical Officer of Health, which has been approved by the Vestry. To this Report, therefore, I am to refer the Committee, as containing a more full exposition of the Vestry's views on the important questions dealt with in your circular letter." I regret to have to state in conclusion that there is no probability of the matter being de.ilt with in Parliament at the instance of the Board during the current Session, and I believe I am correct in stating that the Committee are not likely to make any immediate report to the Board on the subject. NUISANCE FROM BRICK BURNING. During the summer of 1887, as in previous years, complaints were made by several ratepayers in regard to stenches, especially in the early morning hours, almost invariably supposed to be due to sewer gas. The actual 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. One of these actions was based on complaint of nuisance from noxious smells arising at a brickfield at Streatham, interfering with the plaintiffs in the enjoyment of their premises, so much so that in certain states of the wind they—at distances of 400 yards and 800 yards respectively—were unable to open their windows. The cause of nuisance, as proved, arose from the use of dust-bin refuse in the manufacture and in the burning of bricks, the effect being to produce noxious fumes which occasioned suffering to susceptible persons from nausea, loss of appetite, headache, and malaise. Mr. Justice Cave was clearly of opinion that there was a nuisance at the brickfield which could be perceived at the plaintiffs' premises, and to such an extent as to render the occupation of their houses uncomfortable and unenjoyable. His 190 lordship therefore directed judgment for the plaintiffs, with an injunction to restrain the burning of bricks in such a way as to interfere with the comfort of the plaintiffs. In what is known as the Hampstead case, after a few professional and other witnesses had given their evidence, Mr. Justice Wills, at the request of the defendants, consented to view the brickfields, and upon coming into court his lordship said he found a nuisance to exist. With the consent of the defendants he stopped the case, delivering judgment in favour of the plaintiffs, with costs. The nuisance, it may be mentioned, does not arise from burning clay per se, but is due to the combustion of refuse matter obtained from dust-bins, and used in the manufacture of the bricks and as fuel in the baking of the bricks. The dust is sifted to remove matter of an organic nature, animal and vegetable, but no amount of sifting will prevent putrid emanations when the refuse is burned. In the Hampstead case the Vestry's sanitary officers compelled the removal of all " soft core " from the field, and it was admitted that the defendants conducted their business with due care, sifting the refuse repeatedly, etc. Still the nuisance continued. Dust-bin refuse, it may be mentioned, is left a year to "mellow," exposed to wind and rain, and thus the ashes become saturated with organic matter. The clay of which the brick is moulded is usually incorporated with dust-bin ashes. The bricks are burned in " clamps," or layers of green bricks separated by layers of " breeze," i.e., cinder siftings from dustheaps. "Kilns" for burning bricks, on the other hand, have to be constructed, and coal dust is used in them, so that the cost of brick production is considerably enhanced. At the rear of the particular brickfield complained of at Hampstead, there are others in which bricks are burned in kilns, and from these, it is stated, no putrid fumes arise, but plenty of smoke. The Hampstead defendants, however, contended that they must use the sort of material they did use to produce the common stock brick. 191 The decisions in these two cases are satisfactory so far as they go, but although they hold out hope of success in any similar cases, few are the persons rich enough, as in the Streatham case, or the local authorities spirited enough, to ncur the expense and the worry of litigation. The nuisance, however, being unquestionable, and such as may be prevented by the adoption of a particular method of burning bricks, the subject would seem to be a proper one to be dealt with by legislation. The business of a brick maker is an "offensive'' one, in very truth, but it cannot be brought within the provisions of the Slaughter Houses (Metropolis) Act, 1874. A fresh Act, therefore, is necessary. The Metropolitan Board of Works would be the proper authority for introducing such a measure, and I have little doubt but that the Board would take up the question were it encouraged to do so by the several Vestries and District Boards. But it is somewhat difficult to obtain united action by so many different bodies, and it being nobody's business in particular to initiate proceedings which would involve a good deal of trouble, year after year passes by and nothing is done. The Society of Medical Officers of Health did what it could after the trial of the above-mentioned actions by drawing the attention of the Metropolitan Board to the subject in a communication to the effect (1) that there are sufficient reasons for. regulating the trade of brick-making by bye-laws, as other offensive trades have been, with such manifest advantage to the public; and (2) that owing to the considerable distance lo which the effluvia of brick-burning travel, and to the fact that many of the brickfields contributing to the nuisance are outside the Metropolitan area, legislation should be general, and apply to areas within a specified distance of centres of population. Nearly three years have since elapsed, and nothing has been done. FOOD ADULTERATION. A question has arisen whether the addition of foreign substances to food for the purpose of preventing or retarding 192 putrefaction is to be considered in the light of an adulteration within the meaning of the Acts relating to that subject? This question, as it related to the use of Boracic Acid as a Preservative of Milk, was submitted to the Public Analyst and myself by the Special Purposes Committee, who requested us to advise them " Whether the addition of a small quantity of boracic acid to milk is injurious to health ? " We drew up a report on the subject as follows:— " In order to comply with the request of the Committee to be advised as to ' Whether the addition of a small quantity of Boracic Acid to milk is injurious to health,' we have made enquiries as to what is known in regard to the action of this drug upon the human subject, and regret to find that very little information is forthcoming. It would appear, however, that Boracic Acid is usually employed for the preservation of milk and cream in the form of a proprietary article well known to the trade, and which may be designated ' The Preservative.' This article, as it has recently come under our notice, is composed mainly of free Boracic Acid, with a certain amount of Borax. According to the directions it is to be added to milk, in solution, in the proportion of about seven grains to the pint of milk. About double this quantity, per pint, is directed to be added to cream. It must be borne in mind that should the farmer in the country, and the dairyman in London, both use the preservative, the amounts mentioned would be doubled. In such a case, a strong healthy infant taking a quart of milk daily, might consume as much as 28 grains in that time, and it must further be noted that the specified addition is not unlikely to be exceeded through the possible carelessness or ignorance of those making use of the preservative. The medicinal dose of Boracic Acid for an adult ranges from 5 to 30 grains, and it is computed that one-twelfth of the quantity, say a maximum of 2½ grains, would be a suitable dose for a child under one year. Neither Boracic Acid nor Borax, however, appear to have been much used as internal remedies, and accordingly but little 193 information as to their action is to be found in the text books. One authority states that Borax acts as a mild alkali on the alimentary canal; tending to render the fluids alkaline and cause diuresis, that it checks fermentation due to organisms and is used as a diuretic and antacid. Another eminent authority whom we have consulted refers to the tendency of these substances to set up diarrhcea, a disease very prevalent in hot weather, when the preservative is most used to prevent that change which milk and cream are apt to undergo, rapidly, at a high atmospheric temperature. In recent volumes of the Year Book of Pharmacy, with which we were kindly favoured by Mr. Robinson, a Member of the Vestry, there are a considerable number of references to Boracic Acid as a food preservative, but in most of them it is merely regarded as a sort of pickle. Professor J. Forster, however, has published a series of observations, based on experiments, in a German scientific journal (ZV. Dingier's Polytechnisches Journal), which are summed up in the Year Book of Pharmacy for 1884. If these experiments are reliable, they would go to show that the addition of Boracic Acid t o articles of food in far smaller proportion than customary, is injurious to health. The author considers that 'even small doses of it are injurious to the digestive organs.' This injurious action, he says, depends on the circumstance that the drug acts so as to materially increase the proportion of solid matters and nitrogen in the fseces separated. Its action on the intestinal discharges is well marked, even by the exhibition of as little as 4 grains per diem, and is stated to be in direct relation to the quantity taken, and to be maintained for some time after the doses of the drug have ceased. The action described is perceptible, not only with vegetable or animal foods, which contain a large proportion of indigestible ingredients, but also when highly digestible food, such as milk and eggs, is taken. Food to which the acid has been added tends to cause an increase in the secretion of gall during assimilation. Its most important action, however, is the increase which it causes in the discharge of albuminous Rubstances from the intestinal canal. From this 194 Dr. Forster considers it evident that its use, as a food preservative, is not as beneficial as hitherto assumed.* In regard to the possible excessive use of the preservative, we would remind you that in one case which recently came under notice, the amount present was very large, the taste of the drug being very perceptible. We desire to say in conclusion that, although in the present state of our knowledge the injurious action of very small doses of Borax or Boracic Acid, even in the case of infants, and even having regard to the doses being continuous may perhaps be considered as 'not proven,' it will probably become a question whether the use of any known preservative, in lieu of refrigeration, in any amount, however small, should not be prohibited, in view of possible and indeed probable abuse, and while doubt exists as to the action of the drug employed." 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 meet for the purposes of the Acts once a week, and Notices are issued upon the immediate authority of the Committee, who in due course report their proceedings to your Vestry. Summonses continue to be heard by the Justices sitting in Petty Sessions at the Vestry Hall. In my Annual Report for 1885,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 * A complete translation of Dr. Forster's Memorandum upon the use of Boracic Acid as a so-called Food Preservative, appeared in the Lancet (vol. 2, 1887, August 13, page 342), subsequent to the publication of our report—from the pen of Mr. Charles Hancock, a member of the Vestry. 195 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." The Justices subsequently arranged to meet weekly for the purpose of dealing with sanitary cases, but our cases are still placed at the bottom of the list. 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 Yestry in bringing their cases before the court. It is probable that more or less of this work will be transferred to Hammersmith Police-court, now that, at last, it has been made a whole-day 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, 1888. Fifty-one * summonses were taken out for offences under the Nuisances Removal Acts, against 98, 89, 80, and 99 in the four 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 upou whom the Order is made, together * This number is irrespective of 26 summonses under the Sale of Food and Drugs Act, 10 in cases of obstruction, and 7 in cases of disobedience of Justices' Orders, 196 with all costs. The same power should be conferred upon Courts of Summary Jurisdiction in London.† 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—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. 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 l/xbridge 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 them to be in a satisfactory condition. Comparatively little slaughtering is now carried on, and on some of the premises none at all, the licences being kept up apparently 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 undergone much improvement since the passing of the Slaughter-houses (Metropolis) Act, † Provision was made for enabling the Justices to inflict a penalty in the Pablic Health (Metropolis) Bill, 1885, but there was not time to pass the measure, which hitherto has not been re-introduced. 197 1874; it is desirable, nevertheless, that private slaughterhouses 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 public-health 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 the price of English meat, to which, so far as my experience goes, it is in no way inferior. The licensed premises are systematically visited 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 cf private slaughter-houses in the Metropolis, which in 1874 was 1,429, had fallen, in October, 1887, to 74'2. Few businesses have been established anew during the thirteen years the Act has been in operation. Sanction was granted in two cases in 1887. COWSHEDS. The licensed cowsheds are 13 in number; 8 in North Kensington, and 5 in South Kensington. The names of the 198 licensees, and the localities of the licensed premises, are set out in Table XII. (Appendix). The several premises were inspected, in July, by the Works, Sanitary, and General Purposes Committee, and were found in a satisfactory condition, with the exception of two in Blechynden Mews, the renewal of the licences to which was successfully opposed; the licensees subsequently obtaining satisfactory premises in the near neighbourhood of their old sheds. The sheds are licensed for the keeping of 185 cows, but contained 107 only at the time of inspection. The licensed premises are systematically visited by the several Inspectors, although your Vestry have no statutory powers in regard to them, the Metropolitan Board being the " Local Authority" in respect of cow-sheds, as explained in the two following sections. DAIRIES, COWSHEDS, AND MILKSHOPS 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 milkstores, milkshops, 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. 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 199 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 35, whichmight have been prevented had the cowkeeper, whose milk was the cause of the outbreak, strictly complied with the requirements of the Order, section 15 of 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 assist 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 200 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 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, to the end of 1887, upwards of 26,800 registrations, or transfers of registrations, have been effected, and that there are now some 9,000 registered premises in the Metropolis, including' those of about 750 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 fact, which may be considered satisfactory or otherwise, that proceedings under the Dairies Order had to be taken in nine cases only during the year, after 7,506 inspections of cowsheds and 15,216 inspections of dairies, milk stores, and milk 3hops—viz., in two cases for keeping cows on unlicensed premises, and in two cases for breaches of the regulations as to cowsheds ; in two cases against persons who carried on the sale of milk without complying with the Order as to registration, and in three cases for neglect of the regulations applying to dairies. In many instances, however, letters and cautions were sent to occupiers of registered premises. 201 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 couutry the Dairies 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, including the power of making " Orders." The Metropolitan Beard of Works was still to be the " Local Authority " for the Metropolis, outside the city— an objectionable arrangement. Under the auspices of your Yeslry, a strong opposition to this proposal 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 Yestries and the District Boards: these bodies having Medical Officers and Inspectors accustomed to the work. The views of your Arestry 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 Sanita,ry Authorities, the Medical Officers of Health, and the Sanitary Inspectors of the respective districts." * 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. 0 202 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 was dropped, hut its main provisions were included in the Contagious Diseases (Animals) Act, 1886. This is much to be regretted, for it is unreasonable that the sole legal control over dairies, cowsheds, and milkshops should be in the hands of the Metropolitan Board, to the exclusion of the Sanitary Authorities. 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 the premises where explosives are stored, as well as the premises where " offensive businesses," scheduled under the SlaughterHouses (Metropolis) Act, 1874, are carried on. The premises registered under the Dairies, &c., Order of 1885 alone, are, as already stated, some nine thousand in number. The District of the Inspector for Kensington embraces Paddington, St. George's, Hanover Square; St. Margaret and St. John, Westminster ; Hammersmith, Fulhum, and Chelsea. The Vestries and District Boards, by their fifty-four Medical Officers of Health, and some hundred 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 licence if the business is not conducted to their 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, 203 It may be freely admitted that the cowsheds in the Metropolis have been much improved since the first Dairies Order was issued in 1879. The improvement is mainly due to the fact that 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. This good result is attributable, 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. The position of affairs will be recognized 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 occurrence 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 authorized to make known to the Board any premises used for storage and sale of milk which have not been registered. Acting on my suggestion, moreover, 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. 0 2 204 Excepting as regards the one matter dealt with above, the passing of the Act qua dairies, &c., is subject for satisfaction, for the supervision of dairies, cowsheds, &c., is eminently a sanitary matter proper to be placed in the hands of the Sanitarv 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 the 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 Governmental Authorities by the Society of Medical Officers of Health, who were the first to frame "model" codes of regulations for dairies, cowsheds, &c., and for slaughter-houses also; the drafting of which, I may mention, devolved upon myself in connection with papers which I read before the Society, prior to the passing of the Slaughter-houses Act in 1871, and before the passing of the Contagious Diseases (Animals) Act in 1878, which was followed, in due course, 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 205 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 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 206 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 recognize the necesssity for thorough supervision of bakehouses by the Sanitary Authority. It may be mentioned that your Vestry's 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 power for makingregulations, 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 ; 82 in North Kensington, and 67 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 difficulty. The difficulty, common to all parts of the Metropolis, is not likely to be surmounted without 207 tive action. The subject, in relation to certain important parts of it, hasalready been dealt with (at pages 148 and 176),in connection with a report by the Law and Parliamentary Committee, and in my observations on a communication received by your Vestry, in November, from the Metropolitan Board of Works under the heading " Conveyance of Offensive Substances through Streets." I pass on now, therefore, to consider the matter in its local aspects and as it relates to house refuse, stable refuse, and trade refuse. HOUSE REFUSE. The collection of ashes, and miscellaneous refuse, from nearly 22,000 inhabited houses, spread over an area of 2,200 acres, and to the extent of 40,500 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 utilized, 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 systematized by division of the parish into districts, and provision has been made for inspection of dustbins and oversight of the " dusting gangs." A call is now made at every house once a week, and further improvement is scarcely possible until the objectionable practice 208 of refuse-harbourage shall have given place to the only rational system of daily, or, at any rate, frequent collection from move- . able receptacles, to be provided either by the Sanitary Authority or by the householder, The cost of collection has considerably increased of late years, owing mainly, as we are informed by the Wharves and Plant Committee, " to the attention bestowed upon applications for the removal of dust on days other than the regular visiting days of the dustmenand " with the view of saving the large expense incurred by these irregular visits, and the disturbance entailed on the orderly and methodical procedure of the work " the Committee recommended in October last, " that dustbins be cleared only upon the regular appointed days," a proposal to which your Yestry gave assent. The Committee further recommended " That it is advisable that statutory powers should be conferred, enabling Vestries to enforce the abolition of dust-bins, in such districts as may be deemed expedient, and the substitution in lieu thereof of approved movable receptacles, in order that a more frequent and accelerated collection of dust may be made." The Committee, moreover, expressed an opinion that " the Legislature should also define clearly the relative duties of the Local Authority and the householder in the execution of this work. At the present time under the statutes, the Local Authority is bound to remove the refuse, and this removal often entails arduous and dangerous efforts on the part of the dustmen." The Committee consider " that householders should aid in the removal of their household refuse, by providing moveable receptacles, as aforesaid, and placing same in an easily accessible position, such as the forecourt or area of the house." Lastly, the Committee advised that " the Metropolitan Board of Works, or Local Government Board, be memorialized to include in any suitable Bill hereafter promoted by them in Parliament, clauses conferring powers on local authorities, as suggested above." Consequent upon your Vestry's adoption of the views of the Committee, a copy of their report was forwarded in November to the Metropolitan Board of Works, with the request that the Board should "take the matter into their 209 favourable consideration, and take such steps as may appear to them desirable, with a view to an amendment of the law in the direction indicated." Your Vestry's communication was referred by the Board to the Works and General Purposes Committee, and this Committee issued (in December) a circular letter to the several Vestries and District Boards intimating that " a representation as to the desirability of an amendment of the law, so as to enable Vestries and District Boards to enforce the abolition of dustbins in such districts as may be deemed expedient, and the substitution in lieu thereof of approved moveable receptacles in order that a more frequent and accelerated collection of dust may be made." The Committee, "before considering as to any recommendation to the Board," desired to learn the views of the Vestries and District Boards upon the suggestion, and invited observations thereon. The result of the Committee's enquiry has not yet been published. In some portions of the Metropolis the system of frequent collection is in vogue, the Sanitary Authority providing pails for the temporary storage of the dust; and as there can be no doubt as to the desirability of the system being made general by legal enactment, it is to be hoped that your Vestry's suggestions will be adopted, and that the day is not distant when the Metropolis will have been freed from the contaminating influence of the foul dust-bin. It is highly probable that the Metropolitan Board will have no opportunity of dealing with the matter in the manner contemplated, but in any case, the pail system and daily collection being the only proper one, it is quite open to your Vestry to put that system into operation without waiting for legislation. But, to return to matters as they are, it may be observed that delay in removal of the dust was formerly due, not unfrequently, to the inconvenient position of the dust-bin; as, for instance, in an area, to which there was no access save by 210 ladders over the railings. In some cases 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 dust-bin 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 cf, the Parish, and other districts being able to supply the brickmakers' wants. Your Yestry have appointed a Committee, now sitting, to consider as to the practicability of conveying the refuse to the country, for agricultural purposes and other methods of utilization. The result of the Committee's enquiry is awaited with much interest. [The Report of the Select Committee was considered by the Vestry at a Special Meeting, held July 18th, 1888. The Committee recommended purchase of fifteen acres of land, on the river at Purfleet in Essex, sixteen miles below London Bridge, for a Depot, with a view to the conveyance thereto of the whole of the refuse of the Parish—unsorted " dust" and " slop "—from the Wharf at Chelsea on the river, and from the W harf at Kensal Green on the Grand Junction Canal. The Vestry adopted the recommendation, and instructed the Select Committee to " consider and report as to the necessary works to be executed for utilizing the land to the fullest advantage for the purpose of a Refuse and Store Depot." Upon sanitary grounds the Vestry's decision is matter for unmixed satisfaction.] 211 STABLE REFUSE. I have frequently had occasion to draw attention to nuisances arising from the wort-removal of stable refuse. "Notice'' has been given "for the pericdical 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 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. I 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. In my special report dated March 13, 1885, on Sanitary, Nuisances Removal, and other cognate Acts,* made in * Vide page 148. 212 tion 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 no exercised as fully as it might be." 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 Yestry 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 pirish," The Wharves and Plant Committee, having taken the subject into consideration, made the following recommendation, which was adopted by your Yestry, viz.:— " That the attention of the Inspector of Nuisances 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 213 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. 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 the Vestry is bound to remove whatever it would be mischievous and injurious to health to retain on the premises, but not to 214 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 hoots 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 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 Yestry (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, friedfish 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 the effort to make arrangements with tradesmen arose out of " difference of opinion " as to what should be considered " refuse," the Justices moreover, in a disputed case, having decided that what the Surveyor considered " trade refuse " should be deemed dirt or rubbish, and as such removed without cost to the occupier. I felt it to be undesirable that the time of the Inspectors should be diverted from their proper duties to work of the 215 character above indicated, but the difficultly 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." NECESSARY ACCOMMODATION. There are only fourteen 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 " chalets " as a commercial speculation has been long under consideration. Should it ultimately be carried into effect, the experiment will be watched with interest. * Accommodation, it may be added, is provided at about 170 public-houses—not of a very satisfactory sort in many instances, but better than none at all; and much improved as the result of recent efforts, the outcome of proceedings directed to be taken by the Works, Sanitary and General Purposes Committee, as referred to in the following Section. PUBLIC HOUSE URINALS. Complaints had been made of nuisance in the Old Brompton Road, near what is now the Italian Exhibition, which I thought might have been removed by the provision of a public urinal in the said road. The Works, etc., Committee made an inspection of the locality, but were unable to fix upon a satisfactory site in the road, and they failed in an effort to obtain space within the railings of the Brompton Cemetery. In the course of their investigation, attention was drawn to the * A chalet in Norfolk Terrace, Westbourne Grove West, is now (July) approaching completion. 216 unsanitary condition of some public house urinals, arising from want of water supply and from the employment of bell traps to the drains. The Committee thereupon instructed the Sanitary Inspectors to make a report upon the subject generally showing the accommodation provided at the several public houses and beershops, and the situation of the urinals, &c. The Inspectors' reports were duly considered, and the recommendations having been approved by your Vestry, notices were served to provide a water supply and to trap the drain with an approved stoneware gully trap wherever necessary. These notices were complied with in nearly every case. The public houses and beer-houses in the parish number about 170, and with few exceptions they possess the necessary accommodation in some more or less satisfactory form. In the majority of cases the urinal is semi-public, i.e., accessible to passers-by; in others it is in a more or less private situation, either within the house or in a yard. An effort was made to get these more private urinals replaced by others accessible to the public, but without effect. A very few public houses, as intimated, have no urinal at all. The question of the liability of the proprietors to provide such accommodation was referred by your Vestry to the Law and Parliamentary Committee, from the tenour of whose report it may be inferred that there is no statutory obligation. The Committee advised that the attention of the Justices should be called to these cases, believing that they would exercise their unquestioned influence—at the period of the licensing sessions—to secure provision of accommodation necessary alike in the interests of decency and of public health. The following letter was addressed to the Chairman, together with a copy of the Inspectors' Reports:— " Sir,—I am directed by the Yestry of Kensington to forward to you for the information of the Justices of the Peace for the Kensington Division, copy of a return made by the several Sanitary Inspectors showing the urinal accommodation provided at the several public houses and beershops within the parish." 217 " The Vestry, recognizing the necessity for such accommodation, have learned with satisfaction that it has been provided, in nearly all instances, by the proprietors of public houses. They regret, however, to find that in many cases the appliances for preventing nuisance are wanting; in other words, that water supply for flushing purposes has not been provided, and that the drain is trapped by an imperfect and wholly unsuitable appliance, the so-called' Bell Trap.' " This being so, the Vestry have caused notices to be served under the Nuisances Bemoval Acts, upon the proprietors of certain houses, calling upon them to provide a water supply and a suitable gully-trap for flushing and drainage purposes. "In a considerable number of instances the Vestry's notice has been complied with. " The Vestry, however, regret to learn that in some cases nothing has been done; "while in others the proprietors have closed the urinals rather than incur the small expense involved in the provision of appliances, without which the urinal, which is urgently needed, must almost necessarily be a nuisance. " I have therefore been instructed by the Vestry to request the attention of the Justices to the matter, and to express a hope that they will see their way to support, at the forthcoming Licensing Sessions, the efforts of the Vestry to remove an unquestionable nuisance. " The Vestry further hope that the Justices will exercise their undoubted influence to secure the provision of Urinal Accommodation where none now exists." I waited upon the Justices at the licensing sessions—a very busy period—but, although the Chairman expressed entire sympathy with the object your Yestry had in view, and approved of the effort being made to secure water supply and efficient drainage for the existing urinals, the Justices were unwilling to go beyond the limits of what they believed to be their legal powers in dealing with the matter. A few public house proprietors offered sites for the erection of public urinals by your Vestry, but no action has as yet been taken in this direction. On the whole, however, much good work was done, and a sanitary improvement of considerable magnitude successfully carried through. I am not without hope that by continued effort the work may ultimately be carried to an entirely satisfactory issue. p 218 UNDERGROUND ROOMS. The several District Surveyors are required by the Metropolis Management Act to make a half-yearly report to the Metropolitan Board of Works upon Underground Rooms. A copy of the several Reports is forwarded to the Sanitary Authority of the respective districts. Your Vestry always refer these reports to the Works, Sanitary, and General Purposes Committee, and last year the Committee requested me to furnish them with some observations on the subject, which I did in the following terms:— " In my report of March 13th, 1885, on' Sanitary, Nuisances Eemoval, and other cognate Acts, addressed to the Law and Parliamentary Committee, I pointed out that' the Vestry have power to prevent the occupation of underground rooms as dwellings when not built or constructed in conformity with the rules laid down in Section 103 of the Metropolis Management Act, and such rooms, 'I added,' are periodically reported to the Vestry by the District Surveyors; but the powers of the Acts have not hitherto been exercised.' " The Committee in their report, which was adopted by the Vestry, February 10th, 1886, recommended that' the reports of the District Surveyors be referred, when received, to the Works, Sanitary and General Purposes Committee, with a view to inquiry by the Sanitary Inspectors and to such action as the circumstances of each case may seem to warrant.' " The half-yearly reports of the District Surveyors received in January last were duly referred to your Committee, and inquiry has been made with respect to underground rooms by the several Sanitary Inspectors, in conformity with the direction of the Vestry. " The reports of the District Surveyors treat of the circumstances of the several underground rooms as they relate, on the one hand, to structural conditions or defects; and, on the other hand, to removable sanitary detects. The first-named, or structural defects, are beyond the power of the Sanitary Inspectors to remedy, and these officers can only submit needless confirmation of the accuracy of the reports of the District Surveyors as to facts:— such as that a room is not one foot above the surface of the road; that the area is not six inches below the floor nor effectively drained; that there is no proper area, and so on. These reports, as started, come in half yearly, 219 and it is for the Vestry to determine whether any steps should be taken to prevent the use of such 'underground' rooms for the purpose of human habitation. "With regard to removable sanitary defects, such as that the trapping of the area drains is inefficient, or that the dust-bin is without a cover, I beg to report that I have requested the several Inspectors to take the necessary proceedings for remedying the said defects, and that this has been done, or is in the course of being done, in respect of the several cases mentioned by the District Surveyors." It may be added that there are 110 Cellar Dwellings properly so called in Kensington, and that it was proposed in the Public Health (Metropolis) Bill, brought in by Lord Salisbury in the Session of 1885, to transfer the powers and duties of the District Surveyor to the Inspector of Nuisances appointed by the Sanitary Authority. The Bill was withdrawn, and has not hitherto been re-introduced. PUBLIC BATHS AND WASH-HOUSES: The Baths and Wash-houses, at the junction of Lancaster and Silchester Roads, Notting Hill, were opened in April, current year. For the majority of parishioners, 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 several localities, to which the poor might resort for the purpose of washing clothing. The question of public wash-houses might with advantage be separated from that of public baths. MORTUARY. The Mortuary in the Parish Churchyard, at the rear of the Yestry Hall, was opened in July, 1888. In the first year 37 bodies were deposited; in the second year 77; in the third P 2 220 year 100; in the fourth year 97; and in the fifth year 109. The building comprises two chambers, for infectious and noninfectious bodies respectively, separated by " 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 ordeied by the Coroner." (Sanitary Act, 1866, sec. 28.) The Coroner, or his officer rather, now occasionally orders the removal of bodies, but at your Vestry's charge always. The use made of the Mortuary amply justifies the expense incurred in its erection. As time passes the institution will probably be even more appreciated and used; especially 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 WorkingClasses recommended provision of additional mortuaries. What, however, is more required, at present, is power to compel removal of the dead to existing mortuaries, when removal is necessary. The Commissioners recognized 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 thought it desirable, moreovei-, " that in any case where the body lies in a room;vhich is used by other persons, it should, in the same manner, be removed." (Report, p. 31.) 221 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 In nearly one-half of the above cases post—mortem examinations were made by authority. 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 at 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 222 to place a room at the disposal of the Coroner, whenever required, on due notice being given, nnd subject to the payment which the Coroner is authorized to make, and does make, for such accommodation provided elsewhere for the same purpose. About 150 inquests are held in the Parish annually, most of which could have been conveniently held at the Yestry Hall. But none of them were 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 had been willing to pull together, the desire of your Yestry and of parishioners summoned on juries, that inquests should be held at the Vestry Hall, would have been adequately realized. In my Ninth Report (September 12th, p. 83), I again drew attention to the practice of holding inquests at public-houses. The Report was referred by your Vestry to the Special Purposes Committee, who recommended the fitting up of a room in the basement of the Town Hall for the use of the Coroner. The recommendation was adopted, the room was got ready, and on the 21st of January, in the present year, it was used for the first time. From that d.ate to the present writing (June SOth), some 69 inquests have been held in the parish, and of these 26 only have been held at the " Coroner's Court," the great bulk of the remainder having been held at public-houses; so that the object your Vestry had in view in providing the necessary accommodation has not been realized. In the adjoining district of Middlesex the state of matters is different, all inquests, other than those at public institutions (hospitals, etc.), being held in the several courts provided for the Coroner's use by the Sanitary Authorities or otherwise. In the parish of Islington, to cite but one example, all of the inquests (subject to the exception above noted) are held at the 223 Court provided by the Vestry, and adjoining the Public Mortuary in the disused burial ground of St. Mary's Chapel of Ease, Liverpool Road. The Coroner makes his order for the removal, in suitable hearses, of the bodies in respect of which inquisition is to be held, to the appointed places at the appointed times. The cost of this removal, as well as the cost of removal to the " place appointed for post-mortem examinations," when examination is necessary, and the fee for the use of the Court, is defrayed by the Coroner, who charges the same to the Magistrates by whom the expenses are duly allowed as part of the costs of the inquest. The fee paid for the use of the Court is five shillings for a single case. For a second or third case or more, with the same jury, in the same room, the allowance is two shillings and sixpence for each case after the first. Your Vestry made no stipulation with the Coroner who acts in this parish, who voluntarily pays for the use of his Court-room half-a-crown only, or half the amount sanctioned by the Magistrates, and which is paid for inferior accommodation at public-houses,. The Coroner moreover pays nothing for the removal of bodies to the mortuary, although, as above intimated, it would be a lawful charge upon the County rates. The contrast between the practice in the two coterminous districts is thus shown to be very striking. Another objectionable practice in this district is that of allowing post-mortem examinations to be made in private dwellings where, in some instances, the accommodation is altogether insufficient, the whole proceeding, moreover, being painful and distressing to a high degree. Your Yestry caused a communication on the subject to be addressed to the Coroner, reminding him of the " place provided " for the purpose, but to little effect, for cases still occur which ought not to be permitted, nor would be probably were there any appeal to a superior authority. All has been done by your Vestry that is necessary to provide for decency in this matter, in which the feelings of humanity and respect for the dead are much concerned, but with an amount of success altogether below what might reasonably have been expected. 224 DISINFECTION. During the year ending March 25th, 1888, a large number of infected articles, clothing, bedding, etc., were satisfactorily disinfected by the contractor at the cost of your Vestry, the owners being too poor to bear the expense. The weight of the articles was 21 tons 8½ cwts.; their number 10,660, and the cost of the process £421 1s. 2d. Three hundred and eighty-three rooms in 329 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 Persona 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 ventilalation of the Common Passages and Staircases; 5.—For the cleansing and lime-whiting at stated times of such premises. 225 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. 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 Yestry, 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, 1886, upon the illness of the temporary assistant in the clerical department of my office, but has now (July) been resumed on the appointment of a fresh clerk. 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; 226 " 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 possible to enforce Regulation 3, which relates to the " separation of the sexes." Omission to press inquisitorial inquiries, needless in many cases, with respect to personal matters, such as " number, age, and sex of the occupants of each room used for sleeping," etc., will tend to facilitate the application of the sanitary provisions of the regulations. The information to be obtained by such inquiries would have 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. The announcement of intention to register houses proved distasteful to many " landlords," some of whom " stated in writing reasons why the house should not be registeredbut almost without exception the "reason" stated amounted to no more than an " 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 stigmatized 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 quasi-private document; no intimation of registration is given excepting 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 227 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 " foe the guidance or 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 home drain is imperfect, notice must, if necessary, be given to the Surveyor, v;ho will provide workmen for opening it up for examination. 7. That all special soil pipes be air-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 11th, 1885, were by your Vestry, on February 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 228 the 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 existing system of local government may not be perfect, but under it much good work has been done, work that is not likely to be surpassed under any change in the form of local government. The 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 useful to Sanitary Authorities and sanitary officials alike. But there was not time to pass the Bill. Your Yestry having requested Lord Salisbury to reintroduce the Bill last year, his lordship expressed his fear that the chances of any such measure becoming law are at present very remote. The Housing of the Working Classes (England) Act, 1885, to which I adverted in my report for 1885 is a well-intentioned measure, which, however, has not borne much fruit hitherto. It is not without value, however, containing as it does powers which may be found useful for promoting some of the objects it was intended to subserve. THE LIABILITIES OF LANDLORDS. From time to time cases come before the Courts which serve the useful purpose of defining the duties and liabilities of landlords and the rights of tenants. An action of this nature, of considerable interest to landlords and tenants, was tried in the 229 City of London Court, before Mr. Commissioner Kerr, in the early part of the current year, the Plaintiffs—two ladies—tenants of a house in Bayswater, seeking to recover damages for loss sustained by them by reason of the Defendant landlord's misrepresentation as to the state of the drainage of the house. An assurance had been given, by the Defendant or his agent, that the drains were in perfect order, but soon after the Plaintiffs entered into possession they discovered that the drains were defective "and emitted vile and offensive smells." The result of the insanitary condition of the house was that boarders became ill and left, and the Plaintiff's had suffered loss. The house was of the rental value of £90 per annum. A new drain was put in by the landlord at a cost of £20 " because a faulty joint was discovered, and it was felt that the Plaintiffs had a certain claim on the landlord, inasmuch as they took the house on the understanding that the drains were right"—as the Defendant's counsel stated. Damages to the amount of £25 had been claimed, and his Honour gave judgment for the Plaintiff's for £10, with costs on the higher scale, "the case being one of public importance." The case is indeed of public importance, for never a year, probably, passes, that the Sanitary Officers of almost any district do not become aware of similar cases, where tenants have lost lodgers, and so sustained damage, owing to sanitary defects, for the remedy of which the landlord is liable. And this often in cases like the above, when the defects have been speedily discovered upon entry, after distinct assurance that all was " right." A not inconsiderable number of cases of this or a similar sort have come before the Courts within the last few years, and they are of importance as precedents. Oases, 1 mean, in which tenants of insanitary houses have proceeded against their landlords to recover damages for injury to health resulting from drainage defects. Decisions in several cases have been given in favour of the tenant, and it may be hoped that in course of time bad landlords will find out that it is dangerous, in more senses than 230 one, to let an insanitary house. The legal maxim caveat emptor cannot equitably apply in cases like these. There should be an implied warranty, when a house is let, that it is in a proper sanitary condition, that it is fit to live in, and before long I hope that this will be established as a principle of law. METROPOLITAN BOARD OF WORKS AND THE SEWAGE QUESTION. In my Annual Reports for 1886 and 1887, I referred, under the heading, " Metropolitan Main Drainage," to the steps taken by the Metropolitan Board of Works to clarify and deodorize the Sewage of the Metropolis before its discharge into the River, well founded complaints having been made with regard to the condition of the river resulting from the introduction of enormous volumes of crude sewage. For the purpose of clarification, or precipitation of the solid matters, lime and green vitriol were employed, supplemented by the addition of manganate of soda and sulphuric acid to the effluent when necessary. These last-named materials, however, were alleged to be unnecessary when the river water and the sewage were cool, and the latter much diluted by rainfall. But their addition, it was stated, purified and deodorized the effluent to such an extent as to render its discharge into the river unobjectionable at all states of the tide, a statement very generally traversed. I mentioned also that the Board, in order to prevent nuisance within the Metropolis arising from the discharge of offensive gases from the sewer ventilators, were applying the manganate and acid, at numerous stations, to the sewage as it flows through the main sewers. It was hoped that this plan would ensure the arrival of the sewage at the outfalls in a deodorized condition, and thus assist in the production of a satisfactory effluent. The object the Board had was to avoid the 231 necessity for costly land filtration of the effluent, recommended hy the Royal Commission on Metropolitan Sewage Discharge, with a view to ensure the removal of all odour and the possibility of " secondary fermentation." The Board, in giving effect to the views of their scientific advisers, have incurred and are still incurring a large expenditure for works of construction, and in the carrying out of the system adopted. Deferring, however, to the objections made to the system, the Board last year retained the services of Sir Henry Roscoe, as special adviser in this matter, and they have recently consented to the request by Sanitary Authorities—your Yestry among the number—to make that gentleman's reports public. These reports, of which I propose to submit a summary account, are five in number. The first, dated 16th May, 1887, deals with " The Deodorization of Sewage in the Metropolitan Sewers," the second, dated August 7th, 1887, with " The Deodorization of Sewage at the Outfalls." (1.) With reference to the use of chemicals for the purpose of disinfecting the emanations in the Board's Sewers, it appears that a mixture of manganate of soda and sulphuric acid was employed, at a cost, in 1886, of £40,000* for chemicals and labour, with the result of reducing the number of complaints from 64 and 65 in 1883 and 1884, to 28 in 1886. Sir H. Roscoe expresses the opinion that the manganate process does affect a certain deodorization of the sewer emanations, but that the quantity of manganate used in the sewers cannot affect the nature of the sewage at the outfall, being quite insufficient to oxidize even a small part of the putrescent fœcal matter, which gives rise to the emanations. He cannot, moreover, bring him- self to consider that the expenditure of over £40,000 a year is commensurate with the results obtained, no medical evidence having been brought forward to show that illness, much less that any outbreak of an epidemic, has been traced to the emanations complained of. He adds that if it be determined to disinfect * The cost of chemicals used in 1886 is put in a subsequent report (vide page 235) at " upwards of £80,000." 232 the sewers at all, it may prove possible to do so as effectually and more cheaply by the use of other chemicals than manganate of soda and sulphuric acid. Bleaching powder and sulphurous acid, he says, would be cheaper, and probably as efficacious, and he recommended experiments with these two disinfectants, in place of, or in addition to the manganate, for the purpose of comparison. Meanwhile Sir H. Roscoe does not consider the expenditure (£40,000) for the purpose of the manganate deodorization justifiable. The method proposed in a subsequent communication (June 10th, 1887) is that adopted in 1870-73, of dropping solutions of the disinfectants on to a cloth suspended in the ventilating shaft—a method which was proposed and carried out in this parish by the Surveyor to your Vestry, at, I believe, a still earlier date, a tow curtain being used in place of cloth. Sir H. Roscoe states that the object thus to be arrived at is simply to deodorize the sewer emanations (and not to disinfect the sewage itself): the most " effective method of accomplishing this, however, is, wherever practicable, to dilute the sewer emanations with fresh air, by means of suitable ventilation." (2.) The Report on Deodorization of Sewage at the Outfalls (August 7th, 1887) records the results of a month's trial of chloride of lime (bleaching powder) as a deodorant, the effluent being successfully treated by addition of five grains to the gallon. (3.) Following up the Report of August 7th, Sir Henry Roscoe, on December 9th, 1887, addressed a more elaborate Report to the Board, dealing with Deodorization of the Sewage at the Outfalls, July—October, 1887. Reference is made in the Report to the experiments with bleaching powder, followed up as these were by experiments with manganate of soda and sulphuric acid. Before entering into details of the question of the relative value of the two deodorants employed, Sir H. Roscoe expresses his strong conviction that " the use of chemicals of any kind 233 must be considered as a temporary measure sanctioned solely by conditions of time and of place. That is to say, that considering the present condition of the outfalls, the arrangements now existing there, and the conditions arising from drought and high temperature during the summer months the addition of some deodorant to the effluent sewage may be advisable . . The question, however, would assumea different aspect should these conditions be altered, and then the necessity for such addition might decrease, or even disappear." The principles of sewage purification are explained, and it is assumed " that no amount of chemicals which can, with any show of reason, be added, is sufficient, or nearly sufficient, to convert the whole of the foecal matter into harmless forms. Hence the use of chemicals can only be recommended for the purpose either of starting a process of purification, or of simply getting rid of the evil odour." " The purification of the river must be effected by natural processes." Of these, by far the most important is the change produced by living organisms. These " organisms " are classed as " healthy " and " unhealthy the former requiring free oxygen for their growth produce a change which has the result of rendering the organic matter inoffensive: the change due to organisms which flourish in the absence of free oxygen gives rise to products which are offensive. Efforts, therefore, should be made to preserve and assist the life of such organisms as are capable of effecting the innocuous change, and to prevent the growth of such as yield offensive products. The oxygen necessary for the growth of the " healthy " organisms is usually derived from the air dissolved in all unpolluted running water. Sewage, however, contains no dissolved oxygen, or at any rate less than is necessary for the purpose. Hence, in its passage to the outfall, the sewage has already begun to undergo change of a putrescent character, owing to the growth of the putrefactive or " unhealthy" organisms. The products of this putrefactive change absorb free oxygen, and so when the sewage is poured into the river, it robs the water of its dissolved oxygen. Q 234 If the sewage exceeds a certain proportion, as compared with the river water, the whole of the river is deprived of its dissolved oxygen, and the " healthy" growths are thus practically killed. Hence the addition of deodorants has for its object the destruction by chemical oxidation of the putrescent material. Deodorization, however, is only the first step in the process of purification, and for the growth of the necessary " healthy " organisms, the deodorized sewage must be brought into contact with free dissolved oxygen, which, under proper conditions, is obtained from the large volume of unpolluted water. But should the river water be insufficient in quantity, or have lost its oxygen by previous pollution, the water, plus sewage, cannot support the life of the " healthy" organisms, and no further addition of an oxidizing chemical can ever restore the river to its normal condition. " The only natural remedy then remaining is the slow absorption of atmospheric oxygen at the surface of the water." So deodorization (or " chemical oxidation ") of the sewage is only a means to an end, that end being the presence of a sufficient quantity of free dissolved oxygen. Hence it remains to consider whether this same end cannot be brought about by different means, as, for example, aeration of the sewage before entering the river. This point being reserved, the action of the two deodorants, viz., the bleaching powder and manganate of soda acidified with sulphuric acid, is discussed in detail. The river was very foul at the beginning of the experiment with the bleaching powder, which was used to the extent of 3 grains per gallon of sewage, with the effect that on the whole the putrescent odour of the sewage was effectually destroyed throughout the entire period, July 2nd to August 26th. It was concluded, therefore, that bleaching powder is a good deodorant; but a " general impression " formed was, that it is " not possible to express any favourable opinion as to the action of the bleaching powder upon the general condition of the river.'' Hence the necessity 235 for laboratory experiments, which were subsequently carried out. Between August 27th and 5th of October, experiments were carried out with the manganate and acid. Deodorization of the sewage was effected, and a general impression formed that the manganate does not act prejudicially on the river. Diagrams are given showing, in the form of curves, the amount of dissolved oxygen in the river water at Crossness at different periods of the year; the changes in the volume of fresh water coming into the river, as indicated by the quantity of sea-salt present at low tide, the temperature, and the rainfall. " Comparing the general aspect of the curves for the three years, 1885-6-7, it does not appear that those for 1887 show any material indications of a worse state of things than those for the two previous years. And it may well be doubted . . . whether the state of the river in 1886, when upwards of £80,000* was spent in chemicals, was perceptibly better than that in 1887, when £42,000 was spent, or even better than that in 1885, when only £29,000 was spent in deodorants. Indeed, the idea forces itself on one's mind that either the effects of the chemicals are imperceptible, or that the methods of measuring those effects are imperfect." The Laboratory Experiments show that the sewage which had been treated with bleaching powder contained, in common with that treated with manganate, lower forms of life in quantity; but that the higher forms, such as algæ, were conspicuous by their absence in the first and by their presence in the second case. The bleaching powder (9 grains per gallon of sewage) completely and permanently stops the growth of all organisms visible under a high power of the microscope; smaller doses have similar effects differing in degree. The powder, moreover, is very inimical to animal (fish) life, so little as one-third grain per gallon of water being sufficient in time to kill minnows. Neutral manganate of soda added to sewage, 9 grains per gallon, does not prevent but appears to retard the * In a previous report (vide page 231) the cost of chemicals used is put at £40,000 only. Q 2 236 growth of organisms. Smaller doses, 1 to 3 grains, produce no visible effect, and therefore do not act as poisons. Minnows will live for some days in fresh water to which 1 grain of permanganate per gallon has been added, and for twelve hours in a solution twice as strong. Bleaching powder, moreover, disappears but slowly—taking some day—in sewage, whereas manganate is immediately destroyed. The conclusion drawn from the whole series of experiments is that, apart from the consideration of cost, manganate is to be preferred as a deodorant to bleaching powder. Sir H. Roscoe advises the continued use, under specified conditions, of manganate alone, the utility of sulphuric acid being questionable, at an annual average cost of £40,000, although this outlay will not prevent a foul condition of the river occurring during the summer months, in drought or during hot weather. The question of aeration of the sewage is briefly referred to. Free oxygen is to be had for nothing, and the cost of pumping air need not be considerable. Sir H. Roscoe believes that this may turn out to be a solution of the problem. The rapid purifying effects of aeration on the sewage were observed in the laboratory experiments, and it was felt that this is a matter " well deserving of further inquiry." The " general conclusions " are important, having regard to the views of the Royal Commission on Metropolitan Sewage Discharge, as set out in their Report (January, 1884), and to the action taken by the Metropolitan Board. Sir H. Roscoe remarks that he offers'' no opinion as to the processes of precipitation by chemical treatment" (lime and green vitriol) " as this question was not submitted to him by the Board." " Looking, however, at the broad question of the permanent disposal of the Metropolitan Sewage, and believing that the use of deodorants ought to be regarded only as a temporary expedient," he feels " convinced that sooner or later the recommendations of Lord Bramwell's Commission (the Royal 237 Commission above referred to) will have to be adopted, and that the sewage, whether previously clarified or not, must either be filtered through land or discharged into the estuary at a point not higher than the Sea Reach." So it would appear that in Sir H. Roscoe's opinion the costly works which the Board are now constructing for dealing with the sewage in their own way, and in opposition to the views of the Royal Commission, will not effect the object contemplated, and that the Board, or the London County Council rather, will ultimately have to deal with the disposal of sewage on the lines of recommendations by the Royal Commission, which the Board have practically ignored. (4.) A further report, dated March 3rd, 1888, treats of the deodorization of sewer emanations by the use of sulphurous acid—applied, at over 196 different stations in the Metropolitan area, in the form of a saturated aqueous solution allowed to drop upon flannel, and the annual cost being about £11 to £12 per station. It is stated that the offensive smell from the sewers appears to be diminished by the use of the acid, complaints having been less numerous from the occupiers of bouses in the vicinity of the shafts in which the deodorant had been placed, than was the case previously. But the experiments were conducted during the cold months of the year, and " the process has yet to go through the ordeal of summer temperature." (5.) In his latest communication entitled " Second Report on the Deodorization of Sewer Emanations and on Sewer Ventilation'' (undated in the printed copy), Sir H. Roscoe reports the results of inspection by his assistant of the stations in the Metropolis where sulphurous acid is employed for the deodorization of sewer emanations. Sir H. Roscoe has come to the conclusion that'• the present method of applying this substance is not satisfactory," as " the apparatus did not work effectively in 50 per cent." of the stations. The failure resulted from the difficulty in regulating the discharge of the acid, and from 238 insufficient strength of the solution employed, which does not completely deodorize the emanations. Sir H. Roscoe hopes soon to report on a new and more satisfactory method of deodorization. Meanwhile he reports with regard to the use of charcoal boxes in the ventilating shafts of the sewers, placed there to intercept the sewer emanations, that these " not only fail to effect this purpose, but that on the contrary they obstruct ventilation and also act as catch-pits for street-dirt," conclusions, entirely agreeable with my own observations on the subject longago submitted to your Yestry. The Special Purposes and Sanitary Committee of the Board reported to the same effect in January, 1886, and Sir H. Roscoe " fails to understand why . . no order for the removal of these charcoal boxes had been given." He thinks this should be done at once, and the Board, in a circular letter, addressed to the several Vestries and District Boards of Works, dated 12th July inst., intimates that it has " given directions that so far as the sewers under its control are concerned, all the charcoal boxes, or other obstructions to ventilation, shall be removed from the ventilating shafts, and that the mud shall be frequently removed from the air openings in the gratings on the road level." The Board expresses an opinion, in which I agree, that it is " desirable that the Vestries and District Boards on their part should cause all obstructions to the ventilation of the local sewers to be likewise removed," and suggests that the Vestries " should take measures for this purpose." Sir H. Roscoe is of opinion, and no one will question his judgment, that " the discharge of steam and hot water, chemical refuse, &c., into the sewers causes a serious nuisance;" and referring to a recommendation of the Committee above mentioned, " that stringent measures be taken by the Board for preventing" nuisance by the discharge into the sewers of improper substances, says that the recommendation should be acted upon stringently, no action in the matter apparently having been taken hitherto. In part 2 of the Report, dealing with Seiver Ventilation, noting the fact that " nearly the whole ventilation of the sewers depends upon 239 Surface Ventilators, that is to say' on shafts leading from the crown of the sewer to the centre of the road, and covered at the road-level by open gratings,' " Sir H. Roscoe observes that " the efficiency of Surface Ventilators depends mainly on the size of these air openings." The size of these air openings " is altogether insufficient," largely due to the fact that they become more or less completely filled with dirt, and hence the " general ventilation of the sewers appears to be in an unsatisfactory condition." He agrees with the Committee, in their afore-mentioned report, that the mode of ventilation specified " has been the cause of complaint owing to the imperfect manner in which the system has been carried out, the ventilators being deficient both in size and number; and that pipe ventilators can be used with great advantage in addition to, and not in substitution for surface ventilators," under proper conditions and wherever practicable. Sir H. Roscoe remarks that " the escape of sewer air is practically prohibited in many quarters of the Metropolis," as the " temperature of the air in the sewer is often ten degrees above that of the outer air, into which the warmer sewer air would naturally escape, were proper means provided." Sir H. Roscoe's final observation, like so many preceding ones, is entirely in harmony with views long ago expressed by the officers of your Vestry and others, viz., that " the free admission of air into the sewers is the only efficacious means of preventing foul emanations, 1st, by the oxidation of putrescent sewage, and 2nd, by the dilution of any offensive gases evolved." He therefore calls special attention to this portion of the subject, believing that" the policy of closing the air openings to the sewers, instead of allowing as much fresh air to enter as is possible, is based upon a wrong scientific principle, and that the only feasible plan of rendering the sewers sweet is to carry out thoroughly, and on a proper scale, the system of Pipe Ventilation so strongly recommended in the excellent Report of the Special Purposes and Sanitary Committee." 240 I may add that Sir H. Roscoe's assistant speaks favourably of a " method of ventilating" sewers recommended by Mr. Parker, late Surveyor to the Poplar District Board of Works, and in use for many years past, viz., " by carrying a shaft from the sewer to the side of the road, and connecting to it a vertical pipe attached to the head of which is fixed a' cowl.'" The Flushing Inspector of the Metropolitan Board's Sewers in the district, " spoke well in favour of the system," and I must say for myself that, upon hearing Mi;. Parker describe his system, some years ago, and looking at his drawings, the Medical Officer of Health for the district, moreover, testifying to the good results obtained, I formed the opinion that the method was likely to afford a solution to the difficulty, based, as I understand it to be, upon the principle of flooding the sewers with fresh air so as to oxidize, dilute, and favour the escape of the foul emanations from the sewage. Sir Henry Roscoe's Reports were referred by your Yestry to the Works, Sanitary, and General Purposes Committee for consideration, and on July 25th inst., the Committee reported as follows :— (a) " That having regard to the statement that' the effects of the chemicals used are imperceptible,' they doubt the propriety of continuing the attempted deodorization of the sewage as recommended by Sir H. Eoscoe, at a cost] of £40,000 per annum, especially as it is stated that this outlay will not prevent a foul condition of the river occuring during the summer months in drought or hot weather, and as it had been previously stated that such an expenditure is not justifiable. (b) " That as Sir H. Eoscoe is' convinced that sooner or later the recommendations of the Eoyal Commission on Metropolitan Sewage Discharge will have to be adopted, and that the Sewage, whether previously clarified or not, must either be filtered through land or discharged into the Estuary, at a point not higher than the Sea Beach,' it would appear that the Board are proceeding upon erroneous lines in dealing with the Sewage at the Outfalls, and hence the great expenditure being incurred will have been practically thrown away. (c) "That the methods of deodorizing the emanations from Sewers, at a cost of £11 or £12 for each station where it is applied, appear to be practically unsuccessful, and therefore might as well be discontinued. 241 (d) "That the best-known method of dealing with Sewer emanations is by admitting air freely into the Sewers, to oxidize and dilute the emanations, and by favouring the escape of foul air by free openings in the roads, and by pipe ventilators carried above the houses. The Report of the Committee was adopted by your Vestry, as also was their recommendation "That the system of pipe ventilation be carried out in this parish where necessary and practicable, as heretofore, and that all obstructions to the ventilation of the sewers be removed by frequent removal of the mud from the air openings in the gratings on the road level." WATER SUPPLY. Professor Frankland's Reports. It is desirable that your Vestry, as Sanitary Authority should be kept informed with reference to the water supply of the parish, a subject of great importance in relation to public health ; and in pursuance of custom I propose to submit information culled from the reports prepared annually by Professor Frankland for the Registrar-General, and from the annual reports of the Water Examiner under the 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 customer; 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 1887 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 one of his reports he described this water as being "delicious and wholesome" and uniformly excellent 242 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. 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 ease (Ballard v. 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. The year 1887 was characterised by a remarkably small rainfall, never the less London was abundantly supplied with water. The Thames was unusually free from floods, and consequently the conditions were particularly favourable for yielding a supply of water, containing but little impurity either in solution or suspension. With the exception of two samples collected from the mains in January, when the river was in flood, all the filtered river water was clear and bright, pointing to the care and efficiency with which the water is treated by the Companies previous to delivery. The temperature of the river waters varies greatly according to season whilst that of the deep well water is practically constant throughout the year. The variation in Thames water was from 38°3 Fahr. in January to 68°4 in July, a range of 30°1; whilst that of the Kent Company's water was only 2°0; from 54°3 in November to 56°3 in July. 243 This water thus remains cool and refreshing in summer, and is less likely to become frozen in the service pipes in winter. The solid matters found in the waters are mostly composed of mineral substances which, in existing proportions, in no way diminish their fitness for drinking. But the salts of lime and magnesia, which constitute the principal part of these mineral ingredients, are objectionable, imparting to the water its "hardness." The small proportion of organic material which the solid matter contains is of the greatest importance in connexion with the use of water for drinking purposes, as it may be of the most objectionable character on account of its origin. Thus the Thames receives, above the Metropolitan Companies intakes, various contributions of organic matter of animal origin, such as the drainage from manured land, the effluents from sewage works, and even sewage itself. This animal matter may, at any time, be accompanied by zymotic poisons dangerous to health, and although the chance of such substances reaching the water consumer are greatly reduced, both by exclusion of flood waters from the reservoirs and by filtration, there is no absolute guarantee that the noxious ingredients, which may at any time be present, are wholly removed. The deep well water from the chalk contains much more solid matter than the river waters. But the Colne Valley Company, by treating this chalkwater with lime, reduce the solid matter to little more than half the quantity present in river water. During the greater part of the year the river waters contained only a very moderate amount of organic matter—a smaller average indeed than in any previous year since 1868, when these determinations were first commenced. The well known purity of the chalk-water was maintained, the average proportion of organic matter which it contained being but little more than one-third of that present in the Thames. From a sanitary point of view, moreover, the superiority of deep well water is even greater than the figures represent, for the exhaustive filtration it undergoes, in passing through a great depth of porous strata, is far in excess of what can be effected by sand filtration. The greater the storage capacity possessed by any company the more independent it becomes of floods in the river, and the less proportion of organic matter will be found in its water. The whole evidence of the nitrogenous organic matters which have gained access to river waters in the past, as well as those which are still present at the time of analysis, is furnished by the total amount of combined nitrogen both mineral and organic. In river water this total combined nitrogen undergoes considerable reduction in summer, in 244 consequence of the vegetable life which then abounds in such water. On this account, therefore, the amount of total combined nitrogen found in the water during the winter months can alone be regarded as bearing any relationship to the amount of nitrogenous matters which these waters have received. During the past two years there has been an appreciable increase in the proportion of this combined nitrogen, due, probably, to the summer droughts and consequent freedom from floods: the nitrogenous organic matters thus accumulate on the land and there undergo nitrification instead of being rapidly carried away into the rivers; the nitric nitrogen thus formed during the dry summer months then finds its way into the rivers during the more rainy months of the winter. 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 taken as the standard of puritv for comnarison:— Name of Company. Maximum. Minimum, Average. Kent 0.9 0.4 0.6 Chelsea 5.2 1.4 2.8 Grand Junction 6.1 0.9 2.6 West Middlesex 5.5 2.1 2.9 The average proportion of chlorine in the river waters has, during the past three years been slightly in excess of that usually present, the increase being doubtless attributable to the small rainfall. The term "hardness" is used to denote the proportion of carbonate of lime, or its equivalent of other soap-destroying substances, present in 100,000 parts of water. The mean hardness of the Thames water was 19.3, that of the Colne Valley Company, after a softening process, being 5.7. The hardness of the river waters is not so excessive as to influence their fitness for drinking, but it is sufficient to materially diminish their value for washing, steam, and industrial purposes generally. This hardness is almost entirely due to the presence of bi-carbonate of lime in solution: this bi-carbonate of lime, however can be readily removed by treating the water with lime, and is successfully done by the Colne Valley Company, with the result that the hardness of that Company's water is reduced, before delivery, to less than one-fifth of its original amount. The hardness of the river supplies is similarly reducible. This mode of softening is by far the most economical, for it entails only about one-eightieth of the expense which devolves upon the private consumer in the shape of additional soap required for washing purposes. 245 On one occasion the water of the Grand Junction Company was slightly turbid; with this exception the supplies delivered by the Companies in which we are interested were uniformly clear and transparent. The Grand Junction Company's storage capacity is below that of some of the other companies. This Company, however, have 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 generally to supply water of perfectly clear appearance even when the river was in a very impure and flooded state. 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 are very satisfactory. 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. The subjoined Table shows the annual averages of each determination and thus summarizes the average results of the analysis of the waters supplied by the local 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 which 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., 1876. being taken as 1°. Chelsea 10°.5 26.75 .140 .025 .000 .211 .236 1.8 18.8 2.8 West Middlesex 11° 5 27.18 .143 .031 0 .230 .261 1.8 19.3 2.9 Grand Junction 10°.6 27.06 .131 .026 0 .224 .250 1.8 19.4 2.6 Kent 12°.7 41.83 .028 .008 0 .464 .472 2.5 29.9 0.6 246 THE WATEB EXAMINER'S REPORT. I am indebted to the courtesy of Major-General A. de C. Scott, R.E., the Water Examiner, for an early copy of his Annual Report for 1887, from which most of the following particulars are taken. General Scott's duties as Water Examiner 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 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 the late Sir F. Bolton, first Water Examiner, upon:— 1. A sufficient area of properly constructed filter 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. Sir F. Bolton stated, and it appears to be generally agreed, the "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 247 several local companies, in 1887, was as follows :—West Middlesex, 1.33; Grand Junction, 1.80; Chelsea, 1.75. The requirements of the Act in this respect, therefore, are fully carried out. The filter beds are formed as follows:— West Middlesex.—Harwich sand, 2ft. 3in.; Barnes sand, 1ft.; gravel screened to different sizes, and arranged in layers, 2ft. 3in. Total thickness, 5½ft. Grand Junction.—Harwich sand, 2ft. 6in.; Hoggin, Gin.; fine gravel, 9in.; coarse gravel, 9in.; boulders, 1ft. Total thickness, 5£ft. 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. Sand is the efficient agent in filtration as practised, and this it may be added varies in quality. In the Report for 1886, the "West Middlesex" Company, was referred to as prominent in "respect of the uniformity in the quality of its water," this Company using “to an appreciable extent sand from Harwich which is remarkably fine and uniform in grain." The filtering basins are lined with brickwork or concrete, and contain layers of sand, and fine end coarse gravel arranged in descending order. The water passes vertically downwards, and 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 three feet 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 fcur feet six inches. The sand becomes clogged in course of time, and then the upper layer is scraped off and removed. Renewals of sand should take place periodically as the layer becomes reduced below an assigned minimum. 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 248 connection of them with drains through the medium of " wastepipes," 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 efflicient warning-pipe,' within two calendar months next after the Company shall have given to the occupier of, or left at the premises in which such cistern is situate, a notice in writing requiring such alteration to be made." The late Sir Francis Bolton remarked in one of his reports that— "The particular object of the above regulation is to prevent the waste of water; but if the over-flow-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." These remarks are just, and hold good at the present time I would again urge, therefore, that the Companies should be compelled to exercise their power, or that the Vestries and Districts Boards should have co-ordinate authority, to enforce the regulation. Meanwhile, the attention of householders cannot be too frequently drawn to the necessity for the abolition of wastepipes, 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 screw-down 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 249 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, in round numbers, 35, 29, and 37 gallons daily per head of the population, and 251, 173, and 233 gallons per house. 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 sand and 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 large quantities of water that has passed through the natural beds of gravel and sand, which are characteristic of the neighbourhood. Owing to the scanty rainfall, and the infrequency of freshets and floods in the rivers, the conditions under which filtration of the Metropolitan water supply was carried on throughout the year were exceptionally favourable, and the results, as regards freedom from turbidity, and low tone of colour in the water, were generally satisfactory. 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 filtration. 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 250 Companies:—Chelsea, 14; West Middlesex, 8; Grand Junction, 4. It must he 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 1887 his biological experiments by the process known as gelatine-plate cultivation, from which it appears that the average reduction in the number of micro-organisms present in the unfiltered water of the Thames, effected before delivery to the consumers, amounted to 96.7 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:— There has been no extension during the year of the subsiding reservoirs belonging to either of the Companies. The Chelsea Company has constructed a new intake at West Molesey, and provided additional pumping power there. The West Middlesex Company has increased and proposes to still further increase its pumping power. The Grand Junction Company is constructing a storage reservoir for filtered water at Ealing to contain 51 million gallons, an amount equal to three days' average supply for domestic and other purposes. This reservoir will be opened in August of the present year. 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 is giving constant supply to all new estates and buildings, and where new services are laid down constant supply 251 is made compulsory by the Company, on outside stop-valves being fixed; 2,763 houses were put on constant supply during the year, the number of houses on constant supply being 23,256 out of a total of 69,908. The Grand Junction Company was giving constant supply to 41,581 houses out of a total of 53,831; the increase during the year was 1,088. The system has been extended to North Kensington. The Chelsea Company was giving constant supply to 5,961 houses (increase during the past year 801), 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 comparison it may be mentioned that the East London Waterworks Company now gives constant supply to 137,859, out of a total of 160,252 houses supplied, and containing an estimated population of 1,198,040 persons. The percentage of house supplies on the constant system in each local Company's district, Dec. 31st, 1887, was, Chelsea, 17 per cent.; West Middlesex, 33 per cent.; and Grand Junction, 77 per cent. In the East London District the percentage is as high as 86. But considerable advance was made duriDg the past year in London as a whole, in extending the constant supply; 375,076 out of the total number of 733,161 houses supplied, or 51 per cent., being now on constant service, an increase of 28,385 during the year. In general the constant supply system, so far as it extends, seems to have been introduced voluntarily by the Companies and not at the instance of local authorities or inhabitants. It may therefore be assumed that it conduces on the whole to economy in the use of water. 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, 110¾; Grand Junction, 83; and Chelsea, 75½. The Companies are ready to affix hydrants on the mains whenever required to do so. In the Metropolis there were 10,544 hydrants, the total length of mains constantly charged being 1,113 miles, and the total mileage of water pipes being 3,139. The increase in number of hydrants in 1887 was 1,367. 252 Subsequent to the passing of the Act of 1871, the Water Companies have incurred a considerable expenditure, amounting altogether to £4,165,434, 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 1887 amounted to £14,140,433, of which £275,310 was expended during the past year. DETERIORATION OF WATER IN DIRTY CISTERNS. The Local Government Board a few years ago addressed a circular letter to Sanitary Authorities in the Metropolis, stating that Sir F. Bolton, the then 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 often uncovered condition of cisterns; (2) to the need for frequent cleansing of cisterns, and (3) to the misplacing of the cisterns. Not uncommonly there is but one cistern to a house, and that one, frequently, not only situated over a water-closet, 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 253 cleansing alike. The Sanitary Authority has no control over the placing of cisterns, hut the Water Companies might, if so minded, remedy the evil 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 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 were informed that your Vestry, being sensible of the value of the advice given, 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- 254 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 were 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 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 Begulation 14, and these in turn prepared circular notices, which were left at every house in the several districts. In all of these notices 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 had 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 "notice" to every householder, to cut-off all connections of waste-pipes of 255 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 quality of the water arise from deterioration of the supply 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 to reiterate in his monthly reports, to the very last, sound advice which might have dune good if only it could have been impressed on every individual householder ; pointing out, as he did, that if 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 the Chief Gas Examiner, summarize the principal results 256 (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. 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 18.4 16.3 17.0 Quarter ended June 30th 18.3 16.8 17.4 Quarter ended September 30th 17.7 16.7 17.0 Quarter ended December 31st 17.5 16.7 17.0 Averages, whole year 18.0 16.6 17.1 It appears from these results that the illuminating power of the gas at the Station was higher than 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 shows to be defective in lighting power. 257 The 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 cf the use of the sperm candle as a standard, it having been proved that, in spite of precautions taken to secure uniformity in the manufacture of the candles, there remained considerable variation in their lighting power. In the Reports of the Metropolitan Board for 1885 & 1886 no reference was made to the important matters dealt with in the above paragraph, but in the Report for 1887, the subject is again dealt with, and we are informed that in the interval a long series of careful and complete experiments have been made by the Officers of the Board, under the Board's authority, with the result that the Pentane air-gas standard, as devised by Mr. A. Vernon Harcourt, one of the gas referees, has appeared to possess in a higher degree than any other, the merits of simplicity, accuracy, and reliability. It is added that "the Board has not yet formally expressed any opinion on the subject, but the recorded results of the experiments made by the Board's Officers will be of value, when the question of adopting a better standard is taken up by the Board of Trade." 2. As regards parity. The gas was free from sulphuretted hydrogen throughout the year; and the quarterly average quantity of other sulphur compounds present in the gas was considerably less than the quantity permitted, the maximum not having been attained on any occasion. 258 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 11.4 6.4 8.7 Quarter ended June 30th 13.0 6.9 9.2 Quarter ended September 30th 11.7 6.4 8.9 Quarter ended December 31st 12.6 8.1 93 Averages, whole year 12.2 6.9 9.0 Ammonia, a valuable residual product of gas manufacture, was present in the gas more or less frequently throughout the year, but on no occasion was the limit fixed by the Acts of Parliament—viz., four grains in 100 feet of gas—exceeded. The quantity at all times was small, and sometimes ammonia was entirely absent. 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 so 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'6 Superintendent of Street Lighting, is satisfied with the quality of the gas as supplied to the public lamps. Complaints, however, are occasionally made by private consumers, who allege that, although the nominal price of gas may go down (the shareholders' profits going up pari passu) the actual annual payment for gas increases; the reason probably being that no means are adopted for controlling 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 259 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 half-yearly, on the back of the rate-call papers, information shewing bow 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. 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. Conclusion.—It now only remains for me, in bringing this Report to an end, 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 had occasion in previous reports to refer to the cooperation of the Board of Guardians. It would be imposbible to over-value the services rendered by them in past years, through their officers, in measures for preventing the spread of danger ous infectious diseases—viz., by securing the speedy removal of the sick. * 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 equalization 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. 260 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. The Sanitary Inspectors have discharged their onerous, and in some respects perilous, duties with zeal, intelligence, and success. To Mr. Rudman, the Sanitary Clerk, I am much indebted, among other things, for assistance rendering in passing this Report through the press. But above all, my thanks are due to your Vestry for continuance of confidence which, now for seventeen years, has enabled me to carry out, with pleasure and satisfaction, the duties of my office, and to superintend the work of a Department the importance of which, I believe, is now generally recognized. I am, Gentlemen, Your obedient servant, T. ORME DUDFIELD, Medical Officer of Health, Offices : Town Hall, Kensington, W., July, 1888. 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. 263 TABLE I. Shewing Population, Inhabited Houses, Marriages, Births, and Deaths, in 1887, 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 § 1887 175,000 21,566 1,561 3,941 2,872 680 1,129 608 1886 173,500 21,500 1,605 4,149 2,756 636 1,029 604 1885 171,900 21,420 1,480 4,032 2,768 653 1,085 561 1884 169,520 21,290 1,498 4,394 2,638 678 1,020 439 1883 167,561 21,030 1,616 4,230 2,615 601 982 48S 1882 164,880 20,908 1,474 4,327 2,691 635 1,114 403 1881 163,299 20,666 1,461 4,400 2,726 644 1,067 437 1880 161,385 20,700 1,483 4,605 2,884 719 1,219 369 1879 158,231 20,240 1,428 4,790 2,992 722 1,218 424 1878 154,217 19,719 1,331 4,607 3,120 823 1,429 410 1877 151,245 19,330 1,411 4,648 2,625 648 1,040 420 Average of 10yrs. 1877-86. 163,573 20,680 1,478 4,418 2,781 675 1,120 455 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 (1887), 80. * 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. 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 1887 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. 1887 22.5 164 172 237 393 212* 1886 23.9 15.9 154 230 373 219 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 Average o f 10 years 1877—1886. 27.0 16.9 152 242 400 160 * 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 1877.83 the deaths at Brompton Consumption Hospital are included as compensation for an unknown number of deaths of Parishioners at outlying Public Institutions. 264 TABLE III. Deaths registered from all causes in the year 1887. (Exclusive of the Deaths of Non-Parishioners at Public Institutions within the Parish, but inclusive of the Deaths of Parishioners at Public Institutions without 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 178 195 36 13 20 15 2 5 10 3 3 373 480 411 69 II. PARASITIC DISEASES 2 1 ... ... ... ... ... ... ... ... 3 4 2 2 III. DIETETIC DISEAES ... ... ... ... 2 5 ... 5 1 ... ... ... 13 12 1 IV. CONSTITUTIONAL DISEASES 67 61 30 46 63 82 70 79 50 19 4 128 571 441 130 V. DEVELOPMENTAL DISEASES 70 1 1 ... ... ... 1 1 16 45 35 71 170 130 40 VI LOCAL DISEASES 238 176 33 44 50 108 140 215 221 166 28 414 1419 1135 284 VII. DEATHS FROM VIOLENCE 20 9 2 3 3 11 14 6 2 ... 1 29 71 63 8 VIII. DEATHS FROM ILL DEFINED AND NOT SPECIFIED CAUSES 105 6 2 ... 6 4 5 6 5 5 ... 111 144 127 17 680 449 105 106 144 225 232 317 305 238 71 1129 2872 2321 651 I. SPECIFIC FEBRILE or ZYMOTIO DISEASES. 1. —Miasmatic Diseases. Vaccinated ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Small-pox Unvaccinated ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... No Statement ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... 1 Measles 23 73 11 1 ... ... ... ... ... ... ... 96 108 86 22 Searlet Fever 3 28 8 4 1 ... ... ... ... ... ... 31 44 40 4 Typus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough 33 51 2 ... ... ... ... ... ... ... ... 84 86 88 3 Diphteria 3 22 9 3 2 1 ... ... ... ... ... 25 40 33 7 Simple Continued or Ill-defined Fever ... 1 ... ... 1 ... ... ... ... ... ... 1 2 2 ... Entered or Typhoid Fever ... ... 5 1 4 ... ... ... ... 1 ... ... 11 2 9 Other Miasmatic Diseases 2 4 ... ... ... ... ... ... ... ... ... 6 6 6 ... 2.—Diarrhceal Diseases. Simple Cholera ... 1 ... ... ... ... ... ... ... ... ... 1 1 1 ... Diarrhoea, Dysentery 95 12 ... ... 2 3 ... 3 5 2 2 107 124 110 14 3.—Malarial Diseases. Remittent Fever ... 1 ... ... ... 1 ... ... ... ... ... 1 2 1 1 Ague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4.—Zoogenous Diseases Cowpox, and effects of Vaccination ... 1 ... ... ... ... ... ... ... ... ... 1 1 1 ... Other Diseases (e.g., Hydrophobia, Glanders, Splenic Fever) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5.— Venereal Diseases. Syphilis 13 1 ... 1 1 1 ... ... ... ... ... 14 17 16 1 Gonorrhoea, Stricture of the Urethra ... ... ... ... ... ... ... ... 1 ... 1 ... 2 1 1 6—Septic Diseases. Erysipelas 4 ... ... 1 1 2 1 2 ... ... 4 11 9 2 Pyæmia, Septicæmia 2 ... 1 ... 2 ... ... ... 2 ... ... 2 7 6 1 Puerperal Fever ... ... ... 2 7 8 ... ... ... ... ... ... 17 14 3 178 195 36 13 20 15 2 5 10 3 3 373 480 411 69 II. PARASITIC DISEASES. Thrush and other Vegetable Parasitic Diseases ... 2 ... ... ... ... ... ... ... ... ... ... 2 2 2 ... Worms, Hydatids, and other Animal Parasitic Diseases ... 1 1 ... ... ... ... ... ... ... ... 1 2 ... 2 III. DIETETIC DISEASES 2 1 1 ... ... ... ... ... ... ... ... 3 4 2 2 Want of Breast Milk—Starvation ... ... ... ... ... ... .. ... ... ... ... ... ... ... ... Scurvy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chronic Alcoholism ... ... ... ... 1 4 ... 3 1 ... ... ... 9 8 1 Delirium Tremens ... ... ... ... 1 1 ... 2 ... ... ... ... 4 4 ... ... ... ... ... 2 6 ... 5 1 ... ... ... 13 12 1 IV. CONTITUTIONAL DISEASES Rheumatic Fever,Rheumatism of the Heart ... 1 ... 2 4 1 2 ... ... ... ... 1 10 7 3 Rheumatism ... ... ... ... ... ... ... 1 ... ... ... ... 1 1 ... Gout ... ... ... ... ... ... ... 4 4 4 ... ... 12 7 5 Rickets 1 4 1 ... ... ... ... ... ... ... 5 6 4 2 Cancer, Malignant Diseases ... ... ... 1 1 18 18 36 30 9 4 ... 117 84 33 Tabes Mosenterica 32 15 1 ... ... ... ... ... ... ... 47 48 43 5 Tubercular Meningitis, Hydrocephalus 21 30 10 2 .. ... ... ... ... ... ... 51 63 47 16 PhthisiPhthisis ... 1 9 36 53 54 45 27 13 2 ... 1 240 190 50 Other forms of Tuberculosis Scrofula 13 9 9 2 3 4 1 1 ... ... ... 22 42 37 5 Purpura, Hæmorrhagic Diathesis ... ... ... ... ... 1 ... ... ... 1 ... 1 Anæmia, Chlorosis, Leucoeythæmia. ... ... ... 2 1 1 1 1 ... ... ... 6 4 2 Glycosuria, Diabetes Mellitus ... ... ... ... 1 3 2 7 3 4 ... ... 20 13 7 Other Constitutional Diseases ... 1 ... 1 ... 1 ... 2 ... ... ... 1 5 4 1 67 61 30 46 63 82 70 79 50 19 4 128 571 441 130 V. DEVELOPMENTAL DISEASES Premature Birth 58 ... ... ... ... ... ... ... ... ... ... 58 58 46 12 Atelectasis 4 1 ... ... ... ... ... ... ... ... ... 5 5 2 3 Congenital Malformation 8 ... 1 ... ... ... ... ... ... ... ... 8 9 7 2 Old Age ... ... ... ... ... ... 1 1 16 45 35 ... 98 75 23 70 1 1 ... ... ... 1 1 16 45 35 71 170 130 40 VI. LOCAL DISEASES. 1.—Diseases of Nervous System. Inflammation of Brain or Membranes ... 6 5 ... 1 1 1 ... ... ... 1 6 15 14 1 Apoplexy, Softening of Brain, Hemiplegia, Brain Paralysis ... ... 1 1 3 8 25 45 86 36 6 ... 161 121 40 Insanitary ... ... ... ... ... ... ... 1 1 ... ... ... 2 1 1 Epilepsy ... ... 3 4 3 ... 2 1 1 ... ... ... 14 9 5 Convulsions 45 17 2 ... ... ... ... ... ... ... ... 62 64 56 8 Laryngismus Stridulus (Spasm of Glottis) 3 1 ... ... ... ... ... ... ... ... ... 4 4 4 ... Disease of Spinal Cord/Paraplegia, Paralysis Agitans ... 1 ... ... 1 ... 1 1 3 2 ... 1 9 7 2 Other Diseases of Nervous System. 3 ... 1 ... ... ... 2 4 6 4 ... 3 20 16 4 2'—Diseases of Organs of special sense (e.g. of Ear, Eye, Nose) 2 1 ... 1 ... ... ... 1 ... ... ... 3 5 3 2 3.—Diseases op Circulatory System. Pericarditis ... 1 4 1 .. 1 ... ... ... ... ... 1 7 6 1 Acute Endocarditis ... ... ... 2 ... 1 ... ... ... ... ... ... 3 3 ... Valvular Diseases of Heart ... ... 1 3 1 3 8 1 3 1 ... ... 28 16 12 Other Diseases of Heart ... 1 2 5 6 17 28 33 31 16 3 1 142 109 33 Aneurism ... ... ... ... 2 1 4 4 2 ... ... ... 13 10 3 Embolism, Thrombosis ... ... ... ... ... ... 1 ... 2 ... ... ... 3 3 ... Other Diseases of Blood Vessels ... ... ... ... ... ... 1 2 1 ... ... ... 4 3 1 4.—Diseases or Respiratory Organs. Larygitis 3 5 1 ... ... ... 1 1 ... 1 ... 8 12 12 ... Croup 4 15 ... ... ... ... ... ... ... ... ... 19 19 17 2 Emphysema, Astyhma ... ... ... 1 1 ... 3 6 ... 2 ... ... 13 8 6 Brochitis 104 69 3 2 4 9 14 52 76 74 15 173 422 362 60 Pneumonia 26 37 2 7 9 14 14 11 11 9 ... 63 140 112 28 Pleurisy ... ... ... ... 1 2 1 2 3 1 ... ... 10 9 1 Other Diseases of Respiratory System 8 7 ... ... 1 6 4 ... 1 6 ... 15 33 27 6 6.—Diseases op Digestive (System. Dentition 8 7 ... ... ... ... ... ... ... ... ... 15 15 10 5 Sore Throat Quinsy ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 Diseases of Stomach 1 1 ... 3 1 4 1 2 1 ... 1 2 15 10 5 Enteritis 12 3 1 2 1 3 1 2 1 ... ... 15 26 20 6 Obstructive Diseases of Intestine 2 ... 1 ... 1 ... 1 4 3 1 ... 2 13 10 3 Peritonitis 1 ... 3 2 1 5 1 3 2 ... ... 1 18 13 6 Ascites ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cirrhosis of Liver ... ... ... ... 2 7 6 5 5 ... ... ... 25 15 10 Jaundice, and Other Diseases of Liver 4 ... ... ... 2 5 4 11 11 6 ... 4 43 35 8 Other Diseses of Digestive System 4 2 ... 1 1 1 ... 2 2 3 ... 6 16 11 5 6.—Diseases of Lymphatic System (e.g. of Lymphatics and of Speeln) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 7—Diseases of Glandlike Organs of Uncertain Use. (e.g. Bronchocele Addison's Diseases) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 8 -Diseases op Urinary System Nephritis 1 1 1 1 1 2 5 1 2 ... ... 2 15 11 4 Bright's Disease, Albuminuria ... ... 1 2 1 2 6 5 5 3 1 ... 26 20 6 Disease of Bladder or of Prostrate ... ... ... ... ... 2 ... ... 2 ... ... ... 4 4 ... Other Diseases of the Urinary System ... ... 1 2 1 5 4 4 9 1 ... ... 27 22 5 9.—Diseses of Reproductive Sysrtem. a. Of Organ, of Generation. Male Organs ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Female Organs ... ... ... ... ... ... ... ... ... ... ... ... 4 4 ... b. Of Parturition. Abortion, Miscarriage ... ... ... ... ... 1 ... ... ... ... ... ... 1 1 ... Puerperal Convulsions ... ... ... 1 1 1 ... ... ... ... ... ... 3 2 1 Placenta Prævia, Flooding ... ... ... ... ... 1 ... ... ... ... ... ... 1 1 ... Other Accidents 'of Childbirth ... ... ... 2 3 3 ... ... ... ... ... ... 8 7 1 10.—Diseases op Bones and Joints. Caries, Necrosis ... ... ... ... 1 ... 1 2 ... ... ... ... 4 4 ... Arthritis, Ostitis, Periostitis ... ... ... ... ... 1 ... 1 ... ... ... ... 2 2 ... Other Diseases of Bones and Joints ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 11.—Diseases op Integumentary System. Carbuncle, Phlegmon ... ... ... ... ... ... ... ... ... ... ... ... ... .... ... Other Diseases of Integumentary System 7 1 ... ... ... 1 ... ... ... ... ... 8 9 5 4 238 176 33 44 50 108 140 215 221 166 28 414 1,419 1,135 284 VIII. DEATHS FROM VIOLENCE. 1.—Accident or Negligence:. Fractures and Contusions 2 ... 1 2 3 9 8 5 2 ... ... 2 32 30 2 Gunshot Wounds ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cut, Stab ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Burn, Scald ... 3 1 ... ... ... 1 ... ... ... 1 3 6 6 ... Poison ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 ... Drowing ... 1 ... ... ... ... ... ... ... ... ... 1 1 1 ... Suffocation 15 3 ... ... ... ... 1 ... ... ... ... 18 19 15 4 Otherwise ... 1 ... ... ... ... ... ... ... ... ... 1 1 1 ... 2.—Homicide. Manslaughter 3 1 ... ... ... ... 1 ... ... ... ... 4 5 5 ... Murder 3.—Suicide. Gunshot Wounds ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... 1 Cut, Stab ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Poison ... ... ... 1 ... ... ... ... ... ... ... 2 2 ... Drowing ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 ... Hanging ... ... ... ... ... 1 ... 1 ... ... ... ... 2 1 1 Otherwise ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4.—Execution. Hanging ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 20 9 2 3 3 11 14 6 2 ... 1 29 11 63 8 VIII. DEATHS FROM ILL DEFINED AND NOT SPECIFIED CAES. Dropsy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Debility, Atrophy, Inanition 98 6 ... ... ... ... 1 ... ... ... ... 104 105 96 9 Mortification ... ... ... ... ... ... ... 1 1 3 ... ... 5 5 ... Tumour ... ... ... ... ... ... ... 1 1 ... ... ... 2 1 1 Abseases 2 ... 1 ... ... ... ... ... ... ... ... 2 3 2 1 Hæmorrhage 3 ... ... ... ... ... ... ... ... ... ... 3 3 2 1 Sudden Death (Cause not ascertained) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Causes not specified or Ill-defined 2 ... 1 ... 6 4 4 4 3 2 ... 2 26 21 5 105 6 2 ... 6 4 5 6 5 5 .. 111 144 127 17 CAUSES OF DEATH. 0 to 1. X 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. Total under Five Years of Age. Grand Totals, all Ague. Kensington Towm Brompton. AGES. sub-districts. 267 TABLE IV. Shewing the number of Deaths at all ages in 1887 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 1 000 of Total Deaths, at all ages. 1. Principal Zymotic Diseases 416 2.4 144 2. Pulmonary Diseases 649 3.7 225 3. Principal Tubercular Diseases 336 1.9 117 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 156 40 229 5. Convulsive Diseases 74 19 109 NOTES. 1. Includes Small-pox, Measles, Scarlet Fever, Diphtheria, "Whooping-cough, Typhus Fever, Enteric (or Typhoid) Fever, Simple Continued Fever, and Diarrhcea. Thirty-nine 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). 268 TABLE V. Shewing the Number of Deaths from the Principal Zymotic Diseases in the ten years 1876-86 and in the year 1887. Diseases. 1877. 1878. 1879. 1880. 1881. 1882. 1883. 1884. 1885. 1886. Annual Average of ten years 1877-86. Proportion of Deaths to 1000 Deaths in ten years 1877-86. 1887. Proportion of Deaths to 1000 Deaths in 1887. Small Pox 84 24 24 11 55 0 1 26 25 0 25.0 9.0 1 0.3 Measles 54 53 60 75 67 77 39 32 111 56 62.4 22.5 108 37.6 Scarlet Fever 31 77 51 105 38 62 28 18 7 11 42.8 15.4 44 15.3 Diphtheria 10 20 26 22 8 25 24 17 22 30 20.4 7.3 40 13 9 Whooping.Cough 34 185 93 95 85 119 44 81 98 82 91.6 33.0 86 30.0 Typhus Fever 2 3 1 4 2 1 2 0 0 0 1.5 0.5 — – Enteric Fever 20 26 14 24 22 2.5 30 26 12 11 21.0 7.5 11 3.8 Simple Continued Fever 5 4 8 5 5 6 3 4 0 0 4.0 1.4 2 0.7 Diarrhoea 99 181 71 128 101 61 80 110 86 90 100.7 36.2 124 43.2 TOTALS. Kensington 339 573 348 469 383 376 251 314 361 280 369.4 132.8 416 144.8 London 12392 14734 12256 13681 13811 13553 10801 13629 11261 11121 12723 155.5 12684 154.3 England & Wales 66528 84624 62020 62020 58239 69734 58972 71762 57726 |62859 67500 129 '64676 121.9 269 TABLE VI. Inspectors' Report of the Sanitary Work completed in the year 1887.8. Sanitary Districts* No. of Complaints received during the year. J No. of Houses, Premises, &c., inspected. No of Re-inspections of Houses, Premises, &c. Results of Inspection. House Drains. Water Clo&ets. Dust Bins. Water Supply. Miscellaneous. Notices issued for'Sanitary Amendments of Houses and Premises. Houses, Premises, &c., Cleansed, Repaired, Whitewashed, &c. Houses Disinfected after illness of an Infectious character. Repaired, Cleansed, Trapped, &o. Ventilated. Repaired, &c. i Supplied with Water. New Provided. New Provided. Repaired, Covered <fec. Cisterns (new) erected. Cisterns'Cleansed, Repaired,"and Covered. Waste-pipes connected with Drains, &c. abolished. No. of Lodging Houses Registered under 35th Section of the " Sanitary Act, 1866." § Dust Removal—No. of Communications received and attended to. + Removal of Accumulations of Dung, Stagnant Water, Animal and other Refuse. Animals removed, being improperly kept. Regularly Inspected. Proceedings: i.e., Summonses. ‡/ Bakehouses. Licensed Cowsheds. Licensed Slaughter Houses. N.W. 36 1440 922 335 94 62 77 48 111 150 1 23 69 30 79 25 ... 395 60 11 36 6 8 37 N.E. 71 1127 1365 387 241 136 191 11 206 94 2 9 36 2 32 9 ... 424 18 3 46 2 5 25 Centrl 78 1183 1944 314 271 131 146 49 25 231 19 28 39 14 23 14 ... 261 27 4 23 2 7 13 South 193 2098 1894 416 352 120 76 60 56 102 7 5 30 19 94 40 ... 629 259 ... 44 3 2 16 Totals 378 5848 6125 1452 958 449 490 168 398 577 29 65 174 65 228 88 ... 1709 364 18 149 13 22 91 * the North-West Districts lie north of the centre of Oxbridge 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.) mP ouses were registered in 1887. The total number on the Register is, in round figures, 1,500. | The actual complaints of neglect, made by letter, were 27. J Inclusive of proceedings, in 26 cases, under the Food and Diugs Adulteration Act, all of the Inspectors being Inspectors under the Act; in 10 cases of " obstructions," on and over the public ways ; and in 7 cases of disobedience of the Justices' orders. TABLE Via. Summary of Monthly Returns of Work, &c., done by the Sanitary Inspectors, in the year 1887-8. Date of Report. Houses Inspected. Mews Inspected. Slaughter Houses Inspected. Cowsheds Inspected. Bakehouses Inspected. Offensive Trades Inspected. Sanitary Notices Issued. Removal of Dust, Ashes, &c., Letters of Request received and attended to. Date of Report. District. District. District. District. District. District. District. District. N.W. N.E. c. s. N.W N E. c. s. N.W N.E. c. s N.W N.E. c. s. N.W. N.E. c. s. N.W. N E c. s. N.W. N.E. c. s. N w. N E. c. s. 1887, Ap.23 146 106 136 168 111 251 316 190 8 5 8 8 10 2 6 12 6 30 8 2 7 27 13 6 32 38 57 47 56 60 25 69 Ap. 23,1887 „ May 21 126 101 118 188 112 253 295 215 9 8 6 8 5 2 4 12 24 14 8 1 25 19 13 8 40 41 26 62 81 80 36 89 May 21 „ ,, June 18 106 102 127 174 118 248 223 165 11 6 5 9 7 3 4 12 10 41 14 3 40 15 12 10 25 25 26 36 44 54 27 110 June 18 ,, „ July 16 104 123 120 192 101 248 203 198 4 7 9 7 6 5 4 10 7 18 10 9 40 31 15 7 18 52 19 29 53 73 65 122 July 16 „ „ Aug. 13 125 61 110 82 132 188 148 103 16 21 8 4 12 12 5 6 4 25 7 3 16 16 29 4 27 54 29 18 19 25 14 50 Aug. 13 ,, „ Sept. 10 57 36 28 143 78 151 33 146 1 5 ... 6 1 2 ... 9 10 25 ... 1 5 18 1 1 18 2 1 18 11 17 14 15 Sept. 10 „ „ Oct. 8 85 110 67 184 85 270 90 197 9 4 8 8 7 4 6 12 23 19 4 3 20 10 5 4 25 18 4 25 24 17 17 19 Oct. 8 „ „ Nov. 5 113 81 65 83 111 251 92 122 13 7 7 7 5 1 3 11 4 44 13 5 32 31 10 3 25 14 12 15 22 18 10 21 Nov. 5 ,, „ Dec. 3 116 87 85 193 103 248 155 213 2 8 4 8 5 3 3 12 10 31 16 10 23 20 8 7 28 33 29 40 7 13 7 22 Dec. 3 „ „ 31 102 53 84 170 105 252 144 216 9 5 2 8 9 1 3 11 9 29 15 12 23 14 18 4 3 13 13 16 27 18 17 25 „ 31 „ 1888Jan.28 93 66 111 185 92 250 130 222 7 4 6 9 8 2 5 12 20 27 7 13 17 20 10 9 18 14 18 22 32 14 20 34 Jan.28,1888 Feb. 25 124 90 69 161 99 249 115 194 8 3 3 8 5 4 3 12 3 32 4 4 20 23 14 8 46 44 29 64 3 12 5 28 Feb. 25 ,, ,, Mar. 24 143 111 63 175 129 246 85 226 11 7 2 10 6 2 2 12 18 30 3 12 19 12 12 9 30 39 51 24 16 23 4 85 Mar. 24 „ Totals 1140 1127 1183 2098 1376 3105 2029 2407 108 90 68 100 86 43 48 143 148 365 109 78 287 256 160 80 335 387 314 416 395 424 261 629 Totals. 271 TABLE VII. Shewing the Death Eate 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 1887, 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 Zymotio Diseases. Proportion of Deaths to 1,000 Deaths, from seven principal Zymotio Diseases. The Year. Kensington. London. Kensington. London. Kensington. London. 1877 17.3 21.9 339 2.2 3.5 129 160 1877 1873 20.2 23.5 573 3.7 4.1 183 175 1878 1879 18.8 23.3 348 2.2 8.3 116 143 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 22 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 1886 15.9 19.9 280 1.6 2.7 101 135 1886 AVERAGES OP TKN TEARS, 1877.C6. 16.9 21.3 369 2.2 3.2 131 155 AVERAGES OF TEN YEARS, 1877.86. 1887. 16.4 19.6 416 2.4 3.0 144 154 1887. 272 TABLE VIII. Comparative Analysis of the Mortality in all London, and in Kensington, in 1887. LOCALITY. Annual Death Bate per 1,000 living, from all causes Annual Death Eate per 1,000 living, from seven principal Zymotic diseases. Percentage of Deaths under 1 year to Births Eegistered. 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. Eegistered upon information of Coroners. (Inquests.) Eegistered at Public Institutions* Uncertified causes of Death. London 19.6 3.0 15.8 24.3 22.5 15.4 3.7 7.4 21.0 1.2 Kensington 16.4 2.4 17.2 23.7 27.0 14.4 2.5 5.5 21.2 0.7 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, etc. ' TABLE IX. Showing the Localities in which fatal cases of some of the Principal Zymotic Diseases occurred in 1887. Locality. KENSINGTON TOWN REGISTRATION SUB.DISTRICT. Small Pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Fever. Diarrhoea. Total. Locality. Small Pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Fever. Diarrhoea. Total. Typhus. Enteric. | Simple Continued. Typhus. Enteric. Simple Continued. Abingdon Road ... ... ... 1 ... ... ... ... ... 1 Lockton Street ... 1 ... ... ... ... ... ... 1 2 Absalom Road ... ... ... 1 ... ... ... ... 1 2 Lonsdale Road ... 2 1 ... ... ... ... ... 1 4 Acklam Road. ... ... 1 ... ... ... ... ... 3 4 Maxilla Gardens ... ... 2 ... ... ... ... ... ... 2 Admiral Place and Terrace .... 2 ... ... ... ... ... ... 1 3 Munro Mews ... ... ... ... 2 ... ... ... ... 2 Archer Street ... ... 1 ... ... ... ... ... ... 1 Norfolk Terrace ... 1 ... ... ... ... ... ... 1 2 Bangor Street ... ... ... 1 2 ... 1 ... ... 4 Peel Street ... ... 1 ... 4 ... ... ... 1 6 Bevington Road ... ... ... ... 1 ... ... ... 1 2 Portobello Road ... 4 1 ... 1 ... ... ... 5 11 Blagrove Road ... ... ... ... 1 ... ... ... 1 2 Portland Road ... 2 ... 2 2 ... ... ... 3 9 Blechynden Street ... ... ... ... ... ... ... ... 3 3 Prince's Place ... 1 ... ... 3 ... ... ... ... 4 Blenheim Crescent ... ... ... 1 ... ... ... ... ... 1 Queen's Gate Mews ... 3 ... ... ... ... ... ... ... 3 Bolton Mews ... ... 3 ... ... ... ... ... ... 3 Rackham Street ... 1 ... ... 2 ... ... ... 2 5 Bolton Road. ... ... 2 ... ... ... ... ... ... 2 Rendle Street ... 2 1 ... ... ... ... ... ... 3 Bramley Road ... 2 1 ... 1 ... ... ... 3 7 St. Alban's Road ... 1 1 2 .. ... ... ... ... 4 Branstone Street ... 1 ... ... 1 ... ... ... 1 3 St. Ann's Road ... 1 ... 1 2 ... ... ... 2 6 Campden Street ... ... ... 3 ... ... ... ... ... 3 St. Clement's Road ... 1 ... ... 2 ... ... ... 3 6 Clarendon Road ... ... ... ... 2 ... ... ... ... 2 St. Ervan's Road ... ... 1 ... 1 ... ... ... ... 2 Colville Terrace ... ... ... 1 ... ... ... ... ... 1 St. Katherine's Road 1 2 ... 2 ... ... ... 1 6 Convent Gardens ... ... ... 1 1 ... ... ... l 3 St. Mark's Road ... ... 1 ... ... ... ... ... ... 1 Cornwall Road ... ... ... ... ... ... ... ... 3 3 Southam Street ... 1 1 1 2 ... ... ... 4 13 Crescent Street ... 2 ... ... ... ... ... ... ... 2 South Bank Terrace ... ... ... 1 ... ... ... ... ... 1 Dartmoor Street ... 1 ... 1 1 ... ... ... ... 3 Stratford Road ... 1 ... 1 ... ... ... ... ... 2 ??? 1 1 ■* " ... Convent Gardens ... ... ... 1 1 ... ... ... 1 3 St. Mark's Road ... ... 1 ... ... ... ... ... ... 1 Cornwall Road ... ... ... ... ... ... ... ... 3 3 Southam Street ... 1 4 1 2 ... ... ... 4 12 Crescent Street ... 2 ... ... ... ... ... ... ... 2 South Bank Terrace ... ... ... 1 ... ... ... ... ... 1 Dartmoor Street ... 1 ... 1 1 ... ... ... ... 3 Stratford Road ... 1 ... 1 ... ... ... ... ... 2 Edenham Mews ... ... 1 ... ... ... ... ... ... 1 Swinbrook Road ... 1 ... ... 3 ... ... ... 5 9 Edenham Street ... 2 1 ... ... ... ... ... 2 5 Talbot Grove ... 3 ... ... ... ... ... ... 3 7 Ernest Street ... ... ... l 1 ... ... ... ... 2 Tavistock Road ... 1 ... ... ... ... ... ... 1 2 Golborne Road ... 1 ... ... ... ... ... ... 1 2 Telford Road ... 2 ... ... ... ... ... ... ... 2 Golborne Gardens ... 1 1 ... ... ... ... ... 3 5 Testerton Street ... 1 ... ... 2 ... ... ... 1 4 Hazlewood Grescen ... 1 1 ... ... ... ... ... ... 2 Tobin Street, Sec. ... 3 1 2 2 ... ... ... 4 12 Hewer Street ... ... ... 1 ... ... ... ... ... 1 Trafalgar Place ... ... ... 1 ... ... ... ... ... 1 Highlever Road ... ... 1 ... ... ... ... ... 1 1 Treverton Street ... 2 ... ... ... ... ... ... 2 4 Holland Road ... ... ... ... ... ... ... ... 2 2 Uxbridge Street ... ... ... ... 2 ... ... ... 2 4 Infirmary ... 3 1 ... ... ... ... ... ... 4 Virginia Place ... 2 ... ... ... ... ... ... ... 2 Jameson Street ... 1 ... 1 ... ... ... ... ... 2 Walmer Road ... 2 1 2 8 ... ... ... 4 17 Keuilworth Street ... ... ... ... 2 ... ... ... ... 2 Warwick Gardens ... ... ... 1 ... ... ... ... ... 1 Kensington High St. & Road ... ... ... ... 1 ... ... 1 ... ... 2 Warwick Road ... 2 ... ... ... ... ... ... ... 2 „ Park Road ... ... 1 ... ... ... ... ... ... 2 Wellington Mews ... 1 ... ... 2 ... ... ... ... 3 „ Place ... ... ... ... ... ... ... ... 1 2 Western Dwellings ... ... ... 1 ... ... ... ... ... 1 ,, Square ... ... ... ... ... ... 1 1 ... 2 Wheatstone Road ... 2 ... ... 2 ... ... ... 2 6 Ladbroke Grove Road ... 3 1 ... ... ... ... ... ... 4 William Street, Notting Dale ... 1 1 ... ... ... ... ... 2 4 Lancaster Road ... 1 2 1 2 ... ... ... 1 7 Wornington Road ... 1 2 ... 3 ... ... ... 2 11 BROMPTON SUB-DISTRICT. Bolton Gardens 1 ... ... ... ... ... 1 ... ... 2 Ifield Road ... 4 ... ... ... ... 1 ... ... 5 Boltons ... ... ... ... ... ... 1 ... 2 3 Kempsford Gardens ... ... 1 ... ... ... ... ... ... 1 Bramham Gardens ... ... ... ... ... ... 1 ... ... 1 Onslow Gardens ... ... ... ... ... ... 1 ... ... 1 Brompton Road ... ... 1 1 ... ... ... ... 2 4 Redcliffe Square ... 2 ... ... ... ... ... ... ... 2 Cathcart Road ... 1 ... ... ... ... ... ... 1 2 Richmond Road ... ... ... ... 1 ... 1 ... ... 2 Cromwell Road ... ... 1 ... ... ... ... ... 1 2 Seymour Place ... ... ... ... ... ... 1 ... ... 1 Earl's Court Road ... ... ... 1 ... ... ... ... ... 1 Stanhope Mews ... 2 ... ... ... ... ... ... ... 2 Fulham Road ... ... ... 1 1 ... 1 ... ... 3 Stratford Road ... ... ... 1 ... ... ... ... ... 1 Hans Road ... ... ... 1 ... ... ... ... ... 1 Warwick Road ... 1 ... ... ... ... 1 ... ... 2 Harrington Road ... ... 1 ... ... ... ... ... ... 1 Yeoman's Row ... 1 ... ... ... ... ... ... 1 2 275 TABLE X. Return respecting the Vaccination of Children whose Births were Registered in 1886.* DATE. Registration Sub-Districts comprised in Vaccination Officer's District. Number of Births returned in Birth List Sheets. Number of these Births duly entered in Columns 10,11 and 13 of the Vaccination Register (Birth List Sheets), viz.: Number of these Births which are entered in the Vaccination Register, on account (as shewn by Report Book), of Column 10 Successfully vaccinated. Column 11. Column 13, Dead, Unvaccinated. 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. 1886. 1 2 3 4 5 6 8 9 10 1st January to 30th June Kensington Town 1696 1454 3 ... 148 10 2 76 3 Brompton 426 379 2 ... 24 2 1 17 1 1st July to 31st Dec. Kensington Town 1684 1399 2 ... 181 17 3 80 2 Brompton 347 275 2 ... 41 2 1 24 2 Total 4153 3507 9 ... 394 31 7 197 8 * The Return for 1887 is not yet complete. 276 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 ,, Sansom Lonsdale Mews ,, Grove 10, Princes Yard „ Coles Clarendon Mews ,. Colley 41, Princes Place ,, Grant 23, Norfolk Terrace ,, Cornes 61, Silchester Road ,, Crawforth 235, Walmer Road „ Van 4, Royal Crescent Mews ,, Brooker 8, Ditto ditto. ,, Down 277 TABLE XII. LICENSED COWSHEDS. SOUTH OF UXBRIDGE ROAD. LOCALITY. LICENSEE. 5, St. Mark's Road, Fulham Rd. Mr. Cotehing Newland Terrace (rear of) „ Tisdall Addison Cottage, Lome Gardens „ Glenie Campden Street (Yard in) „ Lunn Redfield Lane, Earl's Court. „ Cross NORTH OF UXBRIDGE ROAD. 5, Ledbury Mews Mr. Liddiard 187, Walmer Road ,, Arnsby 235, Walmer Road „ Van 27, Tobin Street ,, Copperwheat 47, Tobin Street ,, Burton 23, Bramley Road ,, Tame 41, St Mark's Road ,, Humfrey Portobello Road (rear of 209) . Aylesbury Dairy Company