LEN 116 THE ANNUAL REPORT on the HEALTH, SANITARY CONDITION, &c., &c., , op the Parish of St. Marn Abbott's, KENSINGTON, FOR THE YEAR, 1889, by T.ORME DUDFIELD, M.D., medical officer of health. PRINTED BY HUTCHINGS AND CROWSLEY, LIMITED, 123, FULHAM ROAD, SOUTH KENSINGTON, S.W. ; and henry street, st. john's wood, n.w. 1 8 9 0. THE ANNUAL REPORT on the HEALTH, SANITARY CONDITION, &c., &c., of the Parish of Si. Marn) |Abbott's, KENSINGTON, FOR THE YEAR 1889, by T. ORME DUDFIELD, M.D., Medical officer of health. PRINTED BY HUTOHINGS AND CROWSLEY, LIMITED, 123, FULHAM ROAD, SOUTH KENSINGTON, S.W. ; and henry street, st. john's wood, n.w. 1 8 9 0. TABLE OF CONTENTS. PAGE Prefatory Remarks on Death-rate—Parochial; Metropolitan ; Urban; and National 1 Registration District Kensington 5 „ Sub-Districts: "Kensington Town,"andBrompton 5 Wards, Division of Parish into 6 Kensington, Population and Rateable value of ; 1801-1889 7 Vital Statistics, 1889, Summary of 7 Zymotic Diseases, General Remarks on the " Seven Principal " 12 „ „ Number of deaths from the „ „ in 1889 14 „ ,, Death-rate from ; in Kensington ; in London and other large Towns, and in England and Wales 15 „ „ Monthly Return of Deaths from, in Kensington ... 16 Small-Pox, Low rate of Mortality from, in London, of late years : only one fatal case (" Doubtful ") in 1889 16 Measles 16 Whooping-cough 17 Scarlet fever 18 „ „ In London 19 „ „ Increased use of the Hospitals for Isolation of Cases of 20 ,, „ Cases of, recorded in Kensington, in 1879-88 and in 1889 21 „ „ Alleged Dissemination of, by the Milk of Diseased Cows 23 Diphtheria 26 „ Epidemic of 26 „ In London 29 „ Hospital Accommodation provided for 30 Fever 31 DIarrhŒa 32 Metropolitan Asylums Board, The Work and Proceedings of the 33 „ ., ,, The Annual Report of the Chairman 33 „ , „ The Annual Report of the Statistical Committee 37 iv. ambulance Service, Metropolitan, Established by the Asylums Board, under the Provisions of the Poor Law Act, 1889 41 „ „ Stations 42 „ „ Wharves 43 „ „ River Service 43 „ „ Annual Report of the Ambulance Committee 43 Small-Pox, Hospital Accommodation for 46 „ „ „ The Gore Farm Hospital for valescents, completed 46 „ „ „ The Hospital Ships 47 Fever, Hospital Accommodation for 48 Western District Fever Hospital (Fulham); Alleged to be inadequate for the needs of the West District: Proposal to enlarge 49 „ „ Annual Report of the Medical Superintendent 51 Non-Pauper Infectious Sick : The question of Payment for, in Hospitals 53 „ „ Expenditure for maintenance of, sanctioned by the Local Government Board 54 Hospitals, Medical Instruction at, to be provided for Students, etc. 54 „ Table shewing Quarterly and Total Admissions of Patients at; from each Parish and Union, in 1889; and Population of the several Districts in 1881 56 Public Health Legislation in 1889 58 Infectious Disease (Notification) Act, 1889, Provisions of 58 „ „ Successful working of the 59 „ „ Medical Certificate form defective 60 „ „ Asylums Board furnish Medical Officers of Health with Weekly Return of Cases notified under the 61 „ „ Defect in the Act requiring remedy 62 „ „ Cases Notified in the several Parishes and Districts between October 28th, 1889, and May 3rd, 1890 (Table) 63 „ „ Compulsory Removal of Non - Isolated Cases to Hospitals, Better Provision for : A Desideratum 64 THE Poor Law Act, 1889, Provisions of 64 „ „ Enables Asylums Board legally to admit Non- Paupers to their Hospitals 64 „ „ Practically makes the Hospitals Free, ving charges upon Common Poor Fund 65 „ „ Enables Asylums Board to admit to their Hospitals Paupers suffering from Diphtheria 65 V. The Poob Law Act, 1889 (oontiimed) „ „ Authorises the use of the Hospitals for Medical Instruction 65 „ „ Makes Provision for Acquisition of Land for Extension of Hospital Sites 65 „ „ Practically establishes a Metropolitan bulance Service under the Management of the Asylums Board 65 Metropolitan Ambulance Sebvice 66 „ „ Regulations made by the Managers with gard to the use of their Carriages 66 „ „ Public Vehicles, Use of for Conveyance of Infectious Cases should be prohibited by Law, being wholly unnecessary 67 Public Health Legislation,- The Progress of 67 Royal Commission on Infectious Disease Hospitals (1882). Resume of its recommendations, and the extent to which they have been carried out, by Law or in Practice 69 Retrospect, 1856-1889, The Fruits of Sanitation 69 Population of Sub-Districts, Number of Inhabited Houses, &c. 72 „ Relative Numbers of Males and Females; at different ages ; in Parish, and in Sub-Districts, in 1881 (Tables) 72 „ Inhabited Houses and Rateable Value, Increase of since 1856, and since 1871 74 Marriages and Marriage Rate 75 Births and Birth Rate . 75 Deaths and Death Rate 76 Infantile Mortality 77 „ „ Among Illegitimate Children 77 Senile Mortality 78 Death Rate at Different Age-Periods (Table) 78 „ Mean Temperature, etc., Monthly 79 Death, Summary Causes of (Table) 80 Death, Assigned Causes of 81 „ „ Specific Febrile or Zymotic Diseases 81 ., „ „ Venereal Diseases 81 „ „ ,. Puerperal Fever 82 „ Parasitic Diseases 82 „ Dietetic Diseases 83 „ „ „ Alcoholism 83 „ Constitutional Diseases 83 „ „ Cancer 84 „ ., „ Tubercular 85 ., Developmental Diseases 86 vi. Death. Assigned Causes of (continued) „ Local Diseases 87 „ „ Nervous System, Diseases of 87 „ „ Circulatory System. „ 88 „ „ Respiratory „ „ 88 ,. „ Digestive „ „ 89 „ „ Urinary „ „ 89 „ „ Reproductive „ ,. 90 „ Violent Deaths 90 „ Ill-defined and Not Specified Causes of 90 Public Institutions, Deaths in 91 „ „ Parish Infirmary and Workhouse. 91 „ „ Outlying Hospitals, &c 92 „ „ St. Joseph's House 93 „ „ Consumption Hospital, Bromptou 9+ „ „ Marylebone Infirmary, Nott-ing Hill 94 Deaths, " Not Certified," in Kensington 94 ., „ The subject of, considered generally 95 „ ,, The position and duties of Coroners and their Officers in relation to 95 Inquests 97 „ Deaths from Violence : Accidental 99 „ „ „ Suicidal 99 „ „ „ Homicidal 100 ,, Why so many become necessary 100 Meteorology 101 Vaccination 101 „ Officer's Return for 1888 101 „ Royal Commission on, appointed 102 „ Animal; Calf Lymph 102 Sanitary Legislation 104 Sanitary, Nuisances Removal, and other cognate Acts, Report on, by the Law and Parliamentary Committee 101 Bye-Laws for Sanitary Administration Purposes, The need of 105 „ Action of the London County Council, with reference to 106 Unity in Sanitary Administration ; A Desideratum 108 Sanitary Administration : The views of the President of the Local Government Board in respect of the Labouring Classes Lodging Houses Acts ; the Artizans Dwellings Acts ; and the Artizans and Labourers Dwellings Improvement Acts 110 vii. Housing of the Working Classes: The Proceedings of the County Council with reference to 113 „ „ Report of the Housing of the Working Classes Committee with reference to 114 „ „ Municipal Common Lodging-House to be built 115 ,. ,. Lord Shaftesbury's Acts 117 ,, „ Emigration, regarded as a means for reducing Overcrowding: A Government Enquiry 118 „ „ Circular letter to the Sanitary Authorities from the President of the Local Government Board 119 „ Report by the Medical Officer of Health on the subjects dealt with in the President's letter; especially treating of Defects of the Law involving delay in proceedings to abate Nuisances and Overcrowding 122 „ „ Bills to Consolidate and Amend the Acts relating to, introduced by the President of the Local Government Board, and favourably received by the House 134 Offensive Businesses 138 „ „ Fat Extractor 138 „ „ Marine Stores 138 Refuse Mattebs, Production of 139 Offensive Substances, Conveyance of, through Streets 140 Brick Burning : Nuisance arising from 141 „ „ Judicial Decisions with reference to 141 „ Legislation required for dealing with 142 „ ., Numerous complaints received with reference to ; Action of the Vestry 143 „ „ Subject of, referred to in Parliament 144 „ „ Views of the Home Secretary 145 „ „ Proposed Legislation for dealing with 145 ,, „ Case decided in a Police Court 145 ,. ,, Judicial Decision in the "Bedford Park Case:'' Injunction granted 147 Rabies and Hydrophobia: Contagious Diseases (Animals) Act: Rabies Order, Dog Muzzling, &c. 148 Nuisances Removal Acts: Committee appointed by the Vestry for carrying out the provisions of the 151 Sanitary Inspectors, The Work of the 152 viii. Slaughter-Houses (Metropolis) Act, 1874 : A Retrospect 153 „ „ Licensed 154 Horse-Flesh, Sale of, Regulation Act, 1889 155 Cowsheds, Dairies, etc.: Contagious Diseases (Animals) Act; Dairies Order: A Retrospect 157 „ Licensed 158 Bakehouse Legislation : A Retrospect 158 Kefuse Matters, Nuisance arising from Removal of 160 House Refuse; The Work of " Dust" Collection and Removal 160 ,. Metropolitan Board (the late), requested to promote Legislation to abolish Dust Bins, made enquiry, but took no other action 161 „ Daily Collection of, from Moveable Receptacles: A Desideratum 162 „ „ Difficulty and Expense of finding "Shoots" for, always on the increase 162 „ „ Vestry possesses Land at Purfleet, in Essex, on the River Thames, available for a Dust, Dung, and Slop Dep6t: Landing Pier constructed 163 Trade Refuse : The Law on the subject of Removal of 163 Stable Refuse : Nuisance from Non-Removal of, largely dependent on the use of improper receptacles 164 „ „ Use of Sunken Dung Pits, condemned 165 „ „ Suggestion that the Vestry should undertake tion and Removal of, at the cost of the Producers, having now a Depot at Purfleet 16 Disinfection in 1889-90 167 Necessary Accommodation : Public, and Public House Urinals 167 Public Baths and Washhouses Opened : Washhouses apart from Baths: A Desideratum 168 Mortuary, Public : Observations with reference to the 169 „ „ Particulars with reference to Bodies admitted to 170 „ „ Views of the Hospitals Commission with respect to 171 Coroner's Court, provided by the Vestry at the Town Hall ... 171 Brompton Cemetery : Movement to close 172 Houses Let in Lodgings, Regulations for: under Sanitary Act, 1866 173 „ „ Vestry's Instructions for the guidance of the Sanitary Inspectors when Inspecting 176 Report of the Royal Commission on the Housing of the Working Classes 177 Unhealthy Houses: The Liabilities of Landlords : Legal decision 177 ix. Underground RoomS: Provisions of the Act with reference to 178 „ „ New Departure with regard to, by the London County Council 180 „ „ In Kensington : Action of the Vestry 182 Metropolitan Sewage Question 183 „ The (late) Metropolitan Board of Works' decision 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 ... 183 „ ,, Sir Henry Roscoe, retained as Scientific Adviser by the Board, reports on the Deodorization of the Sewage at the Outfalls, and in the Sewers 184 „ „ The Vestry's views as to the inutility of Deodorization, as practised 185 „ „ Sir H. Roscoe sums up the whole question, unofficially, in 1889, and condemns the proceedings of the late Board 186 „ „ The cost of Deodorization 188 „ „ The proper place for the Sewage is the Land : Meanwhile, Three Systems of Treatment have been proposed : (1) The Amines Process 189 (2) The International Purification Process 189 (3) The Webster Electrical Process 190 Water Supply : The Regulations 192 „ Cutting-off Powers of the Companies, etc. 193 „ Underground Tanks : The Dangers of 194 „ Professor Frankland's Report, Abstract of 194 „ The Water Examiner's „ „ 196 „ By the Local Companies ... ... 197 Frankland's (Dr. Percy), Biological Experiments 200 „ Constant Supply, Progress of, 201 ,. The Vestry apply for Constant Supply for a district in North-east Kensington : It is refused. 203 Gas, Results of Examination, for ascertaining the Illuminating Power and Purity of 204 „ Proposal to acquire power to test Gas with portable Photometer 204 „ Proposed New Standard for ascertaining the Illuminating Power of 205 Conclusion 207 APPENDIX. STATISTICAL AND OTHER TABLES. page Table 1. Estimated Population, in 1889, and Ten previous years, 1879—88 ; Number of Inhabited Houses, and of Marriages, Births, Deaths, &c 209 II. Birth Rate and Death Rate; Death Rates of Children ; Deaths in Public Institutions, in 1889 and in 1879-88 210 III. Deaths Registered from all Causes in 1889 211 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 213 V. Deaths in 1889 and in 1879-88 from the Seven Principal Zymotic Diseases: in the Parish ; in the Metropolis : and in England and Wales 214 VI. Summary of Inspectors' Reports of Sanitary Work completed in the year 1889-90 215 VIVr. Summary of Monthly Returns of Work done by the Sanitary Inspectors in the year 1889-90 21(1 „ VII. Death Rates, General and Zymotic, in Kensington and London: and Proportion of Deaths from Zymotic Diseases to Total Deaths, in 1889 and 10 previous years 217 ,, VIII. Comparative Analysis of the Mortality in London and Kensington in 1889; Percentage of Deaths under one year to Births registered ; and percentages of Deaths under one year, and at fiO and upwards, from the Principal Zymotic. Diseases, and from Violence; of Inquest cases, and of Deaths at Public Institutions, to Total Deaths 218 IX. Localities where fatal cases of the more important of the Zymotic Diseases occurred in 1889 219 „ X. Vaccination Officer's Annual Return (1888) 221 XI. Slaughter-houses, Licensed : and names of Licencees 222 „ XII. Cowsheds „ „ „ „ „ 223 THIRTY-FOURTH ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH, BEING FOR THE YEAR 1889. 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 28th, 1889; the sanitary statistics being for the statutory year ended March 25th, 1890. The vital statistics are calculated upon an estimated population of 178,000, 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 2412, being 418 below the number in 1888, and 525 below the decennial average corrected for increase of population. The death-rate, 13.5 per 1000, the lowest on record, was 2.4 below the rate in 1888, and 2'9 below the decennial average (16.4). It was 8.9 below the rate in London, as a whole (17.4), and 4'4 below the rate in England and Wales (17.9). The death rate in London shews a decrease of l.l upon that of 1888 (18.5), and is the lowest on record. The rate in p 2 England and Wales (17.9) shews an increase of 0.l per 1000 compared with that of 1888 (17.8), which was the lowest recorded in any year since civil registration began, in 1837. The subjoined table shews the annual death-rate per 1000 persons living, in each of the last eleven years, in Kensington, in London as a whole, and in all England :— 1889. 1888. 1887. 1886. 1885. 1884. 1883. 1882. 1881. 1880. 1879. Kensington 13.5 15.9 16.4 15.9 16.1 15.1 15.5 16.2 16.6 17.8 18.8 London 17.4 18.5 19.6 19.9 19.8 20.4 20.5 21.3 21.3 21.7 22.6 W. Districts 17.0 18.3 19.0 19.0 19.2 19.2 19.5 19.8 19.6 19.8 20.9 North „ 15.7 16.6 17.8 18.0 18.5 19.0 19.0 19.6 20.6 20.8 21.5 Central „ 24.1 25.7 26.1 25.4 24.4 24.9 24.1 24.4 23.5 23.8 26.3 Bast „ 20.2 21.8 22.5 23.2 22.5 22.9 24.1 25.2 24.2 24.3 25.5 South „ 16.6 17.2 18.6 19.1 18.5 19.7 19.5 20.6 20.5 21.3 21.8 England and Wales 17.9 17.8 18.8 19.3 19.0 19.5 19.5 19.6 18.9 20.5 20.7 The Registrar-General, in his "Annual Summary of Births, Deaths, and Causes of Death in London," speaks of 1889 as " a year of excessively low rates." The marriages, he states, give a proportion of 16'3 persons married to 1000 of the population, being a slight recovery from the rate in 1888 (16'1), the lowest on record. The birth-rate, 30'3, is the lowest as yet recorded in London, the rate having fallen continuously year after year since 1876. Nevertheless, in 1889, the excess of births over deaths, or the natural increment, was 55,804, though it had averaged only 51,772 in the four immediately preceding years; so that the decline in the birth-rate was more than compensated by the still greater decline of mortality. The death-rate (17.4) is by far the lowest as yet recorded in London ; moreover, the four next lowest rates are those in the four immediately preceding years 1885-6-7-8, when the figures were respectively 19.8, 19'9, 19'6, and 18.5. 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 1889, to the effect that the " marked decline in the death-rates of recent years," for the decline lias been continuous since 1882 (when it was 21.4), "has been doubtlessly in some part due to the decline in the birth-rate, which must have 3 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 Registrar-General, as usual, has prepared a table shewing diminution or excess of deaths in 1889, compared with annual deaths in 1879-88, corrected for increase of population, from which we learn that there was a marked diminution in the number of deaths from small-pox (712), measles (278), scarlet fever (1103), whooping-cough (1406), "fever" (405), and diarrhoeal diseases (625). There was a diminution also in deaths, among other causes, from phthisis and tubercular diseases (1920), diseases of nervous system (1370), diseases of respiratory system, including croup (4376), and " all other causes " (2525); the total diminution being 14,720. On the other hand, there was an excess under several heads—viz., diphtheria (656), cancer (222), premature birth (108), diseases of circulatory system (510). The excess (1496) being deducted from the diminution, a balance of diminution and excess shews a net diminution of 13,224. In other words, there was a net gain in the year of 13,22 A lives : "that is to say, had the death-rate been equal to the average rate in the ten preceding years, 13,224 more persons would have died in London in the year 1889 than was actually the case." This saving of life was very unequally distributed among the several causes, and there are four headings under which, as we have seen, the mortality was in excess, viz., diphtheria, cancer, premature birth and diseases of the circulatory organs. These headings have shewn similar excess in each of the preceding six years. Similarly with regard to the diseases which shew diminished mortalities: here, also most of the changes are not peculiar to B 2 4 the year 1889, but are parts of a change that has been going on for a considerable time; for there was also a diminution in each of the five preceding years in respect of scarlet fever, typhus, simple and ill-defined fever, enteric fever, diseases of the nervous system, diseases of the respiratory system, and the aggregate of "other causes." "This persistency of decrease," the RegistrarGeneral stated, in his Summary for 1888, " affords good grounds for believing 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 14.6 per 1000, against 16.5, 15.9, and 15.0 in the three preceding years. The death-rate in "Greater London," which is co-extensive with the Metropolitan and City Police Districts, was 16.8 per 1000, against 19.3, 18.9, and 17.8 in the three preceding years. The death-rate in twenty-seven Cities and Boroughs, having an aggregate population exceeding five millions, was 193 ; ranging from 15.1 in Brighton, 16'4 in Derby, and 16.9 in Leicester, to 25.5 in Blackburn, 26.7 in Manchester, and 80.0 in Preston, 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 shews a death-rate of 15.5, Derby 17.0, Blackburn 27.7, Manchester 29.7, and Preston 32'6. In twenty-two of the largest foreign European cities, having an estimated population of more than eleven millions of persons, the mean rate of mortality was 25.4 per 1000, and exceeded by 6.1 the mean rate in the twenty-eight largest English towns, including London, having an aggregate population exceeding nine millions. The lowest rates were 19.4 in Brussels and the Hague, 20.0 in Stockholm, and 20.1 in Ckristiania, ranging upwards to 28'4 in St. Petersburg, 29'3 in Breslau, 29.5 in Buda- 5 Pesth, 30.0 in Venice, 31.0 in Munich, and 39.6 in Moscow. The rate in Paris was 23.5, in Berlin 23.0, and in Vienna 24.4; the mortality in Paris and Berlin shewing an increase upon 1888, while the death-rate in Vienna declined. 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. " 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 Parish of Kensington has been constituted a separate Registration District, and is numbered 1b. It contains 2190 acres according to the Registrar-General; but in your Vestry's Annual Report the area is given as 2245 acres. In 1871 the enumerated houses were 15,735; in 1881, 20,103; increase, 4-368. In 1871 the population was 120,299 ; in 1881, 163,151 ; increase, 42,852. At the middle of 1889 the inhabited houses were some 21,700, and the estimated population 178,000. 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 1497 acres, the area of Brompton being 693 acres. The population of the Town sub-district at the middle of 1889 was about 130,000, and that of Brompton 48,000. The Town sub-distriet 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 4 the year 1889, but are parts of a change that has been going on for a considerable time; for there was also a diminution in each of the five preceding years in respect of scarlet fever, typhus, simple and ill-defined fever, enteric fever, diseases of the nervous system, diseases of the respiratory system, and the aggregate of "other causes." "This persistency of decrease," the RegistrarGeneral stated, in his Summary for 1888, " affords good grounds for believing 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 14.6 per 1000, against 16.5, 15.9, and 15.0 in the three preceding years. The death-rate in "Greater London," which is co-extensive with the Metropolitan and City Police Districts, was 16.8 per 1000, against 19.3, 18.9, and 17.8 in the three preceding years. The death-rate in twenty-seven Cities and Boroughs, having an aggregate population exceeding five millions, was 19'3 ; ranging from 15.1 in Brighton, 16.4 in Derby, and 16.9 in Leicester, to 25.5 in Blackburn, 26.7 in Manchester, and 30.0 in Preston, 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 shews a death-rate of 15.5, Derby 17.0, Blackburn 27.7, Manchester 29.7, and Preston 32.6. In twenty-two of the largest foreign European cities, having an estimated population of more than eleven millions of persons, the mean rate of mortality was 25.4 per 1000, and exceeded by 6.1 the mean rate in the twenty-eight largest English towns, including London, having an aggregate population exceeding nine millions. The lowest rates were 19.4 in Brussels and the Hague, 20.0 in Stockholm, and 20.1 in Christiania, ranging upwards to 28'4 in St. Petersburg, 29'3 in Breslau, 29.5 in 5 Pesth, 30.0 in Venice, 31.0 in Munich, and 39.6 in Moscow. The rate in Paris was 23.5, in Berlin 23.0, and in Vienna 24.4; the mortality in Paris and Berlin shewing an increase upon 1888, while the death-rate in Vienna declined. Haying 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. "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 Parish of Kensington has been constituted a separate Registration District, and is numbered 1b. It contains 2190 acres according to the Registrar-General; but in your Vestry's Annual Report the area is given as 2245 acres. In 1871 the enumerated houses were 15,735; in 1881, 20,103; increase, 4368. In 1871 the population was 120,299 ; in 1881, 163,151; increase, 42,852. At the middle of 1889 the inhabited houses were some 21,700, and the estimated population 178,000. 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 1497 acres, the area of Brompton being 693 acres. The population of the Town sub-district at the middle of 1889 was about 130,000, and that of Brompton 48,000. The Town sub-distriet 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 6 Brompton Cemetery, Government property, is in this subdistrict; the Kensal Green Cemetery, private ownership, is in the Town sub-district. 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 class. The poor in Kensington, however, are better off in one respect than the poor in some other parts of the Metropolis, in that, for the most part, they live in houses fairly well-built and obviously intended for occupation by the lower middle class : miles of streets of such houses 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 shews 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 houses. Increase in 10 years. Population. Idcrease in 10 years. 1871. lfSl. 1871. 1881. St. Ma'-y 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, Norland, £365,012. Total, whole Parish, £935,720. In 1881 the returns for the first and second wards, which cannot now be given separately, shew 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). 7 The subjoined figures illustrate 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 14,42S 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 1889 (July) 178,000 1,902,163 1889 SUMMARY OF VITAL STATISTICS, ETC. The year 1889 was characterised by the lowest death-rate on record, 13.5 per 1000, being 29 below the decennial averageIt was further characterised by a high rate of mortality from diphtheria. This disease, the cause of 111 deaths as against 89 in 1888, and a corrected decennial average of 32, was more prevalent and fatal than in any previous year. "With this single exception, the mortality from each of the principal diseases of the zymotic class was low. In all but one of my thirteen four-weekly reports, I had to chronicle a death-rate below the average, the deficiency ranging from 0'8 per 1000 in the 4 weeks November 30th— December 28th, to 5.9 in the four weeks February 24th—March 23rd. The lowest rate (11.7) was recorded in the four weeks ended November 30th, the highest (16'0) in the following four weeks ended December 28th. In the four weeks September 8th— October 5th, the rate (13.9) was 1.3 above the average. There was no death from small-pox or typhus fever during the year, and the total deaths from the principal diseases of the zymotic class were 269 only, or 114 below the corrected average number: the rate per 1000 persons living being 1.5, so low a rate having been recorded in one previous year only (1883). The mean temperature of the air (48'8°) was 0.2 above the average of 115 years,, but 0.5 below the average of 48 years. The death-rate in the first four weeks of the year ended January 26th, was 15.3 per 1000 of the population, being 4.8 below the decennial average; it was also 6.4 below the rate in the 8 Metropolis as a whole (21.7), this moreover being 2.0 below the decennial average. The deaths from the principal diseases of the zymotic class were 22, and 5 below the decennial average. Diphtheria was the cause of 10 deaths, and measles of 6 deaths (the highest monthly total during the year), scarlet fever and enteric fever of 1 death each. The deaths of children under five years of age were 66, including 39 under one year; those of persons aged sixty and upwards being 77. The diseases of the respiratory system of organs were accountable for 57 deaths, including 43 from bronchitis and 5 from pneumonia. The mean temperature of the air during the four weeks was 35.8° Falir.— the lowest recorded in any four-weekly period during the year, and 0.8 below the means in the corresponding weeks in tie previous ten years. In the second four-weekly period of the year (5th—8th weeks, January 27th to February 23rd) the death-rate fell to 15.1 per 1000, and was 3.4 below the average : it was also 3.2 below the Metropolitan rate (18'3), this being 5.2 below the average. The deaths from the principal zymotic diseases were 18, and 6 below the average. Diphtheria was the cause of 14 deaths, and enteric fever of 1 death. The deaths of children under five, rose (from 66) to 75, including 50 under one year, but tbose of persons aged sixty and upwards fell (from 77) to 57. Forty-eight deaths were caused by diseases of the respiratory organs, including bronchitis 29, and pneumonia 11. The mean temperature was 386° being 1.3 below the average. In the third four-weekly period (9th—12th weeks, February 24th to March 23rd), the death-rate further fell to 13.1, and was 5.9 below the average : it was also 5.8 below the Metropolitan rate (18'9), which, moreover, was 4'1 below the average. The deaths from the principal zymotic diseases were 10, and 15 below the average, including 5 from diphtheria and 3 from diarrhoea. The deaths of children under five fell (from 75) to 49, including 34 under one year, while those of persons aged sixty and upwards rose (from 57) to 60. The deaths from diseases of the respiratory 9 organs were 37, including bronchitis 31, and pneumonia 2. The mean temperature was 37.9°, and 2.8 below the average. In the fourth period (13th—16th weeks, March 24th to April 20th), the death-rate rose to 13.5 per 1000, but was 4.6 below the average, it was also 4.4 below the Metropolitan rate (17.9), this being 4.1 below the average. The deaths from the principal zymotic diseases were 9 (the lowest total recorded in 1889), and 17 below the average ; diphtheria was the cause of 5 deaths, whooping-cough and enteric fever of 2 each. The deaths of children under five rose (from 49) to 56, including 27 under one year, but those of persons aged sixty and upwards fell (from 60) to 53. The deaths from diseases of the respiratory organs were 48, including bronchitis 30, and pneumonia 10. The mean temperature was 44.8°, the same as the average. In the fifth period (17th—20th weeks, April 21st to May 18tli) the death-rate further rose to 13'8 per 1000, but was 1.9 below the average : it was 2.3 below the Metropolitan rate (16.1), which was 3.6 below the average. The deaths from the principal zymotic diseases were 18, and 13 below the average, including diphtheria 10, whooping-cough 4, and scarlet fever 2. The deaths of children under five were again 56, including 38 under one year, but those of persons aged sixty and upwards rose (from 53) to 59. The deaths from diseases of the respiratory organs were 46, including 24 from bronchitis, and 14 from pneumonia. The mean temperature of the air was 52'5°, and 3'2 above the average. In the sixth period (21st—24th weeks, May 19th to June 15th), the death-rate fell again to 13.5 per 1000, and was 2.0 below the average: it was also 1.4 below the Metropolitan rate (14'9, the lowest recorded in 1889), this being 3.1 below the average. The deaths from the principal zymotic diseases were 20, and 7 below the average, including diphtheria 10, diarrhoea 5, enteric fever 2, and scarlet fever 1. The deaths of children under five rose (from 56) to 63, including 34 under one year, but those of 10 persons aged sixty and upwards fell (from 59) to 45. The deaths from diseases of the respiratory organs were 20, including bronchitis 12, and pneumonia 3. The mean temperature was 59.7°, and 3.1 above the average. In the seventh period (25th—28th weeks, June 16th to July 13th), the death-rate further fell to 12.6, and was 1.5 below the average: it was also 3'8 below the Metropolitan rate (16'4), this being 21 below the average. The deaths from the principal zymotic diseases were 28, and 7 below the average, including diarrhoea 16, diphtheria 6, scarlet fever 4, and enteric fever 1. The deaths of children under five were again 63, including 44 under one year, while those of persons aged sixty and upwards further fell (from 45) to 41. The deaths from diseases of the respiratory organs were 24, including bronchitis 14, and pneumonia 7. The mean temperature was 62.5" (the highest recorded in any four weeks in 1889j, and 1'3 above the average. In the eighth period (29th—32nd weeks, July 14th to August 10th), the death-rate rose to 13.0, but was 2.8 below the average: it was also 5'0 below the Metropolitan rate (18.0), this being 2.2 below the average. The deaths from the principal zymotic diseases were 40, and 10 below the average, including diarrhoea 23 (the highest total recorded in 1889), diphtheria 9, scarlet fever 6, and enteric fever 1. The deaths of children under five rose (from 63) to 82, including 53 under one year, whilst those of persons aged sixty and upwards fell (from 41) to 34. The deaths from diseases of the respiratory organs were 15 (the lowest total recorded in 1889), including bronchitis 8, and pneumonia 4. The mean temperature of the air was 60.5°, and 1.0 below the average. In the ninth period (33rd—36th weeks, August lltli to September 7th), the death-rate fell to 11.8, and was 1.8 below the average: it was also 3.3 below the Metropolitan rate (15.1), this being 2.5 below the average. The deaths from the principal zymotic diseases were 28, or 5 below the average, including 11 diphtheria 10, diarrhoea 8, scarlet fever 6, and enteric fever 1. The deaths of children under five fell (from 82) to 63, including 40 under one year; whilst those of persons aged sixty and upwards rose (from 34) to 39. The deaths from diseases of the respiratory organs were 19, including bronchitis 11, and pneumonia 3. The mean temperature of the air was 59.4°, and 0.5 below the average. In the tenth period (37th—40th weeks, September 8th to October 5th), the death-rate rose to 13.9, and for the only time in 1889 was above the average, viz: to the extent of 1.3. It was 1.8 below the Metropolitan rate (15.7), this being 1.5 below the average. The deaths from the principal diseases of the zymotic class were 23, and 2 above the average, including diphtheria 15, (the highest total recorded in 1889), enteric fever 2, and scarlet fever 1. The deaths of children under five years of age fell (from 63) to 62, including 33 under one year, whilst those of persons aged sixty and upwards further rose (from 39) to 63. The deaths from diseases of the respiratory organs were 24, including bronchitis 9, and pneumonia 11. The mean temperature was 53.4', and 1.3 below the average. In the eleventh period (41st—44th weeks, October 6th to November 2nd), the death-rate fell to 12.7, and was 2.4 below the average : it was also 3.3 below the Metropolitan rate (16.0), this being 3.6 below the average. The deaths from the principal zymotic diseases were 19, and 4 below the average, including diphtheria 8, and enteric fever 4. The deaths of children under five further fell (from 62) to 49, including 28 under one year, and those of persons aged sixty and upwards fell (from 63) to 58. The deaths from diseases of the respiratory organs were 35, including bronchitis 19, and pneumonia 9. The mean temperature was 48.3°, and 1.3 above the average. In the twelfth period (45th—48th weeks, November 3rd to 30th), the death-rate further fell to 11.7, the lowest rate recorded in 1889, and was 5.3 below the average: it was also 5.2 below the Metropolitan rate (16.9), this being 3.8 below the average. 12 The deaths from the principal zymotic diseases were 19, and 5 below the average, including scarlet fever 6, diphtheria 5, and enteric fever 2. The deaths of children under five rose (from 49) to 61, including 30 under one year, whilst those of persons aged sixty and upwards fell (from 58) to 34. The deaths from diseases of the respiratory organs were 36, including bronchitis 22, and pneumonia 8. The mean temperature was 44.1°, and 1.3 above the average. In the thirteenth and last four-weekly period (49th—52nd weeks, December 1st to 28th), the death-rate rose to 16.0 per 1000 (the highest rate recorded in 1889), but was 0.8 below the average: it was also 4.9 below the Metropolitan rate (20.9), this being 1.3 below the average. The deaths from the principal zymotic diseases were 15, and 10 below the average, including diphtheria 5, enteric fever 2, and scarlet fever 1. The deaths of children under five further rose (from 61) to 66, including 42 under one year, and those of persons aged sixty and upwards rose (from 34) to 87. The deaths from diseases of the respiratory organs were 61 (the highest total recorded in 1889), including bronchitis 45, and pneumonia 9. The mean temperature was 38.4°, and 0.5 below the average. 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 "Diarrhœal") 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." 13 These zymotic diseases have a special interest for sanitarians, arising out of the fact that, being admittedly of a more or less preventable character, the absence or the prevalence of certain of them is regarded as a test of the sanitary condition of a district. But, without under-rating 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, founded on our own local experiences within the last few years. Thus, Measles was very 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 year. 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 mortality in the Metropolis from Whooping-cough in 1881 was the lowest on record; it is not surprising to find, therefore, that in 1882 the disease was excessively fatal. In our own Parish the large total of 185 deaths from this disease in 1878 followed the minimum return of 34 in the previous year. Diarrhœa may be cited as an illustration of quite another kind. The mortality from this disease, amongst infants, was excessive in 1878; the mortality in 1879 was much below the average; but the diminished mortality in 1879 had no relation to the excessive mortality in 1878. The conditions were altogether different: the summer of 1879 was cold and wet, and, as always happens in these circumstances, the mortality from infantile diarrhoea was low—just as it is always high when the summer is hot and dry, as in 1878. 14 Again, the significance of a high rate of prevalence of Enteric Fever varies widely in different circumstances. This disease may be constantly present in one 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. It need hardly be said that a persistently high rate of mortality from zymotic diseases furnishes matter for serious consideration. Kensington 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 1889, together with the decennial average, etc.:— Disease. Sub-districts. In Hospital. Total. Decennial average. Town. Brompton. Town Brompton. Uncorrected. Corrected for increase of Population Small-pox ... ... ... ... ... 14.3 15.0 Measles 13 1 ... ... 14 74.9 79.3 Scarlet Fever 6 2 19 1 28 39.0 41.3 Diphtheria 62 3 44 2 111 30.3 32.1 Whooping-cough 19 7 ... ... 26 88.3 93.5 Typhus Fever ... ... ... ... ... 1.0 1.0 Enteric Fever 11 5 2 1 19 19.6 20.7 Simple Contd. Fever ... ... ... ... ... 3.5 3.7 Diarrhœa 63 6 2 ... 71 90.9 96.3 174 24 67 4 269 361.8 382.9 15 It appears, then, that the deaths from these diseases were 114 below the corrected decennial average. They were also 151 fewer than in 1888. As usual, the deaths in the Brompton subdistrict (28) were fewer in proportion to population than in the Town sub-district, and to a greater extent than in immediately preceding years. The total deaths were equal to 111 per 1000 deaths from all causes in Kensington (Metropolis, 128), and to a rate of 1.5 per 1000 persons living (Metropolis, 2.2); the decennial average being 2.1 in Kensington, and 3.0 in London. In England and Wales the deaths from these diseases were 118 in each 1000 deaths; and the rate was 2.l per 1000 persons living, the decennial average being 2.3 per 1000. In the 27 Cities and Boroughs grouped by the RegistrarGeneral with the Metropolis, the zymotic death-rate was 2.7 per 1000, ranging from 1.51 in Derby, 1.53 in Brighton, and 1.67 in Halifax, to 4.2 in Manchester, 4.13 in Bolton, 4.57 in Salford, 4.74 in Blackburn, 5.76 in Plymouth, and 7.70 in Preston. The following Table shews the distribution of deaths in Kensington from the principal diseases of the zymotic class, registered in thirteen four-weekly periods, corresponding with my monthly reports:— Report for Four Weeks ended Small-pox. Measles. Scarlet Fever. Diphtheria. Whooping-cough. Typhus Fever. Enteric Fever. Simple Continued Fever. Diarrhoea. Total. January 26 ... 6 1 10 1 ... 1 ... 3 22 February 28 ... 1 ... 14 ... ... 1 ... 2 18 March 23 ... 1 ... 5 1 ... ... ... 3 10 April 20 ... ... ... 4 2 ... 2 ... 1 9 May 18 ... 2 2 10 4 ... ... ... ... 18 June 15 ... ... 1 10 2 ... 2 ... 5 20 July 13 ... ... 4 6 1 ... 1 ... 16 28 August 10 ... ... 6 9 1 ... 1 ... 23 40 September 7 ... 1 6 10 2 ... 1 ... 8 28 October 5 ... ... 1 15 1 ... 2 ... 4 23 November 2 ... 3 ... 8 3 ... 4 ... 1 19 November 30 ... ... 6 5 4 ... 2 ... 2 19 December 28 ... ... 1 6 4 ... 2 ... 3 15 Totals ... 14 28 111 26 ... 19 ... 71 269 16 I now proceed to make a few observations with regard to each of these diseases. SMALL-POX. Two cases were recorded in Kensington; the first was a "sister," who contracted the disease in France, and the second was a probationer in the same Home. In London the disease was at low ebb, only five cases having been received at the hospital ships of the Metropolitan Asylums Board. One death only, and that one marked " doubtful," was recorded, the numbers in the three preceding years respectively having been 24, 9 and 9. The corrected annual average deaths, 1879-88, were 713. The mortality from small-pox in the four years last past has been less —not merely relatively to population, but absolutely—than in any previous years since the present system of civil registration began; the years which most nearly approach the figures above given being 1875 (46 deaths), 1874 (57 deaths), 1873 (113 deaths), and 1883 (136 deaths). The mean annual mortality from this disease in the decennium 1879-88 was 0T7 per 1000 persons living, and lower than in any previous decennium. I have no doubt that the diminution in small-pox mortality in the Metropolis during the last three years was largely due to the perfected system of removal of the sick direct from their homes to the hospital ships, situated as these are outside the London Registration District—a system which was initiated upon my recommendation, made to the Asylums Board and the Local Government Board in 1881. MEASLES. The deaths from this disease in 1889 were 14 (1 only in Brompton), against 56, 108 and 124 respectively in the three preceding years, being 65 below the corrected decennial average. All of the deaths occurred under five years of age, including 5 under one year. Of this disease I had to say, in my Annual Report for 1888, that it was more or less prevalent throughout the year seeing that it appeared as a cause of death in all but one of my 17 thirteen four-weekly reports. In 1889 there was but slight prevalence of it, in a fatal form at any rate, for in seven of my thirteen four-weekly reports no death was ascribed to this cause. In the majority of fatal cases of measles, some intercurrent disease —of the respiratory organs usually—complicating the original malady, is generally the immediate cause of death. Comparatively little care is taken by parents among the poorer classes to prevent the spread of measles. Not regarding it as a serious disease, considering it, moreover, to be just as inevitable as teething, they naturally enough rather like to have all of the children down with 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 usually occupying one house and using a common staircase—almost preclude the possibility of isolation. But more care might be taken to protect the sufferers against secondary affections, which, as already stated, are, as a rule, the immediate causes of death. The deaths in London from measles in 1889 were 2314, being 278 fewer than the corrected decennial average, and about three times as many as the deaths from scarlet fever. "When the year began, a serious outbreak of measles, which had commenced in the early autumn of 1888, and had reached its maximum in the latter part of December, was still in progress, and the mortality from this disease remained above the decennial average until the beginning of May, when the epidemic came to an end, and the mortality remained for the rest of the year considerably below the average of the previous decennium." (Registrar-General's Annual Summary.) WHOOPING-COUGH. Whooping-cough was the cause of 26 deaths in 1889 (7 of them in the Brompton sub-district), against 82, 86 and 100 in the three preceding years, being 62 below the corrected average number. All of the deaths save 2 were of children under five years 18 of age, including 10 under one year. Reference has already been made to the indifference of parents in regard to the spread of measles in their families. The observation is even more generally applicable in regard to whooping-cough, the danger of this always distressing malady being unappreciated by the poor, who, in the engrossing 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, it may be, are not confined to the house; 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 (1749) were 1406 fewer than the decennial average. The comparatively low case-mortality of whooping-cough, and, I may add, of measles also, serves in the public estimation to remove these diseases somewhat out of the category of "dangerous infectious disorders." It is the fact, nevertheless, that the actual deaths from measles and whooping-cough exceed the total deaths from small-pox, scarlet fever, diphtheria, and "fever" combined. Thus, in 1889, the deaths from measles and whooping-cough respectively were 2314 and 1749=4063; the deaths from small-pox (1), scarlet fever (784), diphtheria (1588), and "fever" (593), being 2966 only. SCARLET FEVER. This disease, which was the cause of 11, 40 and 26 deaths in 1886, 1887 and 1888 respectively, proved fatal to 28 persons only in 1889, the corrected decennial average being 41. Only three 19 of the deaths belong to the Brompton sub-district. Twenty of the deaths occurred in hospitals, to which 166 out of 252 recorded cases were removed for treatment. Of the 252 cases, 145 occurred in North Kensington—viz., that part of the Parish north of Uxbridge Road; and 107 in South Kensington—the remainder of the Parish south of that road. The cases recorded in the three preceding years respectively were 100, 465 and 252. The sufferers were for the most part 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. It is satisfactory, however, to find less unwillingness, year by year, on the part of parents to avail themselves of the advantages afforded by the hospitals of the Asylums Board for treatment, and for isolation when this is necessary for preventing the spread of the disease. Evidence of this fact may be seen in the Table at page 21. The deaths in London from this cause were 784, the corrected decennial average being 1887. The type of the disease was. mild, the case-mortality in the hospitals being low. In Kensington the mortality in respect of known cases was 11.1 per cent., a rate probably in excess of the true proportion, as some cases doubtless occurred of which we had no information. Still we have reason to believe that the occurrence of the disease is much more generally reported now than in byegone years. Thus if we compare the figures in the Table for the year 1887 with those for the year 1880, we note that the number of cases recorded was the same in both years, but that the case-mortality in 1880 (22.5 per cent.) was more than double that in 1887; the only conclusion at which we can arrive, therefore, is that in 1880 the concealed cases must have been considerably more numerous than in 1887. It may be added that the deaths in London in 1880 were more than twice as numerous as in 1887; and yet we had then no such alarm as in the latter year. The 20 reason is not far to seek. People did not use the hospitals nine 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. Our local experience may be cited by way of illustration of this statement. In 1880 the hometreated 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, moreover, which in 1880 was 32, had risen in 1887 to 68; it further rose in 1888 to 73, but fell in 1889 to 66. The percentage of deaths in hospitals, which was 21 in 1880, rose to 52 in 1887, and to 71 in 1888, but it fell in 1889 to 66. And, what is true in regard to Kensington is true also in the main in regard to all the other Metropolitan districts. In 1878 the scarlet fever deaths in the hospitals were only 7 per cent, of the total mortality from the disease in London ; in 1889 they were 48'9 per cent., or practically one-half of the whole. STATISTICAL RETURNS. The Asylums Board addressed a circular letter to the Vestries and District Boards, in October, 1887, 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. At the request of your Vestry, I drew up the desired information, in the form of the subjoined Tables, which are selfexplanatory, and to which I have now added the figures for the years 1888 and 1889. 21 Statistics of Scarlet Fever in Kensington in 1889, and in Ten Previous Years. The Year. No. of Recorded Cases. Total Number of Recorded Cases. Percentage of Remoy'ls 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 1889 86 166 252 66 8 20 28* 29 71 1l.l 778* 1888 68 184 252 73 10 16 26 39 61 10.3 1209 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 8073 1879 174 103 277 37 41 10 51 80 20 18.4 2706 *The corrected decennial average number of deaths from Scarlet Fever in Kensington was 41, and in London 1887. 22 Scarlet Fever Cases Recorded in Kensington in 1889, and in Ten Previous Years, in Thirteen Four-Weekly Periods. The Year. Weeks. 1-4 Weeks. 5-8 Weeks. 9-12 Weeks. 13-16 Weeks. 17-20 Weeks. 21-24 Weeks. 25-28. Weeks. 29-32 Weeks. 33-36 Weeks. 37-40 Weeks. 41 44. Weeks. 45-48 Weeks. 49-52 TOTAL. 1889 16 4 6 8 14 17 14 26 19 25 29 41 33 252 1888 46 40 29 19 16 10 15 13 12 7 7 20 18 252 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 21.0 18.6 14.3 13.8 16.6 15.1 14.5 12.4 20.3 32.2 32.2 34.5 25.4 270† * Return comprises five weeks. †Without correction for increase in population. 23 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. Dr. Klein subsequently confirmed the views expressed by Mr. Power, which, moreover, commended themselves to Dr. George Buchanan, Medical Officer to the Local Government Board. It need hardly be said that the subject would be one of equal interest and importance should the views of Mr. Power and Dr. Klein be ultimately sustained. But their views have been contested by more than one subsequent investigator. The first note of opposition was sounded by Professor J. Wortley Axe, of the Royal Veterinary College, in a report dealing, as he believed, with the eruptive malady now commonly referred to as the "Hendon Cow Disease." This disease, he states, is at once common, well known to farmers, innocuous, and has no relation to human scarlatina. He further states 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 without evil effect, though of course, I may add, in contravention of the provisions of the "Dairies Order." He believes that the Hendon milk received its infective power from "some obscure source connected with the dairy by channels which inquiry has failed to reveal." Professor Axe did not see the Hendon cows during the critical period, but he speaks of the disease as an eruptive one, usually confined to the teats, "and as being known among dairy farmers as cow-pox." He admits that it is transmissible to man by inoculation in the form of vesicles (vaccinia), but avers that it is "incapable of communicating scarlatina or other epidemic fever." 24 Professor Crookshank, of the Bacteriological Laboratory, King's College, subsequently investigated a bovine affection which he believes to have been the same as the Hendon cowdisease, and arrived at the conclusion that it is cow-pox. He states that this disease is not scarlatina in the cow; that the milk of affected animals does not produce scarlet fever in man, and that (as Professor Axe had previously assumed) infection in the Hendon milk must have been derived from "some hitherto unascertained human source." The reading of Professor Crookshank's paper at the Pathological Society gave rise to a vigorous controversy, in which each side stuck to the views of the respective principals in the debate. A later contribution to the discussion was supplied in a report by Professor Brown, C.B., of the Agricultural Department of the Privy Council, the most important item in which is the statement that Professor Axe had ascertained, subsequently to the issue of his first report, that there did exist at Hendon "a possible source of infection (of scarlatina) by the agency of persons who visited the Hendon cow-sheds, coming direct from a fever district, even from premises in which scarlatina existed. So that," he adds, "there is an alternative solution to the problem," set by Mr. Power, who, it is assumed, but incorrectly I believe, was unaware of the existence of scarlet fever in the locality, and who, therefore, had stated that the Hendon cows " had not acquired the power to cause scarlatina in any commonly accepted way, as by agency of persons carrying scarlatina infection." The question, I think, must be considered as still sub judice, notwithstanding that Dr. Buchanan in his latest published annual report, for 1888-89, speaking of the Hendon cow disease, writes, "we now confidently recognize it as scarlatina in the cow." For practical purposes we are still in the position occupied prior to Mr. Power's report, for that the poison of scarlet fever may be conveyed in milk infected by human agency is a well-established fact. Against the danger thus arising, consumers have it in their power to guard, by complying 25 with the oft-repeated advice to boil their milk. And for the rest, we must at present 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. The Order enacts that "if at any time disease exists among the cattle in a dairy or cowshed, the milk of a diseased cow therein shall not be mixed with other milk, and shall not be sold or used as human food." DIPHTHERIA. In 1888 diphtheria was, for the first time in my experience, endemic in Kensington, in the north-east portion of the Parish contiguous to the Parish of Paddington from which it would appear to have spread. During that year, 89 deaths were registered, only 2 of them in the Brompton sub-district. In 1889, the deaths were 111, including 5 in Brompton. Sixty-five of the deaths occurred at home, and 46 in hospitals, the majority of them at the Western Fever Hospital. The quarterly totals were 30, 25, 37, and 19 respectively (against 7, 10, 30, and 42 in 1888). The ages at death were: under five years 73, including 1 under one year, 13 between one and two, 15 between two and three, 22 between three and four, and 22 between four and five; between five and fifteen there were 35 deaths, of which 30 occurred between five and twelve. The remaining deaths were of a school girl aged 17, and two married women aged 37 and 42 respectively. The recorded cases of illness were 245, against 144 in 1888, the case-mortality being 45'3 per cent. in 1889, against 61.8 in 1888, in which year, probably, there was a larger proportion of concealed cases: but epidemic diseases tend to become less fatal 26 as the epidemic, so to speak, grows old. Of the 245 cases, reported in 1889, 201 were in North Kensingon, i.e., north of Uxbridge Road, and 44 in South Kensington, i.e., the remainder of the Parish south of Uxbridge Road, against 129 and 15 in 1888. The 201 cases in North Kensington occurred in 148 families, living in 141 houses, and in 69 streets; the 44 cases in South Kensington were in 36 families, living in 36 houses, and in 28 streets. Thirty-six of the streets in North Kensington are in the North-West District, i.e., to the west of Ladbroke Grove, and Ladbroke Grove Road; and 33 in the North-East District, between those roads and the adjacent Parish of Paddington and the detached portion of Chelsea at Kensal Green. In 37 of the 69 streets, one house in each street was invaded; in 17 streets, two houses were invaded; in 7 streets, three houses ; in 1 street, four houses; in 4 streets, five houses; in 1 street, six houses; in 1 street, eight houses; and in 1 street, 9 houses. Of the 37 streets in which one house only was invaded, 21 are in the NorthWest District, and 16 in the North-East District. The total cases in the North-West District were 98, in the North-East District 103.* In 25 of the 28 streets in South Kensington, one house in each street was invaded; in two streets, 2 houses; and in one street (Peel Street, Campden Hill), 7 houses. The streets in which two houses were invaded are Golborne Terrace, Swinbrook Road, Norfolk Terrace, Elgin Mews, Buckingham Terrace, St. Ervan's Road, Horbury Mews, Archer Mews, St. John's Mews, St. Luke's Mews in the North-East District; St. James's Place, Bramley Road, Stoneleigh Street, Treverton Street, St. Ann's Road, Prince's Road, and Manchester Street in the North-West District; and Barker Street and St. Alban's Road in the South District. The streets in which three houses were invaded are Bonchurch Road, Acklam Road, Blagrove Road, and Lonsdale Road in the North-East District; and Walmer * In 1888 the streets invaded in the North-West District were 16, and the cases 25; in the North-East District the streets were 27, and the cases 97. 27 Road, St. Charles's Square, and St. Clement's Road in the NorthWest District. Four houses were invaded in Southam Street in the North-East District; five houses in Clarendon Road, Lancaster Road, and Rackham Street in the North-West District, and Wornington Road, in the North-East District; six houses in Wheatstone Road in the North-East District; seven houses in Peel Street (including Campden Houses, five) in the Central District; eight houses in Portobello Road in the North-East District, and nine houses in Portland Road in the North-West District. In each of 123 houses there was one case only; in each of 42 houses there were two cases; in 4 houses there were three cases in each; in 5 houses there were four cases in each, and in 1 house there were six cases. The second and subsequent cases in a house were usually the result of defective isolation of the primary case. The sufferers comprised 100 males and 145 females; 106 of them were under five years of age, 89 between five and twelve years (the usual public elementary school age), 33 between twelve and twenty-one, and 17 upwards of twenty-one years. Their position in life may be summarized as follows:—29 were adults, viz., colonel in Her Majesty's Service, barmaid, shopman, two coachmen; wives of tailor, crossing-sweeper, bath-chair repairer, clerk, butcher's manager, greengrocer, coachman, and cabmen (2) respectively; labourer, errand boy, laundry woman, and 12 domestic servants. Two hundred and sixteen were children, viz.: of artizans, 68; of labourers, &c., 40; of cabmen, carmen and coachmen, 29; of tradesmen, 21; of persons in service, 17; of shop assistants, 7; of agents, 4; of builder's clerks, of firemen, of persons employed on railways, and of costermongers, 3 each; of gentlefolk, of cashiers and of policemen, 2 each, and other single cases (including 9 of persons whose occupation was unknown), 12 One hundred and twelve of the cases had been in attendance at schools, 92 in North Kensington and 20 in South Kensington. 28 Of the 92 in North Kensington, 47 were connected with Board Schools, viz., Wornington Road Board School 17, the periods of invasion being, in January 3 cases, February 2 cases, April 2 cases, May and June 1 case each, August 3 cases, September and October 1 case each, and December 3 cases; Buckingham Terrace Board School 9, the periods of invasion being, in August 1 case, September 2 cases, October 5 cases, and November 1 case; Portobello Road and Edinburgh Road Board Schools 7 cases each; St. Clement's Board School 3 cases; Latimer Road (Hammersmith) Board School 2 cases, and one case each at Saunders Road (Hammersmith) and Middle Row (Chelsea) Board Schools. The remaining 45 cases in the North District were connected with the following schools:—St. John's Church School 18, the periods of invasion being, in February 1 case, May 8 cases, June 4 cases, July 3 cases, and 1 case each in September and November; St. Peter's Church School 6 cases; St. Clement's Church School 4 cases; 3 cases each, at St. Mark's Church School, St. Francis and St. Mary of the Angels (Westmoreland Road, Paddington) Roman Catholic Schools; St. James' Church School 2 cases; and 1 case each at St. Stephen's and St. Andrew's Church Schools, and at Roman Catholic Schools in Bosworth Road and Silchester Road. The remaining 2 cases were connected with two private schools. Of the 20 cases in South Kensington, 8 were connected with Board Schools, viz.: Silver Street Board School 7, the periods of invasion being, in February, 1 case ; March, 1 case ; August, 1 case; September, 3 cases; and 1 case in December; and Gloucester Grove Board School, 1 case; the remaining 12 cases were connected with the following schools: 3 at St. George's Church School, 2 each at St. Mary Abbott's and St. Philip's Church Schools, and the Nunnery School, Southend; and 1 each at Allen Street British School, at Kensington Square Roman Catholic School, and at a private school. I have no doubt that the disease was spread in many instances through the agency of schools, or that the epidemic would have attained much larger proportions 29 tut for the care taken to debar from school attendance all children residing in houses where it appeared. In 1888 some 44 children attacked were connected with the very large Board School in Wornington Road, in 1889 only 17, the cases moreover, as has been shewn, were spread over the whole year. St. John's Church School furnished the largest number of cases, 18, of which 8 occurred in May, 4 in June, and 3 in July. I have no doubt that the disease spread by direct contagion in this school, which was not in an altogether satisfactory sanitary condition. Only two cases occurred after the summer holidays, during which amendments which I had advised were carried out. Few as the cases were in any school, it was observed that they tended to occur in small groups, indicating connection of the several members of each group. I am pleased to be able to testify that the school authorities generally were assiduous in their efforts to prevent the spread of the disease by exclusion of suspicious cases, which were duly reported to me; but they laboured necessarily under a difficulty arising from the fact that diphtheria presents no external eruption to attract attention to it as something different from a common or non-specific sore throat. Slight cases, therefore, are liable to escape notice, and to the occurrence of such unrecognised cases, spread of the disease through the agency of schools may be reasonably attributed. In some instances sanitary defects were found in the invaded houses, but these were few compared with the total number; in some of the streets, moreover, offensive sewer manholes or gullies were observed. But for the most part the cases occurred singly in houses, and on the whole the information collected seemed to point to direct infection, especially through schools, as the more probable cause of the spread of the disease. The Registrar-General in his Annual Summary, states that the mortality from diphtheria, which had been increasing steadily for many years, in the last two years, 1888 and 1889, made the most alarming bounds, the deaths rising from a total of 953 in 1887, first to 1311 in 1888, and then in 1889 to no less than 30 1588, whereas the decennial average, after correction for growth of population, was only 932. In about half of the Metropolitan Sanitary Areas the deaths have gone up at least 50 per cent. since 1887; in many of them they have been doubled, and in some cases more than trebled in that short period. The mortality was above the decennial average throughout the entire year, having only fallen in two weeks to the average level, but its main excess was in the four months from the middle of June to the middle of October. The Registrar-General further remarks that it is probable that some part of the increase under diphtheria may be due to a diminution under the heading "Croup." But this can be only a partial explanation of the rise which was far greater than the falling off under croup. For the deaths from diphtheria and croup together amounted to 2068 in 1889, while the decennial average, after due correction for increase of population, would have been only 1647. HOSPITAL ACCOMMODATION FOR DIPHTHERIA. I stated, in my Report for 1887, that the Managers of the Metropolitan Asylums District were willing to admit sufferers from diphtheria into their hospitals, but that the Local Government Board, acting upon a medical opinion that this disease does not fall within the category of "Fever," as that term is used in the Metropolitan Poor Act, 1867, deemed it desirable that if cases of diphtheria were to be admitted there should be express legislation for the purpose. Happily the necessary legislation was effected last year by The Poor Law Act, 1889, the third section of which enables the Local Government Board to issue an order authorising the Managers to receive diphtheria cases at their hospitals. So urgent was the need, that the Local Government Board informed the Managers in October, 1888, that if they determined "to admit such cases, the Board, with the view of removing any difficulty with the Auditor, would be prepared, on application from the Managers, to sanction any expenditure incurred in the treatment of such cases, which, in the opinion of the Auditor, was not open to question otherwise" than on the ground that, as they had been 31 advised, persons suffering from diphtheria could not be regarded as patients suffering from fever. During the past year, 770 persons with this disease were admitted to the hospitals, 84, 126, 282, and 278 in the four quarters respectively; of the 245 cases recorded in Kensington, 102 were removed to the Board's hospitals, in addition to some 21 admitted to other hospitals. The Registrar-General in his Annual Summary, expresses a hope, in which I cordially concur, that the constant increase of this disease in late years may receive some check from the arrangements by which cases of it are admitted into the Asylums Board Hospitals. During the year, he adds, 763 cases were admitted, and of 681 completed cases, 271 terminated fatally, giving a casemortality of 39.8 per cent. On this basis he calculates that the 1588 deaths in the whole of London, corresponded to 3990 cases of equal severity to those admitted into hospital, and that of these cases 17'3 per cent.were treated either in the Board's hospitals or the London Fever Hospital. FEVER. No death was registered from Typhus Fever or from Simple Continued Fever. The deaths from Enteric Fever were 19, as against 11,11 and 21 respectively in the three preceding years, being two below the corrected decennial average. Thirteen of the deaths were registered in the Town sub-district, and six in Brompton. Three of the deaths took place in hospitals, to which 25 patients were removed. The recorded cases were 50; 20 in North Kensington and 30 in South Kensington, the Uxbridge Road being the dividing line. During the four weeks July 14th to August 10th, 11 cases were reported in South Kensington. They occurred in ten houses in eight streets. Nine of the sufferers were female domestic servants, one was the wife of a coachman, and one was the wife of a solicitor. Excepting in one house no sanitary defect was observed. The ten houses were supplied with milk by five separate and large firms. The dates of invasion ranged from July 19 to August 9. Several of the cases were of an ill-defined character, so that the hospital authorities were in doubt for many days whether they were really typhoid fever. 32 A somewhat similar and limited outbreak of enteric fever in the district of St. George's, Hanover Square, at about the same date, excited a good deal of attention, having been referred to on more than one occasion in Parliament, as a consequence of the superior social status of the sufferers. It was made, moreover, the subject of an investigation by one of the Medical Inspectors of the Local Government Board, who, in his report, referred to complaints of bad smells from the sewer ventilators and road gullies, and to the fact of the absence of rain, so that the traps of many of the road gullies dried up and allowed the exit of sewer gas close to the pavements. Complaints, moreover, had been made as to the accumulation of stable manure in mews. Nuisance from all of these causes is by no means unknown in this Parish, but I was unable to trace the limited outbreak of fever above-mentioned to any of these causes. There were 15 deaths in London from typhus in 1889, and 43 from ill-defined forms of continued fever, the decennial averages being 48 and 99 respectively. The deaths from enteric fever were 538, "a figure not only far below the decennial average, which, after correction for increase in population, would be 854, but absolutely the lowest as yet recorded." DIARRHCEA. Diarrhoea was the cause of 70 deaths, against 124, 90, and 58 respectively, in the three preceding years, 64 in the Town subdistrict, and 6 in Brompton, being 26 below the corrected decennial average. Sixty-six of the deaths were of children under five, including 57 under one year. Of the total number, 39 were registered in the 8 weeks June 16th to August 10th inclusive. The deaths from diarrhœal diseases in London generally were 2677 (580 below the corrected decennial average), of which 1989 were of infants in the first year of life, and 404 more of children under five. There was a somewhat sharp outbreak of the disease in the months of July and August, but it neither 33 covered so long a period of the summer, nor did the mortality during that period rise to so high a level as the average. The question why diarrhœa is so prevalent and fatal, especially to infants, in hot summers, has been long under consideration by the medical department of the Local Government Board. A "provisional or working hypothesis" has been lately formulated, which assumes the existence of a form of germ life in the earth—especially such as is sewage-tainted or otherwise polluted—which germ, developing into activity when a certain temperature is attained, and rising into the air, finds admission into the system with food, and multiplying there, generates a poison which is the immediate cause of the disease. METROPOLITAN ASYLUMS BOARD. The work and proceedings of the Asylums Board, important at all times to those concerned in sanitary administration within the Metropolis, have of late years acquired additional interest, owing to the steps taken by the Managers to make their hospitals more and more a refuge for the infectious sick in need of isolation. Accommodation has now been provided, adequate, apparently, to the needs of the population; and, during the last three years, beds have been placed at the disposal of registered practitioners, as well as sanitary officials, and the resident medical officers of general hospitals, whose applications for the admission of patients, when made in compliance with the reasonable requirements of the Board's regulations, are now invariably attended to without question or delay. The Board indeed have become in effect the Central Hospital Authority for London in regard to infectious diseases, and discharge right well the duties of the position. THE CHAIRMAN'S ANNUAL REPORT. Sir E. H. Galsworthy, in his report on the work and proceedings of the Asylums Board for the twelve mcnths ended March 25th, 1890, first refers to the important and C 34 beneficial legislation comprised in the Infectious Disease (Notification) Act, 1889, and the Poor Law Act, 1889. Under the first-named Act, he observes that the Managers receive information from the Medical Officers of Health with respect to cases of infectious disease in their several districts, which, after being tabulated, is circulated amongst the same Medical Officers, thus keeping them informed of the progress of disease, from week to week, in all portions of the Metropolis, and, therefore, in districts adjoining their own, thus enabling them to take prompt measures for the eradication of disease. The returns supplied to the Board by the Medical Officers, he adds, are useful to the Managers also, as affording "authentic information" as to infectious disease in the Metropolis as a whole; as by comparing the cases admitted into their hospitals with the total number notified, they are assisted in "regulating the accommodation at their disposal in a more satisfactory and comprehensive manner than could otherwise be the case." "Scarcely less important" to the Managers is the Poor Law Act, 1889, "which removes the disabilities under which they had been placed in the performance of that portion of their duties which has reference to the provision of accommodation for the treatment of infectious disease. The Managers are now enabled (a) to admit non-paupers reasonably believed to be suffering from fever, small-pox, or diphtheria; (b) to admit pauper patients suffering from diphtheria; (c) to purchase, compulsorily, with the consent of the Local Government Board, such land adjacent to an 'Asylum' as may be required for the purposes of the hospital; and (d) to be the ambulance authority in respect of the removal of all classes of infectious sick persons in the Metropolis." The Chairman remarks that the Managers are thus, for the first time, "virtually recognised as the Metropolitan authority for the provision of accommodation for the isolation and treatment of infectious disease, both pauper and non-pauper," as in 1877 I recommended that they should be. He further remarks that they are "now empowered to legally perform duties which the Legislature had imposed 35 upon the District Sanitary Authorities, but which the Managers had hitherto been called upon to perform in consequence of the failure of most (all) of such Sanitary Authorities to provide accommodation for non-pauper patients;" duties which the Chairman knows it was never in the power of those authorities to perform; duties, moreover, which all the world now recognises to be capable of performance, satisfactorily, only by a Metropolitan authority, such as the Board itself. Fever Hospital Accommodation.—The total number of beds for fever patients contained in the Board's hospitals is stated to be 2463. An increase of scarlet fever at the middle of the year necessitated the re-opening in August of the "Northern" Hospital at Winchmore Hill, which, by the erection of two additional pavilions, &c., contains normal accommodation for 480 beds. In September the South-Western Fever Hospital at Stockwell (402 beds) was re-opened, after having been closed against the reception of patients for 18 months. The other hospitals, "Eastern," at Homerton (442 beds), "SouthEastern," at Deptford (462 beds), "North-Western," at Hampstead (415 beds), and "Western," at Fulham (262 beds) were open continuously throughout the year. Reference is made to the proposed extension of the Western Hospital, by providing additional accommodation for fever patients, "the outbreak of scarlet fever in 1887-8 having shewn that the hospital was not large enough to receive all the cases arising in the districts allocated to it;" and a hope is expressed that before another year has elapsed the hospital will have been enlarged so as to admit of the reception of all cases that should be sent to it, "instead of a considerable proportion being, as at present, removed to other and more remote hospitals." The Northern Hospital is intended for the use of convalescing patients from the other hospitals; the Managers having directed (a) that the control of the transfer of patients should be left in the hands of the Clerk to the Board, acting under instructions of the Ambulance Committee, and (b) that every c 2 36 convalescing patient who, in the opinion of the medical Superintendents, would benefit by the change, should be transferred there at the earliest possible opportunity, so long as the hospital remains open. Small-pox Hospital Accommodation.—The brick-hut hospital for convalescing small-pox patients at Darenth, is reported completed, and thus the Managers will have at their disposal accommodation for the treatment of 1150 small-pox patients, viz., 350 on board the hospital ships, 600 in the brickhut hospital, and 200 in the Infirmary on the same site. A few beds have been provided at all of the town hospitals, save the Western, for small-pox patients too ill to be at once removed to the ships. In view of the fact that for three years small-pox has been practically non-existent in London the Managers decided to abandon the idea of adapting a ward at the Western Hospital for this purpose: "it may be however, that provision for a few severe cases at this hospital during epidemic periods will yet have to be made." The Nursing Staff.—The Managers, it is stated, have resolved to appoint Probationers as Nurses, and regulations with regard to this new grade of officers have been approved and adopted. A Sub-committee of the General Purposes Committee are considering the question whether some means may not be devised, whereby, on the closing of any of the hospitals, work may be found for the most valuable members of the staff at such of the other hospitals as remain open; and there is a question of placing the Nursing Staff on a central footing, whereby the Managers will be enabled to retain the services of such a body of skilled nurses as, in times of epidemics, would form a satisfactory working nucleus at any hospital which they might suddenly be called to open. The Managers have other and important duties—connected with the training of pauper boys on the training ship "Exmouth" (having accommodation for 600), and with the treatment of mental 37 diseases (imbeciles and idiots), the accommodation being for 6060 all of which are referred to in the Chairman's report, but do not call for mention here ; but it may be mentioned, as stated by the Chairman, that an eminent authority in the Registrar-General's Department at Somerset House, " in a paper dealing with the statistics of insanity in England, read before the Statistical Society,"pointed out that," if the Tables given by the Lunacy Commissioners were as complete and as instructive as are those published by the Statistical Committee of the Asylums Board, it would be a comparatively simple matter to calculate the precise effect upon the existing numbers of the insane in England and Wales of the reduced death-rate in asylums." Appended to the Chairman's Report are returns (a) of the various institutions and establishments under the Board's control, etc.; and (b) a statement of receipts and expenditure for the year. The total expenditure was £357,819 6s. 3d., viz., maintenance account £79,496 7s. 2d., and common charges account £278,322 19s., 1d. A large sum, doubtless; but, in addition to the ambulance service on land and river, including the maintenance of steamers and wharves, the Managers have provided accommodation to the extent of 10,273 beds, viz., for imbeciles, etc., 6080; fever pitients, 2463; small-PDX patients 1150; and training ship (boys) 600. REPORT OE THE STATISTICAL COMMITTEE. The valuable and interesting annual report of the Statistical Committee opens with a gratulatory reference to the legislation of 1889, which provides for "the admission into the Minagars Hospitals of any persons, irrespective of their means, who may be suffering from small-pox, diphtheria or fever, and for the conveyance in the Managers' ambulances to other places than the Managers' Hospitals of persons suffering from any dangerous infectious disorder; additional powers which give increased importance to the statistics collated by the Committee."Mentioa 38 is also made of the Act for the compulsory notification of infectious disease, careful study of the working of which has led the Committee to the conclusion that " certain amendments are urgently required." The views of the Committee on the imperfections of the medical certificate, approved as they are by the Managers, will he found in the section on Notification (page 60). A new feature in the report are the "Spot" maps of London, shewing the localities from which patients suffering from scarlet, enteric and typhus fevers, diphtheria and small-pox, have been admitted into the hospitals of the Board. But these maps, as well as the tables, are "divided according to the boundaries of the parishes and unions responsible for the maintenance of the patients," a circumstance which somewhat detracts from their value, and is also somewhat inconsistant, as a "return of cases notified" is "arranged according to the areas of the local authorities" (vestries and district boards), "which in some cases are not conterminous with the areas of the parishes and unions," or poor law districts. In course of time, the Committee " hopes to be in a position to have' maps prepared which will shew not the admissions to hospitals only, but the total number of cases which have been notified." The Committee refers to " the effects of aggregating a number of cases of diphtheria 011 one site," and quotes an observation by Mr.Sweeting, late Medical Superintendent of the Western Fever Hospital—who has advanced evidence, "of an increased prevalence of throat illness amongst scarlet fever cases since the reception into hospital of diphtheria cases"—to the effect that " the whole question of this closer interrelation of scarlet fever and diphtheria would seem to be one calling for immediate skilled scientific enquiry" which, I would -venture to add, might well be conducted by Mr. Sweeting himself, now one of the medical staff of the Local Government Board. A variety of statistical information as to admissions to hospitals in 1889, is given by the Committee, the substance of which will be found in other portions of the present report,* printed before the * Vide Chairman's Report (page 33) and Report ot the Ambulance Committee (page 43). 39 Committee's report was published, and which, therefore, need not be repeated here. It is stated that when the year began there were only 853 patients remaining under treatment in the several hospitals. The number continuing to decrease, the Northern Hospital was closed on the '24th March. In the latter part of July the usual increase in the number of admissions commenced, and by the 22nd August the total number of patients under treatment had attained 1000. The increase continuing, the Managers re-opened in succession the Northern Hospital, and the South-Western Hospital which had bean closed since April, 1888. "The total mortality in the hospitals was 13.87 per cent., including cases dying within 48 hours after admission, and those dying from concurrent maladies" : in scarlet fever case it was 8.85 per cent.; in cases of diphtheria, 40'74 percent.; in enteric fever, 15.15 per cent. Twenty-three cases of typhus fever were admitted; six died=31.57 percent. "The monthly admissions of all cases were lowest in June and highest in October." A large part of the Committee's report consists of tables containing valuable information, but insusceptible of treatment by abstract. Scarlet fever and diphtheria cases were admitted from every parish and Union in the Metropolis. In both diseases the mortality is highest under five years of age : in scarlet fever, 19.74 percent., against 10.44 at all ages, calculated on upwards of 36,000 cases admitted into the Board's Hospitals since 1870: in diphtheria, 55'7 percent, against 39.0 percent, on 821 cases admitted to the end of the year 1889. Males would appear to be considerably more liable to both diseases—judging from tbe numbers of cases admitted—and females to have a considerably lower rate of mortality, the difference in their favour being 1*7 per cent, in scarlet fever and nearly 2-5 in diphtheria. The experience derived from 6462 cases of enteric fever, shows a somewhat larger proportion of males admitted, but a percentage mortality of nearly 1'6 in favour of the stronger sex, the total percentage mortality being 17'6 (males 16.86, females 18'44), and the mortality under five being about 14 percent., at which age, however, only 179 cases were admitted. It is stated that, 40 the cases of diseases wrongly diagnosed as fevers admissible to the Managers' Hospitals, the largest numbers were as usual of measles, pneumonia and tonsillitis." The Committee evidently anticipates that these numbers, 181 in 1889, will be reduced in future years, through the facilities about to be afforded to medical students for clinical observation, adverted to at page 54. During the last four years, the total number of cases of small-pox treated in the Managers Hospitals was only 222, of whom 33 died. This "unprecedented immunity of London" from this loathsome disease is attributed, and justly, I believe, to “rapid and systematic removal from crowded districts of infected persons, each of whom might have become a centre of contagion." Since the 1st December, 1870, to the end of 1889, as many as 56,952 cases of small-pox have been admitted into the Managers' Hospitals, of which 9855 ( =17'20 percent.) proved fatal. The Canmittee's report, which also deals with the statistics of imbecility, with ambulance work, and with training ship work, concludes' with the following Summary of the number of patients, etc., who have been under the care of the Managers, in the several hospitals, and asylums, and the training ship "Exmouth," since the opening of the first institution (the Temporary Hospital for Relapsing" Fever at Hampstead) in 1870. Institutions. Admitted direct from Homes or Parishes and Unions. Numbers remaining in the various Institutions 31st December, 1889. Fever Hospitals 46,870 1,789 Small-pox Hospitals 57,980 1 Asylums for Adult Imbeciles 14,528 5,014 Schoolsfor Imbecile Children 1,684 647 Training Ship "Exmouth" 4,137 526 125,199 7,977 In appendices, the Committee gives the annual reports of theseveral medical superintendents of the hospitals and other institutions. Taken as a whole, no report issued by the Managers 41 is of greater interest than that of the Statistical Committee; and the information it contains is likely, with time, to become of increasing value to *11 interested in matters relating to infectious disease. METROPOLITAN AMBULANCE SERVICE. The Poor Law Act, 1879, sec. 16, conferred on the Asylums Board one of its most valuable powers, that of providing ambulances for the conveyance of the infectious sick to the Hospitals of the Managers. Previously, the Boards of Guardians had removed the sick in carriages few of which were wholly satisfactory, and under conditions occasionally prejudicial to the public health. The work of removal—whether by land or water—is now effected in an unexceptionable manner. In my last report, I observed that this remark was applicable only in the case of .patients in course of transit to or from the Managers' Hospitals. It was often quite otherwise in respect of private patients. The law does not forbid the use of public vehicles (cabs) for the .removal of infectious persons, provided that the vehicles are afterwards disinfected. But the driver of a cab may be unaware of his fare's illness: the efficacy of any practicable disinfection, .moreover, may be reasonably doubted. Consideration of these and other objections to the existing law, led me to the conclusion .that cabs, etc., should never be used for this purpose, and that it would be to the public advantage to make the Asylums Board the Ambulance Authority for removal of the infectious sick of all classes. In 1884, therefore, I addressed a communication to the Managers, proposing that they should place their ambulances at the service of the medical profession and Medical Officers of Health, with or without payment, for the conveyance of infectious sick persons. The Managers replied that they were, at that time, " not 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 on this reply in my Annual Report for 1884, I ventured to express a conviction that the Managers would, in course of time, recognize the 42 sirableness of giving effect to my views. That time arrived in 1888, when the Managers stated their opinion " that the conveyance of infectious cases by public vehicles should be prohibited by law,"and expressed willingness to" use the machinery they possess for the prompt and economical removal of infectious cases." Doubting their "power to use their ambulances for other cases than those contemplated by the Poor Law Act of 1879," they were ready to take action" with the view of obtaining for the Board the power to undertake the general removal of infectious cases in the Metropolis."The views of the Managers were communicated to the Local Government Board, and now, under circumstances narrated in the following pages,* the Managers have become the Ambulance Authority, as well as the Infectious Hospital Authority, for all London. The recommendation of the Royal Commission on Infectious Hospitals, 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 thepurpose,—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, Seagrave Road, Fulham. Between 8 a.m. and 8 p.m., on week-days, cases for removal are reported at the Managers' Central Offices, Norfolk. House, Norfolk Street, Strand, W.C.,t these being in telephonic communication with the Station. During the night, and on Sundays, application for a patient's removal is forwarded direct to the Ambulance Station. * Vide page 65. †Telegraphic Address, Asylums Board. London : Telephone Number, 2587. 43 WHARVES. The Managers have acquired or constructed three Wharves for the embarkation 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 brick hut-hospital at Darenth, but which is also intended for the accommodation of the West District generally, has long since been completed. But hitherto it has not been 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 were formerly sent for embarkation, the number of miles travelled by the ambulances was excessive. RIVER AMBULANCE SERVICE. The Managers possess, in their three Ambulance steamers, Bed Cross, Maltese Cross, and Albert Victor, together with the steam pinnace Sivallow a fleet equal to all probable demands. REPORT OF THE AMBULANCE COMMITTEE. Arrangements in connection with the transit of the sick, .between home and hospital, and back again, are under the control of a Committee of the Asylums Board, whose Annual Report states that the year 1889, so far as regards the working .of the Land and River Ambulance Services, was "uneventful." The year, however, was "rendered memorable in the annals of Isolation of Infectious Disorders by a measure passed by Parliament, viz.: The Poor Law Act, 1889, by one section of which the Managers' Hospitals have been made available for the reception of any persons, irrespective of their means, who may be suffering from small-pox, diphtheria, or fever; whilst, by' another section, the Managers' Ambulance system has been 44 tended and completed." The Committee give, under the headings "Admission of Patients to Managers' Hospitals" and "General Conveyance of Persons suffering from Infectious Disease," a succinct and highly interesting account of the steps by which the Asylums Board, from being merely an Authority for providing hospital accommodation for paupers suffering from infectious disease, have developed into a Central Hospital Authority for providing such accommodation for persons in all classes of the community in need of isolation, and the Ambulance Authority for all London—these new powers having been conferred by the Poor Law Acts of 1879 and 1889, to the provisions of which, as well as to the action of the Managers in anticipation of legislation, I have made reference in other portions of the present report. It is interesting to note, in this narrative, the judicious boldness displayed by the Managers, from time to time, in doing what they deemed to be for the public good ; so that it may be truly said that, in almost every instance, legislation followed in the steps of their practice, which often had the great advantage of the moral support afforded by the tacit approval of the Local Government Board. It has now come to pass that persons in any rank of Society suffering from small-pox, diphtheria, or fever, may be admitted to the Managers' Hospitalsupon the application of any duly qualified (registered) medical man ; practically without payment, on the sole condition that a medical certificate be handed to the nurse in charge of the Ambulance, which is sent immediately to remove the patient, without charge, upon receipt of an application at the offices of the Board, or at an Ambulance Station, as the case may be. That the system now in vogue has been attended with the happiest results, in reducing the amount of infectious disease in the Metropolis, and has thus proved a great boon to all classes of the community, is now universally admitted, and your vestry are entitled to no mean share of the credit due to those by whose instrumentality the beneficent scheme has been brought to perfection. During the year, 5685 Fever and Small-pox patients were removed from their homes to the Board's Hospitals, as compared with 5114 in the preceding year. The average daily removals in the first six months of the year were 8.48, and in the latter six months 23.01, as compared with 15'4 and 12.8 respectively, in 1888, and 6'7 and 29.1 respectively, in 1887. The average length of journey of the fever patients removed to hospitals did not exceed 3½ miles. Small-pox Patients.—During the year, 25 persons, certified to be suffering from Small-pox, were removed from their homes, of whom no fewer than 20 were found not to have the disease, and were accordingly taken back direct to their homes. The remaining five patients were conveyed to the Hospital Ships at Long Reach, opposite your Vestry's land at Purfleet. Fever Patients.—5680 patients were removed from their homes to the London Hospitals in the course of the year. In addition, 1731 convalescents were removed to the Northern and other Hospitals; 1372 recovered patients were removed from the Northern Hospital to Town Hospitals for discharge, whilst 125 patients were conveyed from hospitals to homes. Diphtheria.—During 1889, 770 cases of Diphtheria were removed. Of this number, 560 (72.7 per cent.) were removed in the latter half of the year. Under the Poor Law Act, Act, 1889, passed on the 30th of August, diphtheria cases are now lawfully admitted to the hospitals. The Local Government Board, however, had sanctioned the admission of cases in 1888, and the first removal took place 23rd October : from that date up to the end of the year, 96 cases were removed : 210 cases, were admitted in the first half of 1889, and, as already stated, 560' in the latter six months. Cost of Ambulance Services.—The total cost of the Land Ambulance Service in 1889 was a little over £12,000, a sum which includes upwards of £6000 for the reconstruction and enlargement of the South-Eastern Station. The cost of the River Service was £3728. 46 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 2100, or by special exertion, 2700 small-pox patients. The actual accommodation falls very far below the smaller of these totals, consisting as it does of some 350 beds at the hospital ships, a few beds at three of the London hospitals, (beds for exceptional patients, and which the Asylums Board will not suffer to be occupied except in case of urgent necessity), and 800 beds at Darenth. Total, say, 1200 beds. But it must be borne in mind that the Managers' Estate at Darenth is always available upon emergency tor the erection of huts, tents, &c., equal to any probable demand for accommodation. It may be hoped, moreover, that as the Managers now remove every smallpox patient out of London, whose removal can be effected with Safety—and, happily, this is usually the case—hospital accommodation in the future will not be required to the amount provided during former epidemics. The Goee Farm Hospital, for Convalescing Small-pox Patients, which the Managers decided, December, 1887, to erect on their estate at Darenth, is now completed. The buildings of the two Small-pox Camps which, with tents, served for the last epidemic, have now been consolidated into an infirmary on the site of the South Camp, which will accommodate 200 acute cases, with the requisite female staff. The new hospital, on the higher ground, provides accommodation for 600 convalescing patients in two groups, viz., males, 250; females and children, 350. The-administrative block is capable of service for 1000 patients. The whole estate is enclosed, and the two areas for patients' outdoor recreation are defined by iron fencing which is described as unclimbable. The expenditure incurred to date, exclusive of the cost of the site, viz., in building and adaptations, has been about £64,000. 47 The Hospital Ships have been maintained in constant readiness for use. A proposal to close them was sometime since pressed upon the Asylums Board, upon the ground that money would be saved if the sporadic cases of small-pox which occur between epidemic periods, were treated in London itself instead of being taken down the river. The money saving would not be considerable in any case, and certainly not so large as supposed, for it would be necessary to make provision at, say, three of the London hospitals for the reception of such occasional cases; 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 every occasion when small-pox has been treated in the town hospitals, the disease has prevailed around those hospitals, with the effect that during many years, and 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 1n 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 precious lives, 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 be 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 Managers, by a large majority rejected the proposal to close the Ships, and they have kept steadily to their resolution to remove every case to the Ships, when 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 every emergency, and, in my opinion, the Local Government Board did wisely in 48 making the suggestion, a few years ago, that the Managers should endeavour to obtain a further site to the west or southwest of the Metropolis, which should be available for an additional hospital for convalescent patients—having in view the possible exigencies of an epidemic, and taking into account the requirements of London as a whole. FEVER HOSPITAL ACCOMMODATION. The Royal Commission (1882) recommended provision of sites and buildings capable of accommodating 3000 fever patients. " Of the 3000 cases, those in the earlier stages, probably about half, should be provided for in the near neighbourhood of London; the other half—the convalescents—in two other country hospitals." The recommendation of the Commission that the Town hospitals should " become in the main fever hospitals" has 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, a site being obtained at Winchmore Hill, nine miles north-east from Charing Cross, on which the " Northern Hospital," with normal accommodation for 480 convalescent patients, has been erected. The total provision for "Fever" is now 2463 beds, a number that falls considerably short of the recommendation of the Commission. " On the other hand," as we were told by the Asylums Board in May, 1887, " the number of fever patients annually under treatment at any one time during 1886, though in advance of those of the eight previous years," did not exceed 742, so that, as it was further stated, "up to the present time the recommendation that the Managers should provide for 3000 fever patients has not been justified by subsequent experience." 4D The recommendation of the Commission, however, was justified by the experience of 1887, when the requirements of an epidemic of scarlet fever obliged the Managers to re-open the hospitals that had been closed, exhausted the accommodation at all of the Town hospitals, compelled them to hire the Plaistow Hospital at West Ham, and to open the new Northern Convalescent Hospital at Winchmore Hill: it also necessitated the erection of temporary huts at the Eastern, the South-Eastern, and the South-Western Hospitals, and at the Northern Hospital, where at one time upwards of 700 patients were accommodated. In all, some 2700 beds were provided by the Managers, the maximum number of patients at anyone time being 2611. What happened in 1887 may happen again, for the very satisfactory reason that the Managers' Hospitals have 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 in 1887 was due in no slight degree to the larger 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 21. The experience of 1887 accentuates the necessity for additional accommodation as recommended by the Commission, and the matter should be taken in hand without delay, it being probable that in the event of a severe epidemic the demands on the hospitals would be more pressing than ever, as a result of the passing of the Infectious Disease (Notification) Act, 1889. Few cases probably would escape notification, and the more cases notified the greater would be the number of sick persons requiring isolation in hospital. WESTERN FEVER HOSPITAL, FULHAM. In 1888 the Asylums Board had under consideration a memorandum prepared by the Committee for the Western Hospital, respecting the necessity of providing further accommodation for fever patients at that Hospital—a course which 50 would involve* the acquisition of additional land, as no more accommodation can be provided on the existing site. The hospital contains at present only 262 beds, and the experience gained during the prevalence of scarlatina in 1887 shews that it is not large enough to receive all the cases arising in the district allocated to it, inasmuch as, after the Hospital was filled, cases to the number of 355, that should have been admitted, had to be taken to other Hospitals—a course which necessarily occasioned great loss of time and waste of labour, as well as an increased expense to the Ambulance Department. The administration of the hospital is very expensive pro rata with the number of patients: 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 considered it advisable to add considerably to the existing accommodation and they submitted that beds should be provided for at least 400 fever cases, irrespective of those to be allotted to small-pox. Application was made to the Local Government Board, with a view to the compulsory acquisition of the Lillie Bridge grounds adjoining the Ambulance Station, to the extent of four acres. Ultimately, the Local Government Board informed the Managers that there was no authority under which an Order could beissued, authorizing them to acquire land compulsorily ; and as the freeholder refused to sell, nothing could be done. Considerable opposition was offered to the proposal to enlarge the hospital, and meanwhile the London and North-Western Railway Company made arrangements for securing the land for their own purposes. By the Poor Law Act, 1889, however, as I have stated elsewhere,*' the Managers have obtained power, subject to the approval of the Local Government Board, to acquire land compulsorily for the purpose of extending the site of any of their hospitals, and it is probable that this power will be exercised in the course of the present year, with the object of enlarging the Western * Vide page 64. 51 Hospital. At any rate, plans for extending and improving the staff and other accommodation, thus materially increasing the accommodation, have been adopted by the Managers and forwarded to the Local Government Board for their approval. The proposed buildings consist of additions to the administrative block, for the accommodation of nurses and female servants, quarters for subordinate male staff, additional stores, additions to laundry, and dressing and bathrooms for nurses, &c. Four additional wards will be erected. Some 73 members of the staff, moreover, will be provided for in the new building, many of whom have hitherto been housed in temporary wooden huts in the grounds, whilst wards have been converted into sleeping quarters for nurses, so diminishing the number of beds available for patients, and giving rise to inconvenience and discomfort. The nurses', &c., dressing and bathrooms will serve as a further security against the spread of disease by the nurses leaving the hospital in infected clothing. The wood staff-huts in the grounds will be abolished. The approximate estimate of the cost of the works amounts to £8000. This question of the enlargement is one of supreme interest to the sanitary authorities of the district allocated to the hospital which, for all practical purposes, is as much the hospital of those authorities as if they had themselves erected it under the provisions of the Sanitary Act, 1866 (section 37), which confers powers on " the sewer authorities,"separately or in combination, to build hospitals or .places of reception for the sick inhabitants of their districts. The duty of providing infectious hospitals, happily, has fallen into the hands of the Asylums Board, under the provisions of the Metropolitan Poor Act, 1867, and the Poor Law Acts of 1879 and 1889, &c., much to the public advantage as well as to the relief of the sanitary authorities, who could never have properly .carried it into effect. ANNUAL REPORT OF THE MEDICAL SUPERINTENDENT. An interesting summary of the work done at the Western Hospital in 1889 is contained in the Tenth Annual Report of the 52 Medical Superintendent, Mr. R. D. R. Sweeting. No less than 1097 cases were admitted, compared with 871 in 1888; there were 871 discharges and 138 deaths, leaving 195 still under treatment at the end of the year. "The bulk of the admissions, 905, or 82 per cent., were scarlet fever, the rest being made up of 130 diphtheria, 34 enteric and 28 ' other diseases." Of the discharges, 382, or 44 per cent., were transferred as convalescents to the Northern Hospital. "The total percentage fatality was 13.15, made up of a fatality from scarlet fever of 8'86, from diphtheria of 35'82, from enteric fever of 15.62, and from 'other diseases' of 17.85. These rates compare favourably with those of 1888, and have the advantage, moreover, of being based upon even larger numbers. Most of the scarlet and enteric fever cases were admitted in the fourth quarter of the year, most of the diphtheria in the third, whilst the total number of deaths of all cases was also greatest in this quarter. Fulham, Kensington and St. George's contributed in that order the largest number of scarlet-fever cases; whilst from Kensington alone came 89, or 68 percent, of the total diphtheria admissions. Scarlet fever was " more fatal to males than to females, and more fatal to children of both sexes under five than to those over that age." The largest number of admissions was between five to ten years of age. There were no deaths above fifteen years. As to diphtheria, "about half as many females again as males were admitted, and their total fatality was one-fourth higher. The ages one to three were especially fatal, no less than 17 out of 26 children at these ages having succumbed—a case-mortality of 65 per cent. Enteric fever was much more fatal to males than to females, in the proportion of 6 to 1,"but only 34 cases were admitted. Reference is madeto 27 cases of scarlet fever which" developed symptoms of diphtheritic throat-illness, of whom 18 died." Mr. Sweeting does not" pretend to determine whether the increase of this complication in 1889 was due to the continued presence of diphtheria" in the hospital or not. The need for improved sleeping and sitting-room accommodation for the nursing staff 53 is referred to as deserviug of immediate attention: "it will be impossible to acquire or retain the services of a superior class of nurses unless this is undertaken"—as the Board fully intend, subject to the sanction of the Local Government Board to the plans already prepared, and upon the compulsory acquisition of land in extension of the existing site. From Table III. of the Statistical Committee's Report we learn that 280 Kensington patients were admitted into the Western Hospital (besides 7 admitted into other hospitals) in 1889, viz., scarlet fever 172, diphtheria 89, enteric fever 12, other diseases 7 : the deaths were 59. The total admissions from the other Parishes and Unions in the West District, allocated to the hospital, were—Fulham Union 818, Paddington 15 (in addition to 176 removed to other hospitals), Chelsea 81, St. George's Union 157, and Westminster 51. A few patients from each of the parishes, etc., were admitted into other hospitals. In addition, moreover, to the 902 patients admitted from the Parishes and Unions in the West District, 190 were admitted from Parishes and Unions in the other districts, named North, Central, East and South. Per contra, 223 patients from the Parishes and Unions in the West District (including the 176 from Paddington) were admitted into other hospitals, viz., 217 at the North-Western (Hampstead) Hospital and 6 at the South Eastern (Deptford) Hospital. PAYMENT FOR NON-PAUPER CASES IN HOSPITAL. The Asylums Board issued a return in May, 1888, of fever patients admitted to the hospitals, with and without Relieving Officers' orders, shewing that 40 percent, of the cases within a specified time had been admitted without orders. Thereupon a ratepayer expressed his intention of appealing, and he did appeal to the Auditor to surcharge the cost of the maintenance of all patients admitted without Relieving Officers' orders. The Auditor, in due course, had the matter under consideration; 54 but to avoid the delay involved in the process of getting a surcharge remitted, in the event of the Auditor making one, the Clerk to the Managers, under their authority, applied to the Local Government Board to sanction the expenditure incurred in the maintenance of such patients, under the power conferred upon the Board by section 3 of the Local Authorities (Expenses) Act, 1887, which enacts that " Expenses paid by any local authority whose accounts are subject to audit by a district auditor, shall not be disallowed by that auditor if they have been sanctioned by the Local Government Board." The Board sanctioned the expenditure, with an intimation that it was the intention of the President to introduce a Bill for the purpose of removing any doubt as to the legality of expenditure of the character indicated, had circumstances admitted of legislation in the then current Session. The Managers recognizing the importance of the step taken by the Local Government Board, informed the local authorities of the correspondence, and thereafter no further difficulty was experienced in regard to the admission of non-paupers. The President gave effect to his intention by the insertion of a clause in the Poor Law Act, 1889 (vide page 64), which provides, in a practical if not altogether satisfactory manner, for the settlement of the question, thus giving effect to the proposal made by myself and approved by your Yestry, in 1877, that the expenditure incurred in the treatment, in the Managers' Hospitals, of all cases of infectious disease, should be a charge upon a Metropolitan common fund, by whatever name called. MEDICAL INSTRUCTION. AT THE HOSPITALS. The Poor Law Act, 1889, among other valuable provisions, authorises the Managers, if they think fit, " to allow the Asylums provided by them for fever, small-pox, and diphtheria, to be used for purposes of medical instruction, subject to any rules and regulations which the Local Government Board may from time to time make " (section 4). The Managers have recently decided to 55 allow their hospitals to be so used as contemplated by the abovenamed Act; and regulations for giving effect to the plan have been approved and submitted to the Local Government Board. Arrangements will be made in the first instance at the Eastern South-Eastern, and Western Hospitals. The advantages proposed are intended for medical students, who have practically no opportunities at general hospitals for becoming acquainted with the characters and the treatment of infectious diseases, which are now almost entirely excluded from those institutions. Subject to the approval of the Local Government Board, the Medical Superintendents of the several hospitals are to act as clinical instructors, and, as remuneration for their services in this respect, are, until the Managers otherwise order, to receive such portion of the fees paid by the students as the Board shall from time to time direct, subject to the approval of the Local Government Board : moreover, the regulations will be made to apply, as far as may be practicable, to any qualified medical man who may be desirous of attending the course of study, and who shall obtain the consent of the Medical Superintendent of the hospital at which he may elect to study. The minimum period of study for students (who will be non-resident) is two months, with a minimum attendance of not less than two days in each week. Each student who satisfactorily completes the course of study, will receive a certificate to that effect, after it has been signed by the Medical Superintendent. The rules do not apply to the Small-Pox Hospital Ships at Long Reach, but probably, in the case of those ships, some provision will, under suitable rules, be made for the residence of a certain number of students. Happily, opportunities for study of small-pox at the ships are, and long have been, 011 the smallest scale. Last year only five patients were admitted. Reference to the work of the Asylums Board in 1889 may be fitly concluded by the following table, showing the number of cases admitted to the Managers' Hospitals from the several Parishes and Unions which it will be understood are not conterminous with the sanitary districts:— Table shewing Quarterly and Total Admissions of Small-Pox and Fever Patients at the Asylums Board Hospitals in 1889, and Population of the several Parishes, Unions, and Districts in 1881. Parishes, Unions, &c. Small Pox. Total. Scarlet Fever. Total. Enteric Fever. Total. Diphtheria. Total. Grand Total Small-Pox, Fever, and Diphtheria. Population in 1881. 1st. Qtr. 2nd Qtr. 3rd Qtr. 4tli Qtr. 1st Qtr. 2nd Qtr. 3rd Qtr. 4th Qtr. 1st Qtr. 2nd Qtr. 3rd Qtr. 4th Qtr. 1st Qtr. 2nd Qtr. 3rd Qtr. 4th Qtr. West District. Kensington ... ... ... 1 1 14 36 54 78 182 2 3 3 6 14 15 22 34 31 102 299 163,251 Fulham ... ... ... ... ... 13 28 94 154 289 2 1 7 8 18 2 2 5 7 16 323 114,839 Paddington ... ... ... ... ... 16 16 47 43 122 1 2 3 13 8 13 12 46 171 107,218 Chelsea ... ... ... ... ... 21 7 19 29 76 2 1 2 1 6 1 2 3 6 88 88,128 St. Georges, Hanover Sq ... ... ... ... ... 13 16 59 62 150 1 ... ... ... 1 4 3 6 4 17 168 49.748 Westminster ... ... ... ... ... 1 4 37 21 63 1 ... ... 2 3 ... 1 ... ... 1 67 1116 46,549 669,638 North District. St. Marylebone ... ... ... ... ... 23 16 31 19 89 2 ... 2 6 10 ... 2 6 9 17 116 154,910 St. Pancras ... ... ... ... ... 30 62 94 76 262 1 1 4 6 12 1 3 2 24 30 304 236,251 Hampstead ... ... ... ... ... 12 6 6 5 29 ... ... 1 1 2 3 1 6 4 14 45 45,452 Islington ... ... ... ... ... 23 35 117 109 284 1 6 13 23 43 1 3 1 15 20 347 282,865 Hackney ... ... ... ... ... 45 28 61 70 204 6 4 11 9 30 4 4 11 15 34 268 1080 186,462 905,947 Central District. St. Giles and St. George ... ... ... ... ... ... 22 9 4 6 41 1 1 2 2 1 3 46 45,382 Strand ... ... ... ... ... 2 3 11 4 20 ... ... ... 3 3 ... ... ... ... ... 23 33,552 Holborn ... ... ... ... ... 43 40 91 133 307 2 ... 1 19 22 1 3 8 6 18 347 151,835 London, City of ... ...1 ... ... ... 9 6 16 28 59 1 ... 2 ... 3 1 1 3 5 10 72 488 57,430 288,238 Shoreditoh ... ... ... ... ... 13 9 €4 112 198 1 ... 9 14 24 1 ... 13 20 84 256 126,591 East. District- Bethnal Green ... ... ... ... ... 29 11 29 25 94 3 ... 3 3 9 3 8 35 12 58 161 126.961 Whitechapel 2 ... ... ... ... 1 4 10 9 24 ... ... 1 2 3 4 11 15 12 42 72 71,363 St. George's-in-the-East ... Stepney ... ... ... ... ... 10 13 4 9 14 16 21 34 49 72 2 3 2 2 12 4 1 5 17 14 9 3 9 16 30 20 12 17 60 56 126 142 47,157 58,243 Mile End Old Town ... ... ... ... ... 2 3 29 34 68 ... 2 3 3 8 5 4 16 17 42 118 105,613 Poplar ... ... ... ... ... 26 4 16 24 70 3 2 8 23 36 3 12 19 17 51 157 1032 156,510 692.438 South District*. St. Saviour's ... ... ... ... ... 15 48 173 187 423 1 1 2 4 8 1 2 6 4 13 444 195,164 St. Olave's ... ... ... ... ... 20 21 17 43 101 1 2 7 10 1 2 1 5 9 120 134,632 Lambeth ... ... ... ... ... 77 87 118 233 515 2 ... 10 6 18 5 2 12 7 26 559 25.3,699 Wandsworth and Clapham ... ... ... ... ... 46 57 57 100 260 5 4 6 13 28 1 3 7 7 18 306 210,434 Camberwell ... ... ... ... ... 23 25 61 131 240 ... ... 3 4 7 2 ... 9 9 20 267 186,593 Greenwich ... ... ... ... ... 3 10 56 45 114 1 1 5 5 12 ... ... 3 1 4 131 131,233 Woolwich ... ... ... ... ... 1 14 8 20 43 ... ... ... 2 2 ... ... ... 1 1 46 80,845 Lewisham ... ... ... ... ... 36 11 27 39 113 ... ... 2 1 3 ... ... 1 1 2 118 1991 73,337 1,265,937 3 ... ... 2 5 602 629 1436 1894 4561 43 31 .117 180 371 84 126 282 278 770 5707 5707 In addition to the cases in the Table, 24 cases of typhus were admitted, 19 from St. Olave's, Southwark; 2 from Hackney ; and one each from Stepney, Mile End Old Town, and Wandsworth and Clapham; 42 cases of "other diseases" were admitted through error in diagnosis. At the close of the year there were remaining 1797 cases, via.: scarlet fever 1521, diphtheria 135,enteue fever 12:i typhus 9, and " other diseases" 9. 08 PUBLIC HEALTH LEGISLATION IN 1889. The year 1889 will be memorable in the sanitary annals of the Metropolis for the passing of two Acts of the highest importance—the one providing for compulsory notification of infectious disease; the other (Poor Law Act, 1889) for practically free admission to the hospitals, and for the constitution of a Metropolitan Ambulance Service. Both these Acts are deserving of more than a passing notice. Infectious Disease (Notification) Act, 1889. In my Annual Report for 1887 (pp. 88-102), I narrated the steps taken since 1881 by the Sanitary Authorities, and notably by your Vestry, with a view to legislation for the compulsory notification of infectious disease. I pass on, therefore, to state that the measure above named, which was introduced by the President of the Local Government Board, became law in August, and came into operation on the 30th October last. It provides for notification by the medical practitioner called in to attend the case, and also by the head of the family or other responsible person in the house where the infectious sick person is—the so-called dual system. In practice, where this system is operative, it is usual for the medical practitioner only to notify, and this is all that is necessary. But the system has this special recommendation, that, as by law it is equally the duty of the head of the family or other person responsible for the care of the patient to report the illness, the notification by the medical practitioner cannot well be objected to by the friends of the patient. A penalty not exceeding forty shillings is incurred by default of every person who fails to give the required certificate or the notice. A fee of halfa-crown is payable by the local authority (i.e., the Vestry) for each certificate duly sent to the Medical Officer by the medical practitioner, if the case occurs in his private practice; but one shilling only if the case occurs in his practice as a medical officer of any public body or institution. The Asylums Board, as hospital providing authority, had long desired a system of 59 notification, with a view to enable them to form an estimate of probable requirements of beds in the case of an epidemic, and the Act requires the Medical Officer of Health to forward a copy of the medical practitioner's certificate to the Managers "within twelve hours after receipt thereof," so that the Managers will henceforth have the desired information. The local authority receives repayment from the Board of the fee paid for the certificate, if the copy thereof be duly forwarded. The expression "infectious disease" means small-pox, cholera, diphtheria, membranous croup, erysipelas, scarlet fever, typhus, enteric, relapsing, continued and puerperal fevers. Power is given to the local authority to extend the definition of infectious disease by including any other infectious disease after due notice, and with the approval of the Local Government Board. The measure was passed with practical unanimity by both Houses of Parliament, and very much in the form in which the Bill was introduced. The President of the Local Government Board consented to the request of many Members to make it compulsory for the whole of England and Wales. Opposition to this proposal having been threatened, it was withdrawn, but by the desire of the Irish Members, the Act was made applicable to Ireland in like manner as to the provinces, the local authority being enabled to adopt it by resolution. Already (May) the Act has been adopted by 469 urban sanitary authorities, 331 rural sanitary authorities, and 18 port sanitary authorities, a total of 818 authorities—the number of sanitary districts being 1624. The population to which the Act applies is some 20,000,000, and thus far it has worked with remarkable smoothness. Rarely, indeed, in the history of sanitary legislation has so important a measure met with such universal approval in and out of Parliament, in professional circles and in the medical and the general press, &c. The Bill had no wanner supporters in the Lower House than amongst the most "progressive" representatives, who were quick to discern that it was framed in the best interests of all classes of the community. This remarkable consensus of support is the more surprising, considering how little progress appeared to have been made towards the ripening of 60 public opinion on the subject since 1881, when your Vestry led the van in the first great effort of the Metropolitan sanitary authorities to procure legislation; an effort which appeared to have failed completely when a similar measure was shelved, in the debate on the second reading, by a count-out, in 1883. Still, as events have proved, there was a steady, if slow, progress in the growth of opinion, and your Vestry selected a happy moment, in 1887, for approaching the President of the Local Government Board on the subject, and inducing the other sanitary authorities to endorse the request then made for the introduction of a general measure providing for notification. By a fortunate accident, Mr. Ritchie had occasion to visit and speak at Sheffield in January, 1888, when a terrible epidemic of small-pox was raging there, which served to convince him of the necessity for a measure, the passing of which will in future years be regarded as not the least of his titles to public gratitude. For myself, I shall always look back with satisfaction to the part I have been permitted to take in contributing to the success of this great sanitary movement, and with grateful recollection of the undeviating support of my efforts by your Vestry. The Local Government Board, in pursuance of the power given by Section 4, issued an order prescribing the form of certificate to be used by medical practitioners, and required to be sent to the Medical Officer of Health; they also prepared a memorandum for the information of medical practitioners, setting out the duties imposed on them by the Act. The substance of the memorandum, embodied in a circular letter of instructions, was sent by your Vestry to every medical practitioner in the Parish in October. The form of the prescribed certificate was thought to be susceptible of improvement, and the Asylums Board made representations to the Local Government Board on the subject, 61 suggesting, inter alia, that the certificate should state the age and sex of the patient. The Board, in their reply, observed that these particulars were not required for the purpose for which the system of notification was rendered compulsory, and that it would devolve upon the officers of the local authority to obtain this and such further information as might be requisite with reference to the particular case. The Board, therefore, declined to alter their Order, but said that there could be no objection to any medical practitioner furnishing such additional information as was indicated in the Managers' letter, if he were willing to do so. In the form of certificate in use in this Parish, provision was made from the first for giving the age of the patient and the address of the certifying practitioner, and such information is, always given. The Asylums Board considerately acceded to a suggestion made to them to supply to the several Medical Officers of Health a copy of the weekly return oi cases notified. For long prior to the passing of the Act, they had sent to the Medical Officer of each district a daily return of the cases for whose admission to hospital application had been made, a return which was often the first, and sometimes the only, intimation, we had of the occurence of infectious disease in particular houses. When the weekly return of cases notified was issued, the Managers decided to discontinue the daily return of cases admitted to their hospitals. This proved a serious loss, especially in view of the opinion expressed by the Local Government Board, that it is not necessary under the Act for the Medical Officer of a hospital to notify.* The Statistical Committee of the Asylums Board reported (31st March) that in January and February no fewer than 114 * Under section 3, sub-section 1, every case of infectious disease occurring amongst the inmates of any building used for human habitation must be notified, lunless such building is a hospital in which persons suffering from an infectious disease are received," or, in other words, as a natural interpretation would seem to imply, " unless such building is an infectious disease hospital But the Local Government Board expressed an opinion that all general hospitals and infirmaries are exempted by the sub-section from the necessity to notify, the effect of such exemption being that many cases were not notified at all, and the houses wherein such cases occurred were not disinfected. 62 patients were admitted into the Managers' hospitals, in respect of which no notification had been made to the Medical Officer of Health, and 41 of these cases were removed from general hospitals and infirmaries, of which there are some 130 in London. From the 28th October, 1889 to the 1st March, 1890, 657 cases were notified by the Medical Officers of these institutions, notwithstanding that some of them had not notified at all: it would be a serious thing, therefore, should the hospital authorities generally avail themselves of the exemption to which the Local Government Board hold them to be entitled. The point ought to be made clear, and if necessary the Act should be amended, as the exemption, if availed of, would have detrimental effect upon the public health. The expression of the opinion of the Local Government Board was attended with one good result, inasmuch as it led the Managers to renew the issue of the daily return of admissions to their hospitals. It was anticipated that the Managers would issue, for their own and the public information, a weekly summary of cases notified under the Act. They, however, have not thought it necessary to do so hitherto; in my monthly reports, therefore, I have summarised the returns, and I append hereto a statement of all the cases notified in the several sanitary districts, from October 28th, 1889, to the end of April, 1890, a period of six months. [While the report was going through the press the Managers passed a resolution (31st May) to the effect " That the Clerk be directed to prepare and submit each fortnight a return of tlie number of notified cases of infectious disease." 63 Cases of Infectious Disease notified to the Mbtbopolitan Medical Officers of Health under the provisions of the "Infectious Disease (Notification Act, 1889," from October 28th, 1889, to May 3rd, 1890. Name of District. Small-pox. Scarlet Fever. Diphtheria. Enteric Fever. Typhus Fever. Other Continued Fevers. Puerperal Fever. Erysipelas Croup. Cholera. Total. Population in 1881. Kensington 2 179 108 63 ... ... ... 73 7 ... 432 163,151 Battersea ... 237 120 61 ... 3 8 140 14 ... 583 107,262 Bermondsey ... ... 259 18 34 8 ... 1 60 10 ... 390 86,652 Bethnal Green ... 181 104 73 ... 3 3 69 25 ... 458 126,961 Camber well ... 2 360 149 73 1 ... 5 113 14 ... 717 186,593 Chelsea ... 1-36 50 40 ... 1 4 69 10 ... 310 88,101 Clerkenvvell ... 98 34 27 ... 1 1 •28 1 ... 190 69,076 Fulham ... 263 22 24 1 1 6 52 13 ... 382 49,900 Greenwich 2 297 8.3 49 2 2 7 102 9 ... 553 131,233 Hackney ...... 477 140 93 ... 2 9 86 25 ... 832 186,462 Hammersmith ... 223 87 28 ... 45 2 31 2 ... 418 71,939 Hampstead ... ... 98 36 13 ... 1 ... 6 ... 154 45,452 Holborn 1 72 13 15 ... ... ... 6 4 ... 111 35,258 Islington 1 534 150 126 ... 9 7 121 25 ... 973 282,865 Lambeth 1:3 654 164 80 2 34 8 152 36 ... 1143 253,699 Lewisham * 143 20 18 ... 1 ... 19 4 ... 206 53,065 Limehouss ... 101 43 34 1 4 ... 24 5 ... 212 58,513 Mile End .... 199 57 29 1 ... 2 31 12 1 332 105,573 Newington ... ... 67 3 3 ... 2 ... ... ... ... 76 107,850 Paddington ... ... 111 59 32 ... 2 3 38 2 ... 247 107,218 Plumstead 2 127 32 12 ... ... 2 31 8 ... 214 33,250 Poplar ... 260 114 92 ... 16 2 108 36 ... 628 156,510 Rotherhithe ... 1 61 47 21 ... ... 1 43 3 ... 180 36,024 Slioreditch ... 355 81 49 ... 2 6 48 20 ... 561 126,591 StGeorge-in-the-East... ... 58 32 20 ... ... 2 27 4 ... 143 47,157 St. George, Hanover Sqr. ... 61 22 22 ... 4 ... 24 2 ... 135 89,573 St. George-the-Martyr... 1 143 8 12 ... ... ... 24 6 ... 194 58,652 St. Giles, Bloomsbury... ... 31 16 23 1 1 ... 34 5 ... 111 45,382 St. James, Westminster ... 28 5 14 ... 1 1 3 ... 52 29,941 St. Luke, Middlesex ... 99 15 14 ... 1 1 32 7 ... 169 46,849 St. Martin-in-the-Fields ... 7 4 10 ... ... ... 3 1 ... 25 17,508 St. Marylebone 2 77 32 40 ... 7 3 73 5 ... 239 154,910 St. Olave, Southwark ... ... 48 3 3 4 ... ... 6 6 ... 70 11,957 St. Pancras ... 4 232 147 78 2 2 5 195 11 ... 676 23.6,258 St. Saviour, Southwark ... 76 17 7 ... ... ... 12 9 ... 121 28,662 Strand ... 13 4 5 ... ... ... 6 5 ... 33 32,587 Wandsworth... 2 159 55 41 ... 2 4 49 4 ... 316 103,172 Westminster ... ... 34 8 5 ... ... ... 18 ... 65 53,926 Whitechapel ... 1 46 24 12 ... ... 2 25 7 ... 117 70,435 Woolwich 1 42 5 3 ... 1 4 7 1 ... 64 36,635 City of London ... 65 23 23 ... ... ... 9 ... ... 120 Port of London ... 1 3 4 ... ... ... ... ... ... 8 Totals 40 6712 2157 1425 23 148 99 1997 358 1 12960 64 Compulsory Removal of the Infectious Sick.—No provision is made in the Notification Act with respect to compulsory removal to hospital of the infectious sick. This may be effected by Justice's Order, upon the certificate of a registered medical practitioner, if the patient be " without proper lodging or accommodation." But it has been held that the fitness of the lodging or accommodation is to be considered only as it affects the patient himself, and without any reference to the welfare of the other inhabitants of the dwelling-house wherein he lies. The Conference of the Sanitary Authorities, convened by your Vestry in 1881, on the subject of Notification, dealt also with this question of compulsory removal, having passed a resolution to tlie effect that the law, as it stands, is "insufficient for the protection of the public health," and should be " so amended as to empower any justice to direct the removal to a hospital ... of any person suffering from any dangerous infectious disorder, and being without proper lodging or accommodation which would enable him to be properly isolated, so as to prevent the spread of disease to other inmates of tlie same house, or to be properly treated." My own view that such an alteration of the law is necessary is just as strong now as when I drafted the above resolution. But I cannot regret that the subject was left out of the Notification Bill, as its iutroduction might have imperilled the passing of the measure. THE POOR LAW ACT, 1889. A measure with the above title, which passed the legislature without opposition, and almost without observation by sanitary authorities, contains sanitary provisions of the highest importance as affecting the Metropolis. Section 3 enables the Managers of the Asylums Board, subject to regulations and restrictions to be made by tlie Local Government Board, to receive into their hospitals non-paupers suffering from fever, small-pox, or diphtheria. The Guardians of the Union from which the patient is received, are to pay to the Managers the expenses incurred by them for maintenance, &c., but they may recover the amount of 65 those expenses, as a simple contract debt, from the patient, or from any person liable by law to maintain him. But (and here is the crucial point) " the said expenses, so far as the same are not so recoverable by the Guardians, shall be repaid to them out of the Metropolitan Common Poor Fund." It is scarcely probable (nor is it to be desired in the interests of public health) that the Guardians will take the trouble of trying to recover moneys from individuals which they can, without trouble, obtain from the Common Poor Fund. Here, then, we have the practical concession of two great principles : (1) Free admission to the hospitals of infectious sick persons in need of isolation, and (2) devolution upon the Metropolitan Common Poor Fund of all charges incurred in the maintenance of the sick. It is now rather more than twelve years since I first formally submitted reports to your Vestry and to the Asylums Board, urging the adoption of these principles. The same section (3) enables the Local Government Board to issue an order authorising the Managers to receive into their hospitals pauper-patients suffering from diphtheria. Section 4 conditionally authorises the use of the hospitals for medical instruction, an extension of the original purposes of the hospitals contemplated by the promoters of the Metropolitan Poor Act, 1867, but one now rendered necessary by the practical exclusion of infectious diseases from general hospitals. Section 5 gives the Managers full power, with the consent of the Local Government Board, to purchase such land adjoining any of their hospitals or asylums, as is required for the purposes of any such institution; and for the purpose of such purchase, certain sections of the Public Health Act, 1875, are made to apply " as if they were herein reenacted." Under the power thus conferred the Managers will probably take steps to extend the site of the Western Fever Hospital as already stated. Section 6 enables the Managers to allow their ambulances to be used for the conveyance of persons suffering from any dangerous infectious disorder, to and from hospitals and places other than hospitals provided by themselves, and to make (if they think fit) reasonable charge for that use. D G6 This Act is, in effect, the complement to the Notification Act, and in my view, not inferior to it in importance qua the interests of public health. It practically opens the hospitals to all comers without restriction, save that reasonably imposed by the Managers, viz., that no case shall be admitted without a medical certificate, setting forth the nature of the disease, and stating that the patient is fit to be removed ; or, in the alternative, without the order of a Relieving Officer. The Managers lost no time in giving effect to the Ambulance provisions, having, on the recommendation of the Ambulance Committee, resolved (30th November) :— (a) That their carriages may be made use of for the conveyance of persona suffering from "dangerous infectious disorders" to places other than the Board's Hospitals, pursuant to the power conferred upon them by section 6 of the Poor Law Act, 1889. (b) That the charge to be made for each conveyance be, for the present, 5s. {a) That discretionary power be conferred upon the Ambulance Committee to remit the charge for such conveyance when they deem it expedient in the interest of the public health. (d) That the Ambulance Committee be authorised to convey persons under exceptional circumstances to or from places outside the Metropolitan area, and to make an extra charge for the service. (e) That the Ambulance Committee be authorised to frame regulations necessary to give effect to the several decisions arrived at by the Managers. Subsequently the Managers adopted a further recommendation of the Committee, to the effect that nurses be supplied, when applied for, to accompany patients to other places than the Managers' Hospitals; a charge of half-a-crown per journey to be made for the services of each of such nurses: so that an ambulance, and the services of a nurse, for the removal of an infectious case to and from any part of the Metropolis, can now be had for seven shillings and sixpence ; whilst, by special arrangement, an ambulance with a nurse may be obtained for the removal of a patient to a place outside the Metropolitan area. 67 The Hospital and Ambulance service is admirably simple and perfect in operation. It would appear, moreover, that the Local Government Board acquiesce in the arrangements generally, for in a letter with reference to the regulations made by the Managers, they say, "as regards the removal of paupers . . . an order from a Relieving Officer or the Master of a Workhouse is requisite;" even this, however, "might be given after the patient has been received into the hospital" if "the procuring of such order prior to removal would lead to undue delay in dealing with the case." I may be permitted to mention that itis now more than four years since I first proposed to the Asylums Board to make their ambulances available, for the removal of infectious cases to other hospitals than those under their own control, and I note, therefore, with peculiar satisfaction, that more than all I dared to hope for at that time, has now been brought about by the action of the Managers in giving effect to the provisions of the new Act. Only one more thing appears to be necessary, viz., a clause to make it penal in the Metropolis to make use knowingly of a public vehicle, cab or omnibus, for the conveyance of any person suffering from a dangerous infectious disorder; such a clause would be entirely reasonable, seeing that the practice is at once full of danger to the public and altogether unnecessary and unjustifiable. An opportunity for introducing such a clause will be afforded by the Public Health London (Consolidation) Bill in the present Session. In my last Annual Report, I referred to a Synopsis of various matters relating to the extension of the duties and powers of the Managers with respect to infectious disease, which were still under the consideration of the Local Government Board, having been prepared by direction of the General Purposes Committee of the Asylums Board at the latter end of the year 1888, and a copy thereof forwarded to the President of the Local Government Board, " for his information and consideration in connection with any Bill affecting the duties and responsibilities of the Managers, which it may be his intention to submit to Parliament." This D 2 68 document was of interest, as shewing, inter alia, the willingness of the Managers to undertake the duties of a central hospital authority in regard to measures for checking and preventing the spread of infectious disease. The subjects referred to in the Synopsis were— (1.) Admission of all classes of Infectious Patients. (2.) General Conveyance of Infectious Persons to Hospital. (3.) Admission of cases of Diphtheria to the Managers'' Hospitals (4.) Compulsory Notification of Infectious Diseases. (5.) Compulsory removal of the Infectious Sick to Hospital when without proper lodging or accommodation. (6.) Compulsory Purchase of Land. (7.) Contracts with Sanitary Authorities for the Reception and Maintenance in Hospitals of Non-paupers. The objects sought to be attained in respect of (1), (2), (3), (4) and (6) have now been secured, as already explained, by the passing of the Infectious Disease (Notification) Act, 1889 (vide page 58), and the Poor Laiv Act, 1889 (vide page 64). At page 641 have dealt with the question of (5) Compulsory removal of the Sick, which still awaits settlement. With reference to (7), I have stated fully in former reports the grounds of objection to the •contract system, whilst in the present report (at page 65) I have shewn how free admission to the hospitals has now been practically provided for. I conclude this part of my report, then, as I began it, by remarking that the year 1889 will be memorable in the sanitary annals of the Metropolis for its public health legislation, the effect of which has been to elevate the Asylums Board to the position of Central Hospital and Ambulance Authority for all London. 69 HOSPITALS COMMISSION. In 1881, a Royal Commission was appointed to consider the question of Hospital Accommodation for Infectious Diseases, and I was invited to give evidence. The Commission made a number of "Practical Recommendations" in their Report (1882), which were in accord with the principles in regard to public health administration for which I had long contended. Among these may be mentioned : (1) Compulsory notification of all cases of infectious disease; (2) compulsory removal of the sick when necessary for isolation ; (3) unity in Hospital Administration, and representation of the sanitary authorities on the Hospital Board ; (4) separation of hospital treatment from all connection with poorrelief, or, in other words, abolition of distinction of Pauper and Non-pauper, in respect of the treatment of infectious diseases; (5) free hospital treatment of infectious diseases, with pay-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) provision of hospitals in the country for removable cases of small-pox, and for the reception of convalescents generally; (8) transference of vaccination arrangements to the hospital, i.e., the sanitary authority. Previous sections of this report will have shewn to how large an extent, in practice, my views have already been carried out. Parliamentary sanction, I doubt not, will sooner or later be given to those other recommendations, which are as yet in advance of the present state of public opinion. A RETROSPECT. "Reform" of Local Government, as carried out by the Vestries and District Boards, being to all appearance near at hand, it will not be out of place here 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 70 the passing of the Metropolis Management Act, 1855, supplemented as that Act has been by others, entitled " Sanitary," "Nuisances Removal," etc. The effect of these Acts, as carried out by the several local authorities, are apparent enough in the reduced death-rate, by which London compares favourably with the other 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 respectively, the death-rate in London was 24"2; 25'4 ; and 24"8 per 1000 persons living; or for the fifteen years prior to the passing of the Metropolis Management Act, 1855, 24*8 per 1000. 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; in 1861-65, 24*4; and in 1866-70, 24'3. In the next fifteen years, 1871-85, the average rate fell to 21-3 per 1000; the rate in the three quinquennial 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; in 1887, 19"6 : in 1888 it further fell to 18'5, and in 1889 it was only ]7'4, the lowest rate recorded since the present system of civil registration began. It is almost needless to observe that this remarkable decline implies the saving of many thousand lives, to say nothing of illnessesprevented. It is not in my power to furnish a similar return, shewing the results of the administration of the Acts in this Parish : there are no statistics for the period antecedent to 1856, and the figures relating to 1856- 60 are not reliable. But the statistics for subsequent years may be trusted, and these years may be grouped for comparison into quinquennial periods. The deathrate, then, in the five years, 1861-65, was 20'3 per 1000 persons living, that in 1866-70 being 20'2 per 1000. 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 iell to 71 18'9, and in the next five years, 1876-80, to 18*7. A still larger decline was observed in the quinquennium 1881-85, the deathrate in those years being 15-9 per 1000 only. If to those five years we add 1886-87, it will appear that the death-rate in the septennial period, 1881-87, was 16'1 per 1000. In 1888 the rate was 15*9, and in 1889, 13"5 only, the lowest on record. In Kensington, as in London, an eminently satisfactory improvement in the public health has taken place in regard to " preventable " diseases, i.e., diseases 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 endowed under the last-named Act with a magnificent system of hospitals for infectious diseases, organized by the Metropolitan Asylums Board, whilst under the former Act public health has been safe-guarded by provisions for preventing the spread of infectious disease, by exposure of the sick, etc., and for disinfection, etc. It is not probable that the good results of the past thirtyfour years of sanitary administration will be far surpassed in time to come ; but something may be done by legislation to facilitate the proceedings of those, authorities and officers alike engaged in the great work. In my last report, I observed that " what is most wanted is machinery, whereby a nearer approach to Unity in carrying out the provisions of law may be attained. Measures for the Consolidation of Sanitary Laws and for Compulsory Notification of Infectious Diseases, together with a settlement of the Hospital Question on the principles which I have ventured to lay down, are among the most pressing needs of the Metropolis at the present time." Compulsory notification has now been provided for by the Infectious Disease (Notification) Act, 1889; the hospital question has 'jeen practically settled by the Poor Law Act, 1889, whilst a measure, to c msolidate the Public Health Acts, to be introduced by Mr. Ritchie, will probably pass into law during the current Session. 72 POPULATION, INHABITED HOUSES, &c. 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 shew an increase, an increase in the number of people may be inferred, and vice versa. I have, however, no reliable information as to the number of inhabited houses in 1889, as compared with previous years since the census of 1881. Probably they were about 21,700 at the middle of the year. In places with stationary population, the birth-rate may serve as a guide. But this test is of little practical avail in a parish like Kensington, where it is the case that,, with a constantly increasing population, not merely the birthrate, but the absolute number of births also, has constantly declined in recent years (vide Tables I. and II., Appendix). Desirous of avoiding the error of overstating the population, I have assumed, for the purposes of the present report, that there was a small loss last year by migration outwards, thus adding only one thousand to the estimated population of 1888, although the natural increase during the year, represented by the excess of births over deaths registered, was 1286. The population then, estimated to the middle of the year, was, in round numbers, 178,000 (=81 per acre); males, 72,000, and females, 106,000 : that of the Town sub-district being, approximately, 130,000, and that of the Brompton sub-district, 48,000. The RegistrarGeneral, however, places the estimated population so high as 196,000, or 18,000 more than-1 have taken as the basis of our statistics. The most remarkable feature 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 22,000 females ; the majority now is probably not less than 34,000. Females are in excess in the population generally; in London the excess is about 12 or 13 per cent. ; in Kensington it is nearly 50 per cent. 73 The subjoined Tables shew the relative number 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 1260 8339 5472 2901 965 115 8 7,700 Females. Males 65,4.51 8832 13501 12452 10793 8397 5549 3619 1748 502 58 - 65,451 Males. Excess of Females 32,249 —79 1846 10939 8996 4209 2790 1853 1153 463 57 8 32,249 Excess of Females. Total of bothsexes 163,151 17585 28862 35843 30582 21003 13888 9091 4649 1467 173 8 168,151 Total of botnsexes (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. Miles 50,007 6969 10986 9205 7936 6404 4099 2669 1310 386 43 - 50,007 Males. Excess of Females 20,127 —17 1155 6435 5517 2592 1932 12 99 858 315 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 bothsexes 74 Kensington is still in process of development by building,, but at a moderate rate compared with past years—1861-70, for instance. 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. 1889. Gross Increase in 33 years. Estimated number of Inhabited Houses (as per rate books) 7,600 21,700 14,100 Population 57,000 178,000 121,000 Rateable Value of Property £308,000 £1,902,163 £1,584,163 The increase in all respects within the last eighteen years, the period over which my official experience extends, is not inconsiderable, as the subjoined figures shew:— 1871. 1889. Increase in 18 years. Estimated number of Inhabited Houses (as per rate books) 15,395 21,700 6,305 Population 121,000 178,000 57,000 Rateable Value £935,720 £1,902,163 £966,443 The above figures may well be said to speak for themselves : nevertheless, attention may be called to the fact that in 33 years the rateable value of property increased nearly seven-fold, and that in the last 18 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 33 years. 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 24.4 and the rateable value 1 to 16.4. 75 MARRIAGES AND MARRIAGE RATE. The marriages in 1889 were 1491, against 1605, 1561, and 1497 in 1886-7-8 respectively. Of these there were celebrated :— By the Church (73.2 per cent. of total marriages) 1092 At Roman Catholic places of worship 128 At other Nonconformist places of worship 65 At the Superintendent Registrar's Office 206 Total 1491 The marriage rate, i.e., persons married to 1000 inhabitants, was nearly 16.8. The marriage rate in England and Wales was 14.2 per 1000, corresponding with the rate in 1888, and being 0.6 below the mean rate in the ten years 1878-87. The marriage rate in London was 16.1, the lowest rate yet recorded; the five next lowest rates, moreover, being those recorded in the five immediately preceding years, 1883-7, in which the rates were successively 17.9, 17.6, 16.9, 16.6, and 16.3 per 1000. BIRTHS AND BIRTH-RATE. The births registered in 1889 were 3698—males, 1846, and females, 1852 : in the Town sub-district, 3008, and in the Brompton sub-district, 690. The births in 1888 were 3776, or 78 above the number last year, in which the births, 914 below the decennial average corrected for increase of population, were fewer by 343 than in 1872, when the population was smaller by 50,000 than in 1889. The birth-rate in Kensington, considerably lower than the London rate (30.3), and that of England and Wales (30.5), has been declining since 1868, when it was 33.1 per 1000. In 1889 it was 20.8, being 4.5 below the decennial average. The rate in the Town sub-district was 23.1 and in Brompton 14.4. There was one birth to 48.1 inhabitants and 100'3 births of females to 100 of males, a reversal of the usual proportions. The births of illegitimate children were 70 199 (six more than in 1888), viz., males 116 and females 83. Of these births, 182 were registered in the Town sub-district which includes the Parish workhouse, at which institution there were 128 births, including nine still-born, 96 of which were illegitimate. In the Parish generally, the illegitimate births formed 5'4 per cent, of total births, as against 4'7 in each of the three preceding years. The subjoined Table shews the quarterly number of births of males and females in each of the sub-districts :— Kensington Town sub-district. Brompton sub-district. Grand Total Whole Males. Females. Total Males. Females. Total. Parish. 1st Quarter 410 425 835 78 89 167 1002 2nd ,, 358 403 761 92 61 153 914 3rd „ 352 340 692 99 93 192 884 4th ,, 367 353 720 90 88 178 898 1487 1521 3008 359 331 690 3698 For particulars respecting the annual number of births and birth-rates, in the decennial period 1879-88, see Tables I. and II. (Appendix). DEATHS AND DEATH-RATE. The deaths registered in 1889, inclusive of 231 at outlying public institutions, but exclusive of deaths of non-parishioners at intra-parochial public institutions, were 2412, and 525 below the decennial average corrected for increase of population: 1933 of the deaths belong to the Town sub-district and 479 to the Bromptou sub-district. The death-rate, whole Parish, was 18.5 per 1000, compared with 15.9, 16.4 and 15.9 in the three preceding years; being 2.9 below the decennial average and 3.9 below the London rate (17.4) ; this, moreover, being 3.4 below the average (20.8), and the lowest on record. It was 4.4 below the rate in England and Wales (17.9), the lowest on record, save that in 1888 (17.8). The rate in the Town sub district was 14.9, and in Brompton 10.0, as against 17.3 and 12.1 in 1888. The rate in. 77 the male sex was 16.0, and in the female sex 11.9 per 1000, as against 18.9 and 13.9 in 1888. There was one death to every 73.8 inhabitants, as against one to 62.6 in 1888. Out of 72,000 males, 1151 died, equal to one in 62.5, against one in 52.8 in 1888 ; whilst only 1261 females died out of 106,000, or one in 84, against one in 71.8 in 1888. The deaths in the first and fourth, or colder quarters (1243), exceeded those in the second aud third, or warmer quarters (1169) by 74. In the three preceding years consecutively, the difference in favour of the warmer quarters was 320, 272 and 229. INFANTILE MORTALITY. The deaths of young children always bear a high ratio to total deaths. Last year, however, these deaths were by many fewer than usual; those under five years being 789, (386 in the first and fourth quarters, and 403 in the second and third quarters), compared with 1029, 1129, and 1077 in the three preceding years. These deaths were equal to 32.7 per cent. on total deaths, and to 21.3 per cent. on births registered : the equivalent percentages for the wholeMetropolis were 40.1 and 23.1. Under one year of age the deaths were 489 (compared with 636, 680 and 604 in 1886-7-8 consecutively), and were equal to 20.3 per cent. on total deaths, and to 13.2 per cent. on registered births ; the equivalent percentages for the whole Metropolis being 24.5 and 14.1. The deaths of illegitimate children under five years of age were 87—males 39, females 48—of which 78 were registered in the Town sub-district, as against 104, 104 and 101 in the three preceding years, and were equal to 43.7 per cent, on births registered as illegitimate. Of these 87 children, only 19 outlived their first year, 13 dying in the second, and 6 in the third year of life. The causes of death, as registered, were atrophy, debility, and inanition 17 ; premature birth 5 ; tubercular diseases,. 5; zymotic diseases, 13 (diarrhoea, 12, and diphtheria, 1); syhpilis, 9; lung diseases, 18; convulsions, 6 ; brain disease 3; diseases of the digestive organs, 2 ; violence, 5 (viz., 3 from 78 cation, 1 choked with food, and 1 from a fall) 3 from want of proper food, and 1 from skin disease. 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 causes of death. Senile Mortality.—At sixty years of age, and upwards, there were 727 deaths, against 747, 773, and 842 in the three preceding years, or 33.1 per cent. on total deaths, the equivalent percentage in London as a whole being 24'2. The Death-rate per 1000 persons living, at different periods of life, was as follows :— 1889. 1888. 1887. 1886. Under five years of age 41.1 56.4 60.0 55.0 Five and under 15 3.7 4.4 3.4 3.2 Fifteen ,, ,, 25 2.3 2.4 2.8 3.1 Twenty-five „ 35 4.2 5.2 4.4 5.5 Thirty-five ,, 45 8.8 8.7 10.0 9.5 Forty-five „ 55 14.0 15.8 15.5 14.8 Fifty-five ,, 65 27.2 28.5 32.5 29.5 Sixty-five „ 75 56.6 64.1 61.2 65.8 Seventy-five „ 85 141.1 151.6 151.6 144.9 Eighty-five and upwards 328.3 300.0 367.8 338.0 The subjoined Table shews the quarterly number 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 Males. Females. Total. Males. Females. Total. Parish. 1st Quarter 240 268 508 60 69 129 637 2nd „ 207 248 455 61 76 137 592 3rd „ 233 226 459 68 50 118 577 4th „ 246 265 511 36 59 95 606 926 1007 1933 225 254 479 2412 79 The Births were, Males 1846 The Deaths were, Males 1151 Females 1852 Females 1261 Total Births 3698 Total Deaths 2412 2412 Deaths 1286 Excess of Births over Deaths. The subjoined Table shews the rate of mortality and' the mean temperature of the air in each of thirteen periods of tour weeks corresponding with my monthly reports :— Date of Report. Death-rate per 1000 persons living. Above or below Decennial Average. Mean Temperature of tlie Air. 1889. Decennial Average. Above or below Decennial Average 1889. 10 years 1879-83. For four weeks to— Jan. 26. 15.3 20.1 —4.8 35-8° 36-6 —0.8 Feb. 23. 15.1 18.5 —3.4 38.6 39.9 —1.3 March 23 13.1 19.0 —5.9 37.9 40.7 —2.8 April 20. 13.5 18.1 —4.6 44.8 44.8 Average May 18. 13.8 15.7 —1.9 52.5 49.3 +3.2 June 15. 13.5 15.5 —2.0 59.7 56.6 +3.1 July 13. 12.6 14.1 —1.5 62.5 61.2 +1.3 August 10. 13.0 15.8 —2.8 60.5 61.5 —1.0 Sept. 7. 11.8 13.6 —1.8 59.4 59.9 —0.5 Oct. 5. 13.9 12.6 +1.3 53.4 54.7 —1.3 Nov. 2. 12.7 15.1 —2.4 48.3 47.0 +13 Nov. 30. 11.7 17.0 —5.3 44.1 42.8 +1.3 Dec. 28. 16.0 16.8 -0.8 38.4 38.9 —0.5 Averages, whole year 13.5 16.4 48.8 48.8 80 The subjoined Table, a summary of Table III (Appendix), shews the number of deaths of parishioners in each Class and Order, according to the Registrar-General's re-arranged classification :— I. SPECIFIC FEBRILE OR ZYMOTIC DISEASES— No. of Deaths. 1. Miasmatic diseases 199 2. Diarrhoeal „ 73 3. Malarial „ 4. Zoogenous „ 1 5. Venereal „ 28 6. Septic „ 16 — 317 II. PARASITIC DISEASES 4 III. DIETETIC DISEASES 18 IV. CONSTITUTIONAL DISEASES 515 V. DEVELOPMENTAL DISEASES 178 VI. LOCAL DISEASES— 1. Diseases of Nervous system 318 2. Diseases of Organs of Special Sense 2 3. Diseases of Circulatory system 188 4. Diseases of Respiratory system 470 5. Diseases of Digestive system 128 6. Diseases of Lymphatic system 1 7. Diseases of Glandlike Organs of uncertain use 2 8. Diseases of Urinary system 83 9. Diseases of Reproductive system— a. Diseases of Organs of Generation 12 b. Diseases of Parturition 7 10. Diseases of Locomotive system 9 11. Diseases of Integumentary system 3 — 1223 VII. VIOLENCE— 1. Accident or Negligence 47 2. Battle 3. Homicide 2 4. Suicide 17 5. Execution 66 VIII. ILL-DEFINED AND NOT SPECIFIED CAUSES... 91 Total 2412 81 ASSIGNED CAUSES OF DEATH. Having already (at page 12) treated of the deaths from the "principal diseases of the zymotic class," I now proceed to deal with the deaths from the remaining diseases in this class, premising that the classification of the causes of death in the Weekly Returns and Annual Summary of the Registrar-General was considerably modified in 1882. The list of causes, in its new form, is an abbreviation of the more detailed list used in the Annual Reports of Births, Deaths and Marriages in England. Table III. in my reports prior to 1882 was framed upon the lines of the abridged list of the causes in the Annual Summary, and was the basis of some of the other Tables. It being desirable that Table III. should accord with the new list used in the Annual Report, the Society of Medical Officers of Health revised certain Tables, framed at my instance, for uniformity, in 1872, and settled the forms of Tables I.—Y. as they appear in the Appendix. With this explanation, I pass on to deal with the remaining diseases in Class I.—Specific Febrile or Zymotic Diseases. This class comprises six " Orders; " the first and second, " Miasmatic" and " Diarrheal," including the diseases already dealt with (at page 12). Order 3, Malarial Diseases ; no deaths- Order 4, Zoogenous Diseases, includes Hydrophobia; one death. Order 5, Yenereal Diseases, includes Syphilis, Gonorrhoea and Stricture of the Urethra. Syphilis was the registered cause of 26 deaths, against 21, 17 and 13 in 1886-7-8. Twenty-two of these deaths occurred in the Town sub-district: 21 of them were of children under one year of age. If the truth could be 82 discovered, 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, Pyaemia, Septicaemia and Puerperal Fever, the total deaths registered being 16, against 29, 35 and 28 in 1886-7-8. Erysipelas was the cause of 8 deaths, against 7, 11 and 12, in 1886-7-8, five of them in the Town sub-district. Two of the deaths were of children under one year of age. Pyaemia and Septicaemia were the causes of 2 deaths in the Town sub-district. There were 3, 7 and 7 deaths from these causes in 1886-7-8. Puerperal Fever was the registered cause of 6 deaths, against 19, 17 and 9 in 1886-7-8 respectively; all of them in the Town sub-district. Two of the deaths were of women between fifteen and twenty-five years of age, two between twenty-five and thirty-five, and two between thirty-five and forty-five. In addition to these 6 deaths, 7 deaths (5 of them in the Brompton sub-district) were registered as having occurred in " child-birth," as against 15, 13 and 10 in the three 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 (13) were equal to 3'5 per 1000 live births, against 5-8, 7-6 and 5'0 per 1000 in 1886-7-8 respectively. Class II.—Parasitic diseases Include Thrush and other Vegetable Parasitic Diseases, four deaths; and "Worms, Hydatids and other Animal Parasitic Diseases," no death. 83 Class III.—Dietetic Diseases Were the causes of 18 deaths, 16 of them in the Town subdistrict. To Want of Breast Milk, Starvation, 4 deaths of infants under one year were classified; to Scurvy, none. Delirium Tremens was the cause of 6 deaths, against 10, 4 and 4 in 1886-7-8; Chronic Alcoholism of 7 deaths, against 10, 9 and 10. Of the 13 deaths from "drink" in 1»89, 11 were registered in the Town sub-district. It is scarcely necessary, perhaps, to remark that, if all the deaths due, directly or 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, it may be truly said, is accountable for a large part of the misery of his race. "The drink " is a 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 our National Exchequer ! Class IV..—Constitutional Diseases. This important Class comprises the causes of 515 deaths (=21'3 per cent, of total deaths), including 79 of children under the age of five years : 394 of the deaths were registered in the Town sub district, and 121 in Brompton. Rheumatic Fever and Rheumatism of the Heart caused 20 deaths, 6 of them in the Brompton sub-district; Rheumatism, 4 deaths. In fatal cases of rheumatic fever, the immediate cause of death, not infrequently, 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 84 be ascribed to rheumatism as the primary cause. But the connection 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 11 deaths (7 of them in the Town sub-district) and Rickets of 2. Cancer, Malignant Disease, was accountable for 138 deaths ; 102 in the Town sub-district and 36 in Brompton. Cancer is on the increase in the country generally : possibly, however, some portion of the increase in deaths classified to this cause may be due to more accurate diagnosis. The deaths iu Kensington from this cause in the previous ten years, were 95, 90, 112,92, 128, 117, 119, 128, 117 and 121 respectively. Deaths from cancer are usually more numerous, proportionally to population, in the Brompton sub-district, than in the relatively poorer Town sub-district. Cancer, in fact, is quite as prevalent, probably even more prevalent, amongst well-to-do people, than in the poorer classes. The parts of the body most commonly affected are the viscera or internal organs : in women, the uterus and the breast; the malady, moreover, being for the most part one of later life. One hundred and twenty of the deaths took place at ages above forty-five, and 12 between thirty-five and forty-five. It is proper to mention that in Table III. (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, Hemorrhagic Diathesis, was the cause of 2 deaths, Anmnia of 5 deaths : Glycosuria, Diabetes Mellitus, was the cause of 13 deaths, 8 of them in the Town subdistrict. The remaining diseases in this Class belong to the group designated— 85 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. General]}- hereditary, these diseases are nevertheless susceptible of considerable amelioration under improved sanitary arrangements. Scrofula is unknown in Hygieapolis! Pure air and sunlight, efficient drainage and its corollary, a dry subsoil; good food, warm clothing, and temperance in all things, are powerful antidotes to the bane of tubercle, which is fostered by dirt and squalor, by cold and nakedness, by vice and intemperance, by the want of the proper necessaries of life, by over-crowding in ill-constructed, unventilated and sewage-tainted houses, and, in a word, by whatever is inimical to the maintenance of a typical condition of health. The cases that occur amongst the well-to-do classes are frequently traceable to the influence of heredity: modern researches, however, which have thrown great light on the origin of tubercle, raise a presumption that Tuberculosis may be an infectious disease—a specific fever of slow progress with a veiled resemblance to other specific eruptive fevers, and like them depending for its origin on its own specific "bacillus " : we are encouraged to hope, therefore, that a remedy may ultimately be found for this great scourge of the human race. Tubercular diseases were the registered cause of 320 deaths (against 440, 393 and 400 in 1886-7-8), viz., 257 in the Town sub-district, and 63 in Brompton ; 76 of the deaths being of children under five years of age. The numbers in the four quarters of the year respectively were 75, 80, 93 and 72: 147 in the winter and 173 in the summer quarters. In a few instances Phthisis was returned as thecause 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 III., with those certified from "Other forms of Tuberculosis, Scrofula," the total being 38 (of which 22 occurred under five years of age) 86 including 4 registered in the Brompton sub-district. Tabes Mesenterica, popularly known as "consumption of the bowels," was the cause of 25 deaths, including 4 in Brompton, all of them under five years of age, and 18 under one year. Tubercular Meningitis and Hydrocephalus (water on the brain) were the causes of 33 deaths, 12 of them in Brompton, and 26 under five years of age. Phthisis, popularly known as "decline" or " consumption," was the cause of 224 deaths ; 3 under five years of age, 3 between five and fifteen years, and 210 between fifteen and sixty-five; viz., 25, 53, 65, 48 and 19 in the five decades consecutively: 8 deaths were registered at ages over sixty-five. The quarterly numbers were 57, 55, 58 and 54. Of the total, 181 belong to the Town sub-district and 43 to Brompton. The deaths from tubercular diseases were, as usual, disproportionately more numerous in the Town sub-district than in Brompton, a fifth of tbem only 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 subdistrict. It is probable that the deaths ascribed to tubercular diseases do not comprise all the deaths originating in the tubercular diathesis, and that many deaths of children classified to Premature Birth, Atrophy, Debility, Convulsions, &c., were primarily due to the scrofulous taint, In numerous instances some other disease, e.g., of the lungs, as bronchitis, pneumonia, &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 III., 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 Y.—Developmental Diseases. In this Class the total deaths were 178, viz., 129 in the Town sub-district, and 49 in Brompton. Premature Birth was 87 the assigned cause of 53 deaths, 17 of them in the Brompton sub-district; Atelectasis of 7—6 of them in the Town subdistrict; and Congenital Malformation of 5. Old Age was the registered cause of 113 deaths, 109 of them at ages over sixtyfive: between seventy-five and eighty-five there were 53 deaths so classified, and 29 at eighty-five and upwards. Class VI.— Local Diseases. The diseases in this Class, containing eleven Orders named after the systems or organs to which the diseases relate, were accountable for 1223 deaths, or 50.7 per cent, of the deaths from all causes: 981 were registered in the Town subdistrict-, and 243 in Brompton: 330 were of children under five years of age. 1. Nervous System.— Diseases of the nervous system were the registered causes of 318 deaths (against 302, 289 and 310 in 1886-7-8); viz., 259 in the Town sub-district and 59 in Brompton : 92 of the deaths were of children under five years of age. The quarterly numbers were 84, 84, 62 and 88. The fatal diseases were Inflammation of Brain or Membranes, 35 deaths; Apoplexy, Softening of Brain, Hemiplegia, Brain Paralysis, 167 (134 in the Town sub-district, 33 in Brompton, and 146 at ages over forty-five); Insanity, General Paralysis of the Insane, 4; Epilepsy, 9; Convulsions, 53 (all under five, and 47 under one year); Laryngismus Stridulus (spasm of glottis), 11; Disease of Spinal Cord, Paraplegia, Paralysis Agitans, 14; Other Diseases of Nervous System, 25. Convulsions as a cause of death is frequently associated, in medical certificates, with definite diseases, and with "teething." The convulsions being a symptom only, such deaths are classified to the primary 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 88 in bed." 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. The second Order comprises the Diseases of the Organs of Special Sense {e.g., of Ear, Eye, Nose). Two deaths were registered from these causes. 3. Circulatory System.— The deaths due to diseases of the organs of circulation, heart and blood vessels, were 188, against 163, 200 and 196 in 1886-7-8 : 149 were registered in the Town sub-district, and 39 in Brompton. The quarterly numbers were 56, 49, 41 and 62. To specified forms of disease 41 deaths were assigned, viz., Pericarditis, 5; Acute Endocarditis, 3; Valvular Diseases of Heart, 33. Aneurism was the cause of 8 deaths, and Embolism, Thrombosis, of 4. Other Diseases of Heart caused 127 deaths, and Other Diseases of Blood Vessels, 8 deaths. 4. Respiratory System. — The deaths from diseases of the chest, Phthisis being excluded, were 470: 152 fewer than in 1888, and 19.5 per cent, of total deaths. Of this number 390 were registered in the Town sub-district and 80 in Brompton. The quarterly numbers were 154 and 140 in the first and fourth, or colder quarters, and 108 and 68 in the second and third, or warmer quarters. The deaths under five years of age were 152=32.4 per cent, (against 35.4, 42.7 and 42.6 per cent, in 1886-7-8); and at fifty-five and upwards, 185=39.4 per 89 cent, of the whole number (against 42.4, 41.7 and 39.2 per cent, in 1886-7-8). These diseases are thus seen to be most fatal at the extremes of life. The prevalence of them varies considerably in different years, depending on the degree of cold in winter and the general character of that season: they are always most fatal when fog, especially "London fog," is associated with low temperature. The fatal diseases were Laryngitis, 12 deaths; Croup (transferred in the new classification from "miasmatic" diseases), 18; Emphysema, Asthma, 17; Bronchitis, 297; Pneumonia, 96; Pleurisy, 10; Other Diseases of Respiratory System, 20; Bronchitis and Pneumonia, therefore, were accountable for 393 deaths (including 159 under five years of age), 69 of them registered in Brompton. 5. Digestive System.— The diseases of the various organs concerned in digestion were the causes of 128 deaths; 38 of them under five years of age; 103 in the Town sub-district, and 25 in Brompton. In the new classification, Dentition is included in this Order: it was the cause of 11 deaths under five, 7 of . them under one year. Sore Throat, Quinsy (the latter disease transferred in the new classification from "miasmatic" diseases), were the causes of 2 deaths; Disease of Stomach, 8; Enteritis, 18; Obstructive Diseases of Intestines, 22; Peritonitis, 15 and Ascites, 1. Cirrhosis of Liver was the cause of 14 deaths; Jaundice and other Diseases of Liver, 21 (including 3 under one year); Other Diseases of Digestive System, 16. 6. Diseases of Lymphatic System (e.g., of Lymphatics and of Spleen).—One death. 7. Diseases of Gland-like Organs of Uncertain Use {e.g., Broncliocele, Addison's Disease).—Two deaths. 8. Diseases of Urinary Organs.— Of the 83 deaths assigned to these causes, 60 were registered in the Town subdistrict and 23 in Brompton; 3 were of children under five 90 years of age. The diseases were Nephritis, 16 deaths; Blight's Disease (Albuminuria), 40; Diseases of Bladder or of Prostate, 12 ; Other Diseases of Urinary System, 15. 9. Diseases of Reproductive System.—(a) Of Organs of Generation—Male Organs, no deaths; Female Organs, 12; (b) Of Parturition, 7 deaths, viz., from Abortion, 1; Puerperal Convulsions, 1; Other accidents of Child-birth, 5. 10. Diseases of Bones and Joints. — Nine deaths; Caries, Necrosis, 7; Arthritis, 1; Other Diseases, 1. 11. Diseases of Integumentary System.— Three deaths. Class VII.— Deaths from Violence, Sixty-six deaths, including 13 under five years of age (9 under one year), are distributed over the four Orders comprised in this Class : 10 of them belong to Brompton sub-district. 1. Accident or Negligence.—Total deaths, 50, including 6 in Brompton, and 13 under five years of age : viz., from Fractures and Contusions, 27; Burn, Scald, 7; Drowning, 1; Suffocation, generally of infants "overlaid," 12 (including 9 under one year), all but one in the Town sub-district; Otherwise, 3. 2. Homicide.— Two deaths. Murder (criminal abortion) 1, Manslaughter 1. 3. Suicide.— Of fourteen suicidal deaths, 10 belong to the Town sub-district and 4 to Brompton. Poison was the cause of death in 3 cases; Drowning in 2; Hanging in 4; Cut, Stab in 2; Gun-shot Wound in 1; Otherwise 2. Class VIII.— Deaths from Ill-Defined and not Specified Causes. This Class has acquired increased importance in the new classification, from the transfer to it of a certain number of illdefined causes of death from other positions in the old 91 cation. It includes the causes of 91 deaths; 78 under five years of age; 72 and 19 in the Town and Brompton subdistricts respectively. The Diseases named are—Debility, Atrophy, Inanition, 75 deaths (all under five years, and 68 under one year); and Hemorrhage, 1; Causes not specified or ill-defined (or such as find no place in Classes I.—VII.), 15 deaths. 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 (403), and at the Brompton Consumption Hospital (101), 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 (328), at the Brompton Consumption Hospital (8), and at outlying institutions, etc., (234), were 570, or 23.6 per cent, on total deaths, the percentage proportion of deaths in public institutions in the Metropolis generally being 23.3. The Parish Infirmary and Workhouse.— I am indebted to Mr. IT Percy Potter, Medical Superintendent to the Infirmary and Medical Officer to the Workhouse, for the statistics of mortality at these important institutions. The deaths registered in 1889 were 328, compared with 417, 391 and 352 in the three previous years, and were equal to nearly 13.6 per cent, on total deaths. Mr. Potter informs me that the actual deaths in the year were 327, the quarterly numbers being 92 90, 83, 84 and 70: so that 160 deaths occurred in the first and fourth (or cold) quarters, and 167 in the second and third (or warm) quarters. The deaths of males were 173, and of females 151. The ages at death were: under one year 27 (50 in 1888), between one year and sixty years 147 (143 in 1888), and at sixty years and upwards 153 (162 in 1888). Six inquests were held; the cause of death in one case being apoplexy and in the other five cases heart disease. Summary of Causes of Death. DISEASES. Under 1 year. Between 1 year and 60. 60 and upwards Total. Nervous System, Diseases of (including Apoplexy and Epilepsy) 2 13 41 56 Circulatory System, Diseases of ... 12 24 36 Respiratory System, Diseases of 1 26 34 64 Phthisis and Tubercular Diseases 10 62 7 79 Urinarv System, Diseases of ... 11 3 14 Digestive System, Diseases of ... 6 7 13 Enteric Fever ... 1 1 Diarrhœa 1 ... ... 1 Syphilis 3 4 ... 7 Erysipelas ... ... 2 2 Cancer ... 7 10 17 Premature Birth 4 ... ... 4 Senile Decay ... ... 22 22 Asthenia 3 ... ... 3 Infantile Paralysis ... 1 ... 1 (Edema of Glottis ... 1 ... 1 Delirium Tremens ... 1 ... 1 Puerperal Mania ... 1 ... 1 Gout ... ... 2 2 Privation ... ... 1 1 Dentition ... 1 ... 1 27 147 153 327 Outlying Public Institutions, Etc.— By virtue of an arrangement between your Vestry and a gentleman in the office of the Registrar-General, I receive, weekly, a return of the deaths of Kensington parishioners occurring in public institutions and other places outside the Parish. In Table III. (Appendix) all such deaths, 234 in number (against 183, 93 213 and 230 in 1886-7-8 respectively), are included. The deaths occurred in the following institutions, viz.:— St. Mary's Hospital 61 St. George's Hospital 33 West London Hospital 10 Middlesex Hospital 6 St. Bartholomew's Hospital 5 St. Thomas's Hospital 4 Kind's College Hospital 3 London Hospital 3 Charing Cross Hospital 1 University College Hospital 1 Brompton Consumption Hospital (south branch) 2 Western District Hospital 55 North-western,, „ 1 Cancer Hospital (Fulham Road) 3 Queen Charlotte's Hospital 3 Children's Hospital (Paddington) 13 Ditto (Great Ormond Street) 1 Children's (Victoria) Hospital 3 Poplar Hospital 1 Throat (Golden Square) Hospital 2 Heart Disease (Soho) Hospital 1 Homoeopathic Hospital 1 Great Northern Central Hospital 1 North London Consumption Hospital 1 New (Marylebone Road) Hospital for women 1 St. Elizabeth's (Gt. Ormond Street) Hospital 1 Mildmay Road Hospital 1 St. Gabriel's „ 1 St. Elizabeth's Home 1 Hoxton House Asylum 1 Surrey County „ 1 Middlesex (Wandsworth) Asylum 1 Paddington Workhouse Infirmary 2 Chelsea ,, ,, 1 Paddington Workhouse 2 Camberwell „ 1 St. Marylebone „ 1 St. Pancras „ 1 231 The deaths of three male parishioners in addition to the above were recorded as follows:— One of a person who died in a public house in Paddington; one run over and killed in Carlos Street, Grosvenor Square; and one, a publican, who died in the Serpentine. He had entered the water to commit suicide, but death appears to have been actually due to rupture of heart. The deaths at Queen Charlotte's Hospital were of children born at that institution. Deaths from zymotic diseases occurred as follows Western District (Asylums Board) Hospital 54 (diphtheria 34, scarlet, fever 19, enteric fever 1); North-western District Hospital 1 (scarlet fever); St. Mary's Hospital 1 (diphtheria); St George's Hospital 4 (diphtheria); Middlesex Hospital 1 (enteric fever); Children's Hospital, Paddington, 7 (diphtheria 5; enteric fever 1 and diarrhoea 1), and Children's Hospital, Great Ormond Street 1 (diphtheria)—total, 69. St. Joseph's House, Portobello Road.—The deaths at this quasi-public institution are included in Table III. (Appendix). They were 36 in number : males 13 and females 23. All of the deaths save one occurred at ages over sixty; 22 of them at ages 94 over seventy. Thirteen of the deaths were of persons who had been imported from other Metropolitan parishes; 14 of the deceased had previously resided in Ireland, one outside London, while six were foreigners; two were stated to be parishioners. The causes of death included diseases of the heart and lungs, 16;. diseases of the nervous system, 11; phthisis, 2; old age, 3,. and one each from Bright's disease, stomach disease, bladder disease and bed sores. 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 109, viz., males 60, and females 49. Eight of the deaths were of parishioners, and are included in Table III. (Appendix): the remaining deaths, of non-parishioners, are excluded from that Table. Marylebone Infirmary, Notting Hill.— At this hospital, which is under the control of the Guardians of the Poor of the Parish of St. Marylebone, and is even larger than our own Parish Infirmary, 403 deaths of non-parishioners were registered, all of which are excluded from Table III. (Appendix). UNCERTIFIED DEATHS. Four deaths, of 3 males and 1 female (against 25, 20 and 12 respectively in 1886-7-8), were returned as not having been certified, either by a registered medical practitioner or by a Coroner. None of them occurred in the practice of unregistered male practitioners. One of the deaths was stated to have been registered on the information of a midwife. 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 one case each, Premature Birth; 95 Convulsions; Mesenteric disease; and Wasting. The deceased were children, aged one day; twenty-eight days; four months; and two years respectively. The attention of the Metropolitan Sanitary Authorities was called, in 1887, 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 were 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 at all." The proportion of uncertified deaths has steadily declined from 4.7 in 1879 to 2.9 in 1889. The percentage varies within wide limits. In 1889 it was 1.1 per cent, in London; 0.16 in Kensington; ranging upwards to nearly 7.0 in Wales, where probably certification is often impracticable, because, by reason of the inaccessibility of the place of death, or remoteness from a doctor's residence, medical attendance cannot be obtained. In such cases, which probably constitute a large proportion of the total number of uncertified deaths, the suggested duty would be altogether impossible of performance by the Medical Officer of Health. It would take up too much space to deal exhaustively with the subject, but I may further remark, speaking now from my experience in this Parish, that, practically, all of the uncertified deaths are referred to the Coroner, and registration takes place only after the Coroner's decision that inquisition is unnecessary. The preliminary inquiry by the Coroner's officer is not satisfactory; and it is probable that in many cases in which inquisition is now made, inquiry by an expert—e.g., a Medical Officer of Health—would save the time of Coroner and jury, and some expense to the rates, if his decision that inquest was 96 necessary were accepted. In these circumstances, the Medical Officer would become practically "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 uncertified deaths; and to certify in proper cases, referring those from violence, or otherwise involving suspicion of foul play, 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 registered as "not certified," after reference to the Coroner, it cannot be doubted that inquiry and report by a Medical Officer of Health would be more satisfactory than that by a Coroner's Officer. Presumably, the deaths "not certified" in lone and mountainous districts, are not even referred to a Coroner. In some of the manufacturing towns there is much so-called "medical" practice by unregistered persons, 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 unregistered practitioners, an inquiry should be made: the dread of inquisition would tend to limit irregular "medical" practice, which, as a very general rule, must be to the public detriment. The subject of uncertified deaths has engaged the attention of the Society of Medical Officers of Health on more than one occasion, and some years ago the 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 prima facic ground for holding an inquest, direct such cases to be investigated by a registered medical practitioner." * The percentage of uncertified deaths to total deaths in 1889 was 4.2 in Hull, 4.6 in Sheffield, in Hudders field, and 5.6 in Halifax and Liverpool,—corresponding closely with the percentages in previous years. 97 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 those cases submitted to the Coroner as well as the deaths 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 first instance inquiry should be made by an expert. INQUESTS. One hundred and sixty-four inquests were held on parishioners; 110 in the Town sub-district, 31 in Brompton, and 23 at places beyond the Parish, mostly at public institutions (hospitals) to which th's deceased had been removed for treatment. Twenty of these cases belong to the Town sub-district, and 3 to Brompton. The subjects of inquest were, males 84, and females 80. The ages at death were: Under five years 48, including 35 under one year; between 5 and 60 years, 79; at 60 and upwards, 37. The cause of death is stated to have been ascertained by post-mortem examination in 112 cases. Thirteen of the subjects of inquest were illegitimate infants. The Deaths from Violence were 66, of which 10 belong to the Brompton sub-district. E 98 The grounds for holding inquests are, usually, the suddenness of death, or the circumstance that death had been caused by violence. In many instances the Coroner's returns show that the deceased had been "found dead" in bed, or otherwise. The causes of death may be classified as follows:— Deaths caused by disease - 98 Deaths caused by Violence— Accidental 50 Suicidal 14 Homicidal 2 — 66 Total 164 The fatal diseases may be classified as follows:— Diseases of the brain and nervous system (including convulsions, 9, and spasm of the glottis,6) 24 Diseases of the circulatory and respiratory systems- 50 Other visceral diseases 6 Tubercular diseases, including phthisis 4 " Syncope" 5 Zymotic diseases (diphtheria 1," Fever "1) 2 Blood poisoning (abortion); cancer; congenital malformation; malnutrition ; malassimilation of food; want of proper food; and want of care on mother's part: one death ascribed to each cause 7 98 99 The violent deaths were classified as follows:— Accident: Suffocation: of infants (in bed) under one year, 7; of infants choked with food, 2; by inhalation of chloroform, 1; otherwise, 2 12 Burns 7 Drowning 1 Fractures and Contusions (27), viz.— Run over by vehicles 6 Falls under various circumstances 17 Other injuries 4 Rupture of blood vessel in leg 2 Hydrophobia 1 50 Suicide (14): By hanging 4 By poison 3 By drowning 2 By pistol-shot 1 By cut, stab 2 By fall from window 1 On railway 1 Homicide (2): Wilful murder (by criminal abortion) 1 " Manslaughter" 1 66 The Suicidal Deaths, 14, of which 4 belong to Brompton sub-district, comprise 11 of males and 3 of females. The females, aged respectively, fifty-eight, twenty-seven, and twentyseven years, died by drowning, by hanging and by poison (oxalic acid). The causes of death in the males were : hanging 3, poison (corrosive sublimate) 2, cut throat 2, pistol shot, drowning, fall from window, and injuries on underground e 2 100 railway line, one each. Two of the deaths, one by inhalation of chloroform (suffocation resulting) and one by "overdose of morphia," not being returned as suicidal, are classified as accidental. A man aged forty, and a woman aged thirty-eight, died from rupture of a blood vessel in the leg, having been ignorant of the means of staunching the bleeding by pressure. The Homicidal Deaths registered were 2, viz.:— Of a man aged thirty-five, "manslaughter," cause of death not stated; and a woman, aged twenty-six, upon whom criminal abortion had been practised by a "herbalist" now undergoing penal servitude. Among the deaths described as "sudden," or where the person was "found dead," etc., there were, as usual, many due to curable visceral diseases; and there must have been culpable neglect of the deceased, in that medical attendance had not been procured, although the illnesses probably extended over many days, and could scarcely fail 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—and 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 in the proportion of 6.8 per cent, of the total deaths: the rate in the Metropolis was 7'6 per cent.; in England and Wales 5.6 per cent. 101 The reported deaths from different forms of violence were equal to 2.7 per cent. of the deaths from all causes in Kensington, the proportion in the Metropolis being 3 9 per cent, and in England and Wales 3.3 per cent. METEOROLOGY. The mean temperature of the air at Greenwich, in 1889 was 48.8 Fahrenheit: 0.2 above the average of 118 years and 05 below the average of 48 years: the means in the four quarters respectively were 38.2, 54.5, 58.9, and 43.5. The highest reading by day (86.6) was registered in the week ended August 3rd, and the lowest reading by night (18'7) in the week ended March 9th. The highest mean weekly readings by day, in the four quarters respectively, were 54.6, 77.2, 76.2, and 58.4, and of the lowest readings by night, 27.1, 37.4, 41.6, and 27'8. The hottest week was that which ended August 3rd (mean temperature, 64.9), and the coldest week that which ended January 5th (mean temperature, 31.8). June was the hottest month (mean temperature, 61.4); and February the coldest (mean temperature, 37.0). September exhibited the greatest range in temperature, viz., 46.1:—from 81.8 to 35.7; and October the smallest range, viz., 27.0:—from 61.9 to 34.9. Rain fell on 159 days, the total amount registered in the year being 23.29 inches, and 1.69 less than the average of 74 years. Most rain fell in October (3.93 inches), and least in November (078) The means of the readings of the barometer were 29.791 inches; the means of November, 30.043, and of October, 29 521, being, respectively, highest and lowest. The relative proportion of wind was: north, 93; east, 71; south, 111; and west, 90. VACCINATION. Table X (Appendix) is a return respecting vaccination in 1888, compiled by Mr. Shattock, the Vaccination Officer, whose energetic discharge of the duties of his appointment it is always 102 a pleasing duty to recognise. The return shews a loss of six per cent, in the cases, against 4.6, 5.4, and 5.9, respectively, in the three preceding years, "from removal of children to places out of Parish unknown, or which cannot be reached, and cases not having been found." In the Metropolis, as a whole, the loss is somewhat greater than in Kensington. In England and Wales, as we learn on the authority 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, shews no sign of abatement, and as their teaching is calculated to prejudice the general public against the wise compulsion authorised by law, it is well that the Government have appointed a Royal Commission to inquire and report on the subject, the anti-vaccinationists being represented thereon The final report of the Committee will be awaited with interest. Animal Vaccination: Calf Lymph.— An objection to "arm-to-arm" vaccination has been 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 103 made arrangements for affording to parents the option of having their children vaccinated with calf-lymph at the public vaccination stations. This option has long been given at the stations in Kensington, the Guardians having made arrangements for a supply of fresh calf-lymph weekly, on the days appointed for vaccination. The Government at present only supply 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 1000 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 the cases; it follows that the protective influence of vaccination cannot be fully and universally obtained, excepting by the use of lymph taken direct from a vesicle, whether human or animal. 104 SANITARY LEGISLATION. Before entering upon customary details of the work of the Inspectors, under the Nuisances Removal and other Acts, I may refer to a "Special Report on Sanitary, Nuisances Removal, and other cognate Acts," by the Law and Parliamentary Committee. It was the outcome of an enquiry, on reference by your Vestry, "Whether the provisions of the various Acts have been and are being enforced by the Vestry as fully as the circumstances of the Parish demand ?" If not, they were to "advise as to the steps it is desirable to take for their better enforcement; and also, whether any amendment of the law may appear necessary." The first step taken by the Committee was to obtain reports from the Surveyor and the Medical Officer of Health, "with respect to any special matters which in their judgment have not hitherto received, but which should receive, the attention of the Vestry." 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 Vestry, were published and widely circulated. It will suffice, therefore, to say, for my own part in the matter, that attention was frankly called to all of the points which appeared to me to require consideration, whether regard be had to failure to exercise existing powers or to the need for additional powers. The Committee expressed their views on each point raised, and made valuable suggestions in regard to "better enforcement" of the law, and to the need for "amendment of the law." Their conclusions, however, were reassuring, for they found that "the Acts referred to are, upon the whole, satisfactorily administered in Kensington," and that the Acts 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 with the following subjects:—1. The Housing of the working classes. 2. Underground rooms. 3. Construction of drains. 4. Inspection of drains, &c. 5. Power of Vestry to cause work to be done at owner's 105 pense. 6. Vestry'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. Consumpton of smoke. 13. Periodical removal of manure and other refuse matter. 14. Trade refuse. 15. Infectiousdisease hospitals: Ambulances. 16. Disinfecting chamber. 17. Defective enforcement of Sanitary Law. 18. Amendment of Law ; summary powers needed. The Committee's report was adopted by your Vestry (January 8th, 1886), and, subsequently, a joint report by the Committee and the Works, &c., Committee, "as to the best means to be adopted for carrying out the recommendations" contained in the Law Committee's report. The said reports were communicated to the several Vestries and District Boards, and met with considerable approval. They were also forwarded to the Metropolitan Board of Works with a request that action might be taken to obtain amendment of the law in certain respects. The Board, however, "while fully recognizing the importance of the suggestions contained in the ably-prepared documents," "regretted that, in view of the wide range of subjects which are sought to be dealt with," it was not prepared to "proceed to legislation in the direction indicated." THE COUNTY COUNCIL AND BYE-LAWS. In the Special Report above adverted to, I drew attention to the powers of the Metropolitan Board under section 202 of the Metropolis Management Act, 1855, to make Bye-laws for the guidance of the Vestry with respect to house drainage; and, under section 138, with respect to the construction of sewers. The Law and Parliamentary Committee, commenting upon my observations, in their Special Report, expressed the opinion that, the said powers might be exercised with advantage, and recommended that the attention of the members representing 106 sington at the Board be called to the subject, with a view to their advising the Board to exercise the powers conferred by the Act. I further drew attention to the fact that under section 202 (d) the Board had power to make Bye-laws for " works of cleansing and of removing and disposing of refuse," which, I thought, might "cover the removal of refuse from houses and other premises," and so "enable the sanitary authority to deal with the difficult subject of the removal of trade refuse of an offensive character produced upon the premises of fishmongers, poulterers, greengrocers, &c." The Committee recommended that the attention of the Kensington members of the Board be requested to the further question, Whether the Board's power to make Bye-laws for the above purposes might not be exercised so as to assist the sanitary authorities in the removal of refuse of an offensive nature ? The Members representing your Vestry on the Board did as requested, but their representations produced no effect. The powers of the Board having devolved upon the London County Council, and it appearing to your Vestry undesirable that the work of the two Committees should fall to the ground, fruitless, it was resolved, at a meeting in April (1889), to reprint the two Reports, and to forward them, together with the reports of the Surveyor and of the Medical Officer of Health, to the Council and to the several members thereof. The Reports were forwarded on the 3rd May; the covering letter stating that "the Vestry, believing that legislation framed upon the lines of the suggestions" (contained in the Reports) "would be conducive to the interests of public health in the Metropolis, earnestly hoped that the Reports would receive early consideration from the Council." Shortly afterwards a circular letter (dated 10th May) was received from the Sanitary and Special Purposes Committee of the Council, requesting to be informed whether your Vestry had made Byelaws "-in pursuance of Section 202 of the Metropolis Local Management Act, 1855," for any of the purposes therein referred to, under headings marked respectively (a) (b) (c) and (d) ? The 107 heading (c) relates to house drainage; the heading (d) to cesspools and privies and "other works of cleansing and of removing and disposing of refuse." The answer returned was to the effect that "no such Bye-laws have been made by the Vestry, for the reason that the Vestry have no power to make such Bye-laws. The power originally vested in the Metropolitan Board of Works," it was added, to make Bye-laws for the purposes named, "now vests in the London County Council only." The attention of the Committee was drawn to your Vestry's letter of May 3rd, covering the above-mentioned reports, and special attention was directed to the paragraphs dealing with the subject of Bye-laws. "One of the objects" of your Vestry's communication, it was stated, "was to press upon the Council the desirability of the exercise by it of the powers conferred by the 202nd section to frame Bye-laws." The Committee are fully sensible of the importance of this subject, for in their Annual Report for 1889-90 they expressly say that they "consider it to be of the greatest importance that a complete and satisfactory code of sanitary Bye-laws should be made they add, however, that they have "met with great difficulties in formulating such Bye-laws, on account of the limitations put upon them by the terms of the sections," i.e., section 202 of the Metropolis Management Act above mentioned, and section 23 of the Municipal Corporations Act, 1882. The 16th section of the Local Government Act, 1888, gives the Council the power of making Bye-laws under that Act, "for the good rule and government of the County or any specified part thereof, and for the prevention and suppression of nuisances not already punishable in a summary manner." The Committee are giving careful consideration to the subject, and hope it will be possible shortly to prepare Bye-laws which will meet with the approval of the Council, "but under existing laws much doubt if this will be practicable." Accordingly they have suggested the incorporation in the Public Health London (Consolidation) Bill, which Mr. Ritchie proposes to introduce in the present Session, of a more unrestricted power to the Council to make Bye-laws of this nature, " and should this suggestion become law, the 108 Council will undoubtedly be in a position to prepare Bye-laws which will, if uniformly enforced throughout the County, prove to be a valuable addition to the sanitary regulation of London." I may, perhaps, be permitted to add that, in an Address which I delivered before the Society of Medical Officers of Health, in October, 1884, I dwelt strongly upon the importance of Byelaws being framed under the provisions of section 202 of the Metropolis Management Act, 1855, and that in April, 1889, I sent a copy of the Address to each member of the Council. In their Annual Report, the Sanitary Committee say that they " cannot too strongly emphasize their opinion that the London County Council should be empowered to frame Bye-laws for the proper sanitary government of London; that the new District Councils, or the existing local bodies, should put them in force, and that the County Council should be the supervisory body to see that they are properly carried out," a Scheme which corresponds closely to my proposals in the Address above adverted to wherein I advocated, with the view to bringing about— Unity in Sanitary Administration, the establishment of a "Central Board 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 passing bye-laws, &c., and generally to exercise a supervisory control over the work entrusted by the Local Management Acts to the Vestries and District Boards." The Central Board, I added, "would, so to say, be legislative in its functions, the Local Boards executive, and thus substantial unity might be attained with a minimum of change."* With regard to the present state of Sanitary Administration in the Metropolis, the Sanitary Committee of the County Council with the courage of youth, assert that until the halcyon days of * Inaugural Address on Metropolitan Sanitary Administration delivered before the Society of Medical Officers of Health, October, 1883. 109 District Councils arrive "it must remain incomplete, and entirely unsatisfactory," because the existing local authorities are "practically uncontrolled, and no machinery exists for ensuring any uniformity in the different parts of the county." No one regrets more than myself the lack of present means to ensure uniformity; but to say that the sanitary administration of London is "entirely unsatisfactory" is to assert that which is contradicted by many patent facts, to some of which I have alluded in the Retrospect (1856-1889) at page 69. And whilst it is not open to question that sanitary administration is capable of improvement, the local authorities generally, can present a great record of good work effected under powers which the County Council itself finds inadequate to give effect to its own wishes, teste the foregoing observations of the Sanitary Committee on the subject of bye-laws. Much more doubtless will be done with the additional powers that are likely to be conferred on District Councils; but it is scarcely in the spirit of fairness to criticise sharply defects of administration which are admittedly in large measure the result of defects of law. Too much importance, however, must not be attached to the reports of the Committees of the Council. Annual Report of the Council itself, as required by law (Metropolis Management Act, 1855, sec. 200), signed by chairman or clerk, practically there is none; for the interesting Addresses of the chairman summarising the year's work of the Council* have no official validity; and the several Committees, whose reports are interesting and even valuable in the main, though they have authority to act in the matters referred to them, have, after all, but a delegated authority, without the right or the power, separately or in combination, to speak with the voice of the Council. Unfortunately for the local authorities these facts are unknown to the public who have been aught for many a long year to underrate work of the nature and extent of which they are for the most part supremely ignorant. * "A Review of the past year's work of the Council, in a series of Addresses delivered by the Earl of Rosebery, Chairman of the Council, in April and May, 1890 (printed by order of the Council)." Copies of this Review were sent to the Vestry Clerk, by order of the Council, for distribution among the members of the Vestry ; but the Vestry made request to the Council for copies of the "Annual Report of the Proceedings of the Council" to be sent in accordance with the established use of the Metropolitan Board of Works. The request could not be complied with " so few copies having been printed." 110 SANITARY ADMINISTRATION: THE VIEWS OF THE PRESIDENT OF THE LOCAL GOVERNMENT BOARD. The need for improvement in Sanitary Legislation and in Sanitary Administration has not escaped the attention of the President of the Local Government Board, who, in the House of Commons, in March, made a statement indicating the views and intentions of the Government in regard to these matters, especially in connection with the Housing of the Labouring Classes. Premising that it was "not so much legislation that was wanted as a reform of administration," Mr. Ritchie nevertheless admitted that "much still remained to be done, in the way of legislation, to give effect to the Report of the Royal Commission of 1885, by means of the consolidation and amendment of the Sanitary Acts." He hoped, but was unable, to bring in a Bill in the then current Session, which presumably would have been drawn on the lines of measures introduced by Mr. Sclater-Booth in 1877, and by Lord Salisbury in 1885, under the title Public Health (Metropolis) Bill. The first measure was opposed by the sanitary authorities, and was withdrawn ; the second was brought in too late in the Session to be passed. Your Vestry, upon my recommendation, requested Lord Salisbury to re-introduce the Bill, in the Session of 1887. In acknowledging the communication his lordship expressed fear that "the chances of any such measure becoming law were then very remote." The chances have much improved, and it is probable that the Consolidation Bill, which is to be introduced in the present Session, will become law.* Your Vestry's Law and Parliamentary Committee reported on the 1885 measure as being " mainly a Consolidation Bill, but with a few amendments recommended by the Royal Commission on the Housing of the Working * It may be mentioned that Mr. Ritchie forwarded the draft of his proposed Consolidation Bill to the sanitary authorities and others, inviting suggestions thereon. The Bill had not been introduced when this report was passing through the press (in June). 111 Classes." They observed that "it does not in any way touch the Metropolis Local Management Acts" (as in some respects the new Bill will), "but as it will finally clear the Statute Book of 14 Statutes, all of which are already repealed as regards the rest of England, it cannot fail, if passed, to prove very useful to sanitary authorities and sanitary officials alike." * Mr. Ritchie quoted with approval an observation by Lord Shaftesbury that the Labouring Classes Lodging Houses Acts (1851 to 1885) known as "Lord Shaftesbury's Acts," would, "if properly carried out, meet almost every requirement in regard to the Housing of the Working Classes, and remedy a great part of the existing evils": he added, however, that although the Housing of the Working Classes Act, 1885, had made the administration of the Acts metropolitan instead of parochial, nothing had been done. This statement is almost equally true at the present time. The Law Committee, in the report cited above, commenting on my Special Report of March 13th, 1885, expressed an opinion that these Acts "could be dealt with satisfactorily only by an authority having power to consider the requirements of the labouring classes in London as a whole." Such an authority is the London County Council, which has shewn its interest in the question by appointing a Housing of the Working Classes Committee, whose first report (dated March 12th) intimated that they had "caused an abstract of the Acts relating to the Housing of the Working Classes to be made, with a statement as to the extent to which the powers have hitherto been exercised by the Metropolitan Board of Works and other local authorities." This Committee have given much attention to the subject, but their labours have not at present had much practical effect. Mr. Ritchie stated that Lord Shaftesbury's Acts enable the Council to "hire, purchase, erect, furnish, manage, and let houses as lodgings for the working classes," a course, as we shall see, that the County Council have decided to adopt, so far as to erect a model common lodging-house. The Council, he * Special Report on Sanitary, Nuisances Removal, and other cognate Acts : January 8th, 1886, page 16. 112 added, would also have power to carry out the Artizans' Dwellings Acts, 1868 to 1885 (Torrens's Acts), which deal with small unhealthy areas—e.g., courts and alleys—with single houses, and with "obstructive buildings," which may be demolished. The Metropolitan Board, it may be added, had this power, but never exercised it. The Acts are complicated. By consolidation and amendment, their operation might be made more speedy and more effectual.* As regards single houses, the power conferred upon the Justices by the Nuisances Removal Act to close a house unfit for human habitation, until specified works of reparation shall have been carried out, would probably suffice for sanitary purposes, especially if reinforced by a provision corresponding to section 96 of the Public Health Act, 1875, which enables the Justices to inflict a substantial penalty on the person responsible for the creation of a nuisance. The Council have power to deal with large unhealthy areas under Lord Cross's Acts (Artizans1 and Labourers' Dwellings Improvement Acts, 1875 to 1888), to which the Metropolitan Board some years since gave extensive effect, having carried through 22 " Schemes," whereby 59 acres of land were acquired and cleared, on which accommodation has been provided for 38,231 persons of the working classes. The amount expended by the Board in giving effect to the Acts exceeded a million and a half sterling (or about .£40 per head of the population -rehoused); this being irrespective of the outlay on model dwellings erected on the cleared sites by such bodies as the Peabody Trustees. The Board, after taking necessary steps for giving effect to eight additional Schemes, stayed proceedings under the Acts on account of the enormous cost to the ratepayers of the Metropolis involved in carrying tliem into effect, t It has been alleged that a * Bills for consolidating and amending these Acts, brought in by Mr. Ritchie, were read a second time, June 24th, while this report was passing through the press. f The County Council will probably deal with two of these schemes. With respect to the others, they appear to have intimated to the sanitary authorities of the several districts, comprising the insanitary areas, that, in their opinion, the said areas can be dealt with under Torrens's Acts. 113 third of the cost of acquiring the sites was due to excessive valuation of property so bad that demolition was the only possible remedy for the evils to which it gave occasion. Provision against a repetition of this excessive compensation has been attempted to be made in amending Acts passed in 1879, 1882, and 1885.Under Cross's Acts the owners of insanitary dwellings have hitherto received more than the fair market value of their property. In this respect, they have been better off than the owners of houses dealt with under Torrens's Acts, for these may be required to demolish them without compensation; a course for which, but too often, justification might have been found in the condition of houses dealt with under Cross's Acts. THE COUNTY COUNCIL AND THE HOUSING OF THE WORKING CLASSES. The Housing of the Working Classes Committee of the Council are desirous of working Cross's Acts and Shaftesbury's Acts together, by building lodging-houses under the lastnamed Acts upon sites cleared under the first-named Acts—a desirable course, doubtless, if the necessary consent of the Home Secretary can be obtained. In my last annual report I observed that it would be well should it be possible for the Council to enter into competition with the owners of insanitary property, by providing decent homes for the working classes at a moderate but remunerative rent under Lord Shaftesbury's Acts. The Council shortly afterwards (July 2nd) agreed to a report of the Corporate Property, Charities, and Endowment Committee, in which the Housing of the Working Classes Committee concurred, recommending the Council to build houses at a cost of £40,000, to accommodate 1800 persons of the working classes, on a portion of the land at Deptford (" Hughes-fields area "), six or seven acres in extent, acquired by the late Metropolitan Board of *Such provision probably would not have proved very efficacious, but the proposals of Mr. Ritchie in the Bill referred to in the previous footnote (at page 112) are likely to be effectual. 114 Works under the Artizans' Dwellings Acts, and under a Provisional Order confirmed in July, 1885. But, at a later period, the Housing of the Working Classes Committee, having inspected the site— the Home Secretary, moreover, having refused his sanction—they arrived at the conclusion that the decision of the Council should be reconsidered; and on their recommendation (in December), it was resolved to advertise the land in the usual way, subject to the condition of the erection, in a manner approved by the Council, of buildings affording accommodation for the number of persons fixed by the Home Secretary, and to dispose of the remainder of the site as surplus land. The Housing Committee in the same report (December 9th) informed the Council that after full consideration they had resolved that it was desirable that municipal common lodginghouses should be erected by the Council in approved situations, and would report on the whole matter as soon as they were in a position to make a specific recommendation. Accordingly, in March last, they did report in favour of the scheme, on the lines of the system in vogue at Glasgow. For persons in the lowest ranks of the labouring classes nothing better, perhaps, could be devised. In that city " the lowest class of the population, the waifs and strays, too poor or too improvident to be able to rent houses, are provided with furnished, airy lodging-houses, with large day rooms, lavatories, &c., where each has a separate clean bed, at the charge (including use of cooking range and utensils) of 3½d. per night; and these institutions are so managed as to be self-supporting, including 5 per cent. interest on the capital."* This would be an improvement upon our common lodging-house system, administered under the supervision of the police, and which I once heard Lord Shaftesbury commend as " the perfection of sanitary administration as applied to the housing of the poor." * Memorandum by Mr. (now Lord) Gross, Home Secretary, in the Supplementary Report of the Royal Commission on the Housing of the Working Classes, 1885 (page 66). The facts stated are more than borne out by the Housing of the Working Classes Committee of the Council in their report, dated 31st March last, as the result of inspection of this system by members of the Committee 115 After full debate at a subsequent meeting, the Council adopted recommendations of the Committee to the effect:— (a) That the Council, subject to an estimate to be approved by the Finance Committee, do forthwith undertake the erection of a model lodginghouse, to accommodate from 300 to 350 persons, on a plot of vacant land now in possession of the Council, in the Shelton Street (St. Giles') area. (i) That application be made to the Secretary of State, as the confirming authority, and if need be to the Local Government Board, for sanction to the appropriation of so much of the vacant site in question as may be required for the purpose. (c) That it be referred to the Housing of the Working Classes Committee to give effect to the above recommendations, with power to vary the plan and design of the proposed building, and, if found expedient to substitute a fresh one, involving no greater cost. The result of the new departure thus taken by the Council will be awaited with much interest. The Report of the Committee, containing the above recommendation, furnishes other indications of the lines on which the Council, through the Committee, will attempt the solution of the vexed question of the Housing of the Working Classes, especially those of the lower grades. The comprehensiveness of the report may be inferred from the title headings of its several parts, viz.:— 1. As to the means available for securing the sanitaiy condition of existing dwellings. 2. As to the provision of further and better accommodation for the working classes in the Metropolis, considered with reference to—- (a) The re-housing of persons displaced by clearances or improvements. (b) The further provision of accommodation to meet the increase of the population. (c) The provision of "clean, healthy homes for people poorer than those who at present avail themselves of the existing artizans' dwellings," referred to under the heads— (i.) Unfurnished tenements and small cottage tenements, (ii.) Furnished tenements; and (iii.) Common lodging-houses. 116 It is impossible to give a just idea of the full scope of the report in a brief abstract, but it may be stated that the Committee, with regard to (1), recognize the impossibility of relieving, to more than a very limited extent, the present unsatisfactory condition of things, by the provision of fresh accommodation for the working classes, in the form of model dwellings, whether undertaken by philanthropists or public bodies : the bulk of the people must live in existing houses and be dependent on others for the enforcement of sanitary conditions. They are satisfied that Torrens's Acts are ineffectual for clearing out slums or for remedying the work of jerry builders in the hands of the local authorities, who rest content with " improvements " and " patchings-up," when the only practical remedy is demolition. Usual reflections are passed upon " unwilling or interested " Vestries, the remedy proposed being concurrent power to enable the Council to enforce the provisions of Torrens's Acts.* Cross's Acts suffice for dealing with large areas, but operation involves "more or less cost and delay." Approving reference is made to the letter of the President of the Local Government Board (vide page 119), on the assumption that the local authorities neglect their duty of preventing premises unfit for habitation from being inhabited; of preventing overcrowding, and of securing the demolition or improvement of insanitary dwellings. I have dealt with the difficulties of the sanitary authorities in my report on the subject of Mr. Ritchie's letter, &c. (page 122) and will, therefore, only add here that with enlarged experience the Committee will see cause to modify their views and soften their strictures. They hit a distinct blot in sanitary administration, however, in reference to the paucity of Sanitary Inspectors, and recommend, what we try to carry out, regular inspections of working-class dwellings; they also recommend what I have for years * In their annual report, the Committee refer to the unworkability of these Acts. " The local authorities are averse to take action " under them, and " with some justice, as superficial repairs to insanitary houses may be considered sufficient by the justices, to whom an appeal is made by the owner of the property, and thus little result is effected." 117 been trying to bring about, viz., an uniform code of regulations, for houses let in lodgings, for the whole Metropolis. The subject (2) " further and better accommodation for the working classes," is fully treated under headings dealing with (a) re-housing of persons displaced by clearances and improvements; (b) provision to meet the increase of the population, which involves the question of increased railway travelling facilities; and (c) the better housing of the poorest classes, including those who use common lodging-houses—matters with which the local sanitary authorities have no power to deal, but in regard to which the Committee make recommendations; the sub-section (c) being referred to under the headings : (i.) unfurnished tenements of an inferior description and small cottage dwellings; (ii.) furnished tenements or lodgings; and (in.) common lodging-houses. Suggestions are made indicating, inter alia, approval of the " ticketing" system, in relation to the lowest class of lodging-houses, in vogue at Glasgow; but the only practical recommendation made is that already referred to, for the erection of a model common lodging-house in St. Giles's district. The information with respect to the municipal common lodging-houses at Glasgow, obtained by the Committee during their visit, is at once full, interesting, and encouraging to the experiment now about to be tried, and which, in my last annual report (page 132), I ventured to advocate. The Labouring Classes Lodging-Houses Acts combined with Cross's Acts and worked together, will enable the Council to give a fair trial to the system, which seems to me to afford the best prospect of bringing about a practical solution of the difficult questions dealt with in the able report of the Committee. Lord Shaftesbury's Acts.—The County Council, upon the recommendation of the Housing of the Working Classes Committee, decided, in March last, to adopt for the County of London the Labouring Classes Lodging Houses Acts, 1851 to 1885, and application was in due course made to the Home Secretary for his approval of the course taken. On the 21st March, the Home Secretary signified his formal approval of the adoption by the 118 Council of the Acts in question. These Acts enable the Council (as local authority) to erect, purchase, or hire houses, etc., either within or without the Metropolis. The question will naturally arise, therefore, as I observed in my last annual report, whether something might not be done to remedy the evils of overcrowding, by schemes providing for the migration of numbers of the people to workmen's towns a little way out of London, where land is less costly—a plan which, with a service of cheap trains, should be practicable. The carrying out of Cross's Acts in London must needs be a costly procedure at all times, and probably much more so than schemes for migration; which, by lessening the present excessive demand for lodgings, might lead to reduction in rents, and thus enable the poorer classes to obtain more and better accommodation. A rent equal to that paid for a model lodging in London would probably provide a remunerative return for the outlay on a cottage and garden within a moderate train-distance of the centre of the Metropolis. By a large scheme for migration, overcrowding might be diminished, and with it preventible disease resulting from this, the most perilous of insanitary conditions. The model dwellings erected on the sites cleared under Cross's Acts are not tenanted to any large extent by the poorest grades of the labouring classes, those who have been displaced by the clearings. Clerks, and superior artizans able to command constant work, commonly occupy these healthy homes. Plenty others of the like class would doubtless be forthcoming were the accommodation greatly extended. These, however, are the classes for whom it might be practicable to provide out of London. Emigration would seem, at first sight, to be an obvious means of reducing overcrowding, and, the Government have appointed a Committee to inquire into various schemes which have been proposed of State-aided emigration from congested districts of the United Kingdom (London included) to British Colonies and elsewhere; to examine the results of schemes that have had a practical trial, and to report generally on the means and conditions under which such emigration may be best carried out, and the 119 countries to which it should be directed. That emigration would be a boon to those who may be assisted to leave this overcrowded Metropolis goes without saying; but it must be borne in mind that immigration might, and probably would, neutralize the good effects anticipated from the exodus. The estimated annual increase of the population of London in the eight years, 1881-9 was 65,000. The annual excess of births over deaths accounts for 52,000 only, the remaining number, 13,000, being due to immigration, which probably would increase in extent when it became known that better prospects of work were being opened up by a Government scheme of emigration. THE LOCAL GOVERNMENT BOARD ON THE DWELLINGS OF THE LABOURING CLASSES. The President of the Local Government Board addressed a circular letter, in December, to the several local authorities in the Metropolis, dealing with the above subject, as follows:— "Local Government Board, "Whitehall, "2nd December, 1889. "Sib, "The Local Government Board have had under their consideration the great and pressing question of the housing of the labouring classes. They cannot avoid the conclusion that a large number of the working population of this country are at present housed in tenements which are either unfit for human habitation or in such a condition as to be distinctly prejudicial to the health of the inmates. There can be no doubt of the gravity of the evils which result from the insanitary condition of the dwellings of the poor, or of the ability of the local authorities, by a strenuous and judicious exercise of the powers which the Legislature has conferred on them for this purpose, to effect a very material improvement in the present condition of these dwellings. The Board deem it right, therefore, again to bring especially under the attention of the local authorities of the Metropolis the duties which are imposed on them by the Housing of the Working Classes Act, 1885, and the large powers which they possess under the Nuisances Removal Acts and other statutes in relation to this matter. "Section 7 of the Housing of the Working Classes Act, 1885, which was enacted in accordance with a recommendation contained in the report of the Royal Commission on the Housing of the Working Classes, expressly declares that it shall be the duty of every local authority entrusted with the execution of 120 laws relating to public health and local government, to put in force from time to time, as occasion may arise, the powers with which they are invested, so as to secure the proper sanitary condition of all premises within the area under their control. "Since the date of their first constitution in 1855, the Metropolitan Vestries and District Boards have had the power of taking summary proceedings for the closing of houses unfit for human habitation, and for the abatement of overcrowding in any house in their district. Section 134 of the Metropolis Management Act, 1855, made every Vestry and District Board under that Act the local authority to execute the Nuisances Removal Act, 1855; and Section 20 of the Sanitary, Act, 1866, expressly declared that it should be the duty of the local authority to make from time to time, either by themselves or by their officers, inspection of their district, with a view to ascertain what nuisances exist calling for abatement, and to enforce the provisions of the Act of 1855 and of the other Nuisances Removal Acts, for the purpose of securing the abatement of nuisances. " Similar powers and duties have devolved on the Commissioners of Sewers of the City of London and the Woolwich Local Board of Health. "The word 'nuisance' includes 'any premises in such a state as to be a nuisance or injurious to health,' and 'any house or part of a house so overcrowded as to be dangerous or prejudicial to the health of the inmates.' " If, after notice from a local authority, a nuisance is not abated, or if, after notice, it is discontinued, but is, in the opinion of the local authority, likely to recur on the same premises, it is their duty to institute proceedings before Justices. The Justices are empowered by their order to require the person on whom the order is made to do such works and acts as are necessary to abate the nuisance complained of. If they consider that the same or a similar nuisance is likely to recur they may further prohibit its recurrence, and direct the execution of the works necessary to prevent such recurrence, and if, in their judgment, the nuisance is such as to render the house unfit for human habitation, they may prohibit its being used for that purpose until it is rendered fit for habitation, and in that case the house may not be let or inhabited until, by a further order, the Justices have declared that it is habitable. "As regards overcrowding, in cases where a house is inhabited by more than one family, section 29 of the Nuisances Removal Act, 1855, provides that whenever the Medical Officer of Health shall certify to the local authority that any house is so overcrowded as to be dangerous or prejudicial to the health of the inhabitants, and the inhabitants shall consist of more than one family, the local authority shall cause proceedings to be taken before the Justices to abate such overcrowding, and the Justices shall thereupon make such order as they may think fit, and the person permitting such overcrowding shall forfeit a sum not exceeding 40s. Where two convictions in respect to the overcrowding of the same premises are obtained within a period of three months, whether the persons convicted are or are not the same, the Justices are empowered by section 36 of the Sanitary Act, 1866, to order the closing of the house for such time as they may deem necessary. 121 The above provisions have been found in practice to afford a simple and comparatively inexpensive means of procedure by which the local authority can, in gross cases of sanitary neglect, compel landlords either to make their houses fit for human habitation or to close them, and by which the overcrowding of houses in such a manner as to be dangerous or prejudicial to the health of the inmates can be prevented. " These powers, however, are by no means the only ones which have been conferred on the local authority by the Legislature, with a view to enabling them to improve the sanitary condition of the houses of the working classes. " Under the Artizans Dwellings Acts, 1868 to 1885, usually known as Torrens's Acts, the local authority are enabled not only to secure the improvement or demolition of houses which are ' in a condition or state dangerous to health, so as to be unfit for human habitation,' but also to deal with any ' obstructive building,—i.e., a building which, although not in itself unfit for human habitation, is so situated that, by reason of its proximity to other buildings, it stops ventilation, or otherwise makes or conduces to make such other buildings to be in a condition unfit for human habitation, or prevents proper measures from being carried into effect for remedying the evils complained of in respect of such other buildings. " Under these Acts it is the duty of the Medical Officer of Health to report in writing to the local authority any premises in the district coming under either of the above descriptions, and the local authority are required to refer this report to a Surveyor or Engineer for the purpose of ascertaining, in the ease of any house alleged to be unfit for human habitation, whether the causes of the evils complained of can be remedied by structural alterations and improvements, or whether the premises ought to be demolished. In the case of abuilding reported to be an ' obstructive building,' the Surveyor or Engineer is to make a report to the local authority as to the report of the Medical Officer of Health, and state what, in his opinion, will be the probable cost of acquiring the lands on which the building is erected, and of pulling down the building. In the former case, if the Surveyor or Engineer reports that the evils complained of can be remedied by structural alterations or improvements, the local authority may require the owner to execute them, and, on default, they may order the closing or the demolition of the premises, or may themselves execute the necesssry works, at the expense of the owner. On the other hand, if the report of the Engineer or Surveyor is to the effect that the premises should be demolished, they may order the demolition of the premises, and, on default of the owner, may themselves take down and remove them. In the case of an obstructive building the reports of the Medical Officer of Health and of the Surveyor or Engineer must be taken into consideration by the local authority, and if the authority decide to adopt them, they may require the demolition of the building. In that event, if the owner elects to retain the site, they must pay compensation for the demolition; otherwise, they may themselves purchase the site. " Where the evils caused by insanitary dwellings in any area are such that they cannot be remedied otherwise than by the demolition of so many houses belonging to different owners, that a complete scheme of rearrangement and 122 construction of the streets and houses is necessary, large powers are conferred in the City of London on the Commissioners of Sewers, and in the remainder of the metropolis on the County Council of London, for the carrying out of an improvement scheme for the unhealthy area under the Artizans and Labourers Dwellings Improvement Acts, 1875 to 1885, commonly known as Cross's Acts. In any parish or district in the metropolis outside the City of London in which such a scheme is necessary, it is the duty of the Medical Officer of Health of the Vestry or the District Board to bring the facts of the case to the notice of the County Council, by means of an official representation, under section 3 of the Artizans' and Labourers' Dwellings Improvement Act, 1875. " In addition to these powers, section .35 of the Sanitary Act, 1866, as amended by section 47 of the Sanitary Law Amendment Act, 1874, which enactments were put in force by the Local Government Board in December, 1883, in all the districts of the metropolis in which they were not previously in operation enables the local authorities of the metropolis to make regulations enforceable by penalties for the registration and inspection of houses let in lodgings or occupied by members of more than one family, for the prevention of overcrowding therein, and for securing their being kept in a clean and wholesome state. " It will be seen from the above statement that the local authorities have been empowered to take the necessary proceedings to prevent any premises in their district unfit for human habitation from being inhabited; to prevent any house in their district from being overcrowded in such a manner as to be prejudicial to the health of the inmates; and to secure the demolition or improvement of buildings which are either themselves unfit for human habitation, or which, by reason of their situation, are the cause of other buildings being rendered insanitary. These large powers have been intrusted to the local authority in order that they may be exercised for the protection of the poor who are unable themselves for the most part to enforce the observance of the laws relating to public health by their landlords. I have most urgently to impress on the local authority the grave responsibility which they incur if they neglect the duty which has been cast upon them by the Legislature, of taking the necessary steps to insure that the law in relation to each of the above matters shall be duly enforced iu their district. " I am, Sir, " Your obedient Servant, " (Signed) CHAS. T. RITCHIE. " The Clerk of the Local Authority." At the request of the Works, Sanitary, and General Purposes Committee, I submitted a report to your Vestry on the subjects dealt with in the above important communication, in which I endeavoured, at very short notice, to state the difficulties experienced by the sanitary authority in dealing with the Housing of 123 the Poor question, and the necessity for amending legislation to expedite and simplify legal proceedings for'the abatement of nuisances and overcrowding. The report was as follows:— "It is undoubtedly true, as stated by the Local Government Board, that ' a large number of the working population' are at present badly housed, and that it would be difficult to overrate the ' gravity of the evils which result from the insanitary condition ' in which they live, the chief of these being overcrowding. It may also be admitted that existing sanitary laws confer very large powers on the ' local authority,' to ' effect' but, as we shall see, not with the necessary expedition, a ' very material improvement in the present condition of the dwellings of the poor,' especially by ' summary proceedings for the closing of houses unfit for human habitation, and for the abatement of overcrowding,' under the provisions of the Nuisances Removal Acts, and by the enforcement of regulations made under the provisions of the Sanitary Acts of 1866 and 1874, for houses let in lodgings, or occupied by members of more than one family. The lastnamed Acts may, I believe, be used with great effect, provided that the efforts of local authorities and their officers are duly supported by magisterial authorities, viz., by the infliction of substantial penalties for proved breaches of the regulations. These ' Lodging House Clauses' indeed, are so valuable, that it would be well if all houses let in lodgings to the ' working population ' were registered. Practically, this is the course your Vestry have decided to adopt: already close on 1700 houses have been placed on the register, and the work of registration is going on as rapidly as circumstances permit. It is, however, of little use to register houses unless the regulations are enforced. The work is arduous, and without a substantial increase in the sanitary staff it cannot be accomplished within any reasonable time; for, first of all, it will be necessary in respect of each house, to see that the ' Instructions' issued by your Vestry (in February, 1885), ' for the guidance of the Sanitary Inspectors, in regard to the sanitary arrangements of Registered Houses' 124 are duly carried out, so that structural improvements necessary to put the house into a good sanitary condition according to modern requirements, may be effected; and afterwards the premises must be periodically inspected, to see that the requirements of the regulations as to cleanliness, and other matters, are observed. A principal advantage resulting from registration is, that it is only necessary to prove breach of any of the regulations to enable the magistrates to inflict upon the offender whatever penalty they may deem suitable—the maximum penalty being a sum ' not exceeding forty shillings for any one offence, with an additional penalty not exceeding twenty shillings for every day during which a default in obeying the regulations may continue.' " The mode of procedure for the abatement of nuisance under the Nuisances Removal Acts is more elaborate, tedious, and difficult. Notice of the nuisance must be given by the Inspector to the nuisance authority, and such notice as the authority may direct must then be served upon the person by whose act or default the nuisance is caused. Time is necessarily allowed for the abatement of the nuisance, no penalty attaching for default. As a rule, the required work is done within the time limited by the notice, but in the most expeditious cases from one to two or three weeks may be occupied in getting the nuisance abated, without any neglect or avoidable delay on the part of the nuisance authority or their office]'. If the requirements of the authority are not complied with, a summons must be taken out. This is rarely made returnable in less than seven days. Should the case be decided, at the hearing, without delay, all that the Justice can do is to make an order for the execution of such works as, in his opinion, may be necessary for the abatement of the nuisance, his powers in this regard being ample. After the order has been prepared and signed by the Justice, it must be served personally upon the person on whom it is made. Ample time is always allowed in the order for doing the work, and it is only after the lapse of such time that, in cases of disobedience, liability to penalties begins, the penalty being not more than ten shillings 125 per day (during default, and at the discretion of the Justice. Sometimes the work is not begun even, within the time limited by the order. The issue of a summons for disobedience then becomes requisite: this usually rouses the defendant to the necessity for action, and generally before the day of hearing (that is, within seven days) the work will have been done, the nuisance will have been abated, and the case will be at an end. The proceedings will by this time have lasted for many weeks, and meanwhile the inmates of the house may have been suffering in health and comfort without remedy. Nay, more, they may think themselves fortunate if they are not made to pay an increased rent to compensate their aggrieved landlord for the trouble and expense to which he has been put. It may be added that notice of appeal against the Justice's Order may be given, and many more weeks may pass before the case can be finally adjudicated at Quarter Sessions. " It is a commonly received opinion—it has been said very often of late—that the law is sufficient for all purposes, and that what is wanted is improved administration. But I venture to say that the law is not sufficient for dealing effectually with an obstructive defendant or bad landlord, and that there is no power by which 'the nuisance authority can effect abatement of a nuisance expeditiously. What is wanted is power to sanitary officials to initiate proceedings, by notice, upon discovery of the nuisance : power, moreover, should be given to the Justice to inflict a penalty for the offence of creating a nuisance. Bad landlords know that they incur no risk by disregard for a considerable period of the requirements of the nuisance authority, as set out in the ' notice,' and they act accordingly. The public on the other hand, believing the law to be all-sufficient, are apt to lay the blame for delay, unjustly, upon the nuisance authority and their officers. It must be added that bad tenants are quite as common as bad landlords, and the tenant is often responsible for the nuisance which the landlord is called upon to abate. It is the fact, moreover, though it would hardly be inferred from the circular letter, that proceedings for the abatement of nuisances are taken in tens of thousands of cases yearly in the Metropolis. 12ft "But if it is difficult to obtain speedy abatement of a ' nuisance ' arising from the insanitary condition of the dwelling, what shall be said on the subject of ' Overcrowding ' ? of which, doubtless, there are thousands of cases in London alone at the present moment. Here again it is generally believed that the nuisance authority are largely responsible for an admitted evil—in other words that the law confers all necessary powers, but that administration is defective. But is it so ? What are the main causes of overcrowding ? Poverty and High Rents. Over these conditions the local authority have no power. The landlord is blamed for permitting overcrowding, as if he benefited by it. But again I ask, Is it so ? Often enough he is rather to be pitied than blamed, whether he be the non-resident owner of a tenement house or the humble occupier of a house let in lodgings, which, in order that the rent may be paid, must be largely sub-let, the latter being, in my experience, the far more common case. Take a typical example: Application for a single room is made by a couple who declare that they have no family, or, it may be, only one or two children. They are accepted as tenants upon that assurance, but no sooner are they in possession than a whole troop of children turn up, and ' overcrowding' is established. It may be said that all that the landlord has to do, as soon as he discovers the cheat—if he is non-resident it may be long before he does—is to serve a notice to quit. That is easy to do, but it is not always easy to get the notice attended to. The provisions of the law are merciful, and the lower classes of the poor frequently avail themselves of the opportunities for delay which it affords. Assume that the notice to quit is unheeded— and oftentimes it is not given till the rent is long in arrear, to the no inconsiderable loss of the landlord, owner or occupier, as the case may be:—he must then go warily to work, and he will if he knows his business. Nothing remains but to enforce the law of ejectment for the ' recovery of possession of tenements after determination of tenancy' (1 and 2 Vict., cap. 74). A printed form of ' Directions to be observed by persons applying for the police magistrate's assistance to eject tenants paying a less rent 127 than 7s. 8d. a week' may be obtained at any police court. They are as follows:— 1. In case of a weekly tenancy, seven days' written notice to quit (the notice above adverted to) ' should be served on the person in occupation; such notice to expire on the same day of the week as tenancy commenced. A copy of this notice must be kept. 2. If the tenant neglects to leave according to the notice, on any day after that on which the notice to quit expired, serve another notice (in statutory form) giving notice that you will apply at this Court for a warrant to eject him at ten o'clock in the forenoon of a day (to be named in the notice), which must be eight days at least after that on which the notice is served : keep a copy of this notice also. 3. On the day named in the second notice, come to the Court at ten o'clock in the forenoon, and bring with you the copies of the notices, and also a written complaint, stating that you are the owner of or agent for the premises, their situation, the rent payable, the date on which the tenancy expired, the date of the service of the second notice, and how it was served. "In a footnote the applicant is informed that ' this second notice (referred to in 2) ' must be read over and explained to the person upon whom it is served,' and that ' printed forms of notice and complaint may be obtained at law stationers and elsewhere.' Meanwhile, the unfortunate landlord, who may be innocent of wrong-doing, must not take any rent upon pain of vitiating the whole of the proceedings. If everything has been done in due order, the magistrate will issue a warrant to the police, ' commanding them within a period to be therein named, not less than 21 nor more than 30 clear days from the date of such warrant, to enter (by force if needful) into the premises and give possession of the same to the landlord or agent'; the usua course being to turn the people with their goods and chattels into the street, where they (the goods) create an ' obstruction with which in some cases the Sanitary Inspectors have been called upon to deal. In many a case, however, there are no goods and chattels : they have gone to the pawnbroker long before, or have been seized, under a distraint. 128 " But it may be that the proceedings for abating the overcrowding have been taken by the sanitary authority when the fact comes to their knowledge, which is not so very often, and no blame to their officers as it would be easy to shew. If the proceedings are taken under the Lodging Houses Clause of the Sanitary Act, 1866 (already referred to), the offending lodger becomes liable to a penalty for breach of the regulations—if the Justice thinks fit to inflict a penalty which he knows cannot be paid. The landlord, in the case of a tenement house, or the occupier in other cases ('keeper,' as he is styled in the regulations) is also liable to a penalty, if he ' knowingly suffer a greater number of persons to occupy any room,' in the registered house, ' than will allow of air space for each person' according to rules sanctioned by the Local Government Board, but which vary in different districts, so that what is overcrowding in one parish may be lawful occupation in the next. And supposing that the ' keeper,' who in a tenement house is non-resident, and may be also ignorant of the facts till he gets a notice from the Sanitary Inspector (but who also not seldom solicits the aid of the Inspector to enable him to get rid of the lodger), supposing, I say, that the keeper is ever so anxious to obey the order to abate the overcrowding, I presume that he will have to proceed in the manner above indicated, by ejectment, if the lodger refuses or neglects to quit and give up possession. If the house be not ' registered,' the overcrowding may be dealt with as a ' nuisance under Section 19 of the Sanitary Act, 1866, or it may be dealt with otherwise, under Section 29 of the Nuisances Removal Act. The Justice may make an order, under the first-named Act, for the abatement of the nuisance; whilst under the second Act mentioned, any person not obeying the order to abate the overcrowding becomes liable to pecuniary penalties, and the house may be closed if two convictions are obtained in respect of the same house within three months. Under these provisions proceedings are taken from time to time with effect, for the abatement of ' overcrowding of houses in such a manner as to be prejudicial to the health of the inmates.' But 129 considerable delay is involved, as everything has to be done regularly and in proper order, much in the same way as in the proceedings already described for the abatement of a nuisance resulting from other insanitary conditions of the dwelling. " Hitherto I have dealt with the subject much as though the lodger-tenant were an obstructionist, with whom the law may fairly deal as best it can, so as to abate the nuisance; but there are multitudes of cases in which he is the hapless victim of hopeless poverty. What to do in such cases who shall tell ? If he is turned out of one miserable room, made to ' move on' like ' Poor Jo,' he must needs seek another of the same sort, or go into The House. But there are plenty other cases—of people a shade more or less better off, people temporarily out of work and compelled to restrict their expenditure : Artizans, it may be, with large families, who can afford, when times are good, to pay the rent of two, or even three rooms, but who, when work fails, may be compelled to put up with one room which they overcrowd. How shall these be dealt with ? It is useless to say to them, ' You must get a second room,' when they are but too often unable to pay the rent of one, without recourse to the pawnbroker, when the landlord is hard : they get into arrears when the landlord is element. And it is equally vain to say to the head of the family, ' You must get rid of some of your children and so abate the overcrowding.' Overcrowding ! which is so often spoken of as if the landlord necessarily benefited by it, or as if the poor were quite willing agents in the matter. In this connection let us consider for a moment how hard is the lot of so many of the labouring classes at the best of times. What high rents they pay! Compelled to live near their work, and the demand for accommodation being in excess of the supply, competition comes into play and they are constrained to expend an inordinate proportion of their earnings to procure shelter of the most squalid kind. Evidence that this is so may be found to any extent in the ' First Report of Her Majesty's Commissioners for Enquiry into the Housing of the Working Classes ' (1885). F 130 " But there is something to be said on the other side of the question, for in the same report will be found abundant evidence of the destructive habits of the lowest classes of the people,—and how numerous they are !—which make it an almost hopeless task to keep decent homes for them, excepting under that kind of supervision—by the police—which they like least. This point has been admirably brought out in an article which appeared in the Times of the 2nd December, dealing with the question in terms which go far to mitigate the force of the censure upon the local authorities, for presumed neglect to enforce the provisions of the law in cases of ordinary nuisance and overcrowding. " A munificent gift just bestowed on London," with a view to the improvement of the dwellings of the very poor, has once again caused people to think and talk—and write—on the subject, for a little while. But what is a quarter of a million in such a city, with a large proportion of its half-million houses occupied in lodgings by the labouring classes ? The Peabody Trust, and all the companies working to the same end, aided as they have been so largely out of the rates, by the low price at which they have been enabled to purchase sites cleared under Cross's Acts; these bodies, I say, have been scarcely able to touch the fringe of the difficulty; and, speaking generally, have not provided for a tithe of the poor people evicted to make room for the ' Model Dwellings,' which are inhabited, for the most part, by people fairly well off, and able to take care of themselves. What is really wanted is a comprehensive system of Municipal Lodginghouses, to take the place of the ' Common Lodging-houses; in which poor, helpless, thriftless people may be decently and comtortably housed at the cheapest possible rate. I think that the London County Council are beginning to see this,f and to them, to the Local Government Board, and to the Legislature, this great and pressing question must be left for solution. I have so * By Sir Edward Guinness, t The Council have since taken the matter in hand (vide page 114). 131 recently expressed my views on the subject of the housing of the working classes in reports* ''presented to your Vestry, copies of which were forwarded to the several members of the London County Council—that I may be excused from dwelling on it now. But I may observe that if it is true, as reported, that it is the intention of Her Majesty's Government ' to -consolidate all the Acts of Parliament dealing with the Housing of the Working Classes into one Bill, in order to facilitate their application by local authorities,'† an opportunity will be afforded to the Local Government Board to propose to Parliament such amendments of the law as may be required for dealing, not only with this particular matter, but with other subjects referred to in the circular letter, so as to expedite proceedings for the abatement of nuisance and overcrowding. " The circular letter of the Local Government Board makes reference to the powers and duties of the local authority and their officers under Torrens's and Cross's Acts, but as there is no scope for the operation of these Acts in Kensington, I pass over the subject. It also calls attention to the provision in the Housing of the Working Classes Act, 1885, which declares that it shall be the duty of the local authority entrusted with the execution of sanitary laws to enforce those laws ' so as to secure the proper sanitary condition of all premises within the area under their control,' a provision which necessarily has my approval, it being accordant with views published by myself prior to the introduction of the measure. * Viz., in my monthly reports : No. 3, March 25th, page 24, and No. 5, May 20th, 1889, page 49. t A Bill for this purpose was prepared and brought in by the President of the Local Government Board and the Home Secretary, in May of the present year—Housing of the Working Classes Acts (Consolidation) Bill—"to consolidate the Acts relating to Artizans' and Labourers' Dwellings and the Housing of the Working Classes." At the same time another Bill was introduced by the same members "to amend the Acts relating to Artizans' and Labourers' Dwelling and Housing of the Working Classes— 'Housing of the Working Classes (Amendment)Bill.'' "—Vide page 134. f 2 132 " For the rest I would say that we here in Kensington, must continue to strive to discover nuisances and cases of overcrowding, and deal with them as best we may, having regard to all the circumstances in each case, a course in which we are assisted by a Sanitary Aid Committee connected with the Mansion House Council for improving the dwellings of the poor. But I must add that much more is being done in regard to these matters, in the Metropolis generally, by the sanitary authorities, than the general public know or suspect; as might be assumed from a continuously declining death-rate, especially from preventable diseases, and as may be seen by reference to the reports of Medical Officers of Health and Sanitary Inspectors published in connection with the annual reports of the Vestries and District Boards. How indifferent the public are may be inferred from the fact that these volumes, full of information of the most valuable kind, year by year encumber the shelves of the local authority, although the number printed is not very large, and the statutory price to the ratepayer is but twopence." A draft report to the Vestry on the above communication from the Local Government Board, submitted for the consideration of the Works, etc., Committee (but not adopted), is cited here as furnishing a logical answer to the implied condemnation of sanitary authorities for assumed neglect of duty. It suggested that the Committee should Report— " With reference to the letter of the President of the Local Government Board on ' Dwellings of the Labouring Classes,' and the Report of the Medical Officer of Health thereon, referred by the Vestry, December 11th : " 1. That your Committee are acquainted with the provisions of the Acts cited in the letter, and are constantly giving effect to such of them as are applicable to the circumstances of the Parish. " 2. That considerable delay is frequently experienced in proceedings for the abatement of nuisances under the provisions of the Nuisances Removal Acts which is unavoidable in the present state of the law. 133 "3. That delay is also experienced in procuring the abatement of overcrowding, owing to the imperfect provisions of existing law." And it Recommended—" That the President of the Local Government Board be requested to take steps for the amendment of the law so as to secure : " 1. Power to the Sanitary Inspector to initiate proceedings for the abatement of nuisances on discovery. " 2. Power to the Justices to inflict a penalty on the person liable for causing a nuisance. " 3. Power to the local authority to eject persons overcrowding a house or part of a house, after the expiration of a seven days' notice to abate overcrowding." In the result the Committee simply recommended that the Vestry should inform the Local Government Board that they were carrying out the provisions of the several Acts to the best of their ability, and this course was adopted. Meanwhile, sanitary authorities are looking forward hopefully to the increased powers which Mr. Ritchie's projected Public Health, London (Consolidation) Bill will confer on them—a measure to which, moreover, the County Council are also looking in the expectation that it will confer on them the increased powers they desire. It is known that the Bill will include a clause to enable the justices to inflict a penalty on the person liable for causing a nuisance; and it is reasonably hoped that, if power to the Inspector to initiate proceedings by serving a notice for the abatement of a nuisance immediately on discovery (without which irritating and injurious delays must still continue) be not conceded, at least power will be given to the local authority to abate overcrowding without the monstrous expenditure of time, in dilatory procedure, to which reference is made at page 126. Should these concessions be not made by Parliament, it will be 134 more than ever unjust to blame sanitary authorities for neglect of duty, whether directly, as is so often done by the unknowing, or by implication, as in the letter of the President of the Local Government Board. In any case, happily, consolidation of the law will be of material assistance to those whose duty it is to give effect to the decrees of the legislature. Addendum.—Housing of the Working Classes.—On the 24th June, 1889, Mr. Ritchie moved the second reading of two Bills dealing with this question, which had been introduced by himself, Mr. Matthews (Home Secretary), and Mr. Long. In my sixth monthly report (June 16th) I referred to these Bills in the following terms:—" The Acts dealing with the dwellings of the working classes (including Lord Shaftesbury's, Torrens's, and Cross's Acts), are 13 in number ranging from the Labouring Classes Lodging Houses Act, 1851, to the Housing of the Working Classes Act, 1885. All of these measures the Government propose to consolidate by a ' Housing of the Working Classes Acts Consolidation Act.' Few amendments have been introduced in the Bill, and those not of material importance from a sanitary point of view; some of them being intended to remove doubts as to interpretation, and others making the new measure consonant with previous legislation. A few provisions of the existing Acts no longer required are repealed. The subjects dealt with in the Bill have received a good deal of attention from the Housing of the Working Classes Committee of the County Council, who recently had an important interview with the Home Secretary, in order, as they state in their Annual Report, to place before him suggestions which, if carried out, would make Torrens's Acts more workable. ' The difficulties in the way of dealing with insanitary areas were represented to him The Committee suggested that in order to put a local authority in motion the Council should have the power of requiring the local Medical Officer to report; that in the case of demolition the local authority, or, failing it, the Council should have the same powers of compulsory purchase as the Acts give with regard to obstructive buildings; that where 135 premises are required to be purchased, the owner should not have the option of retaining the site; that the term " obstructive building" should be defined; and that some other mode of appeal should be provided than to the High Court ... If clauses to the above effect were to be introduced by Her Majesty's Government this Session, in an amending Act,' the Committee believed that ' much good result would accrue to London.' The action of the Committee had a good result, Mr. Ritchie, Mr. Matthews, and Mr. Long having introduced an amending Bill (' Housing of the Working Classes (Amendment) ' which gives effect to some of their suggestions. Part I. of the Bill (Artizans' Dwellings Acts) is to be construed as one with the Acts, 1868 to 1885, proposed to be consolidated, and to be known in future as the 'Dwellings Act,' 1868, 1879, &c. The Medical Officer of Health is to report to the local authority any premises, as defined by the Dwellings Act of 1868, which appear to him to be in a state so injurious to health as to be unfit for human habitation. The local authority is to take proceedings with a view to closing such premises, by obtaining a 'closing order' (sec. 2). The local authority may pass a resolution that it is expedient to order the demolition of the building, and take all necessary steps to that end, if the closing order should not be determined by a subsequent order, and should the premises not have been rendered fit for habitation (sec. 3). Provision is made for the demolition of an ' obstructive building,' that is to say, ' a building so situate that by reason of its proximity to or contact with other buildings, it (among other things) prevents proper measures from being carried into effect for remedying the evils complained of in respect of such other buildings;' and doubts having arisen as to the meaning of the words ' evils complained of,' such ' evils ' are declared to ' include a nuisance which is inj urious to health' (sec. 4). The fifth section deals with ' Scheme for Reconstruction ' on area comprising houses closed by closing order. Special provisions as to London are contained in sec. 6. The Vestry are required to report their proceeding (e.g., report of the Medical Officer respecting unhealthy premises, or obstructive building; 136 closing order, &c.) to the County Council. Should that body be of opinion that the local authority have neglected their duty in regard to any of the above matters, it may pass a resolution to that effect, and then the powers of the local authority, as respects the premises and building will vest in the Council, and if a closing order, or an order for demolition is made, all the expenses incurred, including any compensation paid, 'shall be a simple contract debt to the Council from the Vestry or district board.' The Council may, in exercising the powers of a Vestry, or on the representation of a Vestry, or proprio motu, take proceedings for preparing and obtaining confirmation of a scheme (as in section 5). Expenses thus arising are to be borne by the County Fund, but the Council, if it considers that part or all of the expenses should be paid by a Vestry, may apply to a Secretary of State who has power to order such payment or contribution to be made by the Vestry. Sections 8 and 9 deal with the expenses of the local authority, and with provisions as to borrowing. Section 10 gives the like effect, for the purposes of the Dwellings Act, 1882, and Part I. of this Act, to a report from the medical officer of a county, submitted to the County Council, and forwarded by that Council to the local authority of any district in the county, as to a report from the medical officer of health of the district. Part II. (Amendment of Artizans and Labourers Dwellings Improvement Acts and of Artizans Dwellings Acts) section 15, deals with the question of compensation in case of overcrowded or insanitary premises, comprised in a scheme, with the object of preventing excessive payment in cases where the rent is enhanced by reason of the premises being injuriously overcrowded; in which case compensation is to be based on a rental that would have been obtainable if only a proper number of persons had inhabited the premises. If the premises are in a bad sanitary state, or are not in good repair, the amount of compensation is to be estimated as their value if they had been put into a sanitary condition or into good repair, after deducting the estimated expense of putting them into such condition or repair. But if the premises are unfit, and not reasonably capable of being made fit, for human habitation, 137 compensation is to be given to the extent only of the value of the land and of the materials of the buildings thereon. Very important provisions these! Section 16 deals with power of arbitrator, in regard to assessment of compensation, questions of costs, etc. ; and 17 with power of local authority to enter and value premises. Section 18 enables the local authority to compensate a tenant for less than a year, on account of his expenses in removing, if they require him to give up poseession of a building, or part of a building, purchased in pursuance of a scheme under the Dwellings Acts, 1875 to 1885, or Part I. of this Act, if the building is not closed by a closing order. Part III., to be construed as one with the Labouring Classes Lodging Houses Acts, 1851 to 1885, makes provision for amendment as to bye-laws, but is not of sanitary interest; and the same remark applies to the General Provisions in Part IV. To sum up, I think it may be said that the passing of the Bill would be a matter of satisfaction to any local authority desirous of discharging fairly and reasonably the provisions of existing sanitary law." It is to be regretted, however, that no provision has been introduced to enable the sanitary authority to abate overcrowding of houses without the cumbrous and tedious proceedings already described (page 126). Possibly such powers may be included in the intended Public Health, London (Consolidation) Bill, which, however, at the present writing, has not been introduced. It was a satisfactory feature in the debate that the difficulties of sanitary authorities, resulting from complexity of the law, and excessive expense in carrying it out, were frankly acknowledged—a fact which may fairly be set against the unfavourable judgments too often unthinkingly, or ignorantly, passed upon these bodies, on the assumption that they wilfully neglect to carry out the duties they are elected to discharge. It has only to be added that the Bills, which were received with favour on both sides of the House, were read a second time without opposition from any quarter, and were referred to the Standing Committee on Law, with an instruction to consolidate the two into one.*] * The Law and Parliamentary Committee having considered these Bills, reported that, "so far as the Metropolis is concerned the Amendment Bill generally, seeks to give too wide powers to the London County Council, and does 138 OFFENSIVE BUSINESSES. What I shall have to say under this head will serve at once to illustrate the advantages of bye-laws, which the Common Council seeks power to frame (vide page 105), and the difficulties with which the existing sanitary authorities have had to contend for want of such bye-laws. Your Vestry took steps some years ago to obtain an extension of powers, by an ineffectual appeal to the Metropolitan Board of Works; but, as it will appear, the Special Purposes and Sanitary Committee of that body ultimately saw reason to modify the views originally expressed, so that their final opinions came to correspond closely with those I had set out in my reports, which led to the afore-mentioned appeal to the Board. With these few remarks, I pass on to observe that the only business coming under the statutory description "offensive," other than that of a "slaughterer of cattle," carried on in this Parish, is that of a "fat-extractor," at Tobin Street, Notting Dale. It gives rise to more or less effluvium-nuisance at times, notwithstanding improved arrangements and care on the part of the proprietor, and regular supervision by the Inspector of the local authority, i.e., the County Council. But the people living in that locality are not of a squeamish nature, and seldom complain. Marine Stores.—Every year, during the hot weather, complaints are received in regard to stenches arising in the collection, storage, etc., of bones, fat, and other animal matters in a putrid not provide sufficient protection to the various local bodies, but subjects them to be over-ridden by the London County Council without any provision for appeal. That whilst no objection is seen to provision being made in the Bill that where it is duly proved that a local authority shall have neglected to perform its duty, the County Council shall have power to intervene, it is only right that this provision should be safe-guarded, and that before the Council shall be authorised to perform any of the duties thrown upon the local authorities under this Act, a proper enquiry shall have been conducted in the district by the Local Government Board." The Committee recommended, and the Vestry resolved, "that the views above expressed be communicated to the President of the Local Government Board, and to the members of Parliament representing the Kensington divisions, with a view to modifications being introduced in the Bills.'' The Bill passed its third reading, amended, but not modified in the sense desired by the Vestry. 139 condition on the premises of "marine-store dealers." Other businesses, such as those of fishmonger, poulterer, etc., may be, and often are, the cause of nuisance and annoyance in connection with the production of refuse matters of an objectionable nature; which, useful in their proper place, are liable, when stored or dealt with in private habitations, to become a source of injury to the health of the community. This subject was reported on by me to your Vestry in 1878, under the heading of Filth Removal, and in 1880 I brought it before the Society of Medical Officers of Health, who referred it to a Committee, of which I was the chairman. The report of the Committee embraced consideration of the best modes of dealing with animal and vegetable trade refuse, e.g., from slaughter houses, fishmongers', poulterers' and greengrocers' shops, etc., with a view to its harmless storage, removal, and ultimate disposal, by utilization or destruction. It also treated of house refuse, stable refuse, and cowshed refuse. The Society forwarded the report to the (late) Metropolitan Board of Works, the Vestries and District Boards, etc. The report was also circulated largely among Members of Parliament; the Society sharing my view that the subject could not be effectually dealt with save by legislation. For some years I had been directing attention to the question, especially as it bore upon the nuisance arising in the conduct of the business of the so-called "marine-store keeper" (rag-and-bone dealer), and ultimately (in 1883) your Vestry resolved to apply to the Metropolitan Board of Works to schedule this particular business as an "offensive business" under the provisions of the Slaughter Houses (Metropolis) Act, 1874. The Board declined to do this, upon the ground that the business was not such as the legislature intended to be dealt with under that Act. The High Court of Justice (Queen's Bench Division), however, in an appeal case,* subsequently came to a different conclusion, and declared the business * Passey (Appellant) v. Oxford Local Board (Respondents). The subject was dealt with in my Annual Report for 1883 (page 94-97, inclusive), in which the (original) views of the Metropolitan Board and my own views are fully set out. 140 of a rag-and-bone dealer to be ejusdem generis with the businesses scheduled in section 3 of the Act. In November, 1887, a communication was received from the Special Purposes and Sanitary Committee of the Board on CONVEYANCE OF OFFENSIVE SUBSTANCES THROUGH STREETS. The Committee intimated that they were satisfied that "serious nuisance does arise in the collection, and conveyance through streets, of offensive substances, such as fish-offal, blood, kitchen stuff, etc." They admitted, also, that the provisions of the Nuisances Removal Acts and the Metropolis Management Act do not enable the Local Sanitary Authorities to deal effectively with the nuisance, and that additional legislative powers were necessary. But before recommending the Board to take any steps for obtaining an amendment of the law, the Committee thought it well to ascertain the views of the several Vestries, etc. In compliance with the request of your Vestry, I reported fully on the subject,* my principal contention being that the nuisance can be dealt with effectually only by regulation of the trades, by "bye-laws entailing an adequate and a fixed penalty for offences bye-laws made by the Board, but the carrying out of which should be entrusted to the local sanitary authorities." Such bye-laws, I said, "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, or, better still, in the storage vessels themselves; (3) to time of daily removal; and (4) to measures for disposal of the refuse." I added that it was "open to consideration whether the duty of removing all offensive substances should not be imposed upon the sanitary authority, at the reasonable cost of the producers thereof," a course which, in my opinion, is imperative if nuisance is to be avoided. * Vide Annual Report for 1887, pages 176—89 (inclusive). 141 Your Vestry approved my report, and forwarded it to the Board (12th December, 1887), together with a letter, in which it was observed that "the success of the Board's Regulations, made under the provisions of the Slaughter Houses (Metropolis) Act, 1874, suggested 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." The Board's existence having been threatened by the introduction of the Local Government Bill in 1888, no legislation was initiated in that Session. Indeed, I believe that the Committee made no report on the subject. The materials collected are available for the use of the County Council, whose attention doubtless has been given to it in connection with the subject of bye-laws to which I have already referred (vide page 114); but nothing has been done hitherto with a view to abatement of the admitted nuisance. NUISANCE FROM BRICK-BURNING. Every summer complaints are made in regard to stenches, usually observed in the evening and early morning hours, commonly supposed to be due to sewer gas, but which are actually due to brick-burning in localities 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, in respect of nuisance arising from this cause at Streatham and Hampstead respectively. [A third and local case, lately carried to a successful issue, is reported at page 147.] 142 The decisions in these two causes are satisfactory so far as they go, injunctions having been obtained; but although they hold out hope of success in any similar proceedings, few are the persons rich enough, as in the Streatham case, or the local authorities spirited enough, as in the Hampstead case, to incur the expense and worry of litigation. The nuisance, however, being unquestionable, and such as may be prevented by the adoption of a particular method of burning bricks, viz., in kilns, as contra-distinguished from the "clamp" system, the subject would seem to be a proper one to be dealt with by legislation. 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 (late) Metropolitan Board of Works 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 regulated, with manifest advantage to the public; and (2) that, owing to the considerable distance to 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. The Board, in its final annual report (1888-9), dealing with "offensive businesses" which do not come within the meaning of the expression as used in the Slaughter Houses (Metropolis) Act, 1874, observed, that "many offensive trades are still carried on without restriction, as, for instance, brick-making in the course of which noxious fumes are given off, causing widespread nuisance and injury in the neighbourhood of the works." It is added that "the experience acquired under the Slaughter Houses Act had led the Board to believe that nuisance-trades could be carried on with little or no offence if proper regulations were persistently enforced, and if there were close supervision." The London County Council would be the proper authority to promote legislation, with a view to putting some limit to the annoyance and injury to health inflicted by this crying nuisance, in 143 regard to which more complaints were received in 1889 than in any previous year. In the early part of the burning season, many of the complaints came from parts of the Parish at considerable distances from the fields; towards the end of the season the complaints were confined to localities near to the source of the nuisance—a fact which would seem to suggest that the intensity of the nuisance in the hot summer months, and its singular prevalence in (not to say limitation to) the night hours, depend on ill-understood atmospherical conditions, which are then at their maximum. In consequence of the reiterated complaints, and my reports thereon, the subject received much attention from your Vestry, and the following resolutions were adopted, July 24th, viz:— (a) That a communication be addressed to the London County Council calling attention to the serious annoyance experienced by the residents of this Parish from the obnoxious smells due to the brick-burning carried on in adjoining parishes; expressing the opinion that the time has arrived when decided steps should be taken to prevent this offensive trade being carried on within the Metropolitan area without restriction, and urging the Council to consider the desirability of their obtaining the necessary powers from Parliament for the formation of bye-laws regulating the trade of brick-making, in the same manner as other offensive trades are regulated. (b) That a communication be also addressed to the Hammersmith Vestry, urging them, as the sanitary authority of the district, to take steps to compel the persons to so carry on their trade as to minimize the nuisance as much as possible. (c) That the question of this nuisance be referred to the Law and Parliamentary Committee, and Works, Sanitary, and General Purposes Committee respectively, to report as to what further steps can be taken by the Vestry in the matter. (d) That a copy of paragraphs 34 and 35 in the Medical Officer's Report (No. 7, July 17th, 1889), dealing with the question of offensive smells from brick-burning, be sent to the Members of Parliament for the Kensington Divisions, with a request that they will bring the matter to the notice of the Home Secretary. The above resolutions were subsequently forwarded to each complainant as an evidence that the Vestry "fully realised the 144 importance of the subject, as affecting the health and comfort of the residents of the Parish, and were very anxious to do all that lay in their power to bring about an abatement of the nuisance." With reference to paragraph (c), it may be mentioned that the Law and Parliamentary Committee consulted your Vestry's Solicitors, who, after careful consideration of the subject, advised that "the simplest and practically the only course open to the Vestry, is to place themselves in communication with the London County Council, urging upon the Council the necessity of the trade of brick-making being brought within the scope of the Slaughter Houses (Metropolis) Act, 1874, which regulates other offensive businesses in the Metropolis." This course was adopted; and in October a letter was received from the Clerk to the Council, to the effect that "the Sanitary and Special Purposes Committee were dealing with the question of the nuisance from brick-burning in connection with the general question of bye-laws for the prevention of nuisances." To this communication a reply was sent, in which it was urged that, "if the Council were prevented from dealing effectively with such nuisances under their present powers, they should early next Session (i.e., 1890) seek to obtain a legislative enactment, placing the trade of brick-burning within the scope of the Slaughter Houses (Metropolis) Act, 1874." On the 23rd January, 1890, a further letter was addressed to the Clerk to the Council, enquiring "Whether any definite action has been taken by the Council in the direction" referred to in the communication, which stated that the Sanitary Committee were "dealing with the question in connection with the general question of bye-laws for the prevention of nuisances"? In February, a reply was received, to the effect that the subject was still under consideration. It is the fact, however, as I believe, that the Committee have arrived at a conclusion I announced many years ago, that nothing effectual can be done without fresh legislation. In compliance with your Vestry's request, the subject was brought to the attention of Parliament, Sir Algernon Borthwick having asked the Secretary of State for the Home Department 145 (August 16th) "Whether his attention had been called to the existence of a nuisance caused to some of the residents in the Parish of Kensington by the burning of bricks in certain fields outside that Parish; and whether Her Majesty's Government would promote or support legislation with a view of making such nuisance removable by law?" The answer given was that "the Secretary of State's attention had been called, by a memorial submitted to him by the Hon. Baronet the Member for South Kensington, to the existence of the alleged nuisance. Apart from such remedies as might be open to individuals for injury to private rights, the abatement of nuisances in the Metropolis is committed by statute to local authorities, such as Vestries and District Boards, and the Secretary of State had no power to initiate proceedings, except where the nuisance complained of amounted to smoke nuisance within the meaning of the Act of 1853, or where it was made to appear to the Secretary of State that the local authorities had failed to proceed actively and impartially in noticing and suppressing nuisances. No pledge could be given as to legislation." The Hon. Member for North Kensington (Sir Roper Lethbridge) at about the same time gave notice of his intention to introduce a Bill in the present Session to deal with the nuisance, but at the present time of writing has not done so. It may be mentioned that in the course of the brick-burning season (1889) a brick-maker was summoned at the Marylebone Police Court, at the instance of the St. Pancras Vestry, for burning bricks so as to be a nuisance and injurious to health. In 1888 he had undertaken to discontinue such brick-burning, and not to burn bricks in future in such a manner, viz., in a "clamp," as to create a nuisance. Nevertheless the burning was resumed; but the defendant alleged that by building a brick wall around the clamp he had converted it into a "kiln." This statement was disproved to the satisfaction of the magistrate, and the defendant's counsel having admitted the nuisance, an order was made to abate the nuisance, and to prohibit its recurrence. 146 The case turned largely, it will be observed, on the method of burning, and counsel for the defendant enquired whether, if his client erected a proper apparatus, the magistrate would prohibit the burning? to which the magistrate replied, that he had no power to say that the defendant must not burn bricks; it was a lawful trade. It may be asked, Why do not the Hammersmith Vestry adopt the same course as the St. Pancras Vestry? Possibly it is because they do not believe that there is any nuisance, for in the correspondence I had with my colleague, the Medical Officer of Health for that parish, the matter was always referred to by him as an "alleged nuisance" only. It may be further mentioned that the subject of nuisance from brick-burning came before one of the superior courts also, in 1889, "The Bedford Park Brickfield Case" was an action of the Attorney-General (at and by the relation of the Chiswick Local Board) v. Thomas Hussey: it came before Mr. Justice Kay, in the Chancery Division, on the 2nd August, in the form of an interlocutory motion for an injunction to restrain the defendant from creating a nuisance by the burning of bricks at his brickfields on the north-east side of Bedford Park, in the Parish of Hammersmith. The defendant undertook, until the trial or further order, not to mould any more bricks, not to burn any bricks with the exception of those then upon the ground, and not to burn any breeze or core containing any vegetable or organic matter. Defendant also undertook not to make or burn any bricks whatever on the ground after the 25th September (last), until the trial of the action or further order, and the Court gave liberty to apply to expedite the trial.* Much has been said from time to time on the subject of the immediate cause of the offensive smells, it being asserted that mere brick-burning could not produce them, and it has been alleged that they must be due to the surreptitious burning of "soft * The case was heard in June, 1890. See Addendum (page 147). 147 core" at night. Brick-burning as practised in country districts, where no dust-bin refuse is used, produces plenty of smoke and smell, but no stink as we understand the word. But I have no reason to doubt that the stink, as we experience it every summer, is due to brick-burning simply, both the bricks themselves, and the fuel used in burning them, being more or less charged with organic matter of animal and vegetable origin, the slow frizzling of which gives rise to the nuisance. Having regard to the intense feeling to which the obnoxious smells gave occasion, it would have argued insensate folly on the part of the brick-makers to flout the public by quite unnecessary proceedings. And the most careful enquiry—by myself, by my colleague the Medical Officer of Health for Hammersmith, by the Sanitary Inspectors of both parishes, and by Mr. Rogers, your Vestry's Superintendent of out-door work—failed to discover any evidence of the burning of soft core at any of the brickfields in Wood Lane. [Addendum.—The Bedford Park Brickfield Case above referred to (page 146) came to a hearing in the High Court of Justice (Chancery Division), before Mr. Justice Kay, who, on the 26th June, put the defendant under an injunction not to burn bricks upon the brickfield, or any part of it, in such a manner as to cause a nuisance to the inhabitants of Bedford Park, and the other neighbourhoods of the brickfield, costs, of course, following the result. In giving judgment (without calling for a reply from counsel for the plaintiffs), the judge described the process of brickmaking and brick-burning as carried on in what are known as "clamps," as distinguished from "kilns," and explained (no expert evidence having been given on either side) how nuisance arises, from the use of dust-bin ashes in the bricks, and of "breeze," used for fuel, offensive smells being due to the burning of the organic animal and vegetable matter contained in the "dust." The resulting "vapour," he said, must be more deleterious to health than the smoke of coal, but a nuisance did not necessarily mean that which was injurious to health. There were plenty of nuisances in law which were not in the least injurious 148 to health: injury to health, however, if proved, rendered a nuisance more considerable and important. It was impossible to conceive that the vapour from such a brickfield, 600 yards away, would not be in the least degree deleterious to health. An explanation was suggested how it came to pass that the nuisance would be variable, according to the conditions of the atmosphere, and commonly worst at night. After reference to an argument founded on the fact that the local board had not been prompt in taking proceedings, his lordship concluded his judgment by saying that there must be an injunction for the following reasons—namely, because he was satisfied from the evidence that there was in 1889 a nuisance which, according to the definition laid down by the Lord Justice Knight Brace, when Vicechancellor, in "Walter v. Self," was to be considered "as more than fanciful, more than one of mere delicacy or fastidiousness, as an inconvenience materially interfering with the ordinary comforts, physically, of human existence, not merely according to elegant or dainty modes and habits of living, but according to plain and sober and simple notions among the English people;" and further because he was also satisfied, if it was necessary to rely upon that—which it was not—that the nuisance was one which was calculated very greatly to interfere with, or be injurious to, health; and because he was satisfied that the nuisance was one which would depreciate the value of property in Bedford Park. For those three reasons, any one of which would be sufficient, he came to the conclusion above stated; judgment being given for the local board with costs.] CONTAGIOUS DISEASES (ANIMALS) ACT. HYDROPHOBIA. The deaths from this disease in the Metropolis in 1889 were 7 in number (including 1 in Kensington), corresponding with the corrected annual average for the ten years, 1879—88. In 1885, the deaths were 27. The County Council, as the local authority under the Contagious Diseases (Animals) Act, 1878, by their 149 Committee, named after the Act, were in communication with the Privy Council (Agricultural Department) in the summer, urging the necessity of an Order being issued for the muzzling of dogs, which order they held, should be made applicable to the whole kingdom. The Privy Council, however, were not disposed to make such an Order, but were willing to make Orders to be applicable to those districts where hydrophobia was prevalent. An order was issued applicable to the County of London and such districts or parts of districts as are within the Metropolitan Police District. It came into force on the 31st July, and was to continue until the end of the year, at which time, however, another Order was issued without any limit as to duration. Under the terms of these Orders, the local authority of each of the districts, are directed to cause all dogs affected with or suspected of rabies, or having been bitten by a dog affected with or suspected of rabies, within their district, to be forthwith slaughtered. No dog is allowed to be in any public place "unless such dog is muzzled with a muzzle so constructed as to render it impossible for such dog, while wearing the same, to bite any person or animal, but not so a.s to prevent such dog from breathing freely or lapping water.' The Order does not apply to packs of hounds, harriers or beagles, or greyhounds, or other sporting dogs, while being used for sporting purposes, or to any dogs while being used for the capture or destruction of vermin, and in charge of competent persons. The local authority of each of the districts (e.g., the County Council in and for London,the City excepted) were to cause all stray dogs, and all dogs not muzzled in accordance with the provisions of the Order, to be seized, and if the dog were not affected with, or suspected of, rabies, it was to be detained in some proper place, and supplied with requisite food and water during its detention. The expenses incurred in respect of any arrested dog, are recoverable summarily from the person having charge of the dog or from its owner. Naturally the "proper place" for detention of wandering dogs is a Home. At one such Home, at Battersea, 24,123 dogs were received in 1889, an increase of 8802, as compared with the 150 returns for 1888, due to the Muzzling Order, nearly all of the dogs having been brought in by the police, who, since the passing of the Metropolitan Streets Act of 1867, have been empowered to seize all stray dogs, and to cause unclaimed dogs to be destroyed. Only 30 of the dogs were found to be rabid, and not one of these came into contact with any other dog at the Home. Upwards of 20,500 homeless, diseased, and worthless dogs were mercifully despatched in the lethal chamber, their carcases being disposed of in the crematorium on the premises. The value of such an institution, in the interests of public health, must be obvious, and yet, strange to say, the Home receives no pecuniary support from the rates. Prior to the passing of the Rabies Order, 1886, the duty of preventing the spread of Rabies devolved upon the police; but the Order devolved the duty upon the "local authority," under the Contagious Diseases (Animals) Act, 1878—the local authority for London now being the County Council, in succession to the Metropolitan Board of Works, whose limited staff of Inspectors would have had, in addition to other multifarious duties, to see to the carrying out of such regulations as the Board might have framed for the muzzling of dogs, or for keeping them under proper control, and for the seizure and disposal of dogs not muzzled or under proper control. The Board, however, did not frame any regulations, and the County Council, after setting the Privy Council in motion, refused to discharge the duties cast upon them by the Order, which was issued under the provisions of an amending Act passed in 1886, and which placed rabies as a "contagious disease," in the same category with pleuro-pneumonia in cattle, and glanders in horses, etc., the definition "animal" having been extended so as to include any kind of four-footed beast. The Council appeared to feel aggrieved that their advice as to the issue of a Muzzling Order to apply to the entire kingdom was not acted on; but the grounds alleged, in a 151 letter to the Privy Council, for their inaction, were, that they did not possess the means for carrying out the Order, and that it was not a part of their duty to lay down regulations over the enforcement of which they had neither superintendence nor control. They said that the duty could only be performed by the police, and the police were in the hands of the Secretary of State. The Council averred that they were powerless to enforce the provisions of the Order, so that, while willing and desirous to perform their obligations, they felt that they had no alternative but to decline a responsibility which they could not enforce. Functions such as those involved in the present instance, should, they added, be performed by the police, who alone possessed the necessary power; and, under the circumstances, the interference of the County Council would be as needless as it would be futile. In a letter to the Chief Commissioner of Police, the Council stated that, under the circumstances of the case, they were not in a position to draw up regulations. In the result, the Privy Council appointed an officer to carry out the provisions of the Order at the cost of the County Council, the active duty, of course, being performed by the police, under the provisions of the Dogs Act, 1871, which are still in operation. It may be mentioned that the number of dogs killed by the police in the Metropolitan Police District in the three years 1887-88-89 were 141, 190, and 330 respectively. Of these dogs 27, 49, and 123 in the consecutive years were found to be rabid. The deaths from hydrophobia were 2, 3, and 7 respectively. COMMITTEE FOR CARRYING OUT THE NUISANCES REMOVAL ACTS. With the view of accelerating proceedings in cases of nuisance, your Vestry, in February, 1885, appointed 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 152 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, in Petty Sessions, at the Town Hall, who now sit weekly for the transaction of sanitary business. THE WORK OF THE SANITARY INSPECTORS. Tables VI. and VIa. (Appendix) contain a summary of the work of the Sanitary Inspectors during the year ended March 25th, 1890. One hundred and forty-two summonses were taken out for offences under the Nuisances Removal, and Sanitary Acts, against 99, 51 and 115 in the three preceding years. This number is irrespective of 42 summonses under the Sale of Food and Drugs Act, and 10 in cases of obstruction. 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 could be imposed, however serious or long-continued the nuisances for which they were 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 impose a penalty, not exceeding five pounds, on the person upon whom the Order is made, together with all costs. The same power should be conferred upon Courts of Summary Jurisdiction in London. Provision was made for enabling the Justices to impose a penalty, in the Public Health (Metropolis) Bill, 1885, but there was not time to pass the measure, which hitherto has not been re-introduced; but during the current Session some such measure, it is hoped, will be introduced. 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 153 Removal Act, 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 to public officers, would be infrequent—always supposing the power were exercised. That our cases are proper to be brought before the Justices is obvious from the fact that dismissal of a summons is a rare occurrence. Proceedings were taken in six cases for disobedience of the Justices' Orders, and penalties were inflicted to the aggregate amount of seven pounds nineteen shillings. SLAUGHTER-HOUSES (METROPOLIS) ACT, 1874. Section 55 of the Metropolis Buildings Act, 1844, provided for the abolition of slaughter-houses in London in 1874. These establishments were then numerous, and for the most part unsatisfactory in nearly every respect. Few of them had been built for the purpose—only one in Kensington out of 48. Parliament, upon the report of a Select Committee of the House of Commons, appointed, in 1873, to consider the subject of this and other "noxious businesses," decided that, subject to proper regulations, slaughter-houses might be allowed to remain, and so the above-named Act was passed. In view of probable legislation, I had read a paper before the Society of Medical Officers of Health (March 21st, 1874), on "Private Slaughter-houses considered with reference to the Report of the Select Committee on Noxious Businesses." In this paper, after describing the unsatisfactory state of the slaughter-houses, and expressing my preference for the abattoir system, I specified the requirements of a sanitary slaughter-house; indicated the conditions necessary to be enforced by bye-laws; foretold that suitable regulations would lead to a large reduction in the number of slaughter houses, and insisted on the necessity for a heavy and irreducible penalty for breach of the regulations. The Act was passed; the Metropolitan Board of Works was constituted "local authority" for carrying it out, and regulations were framed practically embodying my views. The regulations, however, made no 154 vision for separation of the lairage from the slaughter-house, to prevent the living animals seeing the butcher at his work, nor for an entrance to the slaughter-house independent of the house or shop. For both of these points your Vestry, at my instance, contended successfully before the justices, and the local authority subsequently followed suit. Your Vestry, moreover, insisted upon the provision of a water supply in the lairs. In 1875 I made proposals for amendment of the bye-laws, which were approved by the Society of Medical Officers of Health; but the bye-laws remain now as they were originally framed: the London County Council, however, has prepared improved regulations, which have been before the Local Government Board for many months awaiting sanction. The existing bye-laws were serviceable, having led to considerable improvement of licensed premises, and to the closing of many of the worst establishments. In 1874 there were some 1500 slaughter-houses in London; in 1889, 691 only. In Kensington 48 were licensed in 1873, the year before the Act came into operation: in 1874, 31 only. The present number is 22, and no new slaughter-house has been opened since the passing of the Act. The defect of the Act is that it ignores the sanitary authorities (Vestries and District Boards), whose medical officers of health and sanitary inspectors should have been made available for the purposes of inspection and supervision. Such inspection and supervision, however, has been kept up in Kensington with obvious advantage, although your Vestry have no statutory authority, excepting such as is derived from power to oppose the renewal of the annual licence. It is necessary that the Council should be local authority for the purpose of 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 requirements of the regulations. LICENSED SLAUGHTER-HOUSES. Thirteen of the 22 licensed slaughter-houses are in North Kensington (i.e., the district north of Uxbridge Road) and nine in South Kensington (i.e., the remainder of the Parish south of 155 Uxbridge Road). The names of the licensees, and the localities of the 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 all of them in a satisfactory condition. Comparatively little slaughtering is now done: on some of the premises none at all, the licence being kept up, apparently, with the view of maintaining the value of the premises. In the interests of public health it is desirable that private slaughter-houses should give place to public abattoirs, and that the dead-meat trade should be encouraged to the utmost. The London County Council renewed the several licences in October. A communication had been previously addressed to your Vestry by the Council, notifying that, on a given day, "a committee would hear applications for licences, and any objections which may have been received with regard to the same," and your Vestry had decided not to oppose the renewal of any of the licences on the said occasion. The Council being the "local authority" under the Slaughter-houses (Metropolis) Act, 1874, as well as the licensing authority, under the provisions of the Local Government Act, 1888, it may reasonably be expected that the several premises will be well looked after and kept up to the mark of sanitary requirements; and that the licence will be, sooner or later, refused in respect of unsuitable premises. Evidence that this course is likely to be adopted with firmness is not wanting. SALE OF HORSE-FLESH, &c., REGULATION ACT, 1889. In connection with the subject of slaughter-houses, the above-mentioned Act claims a passing notice, legalising, as it does, subject to regulations, the sale of horse-flesh for human food. It provides (sec. 1) for signs, on horse-flesh shops, &c., to be placed in a conspicuous position, and so as to be visible, whether by night or day, when horse-flesh is being offered or exposed for sale, on which signs, words are to be painted, 156 ting that horse-flesh is sold there. Horse-flesh may not be supplied for human food to any purchaser who has asked to be supplied with other meat than horse-flesh, or with some compound article of food (e.g., sausages) which is not ordinarily made of horse-flesh (sec. 2). The Medical Officer of Health, or Inspector of Nuisances, or other officer of a local authority appointed for the purposes of the Act, may at all reasonable times inspect, &c., meat, which he has reason to believe to be horse-flesh, exposed for sale, &c., and intended for human food, in any other place than a horse-flesh shop, &c., and if it appears to him that such meat is horse-flesh, he may seize it so as to have it dealt with by a justice as the Act provides (sec. 3). A search warrant may be granted by any justice, on the complaint made on oath by a Medical Officer, &c., enabling such officer to enter any building, other than a horse-flesh shop, &c., in which he suspects that there is kept or concealed horse-flesh, intended for food, &c.; and such horse-flesh may be seized and carried away to be dealt with by a justice as the Act provides (sec. 4). If it appears to any justice that any meat seized, as aforesaid, is horse-flesh, he may make such order with regard to the disposal thereof as he may think desirable: the person in possession of it, or on whose premises the meat was found, will be deemed to have committed an offence under the Act, unless he proves that such meat was not intended for human food, contrary to the provisions of the Act (sec. 5). The penalty for every such offence is not to exceed twenty pounds. The onus of proving that the meat was not intended for sale for human food rests upon the person exposing it for sale (sec. 6). "Horse-flesh" includes the flesh of asses and mules, and means horse-flesh, cooked or uncooked, alone or accompanied by, or mixed with, any other substance (sec. 7). For this Parish your Vestry are the local authority for the purposes of the Act (sec. 8). The Act came into force on the 29th September, but hitherto no shop has been opened in Kensington for the sale of horse-flesh for food of man. 157 COWSHEDS, DAIRIES, &c. In 1875 I called attention to the cowsheds and dairies in the Metropolis, in a paper read before the Society of Medical Officers of Health; urged the necessity, in the interests of public health, of regulating them by bye-laws, and submitted a draft code. I contended that an Act should be passed, providing for the regulation of cowsheds and dairies; that the Metropolitan Board of Works should be the local authority, to exercise a general supervision, and to make regulations, uniform for the Metropolis; but that the duty of inspection, etc., should devolve on the Vestries and District Boards of Works, The code, with slight alterations, was adopted and published by the Society as "model bye-laws." In 1878 the Metropolitan Board was constituted local authority by Section 34 of the Contagious Diseases (Animals) Act, a position now occupied by the London County Council. The Privy Council framed the Dairies, Cowsheds and Milk Shops Order in 1879; and Regulations, based upon the Society's code, were made by the Board, under the operation of which as much improvement as could be expected has been effected, seeing that the Board's powers were limited. The Order proved very useful; and soon after its promulgation, I obtained a conviction against a dairyman for carrying on his business while his house was practically a small-pox hospital. One of the regulations provides for a certain amount of cubic or "air space " for each animal. Long before it existed, I had successfully contended for 800 feet. The Justices adopted my view, with the result that, in the parishes and districts comprised in the Kensington Division, that amount became a standard allowance which has been enforced, although the regulations require only 600 feet, under certain circumstances. In 1885 a new Dairies Order was issued, which enabled the local authority to frame more stringent regulations, especially for the prevention of contamination of milk, and spread of infectious disease through the agency of milk, a subject to which I have already referred, 158 at page 23. The defect in legislation, qua, Cowsheds, Dairies &c., as in the cognate case of the Slaughter-houses Act, is that no attempt has been made to utilise the services of the Medical Officers of Health and the Sanitary Inspectors for purposes of inspection and supervision, the sanitary authorities (Vestries, &c.) being ignored. There has been considerable reduction in the number of cowsheds in the Metropolis; from 1044 in 1880 to 673 in 1889. In 1878 the number in Kensington was 26; now there are just 12, viz., 8 in North Kensington and 4 in South Kensington. The names of the licensees, and the localities of the licensed premises, are set out in Table XII. (Appendix). The premises were inspected by the Works, Sanitary and General Purposes Committee in July, and found in a satisfactory condition. BAKEHOUSES. Under the provisions of the Bakehouses Regulation Act, 1863, the sanitary authorites (Vestries and District Boards) were responsible for the inspection of bakehouses. In January, 1879, the supervision of these establishments was transferred to the Factory Inspectors, by the Factory and Workshop Act, 1878. The Factory Inspectors, few in number, could not perform the duty, and in the result the bakehouses fell into a state more or less unsatisfactory, depending on the less or more attention bestowed upon them—without statutory authority- by sanitary officials. In some parishes no inspection at all was made, and at last it was seen to be necessary (the Chief Factory Inspector himself being witness) to reverse the legislation of 1878, and to re-transfer the control of bakehouses to the sanitary authorities, which was done by the Factory and Workshop Amendment Act, 1883. In my annual report for 1881, I called attention to the failure of the Aet of 1878, and urged the restoration of the status quo ante 1879. At the same time I pointed out the necessity for a "proper Bakehouse Regulation Act," providing for the licensing of bakehouses, 159 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, and dealing with (1) the position and construction, including lighting and ventilation, of bakehouses, (2) the periodical cleansing of them, and (3) the materials and utensils employed in the manufacture of bread. These views were adopted by your Vestry in 1882, and in January, 1883, they were communicated to the other Vestries and District Boards. The Society of Medical Officers of Health forwarded to the Home Secretary a memorial which I had drafted, in which the grounds for placing the bakehouses under the sanitary authorities were set out. The Operative Bakers and Confectioners' Union, in the same year, addressed the Government on the subject, in a memorial which stated that "at present almost any kitchen or cellar is turned into a bakehouse, often in close proximity to drams, many being even undrained and totally unfit places for the manufacture of human food." And subsequently the President of the Local Government Board received a deputation from the Union, which stated that "the unsatisfactory condition of bakehouses seriously affected the wholesome character of bread, and injuriously affected the health of the operatives." The President observed, in reply, that the Government proposed, by legislation, to prevent the construction of underground bakehouses for the future, but that he could not then hold out any promise as to inspection. In the last days of the session (1883), however, the Factory and Workshop Amendment Act was passed, by which your Vestry are constituted "local authority" in the Parish 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. The President's attention was drawn by me to the imperfect character of the provisions of the Bill, qua bakehouses, but there was no time to get it amended. There has been no fresh legislation on the subject since. The Society of Medical Officers of Health prepared "Suggestions for Regulations with respect to Bakehouses," for the guidance of local authorities. 160 These suggestions were adopted by your Vestry, and communicated to every bakehouse proprietor. The number of bakehouses in Kensington is 148, viz., 81 in North Kensington, and 67 in South Kensington. REFUSE MATTERS. The prevention of nuisance from accumulations of offensive matters, coming under the general description, Refuse, is a matter of no little difficulty. This difficulty, common to all parts of the Metropolis, is not likely to be surmounted without legislative action. The subject, in relation to certain important parts of it, was very fully dealt with in my annual report for 1887 (at pages 153 and 176), in connection with a report by the Law and Parlimentary Committee, and in my observations on a communication received by your Vestry, November, 1887, from the Metropolitan Board of Works, under the heading "Conveyance of Offensive Substances through Streets." A copy of this report was sent to every member of the London County Council, which is the proper and only body able to deal effectively with the matter, viz., by procuring legislative power enabling them to frame sanitary byelaws. HOUSE REFUSE. The collection of ashes and miscellaneous refuse from nearly 23,000 inhabited houses, spread over an area of more than 2200 acres, and to the extent of 42,547 loads in a single year, is no light task. That it is on the whole satisfactorily performed may be inferred from the comparative fewness of complaints, which used to be numerous when the work was in the hands of contractors. Relatively few as the complaints now are, a not inconsiderable proportion of them results from the neglect of domestic servants to allow the refuse to be removed when the periodical call of the dustman is made. Nuisance, in the sanitary sense, need not arise even from a full dustbin: when it does occur it is due to improper use of the receptacle by the deposit therein of animal and vegetable matters, of 161 which it may be said that the former has an appreciable value, and should be utilized,whilst 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," the entire arrangements being under the supervision of the Surveyor. A call is made at every house once a week, and further improvement is scarcely possible until the objectionable practice of refuseharbourage shall have given place to the more rational system of daily, or, at any rate, frequent collection from moveable receptacles, to be provided either by the sanitary authority or by the householder. Desirous of dealing with this nuisance in an effective way, your Vestry, in November, 1887, requested the (late) Metropolitan Board of Works to include in any suitable Bill thereafter promoted by them in Parliament, clauses to confer power enabling sanitary authorities to abolish dust-bins, and to enforce provision, in lieu thereof, of approved moveable receptacles, in order that a more frequent and accelerated collection of the refuse might be made. The Board referred the subject to the Special Purposes and Sanitary Committee, who addressed a communication to the Vestries and District Boards of Works, intimating that a representation had been made to the Board "as to the desirability of an amendment of the law" in the direction indicated, and stating that "before considering as to any recommendation to the Board," they desired to learn the views of the sanitary authorities upon the subject, suggestions being invited. At the meeting of the Board held August 3rd, 1888, the Committee presented their report, as follows:- "Your Committee have considered the letter referred by the Board on the 25th November last from the Vestry of Kensington, representing the desirability of an amendment of the law, so as to enable Vestries and District Boards to enforce the abolition of dust-bins in such G 162 "districts as may be deemed expedient,and the substitution, in lieu thereof, of approved moveable receptacles; asking the Board to take such steps in the matter as may appear desirable, and transmitting copy of a report by the Wharves and Plant Committee of the Vestry on the subject. Your Committee have given careful attention to this matter, and have now to report that in their opinion it is not desirable to promote the suggested legislation. Your Committee recommend the Board to adopt that view, and to inform the Vestry of Kensington accordingly." Amendments proposing (1) that, the report be referred back for further consideration; (2) that your Vestry be furnished with a copy of the replies received from the Vestries, etc., on the subject; and (3) that a copy of the report be sent to all of the Vestries, etc., were successively moved and rejected. The report of the Committee was approved, the mover of it remarking that the local boards had already sufficient power to deal with the matter themselves—a statement which would seem to be borne out by the statement of another member, that the Poplar District Board had in use many thousand pails, and that the system, which is now partially carried out in other districts also, appeared to work well. Nothing can well be more objectionable than the system of dust-harbourage in the statutory brick and wood receptacles, and it would be satisfactory were Parliament to confer upon the sanitary authorities the powers your Vestry desire to obtain. Meanwhile, I am not aware of any reason why the excellent suggestions of the Wharves and Plant Committee, upon which your Vestry's application to the Board was based, should not be carried out, by giving the pail-system an extensive trial in selected districts; seeing that, if successful, it would abolish a serious nuisance by securing a frequent and accelerated collection of the offensive refuse. The subject is important, and is deserving of the serious attention of the London County Council in connection with the proposed sanitary bye-laws. A constantly increasing difficulty is experienced in finding convenient, i.e., accessible "shoots" for bouse refuse, to the deposit of which within their boundaries, the sanitary authorities 163 of contiguous districts naturally object. The refuse, moreover, has little value now that building operations are being prosecuted upon so limited a scale in, or within easy distance of, the Parish, and other districts being able to supply the brickmakers' wants. The land at Purfleet, on the river Thames, sometime since acquired by your Vestry, and in connection with which a landing pier has just been completed, will, it is hoped, ultimately furnish a profitable outlet for all the refuse of the Parish, and so put an end to our difficulties. TRADE REFUSE. In a Special Report, dated March 13th, 1885, on Sanitary, Nuisances Removal, and other cognate Acts, made in connection with an enquiry referred to the Law and Parliamentary Committee (April 9th, 1884), I stated that your 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 (of the Act referred to) would apply in the case of trades which lead to the production of 'refuse' of an offensive character." This subject was fully dealt with in the said Report, and also in my Annual Report for 1887 (pages 176-189), of which copies were forwarded to every member of the London County Council, in 1889. Beyond question, in my opinion, the sanitary authority should undertake the removal of all such "refuse" matters, of animal and vegetable origin, as may become, if kept too long on the premises, injurious to health; and in the interests of public health, moreover, the producer of trade refuse of an offensive sort should be compelled to employ the services of the sanitary authority for its removal. But, at present, it is precisely refuse of an offensive character that the sanitary authority are not called upon or expected to remove—viz., that produced by butchers, fishmongers, fried fish dealers, poulterers, &c., who pay substantial sums for the service, which is conducted, not seldom, in an 164 objectionable manner. The matter is eminently deserving of the attention of the Council, but it is doubtful, as elsewhere stated (page 105), whether they have power to deal with it in the existing state of the law, viz., by framing sanitary bye-laws. STABLE REFUSE. In several of my annual reports mention has been made of the frequency of complaints in regard to accumulations of stable manure, "the most common of recurring nuisances" with which the Sanitary Inspectors have to deal. Your Vestry many years ago exercised the powers conferred by section 53 of the Sanitary Act, 1866, by giving public notice for "the periodical removal of manure or other refuse matter from mews, stables," etc.; the regulations requiring such removal to be effected on "alternate days the penalty for default being "twenty shillings per day for every day during which such manure or other refuse matter shall be permitted to accumulate." Proceedings have been taken occasionally for the recovery of penalties, but not with very satisfactory results. The non-removal is sometimes the fault of the coachman, who will not give the refuse away, and the farmers being now, as a rule, unwilling to pay for it. At certain seasons —e.g., haymaking and harvest-time—there is no doubt a difficulty in getting the receptacles cleared, farmers being too busy to collect the refuse. Formerly, when the Parish consisted largely of market gardens, the cultivators of the soil were glad enough to get the manure by satisfying the demands of the coachmen and others. Now that it has to be hauled miles to the suburban farms and gardens, the stable-owners, moreover, being at the mercy of the waggoners, the case is far otherwise, and not unfrequently payment has to be made to ensure removal. The nuisance caused by accumulation varies in degree according to the character of the receptacle in which the manure is stored. When this is a well-paved and drained enclosure, on the surface of the mews, consisting of a low curb carrying a 165 moveable iron cage attached to the stable-wall by hooks, aircurrents circulating freely through the refuse, and removal being at once easy and complete, there is little or no nuisance in storage, or in transference to the waggon, or in conveyance through streets. Brick receptacles above ground are more or less objectionable, for they are seldom thoroughly cleared out, short straw, &c., being left at the bottom. Nuisance is least when the floor of such receptacles is on, or slightly above, the level of the surface of the mews, and provision is made for allowing moisture to drain away. But when the floor of the receptacle is below the surface of the mews, and even though nominal provision has been made for drainage, nuisance is considerable : rain enters and cannot escape, as the drain gets choked ; the result being that the refuse rots, the receptacle becomes filthy, and the collector will not incur the defilement attending a perfect clearance. All of the evils are intensified in a high degree when the receptacle is entirely underground, being what is called a "sunken dung pit," always undrained, and covered with wooden flaps. The rain enters these pits, and confinement of the organic matters leads to very rapid putrefaction, the result being that, after a short detention, serious nuisance arises, to the great discomfort of persons living in the vicinity. Were these pits cleared regularly, as required by the regulations, they would still be a cause of nuisance. Everyone must have observed the "steam" arising when the contents are disturbed, and been annoyed by its horrible offensiveness. As a rule, the pits are not properly cleared. These sunken dung-pits are a nuisance in themselves, and as the use of them involves a continually recurring nuisance, it should be prohibited. Entertaining these views, and all the efforts of the sanitary inspectors having failed to keep the nuisance within bounds, I thought it desirable to have a return prepared shewing the kind and number of the receptacles actually in use in the mews in the respective districts. This return I submitted, in March last, to the Works and Sanitary Committee, by whom it was ordered to be printed for the information of your Vestry, and 166 with a view to consideration of steps for dealing with the matter, thoroughly and effectually; as, in 1888, nuisances in connection with public-house urinals were dealt with. It may be mentioned that the "nuisance authority" (the Vestry) have power to contract with the occupiers of stables and cow-houses for the collection and removal of manure or other refuse matter from such stables and cow-houses. But at present the nuisance authority can remove it only "with the sanction of the owner." The necessary sanction would be forthcoming, probably, in most cases, once it came to be known that, otherwise, the requirements of the law would be enforced, in case of neglect on the part of the owner to comply with the regulations. In many, if not in the majority of cases, trifling sums are now paid by the owners for the removal of the refuse, and I see no reason why they should not be required to pay to the local authority a small fee for the service. At the same time it is probable that the large amount of refuse produced in the 177 mews in this parish would have an aggregate value sufficient to pay the cost of a well-organized system of collection and removal to the country. In my special report (March '25th, 1885) on "Sanitary, Nuisances Removal, and other cognate Acts," I placed my views as above, before your Vestry. The Law and Parliamentary Committee, to which the report was referred, recognized "the necessity for making proper arrangements for the removal of manure and other refuse matter," but stated that "the Vestry had not depot accommodation or staff or plant adequate to cope with so large a work." For this reason, they considered that the Vestry was not then "in a position to contract generally for the removal of manure and other refuse matter." The circumstances are now different, your Vestry having an admirable depot at Purfleet, to which the manure could be conveyed from the river and canal-side wharves, and where it would probably command a ready sale at a remunerative price for use on the land; 167 the best part of it (the clean litter from South Kensington stables), moreover, being available for the manufacture of paper at the works adjoining your Vestry's property. An opportunity for legislation it was hoped would have been afforded this year. In the proposed Public Health London (Consolidation) Bill, which was to have been introduced by the President of the Local Government Board, the section (53) of the Sanitary Act, 1866, above cited, was to be re-enacted: it might be extended so as to enable or require the sanitary authority to collect and remove manure and other refuse matter from stables and other premises, at the reasonable cost of the producers thereof. But in any case I am of opinion that this duty should devolve upon the authority in the interests of public health. Meanwhile, and whether such legislation should be found practicable or otherwise, I entertain no doubt of the propriety of immediate measures being taken for the abolition of sunken dung pits. DISINFECTION. During the year ending March 25th, 1890, a large number of infected articles, clothing, bedding, &c., were satisfactorily disinfected by the contractor at the cost of your Vestry, the owners being too poor to bear the expense. The weight of the articles was 20 tons 16½ cwts., their number 10,519, and the cost of the process £384 19s. 6d. Three hundred and seventy-five rooms in 353 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. NECESSARY ACCOMMODATION. There are only fifteen public urinals in the Parish—a very inadequate number—and no public water-closets, except those at the rear of the Vestry Hall. Section 88, Metropolis 168 Local Management Act, 1855, 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 for the male sex have frequently been thwarted by local opposition. A proposition to erect "chalets," as a commercial speculation, has been long under consideration, and one chalet has been erected in Norfolk Terrace, Westbourne Grove West; but as the proprietors lately made an application to your Vestry to take it over, it may be doubted whether the speculation has altogether answered expectation. Accommodation is provided at about 170 publichouses—not of a very satisfactory sort in many instances, but better than none at all, and much improved as the result of proceedings directed by your vestry to be taken in 1888. The County Council, in May, 1889, signified to the vestries and district boards its opinion of the necessity for chalet accommodation for men and women, or the construction of places giving such accommodation below the level of the ground, in the manner which has proved successful in the City and elsewhere; moved thereto by the "many cases of physical injury coming to the knowledge" of the medical profession, which are "traceable to the want of proper accommodation of this nature in London." Little, however—nothing at all in this Parish—has been done hitherto to give effect to the views of the Council. PUBLIC BATHS AND WASH-HOUSES. The Baths and Wash-houses, at the junction of Lancaster and Silchester Roads, Notting Hill, opened in April, 1888, have been well supported. But for the majority of parishioners the site is not sufficiently central for bathing; and obviously it is too remote for washing purposes. The same objection would apply to any single site in the Parish. Much good might be effected by the provision of buildings, on a modest scale, in several 169 localities, to which the poor could resort for the purpose of washing clothing. The figures in the report of the Commissioners for 1889-90, shewing the growing use made of the wash-houses, are of a nature to encourage a hope that the Commissioners may find it not merely desirable, but prudent also, to provide, at no distant time, for the wants of the poor in the central and southern parts of the Parish. The total number of washers, 13,950 only, in the year ended March 25th, 1889, rose to 31,113 in the year ended on the 25th March, 1890. The number of hours employed in washing in the former year was 38,709, and in the year lately ended 84,352. Not only is the increase very large, but at present there are no signs of a falling off in that increase. Obviously the question of public washhouses might with advantage be separated from that of public baths. The Sanitary Committee of the London County Council, having "considered the question of the advisability of the Council being invested with powers to establish public baths and laundries in all parts of London came to the conclusion that this was not one of the questions that pressed most for central administration, and that it might be deferred until district councils are created; and with this view the council concurred."* PUBLIC MORTUARY. The mortuary in the Parish Churchyard, at the flank of the Town Hall, was opened in July, 1883. In the first year 37 bodies were deposited; in the second year 77; in the third year 100; in the fourth year 97; in the fifth year 109; in the sixth year 128, and in the seventh year 143. *Annual Report of the Committee. The bodies removed to the mortuary in twelve months, ended March 25th, 1890, were admitted upon application as follows:— 170 In 66 of the above cases post-mortem examinations were made by authority, principally under the coroner's warrant. The mortuary comprises two chambers, for infectious and non-infectious 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 cost of such removal and re-removal to be paid in the same manner, and out of the same fund, as the costs and fees for post-mortem examinations when ordered by the coroner." (Sanitary Act, 1866, sec. 28.) The coroner now frequently orders the removal of bodies for this purpose—but at your Vestry's charge. Too little use is made of the mortuary, and especially as a place of deposit for the bodies of those who have died from infectious disease. Medical men can obtain the removal of the body in such cases by Justice's Order (Sanitary Act, 1866, 1. At the request of relatives of the deceased 4 2. At the request of undertakers 40 3. At the request of the coroner (inquest cases)— Cases of sudden death 52 Cases of violent death 11 — 63 4. Brought in by the Police Found dead 11 Accident cases 4 Suicide ,, 2 — 17 5. On account of death due to infectious disease 11 135 171 sec. 27), but only if persons live or sleep in the room where the body is retained. A body in such a state, from decomposition, as to endanger the health of the inmates of the same house or room, may in like manner be removed to the mortuary. The Royal Commission on the Housing of the Working Classes (1885) recommended provision of additional mortuaries in London. What, however, is more required, at present, is power to compel removal of the dead to existing mortuaries, when removal is necessary on sanitary grounds. The Commissioners recognized this fact, by implication, in 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, moreover, " that in any case where the body lies in a room which is used by other persons, it should, in the same manner, be removed." (Report, page 31). The London County Council thinks it desirable to provide a Morgue for the unidentified dead, and no doubt it would be a useful institution; especially should provision be made for preserving bodies unchanged in appearance whilst awaiting identification. CORONER'S COURT. It is now a common practice to provide a court for the coroner in connection with the public mortuary, so as to obviate the scandal of holding inquests at public-houses. This course seemed to me unnecessary when plans for the mortuary were under consideration, there being rooms at the Vestry Hall suitable for the purpose. My anticipation that a room could and would be provided for the coroner's use in that building not having been realised, your Vestry fitted up a room, in January, at the Town Hall, where in the year ended 31st December, 1889, 61 inquests were held out of a total of 141. The bulk of the 172 remaining 80 inquests were held at public-houses; so that the object your Vestry had in view in providing the accommodation, was but partially realised. When inquests are held at publichouses, the post-mortem examination of the body is necessarily made in the house where death takes place, at which too commonly proper accommodation is totally wanting. Communications passed last year, between the coroner and your Yestry, with regard to the use of the court and of the mortuary, which issued in a more adequate use being made of those valuable institutions. In February of the present year the London County Council passed a resolution to the effect "That all coroners having jurisdiction within the administrative County of London be instructed, as far as it is practicable, and accommodation is available, to cease holding inquests or coroner's courts in public-houses." This resolution, I am glad to state, is bearing good fruit; inquests now being rarely held at public-houses in this Parish. BEOMPTON CEMETERY. A mild agitation for the closing of this cemetery, not the first, was set on foot last year, and a question was put in the House of Commons, in April last, Whether the Government (to whom the cemetery belongs) taking into consideration the great increase of property and population in the neighbourhood, had decided to close it, as was proposed by the Government in 1884, and to hand it over, as a disused burial ground, to the London County Council, with due regard to the vested interests of persons interested, and the policy of the intramural Acts ? In reply, Mr. Jackson stated that it was not necessary on sanitary grounds to close the cemetery and as there was a present income of £6000 per annum derived from the cemetery, he was not prepared to advise that it should be closed on other grounds. It will be remembered that last year the London County Council made inquiry as to your Vestry's views in regard to closing the cemetery as a burial ground, and maintaining it as an open space ? The reply given was to the effect 173 that your Vestry were in favour of the closing of the cemetery as soon as practicable, and considered that, with that object, no further land should be let or sold for the purpose of burial. The subject appears to have been brought to the attention of the Council by the Parks and Open Spaces Committee, who (in May, 1889), being " of opinion that whenever an open space can be obtained for the public use, without outlay beyond the necessary expenditure for maintenance, the Council should secure it;'' and "therefore recommended that the Government be requested to close Brompton Cemetery, and to transfer it to the Council for maintenance as an open space." The subject was referred by the Council to the Sanitary and Special Purposes Committee for consideration and report. The Committee, having "inquired very fully and carefully into the matter," reported, in July, that " o sufficient case to require the closing of the cemetery can at present be established;" a conclusion with which I am bound to agree, and had previously myself arrived at, much as I should wish, upon abstract grounds, to see the cemetery closed. The report of the Committee was approved by the Council. The Chairman of the Committee (Captain James), informed your Vestry, in May last, that the Home Secretary, whom the Committee had received permission to approach on the subject, had decided that no new graves should be opened within thirty feet of the boundary walls, nor interments take place in the public vaults within this zone. It appears that more than 155,000 interments have taken place since 1840, and that about 4000 take place annually, of which 70 per cent. are in the common ground. It is alleged, nevertheless, that there is still available space for common interments for two or three years, and in private ground for an indefinite period. REGULATIONS FOR HOUSES LET IN LODGINGS. The Sanitary Act, 1866 (sec. 35), enables the "Nuisance Authority" (the Vestry), with the cousent of a Secretary of State, to make Regulation "for houses, or parts of houses, 174 let in lodgings or occupied by members of more than one family." The Authority are enabled by their regulations to fix the number of persons who may occupy a house. They may register the house, and inspect it to see that it is kept in a cleanly and wholesome condition. They may enforce the provision of privy accommodation, water supply, etc., and provide for the cleansing and ventilation of the common passages and staircases, and for the cleansing and lime-whiting of the premises at stated times. In all but a very few districts in the Metropolis this useful enactment was ignored for years. In 1871, further powers were conferred under the Sanitary Law Amendment Act, enabling regulations, framed under the first-named Act, to extend to the ventilation of rooms; the paving and drainage of premises; the separation of the sexes; and to notices to be given, and precautions to be taken in case of any dangerously infectious disease occurring in a registered house. The same Act conferred power on the Local Government Board to declare the enactment to be in force in any district. The sections, nevertheless, remained practically a dead letter in most of the Metropolitan districts, the Board not exercising their power. I brought the subject to the notice of your Vestry in 1878, when the Sanitary Department had been reorganised and the staff enlarged; and in April, 1879, I was requested to make an enquiry as to the working of the Acts in places where they had been put into operation. Meanwhile, I had introduced the subject at the Society of Medical Officers of Health, which resolved (1) That the Acts are practicable; (2) That they should be put in operation in London and other large towns; (3) That a uniform code of regulations for the Metropolis was desirable; and (4) That the Society should undertake the framing of such a code. At the request of the Council of the Society, to which the matter was referred, I drafted a code. This draft code, with slight alterations, was adopted by the Society, and in May, 1879, the Regulations were published "for the guidance of Urban Sanitary Authorities." Your Vestry, finding that the Acts were carried out in but 175 very few places, resolved that it was not expedient, at that time (July, 1879) to proceed any further in the matter. In a Presidential Address to the Society of Medical Officers of Health, delivered in October, 1883, I drew attention to the Acts, and to the desirability of their being put in force. This address was printed and widely circulated by the Society. In November your Vestry resolved, unanimously, to take steps for carrying out the provisions of the Acts, and at once set to work to frame regulations. In the following month, December, 1883, the Local Government Board, exercising the power conferred by section 47 of the Sanitary Law Amendment Act, 1874, declared the enactment contained in section 35 of the Sanitary Act, 1866, to be in force in every district of the Metropolis, the Authority of which had not previously made application to the Board for powers to enable them to make regulations. Early in 1884 your Vestry made regulations which, after modifications suggested by the Board, were confirmed by the President in January, 1885, and are now in force. Under these regulations about 1800 houses have been placed upon the register, and the process of registration is still in progress. The announcement of your Vestry's intention to register houses, proved distasteful to many "landlords," some of whom, complying with your Yestry's invitation, "stated in writing reasons why the house should not be registered;" but almost without exception, the "reason" stated amounted to no more than an "objection" to registration altogether; an objection based usually on a mistaken supposition that by registration the "registered house" would become a "common lodging-house," subject to police supervision, and be stigmatized in a manner likely to diminish its letting value. It is hardly necessary to say that these are purely imaginary evils. 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 176 a tenement-house, the "owner" is "keeper" also), and the several lodgers. So far from registration injuring property, I believe it will come to be regarded as a guarantee that the house is in good sanitary condition, when time shall have permitted the carrying out of your Vestry's Instructions for the guidance of the Sanitary Inspectors in regard to the sanitary arrangements of registered houses, which require them to see:— 1. That all cisterns are periodically cleansed and properly covered ; 2. That all waste-pipes from sinks, cisterns, baths, &c., be disconnected, and empty themselves over or, preferably, near surface gratings, and outside the house where practicable ; 3. That the drains under all such gratings be efficiently trapped; 4. That the paving of yards be laid to a fall towards such gratings, with the joints of such paving grouted, or pointed in Portland cement or other impervious material; 5. That all drains be trapped from the sewer, outside the wall of the house next the sewer. Note.— Where convenient or practicable an intercepting chamber with a close-fitting cover and an air-tight pipe should be recommended. 6. That all house drains are air-tight; Note.— Where there is reason for believing that any house drain is imperfect, notice must, if necessary, be given to the Surveyor, who will provide workmen for opening it up for examination. 7. That all special soil-pipes 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 Yestry, on February 10th, 1886, directed to be observed "in respect to all other houses wherein, on examination, sanitary improvements are found to be necessary." 177 Report of the Royal Commission on the Housing of the Working Classes.—In connection with the subject of registration of houses let in lodgings, a full summary of the Report of Her Majesty's Commissioners for enquiring into the Housing of the Working Classes, was given in my Annual Report for 1884-5 (page 184). 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, the best paved, the best drained, the best lighted, the safest and the 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 Loudon County Council, by appointing a Housing of the Working Classes Committee, and in other ways, e.g., by putting Cross's Acts into operation again, has shewn its interest in this question. To what extent it will be enabled to solve the tremendous difficulties by which the question is encompassed, time only can determine. UNHEALTHY HOUSES. By section 13 of the Housing of the Working Classes (England) Bill, 1885, a measure introduced by Lord Salisbury with a view to give effect to recommendations of the Royal Commission, it was proposed to enact that, in any contract for letting an unfurnished house for human habitation, there should be implied a condition that the house was in all respects reasonably fit for habitation; and that in the event of a breach of such condition, any inmate of such house who suffered any loss by injury to health or otherwise, in consequence, should be entitled to recover damages from the person responsible for such breach. The section was in accord with my proposal (in 1884) that "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;" which I hoped would "before long be established as a principle 178 of English law." Unfortunately, the section was altered in Committee so as to become of little value for practical purposes. The "condition," however, is implied by existing law in the letting of a furnished house, as was shewn by the result of an action (Charsley v. Jones) brought, in 1889, for breach of an agreement to let a furnished dwelling house at Ryde. Owing to the alleged defective system of drainage, and the contaminated condition of a well, in connection with the house, several members of the plaintiff's family got typhoid fever; and so the plaintiff and his family had to quit the house and find apartments elsewhere. The learned Judge (Mr. Justice Manisty), in summing up to the (Special) Jury, said that "the law in the case of a furnished house was, that there was an implied undertaking that the house was fit for human habitation. The question was whether the typhoid fever was due to the house not being in a reasonably habitable condition owing to the water or the drains ? It seemed that the defendant honestly believed that the house was in a fit state of habitation ; but that was not the question. The date when the family went to Ryde was important, as in typhoid fever there was a period of incubation." The learned Judge then went carefully through the evidence, and said, as regarded the damages, if they thought the house was not fit for human habitation, the plaintiff was entitled to a verdict for the rent and such other expenses as he was put to. The Jury returned a verdict for the plaintiff, with £70 damages. UNDERGROUND ROOMS. Section 103 of the Metropolis Local Management Act, 1855, enacts that, "Any room of a house, the surface of the floor of which room is more than three feet below the surface of the roadway of the adjoining street . . . when such room is or has been occupied separately as a dwelling, at or before the time of the passing of the Act (14th August, 1855), may continue 179 to be so let or occupied if it possess "certain" requisites," viz., (1) An area of specified dimensions, etc. (2) An open fire-place with proper flue, and (3) a window of specified size made to open. The section further enacts that "no such room not so let or occupied as aforesaid, at or before the time of the passing of the Act, shall be so let or occupied unless it possess" certain " requisites," viz. (1) Unless the room be at least seven feet in height; (2) Unless the ceiling be at least one foot above the surface of the footway of the nearest adjoining street; (3) Unless there be an open area; (4) Unless the area be effectually drained; (5) Unless there be appurtenant to the room the use of a water closet and an ash-pit; (6) Unless there be a fire-place with proper chimney or flue; and (7) Unless there be an opening window of certain specified dimensions There is a proviso that there may be steps, necessary for access to the room; and steps over or across the area for access to any building above the room, if the said steps be so placed as not to be over or across the window. The penalty to which anyone letting or occupying an underground room contrary to the Act is liable, is a sum not exceeding 20s. per diem. Every room in which any person passes the night is deemed to be occupied as a dwelling within the meaning of the Act. It is the duty of the District Surveyor to " report, periodically and otherwise," as the London County Council may order, to the said Council, all cases in which rooms are occupied contrary to the Act in his district ; and also to the Vestries and District Boards in respect of cases in his district within their respective parishes and districts. Any person, moreover, may enforce the enactment and take proceedings for penalties thereunder. The reports of underground rooms were forwarded to your Vestry by the District Surveyors with more or less regularity every half-year, down to the time when the Metropolitan Board ceased to exist, but no action was taken upon them either by the Board or by your Vestry or by any person. I alluded to this fact in a Special Report (13th March, 1885), referred to at page 104. The Law and Parliamentary Committee in their report dealing with the subject, which was adopted by your Vestry in January, 1886, 180 recommended, "that in future 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 by the Vestry as the circumstances of each case may seem to warrant." The reports received in January, 1887, were referred as directed. Inquiry was made by the several Sanitary Inspectors with respect to the underground rooms mentioned, and I reported on the subject in my sixth monthly report (June 20, 1887, page 51) as follows:— "The reports of the District Surveyors treat of the circumstances of the several underground rooms as they relate, on the one hand, to structural condition or defects; and, on the other hand, to removable sanitary defects. 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 footway; that the area is not six inches below the floor of the room, nor effectively drained; that there is no proper area, and so on 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 removeable sanitary defects, such as that the trapping of the area drain was insufficient, or that the dustbin was without a cover, I reported. that the necessary proceedings were being taken for remedying the said defects. No other action was taken with respect to subsequent half-yearly reports received prior to January of the current year. But in March, 1890, the London County Council requested your Vestry's attention to certain "underground" rooms "occupied as dwellings, contrary to law," on which I specially reported (25th March). Nearly all of the houses referred to had been built prior to August, 1855, so that most of the rooms were not "underground" rooms within the meaning of the Act;" a distinction being made between rooms occupied separately as dwellings at or before the time of the passing of the Act, and rooms not so let or occupied at or before the passing of the Act." After shewing "in what 181 particulars each of the several rooms failed to conform to the requirements of the Act," I observed that "the list furnished by the District Surveyor was not exhaustive." In one street named, only two rooms in two houses, built since 1855, were reported, there being in that street alone "scores of houses in which the conditions as to the level and the drainage of the area were the same as in the houses mentioned."These houses, I added, had been "erected under the supervision of the District Surveyor, a remark applicable to all of the houses in the Parish built since 1885." It was not alleged that any of the rooms referred to in the District Surveyor's report were unfit for human habitation, although some of them, undoubtedly, were "occupied as dwellings contrary to law." A copy of my report was forwarded to the County Council, together with a communication intimating that your Vestry were taking— "The necessary action to cause remediable defects in connection with the (specified) underground rooms to be removed," but that it was thought " undesirable to take proceedings to close rooms on account of technical defects, which cannot be removed, in the case of rooms which are otherwise fit for human habitation. The effect of forbidding the occupation of such rooms would be to raise the rent of the other rooms in the several houses, and if the same course were adopted in regard to all underground rooms, the accommodation available for the poorer classes, who occupy such rooms, would be materially curtailed. The Vestry, it is hardly necessasy to observe, could not act partially in the matter, and should they take proceedings upon technical grounds, it would be their duty to deal with many other cases than those mentioned in the District Surveyor's List, which is far from being exhaustive. The Vestry," it was said, "are fully alive to the importance of the subject, and in evidence of their desire to do whatever may be necessary in the interests of public health " were " now taking proceedings to close a considerable number of underground rooms not comprised in the lists of the District Surveyors, upon the ground that they are unfit for human habitation." The County Qouncil, in a further communication (27th May) from the Building Act Committee, stated, "that although they attached considerable importance to the views entertained by the Vestry, they felt that no discretion was conferred upon them by the statute in dealing with cases in which it was found that the law 182 was not being duly observed." Your Vestry, thereupon, directed the necessary steps to be taken, in proper cases, to enforce the provisions of the Act with regard to the rooms mentioned in the three Lists of the three District Surveyors, received in March and June, which comprised 242 rooms in 187 houses, a number far in excess of the numbers contained in any previous lists. The particulars in which the several rooms were alleged not to comply with the requirements of the section, may be summarised as follows:— No proper area, in 13 houses. Area covered (not open), in 7 houses. Area not six inches below the floor of room, in 167 houses. Area not of sufficient width, in 25 houses. Area in front of window; insufficient in width, height, and depth; room not high enough; window opening of insufficient dimensions, in 5 houses. Room less than seven feet in height, in 6 houses. Ceiling of room not one foot above the footway, in 9 houses. Not all of the rooms, it may be added, are "underground rooms" in the eye of the law, some of the houses having been built prior to the passing of the Act in 1855. It was mentioned above, that no action had been taken by the Metropolitan Board of Works upon the half-yearly reports of Underground Rooms, made by the District Surveyors, and it appears from a report of the Building Act Committee of the London County Council (dated 19th February, 1890), that "no record has hitherto been kept as to whether any legal action had been taken by the local authority." The Committee therefore 183 recommended, and the Council resolved:— "(a) That a register be kept accordingly. "(b) That in any case of underground rooms or cellars, occupied as dwellings, reported by a District Surveyor, in which a local authority fails to take action, the Council, after notifying its intention to the local authority, shall, by its solicitor, take the necessary legal steps to obtain a conviction. "(c) That every District Surveyor be required to make a quarterly instead of a half-yearly return of all underground rooms or cellars occupied as dwellings in his district." Theoretically, of course, the Council are correct in saying, as above stated, that "no discretion is conferred upon them by the statute in dealing with cases in which it is found that the law is not being duly observed." But "discretion" in another sense might reasonably be exercised, seeing that, practically, in many of the cases of underground rooms, as defined by the statute, no harm would come from their being "occupied as dwellings;'' and that not being "separately" occupied as dwellings—very many of such rooms, not coming within the cognisance of the law—are lived in without, so far as appears, any detriment to health. THE METROPOLITAN SEWAGE QUESTION. In my annual reports for 1885 and 1886, I referred, under the beading "Metropolitan Main Drainage," to the steps taken by the late 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 184 sewage were cool, and the latter much diluted by rainfall. But their addition, it was stated, purified and deodorised 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 the acid, at numerous stations, to the sewage as it flowed 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 of the Board was to avoid the necessity for costly land filtration of the effluent, as recommended by 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, incurred a large expenditure for works of construction, and in the carrying out of the system adopted. SIR HENRY ROSCOE'S REPORTS. Deferring, however, to the objections made to the system above described, the Board, in 1887, retained the services of Sir Henry Roscoe, F.R.S., as consulting chemist and scientific adviser, to report on the question of the deodorisation of the sewage at the Outfalls, and they ultimately consented to the request of certain sanitary authorities—your Vestry among the number— to make that gentleman's reports public. The reports were five in number. The first, dated 16th May, 1887, dealt with "The Deodorization of Sewage in the Metropolitan Sewers;" the second and third, dated August 7th and December 9th, 1887, with "The Deodorization of Sewage at the Outfalls." The fourth report, dated March 3rd, 1888, treated of the deodorization of sewer emanations by the use of sulphurous acid applied at numerous stations within the Metropolitan area; while the fifth 186 was a further report on deodorization of sewer emanations, and on sewer ventilation. In my annual report for 1887 I summarised the contents of all of these reports (pages 231-240). The reports had been referred by your Vestry to the Works, Sanitary, and General Purposes Committee for consideration. The Committee reported on the subject to the effect:— (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 Henry Roscoe, 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 occurring during the summer months, in drought or hot weather, and as it had been previously stated by Sir H. Roscoe that such an expenditure is not justifiable. (b) "That as Sir H. Roscoe is convinced that sooner or later the recommendations of the Royal 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 Reach,' 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 an annual cost of £11 or £12 for each station where it is applied, appear to be practically unsuccessful, and therefore might as well be discontinued. (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." 186 The latter recommendation arose out of a favourable notice by Sir Henry Roscoe of a method of ventilating sewers recommended by Mr. Parker, late Surveyor to the Poplar District Board of Works, long in use in that district, 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 Mr. 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 Hooding the sewers with fresh air, so as to dilute, oxidize, and favour the escape of the foul emanations from the sewage. Sir Henry Roscoe, in December, 1888, presented a further report to the Board, dealing with The Deodorization of Sewage at the Outfalls, setting out the proceedings taken in 1888; and in March, 1889, yet another report on The Chemical Examination of the Foreshores and Mod Deposits of the River Thames and its Estuary, the outcome of a resolution of the Board, approving of a recommendation of Sir Henry Roscoe, to the effect," That an examination should be made of the condition of the Thames deposits from Barking down the river to the mouth, including the whole of the estuary." In my annual report for 1888, these reports also, were summarized (pages 162-167). Sir Henry Roscoe's engagement with the Board expired at Lady Day, before which date the Board itself came to a premature end. Subsequently, in May, 1889, Sir Henry Roscoe published a paper "On the Metropolitan Sewage Question," in which he summarized the conclusions of the Royal Commission of 1882; the proceedings of the late Metropolitan Board of Works in regard to the treatment of the Sewage, in opposition to the recommendations of the Commission; the views of the Chemists 187 consulted by the Board; and his own reports, above referred to. This paper is well deserving of consideration by all concerned in metropolitan sanitary administration. Primarily, it was prepared for the use of members of the County Council, whose Main Drainage Committee, it was understood, were proceeding upon the liues of the late Board, in carrying out a discredited system, which, it was alleged, would involve a large yearly outlay for disinfectants. After "A criticism of the system proposed by the Metropolitan Board" (page 15), Sir Henry Roscoe concludes by stating his opinion that "the proposal of the late Board for the disposal of the sewage is based on false principles:— " (1) As regards the addition of lime and iron in the proportions recommended. " (2) As regards the addition of manganate of soda to the effluent, after precipitation, in the quantities suggested. " (3) As regards the formation of underground settling tanks at Barking and Crossness. " (4) As regards pumping the sludge into tank steamers and sending it out to sea." The suggestion he made was that "The Main Drainage Committee should appoint an engineer and a chemist of position, to report to them on the whole question of the treatment and disposal of the sewage, as a basis for future action." The County Council, while hoping to be enabled to avail themselves, in the future, of Sir Henry Roscoe's services, did not think it necessary to renew his appointment upon their own accession to the responsible position occupied by the Board in relation to the sewage question; so that the investigations have, for the present at least, come to a close. Sir Henry Roscoe's reports, meanwhile, are on record, and the scientific information they embody will be of value in any future inquiry. It still remains to be seen what will be the effect upon the river of the costly scheme of subsiding 188 reservoirs, and of the deodorization of the sewage, now partially in operation, to which the Council no doubt will give a fair trial, although the defunct Board is exclusively responsible for the experiment; an experiment on a vast scale, made, it may be repeated, in defiance of the recommendations of the Royal Commission, generally opposed by scientific chemists, and condemned by their own chosen adviser, Sir Henry Roscoe himself. It may be added that during the summer of 1889— from 23rd May to 12th October—1313 tons of manganate of soda, and 391 tons of sulphuric acid, were used at the Barking Outfall for disinfecting the effluent before discharge into the river: at Crossness, the tanks not having been completed, 1686 tons of manganate and 664 tons of acid were applied to the crude sewage; and at the Storm Overflows, 187 tons of manganate and 40 tons of acid were used. The total quantity of manganate was 3197 tons, and of acid 1096 ton3, at a cost of £25,305 ; these chemicals being used during the hot weather only. This outlay is independent of that for lime and sulphate of iron, used for precipitating the sewage at the Barking Outfall Works; the quantities estimated by the chemist beiDg, lime 9125 tons, sulphate of iron 2190 tons, for the year, costing some £10,700, so that the total outlay on chemicals during the year was, in round figures, £36,000. The precipitated sludge, it may be mentioned, is taken to the Nore, at a cost of about fourpence a ton; two ships working night and day, and a third being required. From what has gone before, it will be apparent that the best authorities are unanimous in the view that the sewage, crude or after precipitation, must ultimately be taken to the land. At Paris it is stated that 5000 gallons, on an average, are applied to the acre. At this rate 30,000 acres would be required for irrigation purposes, were all the sewage of London, averaging 150 million gallons daily, disposed of in this manner. A larger proportion of a partially purified effluent, presumably, might be 189 used, thus reducing the amount of land required. The land, however, has yet to be found, and in any case a large outlay would be required on main and branch sewers, etc. Projects for conveying the sewage to the land have been before the public for thirty years and more, and nothing has been done. Probably it will be long before anything will be done. The questions remain, therefore, Is the river of necessity to continue to be polluted as heretofore ? Is there no alternative ? Three schemes have been put before the public lately, viz :—(1) The Amines process ; (2) the International Sewage Purification process; and (3) the Webster Electrical process, which appear to deserve notice. The Amines process was tried at Wimbledon on a fairly large experimental scale. Lime was added to the sewage in considerable quantity, mixed with herring brine in the proportion of three grains to the gallon. A good effluent, apparently sterile, was produced. It was believed by many, however, that most of the effect produced was due to the large addition of lime, and a somewhat general impression prevailed that the process could not be regarded as applicable to the case of the London sewage. The International and Electrical systems appear to be decidedly superior, and both are vouched for by Sir Henry Roscoe. Both, moreover, are at the present time undergoing exhaustive competitive trials, side by side, at the Salford sewage works. The International process consists, firstly, in the precipitation of suspended matters by " ferrozone," about eight grains to the gallon being used : this substance contains 26½ per cent. of ferrous sulphate and 2 per cent. of aluminium sulphate, and costs £3 per ton. Secondly, after subsidence in tanks, the effluent is drawn off and passed over filtering beds at the rate of 1000 gallons per square yard of filter in 24 hours. The filtering material is " polarite," which contains about 54 per cent. of magnetic oxide of iron; the cost of the filter being about 14s. per square yard, or £4 per ton. The process is in operation at Acton, upon what may be described as a purely domestic sewage, a good 190 effluent being produced ; but hitherto, I believe, no trials have been made with London sewage, and whether it will prove practically applicable, trial only can determine. Important points to be ascertained are : The durability of the filtering material; the cost of keeping the filters in order; and the proportion of precipitating material necessary to be used. The Webster Electrical process consists in passing the raw sewage through a shoot in which are placed a series of iron plates, about one inch apart, these being in electrical contact with the dynamos. The working trials of this process were made at Crossness, with a plant capable of treating 15,000 gallons per hour. The electrical action produces hydrated ferrous oxide, which is not only a deodorizer, but also possesses the property of removing soluble organic matter; the resulting effluent, moreover, not being liable to secondary putrefaction. In practice it was found that in London sewage the whole of the matters in suspension were removed, and from 50 to 60 per cent. of the oxidizable organic matters in solution. It is estimated that a nett purification of the whole of the crude seAvage to the extent of from 70 to 80 per cent. may be effected at a cost not exceeding £70,000 per annum for coal and iron ; and it is alleged that when irrigation is used, the process will render immense service as an efficient deodorizer, and also materially enhance the rapidity of filtration. This process is considered by Sir Henry Roscoe practicable, as regards the London sewage, and as it appears to afford a reasonable prospect of a solution of the question, pending the maturation of a scheme for conveying the sewage to the land, a few details as to mode and cost of operation will not be out of place. The necessary plant consists of electrolytic channels, containing the iron plates ; copper conductors and measuring instruments ; dynamos ; engines and boilers. Iron is the best of all metals for the required purpose, as sulphuretted hydrogen cannot exist where ferrous or ferric oxides are present. Cast iron plates of the commonest quality, moreover, employed as electrodes, give the best results. The plates are set longitudinally in channels, through which the sewage 191 flows, the alternate plates being connected respectively with the positive and negative terminals of a dynamo. The sewage is entirely split up by the electrical action, suspended matters and part of the organic matter, as before stated, being precipitated, the soluble organic matters being oxidized and burnt up by the nascent oxygen and the chlorine oxides envolved—to whatever extent may be desired. It is stated that thirty effective horse-power is required for treating one million gallons of London sewage in twentyfour hours—the quantity that would be produced by a town of 30,000 people—assuming 450 tons of iron to be laid down. This is equal to ten years' supply, the iron consumed being forty-five tons per million gallons per annum. But as the amount of iron laid down is in inverse proportion to the horse-power required, these two factors can be varied. The larger the quantity of iron laid down the longer it lasts, and the cheaper it is in the long run. The cost of plant, not including iron, for one million gallons daily, is said to be ±'2000. For larger quantities the proportional cost is less, e.g., £10,000 for ten million gallons of sewage. The annual outlay would be for coal and iron consumed, and for labour. Labour for dealing with one million gallons is required in the proportion of two shifts of two men each. The cost of coal and iron would be in proportion to the amount of sewage treated. It is stated that the resultant effluent is fit to discharge into any river. It contains, however, three grains per gallon of suspended matter, almost entirely iron oxides, and innocuous. This can be removed by filtration through a few inches of sand, and then the effluent is fit to go into any stream. Should higher purification be required, it can be obtained by the use of an electric filter, constructed of alternate layers of small coke, separated by sand, or perforated tiles, the first layer of material being sand to separate suspended matter. By suitable connections the layers of coke form positive and negative electrodes. Disease germs cannot be propagated, owing to the nascent oxygen and chlorine produced when the filter is in action. In experiments at Paris, with ordinary treatment by means of iron electrodes, it has been found that 5,000,000 organisms in a cubic centimetre of sewage 192 were reduced to 600 in the effluent. To sum up then, it is averred that, by the electrical process, the sewage is clarified ; the bulk of the sludge is reduced to a minimum; smell is removed; and secondary putrefaction is prevented—results that could not be produced by chemical precipitation—the process being at once simple and economical. Assuming all this to be true, and it appears to be justified by the high authority of Sir Henry Roscoe,* it may be inferred that an approach to a solution of the question of sewage disposal has been reached, and one in all respects only less satisfactory than that to which in the end we shall have to come, when every other process must give way to the only rational system—that, namely, of restoring to the land the valuable organic matters contained in the sewage. WATER SUPPLY. Regulations authorized by the Water Act of 1852 were framed by the Companies in 1872, consequent on the passing of the Water Act, 1871. The " Metropolitan Authority " (Metropolitan Board of Works) declined any responsibility in regard to the regulations—which were allowed by the Board of Trade— disapproving of the provisions with respect to fittings, which they considered would entail an unduly heavy outlay on the consumers. I have always contended, but as yet without success, that the Sanitary Authority should have co-ordinate power with the Companies to enforce certain of the regulations which appear to have been framed in the interests of Public Health; especially Regulation 14, which enables the Companies to cut off all connections of waste-pipes of cisterns with drains; the Companies, for the most purt, regarding this Regulation simply as a provision for preventing waste. Your Vestry, upon my recommendation, applied to the Local Government Board to obtain legislative power to enable the Sanitary Authority to enforce the regulation; but without result, although the application—which was endorsed by many of the Vestries and *Sir Henry Roscoe's conclusions are corroborated by Mr. Alfred E. Fletcher, H.M.' Inspector under the Rivers Pollution Prevention Act for Scotland. 193 District Boards—arose out of a memorandum by the Board's Medical Officer, recommending severance of waste pipes-from drains, made at a time when it was thought that Asiatic cholera might be imported ; and although his advice was in harmony with the views of the then Water Examiner. Cutting-off Poweks.— Section 74 of the Waterworks Clauses Act, 1847, gives power to the Companies to cut off the water supply if the rate is not paid. Such a power cannot be safely entrusted to any commercial body, having regard to the importance of the water supply in relation to the public health. In 1885, a striking exercise of this power by one of the Companies in Kensington, in depriving the people (80 in number) occupying a Mews, led to communications being made to the Local Government Board and to the Sanitary Authorities, which, by drawing public attention pointedly to the subject, contributed to bring about a partial remedy by legislation. I had for some years previously contended that the power should be taken from the Companies; that they should be left to their remedy like other traders, the rate being treated as a debt to be recovered—if they did not enforce the right of prepayment—every facility being given to them for the purpose. The Royal Commission on the Housing of the Working Classes in their report (1885), recommended that the Companies be deprived of the summary power to cut-off the water supply. Your Vestry supported a Bill brought in by Lord Camperdown (1885) intended to settle the question, but it being thought that the Companies had had their own way too much in moulding the Bill in Committee of the Lords, it was thrown out in the Commons. In 1887 a very useful measure, Water Companies (Regulation of Powers) Act, was passed (your Vestry petitioned the House of Commons in favour) which, as respects houses the water rate of which is paid by the landlord, precludes the Companies from cutting off the supply (for which poor people pay in their rent), but gives them very ample powers to enforce payment of their claims. H 194 Underground Tanks : The Regulations.—A communication was received in July from the Coroner, forwarded at the request of a jury, with reference to the death of a child drowned in an underground tank in a mews at South Kensington. The jury very properly observed "that these tanks are exceedingly dangerous, and ought to be done away with." The jury doubtless supposed that the sanitary authority had some power of control over the placing of cisterns ; but it is not so. The Water Companies, however, have powers under regulation 16 which provides that :— . "No cistern buried or excavated in the ground shal 1 be used for the storage or reception of water supplied by the Company, unless the use of such cistern shall be allowed in writing by the Company." Application was made to the several Companies to ascertain whether they had "allowed in writing" the use of such cisterns, and it was suggested that the use of them should be discontinued. The Grand Junction Waterworks Company stated that there were no underground tanks in their district; the other two Companies (West Middlesex, and Chelsea) replied to the effect that they no longer permitted the construction of underground cisterns, but felt it difficult to interfere with the use of those already in existence. Professor Frank land's Report.—The report on the water supply of the Metropolis in 1889, prepared for the Registrar-General by Professor Frankland, F.R.S., is published, as usual, in the Annual Summary. It sets out the results obtained in monthly examinations of the water supplied by the eight Companies, three of which—Grand Junction, West Middlesex, and Chelsea—supply Kensington. The results obtained in a similar periodical examination of the water supplied by the the Colne Yalley Water Company, and by the Tottenham Local Board of Health, are included for the purpose of comparison. The high quality which the river water has now exhibited for several years past, was more than 195 maintained in 1889, the water delivered, by the Companies having- been " on the average, of even better quality than that delivered during the year 1888." But the monthly variation in the temperature of the water was, as usual, very great (viz., from 37°.8 Fahr. in December, to 70°.2 in July = 32°.4), that of the Kent Company's deep well water being 4°.3 only, viz., from 51°.1 in February to 55°.4 in July. Thus this water remains cool and refreshing in summer, and is less likely to become frozen in the service pipes in winter; " whilst river water at 70° or even 65° Fahr., is vapid and unpalatable, and at 39° Fahr. is soon cooled to the freezing point." The river water is soft by comparison with the deep well water, which owes its hardness to the much larger proportion of mineral substances which it contains, and which compose the great bulk of the "solid matters." The hardness of the water, sufficiently great to materially diminish its value for washing, steam, and industrial purposes generally, is almost entirely due to the presence of bi-carbonate of lime in solution : this bi-carbonate of lime can be readily removed by treating the water with lime before delivery, as is so successfully done by the Colne Valley Company ; whereby the hardness of that Company's water is reduced to from one-fourth to one-fifth of its original amount—in 1889 from 29r,9 to 74'0 ; the hardness of the Thames water being 20'2. 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. The small proportion of organic material which the solid matters contain, is of the greatest importance in connection with the use of the water for drinking purposes ; as it may be of the most objectionable character, on account of its origin—such as the drainage from manured land, the effluents from sewage works, or even raw sewage itself. The animal matter may at times be accompanied by zymotic poisons dangerous to health—although the chances of such substances reaching the consumer are reduced by filtration, and by the exclusion of flood-waters from the H2 196 reservoirs. During the greater part of the year the water contained only a very moderate amount of organic matter, the analyses shewing that the Thames water, supplied in 1889, was " superior to that of any former year as regards comparative freedom from organic impurity"—the several waters not differing much from each other in respect of organic matter. Nearly all of the samples of river water were clear and transparent when drawn from the mains, a fact creditable to the Companies as evidence of the care taken in filtration. From the sanitary point of view the deep-well waters are very superior, the exhaustive filtration they undergo, in passing through a great depth of porous strata, being far in excess of what can be effected by the sand filtration, highly valuable as it is, to which the river waters are subjected. The "Water 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 1889, from which many of the following particulars are taken. General Scott's duties as Water Examiner are multifarious. He makes monthly inspections of the several Metropolitan water works, 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 (the first Water Examiner, appointed under the Act of 1871) 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; 197 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. A limit to the rapidity of filtration has been generally adopted. It is represented by the passage of about 540 gallons through each square yard of the upper surface area of the filter in 24 hours, or 2j gallons through each square foot of surface per hour. Water passed through well-constructed filters at a rate not exceeding this, becomes under ordinary conditions bright and clear. Effectual filtration is greatly facilitated by previous subsidence. The average rate of filtration, per square foot of filtering area, in gallons per hour, by the several local companies, in 1889, was as follows:— West Middlesex, 1.27; Grand Junction, 1.93; Chelsea, 1.75. The requirements of the Act in this respect, therefore, were fully carried out. The filtering area per million gallons of average daily supply, possessed by the several Companies is, Grand Junction, 0.66 acre; Chelsea, 0.71; and West Middlesex, 0'91. The filtering basins are lined with brickwork or concrete, and contain layers of sand, and of fine and 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 the 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, ranges from two feet to four feet six inches. 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, 5^ft. 198 Grand Junction.—Harwich sand, 2ft. 6in. : Hoggin, 6in.; fine gravel, 9in. ; coarse gravel, 9in.; boulders, 1ft, Total thickness. 5§ft. Another and more modern kind of filter used by this Company is made up of sand, 2ft.. tine gravel, 9in., pipe drains, 3in. Total 3ft. Chelsea.—Thames sand, 4ft. 6in.: shells, &c., 3in. ; gravel, 3ft. 3in. Total thickness, 8ft. Sand, it may be added, varies in quality, the Harwich sand, which is remarkably fine and uniform in grain, being the best. The sand becomes clogged in course of time with deposited mud and vegetable matter, and then the upper layer is scraped oft' 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 connection of them with drains through the medium of waste-pipes. The attention of householders cannot be too frequently drawn to the necessity for the abolition of waste-pipes, and the periodical cleansing of cisterns used 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-oft'tap should be affixed to the rising main, or service pipe, so that drinking and cooking water may be drawn therefrom, fresh and uncontaminated, without the intervention of cisterns, which are required for washing, flushing, baths, and similar purposes. A stop-valve should be fixed outside the premises to prevent damage to the house in case of pipes burst by frost or other causes. The quantity of water for domestic purposes supplied by the Grand Junction, the West Middlesex, and the Chelsea Companies respectively, last year, averaged 27'8I ; 22'74 ; and 27"50 gallons, daily, per head of estimated population; and 250, 170, and 216 gallons per house. The "intake" of the Chelsea 199 Company is at West Molesey, the intakes of the other Companies being at Hampton. The Grand Junction Company is constructing a new intake, on a small island composed of clean ballast, about one mile above the intake at present in use: the water will percolate through the ballast and so enter the conducting culvert in a clear condition. This Company's supply, moreover, is supplemented from sand and gravel beds at Hampton, the Company haviug 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. " The gravel-beds in the Thames Valley "— we are told by the Water Examiner—" form in some localities a valuable source of supply, the importance of which is being recognized; and which, moreover, is probably capable of being far more largely utilised .... while the integrity of the ground in respect of pollution is assured " ; for, of course, with the growth of population, and its nearer approach to such sources of supply, the risk of sewage-pollution increases; such risk, moreover, arising in a greater or less degree from the manuring of surface lands. " This being the case, there exists always the possibility of the introduction of specific matter of a noxious character." Owing to the effects of rain, the Thames was in a more or less indifferent condition during 191 days of the past year. Nevertheless, the filtration carried out by the Companies was almost uniformly effective in freeing the water from all traces of turbidity. Turbid 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. Turbid water must of necessity be sometimes admitted, and the filters are then overtaxed. 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 200 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 shews the number of days' supply, represented by the capacity of the reservoirs for unfiltered water, belonging to each of the local Companies:—Chelsea, 14*7; West Middlesex, 7*6; Grand Junction, 3"7. But 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 have capacity for 15 days' supply. The same Company is conspicuous by its advance in work for improving the water supply of its district in other respects. Dr. Percy Frankland's biological experiments by the process known as gelatine-plate cultivation, from which it appeared that, in 1887, 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 percent. came to an end when that gentleman left London. The Water Examiner, in his report for 1888, made reference to the value of this test, by cultivation of the bacteria present in potable water, and to the desirability of prosecuting further experiments. Opinions were expressed, that it would be to the interest of the Water Companies, if the efficiency of subsidence and filtration, in the purification of water more or less polluted by sewage, could receive satisfactory experimental demonstration: that the extension and increase of population in the valleys of the rivers Thames and Lea tend to increase the liability to pollution of the sources of supply, and that it is very desirable that the Companies should be able to shew that their treatment of the water drawn from these sources, is such as to obviate the dangers due to the introduction of infected sewage into the rivers. Valuable results, he added, would undoubtedly be obtained from experiments carried out on a scale sufficiently large to represent fairly the conditions 201 present in actual work, and the expenditure necessary for the purpose would be extremely trilling, compared with the interests at stake in connection with the largest system of water distribution in the world. 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 districts of the several Companies may be acceptable:— The West Middlesex Company was giving constant supply at the end of 1889, to 24,737 houses, out of a total of 72,562: the increase during the year was 860. No new area was brought under constant supply in 1889. The Grand Junction Company was giving constant supply to 44,043 houses out of a total of 55.870: the increase during the year was 1055. The system has been extended to North Kensington by the voluntary act of the Company. The Chelsea Company was giving constant supply to 7,217 houses (increase during the past year 710), out of a total of 35,226. 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 158,025, out of a total of 166,369 houses supplied. The increase during the year was 3001 ; 95 per cent, of the houses being on constant supply ; a fact very creditable to the Company having regard to the difficulties, qua waste, with which they have to contend, owing to the carelessness alleged to be rife at the East End—to say nothing of defective fittings in the miserable houses so common in the district. The percentage of house supplies on the constant system in each local Company's district, Dec. 31st, 1889, was as follows, Chelsea, 20 per cent.; West Middlesex, 34 per cent. ; and Grand Junction, 79 per cent. Considerable advance was made during the past year in Loudon as a whole, in extending the constant supply; 451,493 out of the total number of 758,335 houses supplied, or 59 per cent., being now on constant service, an increase of 35,411 during the year ; the number of houses having increased in the year by 12,016 only. 202 In a contrast of the intermittent and constant service systems, the Water Examiner observes that "the intermittent charging of the service pipes favours corrosion, which, in turn, causes turbidity; while the shutting oft' of the water from the service mains, and their depletion by the gravitation of the water into basement cisterns, or by leakage, tends to create a vacuum into which may be drawn either foul air or foul water. These evils are avoided by the constant service; but this necessitates the provision of well constructed house fittings .... in order to avoid the enormous waste from leakage which would otherwise ensue .... Apprehension of the sometimes considerable cost of the alterations required to adapt existing houses to the requirements of constant service, due to the generally inferior condition of the fittings, has in some degree checked the extension of the system ; but it is generally admitted that when this difficulty has been overcome .... the result has been found to be, on the whole, satisfactory alike to the consumers and to the Water Companies. Constant supply seems to conduce on the whole to economy in the use of water. The control of the supply, however, is virtually surrendered to the consumers, but when good house fittings are insisted on and maintained, the privilege is not as a rule abused." The Act prescribes three modes by which a constant supply of water may be obtained : (1) Any Company may propose to give it; (2) the Metropolitan Authority (County Council) may call upon a Company to provide it; (3) failing the above, and under certain conditions, the Local Government Board may require it. In general the constant supply has been voluntarily given by the Companies; neither the Metropolitan Authority in the past (the Metropolitan Board of Works), nor the Local Government Board, nor the Board of Trade, whose powers are now executed by the Local Government Board, having called upon the Companies to provide it. The ground alleged by the (late) Metropolitan Board for their failure to call upon the Companies to provide constant supply, was, that the Companies had made the regulations so 203 stringent as to constitute a heavy and unnecessary burden on the owners and occupiers of houses. It is nevertheless the fact, as we have seen, that, the Companies having taken the initiative, 59 per cent, of the houses in the Metropolis now have constant supply; and the system is being extended daily. For the first time since the passing of the Metropolis Water Act, 1871, the " Metropolitan Authority "(i.e., the County Council) made application, in October, to a Waterworks Company, requiring from the Company a constant supply in a certain district described in the notice. The application was made at the request of the Vestry of St. Pancras, in which Parish the district is situated, and being within the water limits of the West Middlesex Waterworks Company. Your Vestry have recently made application to the same Company for a constant service in the north east district of this Parish, the only portion of Kensington north of Uxbridge Road now on the intermittent service.* If necessary, application will have to be made to the County Council, who can make such applications with authority And it is to be hoped that the Council will henceforth, " make application," from time to time, to the several Companies, until the entire Metropolis shall have obtained constant supply. The Companies are not compelled to give it unless certain conditions as to fittings are complied with, but as they are willing, and speaking generally even desirous of giving it, it may be anticipated that means will be found to satisfy their requirements, which are to a large extent necessary for the avoidance of undue waste of water. Subsequent to the passing of the Act of 1871, the Water Companies have incurred a considerable expenditure, amounting altogether to over 4½ millions, for the improvement of the water supply, both in quantity and quality, viz., by extending the storage capacity of their reservoirs, and increasing their areas of filtration ; by providing for the requirements of constant supply; by the construction of high service reservoirs for filtered water ; by the laying of mains, and by the additionof powerful machinery to their * The Company in effect refused to comply with the application. 204 works. The total expenditure of the Companies on works, improvements, &c., to the end of 1889, amounted to £14,630,246' of which £217,066 was expended during the past year. GAS. The subjoined Tables, based on the quarterly reports of the Chief Gas Examiner, summarize the principal results (averages) of the daily testings, at the Ladbroke Grove Station, of the " common gas " manufactured by the Gas Light and Coke Companv 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 16 candles, was as follows:— Maximum. Minimum. Average. Quarter ended March 31st 17.0 16.1 165 Quarter ended June 30 th 17.3 16.1 16.5 Quarter ended September 30th 17.2 16.2 16.6 Quarter ended December 31st 17.2 161 16.6 Averages, whole year 17.2 16.1 16.5 It appears from these results that the average illuminating power of the gas at the Station was higher than the Parliamentary standard. In the Annual Ileport of the late Metropolitan Board of Works, for 1884, it was stated—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 7io forfeiture 205 or penalty, as they are when the gas is shewn 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 the gas by means of a portable photometer; and the Metropolitan Board advised the Board of Trade that statutory power should be obtained for that mode of testing, so that the companies may be liable to forfeitures for gas which the portable photometer shews to be defective in lighting power. 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, reported adversely to the continuance of 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 Board for 1885 and 1886, no reference was made to the important matters dealt with in the above paragraphs, but in the Report for 1887, the subject was again dealt with, and we were informed that in the interval, a long series of careful and complete experiments had 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, appeared to possess, in a higher degree than any other, the merits of simplicity, accuracy and reliability. It is satisfactory to find that the County Council, through its Sanitary and Special Purposes Committee, have taken up the subject earnestly, having addressed the Board of Trade (in 206 July, 1889) with a view to(l) providing a trustworthy standard of light, (2) prescribing a standard photometer with which all official photometers should be compared, and (3) giving legal force to tests made with a portable photometer; the reasons for which are fully set out in the Committee's communication. No action appears to have been taken in the matter at present by the Board of Trade. 2. As regards Purity. 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, moreover, not having been attained on any occasion. But, as will be seen in the following table, the maximum, the minimum, and the average amounts actually found in 1889, considerably exceeded the proportions in 1888:— 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 12.3 8.8 10.2 Quarter ended June 30th 15.8 9.4 11.3 Quarter ended September 30th 134 9.1 11.3 Quarter ended December 31st 14.7 9.9 11.3 Averages, whole year 14.0 9.3 11.0 Averages, 1888 12.7 7.8 9.7 Ammonia, a valuable residual product of gas manufacture, was present in the gas more or less frequently throughout the year, but only in slight quantities. On no occasion was the limit fixed by the Acts of Parliaments—viz., four grains in 100 feet of gas—exceeded. 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. 207 It now only remains for me, in bringing this Report to a conclusion, to offer my thanks to all who have contributed by their assistance to whatever success may have attended the work of my Department during the past year. I have had occasion in previous reports, to refer to the cooperation of the Board of Guardians. It would be impossible to over-value the services rendered by them, in past years, through their officers, in measures for preventing the spread of dangerous infectious diseases—-viz., by securing the speedy removal of the sick. The sub-district Registrars, Messrs. Barnes and Hume, and the Vaccination Officer, Mr. Shattock, have, as usual, readily complied with my applications for information on subjects connected with their several departments. 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 indebted, among other things, for assistance rendered in passing this Report through the press The Assistant Clerk has performed his duties to my entire satisfaction. But above all, my thanks are due to your Vestry for continuance of the confidence which, now for nineteen 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 recognised. I am, Gentlemen, Your obedient Servant, T. ORME DUDFIELD, Medical Officer of Health. Offices : Town Hall, Kensington, W., July, 1890. 208 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 Eeturns. 209 TABLE I. Shewing Population, Inhabited Houses, Marriages, Births, and Deaths, in 1889, and in 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.§ 1889 178,000 21,700 1,491 3,698 2,412 489 789 566 1888 177,000 21,600 1,497 3,776 2,825 604 1,077 590 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 1,180 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 2,615 601 982 483 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 Average 10 yrs. 1879-88. 168,227 21,092 1,510 4,264 2,776 657 1,094 491 Population in 1861, 70,108 ; 1871, 120,231; 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 (1889), 81. * 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 prece ling inter-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. But the data are somewhat unreliable. ‡ Inclusive of the deaths of parishioners at public institutions outride the Parish, but exclusive of the deaths of non-parishioners at public institutions within the Parish. § Viz. : At the Parish Infirmary, the Brompton Hospital, and outlying public institutions, including the Asylums Board Hospitals. to I—' O TABLE II. Shewing the Annual Birth Rate and Death Rate; Death Rates of Children, and Fioportion of Deaths in Public Institutions in a Thousand Deaths, for the year 1889, 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. 1889 20*8 13.5 132 203 327 235* 1888 21.3 15.9 160 214 381 208 1887 22.5 16.4 172 237 393 212 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 23 o 413 149 1881 26.9 16.6 146 236 391 160 1880 28.5 18.7 156 249 422 128 1879 30.2 18.8 150 241 407 133 Average of 10 years, 1879—1888. 25.3 16.4 154 236 393 176 * 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 1878.83, the deaths at Brompton Consumption Hospital are included as compensation for an unknown number of deaths of Parishioners at outlying Public Institutions. TABLE III. Deaths registered from all causes in the year 1889. (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. I 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 Brompton. (classes ) I. Specific Ferabile or Zymotic Diseases II. Parasitic Diseases 99 117 57 8 6 10 5 4 5 3 3 216 317 281 36 III. Dietetic Diseases 3 1 ... ... ... ... ... ... ... ... ... 4 4 4 ... IV. Constitutional Diseases 4 ... ... ... 5 2 3 3 ... 1 ... 4 18 16 2 V. Development 44 35 23 41 64 83 87 83 39 14 "2 79 515 394 121 VI. Local Diseases 65 ... ... ... ... ... ... 4 ... 3 29 65 178 129 49 VII. Deaths from viollence 196 134 28 36 59 99 ' '106 170 213 153 29 330 1223 981 212 VIII. Deaths from Ill-Defined and not Field 9 4 8 5 6 9 7 6 9 2 1 13 66 56 10 69 9 1 1 1 1 4 ... 4 ... 1 78 91 72 19 489 300 117 91 141 204 212 270 297 226 65 789 2412 1933 479 1. SPECIFIC FEBRILE or ZYMOTIC DISEASES. 1. Miasmatic Diseases Vaccinated ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Small-pox Unvaccinated ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... No Statement ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 5 5 ... ... ... ... ... ... ... ... ... 14 14 13 1 Scarlet Fever 2 14 12 ... ... ... ... ... ... ... ... 16 28 25 3 Typhus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough .10 14 2 ... ... ... ... ... ... ... ... 24 26 19 7 Diphtheria 91 67 39 1 ... 2 ... ... ... ... ... 69 111 105 6 Simple Continued or Ill-defined Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enterin or Typhoid ... ... 3 5 3 5 1 1 1 ... ... ... 19 13 6 Other Miasmatic Diseases ... ... 1 ... ... ... ... ... ... ... ... ... 1 1 2 dlakehceal diseases Simple Cholera ... 2 ... ... ... ... ... ... ... ... ... 2 2 2 ... Diarrhoea, Dysentery 57 9 ... ... ... ... ... 1 2 1 1 66 71 65 6 3—Malarial Diseases Remittent Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4- Zoogenous Diseases Cow-pox, and effects of Vaccination ... ... ... ... ... ... ... ... ... ... ... 1 1 1 ... Other Diseases(e.g Hydrophobia, Glander , Splenic Fever) ... ... ... ... ... ... 1 ... ... ... ... 5- Venereal Diseases Syphilis 21 2 ... ... 1 ... 2 ... ... ... ... 23 26 22 4 Gonorrhoea, Structure of the Urethra ... ... ... ... ... ... ... 1 1 ... ... ... 2 2 ... Erysipelas 2 ... ... ... ... 1 ... ... 1 2 2 2 8 5 3 Pyæmia. Septicæmia ... ... ... ... ... ... 1 1 ... ... ... ... 2 2 ... Puerperal Fever ... ... ... 2 2 2 ... ... ... ... ... 6 6 ... 99 117 57 8 6 10 5 4 5 3 3 216 | 317 281 36 II. PARASITIC DISEASES. Thrush and other Vegetable Parasitic Diseases 3 1 ... ... ... ... ... ... ... ... ... 4 4 4 ... Worms, Hydatids, and other Animal Parasitic Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 1 ... ... ... ... ... ... ... ... ... 4 4 4 ... III. Dietetic Diseases Want of Breast Milk - Starvation ... ... ... ... ... ... ... 1 ... ... ... 4 5 5 ... Seurvy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chronic Alcoholism ... ... ... ... 3 ... 2 1 ... 1 ... ... 7 6 1 Delirium Tremens ... ... ... ... 2 2 1 1 ... ... ... ... 6 5 1 4 ... ... ... 5 2 3 3 ... 1 ... 4 18 16 2 IV. CONSTITUTIONAL DISEASES. Rheumatic Fever, Bheumatism of the Heart ... ... 8 5 2 ... 1 2 1 ... ... 20 14 6 Rheurmatism ... ... ... ... 1 ... 2 ... 1 ... ... ... 4 2 2 Gout ... ... ... ... ... ... 1 4 4 2 ... ... 11 7 4 Rickets ... 1 1 ... ... ... ... ... ... ... ... 1 2 1 1 Cancer, Maligant Diseases ... ... ... 2 1 12 34 62 24 8 2 ... 138 102 36 Tables Measterica 18 7 ... ... ... ... ... ... ... ... ... 25 25 21 4 Tuber Meningitis, Hydrocephatus 10 16 4 2 1 ... ... ... ... ... ... 26 33 21 1 Phthsis ... 3 3 25 53 65 48 19 7 1 ... 3 224 181 43 Other forms of Tuberculsis, Scrofula 14 8 6 6 2 ... 2 ... ... ... ... 22 38 34 4 Purpura Hæmorrhagic Diathesis 2 ... ... ... ... ... ... ... ... ... ... 2 2 ... 2 Anæmia, Chlorosls,Lencocythæmia ... ... 1 1 ... 1 ... 2 ... ... ... ... 5 1 2 Glyeosuria, Diabetes Mellitus ... ... ... 2 3 ... 5 1 2 ... ... 13 8 ... Other Constitutional Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... 44 35 23 41 64 83 87 83 39 14 2 79 515 394 121 V. Developmental Diseases Pramature Birth 53 ... ... ... ... ... ... ... ... ... ... 53 53 36 17 | Atelectasis 7 ... ... ... ... ... ... ... ... ... ... 7 7 6 1 Congential Malformation 5 ... ... ... ... ... ... ... ... ... ... 5 5 4 1 Old Age ... ... ... ... ... ... ... 4 27 53 29 ... 113 83 30 65 ... ... ... ... ... ... 4 27 53 29 65 178 129 49 VI LOCAL DISEASES. 1.- Diseases of Nervous System Inflammation of Brain of Membranes 11 13 2 5 2 ... 2 ... ... ... 24 35 27 8 Apoplexy, Softening of Brain,Hemiplegia,Brain Paralysia ... 1 1 1 3 15 17 26 60 38 0 1 167 134 33 Insanity, General Parzlysis of the Insane ... ......... ... ... ... 2 ... 2 ... ... ... ... 4 4 ... Epilepsy ... ... ... ... ... 1 5 2 ... ... ... 9 42 Convulsions 47 6 ... ... ... ... ... ... ... ... ... 53 o3 1 11 Laryngismus Stridulus (Spasm of Glottis) 7 4 ... ... ... ... ... ... ... ... ... 11 11 9 2 Disease of Spinal Cord, Paraplegia, Paralysis Agitans ... 1 ... ... 2 ... 1 2 5 3 1 1 14 13 1 Other Diseases of Nervous System 1 1 1 ... 1 1 ... 8 5 6 1 2 25 24 1 2.- Diseases of Organs of Special Sence (e.g. of Ear,Eye,Nose) 1 ... ... ... ... 1 ... ... ... ... ... 1 2 ... 2 3.-Diseases op Circulatory System. Pericarditis ... ... ... ... 1 2 ... 2 ... ... ... ... 6 9 2 Acute Endocaedlitis ... ... ... ... ... 2 1 "a ... ... ... ... 33 25 8 Valvular Diseases of Heart ... ... 2 1 11 2 6 3 32 8 6 1 33 102 25 Other Diseases of Heart i ... 1 3 11 11 17 2 32 18 ... 1 127 102 2 Aneurism ... ... ... ... ... 2 4 1 1 1 ... ... 8 6 2 Embolism, Thrombosis ... ... ... 1 ... ... ... 2 ... 1 ... ... 4 8 1 Other Diseases of Blood Vessels ... ......... ... ... 1 2 1 2 2 ... ... ... 8 7 1 4 -Diseases op Respiratory System. Larungitis 2 5 2 ... 1 ... ... 1 I ... ... 7 12 12 ... Croup 1 16 1 ... ... ... ... ... ... ... ... 17 18 17 1 Emphusema Asthma 1 ... 1 ... ... 1 2 6 3 3 ... 1 17 13 4 Bronchitis 73 49 4 ... 4 7 21 32 48 50 2 122 297 24? 48 Pnenmonia 17 20 3 5 7 16 7 8 6 5 37 96 72 21 Pleurisy 1 1 1 1 1 2 1 2 2 10 8 2 Other Diseases of Respiratory System 4 3 1 2 ... 1 3 3 2 1 ... 7 20 16 4 5.—Diseases op Digestive System. Dentiton 7 4 ... ... ... ... ... ... ... ... ... 11 11 1 ... Sore Throat Quinsey ... 1 1 ... ... ... ... ... ... ... ... 1 2 2 ... Diseases of Stomach 4 ... ... ... 1 2 1 1 1 ... ... 4 8 7 1 Enteritis 11 2 ... ... 2| ... 1 2 1 ... 1 13 18 17 1 Obstructive Diseases of Intstine 3 1 ... 2 2 1 2 2 3 ... ... 4 22 16 6 Peritonitis ... ... 4 1 ... 1 4 2 3 ... ... ... 15 12 3 Asetes ... ... ... 1 ... ... ... ... ... ..."•... ... ... 1 1 ... Cirrhosis of Liver ... ... ... ... 2 2 3 4 2 1 ... ... 14 11 3 Jaundice, and other Diseases of Liver 2 1 ... 1 1 3 1 8 4 ... ... 3 21 18 3 Other Diseases of Digestive System 2 ... 2 I 3 2 I 2 ... 3 ... 2 16 8 8 6.- Diseses of Lymphatic System (e.g. of Lymphatics and of Spleen) ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... 1 7.- Diseases of Glandliee organs of Uncertain Use (e.g. Bronchocele, Addison's Diseases) ... ... ... 2 ... ... ... ... ... ... ... ... 2 1 1 8.Diseases op Ueinary System Nephritis ... 2 ... ... ... 3 3 4 2 2 ... 2 16 14 2 Rnffht's Disease Albuminuria ... ... 7 3 10 8 4 2 ... 40 27 13 Disease of Bladder or of Prostate ... ... ... ... ... 1 ... 2 4 4 1 ... 12 6 6 Other Diseases of the Urinary System ... 1 ... 2 2 2 2 1 3 2 ... 1 15 13 2 9.—Diseases op Rep^ob^tive^ystem. Male Organs ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Female Organs ... ... ... ... 4 5 1 ... 1 1 ... ... 12 8 4 B. of Parturition Absortion Miscarriage ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... 1 Puerperal Convulsions ... ... ... 1 ... ... ... ... ... ... ... ... 1 ... 1 Placenta Prtevia, Flooding ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... . Other Accidents of Childbirth ... ... ... 3 2 ... ... ... ... ... ... ... 5 2 3 10.—Diseases op Bones and Joints. Caries, Necrosis ... l ... 1 1 1 3 ... ... ... ... 1 7 6 1 Arthritis, Ostitis, Periostitis ... ... ... 1 ... ... ... ... ... ... ... ... 1 ... 1 Other Diseases of Bones and Joints ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 ... 11.—Diseases op Integumentary System. Carbuncle Phelegmon ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... 1 Other Diseases of Integumentary System ... 1 ... ... ... ... ... 1 ... ... ... 1 2 2 ... 196 134 28 36 59 99 106 170 213 153 29 330 1223 981 242 VII. Deaths from Violence I. Accident or neglifence Fractures and Contusions ... l 5 2 3 3 2 2 6 2 1 1 27 23 4 Gunshot Wounds ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cut, Stah ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Burn, Scald ... 1 3 2 ... ... ... ... 1 ... ... 1 7 7 ... poison ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Drowing ... 1 ... ... ... ......... ... ... ......... ... ... 1 1 ... 1 Suffocation 9 1 ... ... ... ..."1 1 1 ... ... ... 10 12 11 1 OtherWise ... ... ... ... ... 1 1 1 ... ... ... ... 3 3 ... 2.—Homicide. Manslaughter ... ... ... ... ... 1 ... ... ... ... ... ... 1 1 ... Murder ... ... ... ... 1 ... ... ... ... ... ... ... 1 1 ... 3.-Suicide. Gunshot Wounds ... ... ... ... ... 1 ... ... ... ... ... ... 1 1 ... Cut, Stab ... ... ... ... ... 1 1 ... ... ... ... ... 2 1 1 Poison ... ... ... 1 1 ... 1 ... ... ... ... ... 3 2 1 Drowing ... ... ... ... ... l ... 1 ... ... ... ... 2 2 ... Hanging ... ... ... ... 1 1 1 ... ... ... ... ... ... 4 7 Otherwise ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 2 4.—Execution. Hanging ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 9 4 8 5 6 9 7 6 9 2 1 13 66 56 10 VIII. Deaths from ill-defined and not specified causes Dropsy ... ... ... ... ... ... ... ...... ... ... ... ... ... Debility, Atrophy, Inatition 68 7 ... ... ... ... ... ... ... ... 75 75 ... 11 Mortification ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tumour ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Abscess ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Haemorrhage 1 ... ... ... ... ... ... ... ... ... ... 1 1 ... 1 Sudden Death (Cause not ascertained) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... : Causes not specified or ill-defined ... 2 1 1 1 1 4 ... 4 ... 1 2 15 8 7 69 9 1 1 1 1 4 ... 4 ... 1 78 91 72 19 CAUSES OF DEATH. 0 to 1. 1 lto5. | 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 uupwards Total under five Years of Age Grand Total All Ages Kensington Brompton. Ages Sub-Districts . 213 TABLE IV. Shewing the number of Deaths at all ages in 1889, 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 269 1.5 111 2. Pulmonary Diseases 470 2.6 105 3. Principal Tubercular Diseases 289 1.6 119 Division II. (Infants under One Year). Total Deaths. Deaths pel' 1,000 of Births. Deaths per 1,000 of Total Deaths, under one year. 4. Wasting Diseases 132 36 270 5. Convulsive Diseases 97 26 198 NOTES. 1. Includes Small-pox, Measles, Scarlet Fever, Diphtheria, Whooping-cough, Typhus Fever, Enteric (or Typhoid) Fever, Simple Continued Fever and Diarrhoea. Fifty-six of the deaths occurred in Hospitals outside the Parish. 3. Includes Phthisis, Scrofula, Tuberculosis, Rickets, and Tabes. i. 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) 214 TABLE V. Shewing the Number of Deaths from the Principal Zymotic Diseases in the ten years 1879-88, and in the year 1889. Diseases. 1879. 1880. 1881. 1882. 1883. 1884. 1885. 1886. 1887. 1888. Annual Average of ten years 1879-88. Proportion of Deaths to 1,000 Deaths in ten years 1879-88. 1889. Proportion of Deaths to 1,000 Deaths in 1889. Small Pox 24 11 55 0 1 26 25 0 1 0 14.3 5.2 0 .0 Measles 60 75 67 77 39 32 111 56 108 124 74.9 27.0 14 5.8 Scarlet Fever 51 105 38 62 28 18 7 11 44 26 39.0 14.1 28 11.6 Diphtheria 26 22 8 25 24 17 22 30 40 89 30.3 10.9 111 46.0 Whooping-Cough 93 95 85 119 44 81 98 82 86 100 88.3 31.8 26 10.8 Typhus Fever 1 4 2 1 2 0 0 0 0 0 1.0 0.3 0 0.0 Enteric Fever 14 24 22 25 30 26 12 11 11 21 19.6 7.0 19 7.9 Simple C'ntinu'd Fever 8 5 5 6 3 4 0 0 2 2 3.5 1.3 0 0.0 Diarrhoea 71 128 101 61 80 110 86 90 124 58 90.9 32.7 71 29.4 TOTALS. Kensington 348 469 383 376 251 314 361 280 416 420 361.8 130.3 269 111.5 London 12256 13681 13811 13553 10801 13629 11261 11121 12684 10803 12360 1510 9709 128.3 England & Wales 62020 82537 58239 69734 58972 71762 57726 62859 64676 50684 63920 122.4 61027 117.8 215 TABLE VI. Inspectors' Report of the Sanitary Work completed in the year 1889-90. ary Districts* No. of Complaints received during the year. No. of Houses, Premises, &c., inspected. No. of Re-inspections of Houses, Premises, &c. Results of Inspection. House Drains. Water Closets. 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, &c. Ventilated, Trapped, &c. Repaired, &c. Supplied with Water. New Provided. New Provided. Repaired, Covered, &c. Cisterns (new) erected. Cisterns Cleansed, Repaired, and Covered. Waste-pipes connected with Drains, &c., abolished. No. of Lodging Houses Registered under 35th Section of the "Sanitary Act, 1866." § Dust Removal—No. of Communications received and attended to. † Removal of Accumulations of Dung, Stagnant Water, Animal and other Refuse. Animals removed, being improperly kept. Regularly Inspected. Legal Proceedings : i.e., Summonses, t Bakehouses. Licensed Cowsheds. Licensed Slaughter Houses. N.W 45 1327 1550 867 46 110 55 84 61 125 6 20 21 18 34 47 26 287 20 8 36 5 8 68 N.E. 58 902 1809 573 72 118 91 204 194 166 17 11 8 27 38 7 69 437 18 1 45 2 5 53 Central 53 1495 2077 405 213 67 29 108 13 99 31 19 36 14 33 20 43 190 40 6 23 2 7 13 South 284 2221 2545 656 413 67 104 109 69 396 5 6 38 32 161 117 83 368 294 3 44 2 2 14 Totals 440 5945 7981 2501 744 362 279 505 337 786 59 56 103 91 266 191 221 1282 372 18 148 11 22 148 * The North-East and North-West Districts lie north of the centre of Uxbridge Road, to the East and West of Ladbroke G rove and Ladbroke Grove Road respectively (North Kensington): the Central and South Districts are south of Uxbridge Road (South Kensington). § The total number of houses on the Register in March, 1890, in round figures, was 1,800. † Since Jul)- 11th, 1889, most of the Dust Applications have gone through the Vestry Clerk's and Surveyor's departments. ‡ Exclusive of proceedings, in 42 cases, under the Sale of Food and Drugs Act, 1875, all of the Inspectors being Inspectors under the Act; and in 10 cases of "obstruction, etc.." on and over the public ways, but inclusive of 6 cases of disobedience of the Justices' orders. Total number of summonses 200 216 TABLE VIa. Summary of Monthly Returns of Work, &c., done by the Sanitary Inspectors, in the year 1889-90. 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. 1889, April 20 81 48 116 177 90 44 87 155 7 8 6 8 3 3 3 8 15 14 7 4 5 3 18 8 40 41 26 45 22 61 26 46 April 20, 1889 „ May 18 146 63 173 171 91 63 71 112 5 9 4 8 3 2 4 7 2 15 9 3 7 2 11 6 76 31 44 47 66 108 38 76 May 18 ,, „ June 15 134 74 129 194 78 69 69 118 7 9 8 9 5 3 3 8 1 11 6. 5 ... ... 14 3 79 62 53 97 40 97 47 114 June 15 „ „ July 13 98 79 134 200 71 95 72 168 18 12 12 10 8 3 5 10 17 13 6 2 19 8 15 5 192 53 51 36 33 69 21 84 July 13 „ „ August 10 116 45 108 193 111 52 88 109 4 4 2 6 3 2 3 8 10 18 6 6 33 ... 13 2 98 42 30 111 17 10 5 14 August 10 „ „ Sept. 7 62 32 49 121 49 35 41 55 3 3 5 6 4 1 2 6 10 4 2 3 9 ... 12 3 9 15 3 45 10 8 ... 2 Sept. 7 „ „ October 5 131 73 127 158 92 61 63 125 8 9 5 6 6 3 4 7 4 13 6 7 21 2 6 3 63 40 29 45 4 6 3 2 October 5 , „ Nov. 2 155 96 146 193 87 63 74 167 6 5 5 8 11 1 4 8 ... 15 6 6 22 ... 17 6 74 48 33 31 28 11 6 2 Nov. 2 „ „ „ 30 105 76 101 187 82 75 85 204 8 9 5 8 ... 3 3 8 5 8 9 4 18 ... 15 5 64 66 28 74 16 12 7 4 „ 30 „ „ Dec. 28 106 44 90 128 84 50 57 135 ... 2 2 8 5 ... , 4 8 21 19 7 2 28 ... 10 4 26 21 6 31 8 9 ... 1 Dec. 28 „ 1890, Jan. 25 ... 58 182 152 ... 61 70 179 ... 5 6 8 ... 2 4 8 ... 9 6 4 ... ... 18 3 33 61 16 27 14 24 27 5 Jan. 25, 1890 „ Feb. 22 78 80 140 172 52 51 65 149 12 5 6 8 5' 2 4 8 10 11 10 6 7 3 7 9 52 47 78 33 12 15 6 10 Feb. 22 „ „ March 22 115 134 ... 175 84 60 ... 166 8 4 ... 8 7 3 ... 8 6 18 ... 9 25 7 ... 4 61 46 8 34 17 7 4 3 March 22 „ Totals 1327 902 1495 2221 971 779 842 1842 86 84 66 101 60 28 43 102 101 168 80 61 194 25 156 61 367 573 405 656 287 437 190 368 Totals. 217 TABLE VII. Shewing the Death Rate per 1,000 persons living; the Annual Rate per 1,000 from the principal Diseases of the Zymotic Class; and the proportion of Deaths from these Diseases to total Deaths, in Kensington and in all London, in 1889, and in ten preceding years. The Year. Deaths per 1,000 living. Total Deaths from seven principal Zymotic Diseases, Kensington. Annual rate of Mortality per 1,000 living, from seven principal Zymotic Diseases. Proportion of Deaths to 1,000 Deaths, from seven principal Zymotic Diseases. The Year. Kensington. London. Kensington. London. Kensington. London. 1879 18.8 23.3 348 2.2 3.3 116 143 1879 1880 17.8 22.2 469 2.9 3.7 162 170 1880 1881 16.6 21.2 383 2.3 3.6 140 172 1881 1882 16.2 21.4 376 2.2 3.5 140 163 1882 1883 15.5 20.4 251 1.5 2.7 96 134 1883 1884 15.1 20.3 314 1.8 2.7 119 164 18S4 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 1887 16.4 21.1 416 2.4 3.0 144 154 1887 1888 15.9 18.5 420 2.3 2.o 148 137 1888 AVERAGES OF TEN YEARS 1879.88. 16.4 20.8 361 2.1 3.0 129 151 AVERAGES OF 10 YEARS. 1879.88. 1889. 13.5 17.4 269 1.5 2.2 111 128 1839. 218 TABLE VIII. Comparative Analysis of the Mortality in all London, and in Kensington, in 1889. Annual Death Rate per 1,000 living, from all causes. Annual Death rate per 1,000 living, from seven principal Zymotic diseases. Percentage of Deaths under 1 year to Births Registered. PERCENTAGE OF DEATHS TO TOTAL DEATHS. Under 1 year of age. At 60 years of age and upwards. From seven principal Zymotic diseases. From Violence. Registered upon information of Coroners. (Inquests.) Registered at Public Institutions*. Uncertified. London 17.4 2.2 14.1 24.5 24.2 12.8 3.9 7.6 23.3 1.1 Kensington 13.5 1.5 13.2 20.3 30.1 11.1 2.7 6.8 23.6 02 * Viz.—Parish Infirmary and Workhouse, 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. Shewing the Localities in which fatal cases of the Principal Zymotic Diseases occurred in 1889. KENSINGTON TOWN REGISTRATION SUB-DISTRICT. Locality. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Fever. Diarrhoea. Total. Locality. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Fever. Diarrhoea. Total. Enteric. Simple Continued. Enteric. Simple Contimed. Abbey Road ... ... 1 ... ... ... ... 1 Manchester Road ... 1 ... ... ... ... ... 1 Absalom Road ... ... 1 ... ... ... ... 1 Manchester Street ... ... ... ... 1 ... 1 2 Acklam Road ... 1 ... ... ... 2 3 Munro Mews ... ... ... ... 1 ... ... 1 Addison Road North ... 1 ... ... 1 ... ... 2 Newcoinbe Street ... ... 1 ... ... ... ... 1 Admiral Place ... 1 ... ... ... ... ... 1 Norfolk Terrace ... ... 2 3 ... ... 1 6 Albert Terrace ... 1 ... ... ... ... ... 1 Palace Gardens Terrace ... ... 1 ... ... ... ... 1 Archer Mews 1 ... 3 ... ... ... ... 4 Peel Street ... ... ... 6 ... ... ... 6 Aston Road ... 1 ... ... ... ... ... 1 Pembridge Mews ... 2 ... ... ... ... ... 2 Basing Road ... ... 1 ... ... ... ... 1 Pembroke Place ... ... 1 ... ... ... ... 1 Blagrove Road ... ... 1 ... ... ... ... I Portland Road ... ... 7 1 ... ... 2 10 Blenheim Crescent ... 1 ... ... 1 ... ... 2 Portobello Road ... ... 4 1 ... ... 1 6 Bomore Road ... ... 1 ... ... ... ... 1 Powis Gardens ... ... ... ... 1 ... ... 1 Bonchurch Road 1 ... 4 1 ... ... ... 6 Prince's Road ... 1 1 ... ... ... ... 2 Bramley Road ... ... 1 ... ... ... ... 1 Rackham Street 1 ... 5 ... ... ... ... 6 Buckingham Terrace ... ... 1 ... ... ... ... 1 St. Alban's Road ... 2 ... ... ... ... ... 2 Bulmer Terrace ... ... 1 ... ... ... ... 1 „ Ann's „ ... 1 2 ... ... ... ... 3 Cambridge Gardens ... ... ... ... 1 ... ... 1 „ Charles's Square ... ... 2 ... ... ... ... 2 Chesterton Road ... ... 1 ... ... ... ... 1 „ Ervan's Road ... ... 2 ... ... ... ... 2 Clarendon Road ... ... 3 ... ... ... ... 3 „ George's „ ... ... 1 ... ... ... 1 2 Cornwall Road ... ... 1 ... ... ... 1 2 „ James's Place ... ... 3 ... ... ... 1 5 Denbigh Road ... ... ... ... l ... ... 1 „ John's Mews ... ... 1 ... ... ... ... 1 Earl's Court Road ... ... 2 1 ... ... ... 3 „ Eatherine's Road ... ... 1 ... 1 ... 3 5 Edinburgh Road ... 1 ... ... ... ... 1 ,, Quintin Avenue ... 1 ... ... ... ... ... 1 Elgin Mews ... ... 1 ... ... ... 1 2 Southam Street ... 1 2 ... 1 ... 1 5 Farmer Street ... ... ... ... 1 ... ... 1 South End Row ... ... 1 ... ... ... ... 1 Gloucester Walk ... ... ... ... 1 ... ... 1 Stoneleigh Street 1 ... 2 ... ... ... 1 4 Golborne Gardens ... 2 ... ... 1 ... ... 3 Swinbrook Road ... 2 1 1 ... ... 1 5 Hayden's Mews ... ... 1 ... ... ... ... 1 Tabernacle Terrace ... 1 ... ... ... ... 1 2 Holland Park Mews ... ... 1 ... ... ... ... 1 3 Talbot Grove ... 1 1 ... 1 ... ... 3 Horb'ury Mews ... ... 3 ... ... ... ... Telford Road ... ... 2 ... ... ... 1 3 Hurstway Street ... ... 1 ... ... ... ... 1 Testerton Street ... ... 1 3 ... ... ... 4 Infirmary, The ... 1 ... ... 1 ... 2 4 Tobin Street ... ... 1 ... ... ... ... 1 Jameson Street ... 1 ... ... ... ... ... 1 Treverton Street ... 1 1 ... ... ... 1 3 Ladbroke Road ... ... 2 ... ... ... ... 2 Walmer Road ... 1 3 ... ... ... 1 5 Lancaster Mews ... 1 ... ... ... ... ... 1 Warwick Road ... ... 1 ... ... ... ... 1 Lancaster Road 1 ... 2 ... ... ... 1 4 Wheatstone Road ... ... 6 ... ... ... ... 6 Lansdowne Mews ... ... 1 ... ... ... ... 1 Wornington Road 1 ... 3 ... ... ... 1 5 BROMPTON SUB-DISTRICT. Adrian Mews ... ... 1 ... ... ... ... 1 Providence Terrace ... ... ... ... 1 ... 1 2 Barker Street ... ... 2 1 ... ... ... 3 Queen's Gate Gardens ... ... ... ... 1 ... ... 1 Cromwell Road ... ... 1 ... ... ... ... 1 Radley Mews ... ... ... 1 2 ... ... 3 Clifton Place ... 1 ... ... ... ... ... 1 Redcliffe Road ... 1 ... ... ... ... ... 1 Garden Row ... ... ... ... 1 ... 1 2 Richmond Road ... ... 2 ... ... ... ... 2 Fenelon Road ... 1 ... ... ... ... ... 1 Sloane Street ... ... ... ... 1 ... ... 1 Philbeach Gardens ... ... ... ... 1 ... ... 1 Thurloe Square ... ... ... ... 1 ... ... 1 221 TABLE X. Return respecting the Vaccination of Children whose Births were Registered in 1888.* DATE. Registration Sub-Districts comprised in Vaccination Officer's District. Number of these Births duly entered in Columns 10,11 and 13 of the Vaccination Register (Birth List Sheets), viz.: Number of these Births which are not entered in the Vaccination Register, on account (as shewn by Report Book) of Number of Births returned in Birth List Sheets. Column 10 Successfully vaccinated. Column 11. Column 13 Dead. Un-vaccinated. Postponement by Medical Certificate. Removal to District the Vaccination Officer of which has been duly apprised. Removal to places unknown, or which cannot be reached, and cases not having been found Cases still under proceedings by summons and otherwise. Insusceptible of Successful vaccination. Had Small-pox. 1888. 1 2 3 4 5 6 8 9 10 11 1st January t0 31st Dec. Kensington Town 3075 2567 12 ... 273 20 2 198 3 Brompton 705 605 6 ... 56 8 ... 29 1 ■ Total 3780 3172 18 ... 329 28 2 227 4 * The return for 1889 is not yet complete. 222 TABLE XI. LICENSED SLAUGHTER-HOUSES. SOUTH OP 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 . Mrs. Matson NORTH OF UXBRIDGE ROAD. 13, Archer Mews Mr. Grantham 195, Clarendon Road „ Thorn 10, Edenham Mews „ Goddard 2, Ledbury Mews „ Sansoni Lonsdale Mews „ Grove 10, Prince's Yard „ Coles Clarendon Mews „ Colley 41, Prince's Place „ Grant 23, Norfolk Terrace „ T hacker 61, Silchester Road „ Crawforth 235, Walmer Road „ Van 4, Royal Crescent Mews „ Brooker 8, Ditto ditto „ Down 223 TABLE XII. LICENSED COWSHEDS. SOUTH OF UXBRIDGE ROAD. LOCALITY. LICENSEE. Newland Terrace (rear of) Mr. Tisdall Addison Cottage, Lome Gardens „ Glenie Campden Street (Yard in) „ Lunn Redfield Lane, Earl's Court West London Dairy Society NORTH OF UXBRIDGE ROAD. 5, Ledbury Mews Mr. Liddiard 187, Waimer Road ,, Arnsby 235, Walmer Road „ Van 27, Tobin Street „ Copperwheat 47, Tobin Street „ Burton 23, Bramley Road „ Tame 41, St. Mark's Road „ Hickox Portobello Road (rear of 209) Aylesbury Dairy Company -ft <V<