KEN117 THE ANNUAL REPORT ON THE HEALTH, SANITARY CONDITION, OF THE parish of St. Jthrn Abbotts, KENSINGTON, FOR THE YEAR 1890, BY T. ORME DUDFIELD, M.D., Medical Officer of health. PRINTED BY HUTCHINGS AND CROWSLEY, LIMITED, 123, FULHAM ROAD, SOUTH KENSINGTON, S.W. 18 91. THE ANNUAL REPORT ON THE HEALTH, SANITARY CONDITION, &c., &c., OF THE parish of St. Mary Abbotts, KENSINGTON, FOE THE YEAR 1890, BY T. ORME DUDFIELD, M.D., Medical Officer of health. PRINTED BY HUTOHINGS AND OROWSLEY, LIMITED, 123, FULHAM BOAD, SOUTH KENSINGTON, S.W. 18 9 1. TABLE OF CONTENTS. Prefatory Remarks on the Death-rate—Parochial; Metropolitan ; Urban; National, &e. 1 Registration District Kensington " 5 „ Sub-Districts : " Kensington Town," and Brompton 6 Wards, Division of Parish into 7 Kensington, Population and Rateable value of ; 1801-1890 7 Mortal Statistics, 1890, Summary of 8 Zymotic Diseases, General Remarks on the " Seven Principal " 15 „ „ Number of deaths from the „ „ in 1890 17 ,, „ Death-rate from ; in Kensington ; in London and other large Towns, and in England and Wales 17 „ „ Monthly Returns of Deaths from, in Kensington 18 Small-Pox, Low rate of Mortality from, in London 18 Measles 19 „ and Notification 20 Scarlet Fever 21 „ „ In London 22 „ „ Increased use of the Hospitals for Isolation of 22 ,, „ Hospital Accommodation for 23 „ „ Alleged Dissemination of, by Milk of diseased Cows 25 „ „ Statistical Returns of 25 ,, „ Cases of, recorded in Kensington, 1880-90 (Tables) 26 Diphtheria 28 ,, Decrease in Case-mortality of 30 „ and Schools 30 „ In London 32 iv. whooping-cough 32 „ ,, In London 33 „ „ (and Measles), Mortality from, compared with that from the " Dangerous''Infectious Diseases 33 Fever 34 Diarrhœa 34 Influenza, Epidemic of 35 ,, and Chest Diseases, Great increase of mortality due to 35 „ Government Enquiry respecting 37 Metropolitan Asylums Board, The Work and Proceedings of the 38 „ „ ,, The Annual Report of the Chairman 39 ,, „ ,, The Annual Report of the Statistical Committee 42 „ „ ,, Return of cases of Infectious Disease reported to (Table) 43 Ambulance Service, Metropolitan, Established by the Asylums Board, under the provisions of the Poor Law Act, 1889 47 „ ,, Stations 48 „ „ Wharves 49 „ ,, Eiver Service 49 „ „ Annual Report of the Ambulance Committee 49 Small-Pox, Hospital Accommodation for 64 „ The Hospital Ships 54 Fever, Hospital Accommodation for 55 Northern Convalescent Hospital for Fever Patients 57 Eastern District Fever Hospital 58 Western District Fever Hospital 58 „ „ „ „ Annual Report of the Medical Superintendent 61 Western Ambulance Station 63 Non-Pauper Infectious Sick : The question of payment for in Hospitals 64 Hospitals, Medical Instruction at, to be provided for Students, &c. 65 ,, Table shewing Quarterly and Total Admissions of Patients at; from each Parish and Union, in 1890, and Population of the several Districts in 1881 66 Public Health Legislation in 1890 68 Infectious Disease (Prevention) Act, 1890, Provisions of 68 Customs and Inland Revenue Act, 1890: Provision for conditional remission of Inhabited House Duty 73 V. Infectious Disease (Notification) Act, 1889, Successful working of the 75 „ „ Reticence of the Asylums Board with reference to returns under 76 ,, „ Monthly Statement of Notified Cases published by the Medical Officer of Health 76 ,, „ Injudicious circulation of Weekly Returns of, proposed in a Parliamentary Bill 77 ,, ,, Limited Publication of Weekly Returns of, by the Local Government Board 77 „ „ Defect in the Act; Exemption of Hospitals from duty of notifying cases, to be removed 78 „ „ Defects in the statutory form of the Medical Certificate to be remedied 78 „ ,, Managers of Asylums Board resume report to Medical Officers of Health of cases admitted to their Hospitals 79 „ „ Spot Maps published by the Board, shewing cases of disease notified in the several Sanitary Districts 80 „ „ Payment of Fees for Certificates 81 London School Board and Infectious Disease .Prevention : Conference of Medical Officers of Health 81 Compulsory Removal to Hospital, Imperfect Provisions of the Law with respect to 84 Public Health Legislation: Prospective 84 „ „ (London) Acts, to be consolidated 85 „ „ Amendment Bill introduced 86 „ „ Objection made to provisions of Amendment Bill 87 „ Provisions of Amendment Bill 88 „ „ ,, with reference to Nuisances 88 „ „ „ „ Proceedings for Nuisances 89 ,, „ „ ,» Provision of Water-closets 89 „ „ ,, Injuring Closets, &c. 90 ,, „ „ „ Sanitary Conveniences 90 „ „ „ „ Inspection of Drains 90 „ „ „ Overcrowding 90 „ „ ,, „ Unhealthy Houses 90 ,, ,, „ „ Underground Rooms 91 „ „ ,, „ Power of Entry 91 „ „ „ „ Filth removal 91 „ „ „ , Dust removal 92 „ „ „ „ Notification 92 vi. Public Health : Provisions of Amendment Bill (continued)— „ „ „ with reference to Hospitals 93 ,, „ „ „ Compulsory removal of Siek 93 „ „ „ „ Infectious Persons 94 „ „ „ „ Disinfection 94 „ „ „ Mortuaries 94 „ „ „ „ Coroner's Court 94 „ „ „ „ Unsound Food. 94 „ „ „ ,, Smoke 95 „ „ „ „ Bye-laws 95 „ „ „ „ Notices, Fines, Appeals 96 „ „ „ „ Committee of Sanitary Authority 97 „ „ „ „ Authorities 97 ,, „ ,, Recommendation of Amendments by the Medical Officer of Health 97 Sanitary Legislation, Progress in 98 Royal Commission on Infectious Disease Hospitals (1882) : Ittsumi of its recommendations, and the extent to which they have been carried out, by Law or in Practice 100 Population of Sub-Districts, Number of Inhabited Houses, &c. 101 ,, Relative Numbers of Males and Females; at different ages ; in Parish, and in Sub-Districts, in 1881 (Tables) 102 „ Inhabited Houses and Rateable Value, Increase of since 1856, and since 1871 103 Marriages and Marriage-Rate 104 Births and Birth-Rate 104 Deaths and Death-Rate 105 Infantile Mortality 106 ,, „ Among Illegitimate Children 106 Senile Mortality 107 Death-Rate at Different Age-Periods (Table) 107 ,, Mean Temperature, &c., Monthly 108 Death, Assigned Causes of 109 „ ,, Specific Febrile or Zymotic Diseases 109 „ „ „ Venereal Diseases 109 „ ,, „ Puerperal Fever 110 ,, Parasitic Diseases 111 ,, Dietetic Diseases 111 ,, ., „ Alcoholism 111 vii. Death, Assigned Causes op (continued)— „ Constitutional Diseases 1ll „ „ „ Cancer 112 „ „ „ Tubercular 113 „ Developmental Diseases 114 „ Local Diseases 115 „ „ Nervous System, Diseases of 115 „ „ Circulatory System „ 116 „ „ Respiratory „ „ 116 „ „ Digestive „ „ 117 „ „ Urinary „ „ 117 „ „ Reproductive „ „ 118 „ Violent Deaths 118 „ Ill-defined and Not Specified Causes of 118 Public Institutions, Deaths in 119 ,, ,, ,, Parish Infirmary and Workhouse 119 „ „ „ Outlying Hospitals, &c. 121 „ „ ,, St. Joseph's House 122 „ „ „ Consumption Hospital, Brompton 122 „ „ „ Marylebone Infirmary, Notting Hill 122 Deaths, " Not Certified," in Kensington 122 „ „ The subject of, considered generally 123 , „ The position and duties of Coroners and their Officers in relation to 123 Inquests 125 „ Deaths from Violence : Accidental 127 „ „ „ Suicidal 127 „ „ „ Homicidal 127 „ Why so many become necessary 127 Meteorology 128 Vaccination 129 „ Officer's Return for 1889 129 „ Royal Commission on, appointed 129 „ Animal: Calf Lymph 130 Sanitary Legislation 131 Sanitary, Nuisances Removal, and other cognate Acts : Report on, by the Law and Parliamentary Committee 131 viii. Bye-Laws for Sanitary Administration Purposes, The need of 133 ,, Action of the London County Council, with reference to 133 Unity in Sanitary Administration: A Desideratum 135 Sanitary Administration : The views of the President of the Local Government Board in respect to 135 Housing of the Working Classes Act, 1890 : Consolidates and Amends numerous Acts 136 ,, „ Views of the President of the Local ment Board on the subject of 137 „ ,, Action of the Vestry with reference to 138 „ „ Compensation for Property: Important Provisions with respect to 139 Bethnal Green Scheme : The first fruits of the Housing of the Working Classes Act, 1890 140 „ „ Description of the Unhealthy Area 140 „ ,, Estimated Cost of the Scheme 141 „ ,, Resolutions of the County Council with reference to 142 „ „ Principles on which Compensation is based 142 „ „ Costliness of Scheme generally 143 „ „ Mode of providing for the Evicted Tenants on the Area and elsewhere 146 „ „ Scheme Confirmed by the Home Secretary 146 Municipal Common Lodging-houses 147 Dwellings of the Labouring Classes : Views of the Housing, &c., Committee of the County Council 149 „ ,, Views of the Medical Officer of Health 152 Emigration as a Remedy For Overcrowding 152 Conference of County Council and Vestries, &c.5 on the Housing of the Working Classes Act, 1890 153 ,, „ Resolutions adopted at 154 „ „ Houses Unfit for Human Habitation : Report of Metropolitan Medical Officers of Health with respect t 155 Conference of Vestries and District Boards (at Paddington Vestry Hall), on the Housing of the Working Classes Act, 1890 158 „ „ Report of Special Committee appointed by, on Defects in Houses 159 ,, Report of the Executive Committee 160 ix. Housing of the Working Classes Committee of the County Council report on the subject of the Conferences 162 Factory and Workshops Bill, Provisions of 164 Bakehouses, The Regulation of 165 ,, Action of the Vestry with reference to the 165 „ Action of the Society of Medical Officers of Health 166 „ Communications with the Home Secretary, and the Local Government Board, with reference to 166 Water Supply Bills 169 Dwellings of the Labouring Classes, The Local Government Board on the 170 Sanitary Department, Re-organisation of the 172 ,, „ Views of the Medical Officer of Health with reference to the 172 „ ,, Report of the Works and Sanitary Committee on the 176 „ ,, Instructions for the guidance of the Sanitary Inspectors 180 „ j, Duties of the Street Inspectors 182 Offensive Businesses 183 ,, „ Fat Extractor 184 ,, ., Marine Stores 184 Refuse Matters, Production of 185 Offensive Substances, Conveyance of, through Streets 186 Brick Burning: Nuisance arising from 187 ,, Judicial Decisions with reference to 187 ,, Legislation required for dealing with 188 ,, Numerous complaints received with reference to. Action of the Vestry 188 ,, Subject of, referred to in Parliament 189 ,, Action of the County Council with reference to 190 ,, Bye-laws made to regulate 190 X. Offensive Smells, Complaints of: Due to Brick Burning 191 Nuisances Removal Acts : Committee appointed by the Vestry for carrying out the provisions of the 193 Sanitary Inspectors, The Work of the 194 Legal Proceedings, Results of 195 Slaughter-houses (Metropolis) Act, 1874 : A Retrospect 196 „ „ Licensed 198 „ „ Report of the Works and Sanitary Committee on the 198 Horseflesh, Sale of, Regulation Act, 1889 199 Cowsheds, Dairies, &c. : Contagious Diseases (Animals) Act; Dairies Order. A Retrospect 199 „ Licensed 201 „ Report of the Works and Sanitary Committee on the 201 Bakehouses 203 Refuse Matters, Nuisance arising from Removal of 204 House Refuse : The Work of "Dust" Collection and Removal 204 „ ,, Metropolitan Board (the late), requested to promote Legislation to abolish Dust-bins, made enquiry, but took no other action 205 „ „ Daily Collection of, from Moveable Receptacles: A Desideratum 205 „ „ Difficulty and Expense of finding " Shoots " for, always on the Increase 206 ,, ,, Vestry possesses Land at Purfleet, in Essex, on the River Thames, available for a Dust, Dung, and Slop Deplt: Landing Pier constructed 206 Trade Refuse : The Law on the subject of Removal of 206 Stable Refuse : Nuisance from Non-removal of, largely dependent on the use of improper Receptacles 207 „ ,, Use of Sunken Dung-pits, condemned 208 5J ,, Suggestion that the Vestry should undertake Collection and Removal of, at the cost of the Producers, having now a Depot at Purfleet 209 „ „ Removal of, dealt within the Public Health (London)Bill 210 Disinfection in 1889-90 210 Necessary Accommodation: Public, and Public-house Urinals 210 Public Baths and Wash-houses : Wash-houses apart from Baths: A Desideratum 211 xi. Mortuary, Public: Observation with reference to the 213 „ „ Particulars with reference to Bodies admitted to 213 „ ,, Views of the Royal Commission with respect to 214 Coroner's court provided by the Vestry at the Town Hall 215 „ Majority of Inquests held at the 216 Coroners' Disbursements : Schedule of Fees settled by County Council 216 Brompton Cemetery, Movement to close the 217 Houses Let in Lodgings, Regulations for, made under Sanitary Act, 1866 219 „ ,, „ The subject of, considered generally 220 Report of the Royal Commission on the Housing of the Working Classes 221 Unhealthy Houses : The Liability of Landlords : Legal decisions 222 Underground Rooms: Provisions of the Act with reference to 225 „ „ Action of the County Council with reference to 226 „ „ In Kensington : Action of the Vestry 226 Boracic Acid as a Preservative of Milk, Report on 227 Metropolitan Sewage : Action of the late Metropolitan Board of Works with reference to the 229 „ „ Sir Henry Roscoe's Reports and Conclusions with reference to the 230 ., „ Observations on by the Chairman of the County Council 232 ,, „ Report on by the Main Drainage Committee 232 ,, ,, The cost of Deodorization 232 „ „ Three Systems of Treatment have been proposed for dealing with 233 Water Supply : The Regulations 234 „ Cutting-off Powers of the Companies 235 „ Underground Tanks : The Dangers of 237 „ Professor Frankland's Report, Abstract of 238 ,, The Water Examiner's „ ,, 240 xii. "Water Supply: By the Local Companies 242 „ Bacteriological Examination of the 244 „ Constant Supply, Progress of Provision for 245 „ „ How to be obtained 246 „ The Vestry apply for Constant Supply 247 ,, Capital Expenditure of the Companies 247 „ The Plant, &c., of the Companies 248 Gas, Results of Examination for ascertaining the Illuminating Power and Purity of 248 ,, Proposal to acquire power to test Gas with portable Photometer 249 „ Proposed new Standard for ascertaining the Illuminating Power of 249 Conclusion 251 xiii, APPENDIX. STATISTICAL AND OTHER TABLES. Table I. Estimated Population, in 1890 and Ten previous years, 1880-89 : Number of Inhabited Houses, and of Marriages, Births, Deaths, &c 253 ,, II. Birth-rate and Death-rate ; Death-rates of Children ; Deaths in Public Institutions in 1890 and in 1880-89 254 „ III. Deaths Registered from all Causes in 1890 255-6 ,, Ilia. Summary of Table III. 257 „ 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 258 ,, V. Deaths in 1890 and in 1880-89 from the Seven Principal Zymotic Diseases: in the Parish; in the Metropolis; and in England and Wales 259 „ VI. Summary of Inspectors' Reports of Sanitary Work completed in the year 1890-91 260 „ VIa. Summary of Monthly Returns of Work done by the Sanitary Inspectors in the year 1890-91 261 ,, VII. Death-rates, General and Zymotic, in Kensington and London; and Proportion of Deaths from Zymotic Diseases to Total Deaths in 1890 and 10 previous years 262 ,, VIII. Comparative Analysis of the Mortality in London and Kensington in 1890; Percentage of Deaths under one year to Births registered; and Percentages of Deaths under one year, and at 60 and upwards, from the Principal Zymotic Diseases, and from Violence ; of Inquest cases, and of Deaths at Public Institutions, to Total Deaths 263 „ IX. Localfcies where fatal cases of the more important of the Zymotic Diseases occurred in 1890 264-5 „ X. Vaccination Officer's Annual Return (1889) 266 „ XI. Slaughter-houses, Licensed: and names of Licencees 267 „ XII. Cowsheds „ „ „ 268 THIRTY-FIFTH ANNUAL EE PORT op the MEDICAL OFFICER OF HEALTH, Being for the Year 1890. To the Vestry of the Parish of St. Mary Abbotts, Kensington. Gentlemen, The vital and mortal statistics in the following report are for the registration year ended January 3rd, 1891, a period of 53 weeks, and are calculated upon an estimated population of 179,500, a total based on data furnished by the census of 1881 corrected, as far as practicable, by the number of inhabited houses. The deaths registered in the 53 weeks were 2951, being 539 above the number registered in 1889; and, including 74 registered in the 53rd week, were 85 above the decennial average corrected for increase of population. The deaths corresponded to an annual rate of 16.1 per 1000 of the estimated population, or 0.2 above the decennial average (15.9). The rate in 1889 was 13'5 only and the lowest on record. The death-rate in London was 20.3 per 1000, or 0.3 above the decennial average; 2.9 above the rate in 1889 (17'4), which was the lowest on record, and 4.2 above the rate in B 2 Kensington. The death-rate in England and Wales, 19.2, shews an increase of 1.8 per 1000 compared with that of 1889 (17.9), which, with the single exception of 1888, when the rate was 17.8, was the lowest recorded in any year since civil registration began, in 1837. It was 1.1 below the rate in London, and 3.1 above the rate in Kensington. 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 :— 1890.1889. 1888. 1887. 18S6. 1885. 1884. 1883. 1882. 1881. 1880. Kensington 161 135 15.9 16.4 15-9 161 151 15-5 16.2 16.6 17.8 London 20 3 17.4 18.5 19.6 19.9 19.8 20.4 20-5 21-3 21.3 21.7 W. Districts 192 17.0 18.3 19.0 19.0 19.2 19.2 19.5 19-8 19.6 19-8 North „ 181 15-7 16.6 17.8 IS.0 18-5 19.0 19.0 19.6 20.6 20.8 Central „ 29.6 241 25.7 261 25.4 24"4 24.9 241 241 23.5 23.8 East „ 24-0 20-2 21.8 22-5 23.2 22.5 22.9 241 25.2 24.2 243 South „ 185 16-6 17-2 18.6 191 18-5 19.7 19-5 20.6 20.5 21.3 England & Wales 19.2 17.9 17.8 18.8 19.3 19.0 19 5 19-5 19.6 18.9 20.5 The year 1890 stands out in marked contrast, and disadvantageously as we shall see, not only with 1889, but also with several previous years, the death-rate having been the highest recorded since 1884. The increased mortality, and an unusual prevalence of sickness, were due beyond question to the epidemic, or the causes of the epidemic of Influenza, to which reference will be made later on. The London death-rate had been declining yearly since 1884 until 1889 when it reached the lowest point ever recorded. The Registrar-General, in his "Annual Summary of Births and Deaths, and causes of Death," spoke of that year as one of " excessively low rates." The marriage rate (16"3) indeed shewed a slight recovery from the rate of 1888 (16.1), the lowest on record, but the birth rate (30.3) was the lowest ever recorded in London, the rate moreover 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 3 pensated by the still greater decline in mortality. The deathrate (17.4) was by far the lowest recorded in London; the four next lowest rates, moreover, were 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. In 1890 there was a still further, if slight, increase in the marriage rate, to 16.6 per 1000, but the birth-rate continued to fall, being so low as 29.1 per 1000, while the death-rate rose to 20.3, a higher rate than in any year since 1884, when it was 20.4. The birth-rate being so low and the death-rate so high, the excess of births over deaths or natural increment of the population was only 39,447, or 16,357 fewer than in 1889. The Registrar-General, as usual, has prepared a table shewing diminution or excess of deaths in 1890, compared with annual deaths in 1880-89, corrected for increase of population, from which we learn that there was a marked diminution in the number of deaths from small-pox (674), scarlet fever (838), "fever" (304), and diarrhoeal diseases (679). There was a diminution also in deaths, among other causes, from phthisis and tubercular diseases (539), diseases of the nervous system (172), and " all other causes " (556); the total diminution being 3762, against 14,720 in 1889. On the other hand there was an excess under several heads—viz., measles (664), whooping-cough (193), diphtheria (355), cancer (349), premature birth (222), diseases of the circulatory system (1293), diseases of the respiratory system, including croup (2143), and diseases of the urinary system (89). The diminution being deducted from the excess a balance of excess and diminution shews a net excess of 1546 in 1890, against a net diminution of 13,224 in 1889. This saving of life in 1889 was very unequally distributed among the several causes, and there were four headings under which the mortality was in excess, viz., diphtheria, cancer, premature birth, and diseases of the circulatary organs. These headings had shewn similar excess in each of the six preceding years, and they shew it again in 1890, Similarly with regard to the diseases which shew b 2 4 diminished mortalities : here, also, mast of the changes were not peculiar to the years 1889-90, but were parts of a change that had 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, the varieties of " fever," diseases of the nervous system, diseases of the respiratory system, and the aggregate of " other causes." "This persistency of decrease," as 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." It will have been observed that the diminution in respect of all the causes named was maintained in 1890, with the single exception of the diseases of the respiratory system, which, in place of a diminution of 4376 in 1889, shew an excess of 2143 in 1890, a difference of no fewer than 6519 deaths. Measles, again, and whooping-cough, which in 1889 shewed a diminution of 278 and 1406 deaths respectively, shew an excess of 664 and 193 in 1890. The diminution, moreover, in respect of scarlet fever and " fever," in 1890, was considerably less than in 1889, the net result being that 1890 was in point of mortality an average year, the decimal in the nominal death rate of 20.3 corresponding to the deaths accounted for by the inclusion in the London mortality, this year, for the first time, of the deaths of Londoners (1502 in number) that occurred in certain institutions outside the area of Registration London, viz., the Lunatic and Imbecile Asylums. The death-rate in " Greater London," which is co-extensive with the Metropolitan and City Police districts, was as high as 19.4 per 1000, the rate in the four preceding years having been 19.3, 18.9, 17.8, and 16'8. The deaths, however, properly belonging to the Outer Ring, as distinguished from Inner or Registration London, were equivalent to a rate of only 16'5 per 1000 of a population slightly exceeding 1,200,000. But the excess in the death-rate from the principal zymotic diseases was proportionately greater in the Outer Ring than in Inner London, for while the rate in Inner London was 2.73 per 1000, and not more than 5.l per cent. above the mean 5 rate in the three preceding years, the rate in the Outer Ring was 2.45 per 1000, and 23.1 per cent. above the average annual rate of the same period. The death-rate in the twenty-seven Cities and Boroughs next in importance to London, and having a population exceeding five millions, was 21.7, ranging from 16.5 in Nottingham, 17.8 in Brighton, and 17.9 in Leicester, to 25.8 in Bolton, 25'9 in Newcastle, 27.4 in Preston, and 30.6 in Manchester, without correction for differences between one town and another in regard to the age and sex distribution of their respective populations. The death-rates of Edinburgh, Glasgow, and Dublin were 20.0, 25.3, and 26 .4 respectively. In twenty-two of the largest European cities, having an estimated population of about eleven and a-half millions, the mean rate of mortality was 25.3 per 1000, and exceeded by 5.0 the mean rate in the twenty-eight largest English towns, including London, having an aggregate population approaching ten millions. The lowest rates were, Stockholm, 19.6, Christiania, 21.1, Brussels, 21.5, Copenhagen and Berlin, 21.6; ranging upwards to 29 3 at Venice, 30 at Munich, 31.4 at Buda-Pesth, and 40.3 at Moscow. The rate in Rome was 23'4, in Paris, 24.5, in Vienna, 24.6, and in St. Petersburgh, 28'4. In the American cities the general death-rate from all causes ranged from 18.7 in St. Louis, to 28.5 in New Orleans. At Cairo it was 44.8, and at Alexandria, 39.6 per 1000. In Bombay the rate was 26'6, in Calcutta 28.5, and in Madras 42.9. 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 6 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 1890 the inhabited houses were some 21,800, and the estimated population 179,500. 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 1890 was about 131,000, and that of Brompton 48,500. The Town sub-district still includes some open spaces, as Holland Park and Notting Barn Farm. The Brompton sub-district, in which the builder has been busy of late years, many of the new houses being of a palatial character, is now nearly covered. The West London or Brompton Cemetery, Government property, is in this sub-district; the Kensal Green Cemetery, private ownership, is in the Town subdistrict. 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 even an increasing percentage ,of persons of the poorer classes. The poor in Kensington, however, are better off in one 7 respect than the poor in some other parts of the Metropolis, in th at, for the most part, they live in houses fairly well-built and obviously intended for occupation by the lower middle classes; 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 Area in Inhabited houses Increase Population. Increase flameoi wara. Statute Acres. 1871. 1881. in 10 vears. 1871. 1881. inlOyears St. Mary Abbotts 846 4,781 6,573 1,792 35,696 48,831 13,135 Holy Trinity, Brompton439 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 Total ... 2,190 15,735 20,103 4,368 120,299 163,151 42,852 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 could not 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). 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 14,428 93,397 1833 1841 26,834 142,772 1843 1851 44,053 257,103 1853 1861 70,10S 444,030 186S 1871 120,299 975,046 1873 1881 163,151 1,711,495 1883 1890 (July) 179,500 2,012,843 (April) 1891 8 SUMMARY OF MORTAL STATISTICS, ETC. Following a year characterised by the lowest death-rate on record (18.5 per 1000) the year 1890 does not shew to advantage from the hygienic point of view. The death-rate (16.1), it is true, was but little (0'2) above the decennial average (18'9), and the mortality from the so-called "dangerous" infectious diseases— scarlet fever, diphtheria, and enteric fever—was below the average; but measles was more fatal than in any previous year, and the deaths from whooping-cough exceeded the corrected average. The epidemic of Influenza, in addition to the deaths primarily attributed to it, was, as I believe, the underlying cause of many deaths ascribed to diseases of the organs of the respiratory system, at a time—January—when, owing to the unusual mildness of the weather, the deaths from those diseases would, under ordinary circumstances, have been below average. In all but one of my thirteen four-weekly reports, in 1889, I had to chronicle a death-rate below the average, while in 1890 the death-rate in seven of the four-weekly periods was in excess. The lowest rate (11.8) was recorded in the four weeks ended October 4th, the highest (22.4) in the four weeks ended January 25th, and the next highest (20.3) in the following four-weekly period: these eight weeks, moreover, being those in which Influenza was most prevalent, and diseases of the respiratory organs also. The diseases of these organs were again very fatal at the end of the year—the weather being cold—when, in my final report, I had to chronicle the third highest monthly death-rate (19.1). No death from small-pox or typhus or simple continued fever was registered, but the total deaths from the principal diseases of the zymotic class were 14 in excess of the average, after correction for increase of population, the death-rate from these diseases being 2.l per 1000 as against 1.5 in 1889. The mean temperature of the air (48'6) was 0.7 below the average of 49 years. 9 The death-rate in the first four weeks of the year ended January 25th, the highest in 1890, was 22.4 per 1000 of the estimated population, and 3.3 above the decennial average (19.1): it was, however, 7.3 below the rate in the Metropolis as a whole (29.7), this moreover being 6.5 above the decennial average (23.2). The deaths from the principal diseases of the zymotic class were 15 only, and 11 below the corrected decennial average, whoopingcough being the cause of 10 deaths, diphtheria of 4, and scarlet fever of 1. The fatality of diseases of the respiratory organs was very great, no fewer than 136 deaths having been registered (including bronchitis 106, and pneumonia 20), although the temperature was 6.3° above that of 1889, when, in the same four weeks, only 57 deaths (including bronchitis 43, and pneumonia 5) were registered from these causes. The deaths from "Influenza" were 13—two of them in the Brompton sub-district: one, four, five, and three, in the four weeks respectively—this disease being returned in nine cases as the primary cause of death. But there can be no doubt that many additional deaths were really due to Influenza, or to the causes of Influenza, whatever these may have been. The deaths of children under five years of age were 73, including 47 under one year, those of persons aged 60 and upwards being 99. The mean temperature of the air was 42.1° Fahr., and 5.2 above the means in the corresponding weeks in the previous ten years (36.9). In the second four-weekly period of the year (5th—8th weeks, January 26th to February 22nd), the death-rate fell to 20.3: it was 2.3 above the average (18'0), but l.l below the Metropolitan rate (21.4), this being 1.7 below the decennial average (23.1). The deaths from the principal zymotic diseases were 18, and 5 below the average. Whooping-cough was the cause of 11 deaths, diphtheria of 4, and scarlet fever of 1. The diseases of the respiratory organs were fatal to 81 persons (a reduction of 55), as against 48 in the corresponding weeks in the previous year: fifty-one of these deaths were due to bronchitis, and ten to pneumonia. Influenza was the certified cause of 13 10 deaths—7, 3, 1, and 2, in the four weeks respectively. The deaths of children under five years of age rose (from 73) to 79, including 48 under one year, but those of persons aged 60 and upwards fell (from 99) to 87. The mean temperature was 38.8°, being 1.2 below the average (40.0). In the third four-weekly period (9th—12th weeks, February 23rd to March 22nd) the death-rate further fell to 16.6, and was l.l below the average (17.7), and 4.3 below the Metropolitan rate (20.9), this being l.l below the decennial average 22.0). The deaths from the principal zymotic diseases were 24, or 1 above the average, including whooping-cough 11, diphtheria 7 (the highest monthly total in 1890), scarlet fever 3, and enteric fever, 1. The deaths from diseases of the respiratory organs again fell (from 81) to 61 (including bronchitis 38, pneumonia 12), but were 24 above the number in the corresponding weeks of 1889. Influenza was the certified cause of 3 deaths. The deaths of children under five years of age further rose (from 79) to 82, including 49 under one year, but those of persons aged 60 and upwards further fell (from 87) to 66. The mean temperature was 40.1°, and 0.4 below the average (40.5). In the fourth period (13th—16th weeks, March 23rd to April 19th) the death-rate further fell to 15.3 per 1000, being 1.7 below the average (17.0), and 3.0 below the Metropolitan rate (18.3), this, moreover, being 2.8 below the decennial average (21.1). The deaths from the principal zymotic diseases were 25 (being average), including whooping.cough 19 (the highest monthly total in 1890), measles 3, diphtheria and enteric fever 1 each. The deaths from the diseases of the respiratory organs were 60 (including bronchitis 34, and pneumonia 13), against 48 in 1889. Influenza was the certified cause of seven deaths. The deaths of children under five years of age were again 82, including 52 under one, but those of persons aged 60 and upwards further fell (from 66) to 52. The mean temperature was 45.5 and 0.4 above the average (45.1). 11 In the fifth period (17th—20th weeks, April 20th to May 17th) the death.rate, again 15.3, was 0.1 above the average (15.2), but 2.5 below the Metropolitan rate (17.8), this being 1.3 below the decennial average (19.1). The deaths from the principal zymotic diseases were 36, or 10 above the corrected decennial average, including 19 from measles, which was now severely epidemic, 10 from whooping.cough, 3 each from scarlet fever and diarrhoea, and 1 from enteric fever. The deaths from diseases of the respiratory organs fell (from 60) to 49—three more than in 1889—including bronchitis 34, and pneumonia 9. No death was registered from influenza. The deaths of children under five years of age rose (from 82) to 89, including 51 under one year, whilst those of persons aged 60 and upwards further fell (from 52) to 45. The mean temperature was 51.4 and 1.3 above the average (50.1). In the sixth period (21st—24th weeks, May 18th to June 14th) the death-rate rose to 17.3, and was 2.2 above the average (15.1), and 0.7 above the Metropolitan rate (16.6), this being 0.9 below the decennial average (17.5). The deaths from the principal diseases of the zymotic class were 67 (the highest monthly total in 1890), and 41 above the decennial average, including 48 from measles (the largest monthly number), 11 from whooping-cough, and 3 each from scarlet fever and diphtheria. The deaths from diseases of the respiratory organs further fell to 33 (but were 13 above the number in 1889), including bronchitis 22, and pneumonia, 6. One death was registered from influenza. The deaths of children under five years of age further rose (from 89) to 130 (the maximum monthly number), including 55 under one year, while those of persons aged 60 and upwards further fell (from 45) to 41. The mean temperature was 56.3 and 0.8 below the decennial average (57.1). In the seventh period (25th—28th weeks, June 15th to July 12th), the death-rate fell to 15.7 per 1000, but was 1.7 above the average (14.0). It was l.l below the Metropolitan rate (16.8), this being 1.6 below the decennial average (18.4). 12 The deaths from the principal diseases of the zymotic class were again 67, and 31 above the corrected decennial average, viz., 38 from measles (a reduction of ten); 14 (12 of infants) from diarrhoea, 8 from whooping-cough, 5 from diphtheria, and 1 each from scarlet fever and enteric fever. The deaths from diseases of the respiratory organs were 31 (7 more than in 1889), including bronchitis 14, and pneumonia 8. The deaths of children under five years of age fell (from 130) to 117, including 62 under one year. The deaths at 60 and upwards were 42. The mean temperature was 57.8, and 3.9 below the decennial average (61.7). In the eighth period (29th—32nd weeks, July 13th to August 9th), the death-rate further fell to 14.3, being 1.4 below the average(15.7), and 4.0 below the Metropolitan rate (18.3), this being 2.7 below the decennial average (21.0). The deaths from the principal diseases of the zymotic class were 46, or 6 below the average, including diarrhoea 21, measles 20, diphtheria 2, and 1 each from scarlet fever and enteric fever. The deaths from diseases of the respiratory organs were 16, the lowest monthly number in the year (1 more than in 1889), including bronchitis 8, and pneumonia 6. The deaths of children under five years of age further fell (from 117) to 96, including 59 under one year, while those of persons aged 60 and upwards were 41. The mean temperature was 62T, and 0.5 above the average (61.6). In the ninth period (33rd—36th weeks, August 10th to September 6th), the death-rate further fell to 13.7 per 1000, but was 0.3 above the average (13.4). It was 5.6 below the Metropolitan rate (19.3), this being 1.3 above the decennial average (18.0). The deaths from the principal diseases of the zymotic class were 29, or 3 below the average, including 17 from diarrhoea, 8 from measles, 2 from enteric fever, and 1 each from scarlet fever and diphtheria. Whooping-cough had ceased to be prevalent, no death having been registered in the four weeks, and only one in the previous four-weekly period. The deaths from the diseases of the respiratory organs were 21 (two more than in 1889), in- 13 eluding bronchitis 10, and pneumonia 6. The deaths of children under five years of age further fell (from 96) to 81, including 54 under one year, while those of persons aged 60 and upwards rose (from 41) to 45. The mean temperature was 58.2, and 1.5 below the average (59.7). In the tenth period (37th—40th weeks, September 7th to October 4th) the death-rate further fell to 11.8 (the lowest recorded in 1890), being 0.8 below the average (12.6), and 4.9 below the Metropolitan rate (16.7), this being 0.2 below the decennial average (16.9). The deaths from the principal zymotic diseases were 14, or 7 below the average, including diarrho3a 7, measles (no longer epidemic) 2, scarlet fever and enteric fever each 2. The deaths from diseases of the respiratory organs were 26 (two more than in 1889), including bronchitis 16, and pneumonia 6. The deaths of children under five years of age, infantile diseases being at low ebb, further fell (from 81) to 55 (the lowest total in 1890) including 41 under one year, while those of persons aged 60 and upwards further rose (from 45) to 49. The mean temperature was 58.8 and 4.5 above the average (54.3). In the eleventh period (41st—44th weeks, October 5th to November 1st) the death-rate rose to 12.9, but was 2.0 below the average (14.9), and 6.8 below the Metropolitan rate (19.7), this being 0.6 above the decennial average (19.1). The deaths from the principal zymotic diseases were 15, or 8 below the corrected average, including scarlet fever and diarrhoea 5 each, and diphtheria and enteric fever 1 each. The deaths from the diseases of the respiratory organs were 49, an increase of 23, and 14 more than in 1890, including bronchitis 27, and pneumonia 11. The deaths of children under five years rose (from 55) to 71, including 44 under one year, while those of persons aged 60 and upwards were again 49. The mean temperature was 48.4, and 1.3 above the average (47.1). In the twelfth period (45th—48th weeks, November 2nd to 29th), the death-rate further rose to 14.S per 1000, but was 2.1 14 below the average (16.4), and 5.3 below the Metropolitan rate (19.7), this being 0.3 below the average (20 0). The deaths from the principal zymotic disases were 10 (the smallest total in 1890), and, 12 below the corrected average, including enteric fever 3 (the largest monthly number), and scarlet fever and diphtheria 2 each. The deaths from the diseases of the respiratory organs further rose (from 49) to 64 (the same number as in 1889), including bronchitis 33, and pneumonia 17. The deaths of children under five years of age fell (from 71) to 54, including 34 under 1 year, while those of persons aged 60 and upwards rose (from 49) to 69. The mean temperature was 43.5, and 0.1 above the average (43.4). In the thirteenth and last period, one of five weeks (49th— 53rd weeks, November 30th, 1890, to January 3rd, 1891), the death-rate further rose (from 14.3) to 19.1, and was 2.5 above the average (16.6), but 5.6 below the Metropolitan rate (24.7), this being 3 3 above the decennial average (21.4). The deaths from the principal diseases of the zymotic class were 21, or 10 below the corrected average, viz., whooping-cough 7, diphtheria 5 (the highest number since the seventh four-weekly period), diarrhoea 4, scarlet fever 3, and enteric fever 2. The deaths from diseases of the respiratory organs were 114, the largest number since the first four weekly period, and 53 above the number in 1889, including bronchitis 70, and pneumonia 23. The deaths of children under five years of age rose (from 54) to 77, including 55 under one year, and those of persons aged 60 and upwards (from 69) to 137. This was by far the largest total in 1890, after allowance for the fifth week, and is the explanation of the higher death-rate, which was especially caused by diseases of the chest, due to low temperature—29.9, or 9.8 below the average (39.7)—piercing winds and London fog. Thus, the year which began so badly ended badly, diseases of the respiratory organs being conspicuously fatal throughout, the deaths from these diseases in every month, except one, having been in excess of those in the corresponding month of 1889, the total excess for the year being 278; the 15 deaths from the principal zymotic diseases, moreover, shewing an excess to the number of 118, though only fourteen above the corrected decennial average. THE ZYMOTIC DISEASES. Before entering into details with respect to population, births, deaths, etc., 1 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 "Diarrhoeal") include the diseases which the Registrar-General describes as "the seven principal diseases of the zymotic class," grouping as he does, under the generic term "Fever," the three distinct fevers, "Typhus," "Enteric," and "Simple Continued." These zymotic diseases have a 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 1887 and 1888, the deaths being considerably above the average. In 1889, on the other hand, the deaths from measles were greatly 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 16 another; or that the severity of an epidemic may he influenced by the measures taken, or the neglect to take measures, to check the spread of infection. Again, the number of deaths from Whooping-cough in 1889 was the lowest on record; it is not surprising to find, therefore, that in the immediately preceding and succeeding years the disease was fatal above the average. The large total of 185 deaths from this disease in 1878, moreover, followed the then minimum return of 84 in the previous year. Diabkhcea 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. 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 had both been below the 17 decennial average in Kensington. In 1890 the general rate was fractionally above the average, the zymotic rate being average. 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 shews the deaths from the principal zymotic diseases in 1890, together with the decennial average, etc. :— Disease. Sub-districts. In Hospitals. Decennial average. Town. Brompton. Town Brompton. Total. Uncorrected. Corrected for increase of Population Small-pox ... ... ... ... 11.9 12.5 Measles 126 12 2 140 70.3 74.1 Scarlet Fever 5 l 16 4 26 36.7 38.7 Diphtheria 1.2 4 17 2 35 38.8 40.9 Whooping.cough 84 8 1 ... 93 81.6 86.1 Tvphus Fever ... ... 9 9 Enteric Fever 11 2 2 ... 15 20.1 21.2 Simple Oontd. Fever ... 2.7 2.9 Diarrhoea 66 9 1 2 78 90.9 95.9 304 36 39 8 387 353.9 373.2 It appears, then, that the deaths from these diseases were 14 above the corrected decennial average. They were also 118 more than in 1889, but fewer by 33 than in 1888. As usual, the deaths in the Brompton sub-district (44) were fewer in proportion to population than in the Town sub-district, but not quite to the same extent as in the preceding year. The total deaths were equal to 181 per 1000 deaths from all causes in Kensington (Metropolis, 134), and to a rate of 2.1 per 1000 persons living (Metropolis, 2.7); the decennial average being 2.1 in Kensington, and 2.9 in London. In England and Wales the deaths from these diseases were 106 in each 1000 deaths; and the rate was 2.03 per 1000 persons living, the decennial average being 2.3 per 1000. 18 In the 27 Cities and Boroughs grouped by the RegistrarGeneral with the Metropolis, the zymotic death-rate was 2.73 per 1000, ranging from 1.19 in Huddersfield, 1.37 in Halifax, and 1.58 in Nottingham, to 8.73 in Bolton, 3.84 in Salford, 4.01 in Manchester, and 4.28 in Preston. The subjoined 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 Measles. Scarlet Fever. Diphtheria. Whooping-Couglh. Enteric Fever. Diarrhoea. Total. January 25 ... 1 4 10 ... ... 15 February 22 ... 1 4 11 2 18 March 22 1 3 7 11 1 1 24 April 19 3 1 19 1 1 25 May 17 19 3 ... 10 1 3 36 June 14 48 3 3 11 2 67 July 12 38 1 5 8 1 14 67 August 9 20 1 2 1 1 21 46 September 6 8 1 1 ... 2 17 29 October 4 2 2 ... 1 2 7 14 N oveinber 1 ... 5 1 3 1 5 15 November 29 1 2 2 1 3 1 10 January 3 (1891) ... 3 5 7 2 4 21 (5 weeks). Totals 140 26 35 93 15 78 387 I now proceed to make a few observation with regard to each of these diseases. SMALL-POX. Only one case of small-pox, and that an imported one, was recorded in Kensington. In London generally, the disease was at low ebb, only 26 cases having been received at the Asylums Board Hospitals, and only four deaths having been registered, the decennial average number corrected for increase of population being 678. The deaths from small-pox during the 19 quennium, 1886—90, were 47 only : those in the previous quinquennial period, 1881—85, were 5590. The mortality from this cause during each of the past five years was less, not merely relatively to population but absolutely, than in any previous year 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 in the decennium 1880—89 was 0.16 per 1000 persons living, and lower than in any previous decennium. It is probable that the diminution in small-pox mortality in the Metropolis during the last five 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 measles in 1889 were 14 only, the smallest total on record. It is not surprising, therefore, that there should have been a greatly increased mortality from this cause in 1890 ; and, in fact, the deaths registered, 140, were more numerous than in any previous year on record, and were 66 above the corrected decennial average. Only 12 of the deaths were registered in the Brompton sub-district. All but 5 occurred under five years of age—27 only under one year. The excessive fatality was first manifested at the end of April, and as it came to an end at the beginning of September, the epidemic may be said to have been comprised within twenty weeks. Nineteen deaths were registered in the four weeks, April 20th—May 17th ; 48 in the following four weeks, May 18th—.June 14th ; 38 between June 15th and July 12th; 20 between July 13th and August 9th ; and 8 in the four weeks August 10th—September 6th. In the remaining 33 weeks of the year, there were but seven deaths from this cause (vide Table, page 18). 20 The 133 deaths that occurred between April 20th and September 6th, comprised 71 of males and 62 of females. They occurred in 125 houses in 70 streets. Of these streets, 5 were south of Kensington Road, 5 between that road and Uxbridge Road, and 60 north of Uxbridge Road. Three deaths took place in the Parish Infirmary. Twenty-seven of these 133 deaths occurred under one year of age. Between 1 and 2 years there were 54 deaths ; between 2 and 3, 28; between 3 and 4, 15 ; between 4 and 5,4; and above 5, 5 deaths. In 21 of the cases, measles alone was returned as the cause of death : in 112 cases other diseases were named in the medical certificates, including diseases of the respiratory organs in 100 cases, and diseases of the nervous system in 12 cases. In 4 cases not included in the above list, measles co-existed with whooping-cough, which was returned as the primary cause of death. Measles is not one of the diseases required to be notified to the Medical Officer of Health under the provisions of the Act of 1889, and it may be regarded as doubtful whether any great advantage would accrue from its addition to the list, as no provision is made, excepting to a limited extent in the Parochial Infirmaries, for the isolation of sufferers in hospital. That the disease is spread widely through the agency of schools I entertain no doubt, nor that the infection is capable of being conveyed in the clothing of children exposed to it, though themselves protected by a previous attack. The duration of an epidemic might be shortened by the closure of schools which are not seldom deprived of a large proportion of their pupils by an outbreak. An epidemic is sometimes, as in 1890, brought to an end by the occurrence of the long holidays. With a view to prevent the spread of the disease through the agency of public elementary schools, I addressed a letter, at the commencement of the epidemic, to the Superintendent of Visitors of the Chelsea division, pointing out the desirability of an effort being made to exclude from the schools all children from houses where measles existed. The School Board do not allow such children 21 to attend school, but the fact being probably unknown to many parents, I suggested that a circular letter should be sent to the parents of pupils for their instruction. Such a communication, if systematically made at the beginning of an epidemic, would probably be the means of saving many lives, and would certainly have the effect of checking the spread of the disease in the only practicable way short of closing schools : a similar step might be taken with advantage when any infectious disease is epidemic. It is to be regretted that 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 as inevitable as teething, they naturally enough rather like to have all of the children ill at one time, and get the trouble over. 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 1890 were 3291, being 664 above the corrected decennial average, and not far short of quadruple the number of deaths from scarlet fever. SCARLET FEVEE, This disease, which was the cause of 44, 26, and 28 deaths in 1887-88-89 respectively, proved fatal to 26 persons in 1890, the corrected decennial average being 38. Only five of the deaths belong to the Brompton sub-district : twenty occurred in hospitals, to which 214 out of 375 recorded cases were removed. Of the 375 cases, 260 belong to North Kensington, viz., that 22 part of the Parish north of Uxbridge Road; and 115 to South Kensington, i.e., the remainder of the Parish south of Uxbridge Road. The cases recorded in the three preceding years respectively, were 465, 252, and 252. The sufferers were for the most part children of school age ; but no child was knowingly allowed to go to school from an infected house. The spread of the disease 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 that there is 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 26. The deaths in London from scarlet fever were 876, the corrected decennial average being 1714: the type of disease being mild, the case-mortality was low, viz., 6.9 per cent., as compared with 11.1, 10.3, and 9.4 in 1887-8-9 respectively. Some portion, however, of the apparent reduction in the case-mortality may not unreasonably be ascribed to the operation of the Compulsory Notification Act, as doubtless we received information of nearly, if not quite all of the cases, including therefore many of a milder form, such as in pre - notification times would not have been reported. The reduction in the gross mortality is no doubt largely due to the greater use now made of hospitals for isolation of the sick, and the consequent reduction in the number of centres of infection. In 1878 only 7 per cent, of the total deaths from this disease occurred in the London Fever and Metropolitan Asylums Hospitals, from which date the proportion has risen year by year, until, in 1890, it reached 62.2 per cent.; the proportion in Kensington cases being 77 per cent. The percentage of removals, however, in our own Parish in 1890 (57) was not so high as in the four preceding years. This was due in part, probably, to the mildness of many of the cases—parents being unwilling to let their children go to hospital when they do not appear to be very 23 ill. But it was also due in a measure to the fact that the disease was most prevalent among the lowest classes of the population, in which there is the greatest degree of ignorance, with consequent inability to appreciate the advantages afforded by the hospitals. One hundred and eighty-three of the children attacked had been in attendance at schools, many of them at St. Clement.s (Church and Board) Schools, in the Potteries. In my tenth monthly report, dated October 6th, I had to state that "since the middle of July ten cases in as many families, in ten houses, in seven streets, had been notified of children attending St. Clement.s Board Schools, of whom five only were removed to hospital. Nineteen cases in fifteen families, in fourteen houses, in ten streets, had been notified of children attending the St. Clement.s Church Schools, of whom nine only were removed to hospital, and this notwithstanding every effort made to promote removal by appeals to parents, and by communications addressed to persons, who, it was thought, would be able to bring moral influence to bear on parents." It was impossible, however, to discover any effects of such moral influence, if attempted. Happily, however, if the cases were numerous, the deaths were few. Hospital Accommodation. — The rapid increase of the disease at the middle of the year led the Managers of the Asylums Board to consider whether it might not become necessary to provide additional accommodation, and on the 12th July, on the recommendation of the General Purposes Committee, the Managers resolved :— (a) That with the view to the immediate provision of additional accommodation for scarlet-fever patients, the Committee for the South-western Hospitals be instructed to re-open as soon as possible the lower of the two Hospitals at Stockwell, for the reception of fever patients. (i) That the General Purposes Committee be authorised, if and when they consider such a step necessary, to instruct the Small-pox Hospital Committee to fit up, furnish, and open the brick-hut Hospital at Darenth for the reception of convalescing fever patients, and that in the meantime the Hospital Committee be empowered to take the necessary steps for cleansing and disinfecting the hospital furniture, bedding, etc. 24 (c) That, having regard to the probable requirements for the accommodation of scarlet-fever cases, the Ambulance Committee be instructed to discontinue, for the present, the transfer of enteric fever convalescents to the Northern Hospital. The emergency contemplated in the above resolutions arrived in October, and the Gore Farm Hospital at Darenth was opened on the 14th, and by the 17th one hundred patients had been drafted from the Town hospitals. How necessary the relief thus afforded had become, may be inferred from the fact that on the 16th of October, when the Gore Farm Hospital had received 75 patients, the beds available for the reception of scarlet fever cases in London were 100 only, irrespective of 72 reserve beds at the South-western Hospital. No fewer than 883 cases of scarlet fever had been admitted at the Town hospitals in the four weeks ended on November 1st, making, with the admissions in the two previous four-weekly periods, 2412 cases admitted in twelve weeks. The total accommodation at the five Town hospitals for all classes of fever, and for special cases of small-pox, being under 2000, and there being close on 200 cases of enteric-fever under treatment in wards which could be used for no other purpose; scarlet-fever, moreover, being a disease which demands a lengthened period of isolation, it will be understood that the Gore Farm Hospital was opened not a day too soon, and how fortunate the Metropolis was in having this resource so judiciously utilised by the Managers. All of the appointments of officers and staif were "temporary," the Committee for the Hospital (being the Smallpox Hospitals Committee) hoping that it would not be required for more than a few months. It may be mentioned, as an illustration of the vigour with which the Managers attack difficulties, so as to keep accommodation in advance of the needs of the Metropolis, that the order for furnishing and fitting not having been given by the Committee until the 30th September, the Hospital was opened for reception of patients on the 14th October. The Hospital remained open until February, 1891, 25 having in the interval provided accommodation for 463 patients, having thus done good service and contributed, beyond doubt, to bring about the decline of scarlet-fever cases in the Metropolis. SCARLET FEVER AND THE MILK OF DISEASED COWS. In a previous Annual Report I stated that scarlet fever had 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, and must still, I think, be considered as sub judice. 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 have been brought up to date. It need hardly be added that the Board now obtain necessary information by notification, the Tables, nevertheless, still possess interest. 26 Statistics of Scarlet Fever in Kensington in 1890, and in Ten Previous Years. The Year. No. of Recorded Cases. Total Number of Recorded Cases. Percentage of Remov'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 1890 161 214 375 57 6 20 26. 23 77 69 875* 1889 86 166 252 66 8 20 28 29 71 11.1 778 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 18 194 2004 1881 177 110 287 39 30 8 38 79 21 13.2 2108 1880 316 150 466 32 83 22 105 79 21 22.5 3073 The corrected decennial average number of deaths from Scarlet Fever in Kensington was 89, and in London 1714, 27 Scarlet Fever Cases Recorded in Kensington in 1890, 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. 1890 10 32 17 23 24 15 12 19 24 42 71 49 38* 375 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 Average 20.8 17.8 140 13.7 16.7 15.7 15.0 13.9 18.7 32.5 32.3 31.2 26.1 268+ * Return comprises five weeks. f Without correction for increase in population. 28 DIPHTHERIA. In 1888, and still more in 1889, diphtheria was endemic in Kensington, especially in the northern parts of the Parish : the deaths, 89 and 111 in the two years respectively, were 65 and 79 above the corrected decennial average, In 1890 the deaths were only 35 or 15 below the corrected average : 29 in the Town subdistrict and 6 in Brompton; the deaths in the Brompton subdistrict in the two previous years having been 2 and 5 respectively. Sixteen of the deaths took place at home and 19 in hospitals— most of them in the Western Fever Hospital. The quarterly totals were 17, 5, 6, and 7. The ages at death were: under five years, 23 (only one in the first year of life), between five and fifteen 10, and 1 each in the two following decades. The cases notified as diphtheria were 209, viz., 141 north and 68 south of Uxbridge Road. Seventy-six of them were removed to hospital, where, as stated, 19 died, giving a case-mortality of 25 per cent., against 12'0 in the 133 home-treated cases—the hospital cases being, as a rule, severe, while many of those kept at home were very mild in character. Of the 209 cases reported 141 were in North Kensington, i.e., North of Uxbridge Road, and 68 in South Kensington, i.e., the remainder of the Parish south of Uxbridge Road, against 201 and 44 in 1889. The 141 cases in North Kensington occurred in 121 families, living in 119 houses, and in 67 streets; the 68 cases in South Kensington were in 55 families, living in 51 houses and in 44 streets. Twenty-nine 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 38 in the North-east District, between those roads and the adjacent parish of Paddington and the detached portion of Chelsea at Kensal Green. In 47 of the 67 streets in North Kensington one house in each street was invaded ; in 5 streets 2 houses were invaded; in 5 streets 3 houses; in 8 streets 4 houses; in one street 6 houses, and in one street 8 houses. Of the 47 streets in which 29 one house only was invaded, 20 are in the North-west District, and 27 in the North-east District. The total cases in the North-west District were 59, in the North-east District, 82. In 38 of the 44 streets in South Kensington one house in each street was invaded; in 4 streets 2 houses, and in 2 streets 3 houses. The streets in which 2 houses were invaded are Walmer Road and Stoneleigh Street, in the North-west District; Acklam Road, Appleford Road and Bevington Road in the North-east District; Newcombe Street, in the Central District; and Finborough Road, Hans Road, and Onslow Mews West, in the South District. The streets in which 3 houses were invaded are Blechynden Mews, St. Clement's Road, and St. Katherine's Road, in the North-west District; St. Ervan's Road and Tavistock Crescent, in the North-east District; Warwick Road, in the Central District; and Child's Place, in the South District. Four houses were invaded in Portland Road, Lancaster Road, Ladbroke Grove Road, St. Ann's Road, Crescent Street, and Rackham Street, in the North-west District, and Cornwall Road and Swinbrook Road, in the North-east District. Six houses were invaded in Wornington Road, and 8 houses in Portobello Road, both streets being in the North-east District. In each of 148 houses there was one case only; in each of 13 houses there were 2 cases; in 7 houses there were 3 cases in each; in 2 houses there were 4 cases in each, and in one house there were 6 cases. The sufferers comprised 83 males and 126 females; 70 of them were under five years of age, 58 between five and twelve years (the usual public elementary school age), 30 between twelve and twenty-one, and 51 upwards of twenty-one. Their position in life may be summarized as follows:— 64 were adults, viz., of the upper or professional class 4, of the trading class 4, and of the artizan and labouring classes 56 ; one 30 hundred and forty-three were children, viz., of the upper or professional class 9, of the trading class 22, and of the artizan and labouring classes, 112. Seventy-one of the children had been in attendance at schools, 40 in North Kensington and 31 in South Kensington. Of the 40 in North Kensington 25 were connected with Board schools, viz., 6 at Portobello Eoad Board school, 4 each at Buckingham Terrace and St. Clement's Road Board schools, 3 at Wornington Road Board school, 2 each at Edinburgh Road, Latymer Road (Hammersmith), Saunders Road (Hammersmith), and Middle Row (Chelsea) Board schools. The remaining 15 cases in the North District were connected with the following schools:—St. Peter's and St. Luke's (Paddington) Church schools, 2 each, and one case each at St. Clement's, St. James's and St. John's Church schools, St. Francis d'Assissi Roman Catholic schools, Westbourne Schools (Paddington), Jewish School (Paddington), and the High School for Girls, Notting Hill. The remaining 4 cases were connected with 4 private schools. Of the 31 cases in South Kensington, 8 were connected with Board schools, viz., Gloucester Grove 4 cases, Silver Street 2 cases, and one case each at Queen's Gardens and Walton Street (Chelsea). The remaining 23 cases were connected with the following schools:—13 at St. Philip's Church school (including 5 in March, 4 in April, and 2 in May), 2 each at St. George's and St. Mary Abbotts Church schools, and one case each at St. Matthias's Church school, St. Mark's College schools, St. Paul's (Hammersmith) school, and the High School for Girls, St. Alban's Road. The remaining 2 cases were connected with 2 private schools. The case-mortality of diphtheria, 61.8 per cent, in 1888 and 45'3 per cent, in 1889, fell, in 1890 (notification being in practice), to 16'8 per cent.—a reduction too great to be accounted for on the 31 assumption of diminished malignancy in the type of the disease, and more probably due to the inclusion among the hometreated cases notified, of a considerable number of cases of nonspecific throat disease. One could not but feel this to be a reasonable explanation of an otherwise puzzling fact, when, as in September, a whole month passed without a death, although twenty-two cases were notified. In my tenth monthly report (October 6th, page 102), at the conclusion of the fortieth week, I called attention to the subject, and to the diminishing death-rate from the disease. At that date twenty-Fix deaths had been registered: the recorded cases were one hundred and fifty-seven, and the percentage mortality 16.6. But in the first half period, the cases having been seventy-five only, the deaths were sixteen, or 21'S per cent., whilst in the second half period, ten only out of eighty-two cases proved fatal = 12.2 per cent. Of the eighty-two cases, fifty-two were recorded in the twelve weeks ended October 4th, and only three deaths were regis tered, or less than 6 per cent.* In the last four weeks, as. above stated, there were twenty-two cases and no deaths. "It is to be presumed, therefore," I remarked, "that the epidemic, so far at least as this Parish is concerned, is losi ng some of its virulence. That many of the cases are extremel y mild is evidenced by the fact that in some instances when infected houses have been visited immediately oil report of the iJ iness, the patients have been found up and about, and in more tham one instance not at home ! It is almost impossible, however, to resist the conclusion that innocent throat troubles have been sometimes mistaken for diphtheria," and considerable su bsequent experience, reaching down to the present writing, has but strengthened this view. Twenty out of the twentytwo cases above referred to occurred in North Kensington ; only two were remov ed to hospital, and there was no extension of the disease from the cases treated at home, notwithstanding the * In my eleventh report, dated November 3rd, I reported that forty cases had occurred in. the previous eight weeks, and only one death had been registered. This fact is the more noteworthy, seeing that the disease was very prevalent and very fatal in the Metropolis, the weekly numbers of deaths being the highest ever recorded.— Vide Registrar-General's Weekly Returns, 32 extreme contagiousness of diphtheria, and the fact that in many cases there was practically no isolation. A partial explanation of the comparatively non-fatal character of the later cases notified as diphtheria may be found in the fact that an increasing proportion of them occurred in persons above five years of age, many being adults. The danger of spread of true diphtheria was painfully illustrated in one family of four children, aged 1,2, B, and 4, years respectively, all of whom succumbed to the malady. The first case had been notified as scarlet fever, but prior to death the diagnosis was corrected. The father would not allow the body to be removed to the mortuary. Subsequently the other three children were attacked and removed to hospital, where they died. Other illustrations may be found in several of my monthly reports. The deaths from diphtheria in London numbered 1417 (about 355 above the corrected decennial average), being 200 fewer than in 1889, a year characterised by the highest death-rate on record from this disease. Fortunately, the hospitals of the Asylums Board were open for the reception of patients, otherwise the deaths would probably have been far more numerous. It was in more than one or two cases matter for regret that parents would not consent to the removal of a first case, which would have prevented the spread of disease, and fatal results that might have been avoided. WHOOPING-COUGH. The deaths from Whooping-cough in 1889 were 26 only—the lowest number on record, after correction for increase of population. The actually lowest number (22) was recorded in 1863, but the population then was less by 100,000 than in 1889. The deaths from this cause having been so few in 1889, it is not surprising that the mortality should have been in excess in 1890, when 93 deaths, or 7 above the corrected decennial average, were registered; eight of them in the Brompton sub-district. All but two were of 33 children under five years of age, including 36 under one year. Eighty deaths were registered in the first half of the year, and only 13 in the second half. Reference has already been made to the general 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 inevitable and do not think dangerous. Often enough, when the disease ends fatally, the event comes as a surprise, being due' commonly to some complication—of the respiratory organs, or of the nervous system; few deaths being registered from whooping-cough alone. These secondary diseases cannot always be prevented; but the occurrence of bronchitis or pneumonia, for instance, is often due 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 (3276) were 193 above the corrected decennial average, and nearly four times as many as those from scarlet fever. The comparatively low case-mortality of whooping-cough, and, I may add, cf measles also, serves in the public estimation to remove these maladies somewhat out of the category of "dangerous infectious diseases." It is the fact, nevertheless, that the deaths from measles and whooping-cough far exceed the deaths from small-pox, scarlet fever, diphtheria, and "fever" combined. Thus, in 1890, the deaths from measles and whooping-cough respectively were 3291 and 3276 = 6567; the deaths from small-pox (4), scarlet fever (876), diphtheria (1117), and fever" (662), being 2959 only, or less than half the number from ligbtly-regarded measles and whooping-cough. 0 34 FEVER. No death was registered from Typhus Fever or from Simple Continued Fever.* The deaths from Enteric Fever were 15, against 11, 21, and 19, respectively, in the three preceding years; being six below the corrected decennial average. Thirteen of the deaths were registered in the Town sub-district, and two in Brompton. Three took place in hospitals, to which 25 patients were removed. The recorded cases were 77 (50 in 1889): 52 in North Kensington, and 25 in South Kensington, the Uxbridge Road being the dividing line. There were 11 deaths from typhus in London, 33 from simple and ill-defined fever, the decennial averages being 43 and 87. The deaths from enteric fever were 618, or 218 below the corrected decennial average. DIARRHŒA. This disease was the cause of 78 deaths, against 90, 58, and 70, respectively, in the three preceding years; 67 in the Town sub-district, and 11 in Brompton; being 18 below the corrected decennial average. Sixty-five of the deaths were of children under five, including 53 under one year. Of the total number, 52 were registered in 12 weeks—June 15th to September 6th inclusive. The deaths from diarrhœal diseases in London generally were 2753 (652 below the corrected decennial average), of which 1952 were of infants in the first year of life, and 488 of children between one and five. The question why diarrhoea 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 formulated, which assumes the existence of a form of germ life in the earth—especially where this is sewage-tainted or otherwise polluted—which germ, developing into activity when a certain temperature is attained, and rising into the air, finds admission with food into the system, and multiplying there, generates a poison which is the immediate cause of death. * The notifications were, simple continued fever 9, enteric fever 84, typhus fever none. 35 INFLUENZA. The most noteworthy event of the year was the outbreak, in January, of Influenza, a malady grouped with miasmatic diseases in the zymotic class, and which, in its epidemic form, was unknown to all but the elders of the present generation. The epidemic, so far as Europe is concerned, made its appearance first in Russia, towards the end of 1889; and hence it was generally spoken of as the " Russian Influenza." Much suffering as the disease caused to a multitude of persons of all ages, and in all ranks of society, its occurrence would not have greatly swelled the London mortality if it had been answerable for those deaths only primarily ascribed to it; for these were but 652 out of 91,243; this total being 1547 only above the corrected annual averages of 1880-89. There can be no doubt, however, tha-t a large number of deaths from other diseases, and especially from diseases of the respiratory organs, were really due to influenza, or to the causes, be they what they may, of that Protean malady. The deaths from the diseases of these organs were 2145 in excess of the corrected annual averages of the ten years, 1880-89, and some 6000 more than in 1889. The deaths from croup and " other diseases of the respiratory system " were below the average, and those from pleurisy very little above it. But bronchitis and pneumonia were unusually fatal, the deaths (12,448 and 6224) being 1106 and 1299 respectively, above the average. The increase in deaths from pneumonia is especially noteworthy. In January, the mortality from this cause rose 97 per cent. above the average, the rise from bronchitis being only 64 per cent.—a reversal of the proportions usual when rise is due to ordinary causes, as cold, fogs, &c. The winter rise, moreover, in cold seasons, is mainly among aged persons, whereas in January it was mainly among persons between 20 and 60. Not all then of the excess-mortality from bronchitis and pneumonia is to be attributed to Influenza or its causes. The deaths were far above average during the prevalence of the epidemic, and especially in January, not- c 2 36 withstanding that the weather was mild ; the mean temperature being no less than 7. 1° Fahr. above the average for that month ; but a considerable proportion of the total excess occurred in December, when the deaths were 44 per cent. above the corrected decennial average—a result due in large measure to inclement weather, the temperature then being 9.3° below the December average; the cold, moreover, being accompanied with a succession of dense fogs. But in this month also, pneumonia increased, as compared with bronchitis, in more than the usual winter or cold-season proportion—pointing to some unhealthy influence at work. The diseases of the circulatory system shew a like fatality, the deaths (7546) having been 1294 above the corrected annual average—those occurring in January being 55 per cent. above the usual monthly average. The deaths from phthisis, moreover, shot up in the first week of January and continued in excess for ten weeks in succession. The RegistrarGeneral, to whose Annual Summary I am indebted for the above figures, closes his remarks on the epidemic by observing that " it would probably be not far from the truth if the whole increase in mortality from all causes in the aggregate during the mild month of January were attributed to influenza; in which case that disease would have to be credited with having caused 2258 deaths in London in the first four weeks of the year alone," though the deaths directly ascribed to the epidemic only numbered 303 in January. The deaths in Kensington ascribed to Influenza, alone or associated with other diseases, mostly of the respiratory organs, were 39, viz., 29 and 10 in the Town and Brompton sub-districts respectively. The deaths at ages were as follows:—under five years 4, between five and twenty-five 2, and 7, 2, 7, 8, 6 and 3 in the six decades between 25 and 85. Twenty-six of the deaths took place in the first eight weeks of the year, thirteen in each period of four weeks, and three and seven in the two following four-weekly periods. Many of the deceased persons occupied a good position in life. In January there was, in addition to the 37 deaths ascribed to Influenza, an excessive number from diseases of the respiratory organs viz., 136 in the four weeks from December 29th, 1889, to January 25th, 1890, the period covered by my first monthly report: 106 of these were due to bronchitis, alone or associated with pneumonia, and 20 to pneumonia alone. The number in the following four weeks fell to 81. No such numbers were registered again till the close of the year, when in five weeks ended January 3rd, 1891, there were 114 deaths from these diseases, including bronchitis 70, and pneumonia 23. The deaths from phthisis also were unusually numerous in the first quarter, and those from heart diseases in the first four and the last five weeks of the year; our local experience thus conforming to that of London generally as to increased mortality from particular classes of disease, and being amenable to the same explanation, viz., that Influenza was the root of the mischief in the early part of the year, whilst at its close inclemency of weather adequately accounts for the unusual number of deaths. The Medical Department of the Local Government Board, naturally anxious to "gather information respecting the origin and distribution " of Influenza, addressed to Medical Officers of Health a series of questions in January, as follows:— 1.—Has any " Influenza," particularly if characterised by much nervous depression, severe frontal headache, or various muscular pains, shown itself in your District ? 2.—The date of the first occurrence (as far as you know) of such an Influenza 1 3.—The date of commencement of any extensive prevalence of such Influenza ? 4.—Any opinion you have formed (or that you wish to modify) as to the mode of origin of introduction of the disease ; and as to its method of spread ? 5.—Have you observed among domestic animals any unusual complaint ; and in what animals, and with what symptoms ? 6.—Illustrations or observations as to the behaviour of any observed Influenza, especially as to the intervals of attack in members of households, its dissemination among particular communities, and its incidence on particular localities ? 38 At present no report has been made on the subject by the Department. I had little information to offer, for no communication was made to me, locally, with regard to the epidemic, Influenza not being (though it might be made) a notifiable disease under the provisions of the Infectious Disease (Notification) Act: I had not, moreover, any considerable opportunities for forming opinions. I think, however, that the disease is not merely infectious, but also that it is due to some specific atmospherical conditions, which alone would seem adequate to account for the sudden and practically simultaneous attack of so many persons in public institutions and trade establishments. It is hardly necessary to mention, perhaps, that at the present time (May) a recrudescence of the epidemic is producing even more wide-spread havoc than the original outbreak in January, 1890. METROPOLITAN ASYLUMS BOARD. The work of the Asylums Board, important at all times to those concerned in sanitary administration within the Metropolis, has 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 to the average needs of the population ; and during the last four 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 Authority for London in regard to infectious diseases. The work of the Board is summed up in three reports, issued annually by the Chairman (Sir E. H. Galsworthy), the Statistical Committee, and the Ambulance Committee, of which, as usual, I submit abstracts. 39 THE CHAIRMAN'S ANNUAL REPORT. This report opens with a reference to the increased prevalence of scarlet fever in the closing months of 1890, which, although not equalling in combined suddenness and severity the outbreak in the autumn of 1887, was nevertheless such as, at one time, to give the Managers concern as to whether the normal accommodation at their disposal would be adequate to the occasion. Happily the new Small-pox Hut Hospital at Darenth—previously unused—was available in aid of the London Hospitals, and by its appropriation for the reception of convalescing patients, the difficulty was fully met, at an expenditure much less than would have been incurred had it been necessary to erect temporary huts as in 1887. The emergency, however, was not so great, for the largest number of scarlet fever patients under treatment at one time was 2071, against 2611 in 1887'—that being the highest number on record. The question whether the numbers in 1887 will ever again be attained is considered. On the one hand it is assumed that the objections of parents to the removal of their children to hospital will become less year by year, and therefore a larger proportion of cases will be admitted; on the other hand it is pointed out that the prompt isolation of the sick thereby brought about, by reducing the number of centres of infection, ought at no distant date to result in a diminution of the disease, the deaths from which have steadily declined for years past, and so many as 510 out of a total of 876 having occurred in the Board's hospitals last year. " Whichever of these two influences may ultimately predominate, the fact in the meantime remains, that each succeeding autumn witnesses the necessity of permanent relief being afforded to the Eastern Hospital, as recommended by the ' Royal Commission on Infectious Hospitals,' in 1882." The hospital accommodation at the disposal of the Managers, with present distribution of beds to the various diseases, is as follows:— 40  Scarlet. Diphtheria. Typhus. Enteric Other Diseases Total. Western Hospital 210 20 ... 24 8 262 North-western Hospital 357 44 ... 32 10 443 Eastern Hospital 300 49 ... 82 11 442 South-western Hospital 330 ... ... ... 10 340 South-eastern Hospital 312 50 16 72 12 462 Totals 1509 163 16 210 51 1949 Northern Hospital for Convalescents 416 32 ... 32 ... 480 Grand Totals 1925 195 16 242 51 2429 The population of the District usually allotted to the Western Hospital (West District), at the census of 1881, was 641,379, and the ratio of beds to the population was 1 to 2448. The ratio in the other Districts was as follows:— North-west District Population, 826,703 = 1 bed to 1866 East District 1,082,474 = 1 ,, 2449 South-west District 464,133 = 1 ,, 1365 South-east District 801,015 = 1 ,, 1733 In the Metropolitan District as a whole, the population of which in 1881 was 3,815,704, the ratio of beds for acute cases is 1 to 1958 persons, the ratio for all cases (acute and convalescent) being 1 to 1571. Should the Registrar-General's estimate of population in 1891 prove correct, these ratios would be 1 bed to 2305 and 1849 persons for acute cases and total cases respectively. The estimated increase in population (677,000) would therefore amply justify the erection of the proposed additional hospital. The total expenditure on the " original" account, upon the six Fever hospitals to Lady-day, 1891, was in round numbers £537,500. The patients admitted from the several Districts in 1887 numbered 6536: in 1890 they were 8337, distributed as follows;— 41  Scarlet. Diphtheria. Typhus. Enteric Other Diseases. Total. In 1887 5900 ... 35 441 160 6536 Ill 1890 6541 941 16 497 342 8337 Kensington Cases In 1887 311 ... ... 7 9 327 In 1890 230 51 ... 17 12 310 In 1890, the patients taken to hospitals other than those allotted to the several districts, because there was no room at the nearest hospital, numbered 910: but none of them were Kensington cases. The bulk of these cases (651) belonged to the Eastern District, for the service of which the proposed new fever hospital is intended. The percentage mortality of the several diseases in 1890 was, scarlet fever 7.86, diphtheria 33.17, enteric fever 20.10, and typhus fever 25.64. Small-pox.—Only 26 cases of Small-pox were received on board the Hospital Ships at Long Reach, of whom 3 died. One other case was admitted at the South-eastern Hospital and died the next day.* The Gore Farm Brick-hut Hospital at Darenth, for convalescing small-pox patients, was completed in May, at a total cost of a little under £60,000, or nearly £4000 below the original estimate. This Hospital, with the connected " Infirmary," provides accommodation for 800 patients, the Ships for 350 = 1150 beds. The total expenditure on the " original" account to Lady-day, 1891, for these establishments was £158,000. Expenditube.—The expenditure in 1890 exceeded that of the previous year by £29,300, the increase being due to the greater number of fever patients for whom the Managers were called upon to provide. The total expenditure was £387,121 12s. 9d., including £128,762 9s. 11d. on the six fever hospitals, the hospital ships, the Darenth Camps, and the Gore Farm Hospital; viz., maintenance account, £22,189 14s. 2d., and common charges account, £106,572 15s. 9d. The liabilities of the Board on loans on the 28th March last, amounted to £1,013,701 1s. 4d., a decrease of £37,958 17s. 4d., as compared with the amount at Lady-day, 1890. * These were the only deaths from Smail-pox in London during the year. 42 REPORT OF THE STATISTICAL COMMITTEE. The Report of the Statistical Committee opens with a reference to the Notification of Infectious Disease and a return of cases notified, as given on page 43. The Committee state that cases are sometimes certified by more than one medical practitioner, but that in the return only one certificate is included for each case. The return of notifications in my thirteenth four-weekly report for 1890 comprised 30,083 cases, or 288 more than the official return : 281 of these cases in excess represent duplicate certificates, and 7 were cases of " relapsing fever," of which I had taken no note in my monthly summaries. Many cases of infectious disease treated in general hospitals were not notified, the Local Government Board holding that the Act exempts the Medical Officers of these institutions from the duty of notifying. Provision is made in the Public Health (London) Bill now passing through Parliament for abolishing this exemption. In the united parishes of St. Margaret and St. John, Westminster, not all of the cases notified were reported to the Board, and in St. Mary, Newington, only those cases were notified which were removed to the Managers' hospitals. One way and another, therefore, many cases escaped notification. After the present year the returns will be practically complete. Prefixed to the Report there are maps spotted to show the cases of disease notified in 1890. The scarlet fever cases were so numerous that it was found impossible to include them in one map. Four quarterly maps therefore are given, and they are " highly instructive, as showing the gradual progress and extension of the disease from isolated cases occurring in the earlier months of the year; " when usually this disease is at lowest ebb, the admissions to hospitals in 19 years having fallen to the minimum five times in February, four times in March, five times in April, three times in June, once in September, and once in December (1888). 43 Return of Cases of Infectious Disease notified during the 53 weeks ended the 3rd january, 1891 under the provisions of the "INfectious Disease (Notification) Act, 1889." Local Authorities in whose Districts the cases were resident. Small-pox. Scarlet Fever. Typhus Fever. Relapsing Fever. Diphtheria. Membranous Croup. Continued Fever. Typhoid or Enteric Fever. Cholera. Erysipelas. Puerperal Fever. Totals. Kensington 2 388 ... ... 222 9 9 84 ... 126 10 850 Battersea 1 522 1 1 314 33 6 129 ... 249 18 1274 Bermondsey ... 594 3 ... 64 22 4 58 1 153 6 905 Bethnal Green 1 485 ... ... 397 36 7 130 ... 186 7 1249 Camber well ... 918 1 1 261 24 4 150 ... 257 13 1629 Chelsea ... 274 1 ... 289 16 2 61 ... 161 2 806 Clerkenwell 2 354 1 1 79 5 4 37 ... 81 2 566 Fulham 1 296 2 ... 72 23 3 73 ... 117 6 593 Greenwich 3 805 4 2 176 17 1 99 2 269 8 1386 Hackney 1 1219 2 ... 441 46 13 204 ... 204 15 2145 Hammersmith ... 348 3 ... 220 3 *47 67 1 79 3 771 Hampstead 1 186 ... ... 94 2 1 72 1 29 1 387 Holborn 1 184 ... ... 37 6 1 22 ... 22 ... 273 Islington 1 1242 ... ... 410 32 7 203 1 300 24 2220 Lambeth 17 1098 1 ... 326 47 41 154 7 250 13 1954 Lewisham (excluding Penge) 1 222 ... ... 41 3 1 25 ... 30 3 326 Limehouse ... 222 1 ... 123 9 5 72 ... 59 ... 491 Marylebone ... 247 ... ... 96 10 12 66 ... 164 4 601 Mile End Old Town ... 392 2 ... 139 11 2 124 ... 102 2 774 Paddington ... 214 ... ... 225 1 1 58 ... 90 5 594 Plumstead 5 284 ... ... 67 10 3 28 ... 58 7 462 Poplar 2 808 1 2 406 85 36 233 4 330 4 1911 Rotherhithe 4 407 1 ... 80 7 1 40 ... 91 5 436 Shoreditch ... 732 3 ... 206 19 2 145 1 125 6 1239 St. George-in-the-East 2 176 ... ... 98 3 1 33 ... 59 2 374 St. George, Hanover Sq. ... 142 ... ... 73 2 5 40 1 37 ... 300 St. George, Southwark 2 250 1 ... 28 10 ... 28 1 54 4 378 St. Giles ... 137 1 ... 47 5 ... 32 1 65 1 289 St. James, Westminster ... 51 ... ... 13 2 1 8 ... 8 ... 83 St. Luke, Middlesex ... 289 ... ... 34 4 2 27 ... 65 1 422 St. Margaret and St. John, Westminster 1 130 ... ... 42 1 ... 14 ... 67 ... 255 St. Martin-in-the-Fields ... 21 ... ... 6 ... ... 7 ... 6 ... 40 St. Mary, Newington ... 157 1 ... 9 ... ... 20 ... 1 ... 188 St. Olave, Southwark ... 78 2 ... 8 ... ... 12 ... 11 ... 111 St. Pancras 5 650 1 ... 400 22 5 133 2 410 12 1640 St. Saviour, Southwark ... 135 ... ... 33 5 1 11 1 22 ... 208 Strand ... 58 ... ... 8 3 3 10 ... 10 ... 92 Wandsworth 1 322 ... ... 111 5 6 78 ... 145 8 676 Whitechapel 3 258 2 ... 120 11 ... 58 ... 53 5 510 Woolwich ... 103 ... ... 11 1 ... 17 ... 23 6 161 City of London ... 128 ... ... 39 ... ... 12 ... 27 3 209 Port of London 1 4 ... ... 5 ... ... 3 1 3 ... 17 Grand Totals 60 15,330 35 7 5870 550 237 2877 25 4598 206 29,795 * The evidence of disease in some of these 47 oases was considered highly unsatisfactory by the Sanitary Authority. 44 Fever Statistics.—At the beginning of the year there were 1789 fever and diphtheria patients in the six hospitals : the number decreased until at the end of May, it had fallen to the minimum for the year, 1160. In June the numbers began to increase, and they continued to increase until the maximum was attained in November, when, on the 13th, there were 2435 cases distributed amongst the various hospitals as follows:— HOSPITAL. Beds occupied. Scarlet. Diphtheria. Typhus. Enteric. Other Diseases. Total. Eastern Hospital 278 47 ... 75 6 406 North-western Hospital 333 40 ... 20 2 395 Western „ 17.8 19 ... 18 3 218 South-western „ 273 ... ... ... ... 273 South-eastern „ 276 29 1 57 2 365 Northern „ 463 25 ... 23 ... 511 Gore Farm 267 ... ... ... ... 267 Totals 2068 160 1 193 13 2435 The total number of patients under treatment during the year was 10,123. The total admissions were 8334, as compared with 5772 in 1889, 5152 in 1888, and 6537 in 1887— the increase being due, not to excessive prevalence of disease, but to the greater favour in which the hospitals are held, and the greater success of efforts by Sanitary Authorities to secure isolation. The total discharges were 7184 ; the deaths 1005 : the mortality was 12T6 per cent., including cases dying within forty-eight hours after admission, and those dying from concurrent maladies. The monthly admissions of all cases were lowest in February and highest in October. A diagram is given, shewing by curves the monthly admissions of each kind of fever between the years 1872 and 1890. In these 19 years scarlet fever admissions reached the maximum once in January (1888) ; once in July; three times in September; nine times in October ; three times in November; 45 and twice in December. Enteric fever admissions rose to the maximum once in September; eleven times in October; six times in November; and once in December. Diphtheria admissions attained the maximum in November of 1889, and in September of 1890—cases of this disease having been admitted for the first time in October, 1888. Scarlet fever is most fatal to children under five years of age—amongst whom over 50 per cent. of the total deaths have occurred during the period 1872-1890, while of the patients over 15 only 4.76 per cent. died. A greater immunity from attack is enjoyed by the male sex after five years of age (there is equality in sex-liability prior to that age), but the difference in the rate of mortality is 1.52 per cent. in favour of the female sex. Diphtheria is also most fatal in its effects on children under five years of age, amongst whom upwards of 60 per cent. of the total deaths occurred. Enteric fever admissions were 208 in excess of those for 1889 : the type of disease being severer, the mortality was 4.51 per cent. greater than in 1889. With regard to each of the diseases above mentioned, particulars are given shewing, in percentages, the complications that supervened in their course. The tables shewing age and sex of patients admitted with the several diseases, and proportionate mortality, are very interesting: the cases, moreover, being so numerous, the conclusions deducible, in percentages of sex-liability and sex-mortality at different ages, are increasingly valuable. The percentage of cases of mistaken diagnosis was, as regards scarlet fever, 13, diphtheria 7.2, and enteric fever 26 per cent. Of 85 cases wrongly certified as scarlet fever, 32 were measles and 15 were tonsillitis. Of 74 cases certified as diphtheria, 47 were tonsillitis. Of 165 cases certified as enteric fever, 72 had pneumonia, 19 febricula, 6 pleurisy, and 4 influenza. 46 The Committee regret that so few medical students have hitherto availed themselves of the facilities afforded to them for studying, in the Managers' Hospitals, infectious diseases that they cannot hope to see in General Hospitals. The importance of the subject, both to themselves and to the public, is great. " The increasing percentage of errors in diagnosis during the past four years (from 2.4 per cent. to 4.9 per cent.) makes it desirable, in the interest of public health, that steps should be taken to include a practical knowledge of the diseases treated in the Managers' Hospitals in the curriculum of education for medical students." Of 26 cases of small-pox treated at the Hospital Ships at Long Reach, 24 were admitted in the first half of the year, and they came from nine different parishes or unions. Fortunately, isolation and disinfection were effectual to prevent the spread of the disease. Of 1420 persons employed in the hospitals 63, or 4.4 per cent., fell ill with fever, diphtheria or measles, and seven died. The total cases of scarlet fever treated in the hospitals since 1871 were 39,021; of typhus fever 2268 cases; of enteric fever 7312 cases; of diphtheria (since October, 1888) 1763 cases; of "other diseases" (including 218 cases of relapsing fever) 4840 cases; total cases 55,204. The mortality of the cases was: relapsing fever 12.84; diphtheria 37.52; typhus fever 20.90, and enteric fever 18.26 per cent. At the small-pox hospitals 58,007 cases have been admitted, viz. : 56,974 of small-pox and 1033 of " other diseasesThe deaths were 9858 (including 47 from " other diseases ") or 17.30 per cent. Comparing the mortality per 1000 of estimated population of London, from scarlet fever during the 13 years preceding the establishment of the Managers' Hospitals, with the mortality during the past 13 years, the latter shows an average decrease of 1.30 per cent. There has also been a decreasing percentage of mortality from this disease amongst patients in the hospitals, "probably due, 47 in a great measure, to an increased proportion of a better class of the population dealt with." Until July of 1887 the great mass of the patients received into the Managers' Hospitals were the very poor ; but since that date patients of a higher social condition have largely availed themselves of the hospitals, due to the fact that patients have been admitted upon the application of medical practitioners without the intervention of Relieving Officers. The annual mortality-rates from small-pox in London, during the past five years, have been far lower than at any period dealt with in the Registrar-General's returns—a fact explicable only, I believe, by the practice of removing patients out of London to the Hospital Ships, thus effecting perfect isolation and removing centres of infection from among the population. 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 a former report, I had to observe 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 48 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, recognise the desirableness 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." Having communicated their altered views to the Local Government Board, the President of that Board obtained from Parliament the desired powers, with others of not less importance from the Public Health point of view, in the Poor Law Act, 1889, the sanitary provisions of which I summarised (at page 64) in my last Annual Report. Land Service : Ambulance Stations.—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 the purpose—embarking at Wharves which the Managers were authorised to provide by Section 6 of the Diseases Prevention (Metropolis) Act, 1883. Kensington patients are removed by 49 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.,* 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. Wharves.—The Managers have acquired or constructed three Wharves for the embarkation of patients, &c., 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 small-pox patients were formerly sent for embarkation, the number of miles travelled by the ambulances was excessive. River Service.—The Managers possess, in their three Ambulance steamers, Red Cross, Maltese Cross, and Albert Victor, together with the steam pinnace Swalloiv, a fleet equal to all probable demands. Having said so much by way of general introduction, I proceed to deal with the ANNUAL 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, * Telegraphic Address, " Asylums Board, London Telephone Number, 2587. 50 interesting as it is, has nothing eventful to chronicle as in 1889— a year which, as the Committee stated in their report, was "rendered memorable in the annals of Isolation of Infectious Disorders by the passing of the Poor Law Act, 1889, by one section of which the Managers' Hospitals were 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 was extended and completed." The Committee gave in that report, 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 the Authority for providing hospital accommodation for paupers suffering from infectious disease, had 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 previous reports. It was interesting to note, in that 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, however, had the 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 scarlet fever, smallpox, diphtheria, or "fever" may be admitted to the Managers' Hospitals upon the application of any duly qualified 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. 51 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 Yestry are entitled to no mean share of the credit due to those by whose instrumeptality the beneficient scheme has been brought to perfection. The Ambulance Committee commence their report with a congratulatory reference to the freedom from accident to any patient, notwithstanding the severe frosts and dense fogs experienced during the last six weeks of the year. Land Service.—The total number of fever patients removed was 8235, a considerably larger number than in any previous year, and within 268 of the combined numbers of fever and small-pox patients removed in 1884, when the latter disease was epidemic in the Metropolis—the high figure being due not to any exceptional prevalence of disease, but rather to the increased favour in which the Managers' hospitals are held, and to the assistance given by the local sanitary authorities in connection with the working of the Notification Act. The average daily removals in the first six months were 15.97, and in the latter six months 29'66, as compared with 8.48 and 23'01 respectively in 1889, and 15*4 and 12"8 respectively in 1888. The number of journeys made was 8524 : the average length of journey did not exceed the average— 3½ miles, although many patients from districts usually allocated to the Western and Eastern Hospitals, were removed to the North-western Hospital. Forty-eight persons, certified to be suffering from small-pox, were removed from their homes, but in 26 cases only was the diagnosis confirmed. Under the provisions of section 6 of the Poor Law Act, 1889, 125 persons suffering from dangerous infectious disorders (including scarlet fever 36, enteric fever 19, diphtheria 13, and small-pox 2) were conveyed in the ambulances to other places than the hospitals of the Managers, who received £40 1s. 6d. for this service, including 52 £2 17s. 6d. in respect of the services of nurses; the charge for an ambulance being five shillings, and for the attendance of a nurse half-a-crown. The need for increased accommodation at the Western Ambulance Station, demonstrated by the strain upon the land service in 1887, and confirmed by the experience of each succeeding year, has now been recognised, and the question of the practicability of enlarging the station upon the present site was referred to the architects, with the result that they have recently reported that the necessary extension can be made. The question of the desirability of erecting an Ambulance Station at the Northwestern Hospital (at Hampstead) is under the consideration of the Committee. River Service.—Notwithstanding the dense fogs and the blocking of the river with ice at the end of the year, all requisite service was conducted with punctuality and safety. The three ambulance steamers ran collectively 4000 miles, and conveyed 428 patients and other passengers, besides stores, &c., to and from the Hospital Ships at Long Reach. Fever Patients.—At the commencement of the year there were 1820 patients in the Managers' six hospitals, viz., scarlet fever, 1568; diphtheria, 115; typhus, 9; enteric fever, 119: other diseases, 9. By the end of March the number had fallen to 1220, subsequently falling gradually to the lowest number for the year 1160, at the end of May. At the middle of June the numbers began to ascend, and by 12th July had risen to 1451—on which day the Managers authorised the General Purposes Committee, if and when they considered such a step necessary, to instruct the Small-pox Hospitals Committee to fit up, furnish, and open the Brick-hut Hospital at Gore Farm, Darenth, for the reception of convalescent scarlet fever patients. By the 30th September, the number of patients in the hospitals having risen to 1985, the General Purposes Committee gave instructions for the hospital to be opened on such date as the Small-pox Hospitals Committee 53 and the Ambulance Committee might jointly arrange. On the 14th of October the hospital was opened, and by the 21st it contained 141 patients. Without the assistance of this hospital the requirements of the Metropolis in respect of fever accommodation could not have been met, for on the 13th November, no less than 2435 beds were occupied by fever and diphtheria patents, that being the maximum number under treatment at any one time during the year. The distance of the hospital from the Western Hospital is 'z,8 miles. Its distance from all the hospitals, other than the South-Eastern, diminishes ifs value as a relief hospital for fever convalescents, and, of course, during the prevalence of small-pox it could not be made available for fever convalescents at all. The Ambulance Committee therefore express a hope that the question of a fever convalescent hospital in a situation convenient for the requirements of South London, as suggested by the Royal Commissioners in 1882, may receive the attention of the Board at an early date. Diphtheria Patients.—The total number of patients removed to the hospitals was 1049, and of that number 37 per cent, were removed during the first half, and 63 per cent. during the second half of the year. Since June cases of membranous croup, when stated to be diphtheritic in nature, have been admitted into the Managers' hospitals. Cost of the Ambulance Services.—The payments made during the year for the land service were £8095 4s. 5d., including £1018 5s. 1d. on the completion of the reconstruction and enlargement of the South-eastern station. The river service cost £3824 3s. 7d., including £308 13s. 8d. for repairs to the steamers. The total cost therefore was £11,919 8s. The cost of the land service was only 18 per cent. in excess of the amount in 1889, but the work performed, if measured by mileage, was 75 per cent. in excess of that of 1889—a fact which, while it reflects credit on the economical management of the Stations by their respective superintendents, also shows how large a portion of the cost of the service consists in the standing expenses of 54 each Station, as distinct from the additional horses and drivers required in proportion to the work to be performed. It should be mentioned that, in addition to the patients conveyed to the hospitals, much work was effected by the service in conveying convalescents to the Northern and other hospitals, and recovered cases from the Northern hospital to town hospitals for discharge, and from hospitals to homes. The vehicles in all traversed 83,061 miles. SMALL-POX HOSPITAL ACCOMMODATION. The Royal Commission (1882), in one of their " practical recommendations," proposed that provision should be made of sites and buildings which could without difficulty be made capa. ble of receiving 2100, or by special exertion, 2700 small-pox patients. The actual accommodation falls 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, viz., 600 for convalescing patients at the Gore Farm Hospital, and 200 for acute cases in the associated Infirmary, the administrative block being capable of service for 1000 patients. The Darenth estate is always available upon emergency for 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 small-pox patient out of London, whose removal can be effected with safety—and, happily, this is generally the case—hospital accommodation in the future will not be required to the amount provided during former epidemics. The Hospital Ships are maintained in constant readiness for use. A proposal to close them was sometime since pressed upon the Asylums Board, on the ground that money would be saved if sporadic cases of small-pox between epidemic periods, were treated in London instead of being taken down the river. The money saving would not be considerable in any event, as it 55 would be necessary to make provision at two or three of the London hospitals for the reception of such occasional cases, thereby diminishing the accommodation available for fever, diphtheria, &c. 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—to say nothing of the money value of precious lives sacrificed to the loathsome disease. Since it has been the practice to take the sick out of London altogether, as recommended by me in 1881—small-pox, which was almost continuously prevalent previously, 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 down the River, 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 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. Such an additional hospital could be utilized for Fever and Diphtheria Convalescents, when not required for Small-pox. FEVER HOSPITAL ACCOMMODATION. The Royal Commission (1882) recommended provision of sites and buildings capable of accommodating 3000 fever patients. " Of 56 the 3000 cases, those in the earlier stages, probably about half, should be provided tor in the near neighbourhood of London; the other half—the convalescents—in two or three 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, it was 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 Committee, the Managers intended to provide another hospital for East London; but the fever cases under treatment at any one time between 1882 and May, 1887, never having approached 1000, the intention was abandoned, and a site having been obtained at Winchmore Hill, nine miles northeast of Charing Cross, the Northern Hospital with present accommodation for 480 convalescent patients was erected. 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, and having exhausted the accommodation at the Town hospitals, compelled them to hire the Plaistow Hospital at West Ham, and to open the 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 any one 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 57 the Table at page 26. It is probable, moreover, 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 now escape notification, and the more cases notified the greater the number of sick persons requiring isolation in hospital. It is well, therefore, that the Managers are now convinced that a new fever hospital for about 400 patients is indispensable for the relief of the Eastern Hospital, and since the close of the official year they have sealed a provisional contract (subject to the approval of the Local Government Board) for the purchase, at £12,000, of 15 acres of land at Stamford Hill, in the north of London, whereon to erect the proposed new fever hospital. The site is stated to be " in all respects suitable for the erection of a hospital, being, as it is, ample in area, of a convenient shape, and readily accessible by main thoroughfares from those districts of the Metropolis which the proposed hospital is intended to serve." It measures 850 by 800 feet, and is about a quarter of a mile from St. Anne's Station on the Tottenham and Hampstead Junction Railway, Midland Company. So far, so good. But in my view the Metropolis will not be fully equipped for meeting all emergencies without the provision of another hospital for convalescent fever and diphtheria cases south of the river. NORTHERN CONVALESCENT HOSPITAL. It has already been shewn (page 52) what good use the Managers of the Asylums Board made of the Gore Farm Hospital at the crisis of the scarlet fever epidemic in the autumn. The accommodation at the Northern Hospital for Convalescents had proved insufficient, and it was well that, owing to the freedom of the Metropolis from small-pox, it was possible to utilize the Darenth Hospital. The Northern Hospital has not yet attained its full dimensions; but the Managers have resolved, with the approval of the Local Government Board, to make provision for future enlargement, by providing additional accommodation for 58 the staff by the extension of the Administrative Buildings. The plans make provision not only for the present requirements, but also for any extra staff which may be required for four additional Pavilions, for the accommodation of patients, and which could be erected on the Hospital site without overcrowding. The plans provide for (a) Extra sleeping accomodation and bath rooms; (b) Additional mess room accommodation ; (c) Sitting rooms ; and (d) A general recreation room—at a cost approximately estimated at the sum of £8000. EASTERN HOSPITAL. Additional accommodation for the staff, and other structural alterations with a view to centralising and economising the administration, are about to be provided, at an estimated cost of about £5500. 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 this Hospital—a course which involves 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 59 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. It is needless to say that the proposal to enlarge the hospital met with opposition from local authorities and owners and occupiers of property in the neighbourhood. Nevertheless, the Local Government Board, having given due consideration to the representations made to them, informed the Managers that they would not be justified in the public interest, in withholding their general assent to the plans which had been submitted for the extension and improvement of the staff and other accommodation. They pointed out at the same time that in any future extensions at the hospital, it would be necessary that the rule providing a clear space of forty feet between the boundary of the premises and the nearest portion of a building occupied by infected persons or things, should be strictly observed. They further observed that it would also appear desirable that each hospital district of the Metropolis should, as far as possible, bear the burden of providing for its own cases, and that, with this view, hospitals should not be closed even when the number of patients is not sufficient to occupy more than a small number of wards. This course, they added, would seem calculated to meet objections that had been raised by residents in the neighbourhood of these hospitals, when patients had been conveyed there from distant parishes. It had, moreover, been rendered still more desirable by the inclusion of diphtheria among the diseases to be treated in the hospitals, since long journeys of patients suffering from this disease were attended with peculiar danger. The Committee tor the Hospital, it may be added, expressed their concurrence with the views of the Board. The first intention of the Managers was to obtain the additional land required, to the north of the existing site, by acquiring a portion of the Lillie Bridge Grounds, but they 60 had no compulsory powers of purchase: and the land has since been secured by the London and North-western Railway Company. By the Poor Law Act, 1889, however, the Managers 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. Armed with this power they approached the proprietors of land situated on and adjoining the south-east side of the hospital, with whom they have arranged for the purchase of the freehold of, and the leaseholders' interest in, a plot rather over three acres in extent, for the sum of £8150; and they have arranged to take a lease, at £10 per annum for 999 years, of the surface over the tunnel of the Metropolitan District Railway Company of a further piece of land about a quarter of an acre in extent. The plans sanctioned by the Local Government Board provide mainly for the extension and improvement of the staff and other accommodation, which would be necessitated by an increase in the number of patients, at an estimated cost rather exceeding £5000. It is to be presumed that as soon as the land above referred to shall have been obtained (the sanction of the Local Government Board being required), the Managers will take into consideration the question of providing additional accommodation for patients. 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). 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. 61 ANNUAL REPORT OF THE MEDICAL SUPERINTENDENT. The Annual Report of the Statistical Committee of the Asylums Board, has attached to it an interesting summary of the work of the Western Hospital, prepared by Mr. Bruce, the Medical Superintendent, from which we learn that the total number of cases treated during the year was 1437; viz., 1242 cases admitted, and 195 already in the hospital at the beginning of the year. Of this number 1104 were discharged and 140 died, leaving 193 under treatment at the end of the year "Of the cases admitted, 998 were scarlet fever, 130 diphtheria, 65 enteric fever, and 49 'other diseases.' The admissions show an increase of 145 when compared with those in 1889, and of 371 compared with those in 1888. Of the discharges, 404 were sent to their homes, and 700, or nearly two-thirds, to other hospitals of the Board. The death-rate from scarlet fever was 7.96 per cent., from diphtheria 21.87 per cent., from enteric fever 17.60 per cent., and from 'other diseases' 28.86 per cent. The combined percentage mortality in respect of all cases was 11.26." Of scarlet fever cases 12 per cent, more females were admitted than males; but the death-rate was higher amongst males: 31 per cent, of the patients were under five years of age, and 41 per cent, were between the ages of five and ten; whilst 79 per cent, of the deaths occurred at ages under five years. Of 28S admissions at ages above ten only one died. Of the complications incidental to scarlet fever, albuminuria persisting for more than a week was noted in 28.11 per cent. of the completed cases. Next in order of frequency, were inflammation of the glands of the neck, and discharges from the nose and ears. Acute nephritis was observed in 3.26 per cent, and rheumatism in 2.97 per cent, of the completed cases. Diphtheria was contracted in 33 cases, at periods varying from one to eleven weeks after admission." Cases of this disease occurred in every scarlet fever ward save one: 25 of these cases 62 proved fatal=75.7 per cent. The cases admitted with diphtheria were throughout the year of a very mild type, to which fact the low mortality may be attributed. Paralytic sequelae were observed in 24 per cent. of the completed cases, and relapse of the disease occurred in three cases, in all of which the initial attack was well marked. Twenty-four cases admitted with scarlet fever afterwards developed measles. The disease took the form of small local epidemics, initiated by cases which had come in whilst incubating. There were eight deaths from this disease, of which seven were due to laryngeal diphtheria. The question of providing efficient warming power in the wards is under consideration. A portion of a building formerly used as an isolation ward has recently been adapted so as to provide accommodation for medical students. The number of Kensington patients admitted was 307; viz., scarlet fever, 229; diphtheria, 49; enteric fever, 17; "other diseases," 12. Three patients were admitted to other hospitals. The total deaths were 33=10.64 per cent. on all cases admitted. The total admissions from the other parishes and unions in the West District allocated to the hospital, were—Fulham Union, 347; Paddington, 23 (in addition to 176 removed to other hospitals); Chelsea, 127; St. George's Union, 202; and Westminster, 53. A few patients from each of the parishes and unions were admitted into other hospitals. In addition, moreover, to the 1059 patients admitted from the parishes and unions in the West District, 182 were admitted from parishes and unions in the other districts named North, Central, East and South. Per contra 235 patients from the parishes and unions in the West District (including the 176 from Paddington) were admitted into other hospitals, viz., 223 at the North-Western Hospital at Hampstead; 5 at the South-Eastern Hospital at Deptford; 5 at the South-Western at Stockwell, and 2 at the Eastern Hospital at Homerton. 63 WESTERN AMBULANCE STATION, FULHAM. This Station having proved inadequate for the needs of the District, the Managers empowered the Ambulance Committee to consult the Architects as to the practicability of enlarging it on the present site adjoining the Western Fever Hospital. A proposal that the question of such enlargement be referred back, for the Committee to consider the advisability of building an Ambulance Station at the North-western Hospital (Hampstead), was negatived. There is no necessary connection between the two proposals: the hospital districts are separate, and provision of an Ambulance Station at Hampstead would not relieve the strain upon the resources of the Fulham Station, which the Ambulance Committee referred to in their annual report for 1887. Their opinion then formed, as to the need for increased accommodation for staff, horses, &c., has been confirmed by the experience of each succeeding year. The proposed addition to existing accommodation would place it on a level with the other two Stations. The present accommodation is, for male staff, 15; female staff (including nurses), 11; horses, 15; and vehicles 13. The plans which the Managers have now adopted and forwarded to the Local Government Board for their approval, make provision for the construction of additional cubicles for five men and eight small-pox nurses, and other staff accommodation; coachhouse capable of conversion into stabling; extension of washing-shed and of storage for provisions, &c.; removal of laundry and its re-construction on a larger scale on another site; re-construction and enlargement of the Superintendent's house and offices, and other minor improvements, at a total estimated cost of £3000. The Committee are empowered, as soon as the plans have been approved, to advertise for tenders for the execution of the work. It may be added that, in view of the opinion of the Committee that it is desirable to provide increased accommodation on the north side of the Thames for the Ambulance service, the 64 Managers, at a meeting in November, instructed the General Purposes Committee to consider and report as to the desirability of erecting a Station at the North-western 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 per cent. 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, 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, should circumstances admit 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 nonpaupers. The President gave effect to his intention by the insertion of a clause in the Poor Law Act, 1889, which provides in a practical if not altogether satisfactory manner, for the settlement of the question, thus giving effect to the proposal made 65 by myself and approved by your Vestry, 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 decided to allow their hospitals to be so used, as contemplated by the above-named Act; and regulations for giving effect to the plan have been submitted to and approved by the Local Government Board. 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 disease, which are now almost entirely excluded from those institutions. The minimum period of study for students (who will be nonresident) is two months, with a minimum attendance of not less than two days in each week. Eacn student who satisfactorily completes the course of study, receives a certificate to that effect from the Board, 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 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, on the smallest scale. Last year only twenty-six patients were admitted. Reference to the work of the Asylums Board in 1890 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:— D 99 Table shewing Quarterly and Total Admissions of Small-Pox and Fever Patients at the Asylums Board Hospitals in 1890, 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. 4th 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 ... ... ... ... ... 35 43 55 101 234 5 5 6 3 19 21 16 11 11 59 312 163,251 Fulham ... ... ... ... ... 90 58 62 55 265 7 7 5 19 38 4 12 9 18 43 346 114,839 Paddington ... ... ... ... ... 17 16 30 35 98 2 2 4 2 10 7 8 23 32 70 178 107,218 Chelsea ... ... ... ... ... 18 35 35 28 116 1 2 5 3 11 3 11 10 10 34 161 88,128 St. George, Hanover Sq ... 1 ... ... 1 33 53 53 44 183 2 ... ... 2 4 1 3 3 7 14 202 49,748 North District. Westminster ... ... ... ... ... 5 15 20 28 68 1 ... ... 2 3 ... ... ... ... ... 71 1270 46,549 669,633 St. Mlarylebone ... ... ... ... ... 21 24 51 57 153 5 ... 11 4 20 6 9 6 10 31 204 154,910 St. Pancras ... ... ... ... 4 34 67 135 139 375 1 4 9 2 16 18 15 39 20 92 487 236,251 Hampstead ... ... ... ... ... 6 9 17 22 54 2 ... 3 5 10 2 11 6 8 27 91 45,452 Islington ... ... ... ... ... 52 57 119 125 353 6 3 11 13 33 8 6 14 9 37 423 282,865 Hackney ... ... ... ...... ... 71 98 110 169 448 2 4 21 24 51 5 12 22 14 53 552 1757 186,462 905,947 Central District. St. Giles and St. George ... 1 ... ... 1 8 10 23 25 66 1 1 1 1 4 3 5 3 1 12 83 45,382 Strand ... 1 ... ... 1 3 2 3 8 16 ... ... 2 ... 2 ... 2 1 3 22 33,582 Holborn ... ... ... ... ... 91 134 272 192 689 8 2 11 11 32 6 3 7 12 28 749 151,835 London, City of ... ... ... ... ... 6 20 33 29 88 1 1 ... ... 2 4 ... 3 3 10 100 954 57,439 288,238 67 East District. Shoreditch ... ... ... ... ... 33 53 89 98 273 2 4 20 13 39 7 2 6 7 22 334 126,591 Bethnal Green ... ... ... ... ... 15 19 56 55 145 2 2 5 9 18 15 9 25 34 83 246 126,961 Whitechapel ... ... ... ... ... 9 23 50 48 130 ... 2 7 13 22 3 12 23 32 70 222 71,363 St. George-in-the-East ... ... ... ... ... 10 17 51 26 104 3 1 3 ... 7 12 10 12 19 53 164 47,157 Stepney ... ... ... ... ... 5 18 33 18 74 3 3 10 5 21 10 13 15 11 49 144 58,243 Mile End Old Town ... ... ... ... ... 6 16 22 23 67 ... 1 10 7 18 5 5 12 2 24 109 105,613 Poplar ... ... ... ... ... 11 16 50 51 128 4 4 15 33 56 8 7 7 5.5 27 211 1430 156,510 692.438 South District. St. Saviour ... 2 ... ... 2 77 81 159 135 452 6 2 9 16 33 7 2 11 12 32 519 195,164 St. Olave 3 ... ... ... 3 26 53 117 118 314 8 2 4 11 25 5 4 8 10 27 369 134,632 Lambeth 4 4 ... ... 8 106 159 150 185 600 4 6 5 11 26 3 20 7 17 47 681 253,699 Wandsworth and Clapham ... ... ... ... ... 55 65 114 106 340 9 15 13 17 54 5 8 11 29 53 447 210,434 Camberwell ... ... ... ... ... 77 84 103 113 377 7 4 8 20 39 8 6 4 10 28 444 186,593 Greenwich 1 ... ... ... 2 21 40 57 66 184 2 2 8 10 22 1 1 6 3 11 219 131,233 Woolwich ... ... ... ... ... 23 33 28 19 103 1 1 2 4 8 ... 1 ... 2 3 114 80,845 Lewisham ... 3 ... ... 3 12 8 22 23 65 ... ... ... 3 3 2 ... 3 1 6 77 2870 73,337 1,265,937 Port of London ... ... 1 1 2 ... ... 2 ... 2 ... ... 1 ... 1 ... ... ... ... ... 5 5 12 12 2 1 27 976 1326 2121 2141 6564 95 80 209 263 647 179 213 307 349 1048 8286 8286 In addition to the cases in the Table, 15 cases of typhus were admitted, 10 from St. Olave, Southwark ; 2 each from Hackney and Greenwich; and one from St. Saviour, Southwark; 59 cases of "other diseases" were admitted through error in diagnosis. At the close of the year there were remaining 1936 cases, viz.: scarlet fever 1613, diphtheria 158, enteric fever 157, typhus 1, and "other diseases" 7. d2 68 PUBLIC HEALTH LEGISLATION, 1890. The principal Acts passed in the Session of 1890 of interest to those engaged in sanitary administration, were the Housing of the Working Classes Act, to be referred to in another place, and THE INFECTIOUS DISEASE (PREVENTION) ACT. This measure, which came into force on the 4th December, was modified in its course through Parliament by the omission of clauses dealing with dairies and laundries, the proprietors of which, by the terms of the Bill as introduced, might, in certain circumstances, have been called upon to furnish to the Local Authority a list of their customers, a provision practically unnecessary, having regard to the fact that we now possess, in the Infectious Disease (Notification) Act, 1889, a means for obtaining all requisite information as to the existence and spread of infectious diseases. The Act confers upon the Local Authorities and their officers important powers and duties as regards— (a) The inspection of dairies, and the prohibition of the supply of milk therefrom in cases where it appears that infectious disease is attributable to, or likely to be caused by, consumption of milk so supplied; (b) The cleansing and disinfection of premises, bedding, clothing, etc., for the purpose of preventing or checking infectious diseases; (c) The retention, removal, and burial of the bodies of persons who have died from infectious disease; (d) The detention in hospital of persons suffering from infectious diseases, who would, on leaving the hospital, be without proper lodging; and 69 (e) The provision of temporary shelter and attendance for members of families who have been compelled to leave their dwellings for the purpose of the dwellings being disinfected by the Local Authority. Section 4 enables a Medical Officer of Health, under specified conditions, to inspect a dairy, within or without the district of his Local Authority, if he has evidence that infectious disease in the district is attributable to milk from the dairy. Upon his report that infectious disease is caused by consumption of the milk supplied from the dairy, the Local Authority may require the dairyman to appear before them, after not less than twenty-four hours' notice, to show cause why an Order should not be made requiring him not to supply any milk from the dairy within their district until the Order has been withdrawn by the Local Authority. If the Order should be made, certain notices have to be given. The Order may be withdrawn forthwith by the Authority, or the Medical Offiicer on their behalf, if satisfied that the milk supply has been changed, or that the cause of the infection has been removed. The clause is likely to prove practically inoperative, as in cases to which it would apply the delay involved would be fatal to its utility. Section 5 repeals Section 22 of the Sanitary Act, 1866, and substitutes provisions, in regard to disinfection, to the effect that where the Medical Officer of Health, or any other registered medical practitioner, certifies as to the necessity for cleansing and disinfection after infectious disease, the Clerk to the Local Authority is to give notice to the owner or occupier, that the house or part, and infected articles therein, will he disinfected at the cost of the owner or occupier, unless he, within twenty-four hours from the receipt of the notice, informs the Authority that he will do the cleansing and disinfection to the satisfaction of the Medical Officer within a time fixed in the notice. If within twenty-four hours from the receipt of the notice, the person to whom it is given does not inform the Authority that he will so do 70 the cleansing, &c., or if having so informed the Authority, he fails to have the work done within the time fixed in the notice, the work is to be done by the officers of the Local Authority under the superintendence of the Medical Officer of Health. The expenses incurred may be recovered from the owner or occupier in a summary manner. Where the owner or occupier is unable effectually to cleanse and disinfect, the officers of the Local Authority, with the consent of the owner or occupier, may do the work at the cost of the Authority, without the notice already referred to being given. The advantage gained by this section is that the clerk to the Local Authority will have express statutory direction for his action in giving the notice, and will not have to be authorised by the Authority before giving the notice. Another advantage will be in the avoidance of delay, as the officers will be able to proceed to cleanse and disinfect, if, twenty-four hours after the owner or occupier has received the notice, he has not informed the Authority that he will do the work to the satisfaction of the Medical Officer of Health. Section 17. For the purpose of carrying section 5 into effect the Local Authority may, by any officer appointed in that behalf, who shall produce his authority in writing, enter on any premises betweeen the hours of 10 a.m. and 6 p.m. Section 15 provides that, if the members of a family must leave their dwelling, so that it may be disinfected by the Local Authority, the Local Authority shall provide them, free of charge, with temporary shelter or house accommodation, and any necessary attendants. Section 6 provides that the Medical Officer of Health may, by notice in writing, require the owner of any infected bedding, clothing, &c., to cause the same to be delivered over to an officer of the Local Authority for removal, for the purpose of disinfection. The articles, after disinfection, are to be taken back and delivered to the owner free of charge: penalty for failure to comply with the above requirement not to exceed £10. At present the 71 fecting of bedding, clothing, &c., in this Parish, occupies a period of twenty-four hours, because nearly all of it is also cleansed. It would seem desirable that in future, bedding, &c., should be disinfected and returned on the same day, a course which would preclude cleansing, which now costs in the aggregate almost as much as the disinfection itself. Section 7 deals with the letting of a house or part, after infectious disease, and is intended for the protection of persons entering into occupation. But the protection is limited, as the penalty (not exceeding £10) for failure to disinfect, or for omission to give notice to the owner, is not incurred should the out-going tenant vacate the house at any time later than six weeks after it has been occupied by a person suffering from an infectious disease: even though the premises, and articles therein, have not been disinfected; and though the owner of the premises has not had notice from the out-going tenant of the previous existence (within six weeks) of such disease, as required by the Act. Presumably, however, the case would be dealt with by the Local Authority in connection with the Notification Act, and it is the duty of the said Authority, if they are aware that there is a person suffering from an infectious disease in any house, to give notice of the provisions of the section (7) to the occupier. Section 11 makes a person guilty of an offence under the Act who hires or uses a public conveyance, other than a hearse, for the conveyance of an infected body, without notifying the fact to the owner or driver; who, moreover, will be guilty of an offence under the Act if, after receiving such notification, and use of the conveyance, he does not provide for the disinfection of the same. It is an obvious remark that no public conveyance—but a hearse always—should be used for the conveyance of an infectious dead body. Sections 8 to 10 deal with the retention, removal, and burial of dead bodies. After death from an infectious disease, a body may not be retained elsewhere than in a public mortuary, or in a 72 room not used at the time as a dwelling place, sleeping place, or workroom, for more than 48 hours, without the sanction in writing of the Medical Officer of Health, or of a registered medical practitioner (section 8), which sanction surely would not be given. Provision should have been made for the removal of the body, in such circumstances, to the mortuary. Section 9 is intended to provide for the burial, direct from a hospital, etc., of any person who may die therein of an infectious disease. But the body may be removed to a mortuary. The penalty for an offence under this section, which is made operative by the certificate of the Medical Officer of Health, or of a registered medical practitioner, is not to exceed £10. Should the infected body remain unburied, elsewhere than in a mortuary, or in a room as above-mentioned (8), for more than 48 hours after death, without medical sanction; or where any dead body is retained in a house so as to endanger the health of the inmates, any Justice may, on the application of the Medical Officer of Health, order the body to be removed, at the cost of the Local Authority, to any available mortuary, and direct the same to be buried within a time limited in the order. A Justice, moreover, may direct the immediate burial of an infected body, and of any dead body the immediate burial of which he may consider necessary. Should the friends or relatives of the deceased in any of the above cases not undertake to bury the body, and do it within the time limited by the order of the Justice, it will be the duty of the Relieving Officer to bury such body, and the Guardians may recover the expenses incurred, in a summary manner, from any person legally liable to pay the expenses of the burial (section 10). Section 12 provides for the detention in a hospital, at the cost of the Local Authority, by the order of a Justice, of an infectious person who is in the hospital, and would not, on leaving the hospital, be provided with lodging or accommodation in which proper precautions could be taken to prevent him from spreading the disorder. It is to be regretted that the section did not 73 go a step further, and enact that an infectious person not provided with lodging or accommodation, in which proper precautions could be taken to prevent the spreading of the disorder by such person, should be compulsorily removed to hospital. Section 16 deals with penalties. For offending against any enactment by which no penalty is specifically imposed, including the offences of wilfully obstructing the duly authorised officers of the Local Authority, or obstructing the carrying out of any order of a Justice, the penalty is not to exceed £5: and if the offence is a continuing one, a daily penalty not exceeding 40s. a day, so long as the offence is continued, is incurred. Penalties are recoverable in a court of summary jurisdiction, on the information or complaint of the Local Authority, or of their duly authorised officers, but not otherwise. The amounts are to be paid to the Local Authority (section 18). The Local Government Board, in a circular letter to the several Sanitary Authorities, dealing with the provisions of the statute, which "confers large powers with respect to matters of much importance in relation to the public health," expressed their "trust that the Local Authority and their officers would use every effort to carry out efficiently the powers thus entrusted to them." CUSTOMS AND INLAND REVENUE ACT: INHABITED HOUSE DUTY. The 26th section (2) of the Customs and Inland Revenue Act, 1890, contains sanitary provisions of considerable importance and which entail a somewhat invidious duty on Medical Officers of Health. These provisions, which are intended to secure remission of taxation at the dictum of the Medical Officer of Health, are set out in a letter which I received from the Local Government Board, as follows:— 74 "Local Government Board, "Whitehall, S.W., "19th September, 1890. "Sir, "I am directed by the Local Government Board to draw your attention to the provisions contained in section 26 (2) of the Customs and Inland Revenue Act, 1890, with respect to the exemption of certain houses from inhabited house duty. "The section provides that the assessment to inhabited house duty of any house originally built, or adapted by additions or alterations, and used for the sole purpose of providing separate dwellings for persons, at rents not exceeding for each dwelling the rate of seven shillings and sixpence a week, and occupied only by persons paying such rents, is to be discharged by the Commissioners acting in the execution of the Acts relating to the inhabited house duties, provided that a certificate is produced to them to the effect that the house is so constructed as to afford suitable accommodation for each of the families or persons inhabiting it, and that due provision is made for their sanitary requirements. The certificate is to be obtained from the Medical Officer of Health for the district in which the house is situate, or from some other medical practitioner appointed as hereinafter mentioned. "The Act makes it the duty of the Medical Officer of Health of a district, on request by the person who would be liable to pay the house duty on any house in the district if the duty were not discharged by the Commissioners, to examine the house for the purpose of ascertaining whether a certificate can properly be given; and if the house is constructed so as to afford suitable accommodation for each of the families or persons inhabiting it, and due provision is made for their sanitary requirements, he must certify the same accordingly. "The Act, however, provides that when the authority by whom the Medical Officer of Health is appointed, are of opinion that the duties which would thus devolve on him, could not be performed by him without interference with the due performance of his ordinary duties, they may appoint some other legallyqualified medical practitioner having the qualification required for the office of Medical Officer of Health of the district, to make the examinations and give the certificates above referred to. "I am directed to add that the Act does not empower a Medical Officer of Health to charge any fee for a certificate under it, nor is he entitled to any remuneration for the discharge of the duties imposed on him by the Act, in addition to the salary for the time being assigned to him as Medical Officer of Health. "I am, &c., (Signed) "HUGH OWEN, "Secretary." 75 It was proposed in the Bill to pay a fee to the Medical Officer of Health for the duty to be imposed upon him. The proposal, however, was opposed, partly, it would seem, upon the ground that the prospect of losing the fee, if the certificate were not given, would impose too severe a strain upon the honesty of Medical Officers of Health; a view which was somewhat strongly enforced by certain members from the other side of the Channel. Weakly, but reluctantly, the Government allowed the opposition to prevail; consented to erase the proviso, and now no one can allege that the Medical Officer of Health has any temptation to give a false certificate. COMPULSORY NOTIFICATION OF INFECTIOUS DISEASE. The Infectious Disease (Notification) Act, which has been in operation since October, 1889, has worked with uniform success, and without appreciable friction. It has been adopted by large numbers of provincial sanitary authorities, and is now operative in respect of urban and rural sanitary districts, containing some twothirds or more of the population of the United Kingdom. In the Metropolis notification has been compulsory from the first. At page 43 a Table will be found, shewing the number of cases of each of the scheduled diseases notified in 1890 to the several Metropolitan Medical Officers of Health. It is the duty of the Medical Officer of Health, under the provisions of the Act, to forward to the Asylums Board, daily, copies of the medical certificates or "notifications" received by him, and that Board are, in effect, required to send to the County Council a weekly return of the cases so reported to them. When the Act came into operation the Board resolved to print a weekly fist of the cases notified, and to send a copy thereof, not only to the County Council, but also to each of the Metropolitan Medical Officers of Health. They further resolved to issue, "for the information of the Managers and the general public," a weekly summary, shewing the number of cases of each of the notifiable 76 diseases reported in the several sanitary districts. Subsequently, however, and without reason assigned, they decided to defer the publication of the proposed summary. Thereupon, and believing that the information thus officially withheld, would not be without value, and would prove interesting to your Vestry and others, even if published at four-weekly intervals, I prepared and inserted in my monthly report, dated December 4th, 1889 (No. 12, page 133), a table summarising the returns, and have continued to publish a like table monthly, ever since. After a few months the Managers, many of whom, and the Clerk to the Board also, had regularly received my reports, took exception to the publication of the Table, for what reason I know not; there being nothing of a confidential character in it, nothing that might not be published in the daily papers, just as the facts in regard to deaths from infectious diseases are published as they appear in the weekly returns of the Registrar-General. I declined to discontinue the publication of the Table, whereupon the Managers ceased to send me the weekly returns, and I have had to depend upon colleagues, who share my objection to needless secrecy in matters of public health, for the information tabulated in my reports. The Managers subsequently declined to supply a copy of the return to the Medical Officer to the School Board, and they also refused an application for the return made by the editor of a "monthly journal of Public Health." In February last the Statistical Committee reported that, in their opinion, the time had arrived "when returns of cases of infectious disease notified under the provisions of the Act might be periodically published but although the motion to this effect, upon consideration of the Committee's report, was moved and seconded by leading members of the Board, it was defeated by 29 to 15 votes. For what information, therefore, the Managers themselves and the general public possess with regard to the localisation of infectious diseases, as notified, they appear to be indebted to my monthly reports. It is a singular commentary on the reluctance of the Board to publish a mere numerical and localised summary of the 77 mation contained in the returns, with which they are entrusted for public purposes, that in the Public Health (London) Law Amendment Bill, a Government measure brought in by the President and the Parliamentary Secretary of the Local Government Board, and the Home Secretary, in the current Session, provision is made that the full return itself, required by the Notification Act to be sent by the Managers to the County Council, "shall be sent by those Managers to every Sanitary Authority in London, to the London School Board, and to the managers of every public elementary school in London." This, in principle, is as it should be, but all the good results desired can be obtained without such an amount of publicity, which would probably be detrimental to the efficient working of the Act. It must be obvious that the information should be made available for the use of sanitary authorities, by being sent to the Medical Officer of Health, and that profitable use might be made of it by those responsible for the management of public elementary schools, as is being done in this Parish at the present time, under circumstances set out at page 81. But, for the information of the Managers themselves, and of the medical and general public, nothing more is required than such a summary as I publish in my four-weekly reports; such summary to be issued weekly. That the Local Government Board attach value to a summary of the information contained in the medical certificates, is evidenced by the circular letter, dated 11th February, 1891, in which they invited the Sanitary Authorities of such of the large provincial towns as had adopted the Infectious Disease (Notification) Act, 1889, to take part in an arrangement under which, during the last two years, most of the towns where the compulsory notification system had been established by local Acts, had furnished the Board with weekly returns of the cases notified, and had, in the course of a few days, been supplied by the Board with a tabular statement embodying all the returns. The Board forwarded a copy of the letter to the Managers in March, and stated that they would be glad to be able to 78 include the statistics for the Metropolis, if the Managers would cause them to be supplied, in the course of Tuesday in each week, with a numerical summary of the certificates received in the previous week. The Board would then cause the complete return to be issued on every Thursday to the Managers, as well as to the Medical Officers of Health of the provincial towns taking part in the arrangement. Expressions of willingness had, at that date, been received from most of the towns invited to join in the arrangement, which will therefore comprise, with a few exceptions, all the provincial towns having populations of 50,000 and upwards. The Managers shortly afterwards accepted the invitation to take part in the arrangement, and it is to be presumed that, ere long, these weekly summaries will be published for general information. In any case, however, the action taken by the Local Government Board marks an important step in the direction of registration of infectious (and mainly preventable) disease, as distinguished from mere records of mortality. Defects in the Act.—In my last Report I drew attention to defects in the Act, e.g., in regard to the form of the medical certificate prescribed by the Local Government Board, and to the supposed exemption of tbe Medical Officers of General Hospitals from the necessity of notifying to the Medical Officers of Health cases of infectious disease admitted to those institutions.* The attention of the Board having been directed by the Managers to the defects in the certificate, they stated that certain particulars which the Managers desired to be added, were not required for the purpose for which the system of notification was rendered *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, "unless such building is a hospital in which persons suffering from an infectious disease are receivedor, 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 are not notified at all, and the houses wherein such cases occur are not disinfected. 79 pulsory, and that it would devolve upon the officers of the Local Authority to obtain such further information as might be requisite in regard to the particular case. The Board therefore, declined to alter their Order prescribing the form of the certificate, but said that there could "be no objection to any medical practitioner furnishing such additional information as the Managers desired, if he were willing to do so. In the form of certificate in use in this Parish, I had made provision from the first, for obtaining the desired information, including age and sex of the patient, and address of the certifying practitioner, and such information has always been given. The Board now recognise the imperfection of the statutory form of certificate, and in the Public Health (London) Bill are now seeking power to remedy the defects.* In the same measure it is proposed to remove any doubt as to the liability of the Medical Officers of General Hospitals to notify infectious cases, and should the Bill pass a serious blot will be removed from the Act of 1889. For a long time prior to the passing of the Act the Managers 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 occurrence 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 expression of that opinion was attended with one good result, inasmuch as it led the Managers, upon my application, to renew the issue of the daily return of admissions to their hospitals, from which, even down to the present time, information is obtained occasionally of cases which medical practitioners have neglected or forgotten to notify. * Vide page 90. 80 Prom time to time patients present themselves at the Asylums Board Hospitals not provided with the usual medical certificate, and are admitted upon being found to be suffering from infectious disease, no notification usually having been given to the Medical Officer of the district in which the persons so suffering reside. The Local Government Board, taking cognizance of such cases, and deeming it important, in the interests of the public health, that the Medical Officer of Health of the district or parish from which the person affected had come, should be informed of the outbreak, informed the Managers that they would be glad if the Managers would instruct their Medical Officers in the various hospitals, to forward to the Medical Officer of Health, in such cases as those referred to, particulars of the name and address of the patient, and of the disease from which he is found to be suffering; but the Managers did not fall in with the suggestion. Inexplicable as the action of the Managers may be in one respect, in regard to notification matters, it is beyorid question that the Statistical Committee are anxious to make the certificates as useful as possible for public health purposes, and with this object they recommended the Managers to obtain from the Local Government Board, sanction, which was accorded, for the preparation and printing of maps, shewing by "Spots" the cases of scarlet, enteric, and typhus fevers, diphtheria, and small-pox, notified in 1890 under the provisions of the Act. These maps are seven in number, viz., four for the scarlet-fever cases, being one for each quarter of the year; one each for the enteric fever and diphtheria cases, and one for the combined typhus fever and small-pox cases, the cases of small-pox of course being differentiated. It goes without saying that these maps will become increasingly useful, as years pass by, as a means of indicating, and thereby of calling required attention to what may be called the plague spots of the Metropolis. It may be added that the notifications in 1890 of the diseases above-named, as shewn in my summary of the thirteen four-weekly returns, were 24,378, viz.:—Scarlet fever 15,438, diphtheria 5732, 81 enteric fever 3112, small-pox 61, and typhus fever 35. But considerable correction will have to be made for duplicate or multiple certificates of cases received from two or more medical men, who may have had charge of individual patients. PAYMENT OF FEES FOR CERTIFICATES. During the year 1890 certificates were received by me for which the sum of £94 15s. 6d. was paid to medical practitioners in amounts varying from half-a-crown to £9 9s. 6d. These amounts having been paid by your Vestry were recouped by the Asylums Board out of the Metropolitan Common Poor Fund. A question having arisen how the accounts could be most conveniently arranged, I proposed that we should make out a statement of the sums due to the several medical men, and forward to each the amount of his claim, by postal order. This plan—simple and convenient, the amounts due being known, the certificates forming, as it were, a bill of items—was adopted, and has worked satisfactorily. THE LONDON SCHOOL BOARD AND INFECTIOUS DISEASE PREVENTION. In former reports, extending over some fourteen years, I have made reference to the action of the School Board for London, taken, at my instance, with the object of preventing the spread of infectious disease through the agency of public elementary schools. The Visitors first, and subsequently the Head Teachers, were instructed to inform the Medical Officer of Health with regard to any children absent from school, when there was reason to believe that such absence was probably due to illness of an infectious character. Since the Notification Act came into operation, the Board and their Medical Officer have shewn a commendable desire to utilize its provisions to the utmost extent possible, for preventing the spread of disease through Board Schools; and in December a Conference of Medical 82 Officers of Health was held, by invitation of the Board and at their offices, for the purpose of considering what steps, if any, should be taken with the view of preventing the spread of infectious disease through the medium of Board Schools. The meeting, which was sparsely attended, adopted the following resolutions, amongst others:— "(3) That a notification of the occurrence of any of the (specified) 'infectious diseases' be at once forwarded by the Medical Officer of Health to the head teacher of the school attended by the children of the infected household. "(4) That on the completion of the disinfection of the infected premises, a certificate be sent by the Medical Officer of Health to the head teacher, in the same manner as the previous certificate." I ventured to dissent, not alone, from the proposal to send information of infected persons and premises to the teachers of the several schools, urging what I considered to be the superior advantages of the plan of sending a daily report to the Superintendents of Divisions, there being only ten Divisions in the Metropolis, whereas there are several hundred Board Schools— to say nothing of a great number of other public elementary schools (most of them having three Head Teachers, for the Boys', Girls' and Infants' Departments respectively), the absentees from which are looked-up by the "Visitors" appointed by the Board. The desired information, as I pointed out, if sent to the Divisional Superintendent, could be collated by an officer whose duty it would be to send immediate notice to the Visitors, who would communicate to the teachers of the several schools the names and addresses of school children living in infected houses. Some of my colleagues thought it sufficient to exclude children belonging to the infected family, but I contended, in accordance with our invariable practice, for the exclusion of all the children, in the case of an ordinary house let out in tenements, during continuance of infectiveness.* My amendment to resolution (3), viz., *The infectious house is visited immediately on receipt of the notification and all school attendance forbidden, so that there is no delay in giving effect to the Board's Regulations in regard to infectious disease. 83 "That the Medical Officer's daily returns of infectious cases, and of infected premises, should be forwarded to the Divisional Superintendent of the School Board, and not to the Head Teachers of the several schools," was not adopted. In like manner, with reference to resolution (4), I objected to send the daily return of houses disinfected to the several head teachers—a plan which would involve much trouble, quite needlessly, inasmuch as no child is allowed to return to school from an infected house until fourteen days after the date of disinfection—an interval which would afford ample time to the Divisional Superintendent to communicate through the Visitors with the head teachers of the several schools. Nevertheless, my amendment, "That the certificate of disinfection be sent, not to the Teachers, but to the Divisional Superintendent," was negatived. Immediately after the Conference I had an interview with the Superintendent of Visitors of the Chelsea Division, which includes Kensington, who approved my plan and promised to give effect to it. That gentleman has since informed me that the plan works most satisfactorily, and secures the object the School Board had in view in proposing the Conference. The operation of the plan, moreover, is not limited to Board Schools, but is extended to all public elementary Schools. It takes the form of a daily return to the Superintendent, embracing: (a) list of infected houses; (b) list of sick school children and the schools they attend; (c) list of other children living in infected houses and the schools they attend; and (d) list of houses disinfected—which are taken to be "clean" fourteen days after disinfection, if no fresh case of illness has occurred. The School Board Visitors have their appointed districts, and to each Visitor particulars of the cases in his district are at once forwarded. The Visitors immediately distribute the information to the several Head Teachers concerned. Of this plan it may be truly averred that it involves the least trouble to the Medical Officer of Health, he having to report to one Divisional Superintendent instead of to an indefinite number of Head Teachers. It has the effect, 84 over, of informing everybody entitled to information —the Superintendent, the Visitors (who are thus kept away from infected houses) and the Head Teachers themselves; and that just as quickly as if the Medical Officer had the trouble of making separate reports of individual cases. What more, what better could be desired? 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 with this question of compulsory removal also, having passed a resolution to the 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 the 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. PROSPECTIVE PUBLIC HEALTH LEGISLATION. The President of the Local Government Board introduced two Bills in February of the present year, intended to put the law relating to Public Health on a more satisfactory footing, by consolidation of existing statutes and by necessary amendments. 85 The larger measure, entitled Public Health (London) Law Consolidation Bill, represents the third attempt to bring to a focus, as it were, the several Acts dealing with sanitary law in the Metropolis, which, it will be remembered, is not under the operation of the Public Health Act, 1875, which did this thing for the rest of the country. The first of these measures, Public Health (Metropolis) Bill, was introduced in 1877, by Mr. SclaterBooth (now Lord Basing), when he was President of the Local Government Board: its provisions were summarised in my Annual Report for 1876-7 (page 63). The Bill met with considerable opposition from the Sanitary Authorities—why, it seems rather difficult to understand now. In withdrawing it, the President stated that, "if he re-introduced the Bill, it would be his duty to amend the Sanitary Law of the Metropolis more than could be done in a mere consolidation measure but it never fell to his lot to carry the matter any further. In 1885, the present Prime Minister introduced the second Bill, having the same title, which also was mainly a consolidation measure, but with a few amendments recommended by the Royal Commission on the Housing of the Working Classes. It did not touch the Metropolis Management Acts, but as it would have cleared the Statute Book of 14 statutes, all of which are already repealed as regards the rest of England, it would have proved very useful: it was, however, introduced too late in the Session to have any prospect of passing. Your Vestry, in 1886, at my suggestion, requested Lord Salisbury to re-introduce the Bill: in declining to do so, his lordship expressed fear that the chances of any such measure becoming law were at that time "very remote." There is reasonable ground for hope that the prospects of the new Bill becoming law in the current Session are considerable, as consolidation is earnestly desired by the Sanitary Authorities, and as the amendments embodied in the Bill are of a minor character which may be generally agreed upon, not raising any contentious questions likely to excite serious opposition. If the Bill stood alone no doubt it would pass: any danger of failure arises in connection with the Amendment Bill (which doubtless it will be 86 proposed to amalgamate with the Consolidation Bill)*, containing, as it does, provisions of a character certain to excite more or less opposition on the part of the Sanitary Authorities. Prefixed to the Bill is a Memorandum setting out the titles of the numerous statutes in which we have now to grope for the law relating to Public Health in London. In the fourth schedule the enactments to be repealed are set out, and from this we learn that 14 Acts will be wholly repealed, and parts of 18 others, including several sections of The Metropolis Management Act, 1855, which, however, it is proposed to re-enact. The Bill consolidates, among others, the Nuisances Removal Acts, the Sanitary Acts, the Infectious Disease (Notification and Prevention) Acts, the Slaughter-houses Act, and the Smoke Acts, as well as the provisions relating to the Asylums Board Hospitals, which are partly contained in the Poor Law Acts and partly in the Disease Prevention Acts. Some of these enactments were consolidated, as respects the rest of the country, by the Public Health Act, 1875, and substantially they are re-enacted in the Bill in the form in which they appear in that Act. The Common Lodging-Houses Acts of 1851 and 1853, which are in force over the Metropolitan Police District, are left outstanding. In a series of notes the manner is described in which the main difficulties found in an exact reproduction of the existing law have been met. The Bill, to be known as the Public Health (London) Act, is comprised in 116 sections, to which are appended four schedules. The Public Health (London) Law Amendment Bill stands on a different footing to the Consolidation Bill. The latter, as already stated, would not be likely to meet with any serious opposition. The Amendment Bill, however, contains—with many provisions that would be welcomed by all interested in the *The two Bills were amalgamated into one, by the Standing Committee on Law, with various amendments, some of which were suggested by the Vestry or myself. But several proposed amendments, which would have added to the practical value of the Act, were not adopted, 87 public health of the Metropolis—others which are objectionable to the Sanitary Authorities. Copy of a petition against the second reading presented by one of these bodies, was forwarded to the several Vestries and District Boards, with a suggestion of the desirability of their adopting a similar course. The gravamen of the complaint against the Bill, as set out in the petition, was that "a pernicious principle pervades it in many of its clauses and sub-divisions, which is calculated to destroy the efficiency and responsibility of local self-government in the Metropolis; "clauses being cited as rendering the Local Authorities "subordinate to Central Authorities, the members of which cannot by any means be deemed to be so well acquainted with the local circumstances and requirements" of the several districts as the Sanitary Authorities and their officers. It was held, moreover, that one of the effects of such subordination would be, the "discouragement thereby given to men of intelligence and aptitude in local government affairs to join Local Authorities." The petitioners contended that the size of the Metropolis, its population, wealth, &c., established conditions peculiarly and exclusively applicable to it alone .; that there was nothing to warrant the interference of a Central Authority, and that if a change were to be made, it should be in the direction of assimilating the powers of the Vestries to those possessed by the municipalities of similar size and population in the provinces ; subject to the special powers possessed by the County Council for larger or county purposes, such as main drainage, bridges, fire brigade, and other similar Metropolitan undertakings. Clauses were cited as introducing provisions involving derogatory subordination, and as being humiliating to the Vestries, by placing them at the mercy of a common informer. Regret was expressed that the Local Grovernment Board, who last year took steps to elicit the opinions of the Vestries on the draft of a Consolidation Bill, should not have ascertained the views of those Authorities upon the provisions of the Amendment Bill. For the reasons stated, and others, the petitioners prayed the House to pause before accepting the principle of a measure containing so many highly contentious proposals, and not to allow the Bill to be read a second time. 88 The objections to the Bill from the point of view of Sanitary Authorities, may perhaps be summed up in the statement (1) that some of its provisions are of a too stringent character, indicating a want of confidence in the readiness of those bodies to do their duty—although it is acknowledged that failure, such as it is, is due rather to the complexity and scattered condition of the law, than to any unwillingness to carry out the provisions of the law so far as they are understood; (2) that it gives the County Council too much control over the Local Authorities, enabling that body in some instances to supersede them—though this cannot be done without the previous assent of the Local Government Board; the proposed powers, moreover, replacing others which at present place the Local Authorities at the mercy of private individuals, so that the Bill rather modifies the application than changes the principles of existing law; (3) that the common informer is a detestable element in the punitive sections of the Bill, and that his interference would be prejudicial to the dignity of the Local Authorities, and destructive of the hope of inducing men of a superior class to interest themselves in public health work. Having thus stated the character and scope of the official objections to the Bill, I proceed to refer to some of its provisions which are deserving of approval, as marking an advance in public health legislation; to indicate omitted matters that might well have been dealt with; as well as improvements of which the measure appears to be susceptible—always, of course, regarding the subject from a purely sanitary point of view. Nuisances.—In section 2* (and others) it is enacted that provisions in existing laws respecting premises, &c., "when injurious or prejudicial to health, shall extend to the same when dangerous to health," an important extension in the definition of a nuisance. Section 3 extends and enlarges the definition of * It will be understood that the sections in the Consolidated measure— Public Health (London) Bill—are differently numbered. The two Bills were amalgamated and the sections re-numbered, at too late a period to enable me to re-write my observations on the provisions of the Amendment Bill, or to re-cast the clauses as they appeared in the complete measure when it left Committee of the House of Commons. 89 nuisances liable to be dealt with summarily: e.g., any cistern so foul or in such a state as to be injurious or dangerous to health is a "nuisance." The power of putting in force the sanitary clauses of the "water regulations " should have been conferred on the Sanitary Authority, to enable them to secure that cisterns be so placed as to be accessible for inspection and cleansing, and to secure the abolition of waste-pipes, &c. By section 24 (1) an occupied house without a water supply is defined to be a nuisance. Under existing law, where constant supply is given, a house having a good water supply, but being without the "prescribed fittings" is a "nuisance but if it has the prescribed fittings and no water it is not: the nuisance has to be proved! There is no provision forbidding the cutting-off of the water supply to a house for non-payment of the rate or otherwise. Section 24 (2) forbids the occupation of a newly-erected house until the Sanitary Authority have certified that it has a proper water supply. Foul water closets, drains, ash-pits and dung-pits are added to the list of " nuisances " liable to be dealt with summarily. The bye-laws to be framed under section 9 will, it is hoped, suffice to prevent nuisance in the conveyance through streets of manure and every other kind of offensive matter. It is not beyond hope that we may be able to abolish sunken dung-pits. Proceedings for Nuisances.—Section 4 (1) will enable the Sanitary Inspector to bring the existence of a nuisance to the notice of any person who may be required to abate it, by serving a written " intimation," which should properly be deemed to be the notice of the Authority, so that further proceedings might, if necessary, be taken by summons without delay. It will not be necessary to specify the work required to be done for the abatement of the nuisance (section 5 (2).) Provision of Water Closets.—The powers of the Sanitary Authority under existing law are considerably extended and strengthened by section 20. 90 Injuring Closets, dtc.—Section 8 makes it an offence to injure a closet or other sanitary convenience, or water-supply pipe, &c., so as to create a nuisance. No provision is made for a water supply to the closet distinct from the supply for domestic purposes. Sanitary Conveniences.—-Section 22 extends to ash-pits, but ceases to extend to privies, the power of the Sanitary Authority to provide public sanitary conveniences. Inspection of Drains, dtc.—Section 21 (2) provides that the expenses of examination of any of the works mentioned in sections 82 to 85 of the Metropolis Management Act, 1855, if such works are not found to be in proper order, &c., shall be repaid to the Sanitary Authority by the person offending—a very proper provision which I have long advocated. By (3) of the same section, the daily fine for disobedience of the Vestry's notice to execute works within the specified time is increased. But properly the Sanitary Authority should be required (they have the power) to carry out the works at the cost of the person liable, in case of default. Overcrowding.—Section 4 (2) extends provisions of existing law to an overcrowded part of a house, but no provision is made for speedy abatement of the nuisance by power being given to eject the inmates after reasonable notice. The intolerably tedious process of ejectment, as set out in my 12th report for 1889 (page 128), will have to be followed. By section 4 (4), certain fines for offences under the Nuisances Removal Act, 1855, are increased, but there is no obligation upon the Justices to inflict them upon offenders. Unhealthy Houses.—No provision is made for the warranty of houses, as being fit for human habitation, when let. Such a warranty should be implied in all contracts for letting and taking a house. And in the case of a house let on lease, the lessor and not 91 the lessee, should be responsible for the amendment of structural defects which existed, but were not discovered, at the time when the contract was made. Underground Rooms.—The provisions of section 103 of the Metropolis Management Act, 1855, are considerably extended by section 34. Where two or more underground rooms—the expression " cellar " is no longer used—are occupied together, each of them is to be deemed to be separately occupied as a dwelling within the meaning of the section. The provisions of clause 34 (1) (a) to (i) are, at the expiration of six months after the Act comes into operation, to extend to underground rooms let or occupied separately as dwellings before the passing of the Act—but considerable dispensing and modifying powers are to be vested in the County Council. The powers and duties of the District Surveyors as respects underground rooms, are to be transferred to officers of the Sanitary Authority, who will report to such Authority, and a report need not be made to the Coimty Council. Power of Entry.—The power of entry is enlarged absolutely, or on the Order of a Justice (sec. 6), for various purposes, in several sections of the Bill. Stable Manure, die.—Section 18 extends the powers of the Local Authority in respect of the removal of filth. The Sanitary Inspector is authorised to serve a notice on the owner or occupier, e.g., of a stable, requiring him to remove a collection of manure, and if this is not done within 24 hours, the manure may be removed and disposed of by the Sanitary Authority at the cost of the occupier, or (when there is no occupier) the owner of the premises. The Consolidation Bill (sec. 28) enables the Sanitary Authority to collect and remove stable and cow-house manure with the consent in writing of the owners ; but I have always contended that it should be the duty of the Authority to remove all such manure, and indeed the offensive refuse of all trades, at the cost of the producers. Only thus shall we be able to get rid 92 of a large class of nuisances. Section 18 will probably have the effect of bringing about indirectly, such a new order of things, desiderated in the interests of public health. Dust Removal is to be deemed a business carried on by the Sanitary Authority, and the clause relating to it (13) is placed in the section of the Bill dealing with offensive trades. It should, as just stated, be the duty of the Sanitary Authority to remove all offensive trade refuse, just as they are required to remove house refuse, but at the cost of the producers : thus only can nuisance be effectually prevented. Notification of Infectious Disease.—Power is given— section 30 (2)—for needed improvements in the form of the medical certificate, all of which I had introduced into the form in use in this Parish. The certificate should also state, as ours provides, whether the patient has been, or should be removed to hospital. With regard to the payment of the fee to the certifying medical practitioner, it should be made conditional upon the certificate being forwarded "forthwith." It would be a most uncongenial duty to have to prosecute for neglect. I hear of cases of illness, now and then,b efore they are notified, and have to write to the practitioner for his certificate, for which the fee is paid; whereas if the law was duly carried out, penalty would be sued. Hospital authorities, other than the Managers of the Asylums Board, will be required—section 30 (1)—to notify the admission of cases of infectious disease, thus abolishing an exemption which has had ill effects. Provision is made for the weekly return of infectious cases reported to the Asylums Board, now sent by the Board to the County Council, to be sent to the several Sanitary Authorities, to the London School Board, and to the Managers of every Public Elementary School in London. The words italicised are objectionable. Such publicity would have a detrimental effect upon the working of the Act. It is needless, moreover. All that is necessary is that the Medical Officer of Health should send to the Superintendent of Visitors, information of infected houses whence children attend any public elementary school. The Superintendent should be 93 required to communicate the cases to the head teachers. This system is in use in Kensington, and works quite satisfactorily, without any publicity. To send the return to School Managers, who have nothing to do with the admission or the exclusion of children, and who often meet at long intervals, would be alike injurious and futile. The County Council, by section 30 (4), will have, as respects London, the same power of extending the Infectious Disease (Notification and Prevention) Acts to any infectious disease, as a Sanitary Authority have as respects their district, thus being able to over-ride the Sanitary Authority. Hospitals.—Section 31 repeals section 15 of the Poor Law Act, 1879, relating to contracts by the Asylums Board with a Sanitary Authority, for the treatment of infectious persons in the Board's hospitals; a similar provision is enacted in section 63 of the Consolidation Bill. Power, continued to the Sanitary Authority (section 60 of the Consolidation Bill), to provide hospitals is never likely to be exercised. In such hospitals, and in a Board hospital, the patient may be made liable for the expenses of his maintenance. Such liability, practically speaking, is never enforced, nor is it intended to be. It is to the public interest to make the hospitals free, in law, as they are in practice, patients being admitted at the request of any duly qualified medical practitioner; and it is to be regretted that the law has not been assimilated to the practice. The practice has been of inestimable value to the Metropolis, and no one knowing the facts, or having the public welfare at heart, will ever seek to enforce the provisions of law which, if carried out, would lead to the exclusion of numerous patients and to spread of disease, from inability to isolate such patients in their own homes. Compulsory Removal of the Infectious Sick.—No provision is made extending the power of existing law, but the words, in section 26 of the Sanitary Act, 1866, "or lodged in a room occupied by more than one family," are repealed by section 28 (2). 94 Infectious Persons.—Any person suffering from an infectious complaint may not engage in milking, or in picking fruit, or engage in any occupation connected with food, or carry on his business so as to spread disease. The Sanitary Authority may make an allowance to the person, during the period of prohibition, which is not to be deemed pauper relief (section 29). Disinfection.—The Sanitary Authority is required by section 26, to provide a place, with apparatus and attendance, for the disinfection of infected bedding, clothing, &c., together with carriages and vessels for holding and conveying the articles, either free of cost to the owner, or at reasonable charges in the case of persons able to pay. Sanitary Authorities may combine for the purpose. It is to be presumed that the work may be done for the Sanitary Authority by competent persons, under contract, as in this Parish. Mortuaries.—The Sanitary Authority is required to provide a mortuary (section 33). The County Council may require the Authority to provide a place for post-mortem examinations. Such a place, surely, is always provided in connection with a public mortuary ? Sanitary Authorities may combine for these purposes, or one Authority may contract with another for the use of a mortuary, &c. Coroner's Court.— Permissive power is given to the Sanitary Authority by section 33 (4) to provide, in connection with the mortuary and place for post-mortem examinations, a proper place for the holding of inquests. The County Council may contribute to the provision and maintenance of the Court. It is to be hoped that the scandal of inquests in public-houses will soon cease. The Sanitary Authority may, with the consent of the Local Government Board, borrow for the above purposes. Unsound Food.—Existing law is to be amended by section 23, which extends the powers of the Sanitary Authority for the inspection of divers articles of food, and search for articles unfit for food, to all articles intended for the food of man, sold or exposed for sale, &c.: the maximum fine is increased and the 95 maximum term of imprisonment : the original vendor of the article, moreover, will be reached and made liable to the like punishment as the person in whose possession it is found. Smoke.—The duty of carrying out the Acts relating to the prevention of smoke nuisances is transferred, by section 14, from the Police to the Sanitary Authority; but no provision is made for dealing with the nuisance arising from smoke, or the invisible but more dangerous products of combustion, from chimneys so placed, at a low altitude, or otherwise, as to discharge into inhabited rooms. Bye-Laws.—Exception has been taken to the power conferred, by section 9, upon the County Council to make bye-laws, with the sanction of the Local Government Board, for a variety of purposes; on the ground that this is a duty which each of the 40 Sanitary Authorities could perform for their several districts. The Sanitary Authorities should have a consultative voice in the matter, and an appeal to the Local Government Board. But otherwise, surely, the balance of convenience, and of advantage generally, is in favour of uniform bye-laws for the Metropolis in regard to the matters specified. All recognise the advantages of the bye-laws made by the late Metropolitan Board of Works in respect of slaughter-houses and cowsheds; it is only to be regretted that the execution of them has not been relegated to the Local Authorities; the same as in the case of bye-laws to be made under the present measure, and which will have to be submitted to the Local Government Board for sanction not later than six months after the passing of the Act (sec. 47 (2).) My objection to section 9 is that it does not go far enough. Power to make bye-laws for regulating other matters is required, e.g., for the storage of offal and other offensive trade refuse on the premises where it is made, and for the regulation of offensive trades, such as that of a marine-store dealer. Bakehouses, moreover, should be regulated by bye-laws. Brick-burning and ballast-burning also should be controlled. Additional powers to make bye-laws are conferred on the County Council by section 20 (5) with 96 respect to water-closets, ash-pits, &c. (dung-pits should have been included), and with respect to the keeping of water-closets supplied with water for flushing—which, however, should be separate from the domestic supply. Notices by Post.—Among other minor provisions, that in sections 106 and 107 of the Consolidation Bill, and in section 43 of the Amendment Bill, enabling notices to be sent by post, is not the least useful. Informer.—Section 13 enables complaint of a nuisance to be made by any person. Fines.—The expression Fine is used throughout both Bills in place of Penalty, and in section 98 of the Consolidation Bill, provision is made for payment of fines to the Sanitary Authority— excepting so much of the amount as may be handed over to the common informer—but the wording of the section appears to require amendment, so that it may be made clear that the whole amount is to go to the Sanitary Authority when there is no informer. The fines proposed are larger than those now enforceable, but their imposition is at the discretion of the Justices, who are somewhat apt to take too lenient a view of even heinous sanitary offences, and who do not err by excess of sympathy for officers whose disagreeable duty it is to prosecute offenders. Appeals.—Section 5 (5) will checkmate offenders who make appeals against the Orders of Justices, 'without any intention of prosecuting them, but for delay only; inasmuch as a higher penalty will be enforceable should the appellant fail to satisfy the Court of first instance (after dismissal or abandonment of the appeal) that there was substantial ground for the appeal. The Court of Quarter Sessions, in dismissing an appeal, may impose the fine as if the Court were a Petty Sessional Court. More than this, it is provided by sec. 5 (6) that the Petty Sessional Court may, in case of appeal, authorise the Sanitary Authority to 97 abate the nuisance immediately, and recover the costs from the appellant, whose interests, however, are safe-guarded in the event of the appeal proving successful. Committee of Sanitary Authority.—Section 39 enables the Sanitary Authority to appoint a Committee with power to serve and receive notices, take proceedings, and empower an officer to make complaints and take proceedings in their behalf, and otherwise execute the Act. Authorities.—Section 36 empowers the County Council to institute proceedings, and do any act which the Sanitary Authority might have instituted or done, on it being proved to their satisfaction that the Authority have made default in doing their duty under the Act, or the "London Health Acts;" the Council being entitled to recover from the defaulting Authority all expenses incurred. Section 37 enables the Local Government Board, upon complaint by the County Council of default by the Sanitary Authority, to take more stringent measures, and in case of continuing default, to appoint the County Council to perform the neglected duty ; and for that purpose to have all the powers of the defaulting Authority, and to recover the costs and expenses incurred from the said Authority, and to have the power of levying the amount by a rate, and, with the sanction of the Local Government Board, to raise a loan, if necessary. The recommendation I made to your Vestry with regard to this important measure was That steps be taken to secure the introduction of clauses— (1) To confer on the Sanitary Authority concurrent power to enforce certain of the Water Regulations made under the Water Act, 1871 ; particularly Nos. 13, 14, 17, 20, 21, 23, 24 and 25. (2) To prevent the cutting-off of the water supply of houses. (3) To give concurrent power to enforce the Regulations of the County Council in respect of Slaughter-houses and Cow-houses. e 98 (4) To give power to the County Council to make bye-laws to regulate— (a) The storage of offal and other offensive trade refuse whilst upon the premises of the producer. (b) The conduct of the businesses of brick-burner, ballast-burner, and marine-store dealer. (c) The construction of dung-pits. (d) The provision of separate water supply to water closets. (5) To enable the Sanitary Authority to abate speedily the nuisance of overcrowding. (6) To give power to (or entail the duty upon) the Sanitary Authority to collect, remove, and dispose of offal and other offensive trade refuse, and stable and cow-house manure, at the reasonable cost of the owner. (7) To make the Hospitals of the Asylums Board free to all sufferers from certain infectious diseases. (8) To ensure the compulsory removal to hospital of persons suffering from certain infectious diseases, and who are without proper lodging or accommodation, enabling them to be treated at home without risk of spreading disease ; and (9) To enable the Sanitary Authority to make contracts with efficient persons for the disinfection of clothing, bedding, &c., after exposure to infectious disease. I added that it was deserving of consideration, whether objection should not be taken to section 30 (4) which would appear to enable the County Council to extend the Infectious Disease (Notification) Act, without reference to the views or wishes of the Sanitary Authority? and I advised that opposition should be made to clause 3 of the same section, which requires the Managers of the Asylums Board to send the weekly return of Notifications of Infectious Disease "to the Managers of every Public Elementary School in London." PROGRESS IN SANITARY LEGISLATION. In my Annual Report for 1888, 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 99 still under the consideration of the Local Government Board. This synopsis had been prepared by direction of the General Purposes Committee of the Asylums Board at the latter end of 1888, and a copy of it was 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." The document was of interest, as showing 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 by the passing of the Infectious Disease (Notification) Act, 1889, and the Poor Law Act, 1889. At page 84 I 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, which is no longer in question, free admission to the hospitals having now been practically provided for. The year 1889 will be memorable in the sanitary annals of e 2 100 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. 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 principles, in regard to public health administration, for which I had long contended: among others (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 poor relief, 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 removeable cases of small-pox, and for the reception of convalescents generally; and (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 areas yet in advance of public opinion. 101 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 1890, as compared with previous years since the census of 1881; but probably they were about 21,800 at the middle of the year. In places with a 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 birth-rate, but the number of berths also, has largely declined in recent years (vide Tables I. and II., Appendix). In the absence of information as to the enumerated population in 1891, it is with much diffidence, therefore, that I venture to estimate the population at the middle of the year 1890 at 179,500, an increase of 1500 over that of 1889, the natural increase during the year, represented by the excess of births over deaths registered, being 913. The population then, as estimated, gives a density of nearly 82 per acre: it comprised, males 72,800, and females 106,700 : that of the Town sub-district being, approximately, 131,000, and that of the Brompton sub-district, 48,500. The Registrar-General, I may add, estimates a much larger population, viz., 200,000, or 20,500 more than the number I have taken, as the basis for 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. 102 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 Brampton 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. Females97,700 8753 15361 23391 19789 12606 8339 5472 2901 965 115 8 97,700 Females. Males65,451 8832 13501 12452 10793 8397 5549 3619 1748 502 58 — 65,451 Males. Excess of Females 32,249 —79 1860 10939 8996 4209 2790 1853 1153 463 57 8 32,249 Excess of Females Total of bothsexes 163,151 17585 28862 35843 30582 21003 13888 9091 4649 1467 173 8 163,151 Total of bothsexes (b) KENSINGTON TOWN SUB-DISTRICT. All Ages. Under Five Years. 5 to 15. 15 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 to 75. 75 to 85. 85 to 95. 95 and upwards. All Ages. Females 70,134 6952 12141 15640 13453 8996 6031 3968 2168 701 79 5 70,134 Females. Males 50,007 6969 10986 9205 7936 6404 4099 2669 1310 386 43 - 50,007 Males. Excessof Females 20,127 —17 1155 6435 5517 2592 1932 1299 858 315 36 5 20,127 Excessof Females. Total of bothsexes 120,141 13921 23127 24845 21389 15400 10130 6637 3478 1087 122 5 120,141 Total of bothsexes (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. Excessof Females 12,122 —62 705 4504 3479 1617 858 554 295 148 21 3 12,122 Excess of Females. Total of bothsexes 43,010 3664 5735 10998 9193 5693 3758 2454 1171 380 51 3 43,010 Total of bothsexes 103 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 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. 1890. Gross Increase in 34 years. Estimated number of Inhabited Houses (as per rate books) 7,600 21,800 14,200 Population 57,000 179,500 122,500 Rateable Value of Property £308,000 £2,012,843 £1,704,843 The increase in all respects within the last nineteen years, the period over which my official experience extends, is not inconsiderable, as the subjoined figures shew:— 1871. 1890. Increase in 19 years. Estimated number of Inhabited Houses (as per rate books 15,395 21,800 6,405 Population 121,000 179,500 58,500 Rateable Value £935,720 £2,012,843 £1,077,123 The above figures may well be said to speak for themselves : nevertheless, attention may be called to the fact that in 34 years the rateable value of property increased nearly seven-fold, and that in the last 19 years the mere increase was treble the total in 1856. The population more than trebled, and the number of inhabited houses increased nearly three-fold, in 34 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 164. 104 MARRIAGES AND MARRIAGE-RATE. The marriages in 1890 were 1511, against 1605, 1561, 1497, and 1491 in 1886-87-88-89 respectively. Of these there were celebrated:— By the Church (71.6 per cent. of total marriages) 1082 At Roman Catholic places of worship 139 At other Nonconformist places of worship 70 At the Superintendent Registrar's Office 220 Total 1511 The marriage-rate, i.e., persons married to 1000 inhabitants, was 17.4. The marriage-rate in England and Wales was 15.15 per 1000, as compared with 14.2 in 1889. The rate in London was 16.6, against 161 in 1889, which was the lowest rate ever recorded; the five next lowest rates, moreover, being those recorded in the five immediately preceding years, 1883-87, 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 the 53 weeks period, ended January 3rd, 1891, were 3864: males, 1919; and females, 1945; the numbers in the Town and Brompton sub-districts respectively, being 3144 and 720. Including 77 registered in the 53rd week, the births were 166 more than in 1889 (viz., 3698: Town 3008, Brompton 690), but they were 177 fewer than in 1872, when the population (127,400) was 52,100 less than in 1890. The Kensington birth-rate, which is considerably below that of London as a whole (29.1 in 1890) has been declining since 1868, when it was 33.1 per 1000. In 1890 it was 21.5 per 1000, and 2.9 below the decennial average (24.4). The rate was, in the Town sub-district 24.0, and in Brompton 14.8 per 1000. There was one birth to 46.5 inhabitants, and 101.4 births of females to 100 of males, a reversal of the usual proportions. The births of illegitimate 105 children were 222 (23 more than in 1889), viz., males 134, and females 88. Of these births, 206 were registered in the Town sub-district, which includes the Parish workhouse, at which institution there were 119 births (males 60, females 59), including ten still-born, 84 of which were illegitimate. In the Parish generally, the illegitimate births formed 5.8 per cent. of total births, as against 4.7, 4.7, and 5.4 in the three preceding years respectively. 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 434 422 856 72 95 167 1023 2nd „ 421 360 781 91 96 187 968 3rd „ 376 412 788 94 95 189 977 4th „ 356 363 719 75 102 177 896 Totals 1587 1557 3144 332 388 720 3864 For particulars respecting the annual number of births, and birth-rates, in the decennial period 1880-89, see Tables I. and II. (Appendix). DEATHS AND DEATH-RATE. The deaths registered in the 53-weeks period, inclusive of 211 deaths of parishioners at out-lying public institutions, &c., but exclusive of deaths of non-parishioners at public institutions within the Parish, were 2951, and (including 74 in the 53rd week) were 85 above the corrected deeennial average (2866). Of these deaths 2382 belong to the Town sub-district, and 569 to Brompton. The death-rate, which in the three preceding years was 16.4, 15.9, and 13.5 respectively, was for the 53-weeks period, 16.4 per 1000: but corrected for a year of 52 weeks it was 16.1 only, being 0.2 above the decennial average (15.9), and 4.2 below the rate in the Metropolis as a whole (20.3), this being 0.3 above the decennial average (20.0). The rate in the Town 106 sub-district was 18.2, that in Brompton 11.7, as against 14.9 and 10.0 respectively in 1889. The rate in the male sex was 19.5, and that in the female sex 14.3, against 16.0 and 11.9 in 1889. In the Parish, as a whole, there was 1 death to 60.8 persons living, as against 1 to 73.8 in 1889. The deaths of males were 1421, out of a total of 72,800 persons of that sex, or 1 in 51'2, the proportion in 1889 having been 1 in 62.5. Of 106,700 females 1530 died, or 1 in 69.7, as against 1 in 84 in 1889. The deaths in the first and fourth or colder quarters (1622) exceeded those in the second and third or warmer quarters (1329) by 293. In the three preceding years consecutively, the difference in favour of the warmer quarters was 272, 229 and 74. INFANTILE MORTALITY. The deaths of young children always bear a high ratio to total deaths. In 1890 this ratio was higher than in 1889, but not above the average, the deaths having been 1086 (or 1009 deducting the deaths in the 53rd week); against 1129, 1077, and 789 in the three preceding years. The 1086 deaths were equivalent to 36.8 per cent. on total deaths, and to 28.1 per cent. on births registered: the equivalent percentages for the whole Metropolis were 39.6 and 27.6. The deaths under one year, which in the three preceding years were 680, 604, and 489 respectively, were 651 in the 53 weeks, or 596 after deduction of the deaths in the 53rd week. The 651 deaths were equivalent to 22.1 per cent. on total deaths, and to 16.8 per cent. on births registered: the equivalent percentages for the whole Metropolis were 23.3 and 16.3. The deaths of illegitimate children under five years of age, 104, 101 and 87 in the three preceding years respectively, were 118 (males 65, and females 53) of which 110 were registered in the Town sub-district—and were equal to 52.6 per cent. on births registered as illegitimate. Of these 118 children, only 14 outlived 107 their first year, 5 dying in the second, and 1 in the third year of life. The causes of death, as registered, were atrophy, debility, and inanition, 16; premature birth, 10; tubercular diseases, 11; zymotic diseases, 29 (viz., diarrhoea, 12 ; measles and whoopingcough, 8 each, atid diphtheria, 1); syphilis, 8; lung diseases, 26; convulsions, 8; brain diseases, 4; diseases of the digestive organs, 4; violence (accidental suffocation), 5, and erysipelas and thrush, 1 each. Illegitimate children are commonly brought up by hand, under the charge of strangers. The evidence of improper feeding, and of the lack of maternal care, is apparent enough in the above list of the causes of death. SENILE MORTALITY. At sixty years of age and upwards, there were 826 deaths (including 38 in the 53rd week), against 773, 842, and 727 in the three preceding years respectively, being equivalent to 28 per cent, on total deaths, the equivalent percentage in Loudon as a whole being 24.0. The death-rate per 1000 persons living, at different periods of life, was as follows:— 1890. 1889. 1888. 1887. Under five years of age 56.5 41.1 56.4 60.0 Five and under 15 3.3 3.7 4.4 3.4 Fifteen ,, ,, 25 2.7 2.3 2.4 2.8 Twenty-five ,, 35 4.4 4.2 5.2 4.4 Thirty-five ,, 45 9.9 8.8 8.7 10.0 Forty-five „ 55 17.4 14.0 15.8 15.5 Fifty-five ,, 65 32.2 27.2 28.5 32.5 Sixty-five ,, 75 70.9 56.6 64.1 61.2 Seventy-five ,, 85 153.6 141.1 151.6 151.6 Eighty-five and upwards 306.5 328.3 300.0 867.8 108 The subjoined Table shews the quarterly number of deaths of parishioners, 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 348 355 703 79 91 170 873 2nd ,, 305 285 590 59 75 134 724 3rd ,, 242 258 500 45 60 105 605 4th ,, 275 314 589 68 92 160 749 1170 1212 ' 2382 251 318 569 2951 The Births were, Males 1919 The Deaths were, Males 1421 Females 1945 Females 1530 Total Births 3864 2951 Deaths Total Deaths 2951 913 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 four weeks corresponding with my monthly reports:— Date of Report. Death-rate per 1000 persons living. Above or below Decennial Average. Mean Temperature of the Air. 1890. Decennial Average. Above or below Decennial Average. 1890. 10 years 1880-89. Jan.25 22.4 19.1 + 3.3 42.1 36.9 + 5.2 Feb. 22 20.3 18.0 +2.3 38.8 40.0 —1.2 March 22 16.6 17.7 —1.2 40.1 40.5 —0.4 April 19 15.3 17.0 —1.7 45.5 45.1 +0.4 May 17 15.3 15.2 +0.1 51.4 50.1 +1.3 June 14 17.3 15.1 +2.2 56.3 57.1 —0.8 July 12 15.7 14.0 + 1.7 57.8 61.7 —3.9 August 9 14.3 16.7 —1.4 62.1 61.6 +0.5 Sept. 6 13.8 13.4 + 0.4 58.2 59.7 —1.5 Oct. 4 11.8 12.6 —0.8 58.8 54.3 + 4.5 Nov. 1 13.0 14.9 —1.9 48.4 47.1 +1.3 Nov. 29 14.3 16.4 —2.1 43.5 43.4 +0.1 Jan. 3rd, 1891 19.2 16.7 +2.5 29.9 39.7 —9.8 (Five weeks) — — — — Averages, whole year 16.1 15.8 48.7 49.0 109 ASSIGNED CAUSES OF DEATH. Having already (at page 15) 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 the Annual Summary of the RegistrarGeneral, 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.—V. 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 "Diarrhceal," including the diseases already dealt with (at page 15). Orders 3 and 4, Malarial Diseases, and Zoogenous Diseases : no death returned. Order 5, Venereal Diseases, includes Syphilis, Gonorrhoea and Stricture of the Urethra. Syphilis was the registered cause of 14 deaths, against 17, 13 and 26 in 1887-8-9. Ten of these deaths occurred in the Town sub-district: 9 of them were of children under one year of age. If the truth could be discovered, it would probably appear that this Protean malady was account- 110 able, directly or indirectly, for a number of deaths considerably in excess of the record. There was no death from gonorrhoea or stricture of the urethra. Order 6, Septic Diseases. This order comprises Erysipelas, Pyæmia, Septiæmia and Puerperal Fever, the total deaths registered being 24, against 35, 28 and 16 in 1887-8-9. Erysipelas was the cause of 8 deaths,* against 11, 12 and 8 in 1887-8-9, six of them in the Town sub-district. Two of the deaths were of children under one year of age. Pyæmia and Septiæmia were the causes of 6 deaths, five of them in the Town sub-district. There were 7, 7 and 2 deaths from these causes in 1887-8-9. Puerperal Fever was the registered cause of 10 deaths, † against 17, 9 and 6 in 1887-8-9 respectively; six of them in the Town sub-district. Two of the deaths were of women between fifteen and twenty-five years of age, seven between twenty-five and thirty-five, and one between thirty-five and forty-five. In addition to these 10 deaths, 14 deaths (3 of them in the Brompton sub-district) were registered as having occurred in "childbirth," as against 13, 10 and 7 in the three preceding years. Puerperal fever is a communicable disease depending upon "blood poisoning," whereas other causes of death connected with childbirth, are, so to say, accidental, e.g., hemorrhage ("flooding"). The deaths registered as having been caused by diseases and accidents associated with parturition (24) were equal to 6.2 per 1000 live births, against 7*6, 5'0 and 3'5 per 1000 in 1887-8-9 respectively. * The notified cases were 126, many of them being of traumatic origin, unimportant in character, and such as the framers of the Act could scarcely have intended to be notified. † Only ten cases of puerperal were notified. Ill Class II.— Parasitic Diseases Include Thrush and Other Vegetable Parasitic Diseases, five deaths; and "Worms, Hydatids and Other Animal Parasitic Diseases," two deaths. Class III.— Dietetic Diseases Were the causes of 18 deaths, 16 of them in the Town subdistrict. To Want of Breast Milk—Starvation, 3 deaths of infants under one year were classified; to Scurvy, none. Delirium Tremens was the cause of 6 deaths in the Town sub-district, against 4, 4 and 6 in 1887-8-9; Chronic Alcoholism of 8 deaths, 6 of them in the Town sub-district, against 9, 10 and 7. 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 541 deaths (=18.3 per cent. of total deaths), including 103 of children under the age of five years: 402 of the deaths were registered in the Town sub-district, and 139 in Brompton. Rheumatic Fever and Rheumatism of the Heart caused 8 deaths, 7 of them in the Town sub-district; Rheumatism, 3 deaths. In fatal cases of rheumatic fever, the immediate 112 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 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 6 deaths, and Rickets of 3, all of them in the Town sub-district. Cancer—Malignant Disease, was accountable for 125 deaths; 84 in the Town sub-district and 41 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 in Kensington from this cause in the previous ten years, were 90, 112, 92, 128, 117, 119, 128, 117, 121, and 138 respectively. Deaths from cancer are usually more numerous, proportionally to population, in the Brompton sub-district than in the relatively poorer Town sub-district, and were conspicuously so in 1890. 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. Thus 105 of the deaths took place at ages above forty-five, and 16 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. Anæmia was the cause of 7 deaths: Glycosuria, Diabetes Mellitus, of 20 deaths, 10 in each of the cub-districts. No death was registered from Purpura, Hemorrhagic Diathesis. 113 The remaining diseases in this Class belong to the group designated— Tubercular, and they are amongst the most important with which sanitarians have to deal; the degree to which they prevail in a given district being regarded, in some sort, as a test of the healthiness or otherwise of the population. Generally hereditary, these diseases are nevertheless susceptible of considerable amelioration under improved sanitary arraugements. 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 overcrowding 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 scourge of the human race. Tubercular diseases were the registered causes of 369 deaths (against 393, 400 and 320 in 1887-8-9), viz., 287 in the Town sub-district, and 82 in Brompton; 98 of the deaths being of children under five years of age. The numbers in the four quarters of the year respectively were 126, 90, 75, 78, or 204 in the winter and 165 in the summer quarters. In a few instances Phthisis was returned as the cause of death in earliest infancy, a period of life at which the tubercular diathesis commonly manifests itself in other parts of the body than the lungs, e.g., brain, bowels, &c. Such deaths have been classified in Table III., with those certified from "Other forms of 114 Tuberculosis, Scrofula," the total being 40 (of which 22 occurred under five years of age), including 6 registered in the Brompton subdistrict. Tabes Mesenterica, popularly known as " consumption of the bowels," was the cause of 43 deaths, including 6 in Brompton, all of them save one under five years of age, and 32 under one year. Tubercular Meningitis and Hydrocephalus (water on the brain) were the causes of 53 deaths, 11 of them in Brompton, and 34 under five years of age. Phthisis, popularly known as "decline" or "consumption," was the cause of 233 deaths; 6 between five and fifteen years of age, and 221 between fifteen and sixty-five; viz., 33, 44, 75, 50 and 22 in the five decades consecutively: 6 deaths were registered at ages over sixty-five. The quarterly numbers were 96, 51, 31 and 55. Of the total, 174belong to the Town sub-district and 59 to Brompton. The deaths from tubercular diseases were, proportionately, nearly as numerous in Brompton as in the Town sub-district, which is unusual, those from phthisis being even more numerous in proportion to population. 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 V.— Developmental Diseases. In this Class the total deaths were 185, viz., 152 in the Town sub-district, and 33 in Brompton. Premature Birth was the assigned cause of 68 deaths, 17 of them in the Brompton sub-district; Atelectasis of 13—11 of them in the Town sub- 115 district,; and Congenital Malformation of 6. Old Age was the registered cause of 98 deaths, 96 of them at ages over sixty-five: between seventy-five and eighty-five there were 39 deaths so classified, and 33 at eighty-five and upwards. Class VI.—Local Diseases. The diseases in this Glass, containing eleven Orders named after the systems or organs to which the diseases relate, were accountable for 1536 deaths, or 52 per cent. of the deaths from all causes: 1236 were registered in the Town sub-district, and 300 in Brompton: 418 were of children under five years of age. All of these totals considerably exceed the numbers recorded in 1889. 1. Nervous System.—Diseases of the nervous system were the registered causes of 321 deaths (against 289, 310 and 318 in 1887-8-9); viz., 265 in the Town sub-district and 56 in Brompton: 111 of the deaths were of children under five years of age. The quarterly numbers were 91, 68, 76 and 86. The fatal diseases were Inflammation of Brain or Membranes, 47 deaths; Apoplexy, Softening of Brain, Hemiplegia, Brain Paralysis, 144 (118 in the Town sub-district, 26 in Brompton, and 122 at ages over forty-five); Insanity, General Paralysis of the Insane, 4; Epilepsy, 13; Convulsions, 67 (all under five, and 60 under one year); Laryngismus Stridulus (spasm of glottis), 5; Disease of Spinal Cord, Paraplegia, Paralysis Agitans, 13; Other Diseases of Nervous System, 28. 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 sometimes assigned as the cause of death of children "found dead in bed." In the absence of other apparent cause of death, the 116 pre-existeuce of spasm of the glottis may have been inferred: but it is quite possible, to say the least of it, that the children had been suffocated by over-lying—a remark even more 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 their is no pathological condition which would enable one to say positively that a child had suffered, still less that it had died, from convulsions. 2. Diseases of the Organs of Special Sense (e.g., of Ear, Eye, Nose) are comprised in this Order. Four deaths were registered from these causes. 3. Circulatory System.—The deaths due to diseases of the organs of circulation, heart and blood vessels, were 220, against 200, 196 and 188 in 1887-8-9: 169 were registered in the Town sub-district, and 51 in Brompton. The quarterly numbers were 54, 50, 48 and 68. To specified forms of disease 52 deaths were assigned, viz., Pericarditis 6, Valvular Diseases of Heart 30. Aneurism was the cause of 13 deaths, and Embolism, Thrombosis, of 3. Other Diseases of Heart caused 164 deaths, and Other Diseases of Blood Vessels, 4 deaths. 4. Respiratory System.— he deaths from diseases of the chest, Phthisis being excluded, were 745, against 649, 622 and 470 in 1887-8-9, and 25.1 per cent. of total deaths. Of this number 612 were registered in the Town sub-district and 133 in Brompton. The quarterly numbers were 292 and 239 in the first and fourth, or colder quarters, and 143 and 71 in the second and third, or warmer quarters. The deaths under five years of age were 263, or 35.3 per cent. (against 42.7, 42.6 and 32.4 per cent. in 1887-8-9); and at fifty-five and upwards, 307, or 41.2 per cent. of the whole number (against 41.7, 39.2 and 39.4 per cent. in 1887-8-9). These diseases are thus seen 117 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. But, as elsewhere stated (page 35), there is good reason for believing that Influenza, or the causes of that disease, was largely responsible for the fatality of this class of diseases in 1890. The fatal diseases were Laryngitis 11 deaths; Group (transferred in the new classification from "miasmatic" diseases), 17;* Emphysema, Asthma, 15; Bronchitis, 463; Pneumonia, 147; Pleurisy, 31; Other Diseases of Respiratory System, 61. Bronchitis and Pneumonia, therefore, were accountable for 610 deaths (including 210 under five years of age), 98 of them registered in Brompton. 5. Digestive System.—The diseases of the various organs concerned in digestion were the causes of 109 deaths; 27 of them under five years of age; 109 in the Town sub-district, and 32 in Brompton. In the new classification, Dentition is included in this Order: it was the cause of 12 deaths under five, 7 of them under one year. Quinsy (transferred in the new classification from "miasmatic" diseases), was the cause of 1 death; Disease of Stomach, 15; Enteritis, 19; Obstructive Diseases of Intestines, 16; Peritonitis, 20, and Ascites, 1. Cirrhosis of Liver was the cause of 21 deaths; Jaundice and Other Diseases of Liver 27 (including 6 under one year); Other Diseases of Digestive System 9. 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., Bronchocele, Addison's Disease).—Two deaths. 8. Diseases of Urinary Organs. — Of the 65 deaths assigned to these causes, 49 were registered in the Town sub- * Only nine cases of membranous croup were notified. 118 district and 16 in Brompton. The diseases were Nephritis, 8 deaths; Bright's Disease (Albuminuria), 26; Diseases of Bladder or of Prostate, 12; Other Diseases of Urinary ystem, 19. 9. Diseases of Reproductive System.—(a) Of Organs of Generation—Male Organs, no deaths; Female Organs, 11; (b) Of Parturition, 14 deaths, viz., from Abortion, 1; Placenta Prcevia, Flooding, 3 deaths; Other accidents of Child-birth, 10. 10. Diseases of Bones and Joints.—Eight deaths; Caries, Necrosis, 5; Arthritis, 3. 11. Diseases of Integumentary System.—Four deaths. Class VII.—Deaths from Violence. Sixty-seven deaths, including 22 under five years of age (15 under one year), are distributed over the four Orders comprised in this Class: 14 of them belong to Brompton sub-district. 1. Accident or Negligence.—Total deaths, 61, including 14 in Brompton, and 22 under five years of age: viz., from Fractures and Contusions, 37; Burn, Scald, 4; Drowning, 1; Poison, 1; Suffocation, generally of infants "overlaid," 18 (including 17 under 5 and 14 under one year), all but three in the Town sub-district. 2. Homicide.—Manslaughter, one death. 3. Suicide.—The five suicidal deaths (there were 14 in 1889) belong to the Town sub-district. Gun-shot Wound, Cutting and Drowning were the cause of death in one case each, and Hanging in two. 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 119 cation. It includes the causes of 133 deaths; 104 under live years of age and 91 under one year: 119 and 14 in the Town and Brompton sub-districts respectively. The causes named are: Debility, Atrophy, Inanition, 99 deaths (all but one under five years and 86 under one year); Dropsy, 2; Mortification, 6; Tumour, 5; Abscess, 4; and Hemorrhage, 3. To "Causes not Specified or Ill-Defined," 14 deaths are ascribed. 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 (458), and at Brompton Consumption Hospital (165), 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 (392), at the Brompton Consumption Hospital (9), and at outlying institutions, &c. (211), were 612, or 20'7 per cent. on total deaths, the percentage proportion of deaths in public institutions in the Metropolis generally being 24.0. The Parish Infirmary and Workhouse.—I am indebted to Mr. H. Percy Potter, Medical Superintendent to the Infirmary and Medical Officer to the Workhouse, for the statistics of mortality at these important institutions. The deaths registered in 1890 were 394, compared with 391, 352 and 328 in the three previous years, and were equal to nearly 13.4 per cent. on total deaths. The quarterly numbers were 137, 81, 81 and 95, so that 120 232 deaths occurred in the first and fourth (or cold) quarters, and 162 in the second and third (or warm) quarters. The deaths of males and females were equal, 197. The ages at death were: under one year, 45 (65, 50 and 27 in 1887-8-9); between one year and sixty years, 179 (195, 143 and 147 in 1887-8-9); and at sixty years and upwards 170 (159, 162 and 153 in 1887-8-9). Eight inquests were held, the causes of death in 5 cases being violence {burn; injury to hip; injury to spine; suffocation; and suicide by cut throat), and in 3 cases disease, viz., in two cases apoplexy, and in one case 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) 1 16 35 51 Circulatory System, Diseases of ... 11 13 24 Respiratory System, Diseases of 1 50 53 107 Phthisis and Tubercular Diseases 20 64 3 87 Urinary System, Diseases of ... 5 3 8 Digestive System, Diseases of 2 5 8 15 Syphilis ... 1 ... 1 Septicœmia ... 2 ... 2 Croup ... 1 ... 1 Whooping-cough ... 1 ... 2 Diarrhœa 1 ... 1 2 Measles 2 3 ... 5 Enteric Fever ... 2 ... 2 Erysipelas ... 1 2 3 Gangrene ... ... 4 4 Gout ... ... 2 2 Cancer ... 9 11 20 Delirium Tremens ... 3 ... 3 Convulsions 6 ... ... 6 Deformity with Parturition ... 1 ... 1 Premature Birth 5 ... ... 5 Placenta Prævia ... 1 ... 1 Want of Breast Milk 2 ... ... 2 Pernicious Anæmia ... 1 ... 1 Asthenia, Suppuration ... 1 1 2 Burn ... 1 ... 1 Self-inflicted Wound ... 1 ... 1 Overlying 1 ... ... 1 Senile Decay ... ... 34 34 45 179 170 394 121 Outlying Public Institutions, &c.—The deaths of parishioners at public institutions, &c., outside the Parish were 211 in number (against 213, 230, and 234 in 1887-8-9. In Table III. (Appendix) all of these deaths are included. The deaths occurred in the following institutions, viz.:— St. Mary's Hospital 57 St. George's Hospital 36 West 1 ondon Hospital 5 Middlesex Hospital 4 St, Bartholomew's Hospital *1 Charing Cross Hospital 3 Westminster Hospital 3 St. Thomas's Hospital 2 University College Hospital 2 King's College Hospital 1 London Hospital 1 Guy's Hospital 1 Brompton Consumption Hospital (south branch) 2 Western District Hospital 37 North-Western District Hospital 1 Cancer Hospital (Fulham Road) 1 Queen Charlotte's Hospital 7 Children's Hospital (Paddington) 7 Ditto (Great Ormond Street) 4 Children's (Victoria) Hospital 3 Children's Hospital (Belgrave), Pimlico 1 North London Consumption Hospital 1 Homoeopathic Hospital 1 Royal Free Hospital 1 Hospital for Women, Chelsea 1 National Hospital for Paralysis 1 Samaritan Hospital 1 French Hospital (Soho) 2 Dr. Barnardo's Home 1 St. Gabriel's Home 1 St. Peter's (Kilburn) Home 1 St. Joseph's Orphanage 1 Bolingbroke House 1 St. Plagias Crêche (Islington) 1 Licensed Victuallers' Asylum (Peckham) 1 Invalids' Asylum, Stoke ington 1 St. George's Workhouse (Wallis Yard) 3 Paddington Infirmary 2 St. Pancras Infirmary 1 204 The deaths of seven parishioners in addition to the above were recorded as follows:— One, a male, killed on the Great Western Railway at Paddington; a female, by drowning in the Serpentine (suicide); a boy, run over in the street (on the way to St. George's Hospital); a man, who died from syncope and congestion of lungs, whilst being conveyed to St. George's Hospital; a man who died in a house at Paddington; a man who died in a cab in Bishop's Road, Paddington; and a child killed in the street near St. Mary's Hospital. Six of 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, 35 (scarlet fever, 20; diphtheria, 12; enteric fever, 2; and measles, 1); North-western District Hospital, 1 (diphtheria); St. George's Hospital, 3 (diphtheria); St. Mary's Hospital, 2 (measles, 1, diarrhoea, 1); Children's Hospital, Paddington, 1 (diphtheria); Children's Hospital, Great Ormond Street, 1 (diphtheria); and Victoria Hospital for Children, 1 (diarrhoea): total 44. 122 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, 14; females, 22. All of the deaths, save two, occurred at ages over sixty; 25 of them at ages over seventy. Fourteen of the deaths were of persons who had been imported from other Metropolitan parishes: 10 of the deceased had previously resided in Ireland, one in Scotland, and 3 outside London, while 4 were foreigners: 2 were stated to be parishioners, and in 2 cases the previous residence was not given. The causes of death were, diseases of the heart and lungs, 16; diseases of the nervous system, 4; old age, 5; disease of the hip, 3; cancer and disease of the urinary system, 2 each; and one each from diarrhœa, shingles, hernia, and spinal disease. 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 174, viz., males 89 and females 85. Nine of the deaths were of parishioners, and are included in Table III. (Appendix): the remaining deaths of nonparishioners 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, 458 deaths of non-parishioners were registered, all of which are excluded from Table III. (Appendix). UNCERTIFIED DEATHS. Five deaths, of 2 males and 3 females (against 20, 12 and 4 respectively in 1887-8-9), 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. The several cases were duly reported to the Coroner, who did not deem it necessary to hold inquests. 123 The causes of death, as registered, were: in one case each, Asthma; Compression of Brain resulting from a fall; Phthisis; Dropsy, Bronchitis; and Premature Birth. The ages of the deceased were 64, 64, 53 and 32 years, and 2 hours, respectively. The attention of the Metropolitan Sanitary Authorities was called, in 1887, to the subject of uncertified deaths, by the Yestry 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 1890 it was 0'9 per cent. in London; 0.17 in Kensington; 2.8 in England and Wales; 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 docter's residence, medical attendance cannot be obtained. In such cases, which not improbably constitute a large proportion of the total number of uncertified deaths, the suggested duty would be 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 124 expense to the rates, if his decision that inquest was unnecessary were accepted. In these circumstances, the Medical Officer would become practically "Coroner's Officer," as the St. James's Yestry 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 eases, 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.:— * The percentage of uncertified deaths to total deaths in 1890 was 4.9 in Sheffield, 5.5 in Halifax, and 6.1 in Liverpool—corresponding closely with the percentages in previous years. 125 "'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 facie, ground for holding an inquest, direct such cases to be investigated by a registered medical practitioner." It had been suggested that the duty of making the proposed investigation should devolve on the Medical Officer of Health as a part of his ordinary work, but the Society did not approve this view. 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 eighty-seven Inquests were held on parishioners: 133 in the Town sub-district, 32 in Brompton, and 22 at places beyond the Parish, mostly at public institutions (hospitals), to which the deceased had been removed for treatment. Nineteen of these cases belong to the Town sub-district, and 3 to Brompton. The subjects of inquest were: males 97 and females 90. The ages at death were: under five years 64, including 47 under one year; between 5 and 60 years 93; at 60 and upwards 30. The cause of death is stated to have been ascertained by post-mortem examination in 149 cases. Fourteen of the subjects of inquest were illegitimate infants. The Deaths from Violence were 67, of which 13 belong to the Brompton sub-district. 126 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 120 Deaths caused by Violence— Accidental 61 Suicidal 5 Homicidal 1 67 Total 187 The fatal diseases may be classified as follows:— Diseases of the brain and nervous system (including convulsions 11, and spasm of the gbttis 1) 25 Diseases of the circulatory and respiratory systems 78 Other visceral diseases 4 Tubercular diseases, including phthisis 3 "Syncope" 2 Zymotic diseases (diphtheria 1, scarlet fever 1) 2 Rupture of cyst; thrush; alcoholism; atelectasis; debility from birth; inanition through innutrition of mother's milk (one death ascribed to each cause) 6 120 137 The violent deaths are classified as follows:— Accident— Suffocation: of infants (in bed) under one year 14; of infant choked with food 1; in other ways 3 18 Bums 4 Drowning 1 Fractures and contusions (37) viz.— Run over by vehicles 8 Falls, under various circumstances 23 Other injuries 6 Poison (Chloral) 1 61 Suicide (5)— By hanging 2 By cut-stab 1 By drowning 1 By pistol-shot 1 Homicide (1)— "Manslaughter" 1 6 The Suicidal Deaths (none of which belong to Brompton subdistrict) comprise 4 males and 1 female. The female, aged fifty-six, put an end to her existence by drowning in the Serpentine. One Homicidal Death was registered, viz., a man, aged 36, "Manslaughter" (in a fight). Among the deaths described as "sudden," or where the person was "found dead," &c., 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 128 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 6.3 per cent. of the total deaths: the rate in the Metropolis was 7.3 per cent., in England and Wales 5.6 per cent. The reported deaths from different forms of violence were equal to 2.3 per cent. of the deaths from all causes in Kensington, the proportion in the Metropolis being 3.4 per cent. and in England and Wales 3.2 per cent. METEOROLOGY. The mean temperature of the air at Greenwich in 1890 was 48.6° Fahrenheit, the same as the average in 119 years, but 0'7 below the average of 49 years: the means in the four quarters respectively were 41.4, 52.8, 59.4 and 40.8. The highest reading by day (82.8) was registered in the week ended August 9th, and the lowest reading by night (13.1) in the week ended March 8th. The highest mean weekly readings by day in the four quarters respectively, were 57.3, 71.5, 74.4 and 66.3, and of the lowest readings by night 28.5, 33.1 46.0 and 22.1. The hottest week was that which ended August 2nd (mean temperature 62.9), and the coldest week that which ended December 20th (mean 129 perature 26.9). July and September were the hottest months (mean temperature 59.5), December was the coldest month, (mean temperature 29.8). May exhibited the greatest range in temperature, viz., 21.9—from 66.3 to 44.4; and December the smallest range, viz., 8.1—from 33.3 to 25.2. Rain fell on 162 days, the total amount registered in the year being 21.88 inches, and 2.99 inches less than the average of 75 years. Most rain fell in July (4.50 inches) and least in December (0.77). The means of the readings of the barometer were 29.790 inches; the means of February, 30*016, and of April, 26.644, being the highest and the lowest, respectively. The relative proportion of wind was North, 92; East, 72; South, 103; and West, 98. VACCINATION. Table X. (Appendix) is a return respecting vaccination in 1889, compiled by Mr. Shattock, the Vaccination Officer, whose energetic discharge of the duties of his appointment it is always a pleasing duty to recognise. The return shews a loss of 6.5 per cent. in the cases, against 5.4, 5.9 and 6.0 respectively, in 1886-7-8/ "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 beneficient of medical discoveries, shews no sign of abatement; and as their teaching F 130 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 transmiting enthetic disease. This danger, however, though by no means to be disregarded, appears to be slight, and in practice almost inappreciable, seeing that Dr. Buchanan states that he "cannot learn of communication of syphilis in vaccination being actually effected once in a million of vaccinations." Nevertheless, and it being desirable to remove every impediment to the full acceptance of vaccination, it would be satisfactory to know that the Local Government Board had made arrangements for affording to parents the option of having their children vaccinated with calf-lymph at the public vaccination stations. 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, and supplies of vaccine obtained. 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. 131 SANITARY LEGISLATION. My observations under this heading may fitly commence with reference to a "Special Report on Sanitary, Nuisances Removal, and other cognate Acts," by the Law and Parliamentary Committee, which 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 matt ers 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 expense. 6. Vestry's mode of procedure. 7. Rules with respect f 2 132 to house drainage, &c. 8. Power of Metropolitan Board of Works to make Bye-laws, &c. 9. Public conveniences. 10. Drinking fountains. 11. Paving and drainage of private mews, courts, &c. 12. Consumption of smoke. 13. Periodical removal of manure and other refuse matter. 14. Trade refuse. 15. 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 carring out the recommendations" contained in the Law Committee's report. The said reports were communicated to the several Vestries and Districts 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." Upon the formation of the London County Council, the reports were communicated to that body whose influence has been exerted with considerable effect in the promotion of legislation, which, it is believed, will go far to secure many of the objects sought to be attained by your Vestry; as will be apparent on comparison of the recommendations made by the Committee—as set out in previous reports—with the provisions of the Housing of the Working Classes Act, 1890, and those of the Public Health (London) Bill now before Parliament. 133 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. 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" also—bye-laws 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 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, 1889; 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." The Reports were referred to the Sanitary Committee of the Council, who are fully alive to the importance of the subject, for in their 134 Annual Report for 1889-90, they expressly stated that they '' consider it to be of the greatest importance that a complete and satisfactory code of sanitary bye-laws should be made: " they added, however, that they had "met with great difficulties in formulating such bye-laws, on accounnt 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 hoped it would be possible shortly, to prepare bye-laws which would meet with the approval of the Council, but under existing laws much doubted if this would be practicable. Accordingly they suggested the incorporation in the Public Health (London) Consolidation Bill, which it was thought Mr. Ritchie would introduce in the Session of 1890, of a more unrestricted power to the Council to make bye-laws of this nature, believing that if this suggestion became law, the Council would undoubtedly be in a position to prepare bye-laws which would, if uniformly enforced throughout the County, prove to be a valuable addition to the sanitary regulation of London. I may, perhaps, be permitted to mention here that, in an Address which I delivered before the Society of Medical Officers of Health, in October, 1884, I had insisted upon the importance of bye-laws which, I believed, could have been 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 for 1889, the Sanitary Committee stated that they could not " 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 135 Council should be the supervisory body to see that they are properly carried out." This scheme corresponds closely with 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." In the Public Health (London) Bill (ride page 86), to which reference has already been made, a scheme of the sort outlined by the Sanitary Committee of the Council has been provided for, but it is meeting with opposition from some of the Local Authorities, who think that the framing of bye-laws can be equally well effected by themselves. As, in any case, theLocal Government Board's sanction will be necessary before bye-laws become operative, it may reasonably be hoped that no effort will be spared to ensure uniformity, whether the bye-laws are drafted by the Council or by the Local Authority, or by both acting in concert. The need for improvement in Sanitary Legislation and in Sanitary Administration was patent to Mr. Ritchie, President of the Local Government Board, when, in the House of Commons, in March, 1890, he made a statement indicating the views and intentions of the Government in regard to these matters, especially in connection with the Housing of the Working 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, 136 but was unable, to bring in a Bill in the then current Session. His Bills introduced in the present Session are practically certain to become law, and will effect the object in view. In the course of his speech Mr. Ritchie quoted with approval an observation by Lord Shaftesbury that the Labouring Glasses Lodging Houses Acts, commonly 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," but he had to admit 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. By common consent, however, the Housing Acts were allowed to be too complicated, and it was hoped that, by consolidation with amendment, their operation might be made both more speedy and more effectual. The matter was deemed of high importance by the House of Commons, and so, when Mr. Ritchie introduced his Bills, all parties joined in assisting to pass the Act next to be mentioned. HOUSING OF THE WORKING CLASSES ACT, 1890. The Acts dealing with the housing of the working classes prior to the commencement of the Parliamentary Session of 1890, were thirteen in number, ranging from the Labouring Classes Lodging Houses Act, 1851 (Shaftesbury's Act), to the Housing of the Working Classes Act, 1885, and including those connected with the names of Mr. Torrens and Mr. (now Viscount) Cross. A Bill to consolidate these several measures, entitled Housing of the Working Classes Acts (Consolidation), was prepared and brought in by the President of the Local Government Board. Few amendments of existing law, and those not of material importance from a sanitary point of view, were introduced, but regarded merely as a consolidating measure, and if it had stood alone, it would have been very useful. 137 The matters, however, dealt with in the Bill, having received considerable attention from the Housing of the Working Classes Committee of the London County Council, and it being felt by that body that it would be possible to make Torrens's Acts more workable, they sought an interview with the Home Secretary (Mr. Matthews), with the result that an amending Bill (Housing of the Working Classes (Amendment) ) was introduced to give effect to certain suggestions made by the Committee and others. In moving the second reading of this Bill, Mr. Ritchie admitted that the law on the subject was complicated; that procedure under the existing Acts should be simplified; and that the machinery had the effect of enormously delaying any action with regard to unhealthy dwellings; providing, moreover, a loophole for the escape of owners of such property. It could not, therefore, be wondered at, that the Acts were to a large extent inoperative. The Amendment Bill, he said, proposed a much simpler mode of procedure, and assumed that the owner was wholly responsible; so that if a house was declared to be injurious to health, the owner was bound to find out himself what was to be done, and to do it within a limited time. If the repairs were not undertaken within this limited time, the house might be demolished. He referred to complaints (well or illfounded) that had been made of the unwillingness of Vestries and District Boards to put in force the law with regard to insanitary dwellings. Every district, he said, was interested in the health of every other district, and the Central Authority ought, therefore, to have the power to act, if they were satisfied that the Local Authorities were neglecting their duty. Therefore, when it was shewn to the London County Council that Local Authorities were neglecting to deal with unhealthy areas within their localities, the Council would have power to take over their duties—a power which had been asked for by the Council, for good and sufficient reasons, as he thought. The Bill would cut down to a minimum the money payable as compensation to owners who grossly neglected their duty in regard to their property, and he for one would have no mercy on owners who allowed their 138 property to get into such a condition as to be a danger to the health of the locality. In the course of the debate, Mr. Bartley made the just remark that a certain amount of the insanitary condition of the dwellings of the poor was due to the tenants themselves, and that the sanitary condition of the people could not be improved except by improving the education and ideas of the people themselves. The Bills, received with favour on all sides of the House, were referred to the Standing Committee on Law, with an instruction to consolidate the two into one. Some valuable amendments were made, and it is noteworthy that the expression "injurious to health" was throughout the Bill extended, so as to include conditions "dangerous as well as those injurious to health—an important modification, which will bring within the powers of Local Authorities many unwholesome, dangerous, dilapidated, or obstructive buildings with which it would otherwise have been difficult to deal. Some of the provisions of the Amendment Bill (to which copious reference was made in my sixth and seventh monthly reports) did not entirely commend themselves to your Vestry : a communication, therefore, was addressed to the Local Government Board to the effect that the Bill, "generally, seeks to give too wide powers to the London County Council, and does not provide sufficient protection to the various local bodies, but subjects them to be over-ridden by the Council without any provision for appeal." Your Yestry farther observed, that "whilst no objection is seen to provision being made in the Bill that, where it is duly proved that a Local Authority has neglected to perform its duty, the County Council shall have power to intervene; it is only right that this provision should be safeguarded, 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 be conducted in the district by the Local Government Board. The Board, having been requested to introduce modifications in the Bill, in the sense suggested by the above objections, replied, to the following effect:— 139 "Under the Housing of the Working Classes Bill, now before the House of Commons, the London County Council can only intervene when they consider that proceedings for a closing order, as respects a dwelling-house, ought to be instituted, or that an order ought to be made for the demolition of any dwelling-house as to which a closing order has been made, or that an order ought to be made for pulling down an obstructive building, and the Council are of opinion that the Vestry or District Board have failed to institute, or properly prosecute proceedings, or to make an order for demolition, or take steps for pulling down the obstr active building. "If the proceeding is with regard to obtaining a closing order, the County Council would have to obtain the order from a Court of Summary Jurisdiction. As regards the other cases referred to, where an order has been made by the County Council for the demolition of buildings, or for pulling down an obstructive building, there would be an appeal against the order, and consequently in these cases also the action of the Council will be subject to the control of a Judicial Court. "Where a reconstructive scheme is proposed by the County Council, under Bart 2 of the Bill, the sanction of the Local Government Board would be necessary, and before approving of any scheme the Board would direct a local inquiry, at which the Vestry or District Board would have full opportunity of making any representations that they might think desirable. "Having regard to these provisions, the Board cannot concur in the view of the Vestry, that there should be an appeal to the Board with regard to the question as to whether or not the Local Authority have failed in their duty, in any case where the London County Council may propose, under the powers which it is intended to confer upon them, that the powers of the Local Authority should become vested in them," The Bills were consolidated into one, much in the state in which they left the Committee. No part of the Act, perhaps, is more important, from a practical point of view, than that which deals with Compensation, the rock on which previous measures like well-intentioned had split. Provision, therefore, is made in respect 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 140 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, compensation is to be given to the extent of the value of the land and of the materials of the buildings thereon. Very important provisions these! THE BETHNAL GREEN SCHEME. It was not long before the County Council had an opportunity of ascertaining, by a practical test, the value of the new Act, their attention having been directed to a Scheme for improving an unhealthy area in Bethnal Green, by a report of the Housing of the Working Classes Committee, arising out of an Official Representation made to the Council, under Part 1, by the Medical Officer of Health for that Parish. The subject being of importance to every Sanitary Authority, all having to contribute, proportionally to rateable value, to the cost of schemes carried out under Part 1 of the Act, it may be well to place on record, in some detail, particulars in regard to the "Boundary Area Scheme," and to the action of the Council in regard thereto—premising that, at the present time, no part of the scheme has been carried into eifect; that the area cannot be acquired before the end of 1892; and that at least five, possibly seven, years will elapse before the scheme can be completed, as it has been decided to deal with the area in three sections. The following extract from the Committee's report will give an idea of the character of the property proposed to be dealt with:— "The total area is about 15 acres in extent" (the entire parish comprising 755 acres). "The streets" (from 20 to 28 feet in width) "are 20 in number. The average population per room is about 2i, and 107 rooms have 5 or more inhabitants each. There are many small courts of a very 141 bad class. The area comprises 730 houses, of which 652 are occupied, wholly or partly, by persons of the labouring classes; the remaining 78 houses consist of 12 public-houses and beershops, 21 shops and factories, 2 registered lodging-houses (153 beds); and 43 empty houses. The population, exclusive of those in lodging-houses, is 5566—viz., 3370 adults and 2196 children, who occupy 2545 rooms, sub-divided as follows:— 2118 persons occupying 752 single-room tenements. 2265 „ „ 506 two-room tenements. 1183 „ „ 211 tenements of 3 or more rooms (781 rooms) "Including those in the lodging-houses, the total number of persons of the labouring classes displaced will be 5719 " (comprised apparently in about 860 families) "The Medical Officer for Bethnal Green reports that 'a low condition of health prevails in the area, and that this is due to the bad condition of the houses, and bad arrangement of the streets and courts.' He further says 'that the lighting and ventilation of many of the houses are defective, and that a number of them are insufficently provided with proper sanitary conveniences inasmuch as the only access to the closet in the yard is through a dark, badly ventilated cellar.' " The annual rate of mortality in the four years 1886-9 (40 per 1000) was stated to be, from whatever combination of causes, largely in excess of the rate prevailing in the Parish as a whole (22.2 per 1000); the zymotic death-rate (8.6) very high, and the death-rate of the infant population excessive: the density of the population, moreover, is more than double that of the Parish generally, being 373 persons per acre. The above facts, in the opinion of the Committee, effectually removed any doubts as to the metropolitan importance of the scheme, and they proposed accordingly to deal with the area under the provisions of Part 1 of the Housing of the Working Classes Act. "The valuer's estimate of the gross cost of the scheme" (they stated) was "£371,000, from which must be deducted the estimated recoupment of £106,000," from sale of the cleared site, &c. "There must be added the engineer's estimate of the cost of the new and widened streets, a sum of £35,000, bringing the total estimated nett cost of the scheme to £300,000; which, 142 reckoning as a loan for 60 years, becomes a burden to the ratepayers (including interest) of £14,000 for the first year, a charge which will diminish each subsequent year." Of this charge it would appear that about one-eighth will fall upon the City, oneeightieth on the parish benefited, one-sixteenth on Kensington. It would have been more equitable had provision been made in the Act for a reasonable and proper proportion of the total cost to be charged to the parish or district specially benefited by the improvement. After considerable debate the recommendations of the Committee were adopted by the Council, as follows:— "(a) That subject to the necessary estimate being submitted to the Council by the Finance Committee as required by the Statute, the requisite resolution under section 4 of the Housing of the Working Classes Act, 1890, be passed by the Council, and that the seal of the Council be affixed thereto. "(b) That the draft scheme submitted by the Committee for the improvement of the area referred to in the said resolution be approved, and that it be referred to the Committee to complete the scheme, and to take all the necessary steps for depositing and obtaining confirmation thereof." The Chairman of the Committee (Earl Compton) accepted the following addition to the above recommendations, which was agreed to by the Council:— "And that it be an instruction to the Committee to report to the Council, before proceeding to carry out the scheme, when it is confirmed, as to what steps will be taken to limit as far as possible, the amount of compensation to owners of insanitary houses, and also as to their proposals for a gradual clearance of the area, and for the rehousing of those displaced by the scheme." The reference to compensation in this rider needs explanation. The 21st section of the Act, sub-section (2), already briefly alluded to, makes special provision for adjusting compensation payable in respect of any house, &c., as far as practicable, to real value, evidence being receivable by the arbitrator to prove— 1st.—That the rental of the house or premises was enhanced by reason of the same being used for illegal purposes, or being so over-crowded as to be dangerous or injurious to the health of the inmates; or 143 2ndly.—That the house or premises are in such a condition as to be a nuisance or in a state of defective sanitation,or are not in reasonably good repair; or 3rdly.—Thatthe house or premises are unfit, and not reasonably capable of being made fit for human habitation ; and if the arbitrator is satisfied by such evidence, then the compensation— (a) Shall in the first case, so far as it is based on rental, be based on the rental which would have been obtainable if the house or premises were occupied for legal purposes, and only by the number of persons which the house or premises were, under all the circumstances of the case, fitted to accommodate, without such overcrowding as is dangerous or injurious to the health of the inmates; and (b) Shall, in the second case, be the amount estimated as the value of the house or premises if the nuisance had been abated, or if they had been put into a sanitary condition, or into reasonably good repair, after deducting the estimated expense of abating the nuisance, or putting them into such condition or repair, as the case may be; and (c) Shall, in the third case, be the value of the land and of materials of the buildings thereon. Now, if the half of what was said in the course of the debate, as to the condition of the houses, were true, it might well be believed that most of them "are unfit, and not reasonably capable of being made fit, for human habitation," in which case the compensation payable should be "the value of the land and of the materials of the buildings thereon." But the Committee have no power to limit the amount of compensation to be paid to the owners. That is a matter which rests with the arbitrator. The large expenditure contemplated, provides only for acquiring and clearing the land and making the new streets. The land will he re-sold, for the erection thereon of improved dwellings, at an estimated loss of £300,000, or £20,000 per acre. It is, of course, expected, or at any rate hoped, by the Committee, that the poor persons evicted in carrying out the scheme will be re-housed in the new dwellings. In the past, however, when similar schemes were carried out by the Metropolitan Board of 144 Works, this did not prove to be the case, or only to a very moderate extent; so that similar "improvements" resulted in increased overcrowding of adjacent districts. "The Board," as I stated in my Annual Report for 1888 (page 130), "carried out some 22 schemes under Cross's Acts, whereby 59 acres of land were acquired and cleared, on which accommodation has been provided for 38,231 persons. The amount expended by the Board in giving effect to the Acts exceeded a million and a half sterling (or about £40 per head), this being irrespective of the outlay on model dwellings erected on the cleared sites by such bodies as the Peabody Trustees." "The Board," I added, "after taking necessary steps for giving effect to eight additional schemes, stayed proceedings under the Acts on account of the tremendous cost to the ratepayers of carrying them into effect;" it having been alleged, moreover, that "a third part of the cost of acquiring the sites was due to the excessive valuation of property so bad that demolition was the only possible remedy for the evils to which it gave occasion." It is to be feared that, in the scheme under consideration, the cost will be even greater, relatively, than that of the aggregate of schemes carried through by the Metropolitan Board; being estimated at £52 10s. per head of the population dealt with—and this not to provide the people with dwellings, but only to clear land, on which dwellings will be built by others, for letting, to the best tenants obtainable, at current rates. For a smaller outlay freehold cottages and gardens might be provided, a little way out of London, and handed over, free of cost, to the dispossessed people, whose travelling expenses, to and fro, would amount to far less than they now pay in rent for the dens in which they rot, and will have to pay for the rent of rooms in the new dwellings, should they ever set foot therein. No doubt every proper effort will be made to restrict compensation. It is but too probable, nevertheless, that the owners of the condemned houses will obtain more than the fair market value: the 730 houses are estimated to cost £371,000, or, on an average, £508 each, for buildings, compensations, &c. "In this 145 respect," as I observed in my Report for 1888, when treating of similar schemes, "the owners will be better off than the owners of houses dealt with under Torrens's Acts" (now re-enacted in Part 2 of the Housing of the Working Classes Act, 1890), "for these may be required to demolish insanitary dwellings without compensation," a course for which justification might be found in the condition of the houses proposed to be dealt with under the present scheme. In the course of the debate in the Council on the Committee's report, many members urged that the powers of Part 2 should be brought to bear to secure, at the cost of the owners, the improvement of houses capable of being made decently habitable and healthy—though this course would involve the retention of narrow streets—whilst other houses not capable of restoration should be closed under a "closing order" and demolished. I by no means say that this would be a satisfactory course; but having regard to the tremendous cost of schemes under Part 1; to the fact that there must be scores of similar "unhealthy areas" in the Metropolis; and to the certainty that Medical Officers of Health will make "official representations" with regard to such places; ratepayers may well stand aghast at the prospective increase to their present burdens. They will, however, be likely to take the matter into their own hands, at the proper time, and it is more than probable that the Council itself will, ere long, like the Metropolitan Board, see the necessity for holding its hands. Meanwhile, "first come, first served," and those districts which are the earliest in the field will get their "unhealthy areas" cleared, largely at the cost of those districts which have none such; with benefit to the locality, and doubtless to the Metropolis generally. It is a melancholy reflection that, had not the Coal Dues been thrown away, schemes such as this, might have been carried out on a large scale, year by year, with far less objection than they are now likely to excite, in view of the greatly increased taxation rendered necessary by the abolition of that magnificent revenue, which has apparently brought gain to none save colliery owners and coal merchants, who are very sensible of the benefits so unintentionally conferred upon them. 146 But to resume: On the 27th of January, 1891, the Council approved of the manner of dealing with the area, as proposed by the Committee, in three sections. It is estimated that 5720 persons will he displaced by the scheme, but that ultimately there will be rehoused, in four-storied dwellings, 4600 persons, so that 1120 persons less will be housed on the area. It is the duty of the Council to provide for persons to the number of those displaced, but experience proves that many of the latter do not avail themselves of the accommodation ostensibly provided for them. The Committee made proposals for providing 2000 persons elsewhere than on the area, so as to allow use to be made of a part of section 3, for other purposes of a more remunerative character. In the report, reference is made to the possibility of providing for some of the displaced persons by removing them to the suburbs, and it is stated that within five minutes' walk of stations on the Great Eastern Railway, there were vacant houses available: e.g., at Enfield, houses of six rooms, newly built, at 5s. and 5s. 6d. per week; others, of four rooms, at 4s. 6d. per week. Similar houses can be hired at about the same rents, which include rates, taxes, &c., averaging about 1s. to 1s. 2d. per room, at Ponder's End, Lower Edmonton, &c. Workmen's tickets are 1s. a week, or 2d. per day. It may be concluded, therefore, that the rent per room, plus travelling expenses, would not be much, if any more than half the amount paid by the dwellers in insanitary rooms on the unhealthy area. The Committee, however, believe that "but a small number will avail themselves even of cheaper and better dwellings when they are at a distance from town life." Other methods of providing temporarily, in the locality, for the people now living on the area, are discussed in detail in the report. In March last, the Commissioner appointed by the Home Secretary held an enquiry into the correctness of the official representations, made by the Medical Officers of Bethnal Green and Shoreditch, in the matter of the Boundary Street Area. There were 18 opponents, whose principal contention was that the 147 perty in which they were interested was wrongly included in the insanitary area. In June, the Council received from the Home Secretary copies of the provisional order confirming the scheme. The Bill confirming the provisional order has received the Royal assent. The next step in the procedure is that of serving copies of the provisional order upon the owners, lessees, and occupiers, as provided by the Act of Parliament. MUNICIPAL LODGING-HOUSES. In my Annual Report for 1888, I observed that it would be well should it be possible for the County Council to enter into competition with the owners of insanitary houses, by providing decent houses for the working classes at a moderate but remunerative rent, under Lord Shaftesbury's Act. The Council, shortly afterwards, resolved to make the attempt on the "Hughes Field Area," at Deptford, some seven acres in extent, which had been acquired by the Metropolitan Board of Works, under Cross's Acts. 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, 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 Council have been more successful in their attempt to provide Municipal Common Lodging-houses, having obtained the consent of the Home Secretary to their proposal to erect one such on a part of the Shelton Street (St. Giles) area, which was acquired and cleared by their predecessors. The scheme will be carried out on the lines so successfully adopted at Glasgow. 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, 148 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 institutious 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." For persons in the lowest ranks of the labouring classes nothing better, perhaps, could be devised. The proposed model lodging-house is to accommodate about 320 persons. The whole area, it may be mentioned, was cleared in 1889, under a provisional order confirmed in May, 1887. It comprised 108 houses occupied by 1208 persons. The Home Secretary, by a confirming order made in January last, sanctioned a reduction in the number of persons to be provided for to 608, and approved amended plans for the lodging-house. After competition, architects' plans have been obtained and approved. The buildings will have a frontage of 180 feet, a depth of 65 feet, and a height of about 41 feet, being in four stories. The quantities will be taken out as soon as the working drawings have been prepared. The cost of the building, as estimated in April last, when the Committee made their recommendation for its erection, will be £11,000 including furnishing, and the net return, based upon a charge of 4d, a bed per night will, it is estimated, yield 4 per cent. on the outlay and value of the site. The Committee have been authorised this month (June) to issue advertisements, inviting tenders for the erection of the building. * Memorandum by Mr. (now Lord) Cross, Home Secretary, in the Supplementary Eeport 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, 1890, as the result of inspection of this system by members of the Committee. 149 THE COUNTY COUNCIL ON THE HOUSING OF THE LABOURING CLASSES. The valuable report of the Housing of the Working Classes Committee (March 1890), in which they recommended the provision of Municipal Lodging-houses, 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 in the lowergrades. 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 sanitary 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. (&) 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. 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 150 for the enforcement of sanitary conditions. They are satisfied that Torrens's Acts (now re-enacted in the Housing of the Working Classes Act, 1890) are ineffectual for clearing out slums, or for remedying the work of jerry builders in the hands of the Local Authorities, who, they allege, 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 (also re-enacted in the Housing of Working Classes Act, 1890), they say, suffice for dealing with large areas, but their operation involves "more or less cost and delay." Approving reference is made to a letter of the President of the Local Government Board (on "The Dwellings of the Labouring Classes": the letter was re-produced in full in my Report for 1890, on 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 dealt with the difficulties of the Sanitary Authorities, on the subject of Mr. Ritchie's letter, in my last Report (at 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. No one can doubt their earnestness and good intentions, but they are realizing what Local Authorities of older date know but too well; the colossal difficulties in the way of providing decent houses for the poor at any reasonable or remunerative rate; and, I doubt not, will come in time to the conclusion, long since arrived at by myself, that the best hope of success for their well-intentioned efforts to remedy the evils resulting from overcrowding, will be found in schemes providing for the migration of numbers of the people to * 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," 151 workmen's towns a little way out of London, where land is cheap; a plan which, with a cheap service of trains, should be practicable, as indeed has been partly shewn already, at page 146. The Committee hit a distinct blot in sanitary administration, 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 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 (iii.) common lodging-houses. Suggestions are made indicating, inter alia, approval of the "ticketing" system, in relation to the lowest class of lodginghouses, 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 Annual Report for 1889 (page 132), I ventured to advocate. The Housing of the Working Classes Act, 1890, which comprehends Shaftesbury's and Cross's Acts, 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 one of the difficult questions dealt with in the able report of the Committee. 152 By this Act, the Council, with the sanction of the Home Secretary already accorded, are able to erect, purchase, or hire houses, &c., either within or without the Metropolis. The question will naturally arise, therefore, as I observed in my Report for 1889, 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 the provisions of what were formerly known as Cross's Acts in London must needs be a costly precedure 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, who need to live near their work, to obtain better and cheaper accommodation. A rent equal to that paid for two or three rooms in a model lodging-house in London, would certainly 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 would 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 employment, 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 for out of London. EMIGRATION. Emigration would seem, at first sight, to be an obvious means of reducing overcrowding, and, the Government did well in appointing a Committee to inquire into various schemes which had been proposed, of State-aided emigration from congested 153 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 countries to which it should be directed, &c. The Committee, in a report lately issued, state that they have no grounds for thinking that the present condition of the United Kingdom generally, calls for any general scheme of Stateorganized colonization or emigration, and further express the conclusions at which they have arrived, under twelve headings, none of which practically touch our difficulty, so that we are no further advanced by reason of this lengthy and painstaking enquiry. 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 ten years, 1881-90 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. CONFERENCE AT THE COUNTY HALL ON THE HOUSING OF THE WORKING CLASSES ACT. The County Council have sole jurisdiction in respect of Schemes dealing with unhealthy areas under Part 1 of the Act. But under Part 2, the Sanitary Authorities have powers and duties which necessarily bring them into relations with the Central Authority. This being so, it seemed good to the Council to invite the Vestries and the District Boards to appoint representatives to meet the Housing of the Working Classes Committee in Conference, to consider the Act. The particular 154 grounds for calling the Conference were set out in a circular letter, which contained the two following paragraphs:— "The recent consolidation and amendment of the laws relating to the Housing of Working Classes have had the effect of materially extending the obligations which devolve upon the Vestries and District Boards, as well as upon the London County Council, so far as regards the housing of the working people of London. "It is with a sense of the responsibility that the new Act places upon the Council, and with the hope that some mutual understanding may be arrived at between the Council and the District Authorities, both as to the bearings of some of the provisions of the new Act, and as to the methods of procedure to be followed under it, that the Council has resolved to invite a Conference between the Committee of its body charged with the matter, and representatives of the Local Authorities." The Conference was held at the County Hall on the 5th December, every Vestry and District Board having responded to the invitation, by appointing two of its members, with the Vestry Clerk and the Medical Officer of Health, as delegates. The Conference was presided over by Earl Compton, chairman of the Housing of the Working Classes Committee, who, in his opening address, dealt with the subject-matter of Part 2 of the Act, under the three several headings:—{1) Houses unfit for human habitation; (2) Obstructive buildings; and (3) Improvement schemes. The only resolutions adopted by the Conference, upon the motion of Mr. Herbert C. Saunders, Q.C. (Kensington Vestry) dealt with "houses unfit for human habitation," and were to the following effect:— "1. That in the opinion of this Conference it is desirable that some common understanding should be arrived at between the County Council and the Vestries and District Boards in the Metropolis, as to the conditions or defects which would render a house, either permanently or temporarily, 'so dangerous or injurious to health as to be unfit for human habitation,' within the meaning of the Housing of the Working Classes Act, 1890." "2. That with a view to arriving at such common understanding, the Medical Officer of Health to the London County Council be requested to convene a meeting of the Medical Officers of Health of the Vestries and District Boards of the Metropolis, in order that they may report generally on the subject to a subsequent meeting of this Conference, and, if practicable, submit for consideration a 155 list or schedule of the conditions and defects which may be considered to render a house 'so dangerous or injurious to health as to be unfit for human habitation.' " After a general discussion upon several provisions of the Act, the Conference adjourned. The Medical Officer of Health to the Council convened a meeting of his colleagues, at which, after some discussion, a Committee was appointed "to draw up a reply to the reference from the Conference, and report upon the principles that should guide Medical Officers of Health in reporting houses unfit for human habitation." The Committee drew up a report which, as amended, was adopted at a subsequent meeting of the Metropolitan Medical Officers of Health, attended by about one-third of their number. The report was as follows:— "Whether a house is dangerous to health mainly depends upon— (a) Site and surroundings. (b) Construction, (c) Age and general want of repair. (d) N uisances. (a) Site. "A dwelling-house built in a hollow, or in a situation not admitting effectual drainage, or exposed to malarious influences, or built in a manner, or on soil, which causes or permits the air to be contaminated by injurious gases, might be properly represented under section 30 of the Housing of the Working Classes Act, 1890. "The fact that a dwelling-house is built on a site so surrounded by buildings that access of sufficient light and air is impossible, would, in our opinion, be a good ground for representation. (b) Construoti on. ''Under this head would be classed original defect of plan: for example, a dwelling-house improperly ventilated or lighted, or with the closet and dust-bin so situated as to cause nuisance within the house. "Any condition which results in permanent dampness. "Such faulty construction of chimney flues as permits products of combustion from adjoining premises to permanently contaminate the air of living rooms. (c) Aqe and general want of repair. "This, when it reaches a degree of dilapidation, is obviously a just cause for representation. 156 (d) Nuisances. "Bad drainage, faulty closets, filth per sc, &c., are, in our opinion, grounds for action rather under the Nuisances Removal and Sanitary Acts; but when affecting a whole dwelling-house, or when combined with faults of site and construction and general want of repair, they justify action also under the Housing of the Working Classes Act. "In all the above cases the question of 'degree' comes in: it is, indeed, this question of degree that renders precise definition impossible: general principles can alone be laid down." The above report formed the principal subject for consideration at the second meeting of the Conference, held 23rd January last, at which the Chairman (Mr. Beachcroft, Vice-Chairman of the Housing of the Working Classes Committee), after stating that the proceedings would have to terminate with the current meeting, observed that "the closing of the Conference would not interfere either with a suggestion that there should be another Conference called at a later date, or with the Vestries themselves holding a Conference of their own, and then submitting any conclusions arrived at to the Council, which might lead to a future Conference." He added that "the Committee would be prepared to advise the Council to authorise the holding of another Conference if desired." In the course of the discussion, after the report of the Medical Officers of Health had been received, a resolution was proposed by Mr. Mark Judge (Paddington Vestry), and seconded by Mr. H. C. Saunders, Q.C., to the effect:— "That the report of the Medical Officers of Health be referred to a Committee, now to be appointed, to consider and report on the same to a future meeting of the Conference, to be convened either by the Committee of the Council, or by the Committee appointed to consider the report, with the view to the adoption of some principle in accordance with the resolution passed at the last meeting." The mover of the resolution observed that, "with the light which the Medical Officers had thrown upon the matter, if their report were referred to a Committee, a report might result which might form the basis of a common understanding between the Council and the Vestries." The seconder, moreover, "thought 157 he saw in the report the material on which a body of practical inen might work, by which some scheme could be arrived at, so that they could be free from the reproach that on one side of the street they were acting in one way, and on the other side in another." The Minutes of the Conference (from which the above excerpts are taken) inform us that "a discussion ensued as to whether the report of the Committee, proposed to be appointed, should be considered by another Conference to be called by the Vestries, or by the present Conference, if called again by the County Council." The discussion was largely irrevelant, and in the event it was moved, "that the meeting do proceed to the next business," which having been carried by a small majority, the Conference may be said to have ended without result, the delegates having failed to arrive at a" common understanding as to the conditions or defects which would render a house, either permanently or temporarily, 'so dangerous or injurious to health as to be unfit for human habitation' within the meaning of the Act." A resolution was adopted expressive of the view :— "That the County Council should, under sub-section 7 of section 46 of the Act, contribute to the Local Authority one moiety of the expenses of carrying into effect all schemes, comprising an area of five dwelling-houses and upwards, which may be ordered by the Local Government Board, upon the petition of the Local Authority under section 39 of the Act." The Conference then closed. It was felt by several of the delegates present that so lame and impotent a conclusion was unworthy of the occasion. Acting, therefore, on the hint conveyed by Mr. Beachcroft in his opening remarks, they subsequently held a meeting to consider what steps should be taken with a view to arriving at that "common understanding" between the Council and the District Authorities, which at the first meeting was almost unanimously held to be desirable, as to the "conditions or defects which would render 158 a house so dangerous or injurious to health as to be unfit for human habitation," and generally "on some of the other questions raised by the Act, and as to the methods of procedure to be followed under the Act." In the event, some 37 of the delegates, representing 25 District Authorities, resolved that it was desirable that the representatives appointed to the Conference should be again called together, and that the Paddington Vestry should be asked to take the initiative in the matter—by issuing an invitation to the Vestries and District Boards to re-appoint their representatives, in order to give effect to the resolution adopted at the first meeting, "by preparing a list or schedule of the conditions or defects referred to; and to consider the best means of carrying out the duties imposed by the Act on the District Authorities, and the relations of these Authorities to the County Council under the Act." The memorial of the delegates having been presented, the Yestry of Paddington unanimously complied with its request, and invited the several Authorities to appoint representatives, and, with the Medical Officers of Health, and the Vestry and District Board Clerks, to hold the Conference at their Vestry Hall. Two meetings were held, in February and in March, about 25 Vestries and District Boards being represented, the "Objects of the Conference " being, as stated in the Minutes:— "To consider the best means of carrying out the duties imposed by the Housing of the Working Classes Act, 1890, on the District Municipal Authorities, and the relation of these Authorities to the County Council, with a view to a common understanding being arrived at between the several Authorities." Mr. Mark H. Judge was elected Chairman, and Mr. Dethridge (Vestry Clerk, Paddington) Hon. Secretary, of the Conference. An Executive Committee was appointed, and also a Special Committee on "Defects in Houses: " "To prepare for the consideration of the Conference a list or schedule of the conditions which may be considered to render a house 'so dangerous or injurious to health, as to be unfit for human habitation,' within the meaning of the Housing of the Working Classes Act." 159 The Conference unanimously approved of the resolutions adopted by the Conference held at the County Hall, as set out above (page 154). An invitation was addressed to the County Council, inviting that body to appoint delegates to attend the Conference. In their reply the Council, while "glad to know that the Vestries and District Boards were holding a Conference on this important subject," considered it to be "best, inasmuch as the Conference is one between those Boards, that the Council should not be formally represented upon it, but rather that, when any conclusions have been arrived at, these should, if the Vestries and District Boards so desired, form the subject of a further Conference between them and the Council." The Report of the Special Committee on Defects in Houses was approved. After some introductory matter, this report was to the following effect:— "1. That, in the opinion of the Committee, the Housing of the Working Glasses Act, 1890, contemplates a distinction between those defects which make a house temporarily, and those which make it permanently unfit for human habitation. "2. That a house may be considered so 'dangerous or injurious to health ' as to be permanently unfit for human habitation, which— (1) By reason of age or decay, has become so dilapidated or worn out, as to be practically incapable of repair, (2) Being constructed of bad or improper materials, is offensive and unwholesome, (3) Is in a situation not admitting of effectual drainage, (4) Has been erected upon such an improper foundation that it is impregnated with foul air, (5) Is incurably damp, or (6) Is incapable of being provided with light and ventilation. "3. That a house may be considered to be temporarily unfit for human habitation which is in 'such a state as to be a nuisance or injurious to health,' from (1) Dilapidations which are capable of repair, 160 (2) Want of light and ventilation which could be provided. (3) Dampness of a temporary character, (4) Defective or unventilated drainage, (5) Water-closet, defective or ill-placed, badly lighted. or insufficiently ventilated into the open air, (6) Water supply of an unwholesome character; cisterns ill-placed, foul or uncovered, (7) Want of a separate or disconnected water supply for the waterclosets, (8) Dust-bin so situated or constructed as to cause a nuisance: or (9) From filth. "4. One of the chief objects of the Conference, as set out in the Resolution of February 20th, was to promote a 'common uuderstanding' between the Central and District Local Authorities as to 'the conditions or defects' which should be held to 'render a house so dangerous or injurious to health as to be unfit for human habitation within the meaning of the Housing of the Working Classes Act, 1890.' "It is hoped that the foregoing schedule will help to this end; but in submitting and recommending a list of particular defects for the consideration of the said Authorities, the Committee desire to express the opinion that no definition of unfitness can be regarded as inclusive of all cases. "While, however, being of opinion that each case must be dealt with on its merits, and that questions of degree will always have to be taken into consideration, as well as the co-existence of two or more defects, the Committee are convinced that if a general agreement can be arrived at, such agreement will do much to facilitate the satisfactory working of the Act." The principal duties assigned to the Executive Committee were to consider and report on (a) the best means of carrying out the duties imposed by the Act on District Authorities; (b) the relation of these Authorities to the County Council under the Act; (c) the methods of procedure to be taken under the Act, &c. 161 The following passages from the report of the Committee, which was approved, will suffice:— "With regard to the first point, (a) the Committee consider that it would be futile for the Conference to attempt to lay down any fixed lines as to how the Act is to be carried out in the several Districts: it is felt that this must be left to the Authorities themselves to settle, as experience in the working of the Act will alone point out the best means to be adopted in the carrying out of the same." The same view was expressed with reference to (c). The Committee pointed out that:— "The Act does not supersede or take the place of the Nuisances Bemoval Acts and the Sanitary Acts, but simply affords to the Local Authorities greater facilities for dealing with exceptionally bad and unhealthy property (inhabited, as it would appear from the title of the Act, mainly by the working classes) and obstructive buildings, and gives to the London County Council, as the Central Authority, wider powers to take action in Parishes where the Authorites shall have failed to carry out the provisions of the Act." "At the present stage," it was added, "your Committee feel some difficulty in reporting upon the second part of the reference, (b) viz., the relation of the District Authorities to the County Council under the Act, and content themselves by suggesting that it may be desirable, when some practical conclusions have been arrived at by the Conference, that representations should be made to the Council in the hope that that agreement or common understanding, which is so desirable, upon the vital points of the Act, may be established between the London County Council and the District Authorities." The Conference adopted the following further resolution:— "That in the opinion of this Conference it is desirable, in all cases where a Local Authority has obtained a closing order under the Housing of the Working Classes Act, 1890, and they are of opinion that nothing short of demolition will be satisfactory, that they should (in order that the owner, occupier, or other person on whom the notice is served may not be led to incur expenditure in ineffectual repairs), at once communicate with the owners thereof, informing them that, in the opinion of the Local Authority, the continuance of the buildings is dangerous or injurious to the inhabitants of the neighbouring dwelling houses." G 162 It was also resolved:— "That the resolutions passed by this Conference be forwarded to the London County Council, and that a hope be expressed that the Council will see fit (in accordance with the suggestion contained in their letter of March 7th) to convene a further Conference to consider the said Resolutions, and also the relations between the County Council and District Authorities under Part 2 of the Act." The Conference was adjourned sine die, without having, as I think, advanced matters much beyond the point at which they were left at the close of the Conference held at the County Hall. Commenting upon the proceedings of that Conference, the Housing of the Working Classes Committee of the County Council, in a report, dated 2nd February, observed that:— "It was scarcely to have been expected that the Conference itself would produce any immediate results. The main object of it, as stated by the Chairman of your Committee in opening the proceedings, was to bring about co-operation of the District Authorities with the Council, in the administration of the important Act of last Session, and, it may be hoped that the willingness now shown on the part of these Authorities to meet the Council in conference, will be productive of that harmony of action which is so eminently desirable. As will be observed, the interest of the proceedings centred on two points: (1) The definition of a house unfit for human habitation within the meaning of the Act; (2) The amount of contribution to be made by the Council towards improvement schemes under Part 2. As to the first matter, your Committee feel no surprise at the inconclusive bearing of the report of the Medical Officers: precise definition they agree, with the Medical Officers, to be impossible; and, if it were possible, the Magistrates who have to make the closing orders would probably not be willing to surrender their own judgment in the matter. As to the matter of contributions to schemes by the Council, your Committe realize the force of the views expressed by representatives of District Authorities, that the extent of improvement in the condition of insanitary areas, by way of schemes under Part 2, will probably be measured by the amounts which the Council may indicate readiness to contribute. "In a previous report of the 1st December last, your Committee gave it as their opinion that the Council must prepare itself for having to contribute in most cases of schemes towards the expense incurred, and they now think, especially having regard to the resolution adopted at the Conference, that the time has arrived when it is most desirable that some conclusion should be come to by the Council on the subject, which may be communicated to the District Authorities. 163 "The conclusion which your Committee think should be come to is, to treat reconstruction schemes for insanitary areas in a similar manner to street improvements. The practice which prevailed with the late Board, in dealing with street improvements of the smaller kind was, wherever the improvement was thought likely to be of such general benefit as to justify the Board in bearing any part of the cost, to contribute a part—generally one-half—of the nett cost. The Council has followed in the same course, varying, however, its contributions from one-fourth to one-half. Something over a million has been contributed since 1856 in aid of local improvements. In 1888 over £57,000 was so contributed. "A similar yearly contribution in aid of reconstruction schemes, under Part 2, would effect much in a few years to dispose of the worst insanitary areas in the Metropolis, and your Committee submit that, if the recommendations which they append be adopted, it will serve as an immediate encouragement to the Vestries and District Boards to submit for the consideration of the Council, schemes for dealing with insanitary areas in their districts. "Under section 46 of the Act of 1890, Vestries and District Boards are specially authorised to borrow sums required for purchase-money, or compensation, payable under Part 2 of the Act, and the Council is also specially authorised to lend. It follows that the Council is now in a legal position to lend the District Authorities expenses incurred by them in relation to reconstruction schemes, and this fact should greatly facilitate the carrying out of such schemes. "The recommendations your Committee make are:— "'(1) That the Council in all cases—when satisfied upon reports made by the Housing of the Working Classes Committee, that a scheme proposed by resolution of a Vestry or District Board is one which it is proper should be dealt with under Part 2 of the Housing of the Working Classes Act, 1890, and be contributed to by the Council—and subject to the necessary estimate to be submitted to the Finance Committee, do contribute from onefourth to one-half, according to the circumstances of each case, of the nett cost of carrying into effect such scheme. (2) That the total expenditure sanctioned on the part of the Council by way of contribution for the year ending 31st December next, be limited to the sum of £50,000. "'(3) That the Finance Committee be instructed to consider all applications made to the Council by District Authorities, for loans to meet expenses incurred in carrying out schemes under Part 2 of the Act, 1890, with a view to loans being made for this purpose, as authorised by section 46."' G 2 164 Following upon these Conferences the Council, at the instance of the Committee, passed a resolution intended as an encouragment to Local Authorities to initiate reconstruction schemes for small insanitary areas, under Part 2 of the Act, pledging itself to contribute to such schemes when dealing satisfactorily with such areas, and when the Council is satisfied of the need of assistance. But no further Conference has been held, as suggested in the final resolution adopted at Paddington Vestry Hall. FACTORY AND WORKSHOP BILLS. No fewer than six Bills were brought before Parliament in the early part of the current Session, designed to amend and extend (but unfortunately, without consolidating) the existing law on the subject of Factories and Workshops; two in the House of Lords and four in the Commons. One only needs mention here—a measure introduced by the Home Secretary, and entitled A Bill to Amend the Law relating to Factories and Workshops. The several Bills were referred to a Committee, and such provisions of private members' Bills as may be approved, will be incorporated in the Government measure, which does not contain many provisions affecting this Parish. The Bill contained one provision, in section 19, for the practical abolition of the office of Certifying Surgeon, which met with general opposition, and was not adopted. There are a few sanitary provisions. Thus: Section 2 enables the Factory Inspector to take proceedings for punishing or remedying sanitary defects at the cost of the Sanitary Authority, should the said Authority neglect to take proceedings after receiving a notice from the Inspector. Section 3 confers power for enforcement by the Sanitary Authority of sanitary provisions as to workshops, in relation to cleanliness, ventilation, overcrowding, &c., and gives to a Sanitary Authority, and their officers, powers of entry, inspection, and taking legal proceedings, or otherwise, the same as an Inspector under the principal Act. Section 4 (1) enacts that the workshop shall be kept free from effluvia arising from any drain, privy, or other nuisance; and (2) enables the Sanitary Authority to give 165 notice for lime-washing, cleansing, and purifying the premises. Section 5 increases the stringency of Section 3 of the principal Act in respect of overcrowding. Section 18 prohibits the employment of a woman in a factory or workshop within four weeks after she has given birth to a child. Factory legislation being thus to the front, I submitted to your Vestry that an attempt should be made to improve the law with respect to THE REGULATION OF BAKEHOUSES. I called attention to the fact that the Factory and Workshop Act, 1878, by repealing the Bakehouse Regulation Act, 1863, had transferred the duty of supervising bakehouses from the Sanitary Authority to Factory Inspectors, who neglected duties they were physically unable to discharge, the result being that the bakehouses in many parts of the Metropolis fell into an extremely unsatisfactory condition. The representations made to the Government of the day, mainly at the instance of your Vestry, under circumstances fully set out in my Annual Report for 1882 (pp. 133-148 inclusive), had the desired effect of undoing the mischief wrought by the Act of 1878; viz., by re-transference of the duty of supervising bakehouses from Factory Inspectors to the Sanitary Authorities, under the provisions of the Factory and Workshop Amendment Act, 1883. By this Act, the Vestries and District Boards were again made the "Local Authority," so far as relates to cleanliness, ventilation, over-crowding, and other sanitary conditions of bakehouses, with power to enforce sections 3, 33, 34 and 35 of the Factory and Workshop Act, 1878. The recommendations of your Vestry went considerably beyond this, being substantially in agreement with the views expressed in my annual report for 1881, wherein (at page 112) I said:— "What really is required, is a proper Bakehouse Regulation Act, providing for the licensing of bakehouses, and conferring on Sanitary Authorities the power, which they should be obliged to exercise, of regulating the trade by Bye-laws, uniform for the Metropolis, dealing with— 166 (1) The position and construction, including lighting and tion, of bakehouses, and (2) The periodical cleansing of the premises; and (3) The materials and utensils employed in the manufacture of bread." But the Bill was not brought in till the fag end of the Session, when there was scarcely a hope of passing it, even without amendment. I felt it my duty, nevertheless, to request the consideration of the President of the Local Government Board to two points of special importance, viz.: the necessity (1) for the insertion of words in Section 19 to give the Sanitary Inspector the same power of entry, &c., as the Medical Officer of Health, and (2) for the omission of words in Section 17, which appeared to legalise, by implication, the coutinuance within or near existing bakehouses of certain sanitary conveniences of an unsavoury nature. It was found impossible, however, to amend the Bill, which became law on the last working day of the Session. The need for regulation of bakehouses received consideration at the hands of the Society of Medical Officers of Health in 1882, and a memorial, which I drew up, was presented to the Home Secretary, praying that the powers of the Act of 1863 should be restored to the Sanitary Authorities. The memorial pointed out (inter alia)— "(8) That the provisions of the Factory and Workshop Act (1878) are insufficient to secure a proper sanitary condition of bakehouses, regarded as places in which a prime necessary of life, the daily food of man, is prepared. (9) That there is urgent necessity for fresh legislation to secure such proper sanitary condition (10) That in the contemplated legislation, provision should be made for— Licensing or Registration of Bakehouses. Power of entry at all times by the officers of the Local Authority. Power to the Local Authority, being the Sanitary Authority, to frame bye-laws to enable them to deal with— 167 (a) The position and construction, including lighting and ventilation, and periodical cleansing, of bakehouses ; and (b) The materials and utensils employed in the manufacture of bread, pastry, &c. "The Society therefore respectfully recommend the introduction of a Government Bill to secure all the above objects, being of opinion, moreover, that the principles applicable in respect of bakehouses might judiciously be extended to all other places in which articles for food of man are prepared for sale." The Home Secretary was, at the same time, requested to receive a deputation. In his reply he stated that he had referred the suggestions of the Society to the Local Government Board, postponing "for the present the question of receiving a deputation." The deputation was never received, and no action was taken upon the suggestions of the Society. Upon the passing of the Act of 1883 the Society prepared "Suggestions for Regulations with respect to Bakehouses" for the guidance of Sanitary Authorities. The Factory Acts do not authorise the making of regulations, hut it was felt that much good would result, should the Sanitary Authorities see fit to adopt regulations for the guidance of their officers, and communicate them to the proprietors of bakehouses, as an indication of the requirements of the Acts. This course was adopted by your Vestry: the regulations (as set out in my annual report for 1883, at page 103) were printed in large type, and mounted on cardboard, and a copy was supplied to each bakehouse proprietor for suspension in the bakehouse. Since 1883, until the present Session, no opportunity has been afforded for dealing with the question of bakehouse regulation in any manner. But the introduction of the Government Bill to "A mend the Law relating to Factories and Workshops " appearing to afford an opportunity for reopening the question, I recommended, and it was resolved by your Vestry, "that steps be taken to obtain power to effect improvements in respect of the position, the construction, and the regulation by bye-laws of premises where the 168 manufacture of bread, pastry, &c., is carried on." The necessity for such improvements was emphasized, in 1883, by The Operative Bakers and Confectioners' Union, which very properly took up the question of "insanitary bakehouses," in the interests of the health of the employes, and went, in deputation, to the President of the Local Government Board, the Chief Inspector of Factories being present, in order to represent their grievances. In a memorial then submitted, it was stated that, "at present almost any kitchen or cellar is turned into a bakehouse, often in close proximity to drains, many being undrained and totally unfit places for the manufacture of human food." At a subsequent date the Home Secretary received a deputation, when several of the men laid emphasis on the fact that the unsatisfactory condition of bakehouses seriously affected the wholesome character of bread. The Home Secretary, in reply, said that "the Government would, by legislation, prevent, at least so they proposed, the construction of underground bakehouses for the future; "but no provision of this sort is to be found in the Act of 1883, and the subject is not referred to in any of the Bills now before Parliament. These Bills, as I pointed out, do not stand alone in furnishing an opportunity for dealing with the question. It might be dealt with in the Public Health (London) Bill, to the extent, at any rate, of enabling the County Council to make bye-laws for the regulation of bakehouses. My Report dealing with this subject was referred by your Vestry to the Law and Parliamentary Committee, with power to take such action as might be thought best to bring about a much needed sanitary improvement, my specific recommendation being that steps should be taken to secure the introduction of a clause to enable the Sanitary Authority, or the County Council, to make bye-laws for the regulation of bakehouses. The recommendation was adopted, and letters were addressed (28th April) to the Home Secretary and the President of the Local Government Board, pointing out the desirability of advantage 169 being taken, in connection with the Bill, to improve the law by providing for the regulation of bakehouses. The Home Secretary replied that this matter, "so far as relates to sanitation, was rather a matter to be dealt with in a Public Health Bill." Consequently, a further communication was made (on May 4th) to the President of the Local Government Board, who had charge of the Public Health (London) Bill, informing him of the view taken by the Home Secretary, and asking him to give effect to it in that Bill. A reply was received (also dated 4th May) stating that the suggestion would receive the consideration of the Local Government Board: but no action was taken. It may be mentioned that clause 3 (2) of the Bill gives to the Sanitary Inspector the same power of entry to bakehouses as that conferred on the Medical Officer of Health by section 17 (1) of the Factory and Workshop Act, 1883, a bakehouse being a "workshop" within the meaning of the Act. This is an important improvement of the law, to the necessity for which I have directed attention in my several Annual Reports since the passing of the Act in 1883. WATER SUPPLY BILLS. The water supply of the Metropolis formed the subject of no fewer than six Bills introduced into Parliament early in the current Session, three of which are deserving of mention here. The "London Water Commission," was a Private Bill promoted by the Corporation with a view to the establishment of a commission, to be empowered to consider and submit to Parliament, Bills dealing with the subject of water supply. Another measure "Metropolis Water Supply" was a Public Bill, promoted by certain Yestries and District Boards, which aimed at the purchase of the Companies' undertakings and their transference to a Water Trust, but with power to the County Council to adopt the Act within a limited time, and take the place of the Trust. The principal provisions of these measures were set out in Appendices to a "Report of the Parliamentary Committee of the County County on the London Water Bills," a copy of which was 170 furnished to the several members of your Vestry. The Committee criticised both bills unfavourably, and, while agreeing that the Council should be the Water Authority for London, asserted that compulsion to buy out the Companies would involve an expenditure much greater than was necessary for placing the supply upon a satisfactory basis, such as the Council could arrange if empowered to deal with the subject with a free hand. The third measure, "London Water (MeterJ," was also a Public Bill, but introduced by private members, to enable consumers, at their option, to be supplied with water for domestic purposes by "meter." The Bill found little favour, and it is needless to criticise its details. Suffice it to say that to stint the supply of water for domestic purposes—the natural effect of such a measure if carried out in practice—would be about as unwise a course, from the public health point of view, as could well be conceived. The reasons which determined my opposition to former Bills of this description, have been more than once stated in these Reports, and they need not now be repeated; but I may mention that the Society of Medical Officers of Health resolved, at my instance, to petition against the Bill. The several Bills were referred to a Committee of the House, and, although the two chief measures (like the rest) were thrown out, their introduction had a good effect, so that there really seems to be a prospect of the matter being dealt with, so as to bring about, at no distant time, a transference of the property and powers of the Companies, on equitable terms, to some Public Authority, which, probably, will be the County Council. THE LOCAL GOVERNMENT BOARD ON THE DWELLINGS OF THE LABOURING CLASSES. In my last Report (page 119) I reproduced an important letter addressed (December 2nd, 1889) to the Sanitary Authorities by the President of the Local Government Board, dealing with the "great and pressing question of the housing of the labouring classes," many of whom, it was said, "are at present housed in 171 tenements which are either unfit for human habitation, or in such a condition as to be distinctly prejudicial to the health of the inmates." It was further said that there could be "no doubt of the gravity of the evils which result," from this state of things, "or of the ability of the Local Authorities, by a strenuous and judicious exercise" of their powers, "to effect a very material improvement in the present condition of these dwellings." The Board then proceeded to explain the provisions of law bearing upon the subject, and concluded by impressing on the several Authorities the grave responsibility they would incur should they neglect the duty cast upon them by the legislature. At the request of the Works and Sanitary Committee, I presented a Report to your Vestry on the subject, in which I set out, in some detail, the difficulties experienced, by Sanitary Authorities and officials alike, in giving effect to existing law, and shewed "the necessity for amending legislation to expedite and simplify legal proceedings for the abatement of nuisances and overcrowding." Since that report was submitted, much has been done to lessen the difficulties, and to increase the powers, of those engaged in administering sanitary law; viz., by the passing of the Housing of the Working Classes Act, 1890, which consolidates and amends the Acts (1851 to 1885) intended for the improvement of the dwellings of the labouring classes, and by the introduction of Bills, which will shortly become law as the Public Health (London) Act, and by which a large number of scattered provisions, dealing with nuisances, infectious disease (notification, and prevention), and many cognate subjects, will be consolidated and amended. The admitted necessity for these measures furnishes, perhaps, the best defence that the Sanitary Authorities can make to the charges of neglect, in the past, so freely brought against them. At the same time, the fact that such measures have been passed, will, to a considerable extent, deprive Sanitary Authorities of reasonable excuse for allowing the evils complained of to continue. I have referred so fully in other parts of this Report to the leading provisions of these measures (as well as the Factory Bill, which also will shortly become law), that I need not 172 dwell on that part of the subject now. I may, however, make the, perhaps, obvious remark that, without an adequate staff, it will be impossible that the new and onerous duties imposed by recent and impending legislation can be efficiently carried out by any Authority or Medical Officer. Whether the staff in my department, "reorganised" as it has been, under circumstances now to be set out, will prove equal to the task, is a question to which hope rather than faith would give an affirmative reply. THE SANITARY DEPARTMENT: RE-ORGANISATION. At the request of the Works and Sanitary Committee, I submitted (December, 1889) a Report on the subjects dealt with in the letter of the President of the Local Government Board, referred to in the previous paragraph, taking occasion therein to illustrate the difficulties of the Local Authority and their officers arising from defects of the law, some of which were acknowledged and have since been, in part, remedied. I also intimated the necessity for an increase in the staff of Sanitary Inspectors, in order that your Vestry might be in a position to discharge properly the duties imposed by Nuisances Removal, Sanitary, and other cognate Acts. My Report, which, with the official circular letter, was published in extenso in my last Annual Report, was referred to the Works and Sanitary Committee, who recommended the appointment of two additional Sanitary Inspectors, and at the same time requested me to state, for the information of your Vestry, the grounds on which I had made the recommendation for an increase in the staff. I did so, in my Report, dated April 23rd (No. 4, page 36); pointing out, in the first place, that the mere growth of the Parish necessitated the proposed increase; the number of Inspectors (four) being but one more than in 1866, when the population was half what it is now, the houses not many more than half, and the rateable value less than one-third of the present amount. I stated that the staff had been increased to its present strength in 1877, since which date there had been an increase of population by 173 45,000, of houses by 4000, of rateable value by £1,120,000: therefore "the proposed increase" in the staff would be "something less than pro rata, compared with the increased work consequent upon the development of the Parish." I also pointed out that "legislation, directly and indirectly, had materially added to the duties of the Inspectors; that the Lodging-house clauses of the Sanitary Acts had been put into operation, under which already some 1800 houses had been registered, whilst, to give effect to the instructions of your Vestry, a still larger number awaited attention; and that the Act for the Compulsory Notification of Infectious Disease had entailed much and very important additional work, resulting from the largely increased number of cases of infectious disease reported, with consequent visits to infected houses for the removal of patients and for disinfection." The Inspectors, I added, had been appointed to act under the Food and Drugs Adulteration Acts, and were required, when necessary, to make enquiries regarding disorderly-houses; whilst "inspections of mews, slaughter-houses, cowsheds, bakehouses and offensive trades, systematically carried out, took up much time. When to these duties and others, which it would be tedious to specify, we add those which require the attendance of the Inspectors at the office, it will be obvious that but a small portion of the day can be given to the important duty of house inspection," an average number of twenty houses a day only, being inspected by the four Inspectors combined. I further pointed out that the several inspectors had to perform "not only all of the routine duties imposed by the Acts" (set out in my Report to the Salaries Committee in June, 1887); duties considerably increased by the reports of nuisances with which I am favoured by the Sanitary Aid Committee, and other volunteers, and likely to be still further increased shortly, by legislation in respect of the Housing of the Working Classes; but each inspector, moreover, had to "attend daily to complaints that come in, the result being that much time was frittered away in going from place to place," a fact which suggested the desirability, with an increased staff, of "a reorganisation of the work of the department." 174 The recommendation of the Works and Sanitary Committee for the appointment of two additional Inspectors, was referred back by your Vestry (30th April), and the Committee thereupon requested me, prior to giving fresh consideration to the matter, to make a further Report, setting out my views regarding the department. Thereupon I reported as follows:— "(1) Your Committee having requested me to prepare a scheme setting out my views regarding the Sanitary Department, I would beg to say, in the first instance, that, in my judgment, Sanitary Inspectors should be called upon to perform Sanitary work only. (2) At present the Inspectors are required to perform multifarious duties, some of them quite outside the work of Sanitation, and which could be equally well discharged by Street Inspectors with no claim to the position of Sanitary Inspectors, and at a lower rate of wages. (3) I refer to out-door work relating to obstructions, mat-beating, inspection of sun-blinds, drinking fountains, drinking troughs, public and public-house urinals, &c. (1) Street Inspectors, moreover, would be quite competent to inspect mews, so as to see that the Vestry's requirements, as to the periodical removal of manure, &c., are carried out. (5) The Sanitary Inspectors, in my opinion, should, not be called upon to get up cases against keepers of disorderly houses, and they should be relieved from work under the Adulteration Acts. (6) The duties of the Sanitary Inspectors would then consist, mainly, in making house-to-house inspections, and in seeing that the Vestry's regulations with respect to houses registered under the Sanitary Act, 1866, are carried out; in attending to the removal of infectious cases, exercising supervision over cases of that nature kept at home, so that there may be no exposure of infected persons or things, and in seeing that disinfection is carried out properly after death, removal, or recovery of the sick. (7) They would also visit public elementary schools, from time to time, to ascertain that the Sanitary arrangements are in a proper working order, and regularly inspect bakehouses, cowsheds, dairies, offensive trades, &c. (8) Complaints should be attended to by one or two only of the Inspectors, as the case may be. 175 (9) Each Inspector in his own district, would be responsible for the dence to be produced in cases taken before the Justices, and for due supervision of works ordered, whether by the Justices or by the Vestry. (10) The actual work of disinfection might be done by a sanitary labourer. It would be well, moreover, to employ two handy men to open up drains for examination, a kind of work of which too little has been done heretofore. The spare time of these men (if any), and of the sanitary labourer, could be utilized in out-door inspection, as of mews, urinals, &c. (11) The Inspectors should attend at the office from 9 to 10 a.m. to enter up the record of their work, and to arrange with the Sanitary Clerk for the preparation of Orders, which might, with advantage, be served by a messenger. (12) It is deserving of consideration whether it might not be advisable to make two of the Inspectors, one for North Kensington, and one for South Kensington, first-class Inspectors, and responsible for the due performance of the entire work of Sanitary Inspection, for the whole of each of the said districts respectively. But details of administration may well be deferred until the Vestry shall have agreed to the appointment of the additional officers necessary for carrying on the work of the department in an efficient and satisfactory manner." Appended to the Report, there was a statement of the work done by the Inspectors in the year 1889-90; corresponding with Tables VI. and VI.a in the Appendix to this Report. The Committee considered the above Report, and the question generally, at two special meetings, and they interrogated each of the Inspectors, as to his duties, separately and independently. It was incidentally mentioned in the course of the enquiry, that many provincial towns had a much larger Inspectorial staff than our Parish; Brighton being named as one example, where, with a population of 124,000, nine Inspectors are employed, of whom seven are certificated. Hull also was mentioned, population 214,000: thirteen Inspectors, of whom five are certificated. The decision arrived at, by the majority of the Committee, on the reference back of the question which gave rise to their further enquiry, was embodied in a recommendation that "two Street Inspectors be appointed." These appointments having been 176 made, the Committee further considered the duties of the several officers and made a Report thereon, and on the reorganization of the department as follows:— "Report of the Works and Sanitary Committee on the Subjoined Resolutions, adopted by the Vestry on the 4th day of March, 1891, viz.:— "1. That it is incumbent on the Vestry to have an adequate staff of Inspectors, for the purpose of carrying out the duties imposed on it, and on the Medical Officer of Health, under the provisions of the Housing of the Working Classes Act, 1890, the Infectious Disease (Notification) Act, 1889, and the Infectious Disease (Prevention) Act, 1890, without detriment to the ordinary sanitary work of the Vestry. "2. That it be referred to the Works and Sanitary Committee to consider and report to the Vestry whether any, and if so what, arrangements are necessary to give full effect to the preceding resolution. "Your Committee, having carefully considered the reference, beg to report that they are of opinion that the staff of Inspectors would be adequate, for carrying out the duties imposed on the Vestry and on the Medical Officer of Health, under the provisions of the Acts above named, and without detriment to the ordinary sanitary work of the Vestry, provided that the services of the two Street Inspectors, recently appointed, are utilized in rendering assistance to the Sanitary Inspectors in the performance of their ordinary duties; and, to give effect to this suggestion, they submit the following recommendations for adoption by the Vestry:— "(a) That the two Street Inspectors also act as Assistant Inspectors of Nuisances, and be responsible to, and take their instructions from, the Medical Officer of Health, in regard to the duties of a sanitary character devolving upon them. 177 "(b) That the duties of the two Street Inspectors be those defined in Appendix B to this Eeport, and that for the performance of the duties relating to obstructions in, upon, or over the roads and footways of the Parish, the Inspectors be responsible to, and take their instructions from the Surveyor. "(c) That it be an instruction to the Sanitary Inspectors, that they are not to regard the appointment of the Street Inspectors as having relieved them fronx the responsibility of reporting such obstructions and nuisances in the thoroughfares as may come under their observation. "With regard to the foregoing recommendation (b), your Committee desire to state that they are of opinion, after conferring with the Surveyor upon the subject, that it is expedient that all reports as regards obstructions, &c., upon the public footways and roadways, should come through the Surveyor, he being the statutory officer to deal with such matters. "Your Committee having satisfied themselves that additional assistance is required in the clerical staff of the Medical Officer's department, beg to recommend the appointment of a fifth-class clerk, at the commencing salary of that office, viz.:—£30 per annum, and that it be referred to them to make such appointment. "Your Committee beg further to report that they have given careful consideration to the organization of the Sanitary Department and the duties of the Sanitary Inspectors, especially with the view of preventing the time of the Inspectors being frittered away in attending to matters not coming properly within the scope of their duties, and have prepared certain recommendations on the subject, and drawn up a code of instructions for the guidance of the Inspectors. Should the recommendations be adopted, and the instructions be faithfully carried out, your Vestry may reasonably expect a large increase in the number of houses inspected, with consequent improvement in the sanitary condition of the Parish. "The recommendations are as follows:— "1. The Inspector to attend at the office daily at nine o'clock, to enter up the Statistical Record and the Complaint Book, and to assist in the drafting of notices: to leave the office at ten o'clock, proceeding at 178 at once to his district, after recording in a book to be provided for the purpose the time of his departure, together with an explanation of the cause of delay, should he be unavoidably detained. "2. The Inspector to keep a diary, showing the day's work in the order in which it is done, such diary to be entered up at home after office hours. "3. The duty of obtaining particulars of notified cases of small-pox, fever, diphtheria, &c.; of arranging for the removal of the sick to hospitals; of supervising the disinfection of houses after infectious disease; and of superintending the removal of infected articles for disinfection, to be performed by the Inspector for the Central District, who will report to the Medical Officer of Health any sanitary defects or nuisances he may discover on the infected premises. "4. The Inspector to have the services of a labourer in the actual work of preparing rooms for disinfection, as provided by the Order made by the Vestry in 1877. "5. In view of the special and increased duties to be performed by the Inspector for the Central District, the said district to be altered, so as to comprise that part of the parish only, which lies between Kensington Road and Uxbridge Road. "6. The South District in future to comprise the whole of the parish south of Kensington Road. "7. When the Inspector requires a drain to be uncovered for examination, or to be tested, to ascertain its condition, the Medical Officer of Health to give the order to the jobbing contractor for the execution of the works. "8. The Inspector to be responsible for the supervision of work required by any sanitary notice issued by the Vestry, except in cases involving the entire or partial reconstruction of the main drain of the house. In such cases a copy of the notice to be handed to the Surveyor, who will be responsible for the supervision of the work, and will report to the Works and Sanitary Committee, when the same shall have been completed to his satisfaction. "9. Houses not to be visited by the Inspector upon application of the owner or the occupier, unless the ground for such application be stated. Should the application be made in writing, and no reason be given, the letter to be handed to the Medical Officer of Health, with a view to the necessary enquiry being made. "10. Should an application be made for the inspection of a house for the purpose of ascertaining that the sanitary arrangements are satisfactory, merely for the satisfaction of the owner, or the occupier, or 179 of an intending tenant, no nuisance or defect being alleged to exist the applicant to be informed that the Inspector is not permitted to make such inspections or sanitary surveys. 1. Reports by the Inspector in regard to matters arising out of inspections or otherwise, to be made to the Vestry; no reports to be issued by the Inspector to parishioners or others, but only such notices as the Vestry may direct. 12. Letters to the Inspector making complaint of nuisance, or in relation to his duties, or arising out of the service of notices, or otherwise, to be deemed to be addressed to the Vestry, and to be handed to the Medical Officer of Health for record and preservation. "13. In the work of inspection, the several streets in each district to be taken in rotation, the Vestry's Instructions for the guidance of the Inspectors, set out in Appendix A, to be strictly followed. "14. The Inspector, in each case reported by him, to state under what Act he proposes that notices be framed and other proceedings taken. "15. When the requirements of the Vestry's notice for the abatement of a nuisance, or for the execution of works, &c., are not complied with within the time limited therein, the Inspector to report the fact to the Medical Officer of Health forthwith, with a view to proceedings, by summons, being taken, so that each case may be followed up to its legitimate conclusion without loss of time. "16. Slaughter-houses, Cow-houses, and premises where Offensive Trades are carried on, to be visited once a month, and Bakehouses once a quarter, or more frequently if necessary. "Your Committee desire to state that they have not attempted to make their Report on the duties of the Inspectors exhaustive. Their aim has rather been to point out how the time of these officers may be utilized to the utmost advantage; to indicate the lines on which improvement in organization may be most advantageously effected; and to enforce the necessity for concentration of effort, essential to success in the work of the Sanitary Department. "In consideration of the new duty imposed on Inspectors Gaylard and Abbott, of entering up their diaries at home after office hours, your Committee recommend that those officers be allowed to retain the five pounds per annum hitherto paid to them in respect of extra services under the Sale of Food and Drugs Act 180 "Your Committee have now only further to recommend that the reports of the Inspectors be made through the Medical Officer of Health, and that, by resolution of the Yestry, the Sanitary Department be placed under the immediate control and direction of that Officer. "All which your Committee beg to submit." " Appendix A. "Instructions for the Guidance of the Sanitary Inspectors when Inspecting Dwelling-houses. "drainage. "The drain to be water-tight; to be fitted with a clearing pipe at the highest point, where practicable; and to be trapped from the sewer, outside the house, by means of a syphon provided, where practicable, with an access chamber thereto, having a fresh air-inlet and an air-tight cover. "The Drain to be Ventilated by the soil-pipe, and, where directed, by a special ventilating-pipe, carried up above the roof from the highest practicable portion of the drain. "water-closets, &c. "The Water-closet Accommodation to be adequate for the number of inmates, and to be so placed as to admit of lighting and ventilation from the outer air. "The Soil-pipe to be Ventilated from its highest point, by means of a pipe not less than three inches in internal diameter, formed of lead or iron, with all joints made air-tight, and carried up above the roof, as far as practicable from all windows, doors, chimneys, or other openings. "The Water Supply of the closet to be provided from a separate cistern, or from a syphon flushing tank, having a capacity of, at least, two gallons, and a down-pipe l¼ inches in diameter. "water supply. "The Water Supply to be adequate for the requirements of the inmates. 181 "The Cistern to be constructed of proper materials and properly covered; to be so placed as to be easy of access for inspection and cleansing, and to be kept clean. "The Warning or Overflow-pipe to be made to discharge in the open air, where practicable. "Note.—When there is a constant service, drinking water should be drawn from a tap fixed on the rising main. "waste-pipes. "The Waste-pipes of Sinks, Lavatory-basins, Baths, &c.,to be disconnected from the drain, or the trap of the w.c., or the soil-pipe, &c.; to be trapped and made to discharge over or near a properly trapped stoneware gully, outside the house, where practicable. "Note.—Bell Traps are not to be deemed efficient. "roof drainage. "Rain-water Pipes to be disconnected and made to discharge into a properly trapped stoneware gully, above or below a grating. "dust-bin. "The Dust-bin to be so placed as not to be a nuisance. "Note.—-Portable galvanized iron receptacles are preferable, and to be recommended, for storing house refuse. "yard. "The Yard and Areas to be properly paved with impermeable material (preferably with asphalte, or cement on concrete), with an adequate fall to a properly trapped stoneware gully covered with a grating. "Note.—Should the yard be already paved with stone or bricks, the joints of same to be kept efficiently pointed with Portland cement. "yards, area-walls, &c. "The Walls of Yards, Areas, Wash-houses, and outside Water-closets to be periodically cleansed and lime-whitened. 182 "Appendix B. "List of Duties of the Street Inspectors. "1. To keep observation and report, to the Surveyor all cases of obstruction upon or over the roads and footways. "2. To report to the Surveyor all cases where offences are committed by the beating of mats on the public footways, or by the sweeping of refuse from houses and shops into the street. "3. To report to the Surveyor all cases where sun blinds are so fixed as to be at less than the Statutory height from the public footway. "4. To report to the Surveyor all cases where trees or shrubs overhang the public thoroughfare at such a height as to interfere with vehicular or pedestrian traffic. "5. To inspect the drinking fountains and troughs erected in the public thoroughfares. "6. To inspect mews and other stable premises, with a view to the enforcement of the periodical removal of manure therefrom, in conformity with the regulations of the Vestry. "7. To assist the Sanitary Inspectors in the performance of their duties, under the directions of the Medical Officer of Health, attending at the office daily at 9.30 a.m., to receive instructions, make reports, &c. "8. To act under the instructions of the Vestry Clerk in the matter of keeping observation, procuring evidence, and reporting, with regard to houses which are complained of as being of a disorderly character. "9. To procure, in accordance with directions to be received from the Vestry Clerk, samples of Food, Drugs, &c., for the purpose of analysis by the Public Analyst, under the Sale of Food and Drugs Act, 1875. "10. To keep a diary showing the day's work in the order in which it is done, such diary to be entered up at home after office hours. 183 "11. To prepare and serve such notices, under the instructions of the Heads of Departments, as may be necessary; and generally to carry out such other duties as may be allotted by the Vestry from time to time. "Note.—The hours of the Street Inspectors are from 8 a.m. to 5 p.m. (Saturday 2 p.m.)., excepting in so far as they may be required to perform duties at other times under paragraphs 8 and 9." The above Report was adopted by your Vestry; a junior clerk was appointed as well as a "sanitary labourer," and the several officers in the department are now carrying out their duties in conformity with the provisions contained in the Report and Appendices. The pressure of current work therefore, so far as the Sanitary Inspectors are concerned, has been diminished by their release from the performance of a variety of duties which do not come within the definition of "Sanitary Work." To that extent, therefore, the power of the department, for the discharge of the duties proper to the office of Sanitary Inspector, has been increased; but whether the assistance given will suffice for the performance by the Inspectors of their duties as enlarged by recent and impending legislation, time only can determine. OFFENSIVE BUSINESSES. What I shall have to say under this head will serve at once to illustrate the advantages of bye-laws, and the difficulties with which the Sanitary Authorities have to contend for want of byelaws. Your Vestry took steps some years ago, to obtain an extension of powers, by an ineffectual appeal to the Metropolitan Board of Works, referred to in the next but one paragraph; but, as it will appear, the Special Purposes and Sanitary Committee of that body ultimately saw reason to modify the views they had originally expressed, so that their final opinions came to correspond closely with those I had set out in the 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 184 the statutory description "offensive," other than that of a "slaughterer of cattle," carried on in this Parish, is that of a "FAT EXTRACTOR." This business, at Tobin Street, Netting Dale, 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. These premises were inspected in July by the Works and Sanitary Committee, who, in their Report, stated that "many of the inhabitants in the locality made complaints of the stenches as they occur late at night, when the boiling of miscellaneous collections of house refuse, contents of hog tubs, scraps of broken food from hotels, &c., is going on; the fat being collected into barrels, and the liquid remaining over being taken away in a properly constructed iron tank-van, for use as food for pigs. A very large collection of bones that had been properly stored in a closed chamber, was in process of removal, and contributed to the sickening smell which was common to the entire premises." The Committee did "not doubt that the proprietor takes all proper precautions, in the conduct of his business, to minimise nuisance, but they believe that no effort can be wholly successful." Their conclusion, with which I heartily coincide, was that " it would be well indeed, for the locality, could the proprietor be induced to remove the business to a less objectionable site"— in other words, out of London altogether. MARINE STORES. Every year, during the hot weather, complaints are received in regard to stenches arising in the collection, removal, and storage of bones, fat, and other animal matters, in a more or less putrid condition, in connection with the business of "marine-store dealer." Other businesses, such as those of fishmonger, poulterer, &c., may be, and often are, the cause of nuisance and 185 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 dwelling houses, 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 Committeee, 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 slaughterhouses, 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, the District Boards, &c. 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-andbone dealer), and ultimately (in 1883) your Vestry resolved to apply to the Metropolitan Board of Works to schedule this 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 of a rag-and-bone dealer to be ejusdem generis with the businesses scheduled in section 3 of the Act. In November, *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. 186 1887, a commmunication 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, &c." They admitted, also, that the provisions of the Nuisances Removal Acts, and the Metropolis Management Act, did 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, &c. 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. 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 * Vide Annual Report for 1887, pages 176—89, inclusive. 187 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. The Committee, indeed, made no report on the subject, and nothing has been done hitherto with a view to the abatement of an admitted nuisance. There is reason, however, for believing that it can and will be dealt with, as I recommended that it should be, under the provisions of what will shortly be the Public Health (London) Act. NUISANCE FROM BRICK-BURNING. Every summer, complaints are made in regard to stenches, usually observed in the evening and the 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 nuisances arising from this cause, at Streatham and Hampstead respectively, and in a third case, last year, in the district of the Chiswick Local Board, the nuisance existing in the adjoining Parish of Hammersmith. The decisions in these 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 and Chiswick cases, to incur the expense and worry of litigation. The nuisance, however, being unquestionable, and such as may be prevented by the 188 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, at my instance, some years ago, 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 was added that "the experience acquired under the Slaughterhouses 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." In consequence of reiterated complaints, in the summer of 1889, 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 189 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 brickmakers to so carry on their trade as to minimise the nuisance as much as possible. (e) 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 Yestry " fully realised the 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 Yestry's Solicitors, who, after careful consideration of the subject, advised that "the simplest and practically the only course open to the Yestry, is to place themselves in commtmication 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; but the Council did not see their way to falling in with the suggestion. At the request of your Vestry, attention was called to the subject, in Parliament, by Sir Algernon Borthwick, who asked the Home Secretary (16th August), "Whether Her Majesty's Government would promote or support legislation with the view of making such nuisances removable by law ?" to which the answer given was that " No pledge can be given as to legislation," 190 The County Council, I may add, have shown a marked desire to deal with the nuisance, and in October last, the Sanitary Committee presented a Report on the subject, as follows "Our attention has been directed from time to time, to the serious nuisances arising from brick-burning, ballastburning, and kindred trades. These nuisances mainly arise from the evolution of large volumes of offensive effluvia and smoke, in the burning of bricks in clamps, and in the burning of ballast; and also from the burning of the refuse matter, or soft core, which is not suitable for use. On account of the peculiarly offensive nature of the vapours, and the distance to which they are at times carried, the nuisance extends over considerable areas, which are often thickly populated districts. We are satisfied that the discomfort experienced in London from these sources, is more considerable and widespread than perhaps from any other source. The 16th section of the Local Government Act enables the Council to exercise the power, given by the 23rd section of the Municipal Corporations Act, 1882, of making bye-laws for the good rule and government of the County, and for the prevention and suppression of nuisances not already punishable in a summary manner; and we consider it most desirable that byelaws, dealing with the nuisances referred to, should be made by the Council, under this section, without delay. We have prepared, and now submit, the following bye-laws for this purpose:— "Bye-Laws for the prevention of nuisance in brick-burning, ballast-burning, brick-making, tile-making, pipe-making, and the burning of soft core, made in pursuance of section 16 of the Local Government Act, 1888, and section 23 of the Municipal Corporations Act, 1882:— "1.—Every person who carries on within the County of London, any of the following processes; that is to say, brickburning, or ballast-burning, or brick-making, or tile-making, or pipe-making, or the burning of soft core, or any other like pro- 191 cess, shall cause every such process, in which any offensive effluvia, vapours or gases are generated, to be carried on in such manner, that no offensive effluvia, vapours, or gases shall escape into the external atmosphere, and shall cause all such offensive effluvia, vapours, or gases to be effectually arrested or destroyed. " 2.—Every person who shall offend against the foregoing bye-law, shall be liable for every such offence to a penalty of five pounds. "Provided, nevertheless, that the Justices, or Court, before whom any complaint may be made, or any proceedings may be taken, in respect of any such offence, may, if they think fit, adjudge the payment, as a penalty, of any sum less than the full amount of the penalty imposed by this bye-law. "We recommend— "That such bye-laws be made, and the necessary steps taken for obtaining the confirmation of the Local Government Board thereto." The Report was received, the recommendation was adopted by the Council, and the proposed bye-laws were forthwith sent to the Local Government Board for their sanction—which has not been received; a pretty sure indication of doubt on the part of the legal advisers of the Board as to the power to make bye-laws for the purpose; and so far confirmatory of my opinion, long entertained, that legislation is necessary for enabling some Authority (properly, the County Council) to deal with the question. Such legislative powers, I hope and believe, will be conferred by the Public Health (London) Act, which will come into operation on the first day of January, 1892. OFFENSIVE SMELLS. It may be mentioned, in connection with the above subject, that many letters appeared in the daily newspapers, in October, and under a variety of headings, but all making complaint of "offensive smells" in London—smells which, so far as they affected this parish (to which the earlier complaints referred), were due to brick-burning in adjoining districts. In a Report 192 I made on the subject (No. 11, Nov. 3, page 126) I stated that some of the writers charged the local nuisance to refuse destructors which had no existence, whilst others attributed the stinks to the burning of refuse heaps, or of "soft core," of the occurrence of which we were unable to discover any evidence. Sewer gullies and sewer ventilators were blamed, and it was admitted that the gullies are often in fault, as in numerous cases I had reported to the Works and Sanitary Committee. Ventilators being in the centre of streets are less open to suspicion or objection. Effluvia from these sources, however, as I pointed out, are noxious in the immediate locality only : it is not possible to appreciate them at any distance. Some persons attributed the evil to the ventilating-pipes of house drains; but in cases where there is an intercepting chamber, or a syphon, between the house and the sewer, with a fresh-air inlet, no sewer gas can escape by the pipe which ventilates the house drain only; and which, if the arrangements are proper, should not be a cause of annoyance. Where there is no chamber or syphon, the pipe ventilates the sewer also; and it is the opinion of the Surveyor, endorsed by your Vestry, that such ventilation should be effected: not occasionally, or as it were by accident, but systematically, by arrangements specially designed for the purpose. But were this condition more general than it is, or is likely to be for many years, it may be doubted whether stinks, such as those complained of, would result, gases becoming quickly diffused in circumambient air, and so thoroughly diluted as to be imperceptible at any considerable distance. Ventilating-pipes, moreover, are, or should be, placed well above the roof of the house, and away from window or chimney openings. The dust-bin was about the only other alleged source of the nuisance; but stinking as this is often found to be, as a result of improper use, it is a local annoyance, and does not account for the complaints. Indeed, I felt confident that all of the above-recited causes combined, were inadequate to produce the stinks complained of. Moreover, they are constantly in operation, but practically, complaints are confined to a particular season—that, namely, when brick-burning is going on, a process which, I believe, is the all-sufficient cause of the annoyance, which 193 arises from the fact that the bricks themselves, and the fuel used in burning them, are more or less charged with organic matter, of animal and vegetable origin, derived from dust-bin refuse, the slow frizzling of which is the immediate cause of the nuisance. COMMITTEE FOR CARRYING OUT THE NUISANCES REMOVAL ACTS. With the view of accelerating proceedings in nuisance cases, 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 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, during a considerable part of the year, sit weekly for the transaction of Sanitary business. The 81st Section of the Housing of the Working Classes Act, 1890, gives power to the Local Authority to appoint Committees. It reads as follows:— " Section 81.—For the purposes of this Act, a Local Authority acting under this Act may appoint, out of their own number, so many persons as they may think fit, for any purposes of this Act which in the opinion of such Authority would be better regulated and managed by means of a committee: provided that a committee so appointed shall in no case be authorised to borrow any money, to make any rate, or to enter into any contract, and shall be subject to any regulations and restrictions which may be imposed by the Authority that formed it." I recommended the appointment of a committee for the regulation and management of business arising under the Act, and your Vestry delegated the necessary powers to the Works and Sanitary Committee. h 194 THE WORK OF THE SANITARY INSPECTORS. Tables VI. and VIa. (Appendix) contain a summary of the work of the Sanitary Inspectors during the year ending March 25th, 1891. One hundred and fifty-nine summonses were taken out (viz., under the Nuisances Removal Acts, 106 ; the Metropolis Local Management Act, 3; the Lodging-bouse Regulations, 22: for non-removal of manure, under the 53rd section of the Sanitary Act, 1866, 15; for the keeping of swine, 1; and for disobedience of Magistrates' Orders, 12). The number of summonses in the previous year was 148. Orders were made in the 106 cases under the Nuisances Removal Acts, inter alia, for the execution of works as follows:— To repair, cleanse, and white-wash walls of rooms, &c. 40 To provide a supply of water to water-closets 62 To disconnect waste-pipes of cisterns, sinks, &c., and rain-waterpipes from drains 29 To repair, cleanse, and unstop drains 12 To ventilate drains or soil-pipes 18 To repair soil-pipe, ventilating pipe, &c. 9 To abolish bell traps 21 To cleanse and repair water-closets 18 To repair roofs, &c., of houses 8 To cleanse, repair, and provide covers to cisterns 15 To provide new or repair existing dust-bins 21 To pave or repair paving of yards, areas, &c. 19 To abate overcrowding of rooms 2 To improve ventilation of rooms 2 Of the three summonses under the Metropolis Local Management Act, two were withdrawn, the work having been commenced after the service of the summonses, and before the day appointed for the hearing. In the other case (water-closets without water supply) the defendant was fined £3 and costs. Twenty-two summonses were issued for breaches of the Lodging-house Regulations, with the result that fines to the amount of £23 18s. 3d. were inflicted, as follows:— 195 Premises. Offence. Penalty. 15 & 16, Merton Road, Defective drainage . 61 0 0 and costs 13, Convent Gardens, Dirty rooms, &c. 3 16 0 „ 23a, Bolton Road, ,, 0 5 0 „ 24, Bolton Road, Defective drainage 1 0 0 „ 35, Southam Street, Dirty rooms, &c. 0 10 0 „ 42, St. Katherine's Rd., Defective drainage 0 5 0 „ 20, St. Clement's Road, Overcrowding (very poor case) 0 0 3 „ 42, St. Katherine's Rd., Dirty rooms, &c. 0 10 0 „ 2, Bolton Road, ,, 2 0 0 „ 3, Bolton Road, Defective drainage, 1 0 0 „ 4, Bolton Road, Dirty rooms, &c. 1 0 0 „ 5, Bolton Road. ,, 1 0 0 „ 9, Bolton Road ,, 1 0 0 „ 10, Bolton Road ,, 1 0 0 „ 71, Southam Street Choked Drainage 5 0 0 „ 15, St. Mark's Road, Refusing 1 0 0 „ Fulham Road tor admission to room 29, Southam Street Dirty rooms, &c. 0 10 0 „ 4, Absalom Road ,, 0 1 0 „ 7, Absalom Road ,, 0 1 0 „ 8, Absalom Road ,, 1 0 0 „ 9, Absalom Road ,, 1 0 0 „ 10, Absalom Road ,, 1 0 0 „ Three of the 12 summonses for disobedience of the Justices' Orders were withdrawn; fines being inflicted, to the amount of £30 0s. 6d. and costs, in the remaining 9 cases, as follows:— 9, Archer Mews £4 18 6 and costs 10, Archer Mews 1 4 6 „ 11, Archer Mews 1 4 6 „ 219, Ladbroke Grove Road 6 0 0 „ 10, Mary Place 0 5 0 „ 422, Portobello Road 4 12 0 „ 32, Prince's Road 0 10 0 „ 80, Fulham Road 4 16 0 „ 8, Golborne Terrace 6 10 0 „ H 2 196 Fines were inflicted to the amount of £10 6s. in respect of fifteen summonses for non-removal of manure, under the 53rd section of the Sanitary Act, 1866. Nine of these summonses were taken out by the two Street Inspectors who were appointed in November last. A summons was taken out against a man in Tobin Street, Notting Dale, for the keeping of swine on his premises. The Justices inflicted a fine of 1s. with costs, and granted a prohibition order. Proceedings were instituted against a man living in Treadgold Street, for offences under section 38 of the Sanitary Act, 1866, viz., for exposing his child in a public place while suffering from an infectious disorder, scarlet fever, to wit, without proper precautions against spreading the said disorder; and for transmitting and exposing, without previous disinfection, bedding and other household articles, which had been exposed to infection, in the course of removal from one house to another. The man was fined forty shillings and costs. During the year, 6028 houses were inspected, and 2179 notices were issued, viz., under the Nuisances Removal and Metropolis Local Management Acts 1653, and under the Lodginghouse Regulations 526. The number of houses inspected in the previous year was 5945, the notices issued being 2501. 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 abovenamed Act was passed. In view of probable legislation, I had read 197 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 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 provision 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 Yestry, at my instance, contended successfully before the justices, and the Local Authority subsequently followed suit. Your Yestry, 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 nearly two years awaiting sanction. The existing bye-laws are serviceable, having led to considerable improvement of the licensed premises, and to the closing of many of the worst establishments. In 1874 there were some 1500 slaughter-houses in London; in 1890, 665 only. In Kensington 48 were licensed in 1873, the year before the Act came into operation ; in 1874, 31 only. The present number is 21, 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 198 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 license. 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. Twelve of the 21 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 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 and Sanitary Committee, who reported on them as follows:— " All of the premises were found in a satisfactory condition as to general cleanliness, but in more than one or two of them there were offensive collections of offal, &c.,in the receptacles. The licensees stated that such offal was the product of slaughtering within the previous 24 hours. Be this as it may, it is the duty of the licensee to cause offal, &c., to be removed from the premises before it has become offensive. In two or three instances, at premises where no slaughtering had been done for some time, offensive smell was traced to collections of fatscraps, &c., in bags, removed from the shop, and intended for the fatmelter. The bags themselves necessarily become stinking, and it would be well if such fat were stored in impermeable and covered metal vessels pending removal. Enquiries made by your Committee led them to conclude that, as a rule, no definite arrangements are made to secure the daily removal of offal, &e., the licensees often depending on the chance call of manure collectors, into whose carts the receptacles are emptied. It is certainly the rule that receptacles are emptied on the premises, and not taken away with their contents, as they needs must be if nuisance is to be avoided. Such an arrangement would involve the keeping of duplicate sets of receptacles, for which, practically, provision is made in an amended code of bye-laws which the County Council framed, and forwarded to the Local Government Board, as Confirming Authority, so far back as July, 1889, but which has not yet 199 received the sanction of that Board. It may be added that some of the receptacles were out of shape, so that the covers did not fit. In such cases nuisance is inevitable, when the offal, &c., has passed into a state of decomposition. Four of the slaughter-houses, two in Royal Crescent Mews, and one each in Ledbury Mews and Clarendon Mews, are defectively lighted, so that when the doors are closed it is impossible to see to carry on the business, which requires a good light. And as a matter of fact, business was being carried on at two of the premises with open doors, and children were looking on. At several of the premises no business appeared to have been carried on for considerable periods) the slaughter-house being used for other purposes, mostly for standing trade vehicles. Two of the premises were found to have changed hands since the licenses were renewed in October last; in one instance a business had changed hands twice within the year, and no transfer of the license had taken place ; in the other case your Committee saw the business being carried on within public view, contrary to the regulations, a fact which would render a licensee amenable to the penalty prescribed therein. Your Committee are of opinion that such transfer should always be effected, as otherwise it would be difficult to fix on anyone the proper responsibility for breach of the bye-laws. It is a question, moreover, whether the use of a slaughter-house by any other person than the one to whom the license is granted is not unlawful." It may be added that comparatively little slaughtering is now done: on some of the premises none at all, the license 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. In my last Annual Report, I gave a summary of the provisions of the Sale of Horseflesh, &c., Regulation Act, which came into force in September, 1889. Hitherto no shop had been opened in this Parish for the sale of horseflesh for food of man. COWSHEDS, DAIRIES, &o. 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 200 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, &c., 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 J 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, at page 25. 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, 201 &c.) being ignored. There has been considerable redaction in the number of cowsheds in the metropolis; from 1044 in 1880 to 628 in 1890. In 1878 the number in Kensington was 26; now there are 10, viz., 7 in North Kensington and 3 in South Kensington. The names of the licensees, and the localities of the licensed premises, are set out in Table XII. (Appendix). The several licensed premises were inspected by the Works and Sanitary Committee, who reported on them, as follows :—• "The several premises were found in a generally satisfactory condition. On one of the premises there was a large collection of offensive manure, and your Committee were informed by the Inspector that he had frequently had cause to complain of neglect to remove the refuse with due regularity: they, therefore, ordered proceedings to be taken for breach of the Vestry's regulations for the periodical removal of manure; it being questionable whether proceedings could be taken for breach of the regulations of the Local Authority (County Council), the cows belonging to one person, and the license having been granted to another. This cowshed, moreover, requires additional louvre ventilation." The Committee saw no occasion to oppose the renewal of any of the licenses, either of the slaughter-houses or the cowsheds ; but, as usual, formally recommended that the Vestry Clerk and the Medical Officer of Health be authorised to give the required notice of opposition, should occasion arise before the day appointed for the renewal of the licenses. They also recommended that a representation be made to the Sanitary Committee of the County Council, in the sense of their views, as above set out, in regard to the defective lighting of certain of the slaughter-houses, the transfer of premises without the transfer of the license, and other matters dealt with in their Report. In conformity with the instructions of your Vestry, I attended at the County Hall, on the 16th October, the appointed day for the licensing of Slaughter-houses and Cow-houses, in support of the Committee's objections to certain premises above referred to. Objection had been made to three slaughter-houses, on the score of defective lighting, and the renewal of the license in each case was deferred until the said defect had been remedied. 202 Previously, in a communication to the Council, dated 7th October, attention had been drawn to an application for renewal of the license of a cow-house made by A, who does not keep cows, on premises occupied by B, who is the owner of the cows. This case was deferred for enquiry. At the adjourned meeting the new license was granted to A, who has no intention of occupying them. In the same communication your Vestry expressed a desire to "learn the views of the Council as to the legality of the practice of persons who use licensed premises without a license— whether it be (1) by taking over the business of a licensee, or (2) by taking the premises from the licensee, or (3) by arrangement with the licensee " for the casual or regular use of his premises. In their reply, the Council pointed out "that it was the practice throughout the various licensing divisions into which the metropolis was divided" (i.e., prior to the passing of the Act which transferred the licensing powers from the Justices to the Council), "to regard the licenses as being licenses to use certain premises as places for slaughtering cattle or keeping cows, as the case may be." The Council further observed that it had "not been found convenient to regard the licenses as being only for the use of the particular persons who may have applied for them, and this view appeared to be in accordance with the terms of the 93rd section, 25 and 26 Vic., cap. 102; as an offence against the section only arises if any person uses as a slaughter-house or a cow-house any place which has not been licensed. The practice," it was added, had "been found to work well, and the Council considered it would be a great and unnecessary restriction on the trades, if the licenses were to be regarded as merely personal ones, and if on any change of occupant a new license had to be obtained." With reference to the foregoing observations, I may venture to state that in the Kensington Division, it was never "the practice ... to regard the licenses as being licenses to use certain premises" for the conduct of the business by other persons than the licensees; but it was the practice of the Justices to appoint a particular day for the transfer of the license, when a business had been transferred, or the trade had come to be carried on by any other person than 203 the one named in the license as being licensed to use the place. I may add that the Council, in the slaughter-house (or cow-house) license, state that they "do hereby license A, B being a person carrying on the business of a slaughterer of cattle" (or a cowkeeper, as the case may be), "to use a certain place, being a slaughter-house" (or cow-house)—situation described—"in the Parish of Kensington, in the County of London, as a slaughterhouse " (or cow-house), the duration of the license being for one year. It is quite true that it is the place that is licensed, and your Vestry's purpose in asking for information has been sufficiently answered by the Council's reply. The Council, I may add, expressly stated, with reference to a particular case cited, that their "regulations are for prescribing and regulating dairies and cowsheds in the occupation of persons following the trade of cowkeeper or dairyman, and that the occupier" (even though he be not the licensee)" is the person who would be responsible for the observance of the regulations, or any breach thereof." In the case mentioned, an offence having been committed, the Vestry, as the Council were informed, had " felt that they could not proceed under the regulations of the Local Authority, the offender not being the licensee, and the licensee not being the offender." It now appears that your Vestry might have proceeded against the offender for breach of the regulations. Proceedings were successfully prosecuted under the Sanitary Act. I am glad to be able to report that the Council no longer suffer horses to be stabled in cow-houses, their practice, in this respect, now corresponding with the views I submitted to, and which were approved by your Vestry many years ago. BAKEHOUSES. The Bakehouses, to the number of 148, viz., 81 in North Kensington, i.e., north of Uxbridge Road, and 67 in South Kensington, i.e., the remainder of the parish south of that road, 204 were regularly inspected, and such action taken in individual cases as was found necessary for ensuring compliance with the sanitary provisions of the Factory Acts. (Vide page 165 also.) RUFUSE 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, as I have often asserted in these Reports, not likely to be surmounted without legislative action. Such action is now being taken: provisions in the Public Health (London) Bill—which will pass, the Act coming into force in 1892—dealing with the matter, especially by enabling the County Council or the Sanitary Authority to make bye-laws, in conformity with my views, expressed in these Reports (vide page 95). This 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 Parliamentary Committee, and in my observations on a communication received by your Yestry, 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, as I observed in my last Report, "is the proper and only body able to deal effectively with the matter, viz., by procuring legislative power enabling them to frame sanitary bye-laws." HOUSE REFUSE. The collection of ashes and miscellaneous refuse from 22,000 inhabited houses, spread over an area of some 2200 acres, and to the extent of 44,549 loads in 1890, 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 205 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 dust-man is made. Nuisance, in the sanitary sense, need not arise even from a full dust-bin: when it does occur it is due to improper use of the receptacle by the deposit therein of animal and vegetable matters; of which it may be said that the former has an appreciable value, and should be utilized, 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 dust-bins 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 Yestry, 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. Nothing came of your Vestry's action, the Board having adopted the view of their Special Purposes and Sanitary Committee, to the effect that it was "not desirable to promote the suggested legislation." The County Council think otherwise: the matter is dealt with in the Public Health (London) Bill, and much of the required power will be conferred when the Act comes into force in 1892. 206 The subject is important, and can be dealt with effectually under bye-laws, such as will be framed by the Council under the provisions of the pending measure. A constantly increasing difficulty is experienced in finding convenient, i.e., accessible "shoots" for house refuse, to the deposit of which within their boundaries, the Sanitary Authorities of contiguous districts naturally object. The refuse, moreover, has little value now that building operations are being prosecuted upon so limited a scale in, or within an easy distance of, the Parish, and other districts being able to supply the brickmakers' wants. The land at Purfleet, on the river Thames, acquired by your Vestry, and in connection with which a landing pier has been provided, will, it is hoped, ultimately furnish a profitable outlet for the greater part of 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, &c., upon the application, and at the cost of, the owner or occupier of any house, &c.;" 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 the Sanitary Authority should undertake the removal, at the cost of owner, 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 207 the Sanitary Authority for its removal. But, at present, it is precisely the 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 objectionable manner. The subject is dealt with, as I long since said it must be, by power being given to the County Council— in the oft-mentioned Public Health (London) Act, which will come into force in 1892—to enable that body to frame bye-laws, which, it is hoped, may apply to the storage as well as to the removal, in proper vessels, of such refuse through streets. STABLE REFUSE. In many 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," &c.; 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 until lately with 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., hay-making 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 208 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, however irregularly. 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 moveable iron cage attached to the stable wall by hooks, air-currents circulating freely through the refuse, and removal being at once easy and complete, there is little or no nuisance either 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 209 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, 1890, to the Works and Sanitary Committee, by whom it was ordered to be printed for the information of your Vestry, and 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" (i.e., your 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, money is 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 suitable fee for the service. At the same time it is not improbable that the large amount of refuse produced in some 180 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 whom 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 210 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. The best part of it, the clean litter from South Kensington stables, moreover, could be made available for the manufacture of paper at the works adjoining your Vestry's property. This subject of stable-refuse removal is dealt with in the Public Health (London) Bill, and power will be given, enabling the Sanitary Inspector to remove collections of manure, &c., at the cost of the owner: but the section is not stringent enough. The section giving power to the Sanitary Authority to contract with the owner for the removal of the manure, makes no mention of payment for the service, but I do not doubt that proper terms could be arranged if the Authority would undertake the work. In any case, I feel confident that, if the Act should be put in force, i.e., if proper bye-laws are made and enforced, there will not be any serious difficulty in abolishing sunken dung-pits. DISINFECTION. During the year ending March 25th, 1891, a large number of infected articles of 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 23 tons 13 cwt., their number 11,261, and the cost of the process; £448 5s. 5d. Four hundred and twenty-two rooms in 391 houses were disinfected with sulphurous acid by your Vestry's officer, no charge being made for the service. Some rooms, in addition, were disinfected by the contractor, as well as numerous parcels of clothing, bedding, &c., at the request and 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 211 the rear of the Vestry Hall, and at Norfolk Terrace—both for the male sex only. Section 88, Metropolis 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. Increased powers in this direction will be given by the Public Health (London) Act when it comes into operation in 1892, including power to compensate persons injured by the erection of these conveniences near their houses, &c. Accommodation is provided at about 170 public-houses—not of a very satisfactory sort in many instances, but better than none at all, and much improved as the result of proceedings taken by your Vestry 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, has been done hitherto, to give effect to the views of the Council. In this Parish one chalet, for men, in Norfolk Terrace, constructed as a speculation by private persons, and having proved unsuccessful, was taken over by your Vestry, and is now in use. 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 212 to any single site in the parish. Much good might be effected by the provision of buildings, on a modest scale, in several localities, to which the poor could resort for the purpose of washing clothing. The statistics contained in the successive Annual Reports of the Commissioners for Baths, &c., demonstrate a constantly increasing use made of the wash-houses, and are of a nature to encourage the hope that it may be found 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 25th March, 1890, and to 39,829 in the year ended March 25th, 1891. The number of hours employed in washing in the three years consecutively, was 38,709, 84,352, and 106,560. Obviously the question of public wash-houses might with advantage be separated from that of public baths. The bathers in 1890-91 were 89,491—viz., males, 77,905, and females, 11,586; in the swimming baths, 48,871, and in private baths, 40,620. The total number in the previous year was 79,029. The Commissioners, in their Annual Report, state that " the amount received, during the year, of the Vestry towards the repayment of loans and interest, and to meet the expenses of maintaining the Institution was £5692, being but a little more than equal to a rate of three farthings in the £ to the Ratepayers." 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."* * Annual Report of the Committee, 1889-90. 213 PUBLIC MORTUARY. The mortuary was opened in July, 1883. In the first year, July, 1883, to March, 1884, 24 bodies were deposited; in the second year 67; in the third year 100; in the fourth year 97; in the fifth year 100; in the sixth year 128, in the seventh year 135; and in the eighth year 207. The bodies removed to the mortuary in the twelve months, ended March 25th, 1891, were admitted, upon application, as follows: — 1. At the request of relatives of the deceased 6 2. At the request of undertakers 67 3. At the request of the Coroner (inquest cases)— Cases of sudden death 89 Cases of violent death 17 — 106 4. Brought in by the Police Found dead 22 Accident cases 5 — 27 5. On account of death due to infectious disease 1 207 In 104 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 214 of such body; the cost of such removal and re-removal to he 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 frequently orders the removal of bodies for this purpose—but, until quite lately, at your Vestry's charge. Even now 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 effect the removal of the body in such cases, by Justice's Order (Sanitary Act, 1866, 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 Infectious Disease (Prevention) Act, now being incorporated with the Public Health (London) Bill, gives increased powers in this direction, but I do not anticipate much effect from such increased powers, unless medical men actively take up the matter. "Very rarely do the facts of cases come to the knowledge of the Medical Officer of Health, and then usually too late. The Royal Commission on the Housing of the Working Classes (1885) recommended provision of additional mortuaries in London. What, however, is even 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, * This section is re-enacted, in slightly varied terms, in section 24 of the Coroners Act, 1887. 215 page 31). Under the provisions of the Public Health (London) Act, when it comes into operation in 1892, Sanitary Authorities, alone or in combination, will be required to provide mortuaries. The London County Council desire 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. The required power will be conferred by the Public Health (London) Act when it comes into operation in 1892. CORONER'S COURT. For some years it has been a common practice on the part of Sanitary Authorities, 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, as there were 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 buildingnot having been realised, your Vestry fitted up a room, in January, 1889, at the Town Hall, where, in eleven months of the year ended 31st December, 61 inquests were held out of a total of 141. The bulk of the 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 public-houses, the post-mortem examination of the body is almost necessarily made in the house where death takes place, at which, too commonly, proper accommodation is totally wanting. Communications passed in 1889, between your Vestry and the Coroner, with regard to the use of the court and of the mortuary, which issued in a more adequate use being made of these valuable institutions. In February, 1890, 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 216 tion is available, to cease holding inquests or Coroner's courts in public-houses." This resolution had good effect, the number of inquests held at public-houses in this parish having fallen in the same year to 37, and 116 having been held at the Court. Coboners' Disbursements.—Amongst the powers as to Coroners transferred to the County Council, from Quarter Sessions, by the Local Government Act, is that given by Section 25 of the Coroners' Act, 1887, to make a schedule of fees, allowances, and disbursements which, on the holding of an inquest, may lawfully be paid and allowed by the Coroner, other than the fees made to medical witnesses in pursuance of the Act. The Council, upon the recommendation of the Sanitary and Special Purposes Committee, have recently adopted such a Schedule, two or three of the items in which, with the remarks of the Committee thereupon, will be of interest to your Vestry. And first, with regard to the— Inquest Room.—"When an inquest or inquests cannot be held elsewhere than in a room hired for the purpose, there may be paid for the hire of such room per day, (a) when the room is used for four hours or less—not exceeding seven shillings; (b) for more than four hours—not exceeding ten shillings." The fee which the Coroner has hitherto paid to your Vestry for the use of his court is half-a-crown. The fee accustomably paid for the use of a room in a public-house is, I believe, five shillings. The Council, however, like your Vestry, think the practice of holding inquests at public-houses objectionable; and so, presumably with a view to discourage the practice, they have decided that "where the inquest is held in a public-house, not exceeding one-half the above fees shall be paid." Dead body.—" Where any cost is actually incurred in removing the body from the place where found to the place where it is kept until the inquest, the amount of such cost, not exceeding five shillings," will be allowed. Hitherto your Vestry have removed dead bodies to the mortuary at the request of the Coroner, and defrayed the cost by payment of a uniform fee of 217 five shillings for each such removal. Henceforth, this charge will be defrayed by the Coroner. Provision is made that "where it is necessary that the body should be cleansed previously to an inquest" (as not seldom is the case) "and such cleansing is done by persons other than the relatives or friends of the deceased, the cost thereof, not exceeding five shillings," will be allowed. "Payments under the Schedule must in every case be subject to the discretion of the Coroner, who should only allow so much of the sums authorised by the Schedule as the circumstances warrant." The Sanitary Committee conclude their Report on this subject by recommending, "That Coroners be requested to avoid, wherever possible, the holding of inquests in public-houses; "and" that they be informed that the Council will be glad if the system of employing officers of the Metropolitan Police, in lieu of special officers, can be extended to all Coroners' Districts in the County of London." Acting upon my Report, that it was desirable that some definite arrangement should be made with the Coroner, with respect to fees payable under the above heads, a conference was arranged between the Coroner, the Chairman of the Works and Sanitary Committee, the Vestry Clerk, and myself, at which a suitable scale of fees was settled. BROMPTON CEMETERY. A mild agitation for the closing of this cemetery, not the first, was set on foot in 1889, and a question was put in the House of Commons, in April, 1890, viz., 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 therefrom, he was not prepared to 218 advise that it should be closed on other grounds. In 1889 the London County Council had 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 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), were "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. This Committee, having " inquired very fully and carefully into the matter," reported, in July, that "no sufficient case to require the closing of the cemetery can at present be established;" a conclusion with which I 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, 1890, 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 appeared that, at that time, some 160,000 interments had 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 interments in common ground for about two years, and in private ground for an indefinite period. 219 REGULATIONS FOR HOUSES LET IN LODGINGS. The Sanitary Act, 1866 (sec. 35)*, enables the "Nuisance Authority" (i.e., your Vestry), with the consent of a Secretary of State, to make Regulations "for houses, or parts of houses, 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, &c., 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 1874, 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 failing to exercise 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 brought the subject before the Society of Medical Officers of Health, and the Society after due deliberation, resolved (1) That the Acts are practicable; (2) That they should be put in operation in London and other large towns; (3) That a *This Act and the Amending Act (1874) will be incorporated in the Public Health (London) Act, which will come into operation in 1892. 220 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 Model Regulations were published "for the guidance of Urban Sanitary Authorities."Your Vestry, finding that the Acts were carried out in but 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 again drew attention to the Acts, and urged the desirability of their being put in force. This address was printed and widely circulated by the Society. In November, of the same year, your Yestry 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, with 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, as time and opportunity permit. The announcement of your Yestry's intention to register houses, proved distasteful to many "landlords," some of whom, complying with your Vestry'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 221 "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 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 and other houses, which are set out at page 180. 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 London 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, under the form of the Housing of the Working Classes Act, 1890, has shown 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. At page 140 a full account has been given of their first great effort in this direction. 222 UNHEALTHY HOUSES: THE LIABILITIES OF LANDLORDS. Towards the close of the year another of those useful actions which have done so much to define the liabilities of landlords in respect of the letting of insanitary houses, came before the Courts, and with a satisfactory issue. It was an action brought to recover damages for misrepresentation in respect of the drainage of a house, the landlord's agent, who had done the repairs, having alleged that it was perfect in every respect, whereas both the bath and the scullery sink-wastes were directly connected with the drain through the medium of the soil-pipe—an insanitary arrangement by no means rare. The plaintiff's case was to the effect that he went into possession in November, 1887; in December or January following, scarlatina broke out, and in February three of his children were attacked by diphtheria, and one of them died. As a result he was put to great charges for medical and other expenses. On the other hand, the defendant denied that he had acted in any way except perfectly bond fide; and the plaintiff having left in April, 1888, defendant counter-claimed for a year's rent. Counsel for the defence relied on the honest belief of the defendant in the truth of what he said, and further, that in fact the drains were in November, 1887, in good order. Mr. Justice Cave, in summing-up, pointed out that the plaintiff must make out (1) that defendant was guilty of misrepresentation; or (2) that the agent was; and (3) that the agent had defendant's authority for making statements as to the drains. An ordinary agent had not such authority, but here, the agent having actually done the repairs, and knowing a great deal more about the house than the defendant did, it would be for the jury to consider the question of authority. It was in evidence that when the plaintiff had mentioned the agent's name to defendant as having made a statement as to the drains, defendant had never repudiated that statement, but had rather affirmed it. The jury found for the plaintiff on the claim and counter-claim; damages £85, for which sum his lordship gave judgment, with costs. 223 The above case is interesting both as a warning and as an example. It shows how easily people may protect themselves when taking a house—not indeed against ill-health, resulting from insanitary conditions, but against pecuniary loss. It also shows what great risks a negligent or reckless owner may incur by a loose or a false assurance as to the sanitary arrangements about which he may know nothing—or too much. The precedent will be useful, but for my own part I would go even further, and contend (as I did 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; "and repeat the expression of my hope then uttered, "that before long this may be established as a principle of English law." It is a principle of English law in respect of houses or parts of houses inhabited by the working classes, a fact which may not be without its bearing upon the question of " unhealthy areas," such as that dealt with in the scheme of the Housing of the Working Classes Committee of the County Council, referred to in another part of this Report (page 140). Section 75 of the Act, under which that scheme has been prepared, enacts that:— " In any contract made after the 14th day of August, 1885, for letting for habitation, by persona of the working classes, a house or part of a house, there shall be implied a condition that the house is at the commencement of the holding in all respects reasonably fit for human habitation.*" The expression "letting for habitation by persons of the working classes,"means" the letting at a rent not exceeding in England the sum named as the limit for the * It would be an interesting enquiry how many of the 652 occupied houses on the Bethnal Green "unhealthy area." let, wholly or in part, since August 14th, 1885, comply with the "implied condition" of the section, and to what extent the owners of insanitary houses have laid themselves open to damages for breach of the said condition 1 The question is really important, in connection with the report of the Medical Officer of Health for Bethnal Green, as to the state of ill-health of the poor people, and the excessive mortality which prevails. Would that a philanthropist would take up their cause, and help them to obtain the redress to which, by the above law, they would appear to be entitled No better service could be done, to bring about a better state of things in regard to the housing of the poor. 224 position of rates by section 8 of the Poor Rate Assessment and Collection Act, 1869," in other words, at a rent not exceeding £20 per annum, 7s. 6d. being the weekly equivalent. 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 above referred to, 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. 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, to which reference was made in my last Report. 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 int he 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 for habitation ; but that was not the question." The learned Judge, having gone carefully through the evidence, 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. 225 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 to be so let or occupied if it possesses" certain "requisites," which it is unnecessary to specify here. 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 131. The Law and Parliamentary Committee, in their Report dealing with the subject, which was adopted by your Vestry in January, 1886, 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 * This section is, with considerable amendments, embodied in the Public Health (London) Act, which will come into operation in 1892. The duties at present devolving on District Surveyors will be transferred to the officers of the Sanitary Authority. I 226 by the Sanitary Inspectors, and to such action by the Vestry as the circumstances of each case may seem to warrant."But no action was taken. 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 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 remedial 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 necessary to observe, could not act partially in the matter, and should they take proceedings upon technical grounds, it 227 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 proceeding to close a considerable number of underground rooms not comprised in the lists of District Surveyors, upon the ground that they are unfit for human habitation.'" The County Council, 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 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 lists of the three District Surveyors, received in March and June, which comprised 242 rooms in 187 houses. Notices were served and many of the rooms were brought into conformity with the Act. The County Council assisted in the work, by serving penal notices when the required alterations were not carried out; the general result being that the rooms were rendered legally habitable, or ceased to be occupied " separately." BORACIC ACID AS A PRESERVATIVE OF MILK. The question whether the addition of boracic acid to milk or cream is injurious to health, received much attention during the past year at the hands of the Special Purposes Committee and your Vestry. This question' was carefully considered by the Public Analyst and myself in 1887, and formed the subject of a * Many rooms had been reported by the District Surveyors which were not "occupied separately as dwellings." The views of the Law and Parliamentary Committee as to the interpretation to be placed upon the word "separately" were communicated to the County Council, and were endorsed by the Council, being to the effect that the enactment being a penal one must be strictly construed, no undue scope being given to it, and that for a room to come within the definition contained in the section, it must be held "separately" from any other room or rooms in the house. i 2 228 Special Joint Report. In the course of our enquiries, we found that the acid was usually employed in the form of a proprietary article, which we designated "the preservative," composed mainly of free boracic acid, with a certain amount of borax, and that according to the directions, it is added to milk, in solution, in the proportion of about seven grains to the pint; twice this amount being added to cream. We pointed out the probability that both the farmer and the dairyman might make use of the preservative, in which event the above quantities would be doubled. We were able to discover but little information as to the action of boracic acid upon the human frame, it being not much employed in medicine. Reference, however, was made to its alleged tendency to set up diarrhoea, a disease prevalent amongst infants, the chief consumers of milk, in hot weather, when the " preservative " is most used, in order to delay the changes which milk and cream are then liable to undergo quickly. We also quoted certain observations by Dr. Forster, based on experiments, which go to show that the addition of boracic acid to articles of food, in far smaller proportions than customary, is injurious to health. "Even small doses," Dr. Forster states, "are injurious to the digestive organs," its action on the intestinal discharges being well marked, even by the exhibition of as little as four grains per diem, such action being in direct relation to the quantity taken, and being maintained for some time after the doses of the drug have ceased. References to the subject published in the medical papers since 1887 appear to confirm the justness of Dr. Forster's observations. In the course of their recent enquiries the Special Purposes Committee consulted me relative to a sample of cream, to which boracic acid had been added, desiring to be informed whether the quantity of boracic acid certified to be present (=0.17 per cent. by weight of anhydrous acid) was such as to render the article injurious to health. The Committee also desired me to advise as to the quantity of boracic acid that could be used without being injurious to health. Manifestly, these were questions that could 229 not be answered off-hand, so much depending, as I pointed out to the Committee, on the age of the consumer, on the quantity consumed, and on the length of time during which the use of the article is continued. I cannot doubt, however, that it would be injurious to an infant to consume fourteen grains of the acid daily, the quantity presumably present in a quart of milk to which the " preservative " has been added. I should not like to say, moreover, that boracic acid may be used, for any length of time, in quantity barely sufficient to "keep" milk for 24 hours, in close weather, without risk of injury to the health of infants entirely fed upon such milk. A communication on the subject was addressed by your Yestry to the Local Government Board, wLo, in their reply, stated that they had no facts within their own knowledge which would enable them to advise generally as to the wholesomeness or unwholesomeness of additions of boracic acid as a preservative of food. The question has yet to be decided whether or not the addition of boracic acid constitutes an "adulteration" of milk or cream. THE METROPOLITAN SEWAGE QUESTION. In my Annual Reports for 1885 and 1886, I referred, under the heading "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. 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 adding disinfectants 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 being to avoid the necessity for costly land filtration of the effluent, as recommended 230 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 deodorization of the sewage at the outfalls, and they ultimately consented to the request of certain Sanitary Authorities—your Yestry 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 was a further report on "Deodorization of Sewer Emanations, and on Sewer Ventilation." In my Annual Report for 1887-88, I summarised the contents of all of these Reports (pages 231-240). 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 it 1888; and in March, 1889, yet another report on The Chemical Examination of the Foreshores and Mud Deposits of the River Thames and its Estuary, the outcome of a resolution of the Board, appproving 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 231 for 1888-89, these Reports also were summarised (pages 162-167). Sir Henry Roscoe's engagement with the Board expired at Ladyday, 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 summarised 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 consulted by the Board; and his own Reports, above referred to. Primarily, this paper was prepared for the use of members of the County Council, whose Main Drainage Committee, it was understood, were proceeding upon the lines of the 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 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 232 sewage question; so that the investigations came 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 remains to be seen what will be the effect upon the river of the costly scheme of subsiding reservoirs, and of the deodorization of the sewage, now partially in operation, which the Council are carrying out, although the defunct Board is exclusively responsible for the experiment; an experiment on a vast scale, made, it may be repeated, in opposition to the recommendations of the Royal Commission generally opposed by scientific chemists, and condemned by their own chosen adviser. The amount of sewage dealt with last year at the precipitation works at the northern outfal at Barking (those at the southern outfall at Crossness are incomplete) was over 111,000,000 tons. Speaking of the effect, the Chairman of the Council, in his annual address, stated that there was "a marked improvement in the foreshore there, which was until lately covered with black foetid mud, but which is now gradually returning to its normal condition of a gravelly foreshore, on which green algae are beginning to re-appear, and will themselves contribute to the purification of the water." Against this statement, there has to be set the complaint of at least one Sanitary Authority, that the condition of the river above the works (and of course above the Crossness outfall, where mostly untreated sewage is discharged) is as bad or worse than ever this year—notwithstanding tbe coldness and wetness of the season—and that the black and foetid condition of the water is observable to even a higher point than in former years. The Chairman of the Council added that he had "every reason to believe" that when the Crossness works on the south side are also in operation, there will be a "still further improvement in the condition of the river." The Main Drainage Committee, in their Annual Report, state that "including 11,728 tons, the weight of chemicals," the quantity of sludge obtained in 1890 from the 111,505,000 tons of sewage, was 421,500 tons, of 92 per cent. moisture, and that the cost of lime used was £6774, that of iron being £2641. The quantity of sludge taken out to 233 sea from the two outfalls, by the two sludge ships, in twelve months to March 31st last, was about 497,000 tons, or an average 1500 tons per week, only 77,000 tons coming from the southern outfall. In addition to the above outlay for precipitation, £24,560 was spent last summer in deodorising operations at the outfalls and storm overflows, the chemicals used being 1654 tons of manganate of soda, and 749 tons of sulphuric acid. The Committee have made arrangements "by which the whole of the sewage at Crossness will, during the present summer, be stored in the precipitating tanks during flood-tide, and will be allowed to run into the river at ebb-tide only." The Committee believed that this arrangement would be found to be very beneficial during the hot weather—a belief that would appear not to have been realized. From what has gone before, it will have been inferred 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 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, &c. 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? These questions were attempted to be answered in my last Report, wherein (at pp. 189—192) I described three schemes which had then lately been put before the public, viz., the Amines Process, the International Sewage Purification Process, and the Webster Electrical Process. The two last- 234 named processes are vouched for by Sir Henry Roscoe; the former as suitable for dealing with the sewage of small towns, the Webster Process as practicable even as regards the large volume of London sewage. In summing up my observations on this system, I stated that it was 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." The matter appears to rest at present as it was when my last Annual Report was published. 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" (Metropolitian 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 part, regarding this Regulation simply as a provision * Sir Henry Rosecoe's conclusions are corroborated by Mr. Alfred E. Fletcher, H.M. Inspector under the Rivers Pollution Prevention Act for Scotland. 235 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 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. The introduction of the Public Health (London) Bill during the current Session, appearing to afford a convenient opportunity for conferring this power of carrying out the Water Regulations on the Sanitary Authority, communications were addressed to the President of the Local Government Board, recommending the insertion of a clause to give effect to my views on the subject, but without effect. Cutting-off Powees.—Section 74 of the Water Works 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 1884 a striking exercise of this power on the part of one of the Companies supplying Kensington, who deprived 80 people in a mews of the supply for which they had paid the landlord in their weekly rent—he, however, not having paid the rate—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 of cutting-off the supply of water from a house for non-payment of the rate should be taken away from the Companies, and 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 think fit to enforce their right to prepayment.* * Vide Monthly Reports, 1 and 2, February 1st and March 1st, 1883, pp. 6—8, and 13—18. 236 In 1883 the subject was prominently before your Vestry, and a resolution was passed, on the recommendation of the Works, &c., Committee, to the effect:— "That the sections of the (Water) Acts conferring on the Water Companies the power of cutting off the water from premises should be repealed, such other powers, to enable the Companies to recover rates or make good fittings, being substituted, as to the wisdom of Parliament shall be deemed equitable and fitting." Nothing came of it, however, at that time or on some other occasions, supported though the action of your Vestry was by other Sanitary Authorities. Advantage was taken of the sitting of the Royal Commission on the Housing of the Working Classes, to send to every member of the Commission a copy of my Reports, &c., on the cutting-off case adverted to above, with the effect that, in their Report (1885), the Commission 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 in the House of Lords, it was thrown out in the Commons. In 1887 a very useful measure, Water Companies (Regulation of Powers) was introduced by Mr. Forrest Fulton and became law. Your Vestry petitioned the House of Commons in its favour. It is an Act to "limit the powers of the Water Companies to cut off the tenants' water supply where the rate is paid by the landlord." It makes provision for treating the water-rate as a debt to be recovered—primarily, after notice to pay—from the occupier, who is entitled to deduct the amount paid to the Company out of the rent due, or that may next become due from him, when the owner and not the occupier is liable, by law or agreement with the Company, for the payment of the rate, which is to be a charge on the dwelling-house in priority to all other charges affecting the premises. The Act, therefore, as regards a very large number of houses gives effect to the views expressed in my Reports of 1883 and subsequently. 237 The subject again came before your "Vestry, and was reported on by me in my eleventh Report last year (November 3rd, page 129), when it was resolved, upon the recommendation of the Law and Parliamentary Committee, that a communication be addressed to the Local Government Board, expressing approval of the principle laid down in a memorial addressed to that Board by the Poplar Board of Works, to the effect that "the Water Companies should not, on any grounds, be empowered to cut off the water supply from any occupied premises." The Poplar Board in their memorial, copy of which was sent to the several Sanitary Authorities, whose co-operation was invited, referred to the frequency with which the supply of water to a dwelling is cut off in consequence of a defect existing in the fittings governing the supply, whereby distress is caused to the tenants of the house, although the defect arises from no fault on their part. The Water Company having refused to refrain from cutting-off the supply by reason of defective fittings, in that district, on the ground that such a course is absolutely necessary, owing to great waste of water, the Poplar Board requested the Local Government Board to introduce a Bill to extend the powers of the Act 50 and 51 Vic., cap. 21 (Forrest Fulton's Act, before referred to, which prevents the Company from cutting-off the supply of water to a dwelling-house where the water-rate is payable by the owner), so as to make it illegal for a Water Company to cut off water for any reason whatever. But nothing was done. Underground Tanks: The Regulations.—A communication was received, in July, 1889, 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 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 shall be 238 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 Water Works 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. No further action has been taken in the matter. PROFESSOR FRANKLAND'S REPORT. The Report on the water supply of the Metropolis in 1890, prepared for the Registrar-General by Professor Frankland, F.R.S., and published in the Annual Summary, 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 Colne Valley Water Company, and by the Tottenham Local Board of Health, are included for the purpose of comparison. The weather, it is stated, was less favourable than in 1889, for the operations of the Companies which abstract water from the river ; nevertheless the improved quality of this water, upon which comment was made in Professor Frankland's previous Report, was fully maintained. But the monthly variation in the temperature of the Thames water was, as usual, very great (viz., from 37° Fahr. in December to 66° in August, a range of 29°), that of the Kent Company's deep well water being 5.2° only, viz., from 50.9° in December to 56.1° in August. 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 66° Fahr., is vapid and unpalatable, and at 37° Fahr. is soon cooled to the 239 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 about one fourth of its original amount—in 1890 from 29.7° to 7.9°; the hardness of the Thames water being 20.4°. 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 hardness of the river water is similarly reducible. 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 reservoirs. The Companies are endeavouring to substitute, as far as possible, water from subterranean sources for raw river water, whilst the Conservators have almost completely stopped the discharge of untreated town sewage into the Thames. 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 and 1890, was "superior to that of any former year as regards comparative freedom from organic impurity." But in this respect, Thames water is of distinctly inferior quality compared with the river Lea water. From the sanitary point of view the 240 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. 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. THE WATER EXAMINER'S REPORT. Supervision of the water supply is vested in the Water Examiner appointed under the provisions of the Water Act, 1871. This office is held by Major-General A. de C. Scott, R.E., to whose Annual Reports I am indebted for many of the following particulars. General Scott's Report for 1890 is not yet published, but I am indebted to that gentleman's courtesy for a sight of some of the Tables which will be included in it, and of which I am permitted to make use. The duties of the 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 upon:— "1. A suflicient area of properly constructed filter beds, constantly cleaned, and fresh sanded from time to time as the original thickness is reduced; "2. The rate of filtration being controlled and limited to a certain speed ; "3. The water delivered into the filter beds having been previously stored in subsiding reservoirs, and the capacity of these reservoirs being such as to avoid the necessity for the intake of turbid and muddy water during the time of extraordinary and heavy floods, which tend to foul and choke the filters." 241 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 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 1890, was as follows:— West Middlesex, 1.24; Grand Junction, 2.03; 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, 0.63 acre; Chelsea, 0.68; and West Middlesex, 0.88. The filtering basins are lined with brickwork on 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 two feet nine inches in that of the Grand Junction Company. The thickness of the upper layer of sand, which is the most effective of the layers, 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 5½ft. Grand Junction.—Harwich sand, 2ft. 6in.; Hoggin, 6in.; fine gravel, 9in.; coarse gravel, 9in.; boulders, 1ft. Total thickness. 5½ft Another and more modern kind of filter used by this Company, is made up of sand, 2ft., gravel, 9in. Total thickness, 2ft. 9in. Chelsea.—Thames sand, 4ft. Gin.; shells, &c., 3in.; gravel, 3f. 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 242 and vegetable matter, and then the upper layer is scraped off and removed. Renewals of sand should take place periodically as the layer becomes reduced below an assigned minimum. But filtration avails little, if the water is allowed, as frequently happens, to be fouled in the cisterns; whether through the uncleanly condition of those receptacles, or by the 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-off tap should be affixed to the rising main, or service pipe, so that drinking and cooking water may be drawn therefrom, fresh and uncontaminated, without the intervention of cisterns, which are required for washing, flushing, baths, and similar puposes. 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 29.08; 23.35; and 28.41 gallons, daily, per head of estimated population; and 262, 175, and 224 gallons per house. The "intake" of the Chelsea Company is at West Molesey, the intakes of the other Companies being at Hampton. The Grand Junction Company has constructed a new intake, on a small island composed of clean ballast, about one mile above the original intake: the water percolates through the ballast and so enters the conducting culvert in a clear condition. This Company's supply, moreover, is supplemented from sand and gravel beds at Hampton, the Company having a complete system of underground collection of water on about 20 acres of land, and being able, during the time 243 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 utilized 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, 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." Filtration, as already stated, was effective in freeing the water from all traces of turbidity. Turbid water is very difficult to filter. The solid impurities in suspension, consisting chiefly 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 liable to be over-taxed. The fact that the impurity of the water in the river is so largely increased during periods of flood, renders it of great importance that there should be sufficient provision of subsidence and storage reservoirs, to enable the necessary daily supplies to be delivered during such periods, while keeping the intakes closed. The position of the several Companies varies in this respect very considerably. The following statement shows the number of days' supply, represented by the capacity of the reservoirs for unfiltered water, belonging to each of the local Companies:— Chelsea, 14.1; West Middlesex, 7.4; Grand Junction 3.5. 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 comparision it may be added that the East London Company 244 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. Bacteriological examination by Dr. Koch's process of gelatineplate culture, was formerly conducted by Dr. Percy Frankland, 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 per cent. This examination 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 show 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 present in actual work, and the expenditure necessary for the purpose would be extremely trifling, compared with the interests at stake in connection with the largest system of water distribution in the world. The examination has since been resumed, and it appears from Professor Frankland's report for May, in the present year, that one cubic centimeter of each water, collected in sterilized vacuous tubes, developed the following numbers of colonies of microbes:— West Middlesex, 20; Grand Junction. 64; Chelsea 78. The Lambeth Company's water developed 404. 245 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 1890 to 27,245 houses, out of a total of 73,877: the increase during the year was 2,508. No new area was brought under constant supply in 1890. The Grand Junction Company was giving constant supply to 40,490 houses out of a total of 56,572: a decrease during the year of 3,553. The system has been extended to North Kensington by the voluntary act of the Company. The Chelsea Company was giving constant supply to 7,870 houses, out of a total of 35,719: the increase during the year was 653. 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 was giving constant supply, at the end of the year, to 162,000, out of a total of 169,414 houses. The increase during the year was 3,975; 96 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 carlessness 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, 1890, was as follows, Chelsea 22 per cent.; West Middlesex, 37 per cent.; and Grand Junction, 71 per cent. against 79 per cent. in 1889. Considerable advance was made during the past year in London as a whole, in extending the constant supply; 478,041 out of the total number of 769,122 houses supplied, or 62 per cent., being now on constant service: an increase of 26,548 during the year; the number of houses having increased in the year by 10,787 only. At the end of the year there were 1,246 miles of streets in which the mains were constantly charged. In a contrast of the intermittent and constant Service systems, the Water Examiner observed, in his report for 1889, that "the intermittent charging of the service pipes favours 246 corrosion, which, in turn, causes turbidity; while the shutting off 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 housefittings 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 Metropolitan Board for their failure to call upon the Companies to provide constant supply, was, that the Companies had made the regulations so stringent as to constitute a heavy and unnecessary tax on the owners and occupiers of houses. It is nevertheless the fact, as 247 we have seen, that, the Companies having taken the initiative, 62 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, 1889, 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. The constant supply was given in 1890, and also to another district in Paddington, by the same Company. Your Vestry made application to the 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, but the Company, in effect, refused to comply with the application. Application has since been made to the London County Council to require a constant service; and it is to be given. 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 at the end of 1889, 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 addition of powerful machinery to their works. The total expenditure of the 248 panies on works, improvements, &c., to the end of 1889, amounted to £14,630,246, of which £217,066 was expended during 1889. "On the 31st December," 1890, General Scott states, "the works belonging to the eight companies included 54 subsiding and storage reservoirs for unfiltered water, with an aggregate surface area of 481¼ acres, and a capacity of 1,300,100,000 gallons; 59 reservoirs for the storage of filtered water, with a capacity of 215,792,000 gallons, of which 57 were covered; 4,758 miles of water pipes; 17,252 hydrants; and 104 filters, with a surface area of 102½ acres. There were also 184 steam pumping engines of an aggregate of 21,659-horse power; "a truly gigantic" Plant," and various additions to the works were in progress. 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 Company at their Kensal Green Works. 1. With respect to Illuminating Power. The maximum, minimum, and average illuminating power, in standard sperm candles, the statutory standard being 16 candles, was as follows:— Maximum. Minimum. Average. Quarter ended March 31st 17.3 16.2 16.6 Quarter ended June 30th 17.2 16.3 16.7 Quarter ended September 30t 17.4 15.7 16.7 Quarter ended December 31s 17.1 16.4 16.6 Averages, whole year 17.2 16.1 16.6 It appears from these results that the average illuminating power of the gas at the Station, was higher than the Parliamentary standard, and that, excepting on one occasion, the minimum was above the requirements. 249 In the Annual Report 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 no forfeiture or penalty, as they are when the gas is shewn to be defective at the regular testing place. 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 sperm candles 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 Report of the Board 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 250 the subject earnestly, having addressed the Board of Trade (in July, 1889) with a view to (1) 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 1890, considerably exceeded the proportions in 1889, as these exceeded those found 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 15.2 10.8 12.7 Quarter ended June 30th 15.8 10.9 12.5 Quarter ended September 30th 15.8 10.3 13.5 Quarter ended December 31st 17.1 10.8 13.6 Averages, whole year 16.0 10.7 13.1 Averages, 1889 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. 251 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. 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. 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. The department sustained a severe loss by the retirement, in May this year, of Inspector Newberry, he having obtained a valuable appointment of another description elsewhere. Inspector Wightman retired, on a pension, in June, on account of ill-health, after fourteen years' service. 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 twenty 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., June, 1891. 252 APPENDIX. Note.—The forms for Tables I.—VI. were arranged by the Society of Medical Officers of Health, with the object of securing uniformity in Statistical Returns. 253 TABLE I. Shewing Population, Inhabited Houses, Marriages, Births, and Deaths, in 1890, 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.§ 1890 179,500 21,800 ** 1,511 ** 3,864 ** 2,951 651 1,095 612 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 Average 10 yrs. 1880-89. 170,204 21,238 1,586 4,155 2,718 633 1,051 506 Population in 1861, 70,108; 1871, 120,234; 1881, 163,151. Average Number of Persons to each house at Census : in 1861, 7.4; in 1871, 7.6; in 1881, 8.1. Area of Parish, 2,190 acres. Number of Persons to an acre (1890), 82. *For statistical purposes the population is estimated to the middle of the year, on the basis of the rate of increase ruling between the two preceding inter-censal periods, checked by the known number of inhabited houses, and by the average number of persons per house, as ascertained at the last Census. **In 53 weeks. †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 outside 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. 254 TABLE II. Shewing the Annual Birth-rate and Death-rate; Death-rates of Children, and Proportion of Deaths in Public Institutions, in 1000 Deaths, for the year 1890, and ten preceding years. The Year. Birth-rate per 1000 of the Population. Death-rate per 1000 of the Population. Deaths of Children under 1 year; per 1000 of'Registered Births. Deaths of Children under 1 year; per 1000 of Total Deaths. Deaths of Children under 5 years; per 1000 of Total Deaths. Deaths in Public Institutions; per 1000 of Total Deaths. 1890 21.5 16.1 168 221 371 207* 1889 20.8 13.5 132 203 327 2 35 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 16.2 146 230 413 149 1881 26.9 16.6 146 236 391 160 1880 28.5 18.7 156 249 422 128 Average of 10 years, 1880—1889. 24.4 15.9 152 233 385 186 *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 1880-83 inclusive, 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 1890. (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.) For a Summary of this Table see Table IIIa. CAUSES OF DEATH. AGES. Total under Five Years of Age. Grand Total All Ages. sub-districts 0 to 1. 1 to 5. 5 to 15. 15 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65* 65 to 75. 75 to 85. 85 and upwards. Kensington Town. Brompton. (CLASSES.) I. SPECIFIC FEBRILE or ZYMOTIC DISEASES 132 222 26 8 19 6 15 12 11 12 1 354 464 399 65 II. PARASITIC DISEASES 5 ... ... ... ... 1 ... 1 ... ... ... 5 7 5 2 III. DIETETIC DISEASES 3 ... ... ... 1 6 4 2 2 ... ... 3 18 16 2 IV. CONSTITUTIONAL DISEASES 59 44 si 46 51 95 71 64 59 19 2 103 541 402 139 V. DEVELOPMENTAL DISEASES 85 1 1 ... ... ... ... 2 24 39 33 86 185 152 33 VI. LOCAL DISEASES 261 157 38 49 76 113 160 226 258 173 25 418 1536 1236 300 VII. DEATHS FROM VIOLENCE 15 7 7 4 3 6 10 10 2 3 ... 22 67 53 14 VIII. DEATHS FROM ILL-DEFINED AND NOT SPECIFIED CAUSES 91 13 2 2 ... 3 7 6 7 2 ... 104 133 119 14 651 444 105 109 150 230 267 323 363 248 61 1095 2951 2382 569 I. SPECIFIC FEBRILE or ZYMOTIC DISEASES. 1.—Miasmatic Diseases. Sma.ll-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 27 108 5 ... ... ... ... ... ... ... ... 135 140 128 12 Scarlet Fever 1 20 5 ... ... ... ... ... ... ... ... 21 26 21 5 Typhus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough 36 55 2 ... ... ... ... ... ... ... ... 91 93 85 8 Diphtheria 1 22 10 1 1 ... ... ... ... ... ... 23 35 29 6 Simple Continued or III-defined Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric or Typhoid Fever ... ... 2 3 3 2 4 1 ... ... ... ... 15 13 2 Other Miasmatic Diseases—Influenza. 3 1 ... 1 7 2 7 8 6 3 ... 4 39 29 10 2.—Diarrhceal Diseases. Simple Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhoea, Dysentery 53 12 1 ... 1 ... 1 ... 2 8 ... 65 78 67 11 3.—Malarial Diseases. Remittent Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4.—Zoogenous Diseases. Cow-pox, and effects of Vaccination ... ... ... ...... ... ... ... ... ... ... ... ... ... ... Other Diseases (e.g., Hydrophobia, Glanders, Splenic Fever) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5.—Venereal Diseases. Syphilis 9 2 ... 1 ... 1 1 ... ... ... ... 11 14 10 4 Gonorrhoea, Stricture of the Urethra ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6.—Septic Diseases. Erysipelas 2 ... ... ... ... ... 1 2 2 ... 1 2 8 6 2 Pyaemia, Septicaemia ... 2 ... ... ... ... 1 1 1 1 ... 2 6 5 1 Puerperal Fever ... ... ... 2 7 1 ... ... ... ... ... ... 10 6 4 132 222 26 8 19 6 15 12 11 12 1 354 464 399 65 II. PARASITIC DISEASES. Thrush and other Vegetable Parasitic Diseases 5 ... ... ... ... ... ... ... ... ... ... 5 5 4 1 Worms, Hydatids, and other Animal Parasitic Diseases ... ... ... ... ... 1 ... 1 ... ... ... ... 2 1 1 5 ... ... ... ... 1 ... 1 ... ... ... 5 7 5 2 III. DIETETIC DISEASES. Want of Breast Milk—Starvation 3 ... ... ... ... ... 1 ... ... ... ... 3 4 4 ... Scurvy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chronic Alcoholism ... ... ... ... 1 2 2 2 2 ... ... ... 8 6 2 Delirium Tremens ... ... ... ... i 4 1 ... ... ... ... ... 6 6 ... 3 ... ... ... 1 6 4 2 2 ... ... 3 18 16 2 IV. CONSTITUTIONAL DISEASES. Rheumatic Fever, Rheumatism of the Heart ... ... 3 1 2 1 ... 1 ... ... ... ... 8 7 1 Rheumatism ... ... ... ... ... ... 1 1 ... ... .1 ... 3 2 1 Gout ... ... ... ... ... ... 1 1 3 1 ... ... 6 6 ... Rickets 1 2 ... ... ... ... ... ... ... ... ... 3 3 3 ... Cancer, Malignant Disease ... 1 1 1 1 16 17 30 44 13 1 1 125 84 41 Tabes Mesenterica 32 10 1 ... ... ... ... ... ... ... ... 42 43 37 6 Tubercular Meningitis, Hydrocephalus 12 22 12 3 ... 2 2 ... ... ... ... 34 53 42 11 Phthisis ... ... 6 33 44 72 50 22 2 4 ... ... 233 174 59 Other forms of Tuberculosis, Scrofula 14 8 7 7 1 1 ... 1 1 ... ... 22 40 34 6 Purpura, Hæmorrhagic Diathesis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Anaemia, Chlorosis, Leucocythæmia ... 1 ... 1 1 2 ... 1 1 ... ... 1 7 3 4 Glycosuria, Diabetes Mellitus ... ... 1 ... 2 1 ... 7 8 1 ... ... 20 10 10 Other Constitutional Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 59 44 31 46 51 95 71 64 59 19 2 103 541 402 139 V. DEVELOPMENTAL DISEASES. Premature Birth 68 ... ... ... ... ... ... ... ... ... ... 68 68 51 17 Atelectasis 13 ... ... ... ... ... ... ... ... ... ... 13 13 11 2 Congenital Malformation 4 1 1 ... ... ... ... ... ... ... ... 5 6 3 3 Old Age ... ... ... ... ... ... ... 2 24 39 33 ... 98 87 11 85 1 1 ... ... ... ... 2 24 39 33 86 185 152 33 VI. LOCAL DISEASES. 1.—Diseases op Nervous System. Inflammation of Brain or Membranes 15 16 7 1 1 2 3 1 1 ... ... 31 47 37 10 Apoplexy, Softening of Brain, Hemiplegia, Brain Paralysis 1 2 2 ... 6 11 9 29 52 29 3 3 144 118 26 Insanity, General Paralysis of the Insane ... ... ... ... ... ... ... ... 2 2 ... ... 4 2 2 Epilepsy ... ... 1 2 2 2 2 1 1 1 ... ... 13 9 4 Convulsions 60 7 ... ... ... ... ... ... ... ... ... 67 67 59 8 Laryngismus Stridulus (Spasm of Glottis) 4 1 ... ... ... ... ... ... ... ... ... 5 5 5 ... Disease of Spinal Cord, Paraplegia, Paralysis Agitans ... ... ... 2 1 1 ... 3 3 3 ... ... 13 12 1 Other Diseases of Nervous System 3 5 ... 1 3 2 1 3 4 6 ... 8 28 23 5 2.—Diseases op Groans of Special Sense. (e.g., of Ear,Eye, Nose)... ... 1 ... 2 ... 1 ... ... ... ... ... 1 4 3 1 3.—Diseases op Circulatory System. Pericarditis ... ... 2 2 ... ... 1 ... ... 1 ... ... 6 4 2 Acute Endocarditis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Valvular Diseases of Heart ... ... 2 2 3 3 3 9 6 2 ... ... 30 25 5 Other Diseases of Heart ... ... 4 7 8 13 35 32 24 3 ... 164 128 36 Aneurism ... ... ... ... 1 3 1 6 2 ... ... ... 13 8 5 Embolism, Thrombosis 1 ... ... ... ... ... ... 1 ... 1 ... 1 3 1 2 Other Diseases of Blood Vessels ... ... ... ... ... ... ... 4 ... ... ... ... 4 3 1 4.—Diseases of Respiratory Organs. Laryngitis 3 3 ... 1 ... ... 2 ... 2 ... ... 6 11 8 3 Croup 1 15 ... ... ... ... ... 1 ... ... ... 16 17 16 1 Emphysema, Asthma ... ... 1 ... 1 3 4 2 3 1 ... ... 15 9 6 Bronchitis 92 66 5 4 10 24 38 74 87 51 12 158 463 398 65 Pneumonia 31 21 4 7 10 15 16 15 14 13 1 52 147 114 33 Pleurisy 1 2 2 ... 4 4 7 4 3 4 ... 3 31 25 6 Other Diseases of Respiratory System 20 8 1 ... |2 5 5 2 10 7 1 28 61 42 19 5.—Diseases of Digestive System. Dentition 7 5 ... ... ... ... ... ... ... ... ... 12 12 11 1 Sore Throat, Quinsy ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... 1 Diseases of Stomach 4 ... ... ... 4 1 2 1 1 2 ... 4 15 11 4 Enteritis 8 3 ... 2 2 1 1 1 ... 1 ... 11 19 18 1 Obstructive Diseases of Intestine 1 ... ... ... 2 ... 3 2 3 5 ... 1 16 15 1 Peritonitis 1 ... 3 6 2 2 3 1 1 ... 1 1 20 14 6 Ascites ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 ... Cirrhosis of Liver ... ... ... ... ... 2 4 9 5 ... 1 ... 21 14 7 Jaundice, and other Diseases of Liver 6 ... 1 ... ... 2 6 5 6 1 ... 6 27 17 10 Other Diseases of Digestive System 1 1 ... 1 ... 1 ... 1 1 2 1 2 9 8 1 6.—Diseases of Lymphatic System. {e.g., of Lymphatics and of Spleen) ... ... ... ... ... ... ... ... ... l ... ... 1 1 ... 7.-Diseases of Glandlike Organs op Uncertain Use (e.g., Bronchocele, Addison's Disease) ... ... ... ... 1 1 ... ... ... ... ... ... 2 1 1 8.—Diseases of Urinary System. Nephritis ... ... ... ... ... ... 2 3 3 ... ... ... 8 7 1 Bright!,! Disease, Albuminuria Disease of Bladder or of Prostate ... ... ... ... 3 1 4 4 1 8 2 3 2 3 4 1 1 26 12 19 9 7 3 Other Diseases of the Urinary System ... ... ... 3 4 ... 2 3 2 5 ... ... 19 14 5 9.—Diseases of Reproductive System. a. Of Organs of Generation. Male Organs ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Female Organs ... ... ... 2 2 2 4 1 ... ... ... ... 11 6 5 b. Of Parturition. Abortion, Miscarriage ... ... ... ... 1 ... ... ... ... ... ... ... 1 1 ... Puerperal Convulsions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Placenta Prævia, Flooding ... ... ... ... ... 3 ... ... ... ... ... ... 3 2 1 Other Accidents of Childbirth ... ... ... 3 2 5 ... ... ... ... ... ... 10 8 2 10.—Diseases of Bones and Joints. Caries, Necrosis ... 1 3 ... ... ... ... 1 ... ... ... 1 5 4 1 Arthritis, Ostitis, Periostitis ... ... ... ... ... ... ... 1 ... 2 ... ... 3 3 ... Other Diseases of Bones and Joints ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 11.—Diseases op Integumentary System. Carbuncle, Phlegmon ... ... ... 1 ... ... ... ... ... ... ... ... 1 ... 1 Other Diseases of Integumentary System 1 ... ... ... ... ... ... ... l 1 ... 1 3 3 ... 261 157 38 49 76 113 160 226 258 173 25 418 1536 1236 300 VII. DEATHS FROM VIOLENCE. 1.—Accident or Negligence. Fractures and Contusions 1 4 5 3 2 4 7 8 1 2 ... 5 37 30 7 Gun-shot Wounds ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cut, Stab ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Burn, Scald ... ... 1 ... ... ... 1 ... 1 1 ... ... 4 1 3 Poison ... ... ... ... ... ... 1 ... 1 1 ... ... 4 1 3 Drowning ... ... 1 ... ... ... ... 1 ... ... ... ... 1 1 ... Suffocation 14 3 ... ... i ... ... ... ... ... ... 17 18 15 3 Otherwise ... ... ... ... ... ... ... ... ... ... ... 17 ... ... ... 2.—Homicide. Manslaughter ... ... ... ... ... 1 ... ... ... ... ... ... 1 1 ... Murder ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3.—Suicide. Gun-shot Wounds ... ... ... ... ... 1 ... ... ... ... ... ... 1 1 ... Cut, Stab ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 ... Poison ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Drowning ... ... ... ... ... ... ... 1 ... ... ... ... 1 1 ... Suffocation ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Otherwise ... ... 1 ... ... 1 ... ... ... ... ... ... 2 2 ... 4.—Execution. Hanging ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 15 7 7 4 3 6 10 10 2 3 ... 22 67 53 14 VIII. DEATHS FROM ILL-DEFINED AND NOT SPECIFIED CAUSES. Dropsy ... ... ... ... ... ... 1 ... 1 ... ... ... 2 1 1 Debility, Atrophy, Inanition 86 12 1 ... ... ... v ... ... ... ... 98 99 90 9 Mortification ... ... ... ... ... ... 1 ... 4 1 ... ... 6 6 ... Tumour ... ... ... 1 ... ... 2 2 ... ... ... ... 5 3 2 Abscess 1 ... 1 ... ... ... ... ... 1 1 ... 1 4 4 ... Hemorrhage 2 ... ... 1 ... ... ... ... ... ... ... 2 3 3 ... Sudden Death (Cause not ascertained) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Causes not specified or ill-defined 2 1 ... ... ... 3 3 4 1 ... ... 3 14 12 2 91 13 2 2 ... 3 7 6 7 2 ... 104 133 119 14 CAUSES OF DEATH. 0 to 1. 1 to 5. 5 to 15. 15 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 to 75. 75 to 85. 85 and upwards. Total under Five Years of Age. Grand Total All Ages. Kensington Town. Brompton. AGES. Sub-districts 257 TABLE IIIa. Summary of Table III., shewing the number of deaths of parishioners in each Class and Order. I. SPECIFIC FEBRILE OB ZYMOTIC DISEASES— No. of Deaths. 1. Miasmatic diseases 348 2. Diarrhœal „ 78 3. Malarial ... 4. Zoogenous „ ... 6. Venereal „ 14 6. Septic „ 24 464 II. PABASITIC DISEASES 7 III. DIETETIC DISEASES 18 IV. CONSTITUTIONAL DISEASES 541 V. DEVELOPMENTAL DISEASES 185 VI. LOCAL DISEASES— 1. Diseases of Nervous system 321 2. Diseases of Organs of Special Sense 4 3. Diseases of Circulatory system 220 4. Diseases of Respiratory system 745 5. Diseases of Digestive system 141 6. Diseases of Lymphatic system 1 7. Diseases of Glandlike Organs of uncertain use 2 8. Diseases of Urinary system 65 9. Diseases of Beproductive system— a. Diseases of Organs of Generation 11 b. Diseases of Parturition 14 10. Diseases of Locomotive system 8 11. Diseases of Integumentary system 4 1536 VII. VIOLENCE— 1. Accident or Negligence 61 2. Battle ... 3. Homicide 1 4. Suicide 5 5. Execution ... 67 VIII. ILL-DEFINED AND NOT SPECIFIED CAUSES 133 Total 2951 258 TABLE IV. Shewing the number of Deaths at all ages in 1890, from certain groups of Diseases, and proportions to 1000 of Population, and to 1000 Deaths from all causes: also the number of Deaths of Infants under one year of age from other groups of Diseases, and proportions to 1000 Births and to 1000 Deaths from all causes under one year. Division I. (Adults). Total Deaths. Deaths per 1000 of Population at all ages. Deaths per 1000 of Total Deaths, at all ages. 1. Principal Zymotic Diseases 387 2.1 131 2. Pulmonary Diseases 745 4.1 252 3. Principal Tubercular Diseases 319 1.7 111 Division II. (Infants under One Year). Total Deaths. Deaths per 1000 of Births. Deaths per 1000 of Total Deaths under one year. 4. Wasting Diseases 170 44 261 5. Convulsive Diseases 132 34 203 NOTES. 1. Includes Small-pox, Measles, Scarlet Fever, Diphtheria, Whooping-cough, Typhus Fever, Enteric (or Typhoid) Fever, Simple Continued Fever, and Diarrhœa. Forty-four of the deaths occurred in Hospitals outside the Parish. 3 Includes Phthisis, Scrofula, Tuberculosis, Rickets, and Tabes. 4. Includes Debility, Atrophy, Inanition, Want of Breast Milk, and Premature Birth. 5. Includes Hydrocephalus, Infantile Meningitis, Convulsions, and Teething. (In Table III., Hydrocephalus and Infantile Meningitis are classified with tubercular diseases, Convulsions with diseases of the nervous system, and Teething with diseases of the digestive system), 259 TABLE V. Shewing the Number of Deaths from the Principal Diseases of the Zymotic class in the ten years 1880-89, and in the year 1890. Diseases. 1880. 1881. 1882. 1883. 1884. 1885. 1886. 1887. 1888. 1889. Annual Average of ten years 1880-89. Proportion of Deaths to 1000 Deaths in ten years 1880-89. Deaths in 1890. Proportion of Deaths to 1000 Deaths in 1890. Small-pox 11 55 0 1 26 25 0 1 0 0 11.9 4.4 0 0.0 Measles 75 67 77 39 32 111 56 108 124 14 70.3 25.8 140 47.4 Scarlet Fever 105 38 62 28 18 7 11 44 26 28 36.7 13.5 26 8.8 Diphtheria 22 8 25 24 17 22 30 40 89 111 38.8 14.2 35 11.8 Whooping-cough 95 85 119 44 81 98 82 86 100 26 81.6 30.0 93 31.5 Typhus Fever 4 2 1 2 0 0 0 0 0 0 0.9 0.3 0 0.0 Enteric Fever 24 22 25 30 26 12 11 11 21 19 20.1 7.4 15 5.1 Simple C'ntinu'd Fever 5 5 6 3 4 0 0 2 2 0 2.7 1.0 0 0.0 Diarrhœa 128 101 61 80 110 86 90 124 58 71 90.9 33.4 78 26.4 TOTALS. Kensington 469 383 376 251 314 361 280 416 420 269 353.9 130.0 387 131 London 13681 13811 13553 10801 13629 11261 11121 12684 10803 9709 12105 149 12279 134 England & Wales 82537 58239 69734 58972 71762 57726 62859 64676 50684 61027 63821 122 59698 106 k 260 TABLE VI. Sanitary Inspectors' Report of the Sanitary Work completed in the year 1890-91. Sanitary Districts.* No. of Complaints made by Inhabitants. 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 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. § Bakehouses. Licensed Cowsheds. Licensed Slaughter Houses. N.W. 48 1555 1616 707 87 131 72 84 44 105 2 25 21 29 35 44 ... 177 11 36 36 5 8 47 N.E. 79 1145 1949 557 124 121 86 199 293 234 16 25 66 15 61 82 ... 177 9 3 45 2 5 79 Central 41 1226 2057 415 278 38 31 65 14 163 18 17 40 8 23 12 ... 70 20 1 23 1 7 7 South 244 2102 2200 500 410 67 106 81 51 281 2 6 29 24 193 106 ... 101 261 18 44 2 2 26 Totals 412 6028 7822 2179 899 357 295 429 402 783 38 73 156 76 312 244 ... 525 301 58 148 10 22 159 * The North-Bast and North-West Districts lie north of the centre of Uxbridge Road, to the East and West of Ladbroke Grove and Ladbroke Grove Road respectively (North Kensington): the Central and South Districts are south of Uxbridge Road (South Kensington). † The total number of houses on the Register in March, 1890, in round figures, was 1,800. ‡ Since July 11th, 1889, the great majority of the Applications for removal of Dust have gone through the Vestry Clerk's and Surveyor's departments. § Exclusive of proceedings, in 12 cases, under the Sale of Food and Drugs Act, 1875 (all of the Inspectors prior to December having been Inspectors under the Act) but inclusive of cases of disobedience of the Justices' Orders. Total number of summonses 171. 261 TABLE VIa. Summary of Monthly Returns of Work done by the Sanitary Inspectors in the year 1890-91. 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 Eequest 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. 1890, April 19 117 59 94 149 84 78 58 170 9 4 3 8 6 2 3 8 12 2 4 1 16 1 14 6 31 30 17 31 9 19 8 9 April 19, 1890 „ May 17 136 94 134 188 82 78 73 141 6. 3 8 6 1 2 3 6 9 8 13 3 10 6 13 4 55 46 73 55 6 19 6 13 May 17 „ „ June 14 111 83 125 149 115 70 84 184 6 5 6 8 10 2 2 8 9 16 11 5 20 3 21 5 58 46 42 33 10 24 10 6 June 14 „ „ July 12 117 103 155 189 82 72 79 198 5 15 14 8 1 7 6 8 ... 6 12 5 24 2 17 10 177 46 27 85 11 17 8 10 July 12 „ „ August 9 83 89 115 124 58 77 69 142 14 1 7 6 2 2 4 6 1 4 11 2 15 5 24 8 35 46 35 19 5 27 ... 9 August 9 „ „ Sept. 6 70 31 58 132 63 31 51 122 10 ... 4 6 5 ... 2 6 ... ... 7 1 ... ... 11 5 39 12 1 55 10 2 2 7 Sept. 6 „ „ October 4 157 82 76 175 76 57 59 177 2 2 4 9 1 2 8 9 ... 7 7 19 ... 10 16 36 84 54 25 20 13 ... 8 October 4 „ „ Nov. 1 125 98 74 199 77 54 54 189 13 2 5 8 4 2 2 8 ... 7 4 19 10 5 5 3 61 50 33 54 4 3 5 8 Nov. 1 „ „ „ 29 164 87 61 158 71 101 100 206 7 3 6 8 6 1 3 8 20 9 8 10 20 3 11 8 46 71 22 26 7 6 2 1 29 „ „ Dec. 27 87 61 41 124 72 128 73 187 9 3 1 8 4 2 1 8 5 19 4 4 16 7 9 14 48 37 11 24 1 9 ... 1 Dec. 27 „ 1891, Jan. 24 117 111 91 134 72 154 91 202 13 4 4 8 5 1 3 8 17 12 8 6 10 4 14 17 13 10 4 18 56 13 14 16 Jan. 24, 1891 „ Feb. 21 148 149 109 167 85 192 99 207 5 6 9 6 5 1 3 6 ... 3 6 5 8 3 11 14 81 49 47 26 18 12 8 4 Feb. 21 „ „ March 21 123 98 93 214 95 205 131 256 7 6 3 8 ... 2 3 8 13 12 5 3 14 15 17 7 27 30 49 49 20 13 2 9 March 21 „ Totals 1555 1145 1226 2102 1032 1297 1021 2381 106 54 74 97 49 25 37 96 95 98 100 71 182 54 177 117 707 557 415 500 177 177 70 101 Totals. * Since November 10th, 1890, the Mews have been inspected by Street Inspectors; hence the increase in the number of inspections made after that date. K 2 262 TABLE VII. Shewing the Death-rate per 1000 persons living; the Annual Rate per 1000 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 1890, and in ten preceding years. The Year. Deaths per 1000 living. Total Deaths from seven principal Zymotic Diseases, Kensington. Annual rate of Mortality per 1000 living, from seven principal Zymotic Diseases. Proportion of Deaths to 1000 Deaths, from seven principal Zymotic Diseases. The Year. Kensington. London. Kensington. London. Kensington. London. 1880 17.8 21.7 469 2.9 3.7 162 170 1880 1881 16.6 21.3 383 2.3 3.6 140 172 1881 1882 16.2 21.3 376 2.2 3.5 140 163 1882 1883 15.5 20.5 251 1.5 2.7 96 134 1883 1884 15.1 20.4 314 1.8 2.7 119 164 1884 1885 16.1 19.8 361 2.1 2.7 130 140 1885 1886 15.9 19.9 280 1.6 2.7 101 135 1886 1887 16.4 19.6 416 2.4 3.0 144 154 1887 1888 15.9 18.5 420 2.3 2.5 148 137 1888 1889 13.5 17.5 269 1.5 2.2 111 128 1889 AVERAGES OF TEN YEARS 1880.89. 15.9 20.0 354 2.1 2.9 129 149 AVERAGES OF 10 YEARS, 1880-89. 1890. 16.1 20.3 387 2.1 2.7 131 134 1890. 263 TABLE VIII. Comparative Analysis of the Mortality in all London, and in Kensington, in 1890. Annual Death-rate per 1000 living, from all causes. Annual Death-rate per 1000 living, from seven principal Zymotic diseases. Percentage of Deaths under 1 year to Births Registered. PERCENTAGE OP 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 20.3 2.7 16.3 23.3 24.0 13.4 3.4 7.3 24.0 0.9 Kensington 16.1 2.1 16.8 22.1 28.0 13.1 2.3 6.3 20.7 0.2 * 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 Diseases of the Zymotic class occurred in 1890. 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 Continued. Absalom Road 2 ... ... 1 ... ... 1 4 Lancaster Road 7 ... 3 4 ... ... ... 14 Acklam Road 1 ... 1 3 ... ... 1 6 Lansdowne Road ... ... ... ... 1 ... ... 1 Adair Road ... ... ... 2 1 ... 1 4 Lily Terrace ... ... 2 ... ... ... ... 2 Admiral Place ... ... ... ... ... ... 2 2 Lionel Mews ... 1 ... 1 ... ... ... 2 All Saints Road ... ... ... 3 ... ... ... 3 Lockton Street 1 ... ... 2 ... ... ... 3 Appleford Road 2 ... 1 ... ... ... 2 5 Lonsdale Road ... ... ... 1 ... ... 1 2 Bangor Street 2 ... ... ... ... ... 1 3 Lucerne Mews ... ... ... 3 ... ... ... 3 Barandon Street 2 3 ... ... 1 ... ... 6 Manchester Road 3 ... ... ... ... ... ... 3 Bassett Road ... ... ... ... 1 ... ... 1 Manchester Street 3 ... ... ... ... ... ... 3 Bedford Terrace ... ... ... ... 1 ... ... 1 Millwood Street ... ... 1 ... ... ... ... 1 Bevington Road 2 ... ... ... ... ... ... 2 Munro Mews 1 ... 1 ... ... ... ... 2 Blechynden Street 5 1 ... 1 ... ... ... 7 Newcombe Street 1 ... 3 ... ... ... ... 4 Blithfield Street ... ... 1 ... ... ... ... 1 Park Terrace ... ... 1 ... ... ... ... 1 Bomore Road ... 1 ... 1 ... ... ... 2 Portland Road 3 ... ... ... ... ... ... 3 Bosworth Road ... ... ... ... ... ... ... 3 Portobello Road 2 ... ... 2 1 ... 3 8 Buckingham Terrace ... ... 3 ... ... ... ... 3 Queen's Road 1 ... ... ... ... ... 2 3 Bulmer Place and Terrace ... ... ... 6 ... ... ... 6 Rackham Street 3 ... 3 1 ... ... 1 8 Chesterton Road 1 ... ... ... ... ... ... 2 Rillington Place ... ... 1 ... ... ... ... 1 Clarendon Road 1 ... ... 2 ... ... ... 3 St. Ann's Road 1 ... ... 1 ... ... 1 3 Convent Gardens 1 ... ... 1 ... ... ... 2 „ Clement's Road 3 ... ... 1 1 ... 1 6 Cornwall Gardens ... ... ... ... 1 ... ... 1 „ Ervan's Road 1 ... ... 2 ... ... ... 3 Cornwall Gardens Stables ... ... ... 2 ... ... ... 2 „ George's Road 1 1 ... 1 ... ... ... 5 Cornwall Road 1 ... 1 ... ... ... ... 2 „ James's Place 2 ... ... ... ... ... ... 2 Crescent Street 2 ... ... ... ... ... ... 6 ,, Katherine's Road 3 1 ... ... ...... ... 1 5 Dartmoor Street 1 ... ... 2 ... ... ... 3 Silchester Road 1 ... 1 ... ... ... 2 4 Earl's Court Road ... ... 1 ... ... ... ... 1 Southam Street 1 ... ... 6 1 ... 1 9 Faraday Road ... 1 ... 3 ... ... 1 5 Stratford Road ... 1 ... 1 ... ... ... 2 Fowell Street 2 ... ... 1 ... ... ... 3 Swinbrook Road 1 ... 1 3 ... ... 1 6 Golborne Gardens ... ... ... ... ... ... 3 3 Talbot Grove 3 1 ... 1 ... ... ... 5 Golborne Road ... ... ... 1 ... ... 1 2 Tavistock Road ... ... ... 2 ... ... ... 2 Hazelwood Crescent ... ... ... 2 ... ... ... 2 Testerton Street 3 2 ... ... ... ... ... 5 Hesketh Place 1 ... ... 1 ... ... ... 2 Thomas Mews 2 ... ... ... ... ... 1 3 Holland Mews ... 1 ... ... ... ... ... 1 Tobin Street 10 1 ... ... ... ... ... 11 Holland Park Terrace ... ... ... ... 1 ... ... 1 Treadgold Street 1 ... ... 1 ... ... ... 2 Hornton Place ... ... 1 ... ... ... ... 1 Treverton Street ... ... ... 1 ... ... 2 3 Hornton Street ... ... ... ... 1 ... ... 1 Victoria & Western Dwellings 1 1 1 1 ... ... 2 6 Hurstway Street 2 ... ... 1 ... ... ... 3 Walmer Road 5 3 ... 1 ... ... 2 11 Infirmary, The 5 ... ... 2 1 ... 2 10 West Mall ... ... 1 ... ... ... ... 1 James Street ... ... 1 ... ... ... 1 2 Wheatstone Road 1 ... ... 1 1 ... ... 3 Kensington Place 3 ... ... 2 ... ... 1 6 Wilby Mews ... 1 ... ... ... ... ... 1 Ladbroke Grove Road ... ... ... ... ... ... 3 3 Wornington Road 4 1 ... 2 ... ... 5 12 BROMPTON SUB-DISTRICT. Barker Street 2 ... ... ... ... ... ... 2 Hans Road ... ... 1 ... ... ... ... 1 Bolton Mansions [tal ... ... ... ... 1 ... ... 1 Longridge Road ... ... 1 ... ... ... ... 1 Brompton Consumption Hospi- ... ... 1 ... ... ... ... 1 Petersham Mews ... 1 ... ... ... ... ... 1 Cathcart Road ... ... ... ... 1 ... ... 1 Prince's Mews 2 ... ... ... ... ... ... 2 Child's Place ... ... 3 ... ... ... ... 3 Rutland Street ... 1 ... ... ... ... ... 1 Clareville Grove ... 1 ... ... ... ... ... 1 Wallgrave Road 2 ... ... ... ... ... ... 2 Fulham Road 2 ... ... ... ... ... ... 2 Yeoman's Row ... 2 ... ... ... ... 1 3 266 TABLE X. Return respecting the Vaccination of Children whose Births were Registered in 1889.* DATE. Registration Sub-Districts comprised in Vaccination Officer's District. Number of Births returned in Birth List Sheets. Number of these Births duly entered in Columns 10,11 and 13 of the Vaccination Register (Birth List Sheets), viz.: Number of these Births which are not entered in the Vaccination Register, on account (as shewn by Report Book) of Column 10 Successfully vaccinated. Column 11. Column 13 Dead. Un-vaccinated. Postponement by Medical Certificate. Removal to District the Vaccination Officer of which has been duly apprised. Removal to places unknown, or which cannot be reached, and cases not having been found Cases still under proceedings by summons and otherwise. Insusceptible of Successful vaccination. Had Small-pox. 1889. 1 2 3 4 5 6 8 9 10 11 1st January to 31st Dec. Kensington Town 3050 2541 13 ... 266 24 3 201 2 Brompton 692 584 5 ... 52 5 1 44 1 Total 3742 3125 18 ... 318 29 4 245 3 * The return for 1890 is not yet complete. 267 TABLE XI. LICENSED SLAUGHTER-HOUSES. SOUTH OF UXBRIDGE ROAD. LOCALITY. LICENSEE. 6, Church Street, Kensington Mr. Blott 11, Peel Place, Silver Street „ Osborne 25, Silver Street „ Wright 183, Brompton Road „ Joyce 60, Kensington High Street „ Evans 15, High Street, Nutting 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. Bawcombe 195, Clarendon Road „ Thom 10, Edenham Mews „ Goddard 2, Ledbury Mews „ Hellings Lonsdale Mews „ Grove 10, Prince's Yard „ Coles 41, Prince's Place „ Grant 23, Norfolk Terrace „ Rawle 61, Silchester Road „ Craw forth 235, Walmer Road „ Van 4, Royal Crescent Mews „ Brooker 8, Ditto ditto „ Down 268 TABLE XII. LICENSED COWSHEDS. SOUTH OF UXBRIDGE ROAD. LOCALITY. LICENSEE. Campden Street (Yard in) Mr. Lunn Newland Terrace (rear of) „ Tisdall Redfield Lane, Earl's Court West London Dairy Society NORTH OF UXBRIDGE ROAD. 187, Walmer Road Mr. Arnsby 47, Tobin Street „ Burton 27, Tobin Street „ Copperwbeat 5, Ledbury Mews „ Liddiard 23, Bramley Road „ Tame 235, Walmer Road „ Van Portobello Road (rear of 209) Aylesbury Dairy Company