16/11/93 VIII 2 Ken 119 THE ANNUAL REPORT ON THE HEALTH, SANITARY CONDITION, &c., &c., OF THE Parish of st marg Abbotts KENSINGTON, FOR THE YEAR 1892, BY T. ORME DUDFIELD, M.D., Medical officer of health. PRINTED BY SAMUEL SIDDERS, 17, BALL STREET, KENSINGTON HIGH STREET, W. 1893. 1 THE ANNUAL REPORT ON THE HEALTH, SANITARY CONDITION, &c., &c., OF THE Parish of St. mary Abotts, KENSINGTON, FOR THE YEAR 1892, BY T. ORME DUDFIELD, M.D., Medical Officer of Health. PRINTED BY SAMUEL SIDDERS, 17, BALL STREET, KENSINGTON HIGH STREET, W. 1893. TABLE OF CONTENTS. page the Census of 1891 1 Registration District and Sub-Districts of Kensington 2 Wards, Area of, and Inhabited Houses and Population of, in 1881 and 1891 .3 ,, Rateable Value and Population of; Inter-censal Increase in 3 Population of the Parish, 1801-1892; and Rateable Value, 1823-1893 4 Population, Inhabited Houses, and Rateable Value ; Increase of since 1856, and since 1871 4 Population, Inhabited Houses, etc., in 1892 5 Population of the Parish, and of the Sub-Districts, at different Ageperiods (1891) (Table IIa., Appendix, page 206) Marriages and Marriage-Rate 6 Births and Birth-Rate 7 Births, Annual Number of, and Births of Males and Females, and Birth-Rate, 1882-1891 8 Deaths and Death-Rate 8 Infantile Mortality 9 ,, ,, Amongst Illegitimate Children 10 Senile Mortality 10 Death-Rate, and Mean Temperature ; Monthly Table of 11 Death-Rate at different Age-periods (page 68, omitted from page 11) Death-Rates in London, and in England and Wales 11 „ ,, in Large Provincial Towns 14 ,, ,, in Colonial, European and other Foreign Cities 14 Mortal Statistics, etc., 1892 ; Summary of 14 Death, Assigned Causes of 21 Zymotic Diseases, "Seven Principal;" General Remarks on the 21 ,, ,, ,, ,, Number of deaths from, in 1892 22 ,, ,, ,, ,,Death-rate from ; in Kensington; in London and other large Towns; and in England and Wales 23 ,, ,, ,, ,, Monthly returns of Deaths from, in Kensington 23 IV Death, Assigned Causes of—continued. page Small-Pox, Low rate of Mortality from, in London 24 ,, The Prevalence of, in 1892, Mainly Confined to the Vagrant Class 25 ,, Circular with reference to, addressed to the Keepers of Common Lodging Houses 26 ,, History of a Local Outbreak of 27 ,, Provision made by Asylums Board for Medical Instruction in respect of 28 Measles 29 Scarlet Fever 31 Increased Use made of the Hospitals for Isolation of 31 ,, Epidemic of, in London 32 ,, Table shewing Notifications; Admissions to Hospitals, and Deaths, in Kensington, and in London; and Cases in Hospitals, at end of consecutive four-weekly periods 37 ,, Low Case-mortality of 37 ,, Illustrative Examples of; Shewing how the Disease is spread by the Exposure of the Infectious Sick 38 ,, Statistical Returns of Cases of; recorded in Kensington, 1882-1892 (Tables) 40 Diphtheria 42 ,, Decrease in Case-mortality of 42 ,, In London 43 ,, Statistical Table of Cases recorded in Kensington 44 Whooping-Cough 45 ,, In London 45 ,, and Measles; Mortality of, compared with that of the so-called "Dangerous" Infectious Diseases 46 Fever 46 ,, Typhus ; Limited Outbreak of, in North Kensington 46 ,, Enteric 47 Diarrhoea 47 Cholera, English 48 ,, Asiatic 48 ,, ,, Local Government Board's Action with reference to 49 ,, Report by Medical Officer of Health on Precautions to be taken with reference to 51 ,, ,, Sanitary Inspectors (six), temporarily appointed in view of possible Invasion of 53 V. Death, Assigned Causes of— continued page Influenza, Recrudescence of the Epidemic of 53 Zymotic Diseases, Table shewing the Number of deaths from, in Kensington, and in London, in thirteen four-weekly periods 57 Venereal Disease 58 Puerperal Fever 59 Parasitic Diseases 59 Dietetic Diseases 59 ,, ,, Alcoholism 59 Constitutional Diseases 6o ,, ,, Cancer 60 ,, ,, Tubercular 61 Developmental Diseases 63 Local Diseases 63 ,, Nervous System, Diseases of 64 ,, Circulatory System ,, 65 ,, Respiratory ,, ,, 65 ,, Digestive ,, ,, 66 ,, Urinary ,, ,, 66 ,, Reproductive,, ,, 66 Violent Deaths 67 Ill-defined and not Specified Causes of Death 67 Deaths at Different Age-Periods 68 Public Institutions, Deaths at 68 ,, ,, ,, Parish Infirmary and Workhouse 68 ,, ,, ,, Consumption Hospital, Brompton 70 ,, ,, ,, Marylebone Infirmary, Notting Hill 70 „ ,, ,, St. Joseph's House 70 ,, ,, ,, Outlying Hospitals, etc. 70 Not Certified Deaths, in Kensington 71 ,, ,, ,, The position and duties of Coroners and their Officers in relation to 72 Inquests 75 ,, Deaths from Violence: Accident; Suicide ; Homicide 75 ,, Why so many become necessary 77 Meteorology 77 Vaccination Officer's Return for 1891 78 ,, Interim Report of the Royal Commission on 79 ,, Animal; Calf Lymph 81 vi. PAGE Metropolitan Asylums Board, The Work and Proceedings of the 82 Annual Report of the Chairman, Summary of the 84 Notifications of Infectious Disease in 1892, Corrected Table of 88 Statistical Committee, Annual Report of the 89 Ambulance Service, Metropolitan 94 ,, ,, Stations 95 ,, ,, River-Service 95 ,, ,, Wharves 96 ,, Committee, Summary of the Annual Report of the 96 Hospital Accommodation for the Infectious Sick ; The needs of the Metropolis in respect of 100 Hospitals, Additional, wanted, for Fever and Diphtheria 102 ,, Smali.-Pox, sufficiently provided for in respect of 103 ,, Fevfr, etc., Two Thousand additional beds needed 104 ,, Metropolitan Medical Officers of Health, recommend increase of 106 ,, Asylums Board, The views of, in respect to 107 ,, Sites for, Difficulty in procuring 109 North-Eastern Hospital, Erected m Table showing Quarterly and Total Admissions of Patients to the Hospitals from each Parish and Union, in 1892, and Population of Districts 114 Notification of Infectious Disease, Compulsory 116 ,, in London, in 1890-91-92; Number of Cases notified 116 ,, Cases of, in Kensington, and in London, in 1892; arranged in thirteen four-weekly periods 117 ,, London School Board and 118 ,, Payment of Fees for Certificates of 118 Compulsory Removal to Hospital of the Infectious Sick: Imperfect Provisions of the Law with respect to 119 ,, „ Proposed Amendment of the Law, with respect to 119 Sanitary Legislation, Progress in 120 Hospitals Commission (1882), Recommendations of 121 Public Health (London) Act, 1891 ; Bye-Laws etc. 122 Factory and Workshop Acts : Order made by the Home Secretary 124 Sanitary Works and Legal Procedure, in Kensington 128 Sanitary Inspectors, The Work of the 133 ,, ,, The Districts of the 133 Offensive Businesses 134 ,, ,, Fat Extractor 134 ,, ,, Marine Stores 134 ,, ,, Brick-burning 135 vii. PAGE Slaughter Houses, The Licensed 135 ,, ,, Report on, by the Sanitary Committee 136 ,, ,, Reduction in the number of 136 Cow-Houses, The Licensed 137 ,, Report on, by the Sanitary Committee 137 ,, Reduction in the number of 138 Dairies Order of 1885 138 Bakehouses 138 Refuse Matters, Nuisance arising in Removal of 139 House Refuse: The Work of Collection and Removal of 139 ,, ,, Daily Collection of, from Moveable Receptacles: A Desideratum 140 ,, ,, Metropolitan Board (The late), requested (but declined) to promote Legislation to abolish Dust-bins 140 ,, ,, "Shoots" for, Difficulty of finding 141 Trade Refuse: The Law on the subject of the Removal of 141 Stable Refuse: 142 ,, ,, Nuisance from Non-removal of, largely dependent on the use of Improper Receptacles 143 ,, Sunken Dung-pits, Use of for, condemned 144 ,, ,, Removal of, dealt with in the Public Health Act, 1891 145 ,, Sanitary Committee recommend the Vestry to undertake the collection and removal of 146 ,, ,, Wharves and Plant Committee deem proposal of Sanitary Committee for removal of, by the Vestry, to be "impracticable," on the score of expense: Vestry concur 146 Housing of the Working Classes 147 ,, The Boundary Street (Bethnal Green) Scheme 147 ,, The James Street (Kensington) .Scheme 147 ,, Action of the County Council with reference to 148 ,, Overcrowding: M igration as a remedy for 149 ,, „ Emigration „ „ 151 ,, " A West End Avernus": Article in the Daily News.152 ,, ,, Letter from the Chairman of the Sanitary Committee 154 ,, ,, Resolutions of a "Conference" with reference to 155 ,, ,, Medical Officer of Health,Views of, thereon 156 ,, ,, Sanitary Committee, Action of, with reference to 159 ,, ,, Report thereon160 ,, ,, Sanitary Inspector appointed to the district referred to 163 viii. PAGE Common Lodging houses 163 .. ,, List of, in Kensington 164 ,, ,, ,, County Council desire control of 165 Glanders in the Metropolis 167 ,, in Kensington (1879), Action of the Vestry with reference to 16 8 ,, Law relating to, in an unsatisfactory state 169 ,, Veterinary Surgeons in Meeting ; Resolutions of with respect to 171 ,, and Farcy Order (New), Issued by the Board of Agriculture 172 ,, ,, ,, Provisions of the 172 ,, ,, ,, County Council refuse to carry out the permissive provisions of the 174 ,, Losses from in London; Estimated at £ 95,000 yearly, 175 Grand Junction Canal: Report on the state of the 175 Public Mortuary; Observations with reference to the 176 ,, ,, Bodies admitted to ; Particulars with reference to 177 ,, ,, Royal Commission of 1882 ; Views of, with reference to 178 Coroner's Court 178 ,, ,, Inquests held at the 179 Disinfection in 1892; Additional Duties of the Sanitary Authority under the Public Health Act, with reference to 179 Public Baths and Wash-Houses: Separate Wash-houses, A Desideratum 180 ,, ,, Increasing use made of the 180 Houses let in Lodgings, Regulations for 182 Underground Rooms 182 Public Sanitary Conveniences, Deficient number of 182 ix. PAGE Metropolitan Sewage : Action of the (late) Metropolitan Board of Works, with reference to disposal of 183 ,, ,, Crossness Works completed 184 ,, ,, Improved condition of the River Thames 184 „ ,, Bulk of: Disinfectants, &c., used in Treating the 185 ,, ,, Sir Henry Roscoe's views with reference to the 186 ,, ,, Modes of Treatment of, Proposed 187 Water Supply, Royal Commission on the Metropolitan 187 ,, Professor Frankland's Report on the; Abstract of 188 ,, ,, Bacteriological Examination of the 189 ., ,, Water Examiner's Monthly Reports; Notes on the 191 ,, ,, In Kensington 191 ,, ,, Filtration of the 192 ,, ,, Deterioration of the, in Dirty Cisterns 193 ,, ,, Constant Service System; Advantages of the 193 ,, ,, The Companies' Regulations, Proposed amendment of 194 Gas, Results of Periodical Examinations for Ascertaining the Illuminating Power and the Purity of the 196 ,, Variation in the Illuminating Power of the 198 Portable Photometer; Proposal to acquire power to test with 198 ,, Standard for Ascertaining the Illuminating Power of, A Desideratum 199 A Retrospect, 1871 -1892 200 Conclusion 202 X. APPENDIX STATISTICAL AND OTHER TABLES. page Table I. Estimated Population, in 1892, and Ten previous years, 1882-91 : Number of Inhabited Houses, and of Marriages, Births, Deaths, &c. 204 ,, II. Birth-rate and Death-rate; Death-rates of Children; Deaths in Public Institutions, in 1892, and in 1882-91 205 ,, IIa. Population of the Parish, and of the Sub-Districts, at different Age-periods (1891) 206 ,, III. Deaths Registered from all Causes, 1892 207 ,, IlIa. Summary of Table III. 209 ,, 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 210 ,, V. Deaths in 1892, and in 1882-91, from the Seven Principal Diseases of the Zymotic class—in the Parish; in the Metropolis; and in England and Wales 211 ,, VI. Summary of Inspectors' Reports of Sanitary Work completed, in the year 1892-93 212 ,, VIa. Summary of Monthly Returns of Work done by the Sanitary Inspectors, in the year 1892-93 213 ,, VII. Death-rates, General and Zymotic,in Kensington, and London; and Proportion of Deaths from Zymotic Diseases, to Total Deaths, in 1892, and in 1882-91 215 ,, VIII. Comparative Analysis of the Mortality, in London and Kensington, in 1892; Per-centages 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 216 ,, Villa. Streets, &c., in which cases of Infectious Disease were notified in 1892, under the Provisions of Section 55 of the Public Health (London) Act, 1891 217 IX. Localities where fatal cases of the more important of the Zymotic Diseases occurred in 1892 219 X. Vaccination Officers's Annual Return (1891) 220 XI. Slaughter-houses, Licensed: and names of Licensees 221 ,, XII. Cowsheds ,, ,, 222 THIRTY-SEVENTH ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH, Being for the Year 1892. To the Vestry of the Parish of St. Mary Abbotts, Kensington. Gentlemen, The vital and mortal statistics in the present report have, as usual, been compiled for the fifty-two weeks of the Registration year, which, in 1892, terminated with the civil year on the 31st December. In other respects, the report is for the official year, ended March 25th, 1893. In my report for 1891 I gave my reasons for believing that the population of the parish, as enumerated in April, 1891, during the currency of the Easter holidays and the Parliamentary vacation, was considerably below the true normal number. At the same time, I stated that I had felt it my duty to adopt the official figures for statistical purposes, a course which involved the necessity of recasting all calculations of birth and death rates, &c., for each of the preceding ten years. I shall not repeat here the grounds for my opinion as to the deficiencies of the Census figures: it will suffice to refer to my previous report in which they are set out with all needful detail, B 2 REGISTRATION DISTRICT AND SUB-DISTRICTS. "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 comprises, according to the Registrar-General, an area of 2,190 acres. 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 Town sub-district still includes some open spaces, as Holland Park and Notting Barn Farm. The Brompton subdistrict, in which the builder has been busy of late years, many of the new houses being of a palatial character, is now practically covered. The West London or Brompton Cemetery, government property, is in this sub-district; the Kensal Green Cemetery, in private ownership, is in the Town subdistrict. The sub-districts present marked differences, which must be borne in mind in any comparision 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 I believe an increasing, percentage of persons of the poorer classes. The poor in Kensington, however, are better off in one respect than the poor in some other parts of the Metropolis; in that, for the most part, they live in houses fairly well-built, and obviously intended for occupation by the lower middle classes: many 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, 3 WARDS. Kensington is for some local purposes divided into Wards. INCREASE IN RATEABLE VALUE AND POPULATION. The Rateable Value of Property in the several Wards, at ten-year intervals, between 1851 and 1891, was as follows :— Ward. 185i. 186l. 1871 1881. 1891. St. Mary Abbotts £ 68,coo £ 129,958 £ 323,992 £ 619,512 £ 834,875 Holy Trinity, Brompton 61,000 119,302 246,716 459,000 536,492 St. John, Notting-hill, & St. James, Norland 99,500 155,428 365,012 501,704 510,082 +131,394 £228,500 404,688 935,720 1,580,216 2,012,843 These totals show an increase in rateable value, between 1851 and 1861, of 77 percent.; between 1861 and 1871, of 130 percent.; between 1871 and 1881, of 69 percent.; and between 1881 and 1891, of 26 per cent. †These figures represent the value of the hereditaments belonging to the public companies in the Parish, which are not included in the figures given for the respective Wards. Wards. The subjoined Table shews the acreage of the Wards, their population as enumerated, and the number of inhabited houses in each, in 1881 and 1891:— Name of Ward. Area in Statute acres. Inhabited 1881. Houses 1891. Increase in 10 years. Population. Increase in Decrease. 10 years. 1881. 1891. St. Mary Abbotts 846 6,573 7.535 962 48,831 50,823 1,992 Holy Trinity, Brompton 439 3,936 4,440 504 26,746 28,379 1.633 St. John, Nottinghill, & St. James, Norland 905 9,594 10,109 515 87.574 87,106 - 468 2,190 20,103 22,084 1981 163,15' 166,308 3,625 468 4 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, i1801 8,556 £75.916 1823 1821 14,428 93,397 1833 1841 26,834 142,772 1843 [851 44,053 257,103 1853 l86l 70,108 444,030 1863 1871 120,299 975,046 1873 1881 163,151 1,711,495 1883 1891 1892 166,308 166,700 2,037,221 (April) 1893 It thus appears that the population at the commencement of the last decade of the century was nearly twenty times as great as in the first year of the century; and that the rateable value of property has undergone in 70 years an immense increase, being nearly 27 times as great in 1893 as it was in 1823, the first year in respect of which I possess information. Kensington is still in process of development by building, but at a moderate rate compared with past years—1861-70, for instance. The following Table, brought up to date, exhibits the growth of the Parish since the Metropolis Local Management Act came into operation, in 1856:— 1856. 1892. Increase in 36 years. Number of Inhabited Houses 7,600 22,050 14,450 Population 57,000 166,700 109,700 Rateable Value of Property £308,000 £2,025,409 £1,717,409 The increase in all respects within the last twenty-one years, the period over which my official experience extends, is not inconsiderable, as the subjoined figures shew:— 5 1871. 1892. Increase in 21 years. Number of Inhabited Houses 15,735 22,050 6,315 Population 121,000 166,700 45,700 Rateable Value £935,720 £2,025,409 £1,089,689 1 he above figures may well be said to speak for themselves: nevertheless, attention may be called to the fact that in the last 36 years the rateable value of property has increased nearly seven-fold, and that in the last 21 years the mere increase was more than treble the total in 1856. The population nearly trebled, and the number of inhabited houses increased nearly threefold, in 36 years. The rateable value of the Parish is exceeded by that of the Cities of London, Liverpool and Manchester, and by that of only ten of the larger counties with their towns thrown in. The population of Kensington is to that of London about 1 to 25.6, and the rateable value 1 to 16.4. POPULATION, INHABITED HOUSES, &c. It has already been stated that the population of Kensington in 1871, when I was appointed to my present office, was 120,299; that it increased to 163,151 in the ten years to 1881, and to 166,308 in the further ten years to 1891. The inhabited houses numbered 15,735 in 1871, 20,103 in 1881, and 22,002 in 1891. The falling-off in the rate of increase of population between 1881-91, as compared with the two previous decennial periods, is remarkable. It is noteworthy, however, that there was an increase of about 1900 in the number of inhabited houses between 1881 and 1891, which might reasonably have been taken as an indication of a population-increase of not less than 15,000, whereas the enumerated increase but little exceeded a fifth of that number. As already intimated, I feel bound to accept the Census figures, for statistical purposes, and 6 I therefore assume— both for the ten years 1881-91, and as an estimate for the current decennium, commencing in 1891, an annual increase of 300 only, notwithstanding that the average annual excess of births over deaths in the ten years, 1881-91, was 1356— an assumption which involves an annual loss of over 1000, by migration, during the ten years, 1881-91. On this basis it is assumed that the population at the middle of 1892 numbered 166,700, and that there was a loss to the Parish of 536 persons in the year. The density of the population was 76 per acre, the number of persons to a house being 7.56 (against 8.08 in 1881.), the inhabited houses being 22,050 The estimated population of the Town subdistrict was 118,700, that of Brompton being 48,000. The males numbered 65,800: the females were 100,900, and therefore upwards of 35,000 in excess; the excess in 1871 having been 22,000 only. The increase in the excess of females between 1881 and 1891 was 2664, or only 493 fewer than the total increase of population in the ten years (3170); a markable fact, seeing that the male births (20,464) exceeded the female births (19,794) by 670 in the ten completed years 1881-90. MARRIAGES AND MARRIAGE-RATE. The marriages in 1892 were 1,584, against 1,491,1,511, and 1,569 in the preceding three years respectively. Of these there were celebrated: By the Church (73.2 percent. of total marriages) 1160 At Roman Catholic Places of Worship130 At other Nonconformist Places of Worship 64 At the Superintendent Registrar's Office 230 Total 1,584 The marriage-rate, i.e. persons married to 1000 inhabitants, was 19.0, compared with 18.0, 18.2 and 18.9 in the preceding three years respectively. The marriage-rate in 7 England and Wales was 15.4 per 1000* as compared with 14.2, 1515 and 15.5 in the preceding three years. The rate in London in 1892, was 17.4, compared with 17.7 in 1891,17.6 in 1890; 17.1 in 1889, 16.9 in 1888, and 16.8 in 1887; the latter being the lowest rate ever recorded. BIRTHS AND BIRTH-RATE. The births registered in the 52 weeks of the registration year 1892, were 3,718: males, 1,867, and females, 1,851; the numbers in the Town and Brompton sub-districts respectively, being 3,071, and 647. They were 129 fewer than in 1891 (viz., 3,847: Town 3,115; Brompton 732), and 323 fewer than in 1872, when the population (127,400) was 39,300 less than in 1892. The Kensington birth-rate, which is considerably below that of London as a whole (30.9 in 1892) has been declining since 1868, when it was 331 per 1000. In 1892 it was 22.3 per 1000, and 2T below the decennial average (24.4). The rate in the Town sub-district was 25.9, and in Brompton 13.5, per 1000. There was one birth to 44.8 inhabitants, and 100.9 births of males to 100 of females. The births of illegitimate children were 181 (26 fewer than in 1891), viz., males 101, and females 80. Of these births 162 were registered in the Town sub-district, which includes the Parish workhouse, at which institution there were 117 births, males 56, females 61 (including four still-born; male 1, females 3), 81 of which were illegitimate. In the Parish generally, the illegitimate births formed 4.9 percent. of total births, as against 54, 5.8 and 5.4 percent. in the preceding three years respectively. The subjoined Table shews the quarterly number of births of males and females in each of the sub-districts:— *The rate in the four quarters, successively, was 11.7, 16.3, 15.7 and 17.8. Thus only 85,576 persons were married in the first quarter, when Influenza was so prevalent, the number in the fourth quarter being 132,070. 8 Kensington Town sub-district. Brompton sub-district. Grand Total Whole Males. Females. Total. Males. Females. Total. Parish. 1st Quarter 398 370 768 87 78 165 933 2nd „ 407 406 813 88 88 176 989 3rd , 409 373 782 65 92 157 939 4th 342 366 708 71 78 149 857 Totals 1556 1515 3071 311 336 647 3718 For particulars respecting the annual number of births, and the birth-rates, in the decennial period 1882-91, see Tables I. and II. (Appendix). The following statement of the number of births of males and females in each of the ten years, 1882-91, shows the continuous decline of the birth-rate in this Parish, a decline which has been going on during the entire period of my tenure of office. The birth rate in 1872 was 32T per 1000: in 1868, it was 33.1 per 1000. The Year. Population. Total Births. Males. Females. Birth-rate per 1,000 1882 163,540 4,327 2,240 2,087 26.5 1883 163,860 4,230 2,162 2,068 25.8 1884 164,180 4,394 2,246 2,148 26.8 1885 164,500 4,032 2,049 1,983 24.5 1886 164,820 4,149 2,137 2,012 25 .2 1887 165,140 3,941 2,016 1,925 23.9 1888 165,450 3,776 1,914 1,862 22.8 1889 165,760 3,698 1,846 1,852 22.3 1890 166,080 3,864 1,919 1,945 23.3 1891 166,400 3,847 1,935 1,912 23.1 Totals 40,258 20,464 19,794 Average 24.4 Excess of male births in the ten years 670 DEATHS AND DEATH-RATE. The deaths registered in 1892, inclusive of 249 deaths of parishioners at out-lying public institutions, &c., but exclusive of deaths of non-parishioners at public 9 institutions within the Parish, were 2,882, and were 95 above the corrected decennial average (2,787). Of these deaths 2,254 belong to the Town sub-district, and 628 to Brompton. The death-rate, which in the preceding three years had been 14.6, 17.8and 18.4 respectively, was 17.2 per 1,000, being 0.5 above the decennial average (l6.7): it was 3.4 below the rate in the Metropolis as a whole (20.6), this being 0.l above the decennial average (20.5). The rate in the Town sub-district was 19.0, that in Brompton being 134; against 20.5 and 13.0 respectively in 1891. The rate in the male sex was 20.9, that in the female sex being 14.9; against 22.5 and 15.8, in 1891. In the Parish, as a whole, there was one death to 57.8 persons living, the proportion in 1891 having been one to 55.3. The deaths of males were 1,370, out of a total of 65,800 persons of that sex, or one in 47.7; against one in 44.5 in 1891. Of 100,900 females 1,504 died, or one in 66.4; against one in 63.4 in 1891. The deaths in the first and fourth or colder quarters (1,620) exceeded those in the second and third or warmer quarters (1,262) by 358. In the preceding three years consecutively, the difference in favour of the warmer quarters was 74, 293, and 288. LNFANTILE MORTALITY. The deaths of children under five years of age always bear a high ratio to total deaths. In 1892 these deaths were 972, (against 789, 1,095, and 968 in the preceding three years), the corrected decennial average being 1,040. These 972 deaths were equivalent to 33.7 percent. on total deaths, and to 264 percent. on births registered: the equivalent percentages for the whole Metropolis were 39.4 and 26.3. The deaths under one year were 587, against 489, 651, and 633 in the preceding three years, the corrected decennial average being 593. These 587 deaths were equivalent to 20.4 percent. on total deaths, and to 15.7 percent. on births registered: the equivalent percentages for the whole Metropolis were 23.2 and 15.5. 10 The deaths of illegitimate children under five years of age, 87,118, and 119, in the preceding three years respectively, were 119 in 1892 (males 69, and females 50), of which 114 were registered in the Town sub-district, and were equal to 65.7 percent. on births registered as illegitimate. Of these 119 children, 33 only outlived their first year; 28 died in the second, and 4 in the third year of life. The causes of death, as registered, were atrophy, debility, and inanition, 21; premature birth, 10; tubercular diseases, 13; zymotic diseases, 24 (measles, 10; whooping cough, 8; and diarrhoea, 6); syphilis, 1; lung diseases, 33; convulsions, 4; diseases of the digestive organs, 4; violence, 4 (accidental suffocation, 3, and fracture of the skull, 1); want of breast milk, 3; and one each from want of attention at birth, and erysipelas. 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. "Want of breast milk" might probably have been fairly assigned as the cause of many more than the three deaths classified to it" in medical certificates. SENILE MORTALITY. At sixty years of age and upwards, there were 880 deaths, against 727, 826, and 957 in the preceding three years; they were equivalent to 30.5 per cent, on total deaths, the equivalent percentage in London as a whole, being 24.9. The subjoined Table shews the quarterly number of deaths of parishioners, males and females, in each of the sub-districts:— Kensington Town sub-district. Total. Brompton sub-district. Grand Total. Whole Males. Females. Males. Females. Total. Parish. 1st Quarter 363 439 802 106 120 226 1,028 2nd ,, 264 264 528 72 89 161 689 3rd „ 249 232 481 46 46 92 573 4th „ 203 239 442 75 75 150 592 1,079 1,174 2,253 299 330 629 2,882 11 The Births were, Males, 1867 The Deaths were, Males, 1379 Females, 1851 Females, 1503 Total Births, 3718 Total Deaths, 2882 2882 Deaths 836 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 1,000 persons living 1892. 10 years 1882-91. Above or below Decennial Average. Mean Temperature of the Air. 1892. Decennial Average. Above or below Decennial Average. Jan. 30 37 .2 20.5 + 16.7 36.0 38.4 —2.4 Feb. 27 20.6 18.4 + 2.2 39.1 39.4 —0.3 March 26 18.1 18.7 —o.6 37.0 39.8 — 2.8 April 23 16'.2 17.7 —1.5 46.1 45.O +1.1 May 21 17.3 16.3 + 1.0 49.8 50.2 —0.4 June 18 15.8 15.9 —0.1 59.1 56.9 + 2.2 July 16 16.1 14.8 +1.3 60.4 61.5 —1.1 August 13 14.5 I5.9 —1.4 59'.3 61.4 —2.1 Sept. 10 13.3 14.2 —0.9 59.7 59.6 + o.1 Oct. 8 11.9 12.8 —0.9 54.3 55.o —0.7 Nov. 5 14.4 15.2 —o.8 45 .3 48.0 —2.7 Dec. 5 13.1 i6.9 -3.8 43.9 43 .0 + 0.9 Dec. 31 15.1 18.o —2.9 36.2 38.4 2.2 Averages, whole year 17.2 16.7 48.1 49.o DEATH-RATES IN LONDON, ENGLAND AND WALES, &c. Before entering upon details with respect to the causes of death in Kensington, I may mention, by way of comparison with our local mortality-rates, that the death-rate in England and Wales in 1892, was 19 0 per 1000, and was 0 3 per 1,000 below the mean rate in the ten years 1882-91. The rate in London, as already stated, was 20 6 per 1,000, and was 12 0.1 above the decennial average, but 0.8 below the rate in each of the preceding two years. The subjoined table shews the annual death-rate per 1000 persons living, in each of the last eleven years, in Kensington, in London, and in England and Wales :— 1892. 1891. 1890. 1889. 1888. 1887. 1886. 1885. 1884. 1883. 1882. Kensington 17.2 18.4 17.8 I4.6 17.1 17.4 16.7 16.8 16.1 16.0 16.4 London 20.6 21.4 21.4 18.4 19.3 20.3 20.6 20.4 20.9 20.8 21.5 W. District 20.0 20.8 20.5 18 .1 19.3 19.9 19.'8 19.9 19.7 19.8 20. 0 North ,, 19.4 20.0 19.6 16.9 17.7 18.9 18.9 19.3 19.6 19.4 19.8 Central ,, 23.9 26.5 24.8 20.9 22.7 23.5 23.4 22.9 23.8 23.3 24.0 East ,, 23 .5 24.0 25.1 21.2 22.7 23.3 23.9 23. 0 23.4 24.4 25.3 South ,, 19.0 19.8 19.6 17.7 18. 1 19.4 19.9 19.1 20 .2 19.8 20.8 England and Wales 19.0 20.2 19.5 l8.2 18.1 19.1 19.5 19.2 19.7 19.6 19.6 The Registrar-General in his Annual Summary has a table shewing diminution or excess of deaths in 1892, compared with annual deaths in 1882-91, corrected for increase of population. From this we learn that there was a diminution in the number of deaths from small-pox (viz., 303), scarlet fever (60), whooping-cough (524), "fever" (362), and diarrhœal diseases (513). There was a diminution also in deaths, among other causes, from phthisis and tubercular diseases (933), diseases of the nervous system (952), and "all other causes" (796); the total diminution being 4,453, against 14,720,3,762, and 4,712 in the preceding three years. On the other hand there was an excess under several heads, including measles (791), influenza (1945), diphtheria (712), cancer (204), premature birth (310), diseases of the circulatory system (560), and diseases of the respiratory system (392); the total excess being 5,172 against 1,496, 5,308 and 8,859 in the preceding three years. The diminution being deducted from the excess, a balance of excess and diminution shews a nett excess of 719, in 1892, compared with 4,147 in 1891, and 1,546 in 1890, and contrasted with a nett diminution of 13,224 in 1889. This saving of life, in 1889, was very unequally distributed amongst the several causes. There were four headings under which the mortality was in 13 excess, viz., diphtheria, cancer, premature birth, and diseases of the circulatory organs. These headings had shewn similar excess in each of the preceding six years, and as they shew it again in 1890, in 1891, and in 1892, they would appear to be persistently increasing. Similarly with regard to the diseases which shew diminished mortalities: here, also, most of the changes were not peculiar to the last four years, 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 Registrar-General 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 1892 (as in.1890-91 also), with the single exception of the diseases of the respiratory system, which, in place of a diminution of 4,376, as in 1889, shew an excess of 2,143 in 1890, of 4,103 in 1891 and of 392 in 1892, due doubtless to the prevalence in these years of epidemic influenza. The death-rate in "Greater London," which is co-extensive with the Metropolitan and City Police Districts, the population, in 1892, numbering 5,752,204, was 19.3 per 1000, the rate in the preceding three years having been successively, 17.3, 20.1, and 19.8, and the average for the three years 19.1. The deaths properly belonging to the Outer Ring, as distinguished from Inner or Registration London, were equivalent to a rate of only 15.6 per 1000, the rate in the Inner Ring, as already shewn, having been 20.6. The death-rate from the principal zymotic diseases in Inner London, was 2.82 per 1000; in the Outer Ring2.14 only; the rate for Greater London, as a whole, being 2.64 per 1000. Compared with the rates in the preceding 14 three years, these rates show an increase of 13 per cent. in Greater London, of 11 per cent. in Inner London, and of 18 per cent. in the Outer Ring. The death-rate in thirty-two Cities and Boroughs next in importance to London, and having a population of nearly six millions, was 20.2, ranging from 15.8 in Croydon, 18.0 in Bradford, and 18.1 in Huddersfield, to 28.8 in Manchester, 24.6 in Salford, and 24.7 in Liverpool; 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, 19.4, 22.7, and 29.3 respectively. In thirty-four of the largest Colonial, European and other Foreign cities, with an aggregate population of about 20 millions, the mean rate of mortality was 25.5 per 1000, and exceeded by 4.8 the mean rate in the 33 largest English towns; population exceeding ten millions. The lowest rates were, in Sydney 13.5, in Berlin 19.6, and in Copenhagen 19.9, ranging upwards to Trieste, 30.0, Moscow, 36.9, and Hamburg, 39.7. The rate in Paris was 22.4, in Rome, 21.2, and in Vienna 24.3. In American cities the rate ranged from 21.6 in Brooklyn and 22.6 in Philadelphia, to 24.2 in New York, and 29.4 in New Orleans. The rate in Alexandria was 41.3, in Cairo, 47.0, In Calcutta the rate was 27.0, in Bombay, 32.1, and in Madras 46.0 per 1000. SUMMARY OF MORTAL STATISTICS, ETC. The year 1892 from the point of view of the death-rate was, like its predecessor, below the average in respect of the state of the public health, but not to the same degree; for whereas in 1891 the death-rate, 18.4 per 1000 persons living, exceeded the decennial rate (16.6) by 1.8, the death-rate in 1892 (17.2) was only 0.5 above the average, (16.7). There was this further difference, that whereas in 1891 the death-rate in only three of the thirteen four-weekly periods covered by 15 my reports was below the average—being in excess on ten occasions—the death-rate in 1892 was under average on nine occasions, and in excess on four only. The excess in number of deaths was due in both years to the prevalence of epidemic Influenza; but whereas in 1891 the ill-effects of the epidemic appeared to extend more or less throughout the year, as evidenced by the large number of deaths from pulmonary diseases, the brunt of the mischief was confined in 1892 to the first few weeks—practically, indeed, to January; in which month the deaths, 477 in the first four weeks, were about one-sixth of the total for the entire year. In the same weeks the deaths from diseases of the respiratory organs, no fewer than 198 (and 80 more than in the corresponding weeks of 1891), exceeded one-fifth of the total for the year. The highest monthly death-rate recorded in 1892 (37'2 per 1000), was in January, the lowest (11.9), in the four weeks (36th—40th), ended October 8th. The deaths from the principal diseases of thezymotic class (333)were five below the corrected decennial average, but 60 more than in 1891, when they were 77 below average. The most fatal disease was measles, 109 deaths, or 35 above the average. Scarlet fever deaths (36) were nine in excess. All other diseases of this class were below average (vide Table, page 22). The mean temperature of the air (48.10 Fahrenheit) was 11 below the averages of the preceding 50 years. The Death-Rate in the first four weeks of the year, ended January 30th, the highest by far in 1892, was 37.2 per 1000 of the estimated population, and 16.7 above the decennial average (20.5). It was 2.8 below the metropolitan rate (40.0). this being 15.5 above the decennial average (24.5). The deaths from the principal diseases of the zymotic class were 25, and one above the corrected decennial average; viz., whooping-cough, 11, diphtheria, 5, scarlet fever, 4, measles, 3, and diarrhoea, 2. The mortality from diseases of the respiratory organs was excessive: the deaths from these causes were 16 198, including bronchitis, 151 and pneumonia 27; these being the highest monthly numbers in 1892. The deaths of children under five years of age were 104, including 59 under one year; these being the highest monthly numbers in 1892. The deaths at 60 and upwards were 204 (the highest monthly number in 1892), and 101 in excess of the number in the corresponding weeks in 1891. The mean temperature of the air was 36.0 Fahr., and 2'4 below the means in the corresponding weeks in the preceding ten years (38.4). In the second four-weekly period of the year (5th—8th weeks, January 31st to February 27th), the death-rate fell to 20.6, but was 2.2 above the average. It was 4.0 below the Metropolitan rate (24.6), this being 2.1 above the average (22.5). The deaths from the principal zymotic diseases were 17, and 3 below the average; viz., whooping-cough 11, scarlet fever 2, measles 2, and diarrhoea 2. The diseases of the respiratory organs were fatal to 71 persons, a reduction of 127 compared with the previous month: 53 of these deaths were due to bronchitis and 13 to pneumonia. The deaths of children under five years were 85, including 53 under one year. The deaths at 60 and upwards were 94, or 110 fewer than in January. The mean temperature was 394 , and 0*3 below the average (39.4). In the third period (9th—12th weeks, February 28th to March 26th), the death-rate further fell to 18.1, and was 0.6 below the average (18.7). It was 3.6 below the Metropolitan rate (21.7), this being 0.7 below average (22.4). The deaths from the principal zymotic diseases were 19, and 2 below the average, viz., whooping-cough, 11, i^the same as in the two preceding four-weekly periods, and the highest monthly number in 1892), measles 7, and diphtheria 1. The deaths from diseases of the respiratory organs further fell (from 71) to 67, including 49 from bronchitis, and 10 from pneumonia. The deaths of children under five were 82, including 44 under one year. The deaths of persons at 60 and upwards 17 further fell (from 94) to 70. The mean temperature was 37.0, and 2.8 below the average (39.8). In the fourth period, (13th—16th weeks, March 27th to April 23rd), the death-rate again fell, to 16 2, and was T5 below the average (17.'7). It was 4.8 below the Metropolitan rate (21.0), this being 0.3 below the average (21.3). The deaths from the principal zymotic diseases were 21, and one below the average; viz., whooping-cough 9, measles 5, scarlet fever 2, diphtheria 2, diarrhoea 2, and enteric fever 1. The deaths from the diseases of the respiratory organs further fell (from 67) to 51, including bronchitis 23, and pneumonia 18. The deaths of children under five were 64, including 40 under one year. The deaths of persons at 60 and upwards were 72. The mean temperature was 46.1, and 1.1 above the average (45.0). In the fifth period, (17th—20th weeks; April 24th to May 21st), the death-rate rose (from 16.2) to 17.3, and was l.0 above the average (16.3). It was 2.1 below the Metropolitan rate (19.4), this being 0.6 below the average (20.0). The deaths from the principal zymotic diseases were 36, and 11 above the average, viz., measles, 17, whooping-cough, 7, scarlet fever, 4, enteric fever, 3, diarrhoea, 3, and diphtheria, 2. The deaths from the diseases of the respiratory organs were 50, including bronchitis 18, and pneumonia 14. The deaths of children under five were 78, including 32 under one year. The deaths at 60 and upwards were 52. The mean temperature of the air was 49.8, and 0.4 below the average (50.2). In the sixth period, (21st—24th weeks, May 22nd to June 18th) the death-rate fell (from 17.3) to 15.8, and was 0.1 below the average (15.9). It was 1.9 below the Metropolitan rate (1.7.7), this being 0.7 below the average (18.4). The deaths from the principal zymotic diseases were 43 (the highest monthly number in 1892), and 15 above the average; viz., measles 25, diphtheria 8, (the highest monthly number in 18 1892), whooping-cough 5, scarlet fever 2, diarrhoea 2, and enteric fever 1. The deaths from diseases of the respiratory organs fell (from 50) to 30, including bronchitis 18, and pneumonia 9. The deaths of children under five were 86, including 41 under one year. The deaths at 60 and upwards were 49. The mean temperature was 59.1, and 2.6 above the average (56.5). In the seventh period, (25th—28th weeks, June 19th to July 16th), the death-rate rose (from 15.8) to 16.1, and was 13 above the average (14.8). It was T5 below the Metropolitan rate(17.6), this being 0.9 below the average (18.3). The deaths from the principal zymotic diseases were 42, and 6 above the average; viz., measles 26 (the highest monthly number in 1892), diarrhoea 7, scarlet fever 3, diphtheria 3, enteric fever 2, and whooping-cough 1. The deaths from diseases of the respiratory organs further fell (from 30) to 25, including bronchitis 14, and pneumonia 8. The deaths of children under five were 82, including 54 under one year. The deaths at 60 and upwards were 42. The mean temperature was 604. and IT below the average (61*5). In the eighth period, (29th—32nd weeks, July 17th to August 13th), the death-rate fell (from 16"1) to 14-5, and was T4 below the average (15'9). It was 3'3 below the Metropolitan rate (17'8), this being 2'9 below the average (20'7). The deaths from the principal zymotic diseases were 35, and 10 below the average ; viz., diarrhoea 16, measles 15, scarlet fever 2, and diphtheria 2. The deaths from diseases of the respiratory organs again fell (from 25) to 19, including bronchitis 8, and pneumonia 6. The deaths of children under five were 80, including 56 under one year. The deaths at 60 and upwards were 38. The mean temperature was 59'3, and 21 below the average (614). In the ninth period (33rd—36th weeks, August 14th to September 10th), the death-rate further fell (from 14.5) to 19 13.3, and was 0.9 below the average (14.2). It was 3.6 below the Metropolitan rate (16.9), this being 0.3 below the average (17.2). The deaths from the principal zymotic diseases were 41, and 11 above the average; viz., diarrhoea 30, (the highest monthly number in 1892), measles 5, scarlet fever 4, enteric fever 1, and diarrhoea 1. The deaths from diseases of the respiratory organs again fell (from 19) to 12 (the lowest monthly number in 1892), including bronchitis 7, and pneumonia 1. The deaths of children under five were 86, including 58 under one year. The deaths at 60 and upwards were 38, as last month, this being the lowest monthly number in 1892. The mean temperature was 59.7, and 0.1 above the average (59.6). In the tenth period, (37th—40th weeks, September 11th to October 8th), the death-rate again fell (from 13.3) to 11.9 (the lowest rate recorded in 1892), and was 0.9 below the average (12.8). It was 4.0 below the Metropolitan rate (15.9), this being 1.0 below the average (16.9). The deaths from the principal zymotic diseases were 19, viz., diarrhoea 11, diphtheria 3, scarlet fever 2, and whooping-cough 1. The deaths from diseases of the respiratory organs rose (from 12) to 31, including bronchitis 19, and pneumonia 8. The deaths of children under five were 57, including 49 under one year. The deaths at 60 and upwards were 40. The mean temperature was 54.3, and 0.7 below the average (55.0). In the eleventh period, (41st—45th weeks, October 9th to November 5th), the death-rate rose (from 11.9) to 14.4, but was 0.8 below the average (15.2). It was 3.5 below the Metropolitan rate (17.9), this being 1.2 below the average (19.1). The deaths from the principal diseases of the zymotic class were 14; viz., scarlet fever 4, diphtheria 3, measles 2, enteric fever 2, diarrhoea 2, and whooping-cough 1. The deaths from diseases of the respiratory organs further rose (from 31) to 39, including bronchitis 22, and pneumonia 7, 20 The deaths of children under five were 47, including 29 under one year, these being the lowest monthly numbers in 1892. The deaths at 60 and upwards were 55. The mean temperature was 45.3, and 2.7 below the average (48.0). In the twelfth period, (45th—-48th weeks, November 6th to December 3rd), the death-rate fell (from 14.4) to 13 1, and was 3.8 below the average (16.9). It was 4.9 below the Metropolitan rate (18.2), this being 2.l below the average (20.3). The deaths from the principal zymotic diseases were 11; viz., scarlet fever 4, (the highest monthly number in 1892, and the same as in the 1st, 5th, 9th, and 11th periods), whooping-cough 3, diarrhoea 2, diphtheria 1, and enteric fever 1. The deaths from diseases of the respiratory organs again rose (from 39) to 50, including bronchitis 34, and pneumonia 9. The deaths of children under five were 54, including 30 under one year. The deaths at 60 and upwards were 55. The mean temperature was 43.9, and 0.9 above the average (43.0). In the thirteenth and last period, (49th—52nd weeks, December 4th—31st), the death-rate further rose (from 13.1) to 15.1, but was 2.9 below the average (18.0). It was 4.7 below the Metropolitan rate (19.8), this being 2.7 below the average (22.5). The deaths from the principal zymotic diseases were again 11, and the lowest monthly number in 1892, viz., whooping-cough 4, scarlet fever 3, diphtheria 2, and enteric fever 2. The deaths from diseases of the respiratory organs further rose (from 50) to 64, including bronchitis 47, and pneumonia 8. The deaths of children under five were 57, including 40 under one year. The deaths at 60 and upwards were 71. The mean temperature was 36.2, and 2.2 below the average (38.4). 21 ASSIGNED CAUSES OF DEATH. Class I.—Specific Febrile or Zymotic Diseases.*— The "Class" of diseases called Zymotic, comprises, in the Registrar-General's arrangement of the "causes of death," six "Orders." The first and second Orders ("Miasmatic" and "Diarrhœal") include the diseases which the RegistrarGeneral 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, being of a more or less preventable character : the absence or the prevalence of certain of them therefore, 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 illustrations, founded on our own local experience within the last few years. Thus, Measles was very prevalent in 1888 and 1890, the deaths being considerably above the average. In 1889 and 1891, 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 natural consequence of its excessive prevalence and fatality in the preceding years. In saying this, I must not be thought to ignore the fact that one epidemic of a zymotic disease may be more severe than another ; or that the severity of an epidemic may be 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 this disease was fatal above the average : the large total of 185 deaths in 1878, moreover, followed the then minimum return of 34 in the previous year. Diarrhoea may be cited as an illustration of quite another kind. The mortality from this disease, amongst * The classification of the causes of death in the Weekly Returns and Annual Summary of the Registrar-General, was considerably modified in 1882. The list of causes, in its new form, is an abbreviation of the more detailed list used in the Annual Reports of Births, Deaths and Marriages in England. Table III. in my reports prior to 1882, was framed upon the lines of the abridged list of the causes in the Annual Summary, and was the basis of some of the other Tables. It being desirable that Table III. should accord with the new list used in the Annual Report, the Society of Medical Officers of Health revised certain Tables framed, at my instance, for uniformity, in 1872, and settled the forms of Tables I.—V. as they appear in the Appendix. 22 infants, was excessive in 1887; the mortality in 1888 was much below the average: but the diminished mortality in 1888 had no relation to the excessive mortality in 1887. The conditions were altogether different : the summer of 1888 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 1887, 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 rate* 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 decennial average in Kensington. In 1892 the general rate was (as in London also) above the average; the zymotic rate was 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 1892, together with the decennial average, etc. Disease. Sub-districts. In Hospitals. Total. Decennial average. Town. Brompton. Town. Brompton, Uncorrected, Corrected for increase of Population Small-pox ... ... ... ... ... 5.3 5.3 Measles 91 18 ... ... 109 73.0 737 Scarlet Fever 9 ... 18 9 36 26.6 26.9 Diphtheria 14 ... 13 4 31 42.1 42.5 Whooping-cough 49 13 1 ... 63 81.3 82.1 Typhus Fever ... ... ... ... ... 0.3 0.3 Enteric Fever 7 5 2 1 15 19.4 19.6 Simple Contd.Fever 1 1 ... ... 2 1.8 1.8 Diarrhœa 64 10 2 1 77 84.9 85.8 235 47 36 15 333 334.7 338.0 23 It thus appears that the deaths from these diseases were only five below the corrected decennial average. They were 60 more than in 1891; and as usual the deaths in the Brompton sub-district (62) were fewer in proportion to population than those in the Town sub-district (271). The total deaths were equivalent to 115 per 1000 deaths from all causes in Kensington (Metropolis, 136), and to a rate of 2.0 per 1000 persons living (Metropolis, 2.8); the decennial average being 2.0 in Kensington, and 2.9 in London. In England and Wales the deaths from these diseases were 100 in each 1000 deaths, and the rate was 1.9 per 1000 persons living, the decennial average being about 23 per 1000. In the 32 Cities and Boroughs grouped by the RegistrarGeneral with the Metropolis, the zymotic death-rate was 2.64 per 1000; ranging from 1.48 in Huddersfield, 1.58 in Norwich, and 1.64 in Newcastle, to 3.10 in Bolton, 3.87 in Preston, and 4.58 in Salford. 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-cough. Simple Continued Fever. Enteric Fever. Diarrhoea. Total. January 30 3 4 5 11 ... ... 2 25 February 27 3 2 ... 11 ... ... 2 18 March 26 8 ... 1 11 ... ... ... 20 April 23 5 2 ... 8 ... 1 2 20 May 21 17 4 2 6 ... 3 3 35 June 18 25 2 8 5 ... 1 2 43 July 16 26 3 ... 1 ... 2 7 42 August 13 15 2 2 ... 1 ... 15 35 September 10 5 4 ... 1 1 1 30 42 October 8 ... 2 2 1 ... 2 10 17 November 5 2 4 3 1 ... 2 2 14 December 3 ... 4 1 3 ... 1 2 11 December 31 ... 3 2 4 ... 2 ... 11 Totals 109 36 31 63 2 15 77 333 24 I now proceed to make a few observation's with regard to each of these diseases. SMALL-FOX. Only one case of small-pox was notified in Kensington. The source of infection was not traced, but the sufferer had been at a crowded place of entertainment on the day when, probably, she became infected. The case did well. In London 41 deaths were registered, the decennial average number, corrected for increase of population, being 334. The deaths from small-pox during the seven years, 1886—92, were 97 only; viz., 24, 9, 9, 0, 4, 8, and 41, in the successive years; those in the previous septennial period, 1879—85, were 6509. The mortality from this cause during each of the past seven 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 1882—91, was 0.08 per 1000 persons living, and lower than in any previous decennium: the rate in 1892 was 0.01. The disease threatened, between March and July, to assume serious proportions, but thanks to notification, and the consequent isolation of the sufferers, it did not then become epidemic. Three hundred and six cases were admitted to the Asylums Board Hospitals in the course of the year. The notifications were 439, of which 310 were registered in the 20 weeks between February 28th and July 16th. In the next 16 weeks the total notifications were 35 only. In the four weeks ended December 3rd, the notifications were 32, and in the last four weeks of the civil year they were 38. These numbers underwent a considerable increase in the remaining three months of the official year, ended March 25th, 1893. Much disquietude on the subject was excited, in January, by a 25 statement made by the Medical Superintendent of the Hospital Ships, to the effect that, of the cases then recently admitted to hospital, "comparatively few have been persons with a settled residence." The sources of infection in these cases, except in a few instances where more than one person of the same family or household was attacked, had not been discovered, and the disease had, "no doubt, been contracted in a chance way by such persons coming in contact with infected persons, in the streets or where-not." In the same report it was pointed out "that the disease had as yet got but little hold upon the settled population of London. "It had" been imported by tramps and others from the provinces; and such importation is continuing, is likely to continue, and cannot be prevented. The class," it was added, " which so far has been almost entirely affected, is the vagrant class, and the disease is being spread by persons of this class coming in contact with one another in the Casual Wards of Workhouses and other places. In most of the cases the disease appears to have been contracted in one of the Casual Wards, and many have been sent (to hospital) from Casual Wards and Workhouse Infirmaries Owing to the migratory habits of these persons it is difficult to say in which particular Casual Ward the disease was contracted Every Casual Ward in London is acting as a source of infection." The Chairman of the Asylums Board, Sir Edwin H. Galsworthy, caused the above extract from the report of the Medical Superintendent of the Hospital Ships, to be sent to the several Metropolitan Medical Officers of Health, with a statement, that "the adoption of some measures for preventing the further spread of the disease in London is of vital importance"; and it was suggested that "one most effective means to that end would be'a systematic medical inspection of Casual Wards, Shelters, Common Lodging Houses, &c., through the agency of which, it would appear, there is risk of the disease being widely disseminated a conclusion which is justified by the observation of the Medical Superintendent of the Hospital 26 Ships that "cases come under (his) notice which have passed through such institutions without the disease being recognized." It would have been difficult to obtain the desired "systematic medical inspection," excepting in the case of Casual Wards; but I thought it might be possible to induce the Superintendents of Shelters, and the keepers of Common Lodging Houses, to report to the Poor Law Authorities the occurrence of cases of apparent illness, especially if accompanied by an eruption, among the inmates of such places; and in view of the facts stated in the above-mentioned communication from the Asylums Board, I felt it to be my duty to put myself at once in communication with the Keepers of Common Lodging Houses, to each of whom I addressed a letter as follows:— "Small-pox.—Sir.—This disease is spreading in London. So far, most of the sufferers have been poor persons who usually sleep in Casual Wards, Shelters, and Common Lodging Houses, and tramp about Town and Country by day. I ask your help to prevent the further spread of the disease; by careful inspection, night and morning, of the people who sleep at your house. Small-pox commonly begins with pain in the head and back, and sickness. But one or other of these signs may be absent, as all cases are not quite alike. Should any Lodger complain of illness of this character, I beg you to obtain a Medical Order from the Relieving Officer before such person leaves your house, and especially if there is any rash. The rash of Small-pox comes out on the third day of illness, as small hard pimples, which soon get bigger and soften, and then they contain fluid and are like little blisters. In your own interest, as well as in the interests of Public Health, I hope you will give this matter your serious consideration." I forwarded a copy of the above communication to the Clerk to the Guardians, and to the Police Authorities who have the supervision of the Common Lodging Houses. The Guardians made an arrangement with their Medical Officer in charge of the Mary Place Workhouse, "to attend daily at the Casual Ward, and subject each casual to a medical inspection before discharge and the police were" directed to assist, as far as practicable, in impressing on the Keepers of 27 Common Houses, the necessity for complying with the directions contained in (my) circular letter." Shortly after these directions were given a female casual was discovered to be ill with Small-pox, and two male lodgers from Common Lodging Houses also. The several patients were removed to hospital, and, so far as I could ascertain, the disease did not spread. It may be mentioned that on the last day of the official year, 1892-93 (March 25th), there were 240 cases of Small-pox under treatment, viz., 228 in the Asylums Board Hospitals, and 12 in the London Small-pox Hospital, Highgate: 256 cases had been notified, and 20 deaths had been registered, in the four weeks ended on that day. A common cause of the spread of Small-pox is the inability of many medical men to recognise the disease, which few of them have had opportunity of seeing. A very striking illustration of this kind occurred in the early part of the present year. The facts of the case, as set out in my second monthly report, are worth quoting, as follows: — "Four cases of small-pox notified in this parish occurred in one family, three of them being the consequence of failure on the part of a medical practitioner to recognize the nature of the first case, under circumstances which might well have excited suspicion and prompted measures of a precautionary nature. The first case, moreover, illustrates the remarkable power of small-pox infection to pick out and strike susceptible persons, instanter; whilst incidents in the course of it serve to show how disease may unconsciously be spread by an infectious person. The facts are as follows:—At the end of the third week in January a young man who had just obtained his medical qualification, saw, in company with a number of medical students, in the out-patient room of a general hospital, a man who had small-pox, the eruption being pretty plentiful and in the pustular stage. lie was not within fifteen feet of the sufferer, and was not in the room with him more than two minutes. Nevertheless he (and as it appears one of the students also) fell ill on the thirteenth day afterwards, viz., on February 1st, with febrile symptoms indicative of small-pox, followed on the 4th, by the characteristic rash. He saw a medical friend, not resident in Kensington, whom for brevity I will call Dr. Blank, and told him he had small-pox. This gentleman, however, formed the opinion that the case was one of chicken-pox; and, most 28 unfortunately, omitted the precaution of re-vaccinating the other inmates of the house, viz., the father, the mother and the brother of the patient, and a domestic servant. The mother was the next to fall ill, on February 17th, with the initiatory fever of small-pox. The son 'felt sure in his own mind' as to the nature of her illness, but Dr. Blank attributed the symptoms to Influenza, and the rash, when it appeared on the 20th, to the administration of salicylate of sodium. This lady must have received the infection on or about February 5th, or about twenty-four hours after the rash appeared in her son. She was extremely ill: the rash was very copious, and, in character (one would have thought), unmistakeable. The brother's illness began on February 19th, the father's on or about the 21st. These two cases appeared to be of a mild type; but, to the instructed eye, the rash, when it appeared, was characteristic. Returning to the case of the young doctor: he states that in four days after the first symptoms, he felt 'perfectly well,' nevertheless he remained in his bedroom until the 14th February. He went on business to Oxford Street, in a public conveyance, on the 15th, when the marks of the rash (which were plainly visible ten days later) were conspicuous, 'believing by this time, and after such a slight illness, that Dr. Blank must have been correct in his diagnosis and that he himself was wrong,' On the 16th, he went for a walk in a leading thoroughfare, and again on the 19th. Friends at this time were coming in every evening to see him, at a time when he was infectious. On February 23rd, when his mother's rash was fully out, he went on a long railway journey, spent the night at a fashionable watering place, and returned next day, on completion of his business, 'as they were all so ill at home.' When he saw his mother (on the 24th) there could be 'no mistaking the case, and Dr. Blank told him that he had made up his mind the day before that it was small-pox.' On the following day, February 25th, a physician from the hospital where the trouble originated, was called in, and found the three patients to be suffering from small-pox, but was of opinion that the young doctor was non-infectious." I saw the patients the same day: the cases were absolutely typical. The father died suddenly from heart failure on about the eleventh day of illness. The other patients recovered, and, so far as I know, there was no spread of the disease, under circumstances which might have had disastrous results. Medical Instruction.—The General Medical Council require evidence from the medical student that he has attended special hospitals to obtain a practical knowledge of 39 infectious diseases. Some years ago the Asylums Board provided facilities for the attendance of students at the Fever Hospitals, and early in the present year the Managers provided facilities for the acquisition of knowledge of small-pox, by adding the Hospital Ships to the list of Hospitals available for purposes of medical instruction. It will follow that, henceforth, a large proportion of the young medical practitioners will enter upon the practice of their profession with adequate clinical acquaintance with the symptoms, and the appearance of the rash of small-pox. It may be hoped, therefore, that errors in diagnosis, such as in the calamitous story set out above, will become rarer in the future. MEASLES. The deaths from measles in 1889, were 14 only, the smallest total on record: it was 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 66 above the corrected decennial average. In 4891 the deaths from this cause fell to 29. In 1892 the disease again became epidemic, the deaths being 109, viz., 91 in the Town sub-district, and 18 in Brompton, and were 35 above the corrected decennial average: all but 6 occurred under five years of age, 17 under one year, and 86 between one and five years. Measles is not one of the diseases required to be notified to the Medical Officer of Health under the provisions of the Public Health (London) Act, 1891; and, as I endeavoured to show in my report for 1891 (pp. 97—106), it remains to be proved that any great advantage would accrue from its addition to the list. The disease is often spread through the agency of schools: it is probable, therefore, that the duration of an epidemic might be shortened by the closure of schools, which are not seldom deprived of a large 30 tion of their pupils by an outbreak. An epidemic is sometimes, as in 1890, brought to an end on the occurrence of the long holidays. With a view to prevent the spread of the disease through the agency ot public elementary schools, I addressed a letter, at the commencement of the epidemic in that year, 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 children living in infected houses to attend school, a fact probably unknown to many parents. I suggested, therefore, that a circular letter should be sent to the parents of pupils for their instruction; but this course was not adopted. Such a communication, if systematically made at the beginning of an epidemic, would probably be the means of saving many lives, and it would certainly have the effect of checking the spread of measles in the only practicable way short of closing schools. 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. It must be allowed, however, that it is difficult to prevent measles from spreading, the disease being highly infectious from an early stage, if not from the commencement of the attack. The circumstances, moreover, in which the poor live in London—two or more families 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, of the lungs, &c. which are, as a rule, the immediate causes of death. I entertain no doubt that many lives might be saved were it practicable to isolate the little sufferers in hospital, especially such as live in 31 crowded homes, tainted with foul air, and under conditions which preclude the care so necessary in the nursing and management of measles. The deaths in London from measles in 1892, were 3,393, and 791 above the corrected decennial average. In 1890 the deaths from this cause were 3,291, and 664 above the average ; in 1891 only 1,807, and 871 below the average. The mortality from this disease was in excess in six out of the ten years 1882-91. SCARLET FEVER. This disease, which was the cause of 28, 26, and 16 deaths in the preceding three years respectively, proved fatal to 36 persons in 1892, the corrected decennial average being 27. Nine of the deaths belong to the Brompton sub-district; twenty-seven occurred in hospitals, to which 456 out of 715 recorded cases were removed. Of the 715 cases, 457 belong to North Kensington, viz., that part of the Parish north of Uxbridge Road; and 258 to South Kensington, i.e., the remainder of the Parish south of Uxbridge Road The cases recorded in the preceding three years, were 252, 375, and 323 respectively. Scarlet fever was epidemic in London in 1892, but the type of disease was mild, and the deaths (1,174) few relatively to the cases notified, some 28,000 in number. The case-mortality was about 4.2 per cent. The Table at page 37 indicates the progress of the epidemic in this Parish, and in the Metropolis as a whole, by the number of cases and deaths recorded in the thirteen successive periods covered by my four-weekly reports. The resources of the Asylums Board were taxed to the utmost, and for a time proved unequal to the strain: the applications for admission to the hospitals exceeded all previous experience. The admissions during the year exceeded the highest total in any previous year (6,537 in 1890), being about 14,000. 32 It was in May that the indications became clear that the disease was about to assume an epidemic form. On the 21st day of that month the cases under the charge of the Asylums Board were 170 in excess of the available accommodation in the Town Hospitals.* Many patients had already been drafted to the Northern Convalescent Hospital, Winchmore Hill, and it was manifest that the time was at hand when it would again become necessary to provide temporary accommodation, the Managers having been unable to obtain a site for the erection of a much needed additional Fever Hospital, in conformity with the recommendation of the Royal Commission in 1882. The General Purposes Committee were of opinion at this time, that all available accommodation would be exhausted by the beginning of July, a date which experience has shown to coincide with the commencement of the scarlet fever season, and that the Managers would have to provide additional accommodation for "possibly a thousand patients," and the necessary staff, and that to be of any use a large portion would have to be ready before the middle of August. At the end of June, the beds at all of the hospitals were full, 186 patients having been admitted in three days, and the number of scarlet fever cases under treatment being 2,063. At this time the Managers were about to open the Gore Farm (convalescent small-pox) Hospital, at Darenth, for convalescent scarlet fever cases, to the number of 600, and were making provision for the erection of temporary huts at some of the Town Hospitals. The Local Government Board, in giving sanction to this costly and unsatisfactory substitute for the permanent hospital, which they had not enabled the Managers *The admissions to the Fever .Hospitals in the four months January—April, were 2,770, a greater number by 342 than the highest number admitted in the corresponding months of any previous year, whilst the total number in the Managers' Hospitals at the beginning of May (1,686), the bulk of them being scarlet fever cases, was higher by 473 than on the corresponding day in any previous year, 33 to provide, pointed out that the plans for the huts were in several respects not in accordance with the standard generally adopted in hospitals for infectious diseases. Such is the disadvantage of haste in an emergency of this kind, to say nothing of the waste of money; it being a condition of the Board's assent to the plans, given in consideration only of the " pressure" under which the Managers were acting, that the huts should be " removed on the cessation of the epidemic." The notifications of scarlet fever cases, which had been 1788 in the four weeks ended June 18th, sprang up to 2404 in the four weeks ended July 16th, an increase of 616. The admissions, moreover, were more numerous by 402, and the cases in hospital, on the last day of the period covered by my four-weekly report (2488), were 543 above the number on June 18th. All of these numbers were in excess of any previous record, but they were far exceeded as the epidemic spread. The mortality fortunately was not high. Public attention was much excited on the subject of the epidemic at this time, and for many months subsequently; mainly owing to the fact that the Asylums Board had difficulty in coping with the applications for admission, a fact to which the Press frequently drew attention, as if it had been an indication of the severity of the epidemic, whereas it was more properly to be regarded as evidence of the increasing disposition on the part of the public and the medical profession to use the hospitals. Similar excitement, and due to the same cause, had been prevalent five years previously, in 1887, when scarlet fever was epidemic, and it is matter for regret that the Managers should have been unable to forestall occasion for its repetition by the provision of adequate hospital accommodation. The Gore Farm Hospital at this time was doing good service, and without it the Managers would have had far greater difficulties to contend with; a fact worth noting having regard to the strenuous opposition to the erection of this hospital. 34 At the date of my eighth four-weekly report (August l0th), the cases in hospitals had further risen to 3088, an increase of 600 since July 16th: the admissions in the four weeks, (1486), showed an increase of 247 only, the notifications (2690) an increase of 286. To this date the Managers had succeeded in keeping pace with the demands for accommodation, and it was hoped that, as they had just received the sanction of the Local Government Board to the acquisition of the site whereon the North-Eastern Hospital now stands, this addition to their resources would enable them, as on all previous occasions, to cope with the emergency, the urgency of which could not be expected to decline for some weeks, the usual maximum prevalence of scarlet fever, as indicated by the admissions to hospital, not having yet arrived. During a period of twenty years the maximum of admissions had been attained three times in September, four times in November, and nine times in October. In my ninth report—for the four weeks ended on the 10th September—I had to record an addition of 251 to the number of casas in hospitals on the 13th August, and an increase of 123 in the four-weekly number of admissions, and of 89 in the number of notifications. Cause for anxiety was increasing, for the mortality had been greater than in any previous four- weekly period. The deaths (133) showed an increase of 35; they were 34 above the corrected average, and the highest four-weekly number in 1892. The hospitals were now full: the daily discharges and deaths did not equal the daily number of applications for admission. To this date, however, all of our cases had been promptly removed—with a single exception, when a delay of twenty-four hours occurred. It was clear, nevertheless, that a block would ensue; not to be relieved wholly, until completion of the new Hospital, at which the works were being pressed forward with extraordinary energy. In the four weeks ended October 8th, a smaller number of cases was admitted; 1500, compared with 1609 in the 35 ceding four weeks. This decline was due to the fact that the hospitals, being full, were unable to receive many cases that should have been removed for isolation. Some of our own sick were detained in their homes whilst awaiting the accommodation created by the discharge or death of previous cases. Applications for removal were made every day; but each evening, for more than a fortnight, a telegram was received from the Board's offices, intimating that no beds, or very few beds, were available: so that on some days none, and on other days only a portion, of our cases could be admitted. In accordance with instructions received, the several applications were renewed daily before noon, and in some instances as many as five daily applications had to be made before individual patients could be admitted. On and after September 16th, I despatched a special messenger to the offices of the Board, daily, after visitation of the patients to ascertain that they were still in a fit condition to be removed, with the effect of getting a larger proportion of the cases removed without delay. On Sunday (25th) this course was adopted with the result that all detained cases were admitted on that day : subsequently there was less delay in effecting the removal of the sick. The difficulty, however, did not wholly cease when the NorthEastern Hospital was opened, on the last day dealt with in my tenth four-weekly report, viz., Saturday, 8th October. In these four weeks the notifications of scarlet fever cases attained the maximum number of 3959, our contribution, also the maximum, being 98. The cases in hospital on the 8th October were 3628, an increase in the four weeks of 289. The epidemic reached the turning point in the four weeks dealt with in my eleventh report. In these four weeks, ended November 5th, the notifications (3755) showing a decline of 204, compared with the number in the preceding four weeks. But there was an increase of 359 in the admissions to hospital, viz., from 1500 to 1859. The previous total of 1500, however, was a decline of 109 compared with the number admitted in 36 the four weeks ended 10th September, due to the inability of the Managers to admit many of the applicants. The number under treatment on Saturday, November 5th, was 4067, an increase of 437, compared with the number on Saturday, October 8th. Nevertheless, the accommodation was still inadequate, as evidenced by unavoidable delay in the removal of the sick. In the four weeks, 25 of our cases were detained in 22 houses: 7 for one day, 12 for two days, 5 for 3 days; and one for four days. In the twelfth four-weekly period, ended Saturday, December 3rd, there was a further reduction in the number of notifications, of nearly 1000; viz., from 3755 to 2789; and a decline of 447 in the number of admissions to hospitals. The patients remaining at the date named, however (3882), were only 185 fewer than on the fourth preceding Saturday. The mortality was pretty stationary, the deaths in the four weeks being 124, compared with 133, 123, and 127 in the three preceding four-weekly periods: this number, however, was 12 below the corrected average. There was no longer any delay in the removal of the sick, the available accommodation being ample. In the thirteenth and last four-weekly period, there was a still further improvement: the notifications (1968) declined by 821, the admissions to hospital (1051) by 361, and the number of patients in hospital on the last day of the year (3254) by 628, compared with the number on the 3rd December. The deaths also declined from 124 to 105. The total deaths in the year were 1174, and 60 below the corrected average number. The notifications were nearly 28,000 (in Kensington 718), and the admissions to hospital were little short of 13,800, including 456 from Kensington. The subjoined Table shows in a summary form most of the particulars with regard to the epidemic in 1892 set out in the above detailed account. 37 Scarlet Fever in 1892* Date of Report for four weeks ended No. of Notifications Kensington London. No. of cases admitted to hospitals Kensington London. No of Deaths Censington London. No. of cases in Hospital at the end of 1, the period: Jan. 30 28 863 22 412 4 48 1329 Feb. 27 23 776 14 386 2 55 1198 March 26 19 895 12 485 - 39 1226 April 23 41 1491 20 670 2 67 1400 May 21 51 1761 24 835 4 77 1677 June 18 39 1788 22 837 2 85 1945 July 16 70 2404 44 1239 3 93 2488 August 13 74 2690 53 1486 2 98 3088 Sept. 10 59 2773 5° 1609 4 133 3339 Oct. 8 98 3959 63 1500 2 123 3628 Nov. 5 85 3755 59 1859 4 127 4067 Dec. 3 82 2789 43 1412 4 124 3882 Dec. 31 49 I968 3° 1051 3 105 3254 718 27912 456 i378i 36 1174 It may be mentioned, by way of parenthesis, that at the close of the official year 1892-3, there were 1971 scarlet fever cases in the hospitals, 803 patients having been admitted in the four weeks ended March 25th: the deaths in the same period were 83, and the notifications 1428. The epidemic, therefore, had by no means come to an end. A notable feature of the epidemic was the smallness of the case-mortality, which, moreover, in the hospitals at any rate, had been declining for some years previously. In the twenty years the hospitals have been open, the average mortality, per-cent. of the patients treated, was 9.78. Down to 1884, the mortality was practically never below 10 per cent. Since 1884 it has not reached 10 per cent. in any year, the average rate in the last seven years having been 8.76. In 1890 the rate was 7.86 only; it further fell to 6.67 in 1891,and to 6.65 in 1892, "the lowest on record." I think, *The figures in this Table are uncorrected for duplicate notifications and errors in diagnosis. The notifications are taken from the weekly returns of the Asylums Board; the admissions to, and the numbers in, the Hospitals, and the deaths in London, from the weekly returns of the Registrar-General. 38 that this lowered mortality must, in a measure, be due to the admission, of late years, of a greater proportion of mild cases. In olden times the tendency was to keep (and conceal) such cases at home. Concealment, since the Notification Act came into operation (October, 1889), cannot have been largely practised; and a great many mild cases have, as a result of notification, been removed to hospital. In 1887, when the disease was last epidemic, the deaths were 1443. In only four of the 28 years, between 1859 (when scarlet fever and diphtheria were first differentiated by the Registrar-General), and 1886, inclusive, viz., in 1872, 1873, 1885, and 1886, were the deaths so few as in 1887. In these four years the deaths were 918, 645, 722 and 690, respectively. In six of the years the deaths ranged between 1430 and 1902 annually; in ten of the years the deaths were between 2000 and 3000; in five of the years between 3000 and 4000; in one year between 5000 and 6000, and in one year (1870, when the population was a million less than in 1891) upwards of 6000; numbers in comparison with which the 6072 deaths that occurred in the six years 1887-92 seem few indeed The moderate total for 1892, viz., 1174 deaths, being, as before stated, 60 below the corrected average, probably represents, in proportion to cases notified, the lowest rate of mortality on record, viz., 4.2 per cent. The year did not pass without furnishing illustrations of probable modes of spread of the disease. Two may be cited:— A child, aged 10 years, was taken ill on or about May 27th. She with her mother and an adult sister, occupied a single room. Mother and sister worked at two laundries. A doctor was called to see the child May 31st, but he did not notify the illness. On June 4th another doctor was called in, and he notified the case, but neither removed the child to hospital, nor referred to the circumstances above set out. The facts came to light on visitation of the case, on Monday, June 6th, upon receipt of the notification. I wrote to the certifying doctor stating the facts, and advising removal, but had no answer. I wrote to the mother and to the laundresses intimating that the attendance of the mother and the sister 39 at their places of work, must cease till the child recovered, unless she was removed to hospital forthwith. I had no reply from any of the parties, but the child was removed to hospital on June 9th. The doctor who first saw the case, on May 31st, and did not notify it, explained his omission to do so by saying that the child was not then suffering from scarlet fever. He may, of course, have failed to recognise the disease, which there is every reason to believe then existed, and which was plainly visible to the second doctor, who notified the case on being called in four days later. The second case shows how the disease might have been spread innocently, in ignorance, and wilfully by disobedience of instructions given to prevent exposure of infected persons. The particulars are as follows:— Three children of a coachman contracted the disease: the nature of the illness appears not to have been recognised, and soon the children were out and about as though nothing had happened. The father shortly afterwards fell ill, and a doctor having been called in, he was found to be suffering from scarlet fever. The doctor examined the children and finding that three of them were "peeling," he notified all four cases. He also cautioned the man not to go out or allow his children to go out. Notwithstanding, the man did go out and allowed his children to go out, even after he had been again cautioned both by the Sanitary Inspector and by his employer. The facts of this case were laid before the Works and Sanitary Committee, who directed proceedings to be taken under Section 68 of the Public Health Act, 1891. The man pleaded guilty, and was let off with a fine of twenty shillings in his own case, and of one shilling in each of the other two cases, with costs, a total of twenty-eight shillings. STATISTICAL RETURNS:- SCARLET FEVER. At the request of your Vestry, I prepared information, in the form of the subjoined Tables, for the use of the Asylums Board, in 1887, the Managers being desirous of forming a correct estimate of the accommodation likely to be required for scarlet fever in the future. Such information is now furnished by the notification returns. The Tables, nevertheless, as brought up to date, still possess interest, 40 Statistics of Scarlet Fever in Kensington in 1892, and Ten Previous Years. The Year. No. of Recorded Cases. Total Number of Recorded Cases. Percentage of Removals to total Recorded Cases. Deaths. Total Deaths. Percentage of Deaths. Percentage of Deaths to Recorded Cases. Deaths in London from Scarlet Fever. Treated at Home. Removed to Hospital. At Home. In Hospitals. At Home. In Hospitals 1892 259 456 715 64 27 36* 25 75 5.0 1174* 1891 117 206 323 61 3 13 16 19 81 4.9 589 1890 161 214 375 57 6 20 26 23 77 6.9 875 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 19.4 2004 * The corrected decennial average number of deaths from Scarlet Fever in Kensington was 27, and in London 1234. The case-mortality in Kensington patients treated at home was 3.5 per cent, and in patients treated in hospital, 5.9 per cent. 41 Scarlet Fever Cases Recorded in Kensington in 1892, 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 1892 28 23 20 34 51 39 73 74 59 97 85 82 50 715 1891 38 47 18 24 23 23 13 27 17 31 23 22 17 323 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 Average 1882-91 19.8 20.7 12.8 11.8 16.1 15.8 14.1 15.2 17.9 31.9 33.4 29.5 24.0 263‡ * Return comprises five weeks, ‡ Without correction for increase in population. Compulsory Notification has been in operation since the end of October, 1889. 42 DIPHTHERIA. In 1888, and still more in 1889, diphtheria was epidemic 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 6 below the corrected average. In 1891 the deaths further fell to 28, and were 12 below the corrected average. Last year the deaths were 31, and 11.5 below the average. Twenty-seven of the deaths belong to the Town sub-district, and four to Brompton. The deaths in the Brompton sub-district in the preceding four years had been 2, 5, 6 and 4 respectively. Fourteen of the deaths took place at home and 17 in hospitals—most of them in the Western Fever Hospital. The ages at death were: under five years, 21 (one only in the first year of life); between five and fifteen 9; and 1 at the age of 38. The cases recorded as diphtheria were 177, viz., 76 north and 101 south of Uxbridge Road. Eighty-eight of the sufferers were removed to hospital, 31 from North Kensington and 57 from South Kensington. In 1891 the recorded cases were 182—114 North, and 68 South of Uxbridge Road. The sufferers comprised 58 males and 119 females 4 44 of them were under five years of age, 44 between five and twelve years (the usual public elementary school age), 30 between twelve and twenty-one, and 59 upwards of twentyone.* Forty-five of the children had been in attendance at schools, 21 in North Kensington, and 24 in South Kensington. The case-mortality in hospital-treated cases was 19.3 per cent. against 12.8 per cent. in home-treated cases. The total casemortality, 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., and in 1891 to 15.4 per cent. Last year it was 17.5 per cent. This reduction in the rate of mortality is too great to be accounted for on the assumption of diminished malignancy in the type of the disease, and was more * The 89 cases at ages above 12 resulted in only 2 deaths. At ages above 15 there were 75 cases and only one death, 43 probably due to the inclusion, among the home-treated adult cases notified, of a considerable number of cases of nonspecific throat disease. The deaths from diphtheria in London were 1885, and 712 above the corrected decennial average: 524 more than in 1891, and 297 more than in 1889, a year characterized by the then highest death-rate on record from this disease. Part of the excess in 1892, the Registrar-General observes, may be attributed, with much probability, to the decrease of deaths under the heading Croup; but not all, for the deaths under the two headings taken together, amounted to 2,162, whereas the decennial average, after due correction for growth of population, would have given only 1,816. The Registrar-General points out, however, that the rates from diphtheria in the last five years, 1888-92, were all higher than that of any previous year, He also gives a Table showing the number of deaths from this disease, for each of the last six years, in each sanitary area, after due distribution of the deaths in public institutions. The deaths in this parish were 338, including 91 in 1888, and 111 in 1889. It is remarkable how little attention was bestowed upon diphtheria by the "organs of public opinion," last year, at a time when the facts with regard to scarlet fever prevalence were being published daily, and yet the total deaths exceeded those from scarlet fever by no fewer than 711, and were 712 in excess of the corrected average, the deaths from scarlet fever being 60 below the average. Diphtheria, which for many years, was mainly a rural disease, has shown for a considerable period an ever-increasing disposition to become an urban disease. Fortunately, the hospitals of the Asylums Board are available for the reception of sufferers from it, and from its congener, membranous croup, if alleged to be of a diphtheritic character. The Table at page 44 sets out some particulars with regard to Diphtheria in Kensington, in 1892, 44 PARTICULARS WITH REFERENCE TO DIPHTHERIA IN KENSINGTON, IN 1892. Set out in Report for Four weeks ended. Total Cases Notified. Cases Notified in North Kensington* Cases Notified in South Kensington.* Cases removed to Hospital from Deaths in North Kensington. South Kensington. North Kensington. South Kensington. January 30 23 8 15 4 11 3 1 February 27 8 5 3 2 2 ... ... March 26 8 3 5 3 2 1 ... April 23 19 6 13 2 5 1 1 May 21 13 5 8 1 6 1 1 June 18 18 10 8 3 6 8 ... July 16 16 10 6 3 2 2 1 August 13 14 8 6 4 3 2 ... September 10 6 1 5 1 4 ... ... October 8 15 9 6 5 5 2 1 November 5 21 3 18 1 8 2 1 December 3 8 3 5 1 2 ... 1 December 31 8 5 3 1 1 1 1 177 76 101 31 57 23 8 * North Kensington and South Kensington, are the districts to the North and the South of the centre of the Uxbridge Road, respectively. The population of the two districts is about equal. 45 WHOOPING-COUGH. The deaths from Whooping-cough were 63, and 19 below the corrected decennial average; thirteen of them were registered in the Brompton sub-district; all but one were of children under live years of age, including 30 under one year. Fifty-two of the deaths were registered in the first twenty-four weeks of the year, and only 11 in the remaining 28 weeks— seven of them in the last eight weeks. Reference has been made to the indifference of parents among the poorer classes, in regard to the spread of measles in their families. The observation is, perhaps, even more generally applicable in regard to whooping-cough, the seriousness 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 regard as 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 not seldom 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 (2,477) were 524 below the corrected decennial average. The comparatively low case-mortality of whooping-cough, and, I may add, of measles also, serves in the public estimation to remove these 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. 46 Thus in 1892, the deaths from measles and whooping-cough respectively, were 3,393 and 2,477=5,870; the deaths from small-pox (41), scarlet fever (1,174), diphtheria (1,885), and "fever" (467), being 3,567 only, or little more than half the number from lightly-regarded measles and whooping-cough. FEVER. Typhus Fever.— For the first time in many years, there was a limited outbreak of this disease in Kensington—in the month of August. The cases were four in number. The first case, an imported one, came from Brentford, where the sufferer, a married woman, who lived at Acton, had been engaged in fruit picking. Having fallen ill, she sent to her sister, who fetched her to her own home in Tobin Street, and, not suspecting the infectious nature of the illness, slept in the same bed with her. The sick woman was visited by her niece, who lived in Walmer Road, and who was the first to become infected. Subsequently, the sister fell ill, and she in turn infected her husband. Meanwhile, the woman from Brentford had gone to her own home at Acton, whilst apparently infective—if it is true, as is alleged, that she infected her husband. But from what disease she was supposed by the Acton authorities to be suffering I do not know, my application for information not having been acknowledged. The, three Kensington cases were notified by as many doctors (on August 29th, August 30th, and September 6th respectively), as cases of typhoid fever, and as such were removed to the Western Hospital. The Medical Superintendent of the hospital, upon discovering the nature of the illness, immediately communicated with me. I saw the several patients with him, aud concurred in his diagnosis. All recovered. Simple Continued Fever.— There were two deaths from this cause. 47 Enteric Fever.— The deaths from this cause were 15, against 19, 15, and 24 respectively, in the preceding three years: they were five below the corrected decennial average. Nine of the deaths were registered in the Town sub-district, and six in Brompton. Three took place in hospitals, to which 16 patients were removed. The recorded cases were 57 (102 in 1891), viz. 30 in North Kensington, and 27 in South Kensington, the Uxbridge Road being the dividing line. There were 11 deaths from typhus in London and 20 from simpleand ill-defined fever, the decennial averages being 25 and 64. The deaths from enteric fever were 436, or 304 below the corrected decennial average. DIARRHŒA. This disease was the cause of 77 deaths, being 9 below the corrected decennial average, against 70, 78, and 91 respectively, in the preceding three years: 66 in the Town subdistrict, and 11 in Brompton. Sixty-six of the deaths were of children under five, including 56 under one year. Of the total number, 57 were registered in 12 weeks—July 17th to October 8th inclusive; thirty of them in the four weeks ended September 10th. The deaths from diarrhceal diseases in London generally, were 2,546 (504 below the corrected decennial average), including 910 of infants in the first year of life, and 1,484 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. 48 CHOLERA. Among the deaths registered in 1892, were four attributed to English Cholera or Choleraic Diarrhoea, the dates of death being April 8th, July 22nd, July 30th, and September 8th. The deceased, aged respectively 24, 32, 40 and 58, comprised three males—a wire-worker, a painter, and a labourer—and one female, the wife of a postman. There was nothing to distinguish these cases from those cases of English Cholera which occur every year in small numbers; but the case which occurred in September attracted some notice by reason of the severity of the symptoms: the sufferer was a man previously broken down in health. Three of the deaths took place in the Parish Infirmary, the patients, all males, having been removed thereto, from Bangor Street, Wornington Road, and Swinbrook Road. The female died in her home at St. Ervans Road. Asiatic Cholera.— It became apparent at about the middle of the year, that this dreaded disease had undoubtedly extended to the confines of Eastern Europe; and in July a good deal of alarm was excited on account of a number of deaths that occurred in and near Paris, from diseases unquestionably choleraic, but whether of the true Asiatic character did not appear, our neighbours not having the English habit of frankness in the disclosure of disagreeable facts. The Local Government Board, taking into consideration that "cases of an infectious disease alleged to be Cholera now (July 11th) exist in certain parts of France," issued a General Orderto Port and other Sanitary Authorities, forbidding the delivery over-side, except for the purpose of export, or the landing in any port or place in England, of rags from France—a course which, taken with other facts, indicated the view of the Board that, at least, precautionary measures were necessary if an epidemic was to be averted. Before the end of the month Cholera declared itself in many parts of Russia, to which country it was limited for some little time, notwithstanding disquieting rumours to the contrary from some of the Central 49 European States. In view of the circumstances of the case, and of the fact that "rags are imported and large numbers of emigrants are brought to this country by ships from the Baltic or North Sea ports," the Local Government Board on 11th August, issued a further order prescribing regulations forbidding the landing in any port or place in England or Wales of rags, bedding, or disused or filthy clothing, whether belonging to emigrants or otherwise, from any foreign port of Europe, north of Dunkirk, other than ports of Norway, Sweden and Denmark. Such articles, if landed and not exported, were to be déstroyed with proper precautions, and the Order defined the duties of Sanitary Authorities and their Officials in regard to the matters dealt with. Cholera, which at the time was thought to be still far distant from the Western parts of the Continent, made its appearance with startling suddenness not long afterwards at Hamburg, where its ravages were formidable, some 18,000 cases and 7,600 deaths having been reported in the course of the seven weeks over which the epidemic extended. Cases occurred in other ports having more or less free communication with this country, and a few cases were brought to our shores. Happily, there was no extension of the disease, the Local Government Board and the several Port Sanitary Authorities having made all necessary preparations with a view to the isolation and treatment of imported cases. The Board, moreover, issued a variety of circular letters, Memoranda and Orders, for the guidance and instruction of Sanitary Authorities and their Officers, all of which were regularly reproduced for general information in the leading newspapers. The first "Circular to Sanitary Authorities in the Metropolis," dated 25th August, intimated that the Board were considering "the question of the measures of a precautionary character which should be adopted in view of the possible introduction of the disease into London," but did not, at that time, "propose to issue Regulations which would impose on e 50 the Sanitary Authorities the duty of making arrangements the character of which was indicated for the prevention and treatment of Cholera." Reference was made to the duties which would devolve on the Metropolitan Asylums Board and the Sanitary Authorities respectively, under the regulations, and a copy of a letter addressed by the Board to the Managers was enclosed for the information of your Vestry. The Board also issued, under date 26th August, two important papers, signed by their Medical Officer, entitled respectively, "General Memorandum on the Proceedings which are advisable in Places attacked or threatened by Epidemic Disease," and "Precautions against the Infection of Cholera." It is almost needless to say that these documents embodied valuable information and advice. Arrangements, moreover, were made under an Order of the Board to secure the despatch of information to local Medical Officers of Health by the Port Sanitary Authority, in respect of passengers arriving from infected places, so that they might be kept under observation, in view of the possible development of Cholera after arrival at their destination in this country. Provision was made for the detention of suspected persons; for the isolation in hospital at the port of entry of sick persons, and for the disinfection of ships. Quarantine of persons, other than the sick or the suspected, is not attempted, experience having shown its inutility; and the more humane treatment of immigrants adopted in this country, having been proved to afford all necessary protection in respect of Cholera, which is not an infectious disease in the same sense as small-pox and scarlet fever are infectious. The Local Government Board, moreover, placed themselves in communication with the Royal College of Physicians on the subject of Cholera, the specific request made being that the President should communicate to the Board "prescriptions as to the remedies which the College might think most suited to the requirements in view." The President summoned a meeting of the Council, and was authorised to forward to the Board a valuable report which he had prepared, containing 51 instructions to be followed for the prevention of Diarrhœa and Cholera. This report likewise was published in the daily and other papers. With regard to the action taken in this Parish, in view of the possible introduction of the disease, it may be remembered that a special meeting of the Works and Sanitary Committee was held (September 7th), to receive the above-mentioned communications from the Local Government Board, together with reports from the Surveyor and myself, "as to the precautionary steps which have been taken for preventing, as far as possible, the spread of the disease in this Parish, should cases occur therein," and to consider "whether any, and if so, what, further steps should be taken in the matter." I may, perhaps, be permitted to say, with respect to the steps taken by the Surveyor, as set forth in his report, that they appeared to me to be excellent and complete with regard to the matters under his control. My own report to the Committee was to the following effect:— "I beg to report, for your information, that upon becoming acquainted with the outbreak of Cholera at Hamburg, and having in view the danger that cases might be imported into London, I instructed the Sanitary Inspectors to redouble their efforts for the abatement of nuisances. I called their attention particularly, to the necessity for works of cleansing—of cisterns, yards, dustbins, and premises generally, especially in streets inhabited by the poor, who frequently store rubbish which becomes a nest for the accummulation of filth. I also directed their attention to the duty of preventing', as far as possible, the sale of unsound and unwholesome food of every description, especially unripe, over-ripe or decayed fruit, stale vegetables, fish, &c. "With a view to being prepared in the event of Cholera cases occurring, I applied to the Clerk to the Guardians to know whether patients could be received at the Parish Infirmary, and at the supplementary Workhouse at Mary Place, in the Potteries district. The Asylums Board subsequently made a similar application to the Guardians, who have agreed to set aside certain wards for the purpose at both institutions. The Marylebone Infirmary, moreover, I have reason to believe, will be available for North Kensington cases; for the 52 Metropolis will be treated as a whole, without regard to particular districts, should the disease appear, and this institution is too far away to be of use to Marylebone Parish, it being held unsafe to remove patients to a greater distance than one mile from their homes. "The Asylums Board are organising arrangements for providing hospital accommodation in all parts of the Metropolis; their own hospitals being quite full of scarlet fever and other cases; and they are also acquiring hand-ambulances for the removal of the sick. "It will be for your Committee to consider whether something more might not be done to put this Parish into a state of preparedness, as by the appointment of a number of temporary Assistant Sanitary Inspectors, who should make a house to house visitation in the poorer districts, with a view to the discovery and the abatement of nuisances due to filth, which may be said to be the food and the breeding-nest of the Cholera germ. "Assuming that it would be deemed proper to issue some simple directions for the guidance of parishioners in the prospective emergency, as was done in 1883, I have prepared a leaflet, entitled "Precautions against Cholera," a proof of which has been sent to each member of your Committee, and now beg to recommend that if the said leaflet be approved, arrangements be forthwith made for circulating it in the Parish. "It may be mentioned that in the event of an outbreak of Cholera in London, the Local Government Board will issue 'Regulations,' as in 1866, defining the duties of the Sanitary Authorities, which would include the provision of hospitals in their several districts, supplementary to those provided by the Asylums Board, as well as of refuges to which the, as yet, unattached or healthy inmates of infected houses could be removed, in cases where the sick are unfit to be removed to hospital. Other duties which would devolve on these Authorities are, the provision of medical attendance and nursing for the sick, in their homes and at the hospitals, and of necessary attendants at the refuges. It would be their duty also, to provide medical attendance, medicines, disinfectants, &c., for the use and service of poor persons attacked with diarrhœa, &c., and unable to provide these requisites for themselves. The expenses arising from such action would be, to a large extent, chargeable to the Metropolitan Common Poor Fund, at the discretion of the Local Government Board." The Committee approved the leaflet I had prepared and ordered five thousand copies for distribution in the Parish. 53 They also sanctioned the appointment, for a period of four weeks, of six Assistant Sanitary Inspectors, who inspected 1,520 houses and served 1,368 "written intimations" of nuisances, so as to "secure the existence of the nuisance being immediately brought to the notice of any person who may be required to abate it," in conformity with Section 3 of the Public Health (London) Act, 1891. In my report to the Committee at the end of the four weeks, I represented the desirability of continuing this special work for a few additional weeks. The Committee, however, thought it unnecessary, and decided accordingly. It only remains to add that it is probable, judging from past experience, that there will be a recrudescence of Cholera this year, and that it behoves Sanitary Authorities, at home and abroad, to be prepared for this contingency. INFLUENZA. For the third successive year Influenza was prevalent in the Metropolis, as in many other parts of the kingdom. The deaths directly ascribed to this cause in London were 2,264, compared with 2,336 in 1891, and 650 in 1890. The total therefore, in the three years, was 5,252: in the preceding ten years, 1880-89, the deaths had been only 63. But, as the Registrar-General observes, "these 5,252 deaths by no means represent the whole mortality caused by these successive outbreaks. A large number of deaths really due to influenza are certified under other names, and especially under bronchitis and pneumonia, and the deaths under these two headings in the three years numbered 56,070, whereas according to the preceding decennial average they should have been only 47,120. What has been spoken of as three successive outbreaks," he adds, "would be more accurately described as a single outbreak with three periods of exacerbation; for there was scarcely a week, and no succession of two weeks, in the three years without some deaths from this disease. In 1890 the period of maximum 54 intensity was in January, in 1891 it was in May and June, in 1892 it was in January and February, the mortality having risen almost suddenly in the first week of the year, having reached its maximum in the third week, and then gradually subsided." The statement of the Registrar-General respecting the epidemic in London as a whole, is generally applicable to the outbreak in this Parish. But the mortality which attained its maximum in London, in 1891, did not attain its maximum in Kensington until 1892—the deaths in the three successive years having been 39, 113 and 155. Of the 155 deaths in 1892, as many as 106 were registered in the first four weeks— 84 of them in the Town sub-district and 22 in Brompton— irrespective of 13 in which influenza was noted as a secondary cause of death. Some of the deaths were of non-parishioners, including 10 at St. Joseph's House, and 4 at the Marylebone Infirmary. Two were of parishioners at outlying public institutions far away from the Parish. The deaths of parishioners in the parish were 93, viz: 72 in the Town subdistrict and 21 in Brompton: 53 males and 40 females. Fiftyfour of the deaths, or 58 per-cent., occurred at ages over 60 years. It is noteworthy that in 8 cases only, out of the 93, was influenza returned as the sole cause of death; diseases of the lungs were associated with it in 78 cases, other visceral diseases in 7 cases. Fifty of the deaths occurred in houses situated to the north of Uxbridge Road, 11 in houses between that road and Kensington Road, and 32 in houses south of Kensington Road. All classes of the population suffered, the well-to-do most of all, seeing that 42 of the deaths were of persons or in families described as belonging to the gentle and professional classes. Only 16 deaths occurred among the classes engaged in trade, whilst 35 were distributed amongst the classes engaged in laborious occupations. In these same four weeks the unprecedented number of 198 deaths were attributed to diseases of the respiratory system, including bronchitis 151, and pneumonia 27, of which, there can be no 55 doubt, a large proportion were really due to masked or unrecognized influenza. Taking all cases in which Influenza was named in certificates of the causes of death (119), the deaths in the successive weeks were 5, 22, 52 and 40. The death-rate in the first week of the year was equivalent to 29.6 per 1,000 per annum: it rose in the second week to 40.6, and in the third week to 41.8, falling in the fourth week to 36.8 per 1,000. The rate for the four weeks combined, was 37.2, and 16.7 above the corrected decennial average. Nearly one-sixth of the total deaths in 1892 occurred in these four weeks: the number registered was 477, and 214 in excess of the corrected average. The deaths in the Town sub-district were 378, and the rate 414; the deaths in the Brompton subdistrict being 99, and the rate 27.0. The London death-rate in the four weeks was 40.0 per 1,000—15.5 above the decennial average—the rate in the successive weeks 32.8, 40.0, 46.0 and 41.0 per 1,000. The deaths primarily attributed to Influenza were 1,308, viz., 95, 271, 506, and 436, in the four weeks consecutively. But the total deaths in the four weeks, 13,066, were 5,050 in excess of the corrected decennial average—an excess largely accounted for by the mortality from the diseases of the respiratory organs, which were the causes of 4,989 deaths, or 2,571 above the corrected average. The deaths in excess from these diseases in the four weeks consecutively, were 455, 594, 868, and 654. But the deaths primarily attributed to Influenza (1,308), and the deaths in excess from diseases of the respiratory organs (2,751), together (4,059), were 991 fewer than the deaths (5,050) in excess of the corrected average number; and having regard to the comparatively satisfactory condition of the weather during the month, which in ordinary circumstances would have been favourable to the public health, there was but too much reason for believing that a large proportion of those 991 deaths also, was due directly or indirectly to the pestilence which was creating such havoc in this and other countries. 56 The epidemic continued, with constantly diminishing severity, for several more weeks, but the death-rate in the second four-weekly period of the year underwent a great decline: it was only 20.6, or 2.2 above the average, in Kensington; and 24 6, or 2.1 above the average, in London as a whole. In these weeks the deaths in London from influenza were 637 (viz. 314, 183, 79, and 61 in the successive weeks), and in Kensington 34, including five in Brompton. The deaths from diseases of the respiratory system fell from 4,989 to 2,571, in London, and were only 240 above the average. They were 324 in excess in the first fortnight, and 84 below the average in the latter half of the period. In Kensington the deaths from these causes, which in the preceding four weeks had been 198, fell to 77. The anticipation I had expressed in my first monthly report that we had "seen the worst of the epidemic," and might "look forward hopefully to an immediate and progressive decline in the rate of mortality," was thus realized. In the third four-weekly period (February 28th to March 26th), the deaths from Influenza were 119 only in London, and 9 in Kensington: the general death-rate, moreover, was slightly below the average, as it was again in the following four weeks, ended April 23rd, in which only 42 and 3 deaths were registered in London and Kensington respectively, from Influenza. It is noteworthy that the deaths in London from diseases of the respiratory system, which had been 2,143 in excess of the decennial average in 1890, the first year of the epidemic, and 4,103 in excess in 1891, were only 392 in excess in 1892, a remarkable fact seeing that the deaths from these causes in the first four weeks of the year alone, were 2,571 above the corrected average. The early weeks of the current year have witnessed a slight recrudescence of Influenza, but I venture to express the hope that the present generation will see no more of the disease in its severely epidemic form. The following Table showing the relative prevalence, at different periods of the year, in Kensington and in London, of certain diseases of the zymotic class, has been compiled from my thirteen four-weekly reports. 57 Table showing the number of Deaths from Zymotic Diseases in Kensington, and in London, in 1892 Arranged in four-weekly periods. Date of Report. For Four Weeks ended. Weeks of the Year KENSINGTON. LONDON. Weeks of the Year. Date of Report. For Four Weeks ended. Small-pox. Scarlet Fever. Diphtheria. Enteric Fever. Diarrhœa. Typhus & other Continued Fevers. Measles. Whooping-cough. Cholera. Total. Small-pox. Scarlet Fever. Diphtheria. Enteric Fever. Diarrhœa. Typhus & other Continued Fevers. Measles. Whooping-cough. Cholera. Total. January 30, 1892 1-4 ... 4 5 ... 2 ... 3 11 ... 25 1 48 101 29 69 3 301 644 2 1198 1-4 January 30, 1892 February 27 „ 5-8 ... 2 ... ... 2 ... 3 11 ... 18 ... 55 90 18 67 3 183 410 ... 826 5-8 February 27, „ March 26 „ 9-12 ... ... 1 ... ... ... 8 11 ... 20 4 39 122 20 62 3 261 339 2 852 9-12 March 26 „ April 23 „ 13-16 ... 2 2 1 2 ... 5 8 ... 20 6 67 111 21 67 4 423 277 2 978 13-16 April 23 „ May 21 „ 17-20 ... 4 2 3 3 ... 17 6 ... 35 10 77 114 30 54 ... 590 229 1 1105 17-20 May 21 „ June 18 „ 21-24 ... 2 8 1 2 ... 25 5 ... 43 5 85 150 26 108 1 485 149 6 1015 21-24 June 18 „ July 16 „ 25-28 ... 3 3 2 7 ... 26 1 ... 42 6 93 150 24 389 3 350 106 15 1136 25-28 July 16 „ August 13 „ 29-32 ... 2 2 ... 15 1 15 ... ... 35 5 98 139 27 603 4 264 79 16 1235 29-32 August 13 „ September 10 „ 33-36 ... 4 ... 1 30 1 5 1 ... 42 ... 133 146 28 629 2 117 44 27 1126 33-36 September 10 „ October 8 „ 37-40 ... 2 2 2 10 ... ... 1 ... 17 ... 123 180 65 276 3 53 41 11 752 37-40 October 8 „ November 5 „ 41-44 ... 4 3 2 2 ... 2 1 ... 14 ... 127 190 53 115 ... 102 24 2 613 41-44 November 5 „ December 3 „ 45-48 ... 4 1 1 2 ... ... 3 ... 11 3 124 165 46 49 3 122 45 3 560 45-48 December 3 „ December 31 „ 49-52 ... 3 2 2 ... ... ... 4 ... 11 1 105 227 49 58 1 142 90 1 674 49-52 December 31 „ Totals ... ... 36 31 15 77 2 109 63 ... 333 41 1175 1885 436 2546 30 3393 2477 88 12070 Total. * In the Annual Summary, the Registrar-General has a total of 11983. The figures in the Table were collated from the Weekly Returns for publication in my Four-weekly Reports. 58 Thus far I have dealt with the "seven principal diseases of the zymotic class," comprising, with Cholera and Influenza, all those Maladies which in Table III, (Appendix),go to make up Orders 1 and 2 (Miasmatic and Diarrhceal Diseases), in class 1 in the Registrar General's Classification, " Specific Febrile or Zymotic Diseases." Still dealing with this important Class, it appears that no deaths were registered from Malarial Diseases, Order 3, viz., Remittent Fever and Ague; nor from Zoogenous Diseases comprised in Order 4, viz., Cow-pox and Effects of Vaccination and "Other Diseases," e.g,. Hydrophobia, Glanders, Splenic Fever. I pass on therefore to— Order 5, Venereal Diseases, which includes Syphilis, Gonorrhœa, and Stricture of the Urethra. Syphilis was the registered cause of 10 deaths, against 26, 14 and 13 in the preceding three years respectively. Nine of these deaths occurred in the Town sub-district: 5 of them were of children under one year of age. If the truth were known, it would probably appear that this Protean malady was accountable, directly or indirectly, for a number of deaths considerably in excess of the record. There were four deaths from gonorrhoea and stricture of the urethra. Order 6, Septic Diseases. This order comprises Erysipelas Pyæmia, Septicæmia and Puerperal Fever, the total deaths registered being 23, against 16, 24 and 18 in the preceding three years respectively. Erysipelas was the cause of 11 deaths,* against 8 in each of the preceding three years, seven 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 4 deaths, two in each of the sub-districts. There were 2, 6 and 5 deaths from these causes in the preceding three years respectively. * The notified cases were 192, 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. 59 Puerperal Fever was the registered cause of 8 deaths* (against 6, 10 and 5 in the preceding three years respectively), six of them in the Town sub-district. Seven of the deaths were of women between twenty-five and thirty-five, and one between thirty-five and forty-five. In addition to these 8 deaths, other 8 (six of them in the Town sub-district), were registered as having occurred in "childbirth," against 7, 14 and 10 in the preceding three years respectively. 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 (16), were equal to about 4.3 per 1,000 live births, against 3.5, 6.2 and 4.0 per 1,000 in the preceding three years respectively. Class II.—Parasitic Diseases Include Thrush and Other Vegetable Parasitic Diseases; and Worms, Hydatids, and Other Animal Parasitic Diseases. There were two deaths from Thrush under one year of age. Class III.—Dietetic Diseases Were the causes of 27 deaths, all but two of them in the Town sub-district. To Want of Breast Milk—Starvation, seven deaths were classified; to Scurvy, none. Delirium Tremens was the cause of 7 deaths, against 6, 6 and 4 in the preceding three years respectively; Chronic Alcoholism of 13 deaths, against 7, 8 and 7. Of these 20 deaths all save two were in the Town sub-district. It is scarcely necessary, perhaps, to remark that, if all the deaths due, directly or indirectly, to the immoderate use of intoxicating liquors, could be ascertained, "Alcoholism" would occupy a more prominent position in the " Bills of Mortality": but many deaths due to the misuse of alcohol get certified, and therefore are classified, * Only three cases of puerperal fever were notified 60 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 478 deaths (=16.5 per cent. of total deaths), including 79 of children under the age of five years: 359 of the deaths were registered in the Town sub-district, and 119 in Brompton. Rheumatic Fever, and Rheumatism of the Heart caused 10 deaths, 8 of them in the Town sub-district; Rheumatism, 2 deaths. In fatal cases of rheumatic fever, the immediate cause of death, not infrequently, is disease of the heart arising in the course of the malady; and of the deaths certified from heart disease at later periods of life, not a few might properly 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 complication. Gout was the cause of 10 deaths, 9 of them in the Town sub-district, and Rickets of 4, Cancer—Malignant Disease, was accountable for 129 deaths; 91 in the Town sub-district and 38 in Brampton. Cancer is on the increase in the country generally: possibly, however, some portion of the apparent increase in deaths classified to this cause, may be due to more accurate diagnosis. The deaths in Kensington in the previous ten years, were 61 92, 128, 117, 119, 128, 117, 121, 138, 125 and 127 respectively. Deaths from cancer are usually more numerous, proportionately to population, in the Brompton sub-district than in the relatively poorer Town sub-district, cancer being 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 108 of the deaths took place at ages above forty-five, and 17 between thirty-five and forty-five. It is proper to mention that in Table III. (Appendix), the deaths attributed 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 19 deaths. One death was registered from Purpura, Hemorrhagic Diathesis. 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 arrangements. Scrofula is unknown in Hygieapolis! Pure air and sunlight; efficient drainage, and its corollary, a dry subsoil; good food, warm clothing, and temperance in all things, are powerful antidotes to the bane of tubercle, which is fostered by dirt and squalor, by cold and nakedness, by vice and intemperance, by the want of the proper necessaries of life, by overcrowding in ill-constructed, unventilated and 62 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 special "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 293 deaths in 1892 (against 320, 369 and 343 in the preceding three years respectively): viz., 226 in the Town sub-district, and 67 in Brompton; 72 of the deaths being those of children under five years of age. The numbers in the four quarters of the year respectively, were 84, 81, 67 and 61; or 145 in the winter, and 148 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 Tuberculosis, Scrofula" the total being 33 (of which 23 occurred under five years of age), including 8 registered in the Brompton subdistrict, Tabes Meseuterica, popularly known as "consumption of the bowels,," was the cause of 21 deaths, including 2 in Brompton, all of them under five years of age, and 16 under one year. Tubercular Meningitis and Hydrocephalus (water on the brain) were the causes of 37 deaths, 7 of them in Brompton, and 28 under five years of age. Phthisis popularly known as "decline" or "consumption," was the cause of 202 deaths: 5 between five and fifteen years of age, and 191 between fifteen and sixty-five; viz., 30,49, 59, 35 and 18 in the five decades consecutively: 6 deaths were registered at ages over sixty-five. The quarterly numbers were 60, 49, 47 and 63 46. Of the total, 152 belong to the Town sub-district and 50 to Brompton. The deaths from tubercular diseases were, proportionately, not nearly as numerous in Brompton as in the Town sub-district. 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 is 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 170, viz., 128 in the Town sub-district, and 42 in Brompton. Premature Birth was the assigned cause of 56 deaths, 16 of them in the Brompton sub-district; Atelectasis of 7, five of them in the Town subdistrict; and Congenital Malformation of 9. Old Age was the registered cause of 98 deaths, all but one of them at ages over sixty-five: between sixty-five and seventy-five there were 20 deaths so classified; 37 between seventy-five and eighty-five, and 40 at eighty-five and upwards. Class VI.—Local Diseases. The diseases in this Class, comprising eleven Orders, named after the systems or organs to which the diseases relate, were accountable for 1,452 deaths, or 50.4 per cent. of the deaths from all causes: 1,130 were registered in the Town sub-district, and 322 in Brompton: 372 were of children under five years of age. All of these totals fall considerably below the numbers recorded in 1891, when the deaths from local diseases were 1,690, 64 1. Nervous System.—Diseases of the nervous system were the registered causes of 293 deaths (against 318, 321, and 327 in the preceding three years respectively), viz., 220 in the Town sub-district and 73 in Brompton: 76 of the deaths were of children under five years of age. The quarterly numbers were 84, 65, 61 and 83. The fatal diseases were Inflammation of Brain or Membranes, 25 deaths; Apoplexy, Softening of Brain, Hemiplegia, Brain Paralysis, 137 (97 in the Town sub-district, 40 in Brompton, and 121 at ages over fortyfive); Insanity, General Paralysis of the Insane, 12; Epilepsy, 12; Convulsions, 59, (56 under five, and 44 under one year); Laryngismus Stridulus (spasm of glottis) 1: Disease of the Spinal Cord, Paraplegia, Paralysis Agitans, 10; Other Diseases of Nervous System, 37. 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 pre-existence 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—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 there is no pathological condition which would enable one to say positively, that a child had suffered, still less that it had died, from convulsions. 2. 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. 65 3. Circulatory System.—The deaths clue to diseases of the organs of circulation, heart and blood vessels, were 173, against 188, 220 and 198 in the preceding three years respectively: 137 were registered in the Town sub-district, and 36 in Brompton. The quarterly numbers were 57, 43, 30 and 43. To specified forms of disease 59 deaths were assigned, viz., Pericarditis, 4; Acute Endocarditis, 2; Valvular Diseases of Heart, 41. Aneurism was the cause of 10 deaths, and Embolism, Thrombosis, of 2. Other Diseases of Heart caused 107 deaths, and Other Diseases of Blood Vessels, 7 deaths. 4. Respiratory System.—The deaths from diseases of the chest, Phthisis being excluded, were 704, against 470, 745 and 853 in the preceding three years respectively, and 244 per-cent. of total deaths. Of this number 574 were registered in the Town sub-district and 130 in Brompton. The quarterly numbers were 352 and 163 in the first and fourth, or colder quarters, and 128 and 61 in the second and third, or warmer quarters. The deaths under five years of age were 244, or 34.6 per-cent. (against 32 4, 35.3 and 32.1 per-cent. in the preceding three years respectively), and at fifty-five and upwards 305, or 43.3 per-cent. of the whole number (against 39.4, 412 and 44.3 per-cent. in the preceding three years respectively). These diseases are thus seen to be most fatal at the extremes of life. The prevalence of them varies considerably in different years, depending on the degree of cold in winter and the general character of that season: they are always most fatal when fog, especially "London fog," is associated with low temperature. There was good reason for believing that the epidemic of Influenza was largely responsible for the fatality of this class of diseases in 1891; the same remark does not appear to apply, or not to the same extent, with regard to the deaths from diseases of the respiratory organs in 1892. The fatal diseases were Laryngitis, 8 deaths; Croup (transferred in the new classification from "miasmatic "diseases), 10*; Emphysema, Asthma, * Thirteen cases only of membranous croup were notified. F 66 12; Bronchitis, 457; Pneumonia, 140; Pleurisy, 30, and Other Diseases of Respiratory System, 47. Bronchitis and Pneumonia, therefore, were accountable for 597 deaths (including 209 under five years of age), of which 102 were registered in Brompton. 5. Digestive System.—The diseases of the various organs concerned in digestion, were the causes of 177 deaths; 50 of them under five years of age; 127 in the Town subdistrict, and 50 in Brompton. In the new classification, Dentition is included in this Order: it was the cause of 14 deaths under five, 6 of them under one year. Diseases of the Stomach caused 17 deaths; Enteritis, 32; Obstructive Diseases of Intestines, 24; Peritonitis, 26, Ascites, 1. Cirrhosis of Liver caused 23 deaths; Jaundice and Other Diseases of Liver, 30 (including one under one year), and Other Diseases of Digestive System, 10 deaths. 6. Diseases of Lymphatic System (e.g., of Lymphatics, and of Spleen).—No death. • 7. Diseases of Gland-like Organs of Uncertain Use.—(e.g.. Bronchocele, Addison's Disease).—One death. 8. Diseases of Urinary Organs.—Of the 78 deaths assigned to these causes, 53 were registered in the Town subdistrict and 25 in Brompton. The diseases were, Nephritis, 12 deaths; Bright's Disease (Albuminuria), 37; Diseases of Bladder or of Prostate, 16, and Other Diseases of Urinary System, 13 deaths 9. Diseases of Reproductive System.—(a) Of Organs of Generation—-Male Organs, no death; Female Organs, 5 deaths; (b) Of Parturition, 9 deaths, viz., Miscarriage, 1, Placenta Prcevia, Flooding, 4 deaths, and Other Accidents of Child-birth, 4 deaths. 10. Diseases of Bones and Joints.—Six deaths; Caries, Necrosis, 2; Arthritis, 4, 67 11. Diseases of Integumentary System. —Two deaths. Class VII.—Deaths from Violence. Eighty-four deaths, Including 28 under five years of age (21 under one year), are distributed over the four Orders comprised in this Class: 16 of them belong to the Brompton sub-district. 1. Accident or Negligence.—Total deaths, 66, including 8 in Brompton, and 28 under five years of age: viz., from Fractures and Contusions, 29; Burn, Scald, 10; Poison, 3; Drowning, 1; Suffocation, generally of infants "overlaid," 23, including 21 under one year; these 23 deaths were registered in the Town sub-district. 2. Homicide.—Manslaughter, one death; Murder, one death. 3. Suicide.—Total deaths 16, including 8 in Brompton; viz., by Cut, Stab, 5; Hanging, 1; Gun-shot Wounds, 6; Drowning, 2; Poison, 1; and Otherwise, 1. Class VIII.—Deaths from Ill-Defined and not Specified Causes. This Class includes the causes of 140 deaths; 113 under five years of age, and 103 under one year; 121 and 19 in the Town and Brompton sub-districts respectively. The causes named are: Debility, Atrophy, Inanition, 109 deaths (all but two under five years, and 98 under one year); Dropsy, 1; Mortification, 5; Abscess, 3; and Hemorrhage, 2. Sudden death (cause not ascertained) 1. To "Causes not Specified or Illdefined" 19 deaths were ascribed. It may be here stated, (the figures having been accidentally omitted at page 11), that the death-rate per 1,000 persons living, at different periods of life, was as follows;— 68 Under five years of age 65.4 Five and under 15 3.1 Fifteen „ „ 25 23 Twenty-five „ 35 5.4 Thirty-five „ 45 1.1 Forty-five „ 55 17.0 Fifty-five „ 65 35.5 Sixty-five ,, 75 68.1 Seventy-five „ 85 130.6 Eighty-five and upwards 279.4 The number of persons enumerated at different ageperiods, at the Census of 1891, will be found in Table II.A, in the Appendix. 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 remark. 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 nonparishioners at the Marylebone Infirmary, Notting Hill (409), and at the Brompton Consumption Hospital (164), 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 (433), at the Brompton Consumption Hospital (5), and at outlying institutions, &c. (249), were 687, or 23.8 per-cent. on total deaths, the per-centage proportion of deaths in public institutions in the Metropolis generally, being 25 4. The Parish Infirmary and Workhouse.—I am indebted to Mr. H. Percy Potter, Medical Superintendent of the Infirmary and Medical Officer to the Workhouse, for the 69 statistics of mortality at these important institutions. The deaths in 1892, including a few of non-parishioners, were 433, compared with 328, 394, and 523, in the three previous years, and were equal to 15 per-cent. on total deaths. The quarterly numbers were 159, 108, 88 and 78: 267 in the first half of the year therefore, and only 166 in the latter half. The deaths included 205 of males and 228 of females. The ages at death were: under one year, 77 (against 27,45 and 71 in the preceding three years respectively): between one and sixty, 199 (against 147, 179, and 214 in the preceding three years), and at sixty and upwards, 157 (against 153, 170 and 238 in the preceding three years). Summary of Causes of Death. DISEASES. Under 1 year. Between 1 year and 60. At 60 and upwards. Total Nervous System, Diseasesof (including Apoplexy and Epilepsy) 1 19 29 49 Circulatory System, Diseases of ... 12 16 28 Respiratory System, Diseases of 14 55 43 112 Tubercular Diseases (including Phthisis and Hydrocephalus) 33 56 3 92 Digestive System, Diseases of ... 8 8 16 Urinary System, Diseases of ... 6 2 8 Generative System, Diseases of ... 3 1 4 Convulsions 4 ... ... 4 Inanition 7 ... ... 7 Senile Decay ... ... 35 35 Premature Birth 6 ... ... 6 Delirium Tremens ... 2 ... 2 Cancer ... 14 9 23 Congenital Malformation of Heart 1 ... ... 1 Disease of Knee ... 1 ... 1 Gangrene ... ... 1 1 Gout ... ... 1 1 Abscess ... ... 1 1 Whooping-cough 3 4 ... 7 Varicella 1 ... ... 1 Relapsing Fever ... 1 ... 1 Puerperal Septicaemia ... 1 ... 1 Measles 2 4 ... 6 Diphtheria ... 1 ... 1 Diarrhoea 3 ... 1 4 Cholera ... 2 ... 2 Influenza ... 7 5 12 Syphilis ... 1 1 2 Erysipelas 1 3 1 5 77 199 157 433 70 The Infirmary, it may be mentioned, is in process of enlargement, by the addition of extensive new buildings fronting upon the Marloes Road, and will, when completed, be second to none in accommodation or otherwise, among the Poor Law Infirmaries of the Metropolis. 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 Wing" having been established on the farther side of the Fulham Road, in the parish of Chelsea), were 169; males 101, and females 68. Five of the deaths were of parishioners, and are included in Table III. (Appendix): the remaining deaths, of non-parishioners, are excluded from that Table. Marylebone Infirmary, Notting Hill.—At this Hospital, which is under the control of the Guardians of the Poor of the Parish of St. Marylebone, and is even larger than our own Parish Infirmary. 409 deaths of non-parishioners were registered, all of which are excluded from Table III. St. Joseph's House, Portobello Road—The deaths at this quasi-public institution, with a few exceptions, of parishioners, are not included in Table III. (Appendix). They were 44 in number; males, 18; females, 26. Many of the deceased had previously resided in Ireland, a few in London, and the remainder in the provinces. Outlying Public Institutions. — The deaths of parishioners at public institutions, &c. outside the parish, were 236 in number, against 234, 211, and 247, in the preceding three years respectively. In Table III. (Appendix) all of these deaths are included. The deaths occurred in the following institutions, viz.:— 71 St. Mary's Hospital 51 Bethlem Hospital 1 St. George's Hospital 32 City of London Chest Hospital 1 West London Hospital 15 Samaritan Free Hospital 1 St. Thomas's Hospital 4 Royal Free Hospital 1 Middlesex Hospital 4 National Hospital for Paralysis University College Hospital 4 and Epilepsy 1 St. Bartholomew's Hospital 3 British Home for Incurables 1 King's College Hospital 3 St. Peter's Home, Kilburn 1 Charing Cross Hospital 3 A Private Hospital 1 Guy's Hospital 1 Paddington Infirmary 3 Brompton Hospital (South Wing) 7 Paddington Workhouse 2 Western District Hospital 35 Leavesden Asylum 9 North-Western District Hospital 7 Cane Hill Asylum 6 South-Western District Hospital 2 Banstead Asylum 5 Northern District Hospital 1 Caterham Asylum 4 Cancer Hospital (Fulham Road) 4 Darenth Asylum 3 Children's Hospital (Paddington) 2 Hanwell Asylum 3 Children's (Victoria) Hospital 3 Colney Hatch Asylum 2 French Hospital (Soho) 2 Camberwell House Asylum 5 German Hospital 1 Hoxton House Asylum 1 Metropolitan Hospital 1 236 The deaths of thirteen male parishioners, in addition to the above, were recorded as follows: two suicidal by drowning, in the Grand Junction Canal (Paddington), and in Islington parish, respectively; two from accidents at Goods Stations on the Great Western Railway, at Paddington, and Westbourne Park respectively; and 9 which occurred suddenly, viz.:— One in a private house in Fulham, two in Paddington, and one in St. Marylebone, one in a cab on the way to St. George's Hospital, one at the Commissionaire Barracks, Strand; and one each at the East Putney, the Streatham, and the Uxbridge Road Railway Stations. Deaths from zymotic diseases occurred as follows:— Western District (Asylum Board's) Hospital, 35 (scarlet fever 23, and diphtheria 12); North-Western District Hospital, 6 (diphtheria 3; scarlet fever 2, and enteric fever 1); St. Mary's Hospital, 5 (diphtheria 2; enteric fever 1; whoopingcough 1, and diarrhcea 1); South-Western District Hospital, 2 (scarlet fever'); St. George's Hospital, 1 (enteric fever); and Metropolitan Hospital, 1 (diarrhcea). UNCERTIFIED DEATHS. Fourteen deaths, of 6 males and 8 females (against 4, 5, and 8 in the preceding three years respectively), were returned 72 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: three occurred in the practice of midwives, the ages at death being 4 hours, 2 days, and 4 days respectively. The several deaths, with the exception apparently of two of the midwives' cases, were duly reported to the Coroner, who did not deem it necessary to hold inquests. The causes of death, as registered, were premature birth, in four cases; chest diseases, in three cases; convulsions, in three cases; hemorrhage, in two cases; and old age, in one case. In one case the cause of death, of a man aged 65, was returned as "unknown" The ages of the deceased were 74, 73, 65, 52, 51, 48, 32, 14 months, 5 months, 28 days, 12 days, 4 days, 2 days, and 5 hours, respectively. The attention of the Metropolitan Sanitary Authorities was called, in 1887, to the subject of uncertified deaths, by the Vestry of St. James, Westminster, that body being of opinion that "no death should be registered unless the cause thereof is certified either by a qualified medical practitioner, or by the Medical Officer of Health for the District, or by the Coroner upon inquisition." If it were meant that the Medical Officer of Health should, as a part of his duty in that capacity, inquire into and, if practicable, certify the cause of death, I for one should respectfully prefer not to come under any such obligation. It was stated that "at present three to four per-cent. of the total deaths are not certified at all." The proportion of deaths not certified, either by registered medical practitioners or by coroners, had steadily declined from 4.7 in 1879 to 2'7 in 1891. The percentage varies within wide limits. In 1892 it was 09 per cent. in London; 048 in Kensington; 2.7 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 doctor's residence, medical attendance cannot be obtained. 73 In such cases 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 deaths returned as "uncertified " 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 of the cases in which inquests would be held under existing circumstances, an inquiry by an expert—e.g., a Medical Officer of Health—would save the time of the Coroner, and of persons liable to serve as jurymen, as well as some expense to the county, if his decision that an inquest was unnecessary were accepted. In these circumstances, the Medical Officer would become, practically, the "Coroner's Officer," as indeed the St. James's Vestry propose. If suitably remunerated for the task, he might reasonably be authorized to inquire, in the first instance, into the causes of uncertified deaths; and to certify in proper cases; referring those from violence, or otherwise involving suspicion of foul play, to the Coroner. Any such change would require legislation to give it effect; but it may be doubted whether the legislature would entrust to any individual powers of such an exceptional nature.* In the case of deaths registered as "not certified," after reference to the Coroner, it cannot be doubted that an 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 persons who had been duly attended *It may be mentioned that the subject of certification of deaths, and cognate matters, has been referred to a Select Committee which is now sitting, May, 189a. 74 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 held: 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 a resolution to the effect:— "That all cases of uncertified deaths should be repotted 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 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 preliminary enquiry should be made by an expert. * The per-centage of uncertified deaths to total deaths in 1892, was 4.5 in Halifax, 4.7 in Liverpool, and 5.3 in Birmingham. Halifax and Liverpool -had also shown excessive proportions in each of the preceding five years. 75 INQUESTS. One hundred and ninety inquests were held on parishioners; 131 in the Town sub-district, 24 in Brompton, and 35 at places beyond the Parish, mostly at Public Institutions (hospitals), to which the deceased had been removed for treatment. Twenty-seven of these cases belong to the Town sub-district, and 8 to Brompton. The subjects of inquest were: males 108 and females 82. The ages at death were: under five years, 67, including 47 under one year; between 5 and 60 years, 96: at 60 and upwards, 27. The cause of death is stated to have been ascertained by post-mortem examination in 109 cases. Fourteen of the subjects of inquisition were illegitimate infants. The Deaths from Violence were 84, of which 16 belong to the Brompton sub-district. 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 - 106 Deaths caused by violence— Accidental - - 66 Suicidal - - 16 Homicidal - - 2 — 84 Total 190 76 The fatal diseases may be classified as follows: Diseases of the brain and nervous system (including convulsions 10) - - 24 Diseases of the circulatory and respiratory systems - - 52 Other visceral diseases - - 7 Tubercular diseases, including phthisis 3 "Syncope" - - 6 Debility - - - 4 Zymotic diseases (measles, 2, diarrhoea, 1) 3 Other causes - - - 7 106 The violent deaths were classified as follows: Accident, (56, viz. By suffocation: of infants (in bed), under one year, 21; and of a man, by coal gas 22 By burns - - - 10 By drowning - - - 1 By poison - - 4 By fractures and contusions, 29, viz.— By vehicles - - - 4 By falls, under various circumstances 21 By injuries, otherwise - - 4 Suicide, 16, viz.— By hanging - - - 1 By cut, stab - - - 5 By poison - - 1 By pistol-shot - - - 6 Otherwise - - 3 Homicide, 2, viz.— Manslaughter - - 1 Murder - - - 1 84 77 The Suicidal Deaths (none of which belong to the Brompton sub-district), comprised 13 of males and 3 of females. Among the deaths described as "sudden," and in cases of persons "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 doubtless, extended over many days, and could scarcely have failed to be marked by obvious symptoms of a more or less serious and painful nature. The mere finding of the "cause of death," in such cases, seems scarcely to satisfy the requirements of justice; considering that the death of any person—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, have, on several occasions, been found guilty of manslaughter. The inquest cases in Kensington were in the proportion of 6.6 per-cent. of the total deaths: the rate in the Metropolis was 6.8 per-cent., and in England and Wales 5.7 per-cent. The reported deaths from different forms of violence were equal to 2.9 per-cent. of the deaths from all causes in Kensington, the proportion in the Metropolis being 3.7 percent., and in England and Wales 3.3 per-cent. METEOROLOGY. The mean temperature of the air at Greenwich in 1892, was 48.1° Fahrenheit: 0.5 below the average in 121 years, and 1.1 below the average of 51 years: the means in the four quarters respectively, were 37.5, 53.4, 59.2 and 42.3, The 78 highest reading by day (85.9), was registered in the week ended June 11th, and the lowest reading by night (17.6), in the week ended December 31st. The mean of the highest readings of the thermometer in the four quarters respectively (53.4, 77.2, 75.7, and 56.1), was recorded in the weeks ended April 2nd, July 2nd, August 27th and October 8th; and of the lowest readings by night (24.7, 32.2, 44.5, and 22.8), in the weeks ended February 20th, April 16th, September 10th, and December 31st. The hottest week was that which ended August 20th (mean temperature 63.9), and the coldest week that which ended December 31st (mean temperature 28.2). August was the hottest month (mean temperature 61.7). January was the coldest month (mean temperature 36.5). May exhibited the greatest range in temperature, viz., 56.4; from 85.1 to 38.7: and January the smallest range, viz., 29.3; from 51.6 to 22.3. Rain fell on 170 days, the total amount registered in the year being 22.32 inches, and 2.81 inches less than the average of 77 years. Most rain fell in October (3.88 inches), and least in Jannary (0.38). The means of the readings of the barometer were 29.773 inches; the means of November 29'881, and of October 29.545, being the highest and lowest, respectively. The relative proportion of wind was, North, 95; East, 72; South, 95; and West 104. VACCINATION. Table X. (Appendix) is a return respecting vaccination in 1891, compiled by Mr. Shattock, the Vaccination Officer, whose energetic discharge of the duties of his appointment it is always a pleasing duty to recognise. The return shows a loss of 8 per-cent. on the total number of births, against 5/4, 5.9, 6.0, 6.5, and 6.7 in the preceding five years respectively, " from removal of children to places, out of the Parish, unknown, or which cannot be reached, and cases not having been found." In England and Wales, we were told a few years back, on the authority of the then Medical Officer of the Local Government Board, " that the returns give evidence of about 79 95 per-cent. of the infantile population having received the benefits of vaccination within the first year" after their birth; so that the infant population was made up of "19 vaccinated to each unvaccinated individual." The proportion of vaccinated children is now decidedly smaller. 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 ought not to be necessary to say anything; but the pertinacity with which some misguided persons still decry the most beneficent of medical discoveries shows no signs of abatement; and as their teaching is calculated to prejudice the general public against the wise compulsion authorised by law, it was well that the Government resolved a few years back, to appoint a Royal Commission to enquire and report on the subject. It is a matter for regret that last year, at a time when small-pox threatened to assume an epidemic form, the Commissioners should have taken a retrograde step, which is not unlikely to be attended with disastrous results, by encouraging disobedience to the law in respect to vaccination. The anti-vaccinators are represented on the Commission, and their views on the question of prosecutions appear to have had but too much influence with those members who do not doubt the efficacy of vaccination; for in a fifth Interim Report, a recommendation is made which, if carried into effect, would be tantamount to an abrogation of compulsory vaccination. At present, every parent or person having the custody of an unvaccinated child, who, after certain proceedings, disobeys the order of a Justice directing the child to be vaccinated within a certain time, is liable to a penalty not exceeding twenty shillings. And upon proof of continued disobedience, after such order made, the said parent or person may be fined again and again, and even sent to prison in default of payment of the penalty. The Commissioners report, with respect to this state of things, that, in their opinion, "the imposition of repeated penalties 80 in respect of the non-vaccination of the same child should no longer be possible, and should cease to be inflicted altogether." They state that they have arrived at this conclusion "quite independently of the question whether vaccination should continue to be compulsorily enforced," and add that, whatever be the conclusion they may have to submit on this part of their inquiry, and even if it should ultimately appear that they are not able all to agree in the same conclusion, they have no difficulty in agreeing upon the recommendation that repeated penalties should not be inflicted. In other words, exemption from the operation of compulsory vaccination law (and incidentally the power to spread disease, deformity, and death among the community), should be purchasable at the cost of one pound sterling—to be paid doubtless by anti-vaccinating societies ! The Select Committee of 1871, it may be mentioned, dealt with this question, and their recommendation that there should be no repetition of prosecution after two penalties, or one full penalty, found expression in a clause passed in the House of Commons, but which the Lords struck out. It does not follow that the recommendation of the Commission will be carried out, but the effect of such a recommendation having been made has already proved mischievous, not only by giving encouragement to those already predisposed to disobey the law, but also by inciting Boards of Guardians to give instructions to their Vaccination Officers not to prosecute offenders. Whatever the decision of the Government, or of Parliament acting independently, on this question, it must surely be felt that the recommendation of the Commission is ill-timed, and should Small-pox become epidemic may prove disastrous. There is only one consolation in view of this contingency, and it is that people who reject the boon of vaccination when they have no fear of small-pox, very commonly hasten to secure its protection when the disease is prevalent. This applies most, perhaps, in the case of the well-informed among the anti-vaccinators, the brunt of the epidemic usually falling on the poor and 81 ignorant. Those opposed to vaccination are accustomed to cite the experience of one large non-vaccinating town which has succeeded during many years in warding off an epidemic, although local outbreaks, from imported cases, have occurred from time to time. But even in the case of Leicester, the town referred to, immunity from small-pox has been largely secured by vaccination. The Sanitary Authority of that town has not only been diligent in searching-out, and isolating in hospital, every case of small-pox, quarantining and compensating the persons exposed to infection, but the doctors, the nurses, and the other officials of the hospital (and even, it is alleged, the members of the Sanitary or Hospital Committee themselves), are protected by vaccination and re-vaccination. It can hardly be doubted, however, that a time will come when all the admirable precautions taken at Leicester will prove unavailing, and that its rulers will have cause to regret their disregard of Jenner's beneficent discovery, which, with a minimum of risk, and this avoidable by the use of calflymph, has conferred incalculable benefit on every civilized community in the world, and just in proportion to the efficiency with which it has been applied. Lamentable as is the decision of the Commission, it is the more surprising, if it be true, as alleged, that whilst much evidence had been heard on the anti-vaccinators' side against vaccination-administration, the administrators themselves had riot been heard when the decision was arrived at. It would seem indeed, that the majority yielded to the minority, and accepted a compromise on a matter which, in the best interests of the community, does not properly admit of compromise. Animal Vaccination: Calf-Lymph;—An objection to "arm-to-arm" vaccination has been based on the fact that, as the lymph is passed through the human system, it may become the means of transmitting enthetic disease. This danger, however, though by no means to be disregarded, appears to be slight, and in practice almost inappreciable, 82 seeing that the late Medical Officer to the Local Government Board stated, that he "could not 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 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. Stations, moreover, public and private, have been established in London, at which persons can be vaccinated direct from the calf, and supplies of calf-lymph 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,' it has been observed on the highest authority, "is nowise to be had when the lymph" (human or animal) "is used in any preserved condition." It would appear that the Local Government Board have raised objection to the continuance of the practice of affording people the option of vaccination with calf-lymph at the public stations, a practice which originated in Kensington, the cost for the whole parish-being only about £12 per annum. The Guardians, however, adhere to their decision to give this option to all comers. THE METROPOLITAN ASYLUMS BOARD. The work of the Asylums Board has of late years assumed great importance to Sanitary Authorities, by reason of legislation conferring power on the Managers to fulfil for the entire Metropolis functions which under the Sanitary Act of 1866 (now incorporated in the Public Health Act of 1891), devolved upon the forty Vestries and District Boards. The Board are now the Central Authority for providing hospital accommoda- 83 tion for the infectious sick, by warrant of law, as they previously had been in fact; for it is well-known that legislation has, these many years, followed in the steps of the Managers' practice in regard to all that concerns the removal of the sick and their admission to hospital. The available accommodation provided was always sufficient until within the last six years, but the increasing disposition of the public to make use of the hospitals, which dates from the scarlet fever epidemic of 1887, together with the further demands on the resources of the Managers consequent on compulsory notification, have given rise to difficulties to which references will have to be made in other portions of this report. The Board, however, are not satisfied with the extent of their present powers, and at a meeting in July it was resolved,That it be referred to the General Purposes Committee to consider and report upon the suggestion contained in the annual report of the Statistical Committee to the effect:— "That the Managers do petition that the Legislature take at an early date, in the interests of the public health, such measures as will place entirely in the hands of a central body, powers not only of isolating the sick, but of following the ambulance with the means of immediately disinfecting the bedding, &c., from which the infected persons have been removed; of vaccinating or re-vaccinating those who may have been in contact with the infected persons or things; of investigating by skilled assistance, the origin of the outbreak, and of compensating, when necessary, persons detained in quarantine in the interest of the public health." I cannot say that the arrangements for vaccinating or re-vaccinating, in the cases indicated in the resolution, are of the most satisfactory character—they are entirely under the control of the several Boards of Guardians—but should it be thought necessary or desirable to make any change, surely it should be in the direction of transferring the powers with respect to vaccination to the Sanitary Authority, as 1 recommended in 1877. There does not appear to me any occasion for making the suggested change in the arrangements for disinfection, which, so far as my experience goes, is now done 84 speedily and satisfactorily. Sanitary Authorities are not likely to view with approval proposals like the foregoing, which, if carried into effect, would, by weakening their interest, and diminishing their influence, in relation to matters affecting the public health, reduce them to practical insignificance. No action, however, was taken in the matter as the circumstances did not appear to warrant the Managers applying to the Local Government Board to obtain a special enactment from the Legislature. But it is anticipated that the Managers will embrace any favourable opportunity, of the introduction of any Bill for conferring on other Authorities enlarged powers of this nature, to obtain the insertion of similar clauses on their own behalf. The proper work of the Board is summarised in three reports, issued annually,by the Chairman (Sir E. H.Galsworthy), the Statistical Committee, and the Ambulance Committee. As usual, I submit the substance of these interesting and important documents. THE CHAIRMAN'S REPORT. This report opens with a reference to the pressure put upon the Managers' resources by the scarlet fever epidemic, which necessitated the provision of accommodation much in excess of that which had been authoritatively indicated to the Board as the probable maximum accommodation it would be necessary for them to provide. The patients suffering from the disease, admitted to the hospitals, numbered 13,093,* exceeding by 6,556 the largest number admitted during any * In the Table at page 37, the admissions are stated to have been 13,781, this total being ascertained from the figures supplied by the Board to the RegistrarGeneral, and published in his Weekly Returns. The Chairman's figures, presumably, are corrected for errors in diagnosis, and probably represent the true number of scarlet fever cases admitted. They were not available until after the portion of this report dealing with the epidemic had been printed, and they differ somewhat from the figures contained in the Table at page 114, which is compiled from the Board's Quarterly Returns. 85 previous year. The greatest number of patients suffering from Fever and Diphtheria under treatment at any one time, was 4,389, exceeding by 1,389 the number of beds (3,000), for all classes of fever, which the Royal Commission, in 1882, considered would be sufficient for the requirements of the Metropolis. In 1882, however, diphtheria cases were not admitted to the hospitals; notification was not in force; and the Commissioners, presumably, did not anticipate the present extensive use of these institutions by the general public. It is not surprising, therefore, that they under-estimated the requirements of the Metropolis. To the Asylums Board, moreover, their estimate seemed, even so late as 1886, to err largely by excess. The Chairman states that in 1892, a greater proportion than heretofore of the total number of the sufferers from scarlet fever were admitted to the hospitals, and that the experience of that year has demonstrated the insufficiency of the Fever accommodation at the disposal of the Managers, for the requirements of the Metropolis. Reference is made to the obstacles encountered, and the difficulties experienced, by the Managers, in their endeavours to keep pace with, and to meet, the exigencies of the outbreak, of which some account is given in another part of this report.* For a time it was necessary to limit the admission of fever patients to the vacancies occasioned by discharges and deaths, and to give preference, as far as possible, to those patients whose surroundings and conditions of life were such, that retention in their homes would have been prejudicial to themselves or to the community at large. The Chairman discusses the question of additional accommodation for fever and diphtheria patients,in connection with a report of the General Purposes Committee, to which I referred in my first monthly report for the current year, and which I have summarised at page 107. He estimates that * Vide page 32. 86 2208 additional beds should be provided, and states that such provision will be in accord with the now generally accepted proportion of one bed for every 1000 of the population. I am afraid, as I have said elsewhere—basing myself on the increasing appreciation in which the hospitals are held, and on the customary results of notification—that this estimate will be found to err by defect. Interesting references are made to small-pox, a subject already fully dealt with at page 24 of this report. The following figures, to which I have added per-centages of mortality, show the number of patients who were admitted into the Board's Hospitals, and other particulars with reference to the year 1892 :— Admissions. Discharges. Deaths. Case-mortality per-cent. Scarlet Fever 13,093 10.495 839 6.4 Enteric Fever 430 480 65 15.1 Typhus Fever 19 20 2 10.1 Diphtheria 2,019 1,365 582 28.8 Small-pox 352 283 33 9.4 It is stated that the 2,019* patients suffering from diphtheria, or from diphtheritic membranous croup, exceeded by 707 the number admitted in 1891, and that the Managers are considering such enlargement, improvement and distribution of accommodation for diphtheria, as past experience and the probable necessities of the future demand; having regard to the fact that the Metropolis has during the past decade, suffered from a progressive increase in the rate of mortality from this disease; contemporaneously, I may add, with a steady decline in the death-rates from scarlet fever and typhoid fever. * Apparently 2,349 patients were admitted certified to be suffering from diphtheria. Error in diagnosis would thus appear to have occurred in 330 cases. 87 The number of cases of infectious disease notified to the Metropolitan Medical Officers of Health in 1892 were, after elimination of duplicate certificates, 40,074, as against 26,522 in 1891, and 29,795 in 1890. After dealing with the nursing question, one of no ordinary difficulty, the Chairman refers to the action taken by the Board in view of the threatened epidemic of Cholera, and to the arrangements which would have enabled the Managers to provide upwards of 2,000 beds had the need arisen. Questions of internal administration of the several institutions are considered, as well as removals to hospitals, some account of which will be found in the Abstract of the Ambulance Committee's Report at page 96. The provision of accommodation for imbeciles, which is one of the functions of the Board, is also dealt with, but the subject does not call for notice here. The same remark applies to statements relating to the important work of the Managers in connection with the Training Ship "Exmouth." The expenditure of the Board during 1892 exceeded by about £178,000 that of 1891. Of this increase £90,000 is accounted for by the provision of temporary accommodation consequent on the scarlet fever epidemic. The whole sum was charged to the Managers' current account. But for the urgency of the matter, and the uncertainty of the Local Government Board's intention as to the future of the NorthEastern Hospital, which necessarily involved a very large expenditure, the greater portion of the outlay for additional accommodation would have been charged to the Loan Account. The total expenditure on Small-pox and Fever Hospitals amounted to £310,711 13s. 10d., viz., Maintenance Account, £47,995 2s. 0d., and Common Charges Account, £262,710 11s. 10d. The River Ambulance Charges are set down at £0,025 additional. The Notification Fees repaid to the Sanitary Authorities amounted to £4,006 15s. 6d. 88 Cases of Infectious Disease notified in 1892, under the provisions of the Public Health (London) Act, 1891. Local Authorities in whose Districts the cases were resident. Small-pox.. Scarlet Fever. Typhus Fever. Typhoid or Enteric Fever. Continued Fever. Membranous Croup. Diphtheria. Erysipelas. Puerperal Fever. Cholera. Totals. Enumerated Population (un revised) 1891. Kensington 3 727 1 58 4 15 172 184 13 5 1182 166,308 Battersea 4 1131 70 7 17 353 286 15 ... 1883 150,458 Bermondsey 2 645 1 43 ... 7 89 170 5 1 963 84,688 Bethnal Green 36 932 ... 102 3 44 532 336 14 ... 1999 129,134 Camber well 16 1549 ... 103 2 32 281 280 15 ... 2278 235,312 Chelsea 4 533 ... 51 3 36 167 180 6 1 981 96,272 Clerkenwell 3 379 ... 43 2 16 114 164 3 ... 724 65,885 Fulham 2 527 ... 41 ... 15 94 107 10 ... 796 91,640 Greenwich 11 1282 3 116 2 20 173 304 9 ... 1920 165,417 Hackney 27 1958 1 181 10 35 617 353 16 ... 3198 229,531 Hammersmith 2 459 ... 45 8 6 312 120 6 ... 958 97,237 Hampstead 1 322 ... 49 1 3 129 54 8 ... 567 68,425 Holborn 3 294 ... 24 1 ... 61 81 3 2 469 33,248 Islington 42 1726 ... 215 6 45 709, 531 50 3 3327 319,433 Lambeth 24 1777 2 119 35 44 491 410 17 25 2944 275,202 Lewisham ... 273 ... 40 ... 2 123 97 3 ... 538 72,272 Limehouse 7 511 ... 40 ... 12 80 100 17 ... 767 57,599 Marylebone 11 702 1 73 6 8 218 219 243 6 3 1271 142,381 Mile End Old Town 10 954 ... 79 1 9 235 13 1 1551 107,565 Paddington 3 541 ... 47 1 4 168 115 7 ... 886 117,838 Plumstead 19 993 2 40 1 11 134 79 7 ... 1286 88,539 Poplar 5 1470 ... 183 20 48 436 340 12 3 2517 166,697 Rotherhithe ... 167 2 49 .. 5 43 73 2 .. 341 39,074 Shoreditch 83 83,0 2 89 5 15 202 253 11 ... 1490 124,009 St. George-in-the-East 4 289 ... 21 3 6 126 77 5 2 533 45,546 St. George, Hanover Sq. 1 335 ... 44 1 ... 122 58 2 1 564 78,362 St. George, Southwark 2 375 ... 28 ... 2 74 108 4 ... 593 59,712 St. Giles 7 176 ... 26 ... 3 60 105 1 ... 378 39,778 St. James, Westminster 4 69 ... 13 1 2 26 20 1 1 137 24,993 St. Luke, Middlesex 9 229 3 14 2 3 42 103 1 ... 406 42,411 St. Margaret and St. John, Westminster 2 295 ... 24 4 3 138 77 3 ... 546 55,760 St. Martin-in-the-Fields ... 54 ... 6 2 1 25 14 ... ... 102 14,574 St. Mary, Newington ... 955 1 58 ... 18 151 226 5 ... 1414 115,663 St. Olave, Southwark 1 64 ... 7 ... 1 16 21 ... ... 110 12,694 St. Pancras 34 1294 ... 118 4 30 408 426 26 5 2345 234,437 St. Saviour, Southwark ... 121 ... 5 ... 3 39 37 2 ... 207 27,162 Strand 7 111 ... 12 ... 4 28 22 1 ... 185 25,201 Wandsworth ... 886 ... 85 11 22 239 271 13 1 1528 156,931 Whitechapel 23 539 1 42 ... 16 242 177 11 ... 1051 74,462 Woolwich 2 338 ... 17 ... ... 16 45 3 ... 421 40,818 City of London 5 284 ... 28 1 2 91 51 1 ... 463 38,345 Port of London 4 ... ... 17 ... ... 1 1 ... ... 23 Grand Totals 423 27096 20 2465 147 565 7791 6934 347 54 45842 Seven cases of "relapsing fever," one of them in Kensington, were also notified. 89 ANNUAL REPORT OF THE STATISTICAL COMMITTEE. For the corrected Table of notifications of infectious disease on the previous page, I am indebted to the courtesy of the Clerk to the Metropolitan Asylums Board: it will in due course appear in the annual report of the Statistical Committee, which had not been published when the present report went to press. The Table, comprising 45,905 cases, excludes all multiple certificates. In some instances two, or even three, certificates are received with respect to the same case, it being the duty of " every medical practitioner attending on, or called in to visit the patient, forthwith, on becoming aware that the patient is suffering from an infectious disease,"* to report the case to the medical officer of health of the district. The Infectious Disease (Notification) Act of 1889, now repealed, exempted the medical officers of general hospitals, infirmaries, &c.,from the obligation to notify. This exemption was found to work injuriously, as the Sanitary Authority, ignorant of the occurrence of cases admitted to general hospitals, could not take measures for disinfecting the infected houses, or otherwise for preventing the spread of disease. This exemption has been abolished. Complaint has been made by a Sanitary Authority of having to pay for more than one certificate for the same case ; but obviously if two medical men are called in, successively, to treat the patient, each lies under the statutory obligation to certify, and each is entitled to the statutory fee, if he performs his duty, and exposes himself to liability to the statutory penalty if he fails to notify. The dual notifications, in 1892, were 1554, or 30 weekly, (the weekly number of notifications averaging 910), being about three per cent. of the total number. In our parish the dual notifications were 59. "Public Health (London) Act, 1891, Sec. 55 (1) (6). 90 Admissions to Hospitals.—The subjoined Tables show the magnitude and the growth of the work of the Board. The contrast between the large numbers of cases of small-pox dealt with by the Managers in bygone years and the small number admitted to the hospitals in the last seven years is striking. The increase in scarlet fever and other cases admitted to the " fever" hospitals since 1889, compared with previous year, is not less striking. The decrease in small-pox admissions is due to London's immunity from epidemic prevalence of the disease, the increase in the other diseases being largely the result of notification. Table Showing the Admissions and Deaths of Patients and Mortality per cent. at the Managers' SMALLPOX HOSPITALS during each year since the opening of the first Hospital on the 1st December, 1870, together with the Annual Mortality per 1,000 Persons living of the Population of the Metropolis from Smallpox, extracted from the Registrar-General's Annual Summaries. YEAR. ADMISSIONS. DEATHS. Mortality per cent. of Patients treated in Managers' Hospitals. Annual Mortality per 1,000 of estimated Population. Smallpox. Other Disease. Total. Smallpox. Other Disease. Total. Smallpox Smallpox. 1st Dec., 1870, to 3rd Feb., 1871 582 ... 582 97 ... 97 20.81 ... 1871-2 (4th Feb., 1871, to 31st 13,139 6 13,145 2,460 ... 2,460 18.95 2.42 Jan., 1872) 1872.3 (year ended 31st Jan., 1873) 2,359 3 2,362 467 1 468 17.84 0.54 1873.4 (year ended 31st Jan., 1874) 174 17 191 35 ... 35 17.02 0.03 1874 (11 months ended 31st Dec.) 112 8 120 10 ... 10 0.02 1875 89 22 111 22 ... 22 0.01 1876 2,134 16 2,150 372 1 373 21.64 0.21 1877 6,516 104 6,620 1,214 4 1,218 17.92 0.71 1878 4,558 96 4,654 824 9 833 17.99 0.39 1879 1,628 60 1,688 273 5 278 15.69 0.12 1880 1,982 50 2,032 286 2 288 15.95 0.12 1881 8,551 120 8,671 1,417 14 1,431 16.61 0.62 1882 1,799 55 1,854 260 3 263 12.96 0.11 1883 598 28 626 93 ... 93 16.06 0.03 1884 6,363 204 6,567 940 3 943 15.98 0.31 1885 6,146 198 6,344 1,052 3 1,055 15.8 0.35 1886 99 33 132 22 2 24 14.28 0.01 1887 56 3 59 3 ... 3 0.00 1888 62 5 67 8 ... 8 0.00 1889 5 ... 5 ... ... ... ... 1890 22 5 27 3 ... 3 0.00 1891 63 1 64 8 ... 8 0.00 1892 325 23 348 35 ... 35 11.29 0.01 Totals 57,362 1,057 58,419 9,901 47 9,948 17.1 ... Average annual mortality per 1,000 of estimated population of London during the 19 years] (1853 to 1870 inclusive) before the opening of the Managers' Hospitals, extracted from the Registrar-General's Returns 0.26 Average annual mortality per 1,000 of estimated population of London during the past 19 years (1873 to 1892 inclusive), extracted from Registrar-General's Returns 0.15 Increase Decrease 0.11 Table Showing the Admissions and Deaths of Patients and Mortality per cent, at the FEVER HOSPITALS of the Metropolitan Asylumns Board during each Year since 1870, together with the Annual Mortality per 1,000 persons living of the Population of the Metropolis from Scarlet Typhus, and Enteric Fevers and Diphtheria, extracted from the Registrar.General's Annual Summaries. YEAR. ADMISSIONS. DEATHS. Mortality per cent, of Patients treated in Managers' Hospitals. Annual Mortality per 1,000 of estimated Population. Scarlet. Diphtheria Typhus. Enteric. Other Diseases. Total. Scarlet. Diphtheria Typhus. Enteric. Other Diseases. Total. Relapsing Fever. Diphtheria Typhus. Enteric. Scarlet. Diphtheria Typhus. Enteric. 1870 (25th fan. to 15th May) ... ... ... ... 218 218 ... ... ... ... 14 14 12.84 ... ... ... 1.88 0.10 0.15 0.30 ... ... (Relapsing Fever.) 1871 ... ... ... ... ... ... ... ... ... ... Scarlet ... ... ... 0.58 0.11 0.12 0.27 1872 (15 months to 31st Dec., 1872) 108 ... 134 279 343 864 11 ... 30 57 70 168 10.78 ... 23.62 21.96 0.28 0.08 0.05 0.24 1873 92 ... 401 381 271 1,145 6 ... 91 56 58 211 6.55 ... 2.315 15.13 0.19 0.09 0.08 0.27 1874 804 ... 536 435 359 2,134 89 ... 106 63 84 342 12.15 ... 19.62 14.87 0.77 0.12 0.09 0.26 1875 1,182 ... 65 299 269 1,815 160 ... 16 78 54 308 13.69 ... 23.35 24.68 1.06 0.17 0.04 0.23 1876 671 ... 139 288 294 1,392 90 ... 28 59 71 248 12.13 ... 19.31 20.34 0.65 0.11 0.04 0.22 1877 479 ... 170 372 186 1,207 54 ... 36 79 33 202 12.1 ... 23.07 22.93 0.44 0.09 0.04 0.25 1878 679 ... 168 484 2.33 1,564 91 ... 47 100 40 278 14.34 ... 26.25 20.26 0.49 0.15 0.04 0.28 1879 1,469 ... 48 385 196 2,098 211 ... 11 74 39 335 15.27 ... 21.56 19.73 0.72 0.15 0.02 0.23 1880 1,949 ... 28 248 239 2,464 242 ... 6 43 37 328 12.3 ... 20.68 15.63 0.82 0.14 0.02 0.19 1881 1,477 ... 219 415 211 2,322 168 ... 34 86 46 334 11.1 ... 16.95 21.47 0.55 0.17 0.02 0.25 1882 1,850 ... 148 515 354 2,867 189 ... 27 104 60 380 10.37 ... 16.92 20.71 0.52 0.22 0.01 0.25 1883 1,920 ... 45 486 269 2,720 234 ... 11 74 66 385 12.38 ... 21.15 15.64 0.51 0.24 0.01 0.25 1884 1,845 ... 29 493 180 2,547 234 ... 5 98 55 392 12.27 ... 20.00 18 82 0.36 0.24 0.01 0.23 1885 1,353 ... 53 220 229 1,855 130 ... 7 36 46 219 9.47 ... 12.17 15.82 0.18 0.23 0.01 0.15 1886 1,780 ... 10 333 74 2,197 151 ... 4 47 22 224 9.04 ... 42.10 14.85 0.17 0.21 0.00 0.15 1887 5,900 ... 35 441 161 6,537 489 ... 4 61 59 613 9.54 ... 11.59 14.59 0.36 0.23 0.00 0.15 1888 4,408 99 1 450 194 5,152 501 46 ... 72 60 679 9.89 59.35 ... 14.64 0.30 0.32 0.00 0.17 1889 4,518 722 23 290 219 5,772 366 275 6 41 48 736 8.85 40.74 31.57 15.15 0.19 0.39 0.00 0.1.3 1890 6,537 942 16 498 341 8,334 510 316 5 93 81 1,005 7.86 33.55 25.66 19.68 0.21 0.33 0.00 0.15 1891 5,262 1,312 18 755 462 7,809 357 397 1 106 102 963 6.67 30.63 5.88 14.52 0.14 0.32 0.00 0.13 1892 13,093 2,009 19 430 725 16,276 839 583 2 65 140 1,629 7.28 29.35 9.76 13.20 0.27 0.44 0.00 o.io Totals 57,376 5,084 2,305 8,497 6,027 79,289 5,102 1,617 477 1,492 1,285 9,993 Average Annual Mortality per 1,000 of estimated population of London before the opening of the Managers' Hospitals, extracted from the Registrar.General's Returns: Scarlet Fever (only obtainable for 1.3 years), 1859 to 1871, both inclusive 1.7 ... ... ... Typhus Fever (only obtainable for 3 years), 1869 to 1871, both inclusive ... ... 0.17 ... Enteric Fever ditto ditto ditto ditto ... ... ... 0.3 Average Annual Mortality per 1,000 of estimated population of London from Scarlet Fever during the past 13 years, and from Typhus and Enteric Fevers during the past 3 years, extracted from the Registrar General's Returns 0.39 ... 0.00 0.12 Increase ... ... ... ... Decrease 1.31 ... 0.17 0.18 91 Note.— 1. From the ist December, 1870, to the end of September, 1871, Small-pox cases only were admitted to the Board's Hospitals. 2. The deaths of Fever patients include all cases dying within 48 hours after admission, and also those deaths due to intercurrent maladies. 3. Diphtheria cases have only been admitted into the Managers' Hospitals since the 23rd October, 1888. 4. The Mortality rates of patients in the Managers' Hospitals are calculated according to the Registrar General's formula. 92 WESTERN HOSPITAL. The annual report of the Statistical Committee of the Asylums Board will have appended to it a summary of the work of the Western Hospital, by Dr. Bruce, the Medical Superintendent, from whose annual report we learn that the number of cases treated in 1892, was 2,436, an increase of nearly 50 per cent. on the number in 1891. The admissions were 2,287, the discharges, including transfers, 1,912, the deaths 196. At the end of the year 317 cases remained in hospital. Of the admissions 1,900, or 83 per cent., were scarlet fever ; 247 diphtheria; 38 enteric fever. Three cases of typhus were admitted from Kensington (vide page 46); 99 persons suffered from "other diseases." Seventy-three per cent, of the discharged cases were transferred to the Convalescent Hospitals of the Board, a fact which illustrates the value of these Institutions, and the desirability of an increase in their number. The per-centage mortality was 8.91. The mortality of the several diseases was as follows:— Scarlet Fever 5.71 per cent., including 12 deaths from diphtheria contracted during convalescence; Enteric Fever, 4.81 per cent. ; Diphtheria, 31.95 per cent.; "other diseases" 13.87 per cent. The per-centage death-rate of the Scarlet Fever admission under five years of age was 15.5: at all ages above five years, it was only 1.79. In twenty-three cases of scarlet fever, diphtheritic symptoms supervened. Five of these cases presented membrane on the throat when admitted; 18 of the completed cases contracted the disease during convalesence,—or 1.03 per cent., compared with 1.2 per cent. in 1891, and 3.2 in 1890. Nineteen cases developed measles, of whom four died. Eleven cases were complicated with non-fatal whooping-cough. The enteric fever cases were fewer than usual, and the disease was of a mild type. The diphtheria admissions were 117 in excess of those in 1891. The female sufferers exceeded the males at every age-period above one year; the mortality was also slightly 93 higher in the female sex. Sixty-four per cent. of the deaths occurred in children under five. Paralysis supervened in 15'2 per cent. of the cases. Of 28 cases certified as scarlet fever, 16 had Rotheln, and nine Measles. Of 49 cases certified as diphtheria, 43 had tonsillitis. Error in diagnosis therefore, occurred in 16.5 per cent. of 296 cases sent in as diphtheria. Sixty-seven officers were warded for illness, including 26 suffering from infectious disease, viz. 16 from scarlet fever, 6 from diphtheria, 3 from enteric fever, and 2 from measles. All recovered. Owing to the scarlet fever epidemic, it was found necessary, in July, to erect six temporary wooden huts on land adjoining the original site. The accommodation of the hospital was thus increased by 158 beds. The new Administrative Buildings were completed during the spring. The number of Kensington cases admitted was 401, viz.: scarlet fever, 337; diphtheria, 38; enteric fever, 3; typhus fever, 3, and "other diseases" 20: the deaths were 33: 123 scarlet fever cases, 21 of diphtheria, and 2 of enteric fever, were admitted to other hospitals. Three of these patients died. The admissions from other Parishes and Unions in the West District, usually allocated to the hospital, were : Fulham Union, 658 (in addition to 118 removed to other hospitals) ; Paddington 110 (in addition to 280 removed to other hospitals) ; Chelsea, 175 (in addition to 135 removed to other hospitals); St. George's Union, 292 (in addition to 306 removed to other hospitals); and Westminster, 37 (in addition to 78 removed to other hospitals). In addition to 1673 patients admitted from Parishes and Unions in the West District, 614 were admitted from the North, Central, and South Districts, including 41, 50 and 128 from St. Giles, the Strand, and the Wandsworth Unions respectively. Per contra, 1054 patients from the Parishes and Unions in the West District (including 289 from Paddington), were admitted into other hospitals, viz. 254 to the North Western, 16 to the Southwestern, 1 to the Eastern, and 9 to the North-Eastern. 94 METROPOLITAN AMBULANCE SERVICE. Section 16 of the Poor Law Act, 1879, now incorporated in the Public Health (London) Act, 1891, 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 to 1879 the Boards of Guardians had removed the sick, 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, who were but too frequently removed in public vehicles, cabs, &c. The law did not forbid the use of a public vehicle for this purpose, provided that the vehicle was afterwards disinfected. But the driver of a cab was often unaware of the nature 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 public vehicles should never be used for this purpose, and that it would be to the public advantage, were the Asylums Board made the Ambulance Authority for the 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 95 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, in a section of the Poor Law Act, 1889, which, as already mentioned, is now incorporated in the Public Health (London) Act, 1891. This Act (section 70), expressly prohibits the conveyance of any infected person in a public conveyance. Land Service: Ambulance Stations.—The recommendation of the Royal Commission on Infectious Hospitals, in 1882, 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 (the eastern at Homerton, the South-eastern at Deptford, and the Western at Fulham), under the provisions of the now repealed 16th Section of the Poor Law Act, 1879. It is intended shortly to provide a fourth Station at Hampstead in the North-Western District. Kensington patients are removed by the ambulance staff at the western station, Seagrave Road, Fulham. Between 8 a.m. and 8 p.m., on week-days, cases for removal are reported at the Managers' Central Offices, Norfolk House, Norfolk Street, Strand, w.C., these being in telephonic communication with the Station.* During the night, and on Sunday, application for a patient's removal is forwarded direct to the Ambulance Station. River service.—The Managers possess in their three Ambulance Steamers, Red Cross, Maltese Cross, and Albert Victor, together with the steam pinnace Swallow, a fleet equal to all probable demands of small-pox when epidemic. + Telegraphic Address— "Asylums Board, London." Telephone number, 2587, 96 The patients embark at Wharves which the Managers were authorised to provide, by Section 6 of the Diseases Prevention (Metropolis) Act, 1883, now incorporated in the Public Health (London), Act 1891. These Wharves are three in number, respectively named North, South, and West. The North-Wharf is at Blackwall, the SouthWharf at Rotherhithe, The West-Wharf, at Fulham, near Wandsworth Bridge, at which, in the event of a widespread epidemic of small-pox, Kensington patients would embark for the voyage to the Hospital Ships, but which is also intended for the accommodation of the West District generally, has long since been completed ; but hitherto it has not been found necessary to bring it into use. ANNUAL REPORT OF THE AMBULANCE COMMITTEE. Arrangements in connection with the transit of the sick, between home and hospital, and hack again, are under the control of a Committee of the Asylums Board, whose report comprises an interesting statement of the work carried out during the past year—nearly double in amount, so far as regards removal of cases, of any previous year's work. The removals, upwards of 32,000 in number, including the transfer of patients from one hospital to another, were effected without injury to any person. The fever patients removed to the Managers' Hospitals numbered 16,118, as compared with 5,680,8,235 and 7,725 in the preceding three years respectively. The average daily removals in the first six months of the year, were 28.3, and in the last six months 59.5, as compared with 171 and 25"5 respectively in 1891. The removals of small-pox patients were 306, as compared with 5, 26, and 64 in the preceding three years respectively. The average length of journey of the Fever patients removed to Hospital did not exceed 3½ miles per patient. The number of journeys made was 17,607, the miles run by the vehicles, 178,638, 97 Small-pox Patients.—Reference is made to the tendency of Small-pox,in 1892, to invade and re-establish itselfin London, after seven years of freedom from epidemic prevalence. Cases to the number of 78 were removed in March and April, from 20 out of the 30 Poor Law Districts, the greater number coming from Shoreditch, Bethnal Green, and Whitechapel. In May, the removals were 99, including 35 from Shoreditch and 15 from Bethnal Green. The admissions fell to 44 in June ; a considerable further reduction took place in July, and all fears of an epidemic then subsided. This "happy result," attributed " to the united exertions of the Managers and the Sanitary Authorities," would probably not have been attained had not compulsory notification been in practice. Sporadic cases continued to occur throughout the remainder of the year. There were 19 in November, and the number rose to 40 in December (from 17 different districts) nine of them being from Salvation Army Shelters and Casual Wards. The indication at the close of the year was that " great care and watchfulness " would be necessary, in the early months of the current year, "if the onset of the disease was to be again successfully met." Fever Patients.—At the commencement of the year there were 1,841 patients in the Managers' Hospitals, a less number by 84 than that at the beginning of 1891. The minimum for the year (1,438), was touched on the 5th March. The numbers increased slowly to 1,542 on the 17th April, and then somewhat rapidly to 1,798 on the 14th May. At this time it became manifest to the Committee that there were indications of an urgent need of additional accommodation for scarlet fever cases, it being evident, as they warned the Board, that at the then rate of increase—187 patients weekly—the existing vacant beds would be filled by the end of July, "a date which experience has shown is usually the commencement of the scarlet fever season." The Managers thereupon set about providing additional accommodation by an increase of the G 98 beds in the wards of the hospitals, by the diversion of rooms hitherto in use for other purposes, by the opening of the Gore Farm Hospital at Darenth (erected for convalescing Small-pox patients), and by the erection of temporary huts in the grounds at several of the hospitals. They also revived a proposal, made in April, 1891, for the purchase of a site at Tottenham, to which the Local Government Board had declined to consent. Much delay ensued, but, ultimately, on the 11th August, the purchase was sanctioned, and on the 8th October the first wards of the temporary "North-Eastern Hospital," were opened. Before this time, however, the accommodation at the disposal of the Managers had become exhausted, so that many patients had to be left in their own homes until vacancies were created in the hospitals, by deaths, or by the discharge of recovered patients. The highest number of Fever patients under treatment at one time during the year, was attained on the 17th November, when 4,389 cases were in hospital. It is observed that no cases " other than those fully entitled to claim admission to the Board's hospitals, were admitted "—a somewhat superfluous statement, as " the hospitals are supported by the public rates, and, in the interests of public health, Parliament has been pleased to give every inhabitant of London a perfect right to admission and to gratuitous treatment," precisely as I recommended in January, 1877. Enteric Fever prevalence was considerably below the average in 1892. Diphtheria.—The number of patients removed to hospital certified to be suffering from Diphtheria, or from Diphtheritic Membranous Croup (2,349),* was much in excess of the number in the previous year, viz., 1,481; the numbers in the preceding two years were 770, and 1,049, respectively. Forty per cent. of the cases were removed during the first half, and GO per cent. during the second half of the year. * Of this number only 2,019 apparently proved to be of a diphtheritic character, 99 Other Removals.—Under the powers possessed by the Managers, 404 infectious sick persons were conveyed in the ambulances to other places than the Managers' hospitals ; including 191 to the London Fever Hospital, Liverpool Road, Islington : 215 of the cases were Scarlet fever, 38 Erysipelas, 25 Diphtheria, and 4 Small-pox. The Managers received £126 for this work, including £22 12s. 6d. in respect of the services of nurses. Reference is made to the increasing proportion of admissions to the hospitals to total cases occurring in the Metropolis. Compulsory Notification has afforded a means of gauging the relative proportions of these numbers; and it appears that in 1892, about one-half of the cases notified were treated in the Managers' Hospitals. This proportion is likely to increase : the Committee observe, therefore, that the permanent accommodation at the Managers' disposal will have to be largely augmented, if the growing demands of the Metropolis are to be adequately met. They think that the segregation of such large numbers of patients may be expected to result in a material reduction in the prevalence of fever, and a corresponding permanent lowering of the annual death-rate—" indeed, such results appear already to be taking place." It would seem, however, to be the fact, that the case-mortality in hospital-treated cases is unduly high, compared with that of home-treated cases, a fact which deserves more attention than it has hitherto received. The Committee have nothing special to report with respect to the three Ambulance Stations, nor with respect to the River Service, Wharves, etc., in the number and position of which no change has to be recorded. The distance run, collectively, by the three Ambulance steamers, and the Pinnace, was about 11,000 miles : they conveyed 1,389 patients and other passengers. When Small-pox threatened to become epidemic, the Managers temporarily appointed a Medical 100 Officer for duty at the Wharves, whose duty it was to inspect patients brought thereto, with a view to revising the diagnosis in each case, in order to spare patients the often very considerable journey to the South-Eastern Hospital (Deptford), for examination : 368 patients were certified, but only 298 of them were permitted to proceed to the Hospital Ships. The cost of the Ambulance Services is necessarily large. It was £10,528 for the three Stations, irrespective of £2,982 expended out of loan for the enlargement of the Western Station ; but inclusive of £850 spent upon new vehicles required to replace worn-out vehicles, and to meet the increased work of the service. The River Service cost £5,685; the grand total thus being, in round numbers, £19,915. The general expenditure in respect of the three Ambulance Stations was 47 per-cent. in excess of that of 1891, but the work of 1892 exceeded that of 1891 by no less than 149 per-cent. THE NEEDS OF THE METROPOLIS IN RESPECT OF HOSPITAL ACCOMMODATION FOR THE INFECTIOUS SICK. It is an accepted axiom that provision for the isolation of infectious disease should be at the rate of not less than one bed for each thousand of the population. The subject, as regards the Metropolis, was considered by the Royal Commission in 1881-2; and the Commissioners stated in their report (1882), that the then provision of Hospitals should be extended, so as to provide 5,100 beds at the least; viz : 3,000, nominally, for " Fever," and 2,100 for Small-pox. Diphtheria eases were not at that time admissible to the Hospitals. The population of London in 1882 was a little under 4,000,000. Consequently, the recommendation of the Commissioners went, to the extent of 1,100 beds, beyond the theoretical requirements of the day. Naturally, however, they intended to make provision for a lengthened period in advance, 101 As respects " Fever," nothing happened, prior to 1S87, to lead the Managers of the Asylums Board to think that they would be likely to require so many as 3,000 beds, and the only step taken by them towards giving effect to the recommendation of the Commissioners, was the erection of the Northern Convalescent Fever Hospital, at Winchmore Hill, for about 480 patients. In 1887, however, an epidemic of scarlet fever tasked their resources to the utmost. Not only were all the available beds filled, but a large and costly addition of temporary huts had to be run up in the grounds at several of the hospitals; and the "Poplar" Hospital, at West Ham, was also brought into requisition. And yet the deaths from scarlet fever (1,443), were 381 below the decennial average. The total number of "fever" patients received into the Managers' Hospitals in that year, including 5,900 suffering from scarlet fever, was 6,537, or nearly 4,000 more than in any previous year: the maximum number under treatment at any one time was 2,600, or about 700 in excess of the normal accommodation. The great increase in the number of persons admitted was largely due to the increased facilities afforded by the Managers—whose new Regulations, issued in that year, permitted of the reception of patients upon the application of any duly qualified medical practitioner—and to an Order of the Local Government Board, giving effect to a recommendation I had made in 1875, viz., that the certificate of any duly qualified medical practitioner should be accepted as evidence of the nature of the infectious disease. But the operation of compulsory notification must not be left out of account in any explanation of the growing disposition of the public to make use of the rate-supported hospitals; or, I would add, in estimating the probable requirements of the future. How greatly these causes, and the depauperisation, in 1883, of medical relief in the hospitals, which I had been advocating since 1877, operated to popularise the use of these institutions, may be inferred from the fact that the admissions of scarlet fever cases in 1891, when the mortality (589 deaths), was the lowest on 102 record, were no fewer than 5,262, or only about 650 less than in the epidemic year 1887. These numbers were far exceeded in 1892, the admissions having been 13,093, or 7,193 more than in 1887, although the deaths from scarlet fever (1,174) were 269 fewer than in 1887, and 60 below the corrected decennial average. If the demands, for scarlet fever only, upon the accommodation provided by the Managers, were so great, under the circumstances above set out, it may well be asked, What would the requirements be, should the Metropolis be again afflicted with an epidemic like that of 1870, when the deaths from scarlet fever were 6,040, out of a population of millions ? or even like that of 1880, when the deaths were 3,100, out of a population of 3¾ millions ? In the former year there were no hospitals : the epidemic ran its coarse without check, and I do not expect ever again to see such a terrible death-roll from scarlet fever in London. In 1880 the hospitals were in operation ; the scarlet fever admissions, however, were under 2,000, and less than two-thirds of the number of deaths in London from this cause ; whereas in 1892, with a population of 4¼ millions, the admissions were eleven times as many as the deaths; 61 per-cent. of which took place in the hospitals: the maximum number of patients in hospital at one time, in November, exceeded 4,000. It must be manifest from these figures that the demands of scarlet fever alone, are by no means unlikely to require for their satisfaction in the future, a number of beds equal to one in the thousand of the population ; say 4,300. A further allowance will have to be made for enteric fever and diphtheria. The average annual number of deaths from enteric fever in the ten years 1882-91, was 740. In 1892 the deaths were 436 only, the notifications of cases 2,509, and the admissions to hospitals 622. This disease is markedly on the decrease in London. Diphtheriaon the other hand, is markedly on the increase. The notifications of this disease, which had been 5,907 in 1891, were no fewer than 8,064 in 1892: the deaths 103 for some years past, moreover, have exceeded the deaths from scarlet fever. In 1891 they were considerably more than double as many. In 1892, the deaths were 1,885, the highest number on record; 711 more than the deaths from scarlet fever, and 712 above the corrected decennial average. The admissions to hospital, moreover,are becoming morenumerous : 722, 942, and 1,312, in 1889,1890 and 1891,respectively, they were 2,349* in 1892. It is manifest, therefore, that a considerable number of beds will have to be set aside for these diseases, as well as a small number for typhus and ill-defined forms of fever—the average number of deaths from which in the ten years, 1882-91, was 89—and for isolation purposes. On the whole, then, I am of opinion that provision should be made of not less than five thousand beds for Scarlet Fever, "Fever," and Diphtheria, and Isolation. As regards Small-pox the state of affairs presents a more hopeful outlook. There has been no epidemic since 1885, when the deaths in London from this disease were 1,419, and the admissions to the Asylums Board Hospitals 6,146— numbers which pale in presence of the fearful totals of 1871, when the Hospitals received upwards of 13,000 cases, and the deaths in London fell little short of 8,000. In happy contrast with this state of things, the experience of the last seven years, 1886-92, may be cited, the total admissions having been only 613, (306 of them in 1892), and the deaths 97. We might reasonably hope for a continuance of this immunity—provided the Vaccination Laws were efficiently administered—as a result of compulsory notification, which has worked admirably, and was the means of preserving London from an epidemic last year. The practice of removing the sick out of London, carried out of late years, in accordance with the recommendation I made in 1881, has also been attended with the best results, and still further encourages the belief that London * Of this number only 2,019 cases, apparently, proved, under observation, to be of a diphtheritic character. 104 will not again suffer as in 1871, or even as in 1881, when the admissions were 8,551, and the deaths 2,367. It is probable, therefore, that the accommodation provided by the Managers for this disease, amounting to 1,150 beds; viz.—350 on the Hospital Ships, and 800 at the Gore Farm, Darenth, may suffice. It could be supplemented by tents, kept ready to hand, should need arise ; though I would earnestly press for an additional Convalescent Hospital, which could be used interchangeably for Small-pox or "Fever" on occasion. It should be remembered that the Royal Commission recommended provision of sites and buildings which could be made capable of receiving 2,100, or by special exertion 2,700, smallpox patients, a recommendation to which effect could be given by the erection of the suggested hospital on a sufficiently large site. If the above calculations are even approximately correct, it follows that London requires in its rate-supported or public hospitals, at least 6,150 beds ; some 1,050 more, therefore, than the Royal Commission recommended in 1882. The normal accommodation already in existence, or provided for, at the several hospitals, appears to be about 3,959 beds, viz., at the Eastern Hospital, 298 beds ; the North-Western Hospital, 411 beds ; the Western Hospital (shortly to be raised to) 400 beds; the South-Western Hospital, 338 beds; the South-Eastern Hospital, 426 beds; the North-Eastern Hospital, 456 beds ; and the Northern Hospital, for convalescing fever patients), 480 beds. Total, 2,809 beds. To which must be added the Hospital Ships, and the Gore Farm Infirmary, for acute cases of small-pox, 550 beds; and the Gore Farm Hospital for Convalescents, 600 beds: Total, 1,150 beds. Grand Total 5,109 beds. The Administrative Department at the Gore Farm Hospital, it may be mentioned, was designed for 1,000 patients. By utilizing this hospital for scarlet-fever cases; by placing additional beds in the wards of the various hospitals; and by diverting rooms hitherto used for other 105 poses; by the erection of temporary wooden huts in the grounds at several of the hospitals; and, lastly, by the erection of the North-Eastern Hospital, the Managers increased the accommodation for patients, in October, 1892, to 4,110 beds,* a total further raised to some 4,410 on completion of the North-Eastern Hospital. It is hardly necessary to insist on the abstract impropriety of placing additional beds in wards, or of diverting to the use of the sick, during the prevalence of an epidemic, rooms usually employed for other purposes ; and no one defends the costly expedient of temporary structures. It is manifest, therefore, that provision of a permanent sort should be made to supply the reasonable maximum requirements of the Metropolis, which I estimate at 2,200 additional beds. How and where this could best be done is the question. Among the first questions to be settled, if the matter were considered with a seriousness commensurate with its importance, would be, the number of beds which may properly be placed on a given space—say in pavilions of two storeys each—and to what extent additional accommodation may properly be provided on the existing sites ; as the more economical plan, obviously, would be that of enlarging the present Hospitals. The North-Eastern Hospital site, for instance, is adequate, probably, for a thousand beds: the NorthWestern Hospital, which is to be rebuilt, could be enlarged: the Western Hospital could be still further extended. Another highly important question to be solved is the requisite provision for acute and convalescent cases respectively; the latter, of course, being provided for outside London, where less difficulty would be experienced in getting sites. * These 4,110 beds were appropriated to the several diseases as follows: — scarlet fever, 3,550; diphtheria, 280; enteric fever, 130, other fevers, and isolation, 150. 106 The views expressed thus far, were submitted by me to your Vestry at the beginning of October last, in my tenth monthly report. " The next epidemic," I remarked, "should not be allowed to find the Asylums Board unprepared. London should not again suffer the anxieties of 1887 and 1892 ; nor be burthened by a repetition of wasted expenditure, on temporary accommodation, to an amount probably equal to half the cost of providing the permanent accommodation necessary."* I recommended the entire question to the consideration of your Vestry, as " one that concerns every Sanitary Authority in London, no portion of which can suffer from infectious disease without endangering all the rest," and I concluded by saying that "the hands of the Asylums Board should be strengthened by those Authorities who immediately represent the ratepayers." I brought the subject, shortly afterwards, to the attention of the Metropolitan Branch of the Incorporated Society of Medical Officers of Health, by which a resolution was unanimously adopted to the effect, "That the permanent hospital accommodation of London for infectious diseases is insufficient, and in the interests of public health should be increased forthwith." A copy of this resolution was forwarded to the Local Government Board, and the London County Council; as well as to the Asylums Board, by whom it was referred to the General Purposes Committee for consideration. This Committee subsequently adopted a report on the subject, prepared by a sub-committee, which, having been presented to, and generally approved by, the Managers, on the 19th January in the present year, was ordered to be sent to the Local Government Board. As this report, and the "conclusions " arrived at by the sub-committee, may now fairly be taken to indicate the views of the Managers, I think it well to submit to your Vestry the subjoined summary thereof * In 1892, some ,£96,000 was expended in providing temporary accommodation (including the North-Eastern Hospital) and charged to the Managers' current account. 107 Reference is first made to the views of the Royal Commission in 1882, recommending provision of accommodation for 3,000 Fever patients. Since then, the demand for such accommodation has increased, with the increase of the population, to the extent of half-a-million, and by the hospitals having been made free, and by the admission of diphtheria cases. Notification, moreover, has brought more cases to the knowledge of the Sanitary Authorities, and the public avail themselves more and more largely of the facilities afforded for the isolation and treatment of infectious disease. Ten years ago, for instance, " not more than 11 per-cent. of the scarlet fever cases of London were received into the Managers' Hospitals. In 1892, the ascertained percentage was 50. Having regard to these circumstances," the sub-committee say that "the Managers should possess permanent accommodation for at least 4,500 cases of fever and diphtheria," (a number only 211 in excess of the beds actually occupied at one time in 1892), "of which about two-thirds should be for acute cases, and about one-third for convalescent cases." The present accommodation, "excluding temporary structures, and also excluding the North-Eastern Hospital at Tottenham, is about 2,100 beds; but further land has been purchased at the Western Hospital, on which can be provided accommodation for about 192 beds," so that the estimated deficiency to be provided for is 2,208 beds. The sub-committee are therefore of opinion that three "Acute Hospitals," (one in the North of London and two in the South), "each with permanent accommodation for not less than 400 patients, and permanent convalescent accommodation, on one or two sites in the South of London, for not less than 800 patients, should be provided without further delay." It is anticipated that this amount of permanent accommodation would suffice "for all ordinary occasions ;" and, given sites large enough, "temporary provision of a considerable additional number of beds" could be made on the occurrence of any serious epidemic. The sub-committee are convinced that no suitable site for a hospital in the North can be found within the Metropolitan area, and that "no advantage can be gained by giving up the site at Tottenham and purchasing another site outside the area," as would be necessary unless the Local Government Board remove the restriction, limiting the use of that hospital within a period which expires on the 12th August next; and having regard to the pressing nature of the case, they recommend that an application be made forthwith to the Local Government Board "to withdraw their condition, and to sanction the permanent appropriation of the site for the purposes of a Fever Hospital." The sub-committee, "as a first step towards the provision of increased accommodation south of the Thames," recommended the acquisition of a site at Tooting. They point out that the Gore Farm Hospital, at Darenth, which has been so largely used for convalescent scarlet fever cases, having been provided for convalescent 108 pox patients, "can only be used for fever when there is little or no small-pox in London, and on that account only, ought not to be relied on at all"—apart from the inconvenience resulting from its great distance from the Acute Hospitals. "The erection of temporary huts, and the strain caused to the resources of the existing hospitals by the additional patients, are attended with so many serious inconveniences, that huts ought to be adopted only as a last resort." The sub-committee hoped, at an early date, to "submit a site for a second Acute Hospital, and a site for a Convalescent Hospital, in the South of London." Meanwhile, with reference to the sanction given by the Local Government Board to the erection of temporary huts, "on the understanding that such erections are removed on the cessation of the epidemic; "and, "while fully recognizing the undesirability of such huts, unless absolutely necessary," they are of opinion that it would be unwise to pull them down until the proposed new permanent accommodation is ready; and they therefore recommended that the Local Government Board be requested to allow the huts to remain, pending the provision of such permanent accommodation, not necessarily for use, but ready to be used in case an emergency, similar to that of the past year, should again arise." The Recommendations of the sub-committee were as follows:— (a) That, subject to the approval of the Local Government Board, the Tooting Lodge Estate be purchased as a site for a Fever Hospital at the sum of £28,000. (b) That the Local Government Board be forthwith requested to assent to the permanent appropriation of the site of the North-Eastern Hospital at Tottenham to the purposes of a Fever Hospital; and (c) That the Local Government Board be requested to allow the temporary structures which have been erected during the past year, at the various Hospitals, to remain standing until sufficient permanent accommodation is actually ready." 109 With reference to (a), the Managers almost unanimously resolved to acquire the Tooting site. This decision excited much opposition, and, after a public inquiry, the Local Government Board informed the Managers that, " having regard to all the circumstances connected with the site in question, they had come to the conclusion that they could not assent to the proposed purchase." The Board added, that they "were very sensible of the difficulties which will always attend the acquisition of a site for the purpose of a hospital for fever patients in the Metropolis, and of the urgent need of additional hospital provision, and that it was not without much regret that they had arrived at the decision that their consent could not be given to the proposal of the Managers." The communication of the Board was referred to the General Purposes Committee, with power to take action. With reference to (b), the Local Government Board have decided that a public inquiry shall be held upon the subject before a final decision is arrived at. I am not aware that the Board have come to any decision with reference to (c): the Managers' proposal, however, is so reasonable that one can hardly doubt its acceptance. At the close of the official year, the Managers had under consideration a recommendation by the General Purposes Committee, for the acquisition of a site for a Fever Hospital, at Hither Green, in the Parish of Lewisham, in the SouthEast District. It has already been stated, that the Committee were of opinion that, "besides extra convalescent accommodation, sites for three additional Acute Fever Hospitals—one in the North and two in the South of London . . should be provided by the Managers without further delay." The Tottenham site, it was thought, would suffice for the north ; the Tooting site and the Lewisham site were intended to supply the needs of the south. The Tooting site, as we have seen, has been rejected by the Local Government Board, and great opposition, on various grounds, has been raised to 110 the acquisition of the Lewisham site, which comprises an area of 20 acres, and is within a radius of four miles from the City. At the present writing, the Local Government Board, after a public enquiry, are considering the Managers' application for power to purchase the site. The matter is urgent, for not only is small-pox spreading, but scarlet fever is showing a tendency to extend more widely. Should there be an extensive recrudescence of the epidemic, the Managers will not have the Gore Farm Hospital to fall back upon, as, after being cleared of fever patients, disinfected and cleansed, it was opened on the 12th March for its proper use, as a convalescent small-pox hospital. The available accommodation for fever and diphtheria, and isolation, comprised, at the close of the official year, 2,643 beds in the Town Hospitals, to which must be added 972 beds at the Northern Convalescent Hospital at Winchmore Hill. Total, 3,615. Should the scarlet fever epidemic attain the same proportions as in 1892, this number will be inadequate, and further costly provision of temporary accommodation will have to be made. It is possible, moreover, though not probable, that the present accommodation may be decreased by a decision of the Local Government Board, not to allow of the use of the North-Eastern site for the purposes of a Fever Hospital after August next, the Board, in assenting to the purchase of the land, having limited the use of it, " without further order " be made, to a period of twelve months, which will then have expired.* What has been said may suffice to show the difficulties under which, at the beginning of a new official year, the Asylums Board were carrying on the important work en- * Whilst this report was passing through the press, the Managers received a communication from the Local Government Board consenting to the permanent appropriation of the North-Eastern Fever Hospital, They expressed the opinion that the hospital should not be used for small-pox patients, and that the Tottenham Local Board should be allowed to send a limited number of patients to the hospital upon terms to be settled hereafter. 111 trusted to them by the Legislature. Having regard to the difficulties in respect of the acquisition of sites for hospitals, it is not to be wondered at that the Managers should have authorised the General Purposes Committee " to consider, and, if thought desirable, to take steps with the view of obtaining for the Board the power to acquire land compulsorily, similar to the power vested in the County Councils, School Boards, and other public bodies." The Managers already have power, subject to the approval of the Local Government Board, to acquire land compulsorily, for the purpose of extending the site of any existing hospital. THE NORTH-EASTERN HOSPITAL. The Local Government Board, after a public enquiry, intimated to the Managers, in August last, their intention to issue an Order to enable them to acquire the site at Tottenham, for the erection of a fever hospital, subject to the following conditions—(a), That no buildings for the reception of patiencs shall be erected except On such part ol the land as the Board may direct to be used for that purpose ; and (b), That the land and buildings shall, during the twelve months next following the date of the Order, be used for the reception of patients suffering from fever, and of no other patients, and at the expiration of that term shall cease to be used for the reception of patients unless the Board, by Order, otherwise direct. The Managers thereupon, at an extraordinary meeting, held on the 16th August, resolved "that the purchase of the land be forthwith completed." They also appointed a Committee of Management, and a Medical Superintendent, for the new Hospital, now known as the NORTH-EASTERN ; and, with characteristic energy, directed that the architects should be instructed to take the requisite steps, and incur the requisite expenditure, for the erection of boundary walls ; for the preparation of plans according to the directions of the Committee of Management; for the construction of all necessary drains, and for the temporary erection of 112 buildings to accommodate not less than 400 patients, and the necessary staff of officers, with the least possible delay. The construction of the Hospital itself was put in hand forthwith, and the first wards were opened for the reception of patients in October, the greater part of the buildings having been erected within a period of seven weeks. With the full allowance of 144 superficial feet to each bed, the hospital accommodates 456 patients. With the usual allowance of 120 feet, it will accommodate 548 patients. Provision has been made for a staff of 207 officers and servants. I had the privilege of being present at the official inspection made by the Managers prior to the opening, and must confess that no pains appear to have been spared to make the hospital all that a temporary building of this kind should be. The walls, floors, and roofs of the dormitory wards, and other buildings, (excepting the boiler house, chimney shaft, steam coal store, and heating rooms, which are of brickwork), are composed of a double thickness of wood, with an interposed layer of felt. The roofs are covered with galvanized corrugated iron. Ample provision has been made for lighting, ventilation, drainage, etc., and the supply of baths, etc., is abundant. The principal buildings are connected by covered ways, with which are combined brick ducts for the reception of water, gas, and steam pipes. These covered ways form a quadrangle, and their total length is 2,120 feet. No sick ward is placed within one hundred feet of the boundary. Each of the ward-huts contains a ward, 120 feet by 24 feet, sanitary room, bath room, scullery, pantry, and linen closet. The huts, and the other buildings, are upon brick piers raised upon concrete platforms. The buildings consist of twenty-two ordinary patients' blocks; two isolation blocks; two administrative blocks; seven dormitory blocks and two mess blocks for female staff ; one block for male staff; one stores block and one kitchen block; one laundry, including boiler house, disinfecting-room, destructor, 113 &c.; one block for sick nurses; one block for nurses on duty in isolation blocks ; one nurses' dressing block; one porter's lodge and discharge room; two receiving rooms; one patients' own clothes store, (fitted with racks consisting of 500 numbered bins); one mortuary, (which includes friends' room and post-mortem room); one house coal store ; one meter house; and one tank house ; making fifty buildings, all of which are warmed by steam-pipes or radiators worked by the central boilers, which also supply steam to the kitchen and laundry and to the bath water-heaters. The original site of fifteen acres acquired at a cost of £12,400, has been extended by the purchase or rental of adjoining properties, and the site now exceeds nineteen acres. It is bounded on the north by St. Ann's Road, from which it is separated by a wall, without any opening, 800 feet in length. A seven-foot fence encloses the site on the remaining three sides. The South Tottenham Railway embankment constitutes the southern boundary. The western boundary is a large house and grounds (Mayfield House), additional to the original site, at present rented, with option of purchase by the Managers. The eastern boundary, where the entrance has been formed, comprises land and houses abutting on Hermitage Road, all the properties in which, on the hospital side, excepting a police station, have been acquired by the Managers. The site is thus seen to be well isolated, and, as there are few houses in the vicinity, the reason for the refusal of the Local Government Board to its purchase, in 1891, is not apparent. The Hospital has been of the greatest utility. STATISTICAL TABLE. Reference to the work of the Asylums Board in 1892, 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:— 114 Table shewing Admissions of Small-Pox, "Fever," and Diphtheria Patients at the Asylums Board Hospitals in 1892, and Population of the several Parishes, and Unions. Parishes, Unions. Small-Pox. Total. Scarlet Fever. Total. Enteric Fever. Total. Diphtheria. Total. Grand Total Small-Pox, Fever, and Diphtheria. Population in 1891. 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 1 ... 1 ... 2 48 75 182 146 451 ... 1 2 4 7 18 16 15 15 64 524 166,308 Fulham ... 4 ... ... 4 47 79 184 259 569 4 7 4 7 22 30 63 55 34 182 777 188,877 Paddington 1 ... ... ... 1 39 49 91 136 315 2 2 3 3 10 9 10 24 26 69 395 117,838 Chelsea ... ... ... 1 1 20 50 110 81 261 1 2 4 3 10 6 10 16 6 38 310 96,272 St. George, Hanover Sq. 2 ... 1 1 4 27 104 167 174 472 1 1 4 5 11 16 26 69 20 131 618 149,603 Westminster 2 4 ... 1 7 6 15 40 18 79 1 ... 1 ... 2 1 10 3 6 20 108 2,732 52,752 771,650 North District. St. Marylebone 1 1 ... 5 7 89 129 177 131 526 2 ... 10 6 18 13 20 27 40 100 651 142,381 St. Pancras 8 7 3 2 20 74 153 368 283 878 5 3 8 4 20 36 25 38 51 150 1068 234,437 Hampstead ... ... ... ... ... 18 19 51 30 118 ... 1 3 2 6 7 9 13 14 43 167 68,425 Islington 3 2 ... 16 21 42 74 241 300 657 5 7 18 18 48 33 38 45 55 171 897 319,433 Hackney 3 5 ... 8 16 56 138 241 288 723 2 4 15 26 47 21 29 29 33 112 898 3,681 229,531 994,207 Central District St. Giles and St. George 3 1 1 ... 5 6 18 35 35 94 ... ... 2 1 3 1 2 5 7 15 117 39,778 Strand 1 1 ... 1 3 8 7 38 34 87 2 3 5 3 3 3 1 10 105 33,405 Holborn 3 7 ... 1 11 72 113 217 174 576 2 9 9 7 27 11 15 23 22 71 685 167,000 London, City of ... 2 ... 1 3 12 52 53 44 161 1 7 3 1 12 2 21 10 15 48 224 1,131 51,306 291,489 115 East District. Shoreditch 23 49 ... ... 72 57 96 158 150 461 5 9 10 10 34 11 22 26 16 75 642 124,009 Bethnal Green 4 21 ... 1 26 60 74 131 114 379 5 5 9 7 26 17 20 38 41 116 547 129,134 Whitechapel 1 17 1 5 24 11 52 150 136 349 1 1 4 3 9 29 51 53 30 163 545 74,462 St. George-in-the-East ... 1 ... 1 2 16 23 60 97 196 1 ... 6 4 11 13 9 22 19 63 272 45,546 Stepney ... 5 ... ... 5 16 31 125 114 286 ... 1 2 8 11 6 9 10 10 35 337 57,599 Mile End Old Town ... 3 1 ... 4 21 50 101 113 285 ... 2 5 3 10 10 22 23 10 65 364 107,565 Poplar ... 2 1 ... 3 21 73 176 163 433 12 6 24 9 51 18 6 18 7 49 536 3243 166,697 705,012 South District. St. Saviour ... ... ... 2 2 72 161 277 212 722 9 8 13 2 32 12 14 26 28 80 836 195,105 St. Olave ... ... ... 1 1 51 76 173 161 461 10 9 13 11 43 6 7 12 10 35 540 135,654 Lambeth ... 17 ... 1 18 132 213 290 302 937 3 4 11 6 24 22 20 36 36 114 1093 275,202 Wandsworth & Clapham ... ... 2 ... 2 118 247 298 437 1100 15 8 14 14 51 39 42 51 63 195 1348 284,192 Camberwell ... 5 1 7 13 67 146 215 213 641 11 7 3 7 28 8 9 6 25 48 730 235,312 Greenwich ... 5 ... 5 10 34 123 120 118 395 11 3 7 5 26 4 3 10 16 33 464 165,417 Woolwich 1 7 7 1 16 57 159 174 102 492 3 4 3 6 16 ... 3 8 15 26 550 106,961 Lewisham ... ... ... ... ... 15 30 31 38 114 ... ... 2 ... 2 3 2 5 18 28 144 5705 72,533 1,470,376 Port of London 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 58 166 19 61 304 1312 2629 4674 4603 13218 112 113 212 185 622 405 536 719 689 2349 16493 16493 The figures in the above Table have been compiled from the Quarterly Returns of the Asylums Board. The totals will probably be found to vary slightly from those in the as yet unpublished Annual Report of the Statistical Committee. In addition to the cases in the Table, 12 cases of typhus were admitted: 3 each from Holborn and Kensington; 2 fom St. Olave, Southwark; and one each from the City, Fulham, Hackney, and Shoreditch. At the close of the year there were remaining 3,587 cases; viz., small-pox 39, scarlet fever 3,168, diphtheria 288, enteric fever 87, and "other diseases" 5. 116 COMPULSORY NOTIFICATION OF INFECTIOUS DISEASES. The Table at page 88, shows the number of notifications of the scheduled diseases, after correction for duplicate returns, in the entire Metropolis, and in the several sanitary areas comprised therein. The Table at page 117, shows the number of notifications in London and in Kensington, in thirteen periods corresponding with my four-weekly reports. In this Table it has been impossible to make the aforementioned correction ; but the totals will not differ to any material extent. This Table has interest as showing at what periods of the year the several diseases were most prevalent. The notifications in the Town sub-district were 895; in the Brompton sub-district 289. Total 1184. Table IXa (Appendix) shows the streets, &c., where cases of the scheduled diseases occurred. Owing mainly to the prevalence of scarlet fever, the total number of notifications in London (47,341, without correction) shows a great increase upon previous years. The notifications from each of the scheduled diseases during the last three years are set out in the subjoined Table. Total Notifications in London: Year. Small-pox. Scarlet Fever. Diphtheria. Enteric Fever. Typhus Fever. Other Continued Fevers. Puerperal Fever. Erysipelas. Croup. Cholera. Relapsing Fever. Total. 1890 60 15,330 5870 2877 35 237 206 4598 550 25 7 29,795 1891 114 11,398 5907 3372 27 152 221 4764 505 23 39 26,522 1892 439 27,912 8064 2509 21 148 346 7288 554 55 5 47,341 The Notification Act of 1889 has been adopted by a large majority of provincial Sanitary Authorities, urban and rural. The time surely, has arrived when the Act should be made compulsory for the whole kingdom, as it has been in London from the first. 117 Table shewing the number of Cases of Infectious Disease Notified in Kensington, and in London, in 1892, Arranged in four-weekly periods. Date of Report. For Four Weeks ended. Weeks of the Year KENSINGTON. LONDON, Weeks of the Year, Date of Report. For Four Weeks ended Small-pox. Scarlet Fever, Diphtheria. Enteric Fever. Typhus Fever. Other Continued Fevers. Puerperal Fever. Erysipelas. Croup. Cholera. Total. Small-pox. Scarlet Fever. Diphtheria. Enteric Fever. Typhus Fever. Other Continued Fevers. Puerperal Fever. Erysipelas. Croup. Cholera. Total. January 30, 1892 1.4 ... 28 23 ... ... ... 1 9 ... ... 61 7 863 408 132 3 1 19 386 46 2 1867 1.4 January 30, 1892 February 27 „ 5.8 1 23 8 3 ... ... 2 14 ... ... 51 8 776 397 116 1 4 19 364 44 ... 1729 5.8 February 27, „ March 26 „ 9.12 ... 19 8 ... ... 1 1 12 1 ... 42 39 895 452 101 1 5 12 318 38 3 1864 9.12 March 26 „ April 23 „ 13.16 ... 41 20 2 ... ... 1 12 1 ... 77 67 1491 528 111 5 4 29 364 45 1 2645 13.16 April 23 „ May 21 „ 17.20 ... 51 13 8 ... ... 1 10 2 ... 85 88 1761 554 126 ... 12 22 427 42 ... 3032 17.20 May 21 „ June 18 „ 21.24 ... 39 18 7 ... 1 1 17 ... ... 83 94 1788 600 156 ... 14 15 452 40 1 3160 21.24 June 18 „ July 16 „ 25.28 ... 70 16 3 ... ... ... 13 3 3 108 31 2404 629 189 3 21 14 460 35 6 3792 25.28 July 16 „ August 13 „ 29.32 ... 74 14 1 ... 1 1 12 ... 2 105 12 2690 628 180 1 13 31 547 34 10 4146 29.32 August 13 „ September 10 „ 33.36 ... 59 6 8 1 1 1 14 1 1 92 12 2773 662 245 2 18 41 620 26 18 4417 33.36 September 10 „ October 8 „ 37.40 ... 98 16 6 ... ... ... 8 2 ... 130 4 3959 1002 347 2 19 30 819 44 6 6232 37.40 October 8 „ November 5 „ 41.44 ... 85 21 10 ... ... ... 22 ... ... 138 7 3755 851 299 1 13 42 954 50 1 5973 41.44 November 5 „ December 3 „ 45.48 ... 82 8 4 ... ... 1 27 3 ... 125 32 2789 665 278 1 9 32 881 52 3 4742 45.48 December 3 „ December 31 „ 49.52 ... 49 8 5 ... ... 3 22 ... ... 87 38 1968 688 229 1 15 40 696 58 4 3737 41.52 December 31 „ Totals 1 718 179 57 1 4 13 192 13 6 1184 439 27912 8064 2509 21 148 346 7288 554 55 47336 Total. Five cases of Relapsing Fever were notified in addition. 118 THE LONDON SCHOOL BOARD AND NOTIFICATION. In former reports, extending over some sixteen years, I had occasion to make 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 suspect that such absence was due to illness of an infectious character. When the Notification Act came into operation, the Board and their Medical Officer manifested a commendable desire to utilize its provisions to the utmost extent possible, for preventing the spread of disease through Board Schools. The Public Health Act, 1891, makes provision for information to be given by the Medical Officer of Health to the Head Teachers of all Schools, of the occurrence of any of the infectious diseases named therein, whether in school children themselves, or in houses from which children are attending school. This provision has been duly carried out during the past year; by direct communication with the Head Teachers of private schools, and through the Superintendent of Visitors for the Chelsea Division of the London School Board in the case of all public elementary Schools. PAYMENT OF FEES FOR CERTIFICATES. During the year 1892, 1266 certificates were received by me, for which the sum of £134 19s. Od. became due to medical practitioners, in amounts varying from one shilling to £3 15s. Od. These amounts having been paid by your Vestry, were recouped by the Asylums Board and charged to the Metropolitan Common Poor Fund. A question having arisen how the accounts could be most conveniently arranged, I proposed that we should prepare a statement of the sums 119 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. COMPULSORY REMOVAL TO HOSPITAL OF THE INFECTIOUS SICK. This may be effected by a 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 lives. The Conference of the Sanitary Authorities, convened by your Vestry in 1881, on the subject of Notification of infectious disease, 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 twelve years ago. I am glad to observe, therefore, that in a Bill to amend the Public Health (London) Act, 1891, introduced by Sir Henry Roscoe and other members, the subject is proposed to be dealt with in this direction, section 3 providing for the following sub-section to be added, and numbered to section sixty-six of the principal Act, viz.:— 120 (4) A person who is not provided with lodging and accommodation in which proper precautions can be taken to. prevent the spreading of the dangerous infectious disease from which such person is suffering, shall be deemed, for the purposes of this Act, to be without proper lodging or accommodation." In the present state of political affairs there is little prospect of the Bill becoming law this Session, the more especially as it contains other provisions of a contentious character. 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 of the Metropolitan Asylums Board, with respect to infectious disease, which were still under the consideration of the Local Government Board. This synopsis had been prepared by direction of the General Purposes Committee, 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 to Hospital of all classes of Infectious Patients. (2) General Conveyance of Infectious Persons to Hospital. (3) Admission of cases of Diphtheria to the 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 tion and Maintenance in Hospitals of Non-paupers. 121 The objects sought to be attained in respect of (1), (2), (3), (4), and (6) were secured by the passing of the Infectious Disease (Notification) Act, 1889, and the Poor Law Act, 1889, which were repealed by the Public Health (London) Act, 1891, in which their provisions are re-enacted. At page 119 I have referred to the question of (5) Compulsory Removal of the Sick, which still awaits settlement. With reference to (7), I have stated, in former Reports, the grounds of my objection to the contract system, which happily is no longer in question, free admission to the hospitals having now been secured by the Public Health Act. HOSPITALS COMMISSION. In 1881, a Royal Commission was appointed to consider the question of Hospital Accommodation for Infectious Diseases, before which I gave evidence, a summary of which will be found in my Annual Report for 1881 (pages 50—60 inclusive). In my Annual Report for 1882-83 (pages 28—39 inclusive), I dealt with the report of the Commission, reproducing their "Practical Recommendations," which were in accord with the principles, in regard to public health administration in the Metropolis, for which I had long contended. Amongst other principles, which first found expression in these Reports, I may refer to (1), Compulsory Notification of all cases of infectious disease; (2), Compulsory Removal of the sick to hospital 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 the distinction between Pauper and Non-pauper in respect to the treatment of infectious diseases; (5), Free hospital treatment of infectious diseases; (6), Provision of additional hospitals in London, with skeleton staff of doctors, nurses, and other officers, capable of extension, as necessary, to cope with emergencies; (7), Provision of hospitals in the country for removable cases of small-pox, and for the reception of 122 lescents generally; and (8), Transference of Vaccination arrangements to the Hospital (that is, the Sanitary) Authority, Previous sections of this Report will have shown to how large an extent, either by law or in practice, my views have already been carried out. Parliamentary sanction, I doubt not, will sooner or later be given to those recommendations which are as yet in advance of public opinion. PUBLIC HEALTH (LONDON) ACT, 1891; BYE-LAWS, Etc. The subject of Sanitary legislation, which occupied so large a space in my last annual report, calls for little notice on the present occasion, nothing of importance, as regards the Metropolis, having been added to the Statutes in the Parliamentary Session of 1892. The year, however, was distinguished by the coming into operation of the Public Health (London) Act, 1891, which distinctly strengthened the position of Sanitary Authorities in respect of proceedings for the abatement of nuisances. The mere consolidation of public health legislation has proved a great convenience, and would have greatly eased sanitary administration had it stood alone. But the additional powers given, and the moral effect upon negligent property-owners of the more stringent penalties to which they are liable, for noncompliance with the requirements of the Sanitary Authority's notices, have further facilitated our work in an altogether satisfactory way, and with the result of largely reducing the number of occasions on which it has been found necessary to take proceedings at the Police Court. The full powers of the Act, however, have not at present been brought into operation, for, even now, seventeen months after the date at which the Act came into force, no bye-laws have been made. A period of six months was allowed to the County Council, and to the Sanitary Authorities, for preparing bye-laws, and draft byelaws were framed and submitted to the Local Government 123 Board within that period. The bye-laws of the several Sanitary Authorities were based upon a draft submitted by the Board, with the view to secure substantial uniformity for the entire Metropolis. A difficulty, however, arose, due to the fact that the Council, and each of the 39 Sanitary Authorities, have power to make bye-laws for certain practically identical purposes, thus leading to overlapping. The confirming power of the Local Government Board will doubtless be so used as to harmonise the bye-laws to be framed by the Council on the one hand, and by the several Sanitary Authorities on the other; and with the view to secure practical if not verbal identity between the 39 codes to be framed by those Authorities.* By this time, probably, most persons will be agreed that it would have been well, had Parliament given effect to the original intention of the framers of the Act, viz., by authorizing the County Council to make all bye-laws, subject to a reference to the Sanitary Authorities in respect of those it will be their duty to enforce, and with the right of appeal to the confirming Authority in case of disagreement between those bodies. This was the course I always advocated, and in any amendment of * Whilst this report was passing through the press, a circular letter was received from the Local Government Board intimating that "when the matter" (of a bye-law) "was one with respect to which the County Council proposed to make bye-laws, under the powers conferred upon them, it should be excluded from those made by the Sanitary Authorities, and (the Board) have acted on this principle in considering the several sets forwarded to them." The Board, moreover, having considered various amendments to the model clauses issued by them, made by different authorities, covering the same ground, though differently worded, thought that "the more convenient course would be for them to revise the model clauses, and to embody in them such of the suggestions of Sanitary Authorities as they felt able to accept." Not many such amendments would appear to have proved acceptable. The Board "suggest that bye-laws" (in the form of the revised model clauses forwarded) "should be adopted by the Sanitary Authority without further modification" as they will be able to confirm them; thus the bye-laws would be uniform for the Metropolis, but practically they will have been made (as well as confirmed) by the Local Government Board, and not by the Sanitary Authorities. Having regard to the formalities necessary to be observed before the bye-laws can be submitted for confirmation, it is obviously impossible that they can come into operation by the end of June, 1893, the latest date contemplated by the Act. 124 the Act it is a course which, I anticipate, it will be found expedient to adopt. Pending the confirmation of the bye-laws, certain powers of the repealed Acts were to be continued in force for a period of twelve months, i.e., to the end of 1892, such period to be extended at the discretion of the Local Government Board for a further period of not more than six months, which will expire at the end of June in the present year, by which time it is to be presumed that the bye-laws will have been confirmed and become operative. FACTORY AND WORKSHOP ACTS. The Home Secretary issued, late in the year, an Order under the Factory and Workshop Acts, requiring lists to be kept by manufacturers, &c., of outworkers in the following businesses, viz.: (a) The manufacture of articles of wearing apparel. (b) Cabinet and furniture making and upholstery work. (c) The manufacture of electro-plate; and (d) The manufacture of files. The Order, made under section 65 of the Act of 1878, and section 27 of the Act of 1891, requires "the occupier of every factory and workshop, and every contractor employed by any such occupier in any of the businesses mentioned to keep lists showing the names of all persons directly employed by him, either as workman or as contractor, in the said business, outside the factory or workshop, and the places where they are employed." Such lists are to be open to inspection by any Factory Inspector, or by any officer of a Sanitary Authority. The Local Government Board, in communicating the Order to the Sanitary Authorities, stated, in a circular letter, that the Secretary of State "considers it of great importance that all practicable means should be taken to make known the Order to all those who have to comply with it, or are affected thereby." He was, moreover, anxious "that the Sanitary Authorities should give full publicity to the Order in their districts, and follow it up by active steps for the inspection of the 125 shops and houses in which the outworkers are employed, in order that full effect may be given to the object which Parliament had in view when passing the enactment under which the Order is issued." The Board also expressed their "trust that the Sanitary Authority will co-operate in this matter to the utmost of their power," and "at once take measures to secure that the Order is made known to those whom it affects, and that the Medical Officer of Health and the Sanitary Inspectors should be instructed, from time to time, to examine the lists, so that they may become aware of the places in which outworkers in the trades in question are employed," as it is "especially desirable that frequent inspection should be made of these places, so that prompt measures may be taken to deal with any sanitary evils existing in them." In reporting upon this subject, I pointed out that the first duty that would appear to devolve upon the Sanitary Authority under the Order, was to secure for it that "full publicity" which the Secretary of State desired, and which might be attained, by advertisement in the local newspapers, by the circulation of handbills, and by search in directories for the names of occupiers of factories and workshops, whom the Order is likely to affect. The attention of such persons was sought to be attracted by repeated advertisement of the requirements of the Order in the local press. It is noteworthy that neither the Acts nor the Order require the "occupiers" to make themselves known to the Sanitary Authority. Sanitary officials, moreover, do not appear to have any power of initiative under the Order. It is to be presumed that there are not many, if any, manufacturers of electro-plate or of files in this parish, and probably there are not very many outworkers in cabinet and furniture making and upholstery work. But the number of outworkers employed in the manufacture of articles of wearing apparel is no doubt considerable. It is obvious, moreover, 126 that the danger of the spread of infectious disease through the medium of clothing manufactured by outworkers, is one not to be disregarded, having respect to the limited domestic accommodation usually possessed by such persons; and assuredly it is desirable that the places where they carry on their avocation should be known to the Sanitary Authority, so that "any sanitary evils existing in them "may be dealt with; and especially that work in them may be caused to cease at any time when infectious disease prevails in them—a fact with which the Sanitary Authority are made acquainted through the operation of the notification clauses of the Public Health Act. Hut if due effect is to be given to the requirements of the law, there must be co-operation between sanitary officials throughout the Metropolis, in carrying out the duties devolved upon them by Sanitary Authorities, so that the names and addresses of outworkers, not residing in the parish or district in which the factory or workshop is situated, may be communicated to the Medical Officer of Health of the parish or district in which such outworkers reside. But for the purpose of giving that "full effect to the object which Parliament had in view when passing the enactment under which the Order is issued," which the Local Government Board stated the Home Secretary was anxious to secure, I am of opinion that the machinery provided by the Act is ineffective, and in the interests of public health should be amended. Provision should be made so that occupiers of workshops, and their under-contractors, should be required to send periodical lists of their outworkers to the Sanitary Authority, whose proper duty, of inspection of the places where the said outworkers live, would then begin. Given a sufficient staff, there would be no difficulty in making "frequent inspection "of the said "places," in order to measures being taken "to deal with any sanitary evils existing in them." But any present attempt to carry out the law, as comprised in the Act and the Order, will, I fear, end in comparative failure, and it would be well to intimate to the Local Government 127 Board, and the Home Secretary, that the Order, in the present state of the law, imposes on Sanitary Authorities an almost impracticable duty. It will not be altogether out of place here, to mention that the Factory Acts, as I pointed out in my eleventh Monthly Report for 1891 (November 9th, page 140), impose a variety of duties upon Sanitary Authorities, to which practically little effect has been given hitherto. It would be well, therefore, that the list of occupiers of factories and workshops, requisite forgiving effect to the recent Order, should be extended, so as to include the occupiers of all workshops and work-places where work is done exclusively on the premises, which it is the duty of the Sanitary Authority to inspect, and which obviously should be inspected in the interests, alike of the occupiers, the employes, and of the public health. It is hardly necessary to observe, having regard to the definition of the expression "workshop" in section 93 of the Act of 1878, that the work thus foreshadowed would be considerable, and could not be done effectually without material interference with the current work of inspection of dwelling houses, unless local inspectors of factories and workshops should be appointed, to whom might be delegated the duties devolved upon the Sanitary Authority by the smoke consumption clauses of the Public Health Act, which at present are practically in abeyance. In January of the present year, the London County Council forwarded for the information of the several Sanitary Authorities, a report by their Medical Officer of Health on the results of an inspection of numerous workshops in certain East-end districts, with a request that the Council might be informed what arrangements had been made for carrying out, in the respective districts, the provisions of the Public Health (London) Act, 1891, with reference to workshops, having 128 gard to the fact that the duty of sanitary inspection of workshops devolves upon sanitary authorities in consequence of the passing of the Factory and Workshop Act, 1891. In making inquiry into the sanitary condition of the workshops referredto, attention was specially directed (a), to the general state of cleanliness and repair of the workshops; (b), to the amount of cubic space allotted to each worker; (c), to the adequacy or inadequacy of the means of ventilation provided; and (d), to the extent to which section 38 of the Public Health (London) Act, 1891, which relates to the provision of sufficient and suitable accommodation in the way of sanitary conveniences, is complied with. Overcrowding appears to have been the evil most commonly observed, and this evil was aggravated by the inadequacy or the absence of means of ventilation. The conditions as to cleanliness and repair were found fairly satisfactory, but there was generally, a lack of separate sanitary conveniences for the two sexes. The Medical Officer of Health states that the Sanitary Authorities are "primarily responsible for enforcing the law enacted to maintain workshops in a sanitary condition," and adds that "this is a duty of the Sanitary Authorities which the Council might, so far as concerns workshops to which the Public Health (London) Act, 1891, relates, feel itself called upon to undertake, should any Sanitary Authority be in default in this particular." Section 100 and Section 101 (1.) of the Public Health Act are cited as defining the powers of the Council in this matter. SANITARY WORKS AND LEGAL PROCEDURE. At the meeting of your Vestry held on the 21st of December last, a resolution was adopted, with a view to benefiting the "unemployed," to the following effect:— "That it.be an instruction to the Works and Sanitary Committee to expedite as far as possible the carrying out of needed sanitary works in the Parish." The subject was taken into consideration by the Committee at a special meeting on the 28th December, and a resolution was passed to the effect:— 129 "That the Medical Officer of Health be requested to submit, at the next ordinary meeting of the Committee, a list of streets in the Parish in which a house to house inspection has been made during the past 5 years, and of those streets in which, in his opinion, a house to house inspection is urgently needed." In conformity with the above resolution, and after consultation with the several Sanitary Inspectors, I prepared a list of some 70 streets which had been wholly or in large part inspected, from house to house, during the previous eighteen months; and a further list of streets, about 90 in number, being those that, in my opinion, more "urgently needed" early attention. I took advantage of the occasion to submit to your Vestry a report setting out the precise course followed in the Public Health Department, in dealing with nuisance-cases under the Public Health (London) Act, 1891, as follows:— "On receipt of complaint of a nuisance, the premises where the nuisance is alleged to exist are visited without delay by the Sanitary Inspector for the district; and if the complaint is found to be correct (or should a nuisance be discovered by the Inspector himself), 'the existence of the nuisance' is 'immediately brought to the notice of any person who may be required to abate it,' by the service of a 'written intimation ' in the following terms:- 'In conformity with the provisions of Sec. 3 of the Public Health (London) Act, 1891, I hereby give you notice that a nuisance liable to be dealt with summarily under the said Act, exists at the premises known as such nuisance being caused by reason of. This written intimation is given you as being the person by whose act, default, or sufferance, the nuisance arises or continues, or as being the owner or occupier of the premises on which the nuisance exists, and as being the person required to abate the same.' "The Intimation, which is signed and served by the Sanitary Inspector, has appended to it a footnote to the following effect:— I 130 The Vestry's Instructions endorsed hereon, may serve to indicate the works necessary for the abatement of the nuisance. Should further information be required, the Inspector can be seen at the Offices of the Public Health Department any day between 9 and 10 a.m.' "In many cases the necessary works are put in hand forthwith and the nuisance is abated. That this has been done has, of course, to be ascertained by a re-inspection of the premises. Should the nuisance be not abated, a report thereof is made to the Works and Sanitary Committee at their next following meeting, as required by section 4; and the Committee, 'if satisfied of the existence of the nuisance,' direct service of a Notice on the person liable, 'requiring him to abate the same within the time specified in the Notice, and to execute such works, and do such things, as may be necessary for that purpose.' The description of the nuisance, set out on the face of the Notice, is followed by a statement that, in default of compliance with the requisitions of the Notice, a summons will be issued, requiring the defaulter's 'attendance before a Petty Sessional Court to answer a complaint which will be made, for the purpose of enforcing the abatement of the nuisance, and for recovering the costs and penalties that may be incurred thereby.' No penalty attaches to disregard of a 'written intimation,' but, as it is stated in a note at the foot of the Statutory Notice, 'Where a notice has been served on a person under the Act for the abatement of the nuisance, and either (a), the nuisance arose from the wilful act or default of the said person; or (b), such person makes default in complying with any of the requisitions of the notice within the time specified, he shall be liable to a penalty not exceeding Ten Pounds for each offence.' Section 4, Sub-Section (4). "The Notice, moreover, is endorsed with a statement of 'works necessary to be executed, and things to be done, to abate the within-described nuisance'; and it is further stated that, if any of the said works 'necessitate 131 ference with the paving, or connection with the sewers, application must be made, previous to the commencement of such works, to the Vestry's Surveyor.' "The time allowed by the Committee for the abatement of the nuisance is stated on the face of the notice, and generally the nuisance is abated within the time allowed. In nearly every case re-inspection follows within the time stated, and usually several re-inspections are necessary; either to ascertain that the work has been commenced, or with a view to supervision of the required works; a course imperatively necessary, and often consumptive of considerable time, through default or delay on the part of the person liable to abate the nuisance. The date of each re-inspection, and the Inspector's report thereon, is entered upon the counterfoil of the Notice. With a view to obviate delay, as far as possible, each Inspector now receives from me, at the commencement of each week, a 'List of Intimations, or of Time-expired notices;'the 'premises' and the 'date of expiration of notice' being enfaced thereon, with a request for ' further report forthwith.' Should it appear that the work has not been put in hand, or, as often happens, has been commenced and suspended, a 'Final Notice' is forthwith sent by me in the following terms:— ' Re The Sanitary Inspector having reported that the requirements of the Vestry's Notice, in respect of the above described premises, dated , and numbered, have not been duly complied with, I beg to inform you, in conformity with the Vestry's Instructions, that a summons will be applied for without further notice, should the work be not put in hand and completed forthwith. 'I think it right at the same time, to acquaint you with the provisions of subsection (4) of the fourth Section of the Public Health (London) Act, 1891, to the following effect:— "(4) When a notice has been served on a person under this Section and either— 132 "(a) The nuisance arose from the wilful act or default of the said person; or "(b) Such person makes default in complying with any of the requisitions of the notice within the time specified, he shall be liable to a fine not exceeding ten pounds for each offence, whether any such nuisance order, as in this Act mentioned, is or is not made upon him." 'I trust that by your immediate compliance with the requirements of the Vestry's Notice you will obviate the necessity of any further proceedings.' This 'Final Notice' has usually the desired effect, and the required works are, as a general rule, put in hand and completed forthwith. Should this be not done, nothing remains but to apply for a summons, and in such cases 'Information for the Vestry Clerk' is supplied on a printed form, shewing the name and address of the defaulter, the nature of the nuisance, and the premises whereon it exists, with the following further particulars:— 1, Date of Inspection; 2, By whom inspected; 3, Description of Nuisance; 4, Whether a Registered House; 5, If so, date of Registration; and, 6, Regulations Infringed; 7, Date of Service of Written Intimation; 8, Date of Service of Statutory Notice; 9, Vestry's requirements; 10, Date of Service of Final Notice by Medical Officer of Health; 11, Remarks : thus, practically, furnishing a brief for the Vestry Clerk in the conduct of the case in court. Fortunately,it is not often necessary to carry cases into Court, a course which still further extends the time necessary to procure abatement of the nuisance, as the summons is not made returnable in less than a week. "It must be obvious from the foregoing statement that, in many instances, notwithstanding all possible expedition on the part of the Department, an unconscionable time is occupied (extending sometimes to months), in enforcing compliance with the law, by giving effect to the 133 ments of your Vestry. I cannot, however, suggest any further procedure to secure due and immediate compliance with such requirements, 'so as to expedite as far as possible the carrying out of needed sanitary works in the Parish,' unless it be a systematic application to the Court for enforcement of the prescribed penalties, against the worst defaulters—pour encourager les autres." It may be added that some 3,030 "written intimations," and 1,220 statutory notices, were served in the year 1892. The Final Notice was issued in 157 cases, but it was found necessary to take out summonses in seventeen cases only, compared with 148, 159, and 116 in the preceding three years respectively. THE WORK OF THE SANITARY INSPECTORS. Tables VI. and VIA. (Appendix), contain a summary of the work of the Sanitary Inspectors during the year ended March 25th, 1893. The work of the Inspectors is under the supervision of the Works and Sanitary Committee, upon which your Vestry have conferred, by resolution, power to carry out the provisions of the Public Health (London) Act, 1891; the Housing of the Working Classes Act, 1890; and the Factory and Workshop Act, 1891. The staff having been increased by the addition of two Inspectors, it became necessary to re-arrange the Sanitary districts, and with the approval of the Committee the Parish has been mapped out as follows:— All that portion of the Northern Division of the Borough of Kensington, to the north of the City and Hammersmith Railway, now constitutes the north District. The remainder of the Northern Division constitutes the northeast and the north-west Districts; Ladbroke Grove and part of Ladbroke Grove Road being the dividing line. The Central District is, as before, that portion of the Southern Division of the Borough which lies between the centre of High Street, Notting Hill, and Uxbridge Road, and the centre of 134 Kensington High Street, and Kensington Road. The remainder of the Southern Division constitutes the southeast and the south-west Districts, the dividing line running down Marloes Road and Lexham Gardens, to Cromwell Road, crossing that road, and then running down Collingham Road, the Boltons, and Gilston Road to Fulham Road. The Inspector for the South-East District takes both sides of Collingham Road, The Boltons, and Gilston Road. The Inspector for the South-West District takes both sides of Marloes Road and the whole of Lexham Gardens, OFFENSIVE BUSINESSES. The only business coming under the statutory description "Offensive," other than that of a slaughterer of cattle, carried on in this Parish, is that of a FAT EXTRACTOR in Tobin Street, in the Potteries, Notting Dale. This gives rise at all times to more or less effluvium nuisance, despite improved arrangements, care on the part of the proprietor, and supervision by your Vestry's Inspector, as well as by the Inspector of the London County Council. The premises were inspected by the Works and Sanitary Committee in July, at a time when there was little going on, so that the smell perceived in the neighbourhood was less than usual. There was, however, a large accumulation of bones on the premises, and by direction of the Committee the proprietor was requested to provide for a more frequent removal. MARINE STORES Are not scheduled in the Public Health (London) Act, 1891, as an offensive business, but they give rise often to very offensive smells; and as the business of a rag and bone dealer—the popular description of the business—has been held by the Appeal Court to be ejusdem generis with the businesses scheduled in that Act, it would be well should 135 the County Council see fit to add it to the list, as, many years ago, your Vestry requested the late Metropolitan Board to do, but without success. BRICK-BURNING. Your Vestry requested the County Council, in 1889, to add the business of a Brick-burner to the scheduled list of offensive businesses. The Council, however, thought that the business might be regulated by bye-laws, under the provisions of the Local Government Act, 1888, and Section 23 of the Municipal Corporations Act, 1882; and, under circumstances set out in my last Annual Report (page 179), framed bye-laws accordingly. The Local Government Board did not confirm the bye-laws, being of opinion that the Public Health (London) Act, 1891, section 21, when it came into operation, would enable Sanitary Authorities to cope with nuisances due to this cause. The nuisance is a serious one, causing great annoyance over a very large area. For many years, including the year 1891, it was the cause of numerous complaints in this Parish, so surely as the burning season came round. In 1892 not a single complaint was received, a striking fact, seeing that for the first time probably, since I entered upon the duties of my office, no bricks were burned at Wood Lane, Hammersmith, the reputed locality of the nuisance, as it affects Kensington. Comment is needless. LICENSED SLAUGHTER-HOUSES. Eleven of the 19 licensed slaughter-houses are in North Kensington (i.e. the district north of Uxbridge Road), and eight 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:— 136 "With a few exceptions, the several premises were found in a satisfactory 'condition, many of them having recently undergone certain improvements, with a view to compliance with the requirements of the new byelaws of the 'Local Authority,' the London County Council. These bye-laws require, among other things, that the walls of the slaughter house, including doors and other woodwork, shall be covered, to the height of at least six feet, with some impermeable material; that the floor shall be smooth and jointless; that the grating over the trap of the drain shall be a fixture; that a trough shall be provided for supplying wholesome water to the animals in the pens or lairs, and (in effect), that duplicate sets of covered receptacles shall be provided for containing blood, offal, garbage, filth, &c., as these refuse matters are now required to be removed from the premises in such receptacles. At some of the licensed premises these several requirements have been fully complied with already; at others only partially at present." The report further dealt with certain defects, observed in the construction or the management of some of the slaughterhouses, which were removed prior to the renewal of the licenses in October: the County Council, moreover, directed cautionary letters to be sent to the licensees, with a view to prevent recurrence of the causes of complaint. It may be mentioned that in 1874, there were some 1,500 slaughter-houses in the Metropolis; in 1892 only 533, and 118 fewer than in 1891. In Kensington 48 were licensed in 1873, the year before the passing of the Slaughterhouses (Metropolis) Act; in 1874 only 31. The present number is 19. No new slaughter-house has been opened since 1874. The defect of the Act was that it ignored the Sanitary Authorities, (Vestries and District Boards), whose Medical Officers of Health and Sanitary Inspectors should have been made available for the purposes of inspection and supervision: such inspection and supervision, however, have been kept up in Kensington, with obvious advantage, although your Vestry had no statutory authority, excepting such as was derived from power to oppose the renewal of the annual license. It is proper that the Council should be the "Local Authority" for the purpose of making regulations, so as to secure uniformity for the whole 137 polis; bat I have always contended that the Sanitary Authorities should have concurrent power, to enable them to enforce the requirements of the regulations, and this power has practically been conferred by the Public Health (London) Act, 1891. It is to be desired, however,in the interestsof public health, that private slaughter-houses may, at no distant date, give place to public abattoirs. Meanwhile, it is satisfactory to know that comparatively little slaughtering goes on in the Parish, the wants of which are mostly provided for by the dead meat trade. In my Annual Report for 1889, 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 has been opened in this Parish for the sale of horseflesh for food of man. LICENSED COW-HOUSES. Five of the eight licensed cowhouses are in North Kensington, and three in South Kensington. The names of the licensees, and the localities of the premises, are set out in Table XII (Appendix). The several premises were inspected, in July, by the Works and Sanitary Committee, and found to be in a generally satisfactory condition. There were only 52 cows, in all, in the sheds. Not many years ago the sheds were 28 in number, and the cows kept some 500 in number. Objectionable accumulations of dung were observed at two or three of the sheds, and cautionary letters were sent to the licensees. The objection raised by the Works and Sanitary Committee to the grant of a license, in respect of premises in Redfield Lane, to a person who was not the cowkeeper, was sustained at the Licensing Sessions of the County Council, and the license was issued to the owner of the cows, as recommended by the Committee. 138 There has been a considerable reduction in the number of cowsheds in the Metropolis, viz., from 1044, in 1880, to 536 in 1892, or 61 fewer than in 1891. In Kensington the reduction has been from 23 in 1880 to 8 in 1892. I am glad to be able to report that the County Council no longer suffer horses to be stabled in cowhouses, their practice, in this respect, now corresponding with the views I submitted to, and which were approved by, your Vestry many years ago. The defect in legislation qua Cowsheds, Dairies, &c., as in the cognate case of the repealed Slaughter-houses Act, is that no attempt has been made to utilise the services of the Medical Officers of Health and the Sanitary Inspectors for purposes of inspection and supervision, the Sanitary Authorities (Vestries, &c.) being ignored. 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. The result would appear to be very satisfactory. Many years have elapsed since I have had any reason for connecting the occurrence of infectious disease with the consumption of contaminated milk; and it is comparatively rare now to see reference to milk, as the supposed cause of disease of an infectious nature. But legislation would appear to be necessary for putting a stop to the sale of the milk of cows suffering from tuberculous disease. 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, have been regularly inspected, and such action has been taken, in individual cases, as was found necessary for ensuring compliance with the sanitary provisions of the Factory and Workshop Acts. 139 REFUSE MATTER. The prevention of nuisance from accumulations of offensive substances, coming under the general description REFUSE, is a matter of no little difficulty. It is one, moreover, which, as I had often stated in these reports, could not be settled satisfactorily without the intervention of the Legislature. Such intervention has now taken place, by provisions in the Public Health Act enabling the County Council and the Sanitary Authority to make bye-laws for the prevention of nuisances; but whether the powers conferred are adequate remains to be proved, no bye-laws dealing with the matter having at present been confirmed by the Local Government Board. 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 Vestry, November, 1887, from the Metropolitan Board of Works, under the heading "Conveyance of Offensive Substances through Streets." A copy of this Report was sent to every member of the London County Council, which, as I observed in my Report for 1890, "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." Bye-laws in relation to the storage and removal of dust and ashes have been framed. Ere long we shall know whether they will be sufficient for the purpose. HOUSE REFUSE. The collection of ashes and miscellaneous refuse from 22,000 inhabited houses, spread over an area of some 2,200 acres, and to the extent of 45,228 loads in 1892, is no light task. That it is, on the whole, satisfactorily performed, may be inferred from the relative fewness of complaints, in comparison with the number received when the work was in the hands of contractors. Relatively few as the complaints now are, a not inconsiderable proportion of them results from the 140 neglect of domestic servants to allow the refuse to be removed when the periodical call of the dustman is made. Nuisance, in the sanitary sense, need not arise even from a full 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. It might be repeated with advantage. The work of dust collection has been systematised 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 refuse-harbourage shall have given place to the more rational system of daily, or, at any rate, frequent collection from moveable receptacles, to be provided either by the Sanitary Authority or by the householder. Desirous of dealing with this nuisance in an effective way, your Vestry, in November, 1887, requested the (late) Metropolitan Board of Works to include in any suitable Bill thereafter promoted by them in Parliament, clauses to confer power enabling Sanitary Authorities to abolish dust-bins, and to enforce provision, in lieu thereof, of approved moveable receptacles, in order that a more freqnent 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 subject however is dealt with in the Public Health Act to a certain extent, as, in section 141, "the expression 'ash-pit'" is defined to mean "any ash-pit, 141 dust-bin, ash-tub, or other receptacle for the deposit of ashes or refuse matter." The principle of a moveable receptacle thus being admitted, it is hardly probable that builders will now go to the expense of erecting permanent dust-bins which, as commonly mis-used, create or constitute a nuisance liable to be dealt with summarily under the Act. Drastic provisions in relation to the "business" of dust removal, to which the Sanitary Authorities took exception,are contained in section 30. 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 acquired by your Vestry, at Purfleet, on the river Thames, would, it was thought, furnish a profitable outlet for the greater part of the refuse of the parish. Hitherto, however, little use has been made of this land, which is held in reserve in case of emergency. Speaking generally, I have little doubt that a solution of the difficulty of sanitary disposal of house refuse will be found in cremation, which I am convinced can, under proper conditions, be carried out successfully and without the creation of nuisance. 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 142 polis Local Management 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 a copy was forwarded to every member of the London County Council in 1889. Beyond question, the Sanitary Authority should undertake the removal, at the cost of the owner, of all such " refuse " matters, of animal and vegetable origin, as may become, if left too long on the premises, injurious to health; and in the interests of public health, moreover, the producer of trade refuse of an offensive sort, should be compelled to employ the services of the Sanitary Authority for its removal. But 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 in the Public Health Act (section 16), but not in an adequate manner, the powers conferred on the County Council and the Sanitary Authority to make bye-laws, being, I fear, insufficient for the prevention of nuisance. The question may be settled when the bye-laws come into operation. STABLE REFUSE. In many of my Annual Reports mention has been made of the frequency of complaints in regard to accumulations of stable manure, as " 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 143 permitted to accumulate. The non-removal is sometimes the fault of the coachman, who will not give the refuse away, the farmers, moreover, being as a rule, unwilling to pay for it. At certain seasons—e.g., haymaking and harvest time—there is, no doubt, a difficulty in getting the receptacles cleared, farmers being too busy to collect the refuse. Formerly, when the parish consisted largely of market gardens, the cultivators of the soil were glad enough to get the manure, by satisfying the demands of the coachmen and others. Now that it has to be hauled long distances to suburban farms and gardens, stable-occupiers, 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 the accumulation varies in degree according to the character of the receptacle in which the refuse 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 the 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 bottom 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 cannotescape, as the drain (if any) 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 144 receptacle is entirely underground, being what is called a sunken dung-pit—always undraincd, and covered with wooden flaps. The rain enters these pits, and mere 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 who has observed the " steam" arising when the contents are disturbed, must have been annoyed by its horrible offensiveness. These sunken dung pits are a nuisance in themselves, and as the use of them involves a continually recurring nuisance, it should be prohibited. Entertaining these views, and all the efforts of the sanitary inspectors having failed to keep the nuisance within bounds, I thought it desirable to have a return prepared, shewing the kind and number of the receptacles actually in use in the mews in the respective districts. This return I submitted, in March, 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. Under the then existing law, it was found that nothing effectual could be done to get rid of the nuisance. I am hopeful that the bye-laws shortly to come into operation will enable us to abolish sunken dung-pits. The Sanitary Act of 1866 enabled the "Nuisance Authority " (i. e., your Vestry) to contract with the occupiers of stables and cowhouses, for the collection and removal of manure or other refuse matter; but the Authority could remove it only "with the sanction of the owner." The Public Health Act has not made any material difference in the position, for section 36 does no more than authorise the Sanitary Authority to collect and remove the refuse from 145 stables, &c., "the occupiers of which signify their consent in writing to such removal," which would have to be done at the cost of the said authority. The necessary consent 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. Probably many persons would be willing to do so, and thus relieve themselves of an anxious responsibility. At the same time, it is not improbable lhat 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 wellorganized system of collection and removal to the country. Section 35 authorises a sanitary inspector to serve a notice on the owner of any accumulation of manure or other obnoxious matter, requiring him to remove it, and if the notice is not complied with within forty-eight (the BUI read 24) hours from the service thereof, the "matter" becomes the property of the Sanitary Authority, and ma)' be remoyed and disposed of by them at the cost of the former owner. This provision is not likely in practice to supersede enforcement of the regulations by proceedings for recovery of penalties. A better prospect of success in the way of abatement, or rather prevention, of nuisance from stable manure, is held out bysection 39, which requires the County Council to make byelaws "with respect to receptacles for dung, and the proper accessories thereof," which, as I said above, will probably have the effect of abolishing sunken dung-pits. It will be remembered, moreover, that by section 2, any dung-pit so foul, or in such a state as to be a nuisance, or injurious or dangerous to health, is a nuisance liable to be dealt with summarily under the Act. Thus, in one way or another, it may be hoped that we shall be enabled to do something to control a very offensive form of nuisance. J 146 I may be permitted to add that in the Special Report already adverted to, on "Sanitary, Nuisances Removal, and other cognate Acts," I placed my views on this subject generally, 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 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 Works and Sanitary Committee, in a report, dated September 7th, 1892, dealing with the precautions necessary to be taken in connection with the then apprehended visitation of Cholera, stated that, " in considering general matters bearing upon the sanitary administration of the Parish, they were led to discuss the question as to the difficulty which is at present experienced, in securing the due and periodical removal of manure and filth from the stables and mews of the Parish, and were of opinion that the time had now arrived when the Vestry should, on Sanitary grounds, undertake the removal of such manure, &c., themselves." They accordingly recommended, "That it be referred to the Wharves and Plant Committee to consider and report as to the practicability of a scheme being adopted for this work to be undertaken by the Vestry." This course was adopted by your Vestry, and on the 9th November, 1892, a report by the Wharves and Plant Committee was adopted, to the effect, "That the Committee had considered the reference by the Vestry as regards the suggested removal by the Vestry, of the manure from the stables and mews in the Parish, and had to report that they were of opinion that the expenses of 147 any scheme to give effect to the collection and removal of the manure from the mews of the Parish, would be so great as to render the proposal, at the present time, an impracticable one"—a conclusion to which I can only defer in respectful silence. THE HOUSING OF THE WORKING CLASSES. In my Annual Report for 1890, I dealt with the new legislation, by which the Acts relating to the housing of the working classes had been consolidated and amended by the Housing of the Working Classes Act, 1890, and gave a detailed account of the action of the London County Council in connection with The Boundary Street Scheme, for acquiring an "unhealthy area" in Bethnal Green, fifteen acres in extent, at a net estimated cost, for the land and laying-out of new streets, of £300,000, or ,£20,000 per acre— equal to fifty guineas for each person resident in the area ; and this not to provide the people with dwellings, but only to clear the land on which dwellings will be built by others for letting at current rates. The Council determined to deal with the area in sections, so as not to displace the population (some 5,719 in number) too rapidly. Much has already been done to give effect to the scheme, by settlement of claims for property, by arrangements for arbitration where agreement could not be arrived at, and by compensation to the evicted tenants for cost of removal, &c. It is satisfactory to know, on the authority of the Public Health and Housing Committee, that "the gross cost of the scheme will be considerably less than the estimate." No further Improvement Schemes under Part I. of the Act have been taken in hand, but several schemes under Part II. have been initiated by Local Authorities, including the scheme adopted by your Vestry for dealing with the James Street area. In connection with this scheme your Vestry obtained closing orders in respect of 22 houses. In three cases, the owners of as many houses made the houses fit for human 148 habitation, and they are now occupied, although the owners were informed of the intention of your Vestry to apply to the Local Government Board for sanction to a scheme which will necessitate the demolition of the said houses, should the scheme be approved. The County Council contribute to the cost of carrying out schemes—to the extent of not more than one half of the nett expenditure—when the schemes deal satisfactorily with the insanitary areas, and when the need of such contribution is shown to the satisfaction of the Council. In case of disagreement between the Council and the Local Authority, the Home Secretary is authorised by the Act to specify the amount of the contribution (if any) to be made by the Council. In my Annual Report for 1888-89, I observed that it would be well, could the County Council enter into competition with the owners of insanitary houses, by providing decent houses for the working classes, at a moderate but remunerative rent, under what was then known as Lord Shaftesbury's Act. The Council, shortly afterwards, resolved to make the attempt, on the "Hughes-Field site" at Deptforcl, some seven acres in extent, which had been acquired by the Metropolitan Board of Works, under Cross's Acts ; but, for reasons which need not be repeated here, they were unable then to give effect to their resolution. In November last, the Public Health and Housing Committee recommended that renewed application be made to the Home Secretary for permission for the Council to erect dwellings on the vacant plots. The report was referred back with an instruction to the Committee to confer thereon with the Corporate Property Committee. The Council, I think it may be said, recognize the impossibility of relieving, to more than a very limited extent, the present unsatisfactory condition of things, in regard to the housing of the working classes, by the provision of fresh accommodation in the form of model dwellings, whether undertaken by philanthropists or public bodies : the 149 bulk of the people, they admit, must live in existing houses, and be dependent on others for the enforcement of sanitary conditions. No one can doubt the earnestness or good intentions of the Council, and the Public Health and Housing Committee, but they are now realizing what Sanitary Authorities of older date, and their officials, know but too well—the colossal difficulties in the way of providing decent homes for the poor, at any reasonable or remunerative rate. "The Council have completed and opened the Model Lodging House in Parker Street, in the St, Giles' district, of which 1 gave a description in my last Annual Report (page 157). MIGRATION AS A REMEDY EOR OVERCROWDING. By the Housing of the Working Classes Act, the Council, with the sanction of the Home Secretary, already accorded, are enabled to erect, purchase, or hire, houses, &c., without, as well as within, 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 woikmen'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 procedure at all times,* and probably much more so than schemes for migration ; which, by lessening the present excessive demand for lodgings, * "The Metropolitan Board of Works carried through 22 schemes, whereby 59 acres of land were acquired and cleared, on which accommodation has been provided for 38,231 persons. The amoumt thus expended by the Board, in giving effect to Cross's 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" (Annual Report for 1888-89, page 130). 150 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 oft 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 artisans able to command constant employment, commonly occupy these healthy homes. Plenty others of the like classes would doubtless be forthcoming, were the accommodation greatly extended. These, however, are the classes for whom it might be practicable to provide out of London. The Council having come, apparently, to the opinion that migration does afford the most promising solution to a difficult question, have had prepared a report, resulting from an exhaustive enquiry into the number of working men's trains running from and into London termini, showing what has been done in this direction by the railway companies, and what remains to be done to give full effect to this great experiment. Among others, outside the Council, who have taken a strong and practical interest in the question, Sir J. Blundell Maple, M.P., is conspicuous. In the debate on th& Manchester, Sheffield., and Lincoln Railway (Extension to London) Bill, this gentleman stated that the Metropolitan Railway Company had promised that, "on and after June 1st of the present year (1892), they would run workmen's trains at the following rates: For a distance of five miles, 2d.; from five to ten miles, 4d.; from ten to fifteen miles, 6d. per journey 151 these fares include the return journey in every case. Moreover, weekly tickets, in packets, will be issued on this basis. A clause in the new Railway Bill, above mentioned, provides that, " In respect of working men carried by working men's trains, between the London station of the Company and Neasden, and intermediate places, the company shall not be entitled to charge higher fares than are for the time being chargeable, or charged, by the Metropolitan Railway Company, by their workmen's trains, between their Baker Street Station, and Neasden, and intermediate places." It follows, as a result of the above decision by the Metropolitan Railway Company, that the working classes in London will gain the benefits of this new scale of charges on both lines of railway, when the Bill becomes law. As it may not unreasonably be expected that an impetus will be given by these arrangements to the erection of houses for the working classes in the suburbs, we can but hope that care will be exercised to prevent the concessions being so mis-used as to involve the creation of slums outside London. The houses to be built should not be too large, nor too crowded on space. Working men, moreover, should be encouraged to become the owners of their cottage homes. It is especially to be desired, moreover, that workmen's tickets should be issued, so far as practicable, to bond-fide workmen only, so that the suburbs may not be overrun by " outcast London." EMIGRATION. Emigration would seem, at first sight, to be another means of reducing overcrowding, and the late Government did well in appointing a Committee to inquire into various schemes which had been proposed, of state-aided emigration —from congested districts of the United Kingdom, London included, to British Colonies and elsewhere; to examine the results of schemes that have had a practical trial, and to 162 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 due course, made a report, in which they 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 might be assisted to leave this overcrowded Metropolis goes without saying; but immigration from the country and abroad would speedily fill up any gaps in the population thus created. " A WEST-END AVERNUS." Under the above heading, an article appeared in th& Daily News, January 24th, 1893, treating of a district comprised in a few streets in Notting Dale, to wit, St. Katherine's Road, William Street, Bangor Street, Crescent Street, and part of St. Clement's Road. The condition of the people, rather than their dwellings, furnished the basis of the "Commissioner's" strictures; and this was for the most part true in respect of the comments by two local clergymen who wrote letters on the subject. A "leader" appeared, January 30th, followed, on the 31st, by a letter from the Chairman of the Works and Sanitary Committee, with which the newspaper discussion closed. The "Commissioner" dwelt upon "the scenes of degradation and misery" he observed in the district, which appeared, to him, to be " as God-forsaken as anything in London." He frankly confessed that he didn't "know exactly what was wanted, or what ought to be done to remedy the alleged evils," and added that" apparently nobody did know." He spoke of "whole streets steeped to the lips in iniquity, veritable hotbeds of everything vile and 153 abandoned, and hundreds, if not thousands, of people living under conditions of life that are a foul disgrace to our civilization. But nobody dares touch it." The article was largely made up of descriptive touches, of incidents observed, and of persons interviewed by the Commissioner, who said that he has "seen more ruinous and dilapidated neighbourhoods in London," but never" anything in London more hopelessly degraded and abandoned than life in these wretched places." Reference was made to the "furnished apartments," of a certain kind, alleged to be at once numerous and costly, and to the Common Lodging Houses, which have considerably increased in number within the last few years, but are well managed and well kept under police supervision. "This slum neighbourhood," it was averred, "began to develope" when the Old Kensington 'Rookeries' (presumably meaning " Jennings's Buildings)," were swept away; the people migrating here. This, however, is but a very partial explanation of the origin of the state of things described. It began with the clearances in the district of St. Giles' (Bloomsbury), when the slums were swept away to make room for New Oxford Street. This was followed by other clearances in St. Giles's, in "Camden Place," Notting Hill, where "Clanricarde Gardens" now stands, arid in "Jennings's Buildings," High Street, Kensington, which was demolished by Baron Grant. The houses, in the district indicated, were built for a class of people very different to those who now, for the most part, inhabit them; and it is to be presumed that, not finding suitable tenants, they gradually got to be occupied, to a greater or less extent, with the undesirable classes of people referred to both by the Commissioner and his clerical commentators. The Commissioner asked " What is to be done ? Can you banish these evils ? Can you put down such neighbourhoods ?" And " he would not say." The Kensington Vestry, he added. "ought to know best, and they seemed to think they could not." If the writer of the article had little to say about 154 the structural and sanitary condition of the houses, which are the concern of the Sanitary Authority, the clerical correspondents had almost less. And I will only observe here, with reference to the houses, that if it were possible to clear them of their present inhabitants, and to substitute a better class—artizans, labourers, etc., there would be little cause for complaint, and none probably that could not be remedied. The streets in question are almost incessantly under inspection; works of sanitary improvement have been carried out at many of the houses, and works of cleansing are always going on, more or less, All this is known to your Vestry, and especially to the Sanitary Committee, the Chairman of which wrote to the Daily News to the following effect:— "A West-end Avernus.—Sir,—My attention has been called to a recent article in the Daily News under the above heading, and to certain letters by the Rev. Dr. Williamson, Vicar of St. James' Norland, and the Rev. C. E. T. Roberts, Incumbent of St. Clement's, as well as to your leading article in to-day's issue upon the same subject. Throughout these articles and letters, there runs an assumption that the Vestry of Kensington are indifferent to the state of the poor people inhabiting what is known as the 'Potteries' district, Notting Dale. Nothing could be more erroneous. Within the last few years, the Commissioners appointed by the Vestry have erected, in close proximity to the said district, Public Baths and Washhouses at a cost of some £60,000. In 1891, the Commissioners appointed by the Vestry, established a Public Library and Reading Rooms within a convenient distance, and only last year the Vestry provided a large public recreation ground, known as Avondale Park, in the very midst of the poorest streets in the district. Your Commissioner's article, and the letters above referred to, go to show that it is not so much the condition of the houses that forms the subject of complaint as the character and condition of the wretched inhabitants of the district. This is in very deed the fact. The locality is infested with tramps, who come nightly from all parts of the Metropolis to sleep in the numerous common lodging houses which have been registered by the Police Authorities. It contains, moreover, many of the waifs and strays of the people driven from other districts by schemes carried out by the late Metropolitan Board of Works, under powers conferred by the Artizans' and Labourers' Dwellings Acts, devised for improving the dwellings of the poor. The Vestry, as Sanitary Authority, have no control over the Common Lodging Houses, which they would gladly see substituted by a ' Parker Street Palace,' should it be the 155 pleasure of the London County Council, but they cannot prevent, however much they may regret, such immigration. Dr. Williamson sets down the moral evils which exist to the account of the Police, the Publicans, and the Landlords. Over police and publicans the Vestry have no jurisdiction. Bad landlords, however, are more or less amenable to the legal powers vested in the Sanitary Authority, and these powers are exercised as completely as possible, one of the Vestry's Sanitary Inspectors being almost continuously engaged in the district. Within the last few months, some of the streets have been inspected from house to house, and not a meeting of the Sanitary Committee passes without the issue of Notices designed to secure necessary improvement in the sanitary condition of the houses. From the statements in the articles under notice, it might be assumed that the whole neighbourhood is in a state of ruinous decay ; but, as a matter of fact, nearly all of the streets in the district have been laid out, and the houses constructed since the passing of the Metropolis Management Act, in 1855, and they would furnish no ground for complaint were they occupied by a different class of persons. Were it but possible for the clergy, and philanthropists, to bring about an improvement in the morals of the people—and the agencies are numerous, both living, in the shape of clergymen and district visitors, &c., and material, in the form of churches, chapels, public elementary schools in abundance and the organizations referred to by the Rev. Mr. Roberts—the duty of the Vestry as Sanitary Authority would be much easier than it is at the present time, under the conditions so graphically desciibed by your Special Commissioner." The discussion might well have been allowed to close with the Chairman's letter, but in February some half-a-dozen persons met together, constituting themselves a " conference of the leading inhabitants of the district," and passed resolutions to the following effect:— (i.) " That this Conference is of opinion that the present insanitary and immoral condition of the district in North Kensington, comprising St: Katherine's Road, William Street, Bangor Street, Crescent Street, and part of St. Clement's Road, demands the serious attention of the London County Council, the Vestry of Kensington, the licensing justices, and the Kensington Ratepayers' Association. (2.) "That the insanitary condition proceeds from the defective state of the street and house drainage in part of the district, and from the over-crowding of a large number of the houses; and that the latter cause tends greatly to the immorality, which is further much increased by the excessive number of public-houses and beer-houses in the district. 156 (3.) "That a copy of the above resolutions be sent to the London County Council, the Kensington Vestry, the licensing justices, the Kensington, and the North Kensington Ratepayers' Associations, the members of Parliament (Sir A. Borthwick and Mr. Frye), and the members of the County Council (Messrs. Campbell, Doake, Beresford Hope, and Lloyd), to the Mansion House Committee, to the President of the Local Government Board, and to the Bishops of London and Marlborough." A copy of the resolutions having been forwarded to me, I applied to the Chairman of the " Conference," stating that if any "definite facts bearing on the state of individual houses had been brought to the attention of the meeting," I should be glad to be informed and to take such steps as might be necessary. His reply convinced me that the good intentions of the gentlemen concerned, had outstripped their knowledge ; for he could give me no help. At about the same time I had a letter from the hon. secretary of the North Kensington Sanitary Aid Committee, stating the opinion of the Committee that steps should be taken to condemn the area comprised in the five streets, and enquiring, Whether I was prepared to make an "Official Representation " under Part I. or Part II. of the Housing of the Working Classes Act, 1800? The grounds of the "opinion" given, were (1), That the sewerage system is inefficient and insanitary; and (2), That many of the houses are overcrowded and otherwise in an insanitary condition. The sewerage of the district, as your Vestry's Surveyor satisfied the Sanitary Coram ittee, is efficient, and therefore sanitary. With respect to the second reason assigned, why an "official representation" should be made by me, viz., that "many houses are overcrowded, and otherwise in an insanitary condition," these, obviously, are matters that can be dealt with under the provisions of the Public Health (London) Act, 1891; as indeed they are. There is no need for an "official representation." The streets are of ample width, the houses comparatively modern, and the class of property of fairly good construction, excepting on the south side of William Street. 157 With the same exception, all the houses have through ventilation and backyards. The case, therefore, it appeared to me, was one to be met by more frequent sanitary inspection. Already, however, much had been done by your Vestry for the improvement of the district, especially in respect of works of a permanent or structural character, as is on all hands admitted. How much, within a comparatively short time, may be seen on reference to the subjoined return, extracted from your Vestry's official records:- RETURN shewing the number of Inspections of Houses made, and the number of Notices, fee. served, since June, 1891, in the Streets mentioned in the Resolution passed at the Conference held at Mr. Lloyd's House. No. of Tola! No. of Name of the Street. Houses in Notices, &c. Street. Inspect.ons Serve^ St. Catherine's Road 1ll 201 172 William Street 44 102 09 Bangor Street 39 35 22 Crescent Street 40 34 30 St. Clement's Road, part of 51 31 19 Totals 285 403 312 Notes. I,—Of the 312 notices served, 179 dealt with works of a structural character only; 60 dealt with works of cleansing only, and 73 were compound notices dealing with works of both classes. II.—There are 11 Common Lodging Houses in Bangor Street, 8 in Crescent Street and 4 in St. Clement's Road, with accommodation for 723 persons. The good work indicated in the above return, is still going on, and will be continued until entire effect has been given to all modern sanitary requirements. With few exceptions, the houses in the several streets named, have been registered under your Vestry's "Regulations for Houses let in lodgings, or which are occupied by members of more than one family." Could these regulations be carried out effectively, they would probably be found adequate for enforcing 158 ness, and for preventing overcrowding—for that there is some, possibly a good deal of, overcrowding is but too probable. I do not doubt, moreover, that the death-rate in the district is considerably in excess of the average for the whole Parish. The population is far from stationary: indeed, some of our informants make a point of its extremely migratory character;* and I know that many sick wayfarers are removed from the Common Lodging Houses to the Infirmary, and that their deaths form no inconsiderable addition to the total mortality of the Parish. Comparisons have been made to the disadvantage of your Vestry, between the condition of the Common Lodging Houses in the district, and of the rooms occupied by private families. But the two things are not comparable. The common lodging house bedroom contains no article of furniture other than beds and chamber utensils. Provision is made for cooking, and other domestic purposes, in a more or less common room, not overburdened with furniture. All of these houses, so far as my experience goes, are kept in a cleanly condition; for the simple reason that they are inspected twice every week, by a sergeant of police, and would be disregistered were they not so kept. The single room in which the family of the poor man in private life vegetates, is used for all purposes; is often crowded with furniture, including more or less filthy bedding, clothing, etc., to say nothing of its living inhabitants, human and other. The powers of the Sanitary Inspector, moreover, are limited, and incapable of touching some of the worst evils. Such as they are, however, the opportunities for exercising them are too few. Instead of a bi-weekly visitation of the rooms, which, of course, is unnecessary, and would be resented, it is as much as he can do to visit them twice in a year, if so often. And this is not surprising, seeing how many and various are the duties of his * The Superintendent of Visitors for the Chelsea Division of the School Board for London informs me, that "there is ample school accommodation provided in the District, but that the attendance is not so good as in the better class districts," a fact which he attributes " to the migratory character of the people." 159 office, how extensive the area in which he works, and how many the cases calling for his attention. The population of the Parish in 1891 (167,000), was housed in about 22,000 houses. In these houses there resided 36,000 families, and the tenements of less than five rooms each were 20,000. A very large proportion of these tenement dwellings require attention, and an amount of attention which it is at present impossible to give to them. "Avernus" lies in a nutshell—but there are many other crowded streets which, to a less extent, doubtless,but still to a large extent, require, but do not get, the attention necessary to enable the Sanitary Inspectors to enforce, in the letter and the spirit, the requirements of recent sanitary legislation. So much for my own views and for my own part in respect of this matter. The Works and Sanitary Committee, at their Meeting on the 27th February, resolved to make an inspection of the district,as defined, for the first time, in the first of the resolutions of the " Conference," and to request the co-operation and assistance of Mr. Lloyd, L.C.C., the Chairman of the Conference, Mr. Frye, M.P., the Rev. Dr. Williamson and the Rev. C. E. T. Roberts, to each of whom a communication was addressed by the Vestry Clerk, as follows:—■ " Adverting to the articles and correspondence which have recently appeared in the public press relative to the condition of certain streets in Notting Dale, I am directed to acquaint you that the Vestry's Works and Sanitary Committee have decided to make a special inspection of the district in question on Thursday next the 2nd proxo., and will meet with that object at this Hall at two o'clock that afternoon. I am further desired by the Committee to invite yourself and those other gentlemen who have taken an active interest in the matter, to meet the Committee, on this occasion ; and to accompany them on their visit to the locality. If you could also, between this and Thursday, furnish the Committee with any specific cases within your own knowledge of—(a) Streets in which the public sewers are, or are believed to be, defective; (b) Houses in an insanitary condition; and (c) Houses in which pases of overcrowding are known or reasonably suspected to exist, the Committee would esteem it a favour, and they will of course, if it is wished, treat the source of the information as being confidential," 160 A certain amount of information was received from the two clergymen, indicating positions in which it was thought that instances of overcrowding, or of sanitary defects, might be found to exist. But it was again made manifest, from the general tone of the communications, that it was the character of the inhabitants of the locality which, in the opinion of the writers, lay at the root of the evils complained of. Admission, moreover, was frankly made that much had already been done by your Vestry for the sanitary improvement of the district. The Committee made two careful inspections of the District and subsequently reported to your Vestry as follows: " Your Committee beg to report that they held a Special. Meeting at the Town Mall on Thursday, March 2nd, 1893, to consider the articles and correspondence which appeared recently in the Daily News under the heading 'A West-End A vermis.' The Rev. Dr. Williamson, Vicar of St. James5 Norland, the Rev. C. E. T. Roberts, Incumbent of St. Clement's, Notting Dale, Mr. F. C. Frye, M.P., and Mr. John Lloyd, L.C.C. had been invited to attend, and to accompany your Committee in their proposed inspection of the district referred to, which includes William Street, Bangor Street, Crescent Street, and parts of St. Clement's Road and St. Katherine's Road. Mr. Frye and Mr. Lloyd accepted the invitation, and were present, and also took part in the subsequent inspection of the district. The complaints set forth in the articles and letters had reference to alleged structural and sanitary defects and overcrowding of the houses; to the immorality, drunkenness, and general bad behaviour of the inhabitants of the district, and to the excessive number of public-houses therein. It is hardly necessary to observe that your Vestry have no jurisdiction with respect to public-house accommodation, and that the character and habits of the people can only be indirectly influenced by the work carried out by your Committee. No evidence has been laid before them in support of the allegation that many of the houses are 'brothels of the lowest kind.' That many 4 unfortunate ' women reside in "the locality would appear to be certain, but that they ply their occupation to any large extent ' at home' is, to say the least of it, doubtful. It will be in the recollection of your Vestry that the district was placed under special nightly observation for a lengthened period in 1891-2, for the express purpose of discovering whether any of the houses were used as brothels, and that no evidence on which to found proceedings was forthcoming. In three instances, however, it was discovered that women took men to their private rooms in tenement 161 houses. The owners of the houses were so informed, and the women were immediately.turned out. The Police Authorities were communicated with, respecting this district generally, in November, 1891, but no complaint was received from them as to houses used as brothels; and several police officers, present at the time of your Committee's recent inspection, were unable to give any information as to the existence of brothels. Nevertheless, your Committee have directed a further application to be made to the Police Authorities with a view to ascertain whether they can now indicate any houses used for immoral purposes.* "After a general discussion of the subject of their enquiry, your Committee proceeded to the locality, which, in one of the communications laid before them, is inaccurately described as ' a network ' of streets. The district is well laid-out, the streets are straight, the houses in each generally of uniform elevation, and not too lofty for the width of the roadway. The roadways and foot-pavements of all the streets were perfectly clean. Bangor Street, Crescent Street, William Street, and St. Katherine's Road are parallel streets, and lie east and west. St. Clement's Road is at right angles to these streets. With the exception of those on the south side of William Street, the houses in all the streets have good through ventilation and back yards or gardens. The houses in William Street are the oldest in the neighbourhood. Those on the south side are double-fronted, only one room in depth, and have no outlet at the rear. There is a measure of through ventilation by staircase windows, and the several houses have large front yards or forecourts. The street is only about 28ft. in width, but the distance between the fronts of the opposite houses is 55ft. There is room for considerable sanitary amendments in these houses, and the matter is now engaging your Committee's attention. "No evidence was forthcoming in support of the allegation of defective sewerage in Bangor Street and William Street. The allegation is, in fact, quite incorrect. The description of the external appearance of the houses as 'black and filthy, dilapidated, ruinous,' &c., and of the houses themselves as ' foul holes ' is far-fetched and unwarranted. "There is evidence that the district is densely populated, and your Committee have given directions for ascertaining whether any, and if so, which of the houses or rooms are overcrowded, in contravention of the Regulations for houses let in lodgings or which are occupied by members of more than one family. Any such cases discovered will be promptly dealt with. Your *The Commissioner of Police, under date, May 15th, 1893, wrote to the effect that "observation has been kept by the Police," with regard to the question of alleged disorderly houses, "but no evidence has as yet been obtained which would be of any use to the Vestry." He added that "the question will not be lost sight of, and should the Police at any time be in a position to comply with the Vestry's wishes in this respect they shall immediately be communicated with." The letter concluded with an assurance that 11 the attention of the Police has been specially drawn to the locality generally." K. 162 Committee inspected many of the houses, which, for the most part, are in good structural condition; the majority of them, moreover, were in fair sanitary condition. Some of the rooms were dirty, and require cleansing. Cleansing orders will be served next month, with respect to the registered houses (and nearly all of the houses are registered), in conformity with the provisions of Regulation 7. A prime obstacle to carrying out work of this kind satisfactorily, arises from the difficulty of emptying the rooms of their inhabitants whilst the work is in progress. It would be well if temporary shelters for a few families could be provided, so as to give the workmen vacant possession of the rooms successively. But there are no empty houses in the district. Some of the dust-bins and water-cistern covers were observed to be in a defective condition. Occasionally a dirty water-closet pan was seen, and water-supply apparatus out of order. On all sides, however, your Committee observed the fruits of their labours during the last few years, in well-ventilated drains, disconnected waste-pipes, flushing tanks for water-closets, &c. Not all of the houses have been provided with these modern sanitary arrangements, but the work of improvement will be conr tinued to completion. Many of the yards were untidy, mainly from accumulation of useless articles, which possibly the people do not know how to get rid of, and which the dustman might. be authorised to remove. The paving of some of the yards requires attention. "It has been suggested that steps should be taken by your Vestry to get the several streets condemned as "insanitary areas" Your Committee saw no occasion for any such drastic and costly procedure. There may be a few houses which it would be desirable to close temporarily, as being at present ' unfit for human habitation,' but there are none probably, that cannot be repaired and made good at more or less expense. This matter is now engaging your Committee's attention. "Reference having been made, in the correspondence laid before your Committee, to the condition of certain streets and houses in the ' Potteries ' district, they made a careful inspection of the said district on Tuesday, March 14th, 1893. The roadways and foot pavements were clean. Some of the streets have been asphalte-paved with manifest advantage in respect of cleanliness, and your Committee would gladly see this system of paving extended both in the ' Potteries' and in the so-called ' Avernus' district. "The sewerage appears to be satisfactory, and no offensive smell was perceptible, except in close contiguity to the fat-melting works in Tobin Street. The houses for the greater part are of considerable age; most of them, however, appear to be structurally sound. Many are very small, but they have good yards, generally, and are usually occupied by single families. With very few exceptions, those inspected were found in a clean and satisfactory condition, The drains of many of the houses have been ventilated, waste-pipes 163 disconnected, and flushing-tanks fitted to the water-closets. The work of bringing the houses, generally, into line with modern sanitary requirements will be continued to completion. "The least satisfactory part of the district is Thresher's Cottages and Thresher's Mews, with the owner of which your Committee are in communication with reference to necessary structural amendments, or demolition, of certain houses. Complaint had been made with respect to some of the houses that they had no dust-bins. These houses, however, are provided with a common dust-bin in Thresher's Mews, to which the ashes, temporarily stored in small moveable receptacles, are conveyed from time to time. Another complaint was that some of the closets of the smaller houses were without a fixed water supply, being hand-flushed. The pans of these closets were found uniformly clean, and they compared favourably with those flushed through waste-preventing apparatus. Many of the yards, like those in the other district, were littered with useless articles of no value, giving to them an untidy appearance. The paving of some of them requires attention. "It is almost needless, perhaps, to point out to your Vestry that such sanitary defects as have been alluded to, are of constant recurrence in houses occupied by the lowest classes, and are largely brought about by the dirty and careless or mischievous habits of the people themselves. But they are of a remediable character, and the remedy is invariably applied, with all possible expedition, so soon as the evil is detected. "What appears to be most needed in these districts is frequent house-to-house inspection; and, with a view to secure this, your Committee recommend the appointment of a temporary Sanitary Inspector, and that it be referred to them to make the appointment." Your Vestry adopted the Committee's Report, and decided to appoint a temporary Sanitary Inspector for the district for the period of one year.. COMMON LODGING HOUSES. In connection with the subject dealt with in the preceding section, I applied to the Commissioner of Police for the Metropolis for information respecting the Common Lodging Houses in this Parish, and was courteously supplied with the subjoined list of these places, which are 43 in number, and provide accommodation for 1,164 persons. Thirty-two of them are in the North-West Sanitary District, which includes tha so-called "Avernus " and the " Potteries." 164 Return shewing the number of Common Lodging Houses in the Parish of Kensington, and the number of persons of each sex for which the several houses are registered. Sanitary District. Name of Keeper. Address of Common Lodging House. No. of Single Lodgers for which registered. No. of Double Beds Authorized. Male. Female. Total. N. Byrne, Patrick 43, Bramley Road 40 - 40 - „ Do. do. 45 do. 29 - 29 - „ Muller, William 66, Walmer Road 18 - 18 - „ Williams, Thomas 88, Wornington Road 44 - 44 - „ Redding, Stephen 153, Wornington Road 8 - 8 - N.W. Gurney, John 21, Bangor Street 21 - 21 - „ Do. do. 23, do. - 9 9 10 „ Do. do. 25, do. 19 12 31 - „ Moore, John 29, do. - 21 21 5 „ Slater, William 10, do. 16 8 24 2 „ Day, John 18, do. 32 - 32 - „ Do. do. 20, do. 54 - 54 - „ Reynolds, Charles 35, do. 35 - 35 - „ Bucknill, George 5, do. 38 - 38 - „ Do. do. 7, do. 32 - 32 - „ Do. do. 9, do. 19 - 19 - „ Roberts, Rev. C. 11, Blechynden Street 15 - 15 - „ Mitchell, John 3, Bomore Road 9 - 9 - „ Hankin, George 10, Crescent Street 23 7 30 1 „ Do. do. 28, do. 2 14 16 7 „ Do. do. 30, do. 30 - 30 - „ Do. do. 40, do. - 14 14 5 „ Phipps, William 25, do. 22 12 34 5 „ Do. do. 27, do. 9 17 26 - „ Do. do. 31, do. 34 - 34 - „ Do. do. 33, do. - 13 13 7 „ Hallet, Thomas 4, Hesketh Place - 9 9 5 „ Do. do. 6, do. - 6 6 3 „ Do. do. 8, do. - 14 14 3 „ Simpson, James 1, Mary Place 14 - 14 - „ Do. do. 2, do. 21 - 21 - „ Catley, Andrew 3, Princes Road 12 - 12 - „ Davis, Mark 66, Saint Ann's Road 41 7 48 12 „ Day, John 28, St. Clement's Road 12 - 12 8 „ Do. do. 30, do. 35 - 35 - „ Bailey, Henry 29, do. 30 - 30 - „ Do. do. 31, do. 25 - 25 - N.E. Dyer, Ann 12, Blenheim Crescent 15 - 15 - „ Sams, John 112, Portobello Road 9 - 9 - c. Redman, John 28, Peel Street 13 - 13 - „ Do. do. 24, do. do. 20 - 20 - „ Do. do. 22, do. do. 23 - 23 - S.E. Chapman, James 10, New Street 36 - 36 - 165 In connection with this subject it may be interesting to state that, in the month of November last, a deputation from the Public Health Committee of the London County Council waited upon the Home Secretary, to urge the desirability of transferring from the police to the Council, the control of the Common Lodging Houses in the Metropolis, within the jurisdiction of the Council. The Chairman of the Committee stated that the Council desired reform in the registration of Common Lodging Houses, and that the Council should be the authority for making and enforcing regulations and byelaws, for the management of these houses. The Home Secretary expressed sympathy with the object of the deputation, admitting, nevertheless, that the police had performed their duty, in looking after the lodging houses, with great discretion, and in a thoroughly efficient manner. The only question with him was, whether the proposed change was practicable, and, further, what was the best means of effecting it. It had been suggested that, under section 10 of the Local Government Act, 1888, the transference of the powers of the police to the Council might be effected, a course that would involve a minimum of trouble and delay. The prospect of expedition, he said, would not be so clear if an Act of Parliament had to be obtained to achieve the aim of the deputation. Upon this it may be observed, that some consideration is due to the question, whether such transference is desirable ; and, if so, whether the County Council is the proper body to enforce regulations or bye-laws ? If the control of the Common Lodging Houses is to be taken from the police,—a course to which considerable exception may not unreasonably be taken on grounds of public policy,—-it may well be asked, why the duty of enforcing the bye-laws, which the County Council might be authorised to frame, should not devolve on the Sanitary Authorities of the several Parishes and Districts of the Metropolis ? The County Council have built a CommonLodging House in the St. Giles' District; but it will not, I hope, be thought disrespectful to hint a doubt whether 166 they, or the Home Secretary, have the necessary practical acquaintance with the actual state of the case, in respect of the supervision of Common Lodging Houses, and what it involves ; and I would humbly suggest, that before any change is made in the present system, the Home Secretary should take counsel with the Police authorities, both as to the number of Inspectors and other officers engaged in the duty, and as to the conditions under which the work is carried on. Personally, I deprecate any change in a system which works well, and which, in my hearing, the philanthropic Lord Shaftesbury once characterised as "the perfection of sanitary administration applied to the housing of the poor." Should the police require the assistance that Medical Officers of Health and Sanitary Inspectors can give, it is always forthcoming; but I greatly doubt whether the Common Lodging Houses, at any rate in some parts of the Metropolis, could be effectively supervised by any body of men not endowed with the status of police officers. The subject has not received the attention or the criticism which its importance demands, and I, for one, shall be glad should it appear that an Act is necessary to effect the desired transference, so that, before any change is made, the matter may be fully considered in Parliament, with all the light the police are able to throw upon it. It may be interesting to add that at the end of 1891, the registered Common Lodging Houses, under the control of the Metropolitan police, were 863 in number, with accommodation for 33,086 lodgers. During that year 39 new houses were registered, 92 were re-opened and 230 closed. One hundred and fifty-six keepers were served with notices to register their houses: 78 nonregistered houses were periodically visited to enforce the Acts: 89 houses were surveyed, and 8 keepers of registered houses were summoned and convicted. One hundred cases of illness, other than infectious, occurred, 73 of which resulted fatally, necessitating inquests being held. Twenty-four cases of infectious diseases occurred. The Act" for the well ordering of Common Lodging Houses," is 14 and 15 Vict., Cap., 28: it became law 24th July, 1851. 167 GLANDERS. Some alarm was felt in the Metropolis during the summer owing to what was supposed to be an unusual prevalence of glanders and farcy, related diseases of horses which are communicable to man. It was, in fact, due to the death of a man— the disease is always mortal—that so much attention had been given to the subject, and it was a specially regrettable feature of the case that there appeared to be reason for believing that the malady had been spread through the medium of the street drinking troughs,' so benevolently provided for alleviating the thirst of animals. The primary local manifestation of glanders in the horse is exhibited in the form of ulceration of the mucous membrane of the nostrils; and it is believed that the discharges therefrom, passing into the trough, when the nose is plunged into the water, may be the means of infecting animals subsequently using the trough. This risk would be diminished, if not removed, were the surface outlet of the water so arranged that a slow stream should carry off the floating mucus almost always to be seen after a horse has been drinking. The use of the troughs was discontinued for a time, a course which was doubtless the cause of much animal suffering.* At some of the standposts in the streets, buckets for watering horses were provided—a plan which doubtless diminished the danger in question. It cannot, however, be said that a glandered horse using a bucket, in these circumstances, could not infect it and so spread the disease. It is just possible, moreover, that there may be, in either case, a measure of danger for children, as I was credibly informed that children had been seen drinking water out of the buckets, as they might easily do out of the troughs also. Those who wish to secure perfect safety—assuming that the danger of the troughs referred to is real—might do so by following the example of your Vestry, whose horses are supplied with water * The insanitary wooden water-troughs to be seen in the outskirts of the Metropolis, at public house doors, and which are far more likely to be the means of spreading disease than those referred to in the report, were, of course, not closed or interfered with in any way. 168 drawn from the standposts, direct into a pail attached to each vehicle. I dealt fully with the subject of glanders in several of my monthly reports in 1879—under circumstances which, at the present time, are worth recalling. The facts, as summarized from my third and fourth reports for that year, are as follows In the month of March, 1879, a female child, aged 15 months, died of glanders in a room over a stable in a private mews at North Kensington, the premises being so constructed that the air of the living rooms became contaminated by that of the unventilated stable, with which the family had no concern excepting from the health point of view. Upon enquiry I found that a sister of the deceased, aged 18 years, had been removed to St. Mary's Hospital suffering from the same disease, and I also ascertained that glanders had existed for many weeks in the stables. Ten horses had been removed : some had died, others had been killed, and the remainder had been conveyed alive through the streets to the knacker's. Three were ill at the date of my first visit, one of them with farcy. I gave notice of the disease to the Privy Council Veterinary Department, to the Metropolitan Board of Works (Local Authority under the Contagious Diseases (Animals) Act, 1878), and to the Police. The Board ordered three of the remaining horses to be destroyed at once, and two more subsequently. I reported the death of the child to the Coroner for Western Middlesex, who, however, did not deem it necessary to hold an inquest; but the late Dr. Hardwicke, the Coroner for Central Middlesex, to whom I reported the death of the other sufferer, at St. Mary's Hospital, appreciating the gravity of the occurrences, decided to hold an inquest. At this enquiry, at which the Privy Council and the Local Authority were represented, I was enabled to elicit, from unwilling witnesses, facts which made a deep impression on the public mind. It was proved that the law had been violated in several respects: e.g., (1) Notice of horses affected with glanders or farcy had not been given to the police. (2) Glandered horses had not been kept separate from horses in health. (3) Glandered horses had been exposed on public highways and thoroughfares. (4) Carcases of glandered horses had not been buried or destroyed. (5) Carcases of glandered horses had been removed to a knacker's premises at Wandsworth without authority. (6) Dung had been exposed and removed, contrary to the Animals Order of 1879. (7) Glandered and other horses in considerable numbers had been slaughtered on premises in an adjoining Mews, thus "establishing anew," without authority, "the business of a knacker." It was further proved that the Wandsworth knacker had received more than eighty dead horses from the dealer who had purchased the glandered horses, and who, according to the evidence, had been killing three or four horses weekly, on an average, for some time. It seemed to me that the facts of the case would have justified a verdict of manslaughter against the proprietor of the stables. The jury, however, taking a merciful view of the case, and the man having been a heavy loser, contented 169 themselves with a verdict of "Death from glanders," with a rider to the effect that the provisionns of the Act above cited had not been carried out, and that the provisions of the Slaughter-Houses (Metropolis) Act, 1874, had been violated : the jury desired, moreover, that the facts of the case might be formally laid before the Privy Council. Proceedings were subsequently taken by the Local Authority against the proprietor of the horses, for not having given notice of the disease to the police, as required by the Act, and he was fined in the full penalty of £20, with costs, in each of two cases. The Local Authority declined to take proceedings against the horse dealer who had removed and slaughtered so many horses on premises not licensed for the purpose. But the business was put a stop to; and, as a result of the proceedings generally, there was an immediate and a large increase in the number of glandered horses reported to the police. In the report of the Veterinary Department of the Privy Council for 1879, it was stated that "more cases of glanders and farcy have been returned in the metropolis than in any previous year;" but it was added, that there was "no evidence to show that the disease was more prevalent than in former years .... the increased number of cases returned being due to the activity of the executive in carrying out the Act of 1878 and Orders in Council relating to these diseases "—as a result of the proceedings that I had instituted. The disclosure of the cases was due, doubtless, to the announced resolve of the magistrates to inflict the full penalty of £20 for every offence against the Act, which was done in several instances. In 1877 and 1878 respectively, cases of glanders and farcy to the number of 486 and 571 had been reported; the numbers in 1879 and 1880 were 987 and 990, the largest totals ever recorded. The Lords of the Council, I may add, tendered me their thanks for the action I had taken in connection with the above outbreak and enquiry. The law at the time when I reported on this subject, in August last, was contained in The Animals Order of 1886, issued by the Privy Council under the provisions of the Contagious Diseases (Animals) Acts, 1878 to 1886; chapter 6 of which dealt with glanders and farcy. It would have been fairly sufficient for its purpose, probably, had the requirement as to notice to be given by the owner or person in charge of a sick animal, always been carried out, for then there would have been some hope that the disease might in time be stamped out, although account has to be taken of cases in which it exists undetected and even unsuspected. There can be no doubt, however, that cases were often wilfully concealed, the object of the owners being to make use of their horses as long as possible, the heavy fines for neglecting to give notice 170 not being sufficiently deterrent, inasmuch as in a large proportion of such cases the offence of concealment is never discovered. The provisions of the Order, moreover, with respect to the slaughter of glandered horses, were inadequate, allowing as they did of almost indefinite delay when the necessities af the case demanded instant action. It is to be presumed that this unsatisfactory state of things was due to the fact that the Local Authority were not authorised—as in the case of pleuro-pneumonia—to slaughter diseased animals and compensate the owner. This question of compensation is, I believe, the crux of the mattter, and it may be doubted whether glanders and farcy will be exterminated until it is satisfactorily settled. To many a poor man his draught animal is the means of a livelihood, and it may, unknown to him, have been affected with glanders when purchased. It would be but equitable, therefore—if he gave notice of the disease, as the law enjoins, and consented to the slaughter, as common sense and the interests of public and equine health require—that he should be compensated to an extent, say, of one-half of the value of the animal when in health. If this were done there could be no objection to any reasonable severity of punishment for offences against the law. But glanders may, possibly, be generated de novo —it is certainly fostered—by insanitary conditions, and if this be so it will not be got rid of until more than the customary attention is paid to the sanitation of stables. And why should not as much care be bestowed, by operation of law if necessary, upon the construction of stables as in the case of cow-houses ? More air-space, light, ventilation, and better drainage arrangements, are required in these places. It will hardly be questioned that it would "pay," in every way, to treat horses better than is commonly done, in respect of their home accommodation, especially having regard to the fact that insanitary conditions in stables, by reducing the resisting power of the animal, render him more liable to attack by 171 disease ; both of an ordinary kind, and specific like glanders and farcy. But apart from this, it must be remembered that many thousands of persons in the Metropolis necessarily live in contact with horses, in rooms over stables, and it cannot be doubted that disease and death are sometimes the result of malaria, due to the insanitary condition of stables, as in the case to which I have already alluded, where two of our parishioners suffered a horrible death from glanders, which, there was every reason to believe, was caused, not by contact with diseased animals, but by infection conveyed through the medium of a polluted atmosphere. The views, as above set out, expressed in my eighth monthly report, subsequently proved to be in harmony with the highest professional authority, a largely attended meeting of Members of the Royal College of Veterinary Surgeons having been held, in September, to "consider the increase of glanders in Great Britain;" at which, after strong expressions of feeling as to the inefficiency of the laws relating to glanders, the following resolutions were adopted:- "1. That amendment and consolidation of the law relating to glanders and farcy is necessary. "2. That in any alteration of the law, immediate and compulsory slaughter must be applied to all cases of farcy as well as to glanders, "3. That a more systematic inspection of infected or suspected places be enforced. "4. That a staff of Veterinary Inspectors, directed by the Board of Agriculture, be specially applied to effect the extirpation of glanders and farcy; and "5. That compensation be paid for all horses slaughtered as farcied, or suspected of being farcied, or glandered." The meeting expressed disapproval of the action of the Metropolitan Drinking Fountain and Cattle Trough Association, in having re-opened their troughs for the watering of 172 horses, and directed copies of the resolutions to be sent to the Minister of Agriculture, the London County Council, and the Association named. At about this time, I was informed, by the Veterinary Inspector of the Local Authority for this district, that glanders and farcy had been more prevalent in Kensington than usual, one or other disease having appeared in eight stables, at no great distance from the Town Hall. The cases of glanders, in five stables, were 15, of which 10 occurred in one stable; the farcy cases were 4, in as many stables. A fine of £20 was inflicted on one of the owners for having removed an infected horse through the public thoroughfares. No doubt the larger number of cases reported to the Local Authority in 1892 was attributable to the heavy fines inflicted on offenders against the provisions of the Act and the Order. The discussions on the subject which took place did not prove in vain, for at the end of September, the Board of Agriculture issued a new Order, entitled The Glanders and Farcy Order of 1892, which practically gives effect to the two most important recommendations, viz. for slaughter and Compensation, contained in my Monthly Reports, Nos. 8 and 9, dated respectively August 15th and September 12th. The Order, which supersedes so much of "The Animals Order of 1886" as relates to glanders and farcy, makes stringent provision for notice to be given, by the owner or person in charge, to a constable of the police district wherein the glandered or farcied animal is or was (Article 9); and for the visitation by the Inspector of the Local Authority (i.e., the County Council, in London), of the suspected premises, with a view to put in force and discharge the powers and duties conferred or imposed on him as Inspector (Art. 10). It gives power to the Local Authority to make Regulations as to movement of animals affected with either disease, and for disinfection of places and things used by, or for, or about, diseased or suspected animals (Art. 13). Exposure or movement of such 173 animals is prohibited (Art. 15); and provision is made for the seizure, removal, and detention by the Inspector, or other appointed officer of the Local Authority, of diseased or suspected animals. Regulations are prescribed for dealing with animals whether diseased or suspected. If diseased, the animal is to be forthwith slaughtered at the place where it is seized; but it may be removed in charge of an Inspector, or other officer of the Local Authority, to the nearest available horse-slaughterer's or knacker's yard, and there slaughtered. If the animal is suspected only, it may be slaughtered by, or at the request of, the owner or person in charge thereof, at the place where it is seized, or may be removed, under a twelve hours' license, to a horse-slaughterer's or knacker's-yard for the purpose. The suspected animal, if not slaughtered, is to be moved to some isolated place and kept so long as the Local Authority think expedient, but it may be slaughtered at any time by, or at the request of, the owner. If it proves to be diseased, it will be dealt with as though it had been found to be diseased when seized (Art. 16). The main provisions for Compulsory Slaughter and Compensation, in respect of Glanders and Farcy, are contained in Article 19, as follows:- "19.—-(1.) A Local Authority may, if they think fit,' and when required by the Board of Agriculture shall, cause to be slaughtered— (a) any diseased or suspected horse, ass, or mule ; and (b) any horse, ass, or mule being, or having been, in the same field, stable, shed, or other place, or otherwise in contact, with any diseased horse, ass, or mule, or being, or having been, in any way exposed to the infection of disease, "('2.) The Local Authority shall, out of the local rate, pay compensation as follows, for any horse, ass, or mule slaughtered under this article— (a) where the horse, ass, or mule slaughtered was diseased, the compensation shall be one-half of its value immediately before it became so diseased: but so that the compensation do not in any such case exceed twenty pounds ; and (b) in every other case the compensation shall be the value of the horse, ass, or mule immediately before it was slaughtered. 174 "(3.) Provided that if the owner of the horse, ass, or mule, gives notice in writing to the Local Authority, or their Inspector or other officer, that he objects to the horse, ass, or mule being slaughtered, it shall not be lawful for the Local Authority to cause that horse, ass, or mule to be slaughtered, except with the further special authority of the Board of Agriculture first obtained." Compensation may be withheld if the Local Authority should be of opinion that the animal was diseased when brought into their district (Art. 21). The carcases of diseased animals are to be buried whole, covered with lime, and with not less than six feet of earth ; or the Local Authority may, by license of the Board of Agriculture, cause the carcase to be removed, after disinfection, to a knacket's-yard, there to be destroyed, under the inspection of the Local Authority, by exposure to a high temperature, or by chemical agents (Article 23). Offences against the Contagious Diseases (Animals) Act of 1878 are defined in article 29, the penalty for each offence being twenty pounds. It is a defect in the Order that no provision is made for the notification of glandered or farcied horses by Veterinary Surgeons, but probably legislation would be necessary to secure this additional safeguard against concealment of diseased or suspected animals. It was hoped, as a result of the issue of the Order, that the temptation to concealment of diseased animals would no longer operate ; but, unfortunately, the London County Council, dissatisfied, in that the Board of Agriculture had not seen their way to meet the Council's wishes on certain points which they desired to have included in the Order, and believing that a "permissive Order" would be ineffectual as a means of stamping out the diseases, resolved not to enforce the new provisions as to compulsory slaughter and compensation. It will be remembered that the Council having, in 1889, refused to carry out the Rabies Order of 1886, because they had not control of the Police, the Board of Agriculture delegated the duty to an Officer appointed by themselves.* It is to be hoped that the Board of Agriculture may be able to take a similar course with respect to the carrying out of the permissive provisions "of the Glanders * The Public Control Committee reported to the County Council at the end of November, 1892, that Rabies had almost been stamped out in London, but one case having occurred therein during the year. 175 Order, in regard to the slaughter of diseased or suspected animals. Compensation would of course follow. The Metropolitan importance of the question will be understood when it is stated that over 80 per cent. of the reported cases of glanders and farcy in Great Britain occur in London, and that glanders is on the increase; 2,126 cases having been reported in London in the year ended 31st March, 1892, and 2,336 in the year ended 31st March, 1893, compared with 1,716 cases in the year ended March 31st, 1891. Professor Axe, of the Royal Veterinary College, is credited with the statement that 3,000 deaths of horses in London are due to glanders every year, the direct and indirect losses resulting being estimated by him at £95,000 annually. THE GRAND JUNCTION CANAL. The condition of the Regent's and Grand Junction Canals has for a long time been a cause of concern to the sanitary authorities of St. Marylebone, St. Pancras, and Paddington, and a conference of delegates of these bodies was held last year with a view to devise remedies for the nuisances complained of. A copy of the Report of the delegates was forwarded to your Vestry by the London County Council, who, with reference to the state of the canals in the parishes named, and to the recommendations of the delegates, submitted with a view to ensure the future sanitary condition of the canals, desired to be informed as to the condition of the Grand Junction Canal in this Parish, and the course adopted by your Vestry with regard to any matters that might require a remedy ? The recommendations of the delegates with which we may be thought to be concerned, are the following:- (3) "That the Vestries should request the London County Council to make bye-laws pursuant to section 16 of the Public Health (London) Act, 1891, in relation to offensive cargoes and the transport thereof. (4) "That the Canal Companies should be required by the Vestries to systematically scavenge the surface of the canals, and the banks thereof, three times a week, on alternate days, throughout the months of June, July, and August, and twice a week throughout he other months of the year. 176 (5) "That the Canal Companies should be required to concrete parti of the canals, such as basins, lay-byes, and places adjacent to wharves, where mud and other deposits are likely to accumulate." A further recommendation (7), has for its object to secure a more frequent change of the water of the canals than is obtained under present arrangements. All of these recommendations, as well as (1) and (2), which concern the three parishes only, are excellent, and their adoption would doubtless be attended with the best results. But, with reference to that portion of the Grand Junction Canal in this Parish, there does not appear to be, at present, any objectionable condition calling for action on the part of your Vestry. The length of this portion of the canal is about half a mile, viz., from Plough Lane Bridge, Portobello Road, to the limit of the Kensal Gas Works wall on the towing-path side, the Kensal Green Cemetery being on the other side. There are no houses on the banks, and no wharves or lay-byes. No drains, save a few for surface water, or for roof drainage, enter the canal, and there are no visible sources of pollution on the banks. When I inspected the canal, in November last, in connection with the Council's enquiry, the water presented the usual somewhat muddy appearance. I had no evidence as to the depth of the mud deposit. No dead animals were observed floating on the surface of the water, or any other polluting matter ; but some human excreta had been deposited on the towing-path close to the bridge, under the Gas Works wall, I may add that I have received no complaint of the condition of the canal. PUBLIC MORTUARY. The mortuary was opened in July, 1883. In the first year, to March 25th, 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; in the eighth year 207; in the ninth year 256; and in the tenth year, to March last, 239. 177 The bodies removed to the mortuary in the twelve months ended March 25th, 1893, were admitted upon application as follows:- 1. At the request of relatives of the deceased . 6 2. At the request of undertakers 58 3. At the request of the Coroner (inquest cases) Cases of sudden death 103 Cases of violent death 46 149 4. Brought in by the Police Found dead 18 Accident cases 4 22 5. On account of death due to infectious disease 4 239 In 106 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 during the time required to conduct a post-mortem examination ordered by the Coroner; "who" may order the removal of a dead body to and from such place for carrying out such examination, and the cost of such removal shall be deemed to be part of the expenses incurred in and about the holding of an inquest." * The Coroner orders the removal of bodies for this purpose in nearly all cases. Even now, however, 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 * Coroners Act, 1887, section 24. L 178 the removal of the body, in such cases, by Justice's Order (Public Health (London) Act, 1891, sec. 89), if persons live or sleep in the room where the body is retained, or if the body is in such a state, from decomposition, as to endanger the health of the inmates of the same house or room. The Royal Commission on the Housing of the Working Classes (1885), recommended the provision of additional mortuaries in London. What, however, is even more required, at present, is power to compel the removal of the dead to existing mortuaries, when removal is necessary on sanitary grounds. The Commissioners recognized this fact, by implication, in the further recommendation that, "in the event of a death from infectious disease, the body should forthwith be removed to a mortuary, in cases where it would otherwise be retained in a room used as a dwelling by others." They thought it desirable, moreover, "that in any case where the body lies in a room which is used by other persons, it should, in the same manner, be removed." (Report, page 31). These powers have been given, but they will be of little avail without the voluntary assistance of medical practitioners, for very rarely does the Medical Officer of Health hear of proper cases for removal, and then usually not until it is too late to intervene. It may be added that under the provisions of the Public Health (London) Act, Sanitary Authorities, alone or in combination, are required to provide mortuaries. CORONER'S COURT. The Public Health (London) Act, 1891, Section 92, requires the County Council to "provide and maintain proper accommodation for the holding of inquests," and enables them, by agreement with a Sanitary Authority, to provide and maintain the same in connection with a mortuary or a building for post-mortem examinations provided by that authority, or with any building belonging to that authority, and to do so in 170 such terms as may be agreed on with the authority. This is the course which the Council appear desirous of adopting, and it is rendered feasible by section 105 (c) which enables the Sanitary Authority to borrow, with the consent of the Local Government Board, for the purpose of providing a building for the holding of inquests. Unfortunately, the room placed at the service of the Coroner at the Town Hall, is, in every respect, unfit for the purpose, and as no better accommodation can be provided in the building, it would be well, could an arrangement be made for erecting a suitable Court in the disused Parish Churchyard contiguous to the public mortuary. An alternative scheme contemplates the acquisition of a site at the rear of the Town Hall. But to give effect to it, compulsory powers would appear to be necessary. The question of applying to Parliament for such powers is under consideration. The number of inquests held in the year ended 25th March last, was 172: of these 166 were held at the Coroner's Court, 4 at public institutions, and 2 at private houses. 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 accommodation 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. In the past year no inquest in this Parish was held at a public-house. DISINFECTION. The Public Health Act imposes additional duties on the Sanitary Authority in the matter of disinfection, the practical effect of the legislation of late years being to throw the entire cost of disinfecting rooms, bedding, clothing, &c., upon the rates. During the year ended March 25th, 1893, numerous 180 articles of infected clothing, bedding, &c., were satisfactorily disinfected by your Vestry's contractor. The weight of the articles was 41 tons, 2 cwts., their number 20,939, the cost being £816 4s. 3d. These totals represent a great increase on those for the preceding year when the weight of articles disinfected was a little under twenty tons, their number 9,425, and the cost of the process about £381. Six hundred and eightythree rooms in 668 houses, were disinfected by your Vestry's Officer, irrespective of those disinfected by the contractor in his private capacity,—a diminishing number. The rooms disinfected by your Vestry's Officer in the preceding year were 364, in 323 houses. PUBLIC BATHS AND WASH-HOUSES. The Baths and Wash-houses, at the junction of Lancaster and Silchester Roads, Notting Hill, opened in April, 1888, have been well supported. But for the majority of parishioners the site is not sufficiently central for bathing; and obviously it is too remote for washing purposes. The same objection would apply to any single site in the parish. Much good might be effected by the provision of buildings, on a modest scale, in several 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 and Wash-houses, show 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 March 25th, 1890, to 39,829 in the year ended March 25th, 1891, to 42,528 in the year ended March 25th, 1892, and to 46,843 in the year ended March 25th, 1893. The number of hours employed in washing, in the five years, consecutively, was 38,709,84,352,106,560,104,223 and 103,900, 181 The Commissioners state that nearly 13,000 of the washers paid the minimum charge of l½d., for one hour's attendance, "which would seem to prove that the poorest occupants of the very poor neighbourhood surrounding the baths, are availing themselves of the benefit of the institution which was established mainly for their advantage." It is added, that " the average time occupied by each woman was under hours, at an average charge of about 3½d., exclusive of soap, blue, etc." The bathers, who in 1889-90 were 79,029, in 1890-91,89,491, in 1891-92, 93,557, were 104,276 in 1892-93—viz., males, 89,449, and females 14,827: in the swimming baths, 58,179; and in private baths, 46,097. The male bathers in the swimming baths were 52,537, the women 5,642. The male bathers in the private baths were 36,912, the women, 9,185. Taking both classes of baths together, the patrons, men and women, of the first class baths, were 28,940; of the second class baths, 26,513; of the third class baths, 48,823. There was an increased attendance of bathers of all classes, of 10,719, compared with the number in the previous year. 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 .£5,639," being somewhat more than equal to a rate of three farthings in the £ on the rateable value of the Parish. The Sanitary Committee of the London County Council, in their report for the year 1889-90, stated that, 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," they had "come 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. 182 REGULATIONS FOR HOUSES LET IN LODGINGS. The powers conferred on Vestries and District Boards, by the Sanitary Acts of 1866 and 1874, enabling them to make regulations "for houses, or parts of houses, let in lodgings, or occupied by members of more than one family," are re-enacted in the Public Health (London) Act, 1891, section 94 Every Sanitary Authority is thereby required to make and enforce such bye-laws as are requisite for the purposes specified. Your Vestry's regulations for the said purposes were confirmed by the Local Government Board in 1886. Some 1,800 houses have been registered, and many others await attention. UNDERGROUND ROOMS. The duties of the London County Council, in respect of the supervision of underground rooms, under the repealed section 103 of the Metropolis Local Management Act, 1855, have been transferred, by section 96 of the Public Health Act, to the Sanitary Authority, who are required to appoint one or more officers to report such rooms to them, and not to the County Council. The new provisions of law with respect to underground rooms ("cellars" are no longer mentioned), are more stringent than those of the old Act. Some account of them was given in my last annual report, page 125. PUBLIC SANITARY CONVENIENCES. There are only sixteen public urinals in the Parish—a very inadequate number. At the date of my last report there were two sets of public water-closets, viz., at the rear of the Vestry Hall, and at Norfolk Terrace—both for the male sex only. Since then about £1,000 has been expended in the construction of an underground lavatory, with ample w.c. accommodation and urinals, in the Old Brompton Road opposite the Oratory. This place, likewise, provides for the necessities of the male sex only. Section 88 Metropolis 183 Local Management Act, 1855, enabled the vestries and district boards to " provide and maintain urinals, water-closets, and like convenienes 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, were very generally thwarted by local opposition. Increased powers for the purpose of such provision, are given by the Public Health (London) Act, 1891, which, to facilitate the construction of underground conveniences, vests the sub-soil of roadways in the Sanitary Authority, who, moreover, have 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 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 their opinion of the necessity for Chdlet 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 cf 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, it will have been seen, to give effect to the views of the Council. 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 184 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 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 carrying out the system adopted, which involves the transport of the sludge, resulting from precipitation, in specially constructed vessels, out to sea. The works at Barking, on the north side of the river, were completed some years ago ; those at Crossness, on the south side, last year only. Shortly before these were opened, at the beginning of June, the County Council received a letter from the Secretary of State, transmitting an extract from a Report by the Medical Officer of Health for the Port of London, to the effect that the river water, in consequence of a few hot days, had already begun to smell badly in the neighbourhood of the outfalls. The Main Drainage Committee informed the Council, (7th July), on the strength of a report by the Chief Engineer and the Chemist to the Council, that the river was then, already, free from smell arising from sewage, and from the black patches of discoloured water which formerly were so offensive. It was further stated that, even at low tide, no black mud was stirred up in the wake of the steamers passing up and down the. river. These results appeared to the Committee to be very satisfactory, and they directed a copy of the report to be sent to the Secretary of State. Some 30,000 tons of 185 sludge per week were, at that time, being carried to sea from the outfalls. In a subsequent report, at the end of September, it was stated by the Chemist to the Council that, during the past summer, the river had been in a most satisfactory condition: there was no discolouration of the water by sewage matters or black mud; the foreshores had been clean; the aeration of the water, moreover, had shown a marked increase, the quantity of oxygen dissolved in the water being on one occasion (last day of August), the maximum quantity possible —these results being attributable to "no other cause than the operations at the Council's sewage precipitation works," designed and commenced by the late Metropolitan Board of Works. It appears to be generally admitted that the improved condition of the river has been maintained to the present time, and that its condition is now better than it has been for many years. Certainly, no complaints have been made in regard to it during the present year to date, although the rainfall has been scanty and the temperature high. The County Council determined last year, on the recommendation of the Main Drainage Committee, to try some experiments in application of the sludge to land. There is plenty of low-lying land on both sides of the river which might be raised with advantage. The late Metropolitan Board, at one time, contemplated large measures of this kind by the application of blocks of the dried sludge. It may give some idea of the vastness of the operations in dealing with the sewage of London, to mention that the Main Drainage Committee, in a report dated 18th February, 1892, stated that in 1891, 8,516 tons of lime, and 1,563 tons of sulphate of iron, were required for the treatment of 30,172 millions of gallons of sewage at the northern outfall at Barking Creek. The operation resulted in the production of 536,000 tons of sludge, which were sent to sea in two steamers. During the summer, 500 tons of manganate of soda, and 347 tons of sulphuric acid were employed in deodorizing, mainly, 186 that portion of the sewage which was untreated by precipitation. At the Southern outfall at Crossnesss, then uncompleted, 2,228 millions of gallons of sewage were only partially treated, with 407 tons of lime, and 113 tons of sulphate of iron, which yielded 46,873 tons of sludge. The untreated sewage discharged into the river at this outfall during the summer, was deodorized by means of 923 tons of manganate of soda, and 532 tons of sulphuric acid. The cost for lime at both outfalls, during 1891, was about £8,146, and that for sulphate of iron, £3,184. The cost of manganate of soda and sulphuric acid, used at the outfalls and storm overflows, was £27,525; the great bulk of which, the Committee stated, would be saved when, as now, the precipitating operations are in full working order. To sum up: 32,400 millions of gallons of sewage were treated at the two outfalls, and 582,873 tons of sludge were produced; whilst 8,923 tons of lime, 1676 tons of sulphate of iron, 1423 tons of manganate of soda, and 879 tons of sulphuric acid were used, the cost of these chemicals being £38,855. In previous Annual Reports I summarised the objections raised by Sir Henry Roscoe to the system of sewage-disposal now in operation, in reports made by him, after elaborate investigations carried out for the late Metropolitan Board of Works. In common with other eminent authorities, he favours the view that the sewage, crude or after precipitation, must ultimately be taken to the land. At Paris it is stated that 5,000 gallons, on an average, are applied daily 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, but nothing has been done, and probably 187 it will be long before anything is done. The questions-remain, therefore: Is the river of necessity to continue to be polluted, in a measure, as heretofore, supposing the precipitation works should fail of their full expected effect ? Is there no alternative ? These questions were attempted to be answered in my Annual Report for 1889, (pp. 189—192), wherein 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 lastnamed processes are vouched for by Sir Henry Koscoe: 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." WATER SUPPLY. In my last Annual Report, I referred to the appointment of the Royal Commission to enquire into the Water Supply of the Metropolis, and cited the views on the subject entertained by the London County Council. The Commission have completed their inquiry, and at the present time (May) * Sir Henry Roscoe's conclusions are corroborated by Mr. Alfred E. Fletcher, II.M. Inspector under the Rivers Pollution Prevention Act for Scotland. 188 are considering their report. Pending the appearance of that report, I do not propose to deal with the subject at any length. There was no water legislation last year, and I have nothing to add to what I then stated on the constant service system, and on the cutting-off powers which at present are enjoyed by the Companies. Professor Frankland's Report.—A few words may be permitted with respect to Dr. Frankland's report to the Registrar General, from which it appears that, except in November and December, the weather during the year 1892 was, on the whole, not unfavourable for the operations of the Companies who derive water from the Thames, the quality of their- supplies, except in December, having been much more uniformly good, and less subject to violent fluctuations, than during the previous year. But the want of additional storage reservoirs, and in some cases of larger filter areas, is, he states, very emphatically declared both by the chemical and the bacteriological examinations. The water of the Chelsea Company, with its 14.2 days' storage, was, chemically, almost invariably of better quality than that delivered by any other Company obtaining its supply from the Thames, but with storage ranging from 7 to 2'5 days only. But it is added that, "even the storage capacity of the Chelsea Company was insufficient in January, February, and December." Notwithstanding this remediable defect, the samples of water examined were "invariably clear and bright," for," even when analysis showed the admission of flood water, the water actually supplied to consumers was always efficiently filtered." The monthly variation in the temperature in the case of river waters is great; the temperature of the deep well water, on the other hand, is practically constant throughout the. year. The Kent Company's water varied only from 50.7° Fahr. in October to 55.0° in September, a range, therefore, of only 4.3°: that of the Thames waters being 30.4°, viz. from 37.6° in January, to 68 0° in August. The deep well water is thus " cool and refreshing in summer, 189 and is less likely to become frozen in the service pipes in winter; whilst river water at 68.0° is unpleasantly vapid, and at 37.6° is soon cooled to the freezing-point." Dr. Frankland refers to the hardness of the waters, due to the salts of lime and magnesia—mainly bicarbonate of lime—"which in no way diminish the fitness of the water for drinking," but make it unsuitable for washing, and also cause incrustations and deposits in steam and kitchen boilers and hot water pipes. The hardness can be largely reduced by Clark's softening process. By the adoption of this process, which consists in treating the water with lime, the initial hardness of the Colne Valley Company's chalk water, which is much in excess of that of Thames water, is reduced to about a third of the hardness of river water. The usual reference is made to the possible danger to health resulting from the small amount of organic animal matter found in the water, as this may be accompanied by zymotic poisons: but "the chances of such substances reaching the water consumers are enormously reduced, both by the care which is exercised in excluding the flood waters from the reservoirs, and especially by the efficient filtration to which the water is subjected before distribution." Still, " there is no absolute guarantee that the noxious ingredients, which may at any time be present, are wholly removed." It is only fair to add that there is no evidence of injury to health resulting from the use of the water. The discharge of untreated Town sewage into the Thames has been almost completely stopped. Most of the Companies, moreover, are endeavouring to substitute, as far as possible, water from subterranean sources for raw river water. Figures are given to show that in respect of "organic impurity," the Thames water distributed during the year 1892 was of much better average quality than that distributed in 1891. Bacteriological Examination.—Dr. Frankland gives the results of his bacteriological investigation of the waters by Koch's gelatine-plate culture, showing an enormous reduction 190 in the number of microbes in the filtered water compared with those found in the raw river waters. He attaches the utmost importance to this, on the ground that "the smaller the number of microbes found in a given volume (of water) the less is the probability of pathogenic organisms being present." If there are no pathogenic organisms present, all is well. And none have ever been found. Formerly, the water for this bacteriological examination was collected with the samples for analysis, but as it was found that microbes multiplied rapidly during the tew hours which elapse between delivery of the water from the filter beds and its arrival at the standpipes in Town, arrangements were made, at the request and expense of the Companies, so that the samples for microbecultivation should be collected from the filter-wells (this being "the only trustworthy method by which the efficient filtration and comparative bacterial purity of the Metropolitan waters can be ascertained"), with the result that almost complete sterilization of the water is found to be effected by filtration. The results of these examinations are duly set out by Dr. Frankland. It will suffice to say here, that the mean number of microbe colonies, per c.c. of the raw river water, in May to December, 1892, was 2,908: the mean number, after filtration, in the Local Companies' supplies, was; Chelsea Company's water, 7; West Middlesex, 13; Grand Junction, 48. The observations made go to show, inter alia, "That the water in the gravel flanking the Thames, is, bacterially, of enormously better quality than that of the adjacent river," thus proving that " bacterially, as well as chemically, filtration or percolation is immensely more efficient for the purification of water, than mere flow for scores of miles in a river," and that it is possible, by careful filtration, so to arrest microbes and their spores as to transform the river water into a beverage which, bacterially, is but little inferior to that from deep wells in the chalk. Dr. Frankland observes that his examination of the filtered river waters has not yet been continued long enough to enable him to suggest a standard of 191 bacterial impurity (meaning initial number of microbes per c.c. at the filter wells), which should not be surpassed; but it would appear that the Chelsea and the West Middlesex Companies would not have much difficulty in keeping below 50 microbes per cubic centimetre. In view of the importance filtration has assumed, "in the light of recent bacteriological research," he recommends "double filtration, as affording a second line of defence against the invasion of pathogenic microbes, in the case of river waters used for domestic purposes, when these have received sewage or sewageeffluents. " That double filtration is not an impracticable project is proved by the fact that the Grand Junction Company have already begun to carry it out on a very considerable scale." I should be glad if the Companies could see their way to give their customers the added advantages of the softening process, which I cannot but think would materially improve the supply. Supervision of the water supply is vested in a water examiner, appointed under the provisions of the Water Act, 1871, whose report for 1892 has not yet been published. The few particulars subjoined, are mainly taken from his monthly report for March, 1893. In that month, the Grand Junction Company supplied 44i gallons per head, daily, to their customers ; the Chelsea Company, 39 gallons ; the West Middlesex Company, 31 gallons. For domestic purposes the Registrar-General states, in his Annual Summary, the gallons per house supplied, daily, in 1892, by the several Companies, in the order given, were 267,232, and 189. In March, the Grand Junction Company were giving constant service to 85 per cent, of the houses in their district, the West Middlesex Company to 52 per cent., the Chelsea Company to 41 per-cent. The eight Companies which supply London were, at that date, giving constant supply to 560,151 houses, or 71 per cent, of the total number of supplies—-the East London Company heading the list with 98 per-cent. The number of days' supply represented by the 192 capacity of the reservoirs for unfiltered water, belonging to each of the local Companies, was as follows: Chelsea 142, West Middlesex 7, Grand Junction 3.5. The East London Company is the only one that possesses larger capacity than the West Middlesex, viz., 13.7 days. supply, thus coming second to the Chelsea Company. But the Grand Junction Company have the means, during floods, of pumping from the gravel beds adjoining the Thames, and this is practically equivalent to an addition to their storage resources. Provision was made by the Metropolis Water Act, 1,852 (sec. 4), for the efficient filtration of all water supplied by the Companies before distribution. Testimony is uniform that this provision is faithfully carried into effect. The late Sir Francis Bolton, the first Water Examiner appointed under the later Act (1871), laid down the conditions necessary to secure this object; viz. (1) Storage in subsidiary reservoirs, of capacity sufficient to avoid the necessity of intake of flood waters; (2) A sufficient area of properly constructed filter beds; and (3) The limitation of filtration to a certain speed, represented by the passage of about 540 gallons, per square yard of filtering area, in 24 hours, or 2½ gallons through each square foot of surface per hour. These conditions are fully complied with by the several Companies, with the result that, whatever the condition of the water when taken from the river, or passed on to the filtering beds, the filtered water is uniformly bright and clear. Sand is the efficient agent in filtration for securing brightness and clearness; but microbic separation appears to be secured by the gelatinous scum, itself mainly microbic in character, which after a little time forms on the surface of the sand, and which, until lately, was regarded as an impurity requiring to be frequently removed. In former reports I have fully described the apparatus of filtration, and to those reports I may refer for detailed information on the subject. It need hardly be said that filtration, however perfect, avails little, if the water is allowed, as frequently happens, to be fouled in 193 the cisterns. The attention of householders cannot, therefore, be too frequently drawn to the necessity for 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. It may be added, that when "constant supply" is given, a screwdown draw-off tap should be affixed to the rising main, or service pipe, so that drinking and cooking water may be drawn therefrom, fresh and uncontaminated, without the intervention of cisterns, which are required for washing, flushing, baths, and similar purposes. A stop-valve, moreover, should be fixed outside the premises to prevent damage to the house in case of pipes burst by frost or other causes. The Public Health (London) Act, 1891 (sec. 50), enables the Sanitary Authority to make bye-laws for the cleansing of cisterns, and your Vestry have exercised the power. But no bye-law has any validity unless, and until, confirmed by the Local Government Board, and at the present time the necessary confirmation has not been accorded. The importance of a constant service cannot be overrated. It is the intention of the County Council to procure this advantage for Londoners; but how long it will take to bring it about I am unable to say. This subject, doubtless, will be dealt with in the forthcoming Report of the Royal Commission, with the effect, it may be anticipated, of accelerating the desired consummation. For my own views, in extenso, on this important subject, I may refer to my last annual report (pp. 215-221). With respect to the cutting-off powers of the Companies,with which I also dealt in that report (pp. 221-225), it may be interesting to mention that a Bill has been brought into Parliament this year—by private members— which proposes, among other amendments of the Public Health Act of 1891, to take away those powers. M 194 THE WATER REGULATIONS. The Water Regulations framed by the Companies, under the Act of 1871, contain many useful provisions, and it would be well if express power were given to the Sanitary Authorities enabling them to enforce such of them as have a distinctly sanitary bearing. The twenty-first regulation deals with the subject of FLUSHING-TANKS for the supply of water closets, providing that the tank or service-box shall not be capable of discharging more than two gallons at a flush, a quantity which the two-gallon flushing-tank is practically unable to deliver. The attention of the Sanitary Authorities was called, last year, by the St. Giles' District Board of Works, to the desirability of an amendment of the regulation, so as to allow of the provision of a tank of three-gallons capacity, on the just ground that a two-gallon receptacle does not allow a sufficient flush of water to secure the effective action of a water-closet. The Board desired the support of the Sanitary Authorities for an application they had made to the Local Government Board, to take steps "with a view to the 21st Regulation being altered so as to provide for the use of cisterns or service-boxes which will permit a discharge of not less than three gallons of water at each flush." The proposal was supported by your Vestry, although I had the satisfaction of stating that the local Companies did not raise objection to the fixing of tanks of three-gallons capacity, which is all, 1 think, we could fairly ask of them. The Local Government Board desired to be informed of the view taken by the Sanitary Authorities on the subject—and that they were favourable to the view taken by the St. Giles' Board I do not doubt —but at present no steps have been taken to give effect to the request for the amendment of the regulation, which would be necessary to secure the desired object in a lawful way. In my report dealing with this matter (No. 12, December 5th, p. 149), and recommending your Vestry to comply with the request of the St. Giles' Board, I suggested that the Local Government 195 Board should be further requested to amend the 14th Regulation also, so as to require the Water Companies to serve a notice upon consumers to sever all connections of waste-pipes of cisterns with drains. Your Vestry made a representation to the Local Government Board on this subject ten years ago, and it was supported by many of the Sanitary Authorities. The local Companies were also requested to exercise their powers to enforce the cutting off of waste-pipes, but took no step beyond—in common with the other Companies—issuing a circular letter to their customers, indicating the desirability of their doing this, in conformity with the advice of the Medical Officer to the Local Government Board, given in view of the then threatened visitation of Cholera. The Board had communicated to the several Authorities the advice of their Medical Officer, which was but a repetition of what the late SirFrancis Bolton, the Water Examiner, had been insisting on, month by month, for years, in his reports, but without effect. Should there bean outbreak of Cholera this year, it is probable that the Board will once more tender the same advice to the Sanitary Authorities, as they did last year, but without taking any steps to enable those Authorities to give effect to their advice, by procuring the desired amendment of the regulation. It would be well could the Board be induced to comply with the recommendation transmitted to them by your Vestry on the subject, in 1883, when, moreover, they were also asked to give, or obtain, power to enable Sanitary Authorities to enforce other of the regulations having a sanitary bearing ; those numbered 9, 10, 11, 13, 14, 16, 17, 20, 21, 22, 24, 25, 31, and 32, being specified. Your Vestry's action in this important matter was fully set out in my Annual Report, for 1882, pages 117 to 1 26 inclusive, and I would recommend that the attention of the Local Government Board be again invited to the subject. It may be here mentioned that the regulations of the Water Companies were made in 1872, under the provisions of sec. 17—25 of the Metropolis Water Act, 1871, and have never been altered. But any company may repeal or alter 196 existing regulations, or make new regulations instead of any of the same (sec. 18), and if the Metropolitan Authority, or any ten consumers of the water supplied by any company, request the Company, in writing, to repeal or alter any of the regulations, or to make new regulations, instead of any of the same, and the company refuse to do so, the Local Government Hoard may appoint a competent person to report as to the expediency of altering or repealing such regulations, or of making new regulations, in conformity with such request, and on the report of such person the Board may make alterations in the regulations as they think fit. No alteration or repeal of any existing regulations, or any regulation newly made by the company, has any force or effect unless, or until, the same shall have been confirmed by the Local Government Board. It is unlikely that the companies (they act in concert) would voluntarily move in the matter mooted by the St. Giles's Board, or that the Local Government Board would do so unless strongly urged. In the report referred to, I stated that the most likely course to attain the object the District Board had in view would be to approach the Metropolitan authority, i.e., the County Council, whose intervention would probably be successful. I was of opinion that the action of the St. Giles's Board was deserving of the support of the Sanitary Authorities in the Metropolis, and recommended compliance with their request for co-operation. But I stated that if there was to be any alteration made in the Regulations, I would go further and request the Local Government Board, at the least, to amend No. 14 also. 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, 197 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 16.9 15.9 16.4 Quarter ended June 30th 16.9 16.1 16.4 Quarter ended September 30th 16.9 16.2 16.4 Quarter ended December 31st 17.2 16.0 16.4 Averages, whole year 16.9 16.0 16.4 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 equal to or above the requirement. 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. The maximum, the minimum, and the average amounts found in 1890, considerably exceeded the proportions in 1889, as these exceeded those found in 1888. In 1891 there was an improvement in these respects which was more than maintained in 1892. Grains of sulphur per 100 cubic feet of gas ; the mentary limit being 17 grains in 100 cubic feet during the months from April to October, and 22 grains from October to April:— 198  Maximum. Minimum. Average. Quarter ended March 31st 121 8.2 10.2 Quarter ended June 30th 14.1 9.4 11.2 Quarter ended September 30th 16.2 9.1 11.4 Quarter ended December 31st 11.9 8.9 10.5 Averages, whole year 13.6 8.9 10.6 Averages, 1891 154 9.4 120 Averages, 1890 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 Parliament, four grains in 100 feet of gas, exceeded. The Chief Gas Examiner being independent of the Company, it is satisfactory to note that his reports on the daily testing of the gas are so favourable. Variation in Illuminating Power.— 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 199 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. Standard of Light.— The Metropolitan Board, also in 1884, suggested the expediency of an alteration in the standard of light prescribed by the statutes. It is required that the illuminating power of the gas shall, when consumed at the rate of five cubic feet an hour, by means of a standard argand gas burner, be equal in intensity to the light given by 16 sperm candles of 6 to the pound, each burning at the rate of 120 grains per hour. 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 the 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. The County Council, through its Sanitary and Special Purposes Committee, took up the subject, having addressed a communication to the Board of Trade (in July, 1889), with a view to steps being taken for (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. During 1891 the subject continued to receive the attention of the Committee, and formed the subject of several reports. 200 The Board of Trade, moreover, undertook to appoint a scientific Committee to consider what the standard of light should be; but having no fund out of which to defray the costs of the contemplated enquiry, they asked if the Council would defray the expense? a course the Committee were not prepared to recommend, as the Council have no power to make any payment for such a purpose. The Committee, therefore, recommended that steps should be taken to promote a Bill "for substituting a more exact standard of light for that now prescribed," and this course, doubtless, would have been adopted, but for the liberality of the South Metropolitan Gas Company, who undertook to bear the whole of the expenses of a Committee, which the Board of Trade, therefore, agreed to appoint. The Committee was to be composed of two members nominated by the Council, one by the Corporation, three by the London Gas Companies, together with the three Gas Referees, and two independent scientific men. What result, if any, has followed the investigations made by the Committee, I am unable to state, not having seen any reference to their proceedings. A RETROSPECT. In my fourth monthly report, dated April 26th, 1892, I referred to the fact that I had that day completed twenty-one years' service as your Vestry's Medical Officer of Health. " Kensington," I then observed, "has undergone considerable development in that period. The population which in 1871 was 121,000, is now 167,000 : increase, 46,000. The inhabited houses which then numbered 15,700, now exceed 22,000: increase, upwards of 6,000. The rateable value of the parish, which then was not much more than £900,000, now exceeds two millions : increase ,£1,100,000. Considerable advances have been made in sanitary legislation, mainly by the consolidation and amendment of Public Health, Sanitary, Nuisances Removal, and Artizans' Dwellings Acts, and by the passing of Factory and Workshop Acts. Considerable 201 improvements, moreover, have been effected in Public Health administration with respect to infectious diseases; by the adoption of the system of compulsory notification, and by the freeing of the hospitals erected by the Metropolitan Asylums Board under the provisions of the Metropolitan Poor Act, 1867. The Board itself, originally concerned only in Poor Law administration, has in effect become, with respect to infectious diseases, the Hospital Authority, and the Ambulance Authority, by iand and water, for the entire Metropolis. The hospitals, intended originally for the reception of persons in receipt of poor-law relief only, now admit all applicants; the stigma of pauperism, moreover, having been removed by an Act introduced by a former Member for this Borough. In 1871, the infectious sick person could not be admitted to hospital without the order of a Relieving Officer, or the Master of a Workhouse on a certificate signed by a Poorlaw Medical Officer. But, one by one, every barrier has been broken down, and now a Medical Officer of Health, or a Sanitary Inspector, or a registered medical practitioner, can obtain the immediate admittance of a patient, conveyed in the Board's ambulance, and attended by a nurse, without any formality beyond an application and a medical certificate," which, I may now add, may be the notification certificate. "Persons moreover suffering from diphtheria are now received, and a Convalescent Hospital for these and for fever patients, has been provided at Winchmore Hill. Small-pox patients are removed to the Hospital Ships at Long Reach, and a Convalescent Hospital has been provided for their use at Darenth. The benefits accruing from the removal of smallpox patients are plainly visible in the extraordinary immunity London has enjoyed, of late years, from this loathsome disease, the total deaths from which in the last six years, amoiig a population exceeding four millions, were only 55. The mortality from scarlet fever and enteric fever has been largely and continuously reduced, in no small measure as the result of the extended use made of the hospitals. London is to some 202 extent, at least, indebted to your Vestry for these benefits, many of the advances in the Public Health administration to which I have thus briefly referred, having had their origin in proposals initiated in Kensington." I trust it will be regarded as no more than a due* sense of my appreciation and gratitude, to place on record the reference made, by the Works and Sanitary Committee, to the attainment of my "majority," to the following effect: "That the Committee in submitting the (usual) statement of the work performed in the Medical Officer's Department desire to point out to the Vestry that Dr. Dudfield completed his twenty-first year of service on the 26th April, and to state that they have had much pleasure in offering him their congratulations on the occasion, and of placing on record their appreciation of the able, zealous, and conscientious manner in which Dr. Dudfield has performed his duties during the time that he has held the important office of Medical Officer of Health of the Parish." 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 our Public Health work during the past year. To your Vestry I am indebted for continuance of the confidence which, for twenty-two years, has enabled me to carry out, with pleasure and satisfaction, the duties of my office, and to superintend a Department of Local Administration the importance of which is now universally recognised. I am, Gentlemen, Your obedient Servant, T. ORME DUDFIELD, Medical Officer of Health. Public Health Department, Town Hall, Kensington, June, 1893. 203 APPENDIX A. Note.— The forms for Tables I., II., III., IV., V. and VI. were arranged by the Society of Medical Officers of Health, with the object of securing uniformity in Statistical Returns. 204 TABLE I. Shewing Population, Inhabited Houses, Marriages, Births, and Deaths, in 1892, and in the ten preceding years : gross numbers. The Year, Estimated Population* No. of Inhabited Houses,† Marriages. Registered Births, Deaths. Total, all Ages Under One Year, Under Five Years,‡ In Public Institutions,§ 1892 166,700 22,050 1,584 3,718 2,882 587 972 687 1891 166,400 22,002 1,569 3,847 3,066 633 968 773 1890 166,080 21,800 ** 1,511 ** 3,864 ** 2,951 651 1,095 612 1889 165,760 21,700 1,491 3,698 2,412 489 789 570 1888 165,450 21,600 1,497 3,776 2,825 604 1,077 590 1887 165,110 21,566 1,561 3,941 2,872 680 1,129 608 1886 164,820 21,500 1,605 4,149 2,756 636 1,029 604 1885 164,500 21,420 1,480 4,032 2,768 653 1,085 561 1881 164,180 21,290 ** 1,498 ** 4,394 ** 2,638 689 1,034 460 1883 163,860 21,030 1,616 4,230 2,615 602 982 487 1882 163,540 20,908 1,474 4,327 2,691 635 1,114 403 Average, 10 years 1882-91 164,973 21,481 1,530 4,025 2,759 627 1,030 566 Population in 1861,70,108 ; 1871, 120,299 : 1881, 163,151 ; 1891, 166,308. Average Number of Persons to each house at Census : in 1861, 7.4; in 1871, 7.6 ; in 1881, 81 ; in 1891, 7 56. Area of Parish, 2,190 acres. Number of persons to an acre (1892), 76. * 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. †Mean of the numbers on the rate books, in April and October, yearly. But the data are somewhat unreliable. The Census number is given for 1891. ‡X 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, ** In 53 weeks. TABLE II. Shewing the Annual Birth-rate and Death-rate; Death-rates of Children, and Proportion of Deaths in Public Institutions, in 1,000 Deaths, for the year 1892, and the preceding ten years. The Year. Birth-rate per 1,000 of the Population. Death-rate per 1,000 of the Population. Deaths of Children under one year ; per 1,000 of Registered Births. Deaths of Children under one year ; per 1,000 of Total Deaths. Deaths of Children under five years ; per 1,000 of Total Deaths. Deaths in Public Institutions ; per 1,000 of Total Deaths. 1892 22.3 17.2 158 204 337 238 1891 23.1 18.4 164 206 315 252 1890 23.3 17.8 168 221 371 207 1889 22.3 14.6 132 203 327 236 1888 22.8 17.1 160 214 381 208 1887 23.9 17.4 172 237 393 212 1886 25.2 16.7 154 230 373 219 1885 24.5 16.8 161 236 392 202 1884 26.8 16.1 157 261 392 174 1883 25.8 16.0 142 230 375 186 1882 26.5 16.0 146 236 413 149 Average of 10 years, 1882.91. 24.4 16.7 156 227 373 204 205 * 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 1882.83 inclusive, the deaths at Brompton Consumption Hospital are included as compensation for an unknown number of deaths of Parishioners at outlying Public Institutions. 206 Table lla. The following Table (which should have been inserted at page 6), shows the relative Number of Persons of each Sex at the Census of 1891, grouped according to Age, (a) in the Entire Parish, (b) in the Kensington Town Sub-District, and (c) in the Brompton Sub-District. (a) ENTIRE PARISH. All Ages. Under Five Years. 5 to 15. 15 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 to 75. 75 to 85. 85 to 95 95 and upwards. All Ages. Females. 100,591 74 66 14194 24216 21147 13520 9420 5774 3367 1278 202 7 100,591 Females. Males 65,717 7394 12963 12947 10759 8695 6337 3822 2046 666 86 2 65.717 Males. Excess of Females Excess of Females. 34,874 72 1231 11269 10388 4825 3083 1952 1321 612 116 5 34,874 Total of both-sexes 166,308 14860 27157 37163 31906 22215 15757 9596 5413 1944 288 9 166,308 Total of both sexes (b) KENSINGTON TOWN SUB-DISTRICT. All Ages. Under Five Years. 5 to 15. 15 to 25. 25 to 35. 35 '0 45. 45 to 55. 55 to 65 65 to 75. 75 to 85. 85 to 95. 95 and upwards. All Ages. Females 69,384 5976 11192 15483 1333° 9172 6592 4060 2450 969 154 6 69,384 femalesj Males 49,367 5905 10287 9540 7815 6377 4696 2741 1472 470 63 1 49,367 Males. Excess of Females I Excess of [ Females. 20,017 71 905 5943 5515 2795 1896 1319 978 499 91 5 20,017 Total of both sexes 118,751 11881 21479 25023 21145 15549 11288 6801 3922 1489 217 7 118,751 \ Total ot / both sexes (c) BROMPTON SUB-DISTRICT. All Ages. I Under Five j Years. 5 to 15. 15 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. r 65 to 75. 75 to 85 85 to 95. 95 and upwards. All Ages. Females 31,207 1490 3002 8733 7817 434B 2828 1714 917 309 48 1 31,20 7 Females. Males 16.350 1489 2676 3407 2944 2318 1641 1081 574 196 23 1 16,350 Males. Excess of Females Excess of Females. 14,857 1 326 5326 4873 2030 1187 633 343 113 25 — 14,857- Total of both sexes Total of both sexes 47,557 2979 5678 12140 10761 6666 4469 2795 1491 505 71 2 47,557 * The death-rate at the different age-periods will be found at page 68, TABLE III. Deaths registered from all causes in the year 1892. (Exclusive of the Deaths of Non-Parishioners at Public Institutions within the Parish, but inclusive of the Deaths of Parishioners at Public Institutions, etc,, without the Parish.) For a Summary of this Table see Table Ilia. CAUSES OF DEATH. AGES. Total under Five Years of Age. Grand Total All Ages. SUBDiSTRICTS. 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. 119 180 33 8 31 21 21 36 . 39 34 7 299 529 422 107 II. PARASITIC DISEASES 2 ... ... ... ... ... ... ... ... ... ... 2 2 1 1 III. DIETETIC DISEASES 7 ... ... ... 4 6 6 3 ... ... ... 7 27 25 2 IV. CONSTITUTIONAL DISEASES 40 39 16 37 60 83 63 73 51 14 2 79 170 359 119 V. DEVELOPMENTAL DISEASES 71 1 ... ... ... ... ... 1 20 37 40 72 1452 128 42 VI. LOCAL DISEASES 224 148 28 35 75 119 164 218 248 161 32 28 84 1130 322 VII. DEATHS FROM VIOLENCE 21 7 8 6 3 12 12 8 3 2 2 28 84 68 16 VIII. DEATHS FROM ILL-DEFINED AND NOT SPECIFIED CAUSES 103 10 1 2 2 4 3 2 7 6 113 140 121 19 587 385 86 88 175 245 269 341 369 254 83 972 2882 2254 628 I. SPECIFIC FEBRILE or ZYMOTIC DISEASES. 1.— Miasmatic Diseases. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 17 86 6 ... ... ... ... ... ... ... ... 103 109 91 18 Scarlet Fever 3 23 9 1 ... ... ... ... ... ... ... 26 ... ... 9 Typhus ... ... ... ... ... ... ... ... ... ... ... 62 63 50 ... Whooping-Cough 30 32 1 ... ... ... ... ... ... ... ... 21 31 27 13 Diphtheria 1 20 9 ... ... ... ... ... ... ... ... ... 2 1 4 Simple Continued or Ill-defined Fever ... ... ... ... ... ... ... ... ... ... ... ... 15 9 1 Enteric or Typhoid Fever ... ... 4 3 3 1 1 3 ... ... ... ... 119 6 Other Miasmatic Diseases—Influenza 5 7 3 2 13 14 17 24 34 30 6 12 ... 36 2.—Diaurhceal Diseases. ... ... ... ... ... ... ... ...... ... ... ... ... 4 Simple Cholera ... ... ... 1 1 1 ... 1 ... ... ... 67 66 11 Diarrhoea, Dysentery 56 11 ... ... ... ... ... ... 3 3 ... ... ... ... ... 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. ... ... ... ... ... ... ... ... ... ... ... 6 10 9 1 Syphilis 5 1 1 ... 1 ... ... 2 ... ... ... ... 4 4 ... Gonorrhoea, Stricture of the Urethra ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6.—Septic Diseases. ... ... ... ... ... ... ... ... ... ... ... 2 11 ... 4 Erysipelas 2 ... ... ... 2 3 1 1 ... 1 ... ... 4 2 2 Pycemia, Septicemia ... ... ... ... ... 1 ... ... ... ... ... ... 8 6 2 Puerperal lever 119 180 33 8 31 21 21 36 39 34 7 299 529 422 107 II.—PARASITIC DISEASES. 2 2 1 Thrush and other Vegetable Parasitic Diseases 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... Worms, Hydatids, and other Animal Parasitic Diseases 2 ... ... ... ... ... ... ... ... ... ... 2 2 1 1 III.—DIETETIC DISEASES. Want of Breast Milk—Starvation 7 ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scurvy ... ... ... ... ... ... 3 ... ... ... ... ... 13 12 1 Chronic Alcoholism ... ... ... ... ... ... ... ... ... ... ... ... ... 6 1 Delirium Tremens 7 ... ... ... 4 6 6 3 1 ... ... 7 27 25 2 IV. CONSTITUTIONAL DISEASES. Rheumatic Fever, Rheumatism of the Heart ... ... 1 2 2 1 1 1 2 ... ... ... 10 8 2 Rheumatism ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... Gout ... ... ... ... ... ... ... 1 5 3 1 ... 10 9 1 Rickets 1 3 ... ... ... ... ... ... ... ... ... 4 4 3 1 Cancer, Malignant Disease ... ... ... 1 3 ... 24 42 31 10 1 ... 129 91 38 Tabes Mesenterica 16 5 ... ... ... ... ... ... ... ... ... 21 21 19 2 Tubercular Meningitis, Hydrocephalus 9 19 7 2 ... ... ... ... ... ... ... 28 31 30 7 Phthisis ... ... 5 30 49 59 35 18 6 ... ... ... 202 152 50 Other forms of Tuberculosis, Scrofula 14 9 3 1 2 2 ... 1 1 ... ... 23 33 25 8 Purpura, Hemorrhagic Diathesis ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... 1 Anaemia, Chlorosis, Leucocythasmia ... 2 ... ... 1 ... 1 1 2 ... ... ... 7 6 ... Glycosuria, Diabetes Mellitus ... 1 ... 1 2 3 2 7 ... 1 ... 1 19 13 6 Other Constitutional Diseases 40 39 16 37 60 1 83 63 1 73 1 51 14 2 79 3 478 3 359 119 V. DEVELOPMENTAL DISEASES. Premature Birth 56 ... ... ... ... ... ... ... ... ... ... 56 56 40 16 Atelectasis 7 5 Congenital Malformation 8 1 9 9 7 2 Old Age 71 1 1 1 20 20 37 37 40 40 72 98 170 76 128 22 42 VI. LOCAL DISEASES. 1. Diseases of Nervous System. Inflammation of Brain or Membranes 7 8 1 2 1 2 1 2 ... 1 ... 15 25 20 5 Apoplexy, Softening of Brain, Hemiplegia, Brain Paralysis 2 ... 1 2 1 10 21 32 40 22 6 2 137 97 40 Insanity, General Paralysis of the Insane ... ... ... ... 1 1 ... 5 3 2 ... ... 12 9 3 Epilepsy ... 1 1 2 1 2 1 ... 4 ... ... 1 12 9 3 Convulsions 44 12 2 ... ... ... ... ... ... ... 1 56 59 51 8 Laryngismus Stridulus (Spasm of Glottis) 1 ... ... ... ... ... ... ... ... ... ... 1 1 1 ... Disease of Spinal Cord, Paraplegia, Paralysis Agitans ... 1 ... ... ... 1 ... 3 5 ... ... 1 10 7 3 Other Diseases of Nervous System ... ... ... 1 ... 8 8 3 11 6 ... ... 37 26 11 2.—Diseases of Organs of Special Sense. (e.g., of Eye, Ear, Nose) ... ... 1 1 ... ... 1 ... 1 ... ... ... 4 2 2 3.—Diseases of Circulatory System. Pericarditis ... ... 1 1 1 ... 1 ... ... ... ... ... 4 2 2 Acute Endocarditis ... ... ... ... 1 ... ... ... ... 1 ... ... 2 2 ... Valvular Diseases of Heart ... ... 2 6 4 4 6 4 8 6 1 ... 41 33 8 Other Diseases of Heart ... ... 2 2 5 10 15 30 32 11 ... ... 107 86 21 Aneurism ... ... 1 ... 1 1 2 2 3 ... ... ... 10 8 2 Embolism, Thrombosis ... ... ... ... ... ... ... ... 1 1 ... ... 2 2 ... Other Diseases of Blood Vessels ... ... ... ... ... 2 2 3 ... ... ... ... 7 4 3 4.—Diseases of Respiratory Organs. Laryngitis I 1 3 ... 1 1 ... 1 ... ... ... 2 8 5 3 Croup ... 10 ... ... ... ... ... ... ... ... ... 10 10 10 ... Emphysema, Asthma ... ... ... ... ... 1 2 2 6 1 ... ... 12 8 4 Bronchitis 98 68 4 3 8 15 36 62 75 73 15 166 457 388 69 Pneumonia 23 20 2 2 15 20 17 17 16 6 , 2 43 140 107 33 Pleurisy ... 3 2 1 6 6 3 3 2 1 3 3 30 22 8 Other. Diseases of Respiratory System 13 7 1 ... 2 2 2 4 7 9 ... 20 47 34 13 5.—Diseases of Digestive System. Dentition 6 8 ... ... ... ... ... ... ... ... ... 14 14 11 3 Sore Throat, Quinsy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diseases of Stomach 1 1 1 1 ... 1 4 2 3 3 ... 2 17 12 ... Enteritis 19 5 ... 1 2 1 1 2 ... 1 24 32 28 4 Obstructive Diseases of Intestine 2 ... ... 2 1 1 7 3 5 3 ... 2 24 14 10 Peritonitis ... 3 3 4 2 6 4 2 1 1 ... 3 26 19 7 Ascites ... ... ... ... ... 1 ... ... ... ... ... ... 1 1 ... Cirrhosis of Liver ... ... ... ... 3 3 8 6 2 1 ... ... 23 14 9 Jaundice, and other Diseases of the Liver 4 ... ... ... 4 2 7 8 3 2 ... 4 30 20 10 Other Diseases of Digestive System 1 ... ... ... 2 3 ... 3 ... 1 ... 1 10 8 2 6.—Diseases of Lymphatic System. (e.g., of Lymphatics and of Spleen*.) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 7.-Diseases of Glandlike Organs of Uncertain Use. (e.g., Bronchocele, Addison's Disease). ... ... ... ... ... ... ... 1 ... ... ... ... 1 1 ... 8.—Diseases of Urinary System. Nephritis ... ... ... ... 1 2 4 4 1 ... ... ... 12 9 3 Bright's Disease, Albuminuria ... ... ... 1 3 9 5 11 6 2 ... ... 37 24 13 Disease of Bladder or of Prostate ... ... ... ... ... ... 2 2 5 7 ... ... 16 11 5 Other Diseases of the Urinary System 1 ... ... 1 ... 1 1 2 4 ... 3 1 13 9 4 9.—Diseases of Reproductive System. a. Of Organs of Generation. Male Organs ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Female Organs ... ... ... ... 2 ... 2 ... 1 ... ... ... 5 4 1 b. Of Parturition. Abortion, Miscarriage ... ... ... ... 1 ... ... ... ... ... ... ... 1 1 ... Puerperal Convulsions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 2 ... ... ... ... ... ... 4 3 1 Other Accidents of Childbirth ... ... ... ... 4 ... ... ... ... ... ... ... 4 3 1 10.—Diseases of Bones and Joints. Caries, Necrosis ... ... ... 2 ... ... ... ... ... ... ... ... 2 1 1 Arthritis, Ostitis, Periostitis 1 ... ... ... ... ... 1 1 1 ... ... 1 4 2 2 Other Diseases of Bones and Joints ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 11—Diseases of Integumentary System. Carbuncle, Phlegmon ... ... ... ... ... 1 ... ... ... 1 ... ... 2 2 ... Other Diseases of Integumentary System ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 224 148 28 35 75 119 164 218 248 161 32 372 1452 1130 322 VII. DEATHS FROM VIOLENCE. 1.—Accident or Negligence. Fractures and Contusions ... 4 4 2 ... 6 5 3 2 2 1 4 29 24 5 Gun-shot Wounds ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cut, Stab ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Burn, Scald ... 2 3 ... ... 3 ... 1 ... ... 1 2 10 8 2 Poison ... 1 ... ... ... 1 1 ... ... ... ... 1 3 2 1 Drowning ... ... 1 ... ... ... ... ... ... ... ... ... 1 1 ... Suffocation 21 ... ... ... ... ... ... 2 ... ... ... 21 23 23 ... Otherwise ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2.—Homicide. Manslanghter ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 ... Murder ... ... ... ... 1 ... ... ... ... ... ... ... 1 1 ... 3.—Suicide. Gun-shot Wounds ... ... ... 2 1 ... 2 1 ... ... ... ... 6 ... 6 Cut, Stab ... ... ... 1 ... 2 1 1 ... ... ... ... 5 3 2 Poison ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 ... Drowning ... ... ... ... 1 ... 1 ... ... ... ... ... 2 2 ... Suffocation ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 ... Otherwise ... ... ... 1 ... ... ... ... ... ... ... ... 1 1 ... 4.—Execution. Hanging ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 21 7 8 6 3 12 12 8 3 2 2 28 84 68 16 VIII. DEATHS FROM ILL-DEFINED AND NOT SPECIFED CAUSES. Dropsy ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 ... Debility, Atrophy, Inanition 98 9 ... ... ... ... ... ... ... ... ... 107 109 99 10 Mortification ... ... ... ... ... 1 ... ... ... 4 ... ... 5 4 1 Tumour ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Abscess 1 ... ... ... ... 1 ... ... 1 ... ... 1 3 3 ... Hemorrhage ... ... ... ... 1 ... 1 ... ... ... ... ... 2 1 1 Sudden Death (Cause not ascertained) ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 ... Causes not specified or ill-defined 4 1 1 1 1 2 2 2 3 2 ... 5 19 12 7 103 10 1 2 2 4 3 2 7 6 ... 113 140 121 19 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. ' 209 TABLE IlIa. Summary of Table III., shewing the number of deaths of Parishioners in each Class and Order. I. SPECIFIC FEBRILE OR ZYMOTIC DISEASES— f Deaths. 1. Miasmatic Diseases 411 2, Diarrhoeal ,, 81 3. Malarial „ ... 4. Zoogenous „ ... 5. Venereal „ 14 6. Septic ,, 23 - 529 II. PARASITIC DISEASES 2 III. DIETETIC DISEASES 27 IV. CONSTITUTIONAL DISEASES 478 V. DEVELOPMENTAL DISEASES 170 VI. LOCAL DISEASES— 1. Diseases of Nervous system 293 2. Diseases of Organs of Special Sense 4 3. Diseases of Circulatory System 173 4. Diseases of Respiratory System 704 5. Diseases of Digestive System 177 6. Diseases of Lymphatic System — 7. Diseases of Glandlike Organs of uncertain use 1 8. Diseases of Urinary System 78 9. Diseases of Reproductive System— a. Diseases of Organs of Generation 5. b. Diseases of, Parturition 9 10. Diseases of Locomotive system 6 11. Diseases of Integumentary System 2 1452 VII. VIOLENCE— 1. Accident or Negligence 60 2. Battle ... 3. Homicide 2 4. Suicide 10 5. Execution ... 84 VIII. ILL-DEFINED AND NOT SPECIFIED CAUSES ... 140 Total ... 2882 210 TABLE IV. Shewing the number of Deaths at all ages in 1892, 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 1ooo of Total Deaths, at all ages. 1. Principal Zymotic Diseases 333 2.0 115 2. Pulmonary Diseases 704 4.2 244 3. Principal Tubercular Diseases 260 1.5 90 Division 11. (Infants under one year). Total Deaths. Deaths, per 1000 of Births. Deaths, per 1ooo of Total Deaths under one year. 4. Wasting Diseases 172 43 274 5. Convulsive Diseases 59 16 100 NOTES. 1. Includes Small-pox, Measles, Scarlet Fever, Diphtheria, Whooping-cough, Typhus Fever, Enteric (or Typhoid) Fever, Simple Continued Fever, and Diarrhoea. Fifty 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). TABLE V. Shewing the Number of Deaths from the Principal Diseases of the Zymotic Class in the ten years 1882.91, and in the year 1892. Diseases. 1882. 1883. 1884. 1885. 1886. 1887. 1888. 1889. 1890. 1891. Annual Average of ten years 1882-91. Proportion of Deaths to 1000 Deaths in ten years 1882-91. Deaths in 1892. Proportion of Deaths to 1000 Deaths in 1892. Small.pox 0 1 26 25 0 1 0 0 0 0 5.3 1.9 0 0.0 Measles 77 39 32 111 56 108 124 14 140 29 73.0 26.5 109 37.9 Scarlet Fever 62 28 18 7 11 44 26 28 26 16 26 6 9.7 36 12.5 Diphtheria 25 24 17 22 30 40 89 111 35 28 42.1 15.3 31 10.7 Whooping.cough 119 44 81 98 82 86 100 26 93 84 81.3 29.5 63 21.9 Typhus Fever 1 2 0 0 0 0 0 0 0 o 0.3 ... 0 0.0 Enteric Fever 25 30 26 12 11 11 21 19 15 24 19 4 7 0 15 5.2 Simp. Continued Fever 6 3 4 0 0 2 2 0 0 1 T8 0.6 2 o.o Diarrhoea 61 80 110 86 90 124 58 71 78 91 84.9 30.8 77 26.8 TOTALS. Kensington. 376 251 314 361 280 416 420 269 387 273 334.7 121.3 333 115 London. 13553 10801 13629 11261 11121 12684 10803 9709 12279 9675 11551 132.7 11983 136 England & Wales 69734 58972 71762 57726 62859 64676 50684 61027 59698 53221 61035 114.3 56032 100 211 TABLE VI. Summary of the Work of the Sanitary Inspectors during the year 1892—93. 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 Receptacles. 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. Constructed, Repaired, Cleansed, &c. Ventilated, Trapped, &c. Constructed, Repaired, &c. Supplied with Water. Soil-pipes Ventilated. New provided. Repaired, Covered, &c. Cisterns erected. Cisterns Cleansed, Repaired, Covered, etc. Waste-pipes connected with Drains, &c., abolished. No. of Lodging Houses Registered under 94th Section of the Public Health (London) Act, 1891.†† Removal of Accumulations of Dung ment Water, Animal and other Refuse. Animals removed, being improperly ke Regularly Inspected. Legal Proceedings, i.e.,, Summonses Bakehouses. Licensed Cowsheds. Licensed Slaughter-Houses. North. 152 417 2394 400 90 112 120 70 102 109 64 6 11 27 31 7 ... ... 1 22 .. 2 ... N.E. 166 765 4521 813 720 222 386 291 179 212 195 68 114 51 194 124 ... ... 56 28 2 4 12 N.W. 329 1627 4265 851 279 141 185 304 18 431 74 58 160 47 158 28 ... ... ... 28 3 4 6 Central 84 1079 1002 299 176 41 288 141 136 144 138 50 120 76 112 96 2 ... ... 23 1 7 4 S.E. 141 2507 3039 990 571 132 256 177 40 357 156 8 123 8 110 144 ... ... ... 29 1 5 S.W. 44 732 2732 476 280 48 47 117 72 110 51 18 73 57 21 2 ... ... 2 18 2 1 9 916 7127 7953 3829 2116 696 1282 1100 547 1363 678 208 601 266 626 401 2 ... 61 148 8 19 36 212 * For a description of the Sanitary Districts, see page 133. † The total number of houses on the Register in March, 1893, in round figures, was 1800. ‡ These matters are now dealt with by the Street Inspectors. TABLE VIa. (See following page). TABLE VIa. Summary of Monthly Returns of Work de by the Sanitary Inspectors in the year 1892-93. Date of Report. Houses Inspected. Mews Inspected.* Slaughter-houses Inspected. Cohouses Inected. Bakehouses Inspected. Offensive Trades Inspected. Sanitary Notices Issued. Date of Report. District. District. District. District. District. District. District. N. N. E. N.W c. S.E. s.w. N. N.E. N.W c. S.E. s.w. N. N.E N.W c. S.E. S.W N. N.E. N. c. S E. s.w. N. N. K. N.W c. S.E. s.w. N. N.E. N.W c. S. E. S.W. N. N.E. N.W c. S. E. s.w. 1892. April 16 ... 20 59 82 164 ... ... 90 75 48 76 ... ... ... 1 ... 6 ... ... ... 1 ... 6 ... ... ... ... ... ... ... ... 4 12 ... 4 ... ... 18 34 22 92 ... 1892 April 16 May 14 ... 108 81 117 233 ... ... 92 88 50 115 ... ... 9 6 ... 8 ... ... ... 4 ... 8 ... ... 11 12 ... ... ... ... 24 26 ... 4 ... ... 53 49 15 67 ... May 14 June 11 ... 76 95 141 228 ... ... 68 66 32 99 ... ... 3 2 ... 6 ... ... ... ... ... 6 ... ... 19 ... ... 2 ... ... 21 14 13 8 ... ... 68 101 29 116 ... June 11 July 9 ... 51 166 113 249 ... ... 79 81 56 94 ... ... ... 7 ... 8 ... ... ... 3 ... 8 ... ... ... 19 ... 1 ... ... ... 16 7 8 ... ... 75 71 14 81 ... July 9 August 6 ... 90 191 147 152 ... ... 50 41 27 74 ... ... 5 ... 17 6 ... ... 2 ... ... 7 ... ... 3 ... ... ... ... ... ... 12 ... 8 ... ... 65 63 12 67 ... August 6 Sept. 3 ... 65 114 78 156 ... ... 21 29 10 29 ... ... ... ... ... 2 ... ... ... ... ... 2 ... ... 5 15 ... 3 ... ... 8 11 ... 5 ... ... 42 54 14 35 ... Sept. 3 October 1 67 81 153 86 235 85 ... 91 109 56 242 ... ... ... ... ... 8 ... ... ... 2 ... 8 ... ... 7 1 ... ... ... ... 11 42 ... 7 ... 28 49 68 14 62 57 October 1 „ 29 81 57 154 43 212 94 58 100 73 40 111 82 ... ... 7 ... 4 ... ... ... 1 ... 1 ... ... 15 5 12 1 ... ... 16 22 ... 1 ... 50 120 59 24 78 21 „ 29 Nov. 26 47 34 120 31 187 181 62 80 97 49 65 100 ... 5 1 ... 2 ... ... 1 2 ... ... ... ... 5 ... 8 ... ... ... 2 16 ... 2 ... 45 62 107 26 71 71 Nov. 26 Dec. 24 46 12 102 41 149 33 55 123 65 61 139 114 ... ... 5 ... 3 1 ... ... 1 ... ... 2 ... ... 7 1 2 ... ... ... 13 ... 6 ... 33 62 74 16 94 100 Dec. 24 1893. Jan. 21 55 36 81 70 90 96 53 86 67 51 141 153 ... ... ... ... ... 1 ... ... 1 ... ... 2. ... 10 ... ... ... ... ... ... 20. ... 1 ... 77 73 68 33 51 76 1893. January 21 Feb. 18 40 67 110 81 200 103 65 140 51 56 140 124 ... ... ... ... 3 1 ... ... 1 ... ... 2 ... ... ... ... ... ... ... ... 17 ... 2 ... 63 44 46 17 65 65 Feb. 18 March 25 81 68 201 49 252 140 51 96 81 51 250 208 ... 1 5 ... 5 1 ... 2 1 ... ... 2 17 11 16 12 29 18 ... 2 6 ... 2 ... 104 82 57 33 111 86 March 25 Totals 417 765 1627 1079 2507 732 344 1116 923 587 1575 781 ... 23 34 17 61 4 ... 5 17 3 46 8 17 86 75 33 38 18 ... 88 227 26 58 ... 400 813 851 299 990 476 Totals Since November 10th, 1890, the Mews have been inspected by the Street Inspectors; hence the increase in the number of inspections. 217 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 1892, and in the preceding ten 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. 1882 16.4 21.5 376 2.3 3.5 140 163 1882 1883 160 20.8 251 1.5 2.8 96 134 1883 1884 161 20.9 314 1.9 3.5 119 164 1884 1885 16.8 20.4 361 2.2 3.0 130 140 1885 1886 16.7 20.6 280 1.7 2;8 101 135 1886 1887 17.4 20.3 416 2.5 3.1 144 154 1887 1888 17.1 19.3 420 2.6 2.7 148 137 1888 1889 14.6 18.4 269 1.6 2.3 111 128 1889 1890 17.8 21.4 387 2.3 2.8 131 134 1890 1891 18.4 21.4 273 1.6 2.3 89 107 1891 AVERAGE OF TEN YEARS 1882.91. 16.7 20.5 335 2.0 2-9 121 140 AVERAGE OF TEN YEARS 1882-91. 1892. 17.2 20.6 333 2.0 2.8 115 136 1892 218 TABLE VIII. Comparative Analysis of the Mortality in all London, and in Kensington, in 1892. Annual Death-rate per 1000 living, from all causes. Annual Death-rate per 1000 living, from seven principal Zymotic diseases. Per-centage of Deaths under 1 year to Births Registered PER-CKNTAGE OF DEATHS TO TOTAL DEATHS. Under 1 year of age. At 60 years of age and upwards. From seven principal Zymotic diseases. From Violence. Registered upon information of Coroners. (Inquests.) Registered at Public Institutions.* Uncertified. London 20.6 2.8 15.5 23.2 24.9 13.6 3.7 7.8 25.4 0.9 Kensington 17.2 2.0 15.8 20.4 30.5 11.5 2.9 6.6 23.4 0.5 *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 VIIIA. Shewing List of Streets and Places from which cases of Infectious Disease were notified, under the provisions of the Public Health (London) Act, 1891, during the year 1892. The Registration Sub-Districts are Kensington Town (K T), and Brompton (B). Street or Place. Registration Sub-District. Scarlet Fever. Diphtheria. Enteric Fever. Puerperal Fever. Erysipelas. Croup. Cholera. Total. Street or Place. Registration Sub-District. Scarlet Fever. Diphtheria. Enteric Fever. Puerperal Fever. Erysipelas. Croup. Cholera. Total. Abbey Road K T 1 ... ... ... ... ... ... 1 Kensington Park Mews K T 4 ... ... ... ... ... ... 4 Abingdon Road „ 3 1 ... ... 1 ... ... 5 Kensington Park Road „ 3 ... 1 ... ... ... ... 4 Absalom Road „ 4 ... ... ... ... ... ... 4 Kensington Place „ 3 2 1 ... ... ... ... 6 Acklam Road „ 18 1 ... ... 1 ... ... 20 Kensington Square „ ... 1 1 ... ... ... ... 2 Adair Road „ 3 ... ... ... ... ... ... 3 Kensington Workhouse „ ... ... ... ... 1 ... ... 1 Adam and Eve Mews „ ... 1 ... ... 1 ... ... 2 King Street „ 1 ... ... ... ... ... ... 1 Addison Road „ 2 2 ... ... ... ... ... 4 Knaresborough Place „ 1 ... ... ... ... ... ... 1 Admiral Mews „ ... ... 1 ... ... ... ... 1 Kramer Mews „ 1 ... ... ... ... ... ... 1 Albion Place „ 1 ... ... ... ... ... ... 1 Alfred Place B ... ... 1 ... ... ... ... 1 Ladbroke Grove K T ... 1 ... ... 1 ... ... 2 All Saints Road K T 3 1 ... ... 2 ... ... 6 Ladbroke Grove Road „ 13 5 ... 1 1 ... ... 20 Angola Mews „ 1 ... ... ... ... ... ... 1 Ladbroke Square „ ... 1 ... ... ... ... ... 1 Appleford Road „ 2 ... 1 ... 3 ... ... 6 Lancaster Road „ 11 4 2 ... 1 ... ... 18 Archer Mews „ 1 ... ... ... ... ... ... 1 Lansdowne Road „ 3 1 ... ... 1 ... ... 5 Archer Street „ ... ... 1 l ... ... ... 2 Ledbury Road „ 3 ... ... ... ... ... ... 3 Argyll Road „ 1 1 ... ... ... ... ... 2 Lexham Gardens B . 2 ... ... ... ... ... ... 2 Ashburn Mews B ... ... 1 ... ... ... ... 1 Lloyd's Place „ 4 ... ... ... ... ... ... 4 Ashley Cottages B 3 3 ... ... ... ... ... 6 Logan Mews „ ... 3 ... ... ... ... ... 3 Astwood Mews „ 1 1 ......... ... ... ... ... 2 Lonsdale Mews K T 1 ... ... ... ... ... ... 1 Astwood Road „ 1 ... ......... ... ... ... ... 1 Lonsdale Road „ 2 ... ... ... 1 ... ... 3 Atherstone Mews „ 1 ... ... ... ... ... 1 Lome Gardens „ 1 ... ... ... 2 1 ... 4 Atherstone Terrace „ ... ... 1 ... ... ... ... 1 Mall, The K T ... 2 ... ... ... ... 2 Ball Street K T ... 1 ... ... ... ... ... 1 Mall Chambers „ ... ... ... ... ... 1 ... 1 Bangor Street „ ... ... ... ... 3 ... 1 4 Mall Stables „ 1 ... ... ... ... ... ... 1 Barandon Street „ 2 1 ... ... ... ... ... 3 Manchester Road „ 3 1 ... ... 1 ... ... 5 Barker Street B 10 3 ... ... ... ... ... 13 Manchester Street „ 4 ... ... 1 ... ... ... 5 Barkston Gardens „ 2 ... ... ... ... ... ... 2 Manson Place B 1 ... ... ... ... ... ... 1 Barkston Mansions „ ... 1 1 ... ... ... ... 2 Marloes Road K T & B 2 ... ... ... ... ... ... 2 Basing Road K T 5 1 ... ... ... ... ... 6 Mary Place K T 3 ... ... ... 1 ... ... 4 Bassett Road „ 1 ... ... ... ... ... ... 1 Maxilla Gardens ,, 2 ... ... ... ... ... ... 2 Beaufort Gardens B 3 ... ... ... ... ... ... 3 Merton Road „ 4 ... ... ... ... ... ... 4 Bedford Gardens K T ... 1 ... ... ... ... ... 1 Michael's Grove B 1 ... ... ... ... ... ... 1 Bevington Road „ 13 ... ... ... 1 ... ... 14 Milborne Grove ,, 1 ... ... ... ... ... ... 1 Blagrove Road „ ... ... ... ... 1 ... ... 1 Montpelier Street „ 1 ... ... ... ... ... ... 1 Blechynden Street „ 1 ... ... ... ... ... ... 1 Moreton Mews „ 1 ... ... ... ... ... ... 1 Blenheim Crescent „ 1 ... ... ... ... ... ... 1 Munro Mews K T ... 1 ... ... ... ... ... 1 Blithfield Street „ ... ... 1 ... ... ... ... 1 Bolton Gardens B 1 ... ... ... 1 ... ... 2 Nevern Square B 1 1 ... ... ... ... ... 2 Bolton Road K T 8 1 ... ... ... ... ... 9 Newcombe Street K T 1 ... ... ... ... ... ... I Bomore Road „ 1 ... ... ... 1 ... ... 2 Norfolk Terrace „ 2 ... ... ... ... ... ... 2 Bonchurch Road „ 1 ... ... ... ... ... ... 1 Norland Road „ ... ... ... ... 1 ... ... 1 Bosworth Road „ 2 ... ... ... 2 ... ... 4 Boundary Road „ 2 ... ... ... ... ... ... 2 Observatory Gardens K T 1 4 ... ... ... ... ... 5 Bramham Gardens B 3 4 1 ... ... ... ... 8 Onslow Gardens B 2 ... 1 ... ... ... ... 3 Bramley Road K T 6 ... ... ... 2 ... ... 8 Onslow Houses „ ... ... ... ... 1 ... ... 1 Bransford Street „ 1 ... ... ... ... ... ... 1 Onslow Square „ 3 ... ... ... ... ... ... 3 Branstone Street „ 2 ... ... ... 1 ... ... 3 Ovington Gardens „ 1 ... ... ... ... ... ... 1 Brechin Place B 1 ... ... ... ... ... ... 1 Ovington Mews „ 3 ... ... ... ... ... ... 3 Brompton Road „ 8 ... ... ... 3 ... ... 11 . Ovington Square „ ... ... 1 ... ......... ... ... 1 Brunswick Gardens K T 1 ... ... ... ... ... ... 1 Oxford Gardens K T 1 ... ... ... 2 ... ... 3 Brunswick Mews „ 1 ... ... ... ... ... ... 1 Buckingham Mews „ 3 ... ... ... ... ... ... 3 Palace Gardens Terrace K T ... ... 1 ... ... ... ... 1 Buckingham Terrace „ 3 ... ... ... 1 ... ... 4 Peel Place „ ... 2 ... ... ... ... ... 2 Buimer Place „ ... 1 ... ... ... ... ... 1 Peel Street „ 3 1 ... ... 4 1 ... 9 Bulmer Terrace „ 1 ... ... ... 1 ... 1 3 Pelham Crescent B 1 ... ... ... ... ... ... 1 Bute Street B 2 ... ... ... ... ... ... 2 Pelham Street „ ... ... ... ... 1 ... ... 1 Pembridge Mews K T 3 ... ... ... ... ... ... 3 Calverley Street K T ... 1 ... ... ... ... ... 1 Pem bridge Place „ ... 1 ... ... 1 ... ... 2 Cambridge Gardens „ 6 1 ... ... 1 ... ... 8 Pembridge Road „ 1 2 ... ... ... ... ... 3 Campden Hill Gardens „ 2 ... ... ... ... ... ... 2 Pembridge Square „ ... ... 1 ... ... ... ... 1 Campden House Road „ ... 1 ... ... ... ... ... 1 Pembridge Villas „ 2 ... ... ... ... ... ... 2 Campden House Mews „ 1 ... ... ... 1 ... ... 2 Pembroke Gardens „ ... 2 ... ... ... ... ... 2 Campden Street „ 1 ... ... ... 2 ... ... 3 Pembroke Road B 1 ... ... ... ... ... ... 1 Canning Mews „ ... ... 1 ... ... ... ... 1 Pembroke Square K T ... ... 1 ... ... ... ... 1 Cathcart Road B 1 ... ... ... ... ... ... 1 Pembroke Villas B 2 ... ... ... ... ... ... 2 Chapel Place „ 2 1 ... ... 3 ... ... 6 Penywern Road B 1 ... ... ... ... ... ... 1 Chapel Road K T 1 l ... ... ... ... ... 2 Phil beach Gardens „ 1 1 ... ... ... ... ... 2 Charles Street „ 1 2 ... ... 1 ... ... 4 Phillimore Gardens K T 1 ... ... ... ... ... ... 1 Charles Street, Notting Dale „ ... ... ... ... 1 ... ... 1 Portland Road „ 6 ... 1 ... 4 ... ... 11 Charlotte Terrace „ 1 ... ... ... ... ... ... 1 Portobello Road „ 33 5 2 ... 4 1 ... 45 Chepstow Mews „ 2 ... ... ... ... ... ... 2 Powis Gardens „ 3 ... ... ... ... ... ... 3 Chepstow Place „ 1 1 ... ... ... ... ... 2 Powis Square „ 1 ... 2 ... ... ... ... 3 Chesterton Road „ 6 5 ... i ... 1 ... 13 Princes Place „ 1 ... ... ... 1 ... ... 2 Child's Passage B ... 2 ... ... ... ... ... 2 Princes Road „ 3 ... ... ... ... 1 ... 4 Child's Place „ 2 ... ... ... 2 ... ... 4 Church Court K T ... 1 ... ... ... ... ... 1 Queensberry Mews B 1 ... ... ... ... ... ... 1 Church Street „ 3 ... ... ... 2 ... ... 5 Queensberry Mews East „ 2 ... ... ... ... ... ... 2 Clarendon Road „ 2 2 ... ... 2 ... ... 6 Queen's Gate K T & B ... 1 ... ... 2 ... ... 3 Clareville Grove B ... 1 1 ... ... ... ... 2 Queen's Gate Gardens „ 2 1 ... ... ... ... ... 3 Clareville Mews „ ... 1 ... ... ... ... ... 1 Queen's Gate Mews B ... ... 1 ... ... ... ... 1 Clifton Place „ ... 1 ... ... 1 ... ... 2 Queen's Gate Place B ... ... ... ... 1 ... ... 1 Clydesdale Mews K T 1 ... ... ... ... ... ... 1 Queen's Gate Terrace Mews K T 1 ... ... ... ... ... ... 1 Clydesdale Road „ 3 ... ... ... ... ... ... 3 Queen's Road „ 5 1 ... ... ... ... ... 6 Codrington Mews „ 4 ... ... ... ... ... ... 4 Colbeck Mews B 3 ... ... ... ... ... ... 3 Rackham Street K T 6 2 ... ... ... ... ... 8 Coleherne Mews „ 3 ... ... ... ... ... ... 3 Raymede Street „ 4 ... ... ... ... ... ... 4 Coleherne Road „ 1 ... ... ... ... ... ... 1 Redcliffe Gardens B 3 ... ... ... ... ... ... 3 Collingham Place „ 1 ... ... ... ... ... ... 1 Redcliffe Road „ 2 ... ... ... ... ... ... 2 Collingham Road „ 1 ... ... ... ... ... ... 1 Redcliffe Street „ ... ... ... ... 2 ... ... 2 Colville Gardens K T 1 ... ... ... ... ... ... 1 Redfield Lane „ 1 ... ... ... ... ... ... 1 Colville Mews „ 2 ... ... ... ... ... ... 2 Reece Mews „ ... 1 ... ... ... ... ... 1 Colville Road Mansions „ ... ... 1 ... ... ... ... 1 Rendle Street K T ... 2 ... ... ... ... ... 2 Colville Square Mews „ 3 2 ... ... ... ... ... 5 Richmond Road B ... ... ... 1 ... ... ... 1 Convent Gardens „ 7 ... ... ... 1 ... ... 8 Rillington Place K T ... ... ... ... 1 1 ... 2 Cottesmore Gardens „ 1 ... ... ... ... ... ... 1 Roland Houses B 1 ... ... ... 1 ... ... 2 Courtfield Gardens B 2 2 ... ... ... ... ... 4 Rosary Gardens „ ... 1 ... ... 1 ... ... 2 Cornwall Gardens „ ... ... ... ... 2 ... ... 2 Royal Crescent K T 1 ... ... ... ... ... ... 1 Cornwall Road K T 7 ... 1 1 5 ... ... 14 Royal Crescent Mews „ ... ... ... ... 1 ... ... 1 Cottage Place B 1 ... ... ... ... ... ... 1 Russell Gardens „ 1 ... ... ... ... ... ... 1 Cranley Gardens „ 4 1 ... ... ... ... ... 5 Rutland Mews South B 1 1 ... ... ... ... ... 2 Cranley Place „ ... ... ... ... ... 1 ... 1 Rutland Street „ 1 ... ... ... 3 ... ... 4 Crescent Place „ ... 1 1 ... ... ... ... 2 Crescent Street K T ... ... ... ... 3 1 ... 4 St. Alban's Road K T ... 1 ... ... ... ... ... 1 Cromwell Place B ... 1 ... ... ... ... ... 1 St. Ann's Road „ 4 ... ... ... 2 ... ... 6 Cromwell Road „ 1 ... ... ... ... ... ... 1 St. Charles's Square „ 13 ... ... ... ... ... ... 13 St. Clement's Road „ 4 1 ... ... 1 ... ... 6 Dartmoor Street K T 6 ... ... ... ... ... ... 6 St. Ervan's Road „ 10 1 ... ... 2 ... ... 13 Denbigh Road „ ... ... 1 ... ... ... ... 1 St. George's Road „ ... ... ... ... 3 1 ... 4 Denbigh Terrace „ 2 ... ... ... 2 ... ... 4 St. Helen's Gardens „ 2 ... ... ... ... ... ... 2 De Vere Gardens „ 1 ... ... ... ... ... ... 1 St. James's Place „ 2 ... ... ... 1 ... ... ...3 Drayton Gardens B 1 ... ... ... 1 ... ... 2 St. James's Square „ 3 ... ... ... ... ... ... 3 Drayton Terrace „ 1 ... ... ... 1 ... ... 2 St. James's Terrace „ 1 ... ... ... ... ... ... 1 Dulford Street K T 2 ... ... ... ... ... ... 2 St. Katherine's Road „ 2 ... ... ... 8 ... ... 10 St. Lawrence Road K T ... 1 ... ... 1 ... ... 2 Earl's Court Road K T & B 4 1 1 ... ... ... ... 6 St. Mark's Road, Notting Hill „ 2 ... ... ... 1 ... ... 3 Earl's Court Square B 1 ... ... ... ... ... ... 1 St. Mark's Road, Fulham Road B 2 ... ... ... ... ... ... 2 Earl's Terrace K T 1 1 ... ... ... ... ... 2 St. Mary's Road K T ... 1 ... ... ... ... ... 1 East Mews Road ,, 1 ... ... ... ... ... ... 1 St. Marylebone Infirmary „ ... ... ... ... 1 ... ... 1 Edenham Street „ 2 ... ... ... 1 ... ... 3 St. Quintin's Avenue „ 2 2 ... ... ... ... ... 4 Edge Street „ ... ... ... ... 1 ... ... 1 Selwood Place B 1 ... ... ... ... ... ... 1 Edinborough Road „ 2 ... ... ... ... ... ... 2 Seymour Place B ... 3 ... ... ... ... ... 3 Egerton Gardens B 1 ... ... ... 1 ... ... 2 Shaftesbury Road „ ... 2 ... ... ... ... ... 2 Egerton Mews „ ... 1 ... ... ... ... ... 1 Silchester Road K T ... 1 ... ... 4 ... ... 5 Elgin Crescent K T 1 ... ... ... 1 ... ... 2 Silchester Terrace K T 2 ... ... ... 1 ... ... 3 Elgin Mews ,, 3 ... ... ... ... ... ... 3 Sloane Place B 1 ... ... ... ... ... ... 1 Elsham Road „ 1 ... 1 ... ... ... ... 2 Sloane Street „ 1 ... ... ... ... ... ... 1 Elvaston Place B 1 l ... ... ... ... ... 2 Southam Street K T 15 3 2 1 3 ... ... 24 Emperor's Gate „ 1 ... ... ... ... ... ... 1 South End Row „ 2 ... ... ... ... ... ... 2 Ernest Street K T ... 2 ... ... ... ... ... 2 South Street, St. Mark's B 2 1 ... ... ... ... ... 3 Essex Villas „ ... 1 ... ... ... ... ... 1 Stanford Road K T ... 1 ... ... ... ... ... 1 Evelyn Gardens B ... 1 ... ... ... ... ... 1 Stanhope Gardens B 1 ... ... ... 1 ... ... 2 Exmoor Street K T 2 ... ... ... ... ... ... 2 Stanley Crescent K T ... ... 1 ... ... ... ... 1 Stratford Road K T & B 3 ... ... ... ... ... ... 3 Faraday Road K T 5 ... ... ... ... ... ... 5 Sumner Place B ... ... ... ... 3 ... ... 3 Farmer Street „ ... ... ... ... ... ... 1 1 Sussex Villas K T ... 1 ... ... ... ... ... 1 Fenelon Road B ... 1 ... ... 1 ... ... 2 Swinbrook Road „ 10 1 ... ... 2 ... 1 14 Finborough Road „ 1 ... ... ... ... ... ... 2 Fowell Street K T 1 ... ... ... ... ... ... 1 Tabernacle Terrace K T 2 ... ... ... ... ... ... 2 Fulham Road B 1 1 2 ... 3 ... ... 7 Talbot Grove „ 8 ... 1 ... ... ... ... 9 Talbot Mews „ 1 2 ... ... ... ... ... 3 Garden Mews K T ... 2 ... ... ... ... ... 2 Tavistock Crescent „ 2 1 ... ... 1 ... ... 4 Gilston Road B 2 ... ... ... ... ... ... 2 Tavistock Mews „ 3 ... ... ... ... ... ... 3 Gloucester Road K T 3 ... 1 1 ... ... ... 5 Tavistock Road „ 6 ... ... ... ... ... ... 6 Golborne Mews „ 1 ... ... ... ... ... ... 1 Telford Road „ 5 1 ... ... ... ... ... 6 Golborne Road „ 4 ... ... ... 1 ... ... 5 Testerton Street „ ... 3 ... ... ... ... ... 3 Gol borne Terrace „ 1 ... ... ... ... ... ... 1 The Boltons B ... 1 ... ... ... ... ... 1 Gordon Place „ 1 ... 1 ... ... ... ... 2 The Triangle K T 2 ... ... ... 1 ... ... 3 Gregory Place „ 1 ... ... ... ... ... ... 1 Thorpe Mews „ 2 ... ... ... ... ... ... 2 Grove Terrace „ ... ... ... ... 1 ... ... 1 Tobin Street „ 1 ... 1 ... 2 1 ... 5 Trafalgar Place „ 1 ... ... ... 1 ... ... 2 Harcourt Terrace B 2 ... ... ... 1 ... ... 3 Treadgold Street „ 4 ... ... ... ... ... ... 4 Harrington Road ,, ... ... 1 ... ... ... ... 1 Trebovir Road B ... 1 ... ... ... ... ... 1 Hayden Place K T 2 ... ... ... ... ... ... 2 Tregunter Road „ 4 ... ... ... ... ... ... 4 Hazlewood Crescent „ 5 ... 1 ... ... ... ... 6 Treverton Street K T 3 1 ... ... 1 ... ... 5 Hewer Street „ 3 2 ... ... ... ... ... 5 Highlever Road „ 2 ... ... ... ... ... ... 2 Upper Phillimore Place K T 1 ... ... ... ... ... ... 1 High Street, Notting Hill „ 1 ... 2 ... ... ... ... 3 Uxbridge Street „ 2 ... 1 ... 1 ... ... 4 Hogarth Road B ... ... ... ... 1 ... ... 1 Holland Park K T 3 1 1 ... ... ... ... 5 Victoria Dwellings K T 5 ... ... ... ... ... ... 5 Holland Park Gardens „ 1 ... ... ... ... ... ... 1 Victoria Gardens „ 1 ... ... ... ... ... ... 1 Holland Park Road „ 1 1 ... ... ... ... ... 2 Victoria Grove „ 1 ... ... ... ... ... ... 1 Holland Park Terrace „ 2 ... ... ... ... ... ... 2 Victoria Road „ 2 ... ... ... ... ... ... 2 Holland Road „ 3 ... 1 ... ... ... ... 4 Holland Villas Road „ ... ... 1 ... ... ... ... 1 Wallgrave Road B 5 1 ... ... ... ... ... 7 Hurstway Street „ 5 1 ... ... 1 ... ... 7 Wall grave Terrace „ 2 ... ... ... ... ... ... 2 Hyde Park Gate „ ... ... ... ... 1 ... ... 1 Walmer Road K T 10 2 4 ... 4 ... ... 20 Warwick Road K T & B 2 3 ... ... 2 ... ... 7 Ifield Road B 8 4 ... ... ... ... ... 12 Westbourne Grove K T 1 ... ... ... ... ... ... 1 1nkerman Terrace „ ... 1 ... ... ... ... ... 1 West Cromwell Road B 1 5 ... ... ... ... ... 6 Western Dwellings K T 3 ... ... ... ... ... ... 3 Johnson Street K T ... 1 ... ... ... 1 ... 2 Western Terrace „ 2 ... ... ... 1 ... ... 3 West Pembroke Place „ 2 ... ... ... 1 ... ... 3 Kelso Place K T ... 1 ... ... ... ... ... 1 Wetherby Mews B 2 ... ... ... ... ... ... 2 Kempsford Gardens B 2 1 ... ... ... ... ... 3 Wetherby Terrace „ 1 ... ... ... ... ... ... 1 Kenilworth Street K T 1 ... ... ... 1 ... ... 2 Wheatstone Road K T 5 2 ... ... 2 ... ... 9 Kensal Road „ 1 2 ... ... ... ... ... 3 Wilby Mews „ 2 ... ... ... ... ... ... 2 Kensington Buildings „ ... 1 ... ... ... ... ... 1 William Street, Notting Dale „ ... ... ... ... 1 ... ... 1 Kensington Court „ 1 ... ... ... ... ... ... 1 Wornington Road „ 9 1 2 1 ... 1 1 15 Kensington Court Gardens ... „ l ... ... ... ... ... ... 1 Kensington High Street „ 2 1 ... ... ... ... ... 3 Yeoman's Row B 6 2 1 ... 1 ... ... 10 Kensington Infirmary „ 20 ... ... 2 17 ... ... 39 Young Street K T 1 ... ... ... ... ... ... 1 *In addition to the above, one case of small-pox was notified from Walmer Road, one case of typhus fever from Tobin Street, and four cases of continued fever, viz.: one each from Abingdon Villas, Cornwall Road, Ladbroke Grove, and Swinbrook Road, respectively. TABLE IX. (See following page). TABLE IX. Shewing the Localities in which fatal cases of the Principal Diseases of the Zymotic class occurred in 1892. KENSINGTON TOWN FRUSTRATION SUB-DISTRICT. Locality. Measles. Scarlet Fever. Diphtheria. Whoopingcough. Fever. Diarrhoea. Total. Locality. Measles. Scarlet Fever. Diphtheria. Whoopingcough. Fever. Diarrhoea. Total. Enteric. Simple Continued Enteric. Simple Continued Abingdon Villas 1 ... ... 1 ... ... ... 2 Linden Gardens ... ... 1 1 ... ... ... 2 Absalo'n Road 1 1 ... ... ... ... ... 2 Lonsdale Road ... 1 ... ... ... ... 2 3 Addison Road ... ... 1 ... ... ... ... 1 Manchester Road 1 ... 1 ... ... ... ... 2 Appleford Road 3 ... ... ... ... ... 1 4 Manchester Street 3 ... ... ... ... ... ... 3 Archer Mews 1 ... ... 1 ... ... ... 2 Merton Road ... 1 ... ... ... ... ... 1 Bangor Street 2 ... ... ... ... ... 1 5 Munro Mews ... ... 1 ... ... ... ... 1 Barandon Street 1 ... 1 1 ... ... 1 4 Peel Street 2 ... ... ... ... ... ... 2 Bevington Road 1 1 ... ... ... ... 1 3 Pembridge Road ... ... 1 ... ... ... ... 1 Blechynden Street 5 ... ... 1 ... ... ... 6 Pembroke Gardens ... ... 2 ... ... ... ... 2 Bolton Road ... ... 1 ... ... ... 1 2 Pembroke Square ... ... ... ... 1 ... ... 1 Bosworth Road 2 ... ... 2 ... ... 1 5 Portland Road 1 1 ... 1 ... ... 3 6 Bramley Road 3 ... ... 1 ... ... ... 4 Portobello Road ... 1 1 1 1 ... 1 5 Branstone Street 1 ... ... ... ... ... 1 2 Powis Gardens ... 1 ... ... ... ... ... 1 Brunswick Mews ... ... ... 2 ... ... ... 2 Princes Place 2 1 ... ... ... ... ... 3 Buckingham Terrace ... 1 ... ... ... ... ... 1 Princes Road 1 ... ... 1 ... ... ... 2 Chapel Road ... ... 1 ... ... ... ... 1 Queen's Road ... 2 ... ... ... ... ... 2. Charles Street, Notting Dale ... ... 1 ... ... ... ... 1 Rackham Street 1 3 1 ... ... ... ... 5 Chesterton Road ... ... 1 ... ... ... ... 1 Raymede Street ... 1 ... ... ... ... ... 1 Clarendon Road 1 ... 1 1 ... ... 2 5 Rendle Street ... ... 1 1 ... ... 1 3 Crescent Street 1 ... ... ... ... ... 1 2 Rillington Place 2 ... ... ... ... ... ... 2 Dartmoor Street ... 1 ... ... ... ... ... 1 St. Clement's Road 2 ... ... ... ... ... 1 3 Elgin Mews ... 1 ... ... ... ... ... 1 ,, Ervan's Road 2 ... 1 ... ... ... 1 4 Ernest Street 1 ... ... 1 ... ... ... 2 ,, Katherine's Road 3 ... ... ... ... ... 2 5 Golborne Road 1 ... ... 1 ... ... ... 2 Southam Street 3 ... ... 2 ... ... 3 8 Gordon Place ... ... ... ... 1 ... ... 1 Swinbrook Road ... 1 1 ... ... ... ... 2 Hazlewood Crescent 3 ... ... ... ... ... ... 3 Talbot Mews ... ... 1 ... ... ... ... 1 Hewer Street ... ... 1 ... ... ... ... 1 Talbot Grove 1 ... ... ... 1 ... 1 3 Holland Park ... ... 1 ... ... ... ... 1 Testerton Street ... ... ... 2 ... ... 1 3 Hurstway Street 1 ... 1 ... ... ... ... 2 Treverton Street ... ... 1 ... ... ... 1 2 James Street 1 ... ... 1 ... ... ... 2 Tottenham Street 1 ... ... ... ... ... 1 2 Johnson Street ... ... 1 ... ... ... ... ] Uxbridge Street 1 ... ... ... 1 ... ... 2 Kensal Road 4 ... ... 2 ... ... ... 6 Victoria & Western Dwellings ... 2 ... ... ... ... 1 3 Kensington Infirmary 5 ... 1 6 ... ... 5 17 Walmer Road 1 1 ... 1 1 ... 4 8 Kensington Park Road ... ... ... ... 1 ... ... 1 Western Terrace ... ... ... ... ... ... 2 2 Kensington Road ... 1 ... ... ... 1 2 Wheatstone Road 2 2 ... 1 ... ... ... 5 Ladbroke Grove Road 1 ... 2 ... ... ... 2 5 William Street, Notting Dale 1 ... ... 1 ... ... 2 4 Lancaster Road ... 1 ... ... ... ... 1 4 Wornington Road 2 1 ... 3 ... ... 2 8 BROMPTON SUB-DISTRICT. Ashburn Mews ... ... ... ... 1 ... ... 1 Kramer Mews 2 ... ... ... ... ... ... 2 Astwood Mews 1 ... 1 ... ... ... ... 2 Lloyd's Place ... 1 ... ... ... ... ... 1 Atherstone Terrace ... ... ... ... 1 ... ... 1 Logan Mews ... ... 1 ... ... ... ... 1 Bramham Gardens ... ... ... ... 1 ... ... 1 North Street 2 ... ... ... ... ... ... 2 Brompton Road ... 1 ... ... ... ... 1 2 Onslow Gardens ... ... ... ... ... ... ... 1 Chapel Place ... 1 ... ... ... ... ... 1 Seymour Place 1 ... ... 2 ... ... ... 3 Clifton Place 1 ... 1 1 ... ... ... 3 Shaftesbury Road ... 1 1 ... ... ... ... 2 Colbeck Mews ... 1 ... ... ... ... ... 1 Sloane Street ... 1 ... ... ... ... ... 1 Crescent Place ... ... ... ... 1 ... ... 1 Trebovir Road ... ... 1 ... ... ... ... 1 Fulham Road ... ... ... ... 1 ... 1 2 Wallgrave Roed ... 2 ... ... ... ... ... 2 Holmes' Place 2 ... ... ... ... ... ... 2 Warwick Road ... 1 ... ... ... ... 1 2 Ifield Road 2 1 ... 5 ... ... 2 10 Yeoman's Row 2 ... ... 1 ... ... ... 3 225 TABLE X. Return respecting the Vaccination of Children whose births were Registered in 1891.* 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 Vaccination. "Had Small-pox" 1891. 1 2 3 4 5 6 8 9 10 11 1st January 31st Dec. Kensington. Town 3089 2495 9 ... 285 37 ... 262 1 Brompton 734 609 ... ... 59 11 ... 55 ... Total 3823 3104 9 ... 344 48 ... 317 1 *The return for 1892, is not yet complete. 226 TABLE XI. LICENSED SLAUGHTER-HOUSES. SOUTH OF UXBRIDGE ROAD. LOCALITY. LICENSEE. 10, Kensington High Street Mr. Evans 6, Church Street, Kensington „ Blott 35, Earl's Court Road Mrs. Matson 183, Brompton Road Mr. Joyce 21, Peel Place, Silver Street ,, Osborne 15, Silver Street. Mrs. Wright 133, High Street, Notting Hill Mr. Candy 20, Addison Terrace, ditto ,, Austin NORTH OF UXBRIDGE ROAD. 2, Ledbury Mews. Mr. Hellings 23, Norfolk Terrace ,, Rawle Lonsdale Mews ,, Grove 13, Archer Mews. „ Bawcombe 10, Edenham Mews „ Goddard 61, Silchester Road „ Shattock 195, Clarendon Road ,, Thome 235, Walmer Road „ Van 41, Prince's Place. ,, Grant 10, Prince's Yard. „ Coles 4, Royal Crescent Mews. ,, Brooker 227 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 „ Cross NORTH OF UXBRIDGE ROAD. 187, Walmer Road Mr. Arnsby 27, Tobin Street. „ Copperwheat 5, Ledbury Mews. „ Liddiard 23, Bramley Road ,, Tame Portobello Road (rear of 209) Aylesbury Dairy Company