KEN 4 No. VI., 1896. REPORT on the Health, Sanitary Condition, &c. OF KENSINGTON. For the Four Week ft, May 11th to June A3 th, being the list, 22nd, 23rd, and 24th Weeks of the Registration Year, 1896. by T. ORME DUDFIELD, M.D., MEDICAL OFFICER OF HEALTH. Public Health Department, Town Hall, Kensington, W., June 16 th, 1896. Gentlemen, 1. I have to report that 282 births (males 148, females 134), and 205 deaths (males 90, females 115), were registered in the four weeks ended 13th June. After making due allowance for increase of population, the births were 13 below, and the deaths 5 above the numbers registered in the corresponding weeks in the previous ten years, 1886-95. The births were equivalent to an annual rate of 21.6 per 1,000 persons living, or 1.4 per 1,000 below the decennial average (23.0). The deaths were equivalent to an annual rate of 15.7 per 1,000, or 0.4 per 1,000 above the decennial average (15.3). The rate in the successive weeks was 15.6, 15.0, 19.3, and 12.8. The death-rate in the Metropolis was 17.1 per 1,000; 1.4 above the rate in Kensington, and 0.6 below the decennial average (17.7). Eighty-eight of the deaths of Kensington parishioners were of children under 5 years of age, including 45 under 1 year. Forty-three persons died at 60 and upwards. Thirty-four deaths were caused by the diseases of the respiratory organs, including bronchitis 19, and pneumonia 11. The deaths from phthisis were 19, from diseases of the heart, 12, and from tubercular or scrofulous diseases of children under 5 years of age, 5. 56 2.—Zymotic Diseases.—The deaths from the principal diseases of the zymotic class were 33, and 15 above the corrected decennial average number. In the Metropolis, as a whole, the deaths from these diseases were 1,112, and 301 above the corrected average. Measles.— The deaths from measles were 24, compared with 20, 32, and 45, in the three preceding four-weekly periods respectively, In the Metropolis, as a whole, the deaths from this cause were 443, and 151 above the corrected average. Whooping-Cough.—The deaths from whooping cough were 11, compared with 10, 13, and 19, in the three preceding four-weekly periods respectively. In the Metropolis, as a whole, the deatli3 from this cause were 321, and 124 above the corrected average. Diarrhoea. —The deaths from diarrhoea were 2. There had been no death from this cause in the three preceding four-weekly periods. In the Metropolis, as a whole, the deaths from this cause were 61, and 24 below the corrected average. Enteric Fever.—Two cases of enteric fever were recorded in North Kensington, both of which were treated at home. There was no death from this cause, compared with 0, 0, and 1 in the three preceding four-weekly periods. In the Metropolis, as a whole, the deaths from this cause were 22, and 11 below the corrected average. There were 83 cases in the Asylums Board Hospitals on the 13th inst., compared with 78, 77, and 81, on March 21st, April 18th, and May 16th; and 53 cases were admitted in the four weeks, compared with 30, 50, and 53 in the three preceding four-weekly periods. The notifications of cases were 162, compared with 144, 144, and 190, in the three preceding four-weekly periods. Scarlet Fever.—Sixty-nine cases of scarlet fever were recorded (45 in North Kensington and 24 in South Kensington), of which 52 (36 in North Kensington and 16 in South Kensington) were removed to hospital. There was 1 death from this cause, compared with 5, 1, and 2, in the three preceding four-weekly periods. The death occurred in hospital, and was of a North Kensington person. In the Metropolis, as a whole, the deaths from this cause were 66 (3 below the corrected average), compared with 72, 65, and 50, in the three preceding four-weekly periods. There were 2,781 cases in the Asylums Board and London Fever Hospitals on the 13th inst., compared with 2,773, 2,527, and 2,539, on 57 March 21st, April 18th, and May 16th; and 1,272 cases were admitted to the Asylums Board Hospitals in the four weeks, compared with 982, 837, and 1,003, in the three preceding four-weekly periods. The notifications of cases were 1,864, compared with 1,350, 1,224, and 1,383, in the three preceding four-weekly periods. Diphtheria.—Twenty-five cases of diphtheria were recorded (14 in North Kensington, and 11 in South Kensington), of which 19 (10 in North Kensington and 9 in South Kensington), were removed to hospital. There were five deaths from this cause (1 in hospital); 4 of North Kensington persons, and I of a South Kensington person, compared with 6, 3, and 4, in the three preceding four-weekly periods. In the Metropolis, as a whole, the deaths from this cause were 197 (77 above the corrected average), compared with 191, 183, and 161, in the three preceding four-weekly periods. There were 753 cases in the Asylums Board hospitals on the 13th inst., compared with 70t5, 671, and 710, on March 21st, April 18th and May 16th, 1896; and 415 cases were admitted in the four weeks, compared with 386, 355, and 401, in the three preceding four-weekly periods. The notifications of cases were 1,060, compared with 1,009, 785, and 890, in the three preceding four-weekly periods. Small-pox.—One case of small-pox was recorded in North Kensington and was removed to hospital. In the Metropolis, as a whole, there was no death from this cause, the corrected average being 7. There were 27 cases in the Asylums Board hospitals, and the London Small-pox hospital, Highgate, on the 13th inst., compared with 43, 16, and 20, on March 21st, April 18th, and May 16th; and 25 cases were admitted in the four weeks, compared with 27, 13, and 22, in the three preceding four-weekly periods. The notifications of cases were 17 compared with 23, 14, and 22, in the three preceding fourweekly periods. 3.—Deaths in Public Institutions.—Twenty-five deaths of parishioners were registered at the Parish Infirmary, and 29 at outlying public institutions, &c. 4.—Deaths of Non-Parishioners. —There were 43 deaths in the Parish of persons who were not parishioners; viz., 5 at the Bronipton Consumption Hospital, 36 at the St. Marylebone Infirmary, Notting Hill, and 2 at St. Joseph's House, Notting Hill. These cases are excluded from our statistics. 58 5.—Notifications of Infectious Disease in the Metropolis. I append (page 62) a summary of the cases of infectious disease notified to the several Metropolitan Medical Officers of Health (and by them reported to the Metropolitan Asylums Board as the Act directs), 3,639 in number; including small-pox 17, scarlet fever 1,864, diphtheria 1,060, and enteric fever 162. The cases notified in the three preceding four-weekly periods were 2,999, 2,601 and 2,990 respectively. 6.—Inquests.—The cause of death in 21 cases, including 7 from violence, was returned by Coroners. The cause of death in 15 of these cases is stated to have been ascertained by post-mortem examination. An inquest was held on the body of a nonparishioner. Sixteen of the 18 inquests in the Parish were held at the Coroner's Court at the Town Hall, and 2 at the St. Marylebone Infirmary, Notting Hill. 7.—Nuisance from Stable Refuse.—Several complaints of bad smells from stable refuse have been made recently by parishioners and others, in the vicinity of Chepstow Villas, Chepstow Place, Walmer Road, &c. The said smells are due to the use of peat litter, and mainly arise in the course of removal of the refuse from the premises. I have on various occasions called the attention of the Sanitary Committee to this subject, and the Committee have caused communications to be addressed to the proprietors of stables (mostly large public companies, cab proprietors, &c.) on whose premises the nuisance arose. The use of peat litter is now general at such establishments. The material remains in the stable for some considerable time, and becomes more or less charged with the products of the decomposition of animal secretions. It smells badly enough when removed from the stable for temporary deposit in the receptacle, where, in the heap, the process of putrefaction goes on with accelerated speed, the result being that when the refuse is turned over in the course of transfer to the vehicle in which it is to be removed from the premises, offensive gases of a nauseous and penetrating character are given off, to the annoyance of people in the vicinity of the premises, and of all who come near the vehicle in its transit through the streets. I am of opinion that steps should be taken to abate the nuisance on complaint, and to prohibit the recurrence thereof. The County Council's bye-law dealing with the "cleansing of receptacles for dung," requires the owner of any such receptacle, once at least in every week, to cause every such receptacle to be emptied and thoroughly cleansed. But section 36 (2) of the Public Health (London) Act provides that— 59 "Notice may be given by a Sanitary Authority (by public announcement in the district or otherwise) requiring the periodical removal of manure or other refuse matter from stables, cow-houses, or other premises; and where any such notice has been given, if any person to whom the manure or other refuse matter belongs, fails to comply with the notice, he shall be liable, without further notice, to a fine not exceeding twenty shillings for each day during which such non-compliance continues." Your Vestry have given such notice, and require the removal of manure from stables three times every week, namely, on Monday, Wednesday and Friday, or on Tuesday, Thursday and Saturday. According to my information, the requirements of the notice would appear to be generally complied with by the occupiers of the premises at which the nuisance arises to which reference is herein made. In some instances the Sanitary Committee have, upon my advice, authorised the service of a notice, in individual cases, requiring a daily removal of the refuse. But even if this notice were duly complied with, I am of opinion that, under existing arrangements, it would not be effectual to prevent the occurrence of the nuisance which arises, as before stated, in the disturbance of the offensive matter in the course of transfer from the receptacle to the removing vehicle and in its transit through the streets. It need hardly be said that the Sanitary Authority have power, not merely to serve a notice requiring abatement of a nuisance and to call upon the person "by whose act, default, or sufferance the nuisance arises or continues to do such things as may be necessary for that purpose;" but they "may also by the same or another notice served" on such person, "require him to do what is necessary for preventing the recurrence of the nuisance." They may also, "if they think it desirable, specify any works to be executed for that purpose, and may serve that notice notwithstanding that the nuisance may for the time have been abated, if the Sanitary Authority consider that it is likely to recur on the same premises." Now, acting upon my advice, the Sanitary Committee have, on more that one occasion, called the attention of persons by whose act, default, or sufferance, this nuisance arises, to a method of dealing with the refuse which would, I think, materially mitigate the cause of complaint; viz., by placing the refuse, at once on removal from the stable, in the vehicle in which it is to be taken away from the premises. By so doing, the immediate cause of the principal nuisance, viz., disturbance of the matter in transfer from the receptacle to the vehicle, would be avoided; I beg, therefore, to 60 advise that the several persons in occupation of premises in respect of which complaint has been made, or where complaint is likely to arise, be sarved with a prohibition notice, and, in case of disobedience, that proceedings be taken in the petty sessional court, under section 4 of the Public Health (London) Act, 1891, to obtain a " nuisance order," which should be both an " abatement order'' and a " prohibition order." In this connection it may be well to cite sub-section (9) of section 5, which enacts that— "If a person fails to comply with the provisions of a nuisance order with respect to the abatement of a nuisauce, he shall, unless he satisfies the court that he has used due diligence to carry out such order, be liable to a fine not exceeding twenty shillings a day during his default; and if a person knowingly and wilfully acts contrary to a prohibition .... order he shall be liable to a tine not exceeding forty shillings a day during such contrary action; moreover, the Sanitary Authority may enter the premises to which a nuisance order relates, and abate or remove the nuisance and do whatever may be necessary in execution of such order." Apart from the power conferred on the court by the above cited section, the court have further powers under section 4 which enacts, in sub-section (4), that— " When a notice has been served on a person under this section, 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 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." The powers of your Vestry, therefore, if duly supported by the decisions of the petty sessional court, are ample to secure the abatement and prevent the recurrence of the nuisance; and as the nuisance is a serious one, causing great offence to many parishioners, I am of opinion and I recommend that the necessary steps be taken to enforce the provisions of the law as above set out I will only 61 further observe that I think it probable, if due care were exercised in giving effect to the recommendation with reference to the removing vehicle, which might be a covered cart or wagon, similar in construction to a properly covered dust-cart, there would be no occasion to remove the refuse matter oftener than on alternate days as the existing regulation requires, and that any expense to which the owner of such refuse might be put, in providing a suitable vehicle, would probably be less in amount than the fines to which he would render himself liable should he continue to disobey the requirements of the notice of the Sanitary Authority and the order of the petty sessional court. 1 am, Gentlemen, Your obedient Servant, T. ORME DUDFIELD, Medical Officer of Health. To the Vestry of Kensington. [Table. 62 Cases of Jnfectious Disease notified to the several Metropolitan Medical Officers of Health, under the provisions of the Public Health (London) Act, 1891, in the Four Weeks ended Saturday, 13th June, 1896. Name of District. Small-pox. Scarlet Fever. Diphtheria. Enteric Fever. Typhus Fever. 1 Other Continued Fevers. Puerperal Fever. Erysipelas. Croup. Cholera. Totals. Population in 1891. Kensington 1 68 25 2 ... ... 1 17 ... ... 114 166,308 Battersea 2 82 29 4 ... ... ... 16 1 ... 134 150,558 Bermondsey ... 35 16 12 ... ... ... 1 ... ... 64 84,682 Bethnal Green 2 119 38 1 ... ... 4 26 4 ... 197 120,132 Camber well 1 82 106 17 ... ... 1 22 2 ... 231 235,344 Chelsea ... 32 30 3 ... 1 ... 3 1 ... 70 96,253 Clerkenwell 1 31 18 5 ... ... ... 11 3 ... 69 66,216 F ulham ... 50 20 2 ... ... 1 5 ... ... 78 91,639 Greenwich 1 70 73 1 ... i ... 22 1 ... 178 165,413 Hackney 1 119 35 2 ... ... ... 23 3 ... 183 198,606 Hammersmith ... 45 6 5 ... ... ... 7 ... ... 63 97,239 Hampstead ... 14 9 2 ... ... ... 5 ... ... 30 68,416 Holborn ... 16 11 1 ... 1 ... 7 ... ... 36 33,485 Islington 5 162 107 14 ... ... 5 35 ... ... 328 319,143 Lambeth ... 117 36 6 ... ... ... 27 1 ... 187 275,203 Lee ... 7 6 ... ... ... 1 1 ... ... 15 36,103 Lewisham ... 21 26 2 ... ... 2 5 1 ... 57 65,112 Limehouse 1 29 28 ... ... ... 1 4 1 ... 64 57,376 Mile End ... 52 46 2 ... ... 1 15 ... ... 116 107,592 Newington ... 30 39 6 ... ... ... 14 3 ... 101 115,804 Paddington ... 68 28 ... ... ... ... 9 1 ... 106 117,846 Plumstead ... 27 16 2 ... 1 3 2 ... 51 52,436 Poplar ... 77 51 14 ... ... 1 20 2 ... 165 166,748 Rotherhithe ... 8 9 7 ... ... ... 15 1 ... 40 39,255 Shoreditch ... 32 1« 6 ... 1 ... 21 ... ... 72 121,009 St. George-in-the-East ... 43 22 2 ... ... ... 6 ... ... 78 45,795 St. Geoi'ge. Hanover Sq ... 25 15 1 ... ... ... 12 ... ... 53 78,364 St. Georgc-the-Martyr ... 16 17 3 ... ... ... 4 ... 40 59,712 St. Giles, Bloomsbury ... 13 7 2 .. ... ... 6 ... ... 28 39,782 St. James, Westminster ... 9 5 ... ... ... ... ... ... 14 24,995 St. Luke, Middlesex ... 13 13 2 ... ... .. lo ... ... 43 42,440 St. Martin-in-the-Fiolds . ... 3 2 ... ... ... ... 1 ... ... 6 14,616 St. Marylebone ... 7ti 26 12 ... ... ... 18 2 ... 134 142,404 St. Olave, Southwark .... 11 2 ... ... ... ... 1 ... ... 14 12,723 St. Pancras ... 73 44 5 ... ... 1 28 1 ... 152 234,379 St. Saviour, Southwark . ... 6 8 1 ... ... ... , 1 ... ... 16 27,117 Stoke Newington ... 10 11 2 ... ... ... 3 ... ... 26 30,936 Strand ... 8 4 1 ... ... ... 1 ... 14 25,122 Wandsworth ... 65 20 5 ... 1 1 28 ... ... 120 156,942 Westminster ... 14 3 0 ... ... ... 2 ... ... 21 55,539 Whitechapel ... 42 27 2 ... ... ... 13 1 ... 85 73,552 Woolwich 1 7 10 1 ... ... ... 3 ... ... 22 40,848 City of London ... 18 4 2 ... ... ... 2 ... ... 26 37,504 Port of London 1 1 ... ... ... ... ... i ... ... 3 7 1864 1060 162 ... 6 20 478 32 ... 3,639 ions have been eliminated from the total in Kensington.