KEN 30 THE ANNUAL REPORT ON THE HEALTH, SANITARY CONDITION &c., &c., OF THE parish of St.Mary Abbotts, KENSINGTON, FOR THE YEAR 1897, BY T. ORME DUDFIELD, M.D., Medical Officer Of Health. Kensington : I'RINTED BY SAMUF.I. S1DDERS, 17 & 19, BALL STREET, KENSINGTON, W. I898. TABLE OF CONTENTS. page Kensington : Registration District and Sub-Districts 1 ,, Parliamentary Divisions of the Borough of 2 „ Sanitary Districts; Delimitations of the 2 Population, Quinquennial Enumeration of the ; in 1896 4 ,, Number of Persons of each. Sex in the Parish and in the Sub-Districts, at Age-periods ; Enumerated in 1891 5 „ of the Wards 6 Inhabited Houses, Estimated Number of ; in 1897 6 Rateable Value (1823 1897), and Population (1801-97) 7 Parish, The Growth of (Inhabited Houses; Population ; Rateable Value), since 1855 and since 1871 7 Population, Estimated, at the middle of 1897, as Basis of Vital and Mortal Statistics .- 8 Marriages and Marriage-Rate in Kensington, and in London, and in England and Wales 9 Births and Birth-Rate in the Parish and in the Sub-Districts 9 ,, ,, in the Sanitary Districts 10 ,, Excess of, over Deaths, in the Sanitary Districts, etc. 10 „ of Illegitimate Children 10 ,, Quarterly Number of, in the Parish, and the Sub-Districts 11 ,, Annual Number of, Male and Female, and Birth-Rate in the ten years 1887-96 11 Deaths and Death-Rate, in the Parish and the Sub-Districts 12 „ „ in the Sanitary Districts 12 Infantile Mortality in the Parish, the Sub-Districts, and the Parliamentary Divisions 13 ,, ,, in the Sanitary Districts, &c 14 „ „ Deaths of Children under Five Years of age 14 „ ,, in the London Sanitary Areas 14 Senile Mortality 15 Mortality, District Rates of (vide also Table at Page 17) 15 Death-Rate, The True (vide also Table at Page 19) 16 „ ,, of London, 1861-90: Increasing Longevity 20 iv. PAGE Deaths : Quarterly Number of, in the Parish and the Sub-Districts 20 Death-Rate in England and Wales, in London, and in Kensington 21 ,, ,, in Greater London 21 „ „ in the Great Towns, and in Colonial and Foreign Cities 22 Vitai. and Mortal Statistics (Kensington) in 1897 23 ,, ,, ,, „ Summary Table of 24 Death Assigned Causes of 25 Zymotic Diseases. Deaths and Death-rate from the "Seven Principal," in Kensington and in London 25 ,, ,, Deaths and Death-rate from, in the Sanitary Districts, etc 26 ,, ,, Death-rate from, in England and Wales, and in the Great Towns 26 Small-Pox, Mortality from, and Notifications of, in 1897 27 „ Notable Reduction in Mortality from, in London 27 Measles, in Kensington and in London 28 ,, Should it be made a Notifiable Disease ? 28 Scarlet Fever, in Kensington and in London 29 ,, ,, Tables, Showing Notifications ; Admissions to Hospitals; Deaths in Kensington and in London, and Cases in Hospital, in thirteen four-weekly periods, in 1897 and 1896 30 ,, ,, Statistical Returns ol Cases of, recorded in Kensington, 1887-96 (Tables) 31-32 ,, ,, Illustrative Example Showing How Disease is Spread 33 ,, ,, Prosecution for Exposure of a Case of 33 Diphtheria, in Kensington and in London 34 ,, Reduced Mortality from 34 ,, Statistical Tables of Cases of, in Kensington 35-36 ,, Anti-toxic Treatment of 87 ,, Illustrative Examples, Showing How Disease is Spread 37 „ (and Enteric Fever), Mistaken Diagnosis : Summary of Report, by Asylums Board, with reference to 39 Whooping-Cough, in Kensington and in London 41 Fever, in Kensington and in London 41 Diarrhcea, in Kensington and in London 42 ,, Infantile Mortality from, Causation of 42 Cholera, Asiatic, in English Waters 45 Plague, Apprehended Danger of Importation of 46 Influenza 47 V. PAGE Death, Assigned Causes of—continued. Venereal Diseases 48 Septic. Diseases : Puerperal Fever 48 Parasitic Diseases 49 Dietetic Diseases 49 Constitutional Diseases 49 ,, „ Rheumatism 50 „ „ Cancer 50 „ „ Tuberculosis 50 Developmental Diseases 51 Locai Diseases 51 ,, ,, Nervous System, Diseases of the 52 „ „ Circulatory System „ „ 52 „ „ Respiratory System ,, „ 53 „ „ Digestive System „ 53 „ „ Urinary System „ „ 54 „ ,, Reproductive System „ 54 Violence, Deaths from 54 III-Defined and Not-specified Causes of Death 54 Causes of Death in 1897 : Summary of Table III. (Appendix) 55 ,, ,, ,, Classified : Local Government Board's Table A 56 Public Institutions, Deaths at 57 „ ,, ,, ,, Parish Infirmary 57 „ ,, ,, ,, Biompton Hospital 59 ,, ,, ,, ,, St. Marylebone Infirmary 59 ,, „ „ St. Joseph's House 59 „ ,, ,, ,, Outlying Hospitals, etc. 59 Uncertified Deaths 61 „ ,, Report of Select Committee of the House of Commons ; and Report of the Public Control Committee of the County Council on the subject of 61 Inquests: Deaths from Violence ; Accidental, and Suicidal 63 Vaccination in Kensington in 1896 64 „ Increasing Neglect of 64 ,, Government Bill to Amend the Law, Introduced 65 vi. PAGE Metropolitan Asylum Board ; The Work of the 68 Ambulance Service : Annual Report of the Ambulance Committee 69 „ „ New Stations Erected 69 „ „ Arrangements for the Removal of Kensington Patients 73 Hospital Accommodation : Provision of 74 „ „ Fever Hospitals 74 ,, „ Small-pox Hospitals 76 „ „ Existing and Projected 77 „ ,, The Park Hospital Opened 78 ,, ,, Fever, Deficiency of, in 1897 79 Notification of Infectious Disease, in Kensington and in London 81 Local Government Board's Table B 82 ,, in London Sanitary Areas 83 ,, in Four-Weekly Periods, in Kensington and in London 84 Factory and Workshop Act; Duties of the Sanitary Authority with respect to Inspection of Workshops 85 „ „ Lady-Inspector, The Work of the 87 „ ,, Lady-Inspector's Annual Report 88 Sanitary Inspectors, The Work of the 93 Statutory Notices and Written Intimations 93 Legal Proceedings : Summonses 94 „ „ Fines for Offences 94 Sanitary Administration, Hindrances to 97 „ „ „ Report, with reference to, by the Law Committee 99 Offensive Businesses 101 „ ,, Fat-Extractor 101 „ „ Marine Stores 101 „ „ Brickburning 101 Slaughter Houses, The Licensed 102 Cow-Houses, The Licensed 102 Bakehouses 103 Offensive Smells in Streets 104 ,, ,, ,, Report on, by the Law Committee 105 Sewer-Ventilation and Sewer Smells, Report on, and Recommendations by the Medical Officer 107 Vii. PAGE. Combined Drainage : Drain or Sewer ? 114 Drainage Bye-Laws : Action of the County Council 115 Sewerage, Insufficient ; Flooding of Basements 115 House-to-House Inspection 116 Housing of the Working Classes 117 „ ,, ,, Bye-Laws for Houses let in Lodgings 117 „ „ „ Registered Houses in the Sanitary Districts 120 ,, „ „ Streets, the Houses in which should be Registered 121 ,, „ „ Overcrowding; Proposed New Bye-Law 122 Common Lodging Houses, List of 123 ,, „ „ What Constitutes 124 ,, ,, „ Control of 125 " Notting Dale " Special Area 126 „ ,, House to House, Inspection of 126 ,, ,, Street Population, Lodging Houses, etc., in 126 „ ,, Results of the Ilouse-to-House Inspection of (Table) 128 ,, ,, Houses let in Lodgings in : Particulars of (Table) 129 ,, ,, Population; Great Increase of 130 ,, ,, Pauper Sickness: Ill-door or Infirmary Cases 133 ,, ,, ,, ,, Infirmary Admissions: Particulars with respect to (Tables) 134-135 „ ,, ,, ,, Diseases in Infirmary Cases 136 ,, ,, ,, ,, Out-door or Home Cases 136 ,, ., ,, ,, Infectious Disease: Notifications 137 ,, ,, ., * ., Particulars of Cases, Out-door Sick (Table) 138 ,, ,, Diseases in Out-door on Home Cases (Table) 139 „ ,, Mortality, in 1896-97 140 ,, ,, Queen'Jubilee and 142 ,. ,, County Council requested (but decline) to acquire the Houses in 143 ., ,, Improvements effected in; by the Action of the Vestry 144 ,, Final Observations on the 145 viii pagf. Paving of Yards 146 „ ,, Views of ihe Medical Officer to the Local Government Board, with reference to 148 Open Spaces about Buildings, Encroachment upon 150 Refuse Matter, Prevention of Nuisance from 150 ,, „ Offensive; Removal of through Streets 151 ,, „ House Refuse 152 „ ,, „ „ Should be burned 153 „ ,, Stable Refuse 153 „ ,, „ ,, Nuisance from 154 „ ,, ,, „ Removal of; Action by the County Council with reference to 155 Public Mortuary : Bodies admitted into the 160 Coroner's Court 160 Disinfection, Enhanced and Increasing Cost of 161 Disinfecting Station, Question of Providing Considered 162 Shelter for Persons Unhoused during the Process of Disinfection ; Still a Desideratum 163 Cleansing of Persons Act Passed 164 Public Baths and Washhouses, Separate Washhouses a Desideratum 165 Sanitary Conveniences (Public), Insufficient Number of 165 Water Supply, Observations on the 166 „ ,, Cisterns and Bye-Laws 157 „ ,, Deterioration of Water in Dirty Cisterns 167 ,, „ Cutting-off Powers of the Water Companies 171 Conclusion 172 ix. APPENDIX STATISTICAL AND OTHER TABLES. page. Table I. Estimated Population of Kensington, in 1897, and Ten previous years, 1887-96 : Number of Inhabited Houses, and number of Marriages, Births, Deaths, &c. 174 ,, II. Birth-rate and Death-rate ; Death-rates of Children ; Deaths in Public Institutions, in 1897 ; and in 1887-96 175 ,, III. Deaths Registered from all Causes in 1897 176 (For Summary of Table III., see Page 55). ,, 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 181 ,, V. Deaths in 1897, and 1887-96, from the Seven Principal Diseases of the Zymotic class ; in Kensington and in London ; and in England and Wales 182 ,, VI. Summary of the Work executed by the Sanitary Inspectors in 1897 183 ,, VII. Death-rates, General and Zymotic ; in Kensington ; and in London ; and proportion of Deaths from Zymotic Diseases to Total Deaths, in 1897 and in 1887-96 184 VIII. Comparative Analysis of the Mortality, in London and in Kensington, in 1897 ; Percentages 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 ; and of Inquest Cases ; and of Deaths at Public Institutions, to Total Deaths 185 IX. Localities where Fatal Cases of the more important of the Zymotic Diseases occurred in 1897 186 ,, IXa. Streets, &c., in which cases of Infectious Disease were notified, in 1897, under the provisions of Section 55 of the Public Health (London) Act, 1891 188 ,, X. Vaccination Officer's Annual Return for 1896 196 XI. Slaughter-houses, Licensed ; and names of Licensees 197 ,, XII. Cow-houses, Licensed ; and names of Licensees 198 FORTY-SECOND ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH, Being for the Year, 1897. To the Vestry of the Parish of St. Mary Abbotts, Kensington. Gentlemen, The vital and mortal statistics in this report relate to a period of fifty-two weeks commencing January 3rd, 1897, and ending January 1st, 1898, comprised in the registration year, 1897. Registration District and Sub-Districts.—The Registration District of Kensington (No. i b in the Registrar-General's list), comprises an area of 2,190 acres, unequally divided into two sub-districts, respectively named Kensington Town (hereinafter for brevity designated town) and Brompton. The Town sub-district comprises an area of 1,497 acres, the area of Brompton being 693 acres. The Town sub-district comprises all that portion of the parish 2 north of Kensington High-street and Kensington-road, together with a portion of the parish south of those roads and north of a line extending, from west to east, along Pembrokeroad, Stratford-road, and south of the Workhouse, then through Cornwall-gardens to Queen's-gate-place,and thence northwards so as to include Queen's-gate, Jay's mews and Kensingtongore. The Brompton sub-district comprises the remainder of the parish south of the above described line. Parliamentary Divisions. North Kensington and South Kensington are the two divisions of the Parliamentary Borough, separated by High-street, Notting-hill, and Holland-park-avenue: North Kensington comprises the north, the north-east and the north-west sanitary districts, together with a portion of the central district: South Kensington comprises the remainder of the central district, and the south-east and the south-west sanitary districts. The Sanitary Districts are six in number, delimited as follows :— The North Sanitary District comprises the portion of the parish to the north of the Hammersmith and City railway, with the exception of a few streets at the south-west corner of that area. The North-west Sanitary District includes the streets above referred to, its northern and eastern boundaries extending in a somewhat curved line from Latimer-road, along Walmer-road to St. Katharine's-road : it is bounded on the west by St. Ann's-road (even numbers) to Latimer-road. [The "Notting-dale" special area, hereinafter referred to, comprises Bangor-street, Crescent-street, St. Katharine's-road, Kenley (late William) street, and part of Sirdar (late St. Clement's) road in the northwest district.] 3 The North-east Sanitary District comprises the remainder of the area between the railway (north), and a line running through Clarendon-place, St. John's-road, Kensingtonpark-gardens, and Chepstow-villas (south) : it is bounded on the west by Walmer-road, and on the east by the parish boundary. The Central Sanitary District takes in the area between High-street, Notting-hill, and Holland-park-avenue (north), and Kensington High-street and Kensington-road (south); it also comprises the streets in North Kensington to the south of the north-west and north-east districts respectively. The South-east and the South-west Sanitary districts, south of Kensington High-street and Kensingtonroad, lie east and west of a line running along Wright's-lane, Marloes-road.Lexham-gardens, Collingham-road, The Boltons, and Gilston-road, to Fulham-road. 4 POPULATION. The table on page 5 shows the relative number of persons of each sex as ascertained at the census of 1891, grouped according to age; (a) in the entire parish,(b) in the KensingtonTown sub-district, and (c) in the Brompton sub-district. There is no later information as to age-distribution of the population,nor will there be until the next census is taken in 1901. In March, 1896, an enumeration of the population was made, in conformity with the provisions of the Equalization of Rates Act, 1894, the only particulars required of the householder being the sex of each person, and his or her relationship to the head of the family. A full account of the result of this enumeration is contained in the annual report for 1896, pages 3-11, inclusive. It will suffice to state here that the population, as then ascertained, was 170,465, as compared with 166,308 in 1891: increase, 4,157. The males numbered 67,002, the females 103,463, the excess of females being 36,461. In the Town sub-district the population was 122,164, as compared with 118,751 in 1891: increase,3,413. The males numbered 51,101, the females 71,063: excess of females, 19,962. In the Brompton sub-district the population was 48,301, as compared with 47,557 in 1891 : increase 744. The males numbered 15,901, the females 32,400: excess of females, 16,499. The parliamentary division of North Kensington comprised 85,371 persons, viz., males 37,964, and females 47,407: excess of females, 9,443. The division of South Kensington comprised a population of 85,094 persons; viz., males 29,038, and females 56,056: excess of females 27,018. It thus appears that there has been a sensible increase in the population since the census of 1891, and more especially in the Town registration sub-district. The increase in this sub-district in the five years 1891-96 was, as we have seen, 3,413, as compared with a decrease of 1,390 in the ten years 1881-91. In the Brompton sub-district, the increase in the five years was 744, following upon an increase of 4,547 in the ten years 1881-91. 5 (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 7466 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 34,874 72 1231 11269 10388 4825 3083 1952 1321 612 116 5 34,874 Excess of females 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 to 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 13330 9172 6592 4060 2450 969 154 6 69,384 Females Males 49,367 5905 10287 9540 7815 6377 4696 2741 1472 470 63 1 49,367 Males Excess of Females 20,017 71 905 5943 5515 2795 1896 1319 978 499 91 5 20,017 Excess of Females Total of both sexes 118,751 11881 21479 25023 21145 15549 11288 6801 3922 1439 217 7 118,751 Total of both sexes. (c) BROMPTON SUB-DISTRICT. All Ages. Under Five Years. 5 to 15. 15 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 to 75. 75 to 85. 85 to 95. 95 and upwards. All Ages. Females 31,207 1490 3002 8733 7817 4348 2828 1714 917 309 48 1 31,207 Females Males 16,350 1489 2676 3407 2944 2318 1641 1081 574 196 23 1 16,350 Males Excess of Females 14,857 1 326 5326 4873 2030 1187 633 343 113 25 — 14,857 Excess of Females Total of both sexes 47,557 2979 5678 12140 10761 6666 4469 2795 1491 505 71 2 47,557 Total of both sexes *** The death-rate at the different age-periods will he found at page 19 6 DISTRIBUTION OF THE POPULATION. Population of the Wards.—I subjoin a statement of the population of the Wards, as ascertained in March, 1896:— Name of Ward. Enumerated Population.—1896 Males. Females. Total. Golborne Ward 17,690 19,795 37,485 Norland Ward 11,726 14,298 26,024 Pembridge Ward 8,548 13,316 21,864 Holland Ward 7,155 12,728 19,883 Earl's Court Ward 5,270 10,690 15,960 Queen's Gate Ward 4,997 9,577 14,574 Redcliffe Ward 6,956 13,606 20,562 Brompton Ward 4,660 9,453 14,113 Total 67,002 103,463 170,465 The first three Wards are in North Kensington, the last five in South Kensington. Inhabited Houses.—No information was obtained at the quinquennial enumeration in 1896 as to the number of inhabited houses. Theoretically this is to be regretted, seeing that estimates of population, based on the rate of increase in the previous inter-censal period, are checked by the number of inhabited houses, and the average number of persons to a house as ascertained at the preceding census. In practice, however, this test has not proved a very reliable one, as was explained in the last annual report, pages 11-13. The conclusion arrived at, after full consideration, is that, under existing circumstances, the safest course is to assume, year by 7 year, during the decennium, the same average number of persons to a house as in 1891 (viz., 7.53), and this would give 22,669 as the number of inhabited houses at the middle of 1897. Population and Rateable Value.—The subjoined figures exhibit the development of the parish, in population and rateable value, during the present century. The Year. Population. Rateable value of Property. The Year 1801 8,556 £75,915 1823 1821 14,428 93,397 1833 1841 26,834 142,772 1843 1851 44,053 257,103 1853 1861 70,108 444,030 1863 1871 120,299 975,046 1873 1881 163,151 1,711,495 1883 1891 166,308 2,037,221 1893 1897 170,700 £2,119,499 (October) 1897 Growth of the Parish.—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 1897 Increase in 41 years Number of Inhabited Houses 7,600 22,669 15,069 Population 57,000 170,700 113,700 Rateable Value of Property £308,000 £2,119,499 £1,811,499 The increase in all respects within the last twenty-six years, the period over which my official experience extends, is not inconsiderable, as the subjoined figures show:— 1871 1897 Increase in 26 years. Number of Inhabited Houses 15,735 22,669 6,934 Population 121,000 170,700 49,700 Rateable Value £935,720 £2,119,499 £1,183,779 8 From the foregoing figures we learn that in 1897 the population was nearly 20 times as large as in the first year of the century; and that the rateable value of property was more than 27 times as great as in 1823, the first year in respect to which I possess information. Since 1856, the rateable value has increased nearly seven-fold; the mere increase in the last 26 years being nearly four-fold the total in 1856; since which date the population and the number of inhabited houses have increased nearly three-fold. POPULATION IN 1897. For the purposes of the present report the population of the parish, as a whole, at the middle of 1897, and that of the sub-districts, the parliamentary divisions, the sanitary districts, and the "Notting-dale" special area, will be taken to be as follows:— The Parish 170,70 Sub-Districts:— Kensington Town 122,400 Brompton 48,300 Parliamentary Divisions:— North Kensington 86,440 South Kensington 84,260 Sanitary Districts:— North 32,850 North-East* 30,140 North-West* 16,450 "Special Area" 4,000 Central* 27,140 South-East 32,140 South-West 31,980 * The figures in respect of the North-East, the North-West, and the Central districts are not comparable with those for 1896, the boundaries of each of these districts having been varied. This observation applies to all the statistics of these districts throughout the report. 9 MARRIAGES AND MARRIAGE RATE. The marriages in the parish in 1897 were 1,681, as compared with 1,537,1,455,and 1,706, in the preceding three years respectively. Of these marriages there were celebrated— By the Church (69.1 % of total marriages) 1,162 At Roman Catholic places of worship 124 At other Nonconformist places of worship 72 At the Superintendent-Registrar's office 323 The marriage rate (i.e., the number of persons married to 1,000 living) was 19.7, as compared with 18.4, 17.4, and 20.1, in the preceding three years respectively. The marriage rate in England and Wales, was 16.0 per 1,000, as compared with 15.0, 15.0, and 15.8 in the preceding three years. The rate in London was 18.5 per 1,000, as compared with 17.0, 17.1, and 18.0 in the preceding three years respectively. BIRTHS AND BIRTH-RATE. The births registered were 3,683, viz., males, 1,839, and females, 1,844; in the Town sub-district, which includes the parish infirmary, 3,133, and in Brompton 550. The births were 145 below the corrected decennial average (3,828): 194 of them were of illegitimate children. The 3,683 births were 36 fewer than the number registered in the previous year (3,717), but as the registration year 1896 comprised a period of 53 weeks, the births in 1897 were 35 more than in 1896, after correction for the 53rd week. The births were, however, 358 fewer than the number in 1872 (4,041), when the population (127,400) was 43,300 less than in 1897. The Kensington birth-rate, which is considerably below that of London, as a whole (30.0 in 1897), has been declining since 1868, in which year it was 33.1 per 1,000. In 1897 it was 21.6 per 1,000, and 0.8 below the decennial average (22.4). The rate in the sub-districts was : Town, 25.6 ; Brompton, 11.4 per 1,000. In the Town sub-district the registered births were 964 more in number than the deaths, whilst in the Brompton sub-district, the excess of births over deaths was to the number of 52 only. 10 Births and Birth-Rate in the Sanitary Districts.— The births in North Kensington, i.e., the part of the parish north of Holland-park-avenue and High-street, Notting-hill, were 2,579 and the birth-rate 29.8 per 1,000 persons living. The births in South Kensington, i.e., the part of the parish south of those streets, were 1,104 and the birth-rate 13.1 per 1,000. The birth-rate in the several sanitary districts was as follows:— North 1,070 births, or 32.6 per 1,000 persons living. North-East 581 births, or 19.3 per 1,000 persons living. North-West 682 births, or 41.5 per 1,000 persons living. Central 542 births, or 20.0 per 1,000 persons living. South-East 350 births, or 10.9 per 1,000 persons living. South-West 458 births, or 14.3 per 1,000 persons living. The high birth-rate in the North-West district is suggestive of an under-estimate of the population, which, however, is based upon the census of March, 1896. At that time the population of the "special area" was ascertained at 3,740 or thereabouts. In June, 1896, it was found to have increased to 4,000 Inspector Steward, I may add, has for some time .past had suspicions that the population of his district, as a whole, was increasing somewhat rapidly. The births in the "Notting-dale" special area were 130, or 32.5 per 1,000 persons living. In the several sanitary districts the excess of births over deaths was as follows: North, 462; north-east, 197; northwest, 153; central, 103; south-east, 58; south-west, 43. In North Kensington the births exceeded the deaths by 875; the excess of births in South Kensington being to the number of 141 only. In the "Notting-dale" special area the deaths exceeded the births to the number of 93. The registered births of illegitimate children in the parish, as a whole, were, as stated, 194 (27 fewer than in 1896), viz., males, 97, and females, 97. Of these births 183 were registered in the Town sub-district, which includes the parish workhouse, at which institution out of 149 births (males 65, females 84, including nine of still-born children—males 5 females 4), 44 were illegitimate. In the parish generally the 11 illegitimate births formed 5.3 per cent, of total births, as compared with rates of 5.8, 5.0, and 5.9, in the preceding three years respectively. The subjoined table shows the quarterly number of births of males and females, in each of the sub-districts:— Kensington Town Brompton Males Females Total Males Females Total Parish 1st Quarter 418 424 842 74 59 133 975 2nd „ 417 380 797 68 57 125 922 3rd „ 360 413 773 79 87 166 939 4th „ 353 368 721 70 56 126 847 Totals 1,548 1,585 3,133 291 259 550 3,683 The subjoined table shows the population, the number of births, and the birth-rate for each of the ten years 1887-96:— The Year Population Total Births Males Females Birth-rate per 1,000 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 166,500 3,847 1,935 1,912 23.1 1892 167,200 3,718 1,867 1,851 22.3 1893 167,900 3,661 1,893 1,768 21.9 1894 168,600 3,665 1,883 1,782 21.9 1895 169,300 3,621 1,861 1,760 21.4 1896 170,000 3,717 1,943 1,774 21.4 Totals 37,508 19,077 18,431 Average 22.4 Excess of male births in the ten years 646 Excess of births over deaths in the ten years 9,322 Estimated increase of population in the ten years 4,860 Estimated loss of population, by migration or removals, in the ten years 4,462 12 DEATHS AND DEATH-RATE. The deaths registered, inclusive of 333 deaths of parishioners at outlying public institutions, etc., but exclusive of deaths of non-parishioners at public institutions, etc., within the parish, were 2,667 (males, 1,335; and females, 1,332); and 211 fewer than the corrected decennial average (2,878). Of these deaths 2,169 were registered in the Town sub-district, and 498 in Brompton. The death-rate, which in the preceding three years had been 15.6, 16.2, and 16.7, per 1,000, respectively, was 15.6 in 1897, and 1.2 below the decennial average (16.8), and 2.6 below the rate in the metropolis, as a whole (18.2); this, moreover, being 1.7 below the decennial average (19.9). The rate in the sub-districts was : Town, 17.7; Brompton, 10.3 per 1,000, as compared with 18.9 and 11.1, respectively, in 1896. The sex death -rate was, approximately, of males 19.9 per 1,000, of females 12.9 per 1,000, as compared with 20.9 and 14.5, respectively, in 1896. « The deaths in North Kensington were 1,704, and the death-rate 19.7 per 1,000. The deaths in South Kensington were 963, and the death-rate 11.4 per 1,000. Deaths and Death-rate in the Sanitary Districts.—The death-rate in the sanitary districts was as follows:— North 608 deaths, or 18.5 per 1,000 persons living. North-East 384 deaths, or 12.7 per 1,000 persons living. North-West 529 deaths or 32.2 per 1,000 persons living. Central 439 deaths, or 16.2 per 1,000 persons living. South-East 292 deaths, or 9.1 per 1,000 persons living. South-West 415 deaths, or 13.0 per 1,000 persons living. The deaths in the "Notting-dale" special area were 223, or 55.7 per 1,000 persons living. 13 INFANTILE MORTALITY. The deaths under one year, which in 1897 were 609, had been, in the preceding three years 636, 624 and 643, successively. Of the 609 deaths, 98 (or 16.1 per cent.) were of illegitimate children ; the ratio of deaths of illegitimate children to births registered as illegitimate (194) being 505 per 1,000. Of the 609 deaths, 148 occurred within one month after birth, including 80 in the first week, 36 in the second week, 25 in the third week, and 7 in the fourth week. In the second month of life there were 83 deaths ; in the third month 50 deaths; in the fourth month 58 deaths ; in the fifth month 51 deaths ; in the sixth month 45 deaths; in the seventh month 42 deaths ; in the eighth month 33 deaths; in the ninth month 33 deaths ; in the tenth month 29 deaths; in the eleventh month 21 deaths; and in the twelfth month 16 deaths. It is somewhat of an opprobrium to Kensington that the rate of infantile mortality, calculated upon the basis of the number of deaths under one year to 1,000 births registered, is invariably above that of London as a whole. The year to which this report relates was no exception to the rule, for whilst the deaths under one year in London were at the rate of 159 per 1,000 births* the corresponding ratio in Kensington, as a whole, was 166 ; the comparative numbers in 1896 having been 161 and 176. The rate differed greatly in different parts of the parish, the bad pre-eminence of which, in this respect, is due to the excessive infantile mortality in certain districts in North Kensington. The deaths of infants under one year to births registered, in North Kensington, 462 in number, were equal to 179 per 1,000 births, the corresponding ratio in South Kensington being 133 per 1,000, the deaths numbering 147 only. Of the 609 deaths, 78 occurred in the Brompton sub-district, being equal to 142 per 1,000 births, and 531 in the Town sub-district, being equal to *The London rate was 4 above the decennial average. The rate in the 32 great towns of England and Wales, London being excluded, was 189; in England and Wales, as a whole, it was 156 only per 1,000. 14 169 per 1,000 births. In the several sanitary districts the deaths and death-rate of infants under one year, were as follows:— North 173 deaths equal to 162 per 1,000 births. North-east 89 deaths equal to 153 per 1,000 births. North-west 157 deaths equal to 230 per 1,000 births. Central 84 deaths equal to 155 per 1,000 births. South-east 41 deaths equal to 117 per 1,000 births. South-west 65 deaths equal to 142 per 1,000 births. In the "Notting-dale" special area the deaths of infants under one year were 56 and equal to 431 per 1,000 births. The deaths of children over one year and under five years of age, were 303 in number ;the deaths under five years therefore were 912 (as compared with 1,022, 951, and 1,111, in the preceding three years successively), being equal to 248 per 1,000 births; the relative proportion, in London, as a whole, being 241. The deaths of illegitimate children under five years of age—118, 129, and 104, in the preceding three years respectively—were 126 in 1897 (63 of each sex), of which 107 were registered in the Town sub-district, and 19 in Brompton. These deaths were equal to about 63 per cent, on the 194 births registered as illegitimate. Of the 126 children, 28 only outlived the first year. Infantile Mortality in London.—It has already been stated that the deaths of children under one year of age in Kensington, to 1,000 births were 166, and that the proportion in London, as a whole, was 159. The Kensington rate was exceeded in 15 of the sanitary districts, viz.: St. Pancras, 168; Poplar, 170; Hammersmith and Bethnal Green, 171; Rotherhithe, 174; Newington, 177; St. Martin-in-the Fields, 178; Shoreditch, 183; Clerkenwell and Holborn, 184; St. George's, Southwark, 189; Bermondsey, 190; Limehouse, 193: St. Saviour, Southwark, 195; and St. George-in-theEast, 197. In Westminster the rate (166) was the same as in Kensington. In the remaining 27 districts the rate was lower than in Kensington, and in 20 of them it was lower than the rate in London. 15 SENILE MORTALITY. At sixty years of age and upwards there were 735 deaths, as compared with 671, 784, and 778, in the preceding three years successively. These deaths were equal to 276 per 1,000 on total deaths, the equivalent proportion in London, as a whole, being 236 per 1,000. District Rates of Mortality.—The table at page 17 shows the death-rate in the metropolis, the parish, the subdistricts, the parliamentary divisions and the sanitary districts, including the "Notting-dale" special area—not only for the year, as a whole, but also for each of the thirteen fourweekly periods covered by my monthly reports. In any comparison of the respective rates with those in 1896, it must be remembered that the boundaries of three of the sanitary districts (north-east, north-west and central) as delimited in 1897, differ widely from the districts of the same names as constituted in 1896. It will be observed that, as usual, the death-rate in the Town sub-district is far higher than that in the Brompton sub district, and the same observation applies to the parliamentary division of North Kensington as compared with the southern division of the borough. In three of the sanitary districts the death-rate exceeded that of the parish, as a whole (15.6 per 1,000) viz. the central (16.2), the north (18.5), and the north-west (32.2). The last named district, as now delimited,and containing a population of 16,450, includes the so-called "Notting-dale" special area. The mortal statistics of the district are unsatisfactory: the deathrate in 1897 (32.2 per 1000) was considerably more than double the rate in the remainder of the parish (13.9 per 1,000); the zymotic death-rate (4.18 per 1000) was excessive, being more than two-and-a-half times as high as that of the remainder of the parish (l.6 per 1,000); the waste of infant life was also excessive, the deaths under one year (157) being equivalent to 230 per 1,000 births registered, the infantile deaths in the remainder of the parish being in the proportion 16 of 148 per 1,000 births. These figures show to what a large extent the statistics of this district, which contains considerably less than a tenth of the population, spoil those of the parish generally. But if matters were bad in the district, as a whole, they were still worse in the "Notting-dale" special area, which contains a population of 4,000 souls; for its deathrate (50.0 per 1,000 in 1896) was 55.7 per 1,000, as compared with 15.6 in the parish, as a whole, and 24.6 in the north-west district less the special area: the zymotic death-rate was 6.25 per 1,000 persons living, or three-and-a-half times as great as that of the parish, as a whole. The deaths at all ages were 93 more than the births ; the deaths of children under one year of age being in the proportion of 431 per 1,000 (or 43.1 per cent.) on the births registered. The True Death-Rate in 1897.—From time to time observations are made which indicate misapprehension of the signification of the expression "death-rate" as used, in the table at page 17, which shows the rate of mortality for each of the four-weekly periods covered by the monthly reports. It may be well, therefore, to explain by an illustration what is really meant. The deaths in the last four-weekly period of the year were 226, and the death-rate was stated to be 20.0 per 1,000. This statement implies simply, that if the deaths for the whole year were in the same proportion to the population, as in the 49th—52nd weeks, the annual death-rate would be 20.0 per 1,000 of the estimated population in the middle of the year. The estimated population in 1897 was 170,700: the deaths registered were 2,667; the death-rate, therefore, was 15.6 per 1000 (2,667 ÷ 170,700 = 15.6). This method of calculating the death-rate is customary, and is that used by the Registrar-General. The death-rate so calculated is, of course, an uncorrected one, as it does not take cognizance of the relative numbers of the sexes, nor of the Death-rate in the Metropolis and in Kensington, and in certain Districts of the Parish, during the thirteen four-weekly periods ended January 1st, 1898, and in the registration year, 1897. Four Weeks ended. Metropolis. Parish. Sub-Districts. Parliamentary Divisions. Sanitary Districts. "Notting Dale" Special Area. Kensington Town. Brompton. North. South. North. NorthEast. NorthWest. Central. SouthEast. Southwest. January 30 18.6 15.7 17.4 11.3 19.4 11.9 18.2 16.4 30.0 12.9 8.1 15.0 52.0 February 27 19.0 15.9 17.6 11.6 19.6 12.2 17.4 15.5 28.4 17.2 1 0.1 13.0 52.0 March 27 17.9 15.9 17.9 10.7 19.7 12.0 19.0 11.6 30.8 20.1 12.1 9.3 39.0 April 24 17.3 14.2 15.8 10.2 17.3 11.1 15.8 10.4 29.2 13.9 8v5 14.6 45.5 May 22 15.8 13.8 15.5 9.4 16.1 11.4 14.2 12.1 22.1 16.3 6.9 15.4 42.3 June 19 14.7 14.2 16.1 9.2 16.4 11.9 13.1 11.6 29.2 18.2 10.5 10.2 61.8 July 17 14.9 14.2 16.5 8.6 20.0 8.3 15.4 13.8 37.9 12.5 7.3 9.8 74.8 August 14 23.9 17.0 20.1 9.2 22.4 11.4 22.6 13.4 35.6 19.2 7.7 12.6 58.5 September 11 19.5 14.4 15.8 10.8 18.6 10.0 21.0 7.3 30.8 13.9 8.1 12.6 35.8 October 9 15.7 14.2 15.7 10.5 17.8 10.4 17.8 12.2 22.9 13.9 9.3 12.6 39.0 November 6 17.3 16.5 19.3 9.4 22.1 10.8 22.2 12.1 40.3 14.8 7.7 13.0 91.0 December 4 19.9 17.1 19.6 10.5 21.2 12.8 20.2 12.9 33.2 20.1 11.3 12.6 58.5 January 1, 1898 22.2 20.0 22.8 12.7 25.6 14.2 23.7 15.5 47.4 17.2 10.5 17.9 74.8 Death-rate for the Year 1897 18.4 15.6 17.7 10.3 19.7 11.4 18.5 12.7 32.2 16.2 9.1 13.0 55.7 17 18 tion of the population. Correction for these data involves addition to, or subtraction from, the "recorded death-rate," as compared with the " standard death-rate." The necessity for such correction in this parish is obvious, having regard to the great excess of females in the population, and to the lower death-rate in the female sex as compared with the rate in the male sex. As has already been stated, females are, approximately, 36,500 in excess of males, the relative numbers of the two sexes being, males 67,150, and females 103,550. The deaths among the 67,150 males (1,335) were three in excess of the deaths among the 103,550 females (1,332). The death-rate in the male sex was, in round numbers, 20 per 1,000, as compared with a rate of 13 per 1,000 in the female sex. It must be obvious, therefore, that if the numbers of the sexes had been equal, the deathrate would have been somewhat higher than the recorded rate of 15.6 per 1,000. The Registrar-General in his annual summary for 1892 dealt with this question, and gave the "factor for correction for sex and age distribution" in the thirty-three great towns of England and Wales; and in his annual report for 1893, the Medical Officer of Health to the County Council gave the factor for each of the sanitary districts of London. Corrected after the method indicated, the death-rate of Kensington in 1897 becomes (instead of 15.6 per 1,000) one of about 17.2 per 1,000; and the rate for London, as a whole, about 19.4 instead of 18.2. The true death-rate is that which shows the mortality per 1,000 living of each sex at different age-periods, and this is shown in the table at page 19. The True Death-Rate in Kensington in 1897. Age Period. Population. Deaths. Death-Rate. Both sexes. Males. Females. Both Sexes. Males. Females. Both Sexes. Male Sex. Female Sex. Under five years of age 15,253 7,590 7,663 912 488 424 59.8 64.2 55.3 Five and under 15 27,870 13,311 14,559 106 58 48 3.8 4.3 3.2 Fifteen and under 25 38,146 13,290 24,856 104 53 51 2.7 3.9 2.1 Twenty-five and under 35 32,750 11,044 21,706 150 61 89 4.6 5.5 4.1 Thirty-five and under 45 22,802 8,925 13,877 252 128 124 11.1 14.3 8.9 Forty-five and under 55 16,174 6,505 9,669 250 127 123 15.5 19.5 12.7 Fifty-five and under 65 9,849 3,923 5,926 292 150 142 29.6 38.2 23.9 Sixty-five and under 75 5,557 2,101 3,456 308 149 159 55.4 70.9 45.9 Seventy-five and upwards 2,299 773 1,526 293 121 172 127.4 156.5 112.7 Totals 170,700 67,462 103,238 2,667 1,335 1,332 115.6 19.8 12.9 19 20 As showing the increasing longevity of people of both sexes, in London, and the greater expectation of life in the female sex as compared with the male sex, the subjoined statement of the death-rate in London, in three decennial periods, as reported by the Medical Officer of Health to the County Council, will repay perusal. Age Period. Males. Females. 1861-70 1871-80 1881-90 1861-70 1871-80 1881-90 All ages. 26.55 24.38 22.10 22.34 20.60 18.83 The subjoined table shows the quarterly number of deathsin Kensington, of males and females, in each of the subdistricts. Kensington Town. Brompton. Males. Females. Total. Males. Females. Total. Parish. 1st Quarter 290 252 542 56 85 141 683 2nd „ 247 225 472 55 52 107 579 3rd „ 260 272 532 67 50 117 649 4th „ 298 325 623 62 71 133 756 1,095 1,074 2,169 240 258 498 2,667 The Births were, of Males, 1839 The Deaths were, of Males, 1,335 „ Females, 1,844 „ Females, 1,332 Total Births, 3,683 Total Deaths, 2,667 Deduct 2667 Deaths. Shows 1,016 excess of Births over Deaths. Estimated increase of population in the year, 700. 21 DEATH-RATES IN ENGLAND AND WALES; AND IN LONDON; AND IN OTHER LARGE TOWNS. 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 1897, was 17.4 per 1,000, and was lower than the rate in any previous year, excepting 1894 and 1896. As compared with the rate in the ten years 1887-96, the deathrate in 1897 shows a decrease of 1.2 per 1,000. The rate in London, as already stated, was 18.2 per 1,000, being 1.7 below the decennial average (19.9). The subjoined table shows the annual death-rate per 1,000 persons living, in each of the last eleven years, in Kensington, in London, and in England and Wales:— 1897. 1896. 1895. 1894. 1893. 1892. 1891. 1890. 1889. 1888. 1887. Kensington 15.6 16.7 16.4 15.7 17.5 17.2 18.4 17.8 14.6 17.1 17.4 London 18.2 18.6 19.8 17.8 21.3 20.6 21.4 21 .4 18.4 19.3 20.3 W. Districts 16.1 17.6 18.5 17.1 19.7 29.0 20.8 20.5 18.1 19.3 19.9 North „ 16.6 17.1 18.2 16.3 20.2 19.4 20.0 19.6 16.9 17.7 18.9 Central „ 21.8 21.2 23.8 20.0 25.7 23.9 26.5 24.8 20.9 22.7 23.5 East „ 21.2 21.3 23.4 20.8 24.9 23.5 24.0 25.1 21.2 22.7 23.3 South „ 17.2 17.5 18.3 16.2 19.5 19.0 19.8 19.6 17.7 18.1 19.4 England and Wales 17.4 17.1 18.7 16.6 19.2 19.0 20.2 19.5 18.2 18.1 19.1 Greater London.—The death-rate in "Greater London," which is co-extensive with the Metropolitan and City Police Districts, the population, in the middle of the year 1897, numbering 6,291,677 (viz., 4,463,169 in Inner or Registration London, and 1,828,508 in the Outer Ring), was 16.7 per 1,000, as compared with 16.4, 18.3, and 17.0 in the three preceding years respectively. The deaths properly belonging to the Outer Ring, as distinguished from Inner or Registration London, were equivalent to a rate of only 13.2; the rate in the Inner Ring having been 18.2. The death-rate from the principal diseases of the zymotic class in Inner London, was 2.58 per 1,000; in the Outer Ring 2.13; the rate in Greater London, as a whole, being 2.46 per 1,000. 22 Other Large Towns.—The death-rate in thirty-two cities and boroughs next in importance to London, and having a population of 6,529,355, was 19.7 per 1,000, ranging from 13.1 in Croydon, 14.9 in Cardiff, and 15.1 in Brighton, to 23.1 in Manchester, 23.9 in Salford, and 24.4 in Liverpool and Preston—without correction for differences between one town and another in regard to the age and sex-distribution of their respective populations. The death-rates in Edinburgh, Glasgow, and Dublin were 21.3, 22.0, and 29.0 per 1,000 respectively. Colonial and Foreign Cities.—The death-rate in some of the principal foreign and colonial cities was as follows—Indian Cities: Calcutta, 32.3 per 1,000; Madras, 35.5; and Bombay, 57.5; European Cities: Paris, 18.6 per 1,000; St. Petersburg, 29.0; Moscow, 28.7; Berlin, 17.7; Vienna, 20.9; Buda-Pesth, 21.9; Brussels, 16.6; American Cities : New York, 19.4 per 1,000; Boston, 21.1; Philadelphia, 18.8; San Francisco, 17.1; and New Orleans, 24.5. 23 SUMMARY OF VITAL AND MORTAL STATISTICS, KENSINGTON. In the table at page 24 there will be found a summary of the principal vital and mortal statistics of the year arranged in four-weekly periods corresponding to the dates of the monthly reports, the maxima and minima being indicated by distinctive type. We have already seen that the birth-rate in 1897 was 21.6 per 1,000, as compared with the decenial average 22.4, and that the death-rate 15"6 per 1,000 was 1.1 per 1,000 below the rate in 1896 (16.7) and 1.2 below the decennial average (16.8). There were, as usual, considerable fluctuations in the rate at different periods of the year ; the rate ranging between the minimum (13.8) in the fifth four-weekly period, ended May 22nd, and the maximum (20.0) in the thirteenth and last fourweekly period. During the first seven four-weekly periods the rate was invariably below the decennial average rate. In the remaining six four-weekly periods the rate was continuously above the average. The deaths in the first half-period of the year (1,262) were fewer by 143 than those in the second halfperiod (1,405); the death-rate in the two half-period being 13.0 and 16.5 per 1,000 respectively. There was a remarkable difference in the number of deaths from the principal diseases of the zymotic class in the two half-periods (158), the number in the first six months having been 76 only, as compared with 234 in the last half of the year. The 310 deaths from these causes were 150 fewer than the number in 1896, and 54 below the corrected decennial average (364). The deaths from the diseases of the respiratory organs (491) were within 13 of the number in 1896 (504), after correction for the 53rd week included in that registration year. The deaths from phthisis were 240. The mean temperature of the air at Greenwich during the year was 50.3 degrees Fahr.; the means of the four quarters successively being, 41.1, 53.1, 60.9, and 46.0. 24 SUMMARY OF VITAL AND MORTAL STATISTICS, KENSINGTON, 1897. During the four weeks ended. Births. Deaths. death-rate. deaths at ages. deaths from zymotic diseases. diseases of respiratory system. Deaths from Phthisis. Deaths from Heart Disease. Deaths under Five from Scrofulous Diseases. Mean Temperature. kensington. london. 1897. Decennial Average. 1897. Decennial Average. 0-1 1-5 60 and upwards. Totals. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Enteric Fever. Simple continued Fever. Diarrhœa. Totals. Bronchitis. Pneumonia. January 30 342* 206 15.7 22.3 18.6 25.8 47 22 60 12 ... 1 4 2 2 1 2 54 37 11 20 19 7 35.4 February 27 280 209 15.9 18.7 19.0 21.6 38 19 60 11 ... 2 3 4 1 ... 1 39 20 13 24 16 5 42.7 March 27 299 209 15.9 19.5 17.9 22.5 36 25 65 11 ... ... 7 1 2 ... 1 44 27 11 20 19 4 45.0 April 24 248 187 14.2 17.1 17.3 20.0 36 18 62 8 ... 3 7 1 1 ... 2 38 22 12 13 11 10 44.6 May 22 291 181 13.8 16.8 15.8 19.0 33 13 53 7 ... ... 4 ... 2 ... 1 37 20 12 17 16 5 50.4 June 19 303 186 14.2 15.6 14.7 17.8 41 15 52 15 ... 1 10 1 1 ... 1 36 14 16 13 14 8 57.8 July 17 282 187 14.2 15.0 14.9 17.9 48 21 50 30 ... 3 5 3 2 ... 17 20 14 5 13 11 4 63.9 August 14 290 223 17.0 16.1 23.9 20.1 82 25 44 54 ... ... 4 ... 1 ... 49 14 7 5 15 9 7 65.8 September 11 294 189 14.4 13.6 19.5 17.5 64 20 52 43 ... 1 5 1 ... ... 36 14 9 4 25 11 6 58.2 October 9 266 157 14.2 13.2 15.7 16.3 37 23 40 24 5 2 10 ... 4 ... 3 28 12 9 19 16 5 53.7 November 6 275 217 16.3 15.0 17.3 18.5 45 35 47 33 10 6 9 2 3 ... 3 39 28 6 24 18 5 50.2 December 4 242† 224 17.1 16.8 19.9 19.6 46 34 67 30 4 6 12 1 1 ... 6 50 28 10 20 17 3 44.5 January 1, 1898 271 262 20.0 18.4 22.2 21.4 56 33 83 32 13 4 8 3 1 ... 3 78 55 16 17 13 5 42.4 TOTALS 3,683 2,667 15.6 16.8 18.4 19.8 609 303 735 310 33 29 82 19 21 1 125 491 293 130 240 190 74 50.3 * Maximum number during the year, and so throughout the table. + Minimum number during the year, and so throughout the table. 25 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 Diarrhoeal, include the diseases which the Registrar-General describes as the " seven principal diseases of the zymotic class," the three fevers respectively named Typhus, Enteric, and Simple Continued, being grouped under the generic term " Fever." ZYMOTIC DISEASES. The deaths from the seven principal diseases of the zymotic class, which had been 346, 322, and 460, in the preceding three years successively, were 310 in 1897, and 54 below the corrected decennial average (364). These deaths, of which 274 belong to the Town sub-district, and 36 only to Brompton, were equivalent to 1.81 per 1,000 persons living (2.23 in the Town sub-district and 0.74 in Brompton), as compared with 2.7 in 1890. The rate in the Metropolis, as a whole, was 2.58 per 1,000 (3.14 in 1896): the decennial rate being, for London 2.8, and for Kensington 2.1 per 1,000. The subjoined table shows the number of deaths from the several diseases, in the sub-districts, and at outlying public institutions:— Disease. Sub-districts. In Hospital. Total Decennial Average. Town Brompton Town Brompton Uncorrected. Corrected for increase of Population. Smallpox ... ... ... ... ... 1.0 1.0 Measles 30 1 1 1 33 85.6 87.4 Scarlet Fever 3 ... 25 1 29 31.5 32.2 Diphtheria 27 4 43 8 82 65.3 66.7 Whooping-cough 15 4 ... ... 19 71.6 73.1 Typhus Fever ... ... ... ... ... ... ... Enteric Fever 8 3 7 8 21 17.3 17.7 Simple Continued Fever 1 ... ... ... 1 1.2 1.2 Diarrhœa 112 10 2 1 125 83.2 84.9 196 22 78 14 310 356.7 364.2 26 From the above table it appears that the mortality from diphtheria, enteric fever, and diarrhoea was in excess, that from measles and whooping-cough greatly, and that from scarlet fever slightly, below the corrected decennial average. As usual the deaths in the Brompton sub district (36) were fewer in proportion to population, than those in the Town sub-district (274). The deaths from these diseases were equal to 116 per 1,000 deaths from all causes in Kensington, the proportion in the Metropolis as a whole being 142 per 1,000. District Zymotic Death-rate.—The zymotic deathrate in North Kensington (239 deaths) was 2.76 per 1,000 persons living, and in South Kensington (71 deaths) 0.84 per 1,000. The late in the several sanitary districts was as follows:— North 113 deaths or 3.44 per 1,000 persons living. North-East 39 deaths or 1.29 per 1,000 persons living. North-West 69 deaths or 4.18 per 1,000 persons living. Central 42 deaths or 1.54 per 1,000 persons living. South-East 16 deaths or 0.49 per 1,000 persons living. South-West 31 deaths or 0.97 per 1,000 persons living. The deaths in the "Notting-dale" special area were 25, or 6.25 per 1,000 persons living. The table at page 24 shows the distribution of the deaths in Kensington, as a whole, from the several diseases as recorded in the thirteen four-weekly reports. In England and Wales the deaths from these diseases were 124 in each 1,000 deaths from all causes, the rate per 1,000 persons living 2.15, the decennial average being about 2.5 per 1,000. In the thirty-two great towns, excluding London, the rate averaged 3.06 per 1,000, ranging from 1.36 in Swansea, 1.39 in Halifax, 1.43 in Croydon, 1.50 in Huddersfield, and 1.64 in Brighton, to 4.02 in Bolton, 4.22 in Wolverhampton, 5.50 in Salford, and 5.63 in Preston. 27 SMALL-POX. There was no death from small-pox, the corrected decennial average number being one: nor was any case of the disease notified. There had been a few notifications but no deaths during the preceding three years. In London 105 cases were notified : the deaths were sixteen, the decennial average number, corrected for increase of population, being 45. During the preceding ten years the deaths aggregated 429 only, the numbers being 9, 9, 0, 4, 8, 41, 206, 88, 55, and 9, in the successive years. Reduction in Small-pox Mortality in London.— The reduction in small-pox mortality has been very great since the Asylums Board adopted the practice of removing the sick to the country. The Board were first called upon to deal extensively with the isolation of small-pox patients at the latter part of 1870. During the ten years 1871-80, some 33,000 cases were admitted to their hospitals in London. The deaths in these ten years were 15,539, including 7,912 in 1871. In May, 1881, the first Camp Hospital was established at Darenth, and the practice of removing the sick out of London, then initiated, was gradually perfected, so that since 1885 practically all cases coming under the care of the Managers have been treated at the Hospital Ships and the Convalescent Hospital at Gore Farm. During the ten years 1887-96, the cases admitted to these hospitals were 5,232, and the deaths of London people were, as above stated, 429 only: 206 of the deaths were registered in 1893 in which year 2,376 cases were admitted to the Managers' hospitals. Had the mortality during these ten years been at the same rate as in the ten years 1871-80, the deaths, after correction for increase of population, would have been, not 429 but 18,752. There has thus been a saving of 18,323 lives in the ten years. This satisfactory result—admittedly due in large measure to the removal of the sick from London—was the outcome of the deputation of the Sanitary Authorities, and other 28 public bodies, to the President of the Local Government Board, on April 23rd, 1881, the primary object of the deputation being to present the resolutions adopted at the Conference of Sanitary Authorities convened by your Vestry, and held at the Town Hall, 23rd March, to consider the question of the Compulsory Notification of Infectious Disease, a measure for which London had to wait a further period of eight years. The proceedings at the deputation were fully reported in the British Medical Journal (May 7th, 1881, page 744); and in my Annual Report for 1880-81, page 57, may be seen, not only the history of the movement originated by your Vestry to secure Compulsory Notification, but also the story of the circumstances which led up to my recommendation of the removal of small-pox cases out of London ; a recommendation which was acted upon by the Local Government Board and the Asylums Board with such promptitude, that within two or three weeks hundreds of patients were comfortably housed at the Darenth " Camp," and the difficulty of hospital accommodation for sufferers from small-pox was solved, once and for ever, with the happy result above indicated. MEASLES. Measles was the cause of 33 deaths, as compared with 108, 33, and 173, in the preceding three years successively : 31 in the Town sub-district and two in Brompton ; the corrected decennial average being 87.4. All of the deaths save one occurred in the last sixteen weeks of the year, as shown in the table at page 24. The deaths from this cause in the metropolis, as a whole, were 1,929, and 942 below the corrected decennial average (2,871): 762 of the deaths were registered in the first nine months (162, 298, and 302, in the successive quarters) and 1,167 in the fourth quarter. Should Measles be Notified?—The question whether measles should be made a notifiable disease under Section 55 of the Public Health (London) Act, 1891, is raised from time to time by persons who naturally think or hope that publication of sickness returns would lead to reduction in the fatality 29 of the disease. I dealt with this subject fully in my report for 1891 (pages 97-106), and, without repeating the arguments then employed, it will suffice here to say, that I have seen no reason to modify the conclusion at which I then arrived, viz, "that it would be of little or no use to have notification of measles unless hospital accommodation were provided on a large scale for the use of the sufferers therefrom;" and of this there is no present prospect. SCARLET FEVER. The cases notified as scarlet fever were 749, as compared with 390, 525, and 1,011, in the preceding three years successively, viz., 513 in North Kensington and 236 in South Kensington. The deaths were 29 ; and three below the corrected decennial average (32); 28 and 1 in the Town and Brompton sub-districts respectively. Nineteen of the deaths were of children under five years of age: there was no death under one year. Twenty-six of the deaths took place at outlying public institutions, to which 561 cases were removed, and three at home. The case-mortality was 3.9 per cent. (the same as in 1896) ; viz., 4 6 per cent. in hospital cases and 1.6 per cent. in home cases. The deaths in London, as a whole, were 780 (as compared with 962, 829, and 942, in the preceding three years successively) and were 314 below the corrected decennial average (1,091). Of the 780 deaths 592 or 76 percent. took place in public institutions. The cases notified numbered 22,876, as compared with 25,638 in 1896, 19,757 in 1895, 18,440 in 1894, and 36,901 in 1893. The mortality was 3.4 per cent. on cases notified, as compared with 3.7 in 1896; 4.1 in 1895 ; 5.2 in 1894, and 4.3 in 1893. The case-mortality in hospitals (admissions 15,690, deaths 592), was 3.77 per cent. These figures must be regarded as approximate. The tables on page 30 show the degree of prevalence of the disease in the parish, and in London, as a whole, in 1896 and 1897, as indicated by the number of notifications, and of deaths registered, in thirteen successive four-weekly periods, as set out in my reports: — 30 Scarlet Fever in 1897. Report for four weeks ended No. of Notifications Kensington London No. of cases admitted to hospitals Kensington London No. of Deaths Kensington London No. of cases in Hospital at the end of the period Jan. 30 44 1439 37 1000 1 63 3311 Feb. 27 29 1289 27 935 2 52 2817 March 27 41 1174 32 859 ... 41 2585 April 24 28 1206 20 928 3 39 2442 May 22 33 1316 24 1004 ... 49 2508 June 19 56 1454 50 1081 1 48 2670 July 17 66 1701 46 1307 3 56 2903 Aug. 14 52 2019 35 1479 ... 66 3341 Sept. 11 54 1915 46 1443 1 54 3579 Oct. 9 135 2801 90 1483 2 84 3692 Nov. 6 92 2955 74 1537 6 76 3680 Dec. 4 85 2058 57 1560 6 95 3811 Jan. 1, 1898 35 1549 27 1074 4 57 3572 749 22,876 565 15,690 29 780 The notifications are taken from the weekly returns of the Asylums Hoard: the admissions to, and the numbers in, the hospitals, an 1 the deaths in London, from the weekly returns of the Registrar-General. For the sake of comparison, I subjoin the corresponding table for 1896, taken from the report for that year. Scarlet Fever in 1896. Report for four weeks ended No. of Notifications Kensington London No. of cases admitted to hospitals Kensington London No. of Deaths Kensington London No. of cases in Hospital at the end of the period Jan. 25 79 1761 59 1180 5 101 2916 Feb. 22 90 1527 83 1095 2 74 2937 March 21 57 1350 42 982 5 72 2773 April 18 45 1224 36 837 1 65 2527 May 16 37 1383 25 1003 2 50 2539 June 13 68 1864 52 1272 1 66 2781 July 11 93 2235 70 1309 2 59 3088 Aug. 8 94 2532 65 1367 6 76 3369 Sept. 5 92 2766 73 1611 1 70 3610 Oct. 3 84 2963 58 1689 4 73 4020 Oct. 31 104 2846 65 1611 2 66 4160 Nov. 28 91 2300 70 1477 4 78 4030 Jan. 2, 1897 (5 weeks) 77 2224 65 1484 4 92 3707 1,011 2,6975 763 16,917 39 942 The notifications in this table are uncorrected for duplicate returns. The tables on pages 31—32 exhibit certain particulars of interest with respect to scarlet fever prevalence, &c., during 1897, and the preceding ten years, 1887-96. 31 Scarlet Fever Cases Recorded in Kensington in 1897, 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 1897 43 32 40 28 33 58 68 51 55 133 88 84 34 747 1896 79 90 57 45 37 68 93 94 92 84 104 91 77* 1011 1895 20 22 20 23 22 33 39 40 24 63 91 62 66 525 1894 59 37 27 40 28 21 26 23 30 28 31 15 25 390 1893 45 60 38 34 56 84 84 110 67 113 117 88 61 957 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 11 55 115 92 64 34 465 Average 1887-96 35.1 36.3 24.1 25.5 28.7 32.2 40.0 44.0 39.9 60.5 65.0 53.4 41.9 527† * Return comprises five weeks. † Without correction for increase in population. Note.-Compulsory Notification has been in operation since October, 1889. 32 Statistics of Scarlet Fever in Kensington in 1897, 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 1897 188 561 747 75 3 26 29 10.3 89.7 3.9 780 1896 248 763 1011 75 7 32 39 18 82 3.9* 942 1895 167 358 525 68 12 15 27 44 56 5.1 829 1894 131 259 390 66 5 17 22 23 77 5.6 962 1893 389 568 957 59 10 41 51 24 76 5.3 1596 1892 259 456 715 64 9 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 *The case-mortality in Kensington patients treated at home, in 1897, was 1.6 per cent., and in patients treated in hospital, 4.6per cent. 33 How Disease is Spread.—Scarlet Fever is often spread in schools, sometimes owing to the unwitting admittance of children who have passed through an unrecognized attack, followed by an almost imperceptible desquamation ("peeling") of the skin. In other cases, children apparently well in health, but still peeling, are sent to school, either in ignorance or for convenience. One marked case of this kind came to light at Buckingham Terrace Board School. In the tenth report (October 13th, page 115), I reported the absence of 17 children ill with scarlet fever, other 58 children living at the infected houses being excluded from the school. Just at this time a child who had been in attendance for nine days was found to be peeling. Two other children in the family had been previously removed to hospital. This child's case had not been notified, and only came to light upon an examination of her hands by the head teacher, resulting from a communication received from a mother excusing her own girl's non-attendance upon the ground that she didn't want her to come into contact with the infected child: it was obvious, therefore, that the parents could not have been in ignorance of the peeling or of the cause of it. Such an exposure could hardly fail to lead to the spread of disease, and the Sanitary Committee rightly decided to take proceedings. A double offence had been committed, the father having failed to notify the illness as he should have done, no doctor having been consulted. The magistrates inflicted the very moderate fine of five shillings for each offence. The large class room in which the infected child had sat was disinfected, and apparently with good effect, having regard to the diminished number of cases thereafter recorded in connection with the school. 34 DIPHTHERIA. Cases of diphtheria (322) and membranous croup (10) to the aggregate number of 332 were notified, as compared with 268, 365, and 371, in the preceding three years successively: viz., 229 in North Kensington, and 103 in South Kensington. The deaths registered were 82 (as compared with 75, 89, and 72, in the preceding three years respectively), being 15 above the corrected decennial average (67): 70 of them belong to the Town sub-district, and 12 to Brompton ; 60 to North Kensington, and 22 to South Kensington. Fifty-one of the deaths took place at hospitals, to which 237 cases were removed. The case-mortality was 24.7 per cent., and was considerably higher in the home cases (32.6 per cent.) than in the hospital cases (21.5 per cent.) The probable explanation of this difference is that the antitoxic treatment is more generally practised in hospital than at home. The proportional mortality varies from year to year within somewhat wide limits. In 1895 the deaths in hospital cases were at the rate of 20.1 per cent. on notifications, the rate in home cases being 34.2. In 1896 the mortality was only 14.7 in hospital cases, as compared with 27.1 per cent. in home cases. In 1894, before antitoxin was used, the case-mortality was nearly the same in home and hospital cases, viz., 28.3 and 27.7 per cent. respectively. It should be explained that the percentage mortality in hospital cases is calculated upon true diphtheria, whereas in home cases the calculated mortality is based on notified cases—a very different thing, having regard to the large proportion of cases of mistaken diagnosis; so that the proportional success of treatment at the hospitals is even greater than represented by the most favourable of the above figures. In London, as a whole, the deaths were 2,261 (222 above the corrected decennial average, 2,039), as compared with 2,670, 2,316, and 2,683, in the preceding three years respectively. The total notifications were 12,811, as compared with 10,655, 10,772, and 13,361, in the preceding three years successively. 35 The following table, based on the thirteen four-weekly reports, sets out some particulars with regard to diphtheria in Kensington, and in London, in 1897. Diphtheria in 1897. Report for four weeks ended No. of Notifications Kensington London No. of cases admitted to Hospital Kensington London No. of Deaths Kensington London No. of cases in Hospital at the end of the period Jan. 30 23 915 15 421 4 239 902 Feb. 27 15 916 12 405 3 185 855 March 27 28 902 19 413 7 176 808 April 24 21 730 18 375 1 134 774 May 22 19 777 11 411 4 141 785 June 19 20 895 14 494 10 137 840 July 17 20 1011 14 570 5 135 927 Aug. 14 27 1111 19 568 4 163 1027 Sept. 11 23 866 15 494 5 117 982 Oct. 9 31 1169 26 645 10 182 1050 Nov. 6 38 1836 32 640 9 224 1056 Dec. 4 38 1119 27 60^ 12 198 1056 Jan. 1,1898 19 1064 15 616 8 230 1070 322 12,811 237 6,656 82 2,261 The table at page 36 gives particulars with respect to diphtheria in North and South Kensington, respectively. 36 PARTICULARS WITH REFERENCE TO DIPHTHERIA IN KENSINGTON, IN 1897. Set out in Report for Four weeks ended. Total Cases Recorded.* Cases Recorded in North Kensington.† Cases Recorded in South Kensington.† Cases removed to Hospital from Deaths in North Kensington. South Kensington. North Kensington. South Kensington. January 30 21 9 12 8 7 3 1 February 27 16 12 4 10 2 1 2 March 27 28 19 9 11 8 6 1 April 24 21 16 5 14 4 1 ... May 22 19 10 9 5 6 ... 4 June 19 21 17 4 11 3 6 4 July17 18 9 9 9 5 3 2 August 14 28 21 7 14 5 3 1 September 11 23 17 6 12 3 3 2 October 9 31 21 10 18 8 9 1 November 6 40 27 13 23 9 5 4 December 4 39 28 11 20 7 12 ... January 1, 1898 20 16 4 11 4 8 ... 325 222 103 166 71 60 22 * The "recorded" cases seldom accord precisely with the number of "notified" cases. † North Kensington and South Kensington, are the districts to the north and the south of the centre of Notting-hill High-street and Holland-park-avenue, respectively. 37 The Antitoxic Treatment of Diphtheria.—I dealt somewhat fully in the annual report for 1896 (page 46) with this subject, in connection with the first annual report (for 1895) of the Medical Superintendents of the Asylums Board Hospitals, setting out their combined experience on antitoxin. The conclusion arrived at was that in antitoxic serum they possessed " a remedy of distinctly greater value in the treatment of diphtheria " than any other with which they were acquainted. The second annual report (for 1896), published last year, confirms the favourable opinion of the serum as a remedy for this dire disease, and even extends it, better results having been shown in respect to the rate of recovery in laryngeal cases, and in children of the age-group 1-5 years : laryngeal cases being especially dangerous, whilst the mortality in the young, under any other description of treatment, is very great. The new remedy was used in a larger proportion of the cases in 1896, than in 1895—in all, indeed, save the mild ones and those found to be moribund on admittance. The rate of mortality in cases in which the antitoxic serum was used on the first day of disease, was only 5.2 per cent., the rate for all cases admitted to the hospitals during the year having been 20.8 per cent. How Disease is Spread.—Of the four deaths from diphtheria recorded in the fifth report (May 27th, page 57), one was that of a female child aged three years, who was apparently infected by her father, whose ailment had been regarded and treated as common sore throat. The family medical attendant contracted the disease and died, having been infected by either the child or her father, whose illness apparently originated in the city at offices found to be in an insanitary condition. Two of this gentleman's clerks had previously suffered from sore throats, the presumably specific character of which had not been recognized. A more serious outbreak was chronicled in the eleventh report (November 10th, page 131), ten cases having occurred 38 in connection with the Hoard School in Allen-street. The first case was notified August 29th, the child, a girl aged 7 years, having attended school, in the Infants' department, on Friday, the 27th. The second case occurred on the 7th September, the child, a girl aged 7 years, having been at school on the same day, and in the same department. This child's illness was not notified as the Act directs : she died on the 10th. The third case appears to have commenced on the 11th September, the child, a girl aged 4 years, having been at school on the previous day. It was stated that she walked home, on the 7th, with the little girl who, having been taken ill on that day, died on the 10th. The next three cases, two boys and a girl, were members of one family, and aged, respectively, 5 years, 6 years, and 8 years. Their last attendance at school was on September 24th: the notifications were dated September 30th, October 4th, and October 6th, respectively: two of these cases proved fatal: the two latter cases were probably contracted, at home, from the first case. The eighth case was that of a girl, aged 7 years, whose last attendance at school was on October 8th, the notification being dated October 13th. This child also died. The ninth case was that of a child, aged 3 years, and was secondary to the illness in the fourth case, having been contracted at home: the illness was notified on October 15th. The tenth case, that of a boy, aged 8 years, was notified on October 25th, the last attendance at school, in the boys' department, however, having been on the 22nd October. This case was treated at home. The second of the cases was not removed; application for removal was made on the 8th September, the day following the commencement of illness, but no bed was available. The remaining eight cases were removed. The usual directions were given in each case to exclude from school all children living in the infected houses. In one case, the third, these directions were disregarded, the other children having been sent to school, on two consecutive days, after the caution had been given. This was not the only respect in 39 which usual precautions against spread of disease failed to get observed. The various laches of the father, who was manager of a branch business belonging to a dairy company, were duly reported to the County Council, the local authority under the Contagious Diseases (Animals) Act, 1878,and the Dairies Order, who, much to the dissatisfaction of the Sanitary Committee, simply reprimanded the offender, and threatened condign proceedings in the case of a repetition of the offence. Sanitary defects were found at the school in the infants' latrines, and steps were forthwith taken to abolish the nuisance. MISTAKEN DIAGNOSIS: DIPHTHERIA AND ENTERIC FEVER. In many cases diphtheria and enteric fever are "notified" in error, the diagnosis proving to be incorrect. Large numbers of such cases are admitted to the hospitals of the Asylums Board, and detained, for a longer or shorter time, with what would naturally be thought a serious risk of catching the diseases from which on admission they were erroneously supposed to be suffering. Happily this risk proves, in practice, to be a smaller one than might have been expected, for it appears that of 1,202 cases wrongly diagnosed as diphtheria, and admitted to the various hospitals of the Asylums Board, during the years 1895 and 1896, only 26 contracted diphtheria, and in only one such instance "was death strictly due to diphtheria," although the average stay in hospital varied from 16 to 31 days at the different institutions. With regard to enteric (or typhoid) fever, during the same two years 425 cases were wrongly diagnosed and admitted. The average stay in hospital ranged at the different institutions from 17.3 days to 27.7 days, and yet only one patient subsequently contracted the disease, which did not prove fatal. These interesting statistics were elicited as the result of an inquiry, directed by the Managers to be made by the General Purposes Committee, " into the facts connected with the admission into the hospitals of a large percentage of patients certified 40 as suffering from the diseases (named), but subsequently found to be not so suffering." The returns were made by the medical superintendents who, moreover, were asked to state "What steps (if any) can be taken to promote the refusal of admission to, or early discharge from, the hospitals of the Board of all cases wrongly diagnosed as diphtheria, or as enteric fever." The replies to the queries were made separately in respect of each of the diseases by the several medical superintendents, and are very interesting, but it is unnecessary to cite them, having regard to the conclusion which the General Purposes Committee expressed in their report, which reads as follows :— "Having carefully considered (as directed by the Managers) the facts connected with the admission into the hospitals of the Managers of patients certified to be suffering from diphtheria or enteric fever, but subsequently found to be not so suffering, and having consulted the Medical Superintendents thereon, we find from the figures for the years 1895-6, that the danger from infection to the patients so admitted is very small, whereas the risk of serious consequences from their refusal, both to the individuals concerned and to the community at large, would, in the opinion of the Medical Superintendents, be very great. We are therefore of opinion that no change should be made in the existing practice of at once admitting all who are duly certified." I entertain no doubt that, as a general rule, the conclusion at which the Committee arrived was the proper one, having regard to the interests of public health. But questions may nevertheless arise—Whether the care necessary in the circumstances is always taken to avoid error, or to ensure accuracy, in diagnosis?; and whether, if the actual disease is trivial, the patient should be exposed even to the small risk attending admission to the hospital? These questions would admit of something approaching to a correct answer had the Committee appended to the report a statement of the actual diseases from which the patients were "afterwards" found to be suffering. It is an obvious reflection that the medical superintendent has time to make his diagnosis, whereas the time at the disposal of the hardly-worked 41 general practitioner for making a diagnosis may be scanty enough. Of the two evils—admittance of cases not suffering from the notified infectious disease, or delay in removal, so as to ensure accuracy in diagnosis, whereby, in many cases, liability to spread of disease would be entailed—I think the latter to be by far the greater, and this consideration, doubtless, weighed with the medical superintendents and the Committee. Anyhow, as we have seen, the danger of the present practice is not great, and, having regard to the classes of persons who go into these noble institutions, it cannot be doubted that much suffering is alleviated by the admission of persons who are, presumably, very ill, though not suffering from the infectious disease notified ; so that,in the long run, the benefit to the bulk of the sufferers transcends the suffering caused to the few who contract the disease they were wrongly thought to have. It may be a question whether the notification fee should be payable when the diagnosis turns out to have been incorrect ; the expense under this head, however, is small by comparison with the costs entailed by disinfection, which proves to have been unnecessary; and assuredly it would not do to defer disinfection, which, next to isolation of the sick, is the best security against the spread of disease. WHOOPING-COUGH. Whooping-cough was the cause of 19 deaths, as compared with 61, 39, and 99, in the preceding three years successively; 15 in the Town sub-district and 4 in Brompton, the corrected decennial average being 73. All of the deaths were of children under five years of age, including 8 under one year. The deaths in London from this cause were 1,842, and 794 below the corrected decennial average (2,636). FEVER. There was no death from Typhus Fever, nor has there been any during the last fifteen years. From Simple Continued Fever there was one death. Enteric Fever was the cause of 21 deaths, 15 in the Town sub-district and 6 in Brompton, as 42 compared with 21, 15, and 15, in the preceding three years successively ; the corrected decennial average being 18. Ten of the deaths took place at hospitals, to which 71 cases were removed, and 11 at home. One hundred and twenty-two cases were notified, 74 in North Kensington and 48 in South Kensington, as compared with 90, 99, and 94, in the preceding three years respectively. The deaths in London, as a whole, from Enteric Fever were 584, and 40 below the corrected decennial average (624). The notifications were 3,113. There was one death from Typhus, and 8 from Simple Continued Fever, the corrected decennial averages being 10 and 29 respectively. DIARRHŒA. Diarrhœa was the cause of 125 deaths, 114 in the Town sub-district and 11 in Brompton, as compared with 56, 118, and 61, in the preceding three years successively, the corrected decennial average being 85. The deaths from this cause in the Metropolis, as a whole, were 4,104, and 1,125 above the corrected decennial average (2,979). These deaths were equal to a rate of 0.92 per 1,000, the highest rate recorded in any year since 1887; the average rate in the preceding ten years was 0.67 per 1,000. Infantile Diarrhœal Mortality.—It will be seen on reference to the table at page 24 that of the 125 deaths from diarrhœa, 102 were registered in the twelve weeks beginning June 20th and ending September 11th: the numbers in the consecutive four-weekly periods were 17, 49, and 36. Seventy-three of these deaths were of infants under one year of age ; there were 18 of children between one year and two years of age. Excessive diarrhœal mortality was not peculiar to the parish: all parts of the Metropolis suffered more or less alike. The Registrar-General stated in his 31st and 32nd weekly returns, that the mortality from diarrhœa, in 43 proportion to population, was higher in the week ended 7th of August than it had been in any week since July, 1884, and in the week ended August 16th, higher than it had been in any week since July, 1876. During the four weeks ended August 14th, the deaths in the Metropolis from this cause were 1,925, and 924 above the corrected average ; the deaths of children under five were 1,849, including 1,588 in the first year of life. In addition to the deaths certified from diarrhoea, 540 were attributed to gastro-enteritis. These deaths, or very many of them, now classified to enteritis, would in former days have been classified to diarrhoea. The fatal cases of gastro-enteritis under five years, in this parish, in the same four weekt; numbered ten, in addition to those registered as due to enteritis. Three deaths were attributed to English Cholera, and Choleraic Diarrhcea ; the number of such deaths in London, as a whole, during the four weeks was 65. The mean temperature of the air during the three successive four-weekly periods, comprised in the diarrhceal season, was 63°9, 65.8, and 58.2 Fahr.; being 4.3 and 2.1, above the decennial average in the first two periods and 1.7 below average in the third period. The question of the causation of infantile diarrhcea in hot weather is one of much interest and not easy of solution. So far as can be ascertained, this disease does not appear to have prevailed to the same relative extent two centuries ago, there being in the bills of mortality no disease named suggestive of diarrhoea, specially fatal in the summer to infants of the suckling age. In those days children, doubtless, were generally nourished by their mothers ; the rule is not nearly so general now. With regard to the deaths from this cause in Kensington, I, with the assistance of Inspector Pettit, made enquiry into 43 consecutive cases occurring under two years of age, with the following results:—27 of the deaths were in the north sanitary district, six in the north-east district, seven in the north-west district, and three in the central district, two of them to the north of Holland-park-avenue, and 44 street, Notting-hill. Thus all of the deaths save one were of North Kensington infants ; none occurred in the Brompton sub-district. Thirty-two of the deaths were of infants under twelve months, and 11 of children aged between 12 and 24 months. All of the deaths save two (in which cases inquests were held) were certified by medical practitioners. Six of the deceased infants were illegitimate. In some cases complications were recorded, as teething, wasting, vomiting, &c. The parents generally belonged to the artizan and labouring classes, and in about one half of the cases the mother went out to work. There were not two fatal cases in any house, but in some houses there was more than one case of illness in the same or different families. The family occupied the entire house in six instances, four rooms in four instances, three rooms in eight instances, two rooms in sixteen instances and one room in nine instances. With regard to the part of the house occupied, it was the top floor in fifteen cases, the first floor in ten cases, the ground floor in six cases, and the basement in six cases. Of the 43 houses the rooms in 36 were in a satisfactory state ; in five houses they were in a fair condition, and in two houses they were in an unsatisfactory condition. In 24 instances the death was of an only child— a fact indicating maternal inexperience. The most important fact ascertained was that only three of the 43 children were suckled by their mothers: but ten of them, as has been said, were between 12 and 24 months' old. Twenty of the children were fed upon fresh cow's milk, to which probably—regard being had to the state of the weather—"preservatives" had been added ; and preservatives, as was formerly shown in a special report* upon the subject, by the Public Analyst and myself, are but too likely to set up gastric and intestinal troubles. In 19 cases the children were fed upon condensed milk, a food the different brands of which vary much in nutritive value, the cheaper sorts being deprived of most, or * No. 7, July 18th, 1887 (page 61), " Boracic Acid as a preservative of milk." 45 even all, of the fat, the most important constituent of cow's milk considered as a substitute for the mother's breast. In only one case (as alleged) was the child fed on a purely farinaceous food; but farinaceous food of some kind was used with the milk in many of the other cases. There is no reason, so far as I can ascertain, for supposing that any of the children were neglected or not treated kindly ; but it is too often the case that the feeding bottle is allowed to become in a condition to injuriously affect the milk, and pollution of the bottle may in some instances have had a causative effect in setting up diarrhœa. The factor of supreme importance, however, is that nearly all of the victims were deprived of their natural food, and so long as this state of things prevails—and it prevails largely among the upper classes—so long may we look for a continuance of fatal infantile diarrhoea in the families of persons unable to substitute for the natural nutriment, expensive artificial food which may suffice in the families of those whose circumstances enable them to exercise extreme care in the management and surroundings of their offspring. CHOLERA. Not a little stir was caused at the beginning of the year by the news that Asiatic Cholera had been brought into English waters, at Plymouth, on board the hired transport Nubia, from Ceylon. Happily the disease did not spread to any person, soldier or ordinary passenger, after the ship's arrival, nor did any case occur on shore. The apparently healthy troops were landed, and after a few days' detention in barracks were allowed to go to their friends. The ordinary passengers (of whom none had been affected on board ship) were allowed to depart, after their names and intended destinations had been ascertained. The Medical Officers of Health to districts to which passengers were going, were duly apprised of names and addresses. Two of the passengers came to this parish: they were well on arrival and so continued. The arrangements 46 made in this instance were in conformity with the provisions of a General Order of the Local Government Board ("Regulations as to Cholera, Yellow Fever and Plague: Ports") issued in November, 1896, quarantine having been abolished. These regulations,which were forwarded to Fort and all other Sanitary Authorities, Medical Officers of Health, etc., provide for the carrying out of a series of measures, which have hitherto proved effectual for the prevention of the spread, in this country, of cholera, and of other infectious diseases of exotic origin. PLAGUE. Not without some reasonable cause the public mind was disturbed, at the commencement of the year, by the daily reports of the progress of the epidemic of Plague at Bombay; and anxiety far beyond anything felt in England appears to have affected the Governments of other European countries. So great, indeed, was the alarm, lest, following well-known land routes, this dire malady should penetrate to Europe, that an International Conference, to concert preventive measures, met at Venice, in February. In India, the ravages of the disease were to some extent accentuated by famine ; its spread in the Bombay Presidency, moreover, having been favoured by the flight from the city of thousands of the panic-stricken inhabitants. Nothing occurred to justify the fears felt for the safety of this country or the continent generally. It is a matter of history that pestilence in this form has not visited England for more than two centuries, but it is by no means impossible that it should do so again. The germs of the disease may be carried in merchandise, and it is within the bounds of probability that in this way infection may be again introduced to one or other of our ports, at which ships are arriving, from day to day, from India. The provisions of the Regulations referred to in the preceding paragraph (on cholera) are applicable in regard to plague, and should plaguestricken persons arrive in English waters, the steps to be taken for preventing the spread of disease would suffice, doubtless, 47 for the protection of the country. The danger by the importation of infected merchandise is probably the greater, as it is also the more subtle of the two. Reference is needless to the ravages of this terrible disease before the Great Fire, in 1666, purged, at once, the air and the soil of London. Should the plague re-appear in this country we need not fear any such developments as characterised its progress when as yet sanitation was an unknown science. In comments on the subject in the first monthly report, whilst no word was said to create panic, it was stated that it would be folly to suppose that there was no danger. True wisdom, it was observed, "suggests the desirability of setting our house in order—a policy which in any case would bring its own reward. The course to be adopted is a simple one, and one which might almost be summed up in the apt motto adopted by our Commissioners for Baths and Washhouses, viz., 'Wash and be Clean for plague can find no permanent home amongst a well-fed community living clean lives in clean surroundings. Where the ordinary laws of health are observed, and sanitation is duly carried out, though sporadic cases may occur, there is little fear of an epidemic. But where the laws of health are disregarded, and where people herd under conditions too common in many parts of London—west as well as east— where there is overcrowding, and the surroundings in-doors and out-of-doors are filthy, there danger may be apprehended. What is most needed, in view of the possible danger, is frequent house-to-house visitation of the squalid homes of the impoverished masses, followed by such measures of purification, and general aid, as may be effected through the operation of public law and private beneficence." No action was taken: nor did any further cause for alarm arise. INFLUENZA. Forty-four deaths were registered from influenza, as compared with 20,115, and 20, in the preceding three years respectively. Thirty-three of the deaths occurred in the Town sub-district and 11 in Brompton. The deaths in London from this cause were 671, against 727, 2,117, and 491 in the three preceding years, and 398 below the corrected decennial average. 48 Other Diseases of the Zymotic Class.—Still dealing with the diseases in this important Class, it appears that one death from Ague was registered in Order 3 (Malarial Diseases), and no death from Zoogenous Diseases comprised in Order 4. Order 5, Venereal Diseases, includes Syphilis, Gonorrhœa, and Stricture of the Urethra. Syphilis was the registered cause of 21 deaths, against 14, 19, and 18, in the preceding three years respectively. Seventeen of the deaths occurred in the Town sub-district, and 18 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 many deaths in excess of the record. There were three deaths from stricture of the urethra. Order 6, Septic Diseases. This Order comprises Erysipelas, Pyæmia, Septicemia, and Puerperal Fever: the total deaths registered were 21, as compared with 11,18, and 12, in the preceding three years respectively. Erysipelas was the cause of 9 deaths,* seven of them in the Town sub-district, as compared with 3, 9, and 4, in the preceding three years respectively. Pycemia and Septicemia were the causes of seven deaths. Puerperal Fever was the registered cause of 5 deaths, of women between 25 and 45 years of age (as compared with 5, 3, and 7, in the preceding three years respectively), three of them in the Town sub-district. In addition to these 5 deaths, other 9 deaths (all of them in the Town sub-district) were registered as having occurred in childbed, as compared with 8, 8, and 13, in the preceding three years respectively. The deaths registered as having been caused by diseases and accidents associated with parturition (14 in all) were equal to 3-8 per 1,000 live births, against 3.5, 2.5, and 5.4, per 1,000 in * The notified cases of Erysipelas were 237, 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. 40 the preceding three years respectively. The notifications of puerperal fever were 16 in number. Hearing in mind the disastrous series of cases of this disease on which I reported in 1883, when a verdict of manslaughter was returned by a coroner's jury against a midwife, under circumstances set out in the fourth and sixth reports for that year, I have ever since felt it to be my duty to warn nurses, and all other women concerned with these painful cases, of the responsibility they incur by attending other parturient women until after a period of three or four weeks, and disinfection of their persons, clothing, &c. This course was adopted in respect of the cases notified in 1897 with satisfactory results, there having been no spread of the disease. Class II.—Parasitic Diseases. The deaths from the diseases in this Order were 2, from Thrush, one of them of an infant under one year of age. Class III.—Dietetic Diseases. The deaths from the diseases in this Order were 15;9 of them in the Town sub-district. Delirium Tremens was the cause of four deaths, as compared with 2, 3, and 4, in the preceding three years respectively; Chronic Alcoholism of eleven deaths, against 8, 8, and 10. 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, to visceral and degenerative diseases caused or aggravated by drink. Class IV.—Constitutional Diseases. This important Class comprises the causes of 554 deaths (equal to 20.8 per cent. of total deaths), including 85 of children under the age of five years: 445 of the deaths were registered in the Town sub-district, and 109 in Brompton. 50 Rheumatic Fever and Rheumatism of the Heart caused 10 deaths, 7 of them in the Town sub-district; Rheumatism 2 deaths. Gout was the cause of 5 deaths, 3 of them in the Town sub-district, and Rickets of 6, five of them in the Town sub-district. Cancer, Malignant Disease, was accountable for 168 deaths; 121 in the Town sub-district and 47 in Brompton. Cancer would appear to be on the increase in the country generally: possibly, however, some portion of the apparent increase in the number of deaths classified to this cause may be due to greater accuracy in diagnosis. The deaths in Kensington in the preceding ten years were 117, 121, 1:58, 125, 127, 129, 140, 143, 136, and 173, respectively. Deaths from malignant disease are usually more numerous, proportionally 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 disease, moreover, being for the most part one of later life. Thus, 140 of the deaths took place at ages above forty-five, and 23 between thirty-five and forty-five years. Purpura (Hemorrhagic Diathesis) was the cause of two deaths; Ancemia and Leucocythcemia, of 4; Glycosuria, Diabetes Mellitus, of 17. Tubercular Diseases were the registered causes of 340 deaths (as compared with 336, 350, and 318, in the preceding three years respectively); viz., 293 in the Town sub-district, and 47 in Brompton: 75 of the deaths were of children under five years of age. In a few instances Phthisis was returned as the cause of death in infancy, a period of life at which the tubercular diathesis commonly manifests itself in other parts of the body than the lungs, e.g., the brain, 51 bowels, &c. Such deaths have been classified in Table III. (appendix), with those ascribed to " Other forms of Tuberculosis, Scrofulathe total being 53 (of which 32 occurred under five years of age), including 48 registered in the Town subdistrict. Tabes Mesenterica, popularly known as consumption of the bowels, was the cause of 12 deaths (10 of them in the Town sub-district); all of them under five years of age, and 9 under one year. Tubercular Meningitis and Hydrocephalus (water on the brain) were the causes of 35 deaths; 2 only of them in Brompton, and 28 under five years of age. Phthisis, popularly known as decline or consumption, was the cause of 240 deaths ; 3 under five years of age, 3 between five and fifteen years of age, and 226 between fifteen and sixty-five: viz., 34, 53, 63, 47, and 29, in the five decennial periods consecutively: 8 deaths were registered at ages over 65. Of the total deaths, 202 belong to the Town sub-district, and 3S to Brompton. The deaths from tubercular diseases were, proportionally to population, not nearly so numerous in Brompton as in the Town sub-district. Class V.—Developmental Diseases. In this Class the total deaths were 187, viz., 152 in the Town sub-district, and 35 in Brompton. Premature Birth was the assigned cause of 66 deaths, 16 of them in the Brompton sub-district; Atelectasis of 5, all of them in the Town sub-district; and Congenital Malformation of 11, ten of them in the Town sub-district. Old Age was the registered cause of 105 deaths, all of them at ages over sixty-five: between sixty-five and seventy-five there were 19 deaths so classified ; between seventy-five and eighty-five 56; and at eighty-five and upwards 30. Class VI.—Local Diseases. The Diseases in this Class, which comprises eleven Orders, named after the systems or organs to which the diseases relate, were accountable for 1,299 deaths (as compared 52 with 1,353 in 1896) or 48.7 per cent. of the deaths from all causes: 1,045 were registered in the Town sub-district, and 254 in Brompton : 394 were of children under five years of age. The deaths from the diseases comprised in the several Orders were as follows :— 1. Nervous System.—Diseases of the nervous system were the registered causes of 265 deaths (as compared with 295, 248 and, 273, in the preceding three years respectively), viz. 205 in the Town sub-district, and 60 in Brompton: 69 of the deaths were of children under five years of age, and 151 occurred at ages over forty-five. The fatal Diseases were, Inflammation of the Brain or Membranes, 34 deaths; Apoplexy, Softening of the Brain, Hemiplegia, Brain Paralysis, 136 deaths (96 in the Town sub-district, 40 in Brompton); Insanity, General Paralysis of the insane, 15 (ten of them in the Town sub-district:) Epilepsy, 5; Convulsions, 35 (all under five, and 31 under one year); Laryngismus Stridulus, 6; Disease of the Spinal Cord, Paraplegia, Paralysis Agitans, 7; Other Diseases of Nervous System, 27. 2. Diseases ok the Organs of Special Sense (e.g. of Ear, Eye, Nose) are comprised in this Order. Ten deaths were registered from these causes. 3. Circulatory System.—The deaths due to diseases of the organs of circulation, heart and blood vessels, were 210, as compared with 159, 196, and 247, in the preceding three years respectively : 153 were registered in the Town subdistrict, and 57 in Brompton. Heart diseases proper caused 194 deaths. To specified forms of disease, 52 deaths were ascribed, viz.. Pericarditis, 2; Acute Endocarditis, 6; Valvular Diseases of the Heart, 44. Other Diseases of the Heart caused 142 deaths. A neurism was the cause of 5 deaths, and Embolism, Thrombosis, of 7. Other Diseases of Blood Vessels caused 4 deaths. 53 4. Respiratory System.—The deaths from the diseases of the respiratory organs, Phthisis being excluded, were 491 (as compared with 556,574, and 516, in the preceding three years respectively), and 18.4 per cent. of total deaths. Of these deaths 431 were registered in the Town sub-district, and 60 in Brompton. The deaths under five years of age were 190, or 38.7 per cent., as compared with 46.2, 34.0, and 43.8, per cent. in the preceding three years respectively; and at fifty-five and upwards 181, or 36.9 per cent., against 36.0, 46.3, and 38.6, per cent. in the preceding three years respectively. The fatal diseases were Laryngitis, 9 deaths; Croup, 5*, Emphysema, Asthma, 9; Bronchitis, 293; Pneumonia, 130; Pleurisy, 13 ; and other Diseases of the Respiratory System, 32. Bronchitis and Pneumonia, therefore, were accountable for 423 deaths (including 167 under five years of age), of which 44 were registered in Brompton. 5. Digestive System.—The diseases of the various organs concerned in digestion were the causes of 215 deaths: 94 of them under five years of age; 162 in the Town subdistrict and 53 in Brompton. Dentition was the cause of 18 deaths under five, 10 of them under one year. Diseases of the Stomach caused 26 deaths; Enteritis (including Gastroenteritis'), 70 ; Obstructive Diseases of Intestine, 26; Peritonitis, 14 ; Ascites, 1. Cirrhosis of Liver caused 32 deaths; faundice and Other Diseases of Liver, 20 ; (including three under one year); and Other Diseases of Digestive System, 8 deaths. 6. Diseases of Lymphatic System (eg. of Lymphatics, and of Spleen). Four deaths were registered. 7. Diseases of Gland-like Organs of Uncertain Use {eg. Bronchocele, Addison's Disease). Two deaths were registered. * Ten cases of membranous croup were notified. The Registrar-General classifies falal cases of this disease to diphtheria, 54 8. Diseases of Urinary Organs. -Of the 71 deaths ascribed to these causes, 52 were registered in the Town subdistrict and 19 in Brompton. The fatal diseases were, Nephritis, 20 deaths; Bright's Disease (Albuminuria), 27; Diseases of Bladder or of Prostate, 15; and Other Diseases of Urinary System, 9 deaths. 9. Diseases of Reproductive System.—(a) Of Organs of Generation—Male Organs, 1 death; Female Organs, 7 deaths ; (b) Of Parturition, 9 deaths, viz., Miscarriage, 2; Flooding, 1 ; Other Accidents of Childbirth, 6. 10. Diseases of Bones and Joints.—Eight deaths were registered : Caries, 4 ; Arthitis, 1 ; Other Diseases, 3. 11. Diseases of Integumentary System.—Six deaths were registered. Class VII.—Deaths from Violence. Ninety-six deaths, including 27 under five years of age, and 19 under one year, are distributed over the four Orders comprised in this Class : 25 of them belong to the Brompton sub-district. 1. Accident or Negligence.—Total deaths, 72 including 13 in Brompton, and 27 under five years of age; viz., from Fractures and Contusions, 36; Burn, Scald, 10; Poison, 3; Drowning, 2; Suffocation, mostly of infants overlaid, 20. Eighteen of these "accidents" occurred to children of less than one year old. Eighteen of the deaths from suffocation were registered in the Town sub-district. 3. SUICIDE.—Total deaths, 24; including 12 in Brompton, an excessive proportion; viz., by Gun-shot Wounds, 2; Cut, Stab, 7 ; Poison, 3 ; Drowning, 3 ; Suffocation, 3 ; Otherwise, 6. Class VIII.—Deaths from Ill-Defined and not Specified Causes. This Class includes the causes of 109 deaths, 102 under five years of age, and 97 under one year ; 99 and 10 in the Town and Brompton sub-districts respectively. The causes named are: Debility, Atrophy, Inanition, 99 deaths (all under five years of age, and 94 under one year); Dropsy, 1; Mortification, 1; Tumour, 2; and Abscess 2. To Causes not Specified or Ill-defined, 4 deaths were ascribed. 55 The following table which is a SUMMARY of Table III. (appendix) shows the number of deaths from the various diseases in the several Classes and Orders. CLASS L—SPECIFIC FEBRILE OR ZYMOTIC DISEASES. Order No. of Deaths. 1. Miasmatic Diseases 230 2. Diarrhoeal 131 3. Malarial 1 4. Zoogenous — 5. Venereal 22 6. Septic 21 405 II. PARASITIC DISEASES 2 III. DIETETIC DISEASES 15 IV. CONSTITUTIONAL DISEASES 554 V. DEVELOPMENTAL DISEASES 187 VI. LOCAL DISEASES— 1. Diseases of Nervous System 265 2. Diseases of Organs of Special Sense 10 3. Diseases of Circulatory System 210 4. Diseases of Respiratory System 491 5. Diseases of Digestive System 215 6. Diseases of Lymphatic System 4 7. Diseases of Glandlike Organs of uncertain use 2 8. Diseases of Urinary System 71 9. Diseases of Reproductive System— a. Diseases of Organs of Generation 8 b. Diseases of Parturition 9 10. Diseases of Locomotive System 8 11. Diseases of Integumentary System 6 1299 VII. VIOLENCE— 1. Accident or Negligence 72 2. Battle 3. Homicide — 4. Suicide 24 5. Execution — 96 VIII. ILL-DEFINED AND NOT SPECIFIED CAUSES 109 Total 2,667 NOTE.—The form for table "A," on page 56, has been prepared by the Local Government Board in order that a " tabular statement of mortality should be made in all districts on a uniform plan," and the table is required to be appended to the Annual Report of the Medical Officer of Health. 56 (A) Table of DEATHS during the Year 1897, in the Parish of Kensington, in the Metropolitan District, classified according to Diseases, Ages, and Localities (See Note, page 55). Names of Localities adopted for the purpose of these Statistics; Public Institutions being shown as separate localities. (Columns/or Population and Births are in Table B.,post). Mortality from all causes, at subjoined ages. Mortality from subjoined causes, distinguishing deaths of children under five years of age Total. At all ages. Under 1 year. and under 5 5 and under '5- *5 and under 25- »5 and under 65. 65 and upwards 1 2 3 4* 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Smallpox. Scarlatina. Diphtheria. Membranous Croup. Fever. Cholera. Erysipelas. Measles. Whoopingcough. Diarrhcea and Dysentery. Rheumatic Fever. Phthisis. Bronchitis. Pneumonia, and Pleurisy. Heart Disease. Injuries. All other Diseases. Entericor Typhoid. Continued. Relapsing. Puerperal. (a) (b) (c) (d) (e) (f) (g) (h) (i) Kensington Town Subdistrict 1461 454 177 49 54 412 315 Under 5 ... 1 15 1 ... ... ... ... 5 ... 9 13 93 ... 2 133 ... 21 338 631 5 upwds. ... 2 10 ... 7 1 ... 3 ... ... ... ... 12 2 95 164 93 22 419 830 Brompton Sub-district 400 68 20 10 13 156 133 Under 5 ... ... 2 ... ... ... ... ... ... ... 1 4 10 ... ... 11 ... 8 52 88 5 upwds. ... ... 2 ... 3 ... ... 1 ... 2 ... ... ... ... 24 28 42 18 192 312 Kensington Infirmary 501 75 41 8 10 242 125 Under 5 ... ... 1 ... ... ... ... ... ... ... 21 2 2 ... ... 18 ... ... 72 116 5 upwds. ... ... ... ... 1 ... ... 1 1 7 ... ... 5 ... 89 65 46 8 162 385 Brompton Hospital 150 1 ... 4 54 91 ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... 122 3 17 ... 7 149 St. Marylebone Infirmary 487 20 11 4 14 241 197 Under 5 ... ... 1 ... ... ... ... ... ... ... 1 ... 5 ... ... 3 ... 1 20 31 6 upwds. ... ... ... ... 1 ... ... ... ... 3 ... ... 1 ... 87 117 36 8 203 456 St. Joseph's House 26 ... ... ... ... 6 20 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 7 6 ... 7 26 Totals 3025 618 249 75 145 1148 790 Under 5 ... 1 19 1 ... ... ... ... 5 ... 32 19 110 ... 2 165 ... 30 483 867 5 upwds. ... 2 12 ... 12 1 ... 5 1 12 .. ... 18 2 123 384 240 56 990 2158 The subjoined numbers have also to be taken into account in judging of the above records of mortalitv. Deaths occurring out-, side the district among persons belonging thereto 333 28 64 38 24 148 31 Under 5 ... 18 28 ... ... ... ... ... ... ... 2 ... 3 ... 1 6 ... 4 30 92 5 upwds. ... 8 23 ... 10 ... ... ... ... ... ... ... ... ... 23 13 22 29 113 241 Deaths occurring with in the district among persons not belonging thereto 691 37 10 7 65 352 220 Under 5 ... ... 1 ... ... ... ... ... ... ... 1 ... 5 ... ... 3 ... 8 29 47 5 upwds. ... ... ... ... 1 ... ... ... ... 3 ... ... 1 ... 209 129 68 15 218 644 * Column 5 (Typhus), from which disease there was no death, has been excluded owing to exigencies of space. 57 DEATHS IN PUBLIC INSTITUTIONS. The only large public institution within the parish in which we are directly interested, is the parish infirmary and workhouse, situate 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, Portobelloroad, Notting-hill—a Roman Catholic Home for aged poor persons, of both sexes, brought from various parts, largely from Ireland : but the Registrar-General does not class it as a public institution. The deaths of non-parishioners at the Marylebone Infirmary, Notting-hill (485), at the Brompton Consumption Hospital (150), and at St. Joseph's House (23), 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 (493), at the Consumption Hospital (8), at St. Joseph's House (3), and at outlying institutions, &c. (333), were 837, or 31.5 per cent, on total deaths; the percentage proportion of deaths in public institutions in the Metropolis, generally, being 291. The Registrar-General in his Annual Summary states, that, about "one in every seven deaths occurred in a workhouse or workhouse infirmary, one in 44 in a Metropolitan Asylums Board Hospital, one in ten in some other hospital, and one in 48 in a public lunatic or imbecile asylum." The increase in the number of deaths in public institutions has been great and continuous for many years past. The Parish Infirmary and Workhouse.—I am am indebted to Dr. H. Percy Potter, the Medical Superintendent, for the statistics of mortality at these important institutions. The deaths were 493, as compared with 440, 442, and 458, in the preceding three years respectively, and were equal to 18.5 per cent. on total deaths. The quarterly numbers were 145, 119, 119, and 140: 259 deaths, therefore, occurred in the first and fourth, or colder quarters, and 238 in 58 the second and third or warmer quarters of the year. The deaths included 259 of males, and 234 of females. The ages at death were :—Under one year, 81 (as compared with 91, 66, and 66, in the preceding three years respectively); between one and sixty, 255 (as compared with 172,210, and 226, in the preceding three years), and at sixty and upwards, 157 (as compared with 177, 166, and 166, in the preceding three years). SUMMARY OF CAUSES OF DEATH. DISEASES. Under 1 year. Between 1 year and 60 years. At 60 years & upwards. Total. Nervous System, Diseases of 5 21 17 43 Circulatory System, Diseases of ... 30 18 48 Respiratory System, Diseases of 8 55 30 93 Digestive System, Diseases of 3 12 15 30 Urinary System, Diseases of ... 5 7 12 Tubercular Diseases (including Marasmus) 45 94 8 147 Inanition 2 ... ... 2 Diabetes ... ... 2 2 Syphilis 6 ... ... 6 Cancer ... 12 16 28 Measles 3 10 ... 13 Erysipelas ... 3 2 5 Diphtheria 1 ... ... 1 Whooping Cough ... 2 ... 2 Enteric Fever ... 1 ... 1 Senile decay ... ... 38 38 Cellulitis ... 2 2 4 Premature Birth 8 ... ... 8 Peritonitis ... 1 ... 1 Joint Disease ... 1 ... 1 Alcoholism ... 3 ... 3 Gangrene ... 1 ... 1 Fracture of Spine ... ... 1 1 Tetanus ... 1 ... 1 Scalds ... 1 ... 1 Wound ... ... 1 1 81 255 157 493 59 Fourteen inquests were held during the year: the cause of death was natural in seven cases, and in other seven cases injuries of various descriptions. The Hospital for Consumption and Diseases of the Chest.— In the Kensington portion of this, the Brompton Hospital, there were 150 deaths, including 8 of Kensington parishioners which are included in Table III. (appendix), the remaining deaths, of non-parishioners, being excluded from our statistics. St. Marylebone Infirmary, Notting-hill.—At this institution, which is under the control of the Guardians of the Poor of the Parish of St. Marylebone, 485 deaths were registered, all of which are excluded from our statistics. St. Joseph's House, Notting-hill.—The deaths at this quasi-public institution, with the exception of 3 of parishioners, are excluded from our statistics. They were 26 in number. Some of the deceased persons had previously resided in Ireland, some in London, and the remainder in the provinces and abroad. Outlying Public Institutions.—The deaths of parishioners at public institutions, &c., without the parish, which in the preceding three years, successively, had numbered 283, 308, and 353, were 333 in 1897. All of these deaths are included in our statistics. The deaths occurred at the several institutions as follows :— 60 St. Mary's Hospital 42 St. George's Hospital 36 West London Hospital 21 Middlesex Hospital 9 St. Bartholomew's Hospital 5 Westminster Hospital 2 University College Hospital 2 Guy's Hospital 1 King's College Hospital 1 London Hospital 1 St. Thomas's Hospital 1 Royal Free Hospital 1 Brompton Hospital (south wing) •5 Western Hospital 38 North-Western Hospital 29 South-Western Hospital 5 Fountain Hospital 4 Northern Hospital 1 London Fever Hospital 1 Children's Hospital, Paddington 8 Children's Hospital, Great Ormonde Street 5 Victoria Hospital for Children 5 Cancer Hospital, Fulham-road 6 Queen Charlotte's Hospital 3 Hospital for Women, Chelsea 2 Hospital for Women, Soho 1 London Temperance Hospital 2 National Hospital 1 North London Consumption Hospital 1 Samaritan Free Hospital 1 French Hospital 1 German Hospital 1 Belgrave Hospital 1 Royal Chest Hospital 1 Lying-in Hospital, Endell-street 1 Convent Hospital 1 Hampstead Home Hospital 1 Cheyne Hospital 1 Chest Hospital, Bethnal Green 1 Throat Hospital, Golden-square 1 Memorial Cottage Hospital, Mild- may-park 1 Miller Hospital 1 Station Hospital,Vauxhall Bridge- road 1 St. Peter's Home 3 St. Elizabeth's Home 2 Friedenheim I Tome of Peace 2 St. Luke's House 2 St. Camillo's Home 1 Home for Consumptive Females 1 St. Pelagio's Creche 4 Paddington Workhouse 1 Fulham Infirmary 1 Banstead Asylum 11 Han well Asylum 10 Leavesden Ayslum 7 Cane-hill Asylum 4 Caterham Asylum 2 Colney Hatch Asylum 2 Ilford Asylum 2 Central London Sick Asylum 1 Darenth Asylum 1 Licensed Victuallers' Asylum, Peckham 1 London County Asylum 1 312 Other 21 deaths occurred without the Parish, viz., four by drowning (two males in the Grand Junction Canal, and one male and one female in the Serpentine); three of males in the street ; one male on the railway; one male at a railway station ; two males in prison ; three males at hotels ; one male at a public house; and five males and one female at private houses. Deaths from diseases of the zymotic class, occurred at public institutions without the parish, as follows:—Western Hospital, 37 (diphtheria, 22 ; scatlet fever, 13 ; enteric fever, 2); North-Western Hospital, 29 (diphtheria, 20 ; scarlet fever, 7 ; enteric fever, 1 ; measles, 1); St. George's Hospital, 5 (enteric fever); Fountain Hospital, 4 (diphtheria, 3 ; scarlet fever, 1); South-Western Hospital, 5 (diphtheria, 2 ; scarlet fever, 2 ; 61 enteric fever, 1); St. Mary's Hospital, 3 (diphtheria, 2; diarrhata, 1); London Fever Hospital, 1 (scarlet fever) Northern Hospital, 1 (scarlet fever); Station Hospital, Vauxhall-bridge-road, I (scarlet fever); Victoria Hospital for Children, 1 (diphtheria); Children's Hospital, Great Ormondestreet, 1 (diphtheria); Miller Hospital, 1 (entericfever); and St. Pelagio's Creche, 1 (diarrhea). UNCERTIFIED DEATHS. Two deaths only were not certified either by a registered medical practitioner or by a coroner. They were of a newly-born child, information of the death having been given by a midwife, and of a man, aged 57, the cause of whose death, ascertained by post-mortem examination, was heart disease. The cases were reported to the coroner who did not deem it necessary to hold inquisition. In England and Wales the deaths not certified were 2.0 per cent. of total deaths; the proportion in London was 0.0 and in Kensington, 0.07 per cent. The great towns which had the largest proportion of uncertified deaths, were West Ham 2.7 ; Sheffield 2.8 ; Preston and Birmingham 32 ; and Liverpool 3.4 per cent. The subject of uncertified deaths was considered, in the session of 1893, by a Select Committee of the House of Commons, appointed " to inquire into the sufficiency of the existing law as to the disposal of the dead, for securing an accurate record of the causes of death in all cases, and especially for detecting them when death may have been due to poison, violence, or criminal neglect." The recommendations of the Committee were summed up in ten paragraphs, of which it is only necessary to cite the first two, as follows :— (1) " That in no case should a death be registered without production of a certificate of the cause of death, signed by a registered medical practitioner, or by a coroner after inquest. (2) 11 That in each sanitary district a registeied medical practitioner should be appointed, as public medical certifier of the cause of death, in cases in which a certificate from a medical practitioner in attendance is not forthcoming." 62 No action has been taken, hitherto, by the House, to give effect to the recommendations of the Committee. The Public Control Committee of the London County Council have also dealt with the question, and arrived at conclusions on which they based a variety of recommendations, which were fully set out in my annual report for 1894 (page 70). These recommendations having been approved by the Council, the Public Control Committee were " authorised to attend as a deputation before the Lord Chancellor in support of the amendment of the law relating to coroners' inquests in the County of London, in accordance with the recommendations referred to," and were directed to " urge the advisableness of paying a juryman a sum sufficient to compensate a workman for actual loss of time incurred in performing that public duty, and of making it compulsory that coroners' juries should be summoned by rota" Recently the Council have adopted a report of the Committee, recommending that "where the jury have been chosen strictly in rotation from persons in the parish eligible for service, there may be paid to each person summoned, but not exceeding 15 persons in all, two shillings. This fee is for each attendance, irrespective of the number of inquests the juror serves upon, and is to be paid only when the juror applies for payment." This recommendation takes effect from the 1st of April, 1898. INQUESTS. Two hundred and twenty-four inqu~sts were held on parishioners, including 40 at places without the parish, mostly at public institutions to which the deceased persons had been removed for treatment. The cause of death is stated to have been ascertained by post-mortem examination in 113 cases. Forty-five inquests were held on the bodies of non-parishioners who had died in Kensington. Of the 229 inquests in the parish, 223 were held at the coroner's court at the Town Hall, 4 at the St. Marylebone Infirmary, and 2 at the Parish Infirmary. It is now some years since an inquest in Kensington was held at a public house. 63 The causes of death in inquest cases may be classified as follows:— Deaths caused by disease 128 Deaths caused by violence (96), viz.:— Accidental 72 Suicidal 24 96 Total 224 Of the 24 suicidal deaths, 12 belong to the Brompton subdistrict, and 12 to the Town sub-district. The inquests on Kensington parishioners were in the proportion of 8.4 per cent. on total deaths, the rate in the Metropolis being 93. In England and Wales the rate was 63 per cent. The relative percentages in 1896 were 8.2, 9.1, and 6.2, respectively. The registered deaths from violence were equal to 3.6 per cent. on total deaths in Kensington, the proportion in the Metropolis being 3.9 per cent.; and in England and Wales 3.6 per cent. These deaths were equal to 0.54 per 1,000 persons living in Kensington, 0.77 per 1,000 in London, as a whole, and 0.62 per 1,000 in England and Wales. 64 VACCINATION. Table X. (appendix) is a return respecting vaccination in Kensington in 1896 (the return for 1897 is not yet published), compiled by Mr. Shattock, the Vaccination Officer, whose able discharge of duties, not easy of performance in these days, deserves recognition. It appears that of 3,677 infants whose births were returned in "Birth List Sheets" (col. 2) during the year, 2,842 were successfully vaccinated, and 25 were returned as " insusceptible of vaccination." In 56 cases vaccination was postponed by medical certificate; 12 children were removed to other known districts; and 357 died before attaining the age for vaccination; whilst some 374 cases from "removal to places out of the parish unknown, or which cannot be reached, and cases not having been found," are unaccounted for. These cases are equivalent to a "loss" of 101 per cent., as compared with the number of births registered (or 113 percent. if the 357 cases in column 6, "dead unvaccinated," are deducted), the losses in the preceding ten years having been 5.4, 5.9, 6.0, 6.5, 6.7, 8.0, 8.7, 7.7, 8.4, and 9 0, per cent. respectively. These figures clearly indicate that the proportion of unvaccinated persons in this parish is on the increase. Of the 2,842 successful vaccinations in Kensington,in 1896,1,604 (56.4 per cent.) were performed at the public stations and the parish infirmary. Calf lymph was employed when parents expressed the wish to have it. The revaccinations at the stations and the infirmary were 623 in number. Ken. sington still stands in a position superior to the Metropolis, as a whole, for, as stated in the annual report of the Local Government Board for 1896-97, the average of lost cases in the metropolitan district in 1894 was 20.6 per cent. The actual figures, showing loss, both for town and country, as set out in the last published return, in the annual report of the Board for 1896-97, are as follows :— 65 Metropolis. Cases lost. Rest of England Cases lost. 1885 7·0 per cent. 5·5 per cent. 1886 7·8 „ 6·1 „ 1887 9·0 „ 6·7 „ 1888 10·3 „ 8·2 „ 1889 11·6 „ 9·6 „ 1890 13·9 „ 10·9 „ 1891 16·4 „ 12·9 „ 1892 18·4 „ 14·3 „ 1893 18·2 „ 15·7 „ 1894 20·6 „ 19·0 „ A bad look out truly; for it would appear that in 1894 one-fifth of the children born (and the proportion now is probably as high as one-fourth) are without the protection against small-pox afforded by vaccination.* Meanwhile the report of the Royal Commission has been published, and those interested in public health questions anxiously await the revelation by the President of the Local Government Board of his proposals in regard to amendment of the law relating to vaccination. [The Vaccination Bill.—After the report was in type, the President of the Local Government Board brought in a Bill to "amend the Law with respect to vaccination." It comprises five clauses only. The first section (sub-section 1) enables the parent of a child to delay vaccination until " twelve months from the birth of the child, instead of the period of three months," as at present. The parent may require the public vaccinator "to visit the home of the child for the purpose of vaccinating the child," (sub-section (2)); but " if a child is not vaccinated within nine months after its birth, the public vaccinator of the district will be required to visit the home of the child, and to offer to vaccinate the child #Mr. Shattock informs me that false registration, i.e., wrong addresses entered on the birth list sheets is his greatest difficulty: the children cannot be traced, 66 with glycerinated calf lymph," (sub-section (3) ). Section 2 abolishes repeated penalties for disobedience. It reads as follows :— " An order under section 31 of the Vaccination Act of 1867, directing that a child be vaccinated, shall not be made on any person who has previously been convicted of noncompliance with a similar order relating to the same child." Put plainly, this means that any person having the custody of a child may deprive the child of the benefit of vaccination, and imperil the health of the community, by adding an item to the danger of the spread of small-pox, at the moderate (outside) cost of twenty shillings, i.e., the amount of the prescribed penalty for disobedience to the order, and which, doubtless, would be paid out of some League or Defence Fund. The remaining sections do not call for notice. No provision is made to enable payment to be made to other medical persons than public vaccinators for domiciliary vaccination. The Bill makes no provision in regard to revaccination, which should be compulsory. Arm-to-arm vaccination, fortunately, is not prohibited, nor, therefore, is the use of calf-lymph made universally compulsory. The employment of glycerinated calf-lymph is no doubt desirable, when this lymph is employed. Public vaccination stations will be retained. The control of vaccination is left in the hands of the Poor Law Authorities, so many of which have shamefully neglected their statutory duty. The Bill, which contains no " conscience clause," is brought in as one to "amend" the Law, the word "amend" being used in a technical sense. It might be more correctly described as a Bill " to alter the law with respect to vaccination." It does not satisfy those who believe in the efficacy of vaccination as a protection against small-pox, nor does it appear to meet with much favour from those who are impervious to the overwhelming evidence in favour of vaccination. This section of the public, nevertheless, might well be satisfied, as the tendency of the measure 67 will be to increase largely the number of children who fail to get vaccinated, until an epidemic of small-pox occurs, when, too often, the operation is done too late to secure the needed protection. The facts stated in the report show that the country is becoming every year less protected against small-pox; in other words, each year the number of unvaccinated children increases; and, personally, I fail to discern any probability of a large increase in the number of vaccinations (which is the primary desideratum) should the Bill become law. I am not alone, moreover, in regarding the Bill, in its present form, as a somewhat poor outcome of the seven years' labours of the Royal Commission ; this body having, in the judgment of unprejudiced persons, demonstrated both the safety of vaccination, and its efficiency, under prescribed conditions, as a protection against small-pox.] 68 THE METROPOLITAN ASYLUMS BOARD. The work of the Asylums Board has of late years assumed increased importance in relation to the work of the Sanitary Authorities, by reason of legislation which has conferred power on the Managers to discharge for the Metropolis, as a whole, the functions which, under the provisions of the repealed Sanitary Act, 1866, formerly devolved upon the 43 Vestries and Distict Boards in their several districts. The Board are now the central authority for providing hospital accommodation, and an ambulance service, by land and water, 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 admittance to hospital. The ambulance arrangements leave nothing to desire; the accommodation for the sick, moreover, was always sufficient until within the last few years; but the increased and increasing disposition of the public to make use of the hospitals, which dates from the scarlet fever epidemic of 1887, together with the enlarged demands on the resources of the Managers consequent on compulsory notification of infectious disease, have given rise to difficulties to which reference has frequently been made in these reports. Happily, the steps taken by the Managers, with the approval of the Local Government Board, encourage the belief that at no distant time the provision of accommodation will be equal to the demand. The work of the Board is summarised in three reports, issued annually, by the Chairman (Sir E. H. Galsworthy), by the Statistical Committee, and by the Ambulance Committee. The two reports first-named, which have great interest for all who are concerned in the sanitary government of London, and the several sanitary districts thereof, had not been published when this report went to press. I am, therefore, unable to follow my former practice of summarising their contents for the information of your Vestry. 69 ANNUAL REPORT OF THE AMBULANCE COMMITTEE. I submit a risumi of this report with satisfaction. It is fitting that every Sanitary Authority in the Metropolis should know something of the great work being carried on in their behalf by the Metropolitan Asylums Board. The Committee state that both scarlet fever and diphtheria were less prevalent in 1897 than in 1896. Of scarlet fever 22,850 cases were notified, as compared with 25,647 in 1896; of diphtheria 12,803 cases, as against 13,362. During the month of August 77 per cent. of the notified scarlet fever cases, and 58 per cent. of the diphtheria cases, were received into the hospitals; and "it again became necessary to limit admission to cases in which, as a consequence of their surroundings and conditions of life, the. need of isolation was most urgent." The Managers wisely took special steps to increase the number of beds for diphtheria, the more dangerous of the two diseases, by diverting some of the accommodation provided for scarlet fever; and the cases of diphtheria which failed to obtain admission were comparatively few in number. The new Park Hospital, at Hither Green, was not brought into use until the 8th November—too late in the season to be of much service, the prevalence of both scarlet fever and diphtheria being then on the decline. The Grove Hospital, at Tooting, and the additional wards for diphtheria cases at the Western Hospital, will, it is anticipated, be completed and brought into use in 1898. The second of the new Ambulance Stations—the NorthWestern—commenced operations on the 1st September last. It is hoped that the third—the South-Western—will be opened at an early date in 1898. Land Service.—Scarlet Fever patients to the number of 22,795 were removed to the hospitals, as compared with 70 22,152 in 1896: the daily average of removals in the first six months was 51, during the last six months 74; as compared with 53 and 68 respectively in 1896. The aggregate of removals during the year—including inter-hospital transfers— numbered 42,758 : viz., 12,216 by the Eastern Station; 2,149 by the North-Western Station (opened September 1st), 11,739 by the South-Eastern Station, 5,164 by the Brook Station, and 11,739 by the Western Station at Seagrave-road, Fulham, adjoining the Western Hospital, in which we are locally interested. The maximum number of patients removed to hospital on any one day by the Western Station was 40, on the 17th November, and the heaviest week's work at this station was that ended on the 24th July, when 322 removals were effected, and 2,033 miles were travelled by the ambulances. Small-pox.—Patients were admitted to the Managers' hospitals, from 18 out of 30 Poor Law Districts, to the number of 95, including cases which, after observation, proved to be not small-pox: of these removals 52 took place in February, and 10, 8, 7 and 7, in the months of May, January, March, and April respectively. The patients removed from their homes to the Wharves numbered 121, as compared with 265 in 1896. In 71 cases the diagnosis was confirmed by the medical officers who inspected the patients at the Wharves. Forty-nine patients not suffering from small-pox were returned to their homes, and one patient remained in the Shelter at the South Wharf at the end of the year. Fever.—At the commencement of the year there were 4,540 patients in the Managers' fever hospitals (including 323 at the Western Hospital), viz., Scarlet Fever 3,734, Diphtheria 690, and Enteric Fever 116. The cases of these three diseases at the Western Hospital were 225, 84, and 14, respectively. The total number (4,540) was greater by 1,011 than at the beginning of 1896. The number under treatment fell to the minimum (3,136) for the year by the 7th May; after this date 71 the number rose until it attained the maximum (5,023) for the year on the 9th December. This figure, it is stated, would have been exceeded had the Park Hospital been brought into use in the early part of the year. Enteric Fever patients to the number of 186 were removed to general hospitals under the arrangements made with the authorities of those hospitals in 1892. Diphtheria.—The number of patients certified at the time of removal to be suffering from diphtheria, or "diphtheritic membranous croup," was 6,561, as against 5,334 in 1896. The average daily number removed was 15 in the first half of the year, and 21 in the latter half. The Managers conveyed to other places than their hospitals 361 persons suffering from dangerous infectious disorders, under powers conferred by section 79 (3) of the Public Health (London) Act, 1891. Of these, 16 were stated to have measles, 69 scarlet fever, 134 enteric fever, 72 diphtheria, 61 erysipelas, 5 puerperal fever, 2 cholera, 1 relapsing fever, and 1 small-pox. In a considerable number of these cases payment of the modest fee chargeable for this service was remitted on account of the want of means of the patients. The Committee report with satisfaction that "no hitch of any kind" was experienced in regard to the vast number of removals during the year, and that "no patient or nurse had cause to complain of injury sustained while under the charge of the service." Only one person of the numerous staff (a man who contracted diphtheritic sore throat) appears to have sustained illness probably referable to the dangerous character of the work. River Service.—The distance run collectively by the four ambulance steamboats (Red Cross, Maltese Cross, Albert Victor, and Geneva Cross), and the ambulance steam launch 72 (White Cross) was 6,226 miles, and they conveyed 1,223 patients and other passengers, besides stores, to and from the Hospital Ships at Long Reach. Cost of Ambulance Services.—The total expenditure during the year ended Michaelmas was ,£30,405 17s. 3d., viz., £20,661 16s. l1d. for the Land Service(including £4,000 8s. 6d. for the Western Station), and £9,744 0s. 4d. for the River Service, including £1,911 18s. 4d. for the Medical Department. Of this large expenditure, £19,048 17s. l0d. was out of" Loan Account," viz., £17,648 for Land Service, on account of erection of new ambulance stations, and £1,400 3s. 0d. for the River Service, viz., £892 is. 6d. on account of construction of Staff Quarters at South Wharf, and £508 is. 6d. on account of construction of a new Ambulance Steam Launch. Appendices furnish copious detailed information, viz., with respect to Land Service; A, "Number of Persons removed by the Ambulances;" and B, "Return of work" for the year: with respect to the River Service; C, "Number of Patients, Visitors, Staff, etc., conveyed to and from the Hospital Ships during the year." It may be mentioned that the Managers' Fever Hospitals for acute cases are nine in number, respectively designated Eastern, North-Eastern, North-Western, Western, Southwestern, Fountain, South-Eastern, Brook, and Park. The Northern Hospital is for Convalescent Fever and Diphtheria cases. The Hospital ships are for acute Small-pox : the Gore Farm Hospitals, intended for use for Convalescent Small-pox patients, are utilised for Convalescent Fever patients when not wanted for Small-pox patients. Extensive sites have been obtained for further accommodatoin, viz., at Joyce Green, near Long Reach, for acute small-pox, and at Carshalton, for Convalescent Fever patients ; but no buildings have, as yet, been erected at either place. 73 The foregoing abstract of the report of the Ambulance Committee may suffice to show that the duty of removal of the sick to hospital, whether by land or water, is now effected in a satisfactory manner. The use of public vehicles for the removal of persons afflicted with infectious disease is unlawful. Occasionally we hear of the use of a cab, wittingly or unwittingly, and in such cases the vehicle is usually lost sight of before discovery of the nature of the illness, and so does not get disinfected. This is no doubt a serious danger to the public, but it is of rare occurrence compared with the time before the passing of the Public Health (London) Act, 1891, the 70th section of which forbids the employment of public vehicles for the purpose in question. No case of wilful breach of the law came to my knowledge during the year. Ambulance Arrangements.—Kensington patients are removed by the staff at the western Station, which adjoins the Western Hospital at Seagiave Road, Fulham. Between 8 a.m. and 8 p.m., on weekdays, 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, and on Christmas Day and Good Friday, application for a patient's removal is forwarded direct to the ambulance station. The Managers' telegraphic address is "Asylums Board, London;" their telephone numbers are 2858 and 2859 "Gerrard." 74 HOSPITAL ACCOMMODATION. In the annual report for 1893 (pages 117 to 130 inclusive), I dealt with "The needs of the metropolis in respect of Hospital Accommodation for the Infectious Sick," and detailed the steps taken by the Asylums Board to supply the then existing deficiencies, and the difficulties by which their efforts had been confronted and, to a certain extent, foiled. Those difficulties have now been largely overcome; and the needs of the metropolis, in this regard, which are now fully recognised, will ere long be met to the full extent of and, indeed, beyond the estimate of them made in my tenth monthly report for 1892, which, at the time, was thought to be excessive, viz.: of "at least 5,000 beds for scarlet fever, fever, diphtheria, and isolation." Fever Hospital Accommodation.—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 1881-82, and the Commissioners stated in their report (1882) that the then provision of hospitals should be extended so as to provide 5,700 beds at the least; viz., 3,000 nominally for " Fever," and 2,700 for Small-pox. Diphtheria cases 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 1,700 beds, beyond the theoretical requirements of the day. The Commissioners, doubtless, intended to make provision for a lengthened period in advance, and the amount of accommodation they advised to be provided is even now in advance of the standard requirement. But circumstances have since arisen that they could scarcely have anticipated, and which have led to largely increased demands on the Managers' resources ; not only by the Sanitary Authorities, but also by private medical practitioners and others. Among these 75 circumstances may be mentioned (1) the depauperisation of medical relief in the hospitals; (2) the opening of the several institutions to all classes of the people; (3) the admission of patients, on whatever form of application, subject only to the presentation of a medical certificate; (4) gratuitous treatment; (5) the popularity of the hospitals themselves; and last, but not least (6) the increasing recognition by the public of the advantages accruing from the isolation of the infectious sick. The operation of compulsory notification, moreover, has had great effect, for now that Sanitary Authorities become acquainted with, practically, all cases of infectious disease, they are able to secure the admittance to hospital of numbers of cases, such as in pre-notification days they would probably never have so much as heard. In connection with this important question, it may be mentioned that so far back as the end of 1893, the Managers had provided normal accommodation to the extent of about 3,000 beds, for fever and diphtheria patients, by the erection of additional temporary hospitals at Tottenham and Lower Tooting. Since that date the Brook Hospital for upwards of 500 patients has been erected and opened at Shooter's-hill, and (in November last) the Park Hospital at Hither-green, Lewisham, also for upwards of 500 patients. An equally large hospital to be designated "Grove" will at no great distance of time be opened at Tooting, adjoining the "Fountain" hospital, described as a temporary hospital, although from the character of its construction it is calculated to be serviceable for many years. These three hospitals for acute cases of fever, scarlet fever and diphtheria, in addition to isolation wards, will thus add some 1,650 beds to those previously provided by the Managers; who, moreover have acquired a site of 135 acres at Carshalton, Surrey, for a convalescent fever hospital for 700 beds; having already at Winchmore-hill, north of the Thames, the Northern Convalescent Hospital, with accommodation for nearly 1,000 patients. In addition to the new hospitals on new sites, 76 previously existing accommodation has been extended and improved by the more or less complete reconstruction, with additions, of most of the older hospitals. Small-pox Hospital Accommodation.—As regards accommodation for small-pox, the Managers have not, as yet, provided anything like the amount recommended by the Royal Commission in 1882, viz., 2,700 beds. The Hospital Ships at Long Reach, on the Thames, furnish 300 beds for acute cases ; whilst for mixed cases there is accommodation for about 1,200 patients at the Gore Farm Hospital, which, at the present time, is being utilised for about 750 scarlet fever convalescents. The accommodation on this site could be materially increased, in case of emergency, by the erection of temporary buildings, as also at the Joyce-green estate, a new site, of some three hundred acres, which (with considerable additions of intervening land connecting the estate with the hospital ships) the Managers have acquired, and on which they propose to build a permanent hospital for acute cases of small-pox, which, doubtless, will, in course of time, supersede the hospital ships. Summary.—I am indebted to Mr. Duncombe Mann, the Clerk to the Metropolitan Asylums Board, for the subjoined statement of the existing and projected accommodation for various classes of the infectious sick: it cannot fail to be read with interest. 77 "Return showing the permanent Fever Hospital Accommodation existing and projected— (i.) Accommodation existing— Beds. Eastern Hospital 356 North-Eastern Hospital 406 North-Western Hospital 470 Western Hospital 330 South-Western Hospital 368 Fountain Hospital 402 South-Eastern Hospital 463 Park Hospital 548 Brook Hospital 568 Northern Hospital 652 Total 4,563 (ii.) Accommodation projected— Beds. Eastern Hospital (1) 6 North-Eastern Hospital (2) 128 Western Hospital (3) 104 Grove Hospital 520 Northern Hospital 12 Southern Hospital (say) 700 Total 1,470 Grand total 6,033 (1) Isolation block now being erected. (2) Additional beds when re-constructed. (3) Extension buildings approaching completion. N.B.—The Western extension and the Grove Hospital will be ready in a few months. For Small-Pox Patients the existing accommodation is as follows:— Hospital Ships 300 Gore Farm, Upper Hospital 1,000 (At present occupied by Scarlet Fever patients) Gore Farm, Lower Hospital (Wooden buildings) 192 Total 1,492 78 Joyce Green Estate.—On this estate the Managers proposed to provide beds for 940 patients, but the Local Government Board have so far refused to sanction provision being made for more than 400 patients. Plans for the proposed hospital for this number have been prepared and sanctioned. Thus it appears that the Metropolis is endowed, in possession or in early prospect, with accommodation for upwards of 6,000 patients suffering from fever and diphtheria: a number more than double that recommended by the Royal Commission (3,000); irrespective of about 750 beds at Gore Farm, generally available for convalescent cases in the abeyance of small-pox. Time alone can determine whether this provision will suffice for the requirements of the metropolis. For small-pox patients the accommodation is, or will be, to the extent of some 1,900 beds : a number, I repeat, considerably below the recommendation of the Royal Commission (2,700); but which I am sanguine will suffice, seeing how much more effectually this disease has been controlled since the practice of removing the sick out of London for isolation and treatment, first done upon my advice in May, 1881, has been perfected by the Managers, who, since 1884, have practically ceased to use the town hospitals for the isolation of small-pox, removing direct from their homes to the Ships all patients suffering from this disease—with what beneficent results let the statistics of mortality set out at page 27 testify. The Park Hospital.—As elsewhere indicated, the inability of the Asylums Board to receive all of the patients whose admission was desired by sanitary authorities and others, was removed in November when the Park Hospital was opened, there having been, moreover, by that date, a considerable diminution in the amount of scarlet fever and diphtheria notified. The hospital in question is located at Hither-green, in the district of Lewisham. Occupying a site of twenty acres, this fine building—fine in essentials, for it is devoid of external adornment—furnishes accommodation for a total of 548 patients ; viz., for scarlet fever 368 beds, diphtheria 79 and enteric fever 120 beds, in addition to 60 beds for isolation purposes. Accommodation is also provided for 316 staff. The hospital is replete with the latest improvements, and an inspection of it afforded satisfaction to many visitors, both on the occasion of a formal opening by the Prince and Princess of Wales, and subsequently when invitations had been issued to the Sanitary Authorities of the metropolis and others interested in the matter of accommodation for sufferers from infectious disease. DEFICIENCY OF HOSPITAL ACCOMMODATION. In the tenth report (October 13th, page 116), I had to state that the Asylums Board had been unable for some weeks to accommodate all of the patients for whose admission application had been made by the Sanitary Authorities and others. All cases of diphtheria were received, and this was well, although it entailed the refusal of many cases of scarlet fever, a disease which apparently is becoming, year by year, less fatal. The deaths from this cause were, as we have seen, far below the average, corrected for increase of population, although the malady was very prevalent, as shown by the monthly notification table, (vide page 84.) In this parish there were as many as 27 cases awaiting removal at one time. Assuming a proportional number of cases, proper for removal and not removed, in the other sanitary districts, the total for London would have been at least 700 cases, or considerably more than the accommodation provided at the Park Hospital for all classes of infectious disease, &c.; so that the hospital, when opened in November, would not have cleared off the arrear cases had scarlet fever continued as prevalent as it was in September and October. The only remaining provision of accommodation for fever in present contemplation, apart from enlargement of existing hospitals, is that at Carshalton, where, as already stated, a convalescent hospital is to be erected for 700 patients, on a site of some 135 acres. As the Northern Hospital, at Winchmore-hill, provides for nearly 1,000 cases on a site not exceeding 30 acres, it is deserving of the 80 sideration of the Asylums Board whether provision should not be made for an increased number at Carshalton; and whether provision should not also be made for the reception of scarlet fever and diphtheria convalescents at the site of the proposed small-pox hospital, near the hospital ships at Long Reach, when it is not needed for small-pox. There is reason to hope that the Hospital Ships will suffice, for some time at any rate, for the requirements of the Metropolis; small-pox having been in abeyance, and no cases having been under treatment for many months. As regards enteric fever, all applications for the removal of cases were complied with throughout the year, the Asylums Board having an arrangement with certain general hospitals for the admittance of cases for which they themselves are unable to provide accommodation. 81 NOTIFICATION OF INFECTIOUS DISEASE. The table at page 83 shows the number of notifications of infectious disease in London in 1897. The table at page 84 is designed to show the relative prevalence of the several diseases at different periods of the year, being a summary of the figures set out in my four-weekly reports. The Kensington notifications, were 1,457, viz., in the Town sub-district 1,172, and in the Brompton sub-district 285. The notifications in 1893, 1894, 1895, and 1896, were 1,811, 972, 1,289, and 1,781, respectively. Table IX. a (appendix) shows the streets, &c., where cases of the scheduled diseases occurred in 1897. The cases notified in London, as a whole, were 45,465 and 4,234 fewer than in 1896. The notifications of each of the scheduled diseases during the eight years 1890-97, are set out in the subjoined table. Notifications in London, 1890-97. 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 5,870 2877 35 237 206 4598 550 25 7 29,795 1891 114 11,398 5,907 3372 27 152 221 4764 505 23 39 26,522 1892 423 27,096 7,791 2465 20 147 347 6934 565 54 7 45,849 1893 2813 36,901 13,026 3663 22 205 397 9700 668 86 4 67,485 1894 1192 18,440 10,655 3360 21 162 253 6080 535 21 2 40,925 * 1895 978 19,757 10,772 3506 14 105 236 5660 451 29 3 41,511 1896 225 25,638 13,361 3189 6 102 278 6438 446 13 3 49,699 1897 105 22,876 12,811 3113 4 65 264 5801 388 38 1 45,465 * The total includes 204 cases of Diarrhœa. Note.—The form for table "B," on page 82 was prepared by the Local Government Board in order that a "tabular statement of infectious sickness should be made in all districts on a uniform plan : " the table, which is based on the infectious disease register, is required to be appended to the annual report of the Medical Officer of Health. 82 (B) Table of POPULATION, BIRTHS, AND OF NEW CASES OF INFECTIOUS SICKNESS coming to the knowledge of the medical officer of health, during the year 1897, in the parish of Kensington, in the Metropolitan District; classified according to Diseases, Ages and Localities. Names of Localities adopted for the purpose of these Statistics : Public Institutions being shown as separate localities. Population at all Ages. Registered Births. Aged under 5 or over 5. New Cases of Sickness in each Locality, coming to the knowledge of the medical officer of health. Number of such Cases Removed from their Homes in the several localities for treatment in Isolation Hospital. Last Census. Esti* mated to middle of 1897. 1 2 3 4 5 6 7 8 9 10 11 1 2 3 4 5 6 7 8 9 10 11 Small-pox. Scarlatina. Diphtheria. Membranous Croup. Fever. Cholera. Erysipelas. Small-pox. Scarlatina. Diphtheria. Membranous Croup. Fever. Cholera. Erysipelas. Typhus. Enteric or Typhoid. Continued. Relapsing. Puerperal. Typhus. Enteric or Typhoid. Continued. Relapsing. Puerperal. (a) (b) (c) (d) (e) Kensington Town SubDistrict 119713 120806 2997 Under 5 ... 184 93 8 ... 3 ... ... ... ... 14 ... 141 70 3 ... 3 ... ... ... ... ... 5 upwds. ... 404 158 2 ... 78 4 ... 11 ... 135 ... 285 113 1 ... 48 ... ... ... ... 1 Brompton Sub-District 48109 48248 550 Under 5 ... 30 19 ... ... ... ... ... ... ... 2 ... 25 15 ... ... ... ... ... ... ... 1 5 upwds. ... 118 52 ... ... 31 1 ... 3 ... 29 ... 97 35 ... ... 15 ... ... ... ... ... Kensington Infirmary and Workhouse 1648 1648 136 Under 5 ... 5 ... ... ... ... ... ... ... ... 1 ... 5 ... ... ... ... ... ... ... ... ... 5 upwds. ... 8 ... ... ... 5 ... ... 2 1 55 ... 8 ... ... ... ... ... ... ... ... 2 St. Marylebone Infirmary 803 803 ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... Brompton Hospital 192 192 ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Total 170465 171697 3683 Under 5 219 112 8 ... 3 ... ... ... ... 17 ... 171 85 3 ... 3 ... ... ... ... 1 5 upwds. 530 210 2 ... 114 5 ... 16 1 220 ... 390 148 1 ... 63 ... ... ... ... 3 83 Cases of Infectious Disease notified to the several Metropolitan Medical Officers of Health, under the provisions of the Public Health (London) Act, 1891, in the Fifty-two Weeks ended Saturday 1st January, 1898. Local Authorities in whose Districts the cases were resident. Small-pox. Scarlet Fever. Diphtheria. Enteric Fever, Typhus Fever. Other Continued Fevers. Puerperal Fever. Erysipelas. Croup. Cholera. Totals. Population 1896 Kensington ... 749 322 117 ... 5 16 237 10 1 1457 170,465 Battersea 5 1585 604 93 1 ... 7 213 18 1 2527 165,115 Bermondsey 1 507 269 62 ... ... 1 94 9 ... 943 85,475 Bethnal Green 2 723 508 106 1 ... 7 383 41 1 1772 129,162 Camberwell 32 1194 1150 150 ... 1 14 297 19 ... 2857 253,076 Chelsea ... 489 307 52 ... 1 4 98 6 ... 957 96,646 Clerkenwell ... 366 346 63 ... ... 2 99 4 ... 880 66,202 Fulham ... 761 378 53 ... 5 14 134 10 1 1356 113,781 Greenwich 1 818 591 145 ... 2 10 239 9 ... 1815 75,774 Hackney 3 1374 751 209 ... 5 11 273 29 ... 2655 213,044 Hammersmith ... 396 148 45 ... 4 8 92 7 1 701 104,199 Hampstead ... 224 104 32 ... 2 2 40 3 ... 407 75,449 Holborn ... 119 159 25 ... ... ... 46 2 ... 351 31,208 Islington 3 1577 704 259 ... 1 28 313 29 1 2915 336,764 Lambeth 2 1395 727 185 ... 10 27 322 15 17 2700 295,033 Lee 1 210 110 17 ... ... 1 51 ... ... 390 38,588 Lewisham ... 299 217 46 ... ... 2 81 2 ... 647 83,213 Limehouse ... 428 190 52 ... ... 4 87 3 ... 764 58,305 Mile End ... 817 433 83 ... ... 7 145 12 ... 1497 111,060 Newington ... 769 318 81 ... ... 16 159 14 ... 1357 120,939 Paddington 1 489 314 46 ... ... 8 136 10 1 1005 124,506 Plumstead ... 373 132 25 ... ... 3 46 3 4 586 59,252 Poplar 9 1041 671 195 ... 3 12 262 34 1 2228 169,267 Rotherhithe ... 289 82 24 ... ... 4 73 4 ... 476 40,379 Shoreditch 1 627 353 107 ... 2 2 226 19 1 1338 122,348 St. George in-the-East 1 244 181 43 1 1 3 85 8 ... 567 47,506 St. George, Hanover Sq. 1 177 120 40 ... 2 1 51 ... ... 392 79,967 St. George-the-Martyr 1 381 185 40 ... 1 1 88 6 ... 703 60,278 St. Giles, Bloomsbury 3 209 54 33 ... ... 2 94 2 ... 397 38,237 St. James, Westminster 3 131 49 13 ... 2 1 24 1 ... 224 23,050 St. Luke, Middlesex ... 238 185 41 ... ... 2 86 1 ... 553 41,527 St. Martin-in-the-Fields 1 44 12 5 ... ... ... 17 2 ... 81 13,077 St. Marylebone 4 397 218 88 ... 1 5 254 3 2 972 141,188 St. Olave, Southwark 1 88 29 10 ... ... 1 10 ... ... 139 11,731 St. Pancras 3 942 533 223 ... 8 14 388 10 3 2124 240,764 St. Saviour, Southwark ... 131 96 16 ... ... ... 28 8 ... 279 25,365 Stoke Newington 12 108 53 37 ... 1 3 23 1 ... 228 33,485 Strand 8 127 39 20 ... ... ... 18 2 ... 214 23,782 Wandsworth 2 1024 563 99 ... 6 9 239 10 ... 1952 187,264 Westminster ... 181 110 28 ... 1 4 66 1 1 392 53,234 Whitechapel ... 500 283 55 1 ... 4 120 18 ... 981 77,717 Woolwich 2 224 149 18 ... ... 2 36 .. ... 432 41,314 City of London 2 96 60 23 ... ... 2 26 3 2 214 30,970 Port of London 10 15 4 9 ... ... ... 2 ... ... 40 Grand Totals 105 22,876 12,811 3113 4 65 264 5801 388 38 45465 Table showing the number of Cases of Infectious Disease Notified in Kensington, and in London, in 1897, 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 1-4 ... 44 23 8 ... 1 1 15 ... ... 92 8 1439 915 203 ... 6 18 450 57 1 3097 1- 4 January 30 February 27 5-8 ... 29 15 3 ... 1 ... 21 1 ... 70 48 1289 916 198 1 1 26 447 51 ... 2977 5-8 February 27 March 27 9-12 ... 41 28 10 ... 1 1 20 3 ... 104 5 1174 902 166 ... 10 18 395 35 ... 2705 9-12 March 27 April 21 13-16 ... 28 21 6 ... ... 4 22 ... ... 81 9 1206 730 133 ... 4 21 364 25 1 2493 13-16 April 24 May 22 17-20 ... 33 19 6 ... ... 1 9 ... ... 68 15 1316 777 119 ... 1 21 389 28 1 2667 17-20 May 22 June 19 21-24 ... 55 20 6 ... ... 1 18 2 ... 102 3 1454 895 170 ... 3 16 389 15 1 2946 21-24 June 19 July 17 25-28 ... 66 20 4 ... 1 ... 15 1 ... 107 6 1701 1011 157 1 4 19 420 15 1 3335 25-28 July 17 August 14 29-32 ... 52 27 2 ... ... ... 20 1 1 103 3 2019 1111 204 1 8 17 470 8 22 3863 29-32 August 14 September 11 33-36 ... 54 23 8 ... ... ... 21 ... ... 106 1 1915 866 306 ... 9 18 423 16 11 3565 33-36 September 11 October 9 37-40 ... 135 31 21 ... ... 2 22 ... ... 211 1 2801 1169 430 ... 4 21 559 36 ... 5021 37-40 October 9 November 6 41-44 ... 92 38 21 ... 1 3 12 ... ... 167 2 2955 1336 516 1 9 26 561 33 ... 5439 41-44 November 6 December 4 45-48 ... 85 38 15 ... ... 3 27 1 ... 169 3 2058 1119 285 ... 3 22 503 35 ... 4028 45-48 December 4 January 1, 1898 49-52 ... 35 19 7 ... ... ... 15 1 ... 77 1 1549 1064 226 ... 3 21 431 34 ... 3329 49-52 January 1,1898 Totals ... 749 322 117 ... 5 16 237 10 1 1457 105 22876 12811 3113 4 65 264 5801 388 38 45465 Totals. 84 85 FACTORY AND WORKSHOP ACTS. Duties ok the Sanitary Authority with Respect to workshops.—The duties devolving upon the Sanitary Authority under the Factory Acts were set out in considerable detail in the Annual Report for 1896 (pp. 97-103 inclusive). Reference thereto will suffice to show how serious are the responsibilities which the Legislature has imposed on Sanitary Authorities throughout the kingdom. An effort to cope vvith these responsibilities was made by your Vestry,in October, 1893, by the appointment of two ladies as inspectors of workshops, workplaces, and laundries, where women are employed. Both of these ladies, Miss Deane and Miss Squire, have since been appointed, by successive Secretaries of State, to the even more responsible position of factory inspector under the Home Office. Miss Deane's successor, Miss Duncan, who ceased to hold office in July, 1895, has since been appointed to the office of factory inspector by the Government of New South Wales. The appointment held by her in this parish has not been filled. Miss Squire's successor, Miss de Chaumont, does her best to carry out the work of inspection and supervision for the entire parish. Her report for the year is subjoined, page 88. With respect to the workshops, &c., where men only are employed, nothing has been done to give effect to legislation in any way comparable with the work so well carried out by the female inspectors of workplaces where women are employed. These establishments should be taken in hand, but it is impossible with the present limited and reduced staff of sanitary inspectors. We do not so much as know, at present, the localities of any large proportion of the workshops. No doubt, however, their whereabouts could be ascertained from Her Majesty's Superintending Inspector of Workshops, &c., were it, at any time, put in my power to take up this branch of sanitary administration. 86 The question has been asked, more than once, whether your Vestry, by appointing special officers to inspect workshops, workplaces, laundries, &c., were not interfering with duties legally attaching to the office of the factory inspectors appointed by the Secretary of State ? The answer to this question is distinctly negative. There is nothing conflicting in the duties of factory inspectors and those devolving upon the inspectors of the sanitary authority. The duties of the respective offices are reciprocal. One of the duties devolving upon the medical officer of health under the Public Health (London) Act, 1891 (sec. 27), is to give "written notice to the factory inspector" of "any child, young person, or woman, employed in a workshop," and this I have done, since October, 1893, in a large number of instances, upon information acquired for me by the women inspectors. I report, moreover, to Her Majesty's Superintending Inspector of Workshops, &c., every workshop and workplace newly opened,or discovered by the inspector; and, reciprocally, that gentleman forwards to me all notices he receives from persons intimating intention to occupy premises as workshops or workplaces. In like manner the Superintending Inspector reports to me all cases of overcrowding discovered by his assistants, and all cases of dirty and insanitary premises observed by those officers, requiring to be dealt with under the Acts; it being the duty of the sanitary authority to take steps to secure the abatement of all such nuisances. The necessary steps have been taken in many instances (since October, 1893) by the Sanitary Committee, to which your Vestry have entrusted the carrying out of the provisions of the Factory and Workshop Acts, 1878 to 1895, and the Public Health (London) Act, 1891. And to facilitate the discharge of these duties the legislature has conferred on the sanitary authority and their officers "all such powers of entry, inspection, taking legal proceedings, or otherwise," as a factory inspector has under the "principal Act," i.e., the Act of 1878. The powers of the sanitary authority, in regard to the inspection and 87 vision of workshops, in order to the enforcement of the law, would thus appear to be ample. But lest these powers should be allowed to fall into desuetude, or be wilfully neglected, power is given, by sections 1 and 2 of the Factory and Workshop Act, 1891, which enables the factory inspector to supersede a defaulting Authority in the execution of their duties in respect of workshops or laundries; and to recover from the Authority, in whose district the workshops or laundries are situated, "all such expenses in and about any proceedings . . . . as he may incur." Work of the Lady Inspector of Workshops, Etc.: Annual Report.—I have received from Miss de Chaumont the subjoined report with respect to the duties carried out by her, in 1897, as inspector of workshops, workplaces, and laundries where women are employed. In connection therewith I may be permitted to observe that the initiative of your Vestry, in 1893, is being followed up by other sanitary authorities, both in town and in the provinces, several of which now avail themselves of the assistance of women in the work of sanitary administration. There is good ground for hoping that the practice will, in course of time, become much more general. As to the value and success of the movement in this parish there can be no question: it has long since passed out of the experimental stage. I wish it were possible to give effect to the requirements of the Acts in relation to workshops, etc., where men are employed. The obligations devolving upon the Sanitary Authority in this department of administrative work, were set out in a report adopted by the Sanitary Committee,and printed in the annual report of the Medical Officer of Health for 1896(pages 96-103 inclusive)which was accepted by your Vestry as a correct statement of the powers and duties of the sanitary authority. In the final report by Miss Squire it was stated, and it is a matter for satisfaction, that there had become manifest, on the part of employers, an increasing willingness to conform to the requirements of the law, with which many of them had been more or less unacquainted, until they were made known 88 by the visits of the lady inspectors, and by the notices issued by the Sanitary Committee. In no respect has greater good been done than by the abatement of overcrowding, and the improvements effected with regard to the warming of workrooms, and the ventilation of gas iron-heaters, &c. The good work begun by Miss Deane, Miss Squire, and Miss Duncan, has been well carried on by Miss de Chaumont, who has performed her duties with tact and discretion to my entire satisfaction, and, what is of more importance, to the satisfaction of the Sanitary Committee, the body to which has been delegated the carrying out of the duties which devolve upon your Vestry as the local authority under the Acts. Miss de Chaumont's Report.—"At the beginning of the year625 workshops, workplaces, and laundries where women are employed were on the register. During the year 81 new premises were placed on the register, and 43 were removed therefrom. The particulars are as follows:— Workshops, etc. North Kensington. South Kensington. Total for whole Parish. Dressmakers. Laundries. Miscellaneous. Total. Dressmakers. Laundries. Miscellaneous. Total. Added to Register 19 7 6 32 44 ... 5 49 81 Removed from Register 14 8 1 26 15 2 — 17 43 "The net result is an increase of 38 registered workshops, etc., six in North Kensington and 32 in South Kensington, Holland-park-avenue, and Notting-hill High-street separating the two districts. At the end of the year 663 places (comprising an aggregate of 1,116 rooms), were on the register, viz.:— Workshops, etc. North Kensington. South Kensington. Total for whole Parish. Dressmakers. Laundries. Miscellaneous. Total. Dressmakers. Laundries. Miscellaneous. Total. Number on Register 100 208 28 336 280 23 24 327 663 Number of Rooms therein 122 471 39 632 410 48 26 484 1,116 89 "Cubic Space.—In the 81 workshops, etc. newly registered, 99 rooms were measured in order to ascertain the number of persons who may lawfully occupy each room, upon the scale of 250 cubic feet per person, in accordance with the requirements of the Factory and Workshop Act, 1895, section 1. Numerous other rooms in workshops already registered were also measured, such rooms having been enlarged, or newly occupied as additional workrooms. "Overcrowding.—Twenty-six rooms were found to be overcrowded ; one case only was of a serious character: it was at a large dressmaker's establishment in the south district, 14 persons being employed in a room having cubic space for 10 only. The nuisance was at once abated, at my instance, by transferring the excess hands to another room. I have not since found the workroom overcrowded. "Defective Workshops, Yards, Etc.—At many of the registered premises, particularly laundries, roofs and floors were found to be in a defective state. In several cases the necessary work of reparation was carried out on the service of written intimations only ; in other cases, after service of statutory notices. Several yards were well paved during the year, and others were more or less properly repaired, much to the benefit of the employers and employed alike. "Cleansing, Whitewashing, etc.—Numerous workrooms, and staircases and passages connected therewith, were cleansed and whitewashed or re-papered on service of intimations or notices. "Sanitary Conveniences.—Two new water-closets were constructed : one, in the south district, in compliance with the requirements of Section 35 of the Factory and Workshop Act, 1895, and Section 38 of the Public Health (London) Act, 1891, persons of both sexes being employed at the establishment ; and one, in the north district, an unsuitably placed 90 closet, under the stairs, with no direct light or ventilation to the outer air, being abolished, and a new one constructed in the yard. Twenty water-closets found to be either dirty and dilapidated, or defective in water supply, were renovated, more or less satisfactorily. "Warming of Workrooms.—At two dressmakers' establishments in South Kensington, one containing two, and the other three workrooms, the atmosphere was found to be close and oppressive from heating by gas jets. This defect was remedied, and the rooms are now properly warmed—in one case by asbestos gas fires in the grates, and in the other by ordinary fires. The provisions of the Act with respect to warming are now very fairly carried out, with great addition to the comfort of the workers, and, I believe, with advantage to the employers. "Tidiness.—I have been pleased to observe improvement with regard to the sweeping and tidying of workroom floors,and havenot had so frequently to call attention to unswept and untidy floors as during the previous year. "Complaints are occasionally received, and always attended to: they are sometimes anonymous. In one such case complaint was received, through the Home Office, as to want of ventilation in the show rooms, and overcrowding in the bedrooms, at a large drapery establishment. I made a thorough investigation into the matter and found no cause whatever for the complaint. The accommodation generally was, indeed, of an unusually satisfactory character. "General.—I am pleased to report that my visits are, almost without exception, welcomed by employers, who now generally recognise the obligation and propriety of carrying out the duties devolving upon them under the Acts of Parliament and the Orders issued by the Factory Department of the Home Office. To the best of my ability I have endeavoured to 91 carry out the duties devolving on the Sanitary Authority, so as to prevent overcrowding of workrooms, and to enforce cleanliness and ventilation, and so as to secure freedom from effluvia, in conformity with the provisions of the several Acts. Her Majesty's Superintending Inspector of Workshops has forwarded to me complaints of nuisances observed by the factory inspectors, and notifications of new workshops, as required by the Acts. And in accordance with the requirements of the Acts I have reported to that official numerous cases of the employment of 'protected persons,' i.e., 'children' under 14, ' young persons,' between 14 and 18 years of age, and women over 18. Nuisances observed in the discharge of my duties have been duly reported to the Public Health Department." Particulars of some of the work carried out during the year by Miss de Chaumont will be found in the table at page 02. Much of the work accomplished does not admit of tabulation. 92 FACTORY AND WORKSHOP ACTS, 1878 95. Summary Report of Work done by the Lady Inspector during the year 1897. NORTH KENSINGTON. SOUTH KENSINGTON. Total For whole Parish. Dressmakers. Laundries. laneous. Total. Dressmakers. Laundries. Miscellaneous. Total. 1 Workshops, etc., Number of Inspections of 117 390 55 562 409 18 33 460 1022 2 Workshops, etc., Number of Re-inspections of 19 124 2 145 53 3 5 61 206 3 Workrooms, Number of Inspections of 160 1334 69 1563 719 46 40 805 2368 4 Workrooms, found to be overcrowded 10 5 1 16 10 ... ... 10 26 5 Workrooms found to be insufficiently ventilated 1 34 3 38 24 1 3 28 66 6 Workrooms found to be in a dirty condition 10 109 2 121 27 6 1 34 155 7 Workshops, newly discovered and registered 19 7 6 32 44 ... 5 49 81 8 Workshops: Workrooms therein measured 23 10 7 40 54 ... 5 59 99 9 Workshops removed from Register 14 8 4 26 15 2 ... 17 43 10 Houses, visited for enquiry, at which no female hands were employed* 26 22 13 61 50 4 12 66 127 11 Statutory Notices and Written Intimations issued 13 119 2 134 21 2 ... 23 157 12 Nuisances referred to M. O. II. 3 8 ... 11 5 1 ... 6 17 13 Yards, floors, roofs, etc., repaired ... 37 ... 37 ... ... ... ... 37 14 Miscellaneous defects remedied 1 26 ... 27 2 ... ... 2 29 * Houses where the business plate, or the local directory, or newspaper advertisements, implied the probability that female workers would be employed, but at which none were found. 93. THE WORK OF THE SANITARY INSPECTORS. Table VI. (appendix) contains a summary of the work of the Sanitary Inspectors. The duties of the Inspectors are carried out under the Sanitary Committee, your Vestry having conferred on that body, by resolution, power to enforce the provisions of the Public Health (London) Act, 1891 ; the Housing of the Working Classes Act, 1890, and the Factory and Workshop Acts, 1878 to 1895. At page 2 will be found a description of the Inspectors' districts. The staff now comprises seven inspectors, six male and one female, a reduction of two, one of each sex, as compared with the number in 1895. Statutory Notices for the abatement of nuisances to the number of 1,458 were issued during the year, by direction of the Sanitary Committee. Written intimations of nuisances were served by the Inspectors, under section 3 of the Public Health (London) Act, 1891, to the number of 1,964. As a result of these intimations many works of sanitary amendment were carried out without delay, thus realizing the intention of the Legislature, and obviating the necessity of serving statutory notices. With regard to these intimations, I reported to your Vestry, March 2nd, 1890 (No. 2 report, p. 25), pointing out the desirability of an alteration in the form in use, so as to enable the Sanitary Inspector to indicate the character of the works necessary for the abatement of the nuisance. It had been a frequent subject of complaint that such works were not specified, and that the person liable to abate a nuisance was left in ignorance of the requirements of the Sanitary Authority. I therefore suggested the desirability of a reference to the Law Committee, as to whether it would be legal (as it was certainly desirable) to use a form of intimation which would enable the Inspector to specify the works which, in the event of the nuisance not being abated, he would report to the Sanitary Committee to be requisite for the purpose. 94 The reference was made, and in due course the Committee reported that the proposed alteration in the form would be lawful. The Committee also prepared a new form of intimation, the use of which has been attended with advantage. On this form, and on the statutory notice, a note is printed, which gives the person liable for the abatement of the nuisance an opportunity of making what, for convenience, may be called an " appeal " to the Committee, against the requirements of the Sanitary Inspector and the Sanitary Committee respectively. " Appeals," which are very rare, usually take the form of an application for extension of time for carrying out required works. Supervision of reconstruction and trapping of drains, and underground sanitary work generally, is now carried out by the Surveyor, and information on the subject must be sought in that officer's report. Many drains were, as usual, reconstructed by the owners or occupiers of houses, without the issue of sanitary notices, on the deposit of plans for approval. Particulars on this head also will be found in the Surveyor's report. Legal Proceedings.—In 35 cases proceedings were taken before the magistrates: in 21 instances for offences under the byelaws for registered houses, fines to the aggregate amount of £15 1s. being imposed. In other seven cases the offence alleged was failure to comply with the requirements of notices issued by the sanitary authority, fines of ten shillings, twenty shillings, and six pounds, being imposed in three cases. In one case a medical man was fined thirty shillings, and in another case a private person was fined five shillings, for failure to notify a case of infectious disease. In two cases the offence was exposureof persons suffering from infectious disease, fines of forty shillings, and five shillings, being imposed. In two cases closing orders were made, the defendants being fined, in each case, twenty shillings, for failure to comply with the requirements of notices previously issued. Fines for Offences.—In the seven cases above mentioned, application was made to the magistrates, upon 95 mendation, to impose fines for the offence of failure to comply with the requirements of sanitary notices issued under the provisions of the Public Health (London) Act, 1891. In three of these cases the fine was inflicted under the provisions of section 4, sub-section (4), which reads as follows :— " (4) 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." Neglect of notices issued by the sanitary authority is but too common, the result being that much of the time of the inspectors is wasted in fruitless "re-inspections." In every such case—as when the work has not been put in hand at a date when it should have been completed—the appointed fine should be applied for ; seeing that disobedience to notices not only leads to waste of the officer's time, but is also disrespectful to the sanitary authority. In connection with this subject reference may be made to a power which has not been exercised in this parish—though it has been, with good effect, in some districts, and might be put in force with advantage in all—that, namely, embodied in section 11 which is entituled " Costs of execution of provisions relating to nuisances." It reads as follows :— "(1). All reasonable costs and expenses incurred in serving notice, making a complaint, or obtaining a nuisance order, or in carrying the order into effect, shall be deemed to be money paid for the use and at the request of the person on whom it is made; or, if the order is made on the sanitary authority, or if no order is made, but 96 the nuisance is proved to have existed when the notice was served or the complaint made, then of the person by whose act, default, or sufferance the nuisance was caused ; and in case of nuisance caused by the act or default of the owner of premises, such costs and expenses may be recovered from any person who is for the time being owner of such premises. (2). Such costs and expenses, and any fines incurred in relation to any such nuisance, may be recovered in a summary manner or in the County Court or High Court, and the Court shall have power to divide costs, expenses and fines between persons by whose acts, defaults, or sufferance a nuisance is caused, as to it may seem just." This section, it will be seen, enables the sanitary authority to make and recover a reasonable charge (about three shillings is, I believe, deemed a reasonable charge) for costs and expenses incurred in serving the statutory notice, making complaint, or obtaining a nuisance order, or carrying the order into effect. The statutory notice is always preceded by the service of a " written intimation " under section 3 ; and given the existence of a nuisance which has been brought to the attention of the person liable to abate it, and no action having been taken, it is only fair and reasonable that costs should be borne by the offender for the trouble given in taking subsequent steps ; supposing that the Justices have not been asked to inflict a fine, under section 4 (4), already alluded to, for disobedience to the statutory notice—no liability to costs being incurred for the service of the written intimation. I therefore recommended, in the second report, that the power conferred by the section be systematically exercised. It would not be oppressive to the individual offender, but it would serve to show that the offence of allowing a nuisance to occur, or to continue after notice to abate it, is not a venial one ; and seeing that the statutory notices served in the course of the year are numerous (they were 1,210 in 1896, and 1,458 in 1897—the " intimations " having been 1,966 in 1896, and 1964 in 1897), a not inconsiderable sum might be recovered and applied in reduction of the rates. 97 In two cases proceedings had to be taken to close houses where nuisances existed, and were permitted to continue long after the expiration of the time for abatement allowed by the statutory notice. These proceedings were instituted under section 5, sub-section (7) of which enacts that— " A closing order shall only be made where it is proved to the satisfaction of the court that by reason of a nuisance a dwelling-house is unfit for human habitation, and if such proof is given the court shall make a closing order, and may impose a fine not exceeding twenty pounds." In two such cases closing orders were obtained, and although the fine inflicted was only twenty shillings in each case, the result of the proceedings can hardly fail to be beneficial, if only by calling the attention of careless or wilfully disobedient people to the punishment to which they render themselves liable by allowing houses to become in such a state as to be unfit for human habitation. It is clearly the duty of a sanitary authority to protect the otherwise helpless poor, to support their officers, and to vindicate their own dignity and self-respect, so often affronted by an almost contemptuous disregard of notices to abate nuisances : whilst, therefore, I record the result of the proceedings with satisfaction, I would fain hope that in all suitable cases applications to the court for fines for offences under the Act may be the rule rather than, as heretofore, the exception. Hindrances to Sanitary Administration.—In the two cases above referred to, the closing orders having been obtained, and the fines paid, the houses were not vacated, in the one instance until 31 days, and in the other 38 days after. These cases illustrate two common hindrances to sanitary administration, viz., undue delay in enforcement of the law; and excessive waste of time of the Inspector ; some twenty visits to each of the houses having been made between January and the end of March. The cases were brought to the attention of the Sanitary Committee on February 2nd, authority to apply 98 for closing orders being desired. The Committee decided to inspect the premises, and having done so, on 8th February, they unanimously decided that application for closing orders should be made. Summonses were applied for on February 16th. The hearing took place on February 23rd ; closing orders were made by the justices, and were served on the agents to the owner, forthwith. The fact that such orders had been made was reported to the occupying tenants of the houses on the same day by the Inspector, and notice to yield possession was served upon them by the agents in the course of the same week. But no active steps were taken to secure the execution of the orders, for some time ; not, indeed, until the agents were told that if the premises were not closed forthwith further proceedings would be instituted. Then the agents said they would apply to the stipendiary magistrate at the police court for an ejectment order, in one of the cases which admitted of this form of procedure, which usually occupies several weeks How they would have dealt with the other case I do not know. But it became unnecessary to take proceedings, the people having cleared out of the houses on the 26th March and 2nd April respectively. I recommended a reference of the subject, generally, to the Law and Parliamentary Committee, that we might be advised what further steps, if any, could be taken in similar cases, to accelerate the vacation of premises after the service of closing orders ; and whether, when an application is made for a closing order, the occupying tenants of the house could be joined with the owner or landlord, as defendants, so that copies of the order might be served upon them also, so as to make them liable, in case of disobedience, to the fine prescribed in section 5 (9) of the Public Health (London) Act, 1891), which directs that " If a person knowingly and wilfully acts contrary to a . . . . closing order he shall be liable to a fine not exceeding forty shillings a day during such contrary action." In the cases referred to, the agents having alleged 90 that the tenants would not leave, I recommended the service of copies of the orders upon each of them. Copies were prepared, but the warrant officer would not serve them as the orders had been made upon the agents only. It was a legal point which I desired to have determined—whether the occupiers, having had their attention drawn to the fact that closing orders had been made, were guilty of an offence under section 5 (9) by refusing to quit ? Another point was whether copies of the orders should have been served upon them? And another, whether there would be any advantage, when proceeding for a closing order, to proceed under the provisions of the Housing of the Working Classes Act, 1890? This Act requires that, on the representation of the Medical Officer of Health, or information given, the local authority, if satisfied that any dwelling house is unfit for human habitation, must, after serving the proper notice on the owner or occupier, take steps to obtain a closing order against such dwellings ; and when a closing order has been made the local authority must serve seven days' notice of the order upon every occupying tenant of the dwelling house, who is liable, on default, to a fine of twenty shillings a day. It was an incident in the cases under consideration that the houses were in a dangerous condition by reason of a defective parapet and otherwise. As dangerous structures, they were reported to the County Council by whom proceedings were taken, at the Police Court, which led to the demolition of the parapet. The report of the Law Committee on the reference was as follows:— " We are asked whether in taking proceedings for the abatement of a nuisance under sections 4 and 5 of the Public Health (London) Act, 1891, there is power, by notice, to bring both the occupier and owner of the offending premises before the Court, and to obtain such an order as will prevent obstruction to the Vestry's officials in carrying out the order of the Court. 100 "Without reference to any particular case, but generally upon the sections of the Act and their construction, we are of opinion that when proceedings are taken, under section 5, against the person ' by whose act, default, or sufferance the nuisance exists or continues,' two persons may be joined in one proceeding should the local authority be of opinion that the nuisance is wholly or partially caused by the acts or defaults of such two persons, and in such case either, or both, may be ordered to abate, or be prohibited from continuing the nuisance (see section 120 of the Act). To join mere inmates would, however, be unnecessary and useless, unless the evidence of their default be clear. " In case, however, where proceedings are taken against owner or occupier of offending premises as such, the procedure appears to be in the alternative against one or other, and we consider that if two notices were served in respect of one set of premises for summonses to be heard at the same time, the local authority would run a great risk of having one or other dismissed as irregular, with the consequent liability as to costs. " The obvious way sanctioned by the Act to overcome obstruction is to proceed under section 116, and we see no objection to a notice containing the order of the Court made against the owner, and an appropriate extract from section 116, being served on the occupier. " If this course be adopted, we think resort to ejectment proceedings will be unnecessary." 101 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, at Tobin Street, in the Potteries, Notting-dale. The conduct of this business gives rise to more or less effluvium nuisance, despite improved arrangements, and 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. MARINE STORES. The business of a marine store dealer is not scheduled in the Public Health (London) Act, 1891, as an offensive business, but it gives rise often to offensive smells, and it has been held by the Appeal Court to be ejusdem generis with the businesses scheduled, originally, in the now repealed Slaughter-houses (Metropolis) Act, 1874. At my instance your Vestry made application to the late Metropolitan Board of Works, in 1883, to schedule the business under that Act. but without success. And in 1896, upon receipt of complaints of nuisance arising in the conduct of the business, an application was made to the County Council to schedule the business under the provisions of section 19 of the Public Health (London) Act, 1891. This application likewise was unsuccessful. The subject was dealt with fully in the last annual report—pages 119-123. I have only to add that the premises where the business is carried on are regularly visited by the several sanitary inspectors. BRICKBURNING. During the last three years, since the successful proceedings taken by your Vestry to abate the nuisance from effluvia caused by brickburning, no complaint has been made by parishioners of nuisance arising in the conduct of the business of a brickmaker, nor have I had any reason for thinking that cause for complaint has existed. It is a matter 102 for satisfaction that it has been found practicable to burn bricks without causing nuisance, as no one connected with your Vestry ever had any desire to interfere needlessly or vexatiously with the carrying on of a lawful business. LICENSED SLAUGHTER-HOUSES. Thirteen premises were licensed to be used as slaughterhouses by the County Council in October : seven of them are situated in North Kensington and six in South Kensington. The several premises were regularly visited by the Sanitary Inspectors. The names of the licensees, and the localities of the premises, are set out in Table XI. (appendix). The premises were inspected in July by the Sanitary Committee, who reported favourably with respect to them. In 1874 there were some 1,500 slaughter-houses in the Metropolis; in 1897 only 456 and 13 fewer than in 1890. In Kensington, 48 were licensed in 1873, the year before the passing of the Slaughter-houses (Metropolis) Act ; in 1874 only 31. Now, as above stated, there are only 13. The business of a slaughterer of cattle has not been established anew in this parish since 1874. LICENSED COW-HOUSES. Four premises were licensed to be used as cow-houses : three of them are situated in North Kensington, and one in South Kensington. The several premises were regularly inspected by the Sanitary Inspectors. The names of the licensees, and the localities of the premises, are set out in Table XII. (appendix). The premises were inspected in July by the Sanitary Committee, and found to be in a generally satisfactory condition. There were only 20 cows in the sheds. Not many years ago there were 28 sheds, containing about 500 cows. There has been a considerable reduction in the number of cow-houses in the Metropolis, viz., from 1,044 in 1880, to 375 in 1897, or 19 fewer than in 1896. In Kensington, the reduction has been from 23 in 1880, to 4 in 1897. 103 BAKEHOUSES. The bakehouses, to the number of 138, viz., 74 in North Kensington, and 64 in South Kensington, were, as usual, regularly inspected, and such action was taken, in individual cases, as was found to be necessary for ensuring compliance with the sanitary provisions of the Factory and Workshop Acts, 1878 to 1895, and the Public Health (London) Act, 1891. In the annual report for 1894 (pp. 152 to 166 inclusive), when dealing with the " regulation of bakehouses," I summarised the steps which had then been recently taken by the County Council with the object of securing such an amendment of the law as would enable the Sanitary Authority to exercise an efficient control over bakehouses. The Council thought that the Factory and Workshops Bill, which was to be brought in by the Government in 1895, would " afford an opportunity for amending the law relating to bakehouses," and the Public Health Committee of that body waited upon the President of the Local Government Board to press their views with reference to the matter. The President stated that it was improbable that any clause would be inserted in the proposed Bill dealing with London bakehouses, as the Bill would have reference to the whole country, and not particularly to London, and he suggested that the Council itself should introduce a Bill. In accordance with the Committee's recommendation, the Parliamentary Committee was, in January, 1895, instructed to prepare a Bill amending the law relating to bakehouses in London, in accordance with the Council's views ; but no action appears to have been taken. One provision with reference to bakehouses is contained in the Factory and Workshop Act, 1895, in section 27 (3), to the effect that " a place underground shall not be used as a bakehouse unless it is so used at the commencement of this Act," i.e., at the beginning of the year, 1896. The value of this provision has been reduced almost to the vanishing point by magisterial rulings to the effect that the disuse of an underground bakehouse subsequent to the 1st January, 1896, by the premises 104 becoming empty, does not prevent the use of them for the purposes of a bakehouse, however unsuitable in character they may be, upon the premises being re-occupied. A drafting amendment of the terms of the section is necessary to give effect to what may be assumed to have been the intention of the legislature, viz., that underground bakehouses vacant on, or vacated at any time after, January 1st, 189G, should not be again used for the purposes of the business. OFFENSIVE SMELLS IN STREETS. In the ninth report I dealt with this subject, to which attention is usually directed when the hot weather sets in, owing to complaints by inhabitants of bad smells proceeding from untrapped gullies and sewer ventilating openings at the level of the roadway. Cause for complaint is not confined to the sewers under local jurisdiction ; for, as might naturally be expected, the large main sewers under the control of the County Council often emit exhalations offensive in a high degree. By direction of the Sanitary Committee, I had, in July, called the attention of the County Council to complaints of persons resident in Holland-road and Warwick-road, the result being that the ventilating openings which formed the subject of complaint were closed at the beginning of August. The Council's Engineer attributed the smells emanating from certain gullies complained of, in Portobello-road, to offensive matter in the catch-pits, the pipes therefrom being flap-trapped at the outlet in the sewer. But although such accumulations may be a cause of nuisance, especially if the gullies are not cleansed with sufficient frequency, it is beyond question that the main cause for complaint arises in, and proceeds from, the sewers, in the form of offensive gases, and that the flap-trap is incompetent for preventing nuisance from this cause. The subject, as it affected the Council's sewers, had been before the Sanitary Committee in July, and it was resolved to request the Law and Parliamentary Committee to advise as to the position of the Vestry in regard to the matter generally. 105 The Law Committee referred the subject to a SubCommittee who reported as follows :— " Your sub-committee have had before them the correspondence between the Vestry and the London County Council on this subject, and the report of the Medical Officer of Health on "offensive smells in streets." They have also considered the various sections in different Acts of Parliament bearing on the same subject, and advise the Committee that, as to gullies, traps, and ventilators of sewers, the property of the Vestry, there is a clear liability upon the Vestry in respect of nuisance arising therefrom. " It must not be forgotten that the duty to cleanse every grating or gully in a street (except in streets cleansed by the Council), whether the gratings and gullies belong to the Council or the Vestry, is by the London County Council (General Powers) Act, 1894, transferred to the Vestry. " As to sewers vested in the London County Council, the obligation to cover and keep so as not to be a nuisance or injurious to health is upon the Council under section 135 of the Act of 1855. " Power is given to the Vestry (but only with the consent of and after notice to the Council) to prevent effluvia from exhaling from main sewers, and in respect of these London County Council sewers we advise that the London County Council are liable for nuisance occasioned by smells, and not the Vestry. "We recommend that the Works and Sanitary Committee be informed— 1. That they are bound to prevent the Vestry sewers, gully-holes and traps from being a nuisance, and 106 must take all precautions to avoid the same, otherwise the Vestry may be liable at the suit of any one showing injury, or the Vestry may be ordered to comply with their statutory duty by mandamus. II. With regard to the London County Council sewers, the Vestry may, upon a flagrant case of nuisance being proved, through the AttorneyGeneral proceed against the London County Council by information, or in the alternative apply for a mandamus to compel the Council to comply with Section 135 above referred to. " It has been suggested that a Council sewer (looking to the width of the definition clause) may come within the term premises in Section 2 of the Act of 1891, but, without giving a contrary opinion, we consider that a recent decision leaves it in considerable doubt whether the nuisance section in this Act alters or adds anything to the previous law as to sewers. " Before taking action against the Council, the Works Committee would probably recommend that a further communication be addressed to the Council, pointing out the gravity of the nuisance and the obligation the Vestry feel themselves under to protect residents by any means which they may be advised are available. "All which is submitted." The Law Committee approved the report of the subcommittee, and, deeming the subject to be of importance, directed it to be set forth in their report which was adopted by your Vestry on 6th October. My ninth report above adverted to, having been referred to the Sanitary Committee, the subject was subsequently 107 very fully considered, on the loth November, upon the basis of certain recommendations embodied in the said report to which reference will be made hereinafter. In connection with the consideration of these recommendations, the Committee deemed it expedient to obtain a report from the Surveyor setting forth his views on the subject of the nuisance caused by emanations from gullies and from surface sewer ventilators. The Surveyor reported (" On Sewer Ventilation and Sewer Smells") setting out the past action of the Vestry, and the difficulties which had been met with in the past, and which remain to be surmounted before any effective improvement can be made in the present unsatisfactory method of ventilating the sewers. By request of the Committee I drew up a further memorandum on the subject, as follows:— "A desire having been expressed that I should make some observations on the subject of— Sewer Ventilation and Sewer Smells, dealt with in the report of the Surveyor, dated 18th October, 1897, I beg to do so as follows :— "The Surveyor's report is ostensibly based on certain definite recommendations made in my ninth report for the current year, 1897, at page 108. " The first of these recommendations was :— That offensive street gullies in connection with sewers under the control of the Vestry should be efficiently trapped, and that offensive ventilating openings in connection with sewers under the control of the Vestry should be closed ; and, where practicable, that shafts should be substituted for such openings, in conformity with the provisions of section 71 of the Metropolis Local Management Act, 1855. "Your Committee having referred this recommendation to the Law and Parliamentary Committee for their views thereon, have been advised (October 1st)— 108 ' That as to gullies, traps, and ventilators of sewers, there is a clear liability upon the Vestry in respect of nuisance arising therefrom.' " In other words, the Law Committee indicate that it is the duty of the Vestry to carry out the provisions of section 71 of the Metropolis Local Management Act, 185, which reads as follows:— ' 71. Every Vestry shall, by providing proper traps or other coverings, or by ventilation, or by such other ways and means as shall be practicable for that purpose, prevent the effluvia of sewers from exhaling through gullyholes, gratings, or other openings of sewers, in any of the streets or other places within their parish.' " The Law Committee further advised that your Committee— ' Are bound to prevent the Vestry sewers, gullyholes and traps from being a nuisance, and must take all precautions to avoid the same, otherwise the Vestry may be liable at the suit of any one showing injury, or the Vestry may be ordered to comply with their statutory duty by mandamus.' " The second recommendation was :— That application should be made to the County Council, from time to time, for permission to trap offensive gullies, and close offensive ventilating openings connected with sewers under the control of the Council, in conformity with the provisions of the 27th section of the Metropolis Local Management Act, 1862. " In regard to this matter, the Law Committee report that— ' As to the sewers vested in the County Council, the obligation to ' cover and keep so as not to be nuisance, or 109 injurious to health, is upon the Council, under section 135 of the Act of 1855. Power is given to the Vestry, but only with the consent of, and after notice to the Council, to prevent effluvia from exhaling from main sewers (Metropolis Local Management Act, 1862, sec. 27), and in respect of these sewers we advise that the Council are liable for nuisance and not the Vestry.' " The Committee, therefore, state that the Vestry may— 'Upon a flagrant case of nuisance being proved, through the Attorney-General proceed against the Council by information, or in the alternative apply for a mandamus to compel the Council to comply with section 135 (of the Act of 1855) above referred to.' " This being the state of the law, the Vestry will, doubtless when occasion shall arise, discharge their statutory duty in regard to the matter dealt with in my first recommendation. " With regard to the steps to be taken forgiving effect to the second recommendation, your Committee will, doubtless, be guided by the opinion expressed by the Surveyor, par. 23 of his report (page 19), so as to proceed very cautiously in closing offensive ventilators connected with main line sewers under the control of the County Conncil ; but obviously such closure would not be made without provision of an alternative method of ventilation, viz., by a shaft, as indicated in the first of my recommendations, a course which, I apprehend, would obviate the danger to which the Surveyor somewhat vaguely refers in the closing words of his report. " Before leaving this portion of the subject, I may refer to the special need that exists for carrying out the provisions of the law in connection with gullies and ventilating openings in mews—a matter of considerable importance, having regard to the general narrowness of the roadway, and to the fact that the roadway is usually the playground of the children who 110 live over the stables. It will be remembered that in dealing with this question, in a former report,* referred by the Vestry to your Committee, I recommended :— (1) That all gullies in mews be effectually trapped ; (2) That surface sewer gratings be abolished, and (3) That ventilating shafts be erected in suitable tions. " In the said report it was stated that in 176 mews in the parish, there is an aggregate of about 751 drain inlets, of which some 131 appear to be properly trapped by stoneware street gullies, leaving, approximately, 620 to be dealt with. The Surveyor appears to be not unfavourable to the use of syphontrapped pan-gullies in mews, and (as he states, in par. 2), your Committee have given directions for the substitution of such gullies for the ordinary flap-trapped brick-gully in mews, where a regular supply of surface water is insured. I would, therefore, beg definitely to repeat the above recommendation (1) That all gullies in mews be pan-trapped forthwith, and I would not less strongly urge the carrying out of the recommendations (2) and (3) relating to the closure of surface sewer gratings in mews and the substitution, wherever practicable, of ventilating shafts. "As regards the trapping of gullies generally, I venture to submit that it is a somewhat lamentable fact that, as stated by the Surveyor, (in his report, par. 2, page 0), only 200 are pan (ie. syphon-trapped) gullies out of a total of 6,600 ; and I cannot too urgently repeat the recommendation, already cited, viz., That offensive street gullies in connection with sewers under the control of the Vestry be efficiently trapped—in other words, that pan-gullies be substituted, in such cases, for the existing brick cess-pits with flap-trapped outlets. And as it is averred that a not inconsiderable proportion of the * " Sewer Ventilation in Mews," No. 11, 1896 (October 8th, page l29), 111 stench from gullies proceeds from the contents of the cesspits—a view which is shared by the chief engineer to the County Council—I would further recommend that the said cess-pits be cleansed, flushed, and disinfected more frequently than hitherto. ... " Reference having been made to the liability of pan-gullies to become stopped, and to the difficulty of freeing them, I may, perhaps, without presumption, mention that pan-gullies are now constructed with facilities for removing obstructions, which would seem to obviate the objection raised to their general use. In any case, however, I cannot admit that the alleged risk of the unsealing of the trap, by evaporation of the water during hot weather, constitutes an insuperable objection to the use of this form of street gully in any position. " Incidentally, the question of the trapping of house-drains is raised in the Surveyor's report, it being stated that more or less of the stench proceeding from surface sewer ventilating openings is due to the discharges from house-drains which, when the drains are trapped, do not contribute to the ventilation of the sewers. " I do not consider it necessary to go into this matter, which, indeed, is hardly within the reference, having regard to the fact that the Vestry, upon the advice of your Committee, have framed regulations requiring new house-drains to be trapped ; that the draft bye-laws prepared by the County Council also require new house-drains to be trapped ; that the trapping of such drains is enforceable under existing law, and that it is, in the opinion of the great body of sanitary experts and medical authorities, necessary in the interests of public health. " As being related to the subject of the reference, I may perhaps be allowed to mention a further recommendation made by me in a former report, and referred, viz.:— 112 ' That, where practicable, sewers with dead ends be connected with, adjacent sewers so as to allow of free current of air'— and thus, by improving ventilation, bring about a reduction in stench. No action has been taken, hitherto, in regard to this matter, which is, I submit, deserving of attention. "In conclusion, I would beg the serious consideration of your Committee for the several recommendations which form the subject of the reference ; recommendations which, I think, are not materially affected by the interesting résuné and report of my colleague, the Surveyor." The Committee in their report (15th November), stated that the references and reports above referred to (including the report of the Law and Parliamentary Committee) had been dealt with under two heads, viz.:— " The trapping of gullies, and " The abolition of sewer ventilators on the surface of roads." On the first of these points the Committee recommended:— " (a) That offensive street gullies be efficiently trapped. b) That all new gullies to be constructed in the parish be pan-gullies with syphon-trapped outlets. (c) That the County Council be requested to trap with syphon-traps all offensive gullies on the main line sewers." The Committee proceeded to observe that:— " In cases where complaints are made of nuisance or annoyance caused by offensive smells from sewer ventilators, efforts are being made to obtain consent for the fixing of shafts up adjacent houses, and where such consents 113 are obtained the objectionable ventilators are abolished, whilst in those cases where consent is refused, the Vestry have no alternative but to retain the surface gratings." It appeared to the Committee to be— " Most desirable that some further and combined action should be taken to secure a more efficient and less offensive mode of ventilating the sewers of the Metropolis." And they accordingly recommended— '(d) That a communication be addressed to the County Council calling their attention to the matter, forwarding copies of the reports by the Surveyor and the Medical Officer of Health, and requesting them to instruct their Engineer to convene a Conference of the Surveyors and Medical Officers of Health in the Metropolis to discuss the question with him, with a view to his reporting upon the general question of metropolitan sewer ventilation. (e) That the several Vestries and District Boards be requested to support the action taken by this Vestry in regard to this matter." The report of the Committee was adopted, and a communication was addressed to the County Council to the purport of recommendation (d). Subsequently the Main Drainage Committee of the Council, when acknowledging the receipt of the communication, intimated that they readily acquiesced in the proposal as regarded the convening of a conference of representatives of the various local authorities, and had instructed the Chief Engineer to arrange for such a conference at an early date. It may be added that at the end of the year twenty-four Local Authorities had decided to support your Vestry's action; that no action had been taken by two authorities, and that no 114 reply had been received from the remaining fifteen. The Surveyor and the Medical Officer of Health were instructed (January 12th, 1898), to attend the conference on behalf of the Vestry. The Chief Engineer summoned the Surveyors only to the conference, the result of which is unknown to me. COMBINED DRAINAGE. Several of the Metropolitan sanitary authorities made representations to the County Council in 1894, on the need of legislation " with a view to an alteration in the definition of the word drain and the word sewer" in the Metropolis Management Act, 1855 (sec. 250): and ultimately a deputation representing a large majority of the Vestries and District Hoards, waited upon the Main Drainage Committee with reference to the subject. This committee subsequently (7th July, 1894), reported that "a grievance exists, and that a heavy responsibility is thrown upon the local authorities to repair combined drains which were laid down for the benefit of the owners of houses, and with the intention that the owners should be held responsible for their maintenance." Having carefully considered the matter, the committee came to the conclusion that " the Council should, as the central authority, promote legislation in accordance with the views of the local authorities ;" and upon their recommendation it was resolved : " That the Council do apply to Parliament for an amendment of the definition of the words sewer and drain in the Metropolis Local Management Act, in the way desired by the local authorities, and that it be referred to the Parliamentary Committee to prepare a public bill, and take such other steps as may be necessary for that purpose." Such a Bill (" Metropolitan Sewers and Drains ") was brought in on behalf of the Council in 1896, but did not become law. Legislation is certainly necessary, seeing that sanitary authorities are unwilling to carry out the provisions of the law, by repairing, as "sewers," conduits which they consider to be " combined drains " properly repairable at the expense of 115 the owners of the houses drained, in common, thereby. Cases are not unknown in which a sanitary authority have failed to abate nuisances, after the refusal of the owners of houses to comply with notices requiring them to execute work which, in the present unsatisfactory and even inequitable state of the law, has been held by the highest legal authorities to be the duty of the sanitary authority. DRAINAGE BYE-LAWS. Towards the close of the year 1896 the County Council transmitted for the information of the Sanitary Authorities draft bye-laws prepared under section 202 of the Metropolis Management Act, 1855, asking that observations thereon (if any), might be made by 16th January, 1897. The Local Government Board were requested to withhold their confirmation of the bye-laws until the Local Authorities, who will be charged with the enforcement of the same, should have had an opportunity of considering them and submitting their representations to the Board and Council thereon. The time was extended accordingly. The matter received much attention, from the Sanitary Committee, and in the result numerous recommendations and suggestions for amendment of the proposed bye-laws were made, and embodied in a report, which, being approved by your Vestry, was duly forwarded to the Board and the Council. At the end of the year the bye-laws had not been confirmed by the Board. FLOODING OF BASEMENTS. In times of heavy rain the sewers in certain parts of the parish have proved occasionally unable to carry off the storm water, owing to the insufficiency of the main line sewers, thus leading to flooding of the basements of many houses with more or less diluted sewage. This matter has received attention from the Sanitary Committee at various times, over a long period of years. It formed last year the subject of a conference with the sanitary 116 authorities of the adjoining parishes of Chelsea, Fulham, and Hammersmith. The County Council was approached, and the final outcome is that the Council have decided to proceed with the erection of a new pumping station at Lot's-road, Chelsea, at a total cost of £60,000, and to apply to the Secretary of State for consent to the compulsory acquisition of the land required for the purpose. It is devoutly to be desired that this measure may suffice to rid us of the nuisance, which, in the nature of things—owing to the increase in the number of inhabited houses draining into the local sewers—would have become worse but for palliative measures adopted by the local authorities in the reconstruction, deepening, and enlargement of the said sewers. HOUSE-TO-HOUSE INSPECTION. So far as time permitted, house-to-house inspection was carried on during the year, as required by section 1 of the Public Health (London) Act, 1891 ; streets being dealt with as a whole in conformity with the instructions of your Vestry. This work had long been in practical abeyance owing to more pressing engagements of the Sanitary Inspectors in regard to matters requiring attention day by day. But when, in 1896, these officers were relieved of the duty of supervising works of repair of underground drainage, it was felt that some of their time should be devoted to this important duty. I was of opinion, moreover, that their attention should be. given to some of the better class streets, the houses in which are not always so well sanitated, structurally, as the houses in many of the poorer streets, which have properly received attention to the largest extent. I was led to suspect that this might prove to be so by observing in the Inspectors' diaries, that when they had had occasion to inspect " good " houses, on complaint, or by reason of the occurrence of infectious disease thereat, sanitary apparatus was but too commonly found to be defective in construction or condition. It would be well to have made a complete and systematic sanitary survey of all the houses in the Parish, but it is not practicable in existing circumstances. 117 THE HOUSING OF THE WORKING CLASSES. Bye-Laws for Houses Let in Lodgings or occupied by Members ok more than one Family. Under the provisions of the Sanitary Acts of 1866 and 1874, regulations were made by your Vestry, in 1885, and some 1,500 houses have been registered thereunder. The said Acts being repealed, and modified provisions in respect to byelaws having been enacted in the Public Health (London) Act, 1891, the Local Government Board addressed a circular letter on the subjcct to the Sanitary Authorities in 1892, and again in 1894. The Board pointed out that the powers conferred by the new Act (section 94) " differ in some respects from those exerciseable under section 35 of the Sanitary Act, 1866, and section 47 of the Sanitary Law Amendment Act, 1874, in pursuance of which the regulations now in force in (this) district were made ; " inasmuch as section 94 of the new Act " no longer provides that such matters as the enforcement of privy accommodation, the paving of premises, the notices to be given in cases of infectious or contagious disease, the cleansing of cisterns, or the keeping of water-closets in good order, &c., shall be dealt with by regulations applicable to houses let in lodgings. These matters," it was added, "can be otherwise dealt with, in some cases by bye-laws made by the Sanitary Authority, and applicable generally to all houses in the district, whether let in lodgings or not, and in others by byelaws made by the London County Council." The Board's letter was accompanied by copies of " a model series of byelaws, which they had caused to be prepared for the use of San itary Authorities under section 94 of the Act;" and it was statedthat " these model forms were drawn up after very careful consideration by the Board of the regulations which might be properly enforced in the case of the class of houses to which the enactment applies." The Board's model clauses deal with none of the subjects above named, and it was suggested that the existing regulations should be modified on the basis of the 118 model clauses. The subject was referred to the Sanitary Committee, to consider and report what modifications were necessary to bring the regulations into conformity with the provisions of the Act of 1891. The subject being new to many members of your Vestry, I thought it desirable to give an outline of former proceedings with regard to it in the annual report for 1894. To what was then said (pp. 191-199) there is little to add now, inasmuch as the matter stands practically where it did three years ago, when the Sanitary Committee approved the modified bye-laws I had drafted for their consideration, and recommended them for adoption by your Vestry. The Committee had thought it desirable, meantime, to send the proposed new bye-laws to the Local Government Board, tentatively, with the view of ascertaining whether they were such as the Board would be prepared to sanction. After a long wait, and no reply being forthcoming, the proposed bye-laws were submitted to your Vestry, and referred to the Law Committee and the Sanitary Committee, jointly, for further consideration. With a view to lighten the labours of the Joint Committees, I prepared a statement showing " generally, in what respects the proposed new bye-laws differ from the existing bye-laws, and from the model series framed for the guidance of the Sanitary Authorities by the Local Government Board." (Vide No.4 monthly report, April 25, 1895, pp. 50-60 inclusive). To this report I subjoined a list of streets, showing the number of houses in each which had been registered since 1885, and a further list of some of the principal streets, the houses in which, so far as they are let in lodgings or occupied by members of more than one family, appeared to be proper to be registered under the provisions of the Act. The joint Committees submitted their report, July 31st, 1895, and the bye-laws in the form recommended by them were on that day adopted by your Vestry, and ordered to be sent, and they were sent forthwith, to the Local Government Board for their sanction. On the same day a communication had been 119 received from the Board intimating their willingness to approve, with a few, mostly verbal, amendments, the bye-laws which the Sanitary Committee had tentatively forwarded for their consideration five months previously—these bye-laws, differing in some material respects from the bye-laws adopted by your Vestry. After a further long interval the Board returned the second draft bye-laws, with suggested amendments. To some of the Board's suggestions your Vestry demurred, and a further communication was made to the Board, urging, inter alia, the desirability cf a proposed bye-law requiring the landlord of a registered house to give notice to the Sanitary Authority when intending to carry out the annual cleansing, so as to enable the Sanitary Inspector to supervise the execution of the work. The Board had expressed doubt as to the competency of the Sanitary Authority to make such a bye-law.* As to the desirability of such a bye-law, there can, I think, be no question. In the sixth report (25th June, 1897), a further suggestion for a new bye-law was made with a view to enforce the provision and maintenance at the " furnished " rooms in registered houses, of bedding which should be clean and wholesome, and free from noxious insects. The matter was referred to the Sanitary Committee, who recommended (6th October)— " That the Vestry do approve of a draft bye-law in the following terms, and that the same be submitted to the Local Government Board for their approval, viz.:— " The landlord or keeper of a registered house in which rooms are let in furnished lodgings, shall cause the bedding and other articles in such rooms to be at all times maintained in a clean and wholesome condition and free from noxious insects." * The Board's suggestion was that a definite period should be fixed for the execution of the works of cleansing, &c., meaning one month, so that the Sanitary Authority, knowing about when the work would be in progress, should have a chance of being able to exercise supervision. The period limited by the proposed bye-laws, "March 1st to August 1st inclusive," is so prolonged, that it is practically impossible to supervise, as the Inspectors rarely know when the work is likely to be in progress. 120 In the same report the Committee stated that they were about to register the houses in the " Notting-dale " special area which were not already upon the register, and this was done. These houses—about 33 in number—are the only houses that have been registered since the Public Health (London) Act, 1891, came into operation. I have only to add that registration, whilst facilitating the work of the department, has given rise to none of the evils feared by the owners and occupiers of houses proposed to be registered ; that the existing bye-laws, made in 1885, have worked smoothly, and without objection by any of the parties affected by them ; and that the extension of the operation of bye-laws to all tenemented and other houses occupied in lodgings by the poorer classes, would, with an adequate inspecting staff, be an unmixed benefit from the public health point of view, by enabling the Sanitary Authority to maintain the conditions necessary to secure healthy homes for the people who, in regard to such] matters, have little power to help themselves. registered Houses.—At the request of the Sanitary Committee a return was prepared in 1896 showing the streets in which houses have been registered, the number of the houses registered in each street, and the number of houses not registered in the several streets. This return, which was made for each of the sanitary districts, was printed in the annual report for 1896, pp. 136-38. The detailed particulars there given may be summarised as follows :— District. Number of Streets dealt with. Number of Houses in Streets. Number of Houses Registered. Number of Houses not Registered. North Sanitary District 7 303 271 32 North-East Sanitary District 3 183 119 64 North-West Sanitary District 8 412 267 145 Central Sanitary District 16 537 393 144 South-East Sanitary District 7 141 100 41 South-West Sanitary District 19 569 393 176 Totals 60 2,145 1,543 602 121 Many of the houses included in the last column of the return were not let in lodgings or occupied by members of more than one family when the other houses in the same streets were registered, between the years 1886-89. Inspection made in 1895 showed that many of the non-registered houses were then let in lodgings, and a report to that effect was made to the Sanitary Committee. The Committee, however, decided, at that time, not to register any more houses pending the confirmation by the Local Government Board of the proposed new bye-laws. In the fourth monthly report for 1895, this subject was fully dealt with (pp. 50-63 inclusive), and I submitted " a list of some of the principal streets, the houses in which, so far as they are let in lodgings or occupied by members of more than one family, would appear to be proper to be registered," as follows:— (1) North District.—Branstone-street, Rackham-street, Raymede-street, Swinbrook-road, Tottenhamstreet, Trevei ton-street, and Wheatstone-road. (2) north-east District.—All Saints'-road, Bucking- ham-terrace, Dulford-street, Lonsdale-road, St. George's-road, Talbot-grove, and Western terrace. (3) North-west District.— Blechynden-Street (north of Bramley-road), Hurstway-street, Manchesterstreet, Royal Crescent-mews, St. James's-place, Testerton-street, Tobin-street, and Walmer road (south of Lancaster-road). (4) Central District.—None. (5) South-east District.—Chapel-place, Lloyd's-place, Middle-street, New-street, and Rutland-street. (6) south-west District.—Barker-street, Emma-place, Holmes-place, Kensington-buildings, Park-terrace, and Providence-terrace. No action was taken upon the report. 122 It may be mentioned that in October, 1885, the Sanitary Committee settled and recommended a list of 152 streets in the order in which it appeared to them desirable that the said streets should be considered for registration purposes. The list was reported to and adopted by your Vestry ; but it still remains to give effect to the recommendation in a very large proportion of the streets. OVERCROWDING. It is a common practice with people having large families to conceal the number of their children until after entering into possession of their lodging—usually a single room ; and then, should it be desired to get rid of them, all the tedious processes, by notices, police-court proceedings, &c., have to be gone through, these occupying many (at least six) weeks, during which time the unfortunate landlord may not receive any rent on peril of failure to obtain an ejectment order. In regard to registered houses, the " keeper" is equally liable with the " lodger" for the offence of overcrowding, and as I pointed out in the ninth report for 1896 (August loth, page 111), it would be well if a bye-law were made requiring him, under penalty, to report any case of overcrowding to the Sanitary Authority. On consideration of the report your Vestry decided to apply to the Local Government Board for sanction to a bye-law requiring the keeper of a registered house to report overcrowding, as follows :— " It any lodger in a registered house cause or suffer any room under his control to be occupied by a greater number of persons than is allowed by this byelaw, it shall be the duty of the keeper of the registered house, upon his becoming aware of the fact, to notify such fact to the Medical Officer." The Local Government Board's views on the subject of this proposed bye-law have not yet been received. 123 COMMON LODGING-HOUSES. The County Council have taken over from the police the supervision of common lodging-houses, under the circumstances set out in my Annual Report for 1893 (p. 207). I am indebted to the Council's Medical Officer of Health for the subjoined Return of the common lodging-houses in this parish, which are 32 in number, and contain accommodation for 945 persons. Sanitary District. Name of Keeper. Address of Common Lodging House. No. of Single Lodgers for which registered, in 1897. No. of Double Beds Authorized. Male. Female. Total. N. Marsh, Hy. Chas. 88, Wornington Road 35 - 35 - N.w. Moore, John 21, Bangor Street 30 — 30 — „ Do. do. 23, do. — 9 9 10 „ Do. do. 25, do. — 18 18 5 „ Do. do. 29, do. — 21 21 5 „ Newman Boasley 10, do. 24 - 24 - „ Phipps, William 18, do. 32 — 32 —- „ Do. do. 20, do. 54 — 54 - „ Reynolds, Charles 35, do. 35 — 35 - „ Phillips, E. S.. 5, do. 25 — 25 — „ Do. do. 7, do. 29 — 29 - „ Do. do. 9, do. 24 - 24 - „ Hankins, George 10, Crescent Street 32 — 32 - „ Do. do. 28, do. 30 — 30 - „ Do. do. 30, do. 30 - 30 - „ Do. do. 40, do. 24 — 24 - „ Phipps, William 25, do. 41 - 41 - „ Do. do. 27, do. — 16 16 5 „ Do. do. 31, do. 34 - 34 - „ Do. do. 33, do. 20 - 20 6 „ Hallett, Thomas 4, Hesketh Place 13 - 13 3 „ Do. do. 6, do. — 6 6 3 „ Do. do. 8, do. 14 - 14 3 „ Simpson, James 1, Mary Place 16 — 16 - „ Do. do. 2, do. 21 — 21 - „ Davis, Mark 66, St. Ann's Road 43 7 50 12 „ Phipps, William 34, Sirdar Road 13 — 13 6 „ Do. do. 36, do. 35 - 35 - „ Bailey, Henry 29, do. 30 - 30 — „ Do. do. 31, do. 25 — 25 „ Redman; John 24, Peel Street 20 - 20 - „ Do. do.. 22, do. 23 — 23 — Twenty-three of the Common Lodging-Houses, with accommodation for 703 persons, are located in the "Nottingdale " special area. 124 In connection with the inquiry by the Special Committee of 1896, as to the causes of the high death-rate in the " Notting-dale " special area, an application was made to the County Council to define the meaning of the term " common lodging-house," to which a reply was received to the following effect :— " The Council is advised that in order to bring a house within the operation of the Common Lodging-Houses Acts, 1851 and 1853, it is essential that the following facts should exist:— 1. The house must be kept by somebody for the purpose of gain. 2. It must be open for the reception of all comers as lodgers. 3. The persons resorting to the house must be or such a class a;, if left to themselves, would either be unwilling or unable to secure cleanliness and prevent overcrowding. 4. Some one room or rooms in the house must be used in common by all the lodgers. "A large variety of circumstances might arise in any particular cast which might come before the Council, but it is safe to say that if in any case one of the four facts above mentioned were absent, it would be a doubtful question whether the house could be regarded as a common lodging-house within the meaning and intention of the statutes, and such a case would need special and particular consideration. " This opinion has been come to after a careful study of the decisions in the following cases :— Booth v. Ferrett.—Decision by Lord Chief Justice Coleridge and Mr. Justice Mathew. Langdon v. Broadbent.—Decision by Mr. Justice Grove and Mr. Justice Lindley." It is manifest that the houses in the "Notting-dale" special area cannot, under the provisions of the existing law, be dealt with as common lodging-houses, excepting in so far as they may be registered as such by the Council upon the application of the owners—a fact which the Special Committee fully recognized in their report. 125 Control of Common Lodging-houses.—A communication was received in April, 1897, from the Vestry of St. Margaret and St. John, Westminster, expressing the opinion that the want of effective control over common lodging-houses was a serious defect in the existing law, and urging the desirability of representations being made to the Home Secretary with a view to the introduction of a Bill consolidating and transferring to the Local Authorities the administration of the law relating to common lodging-houses, giving such authorities power to licence annually, with the consequent right to withhold any license in the event of mismanagement or other sufficient reason. These views were endorsed by your Vestry, and a communication to this effect was made to the Home Secretary and to the Vestry of St. Margaret and St. John, and to the other Sanitary Authorities of the Metropolis. The Home Secretary, in due course, stated that he had referred the communication to the Local Government Board, as he was of opinion that the question was one which should be dealt with by the Board. Nothing further appears to have been done in the matter. 126 THE " NOTTING-DALE " SPECIAL AREA. House-to-House Inspection.—An inspection of the houses in the Special Area, other than common lodging-houses —which being under the jurisdiction of the County Council were passed over— was made in May and June by Inspector Steward, with the assistance of Inspector Pettit. The Sanitary Committee, upon the joint report of these officers, directed the issue of 222 notices in respect of 210 houses (out of 257 in the district) which were found to be defective in one or more respects, and a large amount of work was done, supervision of which occupied much of the time of the inspector for the district during the remainder of the year. Particulars of interest observed, connected with the occupancy of the houses in the several streets, deserving of record, are here reproduced from the seventh four-weekly report, as follows :— " Bangor Street.—In this street there are 39 houses, of which 11 are common lodging-houses, and 28 are let in lodgings, of which, all save one are registered. The 28 lodginghouses contain 264 rooms, occupied by 229 families, comprising 583 persons (adults 423, children 160), or 2T6 persons to a house. Crescent Street.—In this street there are 39 houses, including 8 common lodging-houses. Six houses (including 2 taverns) are privately occupied, and 25 are let in lodgings : of these lodging-houses 17 are registered, and 8 are not registered, these latter not having been let in lodgings or occupied by members of more than one family, when the houses so occupied were registered in 1886. The 25 houses contain 212 rooms, occupied by 169 families, comprising 429 persons (adults 320, children 109), or 17.2 to a house. " Sirdar (formerly known as St. Clement's) Road.—In that part of this street comprised in "Notting-dale," and lying to the south of the Board School, there are 41 houses, 15 of which (including two shops and one tavern) are privately occupied; 4 are common lodging-houses, and 22 are let in lodgings. Of these lodging-houses 21 are registered. The 22 lodging-houses contain 181 rooms, occupied by 150 families, comprising 431 persons (adults 284, children 147), or 19.6 persons to a house, 127 St. Katharine's Road.—In this street there are 111 houses, of which 12 (including one tavern) are privately occupied, and 99 are let in lodgings. Of these lodging-houses, 92 are registered and 7 arc not registered. The 99 houses contain 665 rooms, occupied by 477 families, comprising 1,320 persons (adults 918, children 402), equal to 13.3 persons to a house. This street is intersected by Sirdar-road. The eastern, which is also the newer section, comprises 59 houses let in lodgings, the houses being larger than those in the older (western) section, formerly known as Cobden-terrace. The 59 houses contain 442 rooms, occupied by 378 families, comprising 992 persons (adults 708, children 284), equal to 1 6.8 persons to a house. " Kenley (formerly known as William) Street.—In this street there are 50 houses, of which 8 are privately occupied, and 42 are let in lodgings ; of these lodging-houses, 26 are registered. The 42 houses contain 203 rooms, occupied by 151 families, comprising 421 persons (adults 301, children 120), or 10.0 persons to a house. " The details above set out, and others with reference to the lodging and other houses, have been arranged in tabular form, for convenience of reference, at pages 128 and 129. The 216 lodging-houses in the five streets collectively, contain 1,525 rooms, and furnish accommodation for 1,176 families, comprising 3,184 persons (adults 2,246, children 938), or 14.8 persons to a house ; and, on an average, 2.08 persons to a room. Cases of overcrowding were observed, but in all, save four, the nuisance was abated upon caution, or by service of written intimations. In 114 of the 216 houses, the rooms are let furnished, exclusively ; in 84 houses the rooms are let unfurnished exclusively : in 18 houses there are both furnished and unfurnished rooms. The registered houses are 183 ; the unregistered 33. In 90 only of the registered houses is there a resident " Keeper," the remaining 93 houses being destitute of the semblance of control and regulation implied by the presence of some person in resident charge of the lodgings, and nominally responsible for theobservanceof many of the bye-laws, 128 THE "NOTTING DALE" SPECIAL AREA. Summary of the Results of the House-to-House Inspection. streets. No. of Houses in Street. No. of Houses let in Lodgings. No. of Common Lodging-Houses. No. of Houses not let in Lodgings. No. of Houses in which rooms are let in Lodgings. Registered Lodging Houses in which there is a Resident Keeper. Population of Houses other than Common Lodging-Houses.* Roofs defective in structure or in drainage (guttering). Walls defective, dirty, &c. Defects observed Water supply from Cistern, and not from rising Main. Other Defects. No. of Houses in respect of which notice is necessary. Registered. Not Registered. Furnished Rooms. Unfurnished Rooms. Furnished and Unfurnished Rooms. No. of Families. No. of Persons. No. of Adults. No. of Children. Drains not trapped from the Sewer. Insufficient W.C. Accommodation. Yards not properly paved. Bangor Street 39 27 1 11 — 13 9 6 9 231 593 429 164 3 23 1 — 21 6 — 26 Crescent Street 39 17 8 8 6 18 7 — 8 175 461 341 120 6 19 — 4 9 14 — 25 Sirdar Road (part of) late St. Clement's Road 41 21 1 4 15 8 12 2 6 161 483 317 166 12 15 10 — 9 9 3 21 St. Katharine's Road 111 92 7 — 12 54 40 5 52 489 1,375 960 415 42 77 51 3 61 41 1 90 Kenley Street late William Street 50 26 16 — 8 21 16 5 15 158 466 333 133 23 40 29 3 23 10 — 48 Totals 280 183 33 23 41 114 84 18 90 1,214 3,378 2,380 998 86 174 91 10 123 80 4 210 * The actual number of persons who slept at the 23 Common Lodging Houses, on May 10th, 1897, was 622, raising the population of the "Special Area" to 4,000. 129 THE "NOTTING DALE" SPECIAL AREA: HOUSE-TO-HOUSE INSPECTION. Particulars as to Houses let in Lodgings. Name of Street. Number of Houses let in Lodgings. Number of Rooms. Number of Families. Number of Adults. Number of Children. Number of Persons. Average per House. Bangor Street 28 264 229 423 160 583 21.6 Crescent Street 25 212 169 320 109 429 17.2 Sirdar Road, part of (late St. Clements Road) 22 181 150 284 147 431 19.6 St. Katharine's Road 99 665 477 918 402 1,320 13.3 Kenley Street (late William Street) 42 203 151 301 120 421 10.0 Totals 216 1,525 1,176 2,246 938 3,184 14.8 130 " Population.—The most interesting fact ascertained in the course of the inspection, was that the population of " Notting-dale" is becoming more dense. The census in March, 1896, showed an increase of 490 persons in the five years since 1891, equivalent to 29 per cent. per annum. The rate of increase during the fifteen months commencing April, 1896, appears to have been, as nearlyas may be, at therate of 4 per cent. per annum, the population now (i.e., May, 1897) being, in round numbers, 4,000. The population, therefore, is greater by 925 per cent. than the estimated number, a fact which may well inspire some anxiety; for the rapid increase in population which is going on, should it prove to be continuous, would seem to point to danger ahead from overcrowding. Hitherto, however, the greater density has been brought about mainly by the occupation of previously empty rooms. Many of the recent immigrants, moreover, are young adults, the males for the most part employed in the construction of the Central London Electric Railway—'good lives,' therefore, in the actuarial sense. The matter calls for such watching as may be practicable, lest there should be an increase in room-crowding to the greater detriment of the health of the inhabitants." Dealing with this subject in the seventh report, I observed that the outlook is of a nature to deepen desire that the houses may be acquired by the County Council under Part III. of the Housing of the Working Classes Act, 1890, in order that the letting of lodgings may be made subject to the regulations, which the " Local Authority" are empowered to make, "for the management, use, and regulation of the lodging-houses." The Sanitary Committee made an unanimous recommendation that your Vestry should request the Council, as Local Authority, to acquire the houses. As we shall see, the application made by your Vestry to the County Council was not successful. Common Lodging-Houses.—It may be mentioned that the twenty-three common lodging-houses in the Special Area 131 contain accommodation for 703 persons. The average number of nightly lodgers is 650, of whom about 96 are "transitlodgers," i.e., wayfarers, travellers,&c., who stay only for a night. The gross number of transit lodgers in the year corresponds to a large but unknown total. The regular nightly lodgers, estimated at 554,are "old-stayers," who have been in the same house, and have occupied thesame beds,for two, three, or four years, and some for still longer periods. This information is based on a report by Mr. Marks, the County Council inspector. Details as to the accommodation provided at the several houses is contained in the table at page 123. An impression prevailing that there was overcrowding at these establishments I explained in the sixth report (June 25th, page 74) that provision is made in the rules of the County Council for the prevention of this dangerous form of nuisance; cubic space being required in the dormitories to the amount of 300 feet for each of the lodgers, the required floor space for each bed being 36 square feet. These spaces I am informed, and believe, are in every instance actually provided. On the 22nd September your Vestry referred to the Sanitary Committee my reports (Nos. 5 to 9) for the twenty weeks, April 7th to September 11th, which embodied a variety of recommendations, made with the view to the improvement of the Special Area, to the following effect:— (a) That the Sanitary Committee should be requested to draft a bye-law for houses let in lodgings or occupied by members of more than one family, to enforce the provision and maintenance at the "furnished" rooms in registered houses, of bedding, etc., which shall be clean and wholesome, and free from noxious insects. (b) That a suitable disinfecting oven should be provided for baking the bedding at common lodging-houses, registered lodging-houses, and other houses inhabited by the poorer classes, when necessary to free such bedding from noxious insects. 132 (c) That the houses let in lodgings ill the Special Area in " Notting-dale," and not at present on the register of houses let in lodgings or occupied by members of more than one family, should be registered forthwith. (d) That at registered houses in the Special Area— (1) All drains should be made perfect and be trapped from the sewer. (2) Additional water closet accommodation should be provided where necessary. (3) Water for drinking and dietetic purposes should be supplied from the rising main, and, where practicable, should be laid on to the upper part of each house. (4) The yards of the several houses should be paved. (5) The houses generally should be put in such a state as to be fit for human habitation. As the outcome of the reference, a bye-law relating to furnished rooms in registered houses was framed and submitted to the Local Government Hoard for their sanction; all the houses not previously registered were put upon the register; additional water-closets were provided where necessary, and a certain number of the yards were paved. Many of the houses in the district now obtain water for potable use direct from the main. Effect was not given to the recommendation of a disinfecting oven. The drains remain as they were, many of them had been disconnected from the sewer prior to the stop put to work of this kind under the circumstanccs set out in the Annual Report for 1895 (pages 83—88). Sickness in " Nottingdale."—The fifth and sixth reports (May 27th, page 58, and June 25th, page 75), treated of sickness in the Special Area, in the practice of the Infirmary and the District Medical Officers, respectively. The information obtained is summarised below. 133 In-door Sick.—During the Poor-Law year, ended 27th March, 1897, there were 723 admissions (representing 675 persons) to the Infirmary from this district, 505 of which were upon Relieving Officers' orders and medical certificates, the remaining 218 admissions representing transfers from the workhouse and other cases not admitted direct by the Relieving Officers. Of the 505 cases, 155, or nearly one-third, were from the 23 common lodging-houses (which contain accommodation for 703 persons, and shelter an average nightly population of 650) ; 350 cases having been admitted from the remaining 252 houses, the ascertained population of which is 3,378. Inmates are not allowed to remain at the common lodging-houses when seriously ill. This fact accounts for the larger proportion of admissions to population from these establishments. The total admissions to the Infirmary during the year were 3,459, so that " Notting-dale," which comprises only one forty-third of the population of the parish, contributed one-fifth of the in-door sick. From the several streets the admissions were as follows:—Bangor-street 178, Crescent-street 186, Sirdar-road 112, St. Katharine's-road 205, Kenley-street 42: total 723. The first three streets contain common lodging-houses: their population is approximately 2,160, and the admissions to the Infirmary were in the proportion of 22 per cent. The other two streets have a population of 1,84:!, and the admissions to the Infirmary were in the proportion of 13.4 per cent. Certain particulars with respect to the admissions to the Infirmary, upon Relieving Officers' orders and otherwise, are set out in the tables at pages 134 and 135. These tables, it will be observed, show (1) the sex, age, street-residence, (common lodging-house,and other cases separately)and length of previous residence of the cases from each of the five streets; (2) the length of previous residence of common lodginghouse cases, and (3) particulars (sex, age, residence), with references to cases admitted to the Infirmary otherwise than by Relieving Officers' orders direct. 134 Particulars with respect to Admissions to the Kensington Infirmary upon the Relieving Officers' Orders (and Medical Certificates) of Persons Residing in the "Notting Dale" Special Area" from April 1st, 1896, to March 31st, 1897. NAME OF STREET. Sex. Totals. Age. Houses. Length of Previous Residence. Males. Females. 0-1 year. 1-5 years. 5-12 years. 12-20 years. 20-60 years. 60 years and upwards. Common Lodging Houses (23 in number) Population 650. Other Houses (252 in number) Population 3,378. Under 1 week. 1-2 weeks. 2-3 weeks. 3-4 weeks. 1-3 months. 3-12 months. 1 year and upwards. Bangor Street 77 43 120 2 1 2 10 84 21 60 60 4 — 3 3 4 11 95 Crescent Street 56 71 127 1 4 1 7 89 25 73 54 4 5 — — 8 16 94 Sirdar Road (part of) (late St. Clement's Road) 44 29 73 — 2 3 2 56 10 22 51 — 1 — 2 2 3 65 St. Katharine's Road 71 76 147 2 9 13 12 97 14 147 — 3 1 1 5 25 112 Kenley Street (late William Street) 20 18 38 3 4 2 2 24 3 — 38 1 1 — — 1 7 28 Total 268 237 505 8 20 21 33 350 73 155 350 9 10 4 6 20 62 394 135 1. Infirmary Admissions from C.L.H. by Relieving Officers' Orders. STREET. Length of Previous Residence. Total. Under 1 week. 1-2 weeks. 2-3 weeks. 3-4 weeks. 1-3 months. 3-12 months. 1 year and upwards. Bangor Street 3 — 3 2 1 4 47 60 Crescent Street 3 4 — — 2 11 53 73 Sirdar Road (part of) (late St. Clement's Road) — 1 — 1 1 — 19 22 Total 6 5 3 3 4 15 119 155 2. Infirmary Admissions otherwise than by R.O.'s Orders, direct. STREET. Sex. Total. Age. Houses. Males. Females. Under 1 year. 1-5 years. 5-12 years. 12-20 years. 20-60 years. 60 years and upwards. From C.L.H. From Other Houses. Bangor Street 40 18 58 1 3 1 2 34 17 38 20 Crescent Street 21 38 59 1 2 2 — 41 13 36 23 Sirdar Road (part of) (late St. Clement's Road) 23 16 39 2 3 1 — 24 9 14 25 St. Katharine's Road 26 32 58 4 8 3 2 30 11 — 58 Kenley Street (late William Street) 1 3 4 — — — 1 3 — — 4 Totals 111 107 218 8 16 7 5 132 50 88 130 3. Notifications in "Notting Dale," April, 1896, to March, 1897. NAME OF STREET. Disease. Totals. Small-pox. Scarlet Fever.* Diphtheria. Enteric Fever.* Erysipelas. * Bangor Street ­ ­ ­ — 9† 9 Crescent Street — 4 3 — 5‡ 12 Sirdar Road (part of) (late St. Clement's Road.) 4 — 2 9 15 St. Katharine's Road 1 11 2 2 11 27 Kenley Street (late William Street) — 8 5 1 2 16 Totals 1 27 10 5 36 79 *One case of S. F., 3 of E. F., and 21 of Erysipelas were admitted to the Infirmary. † Including 2 from Common Lodging Houses. ‡ Including 3 from Common Lodging Houses. 136 The diseases specified on the entrance medical certificates of the 505 admissions direct by Relieving Officers' orders (no information is forthcoming in regard to the other 218 cases) were as follows .— Lungs and air-passages, Diseases of the 99 Heart, Diseases of the 8 Phthisis 33 Nervous system, Diseases of the 44 Digestive-system, „ „ 20 Urinary organs, „ „ 6 Zymotic diseases, viz.: — Measles 5, Diarrhoea 10,Fever 2, Influenza 13, Chicken-pox 1, Erysipelas 13 44 Rheumatism, Gout, Sciatica, etc., 56 Skin diseases (including 37 cases of Ulcerated legs) 52 Syphilis* 10 Organs of Generation, Diseases of the 4 Alcoholism 4 Abscess 11 Diabetes 2 Ophthalmia 9 Joint diseases 2 Bright's disease, Ague, Adenitis, Ear-disease, one each 4 Debility, Anaemia, Malnutrition 22 Other diseases 4 Senile decay Injuries 54 Parturition 12 505 (Out-door Sick.—During the Poor Law Year 1896-97 1,689 medical orders were issued : 388 (one-fifth) to persons too ill to attend at the Dispensary, Mary-place (home-cases), and 1,301 (four-fifths) to "out-patients." These 1,689 cases, of course, include the 505 cases which were admitted to the Infirmary. Particulars of the out-door sick, distinguishing home-cases and out-patients, and showing, sex, age, number of houses in streets, cases from common lodging-houses, and other houses, together with a list of the diseases, treated, are set out in the tables at pages 138 and 139. * Cases of venereal disease are, as a rule, sent direct to the Lock Hospitals. 137 In table 3 at page 135 the notifications of infectious disease in each of the streets are set out. They number 79. The notifications in the parish, as a whole, were 1,665 : they would have been 3,591 had they been in the same ratio to population as in the Special Area. The notifications of scarlet fever (899), diphtheria (243), enteric fever (104), and erysipelas (282) would have been 1,227, 454, 227, and 1,636, respectively, had they been in the same proportion to population as in the Special Area. The cases in the district of scarlet fever, diphtheria, and enteric fever, would have been far more numerous, but for the speedy isolation of the sick in hospital. Having regard to the nature of erysipelas, its prevalence in a ratio nearly six times as great as in the parish, as a whole, is significant as an indication of conditions of life of an unwholesome character. The case of small-pox was removed to hospital, and there was no spread of the disease ; the patient recovered. The 27 cases of scarlet fever occurred in 24 houses: 25 of the cases were removed to hospital. In one case there was refusal to go, and in one case the patient was too ill to be removed, and died. In hospitals there were four deaths. The ten cases notified as diphtheria occurred in 9 houses: 9 were removed to hospital and recovered : the tenth was too ill to be removed, and died. The five cases of enteric fever occurred in as many houses: all of them were removed to hospital, where one died. Of the 36 erysipelas cases 21 were treated at the Infirmary: all recovered. These facts it may be observed, in passing, illustrate the value of hospitals Had the infectious cases been kept at home there would probably have been spread of the several diseases, as isolation would have been impossible, and many more deaths. As it was, the cases were notified and removed to hospital without delay, and the houses were disinfected forthwith, with the result that, despite the number of centres of infection during the year, there was no spread in any case. Of the erysipelas cases five were of persons who had resided at common lodging-houses, this being the only notifiable disease recorded as having occurred at these establishments. 138 Particulars of Sick Cases in the "Special Area," April 1st, 1896—March 31st, 1897. STREET. Sex. Total.. Age. Houses in Streets. Cases at or from Where Treated. Males. Females. 0-1 year. 1-5 years. 5-12 years. 12-20 years. 20-60 years. 60 years and upwards. Common Lodging-Houses. Other Houses. Total. Common Lodging-Houses. Other Houses. At Dispensary. At Home. Bangor Street 150 195 345 19 59 22 24 187 34 11 28 39 68 277 272 73 Crescent Street 124 212 336 23 40 25 22 198 28 8 30 38 79 257 265 71 Sirdar Road (late St. Clement's Road, 121 134 255 14 33 17 9 156 26 4 34 38 24 231 201 54 St. Katharine's Road 218 346 564 61 75 52 45 291 40 ­ 110 110 — 564 426 138 Kenley Street (late William Street) 77 112 189 17 31 23 21 83 14 — 50 50 — 189 137 52 Total 690 999 1689 134 238 139 121 915 142 23 252 275 171 1518 1301 388 Note.—Five hundred and five of the cases were removed to the Infirmary. 139 Diseases, as entered in the Medical Relief Register, occurring in the "Special Area," April 1st, 1896—March 31st, 1897. Diseases. Bangor Street. Crescent Street. Sirdar Road (late St. Clement's Rd.) St. Katharine's Rd. Kenley Street, (late William Street) Total Zymotic Diseases. Measles 10 7 1 16 6 40 251 Small-pox ­ ­ — 1 ­ 1 Diphtheria — 2 — 1 4 7 Scarlet Fever 3 2 3 3 11 Diarrhoea 31 19 14 36 5 105 Whooping-Cough 3 1 — 1 ­ 5 Influenza 1 15 4 24 14 58 Erysipelas 2 1 3 5 1 12 Chicken-pox — 3 — 1 1 5 Simple Continued Fever — 1 1 4 1 7 Venereal Diseases 15 31 5 30 10 91 Phthisis 5 9 13 14 3 44 Lungs and Air Passages, Diseases of the 85 67 75 120 43 390 Heart, Diseases of the 2 3 1 3 1 10 Nervous System, Diseases of the 10 12 11 16 6 55 Digestive System, Diseases of the 39 39 38 60 24 200 Organs of Generation, Diseases of the 2 5 — 4 3 14 Rheumatism, Gout, Sciatica, &c. 34 12 19 39 12 116 Skin Diseases (including 55 cases of Ulcer) 29 27 11 39 9 115 Alcoholism, Delirium Tremens ­ 3 1 3 1 8 Abscess 5 4 4 6 3 22 Eye Diseases 8 4 — 7 1 20 Joint Diseases 1 1 6 2 1 11 Debility Anæmia Malnutrition. &c. 18 21 19 39 12 109 Dentition 7 1 — 6 — 14 Other Diseases 13 6 4 25 10 58 Senile Decay — 3 1 1 1 6 Injuries 14 23 11 29 7 84 Parturition 11 13 11 29 7 71 Total 345 336 255 564 189 1689 See footnote at foot of table, page 138. 140 The deaths (183) in the Poor-Law Year 1896-97, comprised 97 of persons who had previously resided in the three streets having common lodging-houses, the deathrate being about 45 per 1,000; in the other two streets the deaths were 87, and the death-rate was about 47 per 1,000. The deaths of persons who had previously lived at common lodging-houses were 29, and of other inhabitants 154. The death-rate of the district, as a whole, was nearly 4G per 1,000: of the common lodging-house people 44.6 per 1,000; of the other inhabitants 46 per 1,000. Of the 183 total deaths, 94 took place at the Infirmary, 15 at other public institutions, and 74* in the district itself. One conclusion drawn from the enquiry was that (contrary to expectation) the presence of the common lodging-houses did not help to explain the high-rate of mortality, the death-rate of the inmates of those establishments being lower than that amongst the people resident in the other houses. Mortality in 1896 and 1897.—For the sake of comparison, the following facts with respect to the 187 deaths that took place in the registration year 1896, are here inserted:— First as to ages at death. Fifty-one persons died in the first year of life and 31 between the ages of 1 and 5. The deaths under five years (82) were in the proportion of 439 per 1,000 deaths from all causes, as compared with 384 in the parish as a whole. Between 5 and 20 years the deaths were 6; between 20 and 60 there were 70 deaths; at 60 and upwards there were 29 deaths. The causes of death may be summarised as follows: Tubercular diseases, and wasting diseases of children (atrophy, debility, inanition) 40 deaths; diseases of the heart and lungs, 49 deaths; diseases of the zymotic class, 30 deaths; diseases of the nervous system, 17 deaths; cancer, 7 deaths; syphilis, 6 deaths; old age, 4 deaths; other causes, 34 deaths. Among the deaths from "other causes" there were seven from violence; in two cases from accident, viz : male, aged 56, and female, aged 3, from falls ; * Of the 74 deaths which occurred at home 39, or more than a moiety, were certified by the two district medical officers and their deputies, a fact which indicates the large propo.tion of parish cases as compared with the cases medically attended liy private practitioners, by whom 27 deaths were certified: 8 deaths were registered on information given by the Coroner, 141 in two cases by manslaughter, viz.: female, aged 40, injuries by a kick, and female, aged 27, whose throat was cut; two by suffocation, viz.: infant, aged 5 months, in bed with parents, and infant, aged 5 weeks, "how or under what circumstance there is no evidence to show;" a female, aged 65, died from internal hemorrhage due to violence, but how caused is not known. These violent deaths were equal to 3.7 per cent, on the total deaths, the proportion of violent deaths in the parish, as a whole, being 3.5 per cent. Inquests were held in 15 cases, viz., in the above 7 cases of violent deaths, and in 8 cases of deaths from natural causes. The inquests were in the proportion of 8 per cent, on total deaths, the relative proportion of inquest cases in the parish, as a whole, being 8.2 per cent. The vital and mortal statistics for 1897 do not, unhappily, show any improvement on those for 1896, as the following summary indicates :— 1890. 1897. Births 142 130 Birth-rate 38.0 32.5 per 1,000 living Deaths 187 223 Death-rate 50.0 55.7 per 1,000 living Infantile death-rate 432 431 per 1,000 births Zymotic death-rate. 8.0 6.3* per 1,000 living The deaths were 45 in excess of the births in 1896: in 1897 the excess of deaths was to the number of 93 : the 223 deaths in 1897, moreover, were 36 more than the number (187) in 1896. The facts with respect to the 223 deaths (males 97, females 126) in 1897, are as follows :—First as to the ages of deaths. Fiftysix children died in the first year of life, and 35 between the ages of 1 and 5. The deaths under 5 years (91) were in the proportion of 408 per 1,000 deaths from all causes, as compared with 342 in the parish as a whole. Between 5 and 20 years, the deaths were 13 ; between 20 and 60 there were 89 deaths ; * The Zymotic death-rate in 1896 was three times as great as in the parish as a whole; in 1897 it was more than 3 1/2 times as great. 142 at 60 and upwards there were 30 deaths. The causes of death may be summarised as follows: Tubercular diseases, and wasting diseases of children (atrophy, debility, inanition) 69 deaths; diseases of the heart and lungs 52 deaths; diseases of the zymotic class, 28 deaths (viz.: diarrhoea 9, measles 7, scarlet fever 4, diphtheria 2, whooping-cough 3, erysipelas 2, influenza 1); diseases of the nervous system. 20 deaths; cancer, 11 deaths, syphilis, 3 deaths; old age, 3 deaths; other causes, 37 deaths. Among the deaths from " other causes," there were 11 from violence; in 5 cases from accident, viz.: females aged respectively 66, 50, and 4 years, from falls; female, aged 52, from burns; and male, aged 45, from scalds; one suicidal death was that of a man aged 78, who threw himself under a train shortly after the death of his wife. Five deaths were caused by suffocation, viz., of a man aged 40, and 4 infants, aged respectively, 6 months, 10 weeks, 7 weeks, and 5 weeks; all in bed with parents. These violent deaths were equal to 4.9 per cent, on the total deaths, the proportion of violent deaths in the parish, as a whole, being 3.6 per cent. Inquests were held in 25 cases, viz., in the above 11 cases of violent death, and in 14 cases of death from natural causes. These inquests were in the proportion of 11.2 per cent, on total deaths, the relative proportion of inquest cases in the parish, as a whole, being 8.4 per cent. The previous residence of the deceased people was, Bangor-street in 52 cases, Crescent-street in 36, Sirdar-road in 25, St. Katharine's road in 87, and Kenley-street in 23 cases. "NOTTINGDALE" AND THE QUEEN'S JUBILEE.—A Committee of "representative inhabitants" having been formed to consider the best mode of celebrating the Diamond Jubilee, it was resolved "to give effect to the loyal feelings of the parishioners by the promotion of a scheme having for its object the amelioration of the condition of the inhabitants of . . . ' Notting-dale.'" I ventured to propose that this object might be attained by the acquirement of a number of the houses 143 to be utilised as lodging-houses, so as to increase the body of respectable inhabitants already located in the district, and as "Relief" houses, into which to draft the people, in batches, from registered houses, so as to give the owners of such houses vacant possession for the time necessary for carrying out the annual cleansing required by the bye-laws. The ultimate cost of such a scheme would have been small, as the houses pay their owners very well indeed. The proposal did not find favour, and in the result a limited scheme for providing a creche, and resting and warming rooms for the poor people, was adopted. At the present writing (April, 1898) progress has been limited to the acquirementof a site for these proposed buildings. My first proposal having fallen through, I made a further recommendation, viz., to request the County Council to acquire the houses in the district under Part III. of the Housing of the Working Classes Act, 1890, with a view to their utilisation as lodging-houses for the working-classes, subject to regulations framed in accordance with the provisions of section 62. A motion to this effect, brought in by a member, and referred to the Sanitary Committee, was approved by that body, and adopted by your Vestry. The request thereupon addressed to the Council was endorsed by the Ruri-decanal Chapter, who forwarded a petition to the Council in support, a similar petition having been signed by the members for the borough and certain influential inhabitants. The matter came, in due course, before the Housing of the Working Classes Committee, who, in reply, and without previously reporting the matter to the Council, stated that they were of "opinion that Part III. of the Act, being designed to facilitate the provision of dwellings for the accommodation of persons of the working class, in districts where the need for such accommodation is felt, would not be applicable to" the "Notting-dale" area. The Committee added that, "so far from requiring the aid of the Council... the Vestry possess ample powers, under section 94 of the Public Health 144 (London) Act, 1891, for dealing with the evils existing in connection with the houses in the area." They suggested, therefore, the exercise of the powers of inspection and regulation of houses let in lodgings under the said section with a view to mitigating such evils. A further communication was addressed to the Council pointing out that the powers referred to had been exercised, and having been found to be inadequate for the purpose, the aid of the Council, as local authority under the Housing Act, was desired. The Committee, however, again declined to advise the Council to acquire the houses, and thus the most hopeful prospect of effecting some real improvement in the condition of the district came to naught. Before and since that futile effort, much had been done by your Vestry to effect amelioration of the physical conditions of the locality and its inhabitants. Several of the streets have been paved with asphalte, and the remaining streets will be dealt with in like manner ere long. The street gullies have been effectually trapped; the surface sewer ventilating openings have been closed, and the sewers are now ventilated by shafts carried up against houses. As a result of the house-tohouse inspection, by Inspectors Steward and Pettit, made in May—June, much work of a structural character,and cleansing, was carried out in compliance with the requirements of the Sanitary Committee. The houses are, upon the whole, fairly well sanitated: many of the drains have been intercepted from the sewers, and all of them have been ventilated. At many of the houses drinking water is drawn direct from the main. Additional water-closet accommodation has been provided where necessary on account of the number of the persons resident in particular houses. Many of the yards have been more or less well paved—a work which should be carried out to completion. And lastly, the few houses not on the register of houses let in lodgings or occupied by members of more than one family, have been registered. The greatest 145 difficulty with which we have had to contend is overcrowding. When information of this nuisance is obtained there is no difficulty in dealing with it. But it is almost impossible to get information. It must be said, however, that the Inspectors came across very few instances of overcrowding when making their house-to-house inspection, although the result of that inspection was to show that the population had increased from the estimated 3,750 in 1896, to 4,000 in 1897. More cannot be done under existing circumstances.* To sum up this melancholy subject, it has to be said, and it is said with regret, that no improvement in regard to the healthiness of the district, as judged by the death-rate, is as yet manifest, despite the efforts madetoimprove the sanitary state of the houses and their surroundings. Nor is much change for the better, if any, to be expected until means shall have been devised to secure amelioration in the conditions of the home-life of the people. It was hoped that this would have been brought about by action on the part of the County Council, under the provisions of the Housing of the Working Classes Act, 1890. But this hope has been dissipated, the * It will be remembered that the Sanitary Committee, in 1893, regarded "frequent house-to-house inspection" as the prime need of the district, and that on their recommendation an additional (seventh) Sanitary Inspector was appointed to take charge of it exclusively. A vacancy in the staff having occurred at the end of 1895, and not having been filled up, the number of inspectors thereafter was six. The Special Committee (June, 1896) dwelt upon "the necessity of sanitary inspection of the houses," which, they said, could "hardly be overstated," especially between the months of April and October, the period appointed lor the annual cleansing of registered houses. In accordance with their recommendation (d) the Sanitary Committee were requested to "arrange for the suggested increase of sanitary inspection with a view to the more strict enforcement of the bye-laws relating to houses let in lodgings" The Special Committee had intimated that their recommendation of increased sanitary inspection "did not necessarily mean an increase to the permanent staff of Sanitary Inspectors." In July, the Sanitary Committee having ordered the issue of some 220 notices in respect of houses in "Notting-dale," it was proposed to appoint two additional inspectors, for one month, to assist in supervising the execution of the required works, but the proposal was negatived by the Committee, 146 Council not having seen their way to undertake the beneficent task proposed to them. Your Vestry have, at present, no power to put Part III. of the Act into operation; it only remains, therefore—if anything is to be attempted—that steps should be taken to promote legislation, to make the Sanitary Authority the Local Authority, sole or concurrent, under this Part. It was a legislative mistake to endue the Council with exclusive power, and the sooner the mistake is rectified the better. It is a strange anomaly that the Sanitary Authorities of the Metropolis should be denied powers enjoyed by the most insignificant Urban Sanitary Authority. THE PAVING OF YARDS. During the year a good many yards were paved more or less satisfactorily. It would be well if work of this sort could be carried out systematically throughout the parish; but in present circumstances it is impracticable. Individual cases only can be dealt with as they arise out of casual or special inspections, or in the case of house-to-house inspections, of which by far too few are made. The Special Committee on "Notting-dale," in their report (June 18th, 1896), referring to the state of the yards in the Special Area, stated that they were "saturated with human ordure and filth of every description." In a draft report setting out the results of the inspections made of the district, it was stated that the Committee were— "Struck with the bad state of the yards at the backs of the houses-; 'gardens' there appeared to be practically none. The yards, excepting as to a small portion close to the house, are unpaved and undrained. They were littered, in a neglected condition generally, and in many instances filthy with deposited matters of an objectionable character, including ordure, human and animal. Any filth once deposited, must either soak into the ground, whence it will return in hot weather laden with germs, or, becoming dried, will pass as dust from the surface into the atmosphere." 147 The Committee were of opinion that "these yards should be asphalted or paved," and the first' of their recommendations, all of which were approved by your Vestry, was to the following effect— "That it be referred to the Works and Sanitary Committee to have notices served upon the owners or occupiers of the houses in the several streets.... requiring them to asphalte, or pave with impervious material, the yards, in the rear of such houses, which are not in a proper condition." Effect has been given to this recommendation to a certain extent, many of the yards having been paved, wholly, or in part, in a more or less satisfactory manner. The paving of yards is one of the matters dealt with in your Vestry's bye-laws, made under the provisions of section 16 (1) (d) of the Public Health (London) Act, 1891 ; the tenth bye-law reading as follows :— "As to the paving of yards and open spaces in connection with dwelling-houses. "The owner of any dwelling-house in connection with which there is any yard or open space shall, where it is necessary for the prevention or remedy of insanitary conditions that all or part of such yard or open space shall be paved, forthwith cause the same to be properly paved with a hard, durable, and impervious pavement, evenly and closely laid upon a sufficient bed of good concrete, and so sloped to a properly constructed channel as effectually to carry off all rain or waste water therefrom; and he shall cause such pavement to be kept in proper repair." 148 It will be observed that the paving of yards is prescribed "for the prevention or' remedy of insanitary conditions," a fact which is, sometimes, I fear, lost sight of. That paving is "necessary" for this purpose is indubitable, and on this account I have been insistent in pressing the matter, from time to time, upon the attention of the Sanitary Committee. I venture to think that more would be done in this direction, by Sanitary Authorities generally, if due weight were attached to the hygienic importance of cleanliness in the surroundings of dwelling-houses; and I am glad to have the opportunity of enforcing my own feeble utterances on the subject by citation of the views of the Medical Officer to the Local Government Board, who in a recent publication* refers to "the circumstances of the soil and surroundings... favourable to the vitality and multiplication of the typhoid bacillus," the efficient agent in the causation of enteric fever. "They are (he states) that the soil should be pervious, that it should be permeated with a sufficiency of decaying—preferably animal— organic matters, that it should possess a certain amount of moisture, and that it should be subject to a certain temperature. And then (he continues) let us consider what means can be adopted to deprive the soil of one or more of these conditions which appear to favour the retention of the vitality and power of the typhoid bacillus, and to prevent that organism from gaining access to the soil in the neighbourhood of human dwellings"; and here my point comes in, the author proceeding to say that, "to this end he would in the first place advocate the paving of open spaces about dwellings, where these open spaces are of small area and are liable to become contaminated with excreta. In this way fouling of, as well as penetration by, a pathogenic micro-organism into the underlying soil, is practically prevented." He adds that " it *" Soil and Circumstance in their Control of Pathogenic Organisms," By Sir Richard Thorne, K.C.B., F.R.S., whose observations, it may be mentioned, are based, largely, upon investigations made for the Medical Department of the Local Government Board by Dr. Sidney Martin, 149 is well known, not only that the paving of yards about small cottages and tenement property in towns has in its results been shown to be a public health measure of first importance, but also that the nature of such a measure has depended largely on the use of a form of pavement which really ensures impermeability." The reference to this branch of the subject concludes as follows :— "Where open spaces about dwellings are large, and where organic pollution of surface soil is practically absent, we may rely, as inhibitive of this (typhoid) bacillus, on the influence of sunlight and of alternating weather; but in our towns the conditions have become too artificial, and the open air about dwellings has become too restricted, for us to hope that under the unnatural conditions which have been induced by urban aggregations of dwellings, we have any right to expect the full benefit of Nature's remedies." I should but weaken the force of these observations by any comments of my own; and it is, I am sure, unnecessary to dwell on their exact pertinency to the circumstances of the soil and surroundings of the houses in the "Notting-dale" Special Area, to cite the strongest instance of many that from time to time engage the attention of the Sanitary Committee. 150 ENCROACHMENT UPON OPEN SPACES ABOUT BUILDINGS. The Vestry of St. Pancras having invited the observations of the Sanitary Authorities with reference to a report by their Medical Officer of Health, calling attention to the encroachment upon open spaces about buildings, which is sanctioned under recent changes in the building laws, the matter was referred to the Sanitary Committee, which, after approval of my report thereon, expressing agreement with the views set out in the report of the St. Pancras Medical Officer, remitted it to the Law and Parliamentary Committee for an expression of their views as to the state of the law. This Committee endorsed the views of the Sanitary Committee, to the effect " that the provisions of the London Building Act, 1894, are defective," and they recommended that a communication be addressed to the County Council, " in favour of amending legislation being promoted to ensure the provision of adequate open space at the rear of all buildings." This course was adopted, and the St. Pancras Vestry were apprised of the action taken. REFUSE MATTER. The prevention of nuisance in connection with the storage, the collection, and the conveyance through streets of offensive substances coming under the general description "Refuse," which was formerly a matter of no little difficulty, has been facilitated by the County Council's bye-laws made in 1893, under the provisions of section 16 of the Public Health (London) Act, 1891. But in order to prevent nuisance in the conveyance of offensive matter through the streets, constant supervision is necessary, and as the police are always on duty, and have therefore opportunities of observing offences against the bye-laws, it appeared to the Public Health Committee of the Council that it would be useful if the police were instructed to take note of any such offences, and to give notice thereof to 151 the Sanitary Authority of the district concerned. The Committee communicated their views to the Commissioner, who thereupon issued an instruction to the police to note and report to the Sanitary Authorities any breaches of the byelaws made under the Act, and this is done. Removal ok Offensive Matters through Streets. —This subject was dealt with in the report for 1895, the action taken by your Vestry, and other Sanitary Authorities at the instance of your Vestry, with a view to an alteration in the bye-laws of the County Council, being set out. The specific recommendation of the Sanitary Committee was— "That a communication be addressed to the County Council, pointing out the desirability of their Bye-law being revised so as to allow of the removal of fish offal, &c. at other times than those specified in Byelaw No. 1,* provided such offal is removed from the premises in suitable and closely-covered receptacles which will effectually prevent any obnoxious effluvia escaping therefrom." Many of the Sanitary Authorities addressed the Council in support of the resolution, but the Council took no action in the matter. From time to time people concerned with the removal of refuse have appealed to the Council for permission to remove such refuse at other than the prescribed hours, upon the ground that it was not " offensive," and have received answer that the bye-law applies to " offensive " matter only. I am not prepared to admit that any offal of the trade of fishmonger, poulterer, game dealer, etc., is inoffensive, but I do contend that all such offal can be removed inoffensively. My views on this subject were fully set out in a communication addressed by your Vestry to the late Metropolitan Board of Works in 1887, and are contained in the annual report for 1887 (page 177). *The hours for removal prescribed by the Bye-law are, between 4 and 10 a.m. from March to October, and between 6 a.m. and noon from November to February inclusive. 152 The main proposal submitted to the County Council by your Vestry in 1895, was that the offal of the trade of fishmonger, poulterer, &c., should be stored in galvanised iron receptacles with tight-fitting covers, and that the offal should be removed in the vessels, a subsidiary advantage of the plan being that the storage vessels could be effectually cleansed before being returned to the shopkeeper. That this course will have to be adopted sooner or later I entertain no doubt. Removal could then be effected at any hour without nuisance. But removal should, in my opinion, be effected in the evening, after business hours. The existing arrangements, apart from the sanitary question, entail disagreeable consequences to contractors, who, to escape prosecution for breach of bye-law in London, become liable to prosecution for breach of bye-law, say, at West Ham. Offensive matter may not be removed through streets in London excepting in the forenoon. Such matter may not be removed through streets at West Ham excepting in the evening. Could anything be more unfair than the position in which the contractors are thus placed, between the upper millstone of the County Council bye-law and the nether millstone of the bye-law made by the Corporation of West Ham—a locality to which much of London's "offensive matter," i.e., offal, is conveyed for transmutation to useful products ? House Refuse.—The work of collection of ashes and miscellaneous rubbish from our 23,000 inhabited houses, 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 arrangements being under the supervision of the Surveyor. A call is, or should be, made at every house once a week—twice a week in the "Notting-dale" district—and, subject to removal on that basis, 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. 153 Nuisance from house refuse does not arise from the proper contents of the receptacle—ashes—but from the addition of matters of organic origin. With the object of preventing, as far as practicable, nuisance from this cause, a printed notice is periodically issued by your Vestry to every householder, calling attention to the danger, on sanitary grounds, of vegetable and other objectionable refuse being placed in the dustbin, and requesting that directions may be given for all such refuse to be burned. Such a notice was issued on the first day of the current year. At present, a portion of the dust-bin refuse, from the northern part of the parish, is conveyed out of London by the Grand Junction Canal, the refuse from the southern parts of the parish being taken by the contractor down the Thames ; but not to your Vestry's depot at Purfleet, where the land, which lies below high-water mark, is let to the contractor for the deposit of other refuse matter of a presumably less objectionable sort. The time must ultimately come when the refuse will have to be cremated in or near the parish; the otherwise waste-heat thus produced could be employed for the production of "current" for the illumination of the streets by electricity—a practice which has already been adopted with success in other districts. Your Vestry now possess a site in Wood Lane, where, presumably, a Destructor and an electric light installation may be advantageously located. STABLE REFUSE. In former reports I had to note the frequency of complaints of effluvium nuisance arising in the storage, and, much more, in the removal of stable refuse from pits underground. Thanks to the operation of the County Council's bye-law, which has been carried out effectually in this parish, complaints are now few in number ; and as the cause for complaint, the sunken dung-pit, is now almost a thing of the past, we may reasonably hope to have less cause for annoyance on this score in the future. This subject was fully dealt with in my annual report for 1894 (pp. 184-189), to which I would refer anyone 154 desirous of knowing what a serious difficulty the question involved, until we were able to abolish, to a large extent, the brick receptacle, whether above or below ground, and to substitute therefor the iron cage now so familiar an object in the mews in this parish, not far short of two hundred in number. The following statement shows the work done in giving effect to the bye-law:— North District. South District. Total.  Iron cages erected 564 999 1,563 Brick receptacles abolished 171 554 725 Brick receptacles constructed or re-constructed 281 45 326 Sunken pits, improved, allowed to remain 36 38 74 Sunken pits abolished 132 434 566 Sunken pits were allowed to remain in a number of instances simply because, owing to the construction of the stable premises—the entire frontage being occupied by doors—it was impracticable to provide any other form of receptacle. In each such case the pit was reconstructed to a reduced depth (the sides and floor being cemented) and drained to the sewer. Nuisance from Stable Refuse.—As has been frequently stated in these reports, nuisance often arises from the storage, and still more in the removal and transit through streets, of horse dung manure, especially when peat moss litter is used. Complaint had been made on several occasions by persons resident in the vicinity of Brunswick Mews, and the London General Omnibus Company were requested to adopt the best practicable means for preventing offensive effluvia, viz., by providing a vehicle in which the refuse, being deposited therein on removal from the stables, could be removed from 155 the premises, thus avoiding the main cause of stench nuisance, to wit, the disturbance of the accumulated refuse in the transference from the receptacle to the vehicle at the time of removal. It was intimated that failure to carry out this suggestion would entail proceedings under Section 21 of the Public Health (London) Act, 1891, which I thought (and your Vestry's solicitors and the Law and Parliamentary Committee were of the same opinion), would enable us to abate the nuisance. After some delay, the course recommended was adopted, and at the present writing no further complaint has been received. Having conferred with other Metropolitan Medical Officers of Health, I am in a position to say that there is a consensus of opinion that this plan of storage and removal is the only practicable one for preventing nuisance, and that should it not be adopted, in suitable cases, the County Council should be requested to rescind the proviso to the bye-law, dealing with the time and mode of removal of "offensive matter" through streets. The bye law covers, as "offensive matter," the refuse of cow-houses; but the proviso excepts "horse dung manure" from the operation of the bye-law; although this refuse, when peat moss litter is used, is more offensive than the refuse of cow-houses. Removal ok Stable Refuse: Action of the County Council. —During many years I have advocated, in these reports, the removal of offensive matters, including stable refuse, by the Sanitary Authority, but at the cost of the owner; and in 1892, when a visitation of cholera was apprehended, the Sanitary Committee recommended your Vestry to undertake this important act of scavenging. The Wharves and Plant Committee, however, advised that the expense would be too great, and so nothing was done. The view I had expressed was that many people would be glad to pay the cost of removal, especially of stable refuse, and so be quit of the responsibility devolving upon them under the regulations, which require removal on alternate days. At the same time I thought that the refuse, especially from South Kensington 156 mews, where straw is used for litter, would have a value at least equal to the expense of conveying it to the depot at Purfleet, where it would find a ready sale—as all good manurial refuse should—for use on the land. A repealed section (95) of the Metropolis Local Management Act, 1862, authorised the Sanitary Authority to remove such refuse by agreement with the occupiers of stables, &c., but made no provision for payment. This futile provision was re-enacted in the Public Health (London) Act, 1891, sec. 36 (2), and naturally it remains a dead letter. The County Council have now taken up the matter, and it is reasonable to hope that good will come of their action, which was initiated by a circular letter addressed to the Metropolitan Medical Officers of Health by the Council's Medical Officer, at the instance of the Public Health Committee. In this communication it was stated that the Committee, "from time to time, receive complaints of nuisance arising from accumulations of manure at various premises in London;" and also that under Section 36 of the Public Health (London) Act, 1891, the Sanitary Authority is empowered to employ or contract with scavengers "for collecting and removing the manure and other refuse from any stables and cow-houses within their district, the occupiers of which signify their consent in writing to such removal." The Committee, however, had been advised that the Sanitary Authority have no power to charge for this service, and they were considering the question whether, with a view to facilitating the removal of manure, it is desirable to seek an amendment of the section, so as to give the Sanitary Authority power to charge for the removal of manure, when required by the owner or occupier of any premises to remove it, similar to that which they now have under section 33 in respect of trade refuse. The Medical Officer enquired whether I was in favour of such a proposed amendment of the law? In reply, I stated that in reports, during many years, I had advocated not only that the Sanitary Authority should have power to remove accumulations of manure in London districts, but also that, in 157 the interests of public health, it should be made a statutory duty, and that they should be authorised to charge the owner of the refuse a reasonable sum for the service. As the law stands, the owner or occupier of any premises may "require" the Sanitary Authority to remove any trade refuse, on payment (sec. 33), but the Sanitary Authority need only, "if they think fit," collect and remove "manure and other refuse matter from any stables and cow-houses, the occupiers of which signify their consent in writing to such removal"—a consent which may be withdrawn or revoked with one month's previous notice to the Sanitary Authority (section 36). The owner of such refuse cannot "require" the Sanitary Authority to remove it;* nor is he under any obligation to pay for the removal, although, doubtless, many occupiers of stables would be well-pleased to do so, and so, on the one hand, be quit of a troublesome responsibility, and, on the other hand, be freed from liability to fine for neglect of your Vestry's regulations, which require the occupier to remove the refuse on Monday, Wednesday, and Friday, or on Tuesday, Thursday, and Saturday, in each week. This question has engaged the attention of the Sanitary Committee on more than one occasion, and in a report dated 7th September, 1892, they 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 *It is a question, however, whether the refuse of a cow-house, or an omnibusyard, or a cab-yard, may not be classed as "trade-refuse" which the occupier of the premises may "require" the Sanitary Authority to remove, on payment: certainly fish offal, and the offal from slaughter-houses, comes under the definition of "trade refuse," and it is surprising that fishmongers and butchers do not "require" the Sanitary Authority to remove it, 158 that the time had arrived when the Vestry should, on sanitary grounds, undertake the removal of such manure, &c. The Committee 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." The reference was made, and on the 9th November, 1892, a report by the Wharves and Plant Committee was submitted to the effect— "That the Committee had considered the reference . . . 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 expense of 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." This report was adopted by your Vestry. The Sanitary Committee did not contemplate the removal of the refuse without payment; they relied, rather, on the willingness of the occupiers of stables to enter into an arrangement to pay (as in the case of trade refuse), "a reasonable sum for such removal " (section 33). Complaints on the score of stench-nuisance from stable refuse have been less frequent since the abolition of sunken dung pits and the substitution of the iron cage receptacle; but cause for complaint is not likely to cease until the Sanitary Authority shall have undertaken the removal of the refuse. 159 The subject is not new to your Vestry: it was considered, in 1886, upon a report of the Law and Parliamentary Committee on "Sanitary, Nuisances-removal and other Cognate Acts." The Committee, whilst recognising "the necessity for making proper arrangements for the removal of manure and other refuse matter," 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 of manure and other refuse matter." The circumstances are now different, your Vestry having not only staff and plant, but also a depot at Purfleet, to which refuse could be conveyed, from the river and canal side wharves. Should the County Council, therefore, get the law amended, so as to enable the Sanitary Authority to charge for the removal of manure, upon persons desiring to be relieved of the obligation to remove it periodically, as the regulations require, every facility would be present enabling your Vestry to give effect to the recommendation made by the Sanitary Committee in 1892. The proposal is so reasonable in itself that Parliament would, doubtless, give legislative effect to it, if a Bill were to be brought in; and thus it would be put into the power of the Sanitary Authority to effect, without cost to the general body of ratepayers, an improvement in sanitary administration which has been advocated in these reports during the last fifteen years. 160 THE PUBLIC MORTUARY. During the year 290 bodies were deposited at the Public Mortuary, upon application, as follows :— 1. At the request of the relatives of the deceased 7 2. At the request of undertakers 37 3. At the request of the Coroner(inquest cases) Cases of sudden death 153 Cases of violent death 59 212 4. Brought in by the Police Found dead 18 Accident cases 4 22 5. On account of death due to infectious disease 12 290 In 118 of the above cases post-mortem examinations were made, mainly under the Coroner's warrant. INQUESTS AND CORONER'S COURT. During the past five years no inquest in this parish has been held at a public house; and now all of the inquests are held at the Town Hall, in a room placed at the service of the Coroner by your Vestry, but which is unsuitable for the purpose. A suitable Court is now in course of erection in the new buildings at the rear of the Town Hall. For the use of this Court the County Council will pay an agreed rent, under an arrangement authorised by section 92 of the Public Health (London) Act, 1891. DISINFECTION. The Public Health (London) Act, 1891, imposes additional duties on the Sanitary Authority in the matter of disinfection, the practical effect of the legislation of late years 161 having been to throw upon the rates the cost of disinfecting houses, and cleansing and disinfecting bedding, clothing, &c. The cost of this work has increased since the Act came into operation at the beginning of 1892 : the amount expended in 1897 was $1,041, as compared with £381 in 1891. In the latter year the weight of the articles disinfected was under twenty tons, and their number about 9,400 only, whereas in 1897, 25,497 articles were dealt with, of an aggregate weight of 54 tons, 10 cwt. Eleven-hundred and thirty-six rooms, in 1,006 houses, were disinfected after infectious disease by your Vestry's staff, as compared with 364 in 1891. In the report for 1893 (pp. 215-217), under the heading "Duties of the Sanitary Authority with respect to Disinfection," I explained the state of the law, and described your Vestry's practice in regard to this matter. I need only observe now, that the expenditure on disinfection, including cleansing of clothing, bedding, &c., will necessarily vary from year to year, in proportion to the relative prevalence of infectious disease; but under existing arrangements it is likely to increase as the public become better acquainted with the provisions of the Act. I append a statement of the monthly cost of this work in 1897, amounting, as before stated, to £1,041, irrespective of the wages of the disinfector, as compared with £381 in 1891 £ s. d. January 86 16 2 February 62 13 6 March 66 14 1 April 46 4 7 May 64 17 11 June 67 3 4 July 81 16 6 August 84 15 6 September 125 2 8 .October 129 10 3 November 136 19 6 December 88 2 3 162 The expenditure under this head is too great, and, as I have reported on several occasions, might be reduced by some hundreds of pounds per annum, were the work done without the intervention of a contractor, as recommended by the London County Council and by the Metropolitan Asylums Board. Disinfecting Station.—The question of the "desirability of erecting a disinfecting station, and providing a Shelter for persons displaced from their homes during the progress of disinfecting work," was referred for consideration to the Sanitary Committee, who reported thereon in July, 1896. A sub-committee had been appointed to view stations and shelters. One of the places visited was Islington, where, as the sub-committee reported, "the Vestry have provided a most complete station, comprising two Nottingham disinfectors, and ample laundry accommodation for washing and cleansing articles when necessary. A shelterhouse to accommodate four families has also been provided, and a small house erected for the use of the engineer and his wife, who are in charge of the station. The total cost of this station," it was added, "without charge for land, amounted to about £4,500, made up as follows:— Disinfectors, Laundry, Chimney Shaft. Paving and Drainage, £3,500; Shelter and Caretaker's House £1,000; and the annual expenditure amounts to £350 per annum." The report further stated that the cost of disinfecting and cleansing of infected articles in Kensington in the three years 1893-95, had been £2,988, or on an average about £1,000 a year, (irrespective of the wages of disinfecting officers); a sum which was largely exceeded in 1896,$1,361 having been paid to the contractor in that year. Information which I laid before the Committee went to show that a station and a shelter could be erected for a less amount than had been expended at Islington, and that many hundreds of pounds per annum might be saved on the present cost of disinfection. But "as a result of the 163 Committee's consideration of the matter," they came to the conclusion, but upon what grounds I do not know, that "it is not desirable that the Vestry should provide their own disinfecting station in the Parish, but that the disinfecting and cleansing of clothing, bedding, &c., should continue to be entrusted to the present contractors." The Committee accordingly recommended "that no variation be made in the arrangements at present in force for the execution of this work." Their report was adopted by your Vestry. In January, a letter was received from the County Council enquiring whether your Vestry had been able to adopt their suggestion that they should provide a steam disinfector and dispense with the employment of a contractor? No action was taken in the matter. TEMPORARY SHELTER OR HOUSE ACCOMMODATION. The Public Health (London) Act, 1891 (section 60, subsection 4) imposes on the Sanitary Authority the duty of making provision for housing poor persons turned out of their homes during the time necessary for disinfection after infectious disease. The sub section is to the following effect:— "The Sanitary Authority shall provide, free of charge, temporary shelter or house accommodation, with any necessary attendants, for the members of any family in which any dangerous infectious disease has appeared, and who have been compelled to leave their dwellings for the purpose of enabling such dwellings to be disinfected by the Sanitary Authority." Several of the Sanitary Authorities in the Metropolis have failed, so far, to perform this duty. The need for such provision is sufficiently indicated by the fact that in this parish, in 1897, 195 cases of infectious disease occurred in families in occupationof three rooms only; 372 cases infamilies occupying two rooms, and 98 cases in families herded in single rooms. Of the sufferers in families living in single rooms, 60 had scarlet 164 fever, 26 had diphtheria, and 12 had typhoid fever. It need hardly be said that the need of shelter is imperative in the case of families living in single rooms. This subject was referred to the Sanitary Committee, which requested me to report as to any premises which the Vestry might obtain for the purpose referred to—meaning the hiring of one or more houses. No suitable premises have been found,and in my opinion the only satisfactory plan would be to erect a shelter and provide it with a proper equipment. Such a place could be provided most economically in connection with a public disinfecting station. In the absence of provision for the purpose, the Sanitary Inspectors have been authorised to pay for lodgings for people dispossessed of their home during the process of disinfection. It is, however, not easy to obtain accommodation for the people, many of whom, being respectable, object to go to a common lodging-house, where, indeed, they would be neither welcome, nor, in their infectious condition, desirable guests. The best solution of the existing difficulty would be found in compliance with the provisions of the law—in the interests of public health and humanity alike. CLEANSING OF PERSONS ACT, 1897. An Act thus entituled, passed during the session of 1897, gives power to any local authority to permit any person infested with vermin, to have the use of the apparatus (if any) which the authority possess, for cleansing the person and his clothing, and provides that local authorities may expend any reasonable sum on buildings, appliances, and attendants, that may be required for the carrying out of the Act. Effect was given to the Act by an arrangement entered into with the Guardians, whereby the apparatus, &c., at the able-bodied workhouse, Mary Place, Potteries, was made available on payment of a small fee by your Vestry. Three persons and their clothing have been cleansed under this arrangement. 165 PUBLIC BATHS AND WASHHOUSES. The Baths and Washhouses at the junction of Lancasterroad and Silchester-road, Notting-hill, opened in April, 1888, were well supported during the year: the washers in the twelve months ended 25th March, 1898, were 64,347; an increase of 4,387 over the number in the preceding official year; the bathers, 110,857; an increase of 1,902. But it must be admitted that, for the great majority of parishioners, the site is not sufficiently central for baths, and obviously it is too remote for use tor washing purposes. The same objection would apply, more or less, to any single site in the parish. Much good might be effected by the provision of several buildings, on a modest scale, in convenient localities, to which the poor could resort for the purpose of washing clothing, &c. The statistics contained in the successive annual reports of the Commissioners for the Baths and Washhouses, show a constantly increasing use to be made of the washhouses, and are of a nature to encourage the hope that it may be found practicable to provide, at no distant date, for the wants of the poor in the Central and Southern districts of the Parish. PUBLIC SANITARY CONVENIENCES. There are only 20 public urinals in the parish—a very inadequate provision, which, however, is supplemented by about 170 urinals at public-houses, to which the general public have access—accommodation not of a satisfactory sort, as a rule, but better than none at all, and improved as the result of proceedings taken by your Vestry in 1888 and subsequently. There are three sets of public water-closets, for the male sex only, situated, respectively, at the rear of the Central Public Library; at the west end of Westbourne-grove, Notting-hill, and in the Old Brompton-road, opposite the Bell and Horns Tavern. Sanitary Authorities have now ample power to make provision of this sort, section 88 of the Metropolis Management Act, 1855, enabling them "to provide and maintain urinals, water-closets, and like conveniences for both sexes, 166 in situations where they deem such accommodation to be required." Suitable sites exist; none better, perhaps, or where provision of the kind is more needed, than in Kensington Highstreet, where, opposite the Parish Church, an underground retiring place for both sexes might be constructed without giving rise to nuisance in any sense of the word. Increased powers were conferred by the Public Health (London) Act, 1891, which, to facilitate the construction of underground conveniences, vests the subsoil of roadways in the Sanitary Authority, who, moreover, have power to compensate persons injured by the erection of these conveniences near to their houses, &c. WATER SUPPLY. In former reports I have dealt at length with matters affecting the water supply of the Metropolis generally, and of this parish in particular. There is little to be added to what has been said in those reports. The County Council desire to take over the Companies' properties, but with little prospect of success in arranging terms. A Royal Commission has been appointed to enquire as to the desirability of the acquirement of the properties by some public authority, or, in the alternative, the conferment of additional powers of control of the Companies. The question is of importance, affecting as it does the interests of public health, and the material interests of the people of the Metropolis, and of the surrounding districts within the areas served by the several Companies. Constant supply is now nearly universal; and that the public at large are not seriously dissatisfied with the existing arrangements, may not unreasonably be inferred from the fact that during the year no complaint was received in my department, either with regard to the quality of the water, or as to insufficiency of supply. Personally, I consider that, in quality and condition, the water as supplied by the three local Companies (West Middlesex, Grand Junction, and Chelsea) is satisfactory. I would not say, great as have been the 167 improvements already effected, in regard to filtration and otherwise, that there is no further room for improvement. And it is to be presumed that the Companies, under the guidance of their skilled advisers, will do whatever may be proved to be necessary for removing any remaining cause for complaint. I should particularly welcome one improvement, which has been advocated in these reports for many years, viz., the adoption of Clark's softening process, which would, I believe, have a distinctly beneficial effect upon the quality of the water, whilst removing an objection to it, upon economical grounds, which is always referred to by Professor Sir Edward Frankland, F.R.S., in his annual report on the water supply of the Metropolis, appended to the Annual Summary of the Registrar-General; which, for 1897, had not been published when the present report went to press. To sum up, I see no reason for varying the opinion, expressed in many former reports, that the water supply of the Metropolis, from existing and projected sources, is capable of being made everything that can be desired, so as to satisfy the reasonable requirements of its vast population. Cisterns and Bye-Laws.—Upon a notice of motion, in December, the Sanitary Committee were requested to bring up a report "showing how far the bye-laws with respect to the cleansing of cisterns have been enforced in this parish." This subject was dealt with in the twelth report (December 8th, page 141), wherein it was observed that it was one to which, periodically, during many years, I had endeavoured, in reports, to attract the attention of the inhabitants of this parish. In the annual report for 1895 (page 131), to cite but one instance, when dealing with the question of— Deterioration of Water in Dirty Cisterns, I wrote as follows :— "Filtration, however perfect, avails little, if the water is allowed, as frequently happens, to be fouled after delivery. 168 The attention of householders cannot, therefore, be too frequently drawn to the necessity for the periodical cleansing of cisterns for containing potable water. These receptacles, moreover, should be covered, 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. The Public Health (London) Act, 1891 (sec. 50) conferred power on the sanitary authority to make bye-laws, inter alia, for the cleansing of cisterns, and this has been done. But no adequate steps have been taken to make known the provisions of these (or, indeed, of any other) bye-laws which householders are required to observe." The report continued— "The bye-laws—allowed by the Local Government Board in 1893 are designed 'for securing the cleanliness and freedom from pollution of tanks, cisterns, and other receptacles used for storing water used, or likely to be used, by man, for drinking or domestic purposes, or for manufacturing drink for the use of man.' The first of the bye-laws dealing with this matter (it is numbered 12) requires the owner of any premises who shall provide a cistern, &c., 'to cause the same to be so constructed and placed that it may conveniently be cleansed.' This is no new requirement, a similar provision being contained in the loth regulation made by the Water Companies, in 1872*. Nevertheless, many cisterns have been so constructed and placed since that date, as to be practically inaccessible for inspection and cleansing. "The second bye-law (it is numbered 13) requires an outdoor drinking cistern to be provided with a proper cover, and an in-door cistern, likewise, ' if not placed in a suitable "The regulation reads as follows:—" Every cistern used in connexion with the water supplied by the Company, shall be made and at all times maintained watertight, and be properly covered and placed in such a position that it may be inspected and cleansed." 169 chamber, or otherwise constructed or placed so as to prevent the pollution of the water therein.' This provision is insufficient. Every drinking water cistern should be provided with a proper cover. "The third bye-law (it is numbered 14) requires the occupier of any premises to 'empty and cleanse' a drinking cistern once at least in every six months, and at such other times as may be necessary to keep the same in a cleanly state and free from pollution.' The duty of cleansing devolves upon the owner when the cistern 'is used for supplying water to persons occupying two or more separately occupied premises.' In 'the case of any premises the whole of which is let to lodgers, the person receiving the rent payable by the lodger' is, 'for the purpose of this bye-law, deemed to be the occupier.' In the case of a 'registered' house, the occupier, if he lets lodgings to two or more lodgers, or the 'keeper,' if the whole of the house be let in tenements, is responsible for the cleansing of the cistern ('from time to time as often as may be requisite for the purpose of keeping the same in a clean and wholesome condition') under the 14th of your Vestry's byelaws (made in 1885) for the regulation of registered houses. "In my opinion, it is desirable that cisterns used for the storage of drinking water should be 'emptied and cleansed' once in every month. But I attach more importance to the supply of water, for potable and dietetic purposes, without the intervention of cisterns, viz., by means of a tap affixed to the rising main, or service-pipe—a practice which is becoming more usual, but is not at all generally adopted, and which has been advocated in these reports for many years. Should your Vestry decide to call the attention of parishioners to the provisions of the bye-laws relating to the covering and cleansing of cisterns, I would recommend that special attention be drawn to this preferable mode of obtaining drinking water, seeing that the water, as delivered from the main, is in better 170 condition, for potable and dietetic uses, than after detention, for however brief a time, in a storage receptacle—even when, as rarely happens, the receptacle or cistern is emptied and cleansed (not once in six months but) once in every month." The Sanitary Committee, in their report on the reference, stated that, whenever a house is inspected by an inspector, "the cistern always receives attention, and if it is found to be uncovered or dirty, notices are served for the necessary works to be carried out in compliance with the requirements of the bye-laws above adverted to." The Committee, recognising the probability that" very few householders are aware of the responsibility that attaches to them under the bye-laws framed under section 50 of the Public Health (London) Act, 1891, as regards the cleansing of cisterns," considered that it "would be of advantage if steps were taken to acquaint them with the duty which is imposed upon them," and they accordingly recommended — "(a) That the attention of Householders be called (i) to their duty to empty and cleanse drinking water cisterns once at least in every six months, and at other times when necessary to keep the same in a cleanly state and free from pollution; and (ii) to the desirability of their seeing that the cisterns are properly covered. ''(b) That it be also pointed out that, although the Vestry have no statutory power to require that drinking water shall be drawn from the rising main or servicepipe, they strongly advise the adoption of this course, as the water, as delivered from the main, is in better condition for dietetic purposes than after its detention in a storage receptacle. The report was adopted, and the notice was issued accordingly. 171 Cutting-off powers ok the companies.—The Public Health (London) Act, 1891, sec. 49, gives effect to the recommendation made in these reports, many years ago, that a Metropolitan Water Company should be required to give information to the Sanitary Authority, when, from any cause, they had exercised their statutory right to cut-off the water supply of an occupied dwelling-house. Every company is now required to give such notice within twenty-four hours after exercising the said right, under liability to a fine, not exceeding ten pounds, for default. The power to cut-off the supply is, no doubt, of some value to the Companies, when the rate is in arrear, seeing that "an occupied house without a proper and sufficient supply of water," is by law, " deemed unfit for human habitation " (sec. 48). In all such cases, reported by the several Companies, the Sanitary Authority are obliged to take steps to ensure restoration of the supply—which is necessarily preceded by the payment of the Company's claim. The cutting-off powers were materially limited in 1887, by the Water Companies (Regulation of Powers) Act (familiarly known as "Forrest Fulton's Act"), which is described as "an Act to limit the powers of the Water Companies to cut off the tenant's water supply when the rate is paid by the landlord," as is very generally the case in regard to tenement houses and houses otherwise occupied in lodgings,&c., by the poorer classes. The beneficent result of this legislation, the need for which was shown in these reports many years ago, is that the water supply of the poor is generally secured, and that, with the safeguard provided, without material (if any) risk of loss to the Companies. Surely it is time that the power to cut-off the supply from an occupied house should cease altogether ; and that, as I suggested in 1882, " the Company should be left to their remedy for the recovery of the rate as a debt, like other traders," and not be allowed to create a dangerous nuisance merely as a coercive measure for securing the payment of the rate. One enlightened Company, the East London, resolved 172 some years ago to abandon the barbarous practice of cuttingoff, and, I understand, have had no cause to regret the decision. They sue the defaulter, and the result is stated to be, on the whole, " highly satisfactory." The New River Company also, I believe, summons largely in preference to cuttingoff, and other Companies probably, more or less generally, do likewise. Defaulters are summonsed in the Police Court; but the Magistrates have no jurisdiction unless the Company proceed within six months of the debt becoming due; and the debt, i.e., the rate, is due in advance. Inasmuch, therefore, as the Companies only collect half-yearly, they must proceed before the expiration of the six months, and hence have to sue before the second quarter has expired, which to some appears to be a hardship. If greater facilities, including more time, were given to the Companies, for recovering the rate in the Police Court, probably they would be willing to waive the right to cut off the supply, or consent to its abolition. I do not suppose that a question of this sort comes within the limits of the enquiry now being made by the Royal Commission on Water-supply. It might, however, well be brought to their attention. From the public health point of view, it is one of great importance. conclusion.—In bringing this my twenty-eighth annual report to a conclusion, I desire to acknowledge the valuable assistance received from Mr. E. R. Hill, first assistant-clerk in the Public Health Department, particularly in the collation of statistics. I desire also to bear testimony to the good work of the staff generally, and not least to that of the Sanitary Inspectors, which has been carried out as efficiently as was possible, having regard to the limited number of those officers, and to the vastness and variety of the duties devolved on your Vestry by the authority of Parliament. I am, Gentlemen, Your obedient servant, T. ORME DUDFIELD, Medical Officer of Health. Public Health Department, Town Hall, Kensington, W. April, 1898. APPENDIX Note—The Forms for Tables I. to VI. inclusive, were arranged by the Society of Medical Officers of Health, with the object of securing uniformity in Statistical Returns. [Table I. 174 TABLE I. Showing Population, Inhabited Houses, Marriages, Births, and Deaths, in 1897, and in the preceding ten 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.§ 1897 170,700 22,669 1,681 3,683 2,667 609 912 839 1896 170,000 22,576 ** 1,706 ** 3,717 ** 2,891 656 1,111 817 1895 169,300 22,483 1,455 3,621 2,748 624 951 762 1894 168,600 22,390 1,537 3,665 2,623 636 1,022 749 1893 167,900 22,297 1,540 3,661 2,916 625 965 740 1892 167,200 22,204 1,584 3,718 2,882 587 972 687 1891 166,500 22,084 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 165,140 21,566 1,561 3,941 2,872 680 1,129 608 Average, 10 years 1887-96. 167,193 - 1,545 3,750 2,819 619 1,008 691 Notes.—Census Population in 1861, 70,108; 1871, 120,299; 1881, 163,151; 1891, 166,308; 1896, 170,465. Average Number of Persons to each house at Census : in 1861, 7'4 ; in 1871, 7-6 ; in 1881, 8.1 ; in 1891, 7-53. Area of Parish, 2,190 acres. Number of persons to an acre (1897), 77 '9. "For statistical purposes the population is estimated to the middle of the year, on the l>asis of the rate of increase in the preceding inter-censal period, checked by the number of inhabited houses, and by the average number of persons per house, as ascertained at the last Census. † The data are somewhat unreliable. The Census number, which includes houses . occupied only by caretakers, is given for 1891. The number in the years 1892.97, has been calculated upon the assumption of an average number of 7.53 persons to each house as ascertained at the census in 1891. ‡ Inclusive of the deaths of parishioners at public institutions without the Parish, but exclusive of the deaths of non-parishioners at public institutions within the Parish. § Viz.: At the Parish Infirmary, &c., and outlying public institutions, including the Asylums Board Hospitals, ** In 53 weeks. 175 TABLE II. Showing the Annual Birth-rate and Death-rate; Death-rates of Children; and Proportion of Deaths in Public Institutions to 1,000 Deaths, for the year 1897, 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.* 1897. 21.6 15.6 165 229 342 315 1896 21.4 16.7 176 227 384 283 1895 21.4 16.2 172 227 346 277 1894 21.7 15.6 174 242 389 285 1893 21.8 17.4 170 214 331 254 1892 22.2 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 Average of 10 years, 1887-1896. 22.4 16.8 165 220 357 245 *Includes Deaths of Parishioners at outlying Public Institutions, but excludes Deaths of Non-Parishioners at Brompton Consumption Hospital, St. Marylebone Infirmary, Notting-hill, &c. 176 177 TABLE III. Deaths registered from all causes in the year 1897. (Exclusive of the Deaths of Non-Parishioners a, 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 page 55. causes of death. AGES. Total under Five Years of Age. Grand Total All Ages. sub-district 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. 11 14 11 13 8 254 405 346 59 145 109 43 17 20 14 I. SPECIFIC FEBRILE or ZYMOTIC DISEASES ... 2 2 2 ... ... ... ... ... 1 1 ... ... ... ... ... 15 9 6 II. PARASITIC DISEASES 2 7 3 3 ... ... ... ... ... ... ... 554 445 109 58 94 87 90 60 16 3 85 III. DIETETIC DISEASES 39 46 20 41 187 152 35 19 56 30 82 IV. CONSTITUTIONAL DISEASES 82 ... ... ... ... ... ... ... 1299 1045 254 120 136 174 210 128 28 360 V. DEVELOPMENTAL DISEASES 39 41 63 226 134 9 2 27 96 71 25 16 10 9 7 VI. LOCAL DISEASES 5 7 8 4 19 VII. DEATHS FROM VIOLENCE ... ... 102 109 99 10 VIII. DEATHS FROM ILL-DEFINED AND NOT SPECIFIED CAUSES 97 5 ... ... ... 1 3 2 1 250 292 308 222 71 912 2667 2169 498 609 303 106 104 150 252 I. SPECIFIC FEBRILE or ZYMOTIC DISEASES. Order 1.—Miasmatic Diseases. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 33 33 31 2 Smallpox 19 ... ... ... ... ... ... ... ... ... 14 19 29 28 1 Measles 19 8 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... 19 19 15 4 Typhus ... ... ... ... ... 8 11 ... ... 47 82 70 12 ... ... ... Whooping-cough 38 28 3 3 1 ... ... 1 9 ... ... ... 1 ... Diphtheria 1 ... ... ... ... ... ... ... ... ... ... 21 15 6 Simple Continued or Ill-defined Fever 8 6 1 2 1 ... ... ... 3 5 5 45 34 11 Enteric or Typhoid Fever ... 3 1 6 6 7 7 4 2 3 1 Other Miasmatic Diseases— Influenza 2.—Diarrhœal Diseases. 5 6 6 ... Simple Cholera 4 1 ... ... ... ... ... ... ... 1 ... Diarrhœa, Dysentery 90 18 1 1 ... 1 ... 2 3 7 2 108 125 114 11 3.—Malarial Diseases. ... Remittent Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ague ... ... ... ... 1 ... ... ... ... ... ... ... 1 1 4.—Zoogenous Diseases. ... Cow-Pox, and effects of Vaccination ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases (e.g., Hydrophobia, Glanders, Splenic Fever) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5.—Venereal Diseases. Syphilis 18 ... ... ... 2 ... 1 ... ... ... ... 18 21 17 4 Gonorrhœa, Stricture of the Urelhra ... ... ... ... ... ... ... ... ... 1 ... ... 1 1 ... 6.—Septic Diseases. Erysipelas ... ... ... ... 1 2 2 2 1 ... 1 ... 9 7 2 Pyæmia, Septicæmia ... ... 1 ... 2 2 ... 2 ... ... ... ... 7 3 4 Puerperal Fever ... ... ... ... 4 1 ... ... ... ... ... ... 5 3 2 145 109 43 17 20 14 11 14 11 13 8 254 405 346 59 II.—PARASITIC DISEASES. Thrush, and other Vegetable Parasitic Diseases 1 1 ... ... ... ... ... ... ... ... ... 2 2 2 ... Worms, Hydatids, and other Animal Parasitic Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... 2 2 2 ... III.—DIETETIC DISEASES. Want of Breast Milk—Starvation ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scurvy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chronic Alcoholism ... ... ... ... 1 4 3 3 ... ... ... ... 11 6 5 Delirium Tremens ... ... ... ... 1 3 ... ... ... ... ... ... 4 3 1 ... ... ... ... 2 7 3 3 ... ... ... ... 15 9 6 IV.— CONSTITUTIONAL DISEASES. Rheumatic Fever, Rheumatism of the Heart 1 1 1 3 ... 2 1 1 ... ... ... 2 10 7 3 Rheumatism ... ... ... ... ... ... ... 2 ... ... ... ... 2 1 1 Gout ... ... ... ... ... ... 1 2 2 ... ... ... 5 3 2 Rickets 2 4 ... ... ... ... ... ... ... ... ... 6 6 5 1 Cancer, Malignant Disease ... 2 ... ... 3 23 31 48 48 11 2 2 168 121 47 Tabes Mesenterica 9 3 ... ... ... ... ... ... ... ... ... 12 12 10 2 Tubercular Meningitis, Hydrocephalus 13 15 6 ... ... 1 ... ... ... ... ... 28 35 33 2 Phthisis 1 2 3 34 53 63 47 29 5 3 ... 3 240 202 38 Other forms of Tuberculosis, Scrofula 13 19 9 3 2 2 3 1 1 ... ... 32 53 48 5 Purpura, Hæmorrhagic Diathesis ... ... 1 ... ... 1 ... ... ... ... ... ... 2 2 ... Anæmia, Chlorosis, Leucocythæmia ... ... ... 1 ... 1 ... 2 ... ... ... ... 4 3 1 Glycosuria, Diabetes Mellitus ... ... ... ... ... 1 4 5 4 2 1 ... 17 10 7 Other Constitutional Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 39 46 20 41 58 94 87 90 60 16 3 85 554 445 109 178 179 table iii .—(continued). causes of death. AGES. Total under Five Years of Age. Grand Total All Ages. su b- district 0 to 1. 1 to 5. 5 to 15. 15 to 25. 25 to 35. 1 35 to 45. 45 to 55. 55 to 65. 65 to 75. 75 to 85. 85 and upwards. ' Kensington Town. Brompton. V.- DEVELOPMENTAL DISEASE. Premature Birth 66 ... ... ... ... ... ... ... ... ... ... 66 66 50 16 Atelectasis 5 ... ... ... ... ... ... ... ... ... ... 5 5 5 Congenital Malformation 11 ... ... ... ... ... ... ... ... ... ... 11 11 10 1 Old age ... ... ... ... ... ... ... ... 19 56 30 ... 105 87 18 82 ... ... ... ... ... ... ... 19 56 30 82 187 152 35 VI.— LOCAL DISEASES. 1.- Diseases of nervous system Inflaimnation of Brain or Membranes 11 13 7 ... 1 1 ... ... 1 ... ... 24 34 28 6 40 Apoplexy, Softening of the Brain, Hemiplegia, Brain Paralysis ... 1 ... ... 3 11 19 32 38 25 7 1 136 96 5 Insanity, General Paralysis of the Insane ... ... ... 1 2 6 4 ... 1 1 ... ... 15 10 2 Epilepsy ... ... 1 2 ... ... ... ... ... ... ... ... 5 3 ... Convulsions 31 4 ... ... ... ... ... ... ... ... ... 35 35 35 1 I aryngisnms Stridulus (Spasm of Glottis) 4 2 ... ... ... ... ... 1 3 ... ... 6 6 5 1 Diseases of Spinal Cord, Paraplegia, Paralysis Agitans ... ... ... ... 1 2 3 7 2 ... ... 7 6 5 Other Diseases of Nervous System 1 1 ... ... 3 27 22 ... 2.-—Diseases oF Organs oi Special Sense. (e.?., of Eye, Kar, Nose.) 1 3 2 2 2 ... ... 4 10 8 2 s.—diskasks of circulatory system. Pericarditis 1 1 i 2 1 J 6 z 4 2 Acute Endocarditis 2 i Q Q 12 3 44 33 11 Valvular Diseases of Heart 2 3 3 ;> O o 1 4 9 I Other Diseases of Heart 3 5 5 20 19 i 37 31 21 I 1 Z 5 IvO 3 Oi 2 Aneurism 4 j 2 3 9 7 4 3 Embolism, Thrombosis A 2 2 Other Diseases of Blood Vessels •• 1 1 1 •4 4.—Diseases of Respiratory Organs. Laryngitis 2 4 r 1 i 1 ,.. 9 5 7 5 2 Croup o 4 1 1 3 9 7 2 Emphysema, Asthma •" ... i n oo 9 ft 54 31 10 126 293 259 34 Bronchitis li 52 3 y LvJ Lit 1 R So 1 K $ 41 130 120 10 Pneumonia 24 17 5 5 13 19 10 10 0 q o ■i I 1 13 10 3 Pleurisy 1 1 2 2 4 2 1 O 5 1 I 11 32 23 9 Other Diseases of Respiratory System 10 1 1 5.—Diseases ok Digestive System. Dentition 10 8 18 18 16 o Sore Throat, Quinsy Si Diseases of Stomach 5 4 1 3 4 3 5 1 9 26 99 A Enteritis 44 13 1 1 2 1 3 2 2 1 57 70 so 4 1 Q Obstructive Diseases of Intestine 2 1 3 2 1 4 3 4 4 2 2 / u 26 <)£. 91 lo e Peritonitis 1 2 3 3 3 1 1 3 1 4 _ i i 1 0 q Ascites I 11 6 Cirrhosis of Liver 1 7 9 5 7 2 1 i ^9 1 OA ;• Jaundice, and other Diseases of the Liver 3 2 1 2 4 7 1 3 20 13 12 Other Diseases of Digestive System 1 i 1 1 1 2 1 2 3 o 6.—Diseases of Lymphatic System. (e.g., of Lymphatics and of Spleen.) 1 1 2 1 4 4 & 7.—Diseases of Gland-i.ike Organs of Uncertain Use. {e.g., Kronchocele, Addison's Disease.) 1 1 2 2 8.—Diseases of Urinary System. Nephritis 1 1 2 1 4 y 1 2 3 1 20 1 ft liright's Disease, Albuminuria 7 5 8 4 3 27 io 17 4 10 1 )isease of Bladder or of Prostate 2 5 7 1 15 12 3 Other Diseases of the Urinary System ] 2 1 3 2 a o 9.—Diseases of Reproductive System. a. Of Organs of Generation. Male Urgans ••• 1 1 1 Female Organs 1 9 9 9. 7 "1 b. Of Parturition. Abortion, Miscarriage 1 1 2 2 Puerperal Convulsions Placenta Prsevia, Elooding 1 1 1 ... Other Accidents of Childbirth 3 2 1 ft ft •• 10.—Diseases of Bones and Ioints. Caries, Necrosis 3 1 A A Arthritis, Ostistis, Periostitis 1 ** 1 1 1 Other Diseases of Bones and Joints 1 2 1 3 1 3 11.—Diseases of Integumentary System. Carbuncle, Phlegmon 1 1 1 Other Diseases of Integumentary System 1 1 - 3 ... 1 5 5 226 134 39 41 63 120 136 174 210 128 28 360 1299 1045 254 180 TABLE III.—(continued.) causes of death. AGES. Total under Five Years of Age. Grand Tola All Ages. sub-district 0 to 1. 1 to 5. 5 to 15. 15 to 25. 25 to 35. I 35 to 45. ! 45 to 55. i 55 to 65. 65 to 75. 1 75 to 85. 85 and upwards. Kensington Tow n. Brompton. VII— DEATHS FROM VIOLENCE. 1.—Accident or Negligence. Fractures and Contusions ... 1 1 1 3 5 5 6 6 7 1 1 36 29 7 Gun-shot Wounds ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cut, Stab ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Burn, Scald ... 6 1 ... ... ... 2 ... ... ... ... 6 10 9 1 Poison ... ... ... ... 1 ... 1 ... ... ... ... ... 3 1 2 Drowning ... ... 2 ... ... ... ... ... ... ... ... ... 2 2 ... Suffocation 18 1 ... ... ... 1 ... ... ... ... ... 19 20 18 ... Otherwise 1 ... ... ... ... ... ... ... ... ... ... 1 1 ... ... 2.—Homicide. Manslaughter ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Murder ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3.—Suicide. Gun-Shot Wounds ... ... ... ... ... 1 1 ... ... ... ... ... 2 1 1 Cut, Stab ... ... ... 1 1 3 ... 2 ... ... ... ... 7 2 5 Poison ... ... ... 1 ... 1 ... ... ... ... ... ... 3 2 1 Drowning ... ... ... 1 ... 1 ... 1 ... ... ... ... ... ... ... Suffocation ... ... ... ... 1 1 1 ... ... ... ... ... ... ... 4 Otherwise ... ... ... ... 1 3 ... ... ... 2 ... ... 6 ... 4.—Execution. Hanging ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 19 8 4 5 7 16 10 9 7 9 2 27 96 71 25 VIII.-DEATHS FROM ILL-DEFINED AND NOT SPECIFIED CAUSES. Dropsy ... ... ... ... ... ... ... 1 ... ... ... ... 1 1 ... Debility, Atrophy, Inanition 94 5 ... ... ... ... ... ... ... ... ... 99 99 91 8 Mortification ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... 1 Tumour ... ... ... ... ... 1 1 ... ... ... ... ... 2 2 ... Abscess ... ... ... ... ... ... 1 ... 1 ... ... ... 2 2 ... Hemorrhage ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Sudden Death (Cause not ascertained) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Causes not specified or ill-defined 3 ... ... ... ... ... ... ... ... ... ... 3 4 3 1 97 5 ... ... ... 1 3 2 1 ... ... 102 109 99 10 181 TABLE IV. Showing the number of Deaths at all ages in 1697, from certain groups of Diseases, and proportions to 1000 of Population, and to 1000 Deaths from all causes: also the number of Deaths of Infants, under one year of age, from other groups of Diseases, and proportions to 1000 Births, and to 1000 Deaths from all causes under one year. Division I. (Adults). Total Deaths. Deaths per 1000 of Population at all ages. Deaths per 1000 of Total Deaths at all ages. 1. Principal Zymotic Diseases 310 1.8 116 2. Pulmonary Diseases 191 2.9 184 3. Principal Tubercular Diseases 311 1.8 117 Division II. (Infants under one year). Total Deaths. Deaths, per 1000 of Births. Deaths, per iooo of Total Deaths under one year. 4. Wasting Diseases 160 43.4 263 5. Convulsive Diseases 54 14.7 89 NOTES. 1. Includes Small-pox, Measles, Scarlet Fever, Diphtheria, Whooping-cough, Typhus Fever, Enteric (or Typhoid) Fever, Simple Continued Fever, and Diarrhoea. Ninety-two of the deaths occurred in Hospitals without 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). 182 TABLE V. Showing the Number of Deaths from the Principal Diseases of the Zymotic Class in the ten years 1887-96, and in the year 1897. Diseases. 1887. 1888. 1889.' 1890. 1891. 1892. 1893. 1894. 1895. 1896. Annual Average of ten years! 1887-96. Proportion of Deaths to 1000 Deaths from all causes in ten years 1887-96. Deaths in 1897. Proportion of Deaths to 1000 Deaths from all causes in 1897. Small-pox 1 0 0 0 0 0 9 0 0 0 1.0 0.3 ... Measles 108 124 14 140 29 109 18 108 33 173 85.6 30.4 33 12.4 Scarlet Fever 44 26 28 26 16 36 51 22 27 39 31.5 11.1 29 10.9 40 89 111 35 28 31 83 75 89 72 65.3 23.2 82 30.7 Whooping-cough 86 100 26 93 84 63 65 61 39 99 71.6 25.4 19 7.1 Enteric Fever 11 • 21 19 15 24 15 17 21 15 15 17.3 6.1 21 7.9 Simp. Continued Fever 2 2 0 0 1 2 0 3 1 1 1.2 0.4 1 0.3 Diarrhoea 124 58 71 78 91 77 98 56 118 61 83.2 29.6 125 46.9 TOTALS. Kensington. 416 420 269 387 273 333 341 346 322 460 356.7 126.5 310 116.2 London. 12684 10803 9709 12279 9675 11983 13223 11544 11544 i 14100 11754 139.1 11525 142.4 England & Wales 64676 50684 61027 59698 53221 56032 73499 52771 64901 66936 60344 111.1 67051 123.8 183 TABLE VI Summary of the Work of the Sanitary Inspectors during the year 1897. Sanitary Districts.* No. of Complaints made by Inhabitants. &c. i No. of Mouses. Premises, &c.. inspected. No. of Re-inspections of Houses, Premises, &c. Results of Inspection. House Drains. Water Closets. Dust Receptacles. Water Supply. Miscellaneous. Written Intimations of Nuisances served. Notices served by order of the Works and Sanitary Committee. Final Notices signed by Medical Officer served. , Houses, Premises, &c., Cleansed, Repaired, Whitewashed, &c. Houses disinfected after illness of an Infectious character.t Repaired, Cleansed, &c. Ventilated, Trapped, &c. Repaired, &c. Supplied with Water. Soil-pipes Ventilated. New provided. Repaired, Covered, &.c. Cisterns erected. Cisterns Cleansed, Repaired, Covered, &c. Waste-pipes connected with "drain*, &c., abolished. No. of Lodging Houses newly Registered under 94th Section of the Public Health (London) Act, 1891.3: Yards and Areas paved and drained. Animals removed, being improperly kept. Regularly Inspected. Legal proceedings, i.e., Summonses. Bakehouses. Licensed Cowsheds. Licensed Slaughter-Houses. North 258 700 2593 390 275 42 90 264 58 61 188 11 7! 36 9 4 14 ... 38 1 21 ... 1 7 N.E. 216 869 2851 345 214 '4 95 160 155 97 19 175 79 24 54 2 35 18 ... 54 ... 27 1 3 ... N.W. 174 1105 2948 331 479 126 309 194 81 41 247 29 15 43 80 6 52 2 ... 166 ... 13 2 2 17 Central 180 894 2153 323 216 27 139 121 166 79 56 47 92 11 38 12 82 9 ... 208 ... 26 1 6 5 S.E. 136 1321 2208 214 51 4 55 91 47 23 105 68 47 8 12 16 17 ... ... 45 ... 28 ... ... ... S.W. 168 1076 3092 361 223 29 193 176 74 39 288 131 68 40 32 25 109 ... ... 163 4 23 ... 1 6 1132 5968 15845 1964 1458 232 881 1006 581 340 898 461 372 162 225 65 309 29 ... 674 5 138 4 13 35 * For a description of the Sanitary Districts, see page 2. † Done under the supervision of a Special Officer. ‡ The total number of houses on the Register in December, 1897, in round figures, was 1,500. (Vide page 120). 184 TABLE VII. Showing 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 1897, and in the preceding ten years, 1887-96. 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. 1887 17.4 20.3 416 2.5 3.1 144 154 1887 1888 17.1 19.3 420 2.6 2.6 148 137 1888 1889 14.6 18.4 269 1.6 2.3 111 128 1889 1890 17.8 21.4 387 2.3 2.9 131 134 1890 1891 18.4 21.5 273 1.6 2.3 89 107 1891 1892 17.2 20.7 333 2.0 2.8 115 . 136 1892 1893 17.4 21.3 341 2.0 3.1 117 1 1893 1894 15.6 17.8 346 2.1 2.7 132 150 1894 1895 16.2 19.9 322 1.9 2.6 117 133 1895 1896 16.7 18.6 460 2.7 3.1 159 169 1896 AVERAGE OF TEN YEARS 1887-96. 16.8 19.9 357 2.1 2.8 126 138 AVERAGE OF TEN YEARS 1887-96. 1897. 15.6 18.2 310 1.8 2.6 116 142 1897 185 TABLE VIII. Comparative Analysis of the Mortality in all London, and in Kensington, in 1897. Annual Death-rate per 1000 living, from all causes. Annual Death-rate per 1000 living, from seven principal Zymotic diseases. Percentage of Deaths under 1 year to Births Registered PERCENTAGE 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 18.2 2.6 15.9 26.3 23.6 14.2 4.3 9.4 29.3 0.6 Kensington 15.6 1.8 16.5 22.9 27.6 1.1.6 3.6 8.4 31.5 0.1 *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. 186 187 TABLE IX. Showing the Localities in which Fatal Cases of the Principal Diseases of the Zymotic Class occurred in 1897. KENSINGTON TOWN REGISTRATION SUB-DISTRICT. Locality. Small-pox. Measles. Scarlet Fever. Diphtheria. W hooping Cough. Enteric Fever. Diarrhoea. Total. Locality. Small-pox. Measles. Scarlet Fever. Diphtheria. WhoopingCough. Enteric Fever. Diarrhœa,. Total. Abingdon Mansions ... ... ... 1 ... ... ... 1 Jameson Street ... ... ... 1 ... ... 1 2 Abingdon Road ... 1 ... 1 ... ... ... 1 Jolliffe's Yard ... 1 ... ... ... ... ... 1 Absalom Road ... ... 1 1 ... ... ... 2 Kenley Street ... ... 1 ... 1 ... ... 2 Acklam Road ... ... ... 1 ... 1 1 6 Kensal Road ... ... ... 1 ... ... ... 1 Adair Road .. ... ... ... ... ... ... 3 3 Kensington Barracks ... ... 1 ... ... ... ... 1 Adam and Eve Mews ... ... ... 1 ... ... ... 1 Kensington Infirmary ... 21 ... 1 2 1 7 32 Aldermaston Street ... 1 ... ... ... ... ... 1 Ladbroke Grove ... ... ... 1 ... ... ... 1 Appleford Road ... 1 ... 1 ... ... 3 5 Lancaster Road ... ... 1 1 ... 1 2 5 Bangor Street.. ... 1 ... 1 ... ... 1 3 Latimer Mews ... ... ... 2 ... ... ... 2 Bevington Rpad ... ... ... ... ... ... 2 2 Manchester Road ... ... ... 1 ... ... ... 1 Blechynden Street ... ... ... 2 ... ... 2 4 Marloes Road ... ... ... ] ... ... ... 1 Blenheim Crescent ... ... 1 ... ... ... ... 1 Martin Street... ... ... ... ... ... ... 2 2 Bosworth Road ... ... ... ... ... ... 3 8 Mersey Street... ... ... ... ... ... ... 2 2 Bramley Road ... 1 ... 1 ... ... 1 3 Peel Street ... ... 2 ... 1 ... 1 4 Buckingham Terrace ... ... ... ... ... ... ... 2 Phillimore Mews ... ... ... 2 ... ... ... 2 Campden House Mews ... ... ... 1 ... ... ... 1 Portland Road ... ... ... 1 ... ... 2 3 Campden Houses ... ... 1 ... ... ... 1 2 Portobello Road ... ... 2 3 1 1 4 11 Campden Street ... ... ... 1 ... ... ... 1 Powis Square... ... ... ... 1 ... ... ... 1 Chesterton Road ... ... ... ... ... ... 2 2 Prince's Road ... ... ... ... ... ... 2 2 Church Walk ... ... ... 1 ... ... ... 1 Rackham Street ... ... ... ... ... ... 2 2 Clarendon Road ... ... ... 1 ... ... 1 2 Raddington Road ... ... ... ... ... 1 ... 1 Colville Gardens ... ...... ... 1 ... ... ... 1 Railway Mews ... ... 1 ... ... ... ... 1 Convent Gardens ... ... 1 ... ... ... ... 1 St. Ervan's Road ... ... ... 1 ... ... ... 1 Cornwall Road ... 1 1 ... 1 1 1 5 St. George's Road ... ... 1 ... ... ... ... 4 Crescent Street ... ... 1 ... ... ... ... 2 St. James's Place ... ... 1 ... ... ... 2 1 Dartmoor Street ... 1 ... ... ... ... ... 1 St. Luke's Mews ... ... ... 1 ... ... ... 13 Denbigh Terrace ... ... 1 ... ... ... ... 1 St. Katharine's Road ... ... 2 1 1 ... 7 2 Earl's Court Road ... ... ... ... ... ... ... 1 St. Quintin Avenue ... ... ... ... ... ... 2 2 Edenham Street ... ... ... 2 ... ... 3 5 Silchester Road ... ... 1 ... ... ... 1 2 Elgin Crescent ... ... ... ... ... 1 ... 1 Silchester Street ... ... ... 1 ... ... ... 11 Ernest Street ... ... ... ... 1 ..... ... 1 Silchester Terrace ... ... 1 ... ... ... 1 11 Faraday Road ... ... ... ... ... 1 1 4 Southam Street ... ... 1 ... ... ... 4 1 Golborne Gardens .. ... ... ... ... ... ... 2 4 Swinbiook Road ... ... ... 1 ... ... ... 3 Golborne Road ... ... ... ... ... ... 2 2 Tavistock Crescent ... ... ... ... 1 ... ... 2 1 Hazlewood Crescent... ... ... ... ... ... ... 3 5 Thomas Place ... ... ... 1 ... ... ... 3 Hewer Street ... ... ... 1 ... ... ... ... 1 Treverton Street ... ... ... 1 1 ... 2 2 High Street, Notting Hill ... ... ... 3 ... ... ... ... 3 Uxbridge Street ... ... ... ... 1 ... ... 1 Holland Place ... ... ... ... ... 1 ... 1 Victoria Road ... ... ... ... ... ... ... 7 Holland Street ... ... ... ... ... 1 ... 1 Walmer Road ... ... 2 ... ... ... 2 2 Hurst way Street ... 1 ... ... ... ... 1 2 Wheatstone Road ... ... ... 4 ... 1 2 7 James Street ... ... ... ... ... 1 ... 1 Wornington Road ... ... ... 3 ... 1 3 7 BROMPTON SUB-DISTRICT Barkston Gardens ... ... ... 1 ... 1 Logan Mews ... 1 ... ... ... ... ... 1 Bolton Gardens Mews ... 1 ... ... ... 1 Onslow Gardens ... ... ... ... ... 2 ... 2 Bute Street ... 1 ... ... ... 1 Pennant Mews ... ... ... ... ... ... ... 1 Child's Place ... ... ... 1 ... 1 2 Providence Terrace ... ... 1 ... ... ... ... 1 Cranley Gardens ... ... ... 1 ... 1 Queen's Gate ... ... ... ... ... ... ... 1 Crescent Place ... 1 ... ... ... 1 Redcliffe Road ... ... ... ... ... 1 ... 1 Cromwell Road ... ... ... ... 1 1 2 Redfield Lane ... ... ... 1 ... ... ... 1 Ifield Road ... 6 1 ... ... 7 188 TABLE IXa. Showing Streets, etc., in the Registration sub-districts, and in the Sanitary Inspecting districts, from which the 1,457 cases of Infectious Disease were notified, under the provisions of the Public Health (London) Act, 1891, during the year 1897. The Registration SubDistricts are Kensington Town (K T), and Brompton (B). For list of Sanitary Districts see page 2. Street or Place. Registratinn Sub-District. Sanitary District. Scarlet Fever. Diphtheria. Enteric Fever. Continued Fever. Puerperal Fever. Erysipelas. Croup. Total. Abbey Road KT N W 3 ... ... ... ... ... ... 3 Abingdon Mansions ,, s w ... 1 ... ... ... ... ... 1 Abingdon Road ,, ,, 1 ... ... ... ... 1 ... 2 Abingdon Villas ,, ,, 1 1 ... ... ... 1 ... 3 Absalom Road ,, N ... 5 ... ... ... 1 ... 6 Acklam Road ,, ,, 8 5 1 ... ... 2 ... 17 Adair Road ,, ,, 2 4 ... ... ... ... ... 6 Adam and Eve Mews ,, S W 1 1 ... ... ... ... ... 2 Adams' Cottages ,, N W 2 ... ... ... ... ... ... 2 Addison Road North ,, C ... ... ... ... ... ... ... 1 Admiral Mews ,, N ... 1 ... ... ... ... ... 1 Admiral Place ,, ,, ... ... ... ... ... 1 ... 1 Adrian Terrace B S W 3 2 ... ... ... ... ... 5 Alexandei Square ,, S E 2 ... 1 ... ... ... ... 3 All Saints' Road K T N E 12 1 ... ... ... 1 ... 14 Alveston Mews B S E 1 ... ... ... ... ... ... 1 Angola Mews KT N ... ... ... ... ... l ... 1 Appleford Road ,, ,, 2 5 ... ... ... 3 ... 11 Archer Mews ,, N E 1 ... ... ... ... ... ... 1 Archer Street ,, ,, 1 ... ... ... ... ... ... 1 Ashburn Place B S E 2 ... ... ... ... ... ... 2 Ashley Cottages ,, S W 2 1 ... ... ... 2 ... 5 Atherstone Mews ,, S E 1 1 ... ... ... ... ... 2 Atherstone Terrace 11 ,, ... ... 1 ... ... ... ... 1 Aubrey Road K T C 1 ... ... ... ... 1 ... 2 Bangor Street ,, N W 1 1 1 ... ... 4 ... 7 Barandon Street ,, ,, 1 ... 2 ... ... ... ... 3 Barker Street B s w 9 2 1 ... ... ... ... 12 Barkston Gardens ,, ,, ... ... 1 ... ... 1 ... 2 Basse!t Road K T N 4 ... ... ... ... ... ... 4 Beauchamp Place B S E ... 1 ... ... ... I ... 2 Bedford Gardens K T C ... 1 ... ... ... ... ... 1 Bevington Road ,, N 4 ... ... ... ... 1 ... 5 Bina Gardens B S E 1 ... ... ... ... ... ... 1 Blagrove Road K T N 3 2 ... ... ... ... ... 6 Blechynden Mews ,, N W 1 ... ... ... ... ... ... 1 Blechynden Street ,, ,, 5 2 ... ... ... 6 ... 13 Blenheim Crescent . . ,, N E 2 2 ... ... ... ... ... 4 Bolton Gardens B S W 1 ... ... ... ... ... ... 1 189 TABLE IXa.—continued. Street or Place. Registration Sub District. Sanitary District. Scarlet Fever. Diphtheria. Enteric Fever. Continued Fever. Puerperal Fever. Erysipelas. Croup. Total. Bolton Gardens West b sw ... ... ... ... ... 1 ... 1 Bolton Gardens South ,, ,, ... ... ... ... ... ... ... 2 Bolton Gardens Mews ,, ,, ... 1 ... ... ... ... ... 2 Bolton Mews ,, S E ... 1 ... ... ... ... ... 1 Bolton Mews (Notting Hill) ... K T N E 1 ... ... ... ... ... ... 1 Bolton Road ,, ,, 4 3 1 ... ... 1 ... 10 Bomore Road ,, N W 2 ... ... ... ... ... ... 2 Bonchurch Road ,, N ... ... ... ... ... 2 ... 2 Bosworth Road ,, ,, 2 9 ... ... ... ... ... 11 Boundary Villas ,, C 1 ... ... ... ... ... ... 1 Boyne Terrace Mews ,, C 1 ... ... ... ... ... ... 1 Bramham Gardens B SW 2 ... 1 ... ... ... ... 3 Bramley Road k t N W 6 2 2 ... ... 2 ... 12 Bramley Street ,, ,, ... 1 ... ... ... ... ... 1 Bransford Street ,, n ... 1 ... ... ... ... ... 1 Brechin Place b S E 2 1 ... ... ... ... ... 3 Bromp'on Road ,, ,, ... 2 ... ... ... ... ... 2 Buckingham Mews kt N E 1 6 ... ... ... ... ... 1 Buckingham Terrace ,, ,, 2 3 ... ... ... 1 ... 6 Bullingham Mansions ,, C 3 2 ... ... ... ... ... 5 Bulmer Place ,, ,, ... 1 ... ... ... ... ... 1 Bute Street b S E 1 3 ... ... ... ... ... 4 Cambridge Gardens k T N 4 1 1 ... ... 1 ... 7 Campden Houses ,, C 1 1 ... ... ... 1 ... 3 Campden House Court ,, ,, ... 1 ... ... ... ... ... 1 Campden House Mews ,, ,, ... ... ... ... ... ... ... 1 Campden Street ,, ,, ... ] ... ... ... 2 ... 3 Cat heart Road B s w 2 ... 1 ... ... ... ... 3 Chapel Place S E ... 1 ... ... ... ... ... 1 Charles Street, Norlands KT C ... 1 ... ... ... ... ... 1 Chelsea Grove b S E 1 2 ... ... ... ... ... 3 Cheniston Gardens KT s w 1 ... ... ... ... ... ... 1 Chepstow Villas ,, c 2 ... ... ... ... ... ... 2 Chesterton Road ,, N 6 ... ... ... ... ... ... 6 Child's Passage B S W 1 ... 1 ... ... ... ... 2 Child's Place ,, ,, 4 ... 1 ... ... ... ... 5 Child's Street ,, ,, 4 ... ... ... ... ... ... 4 Clanricarde Gardens K T c ... ] ... ... ... ... ... 1 Clarence Mews ,, ,, ... ... ... ... ... 1 ... 1 Clarendon Place ,, ,, 1 ... ... ... ... ... ... 1 Clarendon Road ,, N E 4 1 ] ... ... 1 ... 7 Clareville Grove b S E ... ... ... ... ... 1 ... 1 Claro Terrace ,, S W ... ... 1 ... ... ... ... 1 Clifton Place ,, S E ] ... ... ... ... ... ... 1 Codrington Mews K T N E 1 ... ... ... ... ... ... 1 Coleherne Mews B S w 1 ... ... ... ... ... ... 1 Coleherne Road ,, ,, ... ... 1 ... ... ... ... 1 Collingham Place ,, ,, 2 ... ... ... ... ... ... 2 Colville Gardens KT n E ... 1 ... ... ... ... ... 1 190 table IXa.—continued Street or Place. Registration Sub-District. Sanitary District. Scarlet Fever. Diphtheria. Enteric Fever. Continued Fever. Puerperal Fever. Erysipelas. Croup. Total. Colville Mansions K T n e ... ... 1 ... ... ... ... 1 Colville Road „ „ 5 ... ... ... ... ... ... 5 Colvilie Square Mews „ „ ... 1 ... ... ... ... ... 1 Colville Terrace „ „ 1 ... ... ... ... ... ... 1 Convent Gardens „ „ 5 2 ... ... ... 1 ... 8 Cornwall Gardens K T'& B s e 2 1 ... ... ... ... ... 3 Cornwall Mews South B „ 1 ... ... ... ... ... ... 1 Cornwall Road K T N E 15 1 ... ... ... 1 ... 20 Courtfield Mews B S E 1 ... ... ... ... ... ... 1 Courtfield Road „ „ 1 ... ... ... ... ... ... 1 Cranley Gardens „ „ 2 ... ... ... ... ... ... 2 Cranley Mansions „ „ ... 1 ... ... ... ... ... 1 Crescent Place „ „ ... 1 ... ... ... ... ... 1 Crescent Street K T N W 3 ... ... ... ... 3 ... 6 Cromwell Mansions B s w ... ... ... ... ... ... ... 1 Cromwell Place „ S E 1 ... ... ... ... ... ... ] Cromwell Road „ „ 1 ... ... ... ... 1 ... 2 Dartmoor Street k t c 3 ... ... ... ... ... ... 4 Denbigh Terrace „ N E 3 2 ... ... ... 1 ... 6 De Vere Gardens „ S E ... ... 1 ... ... 1 ... 2 Drayton Gardens B „ 2 ... ... ... ... ... ... 2 Drayton Terrace „ „ ... ... ... ... ... 1 ... 1 Dulford Street K T n e 7 2 ... ... ... ... ... 9 Durham Villas „ C 2 ... ... ... ... ... ... 2 Karl's Court Gardens b S W ... ... ... ... ... 1 ... 1 Earl's Court Road K T & B „ 5 3 ... ... ... ... ... 8 East Mews Road K T n w 1 ... ... ... ... ... ... ] Edenham Street „ n 5 2 ... ... ... ... ... 7 Edge Street „ C 1 ... ... ... ... ... ... 1 Edinburgh Road „ N ... ... ... ... ... 1 ... 1 Edinburgh Terrace „ N W ... 2 ... ... ... ... ... 2 Egerton Gardens B s e 1 ... ... ... ... ... ... 1 Egerton Terrace „ „ 1 ... ... ... ... ... ... 1 Elgin Crescent K T n e ... 1 1 ... ... ... ... 2 Elgin Mews „ „ ... ... 1 ... ... 1 ... 2 Elsham Road „ c 1 ... ... ... ... 2 ... 3 Elvaston Place „ s e ] ... ... ... ... ... ... 1 Ernest Street „ c 2 ... ... ... ... ... ... 2 Evelyn Gardens B s e 2 2 ... ... ... ... ... 4 Essex Villas K T c 1 ... ... ... ... ... ... ] Exmoor Street „ N 2 ... ... ... ... ... ... 2 Faraday Road „ „ 1 3 ... ... ... 1 ... 5 Farmer Street „ C 2 ... ... ... ... ... ... 2 Farnell Mews B S W 1 ... 1 ... ... ... ... 2 191 TABLE IXa. —continued. Street or Place, Registration Sub-District. Sanitary District. Scarlet Fever. Diphtheria. Enteric Fever. Continued Fever. Puerperal Fever. Erysipelas. Croup. Total. Fenelon Road b S W ... 1 ... ... ... ... 1 Finborough Road „ „ 4 2 1 ... 1 1 ... 9 Fowell Street K T N W ... 2 ... ... ... 1 ... 4 Fulham Road B S E & S W 2 1 1 ... 1 ... ... 5 Garden Row „ S E ... 1 ... ... ... ... ... 1 Gledhow Gardens „ „ 2 ... ... ... ... ... 2 Gloucester Road k t „ ... ... ... ... ... ... 1 Gloucester Terrace B „ ... ... ... ... 1 ... 1 Golborne Gardens K T N 3 5 ... ... ... ... ... 8 Golborne Road „ „ 3 2 ... ... ... 4 ... 9 Gordon Place „ C 3 1 1 ... ... ... ... 5 Grenfell Road „ N W 5 ... ... ... 1 ... 6 Harcourt Terrace B S W ... 1 ... ... ... ... ... 1 Harrington Gardens „ S E 3 ... ... ... ... ... 3 Harrington Road „ „ 2 ... ... ... ... ... 2 Hazlewood Crescent K T N 2 5 ... ... ... ... ... 7 Heathfield Street „ N E ... 1 ... ... ... ... 1 Hesketh Place „ N W 1 ... ... ... ... ... 1 Hesper Mews B S W 1 ... ... ... ... ... 1 Hewer Street K T N 1 ... ... ... ... ... 1 High lever Road „ „ 2 ... ... ... ... ... 2 High Row „ C 1 ... ... ... ... ... 1 High Street, Notting Hill „ „ 11 1 ... ... ... 1 ... 13 Hippodrome Stables „ N E 1 2 ... ... ... ... ... 3 Hogarth Place B S W ... 1 ... ... ... ... ... 1 Hogarth Road „ „ 1 1 ... ... ... ... 2 Holland Park k t c 1 1 ... ... ... ... 2 Holland Park Avenue „ „ 1 1 3 ... ... ... ... 7 Holland Park Gardens „ „ 1 ... ... ... ... ... 1 Holland Park Road „ „ ... 1 ... ... ... ... 1 Holland Place „ „ ... 1 ... ... ... ... 2 Holland Place Chambers „ „ ... 1 ... ... ... ... ... 1 Holland Road „ „ 1 ... ... ... ... ... 4 Holland Street „ „ ... 1 ... ... ... ... 1 Hollywood Mews B s w 3 ... ... ... ... ... 3 Hollywood Road „ „ ... 1 ... ... ... ... ... 1 Hooper's Court „ s e 1 ... ... ... ... ... 1 Horbury Crescent K T C 3 ... ... ... ... ... 3 Hurstway Street „ N W 3 1 ... ... ... ... 4 Hyde Park Gate „ S E 1 ... ... ... ... ... 1 Ifield Road B s w 13 10 2 ... ... 1 ... 26 James Street K T S e ... 1 ... ... ... ... 1 Jameson Street „ C ... 2 ... ... ... 1 ... 3 Jay's Mews „ S e 2 ... ... ... ... ... ... 2 192 TABLE IXa.—continued. Street or Place. Registration Sub-District. Sanitary District. Scarlet Fever. Diphtheria. Enteric Fever. Continued Fever. Pucperal Fever. Erysipelas. Croup. Total. Kellield Gardens K T N 2 ... ... ... ... ... ... 2 Kempsford Gardens B S W ... 1 1 ... ... ... ... 2 Kenilworth Street K T N W ... 1 ... ... ... ... ... 1 Kenley Street ,, ,, 4 3 ... ... ... 2 ... 9 Kensal Road ,, N 1 ... ... ... ... 1 ... 3 Kensington Barracks ,, C 1 ... ... ... ... ... ... 1 Kensington Buildings ,, S W ... 1 ... ... ... ... ... 1 Kensington Court Stables ,, S F. ... ... 1 ... ... ... ... 1 Kensington Gore ,, ,, 1 ... ... ... ... ... ... 1 Kensington High Street ,, C ... 1 ... ... ... ... ... 1 Kensington Infirmary ,, S W 13 ... 5 ... ... ... ... 76 Kensington Park Gardens ,, C ... ... 1 ... ... ... ... 1 Kensington Park Gardens Mews ,, ,, ... ... 1 ... ... ... ... 1 Kensington Park Road ,, N E & C ... ... 1 ... ... ... ... 6 Kensington Place ,, C 4 ... ... ... ... ... ... 4 Kensington Square ,, S E 1 1 ... ... ... ... ... 2 Kenway Road B S W 1 ... ... ... ... ... ... 1 Laconia Mews K T S E ... 2 ... ... ... ... ... 2 Ladbroke Crescent ,, N E 1 ... ... ... ... ... ... 1 Ladbroke Gardens ,, ,, 1 ... ... ... ... ... ... 1 Ladbroke Grove ,, N, N E & C 8 7 3 ... ... 4 ... 22 Ladbroke Road ,, C ... ... ... ... ... 1 ... 1 Ladbroke Terrace Mews ,, ,, 2 ... ... ... ... ... ... 2 Lancaster Road ,, n E & N W 14 4 6 ... ... 1 ... 25 Lansdowne Crescent ,, N E ... 1 1 ... ... ... ... 4 Lansdowne Road ,, C ... 1 ... ... ... ... ... 1 Latimer Mews ,, N W ... 1 ... ... ... ... ... 3 Latimer Road ,, ,, ... 1 ... ... ... ... ... 1 Laverton Mews b S W ... ... ... ... ... ... ... 1 Ledbury Mews K T N E ... ... ... ... ... ... ... 2 Ledbury Road ,, ,, 3 ... ... ... ... ... ... 3 Lexham Gardens b S W 4 ... ... ... ... ... ... 4 Linden Gardens K T C ... ... ... ... ... ... ... 3 Linden Gardens Mews ,, ,, 1 ... ... ... ... ... ... 1 Lockton Street ,, n W ... 1 ... ... ... ... ... 1 Lonsdale Mews ,, N E 1 ... ... ... ... ... ... 1 Lonsdale Road ,, ,, 19 1 1 ... ... ... ... 21 Manchester Road ,, N w 6 5 ... ... 1 1 ... 13 Manson Mews B S E 1 ... ... ... ... ... ... 1 Manson Place ,, ,, 1 ... ... ... ... ... ... 1 Marloes Road kt s w ... 2 ... ... ... ... ... 2 Martin Street ,, n w ... ... ... ... ... 1 ... 1 Mary Place ,, ,, 2 ... ... ... ... 4 ... 6 Mersey Street ,, ,, 4 1 ... ... 1 2 ... 8 193 TABLE IXa.—continued. Street or Place. Registration Sub- District. Sanitary District. Scarlet Fever. Diphtheria. Enteric Fever. Continued Fever. Puerperal Fever. Erysipelas. Croup. Total. Middle Street B S E ... 1 ... ... ... ... ... 1 Montpelier Flats ,, ,, 2 ... ... ... ... ... ... 2 Montpelier Row ,, ,, ... 1 ... ... ... ... ... 1 Munro Mews k t N 1 ... ... ... ... ... ... 1 Nevern Mansions B S W ... ... 1 ... ... 1 ... 2 Nevern Square ,, ,, ... 1 ... ... ... ... ... 1 Newcombe Street k t c 1 ... ... ... ... 1 ... o New Road ,, ,, 1 ... ... ... ... ... ... 1 New Street B S E ... 1 ... ... ... ... ... 1 Norfolk Road Villas K t N E 1 ... ... ... ... ... ... 1 Norland Square ,, C 2 ... ... ... ... 1 ... 3 North Street B S W 5 3 ... ... ... ... ... 8 Old Manor Yard B s w 1 ... ... ... ... ... ... 1 Onslow Gardens ,, S E ... 1 3 ... ... ... ... 4 Onslow Mews ,, ,, ... 2 ... ... ... ... ... 2 Onslow Mews West ,, S E 1 ... ... ... ... ... ... 1 Oxford Gardens K T N 2 1 ... ... ... 1 ... 4 Palace Gardens Terrace K T C 1 ... ... ... ... ... ... 1 Palace Gate ,, S E ... ... 1 ... ... ... ... 1 Pamber Street ,, N W 1 ... ... ... ... ... ... 1 Park Terrace ,, S W ... 3 ... ... ... ... ... 3 Peel Place ,, c ... ... ... ... ... 1 ... 1 Peel Street ,, ,, 6 ... ... ... ... ... ... 6 Pelham Place B S E 2 ... ... ... ... ... ... 2 Pembridge Road k t C 1 ... ... ... ... ... ... 1 Pembridge Villas ,, ,, 2 1 ... ... ... 1 ... 4 Pembroke Mews ,, S W ... 1 ... ... ... ... ... 1 Pembroke Road B ,, ... 1 ... ... ... ... ... 1 Pembroke Square K T ,, ... ... ... ... ... 1 ... 1 Pennant Mews B ,, ... 4 ... ... ... ... ... 4 Petersham Terrace K T S E ... ... 1 ... ... ... ... 1 Philbeach Gardens B S W ... ... ... ... ... 1 ... 1 Phillimore Gardens K T c 1 ... ... ... ... ... ... 1 Phillimore Mews ,, ,, ... 3 ... ... ... ... ... 3 Portland Road ,, N E & C 11 4 1 ... ... 4 ... 20 Portobello Road ,, N,NE&C 29 11 2 ... ... 6 ... 49 Pottery Lane ,, C 1 2 1 ... ... ... ... 4 Powis Square ,, N E ... 1 ... ... ... ... ... 1 Prince's Gate B S E ... ... ... ... ... 1 ... 1 Prince's Gate Mews ,, ... ... 1 ... ... ... ... 1 Prince's Place K T C 1 ... ... ... ... 2 ... 3 Prince's Road ,, ,, 11 ... ... ... ... 1 ... 12 Prince Teck Buildings B S W 1 1 ... ... ... ... ... 2 Providence Terrace ,, ,, 5 ... ... ... ... ... ... 5 Queen Ann's Terrace k t N ... ... 7 ... ... ... ... 7 Queensberry Mews West B S E ... 1 ... ... ... ... ... 1 Queensberry Place ,, ,, ... 1 ... ... ... ... ... 1 194 TABLE IXa.—continued. Street or Place. Registration Sub-District. Sanitary District. Scarlet Fever. Diphtheria. Er.teric Fever. Continued Fever. Puerperal Fever. Erysipelas. Croup. Total. Queen's Gate KT&B S E 1 1 1 ... ... ... ... 3 Queen's Gate Mews K T ,, 3 ... ... ... ... ... ... 3 Queen's Gate Terrace ,, ,, 1 ... ... ... ... ... ... 1 Queen's Road ,, C 4 ... ... ... ... 1 ... 5 Rackham Street K T N 7 2 ... ... 1 2 ... 12 Raddington Road ,, ,, ... ... 1 ... ... ... ... 1 Radley Mews B S W ... 2 ... ... ... ... ... ... Railway Mews K T N E ... ... ... ... ... ... ... 1 Raymede Street 11 N ... 1 ... ... ... ... ... 1 Redcliffe Road B S W ... ... 1 ... ... 1 ... ... Redcliffe Square ,, ,, 2 ... ... ... ... ... ... 2 Red field Lane ,, ,, 2 1 1 ... ... ... ... 4 Rendle Street K T N ... 1 ... ... ... ... ... 1 Roland Gardens B SE ... ... ... ... ... ... ... 1 Roland Mansions ,, ,, ... ... 1 ... ... ... ... 1 Rutland Mews South ,, ,, ... 1 ... ... ... ... ... 1 St. Ann's Road K T N W& C 1 3 2 ... ... 4 ... 10 St. Charles's Square ,, N 1 ... ... ... ... ... ... 1 St. Ervan's Road ,, ,, 5 3 2 ... ... 2 ... 12 St. George's Road ,, N E 3 1 ... ... ... 3 ... 7 St. Helen's Gardens ,, N ... 1 ... ... ... ... ... 1 St. James's Place ,, C 3 ... 1 ... ... 1 ... 5 St. James's Square ,, ,, ... ... 1 ... ... ... ... 1 St. James's Terrace St. John's Mews ,, n e 1 1 ... ... ... 1 ... 1 2 St. John's Place ,, C 8 ... ... ... ... ... ... 8 St. Katharine's Road ,, n w 24 3 ... ... ... 4 ... 32 St. Luke's Mews k t n e ... 1 ... ... ... ... ... 1 St. Luke's Road ,, ,, 1 ... ... ... ... ... ... 1 St. Mark's Grove B S W 3 ... ... ... ... ... ... 3 St. Mark's Road, Fulham Road ,, ,, ... ... 1 ... ... 1 ... 2 St. Mark's Road, Notting Hill k t N & N E 2 3 ... ... ... 2 ... 7 St. Marylebone Infirmary* ... ,, N ... ... ... ... ... 1 ... 1 St. Mary's Road ,, N E ... 2 ... ... ... 1 ... 3 St. Quintin Avenue ,, N 2 ... ... ... ... ... ... 2 Scampston Mews ,, ,, 1 ... ... ... ... ... ... 1 Scarsdale Terrace ,, S W 5 ... ... ... ... ... ... 5 Selwood Place B SE 1 ... ... ... ... 3 ... 4 Seymour Place ,, S W 3 1 ... ... ... 2 ... 6 Shaftesbur Mews K T ,, 1 ... ... ... ... ... ... 1 Shaftesbury Road B ,, 1 ... ... ... ... 1 ... 2 Silchester Koad K T N W 9 2 ... ... ... 1 ... 13 Silchester Street ,, ,, ... 2 1 ... ... 1 ... 1 Silchester Terrace ,, ,, 8 1 ... ... ... ... ... 9 Sirdar Road ,, ,, 6 1 1 ... ... 5 ... 13 Sloane Place B S E ... 1 ... ... ... ... ... 1 South Row K T N 1 ... 1 ... ... ... ... 2 Southam Street ,, ,, 12 21 3 ... ... 1 ... 39 Stamford Cottages B S W 1 ... ... ... ... ... ... 1 Stanhope Gardens ,, S E 1 ... ... 1 ... ... ... 2 * Cases occurring at this institution are notified to the Medical Officer of Health for St. Marylebone. This case of erysipelas notified here was that of a Kensington Parishioner. 195 TABLE IXa.—continued. Street or Place. Registration Sub-District. Sanitary District. Scarlet Fever. Diphtheria. Enteric Fever. Continued Fever. Puerperal Fever. Erysipelas. Croup. Total. Stanhope Mews South B S E ... ... 1 ... ...... ... ... 1 Stanley Gardens K T N E 1 ... ... ... ... ... ... 1 Stoneleigh Street ,, NW 3 ... 1 ... ... 2 ... 6 Swinbrook Road ,, N 15 6 ... ... ... 2 ... 23 Sussex Villas ,, S E ... ... l ... ... ... ... 1 Tabernacle Terrace K T C 1 ... ... ... ... 1 ... 2 Talbot Grove ,, N E 3 ... ... ... ... 1 ... 4 Talbot Mews ,, ,, 2 ... ... ... ... ... ... 2 Tavistock Crescent ,, ,, 1 1 ... ... ... ... ... 3 Tavistock Road ,, ,, 2 ... l ... ... ... ... 3 Telford Road ,, N 5 ... ... ... ... ... ... 5 Templeton Place B S W 1 ... ... ... ... .... . . ... 1 Testerton Street K T N W 3 3 ... ... ... ... ... 7 The Grove, Boltons B S w 1 ... ... ... ... ... ... 1 The Triangle K T N 1 ... ... ... ... ... ... 1 Thomas Place ,, NW 2 ... ... ... ... 1 ... 4 Tobin Square ,, ,, ... ... l ... ... ... ... 1 Tobin Street ,, ,, 3 ... ... ... ... 1 ... 4 Tottenham Street ,, N ... ... ... ... ... 1 ... 1 Treadgold Street ,, N W 1 ... ... ... ... ... ... 1 Trebovir Road B S W 1 ... ... ... ... 1 ... 2 Tregunter Road ,, ,, 1 ... ... ... ... ... ... 1 Treverton Street k t N 4 3 2 ... 1 2 ... 12 Upper Addison Gardens K T C 1 ... ... ... ... ... ... 1 Upper Highlever Road |,, N 1 ... ... ... ... ... ... 1 Upper Phillimore Gardens ... ,, C 1 ... ... ... ... ... ... 1 Upper Phillimore Place ,, ,, ... 1 ... ... ... ... ... 1 Uxbridge Street ,, ,, 2 ... 1 ... ... ... ... 3 Victoria Dwellings K T N 3 1 ... ... ... ... ... 4 Victoria Gardens ,, C ... ... ... ... ... 1 ... 1 Victoria Road ,, SE ... ... 1 ... ... ... ... 1 Wallgrave Road B S W ... ... ... ... ... 1 ... 1 Walmer Road K T N W 28 8 2 ... 1 6 ... 45 Warwick Road KT&B SW 8 4 ... ... ... 2 ... 14 Wellington Mews West K T N E 1 ... ... ... ... ... ... 1 Westbourne Grove ,, ,, 1 1 ... ... ... ... ... 2 Western Terrace ,, ,, 1 ... ... ... ... ... ... 1 Westgate Terrace B S W 1 ... ... ... ... ... ... 1 West Pembroke Place K T ,, 1 ... ... ... ... ... ... 1 Wetherby Gardens B ,, ... ... ... ... ... 1 ... 1 Wetherby Mansions 91 ,, ... ... l ... ... 3 ... 4 Wetherby Terrace ,, ,, 1 ... ... ... ... ... ... 1 Wheatstone Road kt N 1 6 l ... 1 ... 9 Williams Place ,, S W ... ... ... ... ... 1 ... 1 Wornington Road ,, N 13 7 3 ... ... 4 ... 27 Wright's Lane ,, S W 1 ... ... ... ... ... ... 1 Wynnstay Gardens ,, i ,, ... 1 ... ... ... ... ... 1 Yeoman's Row B S E 3 1 ... ... 1 ... ... 5 One case of "English Cholera" was notified, in addition, from Kensington Infirmary. 196 TABLE X. Vaccination Officer's Return respecting the Vaccination of Children whose Births were Registered in 1896.* ( Vide page 64). 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" 1896. 1 2 3 4 5 6 8 9 10 11 1st January to 31st Dec Kensington Town 3072 2369 15 299 45 11 327 6 Brompton 605 473 10 ... 58 11 1 47 5 Total 3677 2842 25 ... 357 56 12 374 11 * The Return for 1897, will not be due until February, 1899 197 TABLE XI. LICENSED SLAUGHTER-HOUSES. SOUTH OF HOLLAND PARK AVENUE, (SOUTH KENSINGTON.) LOCALITY OF PREMISES. NAME OF LICENSEE. 60, Kensington High Street Mr. Evans 35, Earl's Court Road Mrs. Matson 21, Peel Place, Silver Sireet Mr. Osborne 25, Silver Street ... „ Wright 133, High Street, Notting Hill „ Candy 113, Holland Park Avenue „ Holloway NORTH OF HOLLAND PARK AVENUE. (NORTH KENSINGTON.) Lonsdale Mews Mr. Grove 13, Archer Mews „ Bawcombe 10, Edenham Mews „ Goddard 61, Silchester Road „ Shattock 195, Clarendon Road „ Simmons 235, Walmer Road Mrs. Van 4, Royal Crescent Mews Mr. Brocker 198 TABLE XI. LICENSED SLAUGHTER-HOUSES. SOUTH OF HOLLAND PARK AVENUE, (SOUTH KENSINGTON.) LOCALITY OF PREMISES. NAME OF LICENSEE. Campden Street, (Yard in) Mr. Lunn NORTH OF HOLLAND PARK AVENUE. (north kensington.) 187, Walmer Road Mr. Arnsby 5, Ledbury Mews „ Liddiard 23, Bramley Road „ Tame