KEN 5 THE ANNUAL REPORT ON THE HEALTH, SANITARY CONDITION &c., &c., OF THE PARISH OF ST. MARY ABBOTTS, KENSINGTON, FOR THE YEAR 1899, BY T. ORME DUDFIELD, M.D., Medical Officer of Health. KENSINGTON P'RINTED BY SAMUEL SIDDERS & CO., 17 & 19, BALL STREET, KENSINGTON W. 1900. TABLE OF CONTENTS. PAGE Kensington: Registration District and Sub-Districts 1 „ Parliamentary Divisions of the Borough of 2 „ Sanitary Districts; Delimitations of the 2 ,, Chief Sanitary Inspector of, Appointed 3 Population in 1891; Census Return 4 „ Number of Houses, and of Tenements of less than five rooms, in 1891 4 ,, Number of Persons of each Sex in the Parish, and in the Sub-Districts, at eleven Age-periods, as enumerated in 1891 (Table) 6 „ Distribution of, in the Wards 6 ,, (1801-99) and Rateable Value (1823-99) 6 Parish, The Growth of the; since 1855, and since 1871, in respect of Inhabited Houses, Population, and Rateable Value 7 Population, and Inhabited Houses, in 1899 8 Marriages and Marriage-Rate, in Kensington, 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, &c. 10 „ Of Illegitimate Children 10 ,, Quarterly Number of, in the Parish, and in the Sub-Districts 11 ,, Annual Number of; Male and Female, and Birth-Rate, in the ten years, 1889-98 11 Deaths and Death-Rate, in the Parish, the Sub-Districts, and the Sanitary Districts 12 Infantile Mortality, in the Parish, the Sub-Districts, the Parliamentary Divisions, and the Sanitary Districts 13 „ ,, Number of Deaths, at Ages from one Week to one Year 13 ,, ,, In the London Sanitary Areas 14 ., ,, Deaths of Children under Five Years of Age 14 Senile Mortality 14 Mortality, District Rates of (see also Table at Page 18) 15 iv. PAGE "Notting-Dale" Special Area; Vital and Mortal Statistics of the 16 Death-Rate (The True ) in 1899 (see also Table, page 21) 19 Deaths; Quarterly Number of, in the Parish, and in the Sub-Districts 20 Death-Rate in England and Wales, in London, and in Kensington 22 „ In Greater London 22 „ In the Great Towns, and in Colonial and Foreign Cities 23 Vital and Mortal Statistics of Kensington, in 1899 24 ,, ,, „ ,, Summary Table of 25 Deaths, Assigned Causes of 26 Zymotic Diseases: 26 Deaths and Death-Rate from the "Seven Principal," in Kensington, and in London 26 Deaths and Death-Rate from, in the Sanitary Districts, etc. 27 Death-Rate from, in England and Wales, and in certain Great Towns 27 Reduction in Mortality from,1873-97 (See also Table page 29) 27 Small Pox, Notifications of, in London, in 1899 30 „ Notable Reduction in Mortality from, in London 30 Measles, in Kensington, and in London 31 „ Should it be made a Notifiable Disease? 32 Scarlet Fever, in Kensington, and in London 34 „ „ Tables, showing Notifications, Admissions to Hospitals, and Deaths, in Kensington, and in London, and Cases in Hospital, in Thirteen four-weekly periods, in 1899, and in 1898 35-36 „ ,, Statistical Returns of Cases of, Recorded in Kensington, 1889-99 (Tables) 37-38 ,, ,, "Return Cases" of 39 Diphtheria, in Kensington, and in London 40 „ Reduction in Mortality from 40 „ Local Outbreaks of 40 ,, Table, showing Notifications, Admissions to Hospital, and Deaths, in Kensington, and in London, and Cases in Hospital, in Thirteen four-weekly periods 42 ,, Cases of, in the Parish, and in the Parliamentary Divisions, in 1899 (Table) 43 ,, Bacteriological Examination in Suspected Cases of 44 ,, Mortality from, in London, and in Kensington, and adjacent districts, in 1889-98 45 ,, Antitoxic Treatment of 46 Whooping-Cough, in Kensington, and in London 46 V. Death, Assigned Causes of—continued. page Fever, Enteric, in Kensington, and in London 47 ,, ,, Endemic of, in Kensington 48 ,, Typhus, in Kensington, and in London 53 ,, Simple Continued, in Kensington, and in London 53 Diarrhœa, in Kensington, and in London 53 Influenza, in Kensington, and in London 54 Venereal Diseases 54 Septic Diseases 54 „ „ Puerperal Fever 55 Dietetic Diseases 55 Constitutional Diseases 56 „ ,, Rheumatic Fever 56 ,, ,, Cancer: Malignant Disease 56 ,, „ Tuberculosis 57 Developmental Diseases 58 Local Diseases 58 ,, ,, Nervous System, Diseases of the 58 ,, ,, Circulatory System „ 59 ,, „ Respiratory System „ 59 ,, ,, Digestive System ,, 60 ,, „ Urinary System ,, 60 ,, „ Reproductive System „ 60 Violence, Deaths from 61 Ill-Defined and not Specified Causes of Death 61 Causes of Death in 1899: Summary of Table III. (Appendix,Page 206) 62 ,, ,, Classified: Local Government Board's Table (A.) 63 Public Institutions, Deaths at 64 „ ,, ,, Parish Infirmary 64 „ „ ,, Brompton Hospital 66 ,, „ ,, St. Marylebone Infirmary 66 „ ,, ,, St. Joseph's House 66 „ „ „ Outlying Hospitals, etc. (Table, page 67) 66 Uncertified Deaths 68 „ ,, Report of a Select Committee of the House of Commons, and Report of the Public Control Committee of the London County Council, on the subject of 68 Inquests: Deaths from Violence; Accidental, Suicidal, &c. 69 vi. PAGE Vaccination in Kensington (1898). See also Table X. (Appendix), p. 226 71 „ Decrease in the practice of, in London, and in England and Wales 71 Vaccination Act, 1898 72 Metropolitan Asylums Board; The Work of the 73 „ Statistical Committee, Annual Report of the, (1898) 73 „ Notification Statistics (1898) 74 ,, ,, Age and Sex-distribution of Cases 76 ,, ,, Ambulance Work 76 ,, ,, Hospital Accommodation 77 ,, ,, Hospital Statistics 77 „ ,, Mistaken Diagnosis, Cases of 79 „ „ Admissions of Cases, 1870-98: Reduction in Mortality 79 ,, ,, Kensington Cases, Admissions, and Deaths 80 ,, ,, Removal of the Sick to Hospital 80 Ambulance Arrangements 80 Hospital Accommodation 81 ,, ,, Fever Hospitals 81 „ „ Small-pox Hospitals 83 ,, ,, Existing and Projected 84 ,, ,, Largely in Excess of Theoretical Requirements 85 Notification ok Infectious Disease, in Kensington, and in London 86 ,, Local Government Board's Table (B.) 87 „ in London Sanitary Areas (Table) 88 ,, in Four-weekly Periods; in Kensington, and in London (Table) 89 ,, in the Parish, the Sub-districts, the Parliamentary Divisions and the Sanitary Districts (Table) 90 ,, Infectious Disease (Notification) Extension Act, 1899 91 Factory and Workshop Acts: Duties of the Sanitary Authority with respect to Inspection of Workshops 94 „ ,, Lady Inspectors, Kensington 94 „ ,, Lady Inspectors in London 96 „ ,, Lady Inspector's Annual Report (Kensington) 97 Public Health (London) Act 1891, Proposed Bill for Amending the 103 vii. PAGE Sanitary Inspectors, The Work of the 104 „ ,, Number of in London Districts 104 Statutory Notices and Written Intimations Issued 106 Legal Proceedings: Summonses 107 Offensive Businesses 108 ,, ,, Fat Extractor: Legal Proceedings (1898) 108 „ „ Fried Fish Shop Nuisance 110 ,, „ Marine Stores 110 „ ,, Brickburning 110 Slaughter-Houses, The Licensed 111 Cow-Houses, The Licensed 112 The Prevention of Consumption 113 The National Association for the Prevention of Consumption, etc. 115 Consumption, Reduction in Mortality from, in England and Wales 117 „ Reduction of Mortality from, in Kensington, 1873-97 (See . Table, page 128) 117 ,, And other Tubercular Diseases; Deaths from, in Kensington, in 1898 (See Table, page 129) 118 „ Deaths from, in the Sanitary Districts etc., in 1898 119 ,, Social position of Victims to, in 1898 119 ,, Deaths from, in 1899 (See Table, (page 130) 120 „ Prevention of; The action of the Vestry; Report of Sub- Committee of the Sanitary Committee 20 ,, „ The views of the Medical Officer of Health on the 124 „ „ Leaflet with respect to; Prepared and Circulated 125 Bakehouses 131 Offensive Smells in Streets; Complaints of 132 Sewer Smells: Enquiry with reference to, by the Sanitary Committee 133 „ „ Street Gullies, as a cause of 134 ,, ,, Report by the Law and Parliamentary Committee with Reference to 136 „ „ Medical Officer's Recommendations with respect to Offensive Gullies and Ventilating Shafts 137 „ „ Action of the Vestry with reference to 138 „ „ Action of the County Council with reference to Complaints arising from: Conference held 138 Combined Drainage: Drain or Sewer? 140 Main Drainage; Insufficiency of: Flooding of Basements 141 „ „ Report by the Law and Parliamentary Committee on 142 Drainage Bye-Laws 144 viii. PAGE House-to-House Inspection 145 Housing of the Working Classes 146 Bye-laws for Houses let in Lodgings, Proposed New 146 „ „ The Existing 150 Registered Houses in the several Sanitary Districts 152 Streets, the Houses in which should be Registered 156 Registration of Lodging-Houses, The Advantages of 157 Common Lodging-Houses, List of the Kensington 158 Common Lodging House, Definition of; or, What Constitutes? 159 Common Lodging Houses, Control of 160 "Notting Dale," Special Area 161 „ ,, Overcrowding and Indecent Occupation of Rooms at 161 ,, „ The Remedy for the Bad Conditions prevailing at 162 „ ,, Sanitary Improvements at 163 ,, ,, Need for more frequent House-to-House Inspection of 164 Overcrowding: Penalty provided for, by Public Health Act, 1891 166 Housing of the Working Classes Act, 1890, (Part III.) Conference of Sanitary Authorities at Bermondsey 166 ,, ,, Views of the Sanitary Committee, and of the Medical Officer of Health on the 167 „ „ Vestry request the County Council to obtain for the Sanitary Authority, Power to put in force the Provisions of Part III. 168 Yards: The Hygienic Value of Paving of 169 ,, Accumulation of Filth and Rubbish in 170 Refuse, Prevention of Nuisance from 171 ,, House: Removal and Disposal of 171 „ Offensive: Removal of through Streets 172 „ „ The County Council and the Removal of 172 ,, „ Nuisance from Removal of: Views of the Medical Officer of Health as expressed at various times (1878-1899) 173 ,, ,, Views of the Society of Medical Officers of Health (1880) on the Removal of 174 ,, ,, Views of the Law and Parliamentary Committee (1884) on the Removal of 175 ,, „ Action of the Vestry (1895-99) with respect to the Removal of 175 ix. Refuse, Offensive—continued. page ,, ,, Memorial from Slaughterers of Cattle (1880) asking the assistance of the Vestry in the Removal of 177 „ ,, Insufficiency of the County Council's present Bye-law (1) with respect to the Removal of, through Streets 178 „ ,, County Council's Proposed New Bye-law (1) dealing with the Removal of 179 ,, ,, Local Government Board's Views with respect to the Removal of, in connection with the Proposed New Bye-law (1) 180 Stable Refuse, Nuisance from, Diminished by Vestry's action under County Council's Bye-law 181 „ ,, Removal of 182 „ ,, Peat: County Council's Action with respect to Nuisance in Removal of 183 ,, ,, The Special Offensiveness of, in Removal through Streets 184 ,, ,, The County Council's Recommendations for vention of Nuisance in Removal of, Anticipated by the Vestry's action 185 ,, ,, The County Council's Proposed New Bye-law (1) would diminish Nuisance in Removal of 18ft Nuisance from Gas Works at Kensal Green 187 James-Street Area Improvement Scheme, Still Unaccomplished 188 Smoke Nuisances, Action of the Vestry with respect to 189 Goods of Evicted Tenants, in streets: Complaints with respect to 189 Paving of Streets, Hygienic; Vestry's Action with respect to; Increasing use of Asphalte 190 Public Mortuary: Bodies Admitted into the 191 Coroner's Court 191 Disinfection, Amount and Cost of 192 ,, Cost of, too great 193 Disinfecting Station, Question of Providing, Considered 193 Shelter for Persons during Disinfection of their Houses; a Desideratum 195 X. page. Cleansing of Persons Act, 1897 196 Public Baths and Washhouses: Separate Washhouses a Desideratum 196 Public Sanitary Conveniences, Insufficient Number of 197 Public House Urinal Accommodation 197 Water Supply: Report of the Royal Commission 198 Vestry's Views with respect to the proposed Water Authority 198 Constant Service now nearly Universal in London 199 Dead Ends of Mains; As a Source of Danger to the Public Health 200 The Cutting-Off Powers of the Companies should be Abolished 200 Conclusion 202 xi. APPENDIX. STATISTICAL AND OTHER TABLES. page. Table I. Estimated Population of Kensington, in 1899, and Ten preceding years, 1889-98: Number of Inhabited Houses, and Number of Marriages, Births, Deaths, &c., 204 ,, II. Birth-rate and Death-rate; Death-rate of Children; Deaths in Public Institutions, in 1899; and in 1889-98 205 ,, III. Deaths Registered from all Causes in 1899 206 (For Summary of Table III., see Page 62) „ IV. Deaths from the Seven Principal Diseases of the Zymotic Class; and from Pulmonary Diseases; Tubercular Diseases; Wasting Diseases of Infants, and Convulsive Diseases of Infants; Gross and Proportional Numbers 211 ,, V. Deaths in 1899, and 1889-98, from the Seven Principal Diseases of the Zymotic Class; in Kensington, and in London, and in England and Wales 212 ,, VI. Summary of the Work executed by the Sanitary Inspectors 213 ,, VII. Death-rates, General and Zymotic; in Kensington, and in London; and Proportion of Deaths from Zymotic Diseases to Total Deaths, in 1899, and in 1889-98 214 „ VIII. Comparative Analysis of the Mortality, in London, and in Kensington, in 1899; Percentage of Deaths under one year, to Births Registered; and Percentages of Deaths under one year, and at 60 and upwards, from the Principal Diseases of the Zymotic Class; and from Violence; and of Inquest Cases; and of Deaths at Public Institutions, to Total Deaths 216 ,, IX. Localities where Fatal Cases of the more important of the Diseases of the Zymotic Class occurred in 1899 216 „ IXa. Streets, &c., in which cases of Infectious Disease were Notified, in 1899, under the provisions of Section 55 of the Public Health (London) Act, 1891 218 „ X. Vaccination Officer's Annual Return for 1898 226 „ XI. Slaughter-houses, The Licensed; and names of Licensees 227 ,, XII. Cow-houses, The Licensed, and names of Licensees 228 FORTY-FOURTH ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH, Being for the Year 1899. 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 1st, and ending December 30th, comprised in the registration year 1899. 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 north of Kensington High-street and Kensington-road, 2 gether with a portion of the parish south of these 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'sroad, Kenley (late William) street, and part of Sirdar (late St. Clement's) road in the north-west 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. Chief Sanitary Inspector. A distinct step in advance was taken during the year 1898, by the appointment of a chief sanitary inspector in the person of Mr. G. M. Pettit, the inspector for the south-east district. But as this officer was still left in charge of the said district, his service in general oversight of the work of the inspectors in the remaining five districts, was necessarily of a limited character. Despite this limitation, however, the arrangement was a judicious one: it worked well in all respects, and to the entire satisfaction of the Sanitary Committee and myself. In the report for 1898 the hope was expressed that, ere long, your Vestry would be pleased to give fullest effect to the objects intended in the creation of the new office, by setting the chief inspector free from district work, and occupying his whole time in the duty of supervision of the sanitary work of the parish. This was done in June, 1899; the result has not disappointed expectation. 4 POPULATION, RATEABLE VALUE, etc. The table at 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 Kensington Town sub-district, and (f)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. The 166,308 persons comprised in the population in 1891, were in occupation of about 22,000 houses or an average of 7.56 to each house. An error, somewhat widely disseminated, that Kensington is almost wholly a parish of rich or well-to-do persons, may be corrected by a reference to the official report of the census of 1891, from which we learn that 70,718 persons, or 42.5 per cent. of the population, were living in 20,052 tenements of less than five rooms. The entire population of the parish at that date was in occupation of 35,953 tenements and certain public institutions. No fewer than 6,398 of these "tenements" consisted of a single room each; these rooms being inhabited by 13,655 persons. The two-roomed tenements were 6,965, and their inhabitants numbered 26,020. The three-roomed tenements were 4,115, and their inhabitants 18,119. The four-roomed tenements were 2,574, and their inhabitants 12,924. Stated in another way, it appears that 8.2 per cent. of the parishioners lived in one-room tenements; 15.6 per cent. lived in two-room tenements; 10.9 per cent. lived in three-room tenements, and 78 per cent. in four-room tenements. In North Kensington there were approximately 8.7 persons to a house; in South Kensington about 6.7. But many houses of eight rooms, in North Kensington more particularly, contained, and contain now, upwards of twenty persons to a house, and some even more than thirty persons. 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 (6) 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 (e) 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 ... 16,3?0 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 be found at page 21. 6 Distribution of the Population in Wards.— The population of the Wards, as ascertained in March, 1896, was as follows :— 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 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 £75,916 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 1896 170,465 2,147,145 (October) 1899 1899 172,400 The rateable value of property in Kensington is about one-sixteenth of that of the Metropolis as a whole. 7 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 1899 Increase in 43 years Number of Inhabited Houses 7,600 22,750 15,150 Population 57,000 172,400 115,400 Rateable Value of Property £308,000 £2,147,145 £1,839,145 From the foregoing figures we learn that the population in 1899, was more than twenty times as large as in the first year of the century, and the rateable value of property more than twenty-eight 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 28 years being nearly four-fold the total in 1856; since which date the population and the number of inhabited houses have increased three-fold. The increase in all respects within the last twenty-eight years, the period over which my official experience extends, is not inconsiderable, as the subjoined figures show:— 1871 1899 Increase in 28 years. Number of Inhabited Houses 15,735 22,750 7,015 Population 121,000 172,400 51,400 Rateable Value £935,720 £2,147,145 £1,211,425 8 Population and Inhabited Houses in 1899.—The population of the parish, estimated to the middle of the year, was 172,400. It comprised, approximately, 68,110 males, and 104,290 females: excess of females 36,180. In the Town subdistrict (estimated population 123,900) the males numbered about 51,468; the females 72,432: excess of females 20,964. In the Brompton sub-district (estimated population 48,500) there were about 16,642 males, and 31,858 females: excess of females 15,216. This population was in occupation of about 22,750 houses, equal to 7.58 persons to a house on an average. In the poorer and most densely populated parts of the parish the number of persons to a house is greatly in excess of the average. For the purposes of this report the population of the parish, the sub-districts, the parliamentary divisions, and the sanitary districts, will be taken to be as follows :— The Parish 172,400 Sub-districts :— Kensington Town 123,900 Brompton 48,500 Parliamentary Divisions :— North Kensington 87,800 South Kensington 84,600 Sanitary Districts :— North 33,470 North-east 30,400 North-west 16,940 Central 27,300 South-east 32,240 South-west 32,050 9 MARRIAGES AND MARRIAGE-RATE. The marriages in the parish in the year were 1,693, as compared with 1,706, 1,681, and 1,648, in the three preceding years respectively. Of these marriages there were celebrated— By the Church (71.5% of total marriages) 1,210 At Roman Catholic places of worship 132 At other Nonconformist places of worship 63 At the Superintendent-Registrar's office 288 The marriage-rate (i.e., the number of persons married to 1,000 living) was 19.6, as compared with 20.1, 19.7 and 19.2, in the three preceding years respectively. The marriage-rate in England and Wales was 16.5 per 1,000, as compared with 15.8, 16.0, and 16.2, in the three preceding years. The rate in London was 18.4 per 1,000, as compared with 18.0, 18.5, and 18.7, in the three preceding years respectively. BIRTHS AND BIRTH-RATE. The births registered were 3,590; viz., males 1,798, and females 1,792: the numbers being, in the Town sub-district (which includes the parish infirmary) 3,046; and in the Brompton sub-district 544. The births were 209 below the corrected decennial average (3,799): 191 of them were of illegitimate children. The births were 43 fewer than in 1898: they were also fewer by 451 than the number in 1872 (4,041): when the population (127,400) was 45,000 less than in 1899. The birthrate, which of late years has been always considerably below that of London, as a whole, (29.4 in 1899, and the lowest on record), has been declining since 1868, in which year it was 33.1 per 1,000 persons living. In 1899 it was 20.8 per 1,000, and 1.2 below the decennial average (22.0). The rate in the sub-districts was, Town, 24.6, and Brompton 11.2 per 1,000. The births in North Kensington, i.e., the part of the parish north of Holland-park-avenue and High-street, Notting-hill, were 2,530, and the birth-rate 28.8 per 1,000 persons living. The births in South Kensington, i.e., the part of the parish 10 south of those streets, were 1,060, and the birth rate 12.5 per 1,000. The birth-rate in the several sanitary districts was as follows:— North 1,065 births, or 3.18 per 1,000 persons living, North-east 576 births, or 18.9 per 1,000 persons living. North-west 636 births, or 37.5 per 1,000 persons living. Central 528 births, or 19.3 per 1,000 persons living. South-east 377 births, or 11.7 per 1,000 persons living. South-west 408 births, or 12.7 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 taken in March, 1896. The births in the entire parish exceeded the deaths by 569. In the Town sub-district, the births were 591 more in number than the deaths, whilst in the Brompton sub-district the deaths exceeded the births to the number of 22, without correction for births at the infirmary. In North Kensington the births exceeded the deaths by 633; in South Kensington the deaths exceeded the births to the number of 64. The excess of births over deaths in the several sanitary districts was as follows: In the North 407; the North-East 106; the North-West, 64; the Central, 19; the South-East, 57. In the South-West district the deaths exceeded the births to the number of 84. The registered births of illegitimate children in the parish, as a whole, were, as already stated, 191 (nine more than in 1898), viz., males 95, and females 96. Of these births 179 were registered in the Town sub-district, which includes the workhouse, at which institution out of 116 births (males 60 females 56), 80, including five of still-born children (males 3, females 2), were illegitimate. In the parish generally the illegitimate births formed 5.3 per cent. of total births, as compared with rates of 5.9, 5.3, and 5.0, in the three preceding years respectively. 11 The subjoined table shows the quarterly numbers of births of males and females in the parish, and in each of the subdistricts :— Kensington Town Brompton Males Females Total Males Females Total Parish 1st Quarter 409 401 810 68 57 125 935 2nd „ 366 382 748 66 74 140 888 3rd „ 387 363 750 67 77 144 894 4th „ 367 371 738 68 67 135 873 1529 1517 3046 269 275 544 3590 Illegitimate 22 22 44 2 3 5 49 Births 20 23 43 1 2 3 46 24 22 46 — 2 2 48 25 21 46 1 1 2 48 91 88 179 4 8 12 191 The subjoined table shows the population, the number of births, and the birth-rate for each of the ten years 1889-98 :— The Year. Population. Total Births. Males. Females. Birth-rate. per 1,000 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 1897 170,700 3,683 1,839 1,844 21.6 1898 172,000 3,633 1,830 1,803 21.1 Totals 37,107 18,816 18,291 Average 22.0 Excess of male births in the ten years 525 Excess of births over deaths in the ten years 9,153 Estimated increase of population in the ten years 6,240 Estimated loss of population, by migration or removals, in the ten years 2,913 12 DEATHS AND DEATH-RATE. The registered deaths, inclusive of 321 deaths of parishioners at outlying public institutions, etc., but exclusive of deaths of non-parishioners at public institutions, etc., within the parish, were 3,021, (males 1,430, females 1,591), and 160 more than the corrected decennial average (2,861). Of these deaths, 2,455 were registered in the Town sub-district, and 566 in Brompton. The death-rate, which in the preceding three years had been 16.7, 15.6, and 16.3, per 1,000, respectively, was 17.5* in 1899, and 0.9 above the decennial average (16.6), and 2.3 below the rate in the metropolis, as a whole (19.8), which was the same as the decennial average. The rate in the sub-districts was: Town, 198, Brompton 11.7 per 1,000, as compared with 18.6, and 10.2, respectively, in 1898. The sex-rate was, of males 21.0, females 15.2, per 1,000. The deaths in North Kensington were 1,897, and the death-rate 21.6 per 1,000. The deaths in South Kensington were 1,124, and the death-rate 13.3 per 1,000. The rate in the several sanitary districts was as follow:— *This is the crude death-rate. The rate corrected for age and sex-distribution was 19.3 per 1,000 The "true" death-rate is set out in the table at page 21. North 658 deaths, or 19.6 per 1,000 persons living. North-east 470 deaths, or 15.5 per 1,000 persons living. North-west 572 deaths, or 33.8 per 1,000 persons living. Central 509 deaths, or 18.6 per 1,000 persons living. South-east 320 deaths, or 9.9 per 1,000 persons living. South-west 492 deaths, or 15.4 per 1,000 persons living. 13 Infantile Mortality, or the proportion of deaths under one year of age to registered births, is an important factor in vital statistics. The deaths under one year, which in the three preceding years had been 656, 609, and 655, respectively, were 642 in 1899, being equivalent to 179 per 1,000 births. Of these deaths 88 were of illegitimate children; the ratio of deaths of illegitimate children to births registered as illegitimate (191) being 461 per 1,000. Of the 642 deaths, 151 occurred within one month after birth, including 90 in the first week of life, 19 in the second week, 23 in the third week, and 19 in the fourth week. In the second month of life there were 62 deaths, in the third month 65, in the fourth month 69, in the fifth month 40, in the sixth month 44, in the seventh month 49, in the eighth month 42, in the ninth month 32, in the tenth month 37, in the eleventh month 27, whilst in the twelfth month 24 deaths took place. The parochial rate of infantile mortality was, as usual, higher than that in the metropolis, being 179 per 1,000 births against 167 in London, as a whole. "This proportion," the Registrar-General states, "corresponded with that in 1898, and exceeds the proportion in any other year since 1871: it was also higher by 10 per 1000 than the average in the preceding ten years." In England and Wales the rate was 163, which is 12 per 1,000 above the mean proportion in the ten years 1889-98. In the Town subdistrict, which includes the infirmary, the deaths under one (574) were equivalent to 188 per 1,000 births, those in Brompton (68) to 125 per 1,000. The deaths in North Kensington were 496, or 196 per 1,000; the deaths in South Kensington were 146, or 138 per 1,000. In the several sanitary districts the rate was as follows :— North 193 deaths, or 181 per 1,000 registered births. North-east 113 deaths, or 196 per 1,000 registered births. North-west 162 deaths, or 255 per 1,000 registered births. Central 70 deaths, or 133 per 1,000 registered births South-east 40 deaths, or 106 per 1,000 registered births. South-west 64 deaths, or 157 per 1,000 registered births. 14 The Kensington rate of infantile mortality was exceeded in 14 of the sanitary districts; viz.:—Hammersmith, 183; Bermondsey, 187; Fulham, 189; Strand, 189; Newington, 191; Clerkenwell, 193; St. George-in-the-East, 200; St. Saviour, Southwark, 203; St. Martin-in-the-Fields, 203; Shoreditch, 204: St. George, Southwark, 205; Westminster, 207; Limehouse, 216; and Holborn, 226. In the remaining 28 districts the rate was below that of Kensington (in 23 of them it was also below that of London as a whole), the lowest rates being in Stoke Newington, 103; St. Giles, 112; Marylebone and Plumstead, 124; Hampstead and St. George, Hanover Square, 129; Lee, 141; St. James's, Westminster, 142; Lewisham, 143; City of London, 144; St. Olave, Southwark, and Whitechapel, 147; St. Luke, 149; Paddington, 151; Hackney and Wandsworth, 153; Camberwell, Lambeth, and Mile End, 158; and Islington, 160. The deaths of children over one year and under five years of age were 290: the total deaths under five years, therefore, were 932, as compared with 1,111, 912, and 1,039, in the preceding three years successively, being equal to 260 per 1,000 births; the relative proportion in London as a whole being 248. The deaths of illegitimate children under five years of age, 104, 126, and 87, in the three preceding years respectively, were 103 in 1899; of which 96 were registered in the Town sub-district, and 7 in Brompton. These deaths were equal to 53.9 per cent. on the 191 births registered as illegitimate. Of the 103 children, 15 only survived the first year of life. Senile Mortality.—At sixty years of age and upwards there were 943 deaths, as compared with 778, 735, and 862, in the three preceding years respectively. These deaths were equivalent to 312 per 1,000 deaths at all ages. The relative proportion in all London was 259 per 1,000. 15 DISTRICT RATES OF MORTALITY. The table at page 18 shows the death-rate in the metropolis, the parish, the sub-districts, the parliamentary divisions, and the sanitary districts, for the year, and also for each of the thirteen four-weekly periods covered by the monthly reports. As usual the rate was far higher in the Town sub-district than 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 (17.5 per 1,000), viz., the central (18.6), the north (19.6), and the north-west (33.8). The last named district, as now delimited, and containing a population of 16,940, includes the so-called "Notting-dale" special area. The mortal statistics of the district, as a whole, are unsatisfactory: the death-rate in 1899 (33.8 per 1,000) was more than double the rate in the remainder of the parish (15.8 per per 1,000), the zymotic death-rate (2.7 per 1,000), though much lower than in 1898 (4.2 per 1,000), was about twice as high as that of the remainder of the parish (1.37 per 1,000); the waste of infant life was also excessive, the deaths under one year (162) being equivalent to 255 per 1,000 births registered, the infantile deaths in the remainder of the parish being in the proportion of 162 per 1,000 births. These figures show to what a large extent the statistics of this district, which contains less than a tenth of the population, spoil those of the parish generally. In the "special area," which contains a population of 4,000 souls; the death-rate was 590 per 1,000, as compared with 17.5 in the parish, as a whole, and 26.0 in the north-west district less the special area: the zymotic deathrate was 3.0 per 1,000 persons living, or twice as high as that of the parish, as a whole. The deaths at all ages were 116 more than the births; the deaths of children under one year of age being in the proportion of 508 per 1,000 on the the births registered. 16 "NOTTING-DALE" SPECIAL AREA. VITAL AND MORTAL STATISTICS, 1899. (The corresponding statistics for the previous three years are added by way of comparison). 1899 1898 1897 1896 POPULATION (Estimated) 4,000 4,000 4,000 3,740 Births 120 117 130 118 Birth-rate 30.0 29.3 32.5 31.6 per 1,000 persons living Deaths 236 182 223 187 Death-rate 59.0 45.5 55.7 50.0 per 1,000 persons living INFANTILE MORTALITY Deaths under one year of age 61 49 56 51 Death-rate 508 419 431 432 per 1,000 births registered ZYMOTIC DISEASES Deaths from the Seven Principal 12 22 25 30 Death-rate from ditto 3.0 5.5 6.3 8.0 per 1,000 persons living Causes of Death.— In 5 cases, diarrhœa (irrespective of 7 from gastro-enteritis); in 3 cases, measles; in 2 cases, diphtheria; and in one case each, scarlet fever, and whoopingcough. The death-rate per 1,000 persons living, in thirteen successive four-weekly periods, was :— (1) 39.0 (2) 45.5 (3) 65.0 (4) 84.5 (5) 55.2 (6) 26.0 (7) 58.5 (8) 65.0 (9) 61.7 (10) 45.5 (11) 58.5 (12) 61.7 (13) 100.7. Ninety-four of the deaths occurred at the homes of the deceased persons, 129 at the Parish Infirmary (the total deaths at this institution being 605), and 13 at other public institutions: 57 of the deaths were of persons who had previously resided at common loding-houses in the area: only one death took place at a common lodging-house. The deaths comprised 127 of males, and 109 of females. 17 The ages at death were: under five years of age, 83 (including 61 under one year); between 5 and 20 years, there were 10 deaths; between 20 and 60 years, 99 deaths; at 60 years and upwards, 44 deaths. Among the principal causes of death were diseases of the nervous system, 8 deaths; diseases of the respiratory system, 78 deaths; diseases of the circulatory system, 9 deaths; other visceral diseases, 19 deaths; tubercular diseases, 42 deaths (including 36 from consumption); wasting diseases of infants, 23 deaths; cancer, 7 deaths; syphilis, 4 deaths; violence, 11 deaths, including 5 of infants from suffocation. Two deaths of infants prematurely born were registered, and 2 deaths from old age. Inquests were held in 20 cases. The deaths were connected with streets as follows: Bangor Street, 57 deaths; Crescent Street, 48 deaths; St. Katharine's Road 73 deaths; Kenley Street, 26 deaths; Sirdar Road, 32 deaths. 18 Death-rate in the Metropolis, and in Kensington, and in certain Districts of the Parish, during the thirteen four-weekly periods ended december 30th, 1899, and in the registration year, 1899. Four Weeks ended. Metropolis. Parish. Sub-Districts. Parliamentary Divisions Sanitary Districts. Kensington Town. Brompton. North. South. North. NorthEast. Northwest. Central. SouthEast. Southwest. January 28 ... 17.5 16.9 18.4 12.9 20.3 13.4 19.0 16.7 23.8 17.6 10.9 16.6 February 25 ... 20.8 18.2 20.5 12.6 21.6 14.7 21.4 16.7 26.1 21.4 9.3 18.7 March 25 ... 23.0 23.1 25.8 16.3 27.1 19.1 23.3 26.5 33.0 26.7 16.1 18.7 April 22 ... 19.7 18.2 20.6 12.1 23.2 12.9 17.5 18.8 37.6 16.2 13.3 14-6 May 20 ... 16.4 15.0 17.1 9.6 18.4 11.5 15.9 15.4 29.2 15.7 7.3 13.4 June 17 ... 15.9 11.9 13.1 8.8 12.3 11.5 9.7 6.8 28.4 13.8 10.5 10.1 July 15 ... 15.3 13.9 15.6 9.4 15.4 12.3 15.1 5.5 31.5 17.6 9.3 12.6 August 12 ... 22.2 19.7 23.6 9.6 28.3 10.8 24.9 23.1 43.7 17.6 8.1 11.8 September 9 ... 23.4 18.9 22.5 9.6 25.3 12.1 24.1 17.1 37.6 19.5 7.3 16.2 October 7 ... 18.1 15.1 17.0 10.2 18.5 11.5 19.4 10.7 33.0 13.8 8.5 13.0 November 4 ... 19.1 16.4 18.3 11.8 19.8 12.9 13.6 15.4 34.5 16.7 11.3 15.8 December 2 ... 17.9 15.5 16.8 12.3 18.7 12.3 20.9 9.8 25.3 17.1 8.5 15.8 December 30 ... 27.8 25.0 28.3 16.3 31.9 17.7 30.7 18.4 47.6 28.6 12.9 22.3 Death-rate for the Year 1899 19 .8 17.5 19.8 11.7 21.6 13.3 19.6 15.5 33.8 18.6 9.9 15.4 19 The True Death-Rate in 1899.—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 18, 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 331, and the death-rate was stated to be 25.0 per 1,000. This statement implied, simply, that if the deaths for the whole of the year had been in the same proportion to the population as in the four weeks, the annual death-rate would have been 25.0 per 1,000 of the estimated population at the middle of the year. The estimated population in 1899 was 172,400: the deaths registered were 3,021: the death-rate therefore, was 17'5 per 1,000 (3,021÷172,400=17.5). 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, a crude or uncorrected one, as it does not take cognizance of the relative numbers of the sexes, nor of the agedistribution 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, 36,180 in excess of males. The deaths among the 68,110 males (1,430), were 161 fewer than the deaths among the 104,290 females (1,591). The death-rate in the male sex was 21.0 per 1000, as compared with a rate of * "The standard death-rate" signifies the death-rate at all ages, calculated on the hypothesis that the rates at each of twelve age-periods in each town were the same as in England and Wales, duting the 10 years 1881-90, the death-rate in England and Wales during that period having been 19.15 per 1,000. RegistrarGeneral's Annual Summary. 20 15.2 per 1000 in the female sex. It must be obvious, therefore, that if the numbers of the sexes had been equal, the death-rate would have been higher than the recorded rate of 17.5 per 1,000 The Registrar-General in his annual summary for 1892 dealt with the 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 1898, 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 1899, becomes, instead of 17.5, one of about 19.3 per 1000; and the rate for London, as a whole, about 21.1 instead of 19.8. The true death-rate is that which shows the mortality per 1000 living of each sex at different age-periods, and this is shown for the parish in the table at page 21 The subjoined table shows the quarterly number of deaths of males and females, in the parish, and in each of the sub-districts. Kensington Town Brompton. Parish. Males. Females. Total. Males. Females. Total 1st Quarter 313 347 660 70 98 168 828 2nd „ 249 271 520 50 68 118 638 3rd ,, 323 297 620 47 74 121 741 4th n 304 351 655 74 85 159 814 1189 1266 2455 241 325 566 3021 The Births were, of Males, 1798 The Deaths were, of Males, 1430 „ Females, 1792 „ Females 1591 Total Births, 3590 Total deaths, 3,021 Deduct 3,021 Deaths Shows 569 excess of Births over Deaths. 21 THE TRUE DEATH-RATE* OF KENSINGTON IN 1899. (Vide page 19). 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 15,405 7,665 7,740 932 487 445 60.5 63.5 57.5 Five and under 15 28,152 13,438 14,714 90 45 45 3.2 3.3 3.1 Fifteen and under 25 38,509 13,406 25,103 82 40 42 2.1 3.0 1.7 Twenty-five and under 35 33,074 11,153 21,921 185 74 111 5.6 6.6 5.1 Thirty-five and under 45 23,028 9,013 14,015 249 127 122 10.8 14.1 8.7 Forty-five and under 55 16,334 6,569 9,765 348 175 173 21.3 26.6 17.7 Fifty-five and under 65 9,947 3,962 5,985 377 177 200 37.9 44.7 33.4 Sixty-five and under 75 5,624 2,122 3,502 350 157 193 62.2 74.0 55.1 Seventy-five and upwards 2,327 782 1,545 408 148 260 175.3 189.3 168.3 Totals 172,400 68,110 104,290 3,021 1,430 1,591 ... ... ... The "true" death-rate is that which shows the rate of mortality per 1,000 persons living of each sex at different age-periods. 22 DEATH-RATE IN ENGLAND AND WALES, AND IN LONDON, AND IN OTHER LARGE TOWNS. The death-rate in England and Wales in 1899 was 18.3 per 1,000, which is higher than the rate in either of the preceding three years, but 0.l below the decennial average. The rate in London, as already stated, was 19.8 per 1,000, being 0.1 below the decennial average: but by excluding the deaths of persons ascertained to have been strangers, the death-rate of London is reduced to 19.3 per 1,000. 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:— 1899. 1898 . 1897. 1896. 1895. 1894. 1893. 1892. 1891. 1890. 1889. Kensington 17.5 16.3 15.6 16.7 16.4 15.7 17.5 17.2 18.4 17.8 14.6 London 19.8 18.7 18.2 18.6 19.8 17.8 21.3 20.6 21.4 21.4 18.4 W. Districts 19.0 17.0 16.1 17.6 18.5 17.1 19.7 20.0 20.8 20.5 18.1 North ,, 18.1 16.9 16.6 17.1 18.2 16.3 20.2 19.4 20.0 19.6 16.9 Central ,, 22.5 22.1 21.8 21.2 23.8 20.0 25.7 23.9 26.5 24.8 20.9 East ,, 23.0 21.7 21.2 21.3 23.4 20.8 24.9 23.5 24.0 25.1 21.2 South ,, 18.5 17.7 17.2 17.5 18.3 16.2 19.5 19.0 19.8 19.6 17.7 England and Wales 18.3 17.6 17.4 17.1 18.7 16.6 19.2 19.0 20.2 19.5 18.2 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, 1899, numbering 6,528,434 (viz., 4,546,752 in inner or Registration London, and 1,981,682 in the Outer Ring), was 18.3 per 1,000, as compared with 17.0, 16.7, and 17.2, 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 14.8, the rate in the Inner Ring having been 18.7. The death-rate from the 23 principal diseases of the zymotic class in Inner London, was 2.48 per 1,000; in the Outer Ring 2.29; the rate in Greater London, as a whole, being 242 per 1,000. The infantile mortality of Greater London was 165 per 1,000 births: of Inner London 167, of Outer London 160. Other Large Towns.—The death-rate in the thirtythree large towns, including London, and having a population of 11,404,408, was 20.2 per thousand; ranging from 15.0 in Croydon, 15.4 in Cardiff, 16.2 in Huddersfield, and 16.7 in West Ham, to 22.8 in Preston, 23.8 in Salford, 24.6 in Manchester, and 26.4 in Liverpool. The death rates in Edinburgh, Glasgow, and Dublin, were 196, 216, and 308 per 1,000 respectively. These death-rates are calculated without correction for differences between one town and another in regard to the age and sex-distribution of their respective populations. This explanation is necessary because, as the Registrar-General points out, "In consequence of the great difference between one town and another, with respect to age and sex-constitution of their several populations, recorded death-rates require correction before they can be justly used for purposes of com parison." The Registrar-General, as already stated, gives in his annual summary, factors by the use of which the necessary corrections can be made with approximate accuracy for each town. Colonial and Foreign Cities.—The death-rate in some of the principal foreign and colonial cites was as follows—Indian Cities: Calcutta, 35.0 per 1,000; Madras, 38.1; and Bombay, 69.0. European Cities: Paris, 20.2 per 1,000; St. Petersburg, 25.2; Moscow, 28.5; Berlin, 18.7; Vienna, 20.6; Rome, 17.4. American Cities: New York, 18.4 per 1,000; Boston, 20.1; Philadelphia, 18.8; San Francisco, 19.0; and New Orleans, 26.3. 24 SUMMARY OF VITAL AND MORTAL STATISTICS, KENSINGTON. In the table at page 25 the principal vital and mortal statistics of the year have been 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 1899 was 20.8 per 1,009, as compared with the decennial average 22.0, and that the death-rate, 17.5 per 1,000, was 1.2 per 1,000 above the rate in 1898 (16.3) and 0.9 above the decennial average (16.6). There were, as nsual, considerable fluctuations in the rate at different periods of the year; the rate ranging between the minimum (11.9) in the sixth four-weekly period ended June 17th, and the maximum (25.0) in the thirteenth fourweekly period ended December 30th. The rate was in seven four-weekly periods below, and in six above the average. The deaths in the first half-period of the year (1,466) were fewer by 89 than those in the second half-period (1,555); the deathrate in the two half-periods being 17.0, and 18.0, per 1,000 respectively. There was a marked difference in the number of deaths from the principal diseases of the zymotic class in the two half-periods, the number in the first six months having been 88 only, as compared with 171 in the latter half of the year. The 259 deaths from these causes were 88 fewer than the number in 1898, and 89 below the corrected decennial average (348). The deaths from the diseases of the respiratory organs (672) were 101 in excess of the number in 1898 (571). The deaths from phthisis were 221, from diseases of the heart 232, and from tubercular diseases in children under five years of age, 70. The mean temperature of the air at Greenwich during the year was, approximately, 50°.6 degrees Fahr.; the means of the four quarters successively being 41.8, 52.8, 63.0, and 44.7. 25 SUMMARY OF VITAL AND MORTAL STATISTICS, KENSINGTON, 1899. During the four weeks ended. Births. Deaths. death-rate. deaths at ages. deaths from zymotic diseases. deaths from diseases of respiratory system. Deaths from Phthisis. Deaths from Heart Disease. Deaths under Five from Tubercular Diseases. Mean Temperature. kensington. london. 1899. Decennial Average. 1899. Decennial Average. 0—1 1—5 60 and upwards. Totals. Measles. Scarlet Fever. Diphtheria. WhoopingCough. Enteric Fever. Typhus Fever. Simple continued Fever. Diarrhœa. Totals. Bronchitis. Pneumonia. January 28 312* 224 16.9 21.9 17.5 25.2 42 20 84 9 ... 1 3 3 2 ... ... ... 55 44 7 16 20 5 0 43.2 February 25 302 242 18.2 18.5 20.8 21.4 48 32 83 19 ... ... 8 11 ... ... ... ... 55 43 6 19 24 8 42.3 March 25 254 307 23.1 19.1 23.0 22.0 45 31 122 18 ... ... 3 11 1 ... ... 2 92 67 16 22 24 6 38.2 April 22 293 241 18.2 16.7 19.7 19.7 45 23 79 16 1 1 ... 14 ... ... ... ... 67 45 15 17 17 5 46.6 May 20 262 199 15.0 16.3 i6.4 18.5 36 24 64 15 2 1 2 9 ... ... ... 1 42 19 20 17 16 2 50.5 June 17 271 158 11.9 15.4 15.9 17.4 23 15 44 8 1 ... ... 4 3 ... ... ... 27 13 13 7 14 4 56.4 July 15 265 184 13.9 14.9 15.3 17.3 38 17 55 12 3 1 2 2 ... ... ... 4 32 19 11 8 19 5 62.9 August 12 247 261 19.7 i6.2 22.2 20.1 108 26 52 62 2 ... ... 2 2 ... ... 56 21 7 10 14 12 8 66.6 September 9 293 250 18.9 13.6 23.4 18.1 83 24 55 41 4 1 3 2 6 ... ... 25 21 8 9 23 13 10 65.5 October 7 296 200 15.1 1.35 18.1 16.6 52 17 50 18 4 1 2 1 1 ... ... 9 24 16 5 20 20 6 53.4 November 4 282 218 16.4 14.6 19.1 17.8 34 18 70 16 1 ... 9 ... 5 ... ... 1 58 33 21 14 15 5 49.9 December 2 279 206 I5.5 15.8 17.9 19.2 34 11 63 12 ... 2 7 ... 1 ... ... 2 42 28 10 20 17 3 46.9 December 30 234† 331 25.0 183 27.8 21.2 54 32 122 13 6 1 3 ... 2 ... ... 1 136 102 29 24 21 3 36.3 TOTALS 3,590 3,021 17.5 16.6 19.8 19.7 642 290 943 259 24 10 42 59 23 ... ... 101 672 444 172 221 232 70 50.6 *Maximum number during the year, and so throughout the table. †Minimum number during the year, and so throughout the table. 26 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 of these Orders, Miasmatic and Diarrhaœl, 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 460, 310, and 347, in the preceding three years successively, were 259 in 1899, and 89 below the corrected decennial average (348). These deaths, of which 215 belong to the Town sub-district, and 44 to Brompton, were equivalent to 1.5 per 1,000 persons living (1.73 in the Town sub-district and 1.32 in Brompton), as compared with 2.0 in 1898. The rate in the Metropolis, as a whole, was 2.48 per 1,000 (2.78 in 1898); the decennial rate being, for London 27, and for Kensington 2.0, 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 ... ... ... ... ... 0.9 0.9 Measles 22 1 1 ... 24 77.7 79.7 Scarlet Fever 1 1 6 2 10 29.7 30.5 Diphtheria 4 4 24 10 42 63.2 64.8 Whooping-cough 44 13 2 ... 59 60.1 61.7 Typhus Fever ... ... ... ... ... 0.2 0.2 Enteric Fever 9 1 11 2 23 17.4 17.9 Simple-Continued Fever ... ... ... ... ... 0.9 0.9 Diarrhœa 89 10 2 ... 101 88.7 91.0 169 30 46 14 259 338.8 347.6 27 From the above table it appears that the mortality from enteric fever was in excess of the corrected decennial average, to the number of five deaths, and from diarrhoea to the number of ten deaths, that from all of the remaining diseases being below the average. District Zymotic Death-Rate.—The deaths in North Kensington were 178, and the rate 2.0 per 1,000 persons living. In South Kensington the deaths were 81, and the rate l.0 per 1,000. The rate in the several sanitary districts was as follows :— North 72 deaths, or 2.1 per 1,000 persons living. North east 49 deaths, or 1.6 per 1,000 persons living. North-west 46 deaths, or 2.7 per 1,000 persons living. Central 29 deaths, or 1.1 per 1,000 persons living. South-east 26 deaths, or 0.8 per 1,000 persons living. South-west 37 deaths, or 1.1 per 1,000 persons living. The table at page 25 shows the distribution of the deaths in Kensington, as a whole, from the several diseasess, as recorded in the thirteen four-weekly reports. In England and Wales the deaths from these diseases were at the rate of 2.21 per 1,000 persons living, the decennial average being about 2.5 per 1,000. In the thirty-three great towns, including London, the average rate was 2.81, ranging from 1.50 in Halifax, 1.56 in Croydon, and l.65 in Derby, to 4.32 in Salford, 4 35 in Burnley, and 4.39 in Sheffield. Before dealing with the local prevalence of the several diseases of the zymotic class, reference may be made to an investigation undertaken to ascertain to what extent reduction in mortality from the principal diseases had ensued upon preventive measures taken during the quarter-century 1873-97— as by provision of hospitals and isolation of the sick; by dis- 28 infection of houses, etc.; by compulsory notification (since 1889), and, generally, by increased attention to sanitation. The numerical results of this enquiry are set out in the table at page 29. It will be observed that, excepting with regard to diphtheria, the results are satisfactory, and such as may be deemed to justify the expenditure incurred in provision of hospitals, etc. The observation, of course, does not apply to measles, whooping-cough, and diarrhœa, diseases which are not admissible to the hospitals, and which, practically, are left to take their course, save in so far as the fatality of them may have been reduced by amelioration in the sanitary condition and the general surroundings of the people. Diphtheria prior to 1887 was essentially a rural disease. At about that time it began to invade towns, and it has since become a distinctly urban plague; which, so far, has not shown itself very amenable to the influences that have led to so satisfactory a reduction in mortality from small-pox, scarlet fever, and fever. Comparing the deaths from diphtheria in the quinquennial period, 1873-77, with those in the five years, 189397, there is shown in the latter period an increase in deaths to the number of 297, after correction for increase of population. Small-pox, on the other hand, shows a corrected reduction in deaths to the number of 102; and the other diseases reductions as follows:—measles, 69; scarlet fever, 88; whoopingcough, 138 ; fever, 125, and diarrhœa, 244. 29 DEATHS REGISTERED IN KENSINGTON FROM THE PRINCIPAL ZYMOTIC DISEASES, 1873 to 1897. Arranged in Quinquennial Periods. (Vide page 27). Quinquennial Period. Diseases. Population. Small-pox. Measles. Scarlet Fever. Diphtheria WhoopingCough. Fever. Diarrhœa. Totals. 1 2 3 4 5 6 7 8 9 1873 to 1877 93 364 215 87 354 185 589 1887 142,100 1878 to 1882 114 332 333 109 577 152 542 2159 160,600 1883 to 1887 53 346 108 133 391 101 490 1622 164,500 1888 to 1892 ... 416 132 294 366 99 375 1682 166,100 1893 to 1897 9* 365 168 401 283 95 458 1779 169,300 Totals 269 1823 956 1024 1971 632 2454 9129 ... *All of these nine deaths occurred in 1893, since which year no death from small-pox has been registered in Kensington. 30 SMALL-POX. There was no death from small-pox, the corrected decennial average number being 0.9; nor was any case of the disease notified. There has been no death from this cause in the parish since 1893, in which year nine deaths were registered after a death-free interval of five years. In London 29 cases were notified, against 979, 225, 104, and 32, in the four preceding years: 18 cases were admitted to hospitals; three deaths were registered; the decennial average number, corrected for increase of population, being 45. During the preceding ten years the deaths aggregated 428 only, the numbers being 0, 4, 8, 41, 206, 88, 55, 9, 16, and 1, in the successive years. Reduction In Small-Pox Mortality in London.— The reduction in small-pox mortality has been great since the Asylums Board adopted the practice of removing the sick to the country. The Board were first called upon to deal 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, my first year of office. 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 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 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 31 been, not 429, but 18,752. There has thus been a saving of more than 18,000 lives in the ten years. This satisfactory result—admittedly due, mainly, to the removal of the sick from London—was the outcome of the deputation of the sanitary authorities, and other 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 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 some 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 24 deaths (all under five years of age and six of them under one), as compared with 173, 33, and 120, in the three preceding years successively: 23 in the Town sub-district and 1 in Brompton; the corrected decennial average being 80. Twenty of the deaths occurred in the second half-period of the year. The deaths from this cause in the metropolis, as a whole, were 2,141, and 700 below the corrected decennial average: 386, 695, 530, and 530, in the four quarters successively. 32 Should Measles be made a Notifiable Disease?— In the early part of 1898, the London County Council received from the School Board a communication urging them "to include 'measles' in the term 'dangerous infectious disease,' in order that the local sanitary authorities might have power to proceed against parents who should send their children to school when suffering from measles." The said communication was based upon a report from the School Board's medical officer, stating that "several cases had come under his notice, of children being present at school whilst suffering from measles;" and calling attention to the fact that "the local authorities have no power at present to take any action in such cases." The Public Health Committee of the Council, "before coming to any decision in the matter," desired to "learn the views of the London sanitary authorities," and therefore asked if your Vestry "would be in favour of the extension to measles of the provisions contained in the Public Health (London) Act, 1891, relating to notification, etc., of infectious disease.' Personally I do not doubt that it would be useful to bring measles within the meaning of the expression, "infectious disease," so far as relates to exposure, and to the prohibition of the use of public vehicles for the conveyance of infected persons (Public Health (London) Act, 1891, Section 70); but I see no reason to modify the views adverse to the notification of measles expressed in these reports,* and approved, on more than one occasion, by your Vestry. Probably not a moiety of the cases of measles in any epidemic come to the knowledge of medical practitioners. Unless, therefore, the child is obviously very ill,—i.e., unless one or other of the complications occur to which the fatal issue in measles is usually due—the malady is *The question of the notification of measles was fully dealt with in my Annual Report for 1891 (pp. 97-106 inclusive), in which it was shown that no benefit had accrued therefrom at Edinburgh; 30,000 cases of measles having been notified (at a cost of ,£3,000) in the ten years, 1880-1889. 33 generally allowed to run its course without medical treatment, properly so-called, and therefore, very many cases would escape notification. It is true that the Act requires a "dangerous infectious disease" to be reported by the head of the family, but notification otherwise than by the medical man is of the rarest, and it would be difficult to enforce. Measles becomes epidemic about every second or third year in this parish; it rages for a few weeks; its victims are numerous; and then, for a time, only sporadic cases occur, the fatality being relatively trifling. (See Table V. Appendix). But during epidemic prevalence, measles is truly a "dangerons infectious disease and taking one year with another, is the cause of a greater mortality than scarlet fever, or even than diphtheria.* In this parish in 1897, there were only 33 deaths from this cause, whilst in 1896 there had been 173 deaths, of which 160 were registered in 24 weeks, including 45 in one period of four weeks. Having regard to the percentage mortality of measles, this number of deaths (160) indicates an immense number of cases, probably 5,000, as compared with 1,780 cases of all the notifiable diseases recorded in the same year. To deal with such a mass of cases—if they did get notified—in so short a period as half-a-year, and without action mere notification is useless, would be a task of great difficulty. And what could we do? I have always held to the view that without hospital accommodation for the bad cases which occur in the crowded and unhealthy homes of the poor, where, owing to complications induced by insanitary conditions, the disease so often proves fatal, no substantial benefit would accrue from notification. There is no such accommodation, nor is there likely to be; and, therefore, I think notification would be of little if any avail, as a means for reducing the fatality of measles. The disease is exceedingly infectious, and once in a tenemented house, or a house let in lodgings, and swarming with children, *The corrected annual average number of deaths in London from measles, in the ten years 1889-98, was 2,841; from scarlet fever 955 ; from diphtheria 2,225, 34 it is almost impossible to prevent it from spreading to all who are susceptible to the infection. The School Board do not allow of the attendance at school of children from infected houses, and it is possible that if measles was made notifiable, the head teachers would have some increased facilities for excluding children from infected houses. But this end might be equally well attained by the adoption of a course I suggested to the local superintendent of the School Board visitors some years ago; viz., that when measles threatens to become epidemic, the parents should be informed that school attendance is not allowed in the case of children living in an infected house. No action was taken in the matter. I venture to think that this course should be adopted, and proved to be ineffective, before resorting to notification, which would certainly be costly, and also involve much labour and trouble, probably to little purpose. SCARLET FEVER. The cases notified as scarlet fever were 443, as compared with 1,011, 749, and 474, in the three preceding years successively; viz., 245 in North Kensington, and 198 in South Kensington. The deaths were ten, and 21 below the corrected decennial average (31): 7 and 3 in the Town and Brompton sub-districts respectively. Five of the deaths were of children under five years of age. Eight of the deaths took place at outlying public institutions, to which 343 cases were removed, and two at home. The case-mortality was 2.1 per cent. (4.8 in 1898); viz., 23 per cent. in hospital cases, and 2.0 per cent. in home cases. The deaths in the three preceding years from this cause were 39, 29, and 23, respectively. The deaths in London, as a whole, were 398 (as compared with 942, 780, and 583, in the three preceding years successively), and were 557 below the corrected decennial average. Of the 398 deaths, 329, or nearly 83 per cent., took place in 35 public institutions. The cases notified numbered 18,112, as compared with 16,917 in 1898, 22,876 in 1897, 25,638 in 1896, 19,757 in 1895, 18,440 in 1894, and 36,901 in 1893. The mortality was 22 per cent. on cases notified, against 3.4 in 1898 and 1897; 3.7 in 1896; 41 in 1895; 5.2 in 1894, and 43 in 1893. Nearly 78 per cent. of notified cases were admitted to hospitals. The case-mortality in hospitals (admissions, 14,095), was 2.3 per cent. The subjoined table shows the degree of prevalence of the disease in the parish, and in London, as a whole, as indicated by the number of notifications, and of deaths registered, in thirteen successive four-weekly periods, as set out in my reports. Scarlet Fever in 1899. Report. for four weeks. ended No. of Notifications No. of cases admitted to hospitals No. of Deaths No. of cases in Hospital at the end of the period. Kensington London. Kensington. London. Kensington. London. Jan. 28 26 1374 19 980 1 39 2679 Feb. 25 20 1284 14 961 — 26 2575 March 25 20 1081 16 854 1 27 2355 April 22 26 905 18 669 1 25 2144 May 20 25 1167 20 915 1 27 2161 June 17 38 1318 29 1029 — 21 2280 July 15 39 1594 33 1251 1 31 2601 August 12 46 1408 38 1123 — 27 2674 Sept. 9 34 1246 27 1020 1 25 2550 Oct. 7 48 1907 38 1570 1 26 3003 Nov. 4 43 2124 33 1647 — 36 3539 Dec. 2 55 1650 43 1249 2 41 3445 Dec. 30 23 1054 15 827 1 47 2881 443 18,112 343 14,095 10 398 The notifications are taken from the weekly returns of the Asylums Board; the admissions to, and the numbers in, the hospitals, and the deaths in London, rom the weekly returns of the Registrar-General. 36 For the sake of comparison, I subjoin the corresponding table for 1898, taken from the report for that year. Scarlet Fever in 1898. Report. for four weeks. ended. No. of Notifications. No. of cases admitted to hospitals. No. of Deaths. No. of cases in Hospital at the end of the period. Kensington. London. Kensington. London. Kensington. London. Jan. 29 34 1302 25 946 4 68 3061 Feb. 26 40 1207 30 873 2 51 2674 March 26 31 1118 28 818 — 41 2371 April 23 40 1243 29 931 3 63 2334 May 21 31 1212 24 866 5 50 2241 June 18 32 1229 23 912 1 43 2194 July 18 40 1214 30 937 1 36 2314 August 13 55 1238 35 933 3 33 2293 Sept. 10 39 1085 29 880 1 37 2300 Oct. 8 30 1467 27 1188 — 29 2606 Nov. 5 32 1774 25 1391 — 44 3092 Dec. 3 36 1536 32 1157 2 45 3142 Dec. 31 34 1292 24 982 1 43 2939 474 16,917 361 12,814 23 583 Note.—Correction has not been made in the above tables for errors in diagnosis either with respect to notifications or admissions to hospital. The tables on pages 37-38, exhibit certain particulars of interest with respect to scarlet fever prevalence, &c., during 1899, and the ten preceding years, 1899-98. 37 Scarlet Fever Cases Recorded in Kensington in 1899, and in the Ten Preceding 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 1899 26 20 20 27 26 38 40 47 35 47 42 55 22 445 1898 34 40 34 39 31 31 40 45 38 31 33 38 34 478 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 Average 1889-98 ... 37.2 38.7 27.7 29.8 31.9 38.9 46.2 51.9 42.5 64.7 67.2 57.2 43.5 577† *Return comprises five weeks. †Without correction for increase in population. Note.— Compulsory Notification has been in operation since October, 1889. 38 Statistics of Scarlet Fever in Kensington in 1899, and in the Ten Preceding 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 1899 101 344 445 77 2 8 10 20 80 2.2 398 1898 117 361 478 76 1 22 23 3.4 95.6 4.8 583 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 86 166 262 66 8 20 28 29 71 11.1 778 39 "Return Cases" of Scarlet Fever, etc.—Not infrequently, infectious disease, scarlet fever, diphtheria, etc., breaks out in families soon after the return of a "recovered" patient from hospital. The matter has received attention at the hands of the Asylums Board, who, a few years ago, were disposed to attribute the occurrence of such " return cases " to any but the probable cause; viz., the continued infectiousness of the apparently recovered patient. The Managers thought it a reasonable explanation of the occurrence of such cases in this parish, to cite but one instance, that your Vestry employed a contractor to do the work of disinfection, and that superheated steam was not employed in the process. But, resolving to make a more precise investigation of the whole subject, in 1898, they appointed a medical expert to inquire into return cases which should be reported to that gentleman by the medical officers of health. The investigation has long since been completed; but, I believe, no report of the results has yet been published. A somewhat striking group of return cases occurred in this parish. A girl, suffering from scarlet fever was in hospital for fourteen weeks, returning home in apparent health at the end of July: it was noticed, however, that she had a nasal discharge. This child resumed customary intercourse with her young friends, four of whom shortly afterwards contracted scarlet fever. There was no doubt that they were infected by their companion, who had kissed them, and with whom they had played both in the streets and within buildings. It is highly probable that the infectious material was contained in the matter passing from the child's nose, but possibly the throat also remained in an infectious condition. So far as I was able to ascertain, desquamation of the skin had come to an end; and certainly the patient was away long enough to secure this object, the long detention in hospital having, I assume, been due to the continued discharge from the nose. 40 DIPHTHERIA. Cases of diphtheria (254) and membranous croup (3) to the aggregate number of 257, were notified, as compared with 371, 332, and 222, in the three preceding years successively: viz., 130 in North Kensington, and 127 in South Kensington. The deaths registered were 42 (against 72, 82, and 26, in the three preceding years respectively), being 23 below the corrected decennial average (65): 28 of them belong to the Town sub-district, and 14 to Brompton; 17 to North Kensington, and 25 to South Kensington. Twentynine of the deaths were of children under five years of age, including 3 under one year. Thirty-four of the deaths took place at hospitals, to which 199 cases were removed. The casemortality was 163 per cent., against 11.7 in 1898, which was about the lowest on record. So few deaths from this disease as in 1898 had not been registered in any year since 1885, the nearest approach to it being 35 deaths in 1890, and 28 deaths in 1891. In London, as a whole, the deaths, including deaths from membranous croup, were 1,946, and 279 below the corrected decennial average, as compared with 2,683, 2,261, and 1,772, in the three preceding years respectively. The notifications of diphtheria were 13,701, as compared with 13,361. 12,811, and 11,561, in the three preceding years successively. The cases of diphtheria admitted to hospitals are stated by the Registrar-General to have been 8,758, and the deaths in hospitals 1193, a mortality of 13.6 per cent. Local Outbreaks of Diphtheria.—In the early part of the year, after the Christmas vacation, there was a slight outbreak of diphtheria connected with St. Barnabas and St. Philip's Associated Schools, at Earl's Court Road, seven cases in all: one case in the boys' department, one case in the girls' department, and five cases in the infants' 41 ment. The dates of attack were, approximately, January 16th, 19th, 20th. 27th, and February 2nd, 4th, and 9th. The seven cases occurred in as many families: three of them proved fatal. The single case in the boys' department was obviously due to personal infection at home. The single case in the girls' department was regarded as a coincidence merely; as was the case of a child aged 2i years (and therefore below school age) whose brothers and sister went to the school, but were unaffected. This little child's case proved fatal. The origin of the outbreak was not ascertained. The spread in the infants' department was doubtless due to personal infection, in or out of school. A case in a child (infants' department) had occurred just before the re-opening of the schools; but no connection was traced between it and the school cases proper. A smaller outbreak also occurred at St. Barnabas Church House School, Warwick-gardens; three children having been attacked on February 3rd, and 4th, respectively. In one instance two members of the same family were in attendance at the two schools ; the first of the two cases occurring at Warwick-gardens School. The occurrence of cases of the disease at the two schools, at about the same time, appeared to be a coincidence. A severe local outbreak of diphtheria occurred at a stable, at Manson-mews, South Kensington, five cases in one family having been been notified between October 24-31. The illness in the first case had existed about a week before removal to hospital: its origin was not traced, nor was the nature of the illness recognized, hence extension of the disease. The first four cases were of children ranging in age from 2 to 16 years. The fifth case was that of the mother: two of the children died. Diphtheria occurred on three occasions at Royalcrescent (western section), Notting-hill: three cases in three adjoining houses, none of which proved fatal. The occurrence of the disease was thought to be connected with the 42 existence of untrapped street gullies, which gave rise to offensive smells frequently the subject of complaint, and ultimately rectified by the trapping of the gullies. The sewer, of an oldfashioned type and defective construction, and of proportions greatly in excess of requirements, is to be ventilated by a shaft carried up one of the houses, at the corner of Darnleyroad. The following table based on the thirteen four-weekly reports, sets out some particulars with regard to diphtheria, in Kensington and in London, in 1899. Diphtheria in 1899. 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. 28 20 991 13 672 3 125 1368 Feb. 25 27 991 22 689 8 150 1394 March 25 15 831 12 518 3 166 1200 April 22 12 665 6 440 — 114 1034 May 20 8 840 6 586 2 111 1066 June 17 8 927 3 633 - 110 1170 July 15 19 1212 16 869 2 121 1434 August 12 24 1169 18 853 - 147 1519 Sept. 9 21 978 16 719 3 115 1463 Oct. 7 24 1272 18 909 2 163 1519 Nov. 4 31 1473 31 1029 9 214 1715 Dec. 2 28 1247 23 915 7 219 1735 Dec. 30 20 1105 15 820 3 208 1693 257 13,701 199 9652 42 1963 Note.—Correction has not been made in the above table for errors in diagnosis either with respect to notifications or admissions to hospital. Cases of membranous Croup are also included. The table at page 43 gives particulars with respect to diphtheria in North and South Kensington respectively. 43 PARTICULARS WITH REFERENCE TO DIPHTHERIA IN KENSINGTON, IN 1899. 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 28 20 9 11 6 7 1 2 February 25 27 13 14 10 12 4 4 March 25 15 6 9 5 7 1 2 April 22 12 8 4 5 1 ... ... May 20 8 4 4 4 2 ... 2 June 17 8 3 5 1 2 ... ... July 15 19 7 12 6 10 1 1 August 12 24 13 11 9 9 ... ... September 9 20 10 10 7 9 1 2 October 7 24 16 8 13 5 1 1 November 4 33 18 15 16 15 4 5 December 2 27 13 14 11 12 4 3 December 30 21 10 11 7 8 ... 3 258 130 128 100 99 17 25 * 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. 44 Bacteriological Examination.—A letter was received from the County Council in September, 1898, inquiring if your Vestry were in favour of powers being conferred on local authorities to establish a bacteriological laboratory, to enable medical officers and medical practitioners to obtain, at the expense of the County, the examination, by a competent bacteriologist, of material from suspected cases of infectious disease, with a view to aiding in the diagnosis? Your Vestry, without deeming it necessary to make it a matter of reference to a committee, passed a resolution directing that the Council should be informed that the Vestry were not in favour of the proposal in question. But in February, 1899, the Sanitary Committee having expressed the opinion that it was desirable arrangements should be entered into with some reliable institution, whereby bacteriological examinations may be obtained in such suspected cases of diphtheria, and other similar specific diseases, as are brought to the notice of the medical officer of health, it was decided that the Jenner Institute would be the preferable body to entrust with such examinations; an arrangement was entered into and has been of great service. 45 Diphtheria Mortality in London, Kensington, and adjacent Districts.—Certain observations in relation to diphtheria in the second monthly report (February 28, page 17 and p. 24: vide page 28 of the present report), created an erroneous impression that the increase in mortality therein referred to was peculiar to Kensington, the fact being that diphtheria had been largely on the increase in London generally for some years. The report in question was referred to the Sanitary Committee, to whom I explained that the increase in mortality had been greater in many other parishes than in Kensington, whose death-rate from this cause compares not unfavourably with that of London, as a whole, and of adjacent parishes, as is shown in the subjoined statement, based upon a table in the Registrar-General's Annual Summary for 1898, which exhibits the number of deaths per 100,000 persons living during the ten years, 1889-98 (after distribution of deaths in public institutions), in London, and in Kensington, Paddington, Hammersmith, Fulham, and Chelsea. The year 1889 1890 1891 1892 1893 1894 1895 1896 1897 1898 Decennial Average. London 38 33 32 44 75 61 52 59 50 39 48 Kensington 67 20 17 20 49 46 53 40 47 15 37 Paddington 36 34 20 23 58 76 38 51 51 48 43 Hammersmith 49 51 75 74 53 49 43 49 28 21 49 Fulham 15 25 21 32 63 99 70 66 53 49 49 Chelsea 25 58 17 41 54 54 59 117 56 43 52 The Kensington diphtheria death-rate, it will be observed, is the lowest in the group. The death-rate from diphtheria per 1,000 persons living, during the ten years 1889-98 (after distribution of deaths in public institutions) in London and Kensington, was as follows :— 1889 1890 1891 1892 1893 1894 1895 1896 1897 1898 London 0.38 0.33 0.32 0.44 0.75 0.61 0.52 059 0.50 0.39 Kensington 0.67 0.20 0.17 0.20 0.49 0.46 0.53 0*40 0.47 0.15 The decennial average rate in London was 0.48; in Kensington, 0.37. 46 The Antitoxic Treatment of Diphtheria.— The reduced mortality of diphtheria, during the last five years, has been the outcome of the use of antitoxin at the hospitals of the Asylums Board. In the report for 1896 (p. 46) I dealt somewhat fully with this subject, in connection with the first annual report (for 1895) of the medical superintendents of these institutions, setting out their combined experience on antitoxin in the treatment of this dire disease. The conclusion arrived at was that in antitoxic serum they possessed a "remedy of distinctly greater value than any other with which they were acquainted." Subsequent experience has served to confirm this view, and the serum has now secured a permanent footing, not only as a remedy but also as a prophylactic. The Managers, it may be mentioned, have made arrangements with the Laboratories Committee of the Royal Colleges of Physicians and Surgeons for the supply of serum to the Hoard's hospitals. It was stated in the annual report of the Chairman of the Board for 1897, that since the introduction of antitoxin in the treatment of the patients suffering from diphtheria, the case-mortality in all the Board's hospitals has fallen—from 293 per cent. during the year 1894, to 17.7 per cent. during the year 1897, "whilst the decrease in the mortality amongst cases of post-scarlatinal diphtheria in the convalescent hospitals had been most striking." The report for 1898 exhibited a still further improvement upon these relatively satisfactory statistics, the death-rate having further fallen to 15.1. In 1899, the mortality was only 136 per cent. WHOOPING-COUGH. Whooping-cough was the cause of 59 deaths, against 99, 19, and 52, in the three preceding years successively; 46 in the Town sub-district and 13 in Brompton, the corrected decennial average being 62. All of the deaths were of children under five years of age, including 29 under one year. The deaths in London, as a whole, from this cause, were 1,720, and 714, below the corrected decennial average. 47 FEVER. Enteric Fever.—One hundred and seven cases were notified during the year, against 94, 117, and 104, in the three preceding years. The deaths were 23 (five above the corrected average), viz., 20 in the Town sub-district, and 3 in Brompton. Thirteen of the deaths took place in hospitals, to which 73 cases were removed, and 10 at home. The deaths in the three preceding years had been 15, 21, and 12. In London, as a whole, the deaths from this cause were 801, and 189 above the corrected average. The notified cases were 4,460 in number. During the fourteen weeks ended December 2nd, no fewer than 2,288 cases were notified, against 1,437 in the corresponding weeks in 1898. The disease was unusually fatal during the last quarter of the year (381 deaths). In the week ended 28th October, 40 deaths were registered, being the highest number registered in any week since November, 1881. This number was afterwards exceeded, 51 and 55 deaths having been registered in the two weeks ended November llth and 18th respectively. In the subsequent two weeks, the deaths fell to 29 and 26. The autumnal increase in enteric fever is sometimes ascribed to drinking water derived from rivers supposed to have been contaminated by infective material washed from land and brooks after copious rainfall. The increase and unusual prevalence in 1899, were coincident with exceptional drought. Many cases of the disease are sent by the Asylums Board to certain general hospitals, under an arrangement sanctioned by the Local Government Board. So great was the pressure for accommodation in the autumn, that the Managers of the Asylums Board made arrangements with an additional hospital for the reception of cases, in wards furnishing beds for 36 patients. In the autumn, cases of enteric fever are not infrequently imported from the country, and from seaside "health resorts" 48 and other holiday places. Several instances of this sort occurred in the parish. Three of the sufferers were men holding official positions, of whom two died ; the wife of one of them contracted the disease from her husband. A fourth case was that of a railway porter. Three other cases were female domestic servants, and one case was that of a lady recently returned from the continent. The infective material of enteric fever is not infrequently conveyed by shell-fish, derived from specifically contaminated water, and it is worthy of remark that in several of the cases locally recorded, the sufferers had partaken of oysters, mussels, etc., at seaside resorts, within such periods of time antecedent to date of illness, as to suggest a relationship of cause and effect. Endemic of Enteric Fever.—The most serious outbreak of the disease in Kensington originated from cases occurring in Haddington in May and June. Some six households in the two parishes furnished 11 or 12 cases; but, with a single exception (case 9), we had no knowledge of any of them until after removal to hospital or death. Two of the cases, the first and the last, were not notified, and some doubt was felt as to the character of the illness, though there was very strong suggestion, amounting to conviction, of typhoid in respect of the first case, which, in the subjoined account (from the ninth monthly report), will be taken as the initial case in the group. Of the twelve cases four were young children, all of whom recovered, and eight were adults, six of whom died; all save the first and the last cases. Case 1.— Minnie S—, aged 31 years, wife of a painter, mother of four young children: occupied two kitchens in Paddington; was described as of dirty habits, living under unwholesome conditions generally, and not particular as to quality of food. She 49 fell ill at the end of May, was attended by Dr. M., and was laid up about one month, with symptoms indicative of typhoid; but the case was not notified. She recovered, having been attended or visited during her illness by several of the persons who subsequently fell ill, in Paddington and in Kensington. Case 2.— Augustus S—, aged 36, painter, husband of case 1; fell ill on or about June 17: case notified by Dr. M. as enteric fever June 22nd: was removed to hospital June 23rd and died on the 26th. During this man's illness, apparently on June 21st, two of his children, Edith and Amy, were removed to a house in Blagrove-road in this parish, where Arthur R—, their mother's brother, with his wife and four children, occupied three rooms. After the death of her husband Mrs. S—, with three children, removed to a house in Kensington-parkroad, to share with her parents and an adult sister two rooms on the top floor. Case 3.— Edith S—, 8 years—the first of the Kensington cases, but infected before arrival in the parish, fell ill at Blagrove-road, on or about July 5th, and was sent to her mother (the widow of case 2), at Kensington-park-road. Case 4.— Amy S—, aged 6 years, fell ill on or about July 7th, at the Kensington-park-road house. She and her sister Edith (case 3) were attended, on July 12th, by Dr. E., who, on 13th, notified both cases as "continued fever, probably typhoid," They were removed to hospital the same day. Both recovered. Case 5.— Arthur R—, aged 7 years, cousin to cases 3 and 4, fell ill at Blagrove-road, on or about July 11th. He appears to have been seen for the first time by Dr. E., on 18th July. 50 Case 6.— Edith R—, aged 5, sister to case 5, fell ill at Blagrove-road on or about July 22nd, was first seen by Dr. E. on 26th, on which day he notified both cases (5 and 6) as enteric fever, and they were removed to hospital on the 27th. Both recovered. Case 7.— Amy R—, aged 23, aunt to the four children (whose washing she had done), and sister to Mrs. S—(case 1) fell ill at Kensington-park-road, on or about July 19th, was first seen on 22nd by Dr. G. who notified the case on 26th, on which day the patient died. The body was removed to the mortuary. Case 8.— Thomas S—, aged 18, a railway porter, who with his mother and brother(absent from home at the time of his illness), occupied three rooms on the first floor in the Kensington-park-road house: fell ill on or about July 20th ; was first seen by Dr. C., on 27th, on which day the case was notified and removed to hospital. He died on 18th August. Case 9.— Arthur R—, aged 27, a painter, brother to Mrs. S—(case 1) and Amy R—, (case 7) and father to two of the children (cases 5 and 6), fell ill at Blagrove-road, on or about July 21st, on which day he was seen by Dr. E., who notified the case on the 31st. The patient had visited Augustus S— (case 2) in hospital, on the day of his death, June 26th. But he probably contracted the disease from his niece, Edith S—(case 3), or by visiting other sick relatives. He refused to go to hospital, and died August 18th. Case 10.— Louisa R—, aged 52, mother or grandmother to all of the previous sufferers, excepting 51 • Thomas S—(case 8, who was not related to the family), Augustus S—(case 2), being her son-in- law : fell ill towards the latter end of July; the case was notified by Dr. G.—, on 2nd August. She was removed to hospital, and died on the 6th August. Case 11.— A Mrs. W—, aged 44, living in Paddington, who had visited Mrs. S— (case 1). and had been in frequent communication with other sufferers, fell ill on or about 18th July; the case was notified, July 26th ; she died 30th July. Case 12 (?).—On or about 26th July, Mrs. T—, Clydesdale-mews, who had nursed, more or less, all of the above cases, fell ill. She was attended by Dr. E—, who, however, did not notify her illness, and, therefore, of course, did not regard it as typhoid. But the nurse herself said her symptoms were similar to those observed in her patients, and, having been ill a month, she felt sure she had had " the fever." [A married couple, Mr. and Mrs. H—, aged respectively 25 and 23 years, who lived in Paddington, fell ill July 25th ; the cases were notified as enteric fever on 5th August; the patients were removed to hospital on the 7th, and died on the 12th and 19th respectively, There 1s a suspicion of connection between these cases and the group, but not very clear. The young woman who attended on them at home, when they were supposed to be suffering from influenza, was a friend of the mother of Mrs. Arthur R—(wife of case 9). There had been a good deal of visiting amongst the various members of the family: formal complaint was made to me, in particular, in respect of Mrs. Arthur R—, herself, who persisted in going about amongst her friends whilst nursing her husband.] 52 The origin of the illness of Mrs. S. (case 1) is unknown; the spread of the disease from person to person in the remaining cases (2 to 12) is clear enough. It was due in part, I believe, to direct infection. Enteric fever is not a highly infectious disease, like typhus for example; but when it spreads from the sick person to the nurse or other person, it is usually owing to the want of cleanliness, and through the agency of the excreta, contaminating hands, etc., or getting into food. I had communications with the doctors in attendance on the sufferers, who attributed the spread to this cause, and to general neglect of necessary precautions, and disregard of the directions given by them. Dr. M., who attended cases 1 and 2, said "Mrs. S.'s illness looked like typhoid," and he said he meant to report it, "but the diarrhoea stopped." He subsequently added that he did not at the first look upon the case as one of typhoid, but knowing what had happened since," he thought "it may have been. Of course," he continued, " if the wife's case was one of typhoid, the husband might quite well have contracted the disease from her, for although he was warning them all the time, they slept in the same bed. The family were not cleanly, and probably drank out of the same dishes, although he warned them against all this." Dr. E., who attended cases 3, 4, 5, 6, 9 and 12, stated that his view with respect to the spread of the disease amongst the children was, that the people, being poor and cramped for room, the parents, moreover, "being uninstructed as to the danger, allowed the bed clothes to get soiled with the excreta, which, having dried and become pulverised, contaminated their food." Dr. C., who attended case 8, and knew of the other cases, attributed the spread of infection to "overcrowding and general carelessness in cleansing and disinfecting contaminated articles." Dr. G.'s patient, Louisa R— (case 10), had partaken of food left by her daughter Amy (case 7), using the same dishes and utensils. The two 53 rooms occupied by this family of three adults, became dangerously overcrowded when Mrs. S—(case 1) and her four children (two of whom were already infected) entered into joint occupation of them. The remarkable feature of the outbreak was its fatality, six out of eight (or possibly seven) adults attacked having perished. Typhus Fever.— Of this disease one non-fatal case was notified. The notifications in London, as a whole, were 14, and the deaths 2 in number. Simple Continued Fever.— No death was registered in Kensington from this cause: the notifications were 17. There was but one death in London, as a whole; 69 cases were notified. DIARRHŒA. Diarrhoea was the cause of 101 deaths, against 61, 125, and 112, in the three preceding years: 91 in the Town subdistrict, and 10 in Brompton, the corrected average being 91. Eighty-one of the deaths took place in the eight weeks ending September 9th ; 56 and 25 in the two successive four-weekly periods. These deaths were irrespective of the deaths from gastro-enteritis, which are now separately classified by the Registrar-General. The deaths from this cause were 74: 73 of them under five years of age, including 58 in the first year of life. Ninety-three of the deaths from diarrhoea were of children under five years, including 84 under one year. In the report for 1897 (pp. 42-45) I dealt at some length with the subject of infantile diarrhoea, and have nothing to add to the remarks on causation, etc., therein set out. The deaths from diarrhoea in London, as a whole, were 4,196, and 941 above the corrected decennial average. The high mortality from diarrhoea and gastro enteritis was mainly due to the effects of the excessive heat of the weather: the mean temperature in the four weeks ended August 12 was 66°.6 F., and in the four weeks ending September 9, 65°.5 being 4 9 above the decennial average. 54 INFLUENZA. One hundred and three deaths were registered, against 20, 44, and 70, in the three preceding years. Sixty-five of the deaths occurred in the Town sub-district, and 38 in Brompton. The deaths in London, as a whole, from this cause were 1,817, as compared with 2,117, 491, and 679, in the four preceding years, and were 545 above the corrected decennial average. Other Diseases of the Zymotic Class.—Still dealing with the diseases in this important Class, it appears that one death from Remittent Fever was registered in Order 3 (Malarial Diseases), and no death from Zoogenous Diseases, comprised in Order 4. Order 5, Venereal Diseases, includes Syphilis, Gonorrhoea, and Stricture of the Urethra. Syphilis was the registered cause of 17 deaths, against 18, 21, and 16, in the three preceding years respectively. Fourteen of the deaths occurred in the Town sub-district, and 15 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 was one death from Stricture of the Urethra. Order 6, Septic Diseases. This Order comprises Erysipelas, Pyœmia, Septiœmia, and Puerperal Fever: the total deaths registered were 17, as compared with 12, 21, and 12, in the three preceding years respectively. Erysipelas was the cause of 8 deaths,* six of them in the Town sub-district, as compared with 4, 9, and 7, in the three preceding years respectively. There were 4 deaths from Pyœmia or Septiœmia. * The notified cases of erysipelas were 210, 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. 55 Puerperal Fever was the registered cause of 5 deaths, of women between 15 and 45 years of age (as compared with 7, 5, and 5, in the three preceding years respectively), all of them n the Town sub-district. In addition to these 5 deaths, other 4 deaths (all of them in the Town sub-district) were registered as having occurred in childbed, as compared with 13, 9 and 6, in the three preceding years respectively. The deaths registered as having been caused by diseases and accidents associated with parturition (9 in all) were equal to 25 per 1,000 live births, against 5 4, 3.8 and 3.0 per 1,000 in the three preceding years respectively. The notifications of puerperal fever were 11 in number. Bearing 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 1899 with satisfactory results, there having been no spread of the disease. Class II.— Parasitic Diseases. The deaths from the diseases in this Order were 7; 6 of them in the Town sub-district. Thrush was the cause of 6 deaths, and Worms of one death. Class III.— Dietetic Diseases. The deaths from the diseases in this Order were 19: 17 of them in the Town sub-district. Delirium Tremens was the cause of two deaths, as compared with 4, 4, and 6, in the three preceding years respectively; Chronic Alcoholism of seventeen deaths, against 10, 11, and 18. It is scarcely necessary, perhaps, to remark that if all the deaths due, directly or 56 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 536 deaths (equal to 17.7 per cent. of total deaths), including 77 of children under the age of five years: 426 of the deaths were registered in the Town sub-district, and 110 in Brompton. Rheumatic Fever and Rheumatism of the Heart caused 10 deaths, 9 of them in the Town sub-district; Rheumatism 5 deaths. Gout was the cause of 6 deaths, 5 of them in the Town sub-district, and Rickets of 3, two of them in the Town sub-district. Cancer, Malignant Disease, was accountable for 169 deaths: 120 in the Town sub-district and 49 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 ten preceding years were 138, 125, 127, 129, 140, 143, 136, 173, 168, and 193, 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, 138 of the deaths took place at ages above forty-five, and 22 between thirty-five and forty-five years. 57 Purpura (Hemorrhagic Diathesis) was the cause of one death ; Anœmia and Leucocythœmia, of 2 ; Glycosuria, Diabetes Mellitus, of 15 ; and Other Constitutional Diseases, of 6. Tubercular diseases were the registered causes of 319 deaths (as compared with 318, 340, and 333, in the three preceding years respectively); viz., 276 in the Town subdistrict, and 43 in Brompton: 71 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, eg., the brain, bowels, &c. Such deaths have been classified in Table III. (appendix) with those ascribed to "Other forms of Tuberculosis, Scrofula" the total being 47 (of which 23 occurred under five years of age) including 39 registered in the Town subdistrict. Tabes Mesenterica, popularly known as consumption of the bowels, was the cause of 14 deaths (12 of them in the Town sub-district); all of them under five years of age, and 10 under one year. Tubercular Meningitis and Hydrocephalus (water on the brain) were the causes of 37 deaths; 5 only of them in Brompton, and 32 under five years of age. Phthisis, popularly known as decline or consumption, was the cause of 221 deaths; 2 under five years of age, 1 between five and fifteen years of age, and 206 between fifteen and sixty-five: viz., 18, 63, 55, 50, and 20, in the five decennial periods consecutively: 12 deaths were registered at ages over 65. Of the total deaths, 193 belong to the Town sub-district, and 28 to Brompton. The deaths from tubercular diseases were, proportionally to population, not nearly so numerous in Brompton as in the Town sub-district.* * Under the heading "The Prevention of Consumption," further information on the subject of Tuberculosis will be found in a later portion of this report. 58 Class V.—Developmental Diseases. In this class the total deaths were 196, viz., 164 in the Town sub-district, and 32 in Brompton. Premature Birth was the assigned cause of 64 deaths, 14 of them in the Brompton sub-district; Atelectasis of 11, all of them in the Town sub-district; and Congenital Malformation of 6, five of them in the Town sub-district. Old Age was the registered cause of 115 deaths, all but two of them at ages over sixtyfive: between sixty-five and seventy-five there were 15 deaths so classified; between seventy-five and eighty-five 59; and at eighty-five and upwards 39. 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 1,616 deaths (as compared with 1,324 in 1898) or 53.5 per cent. of the deaths from all causes: 1,317 were registered in the Town sub-district, and 299 in Brompton: 375 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 291 deaths (as compared with 273, 265, and 241, in the three preceding years respectively), viz., 228 in the Town sub-district, and 63 in Brompton: 56 of the deaths were of children under five years of age, and 177 occurred at ages over forty-five. The fatal diseases were, Inflammation of the Brain or Membranes, 23 deaths; Apoplexy, Softening of the Brain, Hemiplegia, Brain Paralysis, 137 deaths (100 in the Town sub-district, 37 in Brompton); Insanity, General Paralysis of the Insane, 18 (eleven of them in the Town sub-district:) Epilepsy, 14; Convulsions, 32 (all under five, and 25 under one year): Laryngismus Stridulus, 5; Disease of the Spinal Cord, Paraplegia, Paralysis Agitans, 10; Other Diseases of Nervous System, 52. 59 2. Diseases of the Organs of Special Sense (e.e;. of Ear, Eye, Nose) are comprised in this Order. Nine deaths were registered from these causes. 3. Circulatory System,—The deaths due to diseases of the organs of circulation, heart and blood vessels, were 256, as compared with 247, 210, and 200, in the three preceding years respectively : 200 were registered in the Town subdistrict, and 56 in Brompton. Heart diseases proper caused 233 deaths. To specified forms of disease 66 deaths were ascribed, viz., Pericarditis, 5, Acute Endocarditis, 6; Valvular Diseases of the Heart, 55; Other Diseases of the Heart caused 167 deaths. Aneurism was the cause of 6 deaths, and Embolism, Thrombosis, of 9. Other Diseases of Blood. Vessels caused 8 deaths. 4. Respiratory System.—The deaths from the diseases of the respiratory organs, Phthisis being excluded, were 672 (as compared with 516, 491, and 572, in the three preceding years respectively), and 22.2 per cent. of total deaths. Of these deaths 575 were registered in the Town sub-district, and 97 in Brompton. The deaths under five years of age were 183, or 27.2 per cent., as compared with 43.8, 38.7, and 383, per cent. in the three preceding years respectively; and at fifty-five and upwards, 319, or 47 5 per cent., against 38 6, 36 9, and 40 7, per cent. in the three preceding years respectively. The fatal diseases were Laryngitis, 3 deaths; Emphysema, Asthma, 16; Bronchitis, 444; Pneumonia, 172; Pleurisy, 13; and Other Diseases of the Respiratory System, 23. Bronchitis and Pneumonia, therefore, were accountable for 616 deaths (including 179 under five years of age), of which 87 were registered in Brompton. One death was registered from Croup* * Three cases of membranous croup were notified. The Registrar-General classifies fatal cases of this disease to diphtheria. 60 5. Digestive System.—The diseases of the various organs concerned in digestion were the causes of 263 deaths; 126 of them under five years of age; 211 in the Town subdistrict and 52 in Brompton. Dentition was the cause of 17 deaths under five, 13 of them under one year. Diseases of the Stomach caused 27 deaths ; Enteritis, 30; Gastro-enteritis, 74; Obstructive Diseases of Intestine, 21; Peritonitis, 14. Cirrhosis of Liver caused 34 deaths; faundice and other Diseases of Liver, 30 (including three under one year); and Other Diseases of Digestive System, 16 deaths. 6. Diseases of Lymphatic System {e.g., of Lymphatics, and of Spleen). No death was registered. 7. Diseases of Gland-like Organs of Uncertain Use {e.g., Bronchocele, Addison's Disease). Two deaths were registered. 8. Diseases of Urinary Organs.—Of the 92 deaths ascribed to these causes, 70 were registered in the Town subdistrict and 22 in Brompton. The fatal diseases were Nephritis, 19 deaths; Brights Disease (Albuminuria), 34; Diseases of Bladder or of Prostate, 13 ; and Other Diseases of Urinary System, 26 deaths. 9. Diseases of Reproductive System.—(a) Of Organs of Generation—Female Organs, 14 deaths ; {b) Of Parturition, 4 deaths, viz., Miscarriage, 2; Other Accidents of Childbirth, 2. 10. Diseases of Bones and Joints.—Eight deaths were registered : Caries, 1; A rthitis, 6 ; Other Diseases, 1. 11. Diseases of Integumentary System.— Five deaths were registered. 61 Class VII.— Deaths from Violence. One hundred and twelve deaths, including 43 under five years of age, and 30 under one year, are distributed over two of the four Orders comprised in this Class : 17 of them belong to the Brompton sub-district. 1. Accident or Negligence.—Total deaths, 99, including 13 in Brompton, and 43 under five years of age; viz., from Fractures and Contusions, 53; Burn, Scald, 10 ; Poison, 1; Suffocation, mostly of infants overlaid, 31; Otherwise, 4. Thirty of these "accidents" occurred to children of less than one year old. Thirty of the deaths from suffocation were registered in the Town sub-district. 3. Suicide.—Total deaths, 12; including 4; in Brompton, viz., by Gun-shot Wounds, 5; Poison, 5; Drowning, 1 ; Hanging, 1. Class VIII.—Deaths from Ill-Defined and not Specified Causes. This Class includes the causes of 132 deaths, 115 under five years of age, and 102 under one year; 117 and 15 in the Town and Brompton sub-districts respectively. The causes named are: Dropsy, 3; Debility, Atrophy, Inanition, 111 deaths (all under five years of age, and 99 under one year); Mortification, 4; Tumour, 2; Abscess, 3; and Hemorrhage, 1. To Causes not Specified, or Ill-defined, 8 deaths were ascribed. 62 The following table being a Summary of Table III (appendix) shows the number of deaths from the various diseases in the several Classes and Orders. CLASS I.—SPECIFIC FEBRILE OR ZYMOTIC DISEASES. Order. No. of Deaths. 1. Miasmatic Diseases 263 2. Diarrhæal „ 104 3. Malarial „ 1 4. Zoogenous „ - 5. Venereal „ 18 6. Septic „ 17 - 403 II. PARASITIC DISEASES 7 III. DIETETIC DISEASES 19 IV. CONSTITUTIONAL DISEASES 536 V. DEVELOPMENTAL DISEASES 196 VI. LOCAL DISEASES— 1. Diseases of Nervous System 291 2. Diseases of Organs of Special Sense 9 3. Diseases of Circulatory System 256 4. Diseases of Respiratory System 672 5. Diseases of Digestive System 263 6. Diseases of Lymphatic System - 7. Diseases of Gland-like Organs of uncertain use 8. Diseases of Urinary System 92 9. Diseases of Reproductive System— a. Diseases of Organs of Generation b. Diseases of Parturition 4 10. Diseases of Locomotive System 11. Diseases of Integumentary System 5 - 1616 VII. VIOLENCE— 1. Accident or Negligence 99 2. Battle - 3. Homicide 1 4. Suicide 12 5. Execution - - 112 VIII. ILL-DEFINED AND NOT SPECIFIED CAUSES 132 Total 3021 Note.—The form for table "A," on page 63 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. 63 (A) Table of DEATHS during the Year 1899, in the Parish of Kensington, in the Metropolitan District. classified according to Diseases, Ages, and Localities (See Note, page 62). Names of Localities adopted for the purpose of these Statistics; Public Institutions being shown as separate localities. (Columns for Population and Births are in Table B.,Post). (a) Mortality from all causes, at subjoined ages. (i) mortality from subjoined causes, distinguishing deaths of children under five years of age At all ages. (b) Under 1 year. (c) 1 and under 5 (d) 5 and under 15- (e) 15 and under 25- (f) 25 and under 65. (g) 65 and wards (h) 1 2 3 4 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 Smallpox. Scarlatina. Diphtheria. Membranous Croup. Typhus Fever. Fever. Cholera. Erysipelas. Measles. Whoopingcough. Diarrhœa and Dysentery. Rheumatic Fever. Phthisis. Bronchitis. Pneumonia, and Pleurisy. Heart Disease. Influenza. Injuries All other Diseases. Total Enteric or Typhoid. Continued. Relapsing. Puerperal. Kensington Town Sub- district 1649 500 173 46 40 514 376 Under 5 ... ... 3 ... ... ... ... ... ... 2 1 16 41 83 ... 2 140 1 7 35 342 673 5 upwds. ... 1 1 ... ... 10 ... ... 5 1 3 ... ... 6 3 101 233 124 55 22 411 976 Brompton Sub-district 453 65 26 8 11 161 182 Under 5 ... ... ... 1 ... ... ... ... ... ... ... ... 12 8 ... ... 12 ... 1 3 54 91 5 upwds. ... 1 2 1 ... 1 ... ... ... ... ... ... ... 2 ... 14 66 40 36 17 182 362 Kensington Infirmary 607 68 38 9 14 310 168 Under 5 ... ... ... ... ... ... ... ... ... ... ... 7 4 1 ... ... 17 ... ... 1 76 106 5 upwds. ... ... ... ... ... ... ... ... ... ... 4 ... ... ... ... 75 135 41 3 14 229 501 Brompton Hospital 145 ... 1 6 39 98 1 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 119 7 11 ... ... 7 144 St. Marylebone Infirmary 521 27 ... 4 6 281 184 Under 5 ... ... ... ... ... ... ... ... ... ... ... 4 1 2 ... ... 9 ... ... 1 29 46 5 upwds. ... ... 1 ... ... 1 ... ... ... ... 1 ... ... 3 1 111 83 38 3 9 224 475 St. Joseph's House 47 ... ... ... ... 8 39 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 2 3 11 ... ... 30 47 Totals 3422 660 257 73 110 1372 950 Under 5 ... ... 3 1 ... ... ... ... ... 2 1 27 58 94 ... 2 179 1 8 40 501 917 5 upwds. ... 2 4 1 ... 12 ... ... 5 1 8 ... ... 12 4 422 527 265 97 62 1083 2505 The subjoined numbers have also to be taken into account in judging of the above records of mortality. Deaths occurring outside the district among persons belonging thereto 321 18 54 30 17 175 27 Under 5 ... 5 25 ... ... ... ... ... ... ... ... 1 2 2 ... ... 10 1 ... 6 20 72 5 upwds. ... 3 9 ... ... 13 ... ... ... ... ... ... ... ... ... 26 20 23 1 20 134 249 Deaths occurring within the district among persons not belonging thereto 722 36 21 13 45 388 219 Under 5 ... ... ... ... ... ... ... ... ... ... ... 4 1 3 ... ... 10 ... ... 3 36 57 5 upwds. ... ... 1 ... ... 2 ... ... ... ... 1 ... ... 4 1 229 97 57 3 13 257 665 64 DEATHS IN PUBLIC INSTITUTIONS. The only large public institution within the parish in which we are directly interested, is the parish infirmary and workhouse, situated in the Town sub-district. There are several minor public or quasi-public institutions, but, with one exception, they do not furnish occasion for special remark. The excepted institution is St. Joseph's House, 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 (517), at the Brompton Consumption Hospital (141), and at St. Joseph's House (36), 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 (605), at the Consumption Hospital (5), at St. Joseph's House (11), and at outlying institutions, &c. (321), were 942, or 31.2 per cent. on total deaths; the percentage proportion of deaths in public institutions in the Metropolis, generally, being 29 9. The Registrar-General in his Annual Summary states that "about one in every six deaths occurred in a workhouse or workhouse infirmary, one in 47 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 indebted to Dr. H. Percy Potter, the medical superintendent, for the statistics of mortality at these important institutions. The deaths actually occurring during the year were 603, as compared with 458, 493, and 497, in the three preceding years respectively, and were equal to 20 0 per cent., or one-fifth, of all the deaths in the parish. The quarterly numbers were 166, 131, 133, and 173 : 339 deaths, therefore, occurred in the 65 first and fourth or colder quarters, and 264 in the second and third or warmer quarters of the year. The deaths included 315 of males, and 288 of females. The ages at death were:— Under one year, 73 (as compared with 66, 81, and 64, in the three preceding years respectively); between one and sixty, 309 (as compared with 226, 255, and 221, in the three preceding years), and at sixty and upwards, 221 (as compared with 166, 157, and 212, in the three preceding years). SUMMARY OF CAUSES OF DEATHS, 1899. DISEASES. Under 1 year. Between 1 year and 60 years. At 60 years & upwards. Total. Nervous System, Diseases of 2 31 32 65 Circulatory System, Diseases of ... 18 26 44 Respiratory System, Diseases of 9 100 60 169 Digestive System, Diseases of ... 26 11 37 Urinary System, Diseases of ... 22 12 34 Tubercular Diseases (including Marasmus) 33 75 ... 108 Cancer ... 16 15 31 Syphilis 10 1 ... 11 Measles 2 5 ... 7 Pertussis 3 1 ... 4 Varicella 2 ... ... 2 Diarrhœa 1 ... ... 1 Influenza ... ... 3 3 Erysipelas ... ... 3 3 Pyæmia ... 1 ... 1 Delirium Tremens and Alcoholism ... 2 ... 2 Bones and Joints, Diseases of ... 6 ... 6 Debility, Atrophy, Inanition 10 1 ... 11 Fracture ... 3 7 10 Asphyxia ... 1 ... 1 Premature Birth 1 ... ... 1 Senile decay ... ... 52 52 Totals 73 309 221 603 Twenty inquests were held: the cause of death was natural in 6 cases ; injury, in some form, in 14 cases. 66 The Hospital for Consumption and Diseases of the Chest.— In the Kensington portion of the Brompton Hospital there were 146 deaths, including 5 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, 521 deaths were registered, all of which, except four of Kensington parishioners, are excluded from our statistics. St. Joseph's House, Notting Hill.— The deaths at this quasi-public institution, with the exception of 11 of parishioners, are excluded from our statistics. They were 47 in number: viz., males, 18; females, 29. 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 three preceding years, successively, had numbered 353, 333, and 286, were 321 in 1899. All of these deaths are included in our statistics. The deaths occurred at the several institutions as follows:— 67 St. George's Hospital 51 St. Mary's Hospital 47 West London Hospital 18 Middlesex Hospital 8 Charing Cross Hospital 3 Guy's Hospital 3 St. Thomas's Hospital 3 King's College Hospital 2 London Hospital 2 University College Hospital 'J Westminster Hospital 2 St. Bartholomew's Hospital 1 Western Hospital 32 North-Western Hospital 12 Fountain Hospital 5 South-Western Hospital 3 Northern Hospital 2 Cancer Hospital. Chelsea 7 Children's Hospital, Paddington 12 Children's Hospital, Great Ormonde Street 1 Victoria Hospital for Children 1 Brompton Hospital (south wing) 4 North-London Consumption Hospital 1 Royal Chest Hospital 1 Chelsea Hospital for Women ... 1 Hospital for Women,Easton Road 1 Queen Charlotte's Hospital 2 Hospital of SS. John & Elizabeth 2 Evelina Hospital 1 Homoeopathic Hospital 1 Royal Free Hospital 1 Samaritan Free Hospital 1 Friedenheim 3 St. John's Home, Lewisham 2 Boy's Home, Regent's Park Road 1 St. Joseph's Schools, Brook Green 1 Marylebone Workhouse 2 Paddington Workhouse 1 Strand Workhouse 1 Fulham Infirmary 2 Chelsea Infirmary 1 Holborn Infirmary 1 Paddington Infirmary 1 St. George's Infirmary 1 Hanwell Asylum 17 Leavesden Asylum 7 Ilford Asylum 6 Banstead Asylum 4 Cane Hill Asylum 4 Colney Hatch Asylum 3 Darenth Asylum 2 Peckham House Asylum 2 Dartford Asylum 2 Caterham Asylum 1 City of London Asylum 1 Middlesex County Asylum 1 Incubators, Earl's Court Exhibition 2 302 Other 19 deaths occurred without the parish; viz., one male, by drowning, in the Thames; two of males, and one female, in the streets; one, of a male, at an hotel; three, of males, on the railway; two, of males, on railway premises; and five, of males, and four, of females, on private premises. Deaths from diseases of the zymotic class occurred at public institutions without the parish as follows:— Western Hospital, 27 (Diphtheria, 18, Scarlet Fever, 5, Enteric Fever, 4); North-Western Hospital, 12 (Diphtheria, 7, Enteric Fever, 3, Scarlet Fever, 2); Fountain Hospital, 5 (.Diphtheria, 4, Measles, 1); St. Mary's Hospital, 4 (Diphtheria, 1, Enteric Fever, 1, Whooping-Cough, 1, Diarrhoea, 1); Northern Hospital, 2 (Scarlet Fever, 1, Diphtheria, 1); South-Western Hospital, 2 (.Enteric Fever), West London Hospital, 1 68 (.Diphtheria); University Hospital, 1 (Enteric Fever); Middlesex Hospital, 1 (Enteric Fever); St. George's Hospital, 1 (Diphtheria); Evelina Hospital, 1 (Whooping-Cough); Children's Hospital, Great Ormonde Street, 1 (.Diphtheria); Incubator, Earl's Court Exhibition, 1 (Diarrhœa). One death from Enteric Fever took place at a private house. UNCERTIFIED DEATHS: PAYMENT OF JURORS One death only was not certified either by a registered medical practitioner or by a coroner. It was of a laundryman, aged 48, who had been attending at a hospital for heart disease. The case was reported to the coroner, who did not deem it necessary to hold inquisition. In England and Wales the deaths not certified were 1.8 per cent. of total deaths; the proportion in London was 0.6. 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) That in each sanitary district a registered 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." No action has been taken by the House hitherto, to give effect to the recommendations of the Committee. The Public Control Committee of the London County Council have also 69 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" Subsequently the Council 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." The recommendation took effect on the 1st April, 1898. INQUESTS. Two hundred and sixty-seven inquests were held on parishioners, including 39 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 135 cases. Thirty-two inquests were held on the bodies of non-parishioners who had died in Kensington. All of the inquests in the parish were held at the coroner's court at the Town Hall. It is now some years since an inquest in Kensington was held at a public house. 70 The causes of death in inquest cases may be classified as follows:— Deaths caused by disease 155 Deaths caused by violence (112), viz.:- Accidental 100 112 Suicidal 12 — Total ... 267 Of the 12 suicidal deaths, 4 belong to the Brompton subdistrict and 8 to the Town sub-district. The inquests on Kensington parishioners were in the proportion of 8.8 per cent. on total deaths, the rate in the metropolis being 9.2 per cent. In England and Wales the rate was 6.3 per cent. The relative percentages in 1898 were 7.3, 90, and 6.3, respectively. The registered deaths from violence were equal to 3.7 per cent. on total deaths in Kensington, the proportion in the metropolis being 4 2 per cent.; and in England and Wales 3'5 per cent. These deaths were equal to 0 65 per 1,000 persons living in Kensington, 0.83 per 1,000 in London, as a whole, and 0.64 per 1,000 in England and Wales. 71 VACCINATION. Table X (appendix) is a return respecting vaccination in Kensington in 1898 (the return for 1899 is not yet due) compiled by Mr. Shattock, the vaccination officer, whose able discharge of the very onerous duties of his office under the new Act, deserves recognition. It appears that of 3,651 infants whose births were returned in "Birth List Sheets" (col. 2) during the year, 2,728 were successfully vaccinated, and 18 were returned as "insusceptible of vaccination." In 19 cases vaccination was postponed by medical certificate: 413 infants died before attaining the age for vaccination; whilst some 407 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, with those of "conscientious objectors " (55, against 5 in 1897), equivalent to a "loss " of 12'7 per cent., as compared with the number of births registered; the losses in the preceding ten years, successively, having been 6.0, 6.5, 6.7, 8.0, 8.7, 7.7, 8.4, 90, 10.1, and 10.7 per cent. These figures clearly indicate that the proportion of unvaccinated persons in this parish is on the increase ; but Kensington, apparently, still stands in a position superior to that of the metropolis, as a whole, for, as stated in the annual report of the Local Government Board for 1898-99, the average of lost cases in the metropolitan district so far back as 1896 was 26.4 per cent. The actual figures, showing loss, both for town and country, during the twelve years 1885-96, as set out in the report, are as follows:— 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 „ 1895 24.9 „ 19.8 „ 1896 26.4 „ 22.3 „ 72 A bad look out truly; for it would appear that in 1896 more than one-fourth of the children born were without the protection against small-pox afforded by vaccination, and the proportion at the present time is, probably, higher. It is but too probable,moreover, that a large proportionof thechildren not vaccinated prior to the new Act coming into operation, will remain unvaccinated and liable to small-pox. 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. The New Vaccination Act.—In the report for 1897 some account was given of the Vaccination Bill brought in by the President of the Local Government Board. The Bill became law in a strangely altered form; and the Act, in regard to some of its provisions, could scarcely have been more unsatisfactory had it been designed to abolish compulsory vaccination; for the "conscientious objector" can avoid the vaccination of his children without any sensible difficulty and without expense. One good feature in the Act is that it provides for the use of glycerinated calf-lymph, and so cuts the ground from under the feet of those who objected to vaccination because of the possibility of enthetic disease being conveyed in humanised lymph. Public vaccination stations are abolished by the Act, which is entailing considerably increased expenditure upon the ratepayers. 73 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 Vestries and District 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 Mansgers' 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, has 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 always be equal to the demand, as it was during the past year. Report of the Statistical Committee for 1898.— Prior to 1898 the work of the Asylums Board was summarized annually in three reports, prepared respectively by the Chairman of the Board, the Ambulance Committee, and the Statistical Committee. The three reports overlapped in many 74 directions. For 1898, a single report issued by the Statistical Committee covered the entire ground.* The report is comprised in two volumes; the second volume, treating of matters relating to the work of the Managers as the Hospital and Ambulance Authority for London, having naturally the greater interest for sanitary authorities. From this report the following statement of facts, in regard to 1898, is summarized : the report for 1899 had not been published when the present report went to press. Notification Statistics show that 37,316 cases of infectious disease were recorded in the metropolis during the year 1898, being 8,101 fewer than in 1897. Of these,31,821 cases (32 being cases of supposed small-pox, 16,894 of scarlet fever, 11,543 of diphtheria, 312 of membranous croup, and 3,040 of " fever ") were legally eligible for admission to the Managers' hospitals; and 20,849, or 65.5 per cent. of such cases were admitted. The notification figures are uncorrected for mistakes in diagnosis: thus, of the 32 cases notified as small pox, only five were found to be genuine cases of small-pox. Many cases, moreover, notified as diphtheria, proved to be cases of other diseases, and a considerable number of cases of mistaken diagnosis occurred in respect of enteric or typhoid fever. The increase in the ratio of cases of diphtheria to scarlet fever cases, which has been a marked feature for some years past, made further progress in 1898; and in four districts the number of diphtheria notifications exceeded those of scarlet fever. The notifications of infectious disease are addressed to the medical officers of health, who forward copies to the Board. The notification returns assign the cases to the sanitary districts; but when the patients are admitted to the hospitals, the Managers are by law required to assign the cases *The Ambulance Committee, however, issued a separate report, dated January 16th 1899, which forms Appendix I. (p. 45) to the report of the Statistical Committee for 1898. 75 to the Poor Law districts; and over a large part of London the sanitary and the Poor Law districts are not coterminous. This anomaly arises out of the origin of the Board as a body elected by the guardians for purposes connected with the administration of the Poor Law. The reasons for its continuance are purely financial; and, as the committee observe, it might now well be abolished, by an alteration in the law which would enable the Managers to charge the maintenance of patients, and make their precepts direct, upon the common poor fund; when there would be nothing to prevent the patients admitted to the hospitals being classified to the sanitary districts, a course that would enable a comparison to be made of the notification statistics with the admission statistics, which would then possess its full scientific value. Of 16,894 cases notified as scarlet fever, 12,840, or 73.87 per cent. were admitted to the hospitals. Of 11,543 cases notified as dipththeria, 7,388, or 64 00 per cent. were admitted. Great variations are observed from week to week in the percentage of notified cases of these diseases admitted to hospital; ranging from 62 42 to 83.68 in the case of scarlet fever, and from 53.20 to 73.91 in the case of diphtheria. For the first time since 1892 the Managers were practically able to receive all cases offered for admission. From the point of view of hospital provision, other than for smallpox, which is not dealt with in the infectious hospitals in London, the diseases of the greatest interest to the Managers are scarlet fever and diphtheria; as any cases of enteric fever they may be unable to accommodate in their own hospitals can generally be received, under an existing arrangement, into one or other of the large general hospitals. Since 1890 the proportion of scarlet fever admissions has risen from 42.82 to 74.07, and of diphtheria from 17.87 to 62.48 per cent. of cases notified. The rise in the percentage of diphtheria admissions has been exceptionally great and 76 rapid. Notwithstanding that the Managers have more than doubled their accommodation for fever cases during the past few years, the committee state that it is still necessary to make further provision, as the present accommodation would prove inadequate should scarlet fever and diphtheria again become as prevalent as they were in the year 1893. Spotted maps appended to the report show the distribution of the principal fevers throughout the metropolis during 1898. Age and Sex-Distribution.— Both scarlet fever and diphtheria are shown to be most prevalent amongst children, over two-thirds of the cases being under ten years of age. But whereas scarlet fever is most prevalent amongst children from five to ten years of age, diphtheria is most so amongst those under five years. Ambulance Work.— For many years, it is stated, three ambulance stations– the Eastern Station at Homerton, the Western Station at Fulham, and the South-Eastern Station at Deptford— were sufficient for the work of the land ambulance service. But the work has increased so much in recent years— and there is every evidence of a still further increase— that the provision of additional ambulance stations became absolutely necessary. Three new stations were opened in three years, respectively adjoining the Brook Hospital, Shooter's Hill, the North-Western Hospital, Hampstead,and the South-Western Hospital, Stockwell. During the year 20,959 fever, diphtheria, and small-pox patients were conveyed to the various hospitals; 6,437 convalescent patients were transferred to the Northern and Gore Farm Hospitals, and 6,671 recovered patients were brought back from those hospitals to London. Further, 326 private persons were removed, on payment, to other places than the Managers' Hospitals. Altogether, 35,043 removals were effected by the 77 land ambulance service during 1898: the various vehicles made 23,120 journeys, and ran 214,677 miles. The steamboats of the river ambulance service had little employment, owing to the freedom of the metropolis from small-pox. Hospital Accommodation.— The normal accommodation at the fever hospitals open at the end of 1898, comprised 4,647 beds; further accommodation to the number of 1,360 beds was in course of being provided: total 6,013 beds. This accommodation is capable of further increase in times of pressure by the use of extra beds in the wards of several of the hospitals. In addition, there is the Gore Farm Hospital, which can furnish 750 beds for convalescent fever cases; but only so long as it is not required for its proper function of a smallpox convalescent hospital. For small-pox the Managers possess 300 beds at the hospital ships, and are about to erect further buildings, capable of containing 400 beds, on the Joyce Green estate, adjoining the ships. Gore Farm Hospital, if at any time the Managers should be compelled to reclaim it for its original purpose, can, for small-pox convalescents, furnish about 1,192 beds, making nearly 1,900 beds, all told. Hospital Statistics.— The year began with 4,668 patients in the hospitals. By May 28th the number had fallen to the minimum, 3,120; the maximum, 4,745, was attained November 21st. At the close of the year the number had declined to 4,377. At the maximum period the scarlet fever cases were 3,256; diphtheria, 1,231; typhus, 3; enteric, 254. The admissions were; of scarlet fever cases, 12,125; diphtheria, 6,566; enteric, 869; typhus, 9: total, 19,569; of "other diseases," 1,488: grand total, 21,057; or fewer by 1,812 than in 1897, the lesser number of scarlet fever cases accounting for the whole 78 reduction. The diphtheria admissions were 893 more than in 1897, but the death-rate, 15.37 per cent., was the lowest on record. The scarlet fever mortality was 4.12 per cent. The monthly admissions, of all diseases, were lowest in February, and highest in October. The admissions of scarlet fever were notably in excess of the number in 1897, from Fulham, St. Pancras, and Woolwich; and as regards diphtheria, from Fulham, Hampstead, Hackney, St. Saviour, Lambeth, Wandsworth, Woolwich, and Lewisham. Tables are given which show the admissions, deaths, and mortality per cent., of scarlet fever cases in 1898, and in the years 1892-1898, divided according to age and sex. With regard to diphtheria, an interesting comparison is made of the mortality per cent. in the years 1888 to 1894, before antitoxic serum was generally used, and in the years 1895 (when the serum was first generally used), to 1898. In the first period it was 30.3 per cent. at all ages ; in the second period 184. The difference in the mortality rates during the two periods is more particularly striking as regards young children. Under five years of age the rate was 49.9 per cent. in the first period, and only 27.3 in the second period. The rate in cases in the first year of life fell from 61.8 to 38'0; in the second year from 631 to 30 8 ; in the third year from 55.1 to 28.7 ; in the fourth year from 48.3 to 241 ; and in the fifth year from 39 0 to 22.8. Amongst cases from five to ten years of age the mortality fell from 281 to 16.2 per cent. At ages above ten years the differences were not so marked. The enteric fever death-rate was 16 4, and 23 per cent. lower than in 1897. The lowest death-rate is amongst patients between five and ten years of age, increasing with each quinquennium until it attains a percentage of 33.8 amongst patients between forty-five and fifty years of age, and 35.1 amongst patients above fifty. 79 Only five cases of small-pox were admitted during the year, or scarcely more than one per 1,000,000 of the population. Mistaken Diagnosis.— No fewer than 1,488 patients, or 7.2 per cent. of the total admissions, were, after admission, found to be not suffering from the diseases mentioned in the medical certificates upon which they were removed to hospital. Amongst the 603 cases wrongly certified as scarlet fever, there were 73 of measles, and 129 of tonsillitis : 120 had no obvious disease. Amongst the 600 cases wrongly certified as diphtheria, there were 34 of measles and 450 of tonsillitis. Amongst the 265 cases wrongly certified as enteric fever, there were 12 of influenza, 55 of pneumonia, and 6 of bronchitis. Of the 6 patients admitted to the hospital ships, one was not suffering from small-pox. Thirty-six patients were taken to the London wharves, of whom 31 were not suffering from smallpox. "It is evident," the committee observe," that the ordinary practitioner in London practically never sees either small-pox or typhus." Annual Admissions 1870-98 : Reduction in Mortality.— A return is given (on page 32) showing the annual admissions and deaths of patients at the Managers' fever hospitals, with the mortality per cent. since the establishment of the first hospital in 1870, together with extracts from the Registrar-General's annual summaries, showing the annual mortality per 1,000 persons living of the population of the metropolis, from scarlet, typhus, and enteric fevers, and diphtheria. The decreasing percentage of the mortality amongst scarlet fever patients treated in the hospitals continues to be a noticeable feature. More noticeable, however, is the decline in the percentage mortality amongst diphtheria patients; from 40.74 in 1889 (when practically diphtheria cases were first admitted) to 29.29 in 1894, to 22.85 in 1895 ( when the antitoxic serum was first adopted) to 17.69 in 1897, to 15.37 in 1898 ; and, it may be added, to 13.6 in 1899. 80 Kensington Cases.— It may be interesting to state that the admissions of Kensington patients were 583, viz., scarlet fever, 372; diphtheria, 130; enteric, 38; typhus, 8; "other diseases," 35. The deaths, all diseases, were 56, or 9 6 per cent. on admissions; the scarlet fever mortality rate being 5.1; the diphtheria rate 11.7; and the enteric fever rate 12.5 per cent. Removal of the Sick to Hospital.— The duty of removal of the sick to hospital, whether by land or by water, is now effected in a satisfactory manner. The use of public vehicles for the removal of persons suffering 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 danger to the public, but it is of rare occurrence, as 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. 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 Seagrave-road, Fulham. Between 9 a.m. and 8 p.m., on all days in the year, cases for removal are reported at the Managers' offices, Victoria Embankment (corner of Carmelite-street, E.C.), these being in telephonic communication with the station. Between 8 p.m. and 9 a.m. application for a patient's removal must be forwarded direct to the ambulance station. The Managers' telegraphic address is "Asylums Board London"; their telephone numbers are 1601 and 1602 " Holborn," 81 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"; detailed the steps taken by the Asylums Board to supply the then existing deficiencies, and referred to the difficulties by which their efforts had been confronted and, to a certain extent, foiled. Those difficulties have been now largely overcome; and the needs of the metropolis have been met to an extent beyond my estimate of them, made in the tenth monthly report for 1892, which, at the time, was thought to be excessive, viz.: "at least 5,000 beds for scarlet fever, 'fever' diphtheria, aed isolation." Fever Hospital Accommodation.—It is an accepted axiom that provision for the isolation of infectious disease should be made at the rate of not less than one bed for each thousand of the population. The subject, as regards the metropolis, was dealt with 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, presumably, desired that provision should be made for a lengthened period in advance, and the amount of accommodation they advised as necessary, is even now in excess of the standard requirement, the estimated population being under 4,600,000. But circumstances they could scarcely have anticipated have led to largely increased demands on the Managers' resources; not only by the sanitary 82 authorities, but also by private medical practitioners and others. Among these circumstances may be mentioned, the depauperisation of medical relief in the hospitals, and the opening of the several institutions to all classes of the people, (measures advocated in these reports many years before they formed the subjects of legislation); the admission of patients, on whatever form of application, subject only to the production of a medical certificate; gratuitous treatment; the popularity of the hospitals themselves; and 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 the 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 the Park Hospital, at Hither-green, Lewisham, also for upwards of 500 patients. An equally large hospital, the "Grove," was opened in 1899 at Tooting, adjoining the "Fountain" hospital. These three hospitals for acute cases of fever, scarlet fever, and diphtheria, and isolation wards, have added some 1,636 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 patients; having already, at Winchmore-hill, north of the Thames, at the Northern Convalescent Hospital, accommodation for nearly 700 patients. In addition to the new 83 hospitals on new sites, previously existing accommodation has been extended and improved by the more or less complete reconstruction, with additions, of some of the older hospitals. Small-pox Hospital Accommodation.— As regards accommodation for small-pox, the Managers have not hitherto 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 utilized for 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. summary.— I am indebted to Mr. T. Duncombe Mann, Clerk to the Asylums Board, for the subjoined statement of existing and projected accommodation for various classes of the infectious sick : it cannot fail to be read with interest. 84 "Return showing the permanent Fever Hospital Accommodation existing and projected— (i.) Accommodation existing— Beds. Eastern Hospital 362 North-Eastern Hospital* 406 North-Western Hospital 460 Western Hospital 450 South-Western Hospital 366 Fountain Hospital 402 Grove Hospital 528 South-Eastern Hospital 432 Park Hospital 548 Brook Hospital 560 Northern Hospital 664 Total 5178 (ii.) Accommodation projected— North-Eastern Hospital† 128 Southern Hospital (say) 700 Total 828 Grand total 6,006 "For Small-Pox Patients the existing accommodation is as follows:— Hospital Ships 300 Gore Farm, Upper Hospital (At present occupied by Scarlet Fever patients) 1,000 Gore Farm, Lower Hospital (Wooden buildings) 192 Total 1,492" * One ward of 20 beds is in use as a temporary discharge room. † Additional beds when reconstructed. 85 Joyce Green Estate.—On this site of some three hundred acres, which (with considerable additions of intervening land connecting the estate with the hospital ships) the Managers have acquired, they are about to build a hospital for 400 patients, at a cost of £220,000. It thus appears that the Metropolis is endowed, in possession or in early prospect, with accommodation for at least of 6,000 patients suffering from fever and diphtheria, a number precisely double that recommended by the Royal Commission, irrespective of many hundred beds at Gore Farm, generally available for convalescent cases in the abeyance of small-pox. Time only can determine whether this provision will suffice for the requirements of the metropolis. For smallpox 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 enough to hope will suffice, seeing how much more effectually this disease has been controlled since the practice was adopted of removing the sick out of London for isolation and treatment, initiated, upon my advice, in May, 1881, and subsequently perfected by the Managers, who, since 1884, have ceased to use the town hospitals for 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 29 testify. "Deficiency of Hospital Accommodation." Under this heading I have had occasion in several previous reports to deplore the unavoidable necessity of keeping at home, for considerable periods in many cases, numerous patients who could not be admitted to the hospitals owing to want of accommodation. I am pleased to be able to report that no difficulty of this kind was experienced during the past year. 86 NOTIFICATION OF INFECTIOUS DISEASE The tables at pages 88-00 show (1) the number of notifications in London (2) the relative prevalence of the several diseases at different periods of the year, in Kensington and in London, and (3) the notifications in the sanitary districts, &c., of the parish. The Kensington notifications, were 1,046, viz., in the Town sub-district 784, and in Brompton 262. The notifications in the six preceding years were 1,811, 972, 1,289, 1,781, 1,457, and 1,004, respectively. Table IX. A (appendix) shows the streets, &c., where cases of the scheduled diseases occurred in 1899. The cases notified in London, 42,344, were nearly 5,000 more than in 1898. The notifications of each of the scheduled diseases during the ten years 1890-99 are set out in the subjoined table. 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 1598 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 13,020 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 13,391:3189 6 102 27* 6438 446 13 3 49,699 1897 105 22,876 12,811 3113 4 ; 65 264 5801 388 38 1 45,465 1898 35 16,917 11,561 3032 17 55 250 5180 310 23 ... 37.380 1899 29 18,112 13,363 4460 14 69 329 5615 338 15 ... 42,344 NOTE.— The form for table "B," on page 87, 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." 87 (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 1899, 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. 1 2 3 4 5 6 7 8 9 10 11 1 2 3 4 5 6 7 8 9 10 11 Last Census. Estimated to middle of 1899. 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 122149 2935 Under 5 ... 88 66 2 ... 2 ... ... ... ... 10 ... 74 53 1 ... 1 ... ... ... ... ... 5 upwds. ... 227 109 ... ... 79 14 ... 9 ... 119 ... 176 79 ... ... 53 8 ... ... ... ... Brompton Sub-District 48109 48448 544 Under 5 ... 22 25 1 ... ... ... ... ... ... 1 ... 17 25 ... ... ... ... ... ... ... ... 5 upwds. ... 104 54 ... ... 17 3 ... ... ... 29 ... 74 41 ... ... 8 ... ... ... ... 2 Kensington Infirmary and Workhouse 1648 1648 111 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... 2 ... ... 1 8 ... ... 2 ... 50 ... 2 ... ... 1 ... ... ... ... ... ... St. Marylebone Infirmary 803 803 ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... Brompton Hospital 192 192 ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Total 170465 173240 3590 Under 5 ... 110 91 3 ... 2 ... ... ... ... 11 ... 91 78 1 ... 1 ... ... ... ... ... 5 upwds. ... 333 163 ... 1 105 17 ... 11 ... 199 ... 252 120 ... 1 61 8 ... ... ... 2 88 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, 30th December, 1899. Name of District Small-pox.. Scarlet Fever. Diphtheria. Enteric Fever. Typhus Fever. Other Continued Fevers. Puerperal Fever. Erysipelas. Croup. Cholera. Totals. Population, 1896 West Districts. Kensington ... 443 254 107 1 17 11 210 3 ... 1046 170,465 Paddington ... 384 204 98 1 1 7 148 1 ... 844 124,506 Hammersmith ... 441 184 115 1 ... 12 110 7 ... 870 104,199 Fulham 1 849 518 111 ... 1 13 181 10 4 1688 113,781 Chelsea ... 282 234 64 ... 4 9 83 4 1 681 96,646 St. George, Hanover Sq. ... 198 87 46 ... ... 2 74 4 ... 411 79,967 Westminster ... 199 100 45 ... 1 ... 56 1 ... 402 53,234 St. James, Westminster ... 49 37 34 ... ... ... 22 ... ... 142 23,050 St. Marylebone 2 400 192 118 ... 1 6 202 4 ... 925 141,188 North Districts. Hampstead ... 289 112 45 ... ... 5 52 4 ... 507 75,449 St. Pancras ... 862 562 246 ... ... 13 311 16 1 2011 240,764 Islington 3 1500 694 361 ... 2 32 355 17 3 2967 336,764 Stoke Newington ... 182 30 17 ... ... 7 32 ... ... 268 33,485 Hackney 2 988 689 268 ... 5 19 302 20 ... 2293 213,044 St. Giles, Bloomsbury ... 76 28 24 ... ... 1 55 2 ... 186 38,237 Central Districts. St. Martin-in-the-Fields ... 31 17 7 ... ... 1 9 ... 65 13,077 Strand ... 55 37 12 ... ... ... 17 ... 121 23,782 Holborn 1 117 63 36 ... 2 1 44 1 ... 265 31,208 Clerkenwell ... 322 197 91 ... 1 6 71 3 ... 691 66,202 St. Luke, Middlesex ... 162 99 36 ... ... ... 65 4 ... 366 41,527 City of London ... 74 57 86 ... 1 ... 21 ... ... 239 30,970 Shoreditch 1 365 363 169 ... 6 10 202 11 1 1128 122,348 Bethnal Green ... 431 323 203 ... ... 19 326 22 1 1325 129,162 East Districts Whitechapel 2 210 190 139 4 ... 5 125 12 ... 687 77,717 St. George-in-the-East 1 99 95 72 ... ... 5 78 9 ... 359 47,506 Limehouse 2 171 130 135 ... ... 3 78 2 ... 521 58,305 Mile End ... 296 361 138 ... 2 7 149 12 ... 965 111,060 Poplar 2 422 404 278 ... 4 14 230 20 ... 1374 169,267 South Districts. St. Saviour, Southwark ... 91 120 11 ... ... 3 34 2 ... 261 25,365 St. George, Southwark 1 238 442 56 1 1 2 76 6 ... 823 60,278 Newington ... 509 707 111 ... ... 5 201 22 ... 1555 120,939 St. Olave, Southwark ... 64 32 11 ... ... 1 3 ... ... 111 11,731 Bermondsey ... 402 536 110 3 1 3 88 7 ... 1150 85,475 Rotherhithe ... 256 156 54 1 ... 2 83 4 ... 556 40,379 Lambeth 1 1016 1101 222 1 10 27 337 23 3 2741 295,033 Battersea ... 723 594 162 ... ... 14 208 15 ... 1716 165,115 Wandsworth ... 912 611 127 ... 1 13 239 7 ... 1910 187,264 Camberwell 3 1146 1221 176 1 4 19 259 22 ... 2851 253,076 Greenwich 1 1206 650 167 ... 2 14 272 34 1 2347 175,774 Lewisham 1 580 477 58 ... 1 7 84 4 ... 1212 83,213 Woolwich 1 167 130 27 ... ... 5 27 1 ... 358 41,314 Plumstead ... 708 180 25 ... 1 4 65 2 ... 985 59,252 Lee ... 195 135 21 .. ... 2 29 ... 382 38,588 Port of London 4 2 10 21 ... ... ... 2 ... ... 39 Grand Totals 29 18,112 13,363 4460 14 69 329 5615 338 15 42344 89 Table showing the number of Cases of Infectious Disease Notified in Kensington, and in London, in 1899, 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 28 1-4 ... 26 20 8 ... 1 1 28 ... ... 84 2 1374 959 308 1 8 25 517 32 ... 3226 1-4 January 28 February 25 5-8 ... 20 27 5 ... ... ... 18 ... ... 70 ... 1284 957 280 3 5 23 381 34 ... 2967 5- 8 February 25 March 25 9-12 ... 20 15 4 ... ... ... 15 ... ... 54 2 1081 791 172 2 2 20 339 40 ... 2449 9-12 March 25 April 22 13-16 ... 26 12 3 ... ... 2 14 ... ... 57 4 905 645 120 1 1 19 330 20 .. 2045 13-16 April 22 May 20 17-20 ... 25 7 3 ... ... 2 11 1 ... 49 4 1167 820 122 .. 4 25 337 20 ... 2499 17-20 May 20 June 17 21-24 ... 38 8 8 1 1 1 11 ... ... 68 2 1318 904 147 1 5 34 366 23 ... 2800 21-24 June 17 July 15 25-28 ... 39 19 5 ... 3 2 12 ... ... 80 2 1594 1192 147 ... 7 19 399 20 ... 3380 25-28 July 15 August 12 29 32 ... 46 24 14 ... 5 1 9 ... ... 99 4 1408 1152 273 1 6 23 410 17 3 3297 29-32 August 12 September 9 33-36 ... 34 21 12 ... 1 ... 17 ... ... 85 ... 1246 962 331 1 6 21 422 16 9 3014 33-36 September 9 October 7 37-40 ... 48 24 12 ... 1 ... 16 ... ... 101 1 1907 1251 577 ... 6 25 509 21 3 4300 37-40 October 7 November 4 41-44 ... 43 30 11 ... 2 ... 18 1 ... 105 1 2124 1443 778 2 11 45 600 30 ... 5034 41-44 November 4 December 2 45-48 ... 55 28 13 ... 2 ... 25 ... ... 123 1 1650 1208 762 ... 7 26 575 39 ... 4268 45-48 December 2 December 30 49-52 ... 23 19 9 ... 1 2 16 1 ... 71 6 1054 1079 443 2 1 24 430 26 ... 3065 49-52 December 30 Totals ... 443 254 107 1 17 11 210 3 ... 1046 29 18112 13363 4460 14 69 329 5615 338 15 42344 Totals. 90 TABLE showing the Notifications, in 1899, in the Parish, the Sub-Districts, the Parliamentary Divisions, and the Sanitary Districts. DISTRICTS. Scarlet Fever. Diphtheria. Enteric Fever. Typhus Fever. Continued Fever. Puerperal Fever. Erysipelas. Croup. Totals. Population. Notifications per 1000 of the Population. The Parish 443 254 107 1 17 11 210 3 1046 172,400 6.1 Sub-Districts— Kensington Town 316 175 90 1 14 11 175 2 784 123,900 6.3 Brompton 127 79 17 — 3 — 35 1 262 48,500 5.4 Parliamentary Divisions— North Kensington 243 129 79 — 13 10 138 2 614 87,800 7.0 South Kensington 200 125 28 1 4 1 72 1 432 84,600 5.1 Sanitary Districts— North 137 52 26 — 4 6 42 — 267 33,470 8.0 North-East 37 32 25 — 2 2 26 — 124 30,400 4.1 North-West 41 27 19 — 1 — 50 1 139 16,940 8.2 Central 67 40 14 1 7 2 36 1 168 27,300 6.2 South-East 74 38 9 — 1 — 12 — 134 32,240 4.2 South-West 87 65 14 — 2 1 44 1 214 32,050 6.7 91 Infectious Disease (Notification) Extension Act, 1899.—Almost unobserved, and without opposition, a measure with this title became law in 1899, by which notification of infectious disease in England and Wales was made compulsory, as from January 1st, 1900. The passing of the Act served to remind one of the long and weary struggle to secure notification in London, commenced in 1881, in which your Vestry took the leading part. In my first annual report, for 1871, I told of the difficulties which sanitary authorities and their officers experienced in dealing with infectious diseases, arising out of their general ignorance of the occurrence of such cases, excepting when death supervened. Referring to the then prevailing epidemic of small-pox, I observed— " Much mischief was done, and a great amount of private loss and suffering self-inflicted, by concealment of sickness;" and I asked, "Is it unreasonable to anticipate a time when this state of things will no longer be possible; when instruction in the principles of sanitary law and public hygiene will form part of the code of State education ? Whenever that time arrives, I predict that a law will be passed requiring immediate disclosure of all cases of infectious disease, and the removal of cases for which the home resources do not afford either proper lodging or adequate means for obtaining nursing and nourishment. That publicity—by which I mean information to the sanitary authority—would be for the general good, no well-informed person can doubt, and in a matter so vital to all, it is not unreasonable to expect that personal feeling and private interests should yield to the paramount consideration of the public welfare." I am not aware that Board or other Elementary Schools yet include in their curriculum the teaching of matters of such every-day and universal interest as the laws of health; but that disclosure of infectious disease, long since recognized to be necessary, has now been made universally compulsory, is in no slight measure the outcome of your Vestry's action. In the absence of any system of notification, my first efforts, on appointment in 1871, were directed to obtain voluntary information ; and much of great value was given by the Board of Guardians, through the relieving officers, who held the 92 keys of the hospitals of the Asylums Board, which had then recently come into use. In 1881 your Vestry convened the conference of sanitary authorities which declared in favour of notification; free hospital treatment of infectious disease; compulsory removal, when necessary; depauperisation of medical relief in the hospitals, and maintenance of the hospitals out of the metropolitan common poor fund (all of which objects have been secured); the conference having adopted, without dissent, every one of the resolutions which I prepared, and your Vestry had approved. Already, since 1876, a number of provincial sanitary authorities had obtained notification powers, these bodies being endowed with the privilege of promoting Bills in Parliament, denied to the sanitary authorities of London. Parliament had shown no reluctance to confer such powers ; and had the Local Government Board been willing to bring in the measure which the deputation from the vestriesanddistrict boards, and other important bodies, urged them to introduce, no doubt notification, by an adoptive measure at least, would have been conceded to London sanitary authorities in 1881. As it was, the work of the conference, and the representations of the leaders of the deputation, seemed to have been without effect; but happily a result of great importance immediately followed, arising out of the adoption by the Local Government Board of my advice to remove small-pox cases out of London for isolation and treatment. So that, after all, good did come of the conference which had entailed great and long-continued labour. But for notification we had to wait yet eight years; for the further effort to obtain it made by your Vestry in 1887, backed though it was by the sanitary authorities and other important bodies, appeared to have ended in failure. It was then that your Vestry resolved to introduce a system of voluntary notification, and to pay a fee to medical practitioners for each case reported. A large increase in knowledge of cases of 93 infectious disease occurring in the parish, immediately followed; and the results, generally, were such as to demonstrate the value of notification, and to make one long for the fuller light which compulsion alone could afford. In 1889, the Infectious Disease (Notification) Act was passed, having been introduced by the President of the Local Government Board, who had had an object lesson, enforcing the necessity for notification, on the occasion of a visit to Sheffield in January, 1888, when small-pox was raging in that city. The Act, which passed both Houses practically without opposition, made notification compulsory in London; elsewhere the Act was adoptive. By this time (1889) some sixty or seventy municipal corporations and other sanitary authorities, had obtained notification powers in private Acts; and after the passing of the general Act, more and more of such authorities availed themselves of the means placed at their disposal by Parliament, until, in 1899, nearly the whole of England and Wales had come under its operation. And now, the small remainder of the population has been made subject to notification, under the provisions of the Act of last year.* * The history of Notification, and the cognate subjects of Hospital Accommodation for the Infectious Sick, and Ambulance Service, showing the action taken by the Vestry in bringing about the present satisfactory arrangements, is dealt with in my Presidential Address to the Conference of Medical Officers of Health, held at Southampton in August, 1899, in connection with the Congress of the Sanitary Institute. The address was published in the Journal of the Institute in October last. 94 FACTORY AND WORKSHOP ACTS, 1878 to 1895. Duties of 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), with a view to show how serious are the responsibilities which the legislature has imposed on sanitary authorities throughout the kingdom. An effort to cope with these responsibilities was made by your Vestry, on my recommendation, in October, 1893, by the appointment of two ladies as inspectors of workshops, workplaces, and laundries, where women are employed. These ladies, Miss Deane and Miss Squire, have been appointed, by successive Secretaries of State, to the position of factory inspector under the Home Office. Miss Deane's successor, Miss Duncan, who ceased to hold office in July, 1895, has 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. With respect to the workshops, &c., where men only are employed, practically no steps have been taken to give effect to the law. These establishments should be taken in hand, but cannot with the present limited staff of sanitary inspectors. It has been asked, whether your Vestry, by appointing special officers to inspect workshops, laundries, &c., were not interfering with duties legally attaching to the office of factory inspector? The answer to the question is distinctly negative. There is nothing conflicting in the duties of factory inspectors and of inspectors appointed by the sanitary authority: the duties of the respective offices are reciprocal. It is the duty 95 of the medical officer of health under the Public Health (London) Act, 1891 (sec. 27) to "give written notice to the factory inspector" of "any child, young person, or woman employed in a workshop," and this has been done, since October, 1893, in a large number of instances, upon information acquired for me by the lady 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 written notices received from persons intimating intention to occupy premises as workshops or workplaces. The Superintending Inspector reports to me cases of overcrowding discovered by his assistants, and cases of dirty and insanitary premises observed by those officers, and requiring to be dealt with under the Acts; it being the duty of the sanitary authority to take steps to abate such nuisances. The necessary steps have been taken in many instances (since October, 1893), under the authority of the sanitary committee. The sanitary authority and their officers possess " 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 supervision of workshops, in order to the enforcement of the law, are ample. But lest they 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," 96 It is a matter for satisfaction that there has 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 by the visits of the first lady inspectors, and by the notices issued by the sanitary committee. The inspector's visits are now received, as a rule, with marked cordiality. In no respect have they done greater good than by the prevention 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 efficiently 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 the carrying out of the duties which devolve upon your Vestry, as the local authority under the Acts, has been delegated. Lady Inspectors.—The initiative of your Vestry, in 1893, in employing women to assist in sanitary administration, is being followed, but somewhat slowly, by other metropolitan sanitary authorities; the movement has extended to the provinces, and there is ground for hope that the practice will in time become general, whether by requirement of law or otherwise. Seven vestries, &c., in London, have appointed women inspectors, viz.: Islington, St. Pancras, Hackney, St. Marylebone, Poplar, Battersea and St. George the Martyr, Southwark. The last-named body (population of district, 60,000) employs two women, the other six one each. 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. 97 THE ANNUAL REPORT OF THE LADY INSPECTOR OF WORKSHOPS, LAUNDRIES, &c. Subjoined is the statement by Miss de Chaumont with respect to the duties carried out by her, in 1899, as the inspector of workshops, workplaces and laundries where women are employed:— " At the beginning of the year, 672 workshops, &c., where women are employed were on the register. During the year 82 new premises were placed on the register, and 46 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 15 3 9 27 48 1 6 55 82 Register Removed from 9 6 6 21 21 ... 4 25 46 Register " The net result is an increase of 6 registered workshops in North Kensington, and of 30 in South Kensington, a total increase of 36 for the whole parish—Holland Park Avenue and Notting Hill High Street separating the two districts. At the end of the year, 708 places (comprising an aggregate of 1,307 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 119 208 30 357 294 24 33 351 708 Register Number of 145 499 43 687 531 50 39 620 1,307 Rooms therein 98 "In these 708 workshops, etc., there are employed, on an average, upwards of 8,000 women and girls. "Cubic Space.—In the 82 workskops, etc., newly registered, 114 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 conformity with the requirement of the Factory and Workshop Act, 1895, Section 1, which accords with the scale adopted by the Vestry in 1893. Numerous other rooms in workshops already registered, were also measured, such rooms having been enlarged, or newly opened as additional workrooms. "Overcrowding.—Twenty workrooms were found to be overcrowded, being five in excess of the number in 1898. These cases occurred at dressmakers' establishments, the majority of them in the south district. In one case, the same workroom was found overcrowded on four different occasions, and the matter was reported to the sanitary committee. At present, the nuisance is remedied, but I am keeping observation as the season advances. In a newly discovered workshop, 9 persons were at work in a room with cubic space for 5 only. On re-inspecting, I found a second room in use, but the first room was still overcrowded, 6 persons being at work in it. On two subsequent visits no overcrowding was observed. I am, however, keeping observation on these premises also. "Defective Workshops, Yards, etc.—At many of the registered premises, chiefly laundries, roofs and floors were found in a defective state. In several cases the necessary work of reparation was carried out after service of written intimations only; in other cases after service of statutory notices. Several yards and washhouse floors have been levelled and repaired, much to the benefit of the employers and 99 employed alike. In numerous instances staircases leading to workrooms were found dilapidated and unsafe. These have been repaired, and in two cases almost entirely renewed. "Cleansing, Whitewashing, etc.—One hundred and two rooms, with staircases and passages connected therewith, were cleansed and whitewashed, or repapered, on service of intimations or notices. "Sanitary Conveniences.-One new water-closet was ordered at a dressmaker's in the south district, both sexes being employed on the premises by different employers. Two water-closets with no direct light or ventilation to the outer air, have been much improved by ventilating shafts. Thirtysix water-closets, found to be either dirty or dilapidated, or defective in water supply, were renovated, more or less satisfactorily. "Warming of Workrooms.—The provisions of the Factory and Workshop Act, 1895, 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. I am pleased to report that in several cases, fires have been substituted for the injurious open gas-jets formerly employed. In three cases complaint was received of the overheated state of the workshops; on inspection this was found to result from inefficient ventilation, particularly in the evening. Additional means of ventilation have been provided, and these workshops, the temperature of which had averaged 70° to 75° F., are now maintained at an average temperature of 63° or 64° only. "Tidiness.—There is still a good deal to be desired with regard to the sweeping and tidying of workroom floors. That this is an improvement easy of attainment, is evidenced by the many well-kept workshops in both districts. 100 "Complaints.—These are occasionally received from workers, visitors, or societies, such as the Industrial Law Committee, the Women's Industrial Council, etc. Complaints relating to sanitary matters in connection with workshops, whether anonymous or otherwise, are attended to as soon as practicable, and, I may add, are generally found to be well founded. Complaints regarding long hours of work are referred to the Lady Factory Inspectors' Department at the Home Office. Her Majesty's Superintending Inspector of Workshops has forwarded complaints of nuisances observed by the factory inspectors, all of which have been dealt with. "Notifications of all new workshops discovered by me have been made to Her Majesty's Inspector in writing, as required by the Acts. It may be mentioned that it is obligatory on the sanitary authority, through the medical officer of health, to report to the Factory Department all cases of the employment of" protected persons," i.e.,"children" between 11 and 14; "young persons," i.e., persons of both sexes between 14 and 18; and "women," i.e., females over 18 years of age. The factory inspectors are required to forward to the sanitary authority notice of all workshops of which they may have received notice in writing from the occupiers. The addresses of workshops, &c., discovered by Her Majesty's Inspectors casually, are not forwarded, as, in the interests of public health, it is desirable they should be. The omission to forward information is explained on the ground of probability that the sanitary authority may already have knowledge of the workshops, which is often not the case. I occasionally come across workshops, in private houses, which have been known to the Factory Department for years, and not known to the sanitary authority; there being no evidence to show that a business was carried on therein: ten such instances occurred during last year. This appears to me to be a defect 101 in law that might well be dealt with in the next Factory and Workshop Act; for surely it would be better to occasionally receive information of workshops already visited, than that any such premises should escape necessary attention, through ignorance of their existence. "General.—I am pleased to report that my visits, as a rule, are welcomed by employers, who recognise, when informed, the 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. I regret there are no means at present available—e.g., by public notice—of bringing to the attention of employers the obligations and duties devolving upon them. Frequently, on first visits, when I find defects, especially with regard to overcrowding, the offence appears to have arisen not from wilful disregard of regulations, but from want of knowledge of the existence of regulations." Appended is a table setting forth the principal items of work done by Miss de Chaumont during the year. Much of the work, and not the least valuable portion of it, does not admit of tabulation. 102 FACTORY AND WORKSHOP ACTS, 1878-1895 Summary Report of Work done during the year, 1899. North Kensington. South Kensington. Total for whole Parish Dressmakers Laundries Miscellaneous Total Dressmakers Laundries Miscellaneous Total Workshops, Number of visited and inspected 132 385 68 585 388 17 87 492 1077 Workshops, Number of re-inspected 28 165 21 214 94 2 14 110 324 Workrooms, Number of inspected 165 1223 76 1464 544 44 99 687 2151 Workrooms found to be overcrowded 3 ... .. 3 17 ... ... 17 20 Workrooms found to be insufficiently ventilated 5 18 ... 23 24 .. 6 30 53 Workrooms found to be in a dirty condition 7 112 4 123 16 2 6 24 147 Workshops, etc., newly discovered and registered 15 3 9 27 48 1 6 55 82 Workshops: Workrooms therein measured 20 8 11 39 66 2 7 75 114 Workshops reported to H.M. Inspector, on discovery 6 15 4 25 37 1 3 41 66 Workshops removed from Register 9 6 6 21 21 .. 4 25 46 Houses visited where no female hands were employed* 17 19 11 47 25 4 17 46 93 Written Intimations and Statutory Notices issued 11 133 12 156 40 1 6 47 203 Works carried out under supervision:— (a) Additional means of ventilation provided ... 3 1 4 6 ... 2 8 12 (b) Rooms cleansed and whitewashed 4 84 2 90 9 ... 3 12 102 (c) Yards, floors, roofs, etc., repaired 1 85 1 87 ... ... 1 1 88 (d) Sanitary conveniences,dirty, ill-lighted,unventilated,or defective in water supply 2 21 3 26 8 ... 2 10 36 (e) Dust-bins wanting or defective ... 4 1 5 1 ... ... 1 6 (f) Miscellaneous defects remedied 2 16 3 21 ... ... 2 2 23 Nuisances referred to Medical Officer of Health 7 7 3 17 10 .. 4 14 31 Cases of over-crowding of workrooms abated 3 ... ... 3 17 ... ... 17 20 * Houses where the business plate, or the local directory, or advertisements in newspapers implied a probability that female workers would be employed, but at which none were found. 103 Public Health (London) Act.—The need for amendments to the Act of 1891 has long been felt, and the County Council propose to introduce a bill for the purpose when practicable. In February a letter was received from the Public Health Committee, asking for information as to any amendments, which, in the opinion of the Vestry, should be made. The communication was referred to a sub-committee of the sanitary committee, together with reports by the vestry clerk, the surveyor, and the medical officer of health; and also a communication from the Society of Medical Officers of Health, embodying suggestions for amendments and additions to the Act. The sub-committee made suggestions for amendment of section 2, especially for the definition of "overcrowding," corresponding to the provisions of the second bye-law for registered houses. They also proposed that section 5 should be amended, so as to enable the sanitary authority, upon obtaining a closing order, to clear out the tenants. Other proposed amendments dealt with offensive trades, slaughter-houses, cow-sheds and dairies; with the disposal of refuse; regulations as to water-closets, unsound food, notification of infectious disease, cleansing and disinfection of premises after infectious disease; isolation in hospital; exposure of infected persons, &c. A number of additions to the Act were suggested, mainly with regard to the control of infectious disease. The report, subject to a slight variation in regard to proposed amendments to section 55 (notification of infectious disease) was approved by the committee, and submitted to your Vestry. Some of the amendments were adopted; others, and all but two of the proposed additions; were rejected. 104 THE WORK OF THE SANITARY INSPECTORS. Table VI. (appendix) contains a summary of a portion of the work of the sanitary inspectors. The duties of these officers are carried out under the supervision of the sanitary committee, your Vestry having conferred on that body 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 a chief inspector, six district inspectors, and a lady inspector of workshops, laundries, &c., whose annual report will be found at page 97). The two street inspectors inspect mews to see that your Vestry's regulations as to periodical removal of stable refuse are duly carried out. The only change in the staff during the year arose from the appointment of Mr. Macdonald to the south-east district, vice Mr. Pettit, chief inspector, relieved from district work. The inquiry which, in May, 1898, the Local Government Board announced their intention to make, "into the details of sanitary administration in the parish "has not yet been held; but the County Council, by one of their assistant medical officers of health, last year, made a prolonged investigation as to " the sanitary condition of Kensington," the main recommendation arising thereout being for the appointment of four additional inspectors, three males and one female. The report did not commend itself to your Vestry, and no increase to the inspecting staff was made. Sanitary Inspectors in London Districts.—The subjoined statement, showing the proportion of inspectors to population in the several sanitary areas of the metropolis, is based upon a return issued early in 1899 by the medical officer of health to the County Council. From it we learn that at the end of 1898, there was in the City of London, one male inspector to every 4,424 resident inhabitants. 105 The following Districts had one Inspector to fewer than 10,000 population, viz.:— Strand 5,945 St. Martin-in-the-Fields 6,538 St. Giles, Bloomsbury 7,645 Holborn 7,802 Lee 9,647 The following Districts had one Inspector to more than 10,000, and fewer than 15,000 population :— St. James, Westminster 11,525 St. Olave, Southwark 11,731 Plumstead 1 1,850 Lewisham 1 1,887 Whitechapel 12,952 St. Saviour, Southwark 12,682 St. Luke 13,842 Wandsworth 14,405 Hammersmith 14,885 The following Districts had one Inspector to more than 15,000, and fewer than 20,000 population :— St. George, Southwark 15,069 Hampstead 15,089 Newington 15,117 St. George-in-the-East 15,835 Hackney 16,388 Stoke Newington 16,742 Westminster 17,744 Battersea 18,346 Bethnal Green 18,451 Fulham 18,963 Limehouse 19,435 Greenwich 19,530 Islington 19,809 St. George, Hanover Square 19,992 106 The following Districts had one Inspector to more than 20,000 and fewer than 25,000 population :— Rotherhithe 20,189 Shoreditch 20,391 Woolwich 20,657 Paddington 20,751 Camberwell 21,089 Bermondsey 21,368 St. Pancras 21,887 Clerkenwell 22,067 Lambeth 22,695 St.Marylebone 23,531 Chelsea 24,161 Poplar 24,181 The following Districts had one Inspector to more than 25,000 population:— Kensington 28,410 Mile End 37,020 The area of Mile End is 677 acres, that of Kensington being 2,190 acres. In 1893 the number of inspectors in the metropolis (including nine in Kensington : males 7, females 2) was 188. At the end of 1898 the total had risen to 256, including 7 in Kensington ; 6 males and 1 female. Statutory Notices for the abatement of nuisances to the number of 1,408, were issued during the year, by the direction of the sanitary committee. Written Intimations of nuisance were served by the inspectors, under section 3 of the Public Health (London) Act, 1891, to the number of 1,949. As a result of these intimations, many works of sanitary amendment were carried out forthwith, thus realizing the intention of the Legislature, and obviating the necessity for service of statutory notices. On the intimation form, and on the statutory notice, a red ink note gives the person liable for the abatement of the nuisance 107 an opportunity of making what, for convenience, may be called an appeal to the sanitary committee, against the requirements of the sanitary inspector and the committee, respectively. Appeal, which is of rare occurrence, usually takes 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 exercised 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 61 cases proceedings were taken before the magistrates : in 26 instances for offences under the bye-laws for registered houses ; fines to the aggregate, amount of £25 15s. being imposed (£21 10s. upon keepers, and £4 5s. upon lodgers). Fines were inflicted in other cases as follows : for failure to comply with magistrates' orders, in two cases, the fines amounting to £3 6s.; in one case of unsound food, £2; in one case of black smoke, £5; in two cases of neglect to comply with the County Council's bye-laws with reference to w.c. accommodation, £6; and in one case for omitting to give notice in connection with the fixing of a w.c., one shilling. The fines in all amounted to £42 2s. Neglect of the notices of the sanitary authority is somewhat common, the result being that 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 fine prescribed by section 4 (4) of the Act of 1891 should be imposed, or at least applied for: disobedience to notices leads to waste of the officers' time, and is also disrespectful to the sanitary authority. 108 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; care on the part of the proprietor ; and supervision by your Vestry's inspector, as well as by the inspector of the County Council. Not for the first time, more than ten inhabitants of the locality certified this business to your Vestry, in May, 1898, to be (in the words of section 21 of the Public Health (London) Act, 1891), "a nuisance or injurious or dangerous to the health" of themselves and other "inhabitants of the district." The section requires that upon receipt of such a certificate, the sanitary authority shall— "Make a complaint, and if it appears to the petty sessional court hearing the complaint, that the trade, business, &c., carried on by the person complained of is a nuisance, or causes any effluvia which is a nuisance or injurious or dangerous to the health of the inhabitants of the district, then, unless it is shown that such person has used the best practicable means for abating the nuisance, or preventing or counteracting the effluvia, the person so offending (being the owner or the occupier of the premises, or being a foreman or other person employed by such owner or occupier) shall be liable to a fine not exceeding fifty pounds." Communications were opened up with the County Council, the local authority under the Act, in regard to this business, and after much delay proceedings were instituted by that body, the solicitor to the Council having requested that the proceedings your Vestry had intimated intention to take, might be deferred until after the determination of the Council's summons. The presentation of the case at the West London police-court was not satisfactory, and no surprise was felt when, on the third day of the hearing, the presiding magistrate adjourned the proceedings sine die, making no order as 109 to costs, thus leaving the matter entirely open. The magistrate was influenced by the impression that your Vestry had not taken steps to abolish the nuisance during the many years of its alleged continuance, and he indulged in some reflections upon your Vestry's officers in the public health department, for not having reported the nuisance—if any existed ; the fact being, as the Council's representative knew, that during many years, in the annual reports of the medical officer of health, attention had been drawn to the nuisance. The reports were in court, and should have been produced. The sanitary committee, moreover, had reported that "it could not be questioned that at times smells of the most obnoxious character emanate from the premises to the serious inconvenience, if not danger, of the inhabitants of the houses in the immediate vicinity"; and they had recommended that the matter should be dealt with either by complaint to the petty sessional court, or by proceedings in the High Court, so as to secure the abatement of the nuisance; a course which would have been taken had not the Council intervened. Subsequently, the committee thought it would be well to defer proceedings on the part of the Vestry, as sanitary authority, and meantime to get the proprietor of the premises to effect improvements, which, it was thought, might lessen the nuisance, to the gravity of which several of the inhabitants of the district had testified in court. These suggested improvements, which included the provision of a scour or condensing apparatus, and elevation of the chimney shaft, were carried out with apparently good results, judging from the diminution in complaints. 110 FRIED-FISH SHOP NUISANCE. In connection with proposed amendments to the Public Health (London) Act, 1891, the sanitary committee, in a report dated May 9th, expressed the opinion that the business of a fried-fish seller should be added to the list of those specified in section 19; this being the only means of bringing about the regulation of the conduct of the said business, so as to prevent it from being an annoyance to adjoining occupiers. The recommendation of the committee was not adopted by your Vestry; but that the business does give rise to nuisance when carelessly carried on, and without necessary precautions to prevent escape of effluvia, is beyond question. Decided cases, moreover, class it as an "offensive business." The latest of such cases, Duke of Devonshire v. Brookshaw, was tried, in 1899, in the Chancery Division, by Mr. Justice Kekewich; the plaintiff claiming an injunction to restrain the defendant from carrying on the business of a fried-fish seller, (at Eastbourne), or using the house for the business of a fried-fish seller, in breach of a covenant not to carry on any offensive trade or business on the premises. The said business, it appeared, had been carried on since 1887, and in 1892 the Corporation took proceedings, but discontinued them on certain alterations being made. The defendant relied on laches and acquiescence on behalf of the plaintiff; but the judge decided that there had been a breach of the covenant, in the original conveyance, not to carry on an offensive trade or business, and granted an injunction. 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 to offensive smells, and has been held by the Appeal Court to be ejusdem generis with the businesses scheduled, originally, in the now repealed Slaughterhouses (Metropolis) Act, 1874. Acting upon my representations, your Vestry made application to the late Metropolitan 111 Board of Works, so far back as 1883, and again subsequently, 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 annual report for 1896—pages 119123. 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 five years, since the successful proceedings taken by your Vestry to abate the nuisance from effluvia caused by brickburning, in Wood-lane, Shepherd's-bush, 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 for satisfaction that it has been found practicable to burn bricks without causing nuisance, as no one connected with your Vestry desired to interfere needlessly or vexatiously with the carrying on of a lawful business. LICENSED SLAUGHTER-HOUSES. Thirteen premises were licensed, by the County Council, in October, to be used as slaughter-houses; seven in North Kensington and six in South Kensington. The names of the licensees, and the localities of the premises, are set out in Table XI. (appendix). The several premises were regularly visited by the sanitary inspectors, and, as usual, were inspected, in July, by the sanitary committee whose report is printed in the minutes of your Vestry, for July 26th, page 357. The business of a slaughterer of cattle has not been established anew in the parish since the passing of the Slaughterhouses (Metropolis) Act, 1874, in which year there were 56 112 licensed premises. The number of slaughter-houses in the metropolis, as a whole, has undergone a considerable diminution ; viz., from 1,500 in 1874, to 411 in 1899. In the report for 1898 (pp. 98-102), I dealt with the subject of "Abattoirs versus Private Slaughter-houses," in connection with an abortive attempt by the Public Health Committee of the County Council to substitute public for private slaughterhouses. The report of the Committee (dated 21st July, 1898), containing the recommendation, was shelved by the Council on a motion to proceed to the next business ; to my regret, as an advocate for nearly 30 years of public abattoirs. LICENSED COW-HOUSES. Four premises were licensed by the County Council, in October, to be used as cow-houses; three in North Kensington, and one in South Kensington. The names of the licensees, and the localities of the premises, are set out in Table XII. (appendix). The several premises are regularly visited by the sanitary inspectors, and, as usual, were inspected, in July, by the sanitary committee, whose report is printed in the minutes of your Vestry for July 26th, page 357. There were only 14 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, as a whole, viz., from 1,044 in 1880, to 331 in 1899. The County Council have intimated to cowkeepers that the public health committee are of opinion that in the case of premises newly licensed, the recommendation of the Royal Commission on tuberculosis that no cow-shed should be erected within 100 feet of a dwelling-house, should be observed. The Council, can, of course, enforce this view. 113 THE PREVENTION OF CONSUMPTION. The hypothesis that consumption is contagious, entertained on the continent long before it found acceptance in this country, is now generally accepted as the expression of a scientific fact. The subject had received attention in these reports so far as 1881—in which year it was stated that " Modern researches, which have thrown great light on the origin of tubercle, raise a presumption that tuberculosis may really be an infectious disease—a specific fever of slow progress, with a veiled resemblance to other specific eruptive fevers." These researches, it was added, "encourage the hope that, in time, a remedy may be found for this scourge of the human race." Later, a solid basis for the theory of contagiousness, was established by the discovery, by Koch, of an organism—indifferently spoken of as germ, microbe, or bacillus—which is now acknowledged to be the immediate agent in the genesis of tuberculosis in all its varied forms. The first reference to this bacillus was made in the annual report for 1890. Heredity, which formerly was thought to be the all-sufficient explanation of the occurrence of " decline," in successive members of the same family, is now relegated to a secondary position, as a factor in the causation of consumption ; mainly, if not wholly, as creative of a predisposition which favours the development of the bacillus tuberculosis—an organism which, as a rule, does not flourish save in a suitable soil, i.e., where unhealthy or unwholesome conditions of life induce deterioration of general health. This view of the cause of the spread of tubercular disease amongst the badly housed and ill-nourished poor, as well as the means of combatting the disease, found expression in the report for 1879, wherein it was observed that "abundance of sunlight and pure air, efficient drainage and its corollary, a dry soil, good food and warm clothing, and temperance in all things, are powerful antidotes, to the bane of tubercle, which is fostered by the 114 opposites—by filth and squalor, by cold and nakedness, by the want of the proper necessaries of life, by overcrowding in ill-constructed, unventilated, and sewage-tainted houses, and, in a word, by whatever is inimical to the maintenance of a typical condition of health." It was further observed that tubercular disease is "susceptible of considerable amelioration, if not of cure, and ultimate extirpation, under improved hygienic conditions." It is now common knowledge that consumption (using the term in its widest sense), is communicable from person to person, and from animal to man, and that it arises in no other way than from some pre-existing case. It spreads mainly from person to person; but not, as popularly thought, by the breath of the sick—for in breath the bacillus is not found—but by inhalation of air, which, in the vicinity of the sick, abounds with bacilli, derived, in a dry but vital condition, from expectorated matters {sputa) allowed to fall upon the ground, or otherwise so disposed of as to afford opportunity for drying, and passage into the atmosphere in the form of dust. But the tubercle bacillus is also conveyed to man from animals in food, especially in the milk of tuberculous cows, the ingestion of which is frequently productive of those forms of the disease, peculiar to young children, known as tabes mesenterica (consumption of the bowels), tubercular meningitis (inflammation of the membranes of the brain), hydrocephalus (water on the brain), and the varieties of the malady comprised, in the classification of the the Registrar-General, under the heading" Other forms of Tuberculosis, Scrofula." Further, the flesh of diseased animals, but in a lesser degree, is also a source of tuberculosis in man, a subject dealt with in the eleventh and twelfth monthly reports, in 1898. 115 The National Association for the Prevention of Consumption and other forms of Tuberculosis.— The above observations seemed desirable by way of introduction to the subject of the prevention of consumption, which in 1899 attracted attention in all parts of the civilised world; and in this country received a great stimulus, due to the meeting held at Marlborough House, under the presidency of H.R.H. the Prince of Wales, and to the formation of an association for the diffusion of information in relation to the nature and cause of consumption, and the measures necessary for its prevention and cure. The objects of the association, as defined by Sir William Broadbent, at the Marlborough House meeting, are:— (1). To educate the public as to the means of preventing the spread of consumption from those already suffering from the disease; (2). To extinguish tuberculosis in cattle; and (3). To promote the erection of sanatoria for the open air treatment of tuberculous disease. The association does not advocate compulsory notification of consumption; but it urges upon sanitary authorities the desirability of insisting on the disinfection of rooms in which consumptive persons die, or from which such persons may have removed. Against the spread of tuberculosis through milk, it advocates the testing of cows by tuberculin; the isolation of diseased animals; the supervision of cattle sheds, and of dairy farms, and of all the agencies for the distribution of milk. The provision of public slaughter-houses is also recommended—with the view to insure the inspection of carcases before the evidences of disease are removed—and the sterilization of food; of milk by boiling, and of meat by 116 thorough cooking. The benefits to be hoped for from the adoption of such preventive measures, may be fitly summed up in Sir William Broadbent's words:— "If we could ensure the destruction of all the sputa of the sufferers from phthisis, and secure a supply of milk and meat absolutely free from tubercle bacilli, all the diseases due to tuberculosis, which now cause one-seventh or one-eighth of the total number of deaths, would cease from the land." The association (which has been incorporated) has already done much to forward the movement, of which it is the chief exponent, through the agency of branches in different parts of the country. The movement, moreover, is certain to extend, seeing that the medical profession is at one in opinion as to the preventability of tuberculosis, and, within limits, as to the curability of consumption. The medical Press, since the Marlborough-house gathering, has teemed with reports of proceedings at public meetings, and at meetings of Guardiaus of the Poor, called to consider the subject: hospitals are being erected by philanthropic persons, and it is hoped that Boards of Guardians will combine to secure the isolation from other sick persons of poor consumptives committed to their charge, whether for the cure or relief of the less severely afflicted, or for the prevention of the spread of disease by the incurables. The association desires to enlist the assistance of doctors, clergymen, nurses, district visitors, &c., in the spread of information on the nature of tuberculosis, and the means for preventing its spread; but, above all, it appeals to sanitary authorities to take their part in the matter. And a very important part it is, for it rests with these bodies, not merely to spread information and give good advice, but also to do things which they alone can effectually carry out; as disinfection of rooms, supervision of 117 the supply of milk and meat; bacteriological examination of the sputa in suspicious or doubtful cases, and provision of sanatoria for the isolation and treatment of the sick, under the Public Health Acts, which enable the sanitary authority to provide hospitals for the inhabitants of their district. Reduction in Mortality from Consumption, &c. Speaking generally, it may be said that every advance in sanitation—every measure tending to remove or diminish the causes of unhealthiness, especially by improvement in the housing of the people, and abatement of overcrowding (the most deadly of nuisances), and every advance in general prosperity, which enables the poorer classes to feed and clothe better, and to live happier and more wholesome lives,—conduces to the attainment of the object of the National Association. Already much has been done to bring about this happy consummation; for, as stated at the Marlborough House meeting, the mortality from tuberculosis has undergone reduction to the extent of one-half during the last fifty years. But much remains to be accomplished; for, even now, tuberculosis in its various forms is the cause of some 60,000 deaths annually in England and Wales alone, including 40,000 from consumption. In this parish, inquiry made last year showed a considerable reduction in the mortality from tubercular diseases since 1873, the deaths in successive quinquennial periods having been—2,089 in 1873-77; 2329 in 1878-82 2,112 in 1883-87: 1,725 in 1888-92, and only 1,651 in 189397, without correction for increase in population. Subject to such correction, the diminution in the number of deaths during the five years 1893-97, as compared with 1873-77, was 838, or about one-third. A numerical statement of the deaths during this period of 25 years, from the various forms of tuberculosis, and the wasting diseases of children, is set out in the table at page 128, which indicates a marked reduction in the mortality from the varieties of the disease, already alluded to as peculiar 118 to children, viz., Tabes Mesenterica (col. 1), Tubercular Meningitis and Hydrocephalus (col. 2). The reduction in the number of deaths from Phthisis (consumption or decline) is not so considerable, and there is a not inconsiderable increase, after allowance for increase of population, in the deaths from" Other Forms of Tuberculosis, Scrofula" (col. 4). The corrected increase under this head, 51 deaths, admits of a probable explanation on the assumption of greater accuracy in diagnosis; deaths which formerly would have been inserted in columns 1 and 2, now being classified to the diseases included in column 4. Be this as it may, the fact remains of a large reduction in mortality amongst infants and young children in this parish*, which may have been due in part to improvement in the quality of the milk supply, which for many years has come almost exclusively from country districts; whereas a quarter of a century ago a not inconsiderable amount was produced, under conditions more or less unfavourable, in London itself. There is reason for believing, moreover, that the practice of boiling milk—an effectual means of destroying the bacillus—is now more general than formerly. In 1898, the deaths from tubercular diseases in Kensington were 333, and particulars of these deaths, showing the number from each of the diseases, and at different ageperiods, in the parish, as a whole, and in the sub-districts, are set out in the table at page 129. Consumption, the leading disease in the group, was the cause of 217 deaths (12.6 per 10,000 of the population): 71 of the deaths took place at the parish infirmary. These deaths, which comprised 118 of males and 99 of females, were connected with the several sanitary districts as shown in the subjoined table: *Our local experience appears to be at variance with the general experience, for Sir William Broadbent stated, at the Marlborough House meeting, that "tabes mesenterica, the disease of the bowel in children traceable to tubercle conveyed in milk, has increased." British Medical Journal, Dec. 24, 1898. 119 District. South-East North South-West North-East Central North-West " Special Area" Population. 32,200 33,350 32,020 33,040 27,240 16,850 4,000 Deaths from Consumption. 13 34 35 38 37 60 25 Deaths per 10,000 Living. 4.0 10.2 10.9 12.5 13.6 35.6 62.5 In North Kensington (population 87,500) the deaths were 147, as compared with 70 in South Kensington (population 84,500). In the Town sub-district (population 123,600) the deaths were 185, as compared with 32 in the Brompton sub-district (population 48,400). The position in life of the deceased persons (whether heads of families, or their wives, sons or daughters) may be roughly described as follows: Labourer (males 23; females 21, including charwomen, 7) 44 Costermonger, Hawker (males, 5; females, 4) 9 Artizan (males, 34; females, 11) 45 Cabman, Carman, Coachman, Horsekeeper (males, 14; females, 4) 18 Domestic Servant (males, 7; females 22) 29 Railway Servant (males, 6; female, 1) 7 Commercial Traveller, Clerk (males, 5; female, 1) 6 Pensioner, Private Soldier, Fireman, Police Constable (females, 3) 5 Tradesman (males, 8; females, 4) 12 Trade-assistant (males, 3; females, 19, including laundress, 6, dressmaker, 4) 22 Professional (males, 7; females, 1) 8 Persons of independent means (males, 3; females, 3) 6 Hospital Nurse 2 Unknown 4 Total 217 120 The number of deaths bears a fairly close proportional relation to the sanitary condition of the respective districts; the mortality, moreover, being highest amongst the poorer classes. Less detailed information respecting the mortality from tubercular diseases in 1899 will be found in the table at page 130. The Action of the Vestry.—The first monthly report in 1899 dealt somewhat fully with" the prevention of consumption." The importance of the subject being recognised, the report was referred by your Vestry to the sanitary committee, who remitted it to a sub-committee, which included all of the medical members. The sub-committee, after much consideration, reported on the reference as follows:— "1 It may be stated that Tuberculosis is a communicable disease. Consumption, its most common form, is usually spread, from person to person, by the inhalation of the specific germ (microbe or bacillus) of the disease, derived from the dried expectorated matter of a consumptive person, and floating in the atmosphere as dust. But consumption and other forms of tuberculosis may be propagated from animal to man by the ingestion of insufficiently cooked flesh, or the raw milk of tuberculous animals. In young children infected milk is the principal cause of those forms of the disease known as tabes mesenterica (or consumption of the bowels), and tubercular meningitis (or inflammation of the membranes of the brain), etc. "2. But multitudes of people inhale the germs, and eat the flesh, and drink the milk, of tuberculous animals, without themselves becoming the subjects of tuberculosis—in the absence of any predisposition to the disease. Others have inherited a predisposition: many more, probably, contract a predisposition owing to the circumstances in which they are placed, or for which they are personally responsible. The development of tuberculosis in individuals is largely due to this predisposition, which, in turn, is favoured by whatever tends to the lowering of the general health; as, for instance, filthy habits of life and sensual excesses; poverty, which means insufficiency of food and clothing; overcrowding, which implies the re-breathing of polluted air,in rooms, which, too often, are ill-lighted and unventilated, and to be found in houses that are 121 damp, being without damp courses to the walls, or ventilation under basement floors, and without sufficient surrounding space, and not uncommonly are environed by filthy, unpaved, and undrained yards. Living in circumstances like these, too often the unhappy victims are driven to 'the drink,' and thus, whilst finding temporary forgetfulness of their troubles, only aggravate the effect of the conditions which tend to the development of the tuberculous state. "3. Tuberculosis, nevertheless, is preventable, and the means of prevention are largely within the power of those bodies whose title of Sanitary Authority, indicates the raison detre of their existence. What these means are may be briefly indicated:— (a) Enforcement of the provisions of sanitary law, for the prevention of overcrowding, and the abatement of nuisances generally, so as to secure healthy homes for the lower classes; and by systematic inspection of tenemented houses, and houses let in lodgings. (b) Education of consumptives as to the danger of spitting about rooms or in public places, vehicles, etc.,and the necessity of destruction of expectorated matters by disinfection or preferably by fire: viz., by the issue of a circular of advice in which also might be explained the necessity for thorough cooking of meat and boiling of milk. (c) By advising, and in suitable cases carrying out, disinfection of rooms in which consumptives have died, or from which they may have removed. "4. And here it may be said that of 333 persons who died from tuberculous disease in this parish in 1898, 217 fell victims to consumption, exclusive of deaths of non-parishioners at Brompton Hospital. How many sufferers are fading away it is quite impossible to surmise. But much information on the subject could, no doubt, be obtained from medical practitioners, especially those attached to the Poor Law service, and to charitable and provident dispensaries. Such information should be obtained and acted upon with the care bestowed in cases of scarlet fever, diphtheria, and enteric fever; diseases which in 1898 were fatal to 61 persons, or less than a third of the number of the victims to consumption alone. "5. We recommend that the Vestry be advised to adopt all practicable means for the prevention and the cure of consumption and tubercular disease generally, e.g.:— 122 "(1) By spreading information as to the nature and cause, the preventability, and curability of tuberculosis, and especially of consumption; and by inculcating the necessity for thorough cooking of meat and the boiling of milk. "(2) By disinfection of houses after the occurrence of fatal cases of consumption, and after removal of consumptives to new abodes. "6. It is perhaps almost needless to observe that consumption is a common cause of pauperism. The bread winner works while he can, but the time arrives when he can work no longer. Then, too often, he has to come on the rates. Many such cases find their way to the workhouse infirmaries—with disease hopelessly advanced, and beyond remedy. They become a source of danger to other persons, and, no doubt, spread infection, more or less.* It is a question whether it would not be well for Boards of Guardians to make special provision for housing such cases away from other inmates, and preferably in establishments quite distinct. Different Boards might be enabled to unite for such a purpose, and also for the purpose of providing country hospitals for the treatment, with a view to the cure of the disease. Expenditure for such purposes would probably be a profitable investment of public moneys. The Kensington Guardians might be approached on the subject by the Vestry, as sanitary authority. The present time would seem to be an appropriate one to do so, as the Guardians are contemplating the erection of an additional block (at an estimated cost of £13,000), to provide improved and increased accommodation for women and children at the workhouse. It is just possible that by making provision for consumptives away from the workhouse and infirmary, the additional accommodation thus set free would, in part at least, obviate the necessity for the proposed expenditure. But apart from this point altogether, the matter is one in regard to which the sanitary and the poor-law authorities might take counsel together with advantage. "7. Should our report be approved by your committee and the Vestry, we would further recommend that it be referred to us to draw up a detailed scheme for giving effect to the several recommendations above set out. "All which we submit." *At the date of the report, there were about sixty sufferers from consumption in the parish infirmary, spread over the wards assigned to the sick of both sexes. The deaths during the year 1899 were 75. 123 [The draft report prepared for the sub-committee contained the following paragraphs which it was thought desirable to append for the information of the sanitary committee, although they were either deleted or modified. ''Par 3 (a) Enforcement of the provisions of sanitary law for the provention of overcrowding and the abatement of nuisances generally, so as to secure healthy homes for the lower classes—waiters which involve (a) reproductive expenditure under Part III. of the Housing of the Working Classes Act, 1890, and (b), systematic inspection of tenemented houses, and houses let in lodgings, with the view to the abatement of nuisances and enforcement of the bye-laws. And in this parish there are no fewer than 6,400 tenements consisting of a single room each, inhabited by nearly 14,000 persons, and 7,000 tworoomed tenements inhabited by 26,000 persons; all of which, including the registered houses, should be regularly and systematically inspected." The above paragraph was modified by the deletion of the words printed in italics. The two following paragraphs were deleted. After paragraph 3 (c):— "It is unnecessary to do more than observe that the proper discharge of the duty of the Vestry in regard to the above matters, would throw increased work upon the Public Health Department, and necessitate a considerable increase in the sanitary staff." After paragraph 6:— "But consumption is not merely preventable: in its early stages, more especially, it is also curable. But to the generality of sufferers the means of cure are not available, for few of them, probably, possess the means to obtain facilities for the 'open air treatment'—the segregation, the constant exposure to fresh air, light, sunshine, &c., necessary to secure the end in view. Happily it is in the power of metropolitan sanitary authorities to provide these facilities for those who need their help; viz., by the exercise of the powers conferred on them by Section 75 of the Public Health (London) Act, 1891, which enables them to provide hospitals for the inhabitants of their districts, or make other arrangements for the purpose." The following recommendations were deleted:— "3. By a suitable increase in the numbers of the sanitary inspecting staff, so as to make it adequate to the duties above suggested rather than described. "4. By provision of a hospital or hospitals, or by making other arrangements, so as to enable poor consumptive persons to be isolated and treated under the best attainable conditions, and to secure restoration to health."] 124 The committee submitted the report of the sub-committee, with slight modifications, which included the excision of the words "all practicable" in par. 5, and the whole of par. 6.* The report was adopted by your Vestry, and remitted to the committee to "draw up a detailed scheme for giving effect to the suggestions embodied therein." The matter thus came again to the sub-committee, at whose request I stated my views as to the action that should be taken by your Vestry.† Briefly, I advised the preparation of a leaflet for circulation amongst persons likely to be interested in the subject, as, for instance, medical practitioners, nurses, clergymen, district visitors, heads of schools, &c. I stated that disinfection of houses, at the cost of the Vestry, would be required in from 200 to 300 cases annually; after death from consumption, or of removal of consumptives from one abode to another. A system of voluntary notification by doctors was suggested, to secure information of such cases. The cost of disinfection, at the house, and at the station, was estimated at one pound per case; and it was intimated that if this work were undertaken, "further assistance would be necessary in the disinfecting department," I expressed the hope that, in addition to such measures, every effort would be made to secure what the sub-committee recognized to be necessary, viz.—"Enforcement of the provisions of sanitary law for the prevention of overcrowding, and the abatement of nuisances generally, so as to secure healthy homes for the lower classes." My report concluded with the statement that, "The great reduction in mortality from tuberculosis within the present reign has been brought about by the improved sanitation which has characterised the Victorian era, especially since public health legislation entailed the appointment of medical officers of health and inspectors of nuisances to carry out the behests of sanitary authorities." * Vide Minutes of the Vestry, March 22nd, 1899, page 1,037. †Vide Minutes of the Vestry, June 14th, page 204. 125 The sub-committee approved the form of leaflet prepared for their consideration, as follows:— THE PREVENTION OF CONSUMPTION. (An Infectious and a Preventable Disease). The Vestry, as Sanitary Authority. desire to call attention to the subjoined statement prepared by the Medical Officer of Health. INTRODUCTORY. Consumption and other forms of tuberculosis cause one death in every eight deaths in this country, and of all deaths in the United Kingdom between the ages of twenty-five and thirty-five, in the prime of life, nearly onehalf are due to consumption. In Great Britain, at the present time, probably a quarter of a million persons are suffering from consumption alone. This means a vast amount of suffering and permanent ill-health, unfitting the sufferers, more or less, for the discharge of the duties of life. And yet the disease might be prevented by the adoption of means for the improvement of the general health of the community, and for the removal of insanitary conditions in houses, etc.: in many cases, moreover, it is curable by proper treatment, especially in the early stages. The causes which predispose to consumption are such as bring about a low state of health: the susceptibility to it, often inherited, may also be induced by unhealthy conditions of life, or evil habits; as overcrowding in ill-ventilated, dirty, dark, damp dwellings; bad or insufficient food; intemperance; sensual excesses, infectious fevers, and other illnesses. Consumption is not now regarded as hereditary, but as being actually caused by the presence in the body of a term or microbe, called the tubercle bacillus, derived from some person or animal suffering from consumption, or some other form of tuberculosis. This germ, the infective material, under favourable circumstances, as in dark, dirty, damp places, and in ill-ventilated or dusty or overcrowded rooms, workplaces, etc., may live outside the body for long periods of time: it abounds in the spit coughed up from the chest of consumptive persons; it may exist in the flesh of tuberculous animals, and it is present in the milk of cows suffering with tubercular disease of the udder. Such milk, specially dangerous to infants and young children, is often the cause of the wasting diseases peculiar to that lime of life. But the great cause of the spread of consumption is the expectoration or spit of consumptive persons, in which the germs exist in enormous numbers. Whilst wet there is little harm in the spit, but it is very dangerous if allowed to fall on the ground, or otherwise to become dry; for then, floating in the air as dust, it is inhaled in breathing, and so becomes the 126 chief means by which consumption is spread from one person to another, and especially to those predisposed to the disease. Destroy the germs, and consumption will not spread. There is, practically, no risk of taking the disease from the breath of a consumptive person, and there is no objection—if proper precautions are taken—to a consumptive person being closely attended upon by a healthy person, who, moreover, may share the same bedroom but should not sleep in the same bed. PERSONAL PRECAUTIONS TO BE OBSERVED BY CONSUMPTIVE PERSONS. For the protection of their own families, and to prevent the spread of the disease to other persons, the following precautions should be taken by all who are suffering from consumption. Do not spit about the house or workplace, nor on the floor of any cab, omnibus, tram-car, railway carriage, or other conveyance, nor in theatres, concert-rooms, or other public meeting-places. Spitting about the streets, or in other way than as suggested below, is a dangerous habit. Spit only into a covered cup, spittoon, or bottle, kept for the purpose, and containing water, to which a little disinfectant fluid should be added. Out-of-doors a small wide-mouthed bottle, with a well-fitting cork, should be used; or a pocket spittoon, which may be obtained through any chemist and druggist. When a proper vessel is not at hand, or for wiping the mouth, a rag or a piece of paper, which can be burned, should be used, and not a handkerchief; but if a handkerchief is used, it should be kept wet until it can be put into boiling water and wished. The spit, if collected in a cup, bottle, or spittoon, should be carefully destroyed by being put on a clear fire. This is the simplest, quickest, and safest way of destroying the disease germs, and it should be done night and morning at least. When there is no fire, wash the spit, at least twice a day, into the watercloset, or bury it in the earth. The spit-vessel, after emptying, must be soaked and well washed in boiling water. Do not swallow the coughed-up spit, as by so doing tubercular disease may be set up in the bowels and other parts of the body. A consumptive person should not kiss, or be kissed on the mouth. A consumptive mother should not suckle her child, 127 GENERAL PRECAUTIONS TO BE OBSERVED. Rooms in houses occupied by consumptive persons should be kept free from damp, and be well lighted, and well ventilated—sleeping rooms especially. Fresh air and light are preventives of consumption. Bright sunshine kills the germs of tuberculosis. Don't block up the chimney of the bedroom. Open the windows and admit fresh air as much as possible, by day and night. Cleanliness and good sanitary surroundings are all-important, both for the prevention and for the cure of consumption. Rooms, passages, and staircases should be kept free from dust. Where there is dust there is danger. Don't stir up dust: use damp tea leaves, or damp sawdust, when sweeping floors, and damp cloths for dusting; boil the dusters after use, and burn the tea leaves and sawdust. Milk should be boiled for one minute, or it may be heated in a double saucepan for at least five minutes after the water boils in the outer saucepan. In either way the germs of tuberculosis, if present, will be destroyed. It is a wise precaution to treat milk, at all times, as directed, before use. Meat should be thoroughly cooked. After the death of a consumptive person, or after removal of a consumptive person from one house to another, the room occupied by such person should not be occupied again until it and its contents shall have been cleansed and disinfected. If the assistance of the Vestry is desired for disinfection of rooms, carpets, rugs, bedding, clothing, etc., make application to the Medical Officer of Health, at the Town Hall. In all cases in which there may be proved inability to pay, disinfection will be done free of cost Persons in charge of consumptive patients should apply to their regular Medical Attendant, or to the Medical Officer of Health at the Town Hall, for advice as to the disinfection which should be carried out, from time to time, during the illness of the patient. By direction of your Vestry the leaflet was sent to medical practitioners, clergymen, &c. There was no further demand for it—save that one clergyman responded to the invitation to apply for copies for his district visitors—although it was intimated that the leaflet would be supplied on application for the guidance of the head of any household in which there might be a sufferer from consumption. No further action was taken. [T ABLES, 128 DEATHS IN KENSINGTON FROM TUBERCULAR DISEASES, 1873 to 1897. Arranged in Quinquennial Periods. (Vide Page 117). Quinquennial Period. Diseases. Population 7 Tabes Mesenterica. 1 Tubercular Meningitis and Hydrocephalus 2 Phthisis 3 Other forms of Tuberculosis, Scrofula 4 Totals 5 Atrophy Inanition Debility. 6 1873 to 1877 235 376 1,325 153 2,089 756 142,100 1878 to 1882 312 422 1,373 222 2,329 585 160,600 1883 to 1887 253 340 1,290 229 2,112 574 164,500 1888 to 1892 155 208 1,155 207 1,725 499 166,100 1893 to 1897 62 187 1,167 235 1,651 538 169,300 Totals 1,017 1,533 6,310 1,046 9,906 2,952 - 129 Deaths in Kensington from Tubercular Diseases, in 1898. (Vide Page 118.) disease. ages. subdistrict. 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 & upwards. Total under 5 years. Grand Total. Kensington Town. Brompton. tabes mesenterica 6 4 ... ... ... ... ... ... ... ... ... 10 10 10 ... tubercular meningitis hydrocephalus 19 25 11 2 ... ... ... ... ... ... ... 44 57 54 3 phthisis 1 1 6 26 43 68 45 22 5 ... ... 2 217 185 32 other forms of tuberculosis, scrofula 16 17 6 3 3 3 1 .. .. ... ... 33 49 43 6 totals 42 47 23 31 46 71 46 22 5 ... ... 89 333 292 41 130 DEATHS IN KENSINGTON FROM TUBERCULAR DISEASES, IN 1899. (Vide Page 120.) Disease. Total Number of Deaths in Parish. Registration Districts. Parliamentary Divisions. Sanitary Districts. Place of Death. Kensington Town. Brompton. North Kensington. South Kensington. N. N.E. N.W. C. S.E. S.W. j At Home. Kensington Infirmary. Outlying Institutions. Brompton Hospital Kensington Section. Phthisis 221 193 28 156 65 42 34 65 34 11 35 116 75 25 5 Other Tubercular Diseases* 98 83 15 69 29 26 11 23 14 13 11 73 14 11 ... Totals 319 276 43 225 94 68 45 88 48 24 46 189 89 36 5 Death-rate per 10,000 persons living 19 22 9 26 11 20 15 52† 18 7 14 *Namely Tabes Mesenterica (14 deaths); Tubercular Meningitis and Hydrocephalus (37); and other forms of Tuberculosis, Scrofula (47.) The Return does not include deaths from debility, atrophy, inanition, convulsions, or rickets, 146 in all. †Special Area, 42 deaths=105 per 10,000 persons living, or about one per cent of the population. In the North-West District, less the Special Area, there were 46 deaths 36 per 10,000. 131 BAKEHOUSES. The bakehouses, to the number of 134, viz., 74 in North Kensington and 60 in South Kensington, were, as usual, regularly inspected, and action was taken, in several instances, to ensure 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), in dealing with the "regulation of bakehouses," I set out in detail the efforts made by the County Council to secure such an amendment of the law as would enable the sanitary authority to exercise an efficient control over bakehouses. The Council were of opinion that the Factory and Workshops Bill, 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 explain their views. The President said 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 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 in accordance with the Council's views; but no action was 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 undergound 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; but magisterial rulings made this provision inoperative, 132 OFFENSIVE SMELLS IN STREETS, During the hot and dry summer weather, numerous complaints were received of offensive smells in the streets proceeding from untrapped gullies and sewer ventilating openings in the roadways. Many of the complaints were in respect of sewers under your Vestry's jurisdiction. Others related to the main sewers under the control of the County Councilthe Counter's-creek sewer in particular. Several communications were had with the Council's engineer in connection with complaints from persons living in streets traversed by this sewer. Referring to one specially offensive opening, the engineer stated that "the gully is trapped with one of Doulton's best made flaps": he therefore "failed to see how any bad odours could possibly escape from the main sewer." But the stinks do occur, the reason being that the so-called trap—a hanging flap at the outlet—is not a trap in the proper sense of the word, and does not prevent the escape of sewer gas. Consequent upon complaints received, more particularly in connection with this sewer, the Vestry Clerk was instructed, in July,to enquire of the Council's engineer, what measures were being taken to ventilate the sewers under the Council's jurisdiction? In reply, it was stated that iron ventilating shafts, 30 to 36 feet in height and 12 inches in diameter, were being erected at suitable points, such as cross-roads, and in the centre of street refuges, and that the Council would be prepared to consider suggestions as to the erection of such ventilators at places within this parish. I advised that the Council be requested to give the system practical trial on the Counter's-creek and Middle Level sewers. Certain sites, indicated by the surveyor, were approved, and recommended to the Council. At the close of the year no action had been taken. Many complaints of offensive smells were received from inhabitants of the western section of Royal-crescent, Nottinghill. The sewers in this street were ventilated by the street 133 gullies only. Diphtheria occurred in three adjoining houses, the occurrence being naturally attributed by the inhabitants to the smells which were most pronounced at the gulley at the highest part of the sewer, which is of great size (5ft. 10in. by, 2ft. 6in.), but receives the drainage of 22 houses only. With the object of reducing the pressure of sewer gas, shutters were fixed at the outlets of the sewers, east and west; but complaints were still made. Ultimately it was decided to syphon-trap the street gullies, and ventilate the dead end of the western sewer, by carrying a pipe up the wall of the house at the south-west corner of Darnley-road. Few complaints, by comparison, were received with respect to the sewer in the eastern section of the crescent, which is connected to the Counter's-creek sewer, thus allowing of circulation of air. An application was made to the County Council for permission to establish a connection between the highest end of the sewer in the western section with the Counter's-creek sewer, but it was not granted. Towards the end of 1898, the sanitary committee, in connection with their inquiry into the causation of offensive smells in streets, resolved" to collect such information as might be available as to the systems adopted in provincial towns for the ventilation of sewers, and the prevention of nuisance from sewer gas." The information furnished by the sanitary authorities of 30 towns,* comprising a population of more than *The towns in alphabetical order, and the population of each, were:— Birkenhead (population 113,492); Birmingham (515,000); Blackburn (133,000); Bolton (157,315); Bradford (240,000); Brighton (121,000); Bristol (320,911); Burnley (100,000); Cardiff (177,000); Derby (106,000); Edinburgh (296,000); Gateshead (103,000); Glasgow (731,635); Huddersfield (104.000); Hull (200,041); Leeds (418,000); Liverpool (670,000); Manchester (536,000); Middlesborough (95,000); Newcastle-upon-Tyne (228,000); Norwich (112,000); Plymouth (100,000); Portsmouth (182,000); Preston (117,622); Rochdale (75,000); Salford (215,000); Southampton (100,000); South Shields (100,000); Sunderland (143,000); and York (75,500). The information with respect to Bristol and Edinburgh was not given in the Summary (issued February, 1899), but separately at a later date. 134 six millions, was concisely summarised in a tabular form.* From the replies received, it appeared that sewers are ventilated mainly by gratings in the road surface, but also, in part, by special shafts, columns, chimneys, &c. Street gullies in most of the towns are trapped, usually by syphons. At Birmingham there are many untrapped gullies which, however, are being changed as fast as possible. Glasgow is the most notable instance of a large town with untrapped gullies, few being trapped at present; but "all new gullies are to have a water seal." In London the sewers are generally ventilated by open gratings in the roadway, but many ventilating shafts exist; and, as already stated, the County Council intend to increase the ventilation of their main sewers upon this plan, which, it is to be presumed, will be largely followed in connection with the new main sewers about to be constructed at a cost of three millions. This system might be adopted with advantage in connection with sewers under the control of the sanitary authorities. As regards drains, the inquiry elicited the fact that they are intercepted from the houses by syphon traps, constructed "under regulations or bye-laws" made by the sanitary authorities. In London intercepting traps are employed very generally, as we learn from a return issued by the Battersea Vestry in 1894, summarising replies by the local authorities to a series of questions—mainly, with reference to the utility of inspection chambers, which, it appears, are in general use, being in the opinion of the said authorities necessary or desirable. street Gullies.—With respect to street gullies, the more frequent cause of complaint of offensive smells in this parish, valuable information is contained in a report by your * "Summary of replies received from cities, boroughs, &c.,to enquiries addressed to them on the subject of sewer ventilation and sewer smells." The summary was reproduced in the pages of Public Health. the organ of the Society of Medical Officers of Health. The report of the sanitary committee on the subject of the enquiry is in the minutes of the Vestry for 26th July, 1899, page 358. 135 Vestry's surveyor, dated January, 1889, setting out the results of an enquiry made by him of the surveyors to the local authorities in London generally. At that date, in the 80 miles of roads in Kensington, there were approximately 6,500 gullies: a few were of "the most ancient type termed the Westminster Hopper" (as at Royal-crescent, Notting-hill); a larger number being stoneware pan gullies syphon-trapped; but the great majority consisting of brick catchpits, "trapped at the outlet in sewer with 6-inch stoneware block flap traps" —a form of "trap" ineffective for excluding stench. In London generally, "the use of stoneware pan gullies was much smaller than that of brick gullies, and the majority of the surveyors expressed opinions in favour of the latter"— probably on the ground of convenience; for on sanitary grounds the superior efficacy of the syphon-trapped gulley is admitted. "In several mews and a few other places where a regular supply of surface water is assured, stoneware pan gullies with syphoned outlets "were already in use; and such gullies have since been introduced in other mews, and in streets paved with asphalte. No bad consequences have been noted arising from the use of these gullies: complaints of stench are few, and when a pan gulley has been substituted for the brick catch-pit, it has proved effectual. The surveyor describes the comparative merits of the two forms of gullies: the stoneware gullies "are cleaner than brick catch-pits and provide (subject to conditions) a better trap against sewer gas." The virtues of the brick gully are that it is "more substantial, does not choke so readily, and demands much less attention"—excellent points from an executive officer's point of view. The "main objection to brick catch-pit gullies is the inefficient trap"—a fatal defect from a public health point of view. The stoneware gullies "must be regularly flushed with water in dry weather, in order to keep the syphons charged it may, therefore, be assumed that some additional expense 136 in maintenance would be incurred by the substitution of the pan gully for brick catch-pit gullies, but this should not weigh when compared with the advantages of the new system. The outcome of the above mentioned enquiry by the sanitary committee being decidedly in favour of syphontrapping of gullies, I thought it my duty, in order to the prevention of nuisance, and danger to health, to recommend, in the twelfth monthly report (December 7th, page 126) that, as soon as practicable, the brick catch-pit gullies in this parish should be abolished, and syphon-trapped gullies substituted therefor. The matter was referred to the sanitary committee, who reported adversely to the recommendation. The subjects dealt with in this section of the report have received consideration, on various occasions, by the sanitary committee. More particularly was this the case in 1897, in connection with complaints of offensive smells from the County Council's main sewers, when the committee desired the law and parliamentary committee to advise them as to the position of the Vestry in regard to the matter generally. The law committee referred the matter to a sub-committee who reported thereon 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 to sewers, the property of the Vestry, there is a clear liability upon the Vestry in respect to 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's (General Powers) Act, 1894, transferred to the Vestry. 137 "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's 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:- "I. That they are bound to prevent the Vestry sewers, gully holes 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 anyone 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 wit 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 report was approved by the law and parliamentary committee, transmitted to the sanitary committee, and likewise submitted to and adopted by your Vestry. In the ninth monthly report, 1897, I recommended:— "1. 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, that, where practicable, shafts should be substituted for such openings, in conformity with the provisions of section 71 of the Metropolis Local Management Act, 1855. 138 "2. 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." The report was referred to the sanitary committee, who, in their report thereon, recommended:— (a) That offensive street gullies be efficiently trapped. (b) That all new gullies . . . be pan-gullies with syphon-trapped outlets. (c) That the County Council be requested to trap with syphon-traps all offensive gullies on main-line sewers. The committee stated, with reference to the proposed abolition of sewer ventilators at the road level, that— "In cases where complaints are made of nuisance, or annoyance is 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 consent is 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." The committee, moreover, were of opinion that it was— "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." They accordingly recommended— ''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 to discuss the question with him, with a view to his reporting upon the general question of metropolitan sewer ventilation." The report of the committee was adopted; and as the result, a conference of the surveyors with the engineer to the Council, was held, in January, 1898, to consider "The ventilation 139 of sewers with a view of some uniform system being adopted for dealing with complaints of offensive emanations from gratings connected with both local and main sewers." Two of the resolutions adopted by the conference were to the following effect :— "1. That the closing of sewer ventilators, in response to complaints, increases the general evil, the diminution of which is to be obtained by the multiplication of the ventilators at regular frequent intervals. "3. That pipe ventilators up buildings, or otherwise, where possible, should always be adopted in addition to surface ventilators." The engineer reported subsequently that— "The general result of the conference confirmed the action of the main drainage committee and the Council in recent years, and that the remedy for sewer emanations is to be looked for from the maintenance of more ventilating openings, both at the street level and by means of pipes carried up houses and other buildings." Upon the recommendation of the engineer, the main drainage committee directed the report to be printed, and copies thereof to be sent to each member of the Council, and to the engineers and surveyors of the district boards and vestries in the metropolis. The decision of the Council to ventilate the main sewers by large and lofty iron pipes at intersections of roads, street refuges, &c., referred to above, may, perhaps, be regarded as an outcome of the deliberations of the conference. 140 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 the vestries and district boards, waited upon the main drainage committee with reference to the subject. This committee reported (7th July, 1894), 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." The committee further 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 word 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, the special object being to obtain an amendment of the definition of the word " drain " in the Metropolis Management Acts. Legislation is certainly necessary, seeing that many sanitary authorities are unwilling to repair as " sewers," conduits which they consider should be regarded as " combined drains," repairable at the expense of the owners of the houses drained in common thereby. Cases are not unknown in which a sanitary authority have failed to abate nuisances in connection with drainage upon the refusal of the owners of houses to comply with notices requiring them to execute work which, in the present state of the law, has been held by the highest legal authorities to be the duty of the 141 sanitary authority. Some authorities, on the other hand, have expended large sums of money in the repair, as sewers, of combined systems of drainage. With the view to facilitate inquiries as to whether any such system had been sanctioned by the late Commissioners of Sewers, the predecesors to the vestries, &c., and so to settle, as far as practicable, whether it constitutes a " sewer " repairable by the sanitary authority, or is a combined " drain " repairable by the owner or owners of the houses drained thereby, the sanitary committee, upon my advice, resolved, in July, 1898, to obtain an abstract of the records of the Commissioners relating to this parish. The abstract has proved of great service, by saving the labour of a search at Spring Gardens upon each occasion of dispute; and it has already far more than repaid the cost of its preparation, by throwing upon owners the responsibility for repairs, or reconstruction, of combined drains which, without the information afforded by it, would have devolved upon the sanitary authority the duty of repairing them as a sewer. INSUFFICIENCY OF THE MAIN SEWERS. I had occasion to report floodings of the basements of many houses in the parish on the occurrence of severe storms in the week ended July 1st, and again in September (vide seventh and ninth monthly reports, pages 75 and 99;. The inundations were not to the same extent as on a previous notable occasion in October, 1898.* The attention of the County Council was at that date urgently directed to the matter with the view to expedite the commencement of the works at Lot's Road, Chelsea, designed to prevent the recurrence of floodings. The nuisance is due to the insufficiency of the main sewers, more particularly the Counter's-creek sewer, to carry off stormwater. It has been the subject of complaint during many years; and it is really surprising with what patience people have borne the recurrence of an infliction than which one can *See Annual Report of Medical Officer of Health for 1898, page 129. 142 hardly imagine any more trying. In the ninth report (September 16th, page 99), I cited one complaint, couched in terms of exceeding moderation, which may serve as an illustration of the suffering and damage resulting from these periodical inundations of basements with more or less diluted sewage. The writer, a lady living at Cornwall-road, wrote as follows:— "I have had the water in (flooding the basement floor) five times during the present summer. I have been buying the house by instalments; it lessens the value of the property, whether I let or sell it. I feel I cannot go on living here in this state of discomfort; and who would buy such a place ? I had rheumatic fever through it once : my doctor then said it was uot fit to live in ; good paying lodgers left me through that, so I have lost in all ways. I find the Vestry have been most particular I should obey their orders as to the sanitary condition of the house, and the drains have been done according to their plans. I therefore consider it very hard that owing, as far as I can see, to some defect in the sewerage, I should be subjected to a continual stench arising from the impure water which enters my house at every storm— to say nothing of the damage to my carpets and furniture, and other discomforts and troubles arising therefrom. You will greatly oblige me by giving this matter your earliest attention and consideration, as under present conditions, I am very much afraid of some illness arising." The complaint of this unfortunate person was forwarded to the County Council, with an urgent remonstrance against the continued neglect to carry out their statutory duty. This matter had previously formed the subject of a report by the law and parliamentary committee, in February, wherein it was stated that" the evils resulting from these floodings have been brought to the notice of the Council, from time to time, ever since the Council has existed ; and that "the decision of the Council to erect the pumping station" (at Lot's-road, Chelsea)" was come to in December, 1895." At the latter part of 1898, a letter had been received from the Board of Works for the Lee District, with reference to the defective sewerage in a part of their district, intimating that as the Council had made no answer to a memorial addressed 143 to them thereon, they had obtained a rule nisi for a mandamus calling upon the Council to abate the nuisance complained off These proceedings appear to have had the desired effect, although no immediately successful result attended the trial of the case (The Queen v. the London County Council, ex parte The Lee Local Board) upon cause being shown by the Council against the rule calling upon them to show cause why they should not take some steps to improve the sewerage of the part of the Lee district concerned. The law and parliamentary committee, in their afore-mentioned report, animadverted severely upon " the history of the Council's treatment of the main drainage questions during the past ten years," as set out in the Council's minutes ; they having, " as it would appear, in the face of most forcible reports, shelved, from time to time, the various extensive works recommended by both their main drainage committee and their chief engineer, with a view to rendering the main drainage system, in the words of that committee's own report of the 14th November, 1895,' more complete and more effective for the purposes which it is required to fulfil." The committee considered that, "having regard to these recurring floodings, &c.," the Vestry would be justified in going to the same lengths as the Lee Board, but they contented themselves with submitting a recommendation, which was adopted by your Vestry, to the effect— "That a further memorial, under the Common Seal of the Vestry, be addressed to the London County Council, calling upon the Council to perform their statutory obligations and duty by rendering the main drainage system thoroughly efficient for the proper drainage of this parish." A further communication was forwarded to the Council in September (together with my ninth report above adverted to), in which their attention was again called " to the inadequacy of the main sewers of the Council." It was again intimated that unless the remedial works were put in hand, the Vestry would have to bring the Council's default before the 144 Courts of Law," as the Lee Board had already done. The action of this Board, and your Vestry's remonstrances, had the desired result. The Council acquired the necessary land at Lot's-road, Chelsea, and the work has been put in hand. The Council, moreover, as already stated, resolved to expend three millions in the construction of new main line sewers in different parts of the metropolis—a work which, it may be hoped, will suffice for the abatement of the nuisance. But so large a work will necessarily extend over several years. DRAINAGE BYE-LAWS. Towards the close of the year 1896, forty years after the passing of the Metropolis Management Act, 1855, and many years after I had first called attention to the subject, the County Council made, and transmitted for the information of the sanitary authorities, draft bye-laws under section 202 of the said Act. The matter was referred to the sanitary committee, and in the result certain recommendations and suggestions for amendment of the proposed bye-laws were embodied in a report, which, having been approved by your Vestry, was forwarded to the Local Government Board and the Council. At the end of the year 1899, the bye-laws had not been confirmed by the Board. 145 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 houses of a superior class, on complaint, or by reason of the occurrence of infectious disease thereat, sanitary apparatus was not infrequently found to be defective in construction or condition. It would be well to have made a systematic sanitary survey of all the houses in the parish, but this is not practicable with the present staff of inspectors. 146 THE HOUSING OF THE WORKING CLASSES. Bye-Laws for Houses Let in Lodgings or Occupied by Members of 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 1,680 houses have been registered thereunder. The said Acts having been repealed, and modified provisions in respect to bye-laws enacted in the Public Health (London) Act, 1891, the Local Government Board addressed a circular letter on the subject 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 case 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 forwarded "a model series of bye-laws, which they had caused to be prepared for the use of sanitary authorities under section 94 of the Act;" and which had been " drawn up after very careful consideration of the regulations which might be properly enforced in the case of the class of houses to which the enactment applies;" and it was suggested that existing regulations should be modified on the basis of the model clauses. The matter was referred to the sanitary committee, to 147 sider and report what modifications were necessary or desirable to bring the existing regulations into conformity with the provisions of the Act of 1891. The subject being new to many members of the 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 five years ago, when the sanitary committee approved a modified series of byelaws drafted for their consideration, and recommended them for adoption by your Vestry. The committee thought it desirable 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 for approval, and referred to the law and parliamentary 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. 5060 inclusive). To this report was 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 were 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 148 they were sent forthwith, to the Local Government Board for their sanction. On the self-same day a communication was received from the Board intimating their willingness to approve, with a few, mostly verbal, amendments, the bye-laws which I had drafted and the sanitary committee had adopted, and forwarded for the consideration of the Board five months previously : these bye-laws, differing in some material respects from those adopted by your Vestry. After a further long interval the Board returned these proposed 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 of 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.* The desirability of such a provision does not admit of question. It is a common practice of people with large families to conceal the number of their children until after taking possession of their lodging—usually a single room; and then, should it be desired to get rid of them, a tedious process, by notices, police-court proceedings, &c. (as described in the annual report for 1889, page 119), has to be gone through, consuming many (at least six) weeks, during which time the unfortunate landlord may not receive rent on peril of failure to obtain an ejectment order. In regard to registered houses, * 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-law, " March 1st to August 1st inclusive," being the same as in the existing bye-law, (No. 7) is so prolonged that it is practically impossible to supervise, as the inspectors rarely know when the work is likely to be in progress. 149 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 13th, page 111), it would be well if a bye-law were made requiring him, under penalty, to report to the sanitary authority any case of overcrowding coming to his knowledge. 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 :— " If 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 bye-law, 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." In the sixth report for 1897 (25th June, page 79), a further suggestion for a new bye-law was made by me 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 (on 6th October), recommended, and it was resolved— " 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 Local Government Board's views on the subject of these proposed new bye-laws have not yet been received, and the bye-laws adopted in 1885 are still in force. They are to the following effect (No. 1 dealing with the subject of registration of houses:)— 150 2. Number of Lodgers.—The keeper of a registered house shall not knowingly suffer a greater number of persons to occupy any room in such house, nor shall a lodger suffer any room under his control to be occupied by a greater number of persons, than will allow of air space for each person according to the following rules:— (a) The minimum space for each adult in any room in a registered house which may be occupied as a bedroom only, shall be not less than 300 cubic feet. (b) The minimum space for each adult in any room in a registered house which may be occupied as a sitting room and as a bedroom, shall be not less than 400 cubic feet (c) For the purposes of the foregoing rules, two children under the age of 12 years may be counted as one adult. 3. Separation of the Sexes.—The keeper of a registered house, and any lodger therein, shall not suffer more than two persons of different sex, if above the age of 12 years, to occupy the same sleeping room. 4 Drainage.—Theownerof a registered honse shall keep all drains and drainage apparatus in proper working order and good sanitary condition. 5. Privy Accommodation.—The owner of a registered house shall provide and maintain privy accommodation in the proportion of one properly constructed water-closet for every twelve persons lawfully occupying the house. Every water-closet which may be constructed in pursuance of this regulation, shall be provided with a properly fitting door, and all requisite fastenings, and with all requisite water-supply apparatus, and with adequate means of ventilation into the outer air. The soil pipe shall be of impervious material and made air-tight at the joints, and shall be adequately ventilated. 6. Washing and Water.—The owner of a registered house shall cause every part of the water supply apparatus, belonging to such house, to be maintained at all times in good order ; and shall provide adequate accommodation for washing, and an efficient supply of water for the use of the lodgers therein. 7. Cleansing and Ventilation.—The owner of a registered house shall cause the walls and ceilings of every room and of the common passages, staircase, water-closets and out-houses thereof, to be thoroughly stopped, cleansed, and, where not papered or painted, well and sufficiently whitewashed or coloured, at least once every year, between the months of April and August, both inclusive, and at any other time when necessary. He shall strip and wash papered walls of any room after the occurrence of any dangerously infectious or contagious disease therein, and at any other time when necessary. 151 8. The owner of a registered house shall provide requisite means for the ventilation of every room and of the common passages and staircase thereof. 9. Every lodger in a registered house shall cause every room in his exclusive occupation to be ventilated daily, and to be thoroughly cleansed from time to time, as often as may be requisite for the purpose of keeping the same in a clean and wholesome condition. 10. In every case where two or more lodgers in a registered house are entitled to the use in common of any passage or staircase, the keeper shall cause every part of such passage or staircase to be ventilated daily, and to be thoroughly cleansed from time to time, as often as may be requisite for the purpose of keeping the same in a clean and wholesome condition. 11. In every case where a lodger in a registered house is entitled to the exclusive use of any passage or staircase in such house, such lodger shall cause every part of such passage or staircase, to be ventilated daily, and to be thoroughly cleansed from time to time, as often as may be requisite for the purpose of keeping the same in a clean and wholesome condition. 12. Wash-House, Yard, Water-Closet, Dustbin, &c.—The owner of a registered house shall cause every yard and area thereof to be properly paved and drained, and shall cause the walls of every wash-house, yard, and area, to be lime-whitened at least once in every year, between the months of April and August, both inclusive, and at any other time when necessary. 13. The owner of a registered house shall cause every part of the structure of the dustbin belonging to such house to be maintained at all times in good order. 14. In every case where two or more lodgers in a registered house are entitled to the use in common of any yard, area, or wash-house, or of any water-closet, or dustbin belonging to such house, or of any cistern or other receptacle for the storage of water supplied to the premises, the keeper shall cause every part of such yard, area, wash-house, water-closet, dustbin, or cistern, to be thoroughly cleansed from time to time, as often as may be requisite for the purpose of keeping the same in a clean and wholesome condition. 15. In every case where a lodger in a registered house is entitled to the exclusive use of any yard, area, or wash-house, or of any water-closet, or dustbin, belonging to such house, or of any cistern or other receptacle for the storage of water supplied to the premises, such lodger shall cause every part of such yard, area, wash-house, water-closet, dustbin, or cistern, to be thoroughly cleansed from time to time, as often as may be requisite for the purpose of keeping the same in a clean and wholesome condition. 152 16. Infectious Diseases.—The keeper of a registered house shall give immediate notice in writing to the Medical Officer of Health, or to the Inspector, and verbal notice to every lodger, when anyone therein is ill or dead of small-pox, typhus, enteric (or typhoid) fever, scarlet fever, diphtheria, cholera, or any other dangerously infectious or contagious disease, and he shall carry out without delay all measures for disinfection which the Medical Officer or the Inspector may direct 17. Every lodger in a registered house shall give immediate notice in writing to the keeper, and to the Medical Officer of Health, or to the Inspector, and verbal notice to every lodger, when anyone is ill or dead of small-pox, typhus, enteric, (or typhoid) lever, scarlet fever, diphtheria, cholera, or any other dangerously infectious or contagious disease, in any room occupied by him, and he shall carry out without delay all measures for disinfection which the Medical Officer or the Inspector may direct. 18. Animals.—The keeper of a registered house, or any lodger therein, shall not suffer any animal to be kept in any part thereof, under his control, so as to render the premises filthy or unwholesome. 19. Inspection.—The keeper of, and every lodger in, a registered house, shall allow such house and every part thereof to be inspected by the Medical Officer of Health, or the Inspector, on his application, at any hour, and shall not obstruct him in the execution of his duty ; provided always that no inspection by the Inspector shall take place between the hours of 9 p. m. and 6 a. m. without the written authority of the Medical Officer of Health. 20. Penalties.—Every person who offends against any of the foregoing Bye- Laws shall be liable to a penalty not exceeding forty shillings for any one offence, with an additional penalty not exceeding twenty shillings for every day during which a default in obeying such Bye-Laws may continue. Registered Houses.—At the request of the sanitary committee a return was prepared, in 1896, showing the streets in which houses had been registered, the number of the houses registered in each street, and the number of houses not registered in the several streets. This return is here corrected to date for each of the sanitary districts, as follows:— 153 NORTH SANITARY DISTRICT. Name of Street. Number of Houses in Street. Number of Houses Registered. Number of Houses not Registered Adair Road 33 26 7 Admiral Terrace 11 10 1 Appleford Road 58 43 15 Bransford Street 13 11 2 Branstone Street 11 10 1 Bosworth Road 33 21 12 Edenham Street 33 31 2 Edinburgh Road 10 7 3 Golborne Gardens 51 43 8 Southam Street 129 127 2 Totals 382 329 53 NORTH-EAST SANITARY DISTRICT. Name of Street. Number of Houses in Street. Number of Houses Registered. Number of Houses not Registered. Bolton Road 33 27 6 Convent Garden 28 22 6 Portland Road 95 70 25 Totals 156 119 37 NORTH-WEST SANITARY DISTRICT. Name of Street. Number of Houses in Street. Number of Houses Registered. Number of Houses not Registered. Bangor Street 39 32 7 Barandon Street 18 10 8 Calverley Street 13 11 2 Crescent Street 39 24 15 Grenfell Road 27 12 15 Kenley Street 51 37 14 Martin Street 15 5 10 St. Katherine Road 112 102 10 Sirdar Road 93 59 34 Totals 407 292 115 154 CENTRAL SANITARY DISTRICT. Name of Street. Number of Houses in Street Number of Houses Registered. No of Houses not Registered. Campden Street 68 59 9 Cousins Terrace 7 5 2 Dartmoor Street 60 57 3 Duke's Lane 10 10 — Edge Street 35 19 16 Ernest Street 21 20 1 Farmer Street 26 20 6 Jameson Street 31 29 2 Johnson Street 26 16 10 Kensington Place 44 36 8 Lorne Gardens 32 23 9 Newcombe Street 18 16 2 Peel Street 70 44 26 Uxbridge Street 44 22 22 William Street 17 15 2 Total 509 391 118 SOUTH EAST SANITARY DISTRICT. Name of Street. N umber of Houses in Street. Number of Houses Registered Number of Houses not Registered. Clifton Place 8 8 - Merton Road 33 32 1 South End 11 2 9 South End Row 6 4 2 St. Alban's Road 17 10 7 Trafalgar Place 5 3 2 Yeoman's Row 48 41 7 Totals 128 100 28 155 SOUTH-WEST SANITARY DISTRICT. Name of Street. Number of Houses in Street. Number of Houses Registered. Number of Houses not Registered. Ashley Cottages 27 15 12 Barker Street 16 8 8 Blithfield Street 17 17 - Childs Place 21 16 5 Childs Street 20 11 9 Kenelon Road 36 26 10 I field Road 152 136 16 North Row 21 15 6 North Street, St. Mark's 15 15 - Pembroke Place 11 9 2 Pembroke Road 16 12 4 Prince Teck Buildings 12 6 6 Radnor Terrace 5 4 1 Seymour Place 56 35 21 Shaftesbury Road 25 16 9 South Street, St. Mark's 19 16 3 St. Mark's Road 22 16 6 Stamford Cottages 10 7 3 Wallgrave Road 27 23 4 Wallgrave Terrace 13 13 - Warwick Road (late Lily Terrace) 6 5 1 Warwick Road (late Warwick Terrace) 25 15 10 West Pembroke Place 16 14 2 Totals 588 450 138 SUMMARY. District. Number of Streets dealt with. Number of Houses in Streets. Number of Houses Registered. Number of Houses not Registered North Sanitary District 10 382 329 53 North-East Sanitary District 3 156 119 37 North-West Sanitary District 9 407 292 115 Central Sanitarv District 15 509 391 118 South-East Sanitary District 7 128 100 28 South-West Sanitary District 23 588 450 138 Totals 67 2170 1681 489 156 Many 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 houses in the same streets, so let, were registered, between the years 1885-89. Inspections made in 1895 showed that many of the non-registered houses were at that time let in lodgings, and a report to this 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. Latterly, however, a considerable number of the houses have been registered, the committee having thought it desirable to register tenemented houses. The newly registered houses are included in the preceding lists. In 1899 forty-eight houses were registered, 40 in North Kensington and 8 in South Kensington. In the fourth monthly report for 1895 a list was submitted of some of the principal streets, the houses in which, so far as they were let in lodgings or occupied by members of more than one family, appeared to be proper to be registered, as follows :— (1) NORTH District.— Rackham Street, Raymede Street, Swinbrook Road, Tottenham Street, Treverton Street, and Wheatstone Road. (2) North-east District.—All Saints' Road, ingham 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, Manchester Street, Royal Crescent Mews,* St. James's Place,* Testerton Street, Tobin Street, and Walmer Road (south of Lancaster Road). *This street is now in the Central District. 157 (4) South-east District.—Chapel Place, Lloyd's Place, Middle Street, New Street, and Rutland Street. (5) South-west District.—Barker Street, Emma Place, Holmes Place, Kensington Buildings, Park Terrace, and Providence Terrace. No action was taken upon the report. The Advantages of Registration.—Whilst facilitating the work of the public health department, registration of houses let in lodgings, has given rise to none of the evils feared by the owners and occupiers of houses proposed to be registered; the bye-laws, moreover, have worked smoothly and, practically, without objection by any of the parties affected by them. The extension of the operation of bye-laws to all tenemented houses, and other houses occupied in lodgings by the poorer classes, would, with an adequate inspecting staff, and systematic inspection, at frequent intervals, 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. 158 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 is this parish, which are 33 in number, and contain accommodation for 968 persons. Sanitary District. Name of Keeper. Address of Common Lodging-House. No. of Single Lodgers for which registered, in 1899. No. of Double Beds Authorized. Male. Female. Total. N. Marsh, fly. 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. 39 — 39 — „ Do. do. 27, do. — 16 16 5 „ Do. do. 31, do. 34 — 34 — „ Do. do. 33, do. 20 — 20 7 „ 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 — „ Hartwell, Wm 66, St. Ann's Road 43 7 50 11 „ Phipps, William 34, Sirdar Road 13 — 13 7 „ Do. do. 36, do. 35 — 35 — „ Do. do. 38, do. — — — 11 „ Do. do. 40, do. — 26 26 — „ Do. do. 31, do. 30 — 30 — c. Redman, John 24, Peel Street 20 — 20 — „ Do. do. 22, do. 23 — 23 — Twenty-four of the common lodging-houses, with accommodation for 730 persons (100 of them in double beds) are comprised in the " Notting-dale" special area, 159 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 of such a class as, 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 case 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, therefore, that the houses in the " Notting dale" special area cannot be dealt with as common lodginghouses under the provisions of the existing law, excepting in so far as they may be registered as such by the Council upon the application of the owners—a fact which your Vestry's special committee, above referred to, recognized in their report. 160 It remains to be seen what action the Kensington Council will take in regard to the district, under the powers conferred by the Act which brings it into existence next November, and by Part III, of the Housing of the Working Classes Act. 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 to consolidate, and transfer to the local authorities, the administration of the law relating to common lodging-houses, and to give such authorities power to license 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 reply, 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 that Board. Nothing further was done in the matter, nor is the matter dealt with in the Local Government Act, 1899, which leaves the common lodging-houses under the jurisdiction of the County Council. 161 "NOTTING DALE." The vital and mortal statistics of the "special area" have already been given at page 16. They afford little ground for satisfaction excepting in regard to a diminished mortality from the diseases of the zymotic class. The mortality from diseases of the tubercular class (42 deaths) was high, being at the rate of 10.5 per 1,000 (=1 per cent.) of the population (4,000), irrespective of 23 infantile deaths from wasting diseases (atrophy, debility, inanition), closely related in many instances to tuberculosis. The tuberculosis death-rate in the parish, as a whole, was 1.9 per 1,000, that of North Kensington being 2.6. The rate in the North-West sanitary district, including the special area, was 52 per 1,000: irrespective of the special area the rate in this district was 3.6 per 1,000; the nearest approach to this rate was in the North sanitary district, viz., 2.0 per 1,000 (vide table, page 130). Overcrowding and Indecent Occupation of Rooms.—The most notable event of the year in connection with sanitary administration in the special area, was a series of cases of indecent occupation and overcrowding of registered houses brought to light through early morning inspections made by Inspector Steward ; by my authority, and under police protection. The revolting particulars of these cases were set out in the fourth monthly report, (April 26th, page 43) and need not be repeated here. Overcrowding is a nuisance within the meaning of section 2 (1) (e) of the Public Health (London) Act, 1891 : indecent occupation is forbidden and made a punishable offence by the third bye-law relating to registered houses, which reads as follows :— " Separation ok the Sexes.—The keeper of a registered house, and any lodger therein, shall not suffer more than two persons of different sex, if above the age of 12 years, to occupy the same sleeping room." A bye-law to this effect is, I think, rare, if not exclusive to this parish, and without it, in the absence of overcrowding, it would 162 be impossible to deal with the demoralising offence. Heavy fines were imposed upon the keepers of the houses, and the lodgers, also, by the justices, and it is hoped, rather than believed, that the evils described were more than temporarily checked. Incessant supervision, by night visits, so as to make improper occupation of rooms unprofitable, will alone enable us to deal effectively with nuisances of this kind, the most serious of all nuisances from whatever side the matter be regarded. Incidentally, it may be mentioned that the reference to these cases in the fourth monthly report was the determining cause of the decision of the public health committee of the County Council which led to the inspection of the special area, which afterwards developed into the inquiry into the sanitary condition of the parish generally, to which reference has previously been made (page 104). Dealing with this subject in the fourth monthly report, and in answer to the question, "How can the iniquitous practices described be abolished?" I expressed the opinion that it could be done, effectively and finally, only by the acquirement of the houses in the district by some public authority which should let the rooms, at reasonable rents, subject to regulations to ensure the good conduct of the lodgers. The County Council are the only public authority having power to do this, under Part III. of the Housing of the Working Classes Act, 1890.* Rut they have twice refused to do so on the ground that Part III, being (in their opinion) " designed to facilitate the provision of dwellings for * Under the Act regulations may be made — " For securing that the lodging-houses shall be under the management and control " of persons appointed by the local authority for that purpose; " For securing separation at night of men and boys above eight years old from women and girls; and ' For preventing damage, disturbance, interruption, and indecent and offensive language and behaviour, and nuisances." 163 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." I was, and still am of opinion that the acquirement of the houses with a view to letting them in lodgings, would entail no loss upon the ratepayers : the houses pay handsomely the people who farm them out by the night, (at exorbitant rents, it is true) to the lodgers in the "furnished " rooms. The Council were favourable to the the suggestion I made in 1897, that the sanitary authority should be endowed with power to carry out the provisions of Part III., and the London Government Act of 1899 will confer this power ; in 1900, therefore, the Kensington Council will be able to take the course in regard to this distressful locality, which your Vestry in vain urged the County Council to adopt. The Council, when rejecting the application of your Vestry, which was endorsed in petitions by the ruri-decanal chapter, by the members for the borough, and other influential inhabitants, expressed the opinion that " so far from requiring the aid of the Council . . . the Vestry possess ample powers under Section 94 of the Public Health (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. The Council were informed that the powers referred to had been exercised, as far as was practicable, and had been found inadequate for the purpose. The question may naturally be asked whether the sanitary authority have done all that might have been done since attention was publicly drawn to the state of the district in 1893? Much, undoubtedly, has been done for the amelioration of the physical conditions of the locality. The streets have been paved with asphalte; the 164 street gullies have been syphon-trapped; the surface sewer ventilating openings have been closed, and the sewers ventilated by pipe shafts carried up against the houses; and many improvements have been effected in the sanitation of the houses, nearly all of which, being let in lodgings, have been registered. The drains of the large majority of the houses have been trapped and ventilated; and additional water-closets have been provided. In many of the houses water for drinking is now obtained from the rising main. Much of this work had been carried out before the district became the subject of public discussion in 1893. The sanitary committee and your Vestry then, came to the conclusion, which is as true to day as ever, that the best hope for the district was to harass the people who make great profits by letting nightly, at extravagant rents, the " furnished " rooms which abound. The committee, moreover, reported that—" What appears to be most needed is frequent house-to-house inspection;"* and, with a view to secure this, they recommended the appointment of an additional sanitary inspector for one year. The appointment was made, and subsequently was made permanent; but, in 1896, a vacancy having arisen, the inspecting staff was reduced to six, the north-west district was enlarged, and the special area was deprived of its special inspector. The area of the north-west district was, not long after, again reduced to its original dimensions; but having regard to the character of the houses, and the habits of the people who occupy the * The special committee of 1896 recommended "increased sanitary inspection of the district with a view to the more strict enforcement of the bye-laws relating to houses let in lodgings," and to "see that particular attention is given to those cases where the bedding and other contents of the room are in such a state as to cause the premises to be a nuisance or injurious or dangerous to health, in order that the provisions of the Public Health (London) Act, 1891, may be applied to secure the cleansing or destruction of the said articles so that the nuisance may be abated." An impossible task in existing circumstances. 165 lodgings, tenemented and otherwise, it is obviously beyond the capacity of any one inspector to cope with the duties. Nothing but the "frequent house-to-house inspection," recommended by the sanitary committee, night visits, and stern punitive proceedings will avail, so long as the houses are owned, let, and occupied as they now are. In the fourth monthly report for 1899, I suggested that the special area should again be placed under the sole charge of an inspector, and to secure this I pointed out that the outlay would be recouped in fines recovered; and it is fitting that lawbreakers should be made to pay for their offences! It would, moreover, be far more than repaid by reduction in the expenditure caused by the sickness and mortality of the district, which entail a great burden on the rates for parish relief. On this point I recalled to attention the fact that during the poor-law year 1896-7, there were upwards of 700 admissions from the district to the parish infirmary, as shown in the annual report for 1897-98, whilst 1,189 medical orders were issued to the out-door sick. In that year "Nottingdale," which comprises only one forty-third of the population of the parish, was responsible for one-fifth of the admissions to the infirmary. It is obvious that if the amount of sickness could be reduced in even a very small ratio, the saving would greatly outweigh the expenditure on the whole of the inspectorial staff. The sanitary committee are sensible of the deplorable state of the district, and though they made no recommendation for increased inspection, I am persuaded that the individual members would welcome any means by which so sad a state of affairs might be ameliorated. In connection with the magisterial proceedings in the cases of indecent occupation and overcrowding, &c., above referred to, a handbill, setting out the offences and the fines 166 imposed, was circulated in the district from house-to-house. In the thirteenth report, for 1898 (page 132) I called attention to the power vested in the justices, to inflict a penalty more severe than direct money fines, to which recourse could be had should overcrowding be again found, within three months, at any house in respect to which proceedings had been instituted, viz., by closure of the house, under the provisions of section 7 of the Public Health (London) Act, 1891, which enacts that:— "Where two convictions for offences relating to the overcrowding of a house, or part of a house, in any district, have taken place within a period of three months (whether the persons convicted were or were not the same), a petty sessional court may, on the application of the sanitary authority, order the house to be closed for such period as the court may deem necessary." The business of letting so-called furnished rooms in the Notting-dale district, as already intimated, is a profitable one; the "keeper" probably netting thirty shillings a week for a house which costs him twelve or fourteen, the value of the furniture being a negligeable quantity. I therefore advised, and the sanitary committee directed, that, on occasion arising, the magistrates should be asked to close a house, such a course being likely to be more effective, as a deterrent, both to offenders and others, than the infliction of a direct money fine. A case subsequently arose, and an application to close the house was made, but the magistrates, who imposed substantial fines on the offenders, declined to make a closing order, influenced, apparently, by their conception of the inconvenience it might cause to the occupants of other rooms in the house. As a matter of historical interest, it may be mentioned, that in 1898 at a conference of sanitary authorities on the subject of Overcrowding and the Housing of the Working Classes, convened by the Bermondsey Vestry, your Vestry being represented thereat, the following resolution, among others, was passed:— 167 "That the London County Council be approached with a view to the insertion of a clause in their General Powers Bill of 1899, to enable Metropolitan Vestries and District Boards, to erect municipal dwellings, under Part III. of the Housing of the Working Classes Act, 1890." It was argued that metropolitan local authorities should have the same powers as provincial municipalities, &c., under the Act. In dealing with this question, in the annual summary appended in the thirteenth report for 1897 (page 165), I observed that:— "Your Vestry have at present, no power to put Part III. into operation: it only remains, therefore . . . that steps should be taken to promote legislation to make the sanitary authority the local authority, sole or concurrent, under this Part. It was" (I added) "a legislative mistake to endue the County Council with exclusive power, and the sooner the mistake is rectified the better." I pointed out, moreover, the "strange anomaly that the sanitary authority in the metropolis should be denied powers enjoyed by the most insignificant urban sanitary authority without London," and illustrated the benefits that might be conferred on the poor by the experience of the governing authority of the City of Glasgow, "where municipal lodging-houses for the dregs of the population, the outcasts of society, have been provided; the means of a comfortable, homely, and a social life of a sort, being thus secured to these poor creatures, at a reasonable outlay for lodging and other accommodation, and this without entailing any burden on the ratepayers." In connection with the resolutions of the Bermondsey Conference, the sanitary committee had before them, (1) a letter from the Vestry of Battcrsea stating that they had requested the County Council to insert a clause in their next General Powers Bill, empowering local authorities to erect dwellings for the working classes, and asking your Vestry to take similar action; (2) a letter from the North Kensington Ratepayers' Association, supporting the view expressed in the letter from the Battersea Vestry, and (3) my report dated 20th July, (1898), in which the question as to the desirability of local authorities being vested with powers concurrent with those of the County Council, enabling them to 168 adopt and put in force, Part III. of the Housing of the Working Classes Act, 1890, was discussed. The committee came to the conclusion that it was desirable that the Vestry should have the power to put the particular provisions of the Act referred to into operation, and they accordingly recommended, and it was resolved— "That the London County Council be requested to include in their next General Powers Bill (i.e., of 1899) a clause giving the sanitary authority concurrent powers with the Council to put in force Part III. of the Mousing of the Working Classes Act, 1890." The Council subsequently signified their willingness to an alteration of the law, which would enable the sanitary authorities to put Part III. into operation in their respective districts, and this power, as already stated, will be possessed by the Councils constituted by the London Government Act, 1899, which comes into operation in November next. It is to be hoped, therefore, that, ere long, some substantial improvement of the special area may be effected, and an evil of undoubted gravity ameliorated if not wholly removed. 169 THE PAVING OF YARDS. During the year, a good many yards were paved more or less satisfactorily—or unsatisfactorily; for it is not the rule to pave the whole of the small yards at the rear of houses inhabited by the poor, and too commonly the paving is far from what it should be in material and workmanship. It would be well if work of this sort could be carried out systematically throughout the parish; but, 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 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 they were "saturated with human ordure and filth of every description." 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 notice 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 proper condition." Effect has, in a measure, been given to this recommendation. The paving of yards is one of the matters dealt with in your Vestry's bye-laws, the tenth of the series requiring, in respect of "any yard or open space, 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," that it be paved forthwith by the owner of the dwelling-house with which such yard or open space is connected. It will be observed that the paving of yards is prescribed "for the prevention or remedy of insanitary conditions," a fact which is often lost sight of. That paving is "necessary" for this 170 purpose is indubitable, and on this account I have pressed 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 and dryness in the surroundings of dwelling-houses, a matter to which attention was specially directed in the annual report for 1897 (page 146), the authority of the late Medical Officer of the Local Government Board being cited in support of the views therein expressed. In connection with this subject reference may be made to the rubbish, often the accumulation of long periods of time, so frequently seen in the yards of the houses let in tenements to the poorer classes: such as broken bedsteads, rotten straw palliasses, broken crockery, and other things of no value, once the "property," it may be, of dead or departed lodgers. It is nobody's business to remove the things, which simply serve as harbourage for collections of filth. The yards where they occur can not be properly cleansed, and might be regarded as premises in such a state as to be a nuisance or dangerous to health. The special committee of 1896 animadverted on the nuisance as observed in the special area, and it would be well if an instruction were issued authorising the removal of such useless articles, by the dustmen, as house refuse. The importance of the matter gets lost sight of in ordinary times, but let there be a cholera-scare, and everybody forthwith recognises the propriety and necessity of that general clearance of filth and litters, which should be effected regularly at all times. 171 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 for 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 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 sometimes done. 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 collection from moveable receptacles. Nuisance from house refuse does not arise from the proper contents of the receptacle—ashes—but from the addition thereto of matters of organic origin. With the object of 172 venting, 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 to public health arising from the deposit of vegetable and other objectionable refuse in the dust-bin, and requesting that directions may be given for all such refuse to be burned. At present, a portion of the refuse, from the northern part of the parish, is conveyed out of London by the Grand Junction Canal, the refuse from the southern part 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 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 at Wood-lane, Hammersmith, where a "destructor" and an electric-light installation might be advantageously located. Conveyance of Offensive Matter Through Streets.—This subject received considerable attention during 1899, as the outcome of a communication received from the medical officer of health to the County Council, enquiring— Whether the removal of fish offal causes so much nuisance as to necessitate it being dealt with by requiring a proper metal receptacle to be provided, with a covering for same, so that each receptacle, with its contents, can be taken away from the premises without the cover being removed, this arrangement involving an empty receptacle being left at the premises each time the collection is made? The Council's solicitor advised that this plan of removal could not be enforced without 173 lation, and the medical officer desired to know whether, in my opinion, the nuisance was such as to justify an application to Parliament for such power? I replied in the affirmative. The subject of nuisance in connection with the storage, and the conveyance through streets, of offensive matter has been dealt with in these reports on various occasions, and was specially reported on in 1887, in connection with a communication received from the late Metropolitan Board of Works, inquiring (inter alia)— "Whether nuisance is experienced in the district in the collection of offensive material, and in its conveyance through the streets, and if so, the nature and extent of the nuisance?" My report on the subject (No. 12, November 17th, 1887, page 127) was forwarded by your Vestry to the Board, together with a letter intimating that— "Nuisance is experienced . . . in the storage and in the collection of offensive material, and in its conveyance through the streets. The nuisance (it was said) is due to stench, and is co-extensive with the trades which give rise to the production of refuse of an offensive nature." It was further stated that the provisions of the then existing Acts were inadequate to the purpose of preventing nuisance, and that additional powers were necessary. My report concluded with the expression of a hope that the Board would— "Come to the conclusion, at which your Vestry had long since arrived, that the matter can be dealt with, effectively, only by bye-laws entailing an adequate and fixed penalty for offences—bye-laws made by the Board . . . . the carrying out of which should be entrusted to the local sanitary authorities. Such bye-laws (I added) with respect to offensive substances of animal origin, should make provision with regard— (1). To storage vessels, which should be of metal, impervious, and covered; (2). To removal in iron lank vans; but it would be better to provide for the removal of the storage vessels themselves; (3). To time of daily removal, in the evening; and, (4). To measures for the disposal of the refuse." 174 I further observed that it was "open to consideration whether the duty of removing all offensive substances, should not be devolved upon the sanitary authority, at the reasonable cost of the producer thereof." The annual report for 1887 (p, 182) contains references to the previous history of the subject, particularly to a special report on "Filth Removal," (July 24th, 1878), arising out of complaints with regard to the conveyance of offensive matter through the streets in the day time.* The subject was further dealt with in 1880, (Annual Report, p. 113), in connection with "the difficulty experienced in preventing nuisance from accumulations of offensive matter, coming under the general description, "Refuse"; a difficulty, stated to be "common to all parts of the metropolis, and calling for legislative interference for its abatement." At my instance, the Society of Medical Officers of Health, in that same year, appointed a committee to consider and report— "On the best and most convenient ways of dealing with animal and vegetable trade refuse, e.g., from slaughter-houses, fishmongers' and greengrocers' shops, etc., with a view to its collection, removal, and ultimate disposal, whether by utilization or destruction." Subsequently, the reference was enlarged by the inclusion of house refuse, stable refuse and cowshed refuse. In due course the committee, over which I presided, presented a report which was adopted by the society, and will be found in my annual report for 1880 (p. 114). With regard to the refuse of slaughterhouses, and the refuse of the trades of fishmonger, poulterer, greengrocer, &c., being of animal or vegetable origin and liable to decomposition, the society was of opinion that— *The report was referred to the law and parliamentary committee, with a view to the making of a "bye-law regulating the time for the removal of offensive matter through the streets," under the powers conferred by Section 219 of the Kensington Improvement Act. The question, however, dropped out of sight, and the bye-laws adopted by the Vestry in July, 1882, contain no reference to it. 175 "The Nuisance Authority should have power and obligation to collect, remove, and dispose of such refuse, and should receive reasonable compensation for so doing. In any case the refuse should be collected daily, and conveyed in properly constructed covered receptacles, or in vehicles expressly adapted for the prevention of effluvium nuisance." The report was forwarded to the several sanitary authorities of the metropolis, and widely circulated, but without apparent effect. The subject was dealt with in 1884, by the law and parliamentary committee in a report on "Sanitary, Nuisance Removal, and other Cognate Acts." I had submitted that "the power of the Vestry to require the periodical removal of refuse matter . . . from premises" (under Section 53 of the Sanitary Act, 1866) might extend to the case of other refuse than stable refuse, etc., and to other premises than mews, stables, etc.: e.g., to the refuse matters of the trades, and on the premises, of fishmongers, poulterers, greengrocers, etc. The committee thought it "possible that the section might be wide enough" to enable your Vestry to deal with the matter in the way suggested, and recommended that "proceedings be taken to give practical effect to this opinion but no action was taken. To come to more recent times, I may remind your Vestry that the subject was again raised in 1895, in connection with my report to the sanitary committee (29th October) on a communication from a fish and game dealer, who stated that his contractor for the removal of trade refuse had intimated to him that "he was forbidden to collect the refuse on Saturday night," the consequence being that "the refuse would have to remain on the premises from Saturday morning till Monday morning, fermenting and poisoning the adjoining houses," as well as his own: "a serious matter . . as during the game season the offal is very objectionable." The difficulty in which 176 the tradesman found himself arose out of prosecutions by the Vestry of an adjoining parish, in connection with the removal of offensive substances through streets after the prescribed hour, 12 o'clock noon. The sanitary committee made a recommendation, which was adopted by your Vestry (6th November), to the effect— "That a communication be addressed to the County Council pointing out the desirability of their bye-law (1) being revised, so as to allow of the removal of fish offal, etc., at other times than those specified, provided such offal is removed from the premises in suitable and closely-covered receptacles which will effectually prevent any noxious effluvia escaping therefrom." In commenting on the subject (No. 11 Report 1895, November 12th, page 145), I set out your Vestry's proceedings, and recommended that "the attention of the sanitary authorities generally be called to the matter, in the belief that they would be willing to support your Vestry's action, by applying to the Council to make a more reasonable bye-law." This course was adopted*; and many of the vestries, etc., not only expressed agreement with the views set out in the report, but also communicated with the Council. But the Council took no action in the matter. The subject was again dealt with in the eleventh monthly report for 1899 (November 9th, page 112), wherein it was stated that the Council were "now disposed to consider the question, which is much wider than as it relates to the removal of fish offal, and that should legislation be the outcome of enquiry, the Council will be enabled to deal with it in its entirety." It was further observed that "it is not clear that, failing legislation, the sanitary authorities might not themselves do something in the matter, *The main proposal submitted to the Council and to the sanitary authorities, by the Vestry, was that the offal of the trades of fishmonger, poulterer, &c., should be stored in shops in galvanized 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. 177 having (as I had pointed out in a report dated April 9th, 1884) 'power, and indeed, being required, when called upon, to remove the refuse of any trade upon the application, and at the cost of the owner or occupier of any house, etc. In'" the same report it was submitted that the provisions of "the 128th Section of the Metropolis Management Act (re-enacted in Section 33 of the Public Health (London) Act, 1891) would apply in the case of trades which lead to the production of refuse of an offensive character." The subject had been fully dealt with in the aforementioned annual report for 1887, pp. 176-189, of which a copy was forwarded to every member of the County Council in 1889. My opinion was, that the sanitary authority should "undertake the removal, at the cost of the owner, of all such refuse matters of animal or vegetable origin, as might become offensive and dangerous to health; and that in the interests of public health the producers of such refuse should be compelled to employ the staff of the sanitary authority in its removal." Very generally, I believe, they would be only too pleased to do so. In this connection, it may be mentioned that in 1880, the licensees of slaughter-houses presented a memorial to your Vestry, representing that— "For some time the trade has laboured under the greatest difficulty with regard to the removal of offal and manure from the different slaughterhouses," and as this difficulty was on the increase, they begged that your Vestry "would take some immediate steps to arrange for carts to call at the slaughter-houses in the early part of the morning, and convey the refuse to some proper place where it could be deposited"— a service for which the butchers were willing to pay. The memorial was referred to the sanitary committee, which deferred consideration of its prayer pending an intended visit to Leeds to view a "destructor" in operation. But no action was taken in the matter. If my views are correct, persons carrying on trades involving the production of refuse are entitled to "require" the sanitary authority to remove their their refuse on payment of a "reasonable sum for such 178 removal." But it is manifestly desirable that the matter should be put upon a different footing; and that, in the interests of public health, it should be made the duty of the sanitary authority to remove offensive refuse, at the reasonable cost of the producer, as recommended in the annual report for 1887. Under the existing bye-law (1) offensive matter, such as the refuse of the trades of fishmonger, game dealer, etc., is required to be removed in a "suitable carriage or vessel properly constructed," and covered "so as to prevent the escape" of any of the contained matter, and "so as to prevent any nuisance arising therefrom;" the hours prescribed for removal being from 4 to 10 a.m. in summer, and from 6 a.m. to noon in winter. The offal of these trades is, at present, generally, if not always, conveyed through the streets, in tank-vans, the use of which involves more or less nuisance, both when the contents of the shop receptacles are tipped into the tank, and in the transit of the van through the streets. Given properly covered, clean, and sound metal storage receptacles, no nuisance should arise at whatever time of day their removal may be effected, and on sanitary grounds merely there need be no limitation of time for removal. Existing arrangements, apart from the question, of nuisance, 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 save 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's bye-law, and the nether millstone of the bye-law made by the Council of West Ham —a locality to which much of London's "offensive matter," i.e., offal, is conveyed for transmutation to useful products. 179 To complete the subject to date, it may be mentioned that in February of the present year, the public health committee of the County Council had the matter under consideration in connexion with a proposed amendment of the first bye-law dealing with the conveyance of offensive substances through streets. An amended bye-law was prepared, and pursuant to section 114 of the Act, a copy of it was forwarded that your Vestry might make any representation thereon to the Council for its consideration. The proposed amended bye-law reads as follows:— "Every person who shall remove or carry, or cause to be removed or carried, by road or water through London any faecal or offensive or noxious matter or liquid, whether such matter or liquid shall be in course of removal or carriage from within or without or through London, shall use or cause to be used therefor a suitable carriage or vessel properly constructed and furnished with a sufficient covering so as to prevent the escape of any matter or liquid therefrom, and so as to prevent any nuisance arising therefrom. "Such person shall not remove or carry, or cause to be removed or carried, such matter or liquid by road in or through London except during the following periods, viz.:— "Between 5 o'clock a.m. and 10 o'clock a.m., or during the period commencing two hours before sunset and ending one hour after sunset, in any day during the months of March, April, May, June, July, August, September and October. "Between 6 o'clock a.m. and 11 o'clock a.m., or during the period commencing two hours before sunset and ending one hour after sunset, in any day during the months of November, December, January, and February. "Such person shall not remove or carry, or cause to be removed or carried, such matter or liquid by water in or through London except during the period commencing at sunrise and ending at sunset in any day. "This bye-law shall not apply to any person removing or carrying manure consisting only of horse dung, with a sufficient proportion of straw, and shall not apply to any person removing or carrying in a suitable vessel as aforesaid, manure consisting of horse dung and litter other than straw," 180 The committee in their report on the subject stated that the Local Government Board "do not see their way to allow removal either during the night or during hours of the day, when the streets are crowded, especially during the heat of summer." They add that "the extension of hours . . . will be of substantial benefit, although it will not remove all the difficulties" to which their attention had been called, and which "could only be overcome by allowing removal during the night," a course to which the Board "object, as it is then impossible to see that the refuse is not slopped or spilled, and that the vehicles conveying it are properly covered." It may be gathered from the committee's report, that the consent of the Local Government Board to the proposed amended byelaw will not be withheld; but it must be said that the extended hours to be allowed for the conveyance through streets of offensive matter, will not get over the difficulty in regard to West Ham, where, as already mentioned, a bye-law is in operation forbidding the conveyance of offensive matter through streets in the day time. It is to be regretted that the Council have not seen their way to adopt your Vestry's views with regard to the removal of fish offal, and other like refuse, in the shop receptacles, rather than in tank-vans. 181 STABLE REFUSE. In former reports I had to note the frequency of complaints of effluvium nuisance arising in the storage, and especially 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 in respect to private premises are now few in number; and as the cause for complaint, the sunken dungpit, is 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 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 Kensington. South Kensington. 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 certain 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. 182 Removal of Manure.—In the first report for 1898, reference was made to a communication from the medical officer of health to the County Council, with respect to the complaints the public health committee receive, from time to time, of nuisance arising from accumulations of stable manure, and to the power the sanitary authority have (under section 36 of the Public Health (London) Act, 1891) to collect and remove refuse of this sort within their district, but without power to charge for such collection and removal. The committee were considering the question, whether, with a view to facilitate the removal of manure, it was desirable to seek an amendment of the section, so as to enable the sanitary authority, as is reasonable, to charge for the said service.* I had no hesitation in expressing an opinion that such an amendment of the law was desirable. As a result of the enquiry by the committee, and on their recommendation, the Council instructed the parliamentary committee to take the necessary steps "to obtain such an amendment of the law as would give the London sanitary authorities power to charge for the removal of manure, when required by the owner or occupier of any premises to remove it." The parliamentary committee reported that the instructions of the Council to take the necessary steps to obtain such an amendment of the law, involve an amendment of the Public Health (London) Act, 1891, which would necessitate the introduction of a separate Public Bill: it therefore occurred to them that there were probably other respects in which amendments in the Act were desired, and which could most conveniently be dealt with at the same time. The parliamentary committee according consulted the public health committee, and this committee, being of opinion that the question was not of so urgent a character as to necessitate the introduction of a *The question whether the Vestry would be in favour of such a proposed amendment of the law having been considered by the sanitary committee, they advised that no action be taken in the matter, and no action was taken. 183 Public Bill to deal with it alone, instructed the officers to report as to other amendments of the Public Health Act which could be dealt with in the same Bill. Under these circumstances, the Council adopted the recommendation of the parliamentary committee to discharge the reference to them, "to obtain an amendment of the law to enable the London sanitary authorities to charge for the removal of manure." Nuisance from Peat Moss Litter: Action of the County Council.—The Council having had their attention drawn to this subject, a circular letter was addressed, in July, 1898, to the sanitary authorities, as follows:— "In investigating complaints of nuisance alleged to arise from stable manure at various premises in London, the attention of the Council has been directed to the use of peat litter, which appears to be increasingly creating nuisance. The Council will be glad to hear whether your Vestry find that nuisance from peat litter is so great as to render it desirable that the Council should include such litter within the provisions of its bye-laws under section 16 of the Public Health (London) Act, 1891, prescribing the hours of removal of offensive matters throughout London, and the construction of the carriage conveying such matter." The bye-law referred to is to the following effect:— "Every person who shall remove or carry by road or water in or through London any fæcal, or offensive, or obnoxious matter or liquid . shall not . . . (do so) except between the hours of 4 o'clock and 10 o'clock in the forenoon during the months (March to October inclusive), and except between the hours of 6 o'clock in the forenoon and 12 o'clock at noon during the months (November to February inclusive). Such person shall use a suitable carriage or vessel properly constructed and furnished with a sufficient covering so as to prevent the escape of any such matter or liquid therefrom, and so as to prevent any nuisance arising therefrom. "Provided that this bye-law shall not apply to the carriage of horse dung manure." 184 Attention had been called in the monthly reports, from time to time, to the special offensiveness of stable refuse where peat litter is used, and the suggestion had been made that where it is used, the proviso to the bye-law should not apply. On consideration of the Council's letter, I advised that the question asked should be answered in the affirmative, and the sanitary committee reported a recommendation in support of the proposal to abolish the proviso. Their report was referred back for further consideration, but after such further consideration the committee saw no reason for varying their recommendation, which, nevertheless, was rejected by your Vestry.* That a well-nigh insupportable nuisance arises in connection with the use of peat litter, cannot be reasonably denied by any one cognizant of the facts. It is not usual to drain stables where it is used: the peat would stop the drains. It has, moreover, the property of sucking up liquid excreta like a sponge, the result being that the refuse as it leaves the stable is more or less wet. Nevertheless, at this point of time, the litter, if not kept in the stable too long, is not necessarily very offensive. But after a short detention in the usual brick receptacle it acquires a stink of its own, scarcely at all suggestive of the smell proper to peat, or to horse excreta. This stink is especially manifested when the refuse is disturbed in process of removal from the receptacle to the wagon—the bottom layer in the receptacle forming the top layer of the load. With a view to reduce the annoyance to *The committee had before them a number of letters from parishioners making complaint of the nuisance arising in the removal of peat manure (vide Minutes of the Vestry, 1898, pp. 406-7). Their recommendation was— "That the London County Council be informed that this Vestry concur in the desirability of the bye-law referred to in their letter being extended so as to include the removal of peat litter within its provisions." An amendment was carried in the Vestry (by 33 to 22) that before the word "concur," the words "do not" be inserted. 185 the public, and particularly to persons living in the vicinity of the stables, your Vestry, on my advice, induced the London General Omnibus Company to place a vehicle in each of their yards in this parish for the reception of the refuse on removal from the stables, so that it might be taken away without further disturbance. The London Road Car Company, and other large proprietors of horses, subsequently adopted this plan of removal with satisfactory results, few complaints having since been received. It may be remembered that a few years since I expressed the opinion that nuisance from this cause might be dealt with under Section 21 of the Public Health (London) Act, 1891. This view was subsequently endorsed by your Vestry's solicitors; and last year the County Council indicated their concurrence, and also their approval of the plan of removal above described, in a circular letter to the sanitary authorities, dated 4th August, as follows:— "The Council frequently receives complaints as to nuisance arising from peat moss litter and other stable manure at various premises in London, and on enquiry being made into the matter, it is generally found that the nuisance occurs when the manure is removed from the receptacles into which it has been placed, and in the course of such removal which may take place two or three times a week. It has been suggested that the nuisance would be obviated if the manure were removed direct from the stables and placed into properly constructed waggons, or into movable covered receptacles, so that it could be taken out of the yard without being further manipulated. "Section 21 of the Public Health (London) Act, 1891, enables a sanitary authority to deal with any manufactory, building or premises used for any trade, business, process or manufacture, causing effluvia, on complaint made by the medical officer of health, or any two legally-qualified medical practitioners, or by any ten inhabitants of the district. The solicitor advises that, failing other means of remedying the evil, a court might well be asked in the case of livery stables, cab or omnibus proprietors, and other similar businesses, to act under that section in the matter; but that, in his opinion, the case could also be dealt with 186 under the ordinary nuisance provisions of the Act (sections 2, 3, 4, and 5) as being a nuisance which, in the opinion of the sanitary authority, is likely to recur; and that a court might under those sections be asked to make a prohibition order, which would probably have the effect of compelling the occupier to make some such arrangement to obviate the nuisance as has been suggested. "The Council is of opinion that much good might result if sanitary authorities were to endeavour to deal with the recurring nuisances from stable manure in one or other of the ways mentioned, and I am accordingly directed to ask that your Vestry will be so good as to give this suggestion their careful consideration." The Council were informed that the views set out in their communication were in harmony with those long since adopted by your Vestry, and that the practice they recommended has been in existence for a considerable period in this parish. In the month of February of the present year, as already stated, the Council addressed a circular letter to the sanitary authorities in connexion with the removal of offensive matter under a proposed amended bye-law, which should prevent nuisance from peat moss litter, by requiring its removal from stable premises in properly covered carriages. 187 NUISANCE FROM GAS WORKS. Complaints were received during the year of nuisance from the gas works at Kensal-green—a subject fully dealt with in the annual report for 1894 (page 166). There can be no doubt as to the genuineness of the complaints, which receive confirmation from Willesden, the inhabitants of that district suffering when Kensington people have no ground for complaint, and vice versa; the incidence of nuisance varying with change in the direction of the wind. The matter having been referred to the law and parliamentary committee, they reported that— "By section 29 of the Gas Works Clauses Act, 1847, which applies to the Gas Light and Coke Company, the company is not to be exempted from indictment for nuisance, or any other legal proceeding to which they may be liable in consequence of making or supplying gas; and in a case decided in 1877, it was held that a gas company was not entitled to create a nuisance in exercising their statutory powers or in carrying out their statutory obligations (Attorney-General v. Gas Light and Coke Company, 7 Ch. D. 217.") The committee therefore advised the sanitary committee that— "If there be evidence of a substantial public nuisance caused by the Gas Light and Coke Company, the Vestry are entitled to proceed by indictment, or for an injunction to secure its abatement." Your Vestry accordingly addressed a communication to the company intimating that observation would be kept up, so that on any recurrence of the nuisance proceedings might be instituted in regard thereto. A reply was received to the effect that, while objectionable smells did proceed at times from the company's works at Kensal-green—such smells being caused by the elimination of sulphur impurities from the gas, according to the stringent requirements of the metropolitan gas referees—every known appliance for the prevention of nuisance was adopted by them. It was suggested that the gas referees be communicated with, with a view to a visit 188 being made to the works on their behalf, when, the company were of opinion, the referees would be able to satisfy the Vestry that the best possible system was being carried out; or, in the case of a suggested improvement, the directors of the company would immediately give instructions for its adoption. To the company's letter a rejoinder was sent intimating that your Vestry adhered to the position taken up with regard to the legal responsibility of the company to see that no nuisance shall arise from smells from their works, and leaving it to the company to appeal to the gas referees, if they thought any useful purpose would be served by their so doing. That the cause of nuisance is more or less within control would appear from the intermittency of the complaints, and as the smells are at times not perceptible to any noxious degree in the vicinity of the works. No proceedings, whether by indictment or for an injunction, were taken. The James-street Area. The improvement of the James-street area, which, it was hoped, would have been completed long ago under the private Act obtained by the promoters, still hangs fire. The time allowed for compulsory purchase of properties required for the improvement expired in August last, and the time allowed for the completion of the scheme will expire in August, 1901. James-street is in a woe-begone condition, many of the houses having been pulled down, few of the old inhabitants remaining. There is great need for a street improvement in the locality to establish easy communication between South Kensington and Kensington Highstreet, west of the parish church. From time to time the promoters have approached your Vestry with ever increasing demands for pecuniary assistance, with a view to the carrying out of some modified scheme; and it is to be desired that an arrangement of a satisfactory character may be reached before it is too late. The proposed new street would be so obviously 189 a public improvement of more than a local character, that it may be hoped the County Council will see fit to comply with your Vestry's application for co operation, and so contribute to the removal of an eyesore and a nuisance. Smoke Nuisance. Not much was done during the year in the way of smoke-prevention. In July proceedings were taken with respect to the London Colour Printing Works in Exmoorstreet, North Kensington. The summons was adjourned sine die, an undertaking having been given by the company to provide proper appliances, and to use smokeless coals only in the future. At the same date proceedings were taken against the Royal Sanitary Laundry in Hewerstreet, a fine of five pounds being inflicted. In October proceedings were ordered in respect to St. Marylebone Infirmary, Exmoor-street, no action having been taken by the Guardians upon repeated representations made to them on the subject; but ultimately the summons was withdrawn, the Guardians having engaged to adopt measures to prevent recurrence of the nuisance. Goods of Evicted Tenants. Complaints arise from time to time of obstructions to the public thoroughfares due to the practice of depositing thereon furniture and goods in connection with the eviction of tenants under legal process. The inspectors being powerless in the matter, the sanitary committee referred it to the law and parliamentary committee, asking to be advised as to the powers and duties of the Vestry in regard thereto. This committee were of opinion "that the Vestry have power to remove furniture and goods so placed upon the public way when the same is derelict and creating an obstruction, but are under no legal obligation to do so." They also pointed out that by recent magisterial decisions "it has been held to be an offence in carrying out 190 eviction orders, to place furniture and goods on the public highway, so that it is open to the Vestry to institute proceedings against the offending parties in such cases, should they see fit to do so." The "offending parties" (brokers' men) appear to have taken the hint given by the magistrates, as for some time past, in this parish, and so far as I am aware, the objectionable practice has been discontinued. Hygienic Street Paving. During the year some progress was made in the paving with asphalte of streets in poor localities, where traffic is small; such streets, moreover, being largely used by children as playgrounds. This practice, commenced in the Potteries district, and carried out completely in the "Notting-dale" special area, with great and manifest advantage in every respect, will, I hope, be largely extended. In December last, upon the report of the sanitary committee that "it is desirable on sanitary and economical grounds," your Vestry resolved to asphalte pave, at a cost of nearly £3,000, five additional streets, viz., Mary-place, Locktonstreet, Hesketh-place, Testerton-street, and Mersey-street, all in North Kensington. 191 THE PUBLIC MORTUARY. The mortuary underwent considerable improvement during the year, by provision to enable jurymen to view bodies without entering the chamber, by means of glass panels in the entrance doors; and also by the establishment of a direct communication between the chamber and the post-mortem room. Works of general repair, cleansing, painting, &c., were also carried out. Bodies were deposited during the year to the number of 342, upon application as follows:- 1. At the request of the relatives of the deceased 4 2. At the request of undertakers 69 3. At the request of the coroner (inquest cases) Cases of sudden death 151 Cases of violent death 94 245 4. Brought in by the police Found dead 12 Accident cases 2 14 5. On account of death due to infectious disease 10 342 In 129 of the above cases post-mortem examinations were made, mainly under the coroner's warrant. CORONER'S COURT. The coroner's court in the Town Hall Extension Building was completed and brought into use during the year. It affords necessary accommodation for all parties concerned in the holding of inquests. For the use of the court the County Council pay an agreed rent under an arrangement authorised by section 92 of the Public Health (London) Act, 1891, 192 DISINFECTION. The Public Health (London) Act, 1891, imposed additional duties on the sanitary authority in the matter of disinfection,the practical effect of the legislation of late years having been to throw upon the rates the cost of disinfecting houses, and the cleansing and disinfecting of 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 1899 was £729, 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 1899, 19,985 articles were dealt with, of an aggregate weight of 38 tons 3 cwt. Eight hundred and forty-nine rooms, in 747 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 the matter. The expenditure on disinfection, including cleansing of clothing, bedding, &c., necessarily varies from year to year, in proportion to the relative prevalence of infectious disease. Few disinfections are now done at the cost of the occupiers of the houses, or owners of clothing, bedding &c., dealt with. I append a statement of the monthly cost of this work in 1899, which is irrespective of the wages of the disinfector. £ s. a January 52 6 2 February 39 1 4 March 54 18 8 April 35 1 6 May 43 4 11 June 53 15 6 July 74 17 4 August 79 8 1 September 67 4 8 October 88 18 7 November 88 3 6 December 52 8 3 193 The expenditure is too great, and might be very materially reduced, were the work done without the intervention of a contractor, as recommended by the London County Council and by the Metropolitan Asylums Board. The money that might be saved could be put to good use in making provision for carrying out, more thoroughly, the duties of the sanitary authority, by the appointment of additional inspectors. 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 by your Vestry 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 shelter-house 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. 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 the disinfecting officer); 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 194 been expended at Islington, and that a large amount might be saved on the present cost of disinfection. But the committee came to the conclusion, 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," and their report was adopted. 195 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 intectious disease has appeared, and who have been compelled to leave their dwellings (or 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, last year, 127 cases of infectious disease occurred in families in occupation of three rooms; 192 cases in families occupying two rooms, and 73 cases in families herded in single rooms. Of the sufferers in families living in single rooms, 41 had scarlet fever, 16 had diphtheria, and 16 had typhoid fever. It need hardly be said that the need of shelter is imperative in the case of families living in single rooms. The sanitary committee requested me to report as to any premises which the Vestry might obtain for a shelter—meaning the hiring of one or more houses. No suitable premises have been found. The only satisfactory plan would be to erect a shelter and provide it with a proper equipment. Such provision could be most economically made in connection with a public disinfecting station. In the absence of accommodation, the sanitary inspectors are authorised to procure, or pay for lodgings for people dispossessed during the process of disinfection. It is, however, not easy to obtain accommodation for the people, many of whom object to go to a common lodging-house, where, indeed, they would be neither welcome nor, in their infective condition, desirable guests. 196 CLEANSING OF PERSONS ACT. An Act thus intituled, passed in 1897, gives power to any local authority to permit any person infested with vermin, to have the use of the apparatus which the authority may 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. Nominal effect was given to the Act in this parish by an arrangement entered into with the Guardians, whereby cleansing and disinfecting apparatus at the ablebodied workhouse at Mary-place, in the Potteries, was made available on payment of a small fee by your Vestry. Little use has been made of the said apparatus, probably owing to ignorance on the part of the public, no steps having been taken to make known the arrangement entered into with the Guardians. In the parish of St. Marylebone, the Vestry having provided a proper equipment, thousands of cleansing operations are carried out in the course of the year; much, doubtless, to the comfort of dirty and verminous persons. PUBLIC BATHS AND WASHHOUSES. The baths and washhouses at the junction of Lancasterroad and Silchester-road, Notting-hill, opened in April, 1888, are well supported : the washers in the twelve months ended 25th March, 1900, were 63,976 ; an increase of 233, compared with the number in the preceding official year ; the bathers, 101,083; a decrease of 2,483. But for the majority of parishioners the site is not sufficiently central for baths, and is too remote for use by would-be washers. The same objection would apply, more or less, to any single site in the parish. Much good might be effected by the provision of buildings, on a modest scale, and in convenient localities, to which the poor could resort for the purpose of washing clothing, &c. 197 The statistics contained in the successive annual reports of the commissioners for 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 21 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. This latter accommodation is not of a satisfactory sort, as a rule, but it is better than none, and was improved as the result of proceedings taken by yonr Vestry in 1888 and subsequently. There are four sets of public water-closets for the male sex only, situated, respectively, at the rear of the central public library, Kensington High-street; at the west-end of Westbourne-grove, Notting-hill; in Thurloe-place, opposite the Bell and Horns tavern; and at Lancaster-road, Notting-hill, adjoining the public library. Sanitary authorities have ample power in the matter, section 88 of the Metropolis Management Act, 1855, enabling them "to provide and maintain urinals, water-closets, and like conveniences for both sexes 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 High-street, opposite the parish church. Here, 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, section 44 (2), which 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. 198 Water Supply. The Royal Commission appointed in 1898 to consider the question of the future water supply of the metropolis, have presented their report. The reference involved the following points:— (a) Whether it is desirable in the interests of the Ratepayers and Water Companies that the Undertakings of the Companies should be acquired and managed either by one Authority or by several Authorities. And if so, what should be such Authority or Authorities. (b) If the Undertakings are not acquired, whether additional power of trol should be exercised by Local or other Authorities, and if so, what those powers should be. (c) As to the practicability of connecting any two or more of the different systems of supply now administered by the eight Metropolitan Companies. Briefly, it may be said that the report of the Commission is favourable to the existing sources of supply, and foreshadows the creation of a Water Authority, which will not be the London County Council. Your Vestry had, on more than one occasion, expressed disapproval of the proposed purchase of the undertakings of the water companies by the Council, favouring rather the promotion of legislation, by which a central body, representing the ratepayers of the whole of the area of supply of the companies, should be vested with such powers of control and supervision as would, without necessitating the purchase of the undertakings, give to the consumers a directing influence in regard to all schemes for the extension of supply in the future, as well as statutory powers for regulating the system and manner of distribution, such as Parliament has, in times subsequent to the granting of Water Acts, imposed on similar private undertakings for public purposes. 199 The following resolution, adopted on the 8th May, 1895, embodies the most recent declaration by your Vestry as to the policy suitable to be adopted, viz.:— "That in the opinion of the Vestry, it is desirable that legislation should be promoted which shall have the effect of bringing the Undertakings of the Water Companies which now supply the metropolis, under the supervision and inspection, with powers of regulation, of a central body representing the Ratepayers, by which, in return for the rights conferred on the Companies, and without hampering their operations within the area of supply of each, the system of distribution may be rendered thoroughly efficient in all weathers, and universally intercommunicating." A communication was addressed to the Royal Commission in the terms of the resolution, as an expression of the views of your Vestry on the subject. constant Supply is now nearly universal ; and that the public at large are not dissatisfied with the existing arrangements may be inferred from the absence of complaints. Personally, I consider that, in quality and condition, the water as supplied by the three local companies (West Middlesex, Grand Junction, and Chelsea), is fairly satisfactory. I would not say, great as have been the improvements already effected, in regard to filtration and otherwise, that there is not room for further improvement; and it is to be presumed that the companies will be required and willing to do whatever may be necessary for perfecting the supply. I should particularly welcome one improvement, advocated in these reports for many years, viz., the adoption of Clark's softening process, which would, I believe, have a beneficial effect upon the quality of the water, whilst removing an objection to it upon economical grounds which was always referred to by the late Sir Edward Frankland, in his reports appended to the Annual Summary of the Registrar-General. 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 all that can be desired, so as to satisfy reasonable requirements. 200 Dead Ends of Mains.— In the annual report for 1898, reference was made to dead-ends in water mains, as an objectionable feature in the apparatus of water supply, tending to produce sluggishness of flow and fouling of the water, by the growth of organisms, with consequent danger to the public health, unless the main at the dead-end is flushed and cleansed with sufficient frequency. This is done, according to the engineer of the company in respect of whose district complaint was made in 1898. This gentleman, at an interview with the sanitary committee, admitted the evils of dead-ends, and stated that the company were, and for some time past had been, engaged in abolishing them. In the report for 1898, the opinion of the late Sir Edward Frankland was cited as to the dangers latent in deadends, in connexion with an outbreak of enteric fever in a northern town. Whilst "unable to pronounce any authoritative judgment as to the origin of the epidemic," Sir E. Frankland was of opinion, " that the remarkable restriction of it to an area in which an extraordinarily large number of dead-ends of the water mains occur, pointed to particular dangers attending such dead ends," to which he had referred in his report as being "a causa sufficiens of the mischief." This is one of the questions that might well be considered in connexion with any Bill dealing with the water supply of the metropolis, as in the projected Bill to amend the Public Health (London) Act, 1891. cutting-off powers of 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 nformation to the sanitary authority, when, from any cause, they had exercised their statutory right to cut-off the water supply to an occupied dwelling-house. Every company is now required to give such notice within twenty-four hours 201 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, for "an occupied house without a proper and sufficient supply of water," is "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 rate. The cutting-off powers were materially limited in 1887, by the Water Companies (Regulation of Powers; 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, etc., by the poorer classes, The beneficent result of this legislation, which had been advocated in these reports many years previously, is that the water supply of the poor is generally secured, and that without loss to the companies. Surely the time has come that the power to cutoff the supply from an occupied house should cease; 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 some years ago to abandon the practice of cutting-off; and, I am informed by the secretary, 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, summons largely in preference to cutting-off, and other companies now are following suit. Defaulters are summoned 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 202 half-yearly, they must proceed before the expiration of the six months, and hence have to sue before the second quarter has expired, which appears to be a hardship. If greater facilities were given to the companies for recovering the rate, probably they would be willing to waive their right to cut-off the supply, or consent to its abolition. Conclusion. In bringing this my thirtieth 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, in the collation of statistics, and generally. I desire also to bear testimony to the good work of the staff as a whole; and not least to that of the sanitary inspectors, which has been carried out as efficiently as possible, having regard to the limited number of those officers, and to the magnitude 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, 1900. 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. 204. TABLE I. Showing Population, Inhabited Houses, Marriages, Births, and Deaths, in 1899 and in the ten preceding years: gross numbers. The Year. Estimated Population* No. of Inhabited Houses.† Marriages. Registered Births. Deaths. Total, all Ages ‡ Under One Year. Under Five Years. At Public Institutions.§ 1899 172.400 22,750 1,693 3,590 3,021 642 932 942 1898 172,000 22,700 1,648 3,633 2,798 655 1,039 782 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 Average, 10 years 1889-98. 168,404 — 1,572 3,711 2,795 617 982 733 Notes.—Census Population in 1861, 70,108; in 1871, 120,299; in 1881, 163,151; in 1891, 166,308; in 1896, 170,465. Average Number of Persons to each house at Census; in 1861, 7.4; in 1871, 7.6; in 1881, 8 .l; in 1891, 7.53. Area of Parish, 2,190 acres. Number of persons to an acre (1899) 78.7. *For statistical purposes the population is estimated to the middle of the year, on the basis 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. ‡ 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 and outlying public institutions, including the Asylums board Hospitals. In 53 weeks. 205 TABLE II. Showing the Annual Birth-rate and Death-rate; Death-rate of Children; and Proportion of Deaths at Public Institutions, to 1,000 Deaths, for the year 1899; and the ten preceding years. The Year. Birth-rate per 1,000 of the Population. Death-rate per 1,000 of the Population. Deaths of Children under 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 at Public Institutions; per 1,000 of Total Deaths.* 1899. 20.8 17.5 179 213 309 311 1898 21.1 16.3 180 234 371 279 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 Average of 10 years, 1889-1898. 22.0 16.6 166 221 351 263 * Includes Deaths of Parishioners at outlying Public Institutions, but excludes Deaths of Non-Parishioners at Brompton Consumption Hospital, St. Marylebone Infirmary, Notting-hill, &c. TABLE III. Deaths registered from all causes in the year 1899. (Exclusive of the Deaths of Non-Parishioners at Public Institutions within the Parish, but inclusive of the Deaths of parishioners Institutions, etc., without the Parish.) For a Summary of this Table see page 62. 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. I SPECIFIC FEBRILE or ZYMOTIC DISEASES 146 92 19 13 15 26 12 17 26 25 12 238 403 313 90 II PARASITIC DISEASES 2 4 ... ... ... ... 1 ... .. ... ... 6 7 6 7 III DIETETIC DISEASES ... ... ... 1 2 1 5 8 2 ... .. ... 19 17 2 IV CONSTITUTIONAL DISEASES 36 41 17 30 75 81 93 81 53 26 3 77 536 426 110 v developmental diseases 78 ... 2 ... ... 1 ... 2 15 59 39 78 196 164 32 VI LOCAL DISEASES 248 127 47 31 85 131 219 250 244 191 43 375 1616 1317 299 VII DEATHS FROM VIOLENCE 30 13 5 6 7 9 12 14 7 7 2 43 112 95 17 VIII. DEATHS FROM ILL-defined AND SPECIFIED CAUSES 102 13 ... 1 1 ... 6 5 3 3 1 ... 132 117 15 642 290 90 82 1 85 249 348 377 350 309 99 932 3021 2455 566 I. SPECIFIC FEBRILE or ZYMOTIC DISEASES. Order 1.-Miasmatic diseases Smallpox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 6 18 ... ... ... ... ... .. ... ... ... 24 24 23 1 Scarlet Fever ... 5 3 1 ... 1 ... .. ... ... .... 5 10 7 3 Typhus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping-cough 29 30 ... ... ... ... ... ... ... ... ... 59 59 46 13 Diphtheria 3 26 12 ... 1 ... ... ... ... ... ... 29 42 28 14 Simple Continued or Ill-defined Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric or Typhoid Fever ... ... 2 7 6 4 3 ... 1 ... ... ... 23 20 3 Other Miasmatic Diseases—Influenza 8 2 1 3 4 14 7 14 20 24 8 10 105 66 39 2.—Diarrhceal Diseases. Simple Cholera 1 1 ... ... ... ... ... ... ... 1 ... 2 3 3 ... Diarrhoea, Dysentery 84 9 ... ... ... 3 ... ... 2 ... 3 93 101 91 10 3.Malarial Diseases. Remittent Fever ... ... ... ... ... 1 ... ... ... .... ... ... 1 ... 1 Ague ... ... ... ... ... .. ... ... ... ... ... ... ... ... ... 4.—Zoogenous Diseases. Cow-Pox, and effects of Vaccination ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases (e.g., Hydrophobia, Glanders, Splenic Fever) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5.—Venereal Diseases. Syphilis — 15 ... ... ... 1 ... 1 ... ... ... ... 15 17 14 3 Gonorrhoea, Stricture of the Urethra ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 6.—Septic Diseases. Erysipelas ... 1 1 ... ... ... 1 1 3 ... 1 1 8 6 2 Pyaemia, Septicaemia ... ... ... ... 2 1 ... 1 ... ... ... ... 4 3 1 Puerperal Fever ... ... ... 2 1 2 ... ... ... ... ... ... 5 5 .. 146 92 19 13 15 26 12 17 26 25 12 238 403 313 90 II.—PARASITIC DISEASES. Thrush, and other Vegetable Parasitic Diseases 2 3 ... ... ... ... 1 ... ... ... ... 5 6 5 1 Worms, Hydatids, and other Animal Parasitic Diseases ... 1 ... ... ... ... ... ... ... ... ... 1 1 1 ... 2 4 ... ... ... ... 1 ... ... ... ... 6 7 6 1 III.—DIETETIC DISEASES. Want of Breast Milk—Starvation ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scurvy ... ... ... ... ... ... ... ... ... ... ... ... 17 15 2 Chronic Alcoholism ... ... ... 1 1 .. 5 8 2 .. ... ... 2 2 ... Delirium Tremens ... ... • ... 1 1 ... ... .. ... ... ... ... ... ... 1 2 1 5 8 2 ... ... ... 19 17 2 IV.—CONSTITUTIONAL DISEASES. Rheumatic Fever, Rheumatism of the Heart ... 2 2 1 ... 2 1 2 ... ... ... 2 10 9 1 Rheumatism .. .. 1 1 .. ... ... 1 ... 2 ... ... 5 2 3 Gout .. ... ... ... ... ... 2 2 2 ... ... .. 6 5 1 Rickets 2 1 ... ... ... ... ... ... ••• ... ... 3 3 2 1 Cancer, Malignant Disease ... ... 1 3 5 22 29 49 37 20 3 ... 169 120 49 Tabes Mesenterica 10 4 ... ... ... ... ... .. ... ... ... 14 14 12 2 Tubercular Meningitis, Hydrocephalus 10 22 4 1 ... ... ... ... ... .. ... 32 37 32 5 Phthisis 1 1 1 18 63 55 50 20 11 1 ... 2 221 193 28 Other forms of Tuberculosis, Scrofula 13 10 6 6 2 2 4 4 ... .. ... 23 47 39 8 Purpura, Hæmorrhagic Diathesis ... 1 ... ... ... ... ... ... ... ... ... 1 1 1 ... Anæmia, Chlorosis, Leucocythsemia ... ... ... ... ... ... ... 1 1 ... ... ... 2 ... 2 Glycosuria, Diabetes Mellitus ... .. ... ... 3 ... 5 2 2 3 ... ... 15 6 9 Other Constitutional Diseases ... ... 2 ... 2 ... 2 ... ... ... ... ... 6 5 1 36 41 17 30 75 81 53 81 53 26 3 7 7 5 36 110 206 207 Continued. TABLE III.—(continued). 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. V.—DEVELOPMENTAL DISEASES. Premature Birth 64 ... ... ... .. ... ... ... ... .. ... 64 64 50 14 Atelectasis 11 ... .. ... ... .. ... .. ... ... ... 11 11 11 ... Congenital Malformation 3 ... 2 ... ... 1 ... .. ... ... .. 3 6 5 1 Old age ... ... ... ... ... ... ... 2 15 59 39 ... 115 98 17 78 .. 2 ... ... 1 ... 2 15 59 39 78 196 164 32 VI.—LOCAL DISEASES. 1.—Diseases of Nervous System. Inflammation of Brain or Membranes 8 7 5 1 1 1 .. ... . ... ... 15 23 22 1 Apoplexy, Softening of the Brain, Hemiplegia, Brain Paralysis ... ... ... ... 3 8 28 29 28 32 9 ... 137 100 37 Insanity, General Paralysis of the Insane ... ... ... 1 4 4 4 .. 2 ... ... ... 18 11 7 Epilepsy ... 1 3 2 1 2 2 1 1 1 ... 1 14 11 3 Convulsions 25 7 ... .. ... ... ... ... ... .. ... 32 32 29 3 Laryngismus Stridulus (Spasm of Glottis) 3 2 ... ... ... . ... .. ... .. ... 5 5 4 1 Diseases of Spinal Cord, Paraplegia, Paralysis Agitans ... 1 ... ... 1 .. 4 1 2 1 ... 1 10 5 5 Other Diseases of Nervous System 2 ... 4 3 2 9 8 7 14 2 1 2 52 46 6 2.—Diseases of Organs of Special Sense. (e.g., of Eye, Ear, Nose.) ... 2 3 2 ... ... ... 1 1 ... 2 9 8 1 3.—Diseases of Circulatory System. Pericarditis ... 1 3 ... ... ... ... 1 ... ... ... 1 5 5 ... Acute Endocarditis ... 1 2 1 1 ... .. ... 1 ... .. 1 6 6 ... Valvular Diseases of Heart .. ... 4 2 6 6 10 12 10 5 ... .. 55 40 15 Other Diseases of Heart ... ... 4 5 13 12 25 41 40 23 4 ... 167 133 34 Aneurism ... ... ... ... 1 2 2 1 ... ... ... ... 6 6 ... Embolism, Thrombosis ... ... ... ... 1 1 ... 1 3 3 ... .. 9 6 3 Other Diseases of Blood Vessels ... ... ... .. ... ... 2 ... 3 3 ... ... 8 4 4 4.—Diseases of Respiratory Organs. Laryngitis ... 1 1 1 ... ... .. ... ... ... ... 1 3 3 ... Croup ... 1 ... ... .. ... ... ... ... ... ... 1 1 1 ... Emphysema, Asthma ... ... ... ... ... ... 4 6 3 3 ... ... 16 14 2 Bronchitis 90 61 ... 2 5 14 54 69 67 64 18 151 444 379 65 Pneumonia 14 14 4 3 13 22 33 26 18 24 1 28 172 150 22 Pleurisy .. ... ... ... 1 2 1 7 2 ... ... ... 13 11 2 Other Diseases of Respiratory System 1 1 2 ... ... 3 5 2 3 4 2 2 23 17 6 5.—Diseases of Digestive System. Dentition 13 4 ... ... .. ... ... .. .. ... ... 17 17 16 1 Sore Throat, Quinsy ... .. ... ... ... ... ... ... .. ... ... ... ... ... ... Diseases of Stomach 7 ... 1 1 5 3 4 2 3 1 ... 7 27 26 1 Enteritis 17 2 ... ... 2 2 .. 2 3 1 1 19 30 26 4 Gastro-Enteritis 58 15 ... ... ... ... ... 1 ... .. ... 73 74 65 9 Obstructive Diseases of Intestine 3 ... ... 1 1 3 3 3 4 2 1 3 21 11 10 Peritonitis ... ... 3 1 3 2 1 3 ... 1 .. ... 14 11 3 Ascites ... ... ... ... .. ... ... .. ... .. ... ... ... ... ... Cirrhosis of Liver ... ... 1 ... 2 8 8 6 6 3 ... ... 34 21 13 Jaundice, and other Diseases of the Liver 3 1 ... ... 3 5 3 5 6 3 1 4 30 22 8 Other Diseases of Digestive System 3 ... 3 ... 4 3 .. 1 2 ... ... 3 16 13 3 6.—Diseases of Lymphatic System. (e.g., of Lymphatics and of Spleen.) ... ... ... ... ... ... ... ... ... ... ... ... .. ... ... 7.—Diseases of Gland-Like Organs of Uncertain Use. (e.g., Bronchocele, Addison's Disease.) .. ... ... 1 ... ... ... ... 1 ... ... ... 2 2 ... 8.—Diseases of Urinary System. Nephritis .. 2 1 1 1 4 6 1 ... 3 ... 2 19 13 6 Bright's Disease, Albuminuria ... ... ... 2 4 3 5 8 9 3 ... ... 34 24 10 Disease of Bladder or of Prostate ... ... ... ... ... ... ... 4 4 3 2 13 11 2 Other Diseases of the Urinary System ... ... 2 .. 2 3 2 8 5 3 1 ... 26 22 4 9.—Diseases of Reproductive System. a. Of Organs of Generation. Male Organs ... ... ... .. ... ... ... ... ... ... ... ... ... ... ... Female Organs ... 1 ... 1 2 3 5 ... ... 1 1 1 14 9 5 B. Of Parturition. Abortion, Miscarriage ... ... .. ... 1 1 ... ... ... ... .. ... 2 2 ... Puerperal Convulsions .. ... ... ... .. ... ... ... ... ... ... ... ... ... ... Placenta Prævia, Flooding ... ... ... .. ... ... ... ... ... ... ... ... ... ... ... Other Accidents of Childbirth ... ... ... ... 1 1 .. ... ... ... ... .. 2 2 ... 10.—Diseases of Bones and Joints. Caries, Necrosis ... ... ... ... 1 ... .... ... ... ... ... ... 1 1 ... Arthritis, Ostitis, Periostitis ... 1 1 ... ... ... ... ... 3 1 ... 1 6 5 1 Other Diseases of Bones and Joints 1 ... ... ... ... ... .. .. ... .. ... 1 1 1 11.—Diseases of Integumentary System. Carbuncle, .Phlegmon ... .. ... ... ... ... ... 1 ... ... 1 ... 2 1 1 Other Diseases of Integumentary System ... 1 ... ... ... 1 .... ... 1 ... ... 1 3 2 1 248 127 47 31 85 131 219 250 244 191 43 375 1616 1317 299 208 209 Continued. TABLE III.—(continued.) AGES. Total under Five Years of Age. Grand Total All Ages. sub-district causes of death. 0 to 1. 1 to 5. 5 to 15. 15 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 to 75. 75 to 85. 85 and upwards. Kensington Town. Brompton. VII—DEATHS FROM VIOLENCE. 1.—Accident or Negligence. Fractures and Contusions 4 4 1 2 3 7 7 11 5 7 2 8 53 44 9 Gun-shot Wounds ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cut, Stab ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Burn, Scald .. 4 2 1 1 1 .. i .. ... ... 4 10 9 1 Poison ... 1 ... ... ... ... .. ... ... ... ... 1 1 ... 1 Drowning ... ... ... .. ... ... ... ... ... ... ... ... ... ... ... Suffocation 25 3 1 ... 1 ... 1 ... ... .. .... 28 31 30 1 Otherwise 1 1 ... ... ... ... 1 i ... ... ... 2 4 3 1 2.—Homicide. Manslaughter ... ... 1 ... ... ... ... ... ... ... ... ... 1 1 ... Murder ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3.—Suicide. ... Gun-Shot Wounds ... ... ... 3 ... ... ... 1 1 ... ... ... 5 3 2 Cut, Stab .. ... ... ... ... ... ... ... .. ... ... ... .. ... .. Poison ... ... ... ... 2 ... 2 ... 1 ... ... ... 5 3 2 Drowning ... ... ... ... ... 1 ... ... .. ... ... ... 1 1 ... Hanging ... ... ... ... ... ... 1 .. ... ... ... ... 1 1 ... Otherwise .. ... ... ... ... .. ... ... .. ... ... ... ... ... ... 4.—Execution. Hanging ... ... ... .. ... ... ... ... ... ... ... ... ... ... ... 30 13 5 6 7 9 12 14 7 7 2 43 112 95 17 VIII.—DEATHS FROM ILL-DEFINED AND NOT SPECIFIED CAUSES. Dropsy ... ... ... ... ... .. 1 1 1 ... ... ... 3 3 ... Debility, Atrophy, Inanition 99 12 ... ... ... ... ... ... .... ... ... 111 111 103 8 Mortification ... ... ... .. ... .. ... 2 1 1 ... ... 4 2 2 Tumour ... 1 ... ... ... ... 1 ... ... ... ... 1 2 2 ... Abscess 1 .. ... ... ... ... 2 ... ... .. ... 1 3 1 2 Hemorrhage ... ... ... ... 1 ... ... .. ... ... ... ... 1 1 ... Sudden Death (Cause not ascertained) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Causes not specified or ill-defined 2 ... ... 1 ... ... 2 2 1 ... ... 2 8 5 3 102 13 ... 1 1 ... 6 5 3 1 ... 115 132 117 15 210 211 TABLE IV. Showing the number of Deaths at all ages, in 1899, 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. (At all Ages). Total Deaths. Deaths per 1000 of Population Deaths per 1000 of Total Deaths 1. Principal Zymotic Diseases 259 1.5 86 2. Pulmonary Diseases 672 3.9 222 3. Principal Tubercular Diseases 319 1.9 106 Division II. (Infants under one year). Total Deaths. Deaths, per 1ooo of Births. Deaths, per 1ooo of Total Deaths under one year. 4. Wasting Diseases 163 45.4 254 5. Convulsive Diseases 56 15.6 87 NOTES. 1. Includes Small-pox, Measles, Scarlet Fever, Diphtheria, Whooping-cough, Typhus Fever, Enteric (or Typhoid) Fever, Simple Continued Fever, and Diarrhœa. Sixty 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). TABLE V. Showing the Number of Deaths from the Principal Diseases of the Zymotic Class in the ten years 1889-98, and in the year 1899. Diseases. 1889. 1890. 1891. 1892. 1893. 1894. 1895. 1896. 1897. 1898. Annual Average of ten years 1889-98. Proportion of Deaths to 1000 Deaths from all causes in ten years 1889-98. Deaths in 1899. Proportion of Deaths to 1000 Deaths from all causes in 1899. Small-pox ... ... ... ... 9 ... ... ... ... ... 0.9 0.3 ... ... Measles 14 140 29 109 18 108 33 173 33 120 77.7 27.8 24 7.9 Scarlet Fever 28 26 16 36 51 22 27 39 29 23 29.7 10.6 10 3.3 Diphtheria 111 35 28 31 83 75 89 72 82 26 63.2 22.6 42 13.9 Whooping-cough 26 93 84 63 65 63 39 99 19 52 60.1 21.5 59 19.5 Typhus Fever ... ... ... ... ... ... ... ... ... 2 0.2 0.2 ... ... Enteric Fever 19 15 24 15 17 21 15 15 21 12 17.4 6.2 23 7.6 Simp. Continued Fever ... ... 1 2 ... 3 1 1 1 ... 09 0.3 ... ... Diarrhœa 71 78 91 77 98 56 118 61 125 112 88.7 31.7 101 33.4 TOTALS. Kensington. 269 387 273 333 341 346 322 460 310 347 338.8 121.2 259 85.6 London. 9709 12279 9675 11983 13223 11544 11544 14100 11525 12565 11815 139.2 11228 125 England & Wales 61027 59698 53221 56032 73499 52771 64901 66936 67051 69714 62485 113.9 69820 120 212 TABLE VI. Summary of the Work of the Sanitary Inspectors during the year 1899. ary Districts.* No. of Complaints made by Inhabitants, &c. No. of Houses, Premises, &c., inspected. No. of Re-inspections of Houses, Premises, &c. Results of Inspection. House Drains. Water Closets. Dust Receptacles. Water Supply. Miscellaneous. Written Intimations of Nuisance 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.§ Repaired, Cleansed, &c. Ventilated, Trapped, &c. Repaired, &c. Supplied with Separate Water Service. Soil-pipes Ventilated. New provided. Repaired, Covered, &c. Cisterns erected. Cisterns Cleansed, Repaired, Covered, &c. Waste-pipes connected with drains, &c., abolished. No. of Lodging Houses newly Registered under 94th Section of the Public Health (London) Act, 1891. † Yards and Areas paved and drained. Animals removed, being improperly kept. Regularly Inspected. Legal proceedings, i.e., Summonses. Bakehouses. Licensed Cow-houses. Licensed Slaughter-houses. North 248 938 2391 439 314 53 120 200 119 35 289 12 69 60 52 7 83 40 40 105 3 21 ... 1 6 N.E. 202 855 2417 354 161 32 134 96 168 57 161 18 41 25 9 26 40 1 ... 36 6 27 1 3 14 N.W. 153 1070 1634 248 343 13 192 82 68 42 188 20 7 39 40 2 25 1 ... 56 2 13 2 2 29 Central 168 1056 2028 359 210 26 85 113 136 90 147 76 71 5 11 7 62 ... ... 193 ... 26 1 6 5 S.E. 152 925 1117 169 79 11 15 101 40 10 45 12 12 11 4 8 39 2 ... 20 ... 24 ... ... ... S.W. 199 1110 1947 380 301 29 108 155 60 64 150 87 28 35 23 8 32 ... 8 109 2 23 .. 1 7 1122 5954 11534 1949 1408 164 654 747 591 298 980 225 228 175 139 58 281 4 48 519 13 134 4 13 61 213 For a description of the Sanitary Districts, see pace 2. † Under the provisions of sec. 3 Public Health (London) Act 1891. ‡ Or these notices, 720 (218, 132, 94, 140, 41 and 95 in the several sanitary districts) were issued under the provisions of sec. 4 of the Public Health (London) Act, 1891 ; and CSS (96. 29, 249, 70. 38 and 206 in the several districts) under the bve-laws for houses let in lodgings. or occunied by members of more than one family. § Done under the supervision of a Special Officer. †The total number of houses on the Register in December, 1899, in round figures, was 1,650. (Vide page 155.) TABLE VII. Showing the Death-rate per 1000 persons living; the 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 1899, and in the ten preceding years, 1889-98. 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. 1889 14.6 18.4 269 1.6 2.3 1ll 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 3.1 117 136 1893 1894 15.6 17.8 346 2.1 2.l7 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 1897 15.6 18.2 310 1.8 2.6 116 142 1897 1898 16.3 18.7 347 2.0 2.8 124 150 1898 average of ten years 1889-98. 16.6 19.7 339 2.0 2.7 121 138 average of ten years 1889-98. 1899. 17.5 19.8 259 1.5 2.5 86 125 1899 214 TABLE VIII. Comparative Analysis of the Mortality in all London, and in Kensington, in 1899. 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 19.8 2.5 16.7 24.9 25.9 12.5 4.2 9.2 29.9 0.6 Kensington 17.5 1.5 17.9 21.3 31.2 8.6 3.7 8.8 31.2 0.0 215 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. 216 217 TABLE IX. Showing the Localities in which Fatal Cases of the Principal Diseases of the Zymotic Class occurred in 1899. KENSINGTON TOWN REGISTRATION SUB-DISTRICT. Locality. Measles. Scarlet Fever. Diphtheria. WhoopingCough. Enteric Fever. Diarrhœa. Total. Locality. Measles. Scarlet Fever. Diphtheria. WhoopingCough. Enteric Fever. Diarrhœa. Total. Adair Road ... ... ... ... ... 2 2 Ladbroke Grove 1 ... ... 2 ... 1 4 Addison Road North ... ... ... ... 1 1 2 Lancaster Road ... ... 1 ... 2 3 6 Appleford Road 1 ... ... 3 ... 1 5 Lockton Street ... ... ... 2 ... 1 3 Archer Mews ... ... ... 1 ... 1 2 Long's Terrace ... 1 ... ... ... ... 1 Bangor Street ... ... 1 1 ... 2 4 Lonsdale Road 1 ... ... 1 ... ... 2 Bedford Gardens ... ... ... ... 1 ... 1 Lonsdale Yard ... ... ... ... 1 ... 1 Blagrove Road ... ... ... ... 1 ... 1 Lorne Gardens 1 ... ... ... ... ... 1 Blechynden Street ... ... ... ... ... 2 2 Martin Street ... ... 1 ... ... ... 1 Bolton Mews ... ... ... ... 1 ... 1 Merton Road ... ... 2 ... ... 1 3 Bolton Road ... ... ... 3 ... ... 3 Pembroke Mews ... ... 1 ... ... l 2 Bomore Road 2 ... ... ... ... 3 5 Petersham Mews ... ... 1 ... ... ... 1 Branstone Street ... ... 1 ... ... ... 1 Prince's Place ... ... 1 ... ... ... 1 Buckingham Terrace ... ... 1 ... ... ... 1 Portland Road ... 1 ... 1 ... 3 5 Campden Street ... ... 1 ... ... 1 2 Portobello Road 1 ... 1 1 ... 5 8 Chesterton Road ... ... 1 ... 1 ... 2 Rackham Street ... ... ... ... ... 2 2 Clarendon Road ... ... ... 1 ... 2 3 Rendle Street 1 ... ... ... ... ... 1 Convent Gardens ... ... ... 1 ... 1 2 St. Ervan's Road 1 ... ... ... ... 1 2 Cornwall Road ... ... 1 ... 1 3 5 St. Katharine's Road 2 ... ... ... ... 1 3 Crescent Street 1 ... 1 ... ... ... 2 Silchester Terrace ... ... ... 2 ... ... 2 Dartmoor Street ... ... 1 1 ... ... 2 Sirdar Road ... 1 ... ... ... 2 3 Elsham Road ... ... ... ... 1 ... 1 Southam Street ... ... 1 2 ... 2 5 Faraday Road 1 ... ... ... 1 ... 2 Stoneleigh Street ... ... 1 ... ... ... 1 Golborne Gardens ... ... ... 1 ... 2 3 Tavistock Road ... ... 1 ... ... ... 1 Golborne Road 1 ... ... ... ... ... 1 Testerton Street 1 ... 1 ... ... 1 3 Grenfell Road ... ... ... 1 1 ... 2 The Mall ... ... ... 2 ... ... 2 Hazlewood Crescent 1 ... ... ... ... 1 2 Tobin Street ... ... ... ... ... 2 2 Hewer Street ... ... ... ... 1 1 2 Treadgold Street ... ... ... 1 1 ... 2 Hippodrome Stables ... ... ... ... ... 2 2 Treverton Street ... ... ... 2 ... 2 4 Holland Park ... ... ... ... 1 ... 1 Victoria Dwellings ... 1 ... ... ... ... 1 Holland Road ... 1 ... ... ... ... 1 Walmer Road ... ... ... ... ... 2 2 Hurstway Street ... ... 1 ... ... ... 1 Warwick Road ... ... 3 ... ... ... 3 Jameson Street ... ... ... ... ... 2 2 Western Terrace ... ... 1 ... ... ... 1 Kensington Infirmary 7 ... ... 4 1 1 13 West Pembroke Place ... ... 1 ... ... 1 2 Kensington Park Road ... ... ... 1 3 1 5 Wornington Road 1 2 1 1 1 8 14 Kensington Place ... ... 1 ... ... ... 1 BROMPTON SUB-DISTRICT. Adrian Terrace ... ... ... ... 1 ... 1 Manson Mews ... ... 2 ... ... ... 2 Ashley Cottages ... ... 1 ... ... ... 1 Osten Mews ... ... ... 1 ... ... 1 Astwood Mews ... 1 ... ... ... ... 1 Redfield Lane ... ... ... ... ... 1 1 Barker Street ... ... ... 1 ... ... 1 Richmond Road ... ... 1 ... ... ... 1 Beauchamp Place ... ... ... ... ... 1 1 Seymour Place ... ... 1 ... ... 1 2 Bolton Gardens ... ... 1 ... ... ... 1 South Street, St. Mark's Rd. ... ... ... ... 1 ... 1 Bute Street ... ... ... 1 ... 1 2 Stanhope Mews South ... ... ... 1 ... ... 1 Childs' Passage ... ... 1 ... ... ... 1 Sussex Place ... 1 ... ... ... ... 1 Cranley Mews ... ... 1 2 ... ... 3 Sydney Place ... ... ... 1 ... ... 1 Cromwell Place ... ... ... ... ... 1 1 Wallgrave Road ... ... 1 ... ... ... 1 Finborough Road ... ... 1 ... 1 ... 2 Wallgrave Terrace ... ... 2 ... ... ... 2 Fulham Road ... ... 1 2 ... 1 4 Warwick Road ... ... 1 ... ... ... 1 Gloucester Grove East ... ... ... ... ... 1 1 Wetherby Mews ... ... ... ... ... 1 1 Ifield Road ... ... ... 1 ... 1 2 Yeoman's Row ... 1 ... 2 ... ... 3 218 TABLE IXa. Showing Streets, etc., in the Registration Sub-Districts, and in the Sanitary Inspecting Districts, from which the 1,046 cases of Infectious Disease were notified, under the provisions of the Public Health (London) Act, 1891, during the year 1899. The Registration SubDistricts are Kensington Town (=K T), and Brompton (=B). For list of Sanitary Districts see page 2. Street or Place. Registration Sub-District. Sanitary District. Scarlet Fever. Diphtheria. Enteric Fever. Typhus Fever. Continued Fever. Puerperal Fever. Erysipelas. Croup. Total. Abingdon Mansions K T S W 1 ... ... ... ... ... ... ... 1 Abingdon Road KT& B „ 1 ... 1 ... ... ... ... ... 2 Abingdon Villas K T „ 2 3 ... ... ... ... ... ... 5 Acklam Road „ N 4 1 2 ... ... ... 1 ... 8 Adair Road „ „ ... 3 1 ... ... ... ... ... 4 Addison Road „ C 2 1 ... ... ... ... ... ... 3 Addison Road North „ „ ... ... 1 ... ... ... ... ... 1 Admiral Mews „ N ... ... 1 ... ... ... ... ... 1 Admiral Place „ „ ... ... 3 ... ... ... ... ... 3 Adrian Terrace B S W 3 ... ... ... ... ... ... ... 3 Airlie Gardens K T C 1 ... ... ... ... ... ... ... 1 Alfred Place B S E 1 ... ... ... ... ... ... ... 1 All Saints' Road K T N E ... ... ... ... ... 1 ... ... 1 Alma Terrace B S W ... ... ... ... ... ... 1 ... 1 Alveston Mews „ S E 1 ... ... ... ... ... ... ... 1 Appleford Road K T N ... 1 1 ... ... ... 3 ... 5 Archer Street „ N E ... ... ... ... ... ... 2 ... 2 Argyll Road „ C 1 ... ... ... ... ... ... ... 1 Arundel Gardens „ N E 1 ... 1 ... ... ... ... ... 2 Ashburn Mews B S E 1 2 ... ... ... ... ... ... 3 Ashley Cottages „ S W 4 2 1 ... ... ... 1 ... 8 Astwood Mews „ S E 2 3 ... ... ... ... ... ... 5 Astwood Road „ S E 2 ... ... ... ... ... ... ... 2 Atherstone Terrace „ S E ... 1 ... ... ... ... ... ... 1 Bangor Street K T N W ... 3 ... ... ... ... 1 ... 4 Barker Street B S W ... 1 ... ... ... ... ... ... 1 Barkston Gardens „ „ 1 ... ... ... ... ... ... ... 1 Bassett Road K T N ... 2 ... ... ... ... ... ... 2 Beauchamp Place B S E 2 ... 1 ... ... ... ... ... 3 Bedford Gardens K T C ... 1 l ... ... ... ... ... 2 Bedford Terrace „ „ 1 ... ... ... ... ... ... ... 1 Bevington Road „ N 3 2 ... ... ... ... ... ... 5 Blagrove Road „ „ 1 ... 1 ... 3 ... ... ... 5 Blechynden Street „ N W 4 ... l ... ... ... 3 ... 8 Blenheim Crescent „ N E 3 2 2 ... ... ... ... ... 7 Bloomfield Yard „ N W ... ... ... ... ... ... 1 ... 1 Bolton Gardens B S E ... 1 ... ... ... ... ... ... 1 Bolton Mews K T N E ... ... 1 ... ... ... ... ... 1 Bolton Road „ „ 2 ... 2 ... ... ... 1 ... 5 Bonchurch Road „ N 2 ... ... ... ... ... ... ... 2 Continued. 219 TABLE IXa. continued. Street or Place. Registration Sub-District. Sanitary District. Scarlet Fever. Diphtheria. Enteric Fever. Typhus Fever. Continued Fever. Puerperal Fever. Erysipelas. Croup. Total. Bosworth Road K T N ... ... ... ... ... ... 1 ... 1 Bramham Gardens B S W 1 ... ... ... ... ... ... ... 1 Bramley Road K T N W 4 1 1 ... ... ... 2 ... 8 Bransford Street „ N 1 ... ... ... ... 1 ... ... 2 Branstone Street „ „ ... 1 ... ... ... ... ... ... 1 Brompton Road B S E 4 ... ... ... ... ... 1 ... 5 Brompton Square „ „ 1 ... ... ... ... ... ... ... 1 Brunswick Gardens K T C 1 ... ... ... ... ... ... ... 1 Buckingham Terrace „ N E 1 ... ... ... ... ... ... 1 Calverley Street K T N W ... ... ... ... ... ... 1 ... 1 Cambridge Gardens „ N 3 3 ... ... ... ... 1 ... 7 Campden Grove „ C ... 1 ... ... ... ... ... ... 1 Campden Hill „ „ 1 ... ... ... ... ... ... ... 1 Campden Hill Gardens „ „ ... l ... ... ... ... ... ... 1 Campden Hill Square „ „ ... 2 ... ... ... ... ... ... 2 Campden Houses „ „ 5 ... ... ... ... ... 3 ... 8 Campden Street „ „ 3 3 ... ... ... ... ... ... 6 Cathcart Road B S W 1 ... ... ... ... ... 1 ... 2 Chapel Place „ S E 1 1 ... ... ... ... 1 ... 3 Chelsea Grove „ „ 2 ... ... ... ... ... ... ... 2 Chepstow Place K T C 1 ... ... ... ... ... ... ... 1 Chepstow Tavern Mews „ C 1 ... ... ... ... ... ... ... 1 Chesterton Road „ N 3 1 2 ... ... ... ... ... 6 Childs Passage B S W ... l ... ... ... ... ... ... 1 Childs Place „ „ 2 3 ... ... ... ... ... ... 5 Church Street K T C 1 ... ... ... ... ... ... ... 1 Clarendon Road „ N E&C 2 ... 1 ... ... ... ... ... 3 Clareville Grove B S E 1 ... ... ... ... ... ... ... 1 Clifton Place „ „ 1 ... ... ... ... ... ... ... 1 Clydesdale Road K T N E ... ... 1 ... ... ... ... ... 1 Codrington Mews ,, „ ... ... ... ... ... ... 1 ... 1 Coleherne Mansions B S W ... 1 ... ... ... ... ... ... 1 Coleherne Road „ „ ... ... ... ... ... ... 1 ... 1 Colville Square K T N E ... 1 ... ... ... ... ... ... 1 Convent Gardens „ „ ... ... 1 ... ... ... 1 ... 2 Cornwall Gardens „ S E 1 ... ... ... ... ... ... ... 1 Cornwall Gardens Stables „ „ ... 2 ... ... ... ... ... ... 2 Cornwall Mews „ „ 1 ... ... ... ... ... ... ... 1 Cornwall Road „ N E 6 4 3 ... ... 1 2 ... 16 Courtfield Gardens B S E 1 ... ... ... ... ... ... ... 1 Courtfield Road „ „ ... 1 ... ... ... ... ... ... 1 Courtland Terrace K T C 1 ... ... ... ... ... ... ... 1 Cranley Gardens B S E ... 1 ... ... ... ... ... ... 1 Cranley Mews „ „ ... 3 ... ... ... ... ... ... 3 Crescent Place „ „ ... 1 ... ... ... ... ... ... 1 Crescent Street K T N W 3 2 1 ... ... ... 1 ... 7 Cromwell Crescent B S W ... 1 ... ... ... ... 1 ... 2 Cromwell Gardens „ S E 3 ... ... ... ... ... ... ... 3 Cromwell Houses „ „ 1 ... ... ... ... ... ... ... 1 Continued. 220 TABLE IXa.—continued Street or Place. Registration Sub-District. Sanitary District. Scarlet Fever. Diphtheria. Enteric Fever. Typhus Fever. Continued Fever. Puerperal Fever. Erysipelas. Croup. Total. Cromwell Mansions „ S W ... 1 ... ... ... ... ... ... 1 Cromwell Road „ S E ... 1 ... ... ... ... 1 ... 2 Dartmoor Street K T C ... 1 ... ... ... ... 1 ... 2 Denbigh Mews „ N E 1 ... ... ... ... ... ... ... 1 Denbigh Road K T „ 1 ... ... ... ... ... ... ... 1 De Vere Mews K T S E 1 ... ... ... ... ... ... ... 1 Drayton Gardens B „ 2 ... ... ... ... ... ... ... 2 Drayton Terrace „ „ ... ... ... ... ... ... 1 ... 1 Duke's Lane K T C 1 ... ... ... ... ... ... ... 1 Earl's Court Gardens B S W 2 ... ... ... ... ... ... ... 2 Earl's Court Road KT&B „ 2 ... 2 ... ... ... 1 ... 5 East Mews Road K T N W 1 ... ... ... ... ... ... ... 1 Edenham Mews „ N 3 ... ... ... ... ... ... ... 3 Edenham Street „ „ 1 ... 1 ... ... ... 2 ... 4 Edinburgh Road „ „ ... ... ... ... ... ... 1 ... 1 Edwardes Terrace K T S W ... 1 ... ... ... ... ... ... 1 Edwardes Square „ „ 2 ... ... ... ... ... ... ... 2 Egerton Crescent B S E 1 ... ... ... ... ... ... ... 1 Egerton Gardens „ „ ... ... ... ... ... ... 1 ... 1 Elgin Crescent K T N E ... 3 1 ... ... ... ... ... 4 Elgin Mews „ „ ... 1 ... ... ... ... ... ... 1 Elm Place B S E ... 1 ... ... ... ... ... ... 1 Elsham Road K T C 1 ... 1 ... ... ... 2 ... 4 Emma Place „ S W 2 ... ... ... ... ... ... ... 2 Emperor's Gate B S E 1 ... ... ... ... ... 1 ... 2 Ensor Mews „ „ ... 1 ... . ... ... ... ... 1 Ernest Street K T C ... ... ... ... ... ... 1 ... 1 Faraday Road K T N 5 1 1 ... ... ... 1 ... 8 Farnell Mews B S W 1 1 ... ... ... ... ... ... 2 Fenelon Road „ „ ... 1 ... ... ... ... 2 ... 3 Finborough Road „ „ 3 ... 1 ... ... ... 1 1 6 Fulham Road „ S E & S W 6 4 ... ... ... ... 1 ... 11 Gledhow Terrace B S E 2 ... ... ... ... ... ... ... 2 Gloucester Grove East „ „ 1 ... ... ... ... ... ... ... 1 Gloucester Road K T „ ... ... 1 ... ... ... ... ... 1 Golborne Gardens „ N 2 1 ... ... ... ... 2 ... 5 Golborne Road „ „ 9 ... 2 ... 1 ... 1 ... 13 Gordon Place „ C 1 ... ... ... ... ... 1 ... 2 Grenfell Road „ N W 1 ... 2 ... ... ... 1 ... 4 Grenville Mews. B S E 1 ... ... ... ... ... ... ... 1 Hans Road B S E 1 ... 1 ... ... ... ... ... 2 Hansard Mews K T C ... ... ... ... ... ... 1 ... 1 Harcourt Terrace B S W 1 ... ... ... ... ... ... ... 1 Harrington Gardens „ S E 1 ... ... ... ... ... ... ... 1 Continued. 221 TABLE IXa.—continued. Street or Place. Registration Sub-District. Sanitary District. Scarlet Fever. Diphtheria. Enteric Fever. Typhus Fever. Continued Fever. Puerperal Fever. Erysipelas. Croup. Total. Harrington Road B S E 1 1 ... ... ... ... ... ... 2 Hayden Place K T N E 1 ... ... ... ... ... ... ... 1 Hazlewood Crescent „ N 10 5 ... ... ... 1 3 ... 19 Heathfield Street „ N E 1 1 ... ... ... ... ... ... 2 Hesper Mews B S W 1 ... ... ... ... ... ... ... 1 Hewer Street K T N 2 ... 2 ... ... ... ... ... 4 High Street, Notting Hill „ C ... ... 1 ... ... ... 1 ... 2 Hogarth Road B S W 1 ... ... ... ... ... ... ... 1 Holland Mews K T C 1 1 ... ... ... ... ... ... 2 Holland Park „ „ ... ... 1 ... ... ... ... ... 1 Holland Park Avenue „ „ 1 1 ... ... ... ... 1 ... 3 Holland Park Mews „ ,, ... 1 ... ... ... ... ... ... 1 Holland Road „ „ 4 1 1 ... ... ... 1 ... 7 Holland Villas Road „ „ 1 ... ... ... ... ... ... ... 1 Hollywood Road B S W 1 ... ... ... ... ... ... ... 1 Hooper's Court „ S E 3 ... ... ... ... ... ... ... 3 Hurstway Street K T N W 1 1 ... ... ... ... ... ... 2 Hyde Park Gate „ S E ... 1 ... ... ... ... ... ... 1 Ifield Road B S W 5 7 ... ... ... ... 1 ... 13 Jameson Street K T C ... ... 1 ... ... ... ... ... 1 Johnson Street „ „ ... 1 ... ... ... ... ... ... 1 Kenley Street K T N W ... ... 1 ... ... ... 4 ... 5 Kensal Road „ N 1 ... ... ... ... ... ... ... 1 Kensington Crescent „ S W ... 1 ... ... ... ... ... ... 1 Kensington High Street „ C, S E& S W 3 1 ... ... ... ... 1 ... 5 Kensington Infirmary „ S W 2 ... 8 1 ... 2 50 ... 63 Kensington Mansions B „ 1 ... ... ... 1 ... 1 ... 3 Kensington Park Gardens K T C ... 1 ... ... ... ... ... ... 1 Kensington Park Road „ N E ... ... 4 ... 2 ... ... ... 6 Kensington Place „ C ... 2 ... ... ... ... 1 ... 3 Kensington Square „ S E 1 1 ... ... ... ... ... ... 2 King Street „ „ ... 1 ... ... ... ... ... ... 1 Kramer Mews B S W 1 ... ... ... ... ... 1 ... 2 Ladbroke Crescent K T N E ... ... ... ... ... ... 1 ... 1 Ladbroke Gardens „ „ 1 ... ... ... ... ... ... ... 1 Ladbroke Grove „ N, N E & C 7 ... ... ... ... ... 1 ... 8 Ladbroke Road „ C 1 ... ... ... ... ... ... ... 1 Ladbroke Square „ „ 2 ... ... ... ... ... ... ... 2 Lancaster Mews „ n e ... ... 1 ... ... ... ... ... 1 Lancaster Road „ N E & N W 3 4 5 ... ... ... 2 ... 14 Langham Mansions B S W ... ... ... ... ... ... 1 ... 1 Lansdowne Road K T N E & C 1 1 ... ... ... ... 1 ... 3 Continued. 222 TABLE IXa.—continued. Street or Place. Registration Sub District Sanitary District. Scarlet Fever. Diphtheria. Enteric Fever. Typhus Fever. Continued Fever. Puerperal Fever. Erysipelas. Croup. Total. Latimer Road K T N W 1 ... ... ... ... ... ... ... 1 Ledbury Road „ N E & C 1 ... ... ... ... ... 3 ... 4 Leinster Yard „ N E ... 1 ... ... ... ... ... ... 1 Lenthall Mews B S E 1 ... ... ... ... ... ... ... 1 Lexham Gardens „ S W ... ... ... ... ... ... 1 ... 1 Lionel Mews K T N ... 1 ... ... ... ... ... ... 1 Lockton Street „ N W ... ... ... ... ... ... 1 ... 1 Longridge Road K S W 2 ... 1 ... ... ... ... ... 3 Long's Terrace K T „ 1 ... ... ... ... ... ... ... 1 Lonsdale Road „ N E 1 2 1 ... ... ... 2 ... 6 Lonsdale Yard „ C ... ... ... ... 1 ... ... ... 1 Lorne Gardens „ „ ... 2 ... ... ... ... 1 ... 3 Mall Chambers K T C 1 ... ... ... ... ... ... ... 1 Manchester Road „ N W 1 1 ... ... ... ... ... ... 2 Manson Mews B S E 1 5 ... ... ... ... ... ... 6 Marloes Road „ S W 1 ... ... ... ... ... ... ... 1 Martin Street K T N W 1 4 ... ... ... ... ... ... 5 Mary Place „ „ ... ... ... ... ... ... 2 ... 2 Maxilla Gardens „ N 4 ... ... ... ... ... ... ... 4 Melbury Road „ C 2 ... ... ... ... ... ... ... 2 Mentone Mansions B s w 1 ... ... ... ... ... ... ... 1 Mersey Street K T N W ... ... ... ... ... ... 1 ... 1 Merton Road „ S E 4 3 ... ... ... ... ... ... 7 Millwood Street „ N ... 1 ... ... ... ... ... ... 1 Moreton Gardens B S E ... ... 1 ... ... ... ... ... 1 Moreton Terrace „ „ ... ... 1 ... ... ... ... ... 1 Munro Mews K T N 1 ... ... ... ... ... ... ... 1 Nevern Road B S W 3 ... ... ... ... ... ... ... 3 Newcombe Street K T C 2 ... ... ... 1 ... ... ... 3 Norland Road „ „ ... ... ... ... ... ... 1 ... 1 Norland Square „ „ 1 ... ... ... ... ... ... ... 1 Norland Stables „ „ 1 ... ... ... ... ... ... ... 1 North Row B s w ... ... ... ... ... ... 1 ... 1 North Terrace „ S E ... ... 1 ... ... ... ... ... 1 Onslow Gardens B S E 2 ... ... ... ... ... ... ... 2 Ovington Square „ „ 1 ... ... ... ... ... ... ... 1 Oxford Gardens K T N 1 ... ... ... ... ... ... ... 1 Palace Gate K T S E 1 ... ... ... ... ... ... ... 1 Park Terrace „ S W 1 ... ... ... ... ... ... ... 1 Peel Street „ C 3 ... ... ... ... ... ... ... 3 Pelham Place B S E 1 ... ... ... ... ... ... ... 1 Pelham Street „ ,, 1 ... ... ... ... ... ... ... 1 Pembridge Place K T C 1 ... ... ... ... ... ... ... 1 Pembridge Road „ „ 1 ... ... ... ... ... ... ... 1 Pembridge Villas „ ,, ... ... 1 ... ... ... ... ... 1 Pembroke Mews „ S W 2 3 ... ... ... ... ... ... 5 Continued. 223 TABLE IXa.—continued. Street or Place. Registration Sub-District. Sanitary District. Scarlet Fever. Diphtheria. Enteric Fever. Typhus Fever. Continued Fever. Puerperal Fever. Erysipelas. Croup. Total. Pembroke Road B S W 1 ... ... ... ... ... ... ... 1 Pembroke Square K T „ ... ... ... ... ... ... 1 ... 1 Penywern Road B „ 1 ... ... ... ... ... ... ... 1 Petersham Mews K T S E 1 1 ... ... ... ... ... ... 2 Philbeach Gardens B S W 2 ... ... ... ... ... ... ... 2 Phillimore Mews K T C ... 1 ... ... ... ... ... ... 1 Phillimore Terrace „ S W 1 ... 1 ... ... ... ... ... 2 Phœnix Place „ C ... 1 ... ... ... ... ... ... 1 Portland Road „ N E & C 3 3 ... ... ... ... 7 ... 13 Portobello Mews „ C ... ... ... ... ... ... 1 ... 1 Portobello Road „ N N E & C 16 4 2 ... ... 2 5 ... 29 Prince's Gate Mews B S E ... ... 1 ... ... ... ... ... 1 Prince's Place K T C 3 2 2 ... 2 ... 1 ... 10 Prince's Road „ „ 2 ... 1 ... 1 1 1 1 7 Prince Teck Buildings B S W 1 ... ... ... ... ... ... ... 1 Providence Terrace „ „ ... 1 ... ... ... ... ... ... 1 Queensberry Mews East B S E 1 ... ... ... ... ... ... ... 1 Queensberry Mews West „ „ ... ... ... ... ... ... 1 ... 1 Queensberry Place „ „ 1 ... ... ... ... ... ... ... 1 Queen's Gate K T „ ... 2 ... ... ... ... ... ... 2 Queen's Gate Gardens B „ ... 1 ... ... ... ... ... ... 1 Queen's Road K T C ... ... ... ... ... 1 1 ... 2 Rackham Street K T N 9 1 1 ... ... ... 2 ... 13 Raddington Road „ „ ... ... ... ... ... ... 1 ... 1 Radley Mews B S W 2 ... ... ... ... ... ... ... 2 Radnor Terrace K T „ ... 1 ... ... ... ... ... ... 1 Redcliffe Gardens B „ ... 1 ... ... ... ... ... ... 1 Redcliffe Road „ „ 1 ... ... ... ... ... 1 ... 2 Redcliffe Square „ „ 2 ... ... ... ... ... ... ... 2 Redfield Lane „ „ 2 3 ... ... ... ... 1 ... 6 Richmond Mansions „ „ ... ... 1 ... ... ... ... ... 1 Richmond Road „ „ 2 3 1 ... ... ... ... ... 6 Rillington Place K T N E ... ... ... ... ... ... 1 ... 1 Royal Crescent „ C ... 3 ... ... ... ... ... ... 3 Royal Crescent Mews „ „ 1 ... ... ... ... ... ... ... 1 Rutland Mews South B S E 1 ... ... ... ... ... ... ... 1 Rutland Street „ „ 1 1 ... ... ... ... ... ... 2 St. Alban's Road K T S E ... ... 1 ... ... ... ... ... 1 St. Ann's Road „ N W & C 3 2 ... ... 1 ... 2 ... 8 St. Ann's Villas „ C ... 1 ... ... ... ... ... ... 1 St. Charles's Square „ N ... ... ... ... ... ... 1 ... 1 St. Ervan's Road „ N 1 2 ... ... ... ... 1 ... 4 St. George's Road „ N E 3 ... ... ... ... ... 1 ... 4 St. Helen's Gardens „ N 1 ... ... ... ... ... ... ... 1 St. James's Place „ C ... 1 1 ... ... ... ... ... 2 St. James's Square „ ,, ... 2 1 ... ... ... ... ... 3 Continued. 224 TABLE IXa.—continued. Street or Place. Registration Sub-District. Sanitary District. Scarlet Fever. Diphtheria. Enteric Fever. Typhus Fever. Continued Fever. Puerperal Fever. Erysipelas. Croup. Total. St. James's Terrace K T C ... 1 ... ... ... ... ... ... 1 St. John's Place „ „ 3 1 ... ... ... ... ... ... 4 St. Katharine's Road „ N W 4 ... 1 ... ... ... 6 ... 11 St. Lawrence Road „ N 2 ... ... ... ... ... ... ... 2 St. Luke's Mews „ N E 1 ... ... ... ... ... ... ... 1 St. Luke's Road „ „ 2 ... ... ... ... ... ... ... 2 St. Mark's Grove B S W 3 ... ... ... ... ... ... ... 3 St. Marylebone Infirmary K T N ... ... 1 ... ... ... 1 ... 2 St. Mary's Road „ N E ... 2 ... ... ... ... ... ... 2 St. Quintin Avenue „ N 2 ... ... ... ... ... ... ... 2 Scarsdale Terrace „ S W 2 ... ... ... ... ... ... ... 2 Scarsdale Villas ,, „ ... ... 1 ... ... ... ... ... 1 Seymour Place B „ 2 8 ... ... ... ... 1 ... 11 Shaftesbury Cottages ,, „ 1 ... ... ... ... ... ... ... 1 Silchester Road K T N W 2 1 ... ... ... ... 1 ... 4 Silchester Terrace „ „ 1 ... 1 ... ... ... ... ... 2 Sirdar Road ,, „ 5 3 1 ... ... ... 1 ... 10 Sloane Street B S E ... ... ... ... ... ... 1 ... 1 Southam Street K T N 7 4 ... ... ... ... 4 ... 15 Southend Gardens „ S E 1 ... ... ... ... ... ... ... 1 Southend Mews „ „ 1 ... ... ... ... ... ... ... 1 South Street, St. Mark's Road B S W ... ... 1 ... ... ... 1 ... 2 Spear Mews „ „ ... 1 ... ... ... ... ... ... 1 Stanford Road k t S E 1 ... ... ... ... ... ... ... 1 Stanhope Gardens B „ ... ... 1 ... ... ... ... ... 1 Stanhope Mews „ „ 1 ... ... ... ... ... ... ... 1 Stoneleigh Street K T N W 2 1 2 ... ... ... ... ... 5 Stratford Road B S W 1 ... ... ... ... ... ... ... 1 Sussex Place „ S E 2 ... ... ... ... ... ... ... 2 Sussex Villas K T „ 1 ... ... ... ... ... ... ... 1 Swinbrook Road „ N 6 2 ... ... ... 1 1 ... 10 Sydney Place B S E ... ... ... ... 1 ... ... ... 1 Tabernacle Terrace K T C ... ... 1 ... ... ... ... ... 1 Talbot Grove „ N E 1 2 ... ... ... ... ... ... 3 Tavistock Crescent „ „ 1 3 2 ... ... ... 2 ... 8 Tavistock Road „ „ 1 3 ... ... ... ... 1 ... 5 Telford Road „ N 2 4 ... ... ... ... ... ... 6 Testerton Street „ N W ... 3 ... ... ... ... ... ... 3 The Grove Boltons B S W ... 1 ... ... ... ... ... ... 1 The Mall K T C ... 1 ... ... ... ... 1 ... 2 The Triangle „ N 2 2 ... ... ... ... ... ... 4 Thistle Grove Lane B S E 1 ... ... ... ... ... ... ... 1 Thorpe Mews K T N 3 ... ... ... ... ... 1 ... 4 Tobin Street „ N W 1 ... 1 ... 1 ... 3 ... 6 Treadgold Street „ „ ... ... 1 ... ... ... ... ... 1 Continued. 225 TABLE IXa—continued. Street or Place. Registration Sub District. Sanitary District. Scarlet Fever. Diphtheria. Enteric Fever. Typhus Fever. Continued Fever. Puerperal Fever. Erysipelas. Croup. Total. Trebovir Road B S W ... 1 ... ... ... ... ... ... 1 Treverton Street K T N 6 3 2 ... ... ... 3 ... 14 Uxbridge Houses K T C 1 2 ... ... ... ... ... ... 2 Uxbridge Street „ „ ... ... . .. ... ... ... ... 1 Victoria Dwellings K T N 3 ... ... ... . ... . ... 3 Victoria Gardens „ C 1 1 ... ... 1 ... ... ... 4 Victoria Road „ S E ... 2 ... ... ... ... 1 ... 3 Wallgrave Road B S W 1 2 .. ... ... ... ... ... 3 Wallgrave Terrace „ „ ... 3 ... ... ... ... ... ... 3 Walmer Road K T N W 5 2 1 ... ... ... 3 1 12 Warwick Gardens KT&B S W 1 ... 1 .. ... ... ... ... 2 Warwick Road „ „ 6 7 ... ... .. ... 1 ... 14 Westbourne Grove „ N E ... 1 ... ... ... ... ... ... 1 West Cromwell Road B S W ... ... ... ... 1 ... ... ... 1 Western Dwellings K T N 1 ... ... ... ... ... ... ... 1 Western Terrace „ N E 1 1 ... ... ... ... 1 ... 3 West Pembroke Place „ S W ... l ... ... ... ... ... ... 1 Wetherby Place B S E ... l ... ... ... ... ... ... 1 Wheatstone Road K T N 6 l ... ... ... ... 3 ... 10 William Street „ C 1 ... ... ... ... ... ... ... 1 Wornington Road „ N 17 6 1 ... ... ... 3 ... 27 Yeoman's Row B S E 3 ... ... ... ... ... ... ... 3 226 TABLE X. Vaccination Officer's Return respecting the Vaccination of Children whose Births were Registered in 1898.* (Vide page 71). 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 places unknown, or which cannot be reached, and cases not having been found. Cases still under Proceedings, by Summons and Otherwise. Insusceptible of Vaccination. Certificate of Conscientious Objection. 1898. 1 2 3 4 5 6 8 10 11 1st January to 31st Dec. Kensington Town 3095 2287 13 44 365 14 361 11 Brompton 556 441 5 11 48 5 46 — Total 3651 2728 18 55 413 19 407 11 * The Return for 1899 will not be due until February, 1901