KEN 8 THE ANNUAL REPORT on the HEALTH, SANITARY CONDITION, etc., etc., of THE ROYAL BOROUGH OF KENSINGTON FOR THE YEAR 1902. BY T. ORME DUDFIELD, M.D., Medical Officer of Health. LONDON: VAIL & Co., PRINTERS, FARRINGDON ROAD, E.C. The Royal Borough of Kensington. REPORT OF THE MEDICAL OFFICER OF HEALTH For the Year 1902. To the Mayor, Aldermen, and Councillors of the Borough Council, Sir, and Gentleman, The vital and mortal statistics in this report, for the period of fifty-three weeks, December 29th, 1901, to January 3rd, 1903, comprised in the registration year 1902, have been corrected so as to be comparable with those of an ordinary year of fifty-two weeks. In the report for the year 1901 detailed particulars with reference to the Census taken in that year were given in a variety of tables—pp. 4-6. The only table thought necessary to be reprinted in the present report is the Summary of the Age and Sex-Distribution of the Population, as follows :— ation at all Ages, March 31st, 1901. 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 107,544 7,092 13,305 24,769 23,482 15,377 10,953 6,985 3,818 1,515 243 5 107,544 Females Males 69,084 7,056 12,595 13,461 11,491 9,440 7,220 4,586 2,306 820 107 2 69,084 Males Excess of Females 38,460 36 710 11,308 11,991 5,937 3,733 2,399 1,512 695 136 3 38,460 Excess of Females Total of both sexes 176,628 14,148 25,900 38,230 34,973 24,817 18,173 11,571 6,124 2,335 350 7 176,628 Total of both sexes Registration District and Sub-Districts.—The "Kensington" Registration District (No. 1 B in the Registrar-General's list) comprises two sub-districts, respectively named Kensington Town (hereinafter for brevity referred to as Town), and Brompton. The Town sub-district comprises all that portion of the Borough north of Kensington High Street and Kensington Road, together with a large area south of that main thoroughfare, the dividing line running, from west to east, along Pembroke-road, 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 (west side). The remainder of the Borough, south of the line, forms the sub-district of Brompton. The Parliamentary Divisions are two in number, North Kensington and South Kensington; High Street, Notting Hill, and Holland Park Avenue forming the line of demarcation. The Wards are nine in number, of which four—Golborne, St. Charles, Norland, and Pembridge, are in (and constitute) the Parliamentary Division of North Kensington; and five— Holland, Earl's-court, Queen's-gate, Brompton, and Redcliffe, are in (and constitute) the Parliamentary Division of South Kensington. 4 Area.—The Borough comprises an area of 2,291.1 statute acres, an addition of 101.1 acres having accrued from the changes in boundaries brought about by the London Government Act, 1899. Of this addition all but 1.8 acres belongs to the Town sub-district, the area of which (including 3.8 acres of inland water) is 1,596.3 acres; the area of Brompton being 694.8 acres. The acreage of the wards is not given in the census report. POPULATION, 1801-1901. The subjoined table exhibits the growth of population during the nineteenth century:— The Year. Population. 1801 8,556 1811 10,886 1821 14,428 1831 20,902 1841 26,834 1851 44,053 1861 70,108 1871 120,299 1881 163,151 1891 170,071 1901 176,628 Rateable Value.—The growth or development of the Borough during the last 79 years is evidenced by the subjoined table, showing the increase in rateable value. The present total is about one-sixteenth of that of the Administrative County of London. Rateable Value of Property. £75,916 1823 93,397 1833 142,772 1843 257,103 1853 444,030 1863 975,046 1873 1,711,495 1883 2,037,221 1893 £2,262,406 (October) 1902 Population, Inhabited Houses, and Rateable Value, 1856-1902.—The following table, brought up to date, exhibits the growth of the borough since the Metropolis Local Management Act came into operation, in 1856:— 1856. 1902. Increase in 46 years. Population 57,000 177,500 120,500 Number of Inhabited Houses 7,600 28,000 15,400 Rateable Value of Property £308,000 £2,262,406 £1,954,406 The increase in all respects within the last thirty-one years, 1871-1902, the period over which my official experience extends, was very considerable, as the subjoined figures show:— 1871. 1902. Increase in 31 years. Population 121,000 177,500 66,500 Number of Inhabited Houses 15,735 23,800 8,065 Rateable Value £935,720 £2,262,406 £1,326,686 The Year. 5 From the foregoing figures we learn that the population in 1902 was more than twenty times as large as in the first year of the nineteenth century, and the rateable value of property nearly thirty times as great as in 1823, the first year in respect to which I possess information. Since 1856, the rateable value has increased more than seven -fold, the increase in the last 31 years being nearly four-fold the total in 1856; since which date the population and the number of inhabited houses have increased more than three-fold. Population and Inhabited Houses in 1902.—The population of the borough estimated to the middle of the year, was 177,500. It comprised approximately 69,425 males and 108,075 females; excess of females 38,650.* In the Town sub-district (estimated population 128,660), the males numbered about 53,715, the females 74,945; excess of females 21,230. In the Brompton sub-district (estimated population 48,840), there were about 15,710 males and 33,130 females; excess of females 17,420. This population of 177,500 persons was in occupation of about 23,000 houses, equal to 7.7 persons to a house. For the purposes of this report, the population of the borough, the sub-districts, the parliamentary divisions, and the wards, will be taken to be as follows:— The Borough 177,500 Sub-districts:— Kensington Town 128,660 Brompton 48,840 Parliamentary Divisions:— North Kensington 91,510 South Kensington 85,990 Wards:- St. Charles 22,060 North Golborne 26,440 Kensington Norland 23,580 Pembridge 19,430 Holland 20,500 Earl's Court 18,140 South Queen's Gate 14,340 Kensington Redcliffe 18,790 Brompton 14,220 MARRIAGES AND MARRIAGE RATE. The marriages in the year were 1,703 compared with 1,693, 1,543, and 1,651, in the three preceding years respectively. Of these marriages there were celebrated— By the Church (69.7 per cent. of total marriages) 1,187 At Roman Catholic places of worship 126 At other Nonconformist places of worship 63 At the Jewish Synagogue 8 At the Superintendent-Registrar's Office 319 The marriage-rate (i.e., the number of persons married to 1,000 living) was 19.2, compared with 19.6, 17.8, and 18.7, in the three preceding years The marriage-rate in England and Wales was 15.8 per 1,000, compared with 16.5, 16.0, and 15.9 in the three preceding years, and an average of 15.6 in the ten years 1892-1901. The rate in London was 17.8 per 1,000, compared with 18.6, 18.0, and 17.6, in the three preceding years. During the ten years, April 1st, 1891, to March 31st, 1901, the inter-censal period, 15,822 marriages were registered in the Borough. Table A, Appendix 11 (page 152), gives the number of marriages and the marriage-rate in the borough for each of the thirty-two years (1871-1902) during my tenure of office. BIRTHS AND BIRTH RATE. The births registered were 3,488, or 3,422 after correction for the 53rd week; viz., males, 1,711 and females 1,711; the numbers being, in the Town sub-district (which includes the Borough Infirmary), 2,900, and in the Brompton sub-district, 522. The births were, after correction, 369 below the corrected decennial average (3,791), 161 of them being of illegitimate children. They were also fewer by 114 than in the year 1901; and fewer by 553 (or 619 after correction) than the number in 1872 (4,041), when the population (127,400) was 50,100 less than in 1902. * In England and Wales in 1901 the proportion of females to males in the population was as 107 to 100; in London as 112 to 100; in Kensington as 156 to 100. 6 The birth-rate, which of late years has been always considerably below that of London, as a whole, has been declining since 1868, in which year it was 331 per 1,000 persons living. In 1902 it was 19.3 per 1,000, and 2.8 below the decennial average (22.1). The rate in the sub-districts was:—Town, 22.5, and Brompton, 10.7 per 1,000. The London birth-rate (28.5 per 1,000) was lower than that recorded in any one of the ten preceding years; the decennial average rate being 30.1 per 1,000. The births in North Kensington, i.e. the part of the borough north of Holland Park Avenue and High Street, Notting Hill, were 2,486, and the birth-rate 26.6 per 1,000 living, being 1.9 below the Metropolitan rate. The births in South Kensington, i.e., the remainder of the borough south of the streets above named, were 1,002, and the birth-rate 11.4, or 17.1 per 1,000 below the Metropolitan rate. The birth-rate in the several wards, after distribution of the births at the borough infirmary but without correction for the 53rd week, was as follows:— St. Charles 624 births, or 27.7 per 1,000 persons living. North Golborne 880 births, or 32.6 per 1,000 persons living. Kensington Norland 608 births, or 25.3 per 1,000 persons living. Pembridge 374 births, or 18.9 per 1,000 persons living. Holland 279 births, or 13.4 per 1,000 persons living. South Earl's Court 226 births, or 12.2 per 1,000 persons living. Kensington Queen's Gate 117 births, or 80 per 1,000 persons living. Redcliffe 238 births, or 12.4 per 1,000 persons living. Brompton 142 births, or 9.8 per 1,000 persons living. The births in the Borough exceeded the deaths by 742,* without correction for the 53rd week. In the Town sub-district the births were 713 more in number than the deaths; in the Brompton sub-district the excess of births was 29 only, without correction for births at the infirmary. In North Kensington the births exceeded the deaths by 718; in South Kensington to the number of 24 only. The excess of births over deaths in the several wards was as follows:— St. Charles 239 Holland 5 North _ Golborne 392 South Queeen's Gate 1 Kensington Norland 45 Kensington Redcliffe 25 Pembridge 42 Brompton 4 718 85 In Earl's Court Ward the deaths exceeded the births by 11. The registered births of illegitimate children in the borough, as a whole, were, as already stated, 161 (3 fewer than in 1901), viz., males 82 and females 79. Of these births, 151 were registered in the Town sub-district, which includes the workhouse, at which institution out of 132 births (males 74, females 58), 91 were illegitimate. In the borough, generally, the illegitimate births formed 4.6 per cent. of total births as compared with rates of 5.3, 5T, and 4.6, in the three preceding years. The subjoined table shows the quarterly number of births of males and females in the borough, and in each of the sub-districts :— Kensington Town. Brompton. The Borough. Males. Females. Total. Males. Females. Total. Total. 1st Quarter 418 405 823 69 76 145 968 2nd „ 361 346 707 56 55 111 818 3rd „ 373 350 723 69 81 150 873 4th „ 333 370 703 64 62 126 829 1,485 1,471 2,956 258 274 532 3,488 Illegitimate 27 26 53 1 3 4 57 Births 12 20 32 — 1 1 33 22 17 39 2 2 4 43 18 9 27 — 1 1 28 79 72 151 3 7 10 161 * In the Metropolis, as a whole, the births exceeded the deaths by 50,270. 7 The subjoined table shows the population, the number of births, and the birth-rate for each of the ten years, 1892-1901. The Year. Population. Total Births. Males. Females. Birth-rate per 1,000. 1892 167,200 3,718 1,867 1,851 22.2 1893 167,900 3,661 1,893 1,768 21.8 1894 168,600 3,665 1,883 1,782 21.7 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 1899 172,400 3,590 1,798 1,792 20.8 1900 173,000 3,586 1,770 1,816 20.7 1901 177,000 3,602 1,840 1,762 20.4 Totals 36,476 18,524 17,952 Average 21.3 Excess of male births in the ten years 572 During the ten years, April 1st, 1891, to March 31st, 1901, the inter-censal period, 36,641 births were registered in the borough. Birth-rate in the Metropolis, and in Kensington, and the Sub-Districts, Parliamentary Divisions, and Wards —during the thirteen four-weekly periods ended January 3rd, 1903, and in the Registration Year, 1902 Four Weeks ended Metropolis. Borough. Sub-Districts. Parliamentary Divisions. Wards. Kensington Town. Brompton. North. South St. Charles. Golborne. Norland. Pembridge. Holland. Earl's Court. Queen's Gate. Redclifife. Brompton. January 25 30.4 22.9 27.5 10.7 34.5 10.4 41.8 37.9 32.5 24.1 12.7 11.5 100 9.0 8.2 February 22 29.8 20.5 24.5 10.1 28.4 12.1 32.4 36.1 24.8 16.7 12.7 9.3 l5.5 10.4 13.7 March 22 29.6 22.7 25.9 14.4 30.5 14.4 34.2 37.8 26.5 21.4 13.3 13.6 10.9 26.3 4.6 April 19 28.9 20.0 23.3 11.2 28.1 11.3 33.0 34 4 25.9 16.7 13.3 12.2 4.5 12.5 12.8 May 17 28.3 19.0 22.9 8.5 26.1 11.3 22.4 30.0 28.1 22.7 15.2 12.9 9.1 8.3 10.1 June 14 26.9 16.6 20.3 6.9 24.3 8.5 29.5 25.6 23.7 17.4 12.7 12.2 5.4 5.5 4.6 July 12 27.2 19.3 21.6 13.0 24.7 13.5 24.2 31 9 20.4 20.0 13.3 12.2 10.9 16.6 13.7 August 9 27.9 20.0 22.1 14.4 26.3 13.3 24.8 32.9 24.3 21.4 15.2 17.9 5.4 13.1 12.8 September 6 29.9 20.4 23.7 11.7 26.9 13.3 22.9 40.3 25.9 14.7 18.4 12.9 6.3 13.8 12.8 October 4 27.7 17.1 19.9 9.6 23.1 10.6 21.8 29.5 23.7 15.4 10.1 11.5 9.1 13.1 8.2 November 1 28.9 17.6 20.7 9.3 23.9 10.9 23.6 27.5 25.9 16.7 13.9 14.3 7.2 10.4 7.4 ,, 29 28 7 18.2 21.2 10.4 26.8 9.1 25.3 31.9 26.9 21.4 7.0 8.6 6.3 13.8 9.1 January 3rd, 1903 (5 weeks) 26.2 17.1 20.0 9.0 23.6 10.1 25.3 28.5 20.9 17.4 15.2 10.0 3.6 9.7 10.0 Birth.rate for the year 1902 28.5 19.3 22.5 10.7 26.6 11.4 27.7 32.6 25.3 18.9 13.4 12.2 8.0 12.4 0.8 Table A, Appendix II. (page 152) gives the number of births and the birth-rate for each of the forty-seven years, 1856.1902. DEATHS AND DEATH-RATE. The deaths registered, inclusive of 315 deaths of parishioners at outlying public institutions, &c., but exclusive of deaths of non-parishioners at public institutions, &c., within the borough, were 2,746 (males 1,374, females 1,372), or 2,694 after correction; and 204 (after correction) below the corrected decennial average (2,898). Of these deaths 2,243 were registered in the Town sub-district and 503 in Brompton. 8 The death-rate, which in the three preceding years had been 17.5, 15.6, and 15.0, per 1,000 respectively, was 15.2 in 1902* and 1.1 below the decennial average (16.3), and 2.5 below the rate in the Metropolis as a whole (17.7) the decennial average for the Metropolis being 19.2. The rate in the sub-districts was: Town 17.1, Brompton 10.1 per 1,000, as compared with 17.1 and 9.4 respectively, in 1901. The deaths in North Kensington were 1,768, and the death-rate 19.0 per 1,000. The deaths in South Kensington were 978, and the death-rate 11.2 per 1,000. The sex death-rate (whole borough) was : males 19.8, females 12.7 per 1,000. Localised Death-rates.— During some years past the death-rate of localised portions of the parish, including the sanitary districts, has been given in these reports. The rate, as regards the sub-districts and parliamentary divisions, was calculated on the basis of the population of those areas enumerated at quinquennial census periods, corrected yearly for increase, and was closely approximate to the crude rate. But as regards the sanitary districts, only an estimated population and an estimated rate could be given; the continuity of the statistics, moreover, was always liable to be disturbed upon any change in the number of the said districts: four changes were made within a few years. Having, in 1901, received from the Registrar-General a statement of the population of the nine wards comprised in the borough, and regard being had to the improbability of any change in the number, and to the fact that the population of the wards will be ascertainable at five-yearly intervals, it was thought that the value of these localised statistics would be enhanced by adopting the ward, in place of the sanitary district, as the unit tor the calculation of the deathrate, and this was done. The ward-rate for the year 1902 is set out below; the rate for each of the thirteen four-weekly periods in the table at page 12. The ward-rate:— St. Charles 385 deaths, or 17.1 per 1,000 persons living. North Golborne 488 deaths, or 18.1 per 1,000 persons living. Kensington Norland 563 deaths, or 23.4 per 1,000 persons living. Pembridge 332 deaths, or 16.8 per 1,000 persons living. Holland 274 deaths, or 13.1 per 1,000 persons living. Earl's Court 237 deaths, or 12.8 per 1,000 persons living. South Queen's Gate 116 deaths, or 7.9 per 1,000 persons living. Kensington Redcliffe 213 deaths, or 11.1 per 1,000 persons living. Brompton 138 deaths, or 9.5 per 1,000 persons living. The Corrected or True Death-Rate in 1902.—The death rate, 15.2 per 1,000, as calculated above, is a crude or uncorrected one, not taking cognizance of the relative numbers of the sexes, nor of the age-distribution 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 the borough 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. That excess in 1902 was approximately 38,650. The deaths among the 69,425 males (1,374) were practically the same as the number among the 108,075 females (1,372.) The crude death-rate in the male sex was 19.8, as compared with the rate of 12.7 in the female sex. It is obvious, therefore, that if the numbers of the sexes had been equal the death-rate would have been higher than the recorded rate. The Registrar-General, some years since, gave the " factor for correction for sex and age-distribution" in the thirty-three great towns of England and Wales; and the Medical Officer of Health of the London County Council, in his annual report for 1901, gives the corresponding factor for each of the Metropolitan Boroughs. Corrected after the manner indicated, the death-rate of Kensington in 1902 becomes, instead of 15.2, one of about 16.2 per 1,000; and the rate for London, as a whole, about 18.6, instead of 17.7. The "true" death-rate is that which shows the mortality per 1,000 living of each sex at different age-periods, and this is shown for the borough in the following table:— * This is the crude death-rate. The rate corrected for age and sex-distribution was 16.2. per 1,000. The corrected or " true" death-rate is set out in the table at page 9. † "The standard death-rate signifies the death-rate at all ages, calculated on the hypothesis that the rates for each sex at each of twelve age-periods in each town were the same as in England and Wales, during the 10 years 1891-1900, the death-rate at all ages in England and Wales during that period having been 18.21 per 1,000." (Registrar-General's Annual Summary.) 9 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 14,218 7,090 7,128 805 444 36150.7 62.6 50.6 Five and under 15 26,025 12,656 13,369 73 42 31 2 .8 3.3 2.3 2.3 Fifteen and under 25 38,418 13,527 24,891 95 47 48 2.5 3.5 1.9 Twenty-five and under 35 35,146 11,547 23,599 149 78 71 4.2 6.8 3.0 Thirty-five and under 45 24,939 9,487 15,452 229 119 110 9.2 12.5 7.1 Forty-five and under 55 18,262 7,255 11,007 292 155 137 16.0 21.4 12.4 Fifty-five and under 65 11,627 4,607 7,020 365 171 194 31.4 37.1 27.6 Sixty-five and under 75 6,154 2,317 3,837 351 163 188 57.0 70.3 49.0 Seventy-five and upwards 2,711 939 1,772 387 155 232 142.7 165.1 130.9 Totals 177,500 69,425 108,075 2,746 1,374 1,372 ... The subjoined table shows the quarterly number of deaths of males and females in the borough, and in each of the sub-districts :— Kensington Town. Brompton. The Borough. Males. Females. Total. Males. Females. Total. Total. 1st Quarter 325 360 685 74 81 155 840 2nd „ 278 235 513 65 61 126 639 3rd „ 261 208 469 43 43 86 555 4th „ 274 302 576 54 82 136 712 1,138 1,105 2,243 236 267 503 2,746 The Births were, of Males 1,743 The Deaths were, of Males 1,374 „ Females 1,745 „ Females 1,372 Total Births (corrected) 3,422 Total Deaths (corrected) 2,694 Deduct 2,694 Deaths Shows 728 (corrected) excess of Births over Deaths. During the ten years April 1st, 1891, to March 31st, 1901, the inter-censal period, 31,794 deaths were registered in the borough. Table A, Appendix II. (page 152) gives the number of deaths and the death-rate for each of the forty-seven years 1856-1902. 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 642, 641, and 581, respectively, were 515, or 505 after correction, in 1902, being equivalent to 148 per 1,000 births, or 13 fewer than in 1901. The rate in the Metropolis, always below that of Kensington, was 141 in each 1,000 births, as compared with an average proportion of 159 per 1,000 in the ten preceding years. The lowest rates in Metropolitan Boroughs were, Hampstead 87, St. Marylebone 107, Stoke Newington 115 and Hackney 119; the highest, Finsbury, and Poplar 154, Bermondsey and Bethnal Green 155, Southwark 166 and Shoreditch 174. 10 In England and Wales the rate was 133, which is 21 per 1,000 below the mean proportion in the ten years 1892-1901. In the 76 great towns of England and Wales the rate averaged 145, ranging from 84 at Hornsey and 105 at Coventry, to 185 at Merthyr-Tydfil and 189 at Preston; in 103 smaller towns it was 135. The rate in England and Wales less the 179 towns, was 119 per 1,000. In the Town sub-district the deaths under one year (449) were equivalent to 152 per 1,000 births, those in Brompton (66) to 124 per 1,000. The infantile deaths in North Kensington, after distribution of the deaths at the Borough Infirmary, were 386, or 155 per 1,000; the deaths in South Kensington 129, or 129 per 1,000. In the several wards the rate was as follows:— North Kensington St. Charles 88 deaths, or 140 per 1,000 registered births. Golborne 119 deaths, or 136 per 1,000 registered births. Norland 122 deaths, or 201 per 1,000 registered births. Pembridge 57 deaths, or 153 per 1,000 registered births. South Kensington Holland 35 deaths, or 124 per 1,000 registered births. Earl's Court 28 deaths, or 126 per 1,000 registered births. Queen's Gate 17 deaths, or 148 per 1,000 registered births. Redcliffe 26 deaths, or 111 per 1,000 registered births. Brompton 23 deaths, or 165 per 1,000 registered births. Table A, Appendix II. (page 152) gives the number of deaths under one year, and the rate per 1,000 of births registered (the "infantile mortality"), for each of the thirty-two years, 1871-1902, during my tenure of office. The deaths of children over one year and under five years of age were 290; the total deaths under five years, therefore, were 805 (or after-correction 790), compared with 932, 877, and 876, in the three preceding years, being equal to 231 per 1,000 births ; the relative proportion in London, as a whole, being 231. The deaths of illegitimate children under five years of age, 103, 86, and 96, in the three preceding years respectively, were 67 in 1902, of which 63 were registered in the Town sub-district, and 4 in Brompton. These deaths were equal to 41.6 per cent. on the 161 births registered as illegitimate. Of the 67 children 16 only survived the first year of life. Senile Mortality.—At sixty years of age and upwards there were 956 (or, after correction 938) deaths, as compared with 943, 868, and 800, in the three preceding years respectively. These deaths were equivalent to 348 per 1,000 deaths at all ages. The relative proportion in all London was 273 per 1,000. District Rates of Mortality.—The table at page 12 shows (inter alia) the death-rate in the sub-districts, the parliamentary divisions, and the wards 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 (17.1 per 1,000) than in the Brompton sub-district (10.1), and the same observation applies to the parliamentary division of North Kensington (19.0), compared with the southern division of the borough (11.2). In each of the wards in North Kensington, viz., Pembridge (16.8), St. Charles (17.1), Golborne (18.1), and Norland (23.4), the death-rate exceeded that of the borough as a whole (15.2 per 1,000). The rate in each of the wards in South Kensington was more or less largely below the rate for the borough as a whole. In the Nottingdale special area (estimated population 4,000) the death-rate was 45.5 per 1,000, compared with 23.4 in the Norland Ward, as a whole. The zymotic death-rate was 3.5 per 1,000 persons living, more than double that of the borough as a whole. The deaths at all ages were 87 more than the births; the deaths of children under one year of age being in the proportion of 427 per 1,000 on the births registered. The main facts with respect to vital and mortal statistics in this distressful area, in 1902, are summarised on the following page. 11 " NOTTING-DALE " SPECIAL AREA. VITAL AND MORTAL STATISTICS, 1902. (The corresponding statistics for the six preceding years are added for comparison.) 1902. 1901 * 1900. 1899. 1898. 1897. 1896. Population (Estimated) 4,000 4,000 4,000 4,000 4,000 4,000 4,000 Births 98 112 113 120 117 130 118 Birth-rate 24.0 28.0 28.2 30.0 29.3 32.5 29.5 per 1,000 persons living. Deaths 185 194 163 236 182 223 187 Death-rate 45.5 48.5 40.7 59.0 45.5 55.7 46.8 per 1,000 persons living. Infantile Mortality. Deaths under one year of age 41 46 54 61 49 56 51 Death-rate 427 411 478 508 419 431 432 per 1,000 births registered. Zymotic Diseases. Deaths from the Seven Principal 14 37 18 12 22 25 30 Death-rate from ditto 35 9.2 4.5 3.0 5.5 6.3 7.5 per 1,000 persons living. Causes of Death.—In 5 cases Diarrhœa; in 3 cases Measles; in 2 cases each, Whooping-cough and Small-pox; and in one case each, Diphtheria and Dysentery. Among the other principal causes of death were—diseases of the nervous system, 15 deaths; diseases of the respiratory system, 56 deaths; diseases of the circulatory system, 10 deaths; other visceral diseases, 24 deaths; tubercular diseases, 26 deaths (including 21 from consumption); wasting diseases of infants, 7 deaths; cancer, 4 deaths; syphilis, 6 deaths; and violence, 4 deaths, including 2 of infants from suffocation. Five deaths of infants prematurely born were registered, and 4 deaths from old age. Inquests were held in 11 cases. The annual death-rate per 1,000 persons living, in thirteen successive four-weekly periods, was:— (1) 35.7 (2) 48.7 (3) 87.7 (4) 35.7 (5) 61.7 (6) 58.5 (7) 29.2 (8) 29.2 (9) 35.7 (10) 42.2 (11) 39.0 (12) 39.0 (13) 45.5 Seventy of the deaths occurred at the homes of the deceased persons, 102 at the Borough Infirmary (about a fifth of the total deaths at this Institution—528), and 13 at other Public Institutions; 37 of the deaths were of persons who had previously resided at common lodginghouses in the Area; but only one of these deaths took place at a common lodging-house. The deaths comprised 90 of males and 95 of females. The ages at death were; under five years of age, 64 (including 41 under one year); between 5 and 20 years, 4 deaths ; between 20 and 60 years, 72 deaths ; at 60 years and upwards, 45 deaths. The deaths were connected with streets as follows: Bangor Street, 48 deaths; Crescent Street, 32 deaths; St. Katharine's Road, 59 deaths; Kenley Street, 19 deaths; Sirdar Road, 27 deaths. The population in the several streets, as enumerated in 1901, was, Bangor Street, 869; Crescent Street, 678; St. Katharine's Road, 1,412; Kenley Street, 490; Sirdar Road (Nos. 1 to 33 and Nos. 2 to 56), 526. The population of the 23 common lodging houses was 538, viz., in ten houses in Bangor Street, 198 (males, 129; females, 69); in eight houses in Crescent Street, 233 (males, 130; females, 103); and in five houses in Sirdar Road, 107 (males, 51; females, 56). The enumerated population in 1901 was 3,975. 12 Death-rate in the Metropolis, and in Kensington, and the Sub-Districts, Parliamentary Divisions and Wards, during the thirteen four-weekly periods ended January 3rd, 1903, and in the Registration Year, 1902. Four Weeks ended Metropolis. Borough. Sub-Districts. Parliamentary Divisions. Wards. Kensington Town. Brompton. North. South. St. Charles. Golborne. Norland. Pembridge. Holland. Earl's Court. Queen's Gate. Redcliffe. Brompton. January 25 18.8 15.0 17.4 8.8 18.9 10.9 17.1 15.2 23.7 20.1 13.3 14.3 7.2 9.0 9.1 February 22 24.1 21.5 23.3 16.8 25.7 17.1 27.1 24.6 30.3 20.1 14.6 20.1 12.7 22.8 13.7 March 22 23.4 21.3 23.9 14.4 25.9 16.5 24.8 24.6 29.2 24.7 20.3 17.9 10.9 18.7 11.9 April 19 17.9 13.8 15.5 9.3 15.9 11.5 17.1 13.8 17.6 15.4 14.6 10.7 8.2 8.3 15.5 May 17 16.5 15.5 17.3 10.9 19.5 11.3 16.5 16.7 29.8 14.1 12.0 15.0 10.0 9.7 9.1 June 14 15.5 14.6 17.3 7.7 19.0 10.0 18.3 16.2 25.9 15.4 15.2 9.3 9.1 10.4 3.7 July 12 14.6 12.5 13.0 11.2 14.8 10.1 14.1 12.8 15.9 16.7 7.0 14.3 7.3 9.7 12.8 August 9 13.8 11.6 12.3 9.6 14.5 8.5 13.6 11.3 20.9 12.0 8.2 9.3 1.8 10.4 11.9 September 6 15.7 13.2 16.2 5.3 18.2 7.9 17.7 16.7 25.4 12.0 13.3 7.9 4.5 6.9 4.6 October 4 16.7 13.0 15.4 6.4 18.3 7.2 15.9 20.1 19.8 16.7 9.5 6.4 4.5 7.6 7.3 November 1 16.8 13.5 15.2 9.0 16.1 10.7 11.2 20.6 18.2 12.7 14.6 12.2 8.2 10.4 6.4 ,, 29 17.9 15.2 16.8 11.2 19.5 10.7 16.5 21.6 20.4 18.7 11.4 15.0 6.3 10.4 9.1 January 3rd, 1903 (5 weeks) 18.7 16.3 18.5 10.9 20.0 12.4 13.6 20.7 26.5 18.7 15.9 13.6 11.8 11.1 8.2 Death-rate for the year 1902 17.2 15.2 17.1 10.1 18.9 11.1 17.1 18.1 23.4 16.8 13.1 12.8 7.9 11.1 9.5 SUMMARY OF VITAL AND MORTAL STATISTICS, KENSINGTON. In the table at page 13 the principal vital and mortal statistics of the year have been arranged in 13 four-weekly periods corresponding to the dates of the monthly reports, the maxima and minima being indicated by distinctive type. The birth-rate, as already stated, was 19.3 per 1,000, and 2.8 below the decennial average (22.1); the death-rate, 15.2 per 1,000, and 1.1 below the decennial average (16.3). There were, as usual, considerable fluctuations in the death-rate at different periods of the year; the rate ranging between the minimum (11.6) in the eighth four-weekly period ended August 9th, and the maximum (21.5) in the second period ended February 22nd. The rate was in eight of the periods below, and in four above, the average for the year—which was also the rate in the twelfth period. The deaths in the first half of the year (1,479) were 212 more than those in the second half (1,267), the death-rate in the two half-periods being 16.7 and 14.3 per 1,000 respectively. The deaths from the principal diseases of the zymotic class were 263; 57 fewer than in 1901, and 82 below the corrected average; 141 of them occurred in the first half of the year, 122 in the second. Measles was the prevailing disease in the first half, the deaths numbering 85 out of a total of 93 in the year. Of the 19 deaths from enteric fever, 14 occurred in the second half of the year. All of the eleven deaths from small-pox occurred during the first half, and 69 of the 78 deaths from diarrhœa in the second half. The deaths from diseases of the respiratory organs. 614 (or 602 after correction), were 91 more than 1901. Diseases of the heart were the causes of 243 deaths (238 after correction); those from phthisis 225 (221 after correction), and those from tubercular diseases in children under five years of age, 54. The mean temperature of the air at Greenwich during the year was 48.8° Fahr. (and 1.5 below the means in the ten preceding years—50.3); the means of the four quarters successively being 40.5, 50.5, 59.1, and 45.4. 13 Summary of the Vital and Mortal Statistics of the Royal Borough of Kensington, 1902. g 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 Disease Mean Temperature. Kensington. London. 1902. Decennial Average. 1902. Decennial Average. 0—1 1—6 60 and upwards. Totals. Small-pox. Measles. Scarlet Fever. Diphtheria. Whooping- Cough. Enteric Fever. Typhus Fever. Simple continued Fever. Diarrhœa. Totals. Bronchitis. Pneumonia. January 25 *312 205 15.0 21.1 18.8 23.7 41 27 70 21 1 12 4 3 ... 1 ... ... ... 48 27 15 13 19 6 43.8 February 22 280 294 21.5 18.3 24.1 211 45 38 114 33 1 26 1 2 1 1 ... ... 1 97 69 19 22 24 6 33.6 March 22 310 291 21.3 19.3 23.4 21.8 41 36 110 26 3 19 4 ... ... ... ... ... ... 97 73 18 19 17 7 44.2 April 19 273 188 13.8 17.2 17.9 19.6 29 25 69 21 3 10 1 4 2 ... ... ... 1 46 27 13 11 14 4 45.0 May 17 259 212 15.5 15.4 16.5 17.5 37 22 74 17 1 8 4 ... 1 1 ... ... 2 47 21 19 19 20 8 46.5 June 14 †227 200 14.6 14.1 15.5 14.1 33 20 66 15 1 5 ... ... 4 1 ... ... 4 33 13 17 18 19 5 53.8 July 12 263 171 12.5 14.0 14.6 16.5 31 17 75 17 1 7 ... 1 1 2 ... ... 5 21 12 7 8 17 2 61.2 August 9 273 158 11.6 16.8 13.8 20.4 34 17 41 19 ... 3 ... 1 2 3 ... ... 10 27 13 11 14 18 3 59.6 September 6 278 180 13.2 14.2 15.7 19.0 50 25 55 30 ... 2 1 1 3 1 ... ... 22 18 5 12 18 18 1 60.1 October 4 233 177 13.0 13.4 16.7 16.7 56 15 41 28 ... ... 2 5 ... 2 ... ... 19 22 8 10 14 10 2 53.6 November 1 240 184 13.5 14.9 16.8 17.5 40 17 54 18 ... ... 2 ... 2 4 ... ... 10 32 16 15 23 13 5 50.1 „ 29 249 207 15.2 16.0 17.9 19.0 43 14 73 5 ... ... ... ... 2 ... ... ... 3 48 23 21 20 26 3 44.6 Jauuary 3, 1903 (Five weeks) 291 279 16 3 18 2 18.7 20.5 35 17 114 13 ... 1 2 3 3 3 ... ... 1 78 42 31 26 28 2 41.6 Totals 3,488 2,746 15.2 16.9 17.2 19.0 515 290 956 263 11 93 21 20 21 19 ... ... 78 614 349 208 225 243 54 48.8 * Maximum number during the year, and so throughout the table. † Minimum number during the year, and so throughout the table. 14 DEATH-RATE IN ENGLAND AND WALES, AND IN LONDON, AND IN OTHER LARGE TOWNS, ETC. The death-rate in England and Wales in 1902 was 16.3 per 1,000, the lowest rate on record, and 1.6 below the average rate in the ten years, 1892-1901. The rate in London, as already stated, was 17.7 per 1,000, being 1.5 below the decennial average. 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:— 1902. 1901. 1900. 1899. 1898. 1897. 1896. 1895. 1894. 1893. 1892. Kensington 15.2 15.0 15.6 17.5 16.3 15.6 16.7 16.4 15.7 17.5 17.2 London 17.7 17.6 18.8 19.8 18.7 18.2 18.6 19.8 17.8 21.3 20.6 W. Districts 16.7 15.7 17.6 19.0 17.0 16.1 17.6 18.5 17.1 19.7 20.0 North „ 16.1 15.9 16.9 18.1 16.9 16.6 17.1 18.2 16.3 20.2 19.4 Central ,, 21.2 20.8 21.5 22.5 22.1 21.8 21.2 23.8 20.0 25.7 23.9 East „ 20.0 20.7 22.1 23.0 21.7 21.2 21.3 23.4 20.8 24.9 23.5 South „ 16.1 16.6 17.7 18.5 17.7 17.2 17.5 18.3 16.2 19.5 19.0 England and Wales 16.3 16.9 18.2 18.2 17.5 17.4 17.0 18.7 16.5 19.1 19.0 Greater London.— The death-rate in "Greater London," which is co-extensive with the Metropolitan and City Police districts, the population at the middle of the year 1902, numbering 6,705,770 (viz., 4,579,110 in Inner or Registration London, and 2,126,660 in the Outer Ring), was 16.4 per 1,000, as compared with 18.5, 17.7, and 16.3, in the three preceding years respectively. The deaths properly belonging to the Outer Ring, as distinguished from Inner or Registration London, were equivalent to a rate of only 13.4, the rate in the Inner Ring having been 17.7. The death-rate from the principal diseases of the zymotic class in Inner London, was 2.23 per 1,000; in the Outer Ring 1.83, the rate in Greater London, as a whole, being 2.11 per 1,000 The infantile mortality of Greater London was 135 per 1,000 births; of Inner London 141; of Outer London 123. Other Large Towns.—The death-rate in the seventy-six large towns, including London, and having a population of 14,862,878 was 17.4 per 1,000; ranging from 8.6 at Hornsey, 10.9 at Handsworth, and 11.5 at Walthamstow, to 20.6 at Wigan, 22.5 at Liverpool, and 23.1 at Merthyr Tydfil. The death-rates of Edinburgh, Glasgow, and Dublin were 17.8, 20.1, and 24.2 per 1,000 respectively. These death-rates are calculated without correction for differences between one town and another, with regard to the age and sex-distribution of their respective populations. This explanation is necessary because, as the Registrar-General has pointed 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 comparison." 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 of some of the principal Indian and foreign cities was as follows— Indian cities: Calcutta, 37.2 per 1,000; Madras, 42.1; and Bombay, 62.2. European cities: Paris, 18.4 per 1,000; St. Petersburg, 23.0; Moscow, 26.5; and Vienna, 19.4. American cities: New York, 18.7 per 1,000; Boston, 18.7; Philadelphia, 17.7; and New Orleans, 21.5. ASSIGNED CAUSES OF DEATH. In the annual report for 1873 (page 10) the following passage occurs:— "New Forms for Recording Vital and Mortal Statistics.— The tables in the Appendix, numbered I. to VI., inclusive, have been drawn up by the Society of Medical Officers of Health for general use throughout the country, and with a view to facilitate comparison between different districts, and with standard areas. The want of uniformity in statistical returns of the medical reports had long been felt; I was induced, therefore, to bring the subject before the Society, which, after a most careful consideration, and having obtained the views of a great many officers of health, settled these forms, which it is hoped will supply all the information that is absolutely requisite without imposing an undue amount of work on those who may use them. Should the tables come into general use they cannot fail to invest the vital statistics in the reports of medical officers with a much greater and more universal interest than heretofore." Tables similar to those referred to as being numbered I. to VI., had previously been employed in these annual reports, and the Tables I. to VI. were used from 1873, onwards, to 1899, inclusive, in the tabulation of vital, mortal, and sanitary statistics. These tables, between 1894 and 1899, were suplemented by others ("A" and "B"), directed by the Local Government Board to be used, so as to secure a "tabular statement of mortality, and a tabular statement of infectious disease in all districts on a uniform plan." Tables A and B have now been superseded by Tables, numbered I. to IV., directed by the Board to be used. The other tables used in preceding annual reports, now numbered from VI. to XII., will be found in Appendix I., pp. 130—142. 15 NEW LIST OF CAUSES OF DEATH. The Registrar-General issued, in 1902, a "New List of Causes of Death" as used in the Annual Reports for England and Wales, together with "Suggestions to Medical Practitioners respecting Certificates of Causes of Death," in which it is stated to be "highly desirable that Medical Practitioners should use only those terms which are recognised by the Royal College of Physicians of London."* This List will henceforth take the place of that used in these reports for many years in the form of Table III., and since 1900 as Table VIII. It comprises the "General Diseases," i.e., those in which the whole body may be said to suffer, and the "Local Diseases," of various systems and organs, set out in Table VIII. at page 132. The first twenty diseases are those formerly described as "Specific, Febrile or Zymotic Diseases;" chief among them being the nine "Principal Zymotic diseases;" three of which were formerly associated under the generic name "Fever," which comprises three distinct diseases, viz.: Typhus-fever, Enteric-fever, and Simple continued fever. TABLE I. (Required by the Local Government Board to be used in the Annual Report of the Medical Officer of Health.) For Whole District. Year. Population estimated to Middle of each Year. Births. Deaths under One Year of Age. Deaths at all Ages. Total. Deaths in Public Institutions. Deaths of Nonresidents registered in District. Deaths of Residents registered beyond District. Deaths Ages. at all Nett. Number. Rate.† Number. Rate per 1,000 Births registered Number. Rate.† Number. Rate.† 1 2 3 4 5 6 7 8 9 10 11 12 13 1892 167,200 3,718 22.2 587 158 3,272 19.6 1,055 626 236 2,882 17.2 1893 167,900 3,661 21.8 625 170 3,225 19.2 1,042 621 312 2,916 17 4 1894 168,600 3,665 21.7 636 174 2,983 17.7 1,070 643 283 2,623 15.6 1895 169,300 3,621 21.4 624 172 3,065 18.1 1,062 625 308 2,748 16.2 1896 170,000 3,717 21.4 656 176 3,158 18.6 1,065 620 353 2,891 16.7 1897 170,700 3,683 21.6 609 165 3,025 17.7 1,164 691 333 2,667 15.6 1898 172,000 3,633 21.1 655 180 3,151 18.3 1,123 639 286 2,798 16.3 1899 172,400 3,590 20.8 642 179 3,422 19.8 1,320 722 321 3,021 17.5 1900 173,000 3,586 20.7 641 179 3,087 17.7 1,132 672 283 2,698 15.6 1901 177,000 3,602 20.4 581 161 2,964 16.7 1,108 635 321 2,650 15.0 Averages for years 1892-1901 170,810 3,647 21.3 625 171 3,135 18.3 1,114 649 303 2,789 16,3 1902 177,500 3,488 19.3 515 148 3,112 17.2 1,182 681 315 2,746 15,2 Note. The deaths included in columns 7 and 9 of this Table are all those registered during the year within the Borough. The Deaths included in column 12 are the number in column 7 corrected by the subtraction of the number in column 10, and the addition of the number in column 11 term "non-residents" in column 10, means persons brought into the Borough or account of illness and dying there. The term "residents" in column 11, means persons taken out of the Borough on account of illness and dying thereout. Area of Borough in acres 2,291 Total population at all ages 177,500 No. (approximate) of inhabited houses 23,000 Average number of persons per house 7.7 . * The Registrar-General placed at my disposal a sufficient number of copies of the New List to enable me to forward on to each registered medical practitioner in the borough, which was done in October. † Rates calculated per 1,000 of estimated population. 16 TABLE II. (Required by the Local Government Board to be used in the Annual Report of the Medical Officer of Health.) Names of Localities. Kensington. Kensington Town. Brompton. Year. Population estimated to middle of each year. Births registered. Deaths at all ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all ages. Deaths under 1 year. 1892 167,200 3,718 2,882 587 119,600 3,071 2,254 508 47,600 647 628 79 1893 167,900 3,661 2,916 625 120,160 2,993 2,305 541 47,740 668 611 84 1894 168,600 3,665 2,623 636 120,720 3,055 2,091 552 47,880 610 532 84 1895 169,300 3,621 2,748 624 121,280 3,052 2,231 552 48,020 569 517 72 1896 170,000 3,717 2,891 656 121,840 3,101 2,344 578 48,160 616 547 78 1897 170,700 3,683 2,667 609 122,400 3,133 2,169 531 48,300 550 498 78 1898 172,000 3,633 2,798 655 123,600 3,078 2,302 593 48,400 555 496 62 1899 172,400 3,590 3,021 642 123,900 3,046 2,455 574 48,500 544 566 68 1900 173,000 3,586 2,698 641 124,300 3,021 2,193 581 48,700 565 505 60 1901 177,000 3,602 2,650 581 128,300 3,046 2,192 506 48,700 556 458 75 Averages of years 1892-1901 170,810 3,647 2,789 625 122,610 3,059 2,253 551 48,200 588 536 74 1902 177,500 3,488 2,746 515 128,660 2,956 2,243 449 48,840 532 503 66 Note.—The deaths of residents occurring without the Borough are included in this table, and the deaths of non-residents in the Borough are excluded. (See note on Table I. for the meaning of the terms "resident" and "non-resident"). Deaths of residents occurring in public institutions are allotted to the respective sub-districts (Kensington Town and Brompton) according to the previous addresses of the deceased. TABLE IV. (Required by the Local Government Board to be used in the Annual Report of the Medical Officer of Health.) Causes of, and Ages at, Death during the Year 1902. Causes of Death. Deaths in whole District at subjoined ages. Deaths in Localities (at all ages). Deaths in Public Institutio n s All Ages. Under 1 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 65 65 and upwards Kensington Town- Brompton. Small-pox 11 1 ... ... 4 6 ... 10 l 10 Measles 93 20 69 4 ... ... ... 85 8 9 Scarlet Fever 21 1 16 4 ... ... ... 19 2 19 Whooping Cough 21 9 11 1 ... ... ... 16 5 3 Diphtheria, Membranous Croup 20 1 13 3 2 1 ... 17 3 14 Croup ... ... ... ... ... ... ... ... ... ... Fever Typhus ... ... ... ... ... Enteric 19 ... 1 5 4 8 l 18 1 11 Other continued ... ... ... ... ... ... ... ... ... ... Epidemic Influenza 68 1 2 ... 3 35 27 47 21 2 Cholera ... ... ... ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... ... Diarrhœa 78 58 13 ... ... 3 4 74 4 11 Enteritis 35 24 4 ... 1 2 4 31 4 5 Puerperal Fever 5 ... ... ... 2 3 ... 4 1 2 Erysipelas 6 ... 1 ... 3 2 ... 6 ... 3 Other septic diseases 8 ... 1 ... 1 5 1 7 1 ... Phthisis 220 2 1 6 21 178 12 188 32 116 Other tubercular diseases 90 21 35 12 6 14 2 79 11 24 Cancer, malignant disease 155 ... ... 1 2 98 54 113 42 49 Bronchitis 297 52 23 1 ... 84 137 266 31 82 Pneumonia 269 53 59 5 6 104 42 230 39 67 Pleurisy 9 1 ... 1 ... 6 1 8 1 5 Other diseases of Respiratory Organs 51 7 4 2 1 20 17 34 17 9 Alcoholism 55 ... ... ... ... 43 12 38 17 19 Cirrhosis of Liver Venereal Diseases 22 15 1 ... 1 5 ... 19 3 12 Premature Birth 81 81 ... ... ... ... ... 70 11 13 Diseases and accidents of Parturition 5 ... ... ... 2 3 ... 4 1 1 Heart Diseases 251 1 2 5 18 124 101 187 64 70 Accidents 65 12 13 3 3 20 14 58 7 21 Suicides 14 ... ... ... 2 10 2 7 7 1 All other causes 777 155 21 20 13 261 307 608 169 262 All causes 2,746 515 290 73 95 1,035 738 2,243 503 840 Note.— The deaths of residents occurring without the Borough are included in this Table, and the deaths of non-residents recorded in the Borough are excluded. (See note on Table I. for the meaning of the terms "resident" and "non-resident"). 17 Deaths of residents occurring in public institutions are allotted to the respective sub-districts according to the addresses of the deceased as given by the registrars, and, in addition, are classified under the heading Public Institutions. The subjoined table, being a Summary of Table VIII. in the appendix, page 132, (Table III. in annual reports prior to 1900), shows the number of deaths from diseases comprised in the "New List of Causes of Death," as used in the Annual Reports of the Registrar-General for England and Wales, referred to in the following pages, to which I have added the deaths from violence, and certain diseases comprised in the old classification under the heading Ill-defined and Not Specified Causes, e.g., Debility, Atrophy, Inanition, terms which find no place in the New List. No. of Deaths GENERAL DISEASES 1,141 LOCAL DISEASES— Diseases of Nervous system 146 Diseases of Organs of Special Sense 3 Diseases of Heart 251 Diseases of Blood-vessels 160 Diseases of Respiratory Organs 626 Diseases of Digestive System 161 Diseases of Lymphatic System 4 Diseases of Urinary System 81 Diseases of Generative System 9 Accidents of Childbirth 5 Diseases of Locomotive System 3 Diseases of Integumentary System 1 1,450 DEATHS FROM VIOLENCE— Accident or Negligence 65 Homicide 3 Suicide 14 82 ILL-DEFINED AND NOT SPECIFIED CAUSES 73 Total 2,746 Zymotic Diseases.— The Deaths from the "principal zymotic diseases" were 263, and 82 below the corrected decennial average (345). These deaths, of which 239 belong to the Town sub-district and 24 to Brompton, were equivalent to 1.48 per 1,000 persons living (1.86 in the Town sub-district and 0.49 in Brompton) as compared with 1.81 in 1901. The rate in the Metropolis, as a whole, was 2.23 per 1,000 (2.24 in 1901); the decennial average being, for London 2.65, and for Kensington 2.0 per 1,000. The subjoined table shows the number of deaths from the several diseases occurring in the sub-districts and at outlying public institutions, etc. Diaease Sub-Districts. In Hospital. Total Deaths. Decennial Average. Town. Brompton. Town. Brompton. Uncorrected. Corrected for increase of Population. Small-pox 1 — 9 1 11 1.0 1.0 Measles 84 8 1 — 93 79.3 82.4 Scarlet Fever 1 1 18 1 21 25.6 26.6 Diphtheria 5 3 12 — 20 56.5 58.7 Whooping-cough 16 5 — — 21 55.2 67.4 Typhus Fever — — — — — 0. 3 0.3 Enteric Fever 7 1 11 — 19 16.6 17.2 Simple-Continued Fever — — — — — 0.8 0.8 Diarrhœa 69 4 5 — 78 96.8 100.6 183 22 56 2 263 332 345 18 With the exception of small-pox, measles and enteric fever, the mortality from these diseases was below the average. Distribution of the fatal cases of the Principal Zymotic Diseases during the year 1902. Smallpox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Enteric Fever. Diarrhœa. Total. Sub-Districts— Kensington Town 10 85 19 17 16 18 74 239 Brompton 1 8 2 3 5 1 4 24 Parliamentary Divisions— North Kensington 8 77 14 11 14 17 72 213 South Kensington 3 16 7 9 7 2 6 50 Wards— North Kensington St. Charles 2 25 1 5 7 3 19 62 Golborne 2 13 11 4 3 11 28 72 Norland 3 26 ... 1 4 1 14 49 Pembridge 1 13 2 1 ... 2 11 30 South Kensington Holland 2 6 4 5 1 ... 1 19 Earl's Court ... 1 1 ... 2 1 1 6 Queen's Gate ... 1 1 1 1 1 1 6 Redcliffe 1 5 1 3 1 ... 1 12 Brompton ... 3 ... ... 2 ... 2 7 District Zymotic Rate.— The deaths in North Kensington were 213 and the rate 2.33 per 1,000 persons living. In South Kensington the deaths were 50 and the rate 0.58 per 1,000. The rate in the several wards, the first four named being in North Kensington, and the last five in South Kensington, was as follows:— North Kensington St. Charles 62 deaths, or 2.8 per 1,000 persons living. Golborne 72 deaths, or 2.7 per 1,000 persons living. Norland 49 deaths, or 2.1 per 1,000 persons living. Pembridge 30 deaths, or 1.5 per 1,000 persons living. South Kensington Holland 19 deaths, or 0.9 per 1,000 persons living. Earl's Court 6 deaths, or 0.3 per 1,000 persons living. Queen's Gate 6 deaths, or 0.4 per 1,000 persons living. Redcliffe 12 deaths, or 0.6 per 1,000 persons living. Brompton 7 deaths, or 0.5 per 1,000 persons living. The table at p. 13 exhibits the distribution of the deaths in the Borough, as a whole, from the several diseases, as recorded in the thirteen four-weekly reports. In Appendix II., statistical information is given, in Tables B, C, and D, pp. 153-154, showing the number of deaths from the several diseases during the forty-seven years, 1856-1902; viz., in Table B, the annual number of deaths from each of the diseases and the death-rate therefrom; in Table C, the number of deaths grouped in quinquennial periods; in Table D, the rate per 1,000 of the population, in quinquennial periods, from the four notifiable diseases (smallpox, scarlet fever, diphtheria, and "fever"), and the three non-notifiable diseases—measles, whooping-cough, and diarrhœa. In England and Wales the deaths from the principal zymotic diseases were at the rate of 1.64 per 1,000 persons living, the decennial average being about 2.12 per 1,000. In the seventysix great towns, including London, the average rate was 2.12, ranging from 0.63 at Hornsey, 0.78 at Bournemouth and 0.82 at Hastings to 3.20 at West Ham, 3.61 at Burnley and 3.84 at Hanley. 19 In London, as a whole, the mortality from these diseases last year was 17 per cent. below the corrected decennial average. The total deaths were 10,393. The mortality from small-pox shows a considerable excess, that of the other diseases a decrease. The following table shows the rate of mortality per 1,000 persons living from the principal zymotic diseases in Kensington and London, and in England and Wales, in 1902. Small pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Fever. Diarrhœa. Kensington 0.06 0.52 0.12 0.11 0.12 0.11 0.45 London 0.28 0.51 0.12 0.25 0.40 0.13 0.54 England and Wales 0.07 0.88 0.15 0.28 0.29 0.13 0.38 SMALL-POX. The epidemic of small-pox which began in 1901— its history occupied a considerable space in the last annual report— did not die out until the third quarter of 1902 was well advanced. In the ninth monthly report it was stated that on the 6th September there were only 95 cases under treatment, all at Long Reach (temporary) Hospital; the hospital ships having been closed in July. Gore Farm Hospital had already been vacated: the Orchard (temporary) Hospital, furnished and made ready for patients, had not been utilised. The time thus appeared appropriate for a retrospect of the epidemic as it affected Kensington and other parts of the Metropolis, and the information contained in the thirteen four-weekly reports for the period of 52 weeks, commenced August 11th, 1901, and ended August 9th, 1902, was summarised as below. The statistics of the epidemic as they relate to the Borough, and the Metropolis, as a whole, are set out in the tables A to F. Tables A and B (pages 20 and 21) of notifications and deaths in the several Boroughs show the rise, the progress and the decline of the epidemic. Table C (page 22) summarises the statistics, for London, as a whole, and Kensington. Table D (page 23) shows the number of cases in the Borough as a whole, and in the Registration sub-districts, the Parliamentary Divisions and the nine Wards. Table E (page 24) shows the incidence of the disease upon streets and houses in Kensington. Table F (page 23) shows particulars of the fatal cases, of which 8 belong to North Kensington and 4 to South Kensington. Prior to August 11th there had been, in 1901, only one case of small-pox in the Borough— that of a gentleman who had become infected in Paris*, whilst in London the cases notified were only 41, all told. Subsequent to August 9th, 1902, to the end of the year, only 131 cases were notified in London, including one in Kensington, in the month of August. During the specified period of 52 weeks, the notifications of cases in Kensington were 106, and the deaths, including 3 of non-parishioners, 12. The notifications in London, as a whole, were 9,335, the deaths 1,518, of which all but 86 occurred in hospital. * See No. 1 Monthly Report, 1901, page 4. In this connexion it may be mentioned that the epidemic was thought to have originated, in August, through the importation of cases from Paris; and to have been spread by infected clothing, among the employées at a suburban laundry. The boroughs first to be severely affected were St. Pancras and St. Marylebone. 20 TABLE A.— Cases of Small-pox notified in the Metropolitan Boroughs in thirteen four-weekly periods— August nth, 1901— August 9th, 1902. Borough. FOUR WEEKS ENDED Population, 1901. Rate per 10,000 of the population. Sept. 7, 1901 Oct. 5, 1901 Nov. 2, 1901 Nov. 30, 1901 Dec. 28, 1901 Jan. 25, 1902 Feb. 22, 1902 Mar. 22, 1902 April 19, 1902 May 17, 1902 June 14, 1902 July 12, 1902 Aug. 9, 1902 Totals. West. Kensington ... 5 ... 3 4 13 11 15 12 11 20 8 4 106 176,628 6.0 Paddington 1 1 1 8 8 19 16 18 29 11 14 2 3 131 143,976 9.1 Hammersmith ... 1 ... 13 27 24 18 19 5 9 7 8 5 136 112,239 12.1 Fulham ... ... ... ... 15 15 18 15 15 8 12 2 1 101 137,289 7.4 Chelsea 1 2 1 ... 1 3 8 7 8 6 5 2 ... 44 73,342 5.9 City of Westminster 7 4 34 36 19 75 61 28 22 17 18 10 1 332 183,011 18.1 North. St. Harylebone 22 20 9 10 13 27 37 42 17 9 17 3 ... 226 133,301 16.9 Hampstead 2 1 1 1 1 3 1 4 6 2 3 1 ... 26 81,942 3.2 St. Pancras 56 50 29 43 73 82 58 72 46 32 42 24 4 611 235,317 25.9 Islington 3 14 15 13 16 42 22 54 54 56 32 26 2 349 334,991 10.4 Stoke Newington 3 4 1 2 9 13 6 15 10 1 4 2 ... 70 51,247 13.6 Hackney 5 11 3 4 10 44 38 77 127 57 52 23 1 452 219,272 20.6 Central. Holborn 9 13 44 52 99 104 29 46 17 6 8 6 2 435 59,405 73.2 Finsbury 2 19 14 28 30 19 75 37 14 13 6 18 27 302 101,403 29.7 City of London ... 2 1 1 4 6 3 9 6 4 1 4 4 45 26,923 16.7 Shoreditch ... 2 3 2 11 17 179 106 49 41 31 9 2 452 118,637 38.1 East. Bethnal Green 1 3 6 7 16 37 82 139 69 51 81 27 13 532 129,680 41.0 Stepney ... 6 25 44 84 131 401 338 206 121 126 35 14 1,531 298,600 51.3 Poplar ... 4 15 19 32 39 131 135 118 75 107 15 4 694 168,822 41.1 South. Southwark 2 4 9 25 48 70 67 89 81 101 83 24 1 604 206,180 29.3 Bermondsey ... ... 58 30 19 27 40 28 34 38 35 9 4 322 130,760 24.6 Lambeth 1 4 13 15 19 50 66 02 57 43 43 27 9 409 301,895 13.5 Battersea ... ... 5 7 41 41 23 28 22 16 29 14 13 239 169,907 14.1 Wandsworth 1 1 1 8 14 19 22 27 33 10 10 5 5 156 232,034 6.7 Camberwell ... ... 6 28 20 18 31 83 60 60 76 19 8 409 259,339 158 Deptford ... ... 1 2 1 6 13 41 27 19 21 10 3 144 110,398 13.0 Greenwich ... ... 2 3 6 4 20 28 21 10 2 10 4 110 95,770 11.5 Lewisham ... 2 4 ... 5 1 7 37 17 8 11 2 2 96 127,495 7.5 Woolwich ... 2 1 9 11 11 26 58 57 58 10 10 4 257 117,178 21. 9 Port of London ... ... 1 ... 3 1 5 3 ... 1 ... ... 14 — — Totals 116 175 303 413 656 963 1,510 1,602 1,242 893 907 355 140 9,335 — — 21 Table B— Deaths from Small-pox in the Metropolitan Boroughs in thirteen four-weekly periods—August 11th, 1901— August 9th, 1902. Borough. FOUR WEEKS ENDED Population, 1901. Death-rate per 10,000 of the population. Sept. 7, 1901 Oct. 5, 1901 Nov. 2, 1901 Nov. 30, 1901 Dec. 28, 1901 Jan. 25, 1902 Feb. 22, 1902 March 22, 1902 April 19, 1902 May 17, 1902 June 14, 1902 July 12, 1902 Aug, 9, 1902 Totals. West. Kensington ... ... ... ... 1 1 1 3 3 1 1 1 ... 12 176,628 0.7 Paddington ... ... ... ... ... 2 2 4 5 3 2 2 ... 20 143,976 1.4 Hammersmith ... ... ... 2 10 5 1 1 1 ... ... 1 3 24 112,239 2.1 Fulham ... ... ... ... 4 1 5 1 ...... 1 2 1 ... 15 137,289 1.1 Chelsea ... ... ... ... 1 ... 1 ... 1 2 1 1 1 8 73,842 1.1 City of Westminster 1 ... 2 8 4 15 10 9 3 1 2 1 ... 56 183,011 3.1 North. St. Marylebone 1 2 1 ... 1 3 6 7 3 2 1 2 ... 29 133,301 2.2 Hampstead ... 1 ... 1 ... 1 ... 1 ... 1 ... ... ...... 5 81,942 0.6 St. Pancras 11 10 6 8 7 14 9 17 8 9 11 9 4 123 235,317 5.2 Islington ... 1 ... 2 4 6 1 8 7 13 10 5 2 59 334,991 1.8 Stoke Newington ... 1 ... ... 2 1 2 2 4 ... 2 ... ... 14 51,247 2.7 Central. Hackney ... 2 1 1 1 10 3 11 15 17 9 4 ... 74 219,272 3.4 Holborn 2 1 2 13 12 22 11 10 ... 1 ... 2 ... 76 59,405 12.8 Finsbury ... ... 1 4 2 7 9 8 1 1 ... 2 5 40 101,463 3.9 City of London ... ... ... ... 2 2 1 ... 3 1 ... ... ... 9 26,923 3.3 East. Sboreditch ... ... ... 1 4 3 30 24 9 4 3 2 ... 80 118,637 6.7 Betlmal Green ... ... ... ... ... 5 11 13 15 8 7 2 ... 61 129,680 4.7 Stepney ... 1 3 7 11 23 62 74 47 19 21 6 3 277 298,600 9.3 Poplar ... ... 2 4 4 7 14 21 19 13 13 5 1 103 168,822 6.1 South. Southwark ... 1 1 6 6 12 7 12 16 14 9 5 2 91 206,180 4.4 Bermondsey ... ... 5 4 5 1 3 2 ... 9 5 3 ... 37 130,760 2.8 Lambeth 1 ... ... 3 1 7 10 15 9 7 8 2 2 65 301,895 2.1 Battersea ... ... ... 2 ... 6 4 4 5 4 4 1 ... 30 169,907 1.8 Wandsworth ... ... ... 1 3 5 3 3 8 1 ... ... 2 29 232,034 1.2 Camberwell ... ... 1 6 ... ... 3 12 14 13 13 5 2 69 259,339 2.7 Deptford ... ... ... ... ... ... 4 10 9 7 ... 1 ... 31 110,398 2.8 Greenwich ... ... ... ... 5 ... 4 4 7 7 2 1 ... 30 95,770 3.1 Lewisham ... ... ... ... ... ... 1 3 4 7 ... 1 2 18 127,495 1.4 Woolwich ... ... 1 ... 1 3 1 7 13 ... 4 2 1 33 117,178 2.8 Totals 16 20 26 73 91 162 219 289 229 166 130 67 30 1,518 — — 22 TABLE C.—Summary of Notifications of Small-pox; Admissions to Hospital, and Deaths Registered, in London as a whole, and in Kensington, in thirteen successive four-weekly periods, from August nth, 1901, to August 9th, 1902, and Number of Cases in Hospital at the end of each period. FOUR WEEKS ENDED Sept. 7, 1901 October 5, 1901 Nov. 2, 1901 Nov. 30, 1901 Dec., 28, 1901 January 25, 1902 February 22 1902 March 22, 1902 April 19, 1902 May 17, 1902 June 14, 1902 July 12, 1902 August 9, 1902 Totals Cases notified in London 116 175 303 413 656 963 1,510 1,662 1,242 893 907 355 140 9,335 Cases notified in Kensington ... 5 3 4 13 11 15 12 11 20 8 4 106 Cases admitted to Hospital in London* 121 194 310 439 690 983 1,678 1,822 1,367 1,098 903 345 136 10,086 Cases admitted to Hospital from Kensington ... 5 ... 3 4 11 11 15 10 11 20 8 4 102 Deaths registered in London 16 20 26 73 91 162 219 289 229 166 130 67 30 1,518 Deaths registered in Kensington ... ... .. 1 1 1 3 3 1 1 1 ... 12 Cases in Hospital at end of each fourweekly period* 92 169 284 427 660 870 1,321 1,567 1,431 1,30 1,035 579 239 * Including cases from Extra-Metropolitan Districts. 23 TABLE D.— Small-pox in Kensington ; Cases Notified, Number of Streets and Houses Invaded, and numbers of Cases to a House. bLocality. Population. Total No. of cases notified. No. of streets in which the disease occurred No. of Infected Houses. Cases in House. One case in house. Two cases in house. Three cases in house. Four cases in house. Six cases in house. The Borough 177,500 106 58 74 58 7 4 4 1 Sub-Districts — Kensington Town 128,660 96 49 64 48 7 4 4 1 Brompton 48,840 10 9 10 10 — — — — Parliamentary Divisions— North Kensington 91,510 89 44 59 45 5 4 4 1 South Kensington 85,990 17 14 15 13 2 — — — Wards— North K. St. Charles 22,060 15 5 8 5 1 — 2 — Golborne 26,440 27 14 19 16 — 1 2 — Norland 28,580 29 13 20 16 2 1 — 1 Pembridge 19,430 18 12 12 8 2 2 — — South K. Holland 20,500 3 3 3 3 *_ _ Earl's Court 18,140 1 1 1 1 — — — — Queen's Gate 14,340 5 3 3 1 2 — — — Redcliffe 18,790 6 5 6 6 — — — — Brompton 14,220 2 2 2 2 — — — — TABLE F.— Particulars with respect to Fatal Cases of Small-pox, Kensington, 1901-2. Name of Sufferer. Sex. Age. Condition as to vaccination. No. of Case in Monthly Reports. Occupation. Address. 1. Ernest T. M. 17 Unvaccinated 8 Grocer's porter Cromwell Road 2. Minnie M. F. 19 Vaccinated in infancy 15 Domestic servant Buckingham Mews 3. Thomas A. M. 9 mos. Unvaccinated 18 Son of an engineer's fitter Blechynden Street 4. John C. M. 39 Vaccinated in infancy 30 Hawker Crescent Street, Common Lodging-house* 5. Alfred D.† M. 58 Vaccinated in infancy, revaccinated 37 yrs. ago 36 "Auctioneer" WorniNgton Rd., Common Lodging-house 6. Samuel P. M. 20 Vaccinated in infancy 88 Carman Jameson Street 7. Edward W. M. 28 No information 45 Omnibus proprietor Tavistock Road (died at home) 8. Edward J. M. 19 No information 51 Painter's labourer Walmer Road 9. George S.† M. 48 Vaccinated in infancy 57 Labourer Crescent Street, Common Lodging-house* 10. Emma L. F. 34 Unvaccinated 61 No occupation Campden Street 11. Mary W.† F. 61 Vaccinated in infancy 80 Domestic servant Earl's Court Road 12. William H. M. 41 Vaccinated in infancy 92 Carman Blechynden Street Note.—All the deaths save one (No. 7) took place in hospital. * The cases (4 and 9) at common lodging-houses occurred at different houses; and also the cases (3 and 12) at Blechynden Street † Non-parishioners. 24 TABLE E.— Streets, and Number of Houses in each Street, in North Kensington, Invaded by Small-pox, and Cases Notified (11th August, 1901, to 9th August, 1902). Ward. Streets. No. of Houses invaded. No. of Cases. St. Charles Blechynden Street 2 3* Calverley Street 1 1 Lancaster Road 1 4 Backham Street 1 4 Walmer Road 3 3 Golborne Adda Street 1 1 Bevington Road 1 1 Bosworth Road 2 7 Edenham Street 1 1 Faraday Road 1 1 Hazlewood Crescent 1 4 Kensal Road 1 1 Southam Street 3 3 South Row 1 1 Swinbrook Road 1 1 Tavistock Road 1 1† Telford Road 1 1 Wheatstone Road 1 1 Wornington Road 3 3† Norland Bangor Street 1 1 Clarendon Road 1 1 Cornwall Road 1 1 Crescent Street 2 4* Hesketh Place 1 2 Norland Road North 1 1 Norland Square 1 1 St. James's Place 1 1 St. Katharine's Road 3 3 Sirdar Road 2 2 Talbot Grove 2 3 Tobin Street 2 7 Walmer Road 2 2† Pembridge Buckingham Mews 1 1† Buckingham Terrace 1 2 Convent Gardens 1 1 Cornwall Road 1 2 Denbigh Road 1 3 High Street, Notting Hill 1 1 Ladbroke Road 1 1 Lancaster Road 1 3 Linden Gardens 1 1 Lonsdale Road 1 1 Portobello Road 1 1 Westbourne Grove 1 1 Holland Campden Street 1 1† Jameson Street 1 1† Newcombe Street 1 1 Earl's Court Wallgrave Terrace 1 1 Queen's Gate Kensington High Street 1 2 Lexham Gardens 1 1 Queen's Terrace Mews 1 2 redcliffe Cromwell Road 1 1† Earl's Court Road 1 1† Ifield Road 2 2 Redcliffe Road 1 1 Seymour Place 1 1 Brompton Brompton Road 1 1 Chapel Place 1 1 *Two fatal cases. † One fatal case. 25 All things considered, Kensington came well out of the trouble—thanks, largely, to the well vaccinated condition of the population. Hampstead and Chelsea had the fewest notified cases (26 and 44 respectively) proportionately to population. Kensington came next. The small-pox death-rate was lowest in Kensington if the deaths of non-parishioners are excluded; viz., 0.5 per 10,000. Eighty-nine cases occurred in North Kensington (population 91,500), which comprises four Wards, and only 17 in the five Wards comprised in South Kensington (population 86,000). In 58 instances there was but one case to a house, in 7 instances two cases, in 4 instances three, in 4 instances four, in a single instance six. The cases comprised 61 of males and 45 of females; the ages of the patients are set out in the following table, which also shows the number of deaths (including three of non-parishioners) at different age-periods:— Age-period. Notifications. Deaths. 0—1 2 1 1—5 1 — 5—10 4 — 10—20 24 3 20—40 56 4 40—60 16 3 60 and upwards 3 1 Totals 106 12 The subjoined table shows that, with few exceptions, the patients belonged to the poorer classes, who are not characterised by over-much belief in the efficacy of vaccination, nor, as a rule, by willingness to accept re-vaccination, as an ordinary measure of precaution, in the absence of imminent danger. Occupations of the persons attacked by small-pox in Kensington in 52 weeks, 11th August, 1901, to 9th August, 1902— Labourers, carmen, hawkers 40 Artisans 26 Shop-keepers and assistants 16 Laundry women and ironers 6* Lodging-house keeper 1 Domestic servants 5 Clerks 4 Postman 1 Omnibus proprietor 1 "Auctioneer" (Common Lodging-house case) 1 Unknown (3), None (2) 5 Total 106 * Five of these were secondary cases, the origin of one case only is unknown. 26 The histories of Kensington cases were duly set out in the successive monthly reports, but brief reference may be made here to certain groups of cases in illustration of modes of spread of the disease:— (1) A lad, employed in another borough, the nature of whose slight illness was not recognized, infected five inmates of the house in which he resided. (No. 9 Report, 1901, page 122.) (2) A gentleman, living in furnished apartments, the nature of whose indisposition was not recognized, infected a charwoman employed at the house, also his landlady and her niece. The charwoman's case was the first to be notified. She, in turn, infected a man with whom she cohabited, and a sister. (Cases 11—16, No. 1 Report, 1902, page 5.) (3) A man, employed at Grays, in Essex, an infected district, came home ill and infected his son and daughter. (Cases 23—25, No. 2 Report, page 23.) (4) Two brothers, engaged in work at Dagenham Small-pox Hospital, contracted the disease, which they developed at home in Kensington. (Cases 39—40, No. 3 Report, page 58.) (5) A horsekeeper and a post-office official, infected at a house in another borough, developed the disease in Kensington. (Cases 41 and 42, No. 3 Report, page 58.) (6) Two lodgers, and the night deputy, at a common lodging-house, apparently contracted the disease from a previous unrecognized case in the same dormitory (Cases 30 and 31, No. 2 Report, page 23 ; case 32, No. 3 Report, page 57.) (7) A man from Dartford, at a common lodging-house, infected before arrival in the borough, was the source of infection to the bedmaker. (Case 57, No. 4 Report, page 85, and case 67, No. 5 Report, page 97.) (8) A man, who had an illness variously described as "measles" and as "blood-poisoning," infected his mother and his sister. (Cases 54—56, No. 4 Report, page 85.) (9) A woman in attendance at a general hospital had come into contact with a male outpatient in a highly infectious condition.* The nature of this woman's consequent slight illness was not recognized, the result being that two persons contracted the disease from her. One of them was removed to the Western Fever Hospital for supposed "scarlet fever," which proved to be hæmorrhagic small-pox, to which he soon succumbed. (Cases 51—53, No. 4 Report, page 85.) (10) Two children (unvaccinated) who fell ill simultaneously (no history of infection), infected two other children in the same house. (Cases 58 and 59, No. 4 Report, page 86, and cases 62 and 63, No. 5 Report, page 96.) (11) An anonymous letter led to discovery of six cases in one house. The first case was that of a boy, the nature of whose illness there is reason to believe was known (or suspected) by his mother, whom, as well as four other persons, he infected. (Cases 73 to 78, No. 6 Report, page 106.) (12) A carman (source of his infection unknown) infected his wife and two children. (Cases 81—84, No. 6 Report, page 107.) (13) Three days after arrival in the borough, a boy fell ill; the disease was not recognized. He infected three other members of the family, from whom four sisters, in another house, contracted the disease, and in a third house the fiance of one of them. (Cases 88 to 91, No. 6 Report, page 197, and cases 93 to 97, No. 7 Report, page 124.) (14) Two men were infected by their father, whom they had visited before his removal to hospital; a third son, who had slept with his father, escaped. (Cases 101—103, No. 8 Report, page 138.) Amongst individual cases the following are deserving of reference, some of them as indicating sources of infection outside the Borough:— Cases 1 and 2 (No. 13 Report, 1901, page 176) imported from another Borough. Case 3 (No. 13 Report, page 177). A youth employed in Kensington fell ill simultaneously with a fellow employé, who resided in another borough, whose two brothers, moreover, were stricken at the same time. The obviously common source of infection was not traced. Case 4 (No. 14, page 195) was on a visit in another borough at the date of infection. Case 5 (No. 14, page 195), employed in another Borough as a bedmaker at a Rowton House where there were cases of small-pox, was sent home with the premonitory symptoms of small-pox. Case 6 (No. 14, page 195) was infected at the Casual Ward in another borough, before coming to reside at a Boys' Home in Kensington. * Another woman (case 50) who had come in contact with this same man was notified as chicken-pox, but was found to be suffering from small-pox and sent to hospital. There were cases in other boroughs, owning the same origin. 27 Case 8 (No. 1 Report, 1902, page 4). A public-house manager, thought to be suffering from chicken-pox, infected a barmaid, who fell ill of small-pox in another borough. Case 10 (No. 1, page 5). A woman who had previously had small-pox was infected by her husband. * Case 17 (No. 1, page 6). A young woman infected by her fiancé in another Borough. Case 18 (No. 1, page 6). An infant infected by a relation on a visit from Grays, Essex, who also infected his own children. Case 19 (No. 1, page 6). A young woman who came home ill, having been infected in another Borough. Case 21 (No. 2, page 22). A woman, who had slept one night only at a common lodginghouse in the borough, was, two days afterwards, removed to hospital from the infirmary, to which she had been sent for observation. Case 26 (No. 2 Report, page 23). A woman who paid one visit to her son in another borough, prior to his removal to hospital. Case 27 (No. 2 Report, page 23). A man notified as suffering from chicken-pox. Cases 34 to 36 (No. 3 Report, page 57). Three men, who gave false addresses; one of them was traced to his wife's residence in another borough (where he infected his wife and her father); one unknown at the address given, a common lodging-house, and a third a lodger, for one night only, at the same house. Case 37 (No. 3 Report, page 58). A child, aged 5, treated at home for an illness transient and trivial, had only two spots on the face. Case 45 (No. 2 Report, page 58). A man treated at home; disease diagnosed an hour or two before death. Case 46 (No. 3, page 59). An operative baker, who was infected by a fellow workman at an underground bakehouse in another borough. Case 66 (No. 5 Report, page 97). A woman infected by her brother (an unrecognised case) in another district. Case 69 (No. 5 Report, page 97). A man removed from a general hospital, having recently come from Dartford, an infected district. Case 80 (No. 6 Report, page 107). A woman in domestic service who had recently come from another borough. Case 86 (No. 6 Report, page 107). A laundry woman infected by a fellow worker with whom she lived. Case 87 (No. 6 Report, page 107). A tailor infected by a fellow-workman in another borough. A feature in the above cases, grouped and individual, is that the "contacts," or secondary cases, were in nearly every instance infected before any notification of illness in the primary cases was received. In very few instances were there any secondary cases who had become infected after the receipt of the notification of the primary cases. In 27 cases the sufferers were infected in other districts, and, arising out of these, there were a number of secondary cases. In about 48 cases the source of infection could not be traced, but several of these were imported cases. All the common lodging-house primary cases were imported. Preventive Measures.— In the first rank of measures for the prevention of spread of disease comes— Isolation, which was secured in nearly every case by the removal of the patient to Hospital. The removal was effected in 73 cases by medical practitioners, on their own applications and certificates, under the unique system which has been in operation in Kensington since 1887—the Sanitary Authority paying a small fee for the service. In 28 cases the patients were removed by the department, usually upon the notification certificate. Five cases, in 1902, were not removed to hospital: viz., a public-house manager, whose illness had been diagnosed as chicken-pox (case 8, No. 1 Report, page 4) ; an omnibus proprietor, whose case (45, No. 3 Report, page 58) was reported after death; a gentleman (case 12, No. 1 Report, page 5); a woman (case 53, No. 4 Report, page 85), the nature of whose illness was not recognised; and a child, well isolated, and scarcely at all ill (case 37, No. 3 Report, page 58). 28 Ambulance Service.—The patients were removed in every case in the ambulances of the Asylums Board with a promptitude altogether commendable—many of them at night. Hospital Service.—The accommodation from the first was ample. In August, 1901, there were some 1,442 beds available, or that could have been made available; viz., 250 at the ships and 1,192 at the Gore Farm Hospitals, the accommodation at which was largely extended (raising the aggregate to about 1,850 beds) before the close of the epidemic. A temporary hospital for 300 patients was erected at Long Reach. Another temporary structure, the Orchard Hospital, at Joyce Green, with accommodation for 800 beds, was rapidly constructed and furnished, but never used. The accommodation at the several hospitals aggregated about 3,200 beds. The patients at any one time scarcely exceeded half that number. Disinfection.—Upon the removal of a patient the Council's staff disinfected the sick room or rooms without loss of time, and the contractors removed the bedding.* This was frequently done at night. It was not thought necessary to " strip " the wall papers—a course adopted in some boroughs. In no instance was there any spread of the disease suggesting that the disinfection, whether of rooms or infected articles, had not been effective. Sulphurous acid fumigation was practised in the disinfection of rooms : all washable articles were cleansed after disinfection. Re-vaccination.—Without loss of time the Vaccination Officer, and generally the Public Vaccinator also, was informed of the occurrence of an outbreak, and vaccination or re-vaccination was offered to every " contact" and readily accepted by most of them. Many persons were vaccinated by the District Poor-Law Medical Officers these being authorised to vaccinate or re-vaccinate the inmates of houses wherein small-pox occurs I had every reason to be satisfied with the services rendered by the officers of the guardians in this respect. In a special report (No. 10, 1901), the question of vaccination and re-vaccination was dealt with, especially in connection with the examination of the arms of children in elementary schools— Board and Voluntary. A large number of children were found to be unprotected—the majority of them had been born without the borough—and were vaccinated forthwith. There were many re-vaccinations of elder children, and their parents, and other inmates, at the homes—vaccination on the school premises was prohibited—and it is common knowledge that a large number of other persons sought and obtained protection at the hands of the Public Vaccinators and other medical practitioners. Primary vaccinations, moreover, were unusually numerous, but statistical information on the subject, as respects 1902, is not at present available.† Little information respecting the state of vaccination, or otherwise, was forthcoming, the large majority of the patients having been removed before receipt of the notification of an outbreak. Such information, however, in respect of so few cases, would have little value; it is to be anticipated, moreover, that the Asylums Board will publish the statistics of the vaccination-state of the more than 10,000 persons admitted to their hospitals. [In the second report for 1902 reference was made to a preliminary statement by the Managers on this subject, and in the fourth report statistics, furnished by the Registrar-General, were cited as to the state as to vaccination, or otherwise, of over 1,000 fatal cases. Vide page 74.] Contacts.—The incubation period of small-pox is about 12-14 days, and in order to prevent spread of disease it became necessary to exercise supervision of persons who had been exposed to infection. The names and addresses of these " contacts " were obtained, and the several persons visited daily, from the twelfth to the fifteenth day after the first and the last exposure to infection. Several contacts who had been exposed to infection before the receipt of the notification certificate fell ill, but scarcely any when the sick person had been promptly notified and removed, and the usual preventive measures had been adopted. It was not thought necessary to prevent the contacts from following their usual pursuits. They were invited to place themselves in communication with the Department, should occasion arise. Only in one case was it thought desirable to stop a man from work; he was an operative baker who for two or three nights had pursued his occupation (in another borough) at an underground bakehouse with a fellow workman who was suffering from small-pox. He subsequently fell ill and was removed to hospital. (Case 46, page 27.) The Action of the Board of Guardians.—At the commencement of the epidemic, in 1901, the Guardians issued posters giving public information of the arrangements made for vaccination and revaccination, together with the names and addresses of the public vaccinators. The Guardians also adopted the precaution of having the inmates of the casual wards examined daily by one of their medical officers, who revaccinated all who were willing to submit to the operation. No case was discovered amongst the casuals ; but several outbreaks occurred at common lodging-houses, the primary case having been an imported one in every instance. * One of the contractors' employes became infected, having delayed to follow advice to get revaccinated. † For particulars relating to vaccination in 1901 see table page 75. No information is at present available as to the number of re-vaccinations. 29 General Precautionary Measures.—Never before was London so well prepared to deal with an epidemic, whether regard be had to means of removal and isolation of the sick, or the diffusion of information as to the occurrence of outbreaks, the names and addresses of contacts, etc. Through the intermediary of the medical officer of health of the London County Council, there was daily intercommunication between the borough medical officers of health, which kept each fully informed of the occurrence of illness in all other districts of the metropolis. The Asylums Board, moreover, forwarded to each medical officer, daily, a list of deaths and discharges at the several hospitals; and, weekly, a list of cases admitted, embracing a short history of each, indicating, where possible, the source of infection. No case of small-pox in London was removed direct from home to hospital. Every case was removed, in the first instance, to the South Wharf Shelters at Rotherhithe, and thence— if found to be suffering from small-pox—to Long Reach. If the case were doubtful it was detained for observation. If clearly not small-pox, the patient was revaccinated and sent home—information in such cases being forwarded to the Medical Officer of Health. A few such occurred in the borough and happily not one of them was the worse for the journey. Medical practitioners were encouraged by the Asylums Board experts to send doubtful cases to the shelters for diagnosis, which was the best practicable course, the Board having felt unable to supply the services of an expert at the patient's home, as I had suggested. Conclusion.—I thought it desirable at the commencement of the epidemic, which, as we have seen, was mainly confined to North Kensington, to charge the Chief Sanitary Inspector with the sole responsibility of carrying out the arrangements designed to prevent the spread of disease, and it is simple justice to acknowledge that he performed the duty, which included the visitation of some hundreds of " contacts," by day and night, on week-days and Sundays alike, to my entire satisfaction, and I may add, with signal success. A few words will not be out of place here with respect to the extent of the epidemic in London, as a whole. The notifications in 1902 were 7,796 (compared with 29, 88, and 1,702, in the three preceding years), the total for the two epidemic years, 1901-2, being 9,500. The admissions to hospitals, in 1902, were 8,455, against 1,788 in 1901. Of the admissions in 1902, 8,088 occurred in the first half of the year. The deaths in 1902 were 1,314, and exceeded the corrected decennial average by 1,245. The numbers in the four quarters successively were 734, 506, 73, and 1: 1,240 in the first half of the year and 74 in the second half. The ages at death were :— Under one year 105 1—5 182 5—20 239 20—40 481 40—60 258 60—80 47 80 and upwards 2 The case-mortality, calculated upon notifications, was 16.9 per cent. At the end of 1901 there were 666 patients under treatment in the hospitals; at the end of 1902 only 14. The boroughs that suffered most were Holborn, Stepney, Shoreditch, Bethnal Green and Poplar. Subsidiary matters relating to the epidemic, including Hospital Accommodation, Ambulance Service, Vaccination, Notification of Chicken-pox, etc., are dealt with under the several headings. Here, some further reference may be made to subjects cursorily noticed in the preceding summary. And firstly as to— Diagnosis of Doubtful Cases of Small Pox.—The symptoms preceding the appearance of the rash in vaccinated persons are frequently slight—they decline, moreover, on the outcoming of the rash, which itself is often small in quantity and so modified, as to present real difficulty in diagnosis. Even the expert is occasionally puzzled, and would be the last to impute blame for error where there had been a genuine attempt to arrive at a correct diagnosis. Encouraged though they were to send doubtful cases to the Asylums Board Shelter—for diagnosis, or as a 30 matter of precaution, medical men were not unnaturally averse from adopting this course, in the absence of strong grounds for suspicion: but the more dangerous cases (qua, spread of disease), may be those in which the ground for suspicion does not appear to be strong. In doubtful cases the tendency is to throw upon the Medical Officer of Health a responsibility for diagnosis which does not properly attach to his office, and which would, at a period of epidemic prevalence, involve the expenditure of much of his time. Having regard to all the bearings of the case, it seemed to me that the best solution to a serious difficulty would be to obtain the appointment by the Asylums Board of one or more of their expert medical officers to assist private practitioners in the diagnosis of doubtful cases, before removal; i.e., at the home of the patient. I therefore submitted a proposal to this effect to the Managers (6th January), and subsequently had an opportunity of more fully explaining my views at a meeting with the Special and Medical Sub-Committee of the Hospitals Committee. The Sub-Committee in a report (30th January) adopted by the Committee, and subsequently by the Managers, expressed their regret that they could not see their way to recommend the adoption of the suggestion, believing that " bearing in mind the immense size of London, there was grave doubt whether the services of an expert of the Board (even should more than one be appointed), would always be at the disposal of a medical practitioner within a reasonable time, and that, consequently, there would be very considerable danger of patients being kept in their homes for an unduly lengthened period until such time as the Board's expert could attend to make his diagnosis." Personally, I was inclined to think that the delay—had my suggestion been adopted—might have been less than often occurred, as medical practitioners prefer to be fairly sure of their diagnosis before notifying cases, or before adopting the plan of removing doubtful cases to the Shelter at Rotherhithe. Many such cases were sent home again—after revaccination—with results not altogether to the advantage of the practitioner, who, in the removal to the Shelter, had consulted the interests of the patient and the public rather than his own. In connection with this matter it may be mentioned that the County Council sanctioned the employment, in various parts of London, of medical practitioners "who had had large experience of small-pox, and who could be called in by medical practitioners to advise in doubtful cases, with the view to the early detection and isolation of cases of the disease," and that the Local Government Board, upon the application of the Public Health Committee of the Council, intimated that, in order to avoid any question at the audit, they would be prepared to sanction any reasonable expenditure thus incurred, under the Local Authorities (Expenses) Act, 1887. I thought the plan I had proposed to the Managers the better one, for experts in small-pox are mainly restricted to their medical staff. Mistaken Diagnosis.—Disinfection of infected rooms and articles therein was carried out with all possible expedition after the removal to hospital of a case notified as small-pox. It happened occasionally that, through error in diagnosis, a patient removed to the Shelter was found to be not suffering from small-pox. For want of early information of the fact, unnecessary expense was incurred for disinfection, and inconvenience caused to the family of the patient, especially when he belonged to the poorer class, whose domestic accommodation is of the smallest. In hope to mitigate these evils I approached the Asylums Board, who promptly issued instructions to the Medical Officer at the Shelter, which in some cases had the effect of making the Medical Officer of Health aware at the earliest practicable moment, when a patient removed on a certificate of small-pox was found to be not suffering from that disease, and so saved the cost and inconvenience of unnecessary measures of disinfection. Spread of Disease to Country Districts.—Serious complaints by sanitary authorities of the spread of disease in different parts of the country, by persons permitted to visit the sick at the ships, were under the consideration of the Managers at their meeting on the 22nd February. Such visitors refusing to be revaccinated, and subsequently falling ill, became a danger to the districts where they resided. Nevertheless the Managers felt it impossible to refuse permission to visit a dying patient, and they have no power to enforce revaccination. Information with regard to visitors, whether they accepted or refused revaccination, was sent the medical officers of the districts whence the visitors came, in order that, as "contacts," they might be kept under observation for the necessary period of at least fourteen days. It is a question whether it might not be practicable, on occasion, to enable the infectious sick to communicate with relatives by telephone ? What precautions are possible to limit the risk of infection are adopted : the visitors receive sustenance before being admitted to the sick ward; their clothing is effectually shielded from contact with contagious matter; such personal disinfection, moreover, as is practicable, is practised before they leave. The danger nevertheless, in small-pox, to persons who are unprotected is great; and it is a matter for regret that it should be felt to be impossible to forbid visitation. The complainant sanitary authorities claimed that visitation should not be permitted unless the visitors at the time of the visit submitted to revaccination. Revaccination, however, would not prevent a susceptible person from taking the disease; if successful it would modify the attack; but a person suffering from the modified disease is as great a danger to the community as one more severely affected, and possibly an even greater danger, as experience has often proved; for the lighter the attack the more likely is the nature of the disease to be overlooked. 31 Isolation of Contacts.—The Local Government Board, in February, addressed a circular letter to the Borough Councils on "Retention in Dwellings of Persons brought into contact with SmallPox ;" a question having arisen " as to the action which local authorities should take in order to deal effectively with the inmates of dwellings invaded" by small-pox. The Board deemed the quarantining at their homes of such persons to be "not necessary in districts in which sanitary matters are properly administered, and vaccination and revaccination are efficiently carried out"— assuming, of course, that the patient, on a house becoming invaded, was at once removed, and disinfection promptly carried out: all that was then necessary was to keep the "contacts" under observation for a fortnight, and towards the end of the second week to examine them to ascertain if any of them were developing small-pox. This was the view acted upon, and with success, in the Borough. Should exceptional cases occur, and the Borough Council be advised by their Medical Officer of Health that, in the special circumstances, it was essential that the inmates should remain in their own houses, the Board stated that they "would be prepared to sanction a reasonable expenditure in securing such a result." This was the course adopted by the County Council in respect to the inmates of common lodging-houses invaded by the disease. The circular letter concluded with an expression of the Board's opinion that it was competent to a Borough Council " to supply necessary food to any inmate of a temporary shelter, provided by them under section 60 (4) of the Public Health (London) Act, 1891, whilst such person is residing in the shelter for the purpose of enabling his dwelling to be disinfected by the Council." The Borough is not yet possessed of a shelter, but in occasional instances pecuniary assistance was given to contacts whom it was desirable to request to abstain from following their usual avocations. Conference of the Public Health Authorities on Small-Pox. In February, the Holborn Borough Council convened a Conference of the Public Health Authorities to consider, " Whether the measures adopted in dealing with the outbreak could be improved with a view to the more effective suppression of the disease."* The Meeting was held at the offices of the Metropolitan Asylums Board, and upwards of 20 Councils, and the County Council, sent delegates. The resolutions adopted were as follows:— 1. " That, in the opinion of the Conference, the powers and duties at present vested in Guardians of the Poor with regard to Vaccination and Re-vaccination, should be transferred to, and enforced by, Borough Councils. 2. " That, in the opinion of the Conference, an amendment of the law is necessary, to ensure compulsory vaccination and re-vaccination of all persons in a dwelling-house wherein small-pox has broken out. 3. " That, in the opinion of the Conference, it should be declared an offence, under the Public Health (London.) Act, 1891, to refuse or withhold information, or give false information, with respect to persons living in a house in which small-pox has broken out, with regard to (a) their names, (b) employment or occupation, (c) schools attended by their children, or (d) as to any persons not living in such house, but employed therein. 4. " That, in the opinion of the Conference, all disinfections should be carried out by the Sanitary Authority. 5. " That, in the opinion of the Conference, the provisions of the Public Health (London) Act, 1891, with regard to the prevention of infectious diseases, require amendment by (a) shortening the period of twenty-four hours, allowed by section 60, for the master of a house to decide whether he will undertake the disinfection or allow the Sanitary Authority to do so; and (b) extending the provisions of section 64 to the taking of any house, or part of a house, by a person suffering from an infectious disease, or who has been exposed to infection. 6. " That, in the opinion of the Conference, it is advisable that application be made to the Metropolitan Asylums Board to send out, to every Medical Officer of Health in London, daily lists of small-pox cases only, with ages and addresses of patients, as is done weekly in the case of all infectious diseases. 7. " That the Conference approve the communication, addressed by the Town Clerk of the Royal Borough of Kensington to the Local Government Board, requesting them to undertake the supply of lymph to any registered medical practitioner who may apply for the same, instead of to public vaccinators only. 8. " That, in the opinion of this Conference, an amendment of the law is necessary to the effect that any person inhabiting any part of a house which has been infected by smallpox, and who, knowingly, associates with other persons without having his person and clothes cleansed and disinfected to the satisfaction of the Sanitary Authority, shall be liable to a fine not exceeding £20. 9. " That, in the opinion of this Conference, Borough Councils should be allowed to make provision for 'contacts' for whom they may have no accommodation available in their shelters." * a shorthand report of the proceedings was published by the Council of the Borough of Holborn. 32 Resolution 7 brought forward at the instance of the Borough Council, met with unanimous support. It may be remembered, however, that in the report in which the subject was brought to the attention of the Council, I proposed, as an alternative procedure, that the Local Government Board should be " empowered to exercise such supervision over the production of lymph for the use of private practitioners as may be necessary to secure that persons upon whom the lymph is used shall be effectively revaccinated." Resolution 1 in favour of transferring the control of vaccination from the Poor Law to the Sanitary Authority, was carried by 26 to 16 votes, the debate having been closed by a delegate of a Council known to be hostile to vaccination. It may well be asked with what object did this body desire to possess control ? I addressed the Conference in support of an amendment proposing to transfer the control to a Central' Authority, preferably' the " Hospital Authority." It is, in my humble opinion, desirable, in the public interests, that there should be only one authority for London, otherwise the law will not be uniformly carried out—nor carried out much, if at all, better than at the present time, when it is known that certain boards of guardians are, at best, but half-hearted in the matter. It is the fact, moreover, that at elections vaccination has been made a test question, and candidates have been returned with the object of defeating the purpose of the legislature. Who can say that the same thing might not occasionally happen if the control were handed over to the sanitary authorities ? It would avail little that the Council had been faithful to their duty in the matter, as the Kensington Guardians have been, if other Councils, near or far off, were returned with a majority opposed to compulsory vaccination. And what a reproach to municipal government, should a sanitary authority fail in a duty so vital to the public interests! I think the Asylums Board would be the most suitable authority. As hospital authority the Managers are doing splendid work for the sanitary authorities, although they do not legally represent them ; and no one can doubt that they would carry out the law faithfully, were this duty entrusted to them by the legislature. And what a gain would ensue from a rigid execution of vaccination law; it being, humanly speaking, certain that in a population properly vaccinated in infancy, and efficiently revaccinated from time to time, as necessary, small-pox could find no place. Notification of Chicken-Pox. Towards the close of 1901 a letter was received from the Local Government Board suggesting that the Council should consider the desirability of at once taking steps to add chicken-pox, either permanently or temporarily, to the list of notifiable diseases, with the view of affording the Medical Officer of Health the means of detecting possible sources of small-pox infection; which, they said, "were disregarded, and therefore uncontrolled." It is true, as the Board stated, that " cases of small-pox not infrequently escape detection owing to their being regarded merely as cases of chicken-pox;" and I advised the Council that the course recommended by the Board was one that might be adopted with advantage, at any rate as a temporary measure of precaution. At the same time I stated that for some time previously all known cases of chicken-pox in the borough, mostly reported by head teachers of elementary schools, had been visited ; of the bulk of such cases, however, no information was forthcoming. In January, 1902, the Council made an order for the compulsory notification of the disease during a period of six months dating from February 5th. It did not become necessary for the Council to renew the order, the London County Council having, on 7th May, in the exercise of their powers under Sub-section (6) of Section 56 of the Public Health (London) Act, 1891, extended the provisions of the Section to the Metropolis, as a whole, for a period of six months, i.e., to 7th November, and subsequently for a period of two months from the latter date: the order ceased to be operative on 6th January, 1903. During the year 25,708 cases were notified to the Metropolitan Medical Officers of Health, including 669 in this borough. Among the cases notified to me, two were found to be small-pox, and were removed to hospital forthwith. The Medical Officer of Health of another district reported that up to July, fifteen cases notified as chicken-pox had been found to be small-pox, and removed to hospital, and that these caces had been responsible for other twenty-five cases. The Small-Pox Epidemic of 1871. In January, at a time when the minds of people were considerably disturbed by the continued prevalence of small-pox, I took occasion to show how much less severe the epidemic was than that which, commencing in the fourth quarter of 1870, attained its maximum at the middle of 1871, continued with decreasing intensity to the close of 1872, and even into the first half of 1873. It was ancient history—going back to the time when the health interests of the borough were first 33 committed to my superintendence—but it was worth recalling as a standard of comparison with the then current epidemic. It served also to illustrate the immense progress, since 1871, in regard to hospital accommodation, ambulance service, etc., and to show the reduction in mortality, largely due to notification and the removal of the sick out of London. The report was as follows:— " Small-pox, which had been prevalent in a malignant form on the Continent during the Franco-German War, spread to London in the autumn of 1870, and during the fourth quarter was accountable for 584 deaths, including five in Kensington. In 1871 the deaths in the Metropolis from this cause were 7,876—2,400, 3,241, 1,255, and 980, in the four quarters respectively; in England and Wales 23,000. The fatal cases in London in 1872, numbered 1,781—831, 582, 237, and 131, in the successive quarters. In 1873 the deaths were 115, including one in Kensington. The population of London in 1871 was 3,254,260; the smallpox death-rate 2.4 per 1,000. Hospital accommodation available, or improvised during the epidemic, was inadequate—how inadequate will be understood when it is stated that only 2,856 (=36.2 per cent.) of the deaths took place at these institutions; 2,415 of them at the Asylums Board hospitals at Hampstead, Stockwell, and Homerton. The patients admitted to these hospitals in 1871 numbered 12,840; the case-mortality was slightly under 19 per cent. Assuming the same rate of mortality at the minor hospitals, at which 441 deaths occurred, the total cases in London can hardly have been fewer than 42,000, of which only 36 per cent. were isolated in hospitals. Had London suffered in the same proportion during 1902—regard being had to increase of population—the attacks would have been some 60,000. "In Kensington, in 1871, the estimated number of cases was 610; the recorded cases 444; the concealed cases approximately 166. Three hundred patients were removed to hospital, of whom 58 died, a case-mortality of 19.3 per cent. The deaths at home were 62; total deaths, 120. The largest number of reported cases was in May and June—91 and 116 respectively; 343 cases were recorded in the first half of the year; 101 in the second; 302 belonged to North Kensington, 142 to South Kensington; 89 and 31 being the respective number of deaths in the two divisions of the parish; 104 of the deceased had previously resided in the Town sub-district, only 16 in the Brompton sub-district; of the 236 males attacked 62 died; the female cases were 208, the deaths 58. These figures necessarily take no account of concealed cases. " The disease appeared in 179 streets, &c.; 323 houses were invaded. In 256 houses there was one case to each; the case having been reported in good time, the premises disinfected, and the inmates re-vaccinated, there was no spread. In 40 houses there were 2 cases each; in 13 houses 3 cases; in 5 houses 4 cases; in 7 houses 5 cases; in 2 houses 7 cases. In several instances all the cases occurred before the existence of the disease became known; not seldom though the occurrence of a death. * " Admittance to the hospitals of the Asylums Board in the far-off days of 1871 was nominally restricted to persons in receipt of 'relief,' and was obtainable (in most districts) only by an order signed by the relieving officer, or the master of a workhouse, on the certificate of the ' parish doctor.' Nevertheless, the bulk of the patients were ' non-paupers,' the legal restrictions (notably in Kensington) having been wisely relaxed. Now, the hospitals are free to all, the sole condition precedent to admittance being the production of a medical certificate. In 1871 the hospitals were in London. Now, all patients are removed to the ships and the land hospitals out of London. Then, sick people often refused isolation; now, practically all avail themselves of the advantages offered by the hospitals. Hence the need for accommodation on a large scale; but, as it turned out, not to the extent provided. In 1871 the sick were generally removed in vehicles of a more or less unsatisfactory description, provided by the Guardians, and often driven by paupers, assisted by pauper ' nurses.' Practically no supervision was exercised, and the ambulances and their attendants were not infrequently responsible for the spread of disease. Now, the ambulance service provided by the Asylums Board, and whether by land or by water, leaves nothing to be desired. " Among the means now at the disposal of the Sanitary Authorities, enabling them to exercise effective control over infectious disease, the first place is held by Notification, the necessity for which had been urged in my annual report for 1871 (pages 15-16). This allimportant measure did not become operative in the Metropolis until 1889, despite the efforts of the sanitary authorities to obtain it, and which, under the lead of the late Vestry, date back to 1881. " A word must be said about Vaccination, which is still controlled by the Poor Law Authority. Efforts are being made to transfer the control to the 29 sanitary authorities. Personally, I am still of the same opinion as in 1877, when (in the annual report, page 15) I recommended transfer of the execution of the Vaccination Acts to the hospital authority— as did the Royal Commission in 1882. That infant vaccination was much neglected in 1871 was made evident by the fact that 46 (=38.3 per cent.) of the 120 deaths in Kensington were of children under five years of age, including 15 less than one year old. The statistics published in my report for 1871 (pages 17-19) furnish satisfactory evidence of the protective influence of vaccination and re-vaccination. It is all the more gratifying therefore to know that there is not in London a better vaccinated population than that of Kensington." * Full details with regard to this remarkable epidemic may be found in the Annual Report for 1871, pages 13-18. 34 MEASLES. Measles was the cause of 93 deaths, compared with 24, 98 and 77, in the three preceding years, the corrected decennial average being 82. All but four of the deaths occurred under five years of age, and 20 under one year. Eighty five of the deaths belong to the Town sub-district, and eight to Brompton. The deaths from this cause in London, as a whole, were 2,360, and 366 below the corrected decennial average (2,726). In the report for 1900, reference was made to a communication from the Public Health Committee of the County Council intended to elicit the opinion of the Council whether it was advisable that the County Council should include measles in the term " dangerous infectious disease," for the purposes set out in certain sections of the Public Health (London) Act, 1891 ? The sections specified relate (inter alia) to the exposure of infected persons and articles (68); the conveyance of infected persons in public conveyances (70); the casting of infected rubbish into ashpits (62); the disinfection of infected premises, articles and public conveyances (60, 61, 65 and 74); the letting of infected houses (63 and 74); and the removal to hospital of infected persons without proper lodging (66). In the last four-weekly report for 1900 I dealt with this matter, and in the early part of 1901 the Council, on the recommendation of the Public Health Committee, intimated to the County Council that they were in favour of the sections of the Act which prohibit the exposure in public places of persons suffering from an infectious disease, and the use of public vehicles for the conveyance of infected persons, being made applicable to measles. No further action had been taken in the matter to the end of 1902. SCARLET FEVER. The cases notified as scarlet fever were 372, compared with 443, 367, and 475, in the three preceding years successively; 237 in North Kensington and 135 in South Kensington. The deaths were 21 (6 below the corrected decennial average); 19 and 2 in the Town and Brompton sub-districts respectively. The case-mortality was 5.6 per cent. Seventeen of the deaths were of children under five years of age, and 19 took place in hospitals to which 311 cases were removed. The deaths in the three preceding years were 10, 4, and 15, respectively. The information as to scarlet fever mortality in the Borough—1856-1902—set out in Appendix II. (Tables B, C, D, pp. 153-154) shows the large reduction which has taken place in recent years. The deaths from scarlet fever in London, as a whole, were 563, compared with 398, 361, and 584, in the three preceding years, the corrected decennial average being 865. Of the 563 deaths 517, or 91.8 per cent., occurred in public institutions. The notified cases were 18,258, compared with 18,094, 13,809, and 18,390, in the three preceding years. The mortality was 3.1 per cent. on cases notified against 2.2, 2.6, and 3.2, in the three preceding years. The admissions to hospitals were 14,883 (against 13,641,10,734, and 14,159, in the three preceding years), or about 81.5 per cent. of cases notified. At the close of the year there were 2,327 cases under treatment in the hospitals, compared with 2,797, 2,460, and 3,080, at the corresponding period in the three preceding years. The case-mortality in hospitals was 3.5 per cent. The subjoined table shows the degree of prevalence of scarlet fever in the Borough, 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 1902. 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. January 25 35 1,412 29 1,150 4 55 2,658 February 22 30 1,220 27 982 1 51 2,406 March 22 28 1,235 18 1,016 4 36 2,185 April 19 30 1,168 25 1,011 1 41 2,155 May 17 34 1,266 28 1,067 4 43 2,207 June 14 22 1,388 17 1,191 — 43 2,347 July 12 30 1,360 28 1,181 — 40 2,352 August 9 20 1,599 18 1,408 — 46 2,591 September 6 26 1,411 24 1,227 1 45 2,713 October 4 35 1,545 33 1,364 2 38 2,749 November 1 38 1,721 32 1,462 2 43 2,869 November 29 18 1,482 16 1,242 30 2,761 January 3, 1903 (five weeks) 26 1,439 16 1,213 2 52 2,378 372 18,246 311 15,514* 21 563 The notifications are taken from the weekly returns of the Asylums Board ; the admissions to, and the numbers in, the hospitals, and the deaths in London, from the weekly returns of the Registrar-General. * Including cases of mistaken diagnosis. 35 For the sake of comparison, I subjoin the corresponding table for 1901, taken from the report for that year. Scarlet Fever in 1901. 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. January 26 26 819 19 678 — 35 2,078 February 23 18 722 15 627 2 22 1,834 March 23 23 719 18 606 1 26 1,598 April 20 18 765 12 702 1 27 1,526 May 18 31 1,528 26 1,289 — 46 2,052 June 15 32 1,497 24 1,295 1 73 2,594 July 13 47 1,718 36 1,464 — 50 2,918 August 10 56 1,639 46 1,442 — 55 3,148 September 7 44 1,360 36 1,212 3 55 2,994 October 5 48 2,210 42 1,770 — 49 3,157 November 2 49 2,240 42 1,651 — 56 3,391 November 30 44 1,692 37 1,455 3 38 3,278 December 28 39 1,478 30 1,218 4 52 3,137 475 18,387 383 15,409 15 584 Note.—Correction has not been made in the above tables for errors in diagnosis, either with respect to notifications or admissions to hospital. The following tables exhibit certain particulars of interest with respect to scarlet fever prevalence, &c., during 1902, and the ten preceding years, 1892-1901:— Scarlet Fever Cases Recorded in Kensington in 1902, 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. 1902 36 31 27 30 33 21 32 20 26 35 37 18 26* 372 1901 26 19 22 18 31 32 45 56 46 48 52 43 37 475 1900 32 26 28 28 20 22 32 21 23 25 41 31 35 364 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 Average 1892-1901 39.2 36.9 30.6 316 33.5 42.6 54.0 56.1 46.9 66.9 68.4 58.9 44.1 611† * Return comprises five weeks. † Without correction for increase in population. 36 Statistics of Scarlet Fever in Kensington in 1902, and in the Ten Preceding Years. The Year. No. of Recorded Cases. Total N umber 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 Hbspitals. At Home. In Hospitals. 1902 61 311 372 84 2 19 21 10 90 5.6 563 1901 92 383 475 81 4 11 15 27 73 3.2 584 1900 74 290 364 79 — 4 4 — 100 1.4 361 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 188 561 749 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 DIPHTHERIA. Cases of diphtheria and membranous croup to the aggregate number of 184 were notified, compared with 257, 332, and 250, in the three preceding years: 101 in North Kensington and 83 in South Kensington. The deaths registered were 20 (against 42, 27, and 38, in the three preceding years), and 39 below the corrected decennial average (59): 17 belong to the Town Sub-district, and 3 to Brompton ; 11 to North Kensington, and 9 to South Kensington. The mortality was 10.9 per cent. on cases notified. Twelve of the deaths took place in hospitals, to which 147 cases were removed—a case mortality of 8.2 per cent. Fourteen of the deaths were of children under five years of age, including one under one year. Detailed information in regard to diphtheria mortality in the borough—1871-1902—is set out in Appendix II., Tables B, C, and D, pp. 153-154. The deaths in London, as a whole (including those from membranous croup) were 1,181, and only slightly above a half of the corrected decennial average, 2,288; compared with 1,964,1,558, and 1,344, in the three preceding years. The notified cases were 10,735, compared with 13,701, 11,988, and 12,154, in the three preceeding years. In 1902, 8,086 cases were admitted to the hospitals* (compared with 8,777 and 9,090 in the two preceding years), and the deaths in hospital were 745, a case-mortality of 113 per cent. At the close of the year there were 927 cases under treatment in the hospitals, compared with 1,343 and 1,369, at the corresponding period in the two preceding years. • Including nearly 1,400 cases of mistaken diagnosis = 17 2 per cent. 37 The following table, based on the thirteen four-weekly reports, sets out some particulars with regard to diphtheria, in Kensington and in London :— Diphtheria in 1902. Report for four weeks ended No. of Notifications. No. of cases admitted to Hospital. No. of Deaths. No. of cases in Hospital at the end of the period. Kensington. London. Kensington. London. Kensington. London. January 25 20 895 17 671 3 111 1,238 February 22 11 867 6 650 2 112 1,235 March 22 9 839 8 605 — 111 1,120 April 19 18 819 17 598 4 96 1,092 May 17 17 832 16 598 — 102 1,035 June 14 9 774 6 574 — 58 957 July 12 18 790 14 604 1 61 954 August 9 18 892 14 712 1 93 1,054 September 6 7 730 7 561 1 68 1,007 October 4 17 740 12 575 5 79 971 November 1 16 807 14 615 — 85 954 November 29 9 837 4 633 — 88 1,031 January 3, 1903 (five weeks) 15 912 12 690 3 117 939 184 10,734 147 8,086 20 1,181 Note.—Correction has not been made in the above table for errors in diagnosis, either with respect to notifications or admissions to hospitals. Cases of membranous croup are included. The following table gives particulars with respect to diphtheria in North and South Kensington respectively. Particulars with Reference to Diphtheria in Kensington, in 1902. 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 (12 in Hospitals). North Kensington. South Kensington. North Kensington. South Kensington. January 25 20 10 10 9 8 1 2 February 22 11 5 6 4 2 1 1 March 22 9 4 5 4 4 ... ... April 19 19 11 8 10 7 2 2 May 17 17 15 2 15 1 ... ... June 14 9 8 6 3 3 ... ... July 12 18 9 9 9 5 1 ... August 9 18 10 8 8 6 ... 1 September 6 7 8 4 3 4 1 ... October 4 16 10 6 7 5 3 2 November 1 17 11 6 9 5 ... ... November 29 9 2 7 2 2 ... ... January 3, 1908 (5 weeks) 13 6 7 8 4 2 1 183 99 84 91 56 11 9 WHOOPING-COUGH. Whooping-Cough was the cause of 21 deaths compared with 59, 33, and 62, in the three preceding years; 16 in the Town sub-district, and 5 in Brompton; the corrected decennial average being 57. All but one of the deaths were of children under five years of age, including 9 under one year. The deaths in London, as a whole, were 1,880, and 281 below the corrected decennial average (2,161). * 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. 38 FEVER. Eighty cases of enteric fever were notified, compared with 107, 104, and 97, in the three preceding years. The deaths were 19 (two above the corrected decennial average); 18 in the Town sub-district and 1 in Brompton. Eleven of the deaths took place in hospitals, to which 47 cases were removed. The deaths from this cause in the three preceeding years were 23, 16, and 11, respectively. In fourteen of the cases there was ground for suspicion that the illness had been caused by the eating of shell-fish—oysters in twelve of the cases. The deaths in London, as a whole, were 585, and considerably below the corrected decennial average (657). The notifications were 3,412 (3,195 in, 1901): the admissions to hospitals 1806 (compared with 1,835, 2,074, and 1,480. in the three preceding years); and at the close of the year there remained 210 cases under treatment, against 406, 403, and 195, at the corresponding period of the three preceding years. No case of typhus fever occurred in the Borough during the year, and there was no death from this cause in the Metropolis; but four cases were notified. No deaths occurred in the Borough from simple continued fever; four cases were notified. The deaths and notifications in London, as a whole, were 5 and 48. DIARRHŒA. Diarrhœa was the cause of 78 deaths, compared with 101, 105, and 115, in the three preceding years: 74 in the Town sub-district and four in Brompton; the corrected decennial average being 101. Of these deaths, 61 occurred in the sixteen weeks July 13—November 1: viz., 10,22,19, and 10, in the successive four-weekly periods; 71 of the deaths were of children under five years of age, including 58 under one year. The deaths in London, as a whole, were 2,504, and 1,253 below the corrected decennial average (3,757): 2,292 of the deaths were of children under five years of age, including 1,934 of infants under one year old. This low death-rate was due to the cold and wet summer weather. The mean temperature in 1902 (48º8 Fahr.) was 1°5 below the average; the total sunshine in hours, 1,236; the highest proportion in the preceding ten years having been 1,708 hours in 1899, in which year the mean temperature was 50º6 Fahr. There being much uncertainty as to the actual number of deaths from true infantile epidemic diarrhœa, owing to loose certification of death in cases in which laxity of the bowels was present during the fatal illness, the Registrar-General issued to medical practitioners, last year, a memorandum on the subject, as follows:— "The Royal College of Physicians of London, in response to an earnest appeal for its authoritative guidance concerning the certificates of death from diarrhœa, has now expressed an opinion which, if loyally adopted by medical men throughout the country in granting certificates of death, will greatly improve the national records of mortality from this disease. The following is an extract from the proceedings of the College, dated January 25th, 1900: — 'The Royal College of Physicians is convinced, after careful inquiry:—(a) That various unauthorised and misleading terms, such as "gastro-enteritis" "muco-enteritis," "gastric-catarrh," etc., are now commonly employed to designate the disease officially known as "epidemic diarrhœa," whereby its specific character is in danger of being ignored, and great confusion ensues; (b) that the present confusion of terms renders it impossible to determine accurately either the prevalence of the disease in special places and at special times, the extent to which it influences the public health, or the effects produced by sanitary measures; (c) that there is a widespread objection on the part of medical practitioners to the employment of the term "diarrhœa" in certifying the cause of death, probably because the term is generally held by the public to imply a mild disease, insufficient by itself to cause death. 'The College, therefore, has sought to discover, as an alternative for the authorised term (epidemic diarrhœa), some other name, which, whilst equally accurate, should convey to the public the idea of a more serious affection. But the College regards it as essential that the idea of specificity, intended to be conveyed by the term "epidemic," should be retained. 'As the result of much deliberation, the College has agreed to authorise the use of the term "epidemic enteritis" (or, if preferred by the practitioner, "zymotic enteritis"), as a synonym for epidemic diarrhœa. The College has further decided to urge upon practitioners the entire disuse, in medical certificates of death, of such terms as "gastroenteritis," " muco-enteritis," or " gastric catarrh," as synonyms of epidemic diarrhœa.' 39 The advice in the memorandum has been followed to a fair extent by medical practitioners in the Borough during the past year, and it may be anticipated that in course of time the object of the Royal College and the Registrar-General will be attained. In this connexion it is interesting to note that in London as a whole, of the 2,504 total deaths from this cause 1,079 were certified as Epidemic Diarrhœa and Epidemic Enteritis, and 1,425 as Diarrhœa, Dysentery. INFLUENZA. Sixty eight deaths were registered from influenza, as compared with 103, 85, and 28, in the three preceding years: 47 in the Town sub-district, and 21 in Brompton. The deaths in London, as a whole, from this cause were 1,073, against 1,817, 1,950, and 664, in the three preceding years ; and 358 below the decennial average (1,431). OTHER "GENERAL DISEASES." Syphilis was the cause of 21 deaths, all but three in the Town sub-district: Gonorrhoea, Stricture of Urethra, of one. Puerperal Diseases were the causes of five deaths—between 15 and 35 years of age—four of them in the Town sub-district. Five deaths (four of them in the Town sub-district) were registered as having occured from accidents connected with childbirth. The deaths thus registered as having been caused by diseases and accidents associated with parturition (ten in all), were equal to 2.9 per 1,000 live births, compared with rates of 2.5, 6'7, and 3.1 per 1,000 in the three preceding years. Bearing in mind the disastrous series of cases of Puerperal Fever 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 since made it my duty to warn nurses, and other women concerned with these painful cases, of the responsibility they incur by attending parturient women until after a period of three or four weeks, and disinfection of their persons, clothing, etc. This course was adopted in respect of the cases notified in 1902 with satisfactory results, there having been no spread of the disease. Erysipelas was the cause of six deaths, all in the Town sub-district. The notifications of Erysipelas were 189, some of the cases being of traumatic origin, and others unimportant in character, such as the framers of the Act could scarcely have intended to be notified. Tuberculosis in its various forms was the cause of 310 deaths, as compared with 319, 306, and 314, in the three preceding years; 267 in the Town sub-district and 43 in Brompton; 59 of them under five years of age. Tubercular Phthisis (Pulmonary Tuberculosis) was accountable for 220 of the deaths; 188 and 32 in the Town and Brompton sub-districts respectively and 1.24 per 1,000 of the population. Tubercular Meningitis was the cause of 38 deaths; Tubercular Peritonitis of 9; General Tuberculosis of 3, and Scrofula (an objectionable term), of 40. The deaths from Tubercular Diseases were, proportionately to population, not so numerous in Brompton as the Town sub-district. The total deaths were in the proportion of 1.7 per 1,000 of the population. [Under the heading "The Prevention and Treatment of Consumption," further information on the subject of Tuberculosis will be found at page 49.] The deaths from Tubercular Diseases in London, as a whole, in 53 weeks, were 10,377, the corrected decennial average being 11,776. Of these deaths 7,621 were due to Phthisis, the corrected decennial average being 8,389. The death-rate from Phthisis in London, in 1902, per 1,000 persons living, was 1.64 (against 1.90, 1.79, and 1.71, in the three preceeding years), the rate in the several districts being West, 1.40 ; South, 1.52 ; North, 1.56 ; East, 1.85 ; Central, 2.13. Alcoholism, Delirium Tremens, was the cause of eleven deaths, six in the Town sub-district and five in Brompton. The deaths in London, as a whole, in 53 weeks, were 666, the corrected decennial average being 620. It is scarcely necessary, perhaps, to remark that if all the deaths due, directly or indirectly, to the immoderate use of intoxicating liquors were correctly certified, alcoholism would occupy a more prominent position in the bills of mortality; but many deaths due to the misuse of alcohol get certified, and are necessarily classified, to visceral and degenerative diseases caused or aggravated by drink. Rheumatic Fever, Acute Rheumatism, was the cause of 15 deaths, 13 of them in the Town sub-district. 40 Malignant Disease, Cancer, was accountable for 155 deaths; 113 in the Town sub-district and 42 in Brompton. Carcinoma was the registered cause in 55 cases, Sarcoma in 11, and Malignant Disease, Cancer, in 89. 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 129, 140, 143, 136, 173, 168, 193, 169, 152, and 185 respectively. The deaths in 1902 were equal to 8.73 per ten thousand living and to 5.6 per cent. of all deaths registered. Deaths from Malignant Disease are usually more numerous proportionately to population, in the Brompton sub-district than in the relatively poorer Town sub-district, Cancer being quite as prevalent, probably 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 124 of the deaths took place at ages above forty-five, and 20 between thirty-five and forty-five years. In London, as a whole, the deaths from Malignant Disease, Cancer, in 53 weeks, were 4,630, and 608 above the corrected decennial average. Premature Birth was the cause of 81 deaths, 70 in the Town sub-district and 11 in Brompton; Old Age of 116 ; 92 and 24 in the two sub-districts respectively: including 19 between 65 and 75 years, 63 between 75 and 85, and 33 at 85 years and upwards. LOCAL DISEASES. Nervous System. The Deaths from the diseases of this system were 146; 105 in the Town sub-district and 41 in Brompton—as compared with 291, 257, and 246, in the three preceding years—41 of them occurred under five years of age. Thirty-one of the deaths were due to Convulsions (an objectionable term), and 39 to diseases which, not being named specifically in the "New List," are classified to "Other Diseases" of the System. The number of deaths from the several "other diseases" are set out in Table VIII, page 135. Circulatory System. The deaths from Diseases of the Heart were 251; 187 in the Town sub-district and 64 in Brompton—as compared with 256, 227, and 236, in the three preceding years —3 of them under five years of age. The larger number of the deaths, 123, were registered from "Syncope, Heart Disease (not specified)." Valvular Disease was accountable for 69 deaths, Angina Pectoris for 13, Dilatation of Heart, 18, and Fatty Degeneration, 21. Diseases of Blood Vessels were the causes of 160 deaths, 127 in the Town sub-district and 33 in Brompton, including 66 from Cerebral Hemorrhage, Embolism, Thrombosis; and 65 from Apoplexy, Hemiplegia, diseases which generally connote cerebral hemorrhage. Respiratory System. The diseases of the Respiratory Organs (phthisis being excluded), were accountable for 626 deaths, 538 in the Town sub-district and 88 in Brompton—as compared with 672, 542, and 511, in the three preceding years. The principal causes were Bronchitis 297 deaths, and Pneumonia, in one or other of its forms, 172 deaths. The deaths under five years of age were 199, or 31.8 per cent. of the total number, as compared with 27.2, 31.5, and 32.9 per cent. in the three preceding years; and at 55 and upwards 281, or 44.9 per cent. against 47.5, 47.9, and 44.2 in the three preceding years. Bronchitis and Pneumonia were accountable for 469 deaths (including 187 under five years of age), of which 70 were registered in the Brompton sub-district. Digestive System. The diseases of the Digestive System were accountable for 161 deaths; 130 and 31 in the Town and Brompton sub-districts respectively; 45 of them under five years of age. The chief causes were Cirrhosis of the Liver 44 deaths, Other Diseases of the Liver and Gall Bladder 16 deaths, Intestinal Obstruction 19 deaths, and Enteritis 17 deaths. Urinary System. Eighty-one deaths were due to diseases of the urinary system: 67 and 14 in the Town and Brompton sub-districts respectively; Chronic Bright's Disease (Albuminuria), being the cause of 39 deaths, Nephritis (Acute) of 20, and Bladder and Prostate Disease of 14. DEATHS FROM VIOLENCE. Eighty-two deaths, including 27 under five years of age, and 14 under one year, were caused by violence : 66 belong to the Town sub-district, 16 to Brompton. Accident or Negligence occasioned 65 deaths: 58 in the Town sub-district, 7 in Brompton: 25 of them under five years of age, and 12 under one year. Fractures and Contusions were responsible for 36 deaths, Burn, Scald for 8, and Suffocation for 14—of which 9 were of infants under one year. 41 Homicide. One death was certified due to Manslaughter, and two, of infants in the first year, to Murder. Suicide accounted for 14 deaths, seven in each of the sub-districts; viz., from Gun Shot Wounds 3, Cut, Stab 2, Poison 3, Drowning 1, Hanging 3, "Otherwise" 2. Ill-defined and Not specified Causes of death were returned in 73 cases, 63 in the Town subdistrict and 10 in Brompton: 67 were certified due to Debility, A trophy, Inanition, 60 of them of infants under one year. DEATHS IN PUBLIC INSTITUTIONS. The only large public institution in which we are directly interested, is the borough infirmary and workhouse, situated in the Town sub-district. There are several minor public or quasi-public institutions, but, with one exception, they do not furnish occasion for special remark. The excepted institution is St. Joseph's House, Portobello Road, Notting Hill—a Roman Catholic Home for aged poor persons of both sexes, brought from various parts, largely from Ireland—but this is not classed by the Registrar-General as a public institution. The deaths of non-parishioners at the Marylebone Infirmary, Notting Hill (561), at the Brompton Consumption Hospital (74), and at St. Joseph's House (20), are excluded from our statistics, but will furnish occasion for a few remarks later on. The deaths of parishioners at the Parish Infirmary and Workhouse (528), at the Consumption Hospital (1), at St. Marylebone Infirmary (2), at St. Joseph's House (8), and at out-lying institutions, &c. (315), were 854, or 31.1 per cent. on total deaths; the percentage proportion of deaths in public institutions in the Metropolis, generally being 34.1; viz., 13,727 in workhouses and workhouse infirmaries; 2,866 in Metropolitan Asylums Board Hospitals; 9,373 in other hospitals, and 2,170 in public lunatic and imbecile asylums. The Registrar-General in his Annual Summary states that " about one in every six deaths occurred in a workhouse or workhouse infirmary, one in 29 in a Metropolitan Asylums Board Hospital, one in nine in some other hospital, and one in 38 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. The Borough 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, the causes of which are set out in the table below, were 528, compared with 603,476, and 497, in the three preceding years respectively, and were equal to 19.2 per cent., not far short of one-fifth, of all the deaths recorded in the borough. The quarterly numbers were 174, 118, 114, and 122: 296 deaths, therefore, occurred in the first and fourth or colder quarters, and 232 in the second and third or warmer quarters of the year. The deaths included 286 of males and 242 of females. The ages at death were:—Under one year, 61 (compared with 73, 58, and 66, in the three preceding years respectively); between one and sixty, 254 (compared with 309, 213, and 234, in the three preceding years), and at sixty and upwards, 213 (compared with 221, 205 and 197, in the three preceding years). SUMMARY OF CAUSES OF DEATH, 1902. DISEASES. Under 1 year. Between 1 year and 60 years. At 60 years and upwards. Total. Nervous System, Diseases of 2 20 18 40 Circulatory System, Diseases of — 32 40 72 Respiratory System, Diseases of 10 66 55 131 Digestive System, Diseases of 4 13 14 31 Urinary and Generative Systems, Diseases of — 11 16 27 Tubercular Diseases (including Marasmus) 12 88 7 107 Cancer — 5 18 23 Measles 6 3 - 9 Syphilis 8 4 - 12 Gangrene — — 7 7 Premature Birth 11 - - 11 Various other Diseases 8 12 6 26 Senile Decay — — 32 32 61 254 213 528 42 Six inquests were held; the cause of death was natural in four cases, and injury in some form in two cases. The Hospital for Consumption and Diseases of the Chest.—In the Kensington portion of the Brompton Hospital there were 75 deaths, including one of a parishioner. The remaining 74 deaths, of non-parishioners, are excluded from the borough statistics. St. Marylebone Infirmary, Notting Hill.—At this institution 563 deaths were registered, all of which, excepting two of parishioners, are excluded from the borough statistics. St. Joseph's House, Notting Hill.—The deaths at this quasi-public institution, with the exception of 8 of parishioners, are excluded from the borough statistics : they were 28 in number. Outlying Public Institutions.—The deaths of parishioners at public institutions etc., without the borough, which in the three preceding years had numbered 321, 283, and 321, respectively, were 315 in 1902. All of these deaths are included in the borough statistics. The deaths occurred at the several institutions as follows:— St. Mary's Hospital 48 St. George's Hospital 23 West London Hospital 21 Charing Cross Hospital 8 Middlesex Hospital 6 Westminster Hospital 6 St. Bartholomew's Hospital 3 St. Thomas's Hospital 3 King's College Hospital 2 Guy's Hospital 1 Western Hospital 27 North-Western Hospital 7 Grove Hospital 3 Long Reach Hospital 3 Northern Hospital 1 Hospital Ship "Atlas" 3 'Hospital Ship " Castalia" 3 Cancer Hospital, Chelsea 3 Brompton Hospital (south wing) 5 Children's Hospital, Paddington 12 Children's Hospital, Great Ormonde Street 2 Victoria Hospital for Children 2 French Hospital 3 Bethlem Hospital 3 Queen Charlotte's Hospital 3 Women's Hospital, Chelsea 2 Samaritan Free Hospital 1 Convent Hospital 1 Hospital for Women, Euston Road 1 Metropolitan Hospital 1 North-West London Hospital 1 Royal Free Hospital 1 St. Saviour's Hospital 1 Friedenheim 3 Hostel of God 1 Hostel of St. John and St. Elizabeth 2 St. Peter's Home 1 Home of the Guardian Angels, Charlotte Street 1 New Grove House 1 Holborn Workhouse 1 Fulham Infirmary 1 Paddington Infirmary 1 St. George's Infirmary 1 Banstead Asylum 18 Hanwell Asylum 15 Colney Hatch Asylum 10 Claybury Asylum 6 Manor Asylum, Epsom 6 Dartford Asylum 4 Cane Hill Asylum 4 Leavesden Asylum 3 Caterham Asylum 1 Darenth Asylum 1 Peckham House Asylum 1 293 Other 22 deaths occurred without the borough, viz.: two of females by drowning in the Thames and the Grand Junction Canal respectively; and one of a male in the Grand Junction Canal; five of males and one of a female in the streets; one each of a male on the railway, on a steamship, at Lord's Cricket Ground, and in Kensington Gardens; and seven of females and two of males on private premises. Deaths from diseases of the Zymotic class occurred at public institutions without the borough as follows:—Western Hospital, 26 (scarlet fever, 13; diphtheria, 8; enteric fever, 4; small pox, 1); North-Western Hospital, 7 (scarlet fever, 5; diphtheria, 1; enteric fever, 1); St. Mary's Hospital, 6 (diphtheria, 3; enteric fever, 2; diarrhœa, 1); Long Reach Hospital, 3 (small pox); Hospital Ship "Atlas," 3 (smallpox); Hospital Ship "Castalia," 3 (smallpox)', Grove Hospital, 3 (cnteric fever); Children's Hospital, Paddington, 2 (diarrhœa); Northern Hospital, 1 (scarlet fever); Westminster Hospital, 1 (enteric fever); Children's Hospital, Great Ormonde Street, 1 (diarrhœa); Claybury Asylum, 1 (diarrhœa); New Grove House, Hampstead, 1 (measles). UNCERTIFIED DEATHS. Only one death occurred in the borough that was "not certified," either by a registered medical practitioner or by a coroner: it was that of a male, aged 33, an out-patient at Brompton Consumption Hospital: the cause of death was phthisis. In England and Wales the deaths not certified were 1.8 per cent. of total deaths; the proportion in London was 0.3. The subject of uncertified deaths was considered, in the session of 1893, by a Select Committee of the House of Commons, appointed " to enquire 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 43 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 the first two were 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, so far, to give effect to the recommendations. INQUESTS. Two hundred and ten inquests were held on parishioners, including 39 at places without the borough, 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 101 cases. Twenty-eight inquests were held on the bodies of non-parishioners who had died in Kensington. All of the inquests in the borough were held at the coroner's court at the Town Hall. The causes of death may be classified as follows:— Deaths caused by disease 128 Deaths caused by violence (82), viz.: — Accidental 65 Suicidal 14 Manslaughter 1 Murder 2 — 82 Total 210 Of the 14 suicidal deaths, 7 belong to the Brompton sub-district and 7 to the Town subdistrict. The inquests on Kensington parishioners were in the proportion of 7.5 per cent. on total deaths, the rate in the Metropolis being 9.7 per cent.; in England and Wales the rate was 6.7 per cent. The relative percentages in 1901 were 8.8, 8.9, and 6.7, respectively. The deaths from violence (82) were equal to 0.46 per 1,000 of the population in Kensington; 0.73 per 1,000 in London, as a whole, and 0.63 per 1,000 in England and Wales. NOTIFICATION OF INFECTIOUS DISEASE. The most interesting event of the year, in connection with notification, was the temporary addition of chicken-pox to the diseases scheduled in section 55 (8) of the Public Health (London) Act, 1891. This action was taken consequent upon the receipt of a letter from the Local Government Board, in which it was suggested that the Council should consider the desirability of taking steps to add chicken-pox, either permanently or temporarily, to the list of notifiable diseases, the object proposed being to afford the Medical Officer of Health the means of detecting possible sources of small-pox infection, which "are at present disregarded, and are therefore uncontrolled;" "cases of small-pox not infrequently escaping detection owing to their being regarded merely as cases of chicken-pox." In this connexion I may remark that during the latter half of 1901, and prior to the receipt of the Board's letter, all known cases of chicken-pox in the borough—mostly reported by head-teachers of elementary schools—had been visited, but of the bulk of the cases no information was forthcoming. Upon receipt of the Board's approval of the Council's resolution making chicken-pox notifiable, the order was advertised in the local newspapers, as required by the Act, and a copy was sent, with an explanatory letter, to the several medical practitioners within the borough, in conformity with the provisions of section 56 (3). The order was limited to a period of six months from February 6th. Subsequently the London County Council obtained the approval of the Local Government Board to an Order applying the provisions of section 56 (6) to the entire Metropolis for a period of six months. The order, renewed on two subsequent occasions, expired on January 6th, 1903. The tables at pp. 45-48 show (1) the number of notifications of all the scheduled diseases in London in 1902; (2) the relative prevalence of the several diseases at different periods of the year, in Kensington and in London; (3) the notifications in the wards of the Borough, and (4) the caserate and the death-rate of infectious diseases in Kensington in the year 1902, and in the ten preceding years. 44 The Kensington notifications (including 669 of chicken-pox) were 1,608; viz., 1,373 in the Town sub-district, and 235 in Brompton. The notifications in the ten preceding years were 1,182, 1,811, 972, 1,289, 1,781, 1,457, 1,004, 1,046, 986 and 1,025. In 1902 the notifications, excluding chicken-pox, were 939, the lowest number in any year excepting 1890 (787), compulsory notification having come into force in October, 1889. Table XIV. (appendix, p. 146) shows the streets, etc., where cases of the scheduled diseases (some cases of Chicken-pox excepted) occurred. The cases notified in London were 71,790, including 25,708 of chicken-pox. Irrespective of that disease the number was 46,082, and 79 more than in 1901. The notifications of each of the diseases during the thirteen years 1890-1902 are set out in the subjoined table. Year. Small-pox. Chicken-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 2,877 35 237 206 4,598 550 25 7 29,795 1891 114 ... 11,398 5,907 3,372 27 152 221 4,764 505 23 39 26,522 1892 423 ... 27,096 7,791 2,465 20 147 347 6,934 565 54 7 45,849 1893 2,813 ... 36,901 13,026 3,663 22 205 397 9,700 668 86 4 67,485 1894 1,192 ... 18,440 10,655 3,360 21 162 253 6,080 535 21 2 40,721 1895 978 ... 19,757 10,772 3,506 14 105 236 5,660 451 29 3 41,511 1896 225 ... 25,638 13,361 3,189 6 102 278 6,438 446 13 3 49,699 1897 105 ... 22,876 12,811 3,113 4 65 264 5,801 388 38 1 45,466 1898 35 ... 16,917 11,561 2,032 17 55 250 5,180 310 23 — 37,380 1899 29 ... 18,112 13,363 4,460 14 69 329 5,615 338 15 — 42,344 1900 87 ... 13,812 11,788 4,309 7 73 237 4,776 210 5 — 35,304 1901 1,702 ... 18,387 11,967 3,193 20 48 250 4,604 187 3 — 40,361 1902 7,794 25,708 18,246 10,542 3,405 4 48 313 5,537 192 1 - 71,790 The Ages at Notification of certain of the diseases, in 1902, were as follows :— Age. Small-pox. Scarlet Fever. Diphtheria. Enteric l. Fever. Erysipelas. Puerperal . Fever. Chickenpox, from 1st February. 0—1 year 176 230 226 6 169 2,451 1—5 505 5,646 3,933 146 232 11,096 5— 647 6,972 3,437 398 207 9,199 10— 605 2,799 1,234 561 263 — 1,384 15— 864 1,152 612 536 327 12 375 20— 1,186 702 464 528 291 86 211 25— 1,934 570 536 719 758 152 188 35— 1,090 135 194 309 1,039 59 66 45— 492 33 62 140 1,037 2 25 55— 191 10 27 45 660 8 65 and upwards 106 3 5 18 551 — 4 Age not stated — — 1 1 2 — 2 7,796 18,252 10,731 3,407 5,536 311 25,009* Plague was made notifiable by the Local Government Board in 1901, but no case of the disease occurred in the Metropolis in that year or in 1902. 45 Cases of Infectious Disease notified in the several Metropolitan Boroughs in the Fifty-three Weeks ended Saturday, 3rd January, 1903.* Name of Borough. Small-pox. Chicken-pox. Scarlet Fever. Diphtheria. Enteric Fever. Typhus Fever. Other Continued Fevers. Puerperal Fever. Erysipelas. Membranous Croup. Cholera. Totals. Population. 1901. West. Kensington 95 669 372 183 80 ... 4 15 189 1 ... 1,608 176,628 Paddington 113 504 364 217 83 ... 1 14 148 6 ... 1,450 143,976 Hammersmith 101 637 853 182 51 ... 1 7 118 ... ... 1,450 112,239 Fulham 94 472 553 417 74 ... ... 7 124 12 ... 1,753 137,289 Chelsea 39 212 204 130 35 ... ... 7 60 3 ... 690 73,842 City of Westminster 232 742 473 282 132 ... 1 6 144 5 ... 2,017 183,011 North. St. Marylebone 155 475 414 235 96 .... ... 14 218 2 ... 1,609 133,301 Hampstead 20 422 255 97 46 ... 1 7 57 1 ... 906 81,942 St. Pancras 360 1,273 1,219 827 196 .. 3 13 259 9 ... 4,159 235,317 Islington 302 1,847 1,380 874 264 ... 5 19 364 8 ... 5,063 334,991 Stoke Newington 51 363 202 98 22 ... ... 1 52 1 ... 790 51,247 Hackney 423 1,495 882 709 185 ... 6 17 329 12 ... 4,058 219,272 Central. Holborn 219 228 203 116 40 ... ... 7 85 2 ... 900 59,405 Finsbury 211 706 391 237 82 ... 6 7 158 1 ... 1,799 101,463 City of London 39 85 83 94 15 ... 1 ... 82 3 ... 352 26,923 East. Shoreditch 442 755 250 223 150 ... 4 9 175 10 ... 2,018 118,637 Bethnal Green 515 863 529 310 132 ... ... 10 255 14 ... 2,628 129,680 Stepney 1,386 1,564 1,069 744 296 1 ... 22 448 35 ... 5,565 298,600 Poplar 633 847 670 461 209 ... ... 10 191 9 ... 3,030 168,822 South. Southwark 517 1,293 1,099 533 193 ... ... 10 371 5 ... 4,021 206,180 Bermondsey 224 904 506 280 13 1 1 6 190 3 ... 2,245 130,760 Lambeth 362 1,612 1,354 473 218 ... 11 17 337 15 1 4,400 301,895 Battersea 189 1,223 893 291 97 ... ... 15 200 3 ... 2,911 169,907 Wandsworth 131 1,440 1,081 751 145 1 1 21 243 7 ... 3,821 232,034 Camberwell 356 1,534 1,390 685 147 1 ... 15 309 8 ... 4,445 259,339 Deptford 145 1,261 648 264 74 ... ... 6 151 4 ... 2,553 110,398 Greenwich 102 812 468 180 68 ... ... 6 122 3 ... 1,756 95,770 Lewisham 88 824 663 400 60 ... 1 14 112 2 ... 2,164 127,495 Woolwich 236 645 279 244 61 ... 1 11 96 8 ... 1,581 117,178 Port of London 14 1 4 5 24 ... ... ... ... ... ... 48 Grand Totals 7,794 25,708 18,246 10,542 3,405 4 48 313 5,537 192 1 71,790 * The figures in this and the following table collated from the Asylums Board's weekly returns differ slightly from the revised returns issued by the Registrar-General as shown in the table at foot of page 44. 46 Table showing the number of Cases of Infectious Disease Notified in Kensington, and in London, in 1902: Arranged in four-weekly periods. Weeks of the Year. KENSINGTON. LONDON. Weeks of the Year. Date of Report. For FourWeeks endedvv Date of Report. For Four Weeks ended Small-pox. Chicken-pox. Scarlet Fever. Diphtheria. Enteric Fever. Typhus Fever. Other Continued Fevers. Puerperal Fever. Erysipelas. Croup. Cholera. Total. Small-pox. Chicken-pox. Scarlet Fever. Diphtheria. Enteric Fever. Typhus Fever. Other Continued Fevers. Puerperal Fever. Erysipelas. Croup. Cholera. Total. January 25 1- 4 13 ... 35 20 7 ... ... 2 19 ... ... 96 960 547 1,412 878 176 ... ... 37 420 17 ... 4,447 1-4 January 25 February 22 5- 8 11 65 30 10 4 ... 1 ... 12 1 ... 134 1,510 1,483 1,220 841 162 ... 2 27 374 26 ... 5,645 5- 8 February 22 March 22 9-12 15 49 28 9 1 ... ... 2 11 ... ... 115 1,663 2,388 1,235 827 149 ... 2 15 328 12 ... 6,619 9-1 March 22 April 19 13-16 12 25 30 18 1 ... 1 ... 12 ... ... 99 1,241 1,795 1,168 807 101 1 3 17 318 12 ... 5,463 13-16 April 19 May 17 17-20 11 24 34 17 3 ... 1 1 12 ... ... 103 893 2,190 1,266 812 172 1 4 26 352 20 ... 5,736 17-20 May 17 June 14 21-24 20 46 22 9 5 ... ... 2 14 ... ... 118 905 3,430 1,388 758 211 ... 3 18 32 16 ... 7,101 21-24 June 14 July 12 25-28 8 91 30 18 12 ... ... 4 15 ... ... 178 352 3,112 1,360 783 318 ... 6 22 32 7 1 6,353 25-28 July 12 August 9 29-32 4 60 20 18 8 ... ... 2 12 ... ... 124 139 1,488 1,599 882 346 1 9 18 36 10 ... 4,858 29-32 August 9 September 6 33-36 1 33 26 7 4 ... ... ... 19 ... ... 90 73 1,088 1,411 718 319 ... 5 19 497 12 ... 4,142 33-36 September 6 October 4 37-40 ... 25 35 17 11 ... ... ... 7 ... ... 95 18 785 1,545 731 467 ... 4 27 459 9 ... 4,045 37-40 October 4 November 1 41-44 ... 57 38 16 2 ... 1 1 17 ... ... 132 14 1,539 1,721 793 427 1 5 33 537 14 ... 5,084 41-44 November 1 ,, 29 45-48 ... 87 18 9 6 ... ... ... 16 ... ... 136 14 2,559 1,482 824 277 ... 1 21 560 13 ... 5,751 45-48 „ 29 Jan. 3,1903 Five weeks) 49-53 ... 107 26 15 16 ... •••' 1 23 ... ... 188 12 3,304 1,439 888 280 ... 4 33 562 24 ... 6,546 49-53 Jan. 3 1903 (Five weeks) Totals 95 669 372 183 80 ... 4 15 189 1 ... 1,608 7,794 25,708 18,246 10,542 3,405 4 48 313 5,587 192 1 71,790 Totals. 47 (Required by the Local Government Board to be used in the Annual Report of the Medical Officer of Health. Cases of Infectious Disease notified during the Year, 1902. Notifiable Disease. Cases Notified in Kensington. Total Cases Notified in each Sub-District. Number of Cases removed to Hospital from each Sub-District. At all Ages. At Ages—Years Kensington Town. Brompton. Kensington Town. Brompton. Under 1 1 to 5. 5 to 15. 15 to 25. 25 to 65. 65 and upwards Small-Pox 95 2 1 14 29 49 ... 87 8 83 8 Cholera ... ... ... ... ... ... ... ... ... ... ... Diphtheria 183 2 67 59 28 26 1 144 39 121 26 Membranous croup 1 1 ... ... ... ... ... ... 1 ... ... Erysipelas 189 3 9 16 17 121 23 171 18 3 1 Scarlet fever 372 3 105 175 58 31 ... 308 61 264 47 Typhus fever ... ... ... ... ... ... ... ... ... ... ... Enteric fever 80 ... 1 28 20 29 2 65 15 44 3 Relapsing fever ... ... ... ... ... ... ... ... ... ... ... Continued fever 4 ... ... 3 ... 1 ... 4 ... 2 ... Puerperal fever 15 ... ... ... 2 13 ... 12 3 ... 1 Plague ... ... ... ... ... ... ... ... ... ... ... Chicken Pox 669 56 273 297 26 17 ... 582 87 6 ... Totals 1,608 67 456 592 180 287 26 1,373 235 523 86 Table showing the Notifications, in 1902, in the Borough, the Sub-Districts, the Parliamentary Divisions, and the Wards. Area. Small-pox. ' Chicken-pox. Scarlet Fever. Diphtheria. Enteric Fever. Continued Fever. Puerperal Fever. Erysipelas. Croup. Totals. Population. Notifications per 1,000 of the population. The Borough 95 669 372 183 80 4 15 189 1 1,608 177,500 9.1 Sub-Districts— Kensington Town 87 582 308 144 65 4 12 171 1,373 128,660 10.7 Bromptom 8 87 64 39 15 ... 3 18 1 235 48,840 4.8 Parliamentary Divisions— North Kensington 81 481 239 99 58 4 11 149 ... 1,122 91,510 123.3 South Kensington 14 188 133 84 22 ... 4 40 1 486 85,990 5.7 Wards— North K. St. Charles 10 104 66 22 13 ... 1 36 ... 252 22,060 11.4 Golborne 27 177 102 41 22 2 3 49 ...... 423 26,440 160 Norland 27 101 36 19 9 2 5 40 ... 239 23,580 10.1 Pembridge 17 99 35 17 14 ... 2 24 ... 208 19,430 10.7 South K. Holland 2 54 41 29 6 ... 1 8 ... 141 20,500 6.9 Earl's Court 1 34 27 14 7 ... ... 2 ... 85 18,140 4.7 Queen's Gate 5 29 22 14 1 ... 1 14 ... 86 14,340 6.0 Redcliffe 4 47 27 20 3 ... 1 9 1 112 18,790 6.0 Brompton 2 24 16 7 5 1 7 ... 62 14,220 4.4 48 TABLE V.* Comparison of Prevalence of Sickness and Death from Infectious Diseases. (Rates calculated per 1,000 persons on the population estimated to the middle of each year.) Year. Small-pox. Erysipelas. Diphtheria and Membranous Croup. Scarlet Fever. Typhus Fever. Enteric and Continued Fever. Puerperal Fever. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. 1892 o.oo 0.00 1.15 0.06 1.15 0.18 4.28 0.21 0.02 o.oo 0.36 o.1o 0.02 0.05 1893 0.57 0.05 1.63 0.10 2.19 0.49 5.69 0.30 0.00 o.oo 0.64 0.10 0.05 0.06 1894 0.11 o.oo 1.09 0.02 1.65 0.44 2.31 0.13 o.oo o.oo 0.58 0.14 0.05 0.03 1895 0.05 o.oo 1.59 0.05 2.23 0.53 3.10 0.16 o.oo o.oo 0.61 0.09 0.04 0.02 1896 0.07 0.00 1.63 0.02 2.18 0.42 5.95 0.23 0.00 0.00 0.59 0.09 0.05 0.04 1897 0.00 o.oo 1.39 0.05 1.94 0.48 4.33 0.17 0.00 0.00 0.74 0.13 0.09 0.03 1898 o.oo o.oo 1.05 0.04 1.29 0.15 2.75 0.13 0.05 0.01 0.63 0.07 0.06 0.03 1899 o.oo o.oo 1.22 0.05 1.49 0.24 2.57 0.06 o.oo o.oo 0.72 0.13 0.06 0.03 1900 0.03 o.oo 0.92 0.05 1.92 0.16 2.12 0.02 o.oo o.oo 0.66 0.09 0.05 0.03 1901 0.08 o.oo 0.95 0.03 1.41 0.21 2.68 0.08 0.01 o.oo 0.59 0.06 0.05 o.o1 1902 0.53 0.06 1.06 0.03 1.04 0.11 2.09 0.12 0.00 0.00 0.47 0.11 0.08 0.03 * This table is recommended for use by the Society of Medical Officers of Health, as a record of "the frequency and mortality of infectious diseases in the whole district for a series of years." * 49 THE PREVENTION AND TREATMENT OF CONSUMPTION: SANATORIA. Matters relating to the prevention and treatment of tuberculosis continue to engage public and medical attention in a high degree. The National Association for the Prevention of Consumption continues its beneficent work of diffusing information as to the nature and cause of the disease, and the measures necessary for its prevention and cure, and in many parts of the country sanatoria for open air treatment have been established. The Kensington Sanitary Authority have since the establishment of the Association taken interest in its objects, as testified by the many references to the subject in my reports, from the first in 1899. In that year, in a draft report for the Sub-Committee of the Sanitary Committee of the late Vestry, appointed to consider the subject, I recommended among other means for prevention and cure of consumption, the "provision of a hospital or hospitals, or other arrangements to enable poor consumptive persons to be isolated and treated under the best attainable conditions." Power in this respect is given by Section 75 of the Public Health Act, 1891, which reads:— (1) Any sanitary authority may provide, for the use of the inhabitants of their district, hospitals, temporary or permanent, and for that purpose may— (a) Themselves build such hospitals, or (b) Contract for the use of any hospital or part of a hospital, or (c) Enter into any agreement with any person having the management of any hospital for the reception of the sick inhabitants of their district, on payment of such annual or other sum as may be agreed upon. (2) Two or more sanitary authorities may combine in providing a common hospital. The report of the Sub-committee, as modified by the Committee, having been adopted and referred back for the preparation of a "detailed scheme for giving effect to the suggestions embodied therein," I advised the preparation and circulation of an instructional leaflet; disinfection of infected houses, voluntary notification, and enforcement of the law for the prevention of overcrowding, and the abatement of other nuisances, with a view to secure healthy homes for the working classes. The leaflet was prepared and circulated but no further action was taken. In the first report in 1900 the subject was again dealt with. The Local Government Board had refused an application by the Kensington Guardians for authority to provide additional accommodation at the workhouse, there being already a sufficient number of persons housed on the site; and as the needed accommodation could have been obtained by removal of consumptive inmates to a separate establishment in the country, I called the attention of the Guardians to the action taken by certain provincial Boards "to secure separation of consumptives from other sick persons," and recommended that, alone or in combination with other Poor Law Authorities, they should adopt this plan. Subsequently the Guardians fitted up and set apart a sunny south ward for the treatment of tuberculous women and children, 24 in number, which was brought into use in November, 1900. In July, 1901, a ward for men was opened, but proving inadequate for the number in need of isolation and treatment, the Guardians decided to allocate two wards, with accommodation for forty persons, in the new infirmary, for the separate classification and treatment of this class of patients. In October, 1900, a Conference of Metropolitan Poor Law Authorities was held at St. Martin's Hall "to consider the question of establishing hospitals for the open-air treatment," at which the following resolution was unanimously adopted by the 77 delegates representing 26 out of the 32 Boards of Guardians :— "That this Conference of Poor Law Authorities, having discussed the question of the open-air treatment of consumption, are of opinion that the time has come when provision should be made for the treatment by this method of the sick poor of the Metropolis suffering from phthisis, and it recommends the matter for the consideration of the Local Government Board, with a view to the necessary steps being taken by that Board for the carrying out of the proposal." A deputation appointed to bring the matter before the President, designated the Metropolitan Asylums Board as the most suitable Authority for providing the desired accommodation. No action, however, was taken—a remarkable fact, seeing that correspondence read at the Conference showed that the Local Government Board were in sympathy with the proposal to provide for the open air treatment of phthisis; had intimated their opinion that such provision, if made, should be for the Metropolis as a whole, and under the management and control of a Metropolitan Authority, and with this view had suggested the holding of a Conference of the Metropolitan Poor Law Authorities. 50 In 1901 certain communications on the prevention of consumption addressed to the Council were referred by the Public Health Committee to a Sub-committee, whose report, unanimously adopted by the Committee and by the Council, was printed in my annual report for that year (page 39). The Committee reported the resolutions of the Congress on Tuberculosis, held in 1901, which recommended :— (1) Voluntary notification of cases of consumption attended with tuberculous expectoration— the main agent for the conveyance of tuberculosis from man to man; (2) The supply to consumptives, by hospitals and dispensaries, of pocket spittoons, with a view to the suppression of the dangerous habit of indiscriminate spitting; (3) The supply to consumptives, by these institutions, of printed instructions with regard to the prevention of consumption. (4) The provision of sanatoria as an indispensable part of the measures necessary for the nution of tuberculosis; and (5) The provision of anti-tubercular dispensaries, as the best means of checking tubercular disease among the industrial and indigent classes. Premising that time would be required for giving effect to the recommendations, the Committee, as regarded action by the Council, recommended:— 1. (a) The adoption of a system of voluntary notification by medical men of cases of tion attended with tuberculous expectoration. (6) Payment to medical men of the customary fee for notification of such cases; and (c) An arrangement for bacteriological examination of expectoration suspected to be tuberculous. 2. The further circulation of the leaflet on " The Prevention of Consumption." (See Minutes of the late Vestry, June 14th, 1899, page 206.) 3. (a) The appointment of an assistant disinfector; and (6) Disinfection of houses after the occurrence of fatal cases of consumption, and after the removal of consumptives. 4. An appeal to the Local Government Board to give effect to the opinion of the Conference of Poor Law Authorities (above cited). The report concluded by stating, as "evidence of the importance of the subject, that in Kensington consumption alone—apart from all other diseases of the tubercular class—destroys, year by year, very many more lives than small-pox, scarlet fever, diphtheria, and 'fever' combined;" the fact being that in the three years 1898-1900 the deaths from these diseases aggregated 183, only whereas the deaths from consumption were 210 in 1900 alone. The Committee's report having been unanimously adopted by the Council, November 13th, 1901, a letter was addressed to the Local Government Board urging the desirability of steps being taken for giving effect to the resolution of the Conference of Poor Law Authorities, but nothing more than a formal acknowledgment was received. Steps were taken to give effect to a scheme of voluntary notification of Phthisis, which came into operation on January 1st, 1902. Memoranda on the "Cause and Prevention of Consumption" and "Precautions for Consumptive Persons" were prepared for the information and guidance of sufferers; and, together with the Council's leaflet on "The Prevention of Consumption," the National Association's leaflets on "Ventilation" and "Disinfection" have been given to the consumptive person, or the head of the family, in every case visited by the lady inspectors, to whom this duty was entrusted. Disinfection of rooms, offered always after a change of residence, or death, of a consumptive person, has been generally accepted. Action by Sanitary Authorities.—In the eleventh report, 1902 (November 6th, page 202), reference was made to the proceedings of the Bermondsey Borough Council, who in April had addressed a letter to the Asylums Board requesting them to provide Sanatoria.* An epitome of the replies to a communication sent to the other Borough Councils, inviting them to make similar representations to the Managers, and to the Local Government Board, was appended to the letter. * Similar communications were addressed to the Managers by the Chelsea, Holborn, and Poplar Boards of Guardians. 51 In the same (eleventh) Report it was pointed out that the time was favourable for action by the Managers. The small-pox epidemic was at an end, and there was no longer any use for the hospital accommodation so lavishly provided for sufferers from that disease. I suggested, therefore, that some of the buildings might be turned to profitable use as hospitals for consumptives, thus "avoiding, for the present and the immediate future, the outlay that would be involved should the Managers be called upon to provide special hospitals for the purpose." "If these hospitals" (the report continued) "should not be employed for the purpose, they are likely to lie idle; for, if history should repeat itself, it may be many years before the Managers will want them for small-pox." It was shown that "the yearly admissions to the hospitals during the fifteen years 1886-1900, inclusive, exceeded, or approached, 1,000 in any one year on only three occasions,* the largest number of patients in hospital at any one time, in any year, being only 533, in 1893. For such a number, Long Reach Hospital and the Ships (550 beds) would provide. Even in the late epidemic not more than 1,600 beds were occupied at any one time, whereas the accommodation provided, or shortly to be provided, including the as yet unfinished permanent hospital at Joyce Green, would shortly aggregate 4,000 beds." The report was referred by the Council to the Public Health Committee, by whose direction a letter was addressed by the Town Clerk to the Local Government Board (December 4th) as follows:— "Sanatoria for Consumption.—This Council and their Public Health Committee have recently had submitted to them a report by the Medical Officer of Health of this Borough (Dr. T. Orme Dudfield), urging the desirability of the unused accommodation provided, and in course of provision, by the Metropolitan Asylums Board, at the Orchard and Joyce Green Hospitals† for small-pox cases, being utilised for the treatment of persons suffering from consumption, and concur in the opinion of the Medical Officer of Health therein expressed, "In this connection I am to point out that on the 24th December, 1901, the Council of this Borough addressed a letter to the Local Government Board, earnestly representing the desirability of steps being taken ' to give effect to the resolution of the Conference of Poor Law Authorities, held on the 15th October, 1900, to the effect that the said Conference, having discussed the question of open-air treatment of consumption, were of opinion:— "'That the time has come when provision should be made for the treatment by this method of the sick poor of the Metropolis suffering from phthisis, and it recommends the matter for the consideration of the Local Government Board, with a view to the necessary steps being taken by the Board for the carrying out of the proposal.' "The above resolution was presented to the President by a deputation who, it was understood, also commended to the favourable consideration of the Board the view that the Metropolitan Asylums Board should be the authority for providing hospital accommodation for the purpose. "In the letter adverted to, it was stated that the Council felt assured that the Board would agree with them as to the desirability of provision being made, with the least practicable delay, and by some central authority, of sanatoria for the open-air treatment of consumptive persons chargeable to the rates in the Metropolis. " The Authority the Council had in view was the Asylums Board. "The matter has since been taken up by many of the Metropolitan Borough Councils (notably the Councils of Chelsea and Bermondsey), who have addressed communications to the Managers, requesting them to undertake the provision of sanatoria; and the Managers have stated that they would be prepared to consider the question should there be a general consensus of opinion amongst the several Metropolitan Local Authorities favourable to the suggestion. "A copy of the report of the Medical Officer of Health, above referred to, is enclosed herewith; and the Council desire to invite the attention of the Local Government Board to the suggestion contained therein, which they think deserving of serious consideration, that some of the small-pox hospitals might be used, during inter-epidemic periods, for the reception and treatment of consumptive persons chargeable to the rates. * The admissions were as follows:— The Year. Admissions. 1886 99 1887 56 1888 62 1889 5 1890 22 The Year. Admissions. 1891 63 1892 325 1893 2,376 1894 1,117 1895 941 The Year. Admissions. 1896 190 1897 70 1898 5 1899 18 1900 66 † It will be seen subsequently that the Gore Farm Hospitals were found to be more suitable for the purpose. 52 "The Council think it desirable that advantage should be taken of the opportunity afforded by the surplus accommodation which is understood to exist, of making an experiment which they believe would be fruitful of good, by using a portion of such surplus accommodation for consumptives who at present are treated in the Infirmaries under conditions more or less unfavourable, and inimical to the welfare of the other sick poor, with whom, in many instances, they are unavoidably mingled in the wards. "The Council desire to express their earnest hope that the Local Government Board will see their way to advise the Metropolitan Asylums Board to make trial of the plan above outlined, so that before a large expenditure be incurred in building special sanatoria for consumptives, further experience of the benefits expected to accrue therefrom may be obtained." A communication in similar terms was addressed to the Metropolitan Asylums Board; the letter moreover was sent to the Borough Councils and Boards of Guardians, who were invited to support the Council's proposal. And, lastly, a communication was addressed to the Council of the National Association for the Prevention of Consumption as follows:— "Sanatoria for Consumption.—In October, 1900, a Conference of Metropolitan Poor Law Authorities was convened with the approval, if not at the instance of the Local Government Board, to consider the question of establishing hospitals for the open-air treatment of consumption. "The Conference unanimously adopted a resolution to the effect— That the time has come when provision should be made for the open-air treatment of the sick poor of the Metropolis suffering from consumption, and the Conference recommends the matter for the consideration of the Local Government Board, with a view to the necessary steps being taken by that Board for the carrying out of the proposal.' "A deputation was appointed to present the resolution, and to bring the matter generally to the attention of the President of the Board. "In December, 1901, the Council, when informing the Local Government Board that they had decided to make consumption a disease voluntarily notifiable within the Royal Borough, took occasion to recall to the Board's attention the action of the Conference, and to urge the desirability that, with the least practicable delay, provision should be made by some central authority of sanatoria for the open-air treatment of consumptive persons chargeable to the rates in the Metropolis. "Hitherto, however, no steps have been taken to give effect to the views of the Conference; that is to say, no accommodation without the Metropolis has been provided for the purpose. "The attention of the Council has recently been called, by their Medical Officer of Health, in a report, a copy of which is enclosed herewith, to the extensive hospital accommodation which has been provided by the Metropolitan Asylums Board for small-pox, and the Council endorse the suggestion made by their Medical Officer that a portion of any surplus accommodation might be utilised with advantage, during inter-epidemic times, for the treatment of consumptives. "In this connection it may be mentioned that several of the Borough Councils have, at various times, invited the Asylums Board to assume the position of Hospital Authority for Consumption, and the Managers have stated that the question of providing Sanatoria was one which they would be prepared to consider should there be a general consensus of opinion in its favour amongst the several Metropolitan Local Authorities. "I am directed to invite consideration of the subject by the Council of the National Association for the Prevention of Consumption, and to request them, if they agree with the views above set out, to take such steps as they may deem advisable to promote a scheme for the utilisation of the hospitals for the treatment of poor persons suffering from consumption. "For the information of the Council of the Association I enclose a copy of a communication which this Council have addressed to the Local Government Board on the subject, and may add that a letter in almost identical terms has also been forwarded by them to the Metropolitan Asylums Board." The Council of the Association approved these views, and, after an interview I had with them, and an inspection of the Gore Farm Hospitals by their expert representative, the Secretary addressed a communication to the Local Government Board (and to the Asylums Board also) in support of the Council's proposals as follows:— "I am directed by the Council of the National Association for the Prevention of Consumption to state, for the information of the Local Government Board, that they hav3 recently received a communication from the Council of the Royal Borough of Kensington, urging the desirability of utilising as sanatoria for persons suffering from consumption, one or both of the hospitals at Gore Farm now empty of small-pox patients. 53 " The site and buildings have been inspected by a representative of the Council, who reports favourably on their suitability for the purpose. " In regard to this matter I am directed by my Council to say that they feel, very strongly, the accommodation for advanced consumptives among the working classes and poor of London is entirely inadequate; and they beg to invite your attention to a resolution passed at a Conference of the various Boards of Guardians and Poor Law Authorities in the Metropolis, held at St. Martin's Town Hall, on October 15th, 1900, viz.: — " ' That this Conference of Poor Law Authorities, having discussed the question of the open-air treatment of consumption, is of opinion that the time has come when provision should be made for the treatment, by this method, of the sick poor of the Metropolis suffering from phthisis, and it recommends the matter for the consideration of the Local Government Board with a view to the necessary steps being taken by that Board for the carrying out of the proposal.' " Under these circumstances, my Council naturally feel that a great purpose would be served if the hospitals at Gore Farm could be utilised for the accommodation of cases of advanced consumption. " While my Council recognise that the Metropolitan Asylums Board are obviously in the best position to determine whether or not these hospitals may be available for such a purpose, they would respectfully point out that the evidence on the subject of small-pox and infectious diseases generally leads them to hope that this may be the case. " It appears improbable that the Gore Farm Hospitals will be wanted for small-pox in the near future, if ever again; and at no distant time an additional hospital for convalescent fever patients will be provided at Carshalton. " The Council understand that the proposal cannot be carried into effect without legislation, but, believing that it would be for the public interest were the suggestion adopted, they hope that the President, as a preliminary measure, may be pleased to take the steps necessary to obtain an Act to enable the Board, when they shall see fit, to make an order authorising the Managers of the Metropolitan Asylum District to undertake the care and treatment at their hospitals of persons suffering from consumption. " The need for more accommodation for advanced consumptives, who at present remain in their homes and infect others, is a pressing one. " The enclosed pamphlet on ' Homes for Advanced Consumptives," just issued by the Association, will, I venture to think, be of some interest to you, as bearing on the whole question." Many of the Public Health Authorities (and some Boards of Guardians) expressed their concurrence with the views of the Council, having addressed communications to the Local Government Board and the Metropolitan Asylums Board in support thereof. Only three expressed dissent: others offered no opinion on the subject. In July, 1902, the Managers referred the Bermondsey and other letters from Sanitary Authorities to the General Purposes Committee, who, on November 24th, reported thereon as follows:— " We have given due considerati on to the whole question, but having regard to the important issues involved, and to the fact that there is not yet a general consensus of opinion amongst the Metropolitan authorities in favour of the Metropolitan Asylums Board undertaking the treatment of consumptive patients, we have deferred consideration of the matter for twelve months." The report, submitted to the Managers at their meeting held on the 29th November, was adopted, apparently, without discussion. It is almost unnecessary to say that the communications dealt with by the Committee contemplated the erection of specially constructed sanatoria, a course which would involve a very large expenditure: whereas the course approved by the Council would have entailed a comparatively moderate outlay by the way of adaptation of the sick wards, etc., at existing hospitals. The Council's letter, of December 4th, was considered by the Managers on the 13th December, in connection with a motion of which notice had been given, to the effect— " That the Hospitals Committee be instructed to consider and report to the Board as to whether any, and, if so, what, arrangements can be made for the treatment of consumptive persons in any of the establishments under their control.' 54 The motion was lost, and the Board ordered— " That the Kensington Borough Council, and the Chelsea, Holborn, and Poplar Guardians be informed that in the absence of unanimity of opinion among the authorities of the Metropolis the Board has adjourned for twelve months the question of the provision of accommodation for persons suffering from consumption." In the last report for 1902, commenting on this decision, I reminded the Council that the Managers, as to three-fourths of their number, are the nominees of the Boards of Guardians, and that the representatives of those bodies had well considered the subject at the conference held in 1900. At that conference, as already stated, 26 boards, out of 32 in the metropolitan district, were represented by 77 delegates, who, by an unanimous resolution, declared that the time had come when provision should be made for the open-air treatment of " the sick poor " (that is the pauper sick) of the Metropolis, suffering from consumption: it could hardly be said, therefore, so far as the "authorities" who elect the Managers are concerned, that there was not a general consensus of opinion in favour of the Board undertaking the duty. The matter, moreover, is one that primarily concerns the Poor Law authorities; and the importance of it will be understood when it is stated that the Medical Inspector of the Local Government Board, who was present, unofficially, at the conference, informed the delegates that on July 7th, 1900, there were 1,562 consumptive patients in "Metropolitan institutions" (Workhouses and Infirmaries), of whom 1,000 could be moved to a sanatorium or sanatoria within fifty miles of London ; and, of these, 400 were in the initial (and therefore curable) stages of the disease. In the same report (No. 13, 1902, page 229), I further observed that it was "a terrible reflection that there should be so many sufferers in unsuitable institutions in London— a misery to themselves and a danger to their fellow inmates—who might be transferred to sanatoria in the country, where beyond question, many would be restored to health and usefulness, and all would cease to be a danger to other persons.*" The report continued as follows : " If the Boards of Guardians share the views of their delegates, it is to be hoped that they will ere long approach the Local Government Board, and instruct the Managers, who represent them to take steps to obtain power enabling them to undertake the proposed duty. The Managers are known to be willing to do so—but it is unfortunate that they are unwilling to take the initiative, preferring to await the mandate of their constituents. The Sanitary Authorities, it need hardly be said, are not represented on the Board. " The work cannot be undertaken without legislation; excepting, perhaps, for the poor in receipt of relief, under Section 5 of the Metropolitan Poor Act, 1867. The Local Government Board would be the proper authority to introduce a Bill. They appear to be favourable to the proposal, and probably only wait for a clear indication of the views in its favour, of the Sanitary and Poor Law Authorities. The Conference, it may be repeated, was convened with the approval of the Board, if not at their instance.† " The Asylums Board, appointed under the Metropolitan Poor Act, 1867, for the purpose (inter alia) of providing hospitals for ' the sick poor' (i.e., the pauper sick) of the Metropolis, were originally authorised to provide such accommodation for ' small-pox and fever' only. Subsequently, and as the result of a movement in which the late Vestry took no secondary part, the Managers were enabled by Parliament to receive cases of diphtheria into their institutions, and, further, to ' admit any person who is not a pauper,' suffering from either of the diseases named. " These powers were conferred by The Poor Law Act, 1889, Section 3 of which reads as follows: — 3. (1) The managers of the metropolitan asylum district (hereinafter referred to as the asylum managers), subject to such regulations and restrictions as the Local Government Board from time to time make, may admit any person who is not a pauper, and is reasonably believed to be suffering from fever or small-pox or diphtheria, into an asylum provided by the managers. * " The fight with tuberculosis , . , must aim at shutting off the chief, indeed we may say almost the only, source of infection. This is those consumptives who, in consequence of the unfavourable conditions under which they live, or because they obstinately set aside the simplest rules for the prevention of infection, are a danger to their companions In some way or other we must look after these sick people, either by procuring for them more favourable conditions ; for example, as regards dwelling-places, or by so sheltering them in suitable institutions that they cease to be a danger to their neighbours."—Address by Robert Koch, M.D., delivered at the International Conference on Tuberculosis in Berlin, l902. † " Correspondence was read at the Conference, showing that the Local Government Board, on the matter having been brought before them, expressed sympathy with the Managers of the Poplar and Stepney Sick Asylum District (to whose initiative the holding of the Conference was due), in regard to provision being made for the open-air treatment of phthisis, but intimated their opinion that such provision, if made at all, should be for the Metropolis, as a whole, and be under the management and control of a Metropolitan authority. The Board also suggested the holding of a Conference of Metropolitan Poor Law Authorities " (vide No. 10 Report, October 16th, 1900, p. 107, based on a report of the proceedings of the Conference in The Standard). 55 (2) The expenses incurred by the asylum managers for the maintenance of any such person shall be paid by the guardians of the union from which he is received, and those guardians may recover the amount of those expenses as a simple contract debt from the said person or from any person liable by law to maintain him. (3) The said expenses, so far as the same are not recovered by the guardians, shall be repaid to them out of the Metropolitan Poor Fund. (4) After the date of an order of the Local Government Board authorising the asylum managers to receive diphtheria patients into their hospitals, sub-section two of section sixty-nine of the Metropolitan Poor Act, 1867, shall apply as if diphtheria were therein mentioned as well as fever and small-pox. " The Section and Sub-section of the last-named Act read as follows: — 69. Expenses incurred for the following purposes after the 29th day of December, 1867, shall be repaid out of the Common Poor Fund—that is to say (2) For the maintenance of patients in any asylum specially provided under this Act for patients suffering from fever or small-pox. " The Local Government Board forthwith, on the passing of the Act of 1889, issued the necessary order, and thenceforth persons suffering from diphtheria were admitted to the Managers' hospitals—persons of whatever class—without payment, and without any consequent disqualification. " All that would appear to be necessary to enable the Managers to undertake the rare of persons suffering from consumption, is a single clause Act, based on the precedent of the Act of 1889. Is it too much to hope that the Local Government Board will, ere long, introduce such a measure? The President is known to be favourable to the movement* " In their recent communication the Council expressed an ' earnest hope that the Board would see their way to advise the Metropolitan Asylums Board to make trial of the plan ' (of utilising the small-pox hospitals during inter-epidemic periods), ' so that before a large expenditure be incurred in building special sanatoria, further experience of the benefits expected to accrue therefrom may be obtained.' " It is perhaps hardly necessary to observe that no doubt exists as to the benefits that would accrue from sanatorium treatment. The proposals hitherto brought to the attention of the Managers contemplate the erection of special hospitals, which would involve not only legislation, but long delay and enormous cost, whereas the proposal which the Council have submitted to the Local Government Board, the Managers, the Sanitary and the Poor Law Authorities, could, with the sanction of Parliament, be brought into operation within a few months, and without material expense in the adaptation of buildings now lying useless, and likely to do so for years to come. " The Managers will, ere long, have in their small-pox hospitals accommodation for 4,000 patients; in the recent epidemic not nearly a half of that number of cases was under treatment at any one time, and at no one time in the last thirty years have there been 2,000 cases of small-pox in the hospitals. There is good ground for the expectation that the Metropolis will be spared another epidemic for many years ; and surely during the interval some portion of the excessive accommodation available might well be devoted to the isolation and treatment of consumptives." The report concluded as follows :— " Having now put the matter fully, and I hope fairly, before those who alone have power to translate counsel into action, I take present leave of the subject with the hope that, ere long, London will be as well provided with the means of helping sufferers from consumption as those suffering from small-pox, fever, and diphtheria; diseases the mortality from which is relatively moderate + compared with that due to tuberculosis in its varied forms." In a preceeding report ‡ the Joyce Green Hospitals (1,750 beds) had been indicated for the purpose, with the reservation that the remarks made " would be equally applicable should it be thought desirable to send consumptives to the Gore Farm hospitals." I had thought Gore Farm might be wanted for scarlet fever and diphtheria convalescents : there was, however, no need of such accommodation then, nor has any since arisen ; and the Carshalton Hospital for convalescent cases of this description in course of erection for 800 patients will, it is probable, ultimately supply all required accommodation.§ But later information, and view of the hospitals, * " When laying the first stone of the sanatorium which the Guardians of Liverpool and the neighbourhood are erecting for consumptives" (in October, 1901) the Right Honourable Walter Long, M P., "eulogised the work and promised that, so long as he presided over the Local Government Board, the Guardians might be sure there would be no restrictive redtapeism influence, but every encouragement of this kind of work."—Annual Report for 1901 (page 39): quotation from "The Standard." † The Registrar-General in his Annual Report, for 1900, gives the deaths from tubercular diseases in England and Wales, in that year, as 61,302, or 10 4 per cent. of the deaths from all causes, and 1,899 per million of the population, without distinction of sex. Pulmonary phthisis accounted for 42,897, or 70 per cent., of the above-mentioned deaths ; whilst the deaths from small-pox, scarlet fever, diphtheria, and enteric fever, in the aggregate, were under 19.000. In that year, it is true that the deaths from small-pox were only 85. But had the deaths from this cause been as numerous as they were in 1901 or 1902, the total mortality from all these diseases would still have been considerably less than a half of that from consumption alone. ‡ No. 11, 1902, page 203. § This hospital, by its design—detached blocks of buildings, each to contain a moderate number of patients, would itself be well adapted for a consumption hospital. 56 led me to the conclusion that "Gore Farm was the more suitable locality, and the buildings better adapted for consumptives." The two hospitals are separate and distinct, the "Upper" (1,000 beds) being solidly constructed, for the most part of brick, and the lower (850 beds), of a so-called "temporary" description, of iron and wood, but calculated to last 40 years. The majority of the wards, when in use for small pox, afforded 2,000 cubic feet of air-space per patient. So large an amount is, perhaps, unnecessary for consumptives, so that the buildings should provide comfortably for, say, 2,000 consumptive patients, with room for extensions on the site of about 160 acres. The site itself is an admirable one, on high ground, in a beautiful country, near Dartford ; the buildings—whether for patients, staff, or administrative purposes—excellent. Both hospitals are empty, but the Medical Superintendent is in residence, and all that is needed, given the power to use them for consumptives, is staff and furnishing. An incidental advantage that would attend the use of Gore Farm for consumptives would be that small pox patients would, in the future, be treated in a ring fence at the Orchard, the Joyce Green, and the Long Reach Hospitals, which contain an aggregate of over 2,000 beds, more by some four hundred than were in use at any one time during the late epidemic. Owing probably to the number and character of the representations made to the Managers in favour of the Council's suggestion, the matter came up again at the meeting of the Asylums Board held on March 7th, 1903, in connection with a notice of motion to the effect— " That, having regard to the communications recently received from the Metropolitan Borough Councils and Boards of Guardians on the subject of the Managers providing accommodation for cases of consumption, the General Purposes Committee be instructed to re-open consideration of the question, and to report to the Board thereon at an early date." The motion was rejected by 24 to 17. It is to be hoped that when the subject comes on for consideration by the General Purposes Committee in November next, it will receive attention commensurate with its importance. NOTIFICATION OF CONSUMPTION. Towards the close of 1901, the Council resolved, upon the recommendation of the Public Health Committee, to make pulmonary phthisis voluntarily notifiable by medical practitioners as from the commencement of 1902; and, subsequently, with a view to the utilisation of information obtained, the Committee permitted me to employ, temporarily, the services of the lady inspectors in an inquiry into the circumstances of the cases notified (the number was 247), and generally to give effect to the recommendations of their Sub-committee, reference to whose report* has already been made at page 50. I desire to express my appreciation of the services in this connexion rendered by the lady inspectors, whose work is still going on, and in the interests of public health should be continued; but it is a question deserving of the consideration of the Council, whether the inspectors can be permanently employed on it, having regard to the character and extent of the duties for the discharge of which they were specially appointed. With these few prefatory remarks I submit the report, only further premising that a form was prepared to secure coherence to the inquiry by the inspectors, who, in regard to each case notified, obtained information under the subjoined headings :— Case or Phthisis. Date of notification. Room occupied by patient. Date of death if case not notified. How many sleep in patient's bedroom. Patient's name. Has or had patient a separate bed. „ age. Sanitary condition of habitation. „ occupation. Sanitary condition of room. Present address and length of residence. Light. Previous residences. Ventilation. Duration of illness. Sputa, how treated. Number in family. Disinfection done by on Any other cases in family, now or formerly. Cleansing done by on Probable source of infection. Remarks Number of rooms occupied. * The report is printed in the Minutes of the Council's proceedings for 13th November, 1901, pages 19 and 20. 57 The Inspectors' report was as follows :— "Since January 1st, 1902, when the voluntary notification of phthisis came into force in the Borough, we have enquired into all such cases notified up to December 31st, 1902, numbering 247,* of which 79 proved fatal. We have also made inquiries with regard to deaths from phthisis, in cases not notified, numbering 147; making a total of 394 cases investigated. " Fifty-seven of the notified cases were from Common Lodging-houses, and with respect to these little or no information was obtainable. They occurred in 21 houses, the largest number of cases to a house being seven, and six, in one house each, and four in each of other five houses. "A phthisical history was obtained in 104 cases (males 64, female 40) from the patients; including 6 male cases, in which the wife's family was phthisical, and 4 female cases, in which the husband's family was phthisical. " In 22 cases (male 15, female 7) with no phthisical history, the disease appears to have developed after cold from exposure at work, and in 15 cases (males 11, females 4) as a result of intemperance and exposure; in 13 cases (males 8, females 5) symptoms of phthisis were alleged to have supervened after influenza, bronchitis, pleurisy or pneumonia; in 3 cases (males) after lead-poisoning; in 3 cases after confinement; in one case (male) after measles, and in one case (male) after rheumatic fever. " The duration of illness in the cases investigated was very variable. In 363 cases it was less than two years. " In the majority of cases the rooms occupied by the sick persons were found to be fairly clean and ventilated. In other instances the rooms were dirty and close, and it is a significant fact that in nearly every such case the illness had a fatal issue. " In each case instruction was given to the patient, or the relatives, with regard to the necessity of wet cleansing of the room, and the treatment of sputa. The Council's leaflet on The Cause and Prevention of Consumption was distributed, as also a card containing clear and simple rules for the prevention of the spread of infection, such as could be carried out without interfering with the patient's daily avocations. " After a death, whether of a notified case, or one known solely through the weekly returns of mortality, the house was visited and disinfection offered. In the majority of cases this was gladly accepted. In 24 cases disinfection had already been carried out, or was about to be done, under the superintendence of the medical practitioner in attendance. " We desire to acknowledge the courtesy with which our enquiries were received, and the general willingness of all persons concerned to do their best to carry out the instructions given. " The appended Tables summarize the most salient results of the enquiry, in the form prescribed for our use." Distribution of Notified Cases of Phthisis, and of Fatal Cases not Notified (January 1st to December 31st, 1902). Notified Cases. Deaths. Fatal, not notified cases. Total No. of cases. Number of cases in— The Borough 247† 79 147 394 Sub-Districts— Kensington Town 238 75 101 339 Brompton 9 4 46 55 Parliamentary Divisions— North Kensington 218 69 91 309 South Kensington 29 10 56 85 Wards— South K. North K. St. Charles 25 3 16 41 Golborne 47 22 31 78 Norland 117 30 36 153 Pembridge 29 14 8 77 Holland 12 4 8 20 Earl's Court 5 3 11 16 Queen's Gate - 4 — 12 16 Redcliffe 4 3 15 19 Brompton 4 — 10 14 * Duplicate Notifications, or secondary notifications within six months, were not counted ; but in secondary Notifications the patients or premises were visited, and disinfection was carried out for a second time, where necessary. † Duplicate Notifications or second Notifications within 6 months not counted 58 Sex of Cases; Number of Deaths. Males. Females. Total. Sex of notified cases 151 96 247 Number of deaths ensuing 43 86 79 Number of deaths of cases not notified 92 55 147 Sex and Age in Notified Cases (247). - 0-5 5-10 10-20 20-40 40-60 60— Total. Males 2 3 66 70 10 151 Females — 2 4 51 89 - 96 Sex and Age at Death in not Notified Cases (147). ]— 0-5 0-10 10-20 20-40 40-60 60— Total. Males 4 2 4 35 39 8 92 Females 2 1 1 19 22 10 55 Sex and Age at Death ; All Cases (226). — 0-5 5-10 10-20 20-40 40-60 60— Total. Males 4 2 4 57 56 12 185 Females 2 2 3 36 38 10 91 Phthisical History, or Otherwise. ]— Males. Females. Total. Cases with a phthisical history 64 40 104 Cases with no phthisical history 51 27 78 Cases in which no information as to previous family history was obtainable 128 84 212 Status of the Sick. ]— Males. Females. Total. Number of cases in receipt of parochial relief 164 88 252 Number of cases not in receipt of parochial relief 79 68 142 Number of Rooms occupied by the Sick Person or Family in the Several Cases. 1 room. 2 rooms. 3 rooms 4 rooms, etc. c. l. H. Homeless. No information. Total. 129 75 34 76 57 7 16 394 59 Disinfection, Cleansing, etc. Number of infected rooms 361 Number of rooms disinfected by the Council's Officer 135 „ „ the occupier; re-papered, whitewashed, etc. 24 Number of rooms, in occupation, not disinfected 156 Number of cases in which disinfection was refused 46 The occupation of the sufferers, so far as could be ascertained, was as follows :— Males. No. of Cases. Artizan 52 Labourer 27 Cabman, Carman 19 Hawker 10 Porter 6 Potman 5 Stableman 4 Soldier 5 Scavenger 4 Postman 3 Shopman 6 Clerk 10 Baker, Domestic Servant, Musician, Engineer (two each) 8 Artist, Butcher, Canvasser, Farmer, Laundryman, Packer, Sailor, Soda Water Bottler, Superintendent of a Boys' Home, Theatre Attendant, Merchant and Wine Importer (one each) 12 Children 4 Unknown 78 253 Females (of whom 84 were married). Laundress 27 Domestic Servant 20 Charwoman 7 Dressmaker, Tailoress 4 Hawker 2 Hospital Nurse, Shop Assistant (one each) 2 Children 5 No occupation, or occupation unknown 74 141 Grand Total 394 The proportion of deaths from phthisis in the Borough Infirmary to total deaths was large, viz., 82 out of 226 : males 49, and females 33. Seventy of the deaths were of North Kensington persons, 12 of South Kensington persons. These deaths were equal to 15.5 per cent. of all the deaths in the Infirmary, and to 363 per cent. of all the deaths in the borough from this cause. The notified cases were 162 : males 101, females 61; 135 of North Kensington persons, and 27 of South Kensington persons, or 65.6 per cent. of the notifications in the borough as a whole. INFECTIOUS DISEASE AND THE MILK SUPPLY. In the seventh report, 1901, reference was made to proposals contained in a circular letter from the London County Council suggesting the need of legislation for the protection of the public health in connection with the milk supply of the Metropolis. The report having been referred to the Public Health Committee, that body expressed approval of the proposed legislation, and concurred in the view that the matter being one of Metropolitan concern, the powers proposed to be acquired could be most effectively exercised by the County Council, acting for the whole of London. The report of the Committee, having been adopted, was communicated to the County Council, who in their General Powers Bill in the Session of 1902 (Part viii.) introduced clauses (43 to 63) for giving effect to the views of their Public Health Committee.* Part ix. (clauses 64 to 66) dealt with measures for preventing the spread of infectious disease through the agency of Ice Creams—a subject also dealt with in the reports of the Public Health Committee of the County Council, embodied in the aforementioned communication. In regard to this matter also, the Public Health Committee of the Borough Council concurred with the view that legislation on the lines indicated was desirable, and that it was one that should be dealt with by the Council as local Sanitary Authority, as indeed the County Council had suggested. The 66th clause of the Bill proposed to enable the County Council to act in execution of this part, should the local Sanitary Authority be in default, as if the omission to institute proceedings were a default within the meaning of section 100 of the Public Health (London) Act, 1891. * The details of Part viii. were set out in my report for 1901, pp. 44-47. 60 The Milk Clauses (Part viii.) failed to pass; but Part ix. in the Bill, Part viii. in the Act, (" Ice Creams") became law, and came into operation on the 1st November, 1902. It provides that— Any person, being a manufacturer of, or merchant or dealer in, ice creams or other similar commodity, who, within the County— (a) Causes or permits ice creams, or any similar commodity, to be manufactured, sold, or stored in any cellar, shed, or room, in which there is any inlet or opening to a drain, or which is used as a living room or sleeping room; (b) In the manufacture, sale, or storage of any such commodity, does any act or thing likely to expose such commodity to infection or contamination, or omits to take any proper precaution for the due protection of such commodity from infection or contamination ; or (c) Omits, on the outbreak of any infectious disease amongst the persons employed in his business, or living or working in, on, or about the premises in, or on, any part of which any such commodity as aforesaid is manufactured, sold, or stored, to give notice thereof forthwith to the Medical Officer of the Sanitary District in which such business is carried on, or such premises are situate— shall be liable for every such offence, on conviction by a Court of Summary Jurisdiction, to a penalty not exceeding Forty Shillings. The above provisions apply to all persons being manufacturers of, or merchants, or dealers in, ice creams, or other similar commodity. Special provisions are made with respect to street sellers of the dainty, as follows :— Every itinerant vendor of any such commodity as aforesaid shall, if not himself the manufacturer thereof, exhibit in a legible manner, on a conspicuous part of his barrow, a notice stating the name and address of the person from whom he obtains such commodity, and if such vendor is himself the manufacturer of such commodity, he shall in the same manner exhibit his own name and address. Every such itinerant vendor who shall fail to comply with the provisions of this Section shall be liable for each offence, on conviction as aforesaid, to a penalty not exceeding Forty Shillings. The Notice given by the County Council states, that— Proceedings for the recovery of the penalties shall be instituted by the Sanitary Authority for the District in which the offence was committed, or of the District to the Medical Officer of which such notification as aforesaid ought to have been made, or in which such itinerant vendor as aforesaid shall offer any such commodity as aforesaid for sale, as the case may be. The Sanitary Inspectors, before the Act came into operation, inspected the premises of confectioners, etc., where " ice creams " are manufactured ; and with the Chief Inspector I visited the places in the Royal Borough where the commodity is prepared for sale by (or to) itinerant vendors, in order to secure such improved conditions as were necessary for compliance with the requirements of the new legislation. INFANTILE MORTALITY. Reference has already been made (p. 9) to the high rate of infantile mortality in the borough, as measured by the proportion of deaths under one year of age to births registered. The rate in England and Wales in 1901, was 151 to 1,000 births registered, which is 3 per 1,000 below the mean proportion in the ten years 1891-1900. In the thirty-three great towns, containing an estimated population of nearly 11½ million persons, the proportion averaged 168 per 1,000, being lower than the proportion during the preceding ten years by 4 per 1,000. " The towns with the lowest rates of infantile mortality were Halifax 127 per 1,000, Bristol 131, Huddersfield 132, and Croydon 141. The towns with the highest rates were Sheffield 201 per 1,000, Salford 204, Preston 216, and Burnley 226." (Registrar-General's Annual Summary for 1901.) In the Metropolis the rate was 149 per 1,000, as compared with an average proportion of 160 per 1,000 in the ten preceding years. The range in the different districts was considerable, the highest rates having been recorded in Bermondsey, 169 per 1,000, the City of London 175, and Shoreditch 197. Hampstead stood lowest in the list, with a proportion of 104 per 1,000 births; St. Marylebone* next, with a proportion of 107, and Stoke Newington next, with one of 115 per 1,000 births. * The Registrar-General states that " the low infantile mortality in St. Marylebone is partly due to an excess of births owing to the presence of a lying-in hospital." 61 The rate in Kensington, always in excess of that of London, as a whole, was 161 in 1901, and 9 per 1,000 lower than the average in the preceding ten years.* The rate varied widely in the different parts of the Borough, as shown in the following table, in which the number of births and the birth-rate are also shown. Births and Birth-Rate and Infantile Mortality in 1901. Locality. Population. Births. Birth Rate. Deaths 0-1 year. Infantile Mortality per 1,000 registered Births. The Borough 177,000 3,602 20.4 581 161 Sub-districts— Kensington 128,300 3,046 23.7 506 166 Brompton 48,700 556 11.4 75 135 Parliamentary Divisions— North Kensington 91,250 2,576 28.2 447 173 South Kensington 85,750 1,026 11.9 184 131 Wards— North K. St. Charles 22,000 587 26.7 102 174 Golborne 26,370 941 85.7 168 178 Norland 23,510 624 26.5 129 207† Pembridge 19,370 424 21.9 48 113 South K. A Holland 20,440 266 13.0 34 128 Earl's Court 18,090 216 11.9 31 148 Queen's Gate 14,800 125 8.7 20 160‡ Bedcliffe 18,740 251 1..4 31 123 Brompton 14,180 168 11.8 18 107 The table shows an excess of infantile mortality above the London rate in three of the wards in North Kensington: St. Charles, Golborne, and Norland, the parts of the Borough where the population is poorest and most dense. The rate varies in different years according to the prevalence, above or below average, of infantile diseases, especially diarrhoea, a malady fatal every year to thousands of infants in the first year of life; it is safer, therefore, for purposes of comparison of rates of infantile mortality, to take decennial periods. Comparing the rate in the ten years 1891-1900 (170 per 1,000) with the rate in the ten years 1871-1880 (159 per 1,000), it is observed that, with a general death-rate in the first ten years 2.2 per 1,000 of the population below that in the ten years 1871-80, the infantile mortality rate is greater by 11 per 1,000 births. And this is not the only disquieting circumstance, for whilst in the earlier decennial period the birth-rate in the Borough averaged 30.7, in the ten years 1891-1900 it had fallen to 21.6— a decrease of 9.1 per 1,000. * The rates in 1902 were lower all round, having been in England and Wales 133, London 139, and Kensington 148 per 1,000 births registered. † The infantile mortality-rate in the " Special Area," in Norland Ward, in the six years 1896-1901, averaged 447; in 1901 it was 411. ‡ The excessive rate in Queen's Gate Ward is due to the location therein of the Workhouse, and to the necessity for debiting to the Ward a number of deaths of children at that institution the previous abodes of whose mothers could not be traced. Eleven of the 20 deaths occurred at the Workhouse, and in respect of seven of them the previous abode of the mother was not known. 62 The births in 1871, with a population less by 56,390 than that in 1901, exceeded those in the latter year by 202. Proportionally to population the births in 1901 (at the 1871 rate) should have been more by 1,996 than the number registered. The decline in the births and birth-rate during the decennium 1891-1900 was concurrent with a decrease in the average marriage-rate (17.8) of 0.6 per 1,000, as compared with the rate (18.4) in 1871-80. The marriages, however, were 2,723 more than in the earlier decennial period: but marriages have become relatively less fruitful; so that whilst the births in 1871-80 were in the proportion of 3.3 to each marriage, the proportion fell to 2.3 in the ten years 1891-1900. What has happened in Kensington is happening everywhere: the birth-rate has so fallen that the census of 1901 revealed an enormous "shortage" of children to total population, as compared with the proportion in 1881.* It would seem safe to predict that the progressive decline in the birth-rate will continue— a prospect to be deplored in the interests of the Nation and the Empire. Obviously, if the decline in the birth-rate cannot be arrested, to compensate for the diminution in the number of children born, every possible means should be employed to safeguard infantile life: in other words, if the birth-rate cannot be raised no effort should be spared to bring about a decrease in the infantile death-rate.† With a view to effort in this direction, I thought it desirable to make inquiry into the circumstances connected with the deaths of infants in the Borough, and at the commencement of the year I was authorised by the Public Health Committee to employ the services of the Lady Inspectors in the delicate duty of interviewing bereaved mothers, with the view of ascertaining to what extent the mortality might be regarded as due to causes of a more or less preventable character. In due course I received a report framed upon lines designed to elicit a maximum of practical information: I now submit a summary of the facts ascertained. * Mr. Thomas A. Welton writing in The Times (September 8th, 1902) on the " English birth-rate," states that " the most important fact revealed " by inquiry into the Census results, so far published, is "the relatively small increase in children under fifteen." Comparing 1901 with 1881, he states that the number of children in 1901 would have been 2,092,000 greater had the ratio of 1881 been maintained." He states, however, that the total figures worked out in relation to the number of wives, which he gives for 1881 and 1891, would show a shortage, in 1901, compared with 1881, of about 1,579,000 children, which he thinks a truer figure than 2,092,000 ; " but whichever way the matter is regarded, a difference of a million and a half of children is an enormous fact." The "short number of children" in London, in 1901, compared with 1881, is given as 187,500 † How largely the problem is one of infantile life, is shown by the subjoined statement of the true death-rate of children under five years of age, in the borough, in 1901—the Census year. Age-period. No. of Children Enumerated. No. of Deaths. Deaths per 1,000 living at the Age-period. 0—1 year 2,999 581 198.7 1—2 years 2,834 156 55.0 2-8 „ 2,786 70 25.1 8—4 „ 2,786 42 15.1 4-5 „ 2,743 27 9.9 Total under five 14,148 876 61.8 63 The registered deaths under one year of age were 506, and located as follows :— Locality. Sex. Total. Male. Female. The Borough 289 217 506 Sub-Districts— Kensington Town 256 183 439 Brompton 33 34 67 Parliamentary Divisions— North Kensington 226 159 385 South Kensington 63 58 121 Wards— North K. St. Charles 56 32 88 Golborne 74 45 119 Norland 67 60 127 Pembridge 29 22 51 South K. Holland 18 16 34 Earl's Court 19 8 27 Queen's Gate 8 6 14 Redcliff 12 14 26 Brompton 6 14 20 Of the 506 deaths under one year, 54 were of illegitimate children, including six which had been registered as legitimate, all in North Kensington. The number of mothers interviewed in the course of the inquiry was 257.* The ages at death were as follows:— Sex. Under One Month. 1-2. 2-3. 4-4. 4-5. 6-6. 6-7. 7-8. 8-9. 9-10. 10-11. 11-12. Month. TOTAL. 1st wk. 2nd wk. 3rd wk. 4th wk. Males 62 11 13 13 19 21 16 21 22 14 20 20 12 13 12 289 Females 39 17 6 17 9 20 20 15 9 10 8 14 11 13 9 217 101 28 19 80 28 41 36 36 31 24 28 34 23 26 21 506 It thus appears that 178 (=35.2 per cent.) of the deaths occurred within a period of four weeks after birth. The causes of death in the several wards are set out in the table at page 64. The position in life of the male parent, as registered, was as follows :— No. of Cases. Labourer 132 Artizan 91 Coachman, Cabman, Carman 60 Tradesman 36 Porter 13 Clerk 9 Horsekeeper, Stableman 8 Hawker 6 " Dealer" 5 Cellarman 4 Milkman 4 Street Musician 4 Potman 3 " Agent," House Agent 3 Scavenger, Flower-seller, Fireman, Police-constable, Postman, Soldier, Sailor, Company Manager, Gas Stoker, Chaff Cutter, Commercial Traveller, Shipbroker, Chef, Butler, Artist, "Valet, Engineer (two each) 34 Organ-grinder, Omnibus Conductor, Chair-fee Collector, Canvasser, Lamplighter, Waiter, Lift-man, Chimney-sweep, Accountant, M.R.C.S., Cab Proprietor, Lodging-house Keeper, Dentist, Secretary, Actor, Solicitor, Park-keeper, Turncock, Chemist, Lieutenant R.N., Gardener, Photographer, Piano-tuner, Mineral Water Bottler (one each) 24 Independent means 3 * In 36 instances no information was obtainable, the name being unknown at the registered address, or the parents having removed to another abode. No information was sought in 139 cases. There were nine instances of twin-births, and one of triplets. 64 Causes of Deaths of Infants, of Year, in the several Wards. (For distribution of deaths in Sub-districts see Table page 63.) WARDS. ST. CHARLES. GOLBORNE. NORLAND. PEMBRIDGE. HOLLAND. EARLS COURT. QUEEN'S GATE. REDCLIFFE. BROMPTON. Total. SEX. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Principal Diseases of Zymotic class 2 ... 2 1 2 3 1 2 3 ... ... ... ... ... ... 2 ... ... 18* Diarrhœa 9 5 15 6 3 5 3 5 2 2 1 ... ... ... 2 ... ... 2 60 Diseases of the Respiratory Organs 18 14 19 13 20 20 9 3 4 2 3 2 2 2 2 2 3 4 142 Diseases of the Digestive System 4 5 10 5 2 1 ... ... 1 3 1 ... 1 ... 2 1 ... 1 37 Diseases of the Nervous System 2 3 1 1 5 3 5 ... 5 1 2 1 1 1 1 ... ... 2 34 Tubercular Diseases 3 .... 4 5 4 1 1 ... ... ... 1 ... 1 ... ... ... ... ... 20 Wasting Diseases 9 2 8 4 11 8 4 6 ... 4 3 ... 2 1 3 ... 1 ... 66 Premature Birth 8 3 8 7 12 11 5 5 ... 3 5 3 1 2 1 4 1 2 81 Deaths from Violence ... ... 3 ... 3 1 ... ... ... ... ... ... ... ... ... 1 1 1 10 Sundry Other Causes 1 ... 4 3 5 7 1 1 3 1 3 2 ... ... 1 4 ... 2 38 =506 * Viz.: Measles, 15 ; Small Pox (unvaccinated), 1; Scarlet Fever, 1; Whooping Cough, 1; Diarrhœa, 60. Of the deaths from the latter cause 51 occurred in North Kensington as did 11 of the deaths from Measles and the death from Small Pox. 65 Many of the mothers of the deceased children were women who went out to work, their several occupations being given as :— Laundress 58, Charwoman 14, Domestic Servant 7, Dressmaker 3, Shop Assistant, Sick Nurse, Sempstress, Flower-seller, 2 each, Shop-keeper, Match-seller, 1 each. Total 92. The position in life of the mothers of deceased illegitimate children was as follows:— Domestic Servant 25, Laundress 10, Charwoman 6, Dressmaker, Flower-seller, 2 each, Waitress, Carpet Sewer, Shop Assistant, Actress, Independent Means, 1 each, unknown 4. Total 54. The foregoing particulars serve to show to what a preponderating extent the deaths of infants occur among the less prosperous classes. The following cases, illustrating the waste of infant life in the families of the poor, are worth citing; the mothers being responsible for the statements of the causes of death. Of 11 children born in one family, 2 survive, the other 9 having died from "premature birth." „ 4 „ „ „ 1 survives, the other 3 having died from " convulsions" within the first month. „ 16 „ „ „ 4 survive, the other 12 having died within the first year, 6 of them from " premature birth." „ 5 „ „ „ 1 survives, the other 4 having died under one year from " wasting," consumption, etc. „ 11 „ „ „ 1 survives, the other 10 having died from " premature birth." „ 5 „ „ „ 1 survives, the other 4 having died under one year from " wasting." ,,10 „ „ „ 4 survive, the other 6 having died under one year from " teething." ,, 10 „ „ . „ 4 survive, the other 6 having died under one year from " diarrhoea." ,, 6 „ „ „ 1 survives, the other 5 having died under one year from " bowel complaints." ,, 9 „ „ „ 3 survive, the other 6 having died under one year from " consumption." „ 4 „ „ „ 1 survives, the other 3 having died under one year from " chest diseases." ,, 5 „ „ „ 1 survives, the other 4 having died under one year from pneumonia. „ 5 „ ,, ,, 1 „ 6 „ „ „ None survive, all having died under one year. ,, 3 ,, „ „ The Inspectors remark, that, when they could, the mothers (stated that they) nursed their babies, but that " in many cases the milk failed through their own want of nourishment." In numerous instances, however, in which the mother had nursed, it appeared—judging from " their sickly and tired condition "—the quality of the milk could not have been such as to be very beneficial to the child. [In this connexion, reference may be made to the annual report for 1897 (p. 42). on " Infantile Diarrhœal Mortality," in which it was stated that in all but three out of 43 cases investigated, the children had been weaned ; but ten of the children were in the second Year of life.] Seeing that a large proportion of the infants had been brought up by hand, it became an interesting question on what sort of food they had been fed. 66 The following list summarises the information obtained. Foods Used. No. of Cases. Proprietary articles of farinaceous food, with cow's milk 22 „ „ „ without cow's milk 6 Condensed milk—various brands 29 Cow's milk * and barley water 67 Cow's milk and lime water 8 Condensed milk and beef tea 6 Oatmeal and water (no milk) 3 Oatmeal with milk 3 Condensed milk and arrowroot 2 Cow's milk and baked flour 1 Sopped bread 3 Biscuits with milk 10 Bread and milk 3 Boiled bread with butter and sugar 1 "What we had ourselves" 3 167 Thus it appears that of the deceased infants there were (stated to be)— Fed artificially 67 Nursed by mothers entirely 88 Of the 167 infants to which the list relates, 29 were stated to have been nursed by the mothers during the night. In fifteen cases whisky and brandy had also been given—"by the doctor's orders"—in amounts varying from 3 drops to half a teaspoonful in each bottle of food, for variable periods. The infants were generally fed from bottles with long indiarubber tubes—a fertile source of injury to child-health, from want of cleanliness and consequent pollution of the food supply, milk especially. On this diet question, the Inspectors remark " various patented articles are favourite foods, even for infants of two or three months; " whilst sopped bread, arrowroot and cornflour are frequently administered to children under six months on the plea that " the milk does not satisfy." In one case, of a child of eight months that had been weaned, at ten days, owing to failure of the mother's milk, the diet was "nursery biscuits and milk, gravy and potatoes, a drop of tea and anything going." In yet another, a baby of six months was seen, in a perambulator in the street, sucking something which proved to be a fish's head. The conditions which appear to be responsible for many infantile deaths include, unhealthy homes and surroundings; want of maternal care and natural food; improper feeding—with farinaceous products unsuited to the digestive capacity of the infant, condensed skimmed milk loaded with cane sugar, etc., etc. The Inspectors found plenty of evidence of ignorance on the part of mothers, but did not form the opinion that there was much intentional neglect or unkindness. Several such cases, however, were recorded not only by them, but also by Inspector Males, who on various occasions has had to call to his aid the services of the Inspector to the National Society for the Prevention of Cruelty to Children, a body to which I am indebted for many illustrative cases of neglect of children. It is probable that some, at least, of the many premature births are brought about by the mothers continuing at work when they should be resting at home; and the frequency of the deaths of children in the first few weeks of life may not improbably be due to the too early resumption of work after the confinement, with consequent neglect of the children in the critical early days of their brief existence. The law forbids return to work at workshops and factories, until four weeks after confinement, but there is reason to believe that too often poor women resume their place at the washing-tub or ironing-board at a much earlier period. Infantile mortality will always be a main factor in the general death-rate, but the question to be considered is—Whether the amount of it is not greater than it need be, and whether it may not be reduced ? * Information subsequently obtained leads to the conclusion that very few weaned infants, comparatively, are fed upon anything like the proper amount of fresh whole-milk. 67 On the threshold of this inquiry the further question may suggest itself—Are the lives of the children worth preserving, looking at the matter from an economic point of view? It may be conceded that the facts submitted indicate that many children are foredoomed to early death by causes which are not preventable by outside effort: but it is not less true that many lives might be saved by the removal of causes of death that are preventable, and the adoption of measures more or less within the power of the sanitary authority and philanthropic effort. That it is a moral duty to conserve, by all available means, the life of infants born with a reasonable prospect, under favourable conditions, of a healthy life, will be admitted, and in a few words I hope subsequently to show that effort to achieve this object may be properly regarded as a duty to the State. The remedies for the evil may be briefly suggested. Sanitation.—In the first place, whilst it is our duty to do whatever may be practicable to ensure healthy homes for the poor, by the exercise of the powers of the Sanitary Authority: it must be admitted that the effective discharge of the duty, involves many and great difficulties, such as can never be surmounted without external assistance and the help of the people themselves. To a not inconsiderable extent the discomfort, untidiness, and unhealthiness of the home is the result of sheer ignorance on the part of the parents, who are but children of a larger growth, and the first thing to be done is to inculcate habits of cleanliness in the plastic days of youth and school attendance. Instruction in the Laws of Health.—We have begun in elementary schools to teach the girls cookery, a knowledge of which will tend to the welfare of the future family. So far, so good : but I would ask, as I did in the annual report for 1871, " When will instruction in the principles of sanitary law and hygiene form a part of the system of State education ? " When that shall have been brought about 1 predict that there will be a diminution in infantile mortality. Creches.—I hope to see the day when, bv a combined effort on the part of the Sanitary Authority and philanthropic agencies, means will be extensively adopted for the care, during workhours, of the infants of poor women who are compelled to earn their living by labour away from home. What is primarily needed is Municipal Creches, in the management of which leisured ladies might find an admirable scope for benevolent work. It was a part of the inquiry to find out to what extent this want had been supplied by philanthropic effort. On this point the Inspectors reported as follows :— " At the Medical Mission, corner of Adair Road and Appleford Road, a creche is provided under the care of Miss T., a certificated nurse and midwife, with one assistant. Dr. W. attends twice weekly. About 80 children are taken in daily from 8 a.m. to 8 p.m. Tne mothers pay 4d. a day, which includes the food. Children are received up to 4 years of age. The rooms were clean and well ventilated." " In connection with the Latimer Road Mission, Blechynden Street, is an ' Infant Day Nursery,' where about a dozen children are received daily (accommodation for 80) under the care of an experienced woman, who has been there 22 years—with one or two assistants, according to the number of children. The nursery is under the superintendence of Miss. G. There are two rooms, one containing a dozeu cots for the children's mid-day sleep, the other a play room, with low benches about 6 inches from the floor ; largo and sunny rooms. Children are received up to 5 years of age. A charge of 6d. a day (which includes food) is made for one child, ninepence for two children, and one shilling for three from the same family. The place is open from 7.80 a.m. to 8 p.m. from Monday till Friday, and 7.80 to 1 on Saturdays." This work is deserving of praise, but to make an impression on infantile mortality it needs to be greatly extended; moreover, few very young children were found at the creches. A larger number of infants were found to be left with other women, who generally received ninepence a day for each, the mother finding the food. A considerable number of infants are left in the charge of relatives, or committed to the care of elder children; but the total provision, as far as could be judged from so limited an enquiry, was small, and not very satisfactory. It will be remembered that a part of the scheme for the commemoration of the late Queen's Diamond Jubilee was the provision of a creche. Unfortunately that part of the scheme has been abandoned. But a Nurse's Home has been established at Kenley-street, where at least two nurses will be resident and available for work in the neighbourhood, which is a very poor one. I should be glad if the services of these nurses could be especially employed in helping poor women with their babies, and in supervising work at creches. I am persuaded that many leisured women would be found willing workers in such a cause. No better locality, perhaps, than Kenley-street could have been suggested for such an establishment. The road is wide, the opposite houses low, and at the rear is that beautiful open space, Avondale Park. 68 Municipal Milk Supply.—As a necessary supplement to the creche, means should be provided of supplying the infants with wholesome food, and it could be done at small cost by the establishment of a Municipal Milk Depot. The suggestion may excite a smile, but ere long I hope to see such work in full swing, as a part of ordinary municipal organization. Already such depots have been established in important towns like St. Helens (the pioneer County Borough in this matter), Liverpool, and the Metropolitan Borough of Battersea—to mention no others. I have been favoured with much information on the subject by the respective Medical Officers of Health, but will mention here one fact only to emphasize the value of a provision of suitable food for hand-fed infants. At St. Helens the infant mortality in the borough, as a whole, in 1901 was 175 per 1,000 Among infants fed with the sterilized milk supplied by the depot the mortality was 106 per 1,000. The cost to the rates in providing the milk, over and above the payments by the mothers, was £157, and a moderate increase in the number of the customers would make the depot selfsupporting. The capital outlay at St. Helens, and also at Battersea, was relatively small. Assuming that infantile mortality can be reduced by all or any of the means above referred to, the question recurs—Are the lives, from the point of view of the State, worth preserving ? The answer must be in the affirmative, if it can be shown that children so saved have a reasonable prospect of growing up to be healthy men and women. It may be suggested that the "stock" is of doubtful quality often. Possibly. But given favourable conditions and surroundings, good fruit may come of it. Let anyone compare the gutter children of yesterday with the blooming, healthy boys to be seen on the training-ship, or in Homes, such as the " Waifs and Strays,"—hundreds, nay, thousands of them. Their parents would scarcely know them again ! Many, very many, of such children have been sent to Canada, where they have found an overflowing welcome in healthy and happy homes. And there is room for tens, nay, hundreds of thousands. Not long since, Sir Wilfrid Laurier, the Prime Minister, addressing the Chamber of Commerce at Liverpool said—" The Dominion has vast territories unpeopled, and what is needed is men and women to occupy them." " Canada could sustain a population of a hundred millions—it has six millions." For generations to come, therefore, that one great Dominion could absorb all our surplus population, and there is still a surplus, although, as this report shows, it is a declining quantity. The tenth report, in which this subject was brought to the attention of the Council, having been referred to the Public Health Committee, I drew up for the further information of that body the subjoined Memorandum on Municipal Milk Supply. The system of supplying pure sterilised humanized milk for the food of infants brought up by hand "appears to have been originated by Dr. Dufour, at Fécamp in Normandy, a seaside town of some 14,000 inhabitants where infantile mortality was high (247 per 1,000 in the years 1894-98), and to have been followed by a great diminution in the number of deaths of infants fed on the sterilized milk. Similar results have been attained at Havre. " The first town in England to adopt the system was the County Borough of St. Helens, Lancashire.* Liverpool subsequently adopted the system, which is also in operation at Dukinfield and Ashton-under-Lyne. " As an illustration of the importance of the question, reference may be made to an article in The Lancet of September 20th, 1902, on ' Skimmed Milk and Mortality among Children in France,'' which goes to show the vital importance of milk fat in the diet of weaned infants. It is stated that ' mortality among infants and children, resulting from unsuitable or insufficient nutrition, is far more prevalent in the north than in the south of France;' and 'what seems at first sight a strange paradox is the fact that it is precisely in those provinces where there are the richest pasture lands and the most abundant supply of excellent milk, that the children die from starvation. The reason is, however, very simple. These provinces have a large home and export trade in butter, and all the milk is skimmed to make butter In the south, where there is no such trade, the children are able to obtain some milk that has not been skimmed; hence the startling difference in the death-rates.' A further observation is made which applies generally, and equally to fresh milk and condensed milk, viz., that ' the stress of poverty creates a strong temptation to buy the cheaper skimmed milk, and thus the children are starved.' Skimmed milk, it is said, and flour or bread are boiled together, and sometimes a spoonful of coffee or even of alcohol is added to it, and very young children and infants are fed on this. The nutritive part of the milk is exported as Normandy or Brittany butter. The grim remark is added that ' It is the skimmed milk that aids in " the manufacture of angels," which is the most lucrative phase of the baby farmer's business.' But to resume. * By the courtesy of Dr. F. Drew Harris, the Medical Officer of Health, I was enabled to present a copy of his report on The Infant Milk Depot," containing a large amount of information, to each member of the Public Health Committee. 69 " At St. Helens the infantile mortality in the borough, as a whole, in 1901, was 175 per 1,000 birt is registered, but only 106 per 1,000 among infants fed with sterilized milk. At Dukinfield 'the infantile mortality among children fed on humanized milk (in 1901) was 80 per 1,000, whilst that for the whole district was 288.' A still more striking illustration of the value of sterilized milk is furnished by the New York correspondent of The Lancet, in a communication (October 11, 1902) headed— " Free Milk Supply in New York."—It is stated that Mr. Nathan Strauss ' has now for eleven summers given pure fresh milk to the young children of that city. In the course of the summer (of 1902) nearly a million bottles of pasteurised milk and milk food was dispensed* . . . mainly to the ailing children of the tenements of the east and west sides of the city. . . . The low death rate among children under five years of age is largely attributed' to this system, and ' the rate has steadily decreased concurrently with the increase in the distribution of pasteurised milk. . . . The death rate during the hottest months of the year—June, July, August—when the danger to infant life is greatest, has been reduced from 126 per 1,000 in 1891 to 63.6 per 1,000 in the season just passed . . . and a careful investigation of the vital statistics shows that a very low death rate for children is characteristic of those sections of the city where the distributing depots of the Nathan Strauss laboratory are located.' All will agree with the concluding observation, that the facts stated serve as ' a magnificent testimony to the philanthropic work of Mr. Strauss, and might serve to spur on rich men in all large cities to emulate his generosity.' " The information laid before the Council (i.e., in the tenth report), with respect to the feeding of the infants of the poor goes to show that fresh whole milk does not enter largely into their diet. Most of the foods therein referred to are unfit for the sustenance of very young children, being unsuited to their digestive powers. Milk, however, having been mentioned as forming a part of the dietary in a considerable number of instances, it became an interesting question, and steps were taken to ascertain, to what extent this best of foods is used. " Three dairymen in North Kensington, in a fairly large way of business (their joint sale per day is about 1,250 pints), were interviewed, and only one of them admitted the sale of so much as one pint of milk, night and morning, to one family, in the area supplied by them, which comprises parts of Golborne, St. Charles, and Norland Wards. As a rule the milk was sold, night and morning, in very small quantities—farthings'-worth, ' ha'porths,' and, less frequently, ' pen'orths.' " It has been ascertained that a large amount of machine-skimmed milk is sold at a factory in the north of the borough, the price before 8 a.m. being three ha'pence per quart, and at other establishments this article, unfit as we have seen for the sustenance of infants, is vended on similar terms. Condensed milk, moreover, has a large sale, by grocers and oilmen. Samples of different brands to the number 10 (there are probably 50 brands on the market) were obtained, and, of these, no fewer than seven are labelled as ' machine-skimmed.' The label of one only of these samples gives an inkling of its unfitness for the food of infants, by stating that " For infants and invalids we recommend the use of our Full Cream Milk.' " ' Condensed milk' contains a very large proportion of cane sugar used as a preservative and for cheapening the production. In a report on the subject by the Medical Officer of Health for Liverpool, the analyses of 22 samples are given ; 5 of them ' pure milk ' show a percentage of this constituent to total solids ranging from 36 per cent. up to 44.20 per cent. The fat ranged from 0.27 to 2.24 per cent in milks described as ' machine-skimmed.' The ' other solids of milk' ranged from 22.34 up to 35.76 per cent of the total solids, the minimum and maximum of total solids being given as 67.21 and 75.80 per cent.' "The analyses of the five samples of pure' milk show percentages of the various constituents as follows:— Fat. Other Solids of Milks. Added Sugar. Total Solids. 9.01 25.04 40.97 75.02 9.10 27.38 39.62 76.10 10.53 25.96 40.00 76.49 10.88 28.02 36.00 74.90 11.06 22.34 42.40 75.80 Of condensed ' machine-skimmed milks' it will suffice to say that all, being practically devoid of fat,t are unfit for the food of infants ; but the sale of them is extremely large owing to the nominally low price at which they are vended. * In addition " about a million glasses of raw and pasteurised milk were consumed at the stations." † The public analyst has informed me that the actual percentages of fat in the skimmed varieties are so small as to be obviously of no importance from the point of view of " food value;" 0.25-0.3 per cent. being the amounts commonly found The minimum standard for " fat " in " genuine " milk is three per cent. 70 " Enough perhaps has been said to show that great benefit would accrue from the substitution of pure sterilized humanized milk for the patented, and other farinaceous, foods (so called), and the skimmed milk, fresh or condensed, which enter so largely into the diet of infants, and are the cause, to a large extent, of the high rate of mortality under one year of age. It becomes interesting then, to consider, in conclusion, the important question of the Cost involved in the installation, and the working, of Municipal Milk Depots. It appears, in the report already referred to, that the amount expended on the installation at St. Helens (1899-1901) was £358 9s. 6d. At Battersea the primary outlay was £460, of which £250 was for altering the premises, the rest for machinery, bottles, etc. The current expenditure at St. Helens in 1899-1900 (8 months) was £264 l1s. 1d.; in 1900-1901—£471 3s. 2d. In the first year the income from the sale of milk was £187 ; in the second year, £328 9s. 5d.; the total amount falling on the rates in the two years being £250 4s. 9d.—an amount which will decrease to extinction as the sale of the milk increases. The price of the milk is 2d. for a day's supply—a low sum, which ' rather more than covers the cost of materials and fuel, the Corporation agreeing to supply the plant and to pay the rent of the house and the wages for attendance.' At Battersea, the financial statement has not yet been prepared, but the Medical Officer of Health thinks that, at the present time (i.e., October, 1902), there is a loss of a few shillings weekly. He is of opinion, however, that the depot will pay its way when some 350 children are being fed; and that is likely to be soon. At the middle of August, 130 children were fed, in the first week of October, 250; the cash takings being about £17 weekly. The charge is 3d. per day, or one shilling and sixpence per week, payable in advance. At Liverpool, in 1901, a large number of children were being fed from two depots (the charge per child being one shilling and threepence per week), but at what cost to the Corporation is not stated." The Public Health Committee, after careful consideration of the Report (No. 10) and the above Memorandum, reported in favour of the proposal to establish a depot as follows:— "We are of opinion that it would be a desirable thing to establish in the Borough a municipal supply of sterilised and humanised milk for the feeding of children of the poorer classes, in the hope that it might tend to the diminution of the excessive mortality which does, without doubt, exist in a certain portion of North Kensington. "We recommend— " That the Council do endorse the opinion above expressed, and that it be referred back to the Committee to consider and report as to what steps should be taken to give effect to the proposal." The Report came before the Council 9th December when an amendment, that the recommendation of the Committee be rejected, was moved and carried by a large majority. It should be added that, subsequently, the expenses incurred by the Battersea Council in connexion with their Municipal Depot were disallowed by the auditor. Clearly, legislation is necessary to enable Sanitary Authorities to enter upon this branch of (so-called) " municipal trading." THE MIDWIVES ACT, 1902. The Act so entitled came into operation on the 1st day of April, 1903—except as otherwise provided. Its purpose is to secure the better training of midwives and to regulate their practice- A Central Midwives Board, which has already been appointed, will be the authority for administering the Act. The duties and powers of this Board are set out in Section 3 (3). The London County Council will be the " local supervising anthority " over midwives within the area of the administrative county ; but they may delegate, with or without any restrictions or conditions as they may think fit, any powers, duties, conferred or imposed upon them, to a district council. Any powers or duties so delegated may be exercised by a committee appointed by the district council, and consisting either wholly or partly of members of the district council. Women will be eligible to serve on any such committee. The duties of the local supervising authority, or if they delegate their powers, the District Council, are set out in Section 8. The Westminster City Council, being of opinion that the Metropolitan Borough Councils should be entrusted with the carrying out of the provisions of the Act in London, passed a resolution to ask the County Council whether they intended themselves to carry out the provisions of the Act or to delegate their powers to the Metropolitan Borough Councils. They expressed their willingness to undertake the carrying out of the Act in Westminster, and asked the Councils generally to take similar action. The County Council in their reply stated that they had adjourned the consideration of the question involved until such time as the rules contemplated by the Act shall have been framed by the Central Midwives Board. 71 VACCINATION. The table at page 75 is a return respecting vaccination in Kensington in 1901 (the complete return for 1902 not yet being due) compiled by Mr. King, the newly appointed vaccination officer. It appears that of 3,620 infants whose births were returned in the " Birth List Sheets " (col. 2), during the year, 2,937 were successfully vaccinated, and 16 were returned as " insusceptible of vaccination." In 8 cases vaccination was postponed by medical certificate: 344 infants died before attaining the age for vaccination ; in 37 cases infants were removed to other districts, the vaccination officers of which were duly notified of the fact; whilst some 230 cases from " removal to places out of the parish unknown, or which cannot be reached, and cases not having been found," were unaccounted for. These cases are, with those of "conscientious objectors" (46. against 5, 31, and 40, in the three preceding years respectively), equivalent to a " loss " of 7.6 per cent., as compared with the number of births returned in the "Birth List Sheets;" the losses in the ten preceding years having been 8.0, 8.7, 7.7, 8.4, 9.0, 10.1, 10.7, 12.7, 8.1, and 6.8 per cent. Kensington in this repect always compares favourably with the Metropolis, as a whole, for according to the most recent returns it appears that the "loss" in the Metropolis in 1899 was 27.7 per cent., as compared with 12.7 per cent. in Kensington. Mr. Shattock, the late vaccination officer (whose retirement owing to ill-health is greatly regretted) informed me that false registration, i.e., wrong addresses entered in the birth list sheets, largely accounted for the " loss " ; the children could not be traced. The actual figures, showing loss, both for town and country, during the fourteen years 1886-99, as set out in the report of the Local Government Board for 1901-2, are as follows:— Metropolis Cases lost. Rest of England. Cases lost. Metropolis. Cases lost. Rest of England. Cases lost. 1886 7 8 per cent. 6.1 per cent. 1893 18 2 per cent. 15.7 per cent. 1887 90 6.7 „ 1894 20.6 „ 19.0 „ 1888 10.8 8.2 „ 1895 24.9 „ 19.8 „ 1889 11.6 „ 9.6 „ 1896 26.4 „ 22.3 „ 1890 18.9 „ 10.9 „ 1897 291 „ 21.6 „ 1891 16.4 „ 12.9 „ 1898 33.0 „ 19.6 „ 1892 18.4 „ 14.8 „ 1899 27.7 „ 15.4 „ These figures show that the vaccinated children in the Metropolis, and in the country generally, are a great host whose unprotected condition involves a serious danger to the community. In this borough, as already shown, there had been recorded, up to 1898, a yearly increasing " loss " of cases of children who, from removal to places out of the parish, or which cannot be reached, and cases not having been found, are deemed to be unvaccinated. In London, as a whole, in 1886, the " lost " cases were only 7.8 per cent. In 1898 the proportion had increased to 33.0 per cent. This is an average proportion ; in some of the metropolitan boroughs the unvaccinated cases were more numerous than the vaccinated. The "lost" cases in Stepney were 46.6 per cent., in Bethnal Geeen 47.8, in Poplar 49.6, in Shoreditch 52.2, and in Mile End Old Town 69.4 per cent.; and these boroughs were the greatest sufferers (Holborn only excepted) during the small-pox epidemic. The lost cases in Kensington, 6.7 per cent. in 1890 had increased to 12.7 per cent. in 1898 ; but in 1899, as above shown, they fell to 8.1, and in 1900 to 6.8 per cent., under the operation of the new Vaccination Act. In 1901 there was a slight rise to 7.6 per cent.; but probably in no other part of London is there a better vaccinated population than in Kensington, which, as we have seen, was but lightly affected during the recent epidemic. The tide however seems to have turned, for the loss in the Metropolis in 1899 was 27.7 per cent. only, compared with 33.0 in the preceding year. In the rest of England and Wales the " loss " in 1899, was only 15.4 against 19.6 in the preceding year, and succeeding returns may be expected to show further improvement. The influence of the visitation of small-pox is seen in the table at page 75, which shows for 1901 an increase in the number of certificates of successful vaccination in Kensington of no fewer than 879 compared with those received in 1900. The Local Government Board in their report for 1901-2, referring to the vaccination returns for 1899, observe that the " increased acceptance of primary vaccination "—at a time precedent to the epidemic of small-pox—is to be "referred to the altered conditions under which, consequent upon the Vaccination Act, 1898, and their regulations made thereunder, vaccination is now performed, and the increased facilities which now exist for its performance." One of the most potent influences tending to the increase in the number of vaccinations in normal years is the provision for the use of glycerinatcd calf lymph which has cut the ground from under the feet of those who objected to vaccination because of the possibility of enthetic disease being conveyed in humanized lymph. 72 Calf Lymph.—In the last four-weekly report for 1901 (December 31st, p. 198), reference was made to the advantage that would accrue to the public were the Local Government Board to supply medical practitioners generally, and not Public Vaccinators only, with lymph for revaccination ; or, in the alternative, to undertake supervision over the production of lymph at noofficial establishments. The report was referred to the Public Health Committee who recommended— " That the Local Government Board be requested to undertake the supply of lymph to any registered practitioner who may apply for the same, instead of to public vaccinators only, as is the case at present, and that the other Borough Councils be asked to make similar representations." This recommendation having been adopted by the Council, a letter was addressed to the Board, who replied— " That glycerinated calf lymph supplied by the Board is only intended for use by Public Vaccinators in the performance of primary vaccination under contract with the Guardians, aud that under existing arrangements the Board are unable to extend the issue of such lymph to all medical practitioners." This letter, followed obviously on the lines of an old draft, as the Board have for some years supplied to public vaccinators the lymph required for revaccination, and were doing so at the date of the communication. The President of the Local Government Board stated in the House of Commons, on the 10th February, that the establishment was producing 50,000 charges a week (=2,600,000 a year); a quantity far in excess of the requirements of Public Vaccinators, if not sufficient to meet the needs of all private practitioners. Arm-to-arm vaccination, in other words the use of humanized lymph, is now discouraged, and has indeed become impracticable, owing to the abolition of public vaccination stations since the passing of the Vaccination Act, 1898, which will expire, by effluxion of time, at the end of 1903. This subject was again brought to the attention of the Board early in the current year, by an important deputation to the President who stated that it would be impossible to undertake the supply of lymph generally to the whole country; but, if the law of vaccination could be strengthened, panics be avoided, and things brought into an everyday condition {i.e., by the equalization of vaccination at all times), it might be practicable to attempt to deal with the task ; and, certainly, if revaccination was to be made obligatory, as proposed, the lymph should be of the very best quality. During the small-pox epidemic, medical men frequently complained of the difficulty of getting active lymph. Much of the supply then current, while being of sufficient strength to ensure a satisfactory result in primary vaccinations, proved too feeble in cases of attempted revaccination. Great public advantage would undoubtedly accrue if the Local Government Board could be induced to supply doctors with lymph for revaccination, but hitherto the lymph cultivated upon calves at Government establishments has been issued only to public vaccinators. Some of the private firms engaged in the production of calf-lymph send out material to which no exception can be taken ; but it appears desirable that, should the Board be indisposed or unable to supply Government lymph to all applicants, they should, at least, be empowered to exercise such supervision over the production of lymph for the use of private practitioners as may be necessary to secure that persons upon whom it is used shall be " effectively revaccinated." Multitudes of persons, doubtless, during the epidemic were made happy by the thought they were immune to small-pox, as their revaccination did not "take"; the negative result of the operation being due, often, to the inertness of the lymph employed. The change of view as to the relative advantages of calf lymph and humanized lymph, during the last few years, is truly remarkable. In Kensington the Guardians gave parents the option of having their children vaccinated with calf lymph many years ago, and before the publication of the report of the Royal Commission recommending the use of calf lymph. But the then existing Order of the Local Goverment Board, required arm-to-arm vaccination, and calf lymph was supplied to the public vaccinators solely for the purpose of starting a series of vaccinations. Calf lymph for optional use in vaccination, in Kensington, was obtained from a private source; the general use of such lymph was discouraged, not to say penalised; the special grant for successful vaccination having been withheld from the public vaccinators who, acting upon the instructions of the Guardians, gave parents the option of having their children vaccinated with it. Now, the use of calf lymph, by public vaccinators at any rate, would appear to be universal. 73 Vaccination Authority.—In October, 1901, the Stoke Newington Borough Council adopted a resolution to the effect that— " Having regard to the fact that all other measures taken to stamp out the disease of small-pox are under the direction of the sanitary authority, it is an anomaly that vaccination and re-vaccination should not be also under their control." The resolution was communicated to the Local Government Board, with a request that they should initiate legislation for the correction of the anomaly; and also to the Borough Councils, who were requested to support the action taken. In November, 1901, the Paddington Board of Guardians adopted a resolution as follows— " That it is expedient that all powers and duties belonging to the Guardians in connection with vaccination be transferred to the Public Health Department of Borough Councils, so that all questions relating to public health can bo dealt with by one authority." This resolution was communicated to the Local Government Board, the several Boards of Guardians and the Borough Councils. The Kensington Guardians informed the Council that they agreed therewith. Both resolutions were referred to the Public Health Committee, who, in a report dated 19th November, recommended— " That the Council do express their concurrence with the views of the Stoke Newington Borough Council and the Paddington Guardians, and that communications be addressed to the Local Government Board and the Metropolitan local authorities in support of their representations on the subjest." The report of the Committee was adopted by the Council. The subject was raised again at the beginning of the current year by the afore-mentioned deputation to the President of the Local Government Board, who recommended that the administration of vaccination law should be transferred from the guardians to some other authority. The President said, with reference to this question, that nothing could be more inconsistent with the proper functions of a Board of Guardians than that they should be charged with the general duties of vaccinating the people in their neighbourhood. He expressed his preference for the plan of making the County Councils and the Borough Councils the future Vaccination Authorities. For my own part, whilst concurring in the desirability of relieving the poor-law authority of responsibility in connection with the administration of vaccination law, I question whether it would be the better course to transfer the responsibility in London to twenty nine separate authorities; viz., the Metropolitan Borough Councils. Some Boards of Guardians, it is well-known, have all along grievously failed in their duty in this matter, and strange as it may seem, some of the Health Authorities of London are known to be hostile to vaccination. Elections to Boards of Guardians have been fought on this ground, and who shall say that the same thing might not happen at elections to Borough Councils ? The interests of London are one and indivisible, and it would be intolerable that any district should be exposed to danger because a neighbouring authority failed to enforce, or was half-hearted in enforcing the law. The question is too important to be made the subject of party or municipal politics. But if I understand aright the views of the President, as reported in the Press, the responsibility of administering the future Vaccination Act in the Metropolis will be vested in some Central Authority. Substantially this is the course I advocated in 1877, when, (after deprecating the suggestion of the Local Government Board that the vestries, &c., should provide local small-pox hospitals for non-paupers), I urged the desirability of a severance of the connexion between Poor-law administration and the hospital treatment of infectious disease, and recommended the creation of a " Central Hospital Authority," with power to provide accommodation, without payment, and without disqualification, for all persons " whose isolation in hospitals is necessary for preventing the spread of disease "; to which authority I proposed, " on grounds of public policy," to " transfer the execution of the Vaccination Acts."* Should the exigencies of the Government, or any other cause in the present year, lead to postponement of legislation with regard to the questions of re-vaccination and the general supply of calf-lymph by the Vaccine establishment, it is to be hoped that a measure may be passed to transfer the execution of the Acts to central authorities. This is, perhaps, the least contentious of the questions that beset vaccination legislation, and should be capable of solution, even though it be found necessary to prolong the life of the present Act, in relation to other points, by including it in an Expiring Laws Continuation Act. * Annual Report lor 1876-77, p. 14. 74 Revaccination.—The deputation to the President of the Local Government Board urged the necessity of compulsory revaccination of children at 12 or 13 years of age, a plan adopted in Germany with such success that in the population of Berlin, to quote but one instance, small-pox is practically unknown. On this subject the President made no revelation of the intentions of the Government nor, indeed, of his own views. Small-Pox and Vaccination.—This section of the report would be incomplete without a reference to the evidence of the protection conferred by vaccination exhibited in two reports by public authorities issued in the early part of 1902. The first report, by the Statistical Committee of the Metropolitan Asylums Board, dealt with, " Statistics concerning completed Cases of Small-pox treated in the Board's Hospitals during the year 1901." It comprised particulars of 1,017 cases completed, that is, dead or recovered, during the year. The gross mortality was 24.3 per cent.: of vaccinated cases, 14.2 per cent.; of unvaccinated cases, 50.5 per cent. In the annnal report for 1871 I referred to the high mortality amongst children, indicative of a (then) relatively unvaccinated population. Out of a total of 120 deaths in Kensington, 46 were of children under five years of age, including 15 under one year. During 1901, in the whole of London, there were only 12 (out of the 1,017 completed) cases of small-pox among vaccinated children under 10 years of age, and of these not one died ; but there were 95 cases among unvaccinated children, of whom 52 died, a percentage of 54.7. Under 20 years there were 161 vaccinated cases, of whom three died, a percentage of 1.9; and 161 unvaccinated cases, of whom 79 died, a percentage of 49.1. The Registrar-General, in his fourth weekly return, 1902, gave a classified table of deaths from small-pox, registered from the beginning of the epidemic down to the 11th January, 1902. There were 64 deaths under ten years of age, not one of a child vaccinated prior to infection, but including nine of children under five years, who were vaccinated only after infection by small-pox. The statistics in both documents went to show a diminution in the protective influence exercised by primary vaccination after the age of 20 years. The report of the Statistical Committee contains striking illustrations, drawn from the records of the Board, of the protection afforded by revaccination. It will suffice to cite one paragraph. " Of 2,198 persons employed at the small-pox hospitals between 1884 and 1900, inclusive, in which period 17,900 small-pox cases were received into the hospitals, only 17 persons contracted small-pox, of whom 13 were not revaccinated until they had joined the ship, and four were workmen who escaped observation." It is added that " not one of the staff of the hospital ships has ever died of small-pox, and not one has even suffered with the disease for the past eight years." The second report referred to appeared in the fifteenth weekly return of the RegistrarGeneral, the statistics having reference to the deaths from small-pox of 1,015 London residents registered from the beginning of the epidemic in August, 1901, down to the 5th April, 1902, classified as regards vaccination. From this we learn that of children and young persons under 20 years of age, who were not protected by vaccination, 348 had died of small-pox, only 22 deaths from the disease having occurred among persons at the same age who were ascertained to have been vaccinated in infancy. At ages over 20 years there were 103 deaths of unvaccinated persons; 448 of persons who had been vaccinated in infancy (including 13 who had been revaccinated only after infection) ; 2 deaths of persons who had been vaccinated since infancy, but more than twenty years ago; 2 deaths of persons who had been vaccinated at an unknown date, and 7 of persons who had been revaccinated more than 10 years ago. There were also 72 fatal cases in which the facts as to vaccination could not be definitely ascertained. In 58 of these cases the deceased were stated to have been vaccinated, but in none of them was it claimed that revaccination had been performed. Among the 1,015 deaths from small-pox at all ages, there were 932 cases in which the fact of vaccination or non-vaccination was definitely ascertained. Excluding 66 in which vaccination or revaccination was not performed until after the patient's infection, there was only one death which occurred within ten years of the patient's vaccination ; that of an infant aged 13 months, certified to have been imperfectly vaccinated. A concrete illustration of the protective influence of recent revaccination, and the danger of neglecting to secure such protection, was referred to in the second monthly report for 1902, in connection with an outbreak of small-pox at the Mile-End Infirmary. At the time of the outbreak, 40 nurses and two matrons were on duty; 29 of the nurses and the two matrons had been revaccinated prior to the outbreak—some recently and all within two years. None of them contracted the disease. Four nurses were revaccinated immediately after the outbreak and none of them caught the disease. Seven nurses caught small-pox: three of them had not been revaccinated, the other four were revaccinated within the incubation period, i e. (as it turned out), after they had become infected, so that they were virtually not revaccinated. The Steward of the Infirmary was revaccinated, his Clerk not. The Steward, although constantly exposed to the nurses, who were " contacts," escaped ; the Clerk, similarly exposed, contracted small-pox. The medical staff were revaccinated, none of them contracted the disease. 75 Vaccination Officer's Return respecting the Vaccination of Children whose Births were Registered in 1901.* (Vide page 71.) DATE. Registration Sub-Districts comprised in Vaccination Officer's District. Number of Births returned in Births List Sheets Number of these Births duly entered in Columns 1, 2, 4, and 5 of the Vaccination Register (Birth List Sheets), viz. : Number of these Births which are not entered in the Vaccination Register, on account, (as shown by Report Book) of Column I. Successfully Vaccinated. Column II. Column V. Dead, Un vaccinated. Postponement by Medical Certificate. Removed to other Districts and notified to Vaccination Officers of the Districts. Removal to places unknown, or which cannot be reached, and cases not having been found. Total Number of Certificates of Successful Vaccinations received during each of the Calendar Years. Insusceptible of Vaccination. Certificate of Conscientious Objection. 1901. 1902* 1901. 1 2 3 4 6 7 8 9 10 12 13 1st January to 31st Dec. , Kensington Town 3,061 2,478 11 36 297 7 26 204 4,066 3,816 Brompton 559 459 5 10 47 1 11 26 Total 3,620 2,937 16 46 344 8 37 230 4,066 3,816 * The complete Return for 1902 will not be due until February, 1904. 76 THE METROPOLITAN ASYLUMS BOARD. Under the provisions of the (repealed) Sanitary Act, 1866 (sec. 37), the local sanitary authority was endowed with power to provide, for the use of the inhabitants within their district, hospitals for the reception of the sick ; a provision re-enacted in section 75 of the Public Health (London) Act, 1891. But, excepting in a few districts, and for a limited period, in time of emergency; e.g., when small-pox was epidemic, this power was not exercised, despite official pressure brought to bear to induce sanitary authorities to erect local hospitals. The late Vestry led the opposition to the establishment of such hospitals, with little support at first, but ultimately with complete success ; and no one now doubts that the policy of that body, adopted in 1877, was wise, and fruitful in benefit to the entire Metropolis. In 1867, the Metropolitan Poor Act brought the Asylums Board into existence, and this body soon set to work to provide infectious disease hospitals, nominally for paupers only. As a matter of fact, however, and despite the disabilities attaching, in theory, to the use of these hospitals, they were largely used from the beginning by non-paupers; and in course of time legislation secured to the inhabitants of the Metropolis all the advantages desired and contended for by the late Vestry, at my instance, from 1877 onwards. The hospitals are now free to all, no disability attaching to the use of them by any person whatsoever. The Managers, as the central authority, have fulfilled their duties admirably, and have created for London a hospital system unequalled elsewhere, and which, it is perhaps not too much to say, is the admiration of foreign nations. Be this as it may, the Managers fulfil the duties originally devolving upon the local sanitary authorities; duties which those authorities would undoubtedly have had to perform but for the creation of the Board, and the subsequent legislation which has so enhanced their powers as to leave little or nothing to be desired. During the past year, and in 1901, several of the Borough Councils approached the Managers with a suggestion that they should provide accommodation for poor persons suffering from consumption, a subject dealt with elsewhere, and it will have been observed that the Conference of Metropolitan Guardians, held in October, 1900 (see page 49), regarded the Managers as the proper authority to act for them in the fulfilment of this duty—for it is nothing less. The Managers are understood to be willing to assume the position of hospital authority for this purpose, should the local authorities be unanimous in the desire to see it entrusted to their hands, and it is to be hoped that, ere long, some joint action may be taken by the sanitary authorities to bring about such a desirable new departure. But whether the work be done by the Board, at the instance of the Poor Law Guardians, or the Health Authorities, the assistance to be afforded to poor sufferers from this dire disease must be dissociated from " poor relief" in the legal sense of the expression. Report of the Statistical Committee.—In the absence of information relating to the Hospital and Ambulance Work of the Board for 1902—the report not yet being published—a resume of the report of the Statistical Committee for 1901 may not be without interest, as an indication of the character and magnitude of the work of the Managers in respect to infectious disease. Notification Statistics show that during the year 1901 there were notified in the Metropolis 40,361 cases of infectious disease (compared with 35,247 * in 1900), of which 35,501 {30,24.3) were legally admissible to the Managers' hospitals, and 26,521 (21,371), or 74.7 (70.63) per cent., were admitted. In no previous year had the proportion of admittances to notifications been so great. In 1890 the proportion was only 33.59 per cent. For the first time for some years there was a decrease in the ratio of diphtheria to scarlet fever, notwithstanding that the number of diphtheria notifications exceeded those of scarlet fever in 3 (13) different districts, viz., Fulham, Hackney and Poplar. Tables are given which illustrate the great variation from week to week in the percentages of cases admitted to hospital, ranging from 61.80 (65.32) to 91.02 (85.40) in the case of scarlet fever; from 58.28 (62.23) to 92.02 (87.91) in the case of diphtheria; and from 25.00 (35.00) to 65.91 (65.43) in the case of enteric fever. Small-pox.—Practically all cases of small-pox find their way into the Managers' hospitals, less than 3 per cent. of the cases notified in the year being treated elsewhere. Frequently the small-pox admissions exceed the number of notifications, a fact probably explicable in many instances by the " disinclination of medical practitioners to send their certificates to the Medical Officers of Health until they know whether the diagnosis has been confirmed by the Board's experts." Percentage of Admissions to Notifications.—The Committee observe that the proportion which the hospital admissions bear to the total number of cases is of great importance to the Managers in considering the question of the amount of accommodation which should be provided to meet the wants of the Metropolis; and they give for each of the years 1890-1901 a table showing the percentage of admissions to notifications of each admissible disease. * Note that the italic figures in brackets are the corresponding totals for 1900. 77 The proportion of scarlet fever admissions to notifications has risen from 42.82 to 78.89 per cent.; of diphtheria cases from 17.87 to 74.85 per cent., and of enteric cases from 22.49 to 45.34 per cent.—a satisfactory state of affairs from the public health point of view. Increase of Accommodation.—The Managers have more than doubled their accommodation for fever cases since 1891, but the Committee state that it may still become 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. Spot Maps.—As usual, the Committee furnish illuminative maps spotted to show the distribution of the principal fevers throughout the Metropolis. Age and Sex of Notified Cases.—Tables are given exhibiting the age and sex of notified cases. Of scarlet fever and diphtheria, over two-thirds of the cases are children under ten years of age; scarlet fever being most prevalent amongst children from five to ten, diphtheria most so amongst children under five years. Protective Influence of Vaccination.—Owing to the protection afforded by vaccination in infancy, comparatively few cases of small-pox were notified amongst children under ten years of age. Ambulance Work.—During the year (1901) 27,380 (21,524) * fever, diphtheria and smallpox cases were conveyed to the hospitals; 5,223 (5,394) convalescent patients were transferred to the Northern and Gore Farm hospitals, and 5,539 (5,416) recovered patients were brought back from those hospitals to London. Removals to other Hospitals.—Some 388 (327) private persons were removed, on payment, to other places than the Managers' hospitals; of whom 159 (20) were taken from the outpatient departments of general hospitals to their homes owing to there being no suitable beds immediately available in the Managers' hospitals, to which the cases were admitted the following day, none of them being small-pox; 98 (201) enteric patients were removed from their homes to the general hospitals, where arrangements for their reception had been made by the Managers. Land Service.—Alogether 39,966 (33,791) removals were effected by the land ambulance service during 1901, and the various vehicles made 30,587 (24,808) journeys, and ran 317,278 (232,848) miles. River Service.—The steamers conveyed 5,453 (1,635) passengers to and from the hospital ships at Long Reach. Of that number, 1,614 (64) were patients taken to the hospital ships, 633 (69) were recovered patients brought back to London, and 3,206 (1,502) were visitors, staff, workmen, etc. Hospital Accommodation.—The Table at page 82 in the present report shows the accommodation at the several hospitals at the early part of the current year, including the additional accommodation provided to meet the demand created by the epidemic of small-pox. Hospital Statistics.—The year 1901 commenced with 4,142 (4,895) patients in the fever hospitals then open : by 25th April (May 5th, 1900) the number under treatment had fallen to the minimum 2,563 (2,948). The number rose to 4,708 by the 12th August, when it began to decline, and on the 24th of that month it was reduced to 4,508. It then began to rise again, and on November 3rd (November 27th) attained the maximum 5,165 (4,779) for the year, and then declined until the end of the year when 4,588 (4,142) patients remained under treatment. Tables.—The distribution of patients amongst the various hospitals on November 3rd is shown in the Committee's report in a Table at page 18 ; and other Tables (i. to rut.), and an accompanying chart, summarise the particulars relating to the individual hospitals. Fever Patients.—The number of patients under treatment in the fever hospitals was 29,810 ; 3,206 higher than in 1900, and the highest on record. The maximum monthly death-rate was : for scarlet fever in May; for diphtheria in November ; and for enteric fever in August. The minimum rate was: for scarlet fever in November; for diphtheria in April; and for enteric fever in June. Duration of Stay in Hospital.—The average duration of residence of scarlet fever cases was : at the town hospitals 59.72 (66.1) days, including deaths, and 62.48 (68.6) days if the fatal cases be excluded. At the convalescent hospitals the averages were 74.68 and 74.69 (80.0) days respectively —including residence in the town hospitals, so that the total residence of cases completing their recovery at the country hospitals was 12.21 days longer than that of oases at the town hospitals. As regards the residence of the recovered patients in the town hospitals, there were considerable variations, the shortest residence was 50.95 (58 5) at the Eastern Hospital (North-Western Hospital in 1900), or 11.53 (101) below the average, and the longest was 69.00 (74.4), or 6.52 (5.8) days above the average, at the Western Hospital (Western Hospital in 1900 also). * Note that the italic figures in brackets are the corresponding totals for 1900. 78 The average length of residence of diphtheria patients at tne town hospitals was 51.21 (52.3)* days including deaths, and 56.94 (58.9) if the fatal cases be excluded. At the convalescent hospitals, where there was no death, the average residence (iucluding residence in the town hospitals) was 80.78 (76.1) days, or 23.84 days longer than in the town hospitals. The Committee observe that the variations in length of residence at different hospitals were again very remarkable, ranging from 42.86 (47.3) days at the North-Eastern Hospital (Southwestern Hospital), 14.08 (11.6) days below the average, to 67.43 (67.9) days at the South-Eastern Hospital (Grove Hospital), or 10.49 (9.0) days above the average. The average residence of enteric fever patients was 55.90 (52.7) days iucluding deaths, and 62.41 (59.1) days if the fatal cases be excluded. shortest residence of recovered cases was 48.89 (48.8) days, or 13.52 (10.3) days below the average, at the North-Western Hospital (same hospital in 1900), and the longest 77.18 ( 75.4) days, or 14.77 (16.3) days above the average, at the Western Hospital (same hospital in 1900). The Committee stated in their report for 1900 that the length of residence of patients in the hospitals is of the utmost importance from an economical point of view; for not only would any shortening of the period of residence effect a saving in the cost of maintenance; but it would also enable the Managers to treat a larger number of patients without increasing the number of beds, which is of very much greater importance. Small-pox.—Of small-pox patients 1,743 were treated, compared with 66 and 18 in the two preceding years. The average residence of the patients was 24.10 days, or, excluding deaths, 29.94 days. Fifteen cases were admitted from Kensington, 12 of vaccinated persons, 2 of unvaccinated persons (one of whom died), and one case in which the question of vaccination was doubtful. Table II. pp. 113-17, shows the ages, and condition as regards vaccination, of the patients admitted during 1901. Mistaken Diagnosis.—In the course of the year 1901, no fewer than 2,865 (1,706) patients or 9.2 (7.8) per cent. of admissions were found, after admission to the fever hospitals, not to be suffering from the diseases mentioned in the medical certificates upon which they were removed to hospital.† The largest number of cases thus admitted to any one hospital, was at the Park Hospital (same hospital in 1900) where the proportion was 436 (322), out of 3,643 (2,999) admissions, or 11.9 (10.7) per cent. of the total. The percentage on the total scarlet fever cases was 5.6 (5.5); diphtheria cases 12.8 (8.3), and enteric fever cases 25.5 (182). Amongst the 857 (608) cases wrongly certified as scarlet fever, there were 91 (63) of measles, 108 (106) of influenza, 173 (129) of tonsillitis, and 162 (104) of erythema ; 168 (60) had no obvious disease. Amongst the 1,118 (709) cases wrongly certified as diphtheria, were 47 (40) of measles, and 880 (498) of tonsillitis; 21 had no obvious disease. Amongst the 384 (386) cases wrongly certified as enteric fever, were 13 (21) of influenza, 22 (24) of febricula, 86 (89) of pneumonia, and 9 (14) of bronchitis ; 12 had no obvious disease. The cases of mistaken diagnosis in cases removed to the Wharves, as small pox, were 245 (30 in 1900, when the disease was not epidemic), out of 1,845 (94) or 13.3 (32.0) per cent. The medical certificate is revised by one of the Board's Medical Officers at the Wharves. Statistics since the Establishment of the Hospitals in 1870.—At page 33 is a table showing the admissions and deaths of patients and mortality per cent at the fever hospitals, together with the annual mortality per 1,000 persons living of the population of the Metropolis, from scarlet, typhus, and enteric fevers, and diphtheria, extracted from the Registrar-General's Annual Summaries. The total admissions were :—Scarlet fever 176,185; diphtheria (since 1888) 56,151 ; typhus 2,364 ; enteric 15,761 ; other diseases 18,418 ; total 269,874. Of small pox cases the admissions (1871-1901) were 63,888, including 13,139 between February 4th, 1871, and January 31st, 1872. Decreased percentage of case-mortality amongst scarlet fever cases is a noticeable feature * but more noticeable is the decline amongst diphtheria patients—from 40.74 in 1899 to 22.85 in 1895 (when the antitoxic serum treatment was adopted); to 15.88 in 1888 and to 11.14 in 1901 the lowest on record. Staff Illness.—There were 4,162 (4,333) persons employed at the fever hospitals during the course of the year 1901, of whom 197 (216), or 4.7 (4.9) per cent., fell ill with fever or diphtheria, and 1 (3) died ; while 1.216 (1397), or 29.2 (32.2) per cent., suffered from other forms of illness. One ambulance driver contracted small-pox, but of 575 (118) persons employed at the smallpox hospitals none contracted small-pox. The Committee have " many times in (their) annual reports drawn attention to the absolute impunity with which a hospital staff can be brought into * Note that the italic figures in brackets are the corresponding totals for 1900. † The percentage of mistakes to total cases in Kensington was 6 8 79 contact with small-pox, provided the members are properly protected by vaccination," and tbey observe that " the evidence afforded during the epidemic is still to the same effect." It is the Board's practice to insist on the re-vaccination of all officers and servants before they join the hospital or ambulance service—unless they can satisfy the medical superintendent that they are already sufficiently protected. During the late epidemic the immunity enjoyed by the staff, of all degrees, bears eloquent testimony to the effectiveness of re-vaccination when successfully carried out. Kensington Patients.—The admissions of borough cases in 1901 were 633 (613)*; viz., scarlet fever 370 (267), diphtheria 169 (240), enteric fever 49 (55), typhus fever 2, " other diseases" 43 (51). The deaths from all the diseases combined, were 48 (38), or 7.6 (6.2) per cent. on admissions. Removal of the Sick to Hospital.—The removal of the sick to hospital, whether by land or by water, is now effected in a satisfactory manner. The use of public vehicles by persons suffering from infectious disease is unlawful. Very rarely do we hear of the use of a cab, wittingly or unwittingly. 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 extremely rare occurrence compared with the time before the passing of the Public Health (London) Act, 1891 ; the 70th section of which forbids the employment of public vehicles. No 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. In the early part of 1900, the managers, on removing to their new offices, Victoria Embankment (corner of Carmelite Street), E.C., arranged for the reception of applications for the removal of the sick to hospital between the hours of 9 in the morning and 8 in the evening, on all days of the year; so that it is now necessary to apply at the ambulance stations between 8 in the evening and 9 in the morning, only. It cannot be too widely known that the sick are admitted on the application of any person whatsoever, the sole condition being the presentation of a certificate signed by a registered medical practitioner, as evidence of the nature of the disease, and the fitness of the patient for removal. The application may be made personally, or by letter, or by telegraph, or by telephone. The telegraphic address is " Asylums Board, London": the telephone numbers are 1601 and 1602, " Holborn." HOSPITAL ACCOMMODATION. In the annual report for 1893 (pages 117-130 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 now been 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 : " 5,000 beds for scarlet fever, ' fever,' diphtheria, and isolation." Fever Hospital Accommodation.—It is an accepted axiom that provision for the isolation of infectious disease should be 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 1881-2, and the Commissioners stated in their report (1882) that then provision of hospitals should be extended so as to provide 5,700 beds; 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 over 3,860,000; consequently the recommendation of the Commissioners went, to the extent of 1,740 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 resources of the Asylums Board; not only by the sanitary 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 * Note that the italic figures in brackets are the corresponding totals for 1900. † The ordinary provision was to be of 2,100 beds, but capable of being increased, on an emergency, to 2,700. 80 advocated in these reports many years before they formed the subject 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 been very effective; 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, of which in pre-notification days they would probably never have 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, with isolation wards, added upwards of 1,600 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 800 patients;* having already, at Winchmore Hill, north of the Thames, at the Northern Convalescent Hospital, accommodation for about 650 patients. In addition to the new 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. During the last few years the Gore Farm Small-pox Convalescent Hospital has been used for fever and diphtheria convalescents, small-pox having been in practical abeyance in the Metropolis. In September 1901, the Asylums Board informed the medical officers of health that it would be necessary to close this hospital against fever cases, it being required for small-pox patients. They observed that by the consequent loss of the beds, and of certain accommodation held in reserve for a possible outbreak of plague, they had about 1,000 fewer beds for fever purposes than in the preceding year, and this at a time when fever and diphtheria were more prevalent than in 1900. The accommodation set apart for these diseases was, at the time, practically exhausted, so that the Managers, it was expected, would be able to admit patients only as vacancies might be made by discharges or deaths. The medical officers, therefore, were requested to select for removal to hospital, until the height of the fever season should have been passed, and the decline of fever and diphtheria enabled the Board to admit all applicants, only those patients whose surroundings rendered it most desirable that they should be isolated in hospital. I ventured to represent to the Managers that it would be better, in the public health interests of the Metropolis, to make provision for small-pox patients on their land adjacent to the hospital ships—in huts, as at Darenth in 1881, than suddenly to deprive London of the advantages accruing from the use for fever and diphtheria convalescents of the Gore Farm Hospital. Similar representations were subsequently made by the Council, upon the advice of the Public Health Committee, based largely on the consideration that the Hospitals Committee had received authority to provide temporary accommodation for small-pox at Long Reach. A copy of the Council's communication was forwarded to the Local Government Board, and to the several Borough Councils, by some of which the views of the Council were endorsed, in communications to the Managers and the Local Government Board. The Board, however, stated that " having carefully considered the matter, in view of the present prevalence of small-pox in London, and of the possibility that plague may be introduced, they did not feel able to recommend the Managers to adopt any course which would diminish the amount of accommodation now set apart for those diseases." The Gore Farm (Upper) Hospital was utilized for small-pox cases, acute and convalescent, from October 1901 until the end of the epidemic. Happily no inconvenience resulted from its closure to fever and diphtheria, the town hospitals having sufficed for all requirements Proposed Additional Fever Hospital Accommodation.—'In June, consideration was given by the Managers to the question whether further accommodation was needed for fever and diphtheria. They had been advised that the Board should be in a position to deal with 20,000 cases of scarlet fever in a year,+ and that to enable them to do so 5,700 should be the minimum number of beds provided, while probably 2,000 would be needed for diphtheria, ‡a total for these two diseases, and the isolation and separation wards connected therewith, of (say), 7,700 beds * This hospital, the building of which is now in progress, will comprise detached blocks, each to contain a moderate number of patients, a desirable arrangement, as it will diminish opportunities for the spread of disease, such as postscarlatinal diphtheria. The estimated cost is £284,312, including furnishing, &c. † In 1893, 36,900 cases of scarlet fever were notified ; in 1901 about 84 per cent. of cases notified were admitted to hospital. ‡ In 1899, 13,363 cases of diphtheria were notified ; in 1901 about 76 per cent. of cases notified were admitted to hospital. 81 without making any allowance for enteric cases,* or providing for increase of population. The permanent fever hospital accommodation, existing or projected at the time, was 6,050 beds, but some 5,400 beds would approximately represent the number available, including the Southern Convalescent Hospital, at Carshalton, when completed.† The Hospitals Committee, reporting on the subject, recommended (a) That in the opinion of the Managers additional accommodation is required for the isolation of fever and diphtheria patients; and (b) That it be referred to the Hospitals Committee to make inquiries with the view to the acquisition of more land for hospital purposes, and to submit a scheme to the Board for their consideration. With reference to this proposal the Chairman of the Finance Committee furnished statistics in support of the contention that further hospital accommodation was not required, and asked the Board to review their position before entering into larger financial responsibilities. It was pointed out that the Board had never, since 1871, had to deal with more than 2,000 cases of small-pox at any one time, and that the surplus accommodation provided for this disease could be made available for fever and diphtheria. The Council having referred to the Public Health Committee my sixth report (June 19th, p. 113), in which the matter was dealt with, I prepared a memorandum showing that the scheme approved by the Hospitals Committee pointed to a deficiency of some 1,600 beds for fever and diphtheria. On this basis (I observed), three additional hospitals would be required, if it were decided to build in London ; as apparently contemplated by the Committee, who desired to be authorised " to make inquiries with the view to the acquisition of more land for hospital purposes, and to submit a scheme to the Board for their consideration." The report of the Public Health Committee, after some preliminary observations, was to the following effect: — " The deficiency of accommodation appears to be to the extent of 1,600 beds—or about as many as are comprised in the last three hospitals erected by the Board. Judging from the cost of those establishments, it would appear not unreasonable to assume that three new hospitals, on the scale of the " Brook," the "Grove," and the " Hither Green" Hospitals, including sites, furnishing, etc., would involve an approximate expenditure of £800,000, of which about one-sixteenth, or £50,000 would fall upon Kensington. Great as the outlay would be we should not feel justified in objecting to it, could it be proved to be necessary. But we think the Medical Officer has shown prima facie reason for doubting the necessity, and that before such a great additional burden is imposed upon the ratepayers of the Metropolis, the need of it should be conclusively demonstrated. At present the Board have not assented to the proposals of the Hospitals Committee and we hope they will not find it necessary to do so; but should this step be taken, we are of opinion that the Local Government Board, before they shall have given sanction to any scheme, should be asked to institute an inquiry directed to ascertain the feasibility of the suggested alternative of utilising the surplus accommodation at the small-pox hospitals for fever and diphtheria patients. We recommend therefore that the matter be referred back to us with power to make a representation to the Local Government Board with a view to the holding of an inquiry, should occasion arise, and to invite the co-operation of the Sanitary and Poor Law Authorities of the Metropolis generally." The Managers, however, referred back the report of the Hospitals Committee, and no further action appears to have been taken. . . The present hospital state of the Metropolis with respect to fever and diphtheria accommodation is as follows : the ten town hospitals contain some 4,600 beds; the Northern Convalescent Hospital 650; total 5,250. The Southern Convalescent Hospital, now in course of construction, will contain 800 beds ; so that ere long the Managers will have accommodation for about 6,050 patients. Small-pox Hospital Accommodation.—The subject of hospital provision for small-pox, referred to incidentally in the preceding paragraph, occupied a considerable share of the attention of the Asylums Board towards the close 1901, in connection with a report of the Hospitals Committee, dated 2nd November. In view of the necessity for making increased provision for acute cases with the utmost rapidity, the Committee recommended the erection of a temporary hospital on the Managers land at Long Reach, near the Ships, for 300 patients, so as to raise the accommodation in that locality to 550 beds. The Managers adopted the recommendation and * In 1899, 4,460 cases of enteric fever were notified; in 1901 about 25 per cent. of cases notified were admitted to hospital, † The beds reserved in June were, for isolation 463, and for plague 196—say 660. 82 authorised the Committee to take all necessary steps for equipping temporary hospitals, and any other measures that might seem to them requisite, for making emergency accommodation available as rapidly as possible, and to communicate direct with the Local Government Board on their behalf. With regard to Joyce Green, the Committee explained that in July, 1896, the Managers submitted to the Local Government Board plans for a hospital for 940 beds ; the Board did not assent to the proposal; but a partial scheme, for the erection of the administrative buildings for a hospital on this scale, received sanction. The provision to be made for patients, was at that date restricted to ten blocks, to contain 436 beds; of the remaining 12 blocks, and the isolation block, for 504 patients, the foundations and the drains only had been laid, the contract price being £222,459. The Committee pointed out that the value of the hospital would be more than doubled by the comparatively small outlay (estimated at £77,339) required for the completion of the whole of the wards, and they recommended, with a view to steps being taken to that end, as early as practicable, that it be an instruction to the Works Committee to advise the Board as to the course that should be adopted for the erection of the remaining 12 blocks for patients, and the isolation block. The recommendation was adopted; the consent of the Local Government Board was obtained, and the work was put in hand forthwith. Had this hospital been ready for use in 1901, the accommodation—a total of about 2,200 beds, including the ships and the Gore Farm " Upper' Hospital, would have sufficed for the needs of the Metropolis. As it was, the Managers thought it their duty to make arrangements for providing another temporary hospital (the " Orchard,' 800 beds), on a part of the Joyce Green site. This hospital completed and furnished many months ago, has not been brought into use. Yet another hospital (the "Lower"), at Gore Farm was constructed for 850 patients, but it has not been used. Altogether, provision was made for 3,890 cases; 2,040 at Joyce Green and Long Reach (independent of the ships, 250 beds), and 1,850 at Gore Farm.* The requirements of the Metropolis, as estimated by the Royal Commission in 1892, were for 2,100 patients or, on an emergency, for 2,700. The maximum number of patients in 1902, and that for a very brief period scarcely exceeded 1,600 and, as already stated, at no one time since the historic outbreak of 1871, have there ever been so many as 2,000 patients under treatment in the hospitals. 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. " Return showing the permanent Fever Hospital Accommodation existing and projected :— (i.) Accommodation existing— Beds. Eastern Hospital 362 North-Eastern Hospital 520 North-Western Hospital 460 Western Hospital 450 South-Western Hospital 866 Fountain Hospital 402 Grove Hospital 522 South-Eastern Hospital 408 Park Hospital 548 Brook Hospital 560 Northern Hospital 652 Total 5,250 (ii.) Accommodation projected— Southern Hospital 800 Grand Total 6,050 " For Small-pox Patients the existing accommodation is as follows : — Beds. Long Reach Hospital 300 Gore Farm Upper Hospital 1,000 Gore Farm Lower Hospital 850 Orchard Hospital 800 Joyce Green Hospital (first portion of wards) 400 3,850 Accommodation in course of being provided is— Joyce Green Hospital 540 540 Grand total 8,890† * The estimated cost of the two temporory hospitals (" Orchard " at Joyce Green and " Lower " at Gore Farm) which were not used for small-pox, was approximately £300,000; that of Long Reach Hospital some £57,000. † This total is irrespective of the Hospital Ships (250 beds), which are " abandoned," though still afloat at Long Reach. 83 To sum up, the accommodation existing or projected, far exceeds the theoretical requirement of one bed for each thousand of the population. On that scale London would require not more than 4,600 beds, and it has, or soon will have, 10,000. The Royal Commission in 1882, recommended provision of 3,000 beds for fever—diphtheria was not included in the term. We now, or soon shall, possess upwards of 6,000 beds. For small-pox they recommend provision of 2,100, beds, or on an emergency 2,700, and we shall shortly possess nearly 4,000. THE AMBULANCE SERVICE. New Ambulance Station.— Many years ago the Managers constructed a Wharf and landing stage at Wandsworth Bridge with the intention of removing small-pox patients in the West district, therefrom, instead of taking them over a long and crowded route to the North and South Wharves. This "West Wharf" has never been used, but towards the end of 1901 the Managers decided to utilise the site by erecting a new Ambulance Station, the " Mead," which was rapidly built at a cost not much below £30,000 but used for a few weeks only for the removal of patients. Additions and improvements were made at the Shelters connected with the North and South Wharves, for the embarcation of small-pox patients, at a cost of about £9,000; a new Ambulance Steamer, moreover, was purchased at a cost of over £8,000. The Managers now possess seven stations; and the Chairman of the Ambulance Committee stated in January, 1902, that the Board were then in a position to convey 345 patients, in one day, to the country hospitals, irrespective of removals to the town hospitals. Transport of Small-pox Patients from London to the Small-pox Hospitals.—At the meeting of the Asylums Board on March 8th, 1902, a resolution was adopted, upon the recommendation of the Ambulance Committee, as follows :— "That the Ambulance Committee be authorised to take all the necessary preliminary steps with the view of securing sufficient freehold land, for the purposes of an ambulance station aud shelters for patients, midway between Loudon and Gore Farm Hospital." The recommendation was made in connexion with a previous report of the Committee (24th February) in which, referring to the probability of the continuance of the small-pox epidemic " through at least next winter, and perhaps with increased activity," they affirmed it to be "essential that the transport arrangements should be perfected, so that under all circumstances " patients may be conveyed to the hospitals." The river transport was said to be probably equal to any demands that may be made on it under ordinary conditions, but " if a fog (the most likely contingency) of some days' duration should occur, such as to render river navigation impossible, at a time when large numbers of small-pox patients were being daily admitted, the service . . would break down." Fog, however, was not the only " contingency," for in 1895 the ambulance steamships were frozen up at South Wharf, from the 10th to the 23rd February, when, fortunately, the admission of small-pox cases, during the 13 days, were 32 only, so that the steamships afforded sufficient accommodation for them until the ice broke up. Dense fog, the Committee further observed, "may occur at any time, and cause a stoppage of river traffic for days together," and they pointed out that, at the daily rate of admissions (in February), the steamboats " would probably only serve as a resting place for one day's admissions," so that it might some day " become necessary to resort to road transit to the small-pox hospitals for every case admitted." For a large number of cases this would be, with the present organisation, " hopelessly impossible." The Committee thought, therefore, that " no time should be lost in considering and settling how arrangements can be made whereby at a few hours' notice road transit can be set up and worked efficiently to whatever extent maybe necessary." How serious the "problem" will be realized if it is considered " what would be necessary to remove, say, 100 patients a day from their homes to the small-pox hospitals near Dartford;" for, "if no better arrangement could be made than to carry not more than two patients in one ambulance, the number of vehicles, horses, drivers, and nurses required would be enormous." The bulk of the patients, moreover, "would have to be dispatched in the latter part of the day, and the same vehicles could not be back and ready for use again the next day. It was " practically impossible that the whole journey should be performed by the same horses, nurses, and men, all of whom . . . would have to be housed and fed at the small-pox hospitals, a complete duplicate of all horses, vehicles, and drivers being required for similar journeys the next day." Therefore, a " half-way establishment seems to be a necessity, and this must probably be on a considerable scale." The Committee's report concluded with the recommendation already cited as having been adopted by the Managers. A proposal of such gravity, and involving such serious issues to the patients—to say nothing of the immediate expense in making provision of land, buildings, and plant—naturaliy attracted considerable attention; it became, moreover, the subject of comment by the Medical Officer of 84 Health for Paddington, in a report to the Public Health Committee of that borough, in which (inter alia) an attempt was made to forecast the probable requirements of ambulances, horses, drivers, etc., to enable the Managers to deal with the "problem," the "enormous" proportions of which are foreshadowed in the part of the Ambulance Committee's report which I have italicised above. The Ambulance Committee, in a subsequent report (5th May), communicated to the Borough Councils and the Boards of Guardians, disclaimed any intention of submitting to the Managers "a proposal to make provision for the gigantic staff of nurses, men, vehicles and horses " indicated as what would be necessary to give effect to the scheme outlined in their first report, summarised above. They said that they only " proposed the institution of a scheme of road transport which should be available whenever river transport was impossible ; " but such a " scheme " really did involve the provision of a " number of vehicles, horses, drivers, and nurses " on a scale which they themselves had described as "enormous." They appeared, however, to have no settled ideas as to the practical working of the "scheme," for in the later report (5th May) they said " We have not yet determined what means of traction, or what kind of vehicle, shall be recommended to the Managers for use in the road service." Reporting on the proposal, I observed that " the position in which the Managers would be placed, should fog or frost interrupt the river transport service at a time of great prevalence of small-pox, would no doubt be serious. But would road transport enable them to cope with it ? Were the interruption due to frost, in clear weather, the thing would be physically possible—at a risk to the patients which is hardly measurable. But if dense fog stopped river traffic, what guarantee was there that London streets and country roads would be passable at any reasonable . rate of speed ? And who could doubt that long detention, en route, would be detrimental to the sufferers, who, the Ambulance Committee estimated, might be as many as one hundred, to be despatched in the latter part of the day, possibly a winter day ? Was it to be supposed that patients' friends would suffer them to be exposed to such a risk ? And, if not, what might not be the consequences of their detention at home ? Obviously, the Managers were well advised to ' contemplate the desirability of providing a system of transport which would enable them, under great emergency, to convey,' not 'some,' but 'all their patients safely out of London' (were it practicable); if, as they said, ' the necessity of clearing London of small-pox day-by-day is admitted." But the real ' necessity,' is that of ' clearing' the houses of London day-by-day of smallpox. What the Ambulance Committee proposed was, in principle, excellent: the question w as, whether the proposed means of carrying out the ' scheme' was the best ? They alleged it to be the only one available, as any scheme of railway transport would meet with the greatest opposition from the Companies and the travelling public. But what about that greater public on the line ot route ? What would they say to a constant stream of small-pox passing through their midst, causing panic, to say the least of it, and probably ruin to the tradesmen frontagers ? But this by the way. There was, however, as I pointed out, an antecedent question; viz., whether it would be necessary, under emergent circumstances, to use the road at all ? Could not provision be made for accommodating the sufferers for a short time at (or in the vicinity of) the "Shelters?" Upwards of 8,000 patients passed through the South Wharf Shelters between August 1901 and June 1902 (and the Shelters during an epidemic are rarely empty of small-pox)*; but no harm ensued either from the detention of patients, or from the constant stream, day and night, of small-pox into the district. This being so, I asked, why, instead of incurring a vast expense on a new system of transport—which, in any case, would rarely be brought into action—to say nothing of the risk to the sick—why not make provision for temporarily housing the patients in enlarged Shelters on land or water? If the fear of aerial convection of contagiun were dismissed, nothing seemed to stand in the way of such a scheme but a certain amount of expenditure—a fairly large outlay, it might be, of capital which, should it lie for ever "dead," by reason of non-necessity for use of the temporary accommodation, need give no concern to a Board which, with splendid audacity, had not hesitated, in what they believed to be the interests of London, to spend hundreds of thousands upon temporary hospitals at Gore Farm, Long Reach, and Joyce Green. The scheme propounded by the Ambulance Committee came before the Managers again in June, on a recommendation for the purchase, subject to the approval of the Local Government Board, for the sum of £6,000, of 13 acres of land on the Bexley Road, near Blendon, as a site for the proposed ambulance station, midway between London and the hospitals at Gore Farm and Long Reach. The recommendation was referred back to the Committee. * The Local Government Board,.(3rd February) in a letter to the Managers, drew attention to the detention (in January) at the South Whart Shelters of numbers of cases of small-pox, considering it to be " most important that no acute cases of small pox should be allowed to remain at the wharves any longer than is absolutely necsssary, and that the cases should be transferred to a hospital with the least possible delay "—a view with which the Ambulance Committee expressed concurrence. (Report of the Ambulance Committee, 24th February). 85 The Council referred to the Public Health Committee my sixth report, in which this transport question was discussed, and for the further information of that body I prepared a Memorandum, as follows :— " The proposal of the Ambulance Committee is to provide a road service, on a scale which they themselves characterise as " enormous," for the conveyance to Gore Farm and Long Reach of small-pox patients, to be brought into use should fog or frost at any time close the river to the ambulance steamers. To this proposal an alternative has been suggested, that namely of a railway service, which deserves examination. "Apart from this immediate question, I desire to suggest that instead of the proposed road service, for an emergency seldom likely to arise, it would be better to make provision for the temporary detention of patients by enlarging the South Wharf Shelters, a course which is not likely to be detrimental to the locality. The outlay for the large establishment of ambulances, etc., contemplated, and in providing and maintaining an ambulance station midway between London and Dartford, would be great—probably much greater than that involved in the alternative suggested. The ambulance steamers, which are fitted as hospitals, would, with the present shelters, accommodate, on occasion, some 250 patients, and the necessary further accommodation could be provided, on land, or possibly on the river itself, if thought desirable. It may be objected that it would not be right to expose the Sufferers to the risk of catching small-pox at the South Wharf Shelters. But, subject to suitable arrangements, I believe the danger would be remote, even to the extent of negligibility. Lest this expression of opinion should be thought too absolute, I think it well to add that I have indisputable authority for saying that there has been no spread of small-pox in the neighbourhood ot the Shelters due to the transit or detention of patients. The immediate vicinity has been singularly free from small-pox; freer, indeed, than many other parts of the Borough of Bermondsey, although within the last few months upwards of 8 000 patients have passed through the Shelters. Not long since some 140 workmen were employed in erecting an extension to the Shelters, at a time when 80 cases per diem wore being admitted, and although they were uecessarily brought into close proximity to the sick, and were generally unprotected by vaccination, only one of them fell ill—about a week or two before their work ended ; and of him all that could be said was that it was not known whether he had contracted the disease there or elsewhere. The Shelters hold 25 patients, and on one occasion, fog having stopped the river traffic, 120 patients were detained therein, and on the steamers, without ill-effect to the locality. Barges constantly anchor close to the Shelters, but I cannot learn of complaint having ever been made of any spread of disease to the crews The Managers, moreover, have another pier and landing stage adjacent to the Mead Ambulance Station, near Wandsworth Bridge, constructed many years since, but never yet brought into use. The locality would be convenient for Shelters for the Western Districts; and to the use of the wharf as a place of embarkation, there would appear to be no objection, except that the pier is available only when the tide serves : a fact which surely ought not to constitute an insurmountable difficulty." The report of the Public Health Committee on the reference was as follows:— " Upon the reference by the Council we have considered a letter from the Metropolitan Asylums Board, and a report which the Managers have received from the Ambulance Committee, •relative to certain representations made with respect to the proposal of the Committee to obtain land between London and the small-pox hospitals on which to establish a midway ambulance station in connection with the road-transport of patients. "We have also considered paragraph 3 of the sixth report of the Medical Officer of Health, dated 19th June, 1902, dealing with the subject, under the heading " Transport of Small-pox Patients from London to the Small-pox Hospitals," and we concur with the view therein expressed that the proposal of the Ambulance Committee is not a desirable one, and that it would be preferable to provide extended shelters for the temporary accommodation of patients, should frost or fog close the river to traffic. " We hope that the proposals of the Ambulance Committee may not be approved by the Managers, but should they be, we are of opinion that the Local Government Board should be asked to hold an inquiry before giving sanction to a scheme which would be costly and of doubtful benefit to the Metropolis. " We accordingly recommend that the matter be referred back to us with power to make representations to the Local Government Board, with a view to the holding of such inquiry, should it become necessary, and to invite the co-operation of the Sanitary and Poor Law Authorities of the Metropolis generally." Happily, the occasion for the action recommended by the Committee did not arise; the Managers having rejected the proposal of the Ambulance Committee to purchase land for a station intermediate between the Shelters at the Wharves and the Country Hospitals, the scheme of a large installation of vehicles, etc., fell through. Subsequently the Managers obtained the sanction of the Local Government Board to the provision of a motor ambulance calculated to make the journey, to and fro, between the London hospitals and Gore Farm in one day. This vehicle has been provided, but is not likely to be required for the conveyance of small-pox patients. 86 THE HOUSING OF THE WORKING CLASSES. This subject, which occupied considerable space in the two preceding reports, furnishes little ground for observation on the present occasion, the Council having been unable to make any arrangements, under Part III. of the Housing of the Working Classes Act, 1890, for extending housing accommodation. So far, moreover, the Great Western Railway Company have not taken over the properties—in Southam Street, Wornington Road, Admiral Terrace, and Place and Mews—needed for the widening of their line, nor begun to make provision for re-housing the many persons, between 3,000 and 4,000 in number, who will be displaced by their operations. Parliamentary.—In the session of 1902 a Joint Select Committee of the House of Lords and the House of Commons on Housing of the Working Classes, were appointed to consider the Standing Orders relating to houses occupied by persons of the labouring class, and the clauses usually inserted in private and local Bills and provisional order confirmation Bills in pursuance thereof, and to report whether any amendments should be made in such Standing Orders and clauses. The following is the text of the report:— 1. We submit two model clauses and three corresponding Standing Orders, which we recommend in place of the present model clauses and Standing Orders 38 and 111 (H.L.), 38 and 183a (H.C.), dealing with London and all places outside London respectively. 2. We suggest that the model clauses be embodied in a public general Act of Parliament. 3. After hearing evidence and consulting the officials of the Home Office and Local Government Board, we have come to the conclusion that in London it is desirable that every case in which houses of the labouring class are proposed to be taken should be notified to the central authority, while outside London it is sufficient that the attention of the central authority should be called to cases in which 30 persons belonging to the labouring class are displaced in one borough, urban district or rural parish as the case may be. 4. In settling schemes for providing new houses in place of those demolished, we think it advisable that the central authority should exercise a full discretion. 5. We recommend that the new houses to be provided be suitable for persons of the labouring class and not too ambitious in character and design; we attach much importance to these conditions. 6. It will be observed that the area within which the new houses may be provided under a scheme is left by us wholly to the discretion of the central authority. It may be, and, we think, will be, found expedient in some cases to erect the new houses at some considerable distance from the houses demolished, and not necessarily within the jurisdiction of the same local authority. 7. We recommend that in London the central authority be empowered to fix all rents for the new houses. On this point we are not agreed. The above decision was arrived at on a division by six votes to three. 8. In regard to Ireland and Scotland, we were informed that neither the Lord Lieutenant of Ireland nor the Secretary for Scotland desired to make any suggestions to us. So far as we can judge, our recommendations for places outside London are, with the necessary alterations, suitable for Ireland and Scotland. The model clauses and the Standing Orders which the Committee recommend for adoption in place of the present model clauses and Standing Orders, have been issued, together with the proceedings of the Committee, as a Parliamentary Paper [171], one clause being for London and the other for places outside London. It is to be presumed that, as recommended by the Committee, the model clauses will be embodied in a public general Act of Parliament. By-Laws for Houses Let in Lodgings, etc.—With respect to this subject, there is nothing to add to what was said in the report for 1901: the negotiations with the Local Government Board are still going on with reference to the proposed new by-laws, but, for my part, I do not think this a cause for regret, the existing regulations, framed in 1885, being satisfactory, and for practical purposes more advantageous in working than any by-laws the Board are now likely to approve. The Council, upon the recommendation of the Public Health Committee, registered 15 houses during the year, the total number on the register at the present time being 2,050. 87 By request of the Sanitary Committee of the late Vestry a return was prepared in 1896, showing the streets in which houses had been registered, and the number of the houses registered, and the number not registered, in each street. This return is here submitted, corrected to date :— South Kensington. 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 — Campden Street 68 59 9 Childs Place 21 16 5 Childs Street 20 11 9 Clifton Place 8 8 — Cousins Terrace 7 5 2 Dartmoor Street 60 57 8 Duke's Lane 10 10 — Edge Street 85 19 16 Ernest Street 21 20 1 Farmer Street 26 20 6 Fenelon Road 36 26 10 Ifield Road 152 136 16 Jameson Street 31 29 2 Johnson Street 26 16 10 Kensington Place 44 86 8 Lorne Gardens 82 28 9 Merton Road 38 82 1 Newcom.be Street 18 16 2 North Row 21 15 6 North Street, St. Mark's 15 15 — Peel Street 70 44 26 Pembroke Place 11 9 2 Pembroke Road 16 12 4 Prince Teck Buildings 12 6 6 Radnor Terrace 5 4 1 St. Alban's Road 17 10 7 St. Mark's Road 22 16 6 Seymour Place 56 85 21 Shaftesbury Road 25 16 9 South End 11 2 9 South End Row 6 4 2 South Street, St. Mark's 19 16 3 Stamford Cottages 10 7 8 Trafalgar Place 5 8 2 Uxbridge Street 44 22 22 Wallgrave Road 27 23 4 Wallgrave Terrace 18 13 - Warwick Road (late Lily Terrace) 6 5 1 Warwick Road (late Warwick Terrace) 25 15 10 West Pembroke Place 16 14 2 William Street 17 15 2 Yeoman's Row 48 41 7 Totals 1,225 941 284 88 North Kensington. Name of Street. Number of Houses in Street. Number of Houses Registered. Number of Houses not Registered. Adair Road 88 26 7 Admiral Terrace 11 10 1 Appleford Road 58 55 8 Bangor Street 89 32 7 Barandon Street 18 10 8 Blechynden Street 75 65 10 Bolton Road 88 80 8 Bosworth Road 33 28 5 Bransford Street 18 11 2 Branstone Street 11 10 1 Calverley Street 18 11 2 Convent Gardens 28 22 6 Crescent Street 39 24 15 Edenham Street 88 81 2 Edinburgh Road 10 7 8 Golborne Gardens 51 43 8 Grenfell Road 27 12 15 Kenley Street 51 44 7 Lonsdale Road 54 2 52 Martin Street 15 5 10 Portland Road 95 70 25 Princes Road 110 2 108 Raymede Street 17 2 15 St. Ann's Road 67 6 61 St. Katharine's Road 112 102 10 Sirdar Road 93 60 33 Southam Street 145 142 3 Tottenham Street 12 8 4 Treverton Street 62 59 3 Wornington Road 201 181 20 Totals 1,559 1,110 449 Exemption Clause.—An interesting question was raised last year by the County Council on the subject of exemption of houses from registration. Their Public Health Committee had reported that many of the by-laws framed by sanitary authorities " contained clauses exempting from their operation all houses above a certain rental," whilst " in other instances, where no such limits of rental are specified, there are clauses to the effect that a house shall not be subject to the by-laws until the sanitary authority resolves to require its registration, or until it is reported by a committee as suitable for registration." The Committee stated that they had found, in several cases, " that the limits of rental are so low as to exclude from the operation of the by-laws houses which it would be very desirable to deal with, and that the discretionary power given by the form of the by-laws, in other instances, has led to neglect to carry out the requirements of the section :" they therefore thought it desirable to take Counsel's opinion as to the legality of exemption clauses in the by-laws, and the following question was put to Mr. C. A. Cripps, K.C., viz.:— " Whether there is power under section 94 of the Public Health (London) Act, 1891, to exempt any houses from the operation of by-laws for the registration of houses let in lodgings or occupied by members of more than one family, or whether every local authority is bound to make by-laws for the registration of every such house in its district ? " 89 Mr. Cripps's opinion was as follows :— " In my opinion section 94 of the Act of 1891 is imperative, and there is no power to exempt from the operation of by-laws for the registration of lodging-house3 any houses so occupied as to come within the lodging-house definition. a by-law in the Bethnal Green form, which enables the local authority to exempt any or all lodging-houses within their district, is not a compliance with the requirements of the Act, and I am unable to agree with the view put forward by the Local Government Board." The " view " referred to was, that a certain Vestry did not appear to the Board to have been guilty of default in enforcing the by-laws, inasmuch as one of the by-laws allowed the Vestry a discretion as to what houses should be required to be registered. It would now appear, the County Council state, that in Counsel's opinion " Section 94, of the Public Health (London) Act, 1891, is imperative, and that there is no power to exempt from the operation of by-laws for the registration of lodging-houses any houses so occupied as to come within the lodging-house definition." The Committee stated that Counsel's opinion " was of great importance, raising as it did the question of the validity of the exemption clauses in the by-laws of nearly all the London sanitary authorities ; " and on their advice the Council decided to ask the Local Government Board not to confirm in the future any by-laws as to houses let in lodgings containing exemption clauses giving a discretionary power to the sanitary authority. The Local Government Board, however, signified their dissidence from the view of Mr. Cripps, and they are not merely willing to sanction an exempting by-law, but press for one, whether in the terms of their model by-law or in some different form. There is no by-law dealing with this question of exemption in the Council's existing code, the late Vestry having decided to treat, as the Council treat, each case on its own merits, and to exempt from registration at discretion ; and the matter will, I hope, always remain on that footing. Personally, I should welcome a large extension to the operation of the by-laws, for they facilitate administrative work in the Public Health Department, very materially; and I can but repeat, what I have often said, that the application of the by-laws to all tenemented houses, and other houses let in lodgings to the poorer classes, would be an unmixed benefit, by enabling the sanitary authority to enforce conditions necessary to secure healthy homes for the people, who, in regard to such matters, have little power to help themselves. The Advantages of By-Laws.- It has been objected to the by-laws made in 1885, and still in operation, that some of them deal with matters now " otherwise" (but not differently) " dealt with" in the Public Health (London) Act, 1891, and in by-laws framed by the County Council and the sanitary authority. There is, nevertheless, manifest advantage in dealing with such matters in the lodging-house by-laws, for the information of owners, keepers, and lodgers having duties in regard to them. Sanitary administration in relation to registered houses is facilitated by the by-laws which enable the Council to secure conditions necessary to healthiness of the habitation, without recourse to the tedious process of proving nuisance to the satisfaction of the justices, by proceedings under the second section of the Public Health Act. And 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; and practically there has been little objection by any of the parties affected by them. Common Lodging-Houses.—The County Council in 1894 took over from the police the supervision of common lodging-houses, under the circumstances set out in my annual report for 1893 (p. 207). I am indebted to the Council's Medical Officer of Health for the subjoined return of the common lodging-houses in this borough, which are 33 in number, and contain accommodation for 1,019 persons. 90 COMMON LODGING HOUSES. Sanitary District. Name of Keeper. Address of Common Lodging-House. No. of Single Lodgers, for which registered, in 1902. No. of Double Beds Authorised. Male. Female. Total. 2. Phipps, William 194, Kensal Road 75 ... 75 ... „ Marsh, Hy. Chas. 88, Wornington Road 35 ... 35 ... 3. Beasley, Richd. Thos. 21, Bangor Street 30 ... 80 ... „ Do. 23, do. ... 19 19 5 „ Do. 25, do. ... 18 18 5 „ Do. 29, do. ... 21 21 5 „ Phipps, William 18, do. ... 32 32 ... „ Do. 20, do. ... 54 54 ... „ Reynolds, Charles 35, do. 35 ... 35 ... „ Philips, Thos. Jno. 5, do. 25 25 ... „ Do. 7, do. 29 ... 29 ... „ Do. 9, do. 24 ... 24 ... „ Hankins, George 10, Crescent Street 32 32 ... „ Do. 28, do. ... 14 14 8 „ Do. 30, do. 30 . . . 30 ... „ Do. 40, do. ... 16 16 4 „ Phipps, William 25, do. 17 20 37 1 „ Do. 27, do. . . . 4 4 11 „ Do. 31, do. ... 26 26 4 „ Do. 33, do. 20 . . . 20 7 „ Hallett, Thomas 4, Hesketh Place 11 ... 11 4 „ Do. 6, do. ... 6 6 3 „ Do. 8, do. 14 ... 14 3 „ Simpson, James 37, Mary Place 16 ... 16 ... „ Do. 35, do. 21 ... 21 . . . „ Davis, Mark 66, St. Ann's Road 43 7 50 11 „ Phipps, Wm. 34, Sirdar Road 9 ... 9 9 „ Do. 36, do. ... 35 35 . . . „ Do. 38, do. ... ... ... 11 „ Do. 40, do. ... 26 26 „ Bayley, Henry 31, do. 30 ... 30 ... 7. Redman, John 24, Peel Street 20 . . . 20 ... „ Do. 22. do. 23 ... 23 . . . Twenty-three of the common lodging-houses, with accommodation for 706 persons (140 of them in double beds) are comprised in the " Notting-dale " special area. FACTORY AND WORKSHOP ACT, 1901. This Act requires the Council to " Keep a register of all workshops situate within their district." It also requires the Medical Officer of Health in his annual report to the Council to " report specifically on the administration of the Act in workshops and workplaces," and to send a copy of the report, or so much of it as deals with this subject, to the Secretary of State." Inspection of workshops where women are employed has been thoroughly carried out since 1893, when the late Vestry, at my recommendation, appointed two ladies (who are now His Majesty's Inspectors of Factories) to supervise the carrying out of the provisions of the then existing Factory and Workshop Acts, in relation to workshops, laundries, etc. The precedent then established has since been largely followed by Public Health Authorities within and without the Metropolis, and ere many years shall have passed it is probable that the practice of employing the services of women in sanitary administration will have become general. The report of the Inspectors of workshops, laundries, etc. where women are employed is as follows:— 91 " At the beginning of the year 1902, 869 workshops, etc., where women are employed, were on the register. During the year, 177 premises were placed on the register, and 62 were removed therefrom. The particulars are as follows :— Workshops, etc. North Kensington. South Kensington. Total for Borough Dressmakers. Laundries. Miscellaneous. Total. Dressmakers. Laundries. Miscellaneous. Total. Added to Register 6 9 38 53 52 1 71 124 177 Removed from Register 17 8 2 27 29 5 1 35 62 " The net result is an increase of 26 registered premises in North Kensington, and 89 in South Kensington; total 115. At the end of the year, 984 places (comprising an aggregate of 1,989 rooms) were on the register, viz. :— Workshops, etc. North Kensington. South Kensington. Total for Borough Dressmakers. Laundries. Miscellaneous Total. Dressmakers. Laundries. Miscellaneous. Total. No on Register 104 326 79 509 328 20 127 475 984 No. of Rooms therein 134 931 97 1,162 578 48 201 827 1,989 " The subjoined list comprises the businesses carried on at the registered premises:— Trade or Business. North Kensington. South Kensington. Borough. Art needlework 1 2 8 Blind-maker - 2 2 Blouse-maker 3 8 6 Boot header 1 - 1 ,, closer 2 - 2 ,, maker - 1 1 Cardboard box maker - 1 1 Corset maker 1 4 5 Cracker maker 1 - 1 Dressmaker and ladies' tailor 101 818 414 Dyer and cleaner 6 4 10 Eyelet hole finisher 1 - 1 Furrier 1 1 2 Haberdashery specialities 1 — 1 Hair wash manufacturer 1 - 1 Hosier - 1 1 Lace goods maker 2 — 2 Lamp shade maker 1 1 2 Laundries (workshop) 282 16 298 ,, (factory) 44 — 44 Machinist — 1 1 Mantle maker - 6 6 Milliner 1 32 33 Outfitter - 4 4 Photographer 8 11 14 Printer — 4 4 Restaurant and dining room 31 51 82 Starch manufacturer 1 - 1 Tailor 21 4 25 Typist — 4 4 Upholsterer 1 8 9 Waistcoat maker 2 - 2 Wig maker — 1 1 Grand total 509 475 984 number of persons who may lawfully occupy each of such rooms, upon the scale of 250 cubic feet per person, in conformity with the provision in the Factory and Workshop Act, 1901 (section 3, sub-section (1). The Secretary of State, by an Order, under sub-section 3 of the same section, has modified the requirement as to space in respect of workrooms at workshops (not being domestic workshops) which are used by night as sleeping places, a minimum of 400 cubic feet being now required for each person employed therein. " Overcrowding has undergone a considerable diminution: in North Kensington one case only occurred, and that under exceptional circumstances, and on two days only. In South Kensington 25 cases of overcrowding were recorded, a reduction of 28 on the number in the preceding year. Written intimations were sent in these 25 cases, and with one exception the nuisance was immediately abated. In the excepted case proceedings had to be taken It was that of a Court dressmaker, whose premises had been found overcrowded on several previous occasions during the last six years. Verbal cautions and notices having been disregarded, the Public Health Committee ordered two summonses to be taken out, and the defendant was fined £8 with costs ; since which she has provided herself with additional accommodation. " Sanitary Conveniences, etc.—Proper attention is now generally given to ensure cleanliness of the sanitary conveniences attached to workshops; but in 63 cases they were found to be either dirty, or dilapidated, or defective in water supply, compared with 118 cases in 1901. One closet in direct communication with the kitchen of a restaurant was abolished; three closets with no direct light or ventilation to the outer air were provided with windows or air shafts, and three supplied direct from the drinking water cistern were provided with separate flushing services. " Defective Workshops, Yards, etc.—At a number of registered premises, chiefly laundries in North Kensington, roofs and floors found in a defective state and dilapidated, and unsafe staircases leading to workrooms, have been satisfactorily repaired. " Ventilation and Warming of Workrooms.—These matters mainly concern registered premises in South Kensington*: 53 workrooms (compared with 91 in 1901) having been found either insufficiently warmed, or warmed in such a manner, by open gas-jets and gas iron-heaters, as to impair the purity of the air, written intimations were served, and the nuisance was abated by the substitution of coal fires or hygienic gas-stoves. In one instance the manager of a large business establishment, on our representing to him the insufficient temperature of his workrooms in the early morning, adopted the recommendation to have the fires lighted for a considerable time before the arrival of the workers, much to the comfort of the workers and to the advantage of their employers. "Infectious Disease.—Notifiable cases of illness occurred at thirty workshops or houses connected therewith, viz.: Diphtheria—at a dressmaker's, and three laundries; and in the homes of two laundry outworkers in the North district; Scarlet Fever—at two dressmakers in the South district, and three laundries and a tailor's in the North district; Enteric Fever —at a laundry and a tailor's workshop ; Erysipelas—at a dressmaker's, a laundry, and two tailor's workshops ; Chicken-pox —at a dressmaker's, three laundries, and five miscellaneous workshops, all in the North district. The necessary precautions were taken, and work was suspended until after the disinfection of the premises. "Outworkers—Under the Factory and Workshop Act, 1901, Sec. 107, the occupier of any factory or workshop, or the occupier of any place from which any work is given out, is directed to keep lists of all outworkers employed, and to send on or before the 1st day of February and the 1st day of August in each year, copies of these lists to the Council of the district in which the factory or workshop is situate. With a view to make known to the occupiers of workshops, etc., the duty devolved upon them by the Act in this regard, notice was given in the local newspapers, by way of advertisement, and a copy of the notice was forwarded to upwards of 1,000 persons, in occupation of premises where the scheduled businesses were being carried on, together with a print of the " Home Work Order," issued by the Secretary of State, and the schedule attached thereto, indicating the particulars required to be supplied, and the proper form of the return. In February, 73 lists of outworkers were received, 43 from the North district and 30 from the South, comprising the names and addresses of 375 outworkers; 130 in the North and 245 in the South district. The outworkers residing within the borough were visited, and the names and addresses of all those working for firms within the borough, but not residing therein, were forwarded to the medical officers of the boroughs in which the said outworkers resided. Corresponding information was received with respect to 81 outworkers living in the borough, but employed by firms in other districts. In the majority of cases the homes of the outworkers were found in a cleanly condition, and in the case of those employed in tailoring, separate rooms were reserved as workshops. Cases of infectious disease occurred in eight houses where outworkers were known to reside, but in three cases only (Diphtheria 2, Scarlet Fever 1) did the illness occur actually in the rooms occupied by the outworkers. In these three cases (children of ironers for laundries in the North district) work was stopped till after the removal of the sick and disinfection of the premises. The other cases were, Enteric Fever 1, Erysipelas 2, Chicken-pox 5. The houses where these cases occurred were visited, but it was not found necessary to stop the work. Since August 1st, when, according to the Act, the lists were again due, only 23 have been received; 20 from the North district, comprising 56 names, and 3 from the South, with 21 names of outworkers. The total number of known outworkers resident in the borough at the close of the year was 222; of these 19 only (chiefly tailors) were aliens, and in each case work was carried on either in a shop or a room kept solely as a workshop. " Restaurants and Dining Rooms.—The inspection of these places, reported on in 1901, was continued last year with satisfactory results. In the South district a water-closet opening directly out of the kitchen of a restaurant was abolished, there being other accommodation on the premises; and a water-closet, lighted and ventilated direct from the dining-room of a restaurant was reconstructed so as to obtain direct light and ventilation to the outer air. " Complaints—of overcrowding, &c., usually come from workers, visitors or societies, such as the Industrial Law Committee, the Women's Industrial Council. &c. Complaints relating to 93 whether anonymous or otherwise. They generally prove to be well founded. Complaints regarding long hours of work are referred to the Lady Factory Inspectors' Department at the Home Office. Complaints of nuisances observed by the factory inspectors, and forwarded by His Majesty's Superintending Inspector of Workshops, received due attention. " General—We are pleased to report that our visits to registered premises are generally welcomed by employers, who, as a rule, willingly conform to the provisions of the law, when informed of them. We find an increasing readiness on the part of the occupiers to carry out our requirements on verbal request only; and even in those cases where written intimations were served, a reference to the table at the end of this Report will show that, especially in the South district, only a small proportion of statutory notices were necessary to secure cleansing, repairs, etc. In no case, during the year, was difficulty experienced in obtaining admittance to any workshop, laundry, or workplace." Appended to the report is the subjoined table, setting out certain particulars of the work of the year so far as this admits of tabulation. North Kensington. South Kensington. Total for Borough. Dressmakers. Laundries. Miscellaneous Total Dress makers Laundries. Miscellaneous Total. Workshop inspections 93 451 287 831 1,009 66 271 1,346 2,177 „ re-inspections 18 161 16 195 241 11 53 305 500 • Workroom inspections 129 1,867 310 2,306 1,572 151 388 2,111 4,417 Workrooms found overcrowded — 1 - 1 18 — 7 25 26 ,, insufficiently ventilated 8 11 8 22 40 — 13 53 75 ,, in a dirty condition 4 86 13 103 7 6 3 16 119 ,, measured; number of 8 18 4 30 154 1 23 178 208 Workshops, &c., reported to H.M. Inspector, on discovery 4 8 6 18 40 1 7 48 66 Workshops, &c., reported by H.M. Inspector 3 3 — 6 14 1 1 16 22 Workshops, &c., newly discovered and registered 6 9 38 53 52 1 71 124 177 Workshops, &c., removed from register 17 8 2 27 29 5 1 35 62 Houses visited for enquiry where no females were employed* 7 4 177 188 30 7 96 133 321 Domestic workshops and workplaces inspected 13 105 91 209 38 11 32 81 290 Written intimations issued 1 86 6 93 66 3 18 87 180 Statutory notices issued 1 31 1 33 12 1 3 16 49 Sanitary defects remedied :— (a) Additional means of ventilation provided 1 4 1 6 13 — 7 20 26 (b) Rooms cleansed and whitewashed — 66 2 68 4 2 1 7 75 (c) Yards, floors, roofs, &c., repaired — 38 4 42 3 1 — 4 46 (d) Sanitary conveniences; defects remedied 1 19 — 20 34 1 8 43 63 (e) Dustbins provided or repaired — 5 — 5 6 — 2 8 13 (f) Miscellaneous defects remedied 1 26 2 29 15 — 5 20 49 Nuisances reported to Medical Officer of Health 8 8 15 26 5 1 5 11 37 Cases of overcrowding of workshops abated — 1 — 1 18 — 7 25 26 Workroom cards distributed, number of HI — 5 36 181 — 22 203 239 * Houses, that is at which 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. 94 Men's workshops (i.e. workshops conducted on the system of not employing any woman, young person or child therein) are in a somewhat different position to those where women are employed, inasmuch as (inter alia) the sections in Part I. relating to temperature, thermometers, means of ventilation, drainage of floors, sanitary conveniences, etc., are not applicable to them. Matters relating to ventilation of workshops where women are employed come within the purview of the Council: those relating to temperature are subject to control by the factory inspectors. Considerable improvement with regard to workshop inspection generally took place in 1902, consequent on the appointment of additional male inspectors, which permitted of men's workshops being brought under supervision. I have received from the Chief Sanitary Inspector the subjoined account of the administration of the Act in relation to men's workshops. "The businesses carried on at the workshops where men are employed, 729 in number, are set out in the subjoined list compiled from the register, in which the trades are classified, columns being provided for the address and the name of the occupier, and a column for the " Number of protected persons " employed at the date of inspection of the premises. Trade or Business. North Kensington. South Kensington. Borough Baker 68 48 111 Basket Maker 6 6 Blacksmith 16 19 35 Bootmaker 68 39 107 Box Maker 2 2 Builder 53 53 106 Cabinet-maker and Joiner 23 19 42 Carver and Gilder 1 5 6 Coach-builder 27 8 35 Cycle Maker 9 11 20 Firewood Manufacturer 13 13 French Polisher 1 2 3 Marble Mason 6 2 8 Printer 3 3 6 Saddler 5 11 16 Tailor 32 15 47 Trunk Maker 6 6 12 Umbrella Maker 3 2 5 Undertaker 7 4 11 Upholsterer 12 6 18 Watchmaker 18 20 38 Wig Maker 12 12 Sundry businesses 45 25 70 Grand Total 424 805 729 " The several premises were inspected from time to time to see that the provisions of the Act were duly carried out. " Notices were served, when requisite, to secure the abatement of nuisances, and necessary works of reparation, &c. " The works carried out, under supervision, consequent on the service of written intimations or statutory notices, or both, were as follows :— Number of Cases. Drains repaired and made sound 16 Water-closets, new, provided 22 „ existing, repaired 60 Soil pipes re-constructed 13 „ existing, repaired 5 Water cisterns, repaired and cleansed 18 Ashpits, new, provided 17 „ existing, repaired 12 Sink waste-pipes repaired 24 Yards paved 10 Sundry repairs 6 Premises cleansed, etc. 70 Offensive accumulations removed 5 95 " It became necessary to issue a summons in one instance only—with reference to an effluvium nuisance at a confectioner's, the requirements of the Council's notice having been disregarded. A fine of ten pounds was imposed." BAKEHOUSES. The bakehouses to the number of 111; 68 in North Kensington and 43 in South Kensington, were periodically inspected during the year, and action was taken, when necessary, to ensure compliance with the sanitary provisions of the Public Health Act and the Factory and Workshop Act relating thereto. The latter Act, which came into operation, generally, on the first day of January, 1902, re-enacted the provisions of the former and now repealed Acts (1878-1895), with an important addition contained in section 101, materially affecting the future of underground bakehouses—a subject frequently dealt with in these reports during the last quarter of the nineteenth century. In the third report for 1902 (March 29th, p. 69), the subject was fully dealt with, in order that the Council should be in a position to appreciate the new condition of affairs. The matter was and is of great importance, whether regarded from the point of view of the interests of " the trade " or those of the public health. If the object of the legislature, viz., abolition of insanitary underground bakehouses, is to be attained, uniformity of action on the part of the Borough Councils is essential, and to ensure this, by-laws for the Metropolis, as a whole, regulating the structure of the premises and the conduct of the business, should be framed by a central authority. But at the present time there is no power to make by-laws for the purpose. It would be well, I think, to make the County Council the central authority in consultation with the Borough Councils, with power to make by-laws subject to confirmation by the Local Government Board. A short Act, or a section in the London County Council's General Powers Act, is needed to give effect to this suggestion. With this brief preface I submit the report above referred to, as follows :— " The Factory and Workshop Act, 1901: Bakehouses.—Regarded from the public health point of view, probably no part of the new Act is of more immediate or greater interest to the sanitary authority than that relating to bakehouses. As respects London, the defects of the places where bread is made are largely dependent on two factors : (1) that the premises were not constructed for the purpose, and (2) that they are underground. Ere long, the Borough Councils will have to face the question whether these underground premises are sanitarily ' suitable.' When the Factory and Workshop Act, 1895, became law, it was hoped that (by sub-section (3) of section 27) a step towards the abolition of underground bakehouses had been achieved; but this hope was not realised; and although the defect in the sub-section had been demonstrated, under circumstances to be related later on, the Act of 1901 did nothing immediately to secure the desired object. But there is hope in the future, and I wish to draw the attention of the Council to the matter while there is yet time to avoid, in respect of bakehouses, the fatal mistake resulting from the inaction of the sanitary authorities, between 1856-1873, in regard to private slaughter-houses. The Metropolis Buildings Act, 1844, section 55, made provision for the discontinuance in London of certain offensive businesses, including that of a slaughterer of cattle, at the end of thirty years; but public abattoirs not having been established, the private slaughterhouses obtained a new lease *—under conditions, it must in fairness be admitted, which mitigated the danger to public health from their existence, often in crowded and insanitary localities. But to return. It would appear that by section 101 of the new Act, the legislature intended to confer power on ' District Councils' throughout England and Wales, enabling them to close, in January, 1904, insanitary underground bakehouses, which are in large measure (I think) peculiar to London. But if this is to be done, steps to that end should be inaugurated forthwith—in justice to the trade, and in the interests of public health—for the underground bakehouses (and the majority of bakehouses in London are underground) will surely not be closed, however unsuitable they may be, if steps be not taken, soon, to provide substitute establishments above ground. " Before proceeding further, it may be well to explain the course of legislation in regard to this matter. By The Bakehouse Regulation Act, 1863, bakehouses were first brought under a measure of control by the sanitary authorities; and if no material structural improvement resulted from such powers of supervision as were then conferred, at least some effort was made, by periodical inspection, to ensure cleanliness of the premises. In 1879, by the Factory and Workshop Act, 1878 (the ' Principal Act'), control of the bakehouses was taken from the sanitary authority, and handed over to the factory inspector—apparently with a view to the * By the passing of the Slaughter Houses (Metropolis) Act, 1874. 96 protection of ' young persons ' employed thereat .* The result was disastrous. The factory inspectors, two or three in number, at the most, in London, were unable to discharge the duties which had been carried out, more or less satisfactorily, by numerous sanitary officers, and the bakehouses fell into a deplorable condition, some account of which was given in my annual report for 1881 (page 109) in the form of extracts from a report by an assistant factory inspector. In Kensington, the sanitary inspectors continued their supervision of bakehouses, in 1879, and subsequently, with manifest advantage; but to a large extent in London generally, such supervision practically ceased to be exercised. The evils resulting from change of authority at last became so patent that reversion to the original system was inevitable. In 1881, the (then) Chief Factory Inspector recommended that the duty of enforcing the provisions of law should be transferred, in London, from the factory inspectors, who could not do the work, to the Metropolitan Board of Works, a body which had neither medical officer nor sanitary inspectors; thus ignoring the sanitary authorities, who, in all other parts of the kingdom, were recognised by him to be the proper bodies for the purpose. In 1881 I reported t on the subject to the late Vestry, as follows : — ' The manufacture of bread, as carried on ordinarily, by semi-nude men, is open to objection, and this should be put an end to by a law requiring the substitution of machinery for manual labour. By-laws should be framed, to regulate the construction of bakehouses and flour stores; to provide for cleanliness, by cemented and painted walls, and by impermeable floors furnishing no holes for insects; and to secure light, ventilation, etc. There should be no drain inlet within the bakehouse, and no other possible source of nuisance within reach of it. To sum up, what is required is a Bakehouse Regulation Act, providing for the licensing of bakehouses, and conferring on sanitary authorities the power of regulating the trade by by-laws, uniform for the Metropolis, dealing with— ' (1) The position and construction, including lighting and ventilation, of bakehouses; ' (2) The periodical cleansing of the premises; and ' (3) The materials and utensils employed in the manufacture of bread.' "In 1882, the Vestry took the matter up, recognising that in the movement to secure reform of bakehouses the primary step must necessarily be re-transference to the sanitary authority of the duty of inspecting the premises and regulating the business. The support of the sanitary authorities was invoked, and support was given to the movement by the Society of Medical Officers of Health, who addressed to the Home Secretary a memorial ‡ on the subject, which I had drafted, and requested an interview, which was not granted. At about the same time, the Operative Bakers and Confectioners Union, who had taken up the matter in the interests of the personal health and welfare of the employes, were more favoured, having obtained audience not only of the Home Secretary, but also of the President of the Local Government Board, with whom the State Secretary had informed the medical officers that he was in communication on the subject. The deputation was introduced by Mr. Broadhurst, M.P., who quoted a paragraph from the operatives memorial setting out their grievances, and alleging that ' almost any kitchen or cellar was turned into a bakehouse, often in close proximity to drains, many being even undrained, and totally unfit places for the manufacture of food.' The deputation laid emphasis on the fact that the unsatisfactory condition of bakehouses seriously affected the wholesome character of bread.' The Secretary of State in his reply said that the Government proposed, by legislation, to prevent the construction of underground bakehouses in the future—a pledge which will be fulfilled in 1904. " The Chief Factory Inspector returned to the subject in his annual report for 1882, emphasising the necessity of conferring power on the authority who should have control over the construction of bakehouses, to make by-laws for regulating the conduct of the business. This ' authority ' in London, had his views prevailed, would have been the Metropolitan Board of Works. With reference to this point, in the annual report for 1882 (page 146) I observed that— ' Having regard to the desirability of uniformity in by-laws the power of framing such as are necessary for regulating the construction and sanitary supervision of bakehouses should be vested (in the Board), provided that the by-laws so framed, are submitted to the Local Government Board for confirmation but the duty of inspection, and generally of carrying out the by-laws, should be entrusted to the sanitary authorities.' Twenty years have elapsed, and we are still without by-laws! " In 1883, the Government brought in another Factory and Workshop Bill—it became law in the last hours of the session—which restored to the Vestries their former position of " local authority," so far as related to cleanliness, ventilation, overcrowding, and other matters * See Annual Report for 1879, page 79. † Annual Report for 1881, page 112. ‡ See Memorial in my Annual Report for 1882, page 141. 97 affecting the sanitary condition of bakehouses; viz., by enabling them to enforce sections 3, 33, 34 and 35 of the Factory and Workshop Act, 1878.* The measure was imperfect, falling far short of the recommendations of the Vestry, but it was a step gained; and the Society of Medical Officers of Health, desiring to make the most of it, embodied the provisions of law in a code of ' Suggestions for Regulations with respect to Bakehouses,' which the Vestry had printed in large type and mounted on cardboard, a copy being supplied for suspension in each of the bakehouses.† " When in 1891 a fresh Bill was brought in to ' amend the law relating to factories and workshops,' the Vestry, on my advice, made a further effort in the direction of bakehouse reform. A Public Health (London) Bill having also been brought in, the Vestry's appeals were directed both to the Secretary of State and the President of the Local Government Board, who had charge of the two measures respectively. In the third monthly report for that year, specific recommendations were made to secure power of entry to bakehouses for sanitary inspectors, and power to sanitary authorities to make by-laws for regulating the structure of the premises and the conduct of the business. The Factory Act gave the desired power of entry, and, with the Public Health (London) Act, of the same year, increased the powers of the sanitary authority to enforce measures for securing such improved sanitary conditions in bakehouses as were practicable in underground premises. At this time the Public Health Committee of the County Council issued a report covering a good deal of the subject matter of reform in bakehouses as dealt with in my report for 1881. The co-operation of the Committee was welcomed, and there was no hesitation in agreeing to their suggestion that the Council ' should be empowered to make regulations; ' but the Committee went too far in proposing that ' the Council, as Central Metropolitan Authority, rather than the local sanitary authority, should have charge of the bakehouses of London.' ' The precedent of the Public Health (London) Act, 1891 (I said) was in point: the Council should be empowered to make by-laws, but the duty of enforcing the by-laws should rest with the sanitary authorities.' * On the passing of the Act, I prepared an abstract of the provisions relating to bakehouses, with all necessary information for the guidance of masters and journeymen bakers, a copy of which was furnished to the several occupiers of bakehouses in the parish. † The Regulations were as follows :— " 1. Every bakehouse shall be kept in a cleanly state, and free from effluvia arising from any drain, privy, water closet or other nuisance. The floors shall be carefully swept at least every twenty-four hours, and the sweepings shall be immediately placed in an impermeable covered receptacle, and removed from the bakehouse at not longer intervals than every seven days. " 2. All the inside walls of the rooms of the bakehouse, and all the ceilings or tops of such rooms, and all the passages and staircases of the bakehouse, shall either be painted with oil, or varnished, or limewashed. Where painted with oil or varnished, there shall be three coats of paint or varnish, and the paint or varnish shall be renewed once at least in every seven years, and shall be washed with hot water and soap once at least in every six months. Where limewashed the limewashing shall be renewed once at least in every six months. The cleansing should be done in the months of April and October. " 3. The troughs and all the utensils used in the making of bread and pastry shall be kept scrupulously clean. "4. A place on the same level with the bakehouse, and forming part of the same building, shall not be used as a sleeping place— (a) Unless it is effectually separated from the bakehouse by a partition extending from the floor to the ceiling ; (b) Unless there be an external glazed window of at least 9 superficial feet of area, of which at least 4¼ superficial feet are made to open for ventilation. " 5. No water closet, earth closet, privy, or ash-pit shall be within, or communicate directly with, the bakehouse. " 6. Any cistern for supplying water to the bakehouse shall be separate and distinct from any cistern for supplying water to a water closet. " 7. No drain or pipe for carrying off faecal or sewage matter shall have an opening within the bakehouse, and every sink-waste, or other pipe used for carrying off surface water within the bakehouse, shall be efficiently trapped and disconnected from any drain. " 8. Every bakehouse shall be efficiently lighted, shall be ventilated so as to render harmless all gases and dust, and shall not be overcrowded while work is carried on therein. " 9. Every bakehouse shall be used for the purposes of the trade only. " 10. No animal shall be kept in the bakehouse on any pretence whatever. " 11. No person suffering, or who has recently suffered, from any infectious disease shall be permitted to enter the bakehouse, or take part in the manufacture or sale on the premises, of bread, biscuits or confectionery. " 12. The owner or occupier of a bakehouse shall give immediate notice to the Medical Officer of Health of any case of infectious disease occurring on the same premises as the bakehouse. "Penalties.—Every bakehouse in which there is a contravention of sections 3, 33, or 34 of the Factory and Workshop Act, 1878, which provide for the sanitary condition and cleansing of the bakehouse, shall be deemed to be not kept in conformity with the Act, and the occupier thereof is liable for default to a fine not exceeding Ten Pounds. " The use of a bakehouse for sleeping purposes, or of a room on the same level as the bakehouse, insufficiently separated from it, or insufficiently ventilated and lighted, is punishable under the 35th section of the same act by a fine not exceeding Twenty Shillings for the first offence, and of a sum not exceeding Five Pounds for every subsequent oflence. "An infringement of the 15th section of the Factory and Workshop Act,.1883, which prohibits— " A direct communication between a water closet, earth closet, privy, or ash-pit, with the bakehouse; " The supply of water to a bakehouse from a cistern also supplying a water closet; " The opening into a bakehouse of a drain carrying off faecal or sewage matter— is punishable by a fine not exceeding Forty Shillings, and a further fine not exceeding Five Shillings for every day during which the infringement is continued after a conviction." 98 "In 1895 another Factory and Workshop Act was passed, section 27 (3) enacting that— ' A place underground shall not be used as a bakehouse unless it is so used at the commencement of this Act'—i.e., January 1st, 1896. " It was hoped, as already stated, that this sub-section would enable the sanitary authorities, from time to time, to close insanitary underground bakehouses on vacation of premises—a hope that was disappointed by magisterial decisions. The point, moreover, came before the High Court in Schwerzerhof v. Wilkins,* on an appeal from a conviction by a Metropolitan Magistrate under the Summary Jurisdiction Acts. From the statement of the case, it appeared that the premises in question had been fitted up as an underground bakehouse in 1879, and had been occupied and used as a baker's premises down to October, 1895, when the tenant left. The owner then put the premises into repair, and the work was completed at about Christmas, 1895. The appellant became tenant of the premises in February, 1896, and at once commenced to use the underground bakehouse for the purposes of his business, and had continued to do so down to October 15th, 1897. It was contended for the appellant that the premises were ' used as a bakehouse' within the meaning of the Act, at the time when the Act came into operation. The magistrate, however, held that the place was not 'used as a bakehouse' on January 1st, 1896, and convicted the appellant, but stated a case for the opinion of the Court. It was held by the Court (Wright and Darling, J.J.) that the premises were ' used as a bakehouse ' at the commencement of the Act—but Mr. Justice Wright was ' far from saying that there might not be cases in which the Court would take a different view.' The conviction was quashed. " In the Factory and Workshop Act, 1901, sub-section (1) of section 101, re-enacting in almost identical words sub-section (3) of section 27 of the Act of 1895, reads as follows : — ' An underground bakehouse shall not be used as a bakehouse unless it was so used at the passing of this Act'—i.e., August 17th, 1901. Under this sub-section proceedings were recently instituted by direction of the Council's Public Health Committee in a case, the undisputed facts of which are as follows : —An underground bakehouse at North Kensington ceased to be used on August 4th, 1901, the occupying tenant having been ejected by his landlord, who, late in September (as I was informed), began to repair the house (which had gone out of rating though still occupied in tenements), and whitewashed the bakehouse, with a view to its future use as a bakehouse. Hearing, in Octo'ber, 1901, that the premises were advertised to be let as a bakehouse, I called the agent's attention to the provisions of the sub-section, and subsequently saw the owner, who admitted that the bakehouse was not 'used' on August 17th, 1901. The bakehouse remained out of use until December 31st. On that day (it was stated) the owner, who carries on a baker's business at Islington, began to bake bread on the premises, and continued to carry on the business by a resident employe thereafter. The Council took proceedings against the owner (under sub-section (6) of section 101), for using the bakehouse in contravention of the Act. The case was heard before the magistrates of the Kensington Division on March 11th, 1902. The solicitor for the defendant relied on the decision of the High Court in the case above cited (Schwerzerhof v. Wiliins), which he held to be on 'all-fours' with the case under consideration ; and with this view the magistrates concurred, dismissing the summons, without costs, at the same time offering to state a case. The matter in due course came before the Law Committee, who decided not to proceed to appeal, so that no opportunity was afforded for ascertaining whether this was a case, in which, as Mr. Justice Wright had suggested, ' the Court might take a different view' to that taken in the case cited. "So far, then, the attempt to close unsuitable underground bakehouses—if that was the object aimed at by the Legislature in the Acts of 1895 and 1901—has failed in regard to individual cases. But the Act of 1901 goes much further than the Act of 1895, as it provides (section 101 (2)) that, subject to the provisions of sub-section (1)— 'After the first day of January, 1904, an underground bakehouse shall not be used unless certified by the District Council to be suitable for that purpose.' The following sub-section (3) defines an underground bakehouse to mean— ' A bakehouse, any baking room of which is so situate that the surface of the floor is more than three feet below the surface of the footway of the adjoining street, or of the ground adjoining or nearest to the room. The expression " baking room" means any room used for baking or for any process incidental thereto.' And then follows the crucial sub-section (4), which enacts that— ' An underground bakehouse shall not be certified as suitable, unless the District Council is satisfied that it is suitable as regards construction, light, ventilation, and in all other respects.' With few exceptions the bakehouses in the Borough are underground bakehouses, being generally the two basement rooms—kitchen and scullery—of an ordinary dwelling house, adapted by the construction of one or more ovens under the footway of the adjoining street; * Law Reports, 1898.—I., Q.B., p. 640. 99 imperfectly lighted by a hinged sash in the stall-board of the shop; this, moreover, being the principal if not the only means of ventilation. In practice, however, the window is seldom opened—for operative bakers, who work in great heat, are very susceptible to the ill effects of draughts—and when opened it admits dust and other street filth blown in from the carriageway. It would seem impossible to a sanitary authority to ' certify ' a bakehouse so situated, so constructed, so ill-lighted, and practically unventilated, to be ' suitable' for the purposes of of a business demanding the utmost cleanliness. " But we have not yet done with the new provisions of law, for it is further enacted, in sub-section (7), that— ' In the event of the refusal of a certificate by the District Council, the occupier of the bakehouse may within twenty-one days from the refusal, by complaint apply to a court of summary jurisdiction, and if it appears to the satisfaction of the court that the bakehouse is suitable for use as regards construction, light, ventilation, and in all other respects, the court shall thereupon grant a certificate of suitability of the bakehouse, which shall have effect as if granted by the District Council.' " In a word, a single magistrate, who may be without practical knowledge or experience in regard to the matter, may override the decision of the District Council—a sanitary authority acting upon the advice of their expert officers. " It is, of course, to be hoped that no such conflict will arise in the execution of the law, but that the trade will themselves take steps to bring matters to a satisfactory settlement in conformity with the requirements of the Act and the necessities of the case. It should not be difficult to establish co-operative bakeries, if it were found impracticable for each baker to provide himself with a ' suitable' bakehouse above or under ground. Probably a solution may be found in a new system, under which bakers' shops should become, in the main, distributing agencies, or places for the sale of bread made in large wholesale bakeries, where this staple article of human food shall have been prepared by machinery. Nothing better could be desired—looking at the matter from the point of view proper to the sanitary authority. In any case, the matter should not be allowed to drift, for if the bakers do nothing, and if the sanitary authorities fail to make their views known, it may be alleged, and not unreasonably, on the expiration of the period of grace, that the people cannot be supplied with the ' staff of life' should ' unsuitable' underground bakehouses be closed, in conformity with the express provisions of the new Act." The above report was referred to the Public Health Committee, who after careful enquiry and anxious deliberation, reported to the Council, as follows :— " We have had before us, pursuant to the reference by the Council of the 15th April last, paragraph 10 of the report of the Medical Officer of Health dated 29th March, 1902, under the heading ' The Factory and Workshop Act, 1901: Bakehouses.' We have also had before us subsequent reports by the Medical Officer of Health, giving the results of his personal inspection of the 95 underground bakehouses in the Borough, and the measurements and other data which have been collated in connection therewith. We have ascertained that it is the intention of all the occupiers of this particular class of workshop to apply for certificates of fitness enabling them to continue the use of their several premises after the 1st January, 1904, and have appointed a Sub-Committee for the purpose of visiting a number of the underground bakehouses in the Borough, with a view to arriving at a standard of suitability which might be communicated to the respective occupiers. We have now received a report from the Sub-Committee, which we submit, in full, for the information of the Council, as follows: — 21st January, 1903. Previously to our appointment, the Committee caused a letter to be written to each occupier of an underground bakehouse with a print of Sections 101 and 102 of the Factory and Workshop Act, 1901, hereafter set out, making enquiry whether he intended to apply to the Council for a certificate. We have received answers from all occupiers notifying their intention to apply. The following are the Sections of the Act of 1901 specially applicable to underground bakehouses:— 101.—(1) An underground bakehouse shall not be used as a bakehouse unless it was so used at the passing of this Act. (2) Subject to the foregoing provision, after the first day of January, one thousand nine hundred and four, an underground bakehouse shall not be used unless certified by the District Council to be suitable for that purpose. (3) For the purpose of this section an underground bakehouse shall mean a bakehouse any baking room of which is so situate that the surface of the floor is more than three feet below the surface of the footway of the adjoining street or of the ground adjoining or nearest to the room. The expression ' baking room ' means any room used for baking or for any process incidental thereto. 100 (4) An underground bakehouse shall not be certified as suitable unless the District Council is satisfied that it is suitable as regards construction, light, ventilation, and in all other respects. (5) This section shall have effect as if it were included among the provisions relating to bakehouses which are referred to in section twenty-six of the Public Health (London) Act, 1891. (6) If any place is used in contravention of this section it shall be deemed to be a workshop not kept in conformity with this Act. (7) In the event of the refusal of a certificate by the District Council, the occupier of the bakehouse may within twenty-one days from the refusal, by complaint apply to a Court of Summary Jurisdiction, and if ft appears to the satisfaction of the Court that the bakehouse is suitable for use as regards construction, light, ventilation, and in all other respects, the Court shall thereupon grant a certificate of suitability of the bakehouse, which shall have effect as if granted by the District Council. (8) Where any place has been let as a bakehouse, and the certificate required by this section cannot be obtained unless structural alterations are made, and the occupier alleges that the whole or part of the expenses of the alterations ought to be borne by the owner, he may by complaint apply to a Court of Summary Jurisdiction, and that Court may make such order concerning the expenses or their apportionment as appears to the Court to be just and equitable under the circumstances of the case, regard being had to the terms of any contract between the parties, or in the alternative the Court may, at the request of the occupier, determine the lease. 102.—As respects every retail bakehouse, the provisions of this part of this Act shall be enforced by the District Council of the district in which the retail bakehouse is situate, and not by an inspector; and for the purposes of this section the Medical Officer of Health of the District Council shall have and may exercise all the powers of entry, inspection, taking legal proceedings, and otherwise, of an inspector. In this section the expression ' retail bakehouse' means any bakehouse or place, not being a factory, the bread, biscuits, or confectionery baked in which are sold, not wholesale, but by retail, in some shop or place occupied with the bakehouse. We have specially addressed ourselves to considering as to how far the bakehouses in the Borough are, or can be made, ' suitable as regards construction, light, ventilation, and in all other respects' In order to ascertain the character of the several premises, we requested the occupiers to furnish us with ' a neatly drawn plan and section of the premises to a scale of a quarter of an inch to the foot' and showing— 1. Position of the bakehouse and all rooms and passages in the basement of the premises (whether or not used in connection therewith), including the flour store, coal cellar, vaults, areas, etc., and the means of communication between the several rooms, etc.; also the dimensions of the yard or garden (if any). Figured dimensions to be marked on the plan. 2. Drainage.—All drain-inlets on the basement level, inspection chambers and the position of the lavatory, water-closet and urinal. The section, it was stated, should show— The height of each baking room and other basement premises; the means of access to the bakehouse from the shop and otherwise; the height of the ceiling above, or (as the case may be) the depth thereof below, the footway of the adjoining street, or of the ground adjoining or nearest to each baking room; and the means of lighting and ventilation. We are glad to state that in response to this request we have received plans of 89 out of the 95 premises in the Borough, and of these only six plans have failed to give the requisite information. The Medical Officer of Health has submitted to us reports on the several underground bakehouses prepared by the Sanitary Inspectors, and we have up to the present personally inspected 20 bakehouses, which we are informed may be considered fair specimens of the whole, and examples of the conditions usually found. After consideration of these reports, and as a result of our investigations, we are able to report upon the various points as follows : — Construction. With few exceptions the underground bakehouses were not constructed for the purpose, but consist of basement rooms adapted, the oven or ovens being generally built under the pavement of the adjoining street. 101 The capacity of the baking room, with nine exceptions, exceeds 1,500 cubic feet; the floor space, with 11 exceptions, 200 feet superficial. As regards height, 17 bakehouses exceed 8 ft. 6 in. 25 „ are 8 ft. and less than 8 ft. 6 in. 26 „ are 7 ft. 6 in. and less than 8 ft. 22 „ are 7 ft. and less than 7 ft. 6 in. 4 „ are 6 ft. 6 in. and less than 7 ft. 1 bakehouse is less than 6 ft. 6 in. in height. The ceiling is above the level of the roadway in eight cases, to the extent of from 3 to 72 inches; is level with the roadway in 31 cases, and is below the level of the roadway in 56 cases, to an extent ranging from 2 inches to 27 inches. The floor is below the level of the roadway to a depth ranging from 3 ft. 7 in. to 11 ft. In 35 cases there are areas wholly or partly open to the street or ground adjoining. In some cases the areas are covered in, and in some the area has been taken into, and forms part of, the baking room. The walls are usually plastered, though some are whitewashed brick, and in one or two cases impermeable substances have been used. The ceiling as a rule is lath and plaster, but in some cases it is formed by the floor boards of the shop or room overhead. The floor is of various materials and often very irregular on the surface. Light. The light is usually obtained by a hinged sash or sashes in the stall-board, and when there is an area, by a window or windows opening thereinto. As a rule, the supply of light is not sufficient to enable work to be carried on by day without recourse to artificial illumination. Ventilation. This (such as it is) is dependent, in by far the larger number of instances, on the opening of windows which admit air with draughts, there being no outlet for the escape of vitiated air, and nowhere have we seen a satisfactory method of ventilation by inlets and outlets. It is obvious that a window, opening on or near the street level, provides an inlet for dust as well as air, and is therefore a means of ventilation of the worst kind, when the character of the industry carried on below is considered. All Other Respects. In many baking rooms a sink has been provided, the waste water being discharged over a gully, which in some instances is connected to a drain for carrying sewage matter. In other cases, waste water is made to discharge over a gully outside the house; a course which is not always practicable. In some instances, the water-closet is more or less in aerial communication with the baking room, and in many cases the accommodation is not conveniently situated, having regard to the conditions under which the operatives work. In 64 instances the water supply is obtained from the rising main; in the remainder, from a cistern more or less satisfactorily constructed and placed. The walls, ceiling and floor are in many cases in an unsatisfactory state. In 51 instances there is a cellar, generally a coal cellar, in direct communication with the baking room. This is the case usually when the area has been taken into the baking room, and it constitutes one of the most serious objections to many underground bakehouses, because of the facilities afforded for the admittance of foul air and dirt and the harbourage of insects. We have carefully considered the measures necessary to bring the various premises up to a proper standard, and in connection therewith have had before us certain ' Suggested Requirements ' adopted by the Incorporated Society of Medical Officers of Health. 102 In view of all the facts, and in order that the present underground bakehouses may be brought up to such a standard as would justify the Council in granting certificates for their continued user as such, we suggest that the occupiers or owners should be called upon to conform to the following requirements, in the interests of public health and the well-being of the operatives therein employed. Suggested Requirements. Construction. 1. Floor space. To be not less than 200 superficial feet. 2. Height. To be not less than 7 ft. 6, in. 3. Capacity. To be not less than 1,500 cubic feet. 4. Floor. To be constructed of hard, smooth, durable and impervious material. 5. Walls. To be constructed of material with a surface smooth, hard, durable, and, where practicable, impermeable to damp. 6. Ceiling. To have a surface smooth, durable, and impermeable to dust and damp. 7. Access. To be by a suitable staircase adequately lighted and ventilated, spective of any means of access from the shop. 8. Light. The bakehouse to be efficiently lighted by daylight obtained by means which shall exclude the entrance of dust and dirt. 9. Ventilation. The bakehouse to be adequately ventilated, and, where necessary, by permanent inlet and outlet tubes with openings so placed as to prevent the entrance of dust and dirt. When natural ventilation is not effective, or is insufficient, ventilation by artificial means must be provided. " All Other Respects." 10. Flour store. Proper provision to be made for the storage of flour elsewhere than in the bakehouse. 11. Sanitary Free access to be provided to suitable sanitary conveniences. conveniences. 12. Cellars, etc. No coal or other cellar, or room, or wash-house, or area, or unpaved yard, which may cause contamination by foul air, dust or dirt, to be in direct communication with the bakehouse; unless, in the case of a cellar, protected by a close-fitting door and adequately ventilated. 13. Water supply. Provision should be made for the water supply to the bakehouse being taken from the rising main. 14. Drainage. Every soil pipe passing through, or drain under, the bakehouse or flour store to be gas and water-tight. 15. Dough troughs. These and other fittings of the bakehouse must be so arranged as to allow of the whole of the floor and walls of the bakehouse being periodically cleansed. Note.—In determining whether a certificate shall be granted in respect of any particular premises, the Council will take into consideration any possible liability to flooding which may exist at such premises. We ask the Committee to obtain the Council's sanction to the above requirements, for our guidance in dealing with each case, and we deem the matter urgent, in order that sufficient time may be given for compliance therewith before a certificate is granted. It should be remembered that many requirements as to sanitation apply to underground bakehouses equally with other factories and workshops, but we have not considered it necessary more particularly to refer to these provisions. We desire also to point out that the requirements suggested by us only very indirectly refer to the user of the bakehouse. The question of the necessity for bye-laws regulating such user should in our opinion receive the attention of the Committee. We append a list of the bakehouses arranged according to Wards. 103 List of Underground Bakehouses. (Grouped in Wards.) Reference St. Charles Ward. No. 1 Barandon Street No. 13 2 Blechynden Street „ 56 3 Bramley Road „ 40 4 „ „ „ 72 5 Ladbroke Grove „ 120 6 „ „ „ 248 Golborne Ward. 12 All Saints' Road No. 31 13 Appleford Road „ 24 14 Bosworth Road „ 19 15 Golborne Gardens „ 20 16 Golborne Road „ 9 17 „ „ „ 51 18 „ „ „ 65 19 „ „ „ 75 20 Kensal Road „ 67 Norland Ward. 29 Clarendon Road . No. 110 30 „ „ „ 138 31 Holland Park Avenue „ 146 32 „ „ „ „ 204 33 Lancaster Road „ 153 34 Portland Road „ 134 35 „ „ 139 Pembridge Ward. 42 Archer Street No. 12 43 „ „ „ 39 44 Buckingham Terrace „ 1 45 Cornwall Road „ 107 46 Elgin Crescent „ 14 47 High Street, Notting Hill „ 134 48 Kensington Park Road „ 196 Holland Ward. 55 Church Street No. 21 56 High Street, Notting Hill „ 47 57 Holland Park Avenue „ 107 58 Holland Street „ 31 Earl's Court Ward. 63 Abingdon Road No. 67 64 Earl's Court Road „ 20 65 „ „ 121 66 „ „ 151 67 „ „ „ 162 Queen's Gate Ward. 73 Gloucester Road No. 27 74 Kensington High Street „ 11 75 „ „ „ 29 Redcliffe Ward. 79 Adrian Terrace No. 178 80 Coleherne Terrace „ 11 81 Fulham Road „ 178 82 „ „ „ 200 83 „ „ 290 Brompton Ward. 88 Brompton Road No. 87 89 „ ,, „179 90 Bute Street 5 91 Fulham Road „ 62 Reference No. 7 Ladbroke Grove No. 353 8 Lancaster Road „ 196 9 Portobello Road „ 289 10 „ 383 11 Silchester Road „ 106 21 Kensal Road No. 193 22 Portobello Road „ 252 23 „ „ „ 312 24 „ „ „ 332 25 „ „ „ 346 26 St. Ervan's Road „ 3 27 Tottenham Street „ 3 28 Wornington Road „115 36 Princes Road No. 16 37 „ „ „ 70 38 „ „ 81 39 Queen's Road „ 32 40 St. Ann's Road „ 52 41 St. Mark's Road „ 23 49 Ledbury Road No. 69 50 Pembridge Road „ 59 51 Portobello Road „ 82 52 „ „ „ 154 53 „ „ „ 216 54 Talbot Road „ 120 59 Johnson Street No. 27 60 Peel Place „ 8 61 Russell Gardens „ 11 62 Uxbridge Street „ 32 68 Earl's Court Road No. 216 69 Kensington High Street „ 251 70 Richmond Road „ 96 71 Stratford Road „ 2 72 Warwick Road „ 72 76 St. Alban's Road No. 14 77 "Victoria Grove „ 1 78 Young Street „ 19 84 Fulham Road No. 346 85 Gledhow Terrace ,, 6 86 Ifield Road „ 61 87 Moreton Terrace „ 4 92 Fulham Road No. 82 93 Gloucester Road „ 99 94 Sussex PlaceNos. 34 & 35 95 Walton Street No. 46 The Committee's report was submitted to the Council on the 3rd February in the current year, and after some discussion the further consideration of it was adjourned, an intimation having been received that a meeting of master bakers was about to be held to consider the requirements, and that a deputation would be appointed to wait upon the Committee with reference thereto. 104 The deputation attended on February 10th, and their spokesman explained that the bakers having met to consider the suggested requirements of the Council in respect of underground bakehouses, as from the 1st January, 1904, after a general discussion of all the requirements, it was decided to appoint a deputation to wait upon the Public Health Committee, to make representations as follows :— " (1) Floor. That in all cases, whatever material the floor is at present made of, should be, where satisfactory, allowed to continue. For example, if York Stone be in a satisfactory condition, and properly jointed, it should not be compulsory on the part of the baker to have it removed. Where unsatisfactory, of course, the Committee would require an alteration, and the feeling of the meeting was 'generally in favour of a concrete and cement floor. Personally, I think that would not be suitable for use in front of the ovens, where the heat is exceptionally trying. My experience goes to support the York Stone pavement, which will stand any amount of heat, wear and tear. It could always be a matter for inspection by the Council's officials that the joints in such floor were kept properly in repair. " (2) Ceiling. Whilst thoroughly agreeing with the suggestion that this should be a smooth surface, durable and impermeable to dust, the meeting were unanimously of the opinion that nothing could improve upon lath and plaster ceiling, with due attention to thorough cleansing twice annually as at present arranged. It must be admitted that to have a ceiling made of heavier material would be undesirable by reason of the considerable traffic which naturally obtains in the shop, and under which the bakehouse usually runs. " (3) Light. It was felt by some that this was rather a stringent condition that it should be possible to read a newspaper between 12 and 3 o'clock without the aid of artificial light. It may be pointed out that 7/10ths of the work in a bakehouse is done in the night, when artificial light must be used; at the same time the feeling was generally expressed that a baker should improve his light where possible, and as much as he is able. " (4) Ventilation. This was felt to be the most important of all the requirements, but no sort of unanimity could be obtained as to how it should be carried out. Many suggestions were made as to special schemes for complying with this condition, and it is accurate to say that the general impression was that one of these plans could be adopted, with due regard to differing circumstances of the bakehouses. " (5) Flour Store. This requirement was understood to mean that, whilst a storage of flour should be elsewhere than in the bakehouse, yet there was no objection to the necessary flour being put in the bakehouse for the next day's work, for of course it is important that the temperature of the flour in winter must be raised for satisfactory manufacture. " (6) Cellars, &c. The meeting desired a more careful and lucid explanation of the meaning of the two words which close this paragraph, viz., " adequately ventilated." These points gather up all that the meeting was in doubt about, and it is not necessary to assure the Public Health Committee that the bakers of Kensington are desirous of assisting them in the administration of this Act, and most certainly not to in any way place obstacles in their duty." (IT'""" A brief discussion ensued, and the deputation retired. The report of the Committee was adopted unanimously by the Council on February 17th. Shortly afterwards the Town Clerk, by direction of the Committee, addressed a communication to the occupiers of the several proprietors of underground bakehouses, as follows :— "Factory and Workshop Act, 1901—Section 101. " Underground Bakehouses. " By direction of the Council, I forward herewith a copy of the Requirements for Underground Bakehouses, compliance with which is the condition on which the Council will be prepared to grant their certificate, under the above section (a copy of which has already been sent to you), that the premises in your occupation are, in the words of the Act, ' suitable for the purpose as regards construction, light, ventilation, and in all other respects.' 105 " For your further information, I also forward a statement showing in what particulars the premises in your occupation appear not to conform with the Council's requirements. " The annexed Notes on certain of these requirements will, it is hoped, be of service to you should you decide to apply for the Council's certificate. " Should you so decide, will you be so good as to forward to the Medical Officer of Health, at your early convenience, a specification of the work you propose to carry out ? "I am to suggest that it would be undesirable to put any such work in hand until the said specification shall have been submitted. The Requirements as printed above (page 102), were appended. The " Notes on the Requirements for the guidance of Applicants for the Council's Certificate of Suitability," were as follows:— Requirement No. (4) Floor. The floor may be composed of Granolithic Paving, or Rubbed York Stone with cement joints, or approved paving tiles laid in cement, or any other similar approved material. In every case the paving must be laid on six inches of proper cement concrete. (5) Walls. The surface of the walls may be composed of white glazed bricks or white glazed tiles, or Crystopal, or Opalite, or any similar approved material; but the walls, where not exposed to the direct heat of the oven, may be plastered and finished to a smooth surface in Keene's Cement, or similar composition, and painted. (6) Ceiling. Open ceiling joists must be covered by approved metallic plates, or other approved material, effectively jointed and enamelled. A plastered ceiling may be finished to a smooth surface in Keene's Cement, or similiar composition, and painted. (8) Light. Where practicable, the most satisfactory method of securing the maximum of daylight is by the insertion of prismatic lights. (9) Ventilation. Efficient inlet and outlet dust-excluding tubes will be required, aided, if necessary, by mechanical power. (14) Drainage. Before the new floor is laid, the hydraulic test will be applied to all drains running under the bakehouse. Any soil-pipe passing through the bakehouse must be proved to be gas-tight, and be protected from risk of damage. Lavatory and It is very desirable that provision for ablution and the storing of clothing Clothes Room. should be made outside the bakehouse. A copy of the foregoing letter, the Requirements, the "Notes" and the particulars in regard to which the bakehouse appeared not to conform with the requirements, was sent to the owner of the premises also, together with Section 101 of the Act above cited (page 99) in March. PUBLIC HEALTH (LONDON) ACT, 1891. The need of amendments to this Act is recognised, and it was expected that the County Council would introduce a Bill during the session of 1900. In February, 1899, a letter had been received by the late Vestry, from the Public Health Committee of that body, desiring information as to amendments which, in their opinion, 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 recommendations for amending section 2, and especially by a definition of " overcrowding," corresponding to the provisions of the Council's second bye-law for registered houses. They further proposed that section 5 should be amended, so as to enable the sanitary authority, upon obtaining a closing order, to evict the tenants. Other proposed amendments dealt with offensive trades, 106 slaughter-houses, cow-houses; and dairies; with the disposal of refuse; regulations as to waterclosets, unsound food, notification of infectious disease, cleansing and disinfection of premises after infectious disease; isolation in hospital; exposure of infected persons, etc. Further additions to the provisions of the Act were suggested, especially 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 the Vestry. Some of the amendments were adopted; others, and all but two of the proposed additions, were rejected. The somewhat barren result of the enquiry was communicated to the County Council, but no further action has hitherto been taken by that body. THE WORK OF THE SANITARY INSPECTORS. In no respect, perhaps, has the municipalisation of London produced greater effect than in the stimulus given to the appointment of additional sanitary inspectors. In reports to the late Vestry, I summarised returns prepared by the Medical Officer of Health for the County of London, showing the number of inspectors employed by the several Vestries and District Boards of Works. In the early part of the current year a revised return was issued, from which the subjoined summary has been compiled. Metropolitan Boroughs. Enumerated Population 1901 (Parliamentary Census). Number of Sanitary Inspectors 1903. Population to each Sanitary Inspector on the basis of the Census, 1901. West. North. Central. East. South. Paddington Kensington Hammersmith Fulham Chelsea Westminster 143,954 176,623 112,245 137,289 73,856 182,977 12 13 9 6 4 11 11,996 13,586 12,472 22,881 18,464 16,684 Marylebone Hampstead Pancras Islington Stoke Newington Hackney 133,239 81,902 235,284 834,928 51,247 219,288 *8 7 16 20 8 14 16,655 11,700 14,705 16,746 17 082 15,663 Holborn Finsbury London, City of 59,890 101.476 26,908 5 9 †17 11,878 11,275 1,588 Shoreditch Bethnal Green Stepney Poplar 118,705 129,681 298,548 168,838 6 9 18 8 19,784 14,409 16,586 21,105 South wark Bermondsey Lambeth Battersea Wandsworth Camberwell Deptford Greenwich Lewisliam Woolwich 206,128 130,486 801,873 168,896 282,030 259,258 110,513 95,757 127,460 117,165 17 *9 13 11 ‡11 14 7 §7 8 9 12,125 14 498 23,221 15,854 21,093 18,518 15,787 13,680 15,931 13,018 London 301 * Including one temporary inspector, †Including seven meat inspectors. ‡ There are also five inspectors concerned with drains and sanitary fittings in old and new houses. These officers are under the direction and control of the Surveyor. § Including two temporary inspectors. 107 Since 1893 the number of inspectors has been increased by sixty per cent., viz., from 188 to 301, of whom twenty are women. The borough staff, which was enlarged in 1901 by the appointment of four additional male inspectors and one lady inspector, now comprises a chief inspector, ten male inspectors, and two lady inspectors of workshops, workplaces, and laundries where women are employed. The services of the two street inspectors were dispensed with in 1901, and the duties formerly performed by them in connection with the Food and Drugs Adulteration Acts, inspection of mews, etc., devolved upon the male inspectors. The table at page 108 contains a summary of the work of the male inspectors (so far as it admits of tabulation) in their several districts, of which six are in North Kensington; i.e., north of High-street, Notting-hill and Holland-park-avenue; and four in South Kensington, three of them to the south of Kensington High-street and Kensington-road; the remaining district lying between the principal thoroughfares named. The work of the inspectors is carried out under the supervision of the Public Health Committee, the Council having conferred on that body authority to enforce the provisions of the Public Health (London) Act, 1891, the Housing of the Working Classes Acts, 1890-1900, and the Factory and Workshop Act, 1901. Written Intimations of nuisance were served by the inspectors to the number of 2,424. As a result of these intimations, many works of sanitary amendment were carried out forthwith, thus realising the object of the legislature, and obviating in many instances the necessity for service of statutory notices. In the intimation form a red ink note authorises the person liable to abate a nuisance to make what, for convenience, may be called an " appeal " to the Committee, against the requirements of the sanitary inspector. Appeal, which is of rare occurrence, usually takes the form of an application for extension of time for carrying out works. Statutory Notices for the abatement of nuisances to the number of 734, were issued by direction of the Committee; and 1,219 notices under the by-laws for houses let in lodgings. Supervision of underground work, reconstruction and trapping of drains, is exercised by the Borough Engineer, and information on the subject must be sought in that officer's report. A considerable number of drains were voluntarily reconstructed by the owners or occupiers of houses, on the deposit of plans for the approval of the Public Health Committee. Particulars on this head also will be found in the Borough Engineer's report. Drainage, etc.—In regard to this subject, the Royal Institute of British Architects not long since addressed a communication to the Borough Councils, asking that the detection only of nuisances arising from sanitary apparatus or drains should remain in the department of the Medical Officer of Health, and that matters relating to the construction, reconstruction, amendment and repair of drains and sanitary appliances, and the structural removal of nuisances in connection therewith, should be referred to the department of the Borough Engineer. The Institute was informed that substantially the course they recommended was in practice in the borough. In nearly every other borough in the Metropolis this work is entrusted to the Public Health department, save as to the construction of new drains. The practical universality of the rule cannot be the result of accident. Kensington is almost the only borough in which the sanitary inspectors are relieved of this duty. Here, work in connection with underground drainage, etc., is supervised by a staff—chief and second officer and two assistants—in the Borough Engineer's department. Were this staff transferred to the Public Health department, and the several officers qualified as sanitary inspectors, a considerable economy would be effected, as half the salaries would be repayable to the Council out of monies voted by Parliament. 108 Summary of the Work of the Sanitary Inspectors during the Year 1902. (See page 107.) Sanitary 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 Sanitary Committee. Notices served under the Lodging-House By-laws Final Notices (signed by Medical Officer) served. Houses, Premises, &c., Cleansed, Repaired, Whitewashed, &c. Houses disinfected after illness : Infectious disease, † Repaired, Cleansed, &c. Ventilated, Trapped, &c. Repaired. 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. Dairies, Milkshops, &c. Licensed Cow-houses. Licensed Slaughter-houses. No. I. District 38 771 2,723 221 89 88 23 212 61 92 19 350 19 — 105 95 5 120 — 2 101 8 2 17 — — 5 No. II. „ 62 437 928 238 74 179 39 131 162 70 37 187 8 1 27 17 2 46 1 — 53 3 15 58 - 2 8 No. III. „ 41 1,011 2,272 264 75 451 80 314 85 92 10 152 74 11 34 50 1 31 — 13 64 5 9 35 1 1 — No. IV. „ 108 963 2,041 320 89 55 30 119 82 37 10 133 3 14 38 15 2 27 — — 5 — 15 44 — 1 1 No. V. „ 63 1,002 2,036 388 90 17 14 128 96 32 9 125 19 4 22 4 — 51 — — 7 1 14 34 — — 3 No. VI. „ 68 938 2,115 235 66 91 28 116 60 81 41 121 6 11 36 6 8 26 2 — 34 3 13 20 1 2 3 No. VII. „ 62 931 1,469 197 72 141 16 133 92 71 45 84 48 31 16 25 3 19 — — 112 — 9 19 — 4 — No. VIII. „ 91 875 1,738 99 27 51 8 71 54 31 1 9 10 5 23 10 3 25 — — 8 — 9 15 — 1 — No. IX. „ 81 877 1,598 296 70 114 16 88 96 44 13 113 63 12 45 24 4 40 — — 54 — 16 25 — — 4 No. X. „ 88 914 1,359 166 82 32 27 85 42 53 12 77 35 10 83 3 — 8 1 — 24 4 9 16 — 1 5 702 8,719 18,279 2,424 734 1,219 281 1,397 830 603 197 1,301 285 99 429 249 28 393 4 15 462 24 111 283 2 12 29 * Under the provisions of sec. 3 Public Health (London) Act, 1891. † Done under the supervision of a Special Officer. J The total number of houses on the Register in December, 1902, in round figures, was 2,050. 109 Legal Proceedings.—In 29 cases proceedings were instituted : in four instances for offences under the by-laws for registered houses, the fines amounting to £10. The other cases were as follows:—For failure to periodically remove manure in two cases, the fines amounting to £2 10s.; in two cases for failing to comply with the magistrates' orders, fines amounting to £6 being inflicted ; in fifteen cases for non-compliance with the Council's notices, fines to the amount of £29 being inflicted; in two cases for removing offensive matter during prohibited hours, the fines amounting to £8 ; and in three cases for carrying out alterations to soilpipes without giving due notice, a fine of 40s. being inflicted in one case. The fines in all amounted to £57 10s. Neglect to carry out the requirements of notices, issued by order of the Public Health Committee, within the specified time, is still somewhat common, the result being waste of the time of the inspectors in fruitless visits to premises. In every such case, at any rate in every case when the work has not been put in hand at a date when it should have been completed, application for the fine "not exceeding ten pounds" prescribed by section 4 (4) of the Public Health Act should be made. Failure to comply with the requirements of notices, besides leading to waste of officers' time, is also disrespectlul to the sanitary authority and merits punishment. OFFENSIVE BUSINESSES. The County Council forwarded to the Council in 1901, lists of slaughter-houses, and of dairies, milkshops, cow-houses, etc., and also copies of the by-laws and regulations in force with respect to these establishments, which, under the Local Government Act, 1899, it is the duty of the Council to enforce. The said by-laws, etc., were referred to me, with instructions to see that the requirements were complied with, and to report any infringement thereof; this has been done. The only business coming under the statutory description " offensive," other than that of a slaughterer of cattle, carried on in the borough, is that of a Fat Extractor, at Tobin Street, in the Potteries, Notting Dale. The conduct of this business still gives rise to effluvium nuisance, despite improved arrangements, care on the part of the proprietor, and supervision by the Council's inspector, as well as by the inspector of the County Council. The improvements carried out consequent on proceedings instituted by the County Council in 1899, included the provision of a scour or condensing apparatus, and elevation of the chimney shaft. Complaints have been less frequent since these works were completed; but the locality is obviously unfit for the carrying on of so offensive a business. LICENSED SLAUGHTER-HOUSES. Twelve slaughter-houses were licensed by the County Council in October—six in North Kensington and six in South Kensington. The several premises were regularly visited by the sanitary inspectors, and inspected in September by the Public Health Committee. The business of a slaughterer of cattle has not been established anew in the borough since the passing of the (now repealed) Slaughter-houses (Metropolis) Act, 1874, in which year there were 56 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 362 in 1902. The names of the licensees, and the localities of the Kensington slaughter-houses, are as follows:— North Kensington. South Kensington. Lonsdale Mews .... Mr. Grove. 85, Earl's Court Eoad - - - Mrs. Matson. 13, Archer Mews ,, Bawcombe. 21, Peel Place, Silver Street - - Mr. Osborne. 10, Edenham Mews ,, Goddard. 25, Silver Street Wright. 195, Clarendon Road „ Simmons. 183, High Street, Notting Hill - „ Candy. 235, Walmer Eoad - - - Mr. Van. 113, Holland Park Avenue - - ,, Holloway. 278, Kensal Road - - - Mr. Miles. 123, Marlborough Road - - „ Bolton. The premises in Kensal Road and Marlborough Road were transferred from Chelsea to Kensington in November, 1900. At the same time, a Kensington slaughter-house at Silchester-road passed to the control of the Borough Council at Hammersmith. One slaughter-house has been demolished in the High Street widening, and no application was made in respect to the old established premises at Royal Crescent Mews. In the annual report for 1898 (pages 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 slaughter-houses. 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—much to my regret, as an advocate for 30 years of public abattoirs. No further action in the matter has since been taken. 110 LICENSED COW HOUSES. Two cow-houses, in North Kensington, were licensed by the County Council in October. The premises were regularly visited by the sanitary inspectors, and inspected, in September, by the Public Health Committee. Only five cows were found on the premises; in bygone days, within my experience, there were 28 licensed premises, containing 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 290 in 1902. The County Council intimated to cowkeepers, some time since, that their Public Health Committee were of opinion that in the case of premises . newly licensed, the recommendation of the Royal Commission on tuberculosis, that no cow-house should be erected within 100 feet of a dwelling house, should be observed. The Council can, of course, enforce this condition if they think fit. The names of the licensees, and the localities of the Kensington cow-houses are as follows:— 187, Walmer Road - - - Mr. Arnsby. | 5, Ledbury Mews - - - Mr. Liddiard. • Dairies Order.—The Council, as Local Authority for the registration of milkshops, etc., received last year 13 applications for registration; a subject with which I dealt in a report to the Public Health Committee (24th September 1901) in relation to applications where the premises could not be deemed suitable for the storage of milk. At many small general provision shops, milk is sold in insignificant quantity, usually from a small earthenware vessel standing on the counter, and mainly for the convenience of customers ; but also in self-defence, lest customers should be induced to transfer their dealings to shops where this necessary article of diet can be obtained. The Local Authority appear to have no power to refuse compliance with applications for registration, but only to enforce the regulations made under the provisions of the Order. The County Council, when local authority, always acted on the principle that applicants for registration must be registered; but usually sent a letter to persons whose premises were regarded as unfit. The vendor in such a case was told, " that the premises were quite unsuitable for carrying on the sale of milk," and requested without delay, to " provide a suitable place for storing milk, and for washing and storing the utensils, or at once cease the sale of milk." The regulations dealing with the subject are to the following effect:— " 8. Every purveyor of milk, or person selling milk by retail, shall not keep milk for sale in any place where it would be liable to becoma infected or contaminated by gases or effluvia arising from any sewers, drains, gullies, cesspools, or closets, or by any offensive effluvia from putrid or offensive substances, or by impure air, or by any offensive or deleterious gases or substances. " 4. Every purveyor of milk, or person selling milk by retail, shall only keep milk for sale in clean receptacles; and all utensils used in connection with the keeping or sale of such milk shall be at all times kept clean. "5. Every purveyor of milk, or person selling milk by retail, shall at all times employ such means, and adopt such precautions as may be necessary for preserving the purity of milk, and for protecting it against infection or coutamination. The containing vessels at the little shops referred to are kept clean; but the air of the premises is far from " pure;" the commonly prevailing odour being that of mineral oil, or some one or other of the miscellaneous articles of food, cooked or uncooked, vended thereat. I should be glad to see a better state of affairs, but do not know how the poor people in the localities referred to could obtain the modicum of milk they want were the regulations strictly enforced. At the close of the year 283 premises were on the register. Fried-Fish Shop Business.—In connection with proposed amendments to the Public Health (London) Act, 1891, elsewhere referred to (page 105), the Sanitary Committee of the late Vestry, expressed the opinion that the business of a fried-fish seller should be added to the list of those specified in section 19, in order to the regulation of the conduct of the business, and so as to prevent it from being an annoyance to adjoining occupiers. This business, undoubtedly, gives rise to nuisance when carried on negligently, without necessary precautions to prevent the escape of effluvia, and is a not infrequent subject of complaint: decided cases, moreover, class it as an ' offensive business.' One of 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, at Eastbourne, the business of a fried-fish seller, or using the house for the business, in breach of a covenant not to carry on any offensive trade or 111 business on the premises. The business, it appeared, had been carried on since 1887, and in 1892 the Corporation had taken proceedings, but discontinued them on certain alterations to the premises being made. The defendant relied on laches and acquiescence on behalf of the plaintiff; but the court 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,' though it gives rise to objectionable smells, and has been held by the Appeal Court to be ejusdem generis with the businesses scheduled, originally, in the (now repealed) Slaughter-houses (Metropolis) Act, 1874. Acting upon my advice, the late Vestry made application to the late Metropolitan Board of Works, in 1883, and 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, a similar application was made to the County Council 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 119-123. The premises where the business is carried on are kept under observation by the sanitary inspectors. REFUSE MATTER. The prevention of nuisance in connection with the storage, collection, and 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 by-laws made in 1893, under the provisions of section 16 of the Public Health (London) Act, 1891. To prevent nuisance in the conveyance of offensive matter through streets, supervision is necessary ; and as the police have constant opportunities for observing breaches of the by-laws, it appeared to the Public Health Committee of the County Council that good might be effected were the members of the force instructed to take note of offences, and to give information to the sanitary authority of the district. The Committee communicated their views to the Commissioner, who thereupon issued an instruction to the police to report to the sanitary authority any breach of the by-laws. House Refuse.—The work of collection of ashes and miscellaneous rubbish from the 23,000 inhabited houses, has been systematised by division of the borough into districts, and provision has been made for inspection of ash-pits, and oversight of the dusting-gangs, the arrangements being under the supervision of the Borough Engineer. A call is made at every house once a week, and further improvement is scarcely possible, until the objectionable practice of refuse-harbourage shall have given place to the more rational system of daily collection from movable receptacles. The arrangements for domestic storage at ' flats' are unsatisfactory, the receptacles being placed, frequently, in unsuitable positions; and complaints are common. In many instances, the Works Committee have made arrangements for clearing the receptacles two or three times a week, and in some cases daily. 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 preventing nuisance from this cause, a printed notice was periodically issued by the late Vestry to every householder, in which attention was called to the danger to public health arising from the deposit of vegetable and other objectionable refuse in the ash-pit, request being made that all such refuse should be burned. A portion of the refuse, from the northern part of the borough, is conveyed out of London on the Grand Junction Canal, the refuse from the southern district being taken down the Thames. The time when the refuse will be cremated at the Council's depot, at Wood Lane, Hammersmith, would appear to be near at hand. Defective Ash-pits.—The Public Health Committee, at my suggestion, in 1901, made request to the Works Committee that information might be given to the Public Health Department whenever the inspectors of the dusting gangs should discover defective ash-pits, and where no ash-pit was found. A large number of such cases have been reported, and the necessary proceedings taken for the provision or repair of receptacles. Removal of House Refuse.—At a conference of London Sanitary Authorities on streets and street traffic, held in 1901, one of the resolutions passed was— " That in the opinion of this conference, house refuse should be removed daily, where practicable." 112 In connection with this resolution, the Public Health Committee of the County Council reported that they had had under consideration the question, whether any alteration might, with advantage, be made in the by-law framed by the Council in 1893, under section 16 (2) of the Public Health (London) Act, 1891, to the effect that—" The sanitary authority shall cause to be removed not less frequently than once in every week the house refuse produced on all premises within their district." The Committee stated the reasons which make removal at frequent intervals necessary, and expressed the opinion that the time had arrived when an effort should be made to secure the collection of house refuse in London more often than once a week : in Edinburgh and some other places the refuse is collected daily. The Committee added that in certain parts of London, especially in business thoroughfares, a daily collection is in force, and they hoped that the effect of the resolution adopted at the conference would be. to extend the system of daily removal. Having regard, however, to the extent of London, and the varying circumstances of the different districts, they did not think it practicable then to make a by-law requiring a universal daily collection, but thought a bi-weekly collection to be practicable, and that it should be made compulsory. They therefore proposed that the word 'twice' should be substituted for 'once' in the existing by-law, and that a copy of the proposed amended by-law should be sent to the sanitary authorities for their observations, pursuant to section 114 of the Public Health (London) Act, 1891. This was done. The specific recommendation made by the Committee was that by-law No. 7 should be amended so as to read as follows :— " The sanitary authority shall cause to be removed not less frequently than twice in every week the houso refuse produced on all premises within their district." As a condition precedent to the proposed alteration in the by-law, provision should be made for the abolition of the fixed ' ash-pit,' i.e., the common brick dust-bin, ' furnished with proper doors and coverings' (Public Health (London) Act, 1891, sec. 37 (1)). In the interpretation section (141) of the Act, the expression ' ash-pit' is defined to mean ' any ash-pit, dust-bin, ash-tub, or other receptacle for the deposit of ashes or refuse matter '; but the County Council's by-law 16, requires that any ' ash-pit' newly provided shall be in the form of one or more movable metal receptacles, with one or more suitable handles and cover. By-law 18 requires that where any sanitary authority shall have arranged for the daily removal of house refuse in their district, or part thereof, the owner of any premises shall provide an ' ash-pit,' in the form of a movable iron receptacle. Such receptacles would have (under by-law 6) to be deposited upon the kerbstone of the pavement in front of the house, or other conveniently accessible position, as the sanitary authority may by written notice prescribe, in order to the collection therefrom of the refuse, between such hours of the day as the sanitary authority may have fixed, and notified by public announcement in their district. Such deposit of the ' ash-pit' on the kerbstone, etc., would not be proper excepting in the case of a daily removal; but to facilitate even a bi-weekly removal it is imperative, in order to avoid excessive increase in the cost of collection, that the refuse be stored in movable receptacles, which admit of being carried from the premises to the dust-cart. The proposal of the County Council did not meet with a favourable reception from the Borough Councils, and no progress towards the realisation of the views of their Public Health Committee has been made. Stable Refuse.—In many former reports note has been taken of the frequency of complaints of effluvium nuisance arising in the storage, and more especially in the removal of stable refuse from pits underground. Thanks to the operation of the County Council's by-law, which has always been carried out thoroughly in this borough, complaints in respect to this matter are now relatively few in number ; and as a principal cause for complaint, the sunken dung-pit, is almost a thing of the past, we may reasonably hope to have even less cause for annoyance on this score in the future. The subject was fully dealt with in the annual report for 1894 (pp. 184-189), to which I would refer anyone desirous of knowing what a serious difficulty was involved, until we were able, generally, to abolish the brick receptacle, above or below ground, and to substitute the iron cage now so familiar an object in the mews in this borough, not far short of two hundred in number. The following statement shows the work done in giving effect to the by-law:— North Kensington. South Kensington. Total. Iron cage receptacles erected 564 999 1,563 Brick receptacles abolished 171 554 725 Brick receptacles constructed or reconstructed. 281 45 326 Sunken pits, improved, allowed to remain 36 38 74 Sunken pits abolished 132 434 566 113 Sunken pits were necessarily allowed to remain where, owing to the construction of stable premises—the entire frontage being occupied by doors—it was impracticable to provide any other form of receptacle. In each such case, and the cases were not numerous, the pit was reconstructed to a reduced depth (the sides and floor being cemented) and drained to the sewer. Nuisance from Stable Refuse and the Remedy.—The subject of nuisance from offensive collections, or delay in removal, of stable refuse, has found a place in these reports for nearly 30 years. Until within a comparatively recent date, the principal cause of nuisance was the sunken dung-pits, now, as we have seen, generally displaced by the iron cage receptacles recommended by me in 1875. More than a quarter of a century ago, the late Vestry made regulations with a view to secure the removal of stable refuse three times in each week, on alternate days; and on the whole the work of clearance has been effected of late years in a fairly satisfactory manner. Nuisance now arises most frequently in connection with the removal of peat refuse. The County Council appreciating the gravity of the complaints on this score, have recently made a new by-law requiring removal of this description of refuse under the conditions which apply to the removal of offensive matter generally. Improvement is likely to ensue under the by-law, but nuisance will not cease so long as peat refuse, on removal from stables, continues to be placed in a fixed receptacle from which it must needs be transferred to the carriage provided for its conveyance through streets. Intolerable stink arises in the turning over of the refuse, and the only remedy, long practised in the borough, is immediate deposit in the vehicle in which removal is to be effected. But nuisance in connection with the removal will never be wholly prevented until sanitary authorities shall have obtained power, and be required, to remove this offensive matter at the cost of the owner. In the (now repealed) Sanitary Act of 1866, power to do this, at their own cost, was given to the sanitary authority, but only with the consent of the owners of the refuse; and in many of these reports the late Vestry were advised to undertake the duty. As the law now stands, the occupier of any premises may ' require' the sanitary authority to remove any trade refuse on payment (Public Health Act, 1891, section 33); but the sanitary authority need only 'if they think fit,' collect and remove ' manure and other refuse matter from any stables the occupiers of which signify their consent in writing to such removal'—a consent which may be withdrawn or revoked after one month's previous notice (section 36). The owner of such refuse cannot 'require' the sanitary authority to remove it,* nor is he under any obligation to pay for the removal; although doubtless, many occupiers of stables would willingly do so, and be quit of a troublesome responsibility, and of liability to fine for non-compliance with the regulations. This subject engaged the attention of the Sanitary Committee of the late Vestry on more than one occasion, in connection with my recommendations; but without effect until 1892, when, under the inflence of a cholera scare, they reported that— ' In considering general matters bearing upon the sanitary administration of the parish, we have been led to discuss the question as to the difficulty experienced in securing the periodical removal of manure and filth from stables and mews, and are of opinion that the time has arrived when the Vestry should, on sanitary grounds, undertake such removal.' The Committee recommended— ' That it be referred to the Wharves and Plant Committee to consider and report as to the practicability of a scheme being adopted for this work to be undertaken by the Vestry.' The reference was made, and the Committee reported— ' That the expense of any scheme to give effect to the collection and removal of the manure from the mews would be so great as to render the proposal at the present time impracticable.' The report was adopted by the Vestry.t The Sanitary Committee had not contemplated removal at the public expense, but relied on the willingness of the occupiers of stables to pay (as in the case of trade refuse) ' a reasonable sum for such removal,' and they were not uninfluenced by the opinion expressed in these reports, that * It is open to question, however, whether the refuse of an omnibus yard or cab yard may not be deemed to be ' trade refuse ' which the occupier of the premises may ' require' the sanitary authority to remove on payment: certainly fish offal and the offal from slaughterhouses comes within the definition 'trade refuse,'and it is surprising that fishmongers and butchers should not have ' required ' the sanitary authority to remove it. † The subject was not new to the Vestry; for, apart from my reports, it had been considered in 1886 upon a report of the Law and Parliamentaiy Committee on 'Sanitary, Nuisances Removal and other Cognate Acts.' The Committee, whilst recognising ' the necessity for making proper arrangements for the removal of manure and other refuse matter,' stated that ' the Vestry had not depot accommodation or staff or plant adequate to cope with so large a work,' as I had recommended. For this reason they considered that the Vestry was not then ' in a position to contract generally for the removal of manure and other refuse matter.' In 1892 the circumstances were different, the Vestry not only having staff and plant, but also a depot, at Purfleet, to which refuse could have been conveyed from the river and canal-si-le wharves, and where, doubtless, a market could have been found for its use on the stiff clay lands in the vicinity. The depot has now been sold. 114 the refuse would be of value sufficient to defray the cost of removal. Since the date of the aforementioned report, the question was not again seriously entercained until 1901, when the Borough Engineer, in a report dealing with the utilisation of the Council's land at Wood Lane, adjoining the West London Railway at Shepherd's Bush, stated that— ' Great and increasing difficulty is experienced in getting btable manure regularly removed. 'On the one hand, sanitary officials are pressing and prosecuting for more frequent removal, and on the other hand the occupiers of stables have the greatest difficulty in getting market gardeners and others to send for the manure. Take the Council's case, relative to then- own stud of (about) 125 horses : a few years ago market gardeners were contracting to clear the manure regularly twice a week and pay £100 per annum for it: now it costs the Council a small sum per annum to get rid of the said manure, with a good deal of attendant bother to ensure regularity of removal. Stable manure ahould, in my opinion, be regularly collected by the Council, and should become their property, in the same way as tbe statutes deal with house refuse, and steps should be taken to get the law amended accordingly. ' I am of opinion (he added) that under skilful and energetic management, the manurial refuse collection and disposal could be made to yield considerable profit to the Borough, with good results in the country districts absorbing the refuse.' It was gratifying to me that an officer of such wide practical experience as the Borough Engineer should thus corroborate the views expressed in these reports during the last quarter of a century, and I hoped that our common, and independent, advice would have prevailed. The report of the Special Committee dealing with the Wood-lane depot utilisation question was to the following effect— "In the report of the Borough Engineer of the 23rd September, 1901, allusion is made to the increasing difficulty experienced by the owners of horses in getting stable manure regularly removed, and a suggestion is put forward that such manure should be collected and disposed of by the Council in a similar manner to that adopted in regard to house refuse. "Under section 36 (1) of the Public Health (London) Act, 1891, the Council are empowe ed to remove manure from any stables and cow-houses within their district, the occupiers of which signify their consent in writing to such removal, and the Borough Engineer suggests that this law should be amended so that all stable manure shall become the property of the local authority of the district, and be collected by them accordingly. " With the merits of this question we do not propose to deal, but we consider that, as it will be necessary for railway sidings to be constructed in connection with the general development of the land, it is expedient that provision should be made for the necessary sidings which would allow of the Council, should they think fit, at any time, in the future to do so, to undertake the removal of manure from the stables in the Borough. " We therefore recommend— " ' That in the plans to be prepared for the utilisation of the depot, railway sidings be included, at an estimated cost of £2,500.' " The report was adopted by the Council. The Borough Engineer in his report proclaimed the need of legislation to place stable refuse in the same category as house refuse, both as regards the obligation to remove it, and as to property rights in the collected matter. It may be useful, therefore, to recall the fact that the subject, in these aspects, received special consideration in the annual reports for 1897 (p. 156) and 1898 (p. 142). Having regard to the practical uselessness of the enactment in the Public Health (London) Act, 1891, section 36 (2), the Public Health Committee of the County Council, in 1897, had caused a communication to be addressed to the Metropolitan Medical Officers of Health, in which it was stated that they ' from time to time, received complaints of nuisance arising from accumulations of manure at various premises in London.' Reference was made to the provisions of section 36 ; but, finding that the sanitary authority had no power to charge, they were considering whether, with a view to facilitating removal, it was desirable to seek an amendment of the section, so as to give the said authority power to charge for the service, when required by the owner or the occupier of any premises to remove the refuse ; similar to that which they now have under section 33 in respect to trade refuse. The enquiry addressed to me was, Whether I was in favour of such a proposed amendment of the law ? In replying, I stated that, in reports during many years, I had advocated the view that not only should the sanitary authority have power to remove accumulations of manure, but also that, in the interests of public health, it should be made their statutory duty to do so, and that they should be authorised to charge the owner of the refuse a reasonable sum for the service. 115 As an outcome of the enquiry by the Committee, and on their recommendation, the County Council on 29th March, 1898, instructed the Parliamentary Committee to take the necessary steps to ' obtain such an amendment of the law as would give the 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 (3rd November, 1898) that the instructions of the Council to take the necessary steps to obtain such an amendment of the law would involve an amendment of the Public Health (London) Act, 1891, and this would necessitate the introduction of a separate public Bill: it therefore occurred to them that there were probably other respects in which amendments of the Act were desired, and which could most conveniently be dealt with at the same time. They accordingly consulted the Public Health Committee, who, being of opinion that the question was not of so urgent a character as to necessitate the introduction of a public bill to deal with it alone, instructed the officers of the Council to report as to other amendments of the Public Health Act which could be dealt with in the same Bill; and hence the enquiry referred to at page 105 in the present report, which hitherto has bcrne no fruit. The County Council adopted the recommendation of the Parliamentary Committee, and discharged the reference. It is hardly necessary to observe that the proposed ' amendment of the law' would not have sufficed to give effect to the recommendation of the Borough Engineer, based on the views so long advocated in these reports. It would, moreover, be of small value; for even now, though the sanitary authority are authorised to remove the refuse free of charge, occupiers of stables do not seek their aid. How much less likely would they be to do so if they had to pay fcr the service ? No, the only useful amendment of law is that which I have so often advocated; viz., to make it the duty of the sanitary authority to remove the refuse at the reasonable cost of the owner. In this Borough, besides nearly 200 mews, there are a great number of private stables and thousands of horses ; the need, therefore, of regular removal of manure is pressing, and I suggest that it would be well for the Council to exercise their power to promote a Bill in Parliament for that purpose; an additional motive for speedy action in this direction may be derived from the large outlay (£2,500) about to be incurred for "sidings" intended for use in connection with this proposed work, and, so far as would appear at present, not otherwise likely to be immediately wanted. Conveyance of Offensive Matter Through Streets.—Reference has been made aDove to nuisance arising from the use of peat stable refuse, and to the necessity of depositing such refuse in a suitable carriage on removal from the stables, so as to allow of its conveyance from the premises without disturbance, such as takes place when the manure is stored in an ordinary brick receptacle , the stenches complained of being due, as already explained, to such disturbance. Reference, moreover, has frequently been made in these reports to nuisance in connection with the storage and removal of other offensive matter—more particularly that of the trades of fishmonger, game dealer, poulterer, etc. Refuse of this latter description is required by the by-law of the County Council to be removed, within prescribed hours, 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.' During some years, at the instance of the late Vestry and the Council, peat manure at the large yards occupied by omnibus companies and other large proprietors of horses, has been stored in waggons, and removed in them, without giving rise to serious complaint. With regard to other forms of offensive matter, the views expressed in these reports indicate the desirability of fish offal, and such like matters, being removed from the tradesmen's premises in the storage vessels, and not, as now, 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 transit through the streets. Given properly covered, externally clean, and sound metal receptacles, no nuisance is likely to arise in transit through the streets, at whatever time of day removal may be effected, and on purely sanitary grounds there need be no limitation of hours for the removal. The necessity for amendment of the by-law, especially with a view to prevent nuisance in connection with the removal of peat stable manure, had long been recognised, and in 1901, a new by-law was made by the County Council and approved by the Local Government Board, as follows:— " 1. Every person who shall remove or carry, or cause to be removed or carried, by road or water in or through London any fecal 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 4 o'clock a.m. and 10 o'clock a.m. in any day during the months of March, April, May, June, July August, September, and October. 116 " Between 6 o'clock a.m. and 12 o'clock at noon in any day during the months of November, December, January, and February. " This by-law shall not apply to any person removing or carrying manure, consisting only of horse dung with a sufficient proportion of straw to render it inoffensive, and shall not apply to any person removing or carrying in a suitable carriage or vessel as aforesaid manure consisting of horse dung and litter other than straw. " 2. Every person who shall offend against the foregoing by-law shall be liable for every such offence to a penalty of five pounds, and, in the case of a continuing offence, to a further penalty of forty shillings for each day after written notice of the offence from the sanitary authority. " Provided nevertheless, that the justices or court before whom any complaint may be made or any proceedings may be taken in respect of such offence may, if they think fit, adjudge the payment as a penalty of any sum less than the full amount of the penalty imposed by this by law." This by-law, in effect, requires peat refuse to be removed under the same conditions as other offensive matter. It is satisfactory that the views approved by the late Vestry, in regard to the storage and removal of this material should thus so far have prevailed ; but it is to be regretted that the County Council did not see their way to adopt the view set out in these reports with regard to the removal of fish offal, and other like refuse, in the shop receptacles, rather than in tank-vans. The Public Health Committee of the County Council, in their report on the new by-law, stated that the Local Government Board did not ' see their way to allow the removal of offensive matter either during the night, or during hours of the day when the streets are crowded, especially during the heat of the summer.' They added that 'the extension of hours . . . would be of substantial benefit, although it would 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.' In a circular letter to the Borough Councils (May 9th, 1901), the County Council stated that a protest had been made to the Local Government Board against the amended by-laws, by firms engaged in the collection of bones and fat from the shops of butchers and marine store dealers, on the ground that the hours proposed were too limited to enable them properly to carry on their business. For my part, I see no objection to removal at any time, if only proper precautions be taken; but preferably refuse should be removed in the evening after business hours. I have never seen any reason to modify the views expressed in my annual report for 1887 (pp. 176-189 inclusive), and with less detail, in the annual report for 1900 (page 58); the main point being that, as regards refuse, it should be removed in the storage vessels, instead of, as now, in tank vans, into which the refuse is tipped, nuisance often being caused by spilling and slopping. These views which had been approved by the late Vestry, were communicated to the County Council in 1899, as they had been to the late Metropolitan Board of Works in 1887. THE COUNTER'S CREEK AND MIDDLE LEVEL SEWERS. Several complaints were reported to the Public Health Committee in 1901, with reference to offensive smells emanating from the Counter's Creek sewer, in different parts of its course from North Kensington to Lot's-road, Chelsea. This sewer which, south of Kensington Road, is upwards of eight feet in diameter, is vested in the London County Council, with which body the late Vestry and the Council have had many communications arising out of complaints of smells, and also of the flooding of basements of houses at times of great and rapid rainfall. With respect to sewer smells, a memorial was addressed to the Council by inhabitants residing at South-row and adjoining streets in the Kensal Town district, taken over in November, 1900, from Chelsea. The Sewer in South-row, a branch of the Middle-level sewer, receives the drainage of the Queen's Park estate (the portion of the Kensal Town district which was transferred from Chelsea to Paddington), a circumstance to which the memorialists attributed the "increase of fever" which they erroneously alleged to exist in the locality. By direction of the Public Health Committee, a communication was addressed to the County Council embodying the complaint of the memorialists, together with my report thereon; and with a request that steps might be taken to remedy the evil by shaft ventilation of the sewer in South-row, closure of the ventilators at road level, and trapping of the street gullies The County Council have since erected a ventilating shaft in the course ox the sewer, and in the course ot the Counter's Creek sewer eleven such shafts, and closed certain ventilators, with satisfactory results, no complaints having been received from inhabitants during the past year. 117 Flooding of Basements.—Complaints have been received from time to time of the flooding of basements of houses in Cornwall-road, Edinburgh-road, St. Mark's-road, Silchester-road, St. George's-road, and Talbot-grove in North Kensington, and Holland-road, Elsham-road, and Warwick-road in South Kensington. It is an old grievance, due to the insufficiency of the Counter's-creek sewer to carry off a heavy downpour of rain with requisite rapidity. The County Council are erecting at Lot's-road, Chelsea, a pumping station designed to prevent a recurrence of the trouble, and it is expected that the work will be completed this year. The pumps which will be operated by gas engines aggregating 1,040 horse power, will be capable of lifting 12,000 cubic feet of water per minute, the calculated maximum discharge at the outlet of the sewer being 11,000 cubic feet. During heavy rainfall the pumped liquid will be discharged into the river. In ordinary circumstances the sewage is conveyed from the Counter's-creek sewer into the low level sewer. It is to be hoped that the nuisance complained of will soon be a thing of the past. UNTRAPPED STREET GULLIES. The Sanitary Committee of the late Vestry gave attention to this subject in connection with a recommendation, in my twelfth report for 1899 (December 7th, page 126), that, " as soon as practicable, the brick flap-trapped street gullies should be replaced by pan syphon-trapped gullies." I suggested that, at the earliest practicable date, all brick, flap-trapped gullies, should be abolished in favour of pan syphon-trapped gullies. The Surveyor reported that there were about 5,000 brick flap-trapped gullies in the parish, and that the cost of fixing syphon-trapped pan gullies in lieu thereof would be about £3 per gulley—say ±'15,000 in all; a large sum, doubtless, but still less than has been expended recently on wood-paving in a single street, Cromwell-road. The Committee reported (February 14th, 1900), that all brick gullies proved to be offensive, are replaced with the newer pattern of gulley ; that any new gullies constructed are of this type, and that pan gullies are also fixed in roads converted from macadam to asphalte, or wood-paved. They further observed that, with the question of syphon-trapping of street gullies, is closely involved the question of sewer ventilation, and that until some solution has been found of the difficulties encountered in dealing with this latter question, they could not see their way to advise the adoption of the scheme indicated in my report ; they recommended therefore, and it was resolved, that the Vestry " do adhere to the course hitherto adopted of dealing with each complaint of smells from gullies on its merits." For what it is worth, it may be mentioned that in some towns the gullies are trapped although the sewers are not ventilated. Bristol is a notable instance, and that city is by no means an unhealthy one. Means of ventilation, in any case, could surely be devised, and I feel it my duty again to urge that brick flap-trapped gullies should be displaced, generally, by syphon-trapped gullies. The so-called " flap-trap" is not a trap at all in the sanitary sense of an apparatus for preventing the escape of sewer gas. In numerous instances complaint was made, usually by residents in the vicinity of untrapped street gullies and ventilating grids in the carriage ways, of offensive smells arising therefrom. In all such cases references were made to the Works Committee, with a view to the proper trapping of the gullies and the closing of the offensive ventilating openings In some instances the sewers were under the jurisdiction of the London County Council, to whom the complaints were referred for abatement of the nuisance. 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 (July 7th, 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, as the central authority, should 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, but it did not become law. 118 The Borough Councils have power to promote bills in Parliament, and it will probably be thought desirable to take joint action in the matter, as the County Council will make no further effort to obtain an amendment of the Act. Legislation is necessary, seeing that many sanitary authorities have shown unwillingness to repair, as "sewers," conduits which they consider should be regarded as " combined drains," reparable at the expense of the owners of the houses drained in common thereby. Cases, moreover, are not unknown in which a sanitary authority have failed to abate nuisance 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, properly devolves upon the 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 predecessors to the late Vestries, etc., and so determine, whenever practicable, whether it constitutes a " sewer " reparable by the sanitary authority, or is a combined " drain " repairable by the owner or owners of the houses drained thereby, the sanitary committee of the late Vestry, upon my advice, resolved, some years since, to obtain an abstract of the records of the Commissioners relating to this borough, which has been of great service, saving the labour of a search at Spring Gardens upon each occasion of dispute: it has already far more than repaid the cost of preparation, by throwing upon owners the responsibility for repair, or reconstruction, of combined drains which, without the information afforded by it, would have devolved upon the sanitary authority. SMOKE NUISANCE. In several instances complaints were made of nuisance from emissionof black smoke—by the Smoke Abatement Society, the London County Council and private persons. Cautionary letters were addressed to the occupiers of the premises to which the complaints related. No further proceedings became necessary. PUBLIC SANITARY CONVENIENCES. There are only 19 public urinals in the parish—an inadequate provision, but supplemented by about 170 external urinals at public-houses. This latter accommodation is not of a satisfactory sort, as a rule, but it is better than none : it was improved, moreover, as the result of proceedings taken by the late Vestry in 1888, and subsequently. There are three sets of public water closets, for the male sex only, situated, respectively, at Thurloe Place, Brompton ; at the rear of the central public library, Kensington High-street; and at Laneaster-road, adjoining the public library; and two for both sexes, viz.: at the west end of Westbourne-grove; and at Talbot-road. Sanitary authorities have power (section 88 of the Metropolis Management Act, 1855) "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, where, in my opinion, an underground retiring place for both sexes might be constructed without giving reasonable cause for objection. Increased powers were conferred by the Public Health (London) Act, 1891, section 44 (2), of 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, etc. Domestic Sanitary Conveniences.—The 26th by-law of the County Council requires the landlord or owner of any lodging-house to provide and maintain in connection with such house, water-closet . . . . accommodation in the proportion of not less than one water-closet . . . for every twelve persons. And a similar provision is contained in the Borough Couucil's by-laws for houses let in lodgings or occupied by members of more than one family. In conformity with these by-laws at a considerable number of houses, the inhabitants of which exceed twelve in number, a second water-closet has been provided. In some instances the owner preferred to reduce the number of persons to twelve or less, rather than incur the expense of erecting a second closet. Separate Sanitary Conveniencies for the Two Sexes.—Section 38 of the Public Health (London) Act, 1891, enacts that where persons of both sexes are employed at a factory, workshop, or workplace, separate sanitary conveniences for persons of each sex shall be provided. Steps are taken, when necessary, to give effect to this laudable provision of law. THE PAVING OF YARDS. During the year, a considerable number of yards were paved more or less satisfactorily—or unsatisfactorily ; for it has not been the rule to require the entire surface of the small yards at the rear of houses inhabited by the poor to be paved; and too commonly the paving is not what it should be in material or workmanship. It would be well if this work were carried out systematically throughout the borough ; but individual cases only are dealt with as they arise out of 119 casual or special inspections, or house to house inspection. The Special Committee on Notting-dale, in their report (June 8th, 1896), stated that the yards in the " special area " were " saturated with human ordure and filth of every description." The Committee were of opinion "that the yards should be asphalted or paved," and the first of their recommendations, all of which were approved by the late Vestry, was to the effect— " That it be referred to the Works and Sanitary Committee to have notices served upon the owners or occupiers of the houses in the several streets . . . requiring them to asphalte, or pave with impervious material, the yards in the rear of such houses which are not in proper condition." Effect has, in a measure, been given to this recommendation. The paving of yards is one of the matters dealt with in the Council's by-laws, the tenth 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 too often lost sight of. That paving is "necessary" for this purpose is indubitable, and the subject is deserving of the attention of sanitary authorities, by whom generally, more would be done, probably were due weight attached to the hygienic importance of cleanliness and dryness in the surroundings of dwelling-houses—a matter to which attention was specially directed in my 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 so frequently observed in yards of houses let in tenements to the poorer classes ; broken bedsteads, rotten straw palliasses, and other things of no value, once the " property," it may be, of dead or departed tenants or lodgers. In the report for 1889 it was observed that " it is nobody's business to remove the things, which simply serve as harbourage for collections of filth." The yards where they exist cannot be properly cleansed, and might be regarded as premises, " in such a state as to be a nuisance or dangerous to health." The importance of the matter is lost sight of in ordinary times, but let there be a cholera scare, and everybody recognises the necessity for that general clearance of filth and litter which should be effected systematically at all times. HYGIENIC STREET PAVING. During the year some progress was made in the paving with asphalte of streets in poor localities where traffic is small; streets, moreover, used by children as playgrounds, in default of more suitable provision. This practice, commenced in the Potteries district some years since, was subsequently carried out to completion in the Notting Dale "special area" with manifest advantage. During last year the following roadways were paved with this material, Childs Place, Queen's Place, Boyne Terrace, and Lansdowne Mews, at a cost of more than eight hundred pounds. When streets are paved with asphalte it is the practice to substitute syphon-trapped pan gullies for brick gullies with flap-traps (which in the proper sense are not traps at all) ; and, wherever practicable, sewer ventilators at road level are abolished, ventilating pipes being carried up the front of adjacent buildings, the work thus constituting a very real sanitary improvement. This question of the paving of carriageways was ably dealt with, some ten years, since by the present Mayor of the Royal Borough, in a Paper read before the Society of Arts, which obtained the silver medal of the Society. The comparative merits and demerits of the several materials used for paving purposes—granite, wood, asphalte—were passed in review. To asphalte the second place was assigned in respect of noislessness, safety for horses, and durability; the third place with respect to economy, and the first with respect to the points which most concern a sanitary authority; viz., public hygiene and cleansing. "On the score of hygiene" (the author said) "asphalte holds pre-eminently the first place, owing to its impermeability, and the consequent impossibility of absorption on its part; and in addition to this it may be stated in its favour that it is more easily cleansed, and dries more readily than any other pavement." No one acquainted with the asphalted streets in the borough can be in doubt as to the advantages of this material, and on sanitary grounds I should be glad to see the use of it largely extended, a course which has for its justification the admirable merit of economy. PUBLIC BATHS AND WASHHOUSES. The washers in the twelve months ended 31st March, 1903, were, 65,456, compared with 70,776 in the preceding year: the bathers, 78,357 (males, 67,094, females, 11,263), irrespective of members of male classes, 1,582; of female classes, 894; male pupil teachers, 264; female pupil 120 teachers, 261; and boys, from two institutions, to the number of 1,670; making a gross total of 83,028 bathers, compared with 92,781 in 1901-2. The falling off in washers, was 2,901 ; in bathers, 9,753. The reasons assigned for this falling off, as regards the bathers, are the cold and wet summer, the coronation festivities, which distracted public attention ; competition which took away many bathers, from Kensal Town and Walham Green, and the provision of a swimming bath at St. Paul's School. The falling off in the laundry department is attributable to the fact that the establishment was closed for repairs for three weeks in August. As I have remarked in former reports, for the majority of parishioners the site of the establishment is not sufficiently central for bathers, and is too remote for use by would-be washers. The same objection would apply to any single site in the borough. What is to be desiderated is the provision, in convenient localities, of buildings, on a modest scale, to which the poor in the central and southern districts might resort for laundry purposes. CLEANSING OF PERSONS ACT. This Act, passed in 1897, gives power to the sanitary authority to permit any person infested with vermin to have the use of the apparatus which the authority may have provided for cleansing the body and clothing, and authorises expenditure on buildings, appliances, and attendants that may be required for the carrying out of the Act. Nominal effect was given to the Act soon after it passed, by an arrangement with the Guardians, whereby cleansing and disinfecting apparatus at the able-bodied workhouse, Mary-place, in the Potteries, was made available, on payment of a small fee, by the late Vestry—an unsatisfactory arrangement still in force. Little use has been made of the apparatus, owing possibly to ignorance of the arrangements on the part of the poor intended to be benefited, and probably, to some extent, owing to the locality and ownership of the apparatus. In the borough of St. Marylebone, a proper equipment having been provided, several thousand cleansing operations are carried out in the course of the year; much to the comfort of dirty and verminous persons, who, for the most part, come from an adjacent Salvation Army Shelter. The question of providing a place for the purposes of the Act is engaging the attention of the Council. For convenience of administration, and on grounds of economy, I recommended that a place for giving effect to this Act should be provided in connection with the proposed disinfecting station and shelter, but not at Wood-lane. The Council decided otherwise. UNDERGROUND ROOMS ILLEGALLY OCCUPIED. In a number of instances rooms " underground " were found to be illegally occupied in various parts of the borough. The illegal occupation was in each case discontinued on the service of a written intimation or a statutory notice. OVERCROWDING. Overcrowding is occasionally brought about by the action of railway companies, schoolboards, etc., who are not required to provide for the rehousing of persons displaced by the demolition of houses, provided that fewer than twenty houses are compulsorily acquired at any one time. This subject was brought to the attention of the sanitary authorities in 1900 by the late Vestry of St. George-the-Martyr, Southwark, a suggestion having been made that the School Board should be compelled to provide housing accommodation for persons displaced by their action ; the Vestry, moreover, advocated an amendment of the Standing Order of the House of Commons, so that all classes of" Promoters" should be required to make provision for rehousing, even when a smaller number of houses than twenty is taken. It was overlooked that Parliament had dealt with the subject, in the session of 1899, by bringing the School Board for London under the Standing Order, as regards liability for rehousing persons displaced, a clause with this object having been inserted in their Provisional Order Confirmation (London) Act, 1899 : the clause, moreover, was made retrospective; it being provided therein that all houses or lands occupied by persons of the labouring class, taken by the Board in the previous five years, should be regarded as acquired under that Act. No houses appear to have been so acquired in the borough within that period, but the subject is of interest to the Council in view of the demolitions shortly expected—at Southam-street and Wornington-road, etc.—in connection with the intended widening of the Great Western Railway in that locality, to which reference has already been made (page 86). NUISANCE FROM GAS WORKS. Complaints are occasionally received 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 121 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 of the late Vestry, 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." The Vestry accordingly addressed a communication to the company intimating that observation would be kept up, and that on any recurrence of the nuisance proceedings would be instituted. A reply was received to the effect that, while objectionable smells did proceed at times from the works, 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. The company suggested a reference to the gas referees, being of opinion that they would be able to satisfy the Vestry that the best possible system was being carried out; but, in the event of improvement being suggested, the directors signified willingness to adopt and to carry out any recommendation. The Vestry adhered to the position taken up with regard to the legal responsibility of the Company to see that no nuisance should arise from smells from their works, and left it to the Company to appeal to the gas referees, if they thought any useful purpose would be served by 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, have hitherto been taken. 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 disinfecting and cleansing of bedding, clothing, etc The cost of this work has largely increased since the Act came into operation in 1892 ; the amount expended in 1902 was £'989, compared with £381 in 1891. In the latter year the weight of the articles disinfected was under 20 tons, their number being about 9,400 only ; whereas in 1902 some 26,625 articles were dealt with, of an aggregate weight of 54 tons 6 cwts Nine hundred and twenty five rooms, in 830 houses, were disinfected after infectious disease, compared with 364 in 1891. The expenditure on disinfection, including cleansing of clothing, bedding, etc., varies from year to year, with the prevalence of infectious disease. Very few disinfections are now done at the cost of the occupiers of the houses, or the owners of clothing, bedding, etc. I append a statement of the monthly cost of this work in 1902, which is irrespective of the wages of the disinfecting officer. £ s. d. January 101 11 5 February 74 12 5 March 89 11 1 April 111 10 9 May 89 3 6 June 92 16 5 July 91 12 5 August 69 11 6 September 79 2 6 October 74 4 1 November 46 13 6 December 68 18 6 122 In previous reports an opinion was expressed that the expenditure on disinfection might probably be reduced, were the work done without the intervention of a contractor, as recommended by the London County Council and the Metropolitan Asylums Board; this opinion is likely, ere long, to be subjected to the test of experience, the Council having decided to erect a station at their depot at Wood Lane, Shepherd's Bush. TEMPORARY SHELTER OR HOUSE ACCOMMODATION. The Public Health (London) Act, 1891 (section 60, sub-section 4), imposes on the sanitary authority the duty of making provision for housing poor persons during the time necessary for disinfection of rooms after infectious disease. The sub-section is to the following effect:— " The sanitary authority shall provide, free of charge, temporary shelter or house accommodation, with any necessary attendants, for the members of any family in which any dangerous infectious disease has appeared, and who have been compelled to leave their dwellings for the purpose of enabling such dwellings to be disinfected by the sanitary authority." The need for this provision is shown by the fact that in this Borough last year, 116 cases of infectious disease occurred in families in occupation of three rooms ; 198 cases in families occupying two rooms, and 61 cases in families herded in single rooms. Of the sufferers in families occupying single rooms, 20 had scarlet fever, 18 each had diphtheria and small-pox, and 5 had typhoid fever. The subjoined table was prepared for the information of the Public Health Committee when considering the question of providing a shelter, which still awaits settlement. Cases of Infectious Disease which occurred in Tenements of less than Four Rooms, during the Years 1894-1902. The Year. In Three Room Tenements. In Two Room Tenements. In One Room Tenements. Total. 1894 119 158 64 341 1895 165 268 101 534 1896 305 384 144 833 1897 195 372 98 665 1898 124 210 80 414 1899 127 192 73 392 1900 123 239 53 415 1901 164 195 63 422 1902 116 198 61 375 Totals 1,438 2,216 737 4,391 Cases of Infectious Disease occurring in One Room Tenements. The Year. Small-pox. Scarlet Fever. Diphtheria. Typhus Fever. Typhoid Fever. Total. 1894 4 34 19 7 64 1895 1 42 46 — 12 101 1896 5 88 43 — 8 144 1897 — 60 26 — 12 98 1898 — 44 18 — 18 80 1899 — 41 16 — 16 73 1900 — 22 22 — 9 53 1901 2 33 19 2 7 63 1902 18 20 18 — 5 61 Totals 30 384 227 2 94 737 123 As pointed out in preceding reports, " the only satisfactory mode of dealing with this matter would be to erect a shelter and provide it with a proper equipment," which could be " most economically done in connection with a disinfecting station." The Council however, have decided that the depot at Wood Lane, where the disinfecting station is to be erected, is not a suitable situation for a Shelter. It will be remembered that I recommended the Council's Wharf at Kensal Road, as a suitable and convenient site for the disinfecting station, and the shelter, as well as for carrying out the provisions of the Cleansing of Persons Act, all under a single management. PUBLIC MORTUARY. Bodies were deposited at the Mortuary during the year to the number of 273, upon application, as follows :— 1. At the request of the relatives of the deceased 7 2. At the request of undertakers, mainly at the instance of the relieving officers 73 3. At the request of the coroner (inquest cases):— Cases of sudden death 118 Cases of violent death 49 167 4. Brought in by the Police j^ound dead 16 ° ' (Accident cases 4 — 20 5. On account of death due to infectious disease.6 273In 92 of the above cases post-mortem examinations were made under the coroner's warrant. Coroners' Districts.—The districts of Coroners do not in all cases correspond with the municipal areas, and in certain parts of the borough bodies of persons upon whom it became necessary to hold inquests were removed to Paddington for that purpose. A communication was addressed to the London County Council in January, calling attention to the desirability of steps being taken to secure the adjustment of boundaries of the Coroners' districts, so that every Borough shall be wholly situated in one of such districts. The matter remains in statu quo, but there is ground for hoping that the desired re-arrangement of the districts will ere long be taken in hand. Occasionally complaint is made of improper detention at the homes of the poor of the bodies of deceased relatives, on the supposition that the Council possess arbitrary power to remove bodies to the public mortuary. What the law enables the Council to do is set out in the 89th section of the Public Health (London) Act, 1891, which provides that— " When either— (a) The body of a person who has died of any infectious disease is retained in a room in which persons live or sleep ; or (b) The body of a person who has died of any dangerous infectious disease is retained without the sanction of the medical officer of health, or any legally qualified medical practitioner, for more than 48 hours, elsewhere than in a room not used at the time as a dwelling place, sleeping place, or work-room ; or (c) Any dead body is retained in any house or room so as to endanger the health of the inmates thereof, or of any adjoining or neighbouring house or building ; a justice may, on a certificate signed by a medical officer of health, or other legally qualified medical practitioner, direct that the body be removed, at the cost of the sanitary authority, to any available mortuary, aud be buried within the time limited by the justice." The majority of cases of improper deposit of dead bodies in living rooms occur in connection with the removal from the infirmary mortuary of deceased patients for private burial. But until recently the Council's officers were without information, and so were unable to exercise influence to effect the transfer of bodies to the public mortuary, however sanitarily unsuitable the place of temporary deposit—occasionally a single-room tenement—might be. The Guardians, in 1902, gave instructions to the steward of the infirmary to report to me all necessary particulars when a dead body is removed from the mortuary at that establishment for private burial by the friends of the deceased, and this is now done. 124 CHAPEL OF REST FOR THE DEAD. The Council resolved last year to provide a place for the temporary reception of dead bodies at North Kensington consequent upon presentation of my third report (March 29, p. 64), which dealt with the need of such accommodation to the following effect- " It is not unusual among the poor to prolong, unduly, the interval between the death and burial of deceased relatives, whose bodies frequently are retained in houses (generally lodgings) unsuitable for the purpose. This fact has. on more than one occasion, given rise to the question of the desirability of providing a mortuary chapel, more especially for the use of the poorer classes, at North Kensington, and the subject has been under the consideration of the Public Health Committee on a notice of motion. " The need for such provision engaged the attention of the Sanitary Committee of the late Vestry when the mortuary in the Churchyard was established, in 1883 : but it having been ascertained that an undertaker's charge for carriage of a body thereto was the same from any part of the parish, it was thought that, if the accommodation proved sufficient, there would be no necessity for a second building. But, whether on account of the remoteness of the site from the more densely populated parts of North Kensington, or from whatever other cause, few bodies have been deposited, except of the pauper class, and these mostly at the request of the relieving officers, or (the great majority of admissions) on the order of the coroner in inquest cases. It has been suggested that association with the mortuary of the " place for the making of post-mortem examinations " may explain the disinclination of the poor to avail themselves of the convenience provided for their benefit; and, therefore, in considering the recent proposal, it was decided to be, in any event, undesirable to provide anything beyond a mortuary chapel, pure and simple, as a temporary resting place for the dead awaiting burial. " With a view to the information of the Cemeteries Sub-Committee, to which the matter was referred, I instituted inquiries, the result of which seemed sufficiently interesting to be brought to the knowledge of the Council. " About one-sixth of the deaths in the borough occur at the infirmary, and of the poorest of the people, the majority of them of North Kensington persons. It was natural, therefore, to turn in the first instance, to Mr. Rutherglen, the Clerk to the Guardians, who, with the approval of the Infirmary Committee, furnished me with all desired information. The inquiry was primarily directed to ascertain ' the practice of the Guardians in relation to the burial, or removal for burial, of the bodies of persons who had died in the Infirmary.' The specific questions asked were, as to —(a) the number of bodies buried from the Infirmary mortuary in 1901; (6) the number removed thence to the former homes, or to the homes of surviving relatives of the deceased ; (c) the steps taken to ascertain the suitability of the place of deposit; (d) whether any of the removed bodies were buried at the cost of the rates; (e) whether it was on account of want of accommodation at the Infirmary mortuary that bodies were permitted to be removed therefrom to places that might be unsuitable; or (/) whether it was that the Guardians had no legal power to detain bodies till the time of burial; or (g) that they yielded to the natural desire of the survivors to pay the last offices to the dead, ' at home,' without regard to the suitability of the available accommodation. " In his reply, Mr. Rutherglen stated that of 486 persons who died in the infirmary in 1901, the bodies of 231 were removed for the purpose of being privately buried by their friends, none of them having been subsequently buried at the cost of the Guardians. In respect of these cases, he said :— ' The Guardians have no means of knowing whether the bodies are removed to the homes from which the persons were admitted, to the houses of the relatives and friends who may be undertaking the burial, or to the premises of the undertaker who is carrying out the funeral: there is no staff available for embarking on an inquiry as to whether the place to which the body is to be removed is sanitarily suitable for its reception and detention ; nor do I think that the Guardians would be justified in refusing to give up a body to the friends or relatives, even if they were not satisfied with the proposed accommodation. If the relatives or friends of a patient have the desire and the means to bury the body of their departed friend, the Guardiaus have always felt—firstly, that they have no power to refuse to allow them to do so; secondly, that it is desirable to encourage so natural a desire ; and thirdly, that the rates should not be saddled with the outlay when there are friends able and willing to incur it; and therefore applications for permission to remove a body for private burial are, practically without exception, at once acceded to. As I have already said, the question of ' suitability of accommodation ' does not enter into the question in allowing the removal of a body, and the permission for such removal has never had to be given because of insufficient accommodation in the Infirmary mortuary.' " Mr. Rutherglen was subsequently requested to favour the sub-committee ' with the addresses of the places to which the 231 bodies were removed,' in order that they might be ' in a position to form an opinion as to the probable sanitary suitability, or otherwise, of the accommodation/ 125 This information could not be given, but I was permitted to obtain, in respect of each dead body buried by the friends, the name and age of the deceased, the date of death, the date of removal, the name and address of the undertaker.* " Armed with the necessary information, I made application to fourteen undertakers concerned with the burial of 178 of the North Kensington persons, with a view to ascertain whether, in their opinion, a mortuary chapel 'would supply a public want, and be likely to find favour with the relatives of deceased poor persons ?' And with a view to ' ascertain the mode of disposal of bodies between the date of removal from the Infirmary mortuary and their interment,' a list of cases dealt with by him was given to each undertaker, who was requested to state where the several bodies had been deposited; and if at a private house, the address thereof, and the date of burial. The desired information was supplied by six undertakers only, and with respect to about 80 bodies, of which nearly all had been deposited in private houses in streets inhabited by the poorer classes, in lodgings or in tenements comprising very limited accommodation. In 12 cases the body had been removed from the Infirmary mortuary for interment on the same day, but apparently had been temporarily deposited in the former homes in five instances. In 14 cases the body had been retained in the place of deposit for one night; in 18 cases for two nights; in 16 cases for three nights; in 6 cases for four nights; in 3 cases for five nights; in 2 cases for six nights. One undertaker deposited the five bodies buried by him in his private mortuary; one body was deposited at the public mortuary; seven bodies had remained in hearses between removal and burial, and two had been kept in an undertaker's shop. " The opinions expressed as to the want of a mortuary chapel by the four undertakers who favoured me with their views, are subjoined. " Mr. A., who had buried eight bodies, two of which had been deposited in his shop and six at the homes of surviving relatives, offered no opinion: nor did Mr. B., who buried two bodies that had been deposited at the homes of surviving relatives. " Mr. C., who had buried twenty bodies, all of which, between the time of removal from the Infirmary mortuary and the interment, had been retained in the homes of the surviving relative, wrote:— ' I do not think a mortuary chapel is required. The one at Kensington, to my mind, is ample.' " Mr. D., who had buried five bodies, all of which had been deposited at his private mortuary, wrote as follows :— ' However one may realize the usefulness of a Public Mortuary (in North Kensington) it is very doubtful whether the class of people for whom it is intended would make use of it. The poor are very conservative and have a horror of a public mortuary. From a sanitary point of view it is undoubtedly necessary that something should be done to prevent the present system of keeping the dead. One often finds the corpse in the same room as some of the family sleep, and often eat, in. They absolutely refuse to have the lid of the coffin screwed on, the consequence being that the body is often in a decomposed state by the time of burial. Such an establishment would supply a public want, but is not likely to find favour with the relatives of deceased poor persons.' " Mr. E., who had buried three bodies, expressed the opinion that a mortuary chapel at North Kensington, 'would be a great convenience.' " Mr. F., who had buried forty bodies, six of which had been deposited in hearses for interment on the day of removal from the Infirmary mortuary, wrote as follows :— ' I am of opinion that the proposed mortuary chapel at North Kensington will not be likely to find favour with the relatives of deceased poor persons In some cases where (the friends) have no accommodation for the remains to be taken home, those dying in the Infirmary must be removed somewhere (i.e., after removal from the mortuary) previous to burial, as the hour arranged for removals, viz., 7 to 8 a m., is much too early to arrange for a funeral, and 60 the body has to go either to the house or the public mortuary to await the hour of burial, causing extra expense. I consider the Infirmary mortuary should be available at any time for removal of remains.' "The obligation to remove bodies at an inconvenient time, arose, I understand, out of the complaints of residents in Marloes Road, witnesses of the all too frequent sight of the undertaker's hearse ; the mortuary being unfortunately placed in the forefront of the Infirmary, abutting on the street. * It may be mentioned that, as an outcome of the correspondence, the Infirmary Committee gave directions that in all future cases notice should be given to me of the intended removal of a body for private interment, with the name of the undertaker and the name and address of the person undertaking the burial—and this has been done. 126 "To the Relieving Officers and the District Medical Officers a letter was written, as follows:— ' Proposed Mortuary Chapel for North Kensington.—The Cemeteries Sub-Committee of the Public Health Committee are considering whether it would be desirable to provide at North Kensington a mortuary chapel for the reception of the bodies of poor persons who may have lived, or who have died, in that portion of the Borough, and for which there is no suitable accommodation at the homes of the deceased persons or their relatives. The suggestion to provide such temporary resting place for the dead, as distinct from the mortuary to which the Coroner's court is attached, arose out of an expression of opinion that the little use made of the existing mortuary by poor persons residing at North Kensington was due to its distance from the poorer parts of that division of the Borough. In this connection I may mention that, last year, not more than five bodies were admitted at the- request of the relatives of deceased persons. During the same period 67 bodies were admitted at the request of undertakers,* 37 from North Kensington. ' In the year 1901 about 230 bodies of parishioners were removed from the Infirmary for burial by the friends of the deceased, the larger portion, presumably, to North Kensington, and to poor homes without suitable accommodation. ' The object of this letter is to ask you to favour me, for the information of the Sub-Committee, with an expression of your opinion whether the provision of a mortuary chapel (without facilities for the making of post-mortem examinations) would meet a public want ? and whether, from your knowledge of the sentiments of the poor in your district, you think there is reasonable probability that such use would be made of a second mortuary as to justify the expenditure in construction and maintenance as would be entailed thereby ? ' " Replies were received from two Relieving Officers, as follows :— (1) ' A mortuary chapel, such as is suggested, would, if made use of, no doubt be a boon, but I am of opinion it would rarely be used by those for whom it was intended.' (2) ' Adequate provision is provided for the pauper class and almost in every case the bodies are removed to the public mortuary by the contracting undertaker ;' but ' whether the poorer class would avail themselves of such provision is difficult to say. If such a mortuary were built, no doubt they would soon see that it was to their advantage. The suggestion, I think, deserves consideration.' "The senior District Medical Officer for North Kensington wrote: ' I have often been most forcibly struck by the need (of the proposed mortuary chapel) in a district in which many families are unable to provide more than two or three rooms, and often only one, for living purposes. It seems to me terrible that, sometimes for days together, these must be tenanted by the living and the dead It is a crying evil which should be remedied without delay, and I have little doubt that a mortuary chapel would be extensively used.' " Excepting the last, all of the foregoing communications had reference, mainly, to the dead bodies of poor persons who had been in receipt of ' relief,' in-door or out-door, at the time of death, or whose relatives were so poor as to be dependent on the Guardians for ' burial orders,' whether by way of ' relief or loan. But in addition to these cases there are, in the course of the year, hundreds of deaths of persons, poor but not paupers, who had resided with their families in lodgings or tenements so restricted for room as not to afford suitable accommodation for the bodies during the time—often extending to a week—between death and burial. The surviving relatives of deceased persons of this class, it is probable, would come in course of time to value such provision as is contemplated for the reverent care of their dead. And it can hardly be questioned that they would be encouraged to avail themselves of it by ministers of religion and medical practitioners, who would know how to estimate its value." In connection with the enquiry I had communication with the Medical Officer of Health for the Borough of St. Marylebone, which possesses accommodation of the sort desiderated. He informed me that in the year 1901, 561 bodies were deposited; of which, 212, in the ordinary mortuary, became the subjects of inquisition by the coroner, whilst 97 had been admitted from the parochial infirmary or workhouse The remaining 252 bodies, deposited in the mortuary chapel, had been removed from the homes of parishioners at the request of surviving relatives ; a number which contrasts favourably with the " five " cases of deposit at our own mortuary, and would seem to indicate that in St. Marylebone the accommodation provided, mainly for the benefit of the poor, is appreciated. The upshot of the report was that the Public Health Committee recommended the erection of the proposed chapel, and their report was adopted by the Council. After full consideration, the site I proposed, at the north-east corner of Avondale Park, near the superintendent's lodge, was approved, and at the present time of writing the foundations of the building are being laid. * In many cases on the order of the relieving officers. 127 CREMATION. The Cremation Act, 1902, described as " an Act for the regulation of the burning of Human Remains, and to enable Burial Authorities to establish Crematoria," received the Royal Assent in July, and will come into operation April 1st, 1903. It empowers the burial authority—in this Borough the Council—to provide and maintain a Crematorium—an expression defined to mean ' any building fitted with appliances for the purpose of burning human remains '—under regulations to be made by the Secretary of State, ' prescribing in what cases and under what conditions the burning . . . may take place . . . and prescribing the forms of the notices, certificates, and declarations to be given or made before any such burning is permitted to take place.' The main provisions of the Act are as follows :— A crematorium may not be constructed within '200 yards of a dwelling house except with the written consent of the owner, lessee, and occupier of such house, nor within 50 yards of a public highway, nor on the consecrated part of a burial ground. No remains may be burned until the plans and site of the crematorium shall have been approved by the Local Government Board, and the crematorium shall have been certified by the , burial authority to the Secretary of State to be complete and properly equipped for the purpose. A burial authority may accept a donation of land for the purpose of a crematorium, and a donation of money or other property for enabling them to acquire or construct or maintain a crematorium. Penalties are prescribed for breach of the regulations, and for carrying out or procuring or taking part in a cremation otherwise than in accordance with the regulations and the Act; and also for the making of any false declaration or misrepresentation, and the signing of any false certificate with a view to procuring the burning of any human remains—offences, which, in addition to any penalty or liability an offender may otherwise incur, entail liability to imprisonment, with or without hard labour, not exceeding two years. Such fees will be payable for cremation as may be authorised by any table approved by the Local Government Board. Nothing in the Act is to interfere with the jurisdiction of any coroner, or authorise the burial authority or any person to create or permit a nuisance. The Secretary of State, being required by the Act to make regulations prescribing in what cases and under what conditions cremation may take place, appointed a Departmental Committee to consider the subject. The Committee reported that the point they had considered of 'prime importance' was to ' frame regulations, which, while avoiding unnecessary restrictions such as might discourage cremation, or involve unnecessary delay in the disposal of the body, would reduce to a minimum the risk of cremation being used to destroy the evidence of murder by violence or poison.' The regulations proposed are stringent enough, and, with the report, furnish interesting reading to public bodies and others proposing to " run " a crematorium. It is not to be expected that the practice of cremation will make rapid progress in this country, and not probable therefore, that burial authorities will be in a hurry to avail themselves of the powers conferred by the Act. When Metropolitan Borough Councils do take action, it is to be desired that they should unite for the purpose of erecting crematoria for the common use of the combined districts. With respect to the Council's cemetery at Hanwell, after inspection of the site, I think it doubtful whether there is a suitable spot on which a crematorium could be erected, having regard to the restrictions of the Act. Closely adjacent to it, however, there is a cemetery under the jurisdiction of the Council of the City of Westminster, somewhat larger, and having a considerable area of ground in which interments have not yet taken place. It should, I think, be possible to erect at that cemetery a crematorium which would not infringe the provisions of law, qua distance from houses and highways; but whether there is available unconsecrated ground remains to be ascertained. Should the Council of the Royal Borough and the Council of the City of Westminster think it desirable to make provision for cremations, obviously the most economical procedure would be to erect a suitable building, at one or other of the cemeteries, for their joint use. WATER SUPPLY, The daily average quantity of water distributed to each house by the Companies supplying the Borough was : Chelsea, 244 gallons ; West Middlesex, '205 ; Grand Junction, 214 ; the relative quantities in 1901 having been 273, 210 and 240 gallons. Complaints were received on more than one occasion with respect to the quality of the water supplied by one of the three companies who 128 serve the borough—the Grand Junction Company to wit. This company has been called on for a considerable increase to the number of supplies, so that probably the process of filtration has been hurried. It will be observed that the daily supply per house was considerably decreased in 190'2 compared with 1901. The supplies of the several Companies are examined monthly by the public analyst, whose reports thereon are published in the minutes of the proceedings of the Council. Constant supply is given in all parts of the borough. The Water Bill brought in by the President of the Local Government Board, in the Session of 1902, became law, and the Companies' properties will ere long be acquired by the Water Board constituted under the Act, who will be responsible for the future supply of water within, and to a large area without, the Metropolis. CONCLUSION. In bringing this report to a conclusion, I desire to acknowledge the able assistance received from Mr. E. R. Hill, chief 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 particularly to that of the inspecting staff, male and female. Mr. Pettit, the chief inspector, rendered me great assistance in every respect, and especially in connexion with the recent epidemic of small-pox, to which reference has been made in another part of this report. I have the honour to be, Mr. Mayor, and Gentlemen, Your most obedient Servant, T. ORME DUDFIELD, Medical Officer of Health. Public Health Department, Town Hall, Kensington, W., May, 1903. APPENDICES AND INDEX. 130 APPENDIX I. (Vide page 14.) TABLE VI. (Table I. in Annual Reports prior to 1900.) Showing Population, Inhabited Houses, Marriages, Births and Deaths in 1902, 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.§ 1902 177,500 23,000 ** 1,703 ** 3,488 ** 2,746 515 805 832 1901 177,000 23,000 1,651 3,602 2,650 581 876 801 1900 173,000 22,800 1,543 3,586 2,698 641 877 764 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 Average 10 years 1892-1901. 170,810 1,603 3,647 2,789 625 965 808 Notes.—Census Population in 1861, 70,108: in 1871, 120,299; in 1881, 163,151; in 1891, 166,308; in 1896, 170,465; in 1901, 176,628. Average Number of Persons to each house at Census ; in 1861, 7'4; in 1871, 7 6; in 1881, 8 1 : 1891, 7 53 ; in 1901, 7 7. Area of Borough, 2,291 acres. Number of persons to an acre (1901) 77. * 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 Borough, but exclusive of the deaths of nonparishioners at public institutions within the Borough. § Viz.: At the Borough infirmary and outlying public institutions , including the Asylums Board Hospitals. ** In 53 weeks. 131 TABLE VII. ( Table II. in Annual Reports prior to 1900.) 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 1902, and 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.* 1902 19.3 15.2 148 187 293 303 1901 20.4 15.0 161 219 331 302 1900 20.7 15.6 179 238 325 283 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 17.6 170 214 331 254 1892 22.2 17.2 158 204 337 238 Average of 10 years. 1892-1901. 21.3 16.3 171 225 346 283 * Includes Deaths of Parishioners at outlying Public Institutions, but excludes Deaths of Non-Parishioners at Brompton Consumption Hospital, St. Marylebone Infirmary, Notting-hill, &c. 132 133 TABLE VIII. (Table III. in Annual Reports prior to 1900.) Deaths registered from all causes in the Year 1902. (Exclusive of the Deaths of Non-Parishioners at Public Institutions within the Borough, but inclusive of the Deaths of Parishioners at Public Institutions, &c., without the Borough). For a Summary of this Table see page 17. 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 GENERAL DISEASES 251 169 44 50 75 108 109 104 91 103 37 420 1141 943 198 LOCAL DISEASES 189 103 26 40 68 111 177 248 249 188 51 292 1450 1171 279 DEATHS FROM VIOLENCE 14 13 3 5 6 9 5 11 8 6 2 27 82 66 16 DEATHS FROM ILL-DEFINED AND NOT SPECIFIED CAUSES 61 5 ... ... ... 1 1 2 3 ... ... 66 73 63 10 515 290 73 95 149 229 292 365 351 297 90 805 2746 2243 503 GENERAL DISEASES. Small-pox Vaccinated ... ... ... 2 ... 2 2 1 ... ... ... ... 7 6 1 Not Vaccinated 1 ... ... ... 1 ... ... ... ... ... ... 1 2 2 ... Doubtful ... ... ... 2 ... ... ... ... ... ... ... ... 2 2 ... Cow-pox, Effects of Vaccination ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles (Morbilli) 20 69 4 ... ... ... ... ... ... ... ... 89 93 85 8 Epidemic Rose Rash, German Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever 1 16 4 ... ... ... ... ... ... ... ... 17 21 19 2 Typhus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Influenza 1 2 ... 3 5 6 8 16 10 14 3 3 68 47 21 Whooping-Cough 9 11 1 ... ... ... ... ... ... ... ... 20 21 16 5 Mumps ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria, Membranous Croup 1 13 3 2 ... ... ... 1 ... ... ... 14 20 17 3 Cerebro-Spinal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Simple Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever ... 1 5 4 5 3 ... ... ... 1 ... 1 19 18 1 Asiatic Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Epidemic Diarrhœa, Epid. (or Zym.) Enteritis 58 10 ... ... ... ... ... ... ... ... ... 68 68 64 4 Diarrhœa, Choleraic Diarrhœa ... 3 ... ... ... ... ... 1 2 2 ... 3 8 8 ... Dysentery ... ... ... ... ... 2 ... ... ... ... ... ... 2 2 ... Malarial Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Hydrophobia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Glanders, Farcy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Anthrax, Splenic Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tetanus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Syphilis 15 1 ... 1 1 2 1 ... ... ... ... 16 21 18 3 Gonorrhœa, Stricture of Urethra ... ... ... ... ... ... ... 1 ... ... ... ... 1 1 ... Puerperal Septicaemia, Sapræmia ... ... ... 2 2 ... ... ... ... ... ... ... 4 3 1 Puerperal Pyæmia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Phlegmasia Dolens ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever ... ... ... ... 1 ... ... ... ... ... ... ... 1 1 ... Infective Endocarditis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Epidemic Pneumonia, Pneumonic Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas ... 1 ... ... 1 ... 2 ... 1 1 ... 1 6 6 ... Septicæmia (not Puerperal) ... ... ... ... 1 ... 1 ... ... ... ... ... 2 1 1 Pyæmia (not Puerperal) ... ... ... 1 ... ... ... 1 ... ... ... ... 2 2 ... Phlegmon, Carbuncle (not Anthrax) ... 1 ... ... ... ... 1 1 ... 1 ... 1 4 4 ... Phagedæna ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Septic Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculous Phthisis (Pulm. Tuberculosis) 2 ... 6 13 27 42 34 17 6 1 ... 2 148 127 21 "Phthisis" ... 1 ... 8 14 19 18 7 5 ... ... 1 72 61 11 Tuberculous Meningitis 11 17 7 1 1 1 ... ... ... ... ... 28 38 35 3 Tuberculous Peritonitis 2 6 ... ... ... ... ... ... 1 ... ... 8 9 9 ... Carried forward 121 152 30 39 59 77 67 46 25 20 3 273 639 554 85 Continued. 134 135 TABLE VIII.—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. Brought forward 121 152 30 39 59 77 67 46 25 20 8 273 639 554 85 GENERAL DISEASES. Tabes Mesenterica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Lupus ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tubercle of other Organs ... 1 1 ... 1 ... ... ... ... ... 1 3 3 ... General Tuberculosis 8 11 4 5 3 3 4 1 ... 1 ... 19 40 32 8 Scrofula ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Parasitic Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Starvation ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scurvy ... ... ... ... ... ... ... ... ... ... ... ... ... ... Alcoholism, Delirium Tremens ... ... ... ... 1 3 2 4 ... 1 ... ... 11 6 5 Opium, Morphia Habit ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ptomaine Poisoning ... ... ... ... ... ... ... ... ... ... ... ... ... ... Industrial Poisoning by Lead ... ... ... ... ... ... ... 1 ... ... ... ... 1 1 ... by Phosphorus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... by Arsenic and other Metals ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Rheumatic Fever, Acute Rheumatism ... ... 5 3 ... 3 2 2 ... ... ... ... 15 13 2 Rheumatism of Heart ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chronic Rheumatism ... ... ... ... ... ... ... ... ... 1 ... ... 1 1 ... Rheumatic Arthritis, Rheumatic Gout ... ... ... ... ... ... 1 3 1 ... ... ... 5 1 4 Gout ... ... ... ... ... ... ... 2 2 1 ... ... 5 4 1 Carcinoma ... ... ... ... 2 7 10 14 16 5 1 ... 55 42 13 Sarcoma ... ... 1 2 ... 3 1 3 1 ... ... ... 11 6 5 Malignant Disease, Cancer ... ... ... ... 6 10 20 22 21 10 ... ... 89 65 24 Rickets 4 1 ... ... ... ... ... ... ... ... ... 5 5 3 2 Purpura ... ... ... ... 1 ... ... 1 ... ... ... ... 2 2 ... Haemophilia, Hæmorrhagic Diathesis 1 ... ... ... ... ... ... ... ... ... ... 1 1 1 ... Anaemia, Leucocythæmia ... ... ... ... ... 1 1 ... 2 1 ... ... 5 4 1 Diabetes Mellitus ... ... 2 2 1 1 4 4 ... 1 ... 14 8 6 Premature Birth 81 ... ... ... ... ... ... ... ... ... ... 81 81 70 11 Congenital Defects 8 ... 1 1 ... ... ... ... ... ... ... 8 10 6 4 Injury at Birth 4 ... ... ... ... ... ... ... ... ... ... 4 4 3 1 Atelectasis 16 • • • ... ... ... ... ... ... ... ... ... 16 16 14 2 Want of Breast Milk 1 ... ... ... ... ... ... ... ... ... ... 1 1 1 ... Teething 7 4 ... ... ... ... ... ... ... ... 11 11 11 ... Old Age ... ... ... ... ... ... ... 1 19 63 33 ... 116 92 24 251 169 44 50 75 108 109 104 91 103 37 420 1141 943 198 LOCAL DISEASES. Diseases of Nervous System. Meningitis, Inflammation of Brain 4 4 3 ... ... ... 1 1 ... ... ... 8 13 9 4 Softening of Brain ... ... ... ... ... ... 2 2 ... 7 ... ... 11 6 5 General Paralysis of Insane ... ... ... 1 3 7 3 4 ... ... ... ... 18 14 4 Insanity (not Puerperal) ... ... ... ... ... 2 ... ... 1 ... ... ... 8 2 1 Chorea ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... 1 Epilepsy ... ... 1 2 3 4 ... 3 2 2 ... ... 17 11 6 Convulsions 29 2 ... ... ... ... ... ... ... ... ... 31 31 24 7 Laryngismus Stridulus 2 ... ... ... ... ... ... ... ... ... ... 2 2 2 ... Locomotor Ataxy ... ... ... ... ... ... ... 1 1 1 ... • •• 8 3 ... Paraplegia and Disease of Cord ... ... ... ... ... 1 1 ... 1 ... ... ... 3 8 ... Neuritis, Periph, Poly-Neuritis ... ... ... ... ... ... 2 ... ... ... ... 2 2 ... Brain Tumour (not specific) ... ... ... ... ... 1 1 1 ... ... ... ... 3 2 1 Nervous System, other Diseases ... ... ... 1 3 2 5 11 8 7 2 ... 39 27 12 Diseases of Organs of Special Sense. Otitis, Mastoid Disease ... 1 ... ... ... ... 2 ... ... ... ... 1 3 2 1 Epistaxis, Nose Disease ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ophthalmia, Eye Disease ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diseases of Heart. Valve Disease, Endocarditis (not infective) ... ... 2 5 12 7 8 16 10 9 ... ... 69 46 23 Pericarditis ... 1 1 1 ... ... 2 1 ... ... ... 1 6 5 1 Hypertrophy of Heart ... ... ... ... ... ... ... 1 ... ... ... ... 1 1 ... Angina Pectoris ... ... ... ... ... ... 2 3 5 3 ... ... 18 7 6 Dilatation of Heart ... ... ... ... 1 ... 2 4 7 2 2 ... 18 14 4 Fatty Degeneration of Heart ... ... ... ... ... 1 6 3 7 4 ... ... 21 16 5 Syncope, Heart Disease (not specified) 1 1 2 12 4 11 12 28 29 19 4 2 123 98 25 Carried forward 36 9 10 22 26 36 49 79 71 54 8 45 400 294 106 Continued. 136 137 TABLE VIII.—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 26. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 to 75. 75 to 85. 85 and upwards. Kensington Town. Brompton. Brought forward 36 9 10 22 26 36 49 79 71 54 8 45 400 294 106 LOCAL DISEASES. Diseases of Blood, Thrombosis Cerebral Hæmorrhage, Embolism, Thrombosis ... ... ... ... 3 3 6 15 18 16 5 ... 66 52 14 Apoplexy, Hemiplegia ... ... ... ... ... 3 14 15 18 11 4 ... 65 52 13 Aneurysm ... ... ... ... 3 2 1 1 ... 1 ... ... 8 7 1 Senile Gangrene ... ... ... ... ... ... ... 2 5 4 ... ... 11 9 2 Embolism, Thrombosis (not Cerebral) ... ... ... ... ... ... ... ... 1 2 ... ... 3 1 2 Phlebitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... Varicose Veins ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Blood Vessels, other Diseases ... ... ... ... ... 2 ... ... 2 2 1 ... 7 6 1 Diseases of Respiratory Organs. Laryngitis 1 2 2 ... ... 1 ... ... ... ... ... 3 6 6 ... Membranous Laryngitis (not Diphtheritic) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Croup (not Spasmodic or Membranous) ... ... ... ... ... ... ... ... ... ... ... ... ... ... Larynx, other Diseases (not specified) ... ... ... ... ... ... ... ... ... ... ... ... ... Bronchitis 52 23 1 ... 3 9 29 43 63 52 22 75 297 266 31 Lobar, Croupous-Pneumonia ... 1 2 ... 1 7 5 4 1 ... ... 1 21 18 3 Broncho, Catarrhal, Lobular Pneumonia 32 42 3 1 1 1 6 5 10 5 1 74 107 94 13 Pneumonia 21 16 ... 5 14 14 26 20 17 8 37 141 118 23 Emphysema, Asthma ... ... ... 1 ... 1 1 5 ... ... 1 ... 9 9 ... Pleurisy 1 ... 1 ... 1 ... 3 2 1 . ... 1 9 8 1 Fibroid Disease of Lung ... ... ... ... 1 ... 3 1 ... ... ... 5 2 3 Respiratory Diseases, other 6 2 ... ... 1 2 3 2 4 8 3 8 31 17 14 Diseases of Digestive System Tonsillitis Quinsy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Mouth, Pharynx, Disease (not Specific) 1 1 ... ... ... ... ... ... ... ... ... 2 2 2 ... Gastric Ulcer ... ... 1 1 ... 2 1 ... ... 1 ... ... 6 4 2 Gastric Catarrh 10 ... ... ... ... ... ... ... ... ... ... 10 10 10 ... Stomach, other Diseases (not Malignant) 5 ... ... ... ... 2 1 1 ... 1 ... 5 10 10 ... Enteritis (not epidemic) 9 1 ... 1 ... 1 1 ... 3 1 ... 10 17 14 3 Gastro-Enteritis 5 3 ... ... ... ... ... ... ... ... ... 8 8 7 1 Appendicitis, Perytyphlitis ... ... ... 1 1 2 1 1 ... ... ... ... 6 6 ... Hernia ... ... 1 1 1 ... 2 2 ... ... ... ... 7 6 1 Diseases of Digestive System.-continued. Intestinal Obstruction 4 1 2 ... ... 3 2 2 4 ... 1 5 19 16 3 Other Diseases of Intestines 1 ... ... ... ... ... 1 ... 1 ... ... 1 3 2 1 Peritonitis (not Puerperal) ... ... 2 1 3 1 ... ... ... ... 1 ... 8 6 2 Cirrhosis of Liver ... ... ... ... 1 6 11 15 8 2 1 ... 44 32 12 Liver and Gall Bladder, other Diseases 2 ... ... 1 1 ... 1 4 3 4 ... 2 16 10 6 Digestive System, other Diseases 2 ... ... ... 1 ... ... 1 ... 1 ... 2 5 5 ... Lymthatic Diseases. Spleen Disease ... 1 ... ... ... ... ... ... ... ... ... 1 1 1 ... Lymphatic System, other Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... Thyroid Body Disease ... ... ... ... ... 1 ... ... ... ... ... ... 1 1 ... Supra Renal Capsules Disease ... ... ... ... ... 1 ... ... 1 ... ... ... 2 1 1 Diseases of Urinary System. Nephritis Acute 1 ... ... 2 ... ... 5 4 5 2 1 1 20 14 6 Chronic Bright's Disease, Albuminuria ... ... ... 1 3 4 6 14 6 5 ... ... 39 34 5 Calculus (not Biliary) ... ... ... ... ... 1 ... 1 ... ... ... ... 2 1 1 Bladder and Prostate Disease ... ... ... ... ... ... ... 1 4 7 2 ... 14 12 2 Urinary System, other Diseases ... ... ... ... 1 1 1 1 1 1 ... ... 6 6 ... Diseases of Generative System Ovarian Tumour (not Malignant) ... ... ... ... ... ... 1 1 ... ... ... ... 2 ... 2 Other Diseases of Ovary ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Uterine Tumour (not Malignant) ... ... ... ... ... 1 ... 2 ... ... ... ... 3 3 ... Other Diseases of Uterus and Vagina ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Disorders of Menstruation ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Generative and Mam. Organs, other Diseases ... ... ... ... ... 2 ... 2 ... ... ... ... 4 1 3 Accidents, Childbirth. Abortion, Miscarriage ... ... ... 1 ... ... ... ... ... ... ... ... 1 1 ... Puerperal Mania ... ... ... ... 1 ... ... ... ... ... ... ... 1 1 ... Puerperal Convulsions ... ... ... ... ... ... ... ... ... ... ... ... ... ... Placenta Prævia, Flooding ... ... ... ... 1 ... ... ... ... ... ... ... 1 1 ... Other Accidents of Pregnancy and Childbirth ... ... ... 1 ... 1 ... ... ... ... ... ... 2 1 1 Joint Diseases. Caries, Necrosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Arthritis, Periostitis ... 1 1 ... 1 ... ... ... ... ... ... 1 3 3 ... Other Diseases of Locomotor System ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Carried forward 189 103 26 40 68 111 177 248 248 188 51 292 1449 1170 279 Continued. 138 139 TABLE VIII.—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. j 35 to 45. 45 to 55. 55 to 65. 65 to 75. \ 75 to 85. 85 and upwards. Kensington Town Brompton. Brought forward 189 103 26 40 68 1ll 177 248 248 188 51 292 1449 1170 279 LOCAL DISEASES Skin Diseases Ulcer, Bedsore ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 ... Eczema ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pemphigus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Skin Diseases, other ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 189 103 26 40 68 111 177 248 249 188 51 292 1450 1171 279 DEATHS FROM VIOLENCE. 1.-Accident or Negligence Fractures and Conditions 1 5 2 3 2 4 2 4 6 5 2 6 36 32 4 Gunshot Wounds ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cut, Stab ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Burn, Scald ... 6 1 ... ... ... ... 1 ... ... ... 6 8 7 1 Poison ... ... ... ... ... ... ... 1 ... ... ... ... 1 1 ... Drowning ... ... ... ... ... 1 1 ... ... ... ... ... 2 2 ... Suffocation 9 2 ... ... ... 2 ... ... 1 ... 11 14 12 2 Otherwise 2 ... ... ... ... 2 ... ... ... ... ... 2 4 4 ... 2.-Homicide. Manslaughter ... ... ... ... ... 1 ... ... ... ... ... ... 1 1 ... Murder 2 ... ... ... ... ... ... ... ... ... ... 2 2 ... 2 3.-Suicide Gunshot Wounds ... ... ... ... ... ... ... 2 1 ... ... ... 3 2 1 Cut, Stab ... ... ... ... 1 ... ... 1 ... ... ... ... 2 1 1 Poison ... ... ... 1 2 ... ... ... ... ... ... ... 3 2 1 Drowning ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 ... Hanging ... ... ... ... ... 1 ... 2 ... ... ... ... 3 1 2 Otherwise ... ... ... 1 1 ... ... ... ... ... ... ... 2 ... 2 4.-Execution Hanging ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 14 13 3 5 6 9 5 11 8 6 2 27 82 66 16 DEATHS FROM ILL-DEFINED AND NOT SPECIFIC CAUSES. Dropsy 1 ... ... ... ... ... ... ... ... ... ... 1 1 1 Debility, Atrophy, Inanition 60 5 ... ... ... ...... ... 1 1 ... ... 65 67 59 8 Tumour ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Abscess ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 ... Hæmorrhage ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Sudden Death (cause not ascertained) ...... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... Causes not Specified or Ill-defined ... ... ... ... ... ... ... 1 2 ... ... ... 4 3 1 61 5 ... ... ... 1 1 2 3 ... ... 66 73 63 10 140 TABLE IX. . ( Table IV. in Annual Reports prior to 1900.) Showing the number of Deaths in the Borough at all ages, in 1902, from certain groups of Diseases, and proportion to 1,000 of Population, and to 1,000 deaths from all causes: also the number of Deaths of Infants under one year of age from other groups of Diseases, and proportions to 1,000 Births, and to 1,000 Deaths from all causes under one year. Division I. (At all Ages.) Total Deaths. Deaths per 1,000 of Population. Deaths per 1,000 of Total Deaths. 1. Principal Zymotic Diseases 263 1.5 96 2. Pulmonary Diseases 626 3.5 228 3. Principal Tubercular Diseases 315 1.8 115 Division II. (Infants under one year.) Total Deaths. Deaths per 1,000 of Births. Deaths per 1,000 of Total Deaths under one year. 4. Wasting Diseases 142 40.7 276 5. Convulsive Diseases 51 14.6 99 NOTES. 1. Includes Small-pox, Measles, Scarlet Fever, Diphtheria, Whooping-cough, Typhus Fever, Enteric (or Typhoid) Fever, Simple Continued Fever, and Diarrhoea. Fifty eight of the deaths occurred in Hospitals without the Borough. 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 VIII., Hydrocephalus and Infantile Meningitis are classified with tubercular diseases, Convulsions with diseases of the nervous system, and Teething with diseases of the digestive system.) I4i TABLE X. (Table V. in Annual Reports prior to 1900). Showing the Number of Deaths from the Principal Diseases of the Zymotic Class in ten years, 1892-1901, and in the year 1902. DISEASES. 1892. 1893. 1894. 1895. 1896. 1897. 1898. 1899. 1900. 1901. Annual Average of ten years, 1892-1901. Proportion of Deaths to 1000 Deaths from a11 causes in ten years, 1892-1901. Deaths in 1902. Proportion of Deaths to 1000 Deaths from all causes in 1902. Small-pox ... \ 9 ... ... ... ... ... ... ... 1 1.0 0.4 11 4.0 Measles 109 18 108 33 173 33 120 24 98 77 79.3 28.4 93 33.9 Scarlet Fever 36 51 22 27 39 29 23 10 4 15 25.6 9.2 21 7.6 Diphtheria 31 83 75 89 72 82 26 42 27 38 56.5 20.3 20 7.3 Whooping-cough 63 65 61 39 99 19 52 59 33 62 55.2 19.8 21 7.6 Typhus Fever ... ... ... ... ... ... 2 ... ... 1 0.3 0.2 ... – Enteric Fever 15 17 21 15 15 21 12 23 16 11 16.6 6.0 19 69 Simp. Continued Fever 2 ... 3 1 1 1 ... ... ... ... 0.8 0.3 ... ... Diarrhœa 77 98 56 118 61 125 112 « 101 105 115 96.8 34.7 78 28.4 TOTALS. Kensington 333 341 346 322 460 310 347 259 283 320 332 119.3 263 95.7 London 11,983 13,223 11,544 11,544 14,100 11,525 12,565 11,228 10,187 10,203 11,810 139.1 10,393 125.9 England & Wales 56,032 73,499 52,771 64,901 66,936 67,051 69,714 69,820 64,059 66,531 65,131 117.6 53,795 100.1 142 TABLE XI. ( Table VII. in Annual Reports prior to 1900.) Showing the Death-rate per 1,000 persons living; the Rate per 1,000 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 1902, and in the ten preceding years, 1892-1901. The Year. Deaths per 1,000 living. Total Deaths from seven principal Zymotic Diseases, Kensington. Annual rate of mortality per 1,000 living, from seven principal Zymotic Diseases. Proportion of Deaths to 1,000 Deaths, from seven principal Zymotic Diseases. The Year Kensington. London. Kensington. London. Kensington. London. 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 2.7 132 150 1894 1895 16.2 19.9 322 1.9 2.6 117 133 1895 1896 16.7 18.6 460 2.7 3.1 159 169 1896 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 1899 17.5 19.8 259 1.5 2.5 86 125 1899 1900 15.6 18.8 283 1.6 2.2 105 119 1900 1901 15.0 17.6 320 1.8 2.3 121 128 1901 Average of Ten Years 18921901. 16.3 19.1 332 1.9 2.7 119 139 Average of Ten Years 18921901. 1902 15.2 17.7 263 1.5 2.2 96 126 1902 TABLE XII. ( Table VIII. in Annual Reports prior to 1900.) Comparative Analysis of the Mortality in all London, and in Kensington, in 1902. Annual Death-rate per 1,000 living, from all causes. Annual Death-rate per 1,000 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 17.7 2.2 14.1 22.5 27.1 12.6 4.3 9.7 34.1 0.3 Kensington 15.2 1.5 14.8 18.7 34.8 9.6 3.0 7.6 31.1 0.00 * Viz.—Borough Infirmary and Workhouse, Brorapton Consumption Hospital, so far as relates to Deaths of Parishioners therein, and Outlying Public Institutions, i.e., General and Special Hospitals, &c. 143 TABLE XIII. (Table IX. in Annual Reports prior to 1900.) Name of Streets, etc., in the Registration Sub-Districts, and in the Wards in which occurred the 263 fatal cases of the Principal Zymotic Diseases during the year 1902. The Registration Sub-Districts are Kensington Town (=K T), and Brompton (=B). The Wards, with their abreviations, are St. Charles (=St. C), Golborne (=G), Norland (=N), Pembridge (=P), Holland (=H), Earl's Court (=E C), Queen's Gate (=Q G), Redcliffe (= R), Brompton (= B). Street or Place. Registration Sub-District. Ward. Small-pox. Measles. Scarlet Fever. Diphtheria. Whooping-cough. Enteric Fever. Diarrhoea. Total. Abingdon Road K T E C ... 1 ... ... ... ... ... 1 Acklam Road K T G ... ... ... ... 1 ... 1 2 Adair Road „ „ ... ... ... 1 ... ... 1 2 Adrian Terrace B R ... 1 ... ... ... ... ... 1 Albert Mews K T Q G ... 1 ... ... ... ... ... 1 Albion Place „ P ... 2 ... ... ... ... ... 2 All Saints Road „ G ... 1 ... ... ... ... ... 1 Appleford Road „ „ ... 3 ... 1 ... . . . ... 4 Archer Mews „ P ... 1 ... ... ... ... ... 1 Bangor Street „ N ... ... ... ... 1 ... 2 3 Barker Street B R ... ... 1 ... ... ... 1 2 Basing Road K T P ... 1 1 ... ... ... ... 2 Bevington Road „ G ... ... 1 ... 1 ... ... 2 Blechynden Street „ St. C 2 ... ... ... ... ... ... 2 Blenheim Crescent „ P ... 2 ... ... ... 1 ... 3 Bolton Road „ „ ... 1 ... ... ... ... 1 2 Bomore Road „ N ... 2 ... ... ... ... 1 3 Bosworth Road „ G ... ... 2 ... ... ... 1 3 Bramley Road „ St. C ... 1 ... ... ... ... ... 1 Bransford Street „ „ ... ... ... ... ... . . . 1 1 Brunswick Mews „ P ... ... 1 ... ... ... ... 1 Buckingham Mews „ „ 1 ... ... ... ... ... ... 1 Buckingham Terrace „ „ ... 1 ... ... ... ... ... 1 Bute Street B B ... ... ... ... 1 ... ... 1 Calverley Street K T St. C ... 1 ... ... ... ... 1 2 Campden Houses „ H ... 2 ... 1 ... ... ... 3 Campden Street „ „ ... 1 1 ... ... ... ... 3 Chesterton Road K T St. C ... . . . ... ... ... 1 ... 1 Childs' Passage B E C ... ... ... ... 1 ... ... 1 Clarendon Road K T N ... 2 ... ... 1 ... ... 1 Clydesdale Mansions „ P ... ... ... ... ... ... 1 1 Colelierne Mews B R ... 1 ... ... ... ... ... 1 Collingham Road „ „ ... ... ... 1 ... ... ... 1 Colville Mews K T P ... ... ... ... ... ... 1 1 Cornwall Road „ „ ... 1 ... ... ... ... ... 1 Crescent Place B B ... ... ... ... 1 ... ... 1 Crescent Street K T N 2 ... ... ... ... ... 3 5 Dartmoor Street „ H ... ... ... ... 1 ... ... 1 Dunworth Mews „ P ... ... ... 1 ... ... ... 1 Earl's Court Road B R 1 ... ... ... ... ... 1 Earl's Court Square „ E C ... ... 1 ... ... ... ... 1 Edenham Mews K T G ... ... ... ... ... 1 ... 1 Edenham Street „ „ ... ... ... ... 1 1 ... 2 Edge Street „ H ... 1 ... ... ... ... ... 1 Faraday Road K T G & St. C ... ... ... 1 ... 1 ... 2 Finborough Road B R ... 2 ... 2 ... ... ... 4 Fowell Street K T N ... 2 ... ... ... ... ... 2 Continued. 144 TABLE XIII.—continued. Street or Place. Registration Sub-District. Ward. Small-pox. Measles. Scarlet Fever. Diphtheria. Whooping-cough. Enteric Fever. Diarrhoea. Total. Golbome Gardens K T G ... ... ... ... ... ... 2 2 Golborne Road ,, ,, ... ... ... 1 ... ... ... 1 Handover Dwellings ,, ,, ... ... 1 ... ... ... ... 1 Harrow Road ,, St. C. ... 1 ... ... ... ... ... 1 Hazel wood Crescent ,, G ... 1 ... ... ... ... 3 5 Hesper Mews B R ... ... ... ... 1 ... ... 1 Holland Mews K T H ... ... ... 1 ... ... ... 1 Holland Park Mews ,, ,, ... ... ... ... ... ... ... 1 Hurstway Street KT St. c ... 4 ... ... ... ... 1 5 Hyde Park Gate ,, Q G ... ... ... ... ... 1 ... 1 Jameson Street ,, H 1 ... ... ... ... ... 1 2 Johnson Street ,, ,, ... ... ... 1 ... ... ... 1 Kendrick Mews B B ... 1 ... ... ... ... ... 1 Kenley Street K T N ... 2 ... ... 1 ... ... 3 Kensal Road ,, G ... ... ... 1 ... 1 5 7 Kensington Infirmary ,, Q G ... 1 ... ... 1 ... 4 6 King Street Chambers ,, ,, ... ... ... ... 1 ... ... 1 Ladbroke Grove ,, St. C ... ... ... 1 2 ... 1 4 Lancaster Road ,, St. C&N ... 2 ... ... ... ... 1 3 Latimer Road ,, St. C ... 2 ... ... ... ... ... 3 Ledbury Road ,, P ... ... ... 1 ... ... ... 1 Lexham Gardens B E C ... ... ... ... ... ... 1 1 Lockton Street K T St. 0 ... ... ... l ... ... 1 2 Lonsdale Road ,, p ... 1 ... ... ... ... 4 5 Manchester Road ,, St. c ... ... ... ... ... ... 1 1 Martin Street ,, ,, ... ... ... 1 ... ... 1 2 Mary Place ,, N ... 1 ... ... ... ... 1 2 Mersey Street ,, St. C ... 1 ... ... ... ... ... 1 Middle Row ,, G ... ... ... ... ... 1 ... 1 Munro Mews ,, ,, ... ... ... ... ... ... 1 1 Nevern Square B E C ... ... ... ... ... l ... 1 Newcombe Street K T H ... ... ... 1 ... ... ... 1 Oxford Gardens ,, St. C ... ... ... ... 1 ... ... 1 Palace Gardens Terrace K T H ... ... 1 ... ... ... ... 1 Palace Gate ,, Q G ... ... ... 1 ... ... ... 1 Pamber Street ,, St. C ... 1 ... ... ... ... ... 1 Peel Street ,, H ... 1 ... ... ... ... ... 1 Phoenix Place ,, N ... 1 ... ... ... ... ... 1 Portland Road ,, ,, ... 3 ... ... ... ... 1 4 Portobello Road ,, G ... 1 ... ... ... ... 2 3 Powis Square ,, P ... ... ... ... ... 1 1 Prince's Road ,, N ... ... ... ... ... 1 2 3 Queen's Road ,, ,, ... 1 ... ... ... ... ... 1 Rackham Street ,, St. C ... ... ... ... ... ... 1 1 Rendle Street ,, G ... ... ... ... ... ... 1 1 St. Ervan's Road ,, ,, ... ... ... ... ... ... 2 2 St. George's Road ,, N ... 2 ... ... ... ... ... 2 St. James's Place ,, ,, ... ... ... ... 1 ... ... 1 St. Katharine's Road ,, ,, ... 1 ... l ... ... 2 4 St. Luke's Mews ,, P ... ... ... ... ... ... 1 1 St. Mark's Road, Notting Hill ,, N ... 1 ... ... ... ... ... 1 St. Marylebone Infirmary ,, St. C ... ... ... 1 ... ... ... 1 Continued. 145 TABLE XIII.—continued. Street or Place. Registration Sub-District. Ward. Small-pox. Measles. Scarlet Fever. Diphtheria. Whooping-cough. Enteric Fever. Diarrhœa. Total. Scarsdale Terrace K T Q G ... ... 1 ... ... ... ... 1 Seymour Place B R ... 1 ... ... ... ... ... 1 Silchester Road K T St C ... 1 ... ... ... ... 2 3 Silchester Terrace ,, ,, ... ... ... ... ... ... 1 1 Sirdar Road ,, N ... 1 ... ... ... ... 1 2 Snarsgate Street ,, St.C ... 4 ... ... ... ... ... 4 Southam Street ,, G ... 4 ... ... ... 1 4 13 South Row ,, ,, ... ... ... ... ... ... 1 1 Stanhope Mews East B B ... 1 ... ... ... ... ... 1 Stanhope Mews West ,, ,, ... 1 ... ... ... ... ... 1 Sumner Place B B ... ... ... ... ... ... 1 1 Swinbrook Road K T G ... 1 ... ... ... ... 1 2 Talbot Grove ,, N ... 1 ... ... ... ... ... 1 Tavistock Cresceut ,, G ... ... ... ... ... ... 2 2 Tavistock Road ,, ,, ... ... ... ... ... 2 ... 3 Telford Road ,, ,, ... 1 ... ... ... ... ... 1 Testerton Street ,, St. C ... 2 ... ... ... ... 1 3 The Mall ,, H ... 1 ... ... ... ... ... 1 Thomas Place ,, N ... 1 ... ... ... ... ... 1 Thresher's Place ,, ,, ... 1 ... ... ... ... ... 1 Treadgold Street ,, N ... ... ... ... ... ... 1 1 Treverton 8treet ,, St. C ... 4 ... ... ... 2 4 10 Uxbridge Street ,, H ... ... 1 ... ... ... ... 1 Walmer Road ,, St.C &N 1 5 ... ... 3 ... 1 10 Warwick Road B E C ... ... ... ... 1 ... ... 1 Western Terrace K T P ... 2 ... ... ... ... 1 3 Wheatstone Road ,, G ... ... ... ... ... 1 ... 1 Wornington Road ,, ,, 1 1 2 ... ... 2 1 7 Yeoman's Row B B ... ... ... ... ... ... 1 1 Note.—The deaths in the Borough Infirmary have, as far as practicable, been allocated to the several streets from which the patients were admitted to the Infirmary. 146 TABLE XIV. (Table IXa. in Annual Reports, prior to 1900.) Names of Streets, etc., in the Registration Sub-Districts, and in the Wards, from which the 1,608 cases of Infectious Disease were notified, under the provisions of the Public Health (London) Act, 1891, during the year 1902. The Registration Sub-Districts are Kensington Town (=K T), and Brompton (=B). The Wards, with their abbreviations, are St. Charles (=St. C), Golborne (=G), Norland (=N), Pembridge (=P), Holland (=H), Earl's Court (=E C), Queen's Gate (=Q G), Redcliffe (=R), Brompton (=B). Street or Place. Registration Sub-District. Ward. Small-pox. Chicken-pox. Scarlet Fever. Diphtheria. Enteric Fever. Continued Fever. Puerperal Fever. Erysipelas. Croup. Total. Abbey Road K T N ... ... ... ... ... ... ... 1 ... 1 Abingdon Road „ E C ... 5 2 ... ... ... ... ... ... 7 Abingdon Villas „ „ ... ... 1 ... ... ... ... ... ... 1 Acklam Road „ G ... 8 4 1 ... 2 ... 2 ... 17 Adair Road „ „ ... 1 1 3 ... ... ... ... ... 5 Adam and Eve Mews „ E C ... 1 1 ... ... ... ... ... ... 2 Adams Cottages „ N ... 4 ... ... 1 ... ... ... ... 5 Adela Street „ G 1 ... 1 ... ... ... ... 1 ... 3 Adrian Terrace B R 1 1 1 ... ... ... ... 1 ... 4 Albert Mews K T Q G ... ... ... 1 ... ... ... ... ... 1 Alderson Street „ G ... ... 1 ... ... ... ... ... ... 1 Alfred Place West B B ... ... ... 1 ... ... ... ... ... 1 All Saints Road K T G & P ... 3 1 ... 3 ... ... ... ... 7 Appleford Road „ G ... 15 4 l ... ... ... ... ... 20 Archer Mews „ P ... 3 ... ... ... ... ... ... ... 3 Archer Street „ „ ... ... ... l ... ... ... ... ... 1 Argyll Road „ H ... 2 1 ... ... ... ... ... ... 3 Ashburn Place B R ... 2 ... ... ... ... ... ... ... 2 Ashton Road K T P ... ... 1 ... ... ... 1 ... ... 2 Ball Street K T Q G ... 1 1 l ... ... ... ... ... 3 Bangor Street „ N 1 1 ... l 2 ... ... 4 ... 9 Barker Street B R ... 2 2 ... ... ... ... ... ... 4 Barkston Gardens „ R ... . . . 2 ... ... ... ... 1 ... 3 Basing Road K T P ... 1 2 ... ... ... ... 1 ... 4 Bassett Road „ St. C ... ... 2 ... ... ... ... ... ... 2 Beaufort Gardens B B ... ... ... ... 1 ... ... ... ... 1 Bedford Gardens K T H ... ... 1 ... ... ... ... ... ... 1 Berkeley Gardens „ „ ... 2 ... ... ... ... ... ... ... 2 Bevington Road „ G 1 1 3 ... 1 ... ... ... ... 6 Blagrove Road „ „ ... 2 2 ... 1 ... ... ... ... 5 Blechynden Street „ St. C 3 3 ... l 1 ... ... 3 ... 11 Blenheim Crescent „ P ... 3 ... ... 1 ... ... ... ... 4 Bolton Mews „ „ ... 2 ... ... ... ... ... ... ... 2 Bolton Road „ „ ... 8 ... 1 ... ... ... 1 ... 10 Bonchurch Road „ St. C ... ... 1 ... . . . ... ... ... ... 1 Bosworth Road „ G 7 8 5 l ... ... ... 3 ... 24 Bramham Gardens B R ... ... 1 ... ... ... ... ... ... 1 Bramley Road K T St. C ... 10 ... ... 1 ... ... ... ... 11 Bransford Street „ „ ... 1 1 ... ... ... ... ... ... 2 Branstone Street „ „ ... ... ... ... 2 ... ... ... ... 2 Brechin Place B R ... ... ... l ... ... ... ... ... 1 Brewster Gardens K T St. C ... 2 ... ... ... ... ... ... ... 2 Brompton Road B B 1 1 ... ... ... ... ... 1 ... 3 Brompton Square „ „ ... 2 1 ... ... ... ... ... ... 3 Brunswick Gardens K T H ... 2 ... ... ... ... ... ... ... 2 Brunswick Mews „ P ... ... 2 ... ... ... ... ... ... 2 Buckingham Mews „ „ 1 ... ... ... ... ... ... ... ... 1 Buckingham Terrace „ „ 2 1 ... ... ... ... ... ... ... 3 Bulmer Place „ „ ... ... ... l ... ... ... ... ... 1 Bulmer Terrace „ „ ... 1 ... l ... ... ... ... ... 2 Continued. 147 TABLE XIV.—continued. Street or Place. Registration Sub-District. Ward. Small-pox. Chicken-pox. Scarlet Fever. Diphtheria. Enteric Fever Continued Fever. Puerperal Fever. Erysipelas. Croup. Total. Calverley Street K T St. C 1 1 ... ... ... ... ... ... ... 2 Cambridge Gardens „ „ ... 2 2 ... ... ... ... ... ... 4 Campden Grove „ H ... ... 1 ... ... ... ... ... 1 Campden Hill „ „ ... ... 1 ... ... ... ... ... ... 1 Campden Hill Gardens „ „ ... ... 1 ... ... ... ... ... ... 1 Campden Hill Road „ „ ... ... 1 1 ... ... ... ... ... 2 Campden Hill Square „ „ ... ... 1 ... ... ... ... ... ... 1 Campden House Mews „ „ ... ... 1 ... ... ... ... ... ... 1 Campden Houses „ „ ... ... 3 2 ... ... ... ... ... 5 Campden Street „ „ 1 7 5 3 1 ... ... ... ... 17 Carlyle Mansions „ „ ... ... 1 2 ... ... ... ... ... 3 Cathcart Road B R ... ... ... 1 ... ... ... 2 ... 3 Chapel Place „ B 1 1 ... ... ... ... ... ... ... 2 Charles Street, Notting Hill K T N ... 2 ... ... ... ... ... ... ... 2 Cheniston Gardens „ E C ... ... ... 1 ... ... ... ... ... 1 Chepstow Mansions „ P ... 2 ... ... ... ... ... ... ... 2 Chesterton Road „ St C ... 5 6 4 2 ... ... 1 ... 18 Childs' Passage B E C ... 1 ... 1 ... ... ... ... ... 2 Childs' Place „ „ ... ... 2 ... ... ... ... ... ... 2 Childs' Street „ „ ... ... 1 1 ... ... ... ... ... 2 Church Walk K T H ... 2 1 ... ... ... ... ... ... 3 Clanricarde Gardens „ P ... ... ... 1 ... ... ... ... ... 1 Clarence Mews „ H ... ... 1 ... 1 ... ... ... ... 2 Clarendon Road „ N ... 4 6 1 ... ... ... 2 ... 14 Codrington Mews „ P ... 1 1 ... ... ... ... ... ... 2 Coleherne Road B R ... 1 ... 1 ... ... ... ... ... 2 Collingham Gardens „ „ ... ... ... ... 1 ... ... ... ... 1 Collingham Road „ „ ... ... 4 1 ... ... ... ... ... 5 Colville Gardens K T P ... 1 ... ... 1 ... ... ... ... 2 Colville Mews „ „ ... ... ... 1 ... ... ... ... ... 1 Colville Road „ „ ... 2 2 ... ... ... ... ... ... 4 Colville Square „ „ ... ... ... 1 ... ... ... 1 ... 2 Colville Square Mews „ „ ... 2 ... ... ... ... ... 1 ... 3 Convent Gardens „ „ 1 1 ... ... ... ... ... ... ... 2 Cornwall Gardens Stables „ Q G ... ... 2 ... ... ... ... ... ... 2 Cornwall Road „ P & N 3 11 4 1 1 ... ... 3 ... 23 Cottesmore Gardens „ Q G ... ... ... ... ... ... ... 1 ... 1 Courtfield Gardens B R ... ... 1 1 ... ... ... ... ... 2 Courtfield Road „ „ ... ... ... 1 ... ... ... ... ... 1 Cranley Mews „ „ ... ... 1 ... ... ... ... ... ... 1 Crescent Street K T N 4 2 ... 2 ... ... ... 3 ... 11 Cromwell Road „ E C, Q G & B ... 3 4 ... 1 ... ... ... ... 8 Dartmoor Street K T H ... 1 1 2 1 ... ... 1 ... 6 Denbigh Road „ P 3 ... ... ... ... ... ... ... ... 3 Denbigh Terrace „ ,, ... ... ... ... ... ... ... 3 ... 3 De Vere Gardens „ Q G ... ... 1 ... ... ... ... ... ... 1 Drayson Mews „ H ... ... 1 ... ... ... ... ... ... 1 Drayton Gardens B R ... 1 ... ... ... ... ... 1 ... 2 Dunworth Mews K T P ... ... ... 1 ... ... ... ... ... 1 Earl's Court Gardens B R ... 3 2 ... ... ... ... ... ... 5 Earl's Court Road K T&B E C&B 1 2 2 3 1 ... ... ... 9 Earl's Court Square B E C ... 2 2 ... ... ... ... ... ... 4 East Mews Road K T St. C ... ... 1 1 ... ... ... ... ... 2 East Row „ G ... ... 1 ... ... ... ... 2 ... 3 Edenham Mews „ „ ... 4 ... ... 1 ... ... ... ... 5 Edenham Street „ „ 1 5 4 1 1 ... ... 2 ... 14 Edge Street „ H ... ... 3 3 ... ... ... ... ... 6 Edinburgh Road „ St. C. ... 1 ... ... ... ... ... 2 ... 3 Continued. 148 TABLE XIV.—continued. Street or Place. Registration Sub-District. Ward. Small-pox. Chicken-pox. Scarlet Fever. Diphtheria. Enteric Fever. Continued Fever. Puerperal Fever. Erysipelas. Croup. Total. Edwardes Square K T E C ... 1 ... 1 ... ... ... ... ... 2 Egerton Gardens B B ... 6 ... ... 1 ... ... ... ... 7 Elgin Crescent K T P &N ... 2 4 ... ... ... ... ... ... 6 Elsham Road „ H ... 2 ... ... ... ... ... ... ... 2 Elvaston Place „ Q G ... ... ... 1 ... ... ... ... ... 1 Emperor's Gate B „ ... ... ... 1 ... ... ... ... 1 Faraday Road KT St C&G 1 2 1 3 1 ... ... ... ... 8 Finborough Eoad B R ... 6 ... 4 1 ... ... ... 1 12 Fowell Street K T N ... 3 ... 1 ... ... ... ... ... 4 Fulham Road. B R & B ... 2 3 1 ... ... 1 ... ... 7 Gadsden Mews K T G ... ... 2 1 ... ... ... ... ... 3 Gaspar Mews B R ... ... 1 ... ... ... ... ... ... 1 Grenfell Eoad K T N ... ... ... ... ... ... ... 1 ... 1 Golborne Gardens „ G ... 7 2 2 ... ... ... 3 ... 14 Golborne Road „ „ ... 4 2 3 1 ... ... 2 ... 12 Handover Dwellings K T G ... ... 1 1 ... ... ... ... ... 2 Hans Road B B ... ... 1 ... ... ... ... ... ... 1 Harcourt Terrace „ R ... ... ... 2 ... ... ... ... ... 2 Hazel wood Crescent K T G 4 6 3 4 ... ... ... ... ... 17 Hesketh Place „ N 2 1 ... ... ... ... ... ... ... 3 Hewer Street „ St. C ... 8 ... ... ... ... ... ... ... 8 High Street, Notting Hill „ P & H 1 2 1 ... ... ... ... 1 ... 5 Holland Mews „ H ... 1 ... ... ... ... ... 1 Holland Park „ „ ... ... 1 ... ... ... ... ... ... 1 Holland Park Mews „ „ ... 3 2 ... ... ... ... ... ... 5 Holland Place „ „ ... ... 1 ... ... ... ... ... ... 1 Holland Road „ „ ... 3 1 2 1 ... ... ... ... 7 Hollywood Road B R ... 2 ... ... ... ... ... ... ... 2 Hornton Place K T H ... ... ... ... ... ... ... 1 ... 1 Hornton Street „ „ ... ... 1 1 ... ... ... ... ... 2 Ifield Road B R 1 10 3 2 ... ... ... ... ... 16 Inkerman Terrace K T E C ... ... 1 ... ... ... ... ... ... 1 Jameson Street K T H 1 ... ... ... ... ... ... ... ... 1 Johnson Street „ „ ... ... ... 3 ... ... ... 1 ... 4 Kelfield Gardens „ St C ... ... ... ... ... ... ... 1 ... 1 Kelso Place „ Q G ... ... 1 ... ... ... ... ... ... 1 Kenley Street „ N ... ... ... ... ... ... 1 2 ... 3 Kensal Road „ G 1 4 7 7 ... 1 1 5 ... 26 Kensington Court „ Q G ... 2 1 ... 1 ... ... ... ... 4 Kensington Court Gardens „ „ ... ... ... ... ... ... ... 1 ... 1 Kensington High Street „ H & QG 2 ... ... ... ... ... ... 1 ... 3 Kensington Infirmary „ Q G ... 14 3 2 ... ... ... 11 ... 30 Kensington Palace Gardens „ H ... 2 ... 1 ... ... ... ... ... 3 Kensington Park Gardens „ P ... 3 2 ... 1 ... ... 1 ... 7 Kensington Park Mews. „ „ ... 3 ... ... ... ... ... ... ... 3 Kensington Park Road „ „ ... 6 1 ... ... ... ... ... ... 7 Kensington Place „ H ... 2 1 ... ... ... ... ... ... 3 Kenway Road B E C ... ... 1 ... ... ... ... ... ... 1 Ladbroke Dwellings K T G ... ... 1 ... ... ... ... 1 ... 2 Ladbroke Grove „ St. C &P ... 9 7 2 1 ... ... 2 ... 21 Ladbroke Road „ P 1 1 ... 1 ... ... ... ... ... 3 Ladbroke Terrace „ „ ... ... 1 ... ... ... ... ... ... 1 Continued. 149 TABLE XIV.—continued. Street or Place. Registration Sub-District. Ward. Small-pox Chicken-pox. Scarlet Fever. Diphtheria. Enteric Fever. Continued Fever. Puerp ral Fever. Erysipelas Croup. Total. Ladbroke Terrace Mews KT P ... ... ... 1 ... ... ... ... ... 1 Lancaster Road „ St. C N & P 3 17 3 2 ... ... ... 3 ... 28 Langham Mansions B E C ... ... ... 1 2 ... ... 1 ... 4 Lansdowne Crescent K T N ... 1 ... 1 ... ... ... 1 ... 3 Lansdowne Road „ „ ... 2 ... ... ... ... ... ... ... 2 Latimer Road „ St. C ... 5 4 1 ... ... ... 2 ... 12 Ledbury Mews „ P ... ... 3 ... 1 ... ... ... ... 4 Ledbury Mews West „ ,, ... ... ... 1 ... ... ... ... ... 1 Ledbury Road „ ,, ... 2 ... 1 ... ... ... ... ... 3 Lexham Gardens B Q G 1 ... ... 1 ... ... 1 ... ... 3 Linden Gardens K T P 1 ... 1 ... ... ... ... ... ... 2 Lionel Mews „ St. C ... 3 ... ... ... ... ... ... ... 3 Longridge Road B E C ... ... 1 1 ... ... ... ... ... 2 Lonsdale Road K T P 1 9 4 ... ... ... ... 2 ... 16 Mall Chambers „ H ... ... ... ... ... ... 1 ... ... 1 Manchester Road „ St C ... ... ... ... ... ... 1 1 ... 2 Marines Road „ QG&EC ... 2 ... 1 ... ... ... ... ... 3 Martin Street „ St C ... 2 1 1 ... ... ... ... ... 4 Mary Place „ N ... 2 ... 1 ... ... ... 4 ... 7 Maxilla Gardens „ St. C ... ... 2 ... ... ... ... 1 ... 3 Mersey Street „ „ ... 1 ... ... ... ... ... 2 ... 3 Merton Road „ Q G ... 2 3 ... ... ... ... ... ... 5 Middle Row „ G ... ... ... ... l ... ... ... ... 1 Moreton Gardens B E ... ... ... 1 ... ... ... ... ... 1 Munroe Mews K T G ... ... 1 1 ... ... ... ... ... 2 Nevern Square B E C ... 2 ... ... 1 ... ... ... ... 3 Neville Terrace „ B ... ... 1 ... ... ... ... ... ... 1 Newcombe Street K T H ... ... 1 2 ... ... ... ... ... 3 Norland Road „ N ... 1 1 ... ... ... ... ... ... 2 Norland Road North „ „ 1 ... ... ... ... ... ... ... ... 1 Norland Square „ „ 1 1 ... ... ... ... ... ... ... 2 Norwood Place „ H ... ... 1 ... ... ... ... ... ... 1 Oakwood Court K T H ... 1 1 ... ... ... ... ... ... 2 Onslow Gardens B B ... ... ... 3 ... ... ... 1 ... 4 Onslow Square „ „ ... ... ... ... 1 ... ... ... ... 1 Ovington Square „ „ ... ... ... ... ... ... ... 1 ... 1 Oxford Gardens K T St. C ... 2 ... ... 1 ... ... ... ... 3 Palace Gate „ Q G ... ... ... 2 ... ... ... ... ... 2 Palace Gardens Terrace „ H ... 4 2 1 1 ... ... ... ... 8 Pamber Street „ St. C ... ... ... ... ... ... ... 1 ... 1 Peel Place „ H ... ... ... 1 ... ... ... ... ... 1 Peel Street „ ,, ... 3 1 1 ... ... ... ... ... 5 Pembridge Crescent „ P ... ... 1 ... ... ... ... ... ... 1 Pembridge Gardens „ „ ... 1 ... ... ... ... ... 1 ... 2 Pembridge Road „ „ ... 1 1 ... 1 ... ... ... ... 3 Pembridge Square „ „ ... 3 ... ... ... ... ... ... ... 3 Pembridge Villas „ P ... 2 ... ... ... ... ... ... ... 2 Pembroke Gardens „ E C ... 1 1 ... ... ... ... ... ... 2 Pembroke Mews „ „ ... ... 1 ... ... ... ... ... ... 1 Pembroke Place „ „ ... 2 ... ... ... ... ... ... ... 2 Penywern Road B „ ... 1 ... 1 2 ... ... ... ... 4 Philbeach Gardens „ „ ... 1 1 ... ... ... ... ... ... 2 Phillimore Mews K T H ... ... 1 ... ... ... • •• ... ... 1 Portland Road „ N ... 5 1 ... 1 ... ... ... ... 7 Portobello Road „ St. CG & P 1 23 8 6 2 ... 1 5 ... 46 Powis Gardens „ P ... ... ... ... ... ... ... 1 ... 1 Continued. 150 TABLE XIV.—continued. Street or Place. Registration Sub-District. Ward. Small-pox. Chicken-pox Scarlet Fever. Diphtheria. Enteric Fever. Continued Fever. Puerperal Fever. Erysipelas. Croup. Total. Powis Square K T P ... ... ... ... 1 ... ... ... ... 1 Prince of Wales „ „ Terrace „ Q G ... ... 1 ... ... ... ... ... ... 1 Prince's Place „ N ... 1 ... 1 ... 1 ... ... ... 3 Prince's Road „ „ ... 1 ... ... 1 ... ... 2 ... 4 Prince Teck Buildings B E C ... ... ... ... ... ... ... 1 ... 1 Queensberry Place B B ... ... ... ... 1 ... ... ... ... 1 Queen's Gate K T &B Q G&B 3 1 ... ... ... ... 1 ... 5 Queen's Gate Terrace K T Q G ... ... 1 1 ... ... ... . . . ... 2 Queen's Road „ N ... 6 1 ... ... 1 ... ... ... 8 Queen's Terrace Mews „ Q G 2 1 ... ... ... ... ... ... ... 3 Rackham Street „ St. C 4 1 4 2 ... ... ... 2 ... 13 Raddington Road „ G ... 2 ... ... ... ... ... ... ... 2 Radley Mews B E C ... 2 1 ... ... ... ... ... ... 3 Raymede Street K T St. C ... 1 2 2 ... ... ... 1 ... 6 Redcliffe Gardens B R ... ... ... 1 ... ... ... ... 1 Redcliffe Road „ „ 1 ... ... ... ... ... ... ... ... 1 Redcliffe Square „ „ ... 2 ... ... 1 ... ... ... ... 3 Redfield Lane „ E C ... ... 2 ... ... ... ... ... ... 2 Rendle Street K T G ... 3 1 ... ... ... ... 2 ... 6 Rillington Place „ St. c ... 1 ... ... ... ... 1 ... 2 Roland Gardens B R ... ... 2 ... ... ... ... ... ... 2 Roseland Place K T P ... ... 1 ... ... ... ... ... ... 1 Royal Crescent „ N ... 1 ... ... ... ... ... 2 ... 3 Royal Crescent Mews „ „ ... ... 1 ... ... ... ... ... ... 1 Russell Gardens Mews. „ H ... ... ... ... ... . . . ... 1 ... 1 Russell Road „ „ ... ... ... ... ... ... ... 1 ... 1 St Alban's Road „ Q G ... 5 2 2 ... ... ... ... ... 9 St. Ann's Road „ N ... 1 3 ... ... ... 1 1 ... 6 St Charles's Square „ St. C ... 2 ... 1 ... ... 1 ... 4 St. Ervan's Road „ G ... 10 4 2 ... ... 1 2 ... 19 St. George's Road „ N ... ... ... ... ... ... 1 ... 1 St. George's Terrace „ Q G ... ... 1 ... ... ... ... ... ... 1 St. James's Place „ N 1 1 ... 1 ... ... ... ... ... 3 St. John's Place „ „ ... 4 ... ... ... ... ... 1 ... 5 St. Katharine's Road „ „ 2 15 1 3 1 ... 2 3 ... 27 St. Luke's Mews „ P ... 6 ... ... 1 ... ... ... ... 7 St Mark's Road, Fulham Road B R ... ... 2 ... ... ... ... ... ... 2 St. Mark's Road, Notting Hill K T St. C ... 4 9 ... ... ... ... ... ... 13 Scarsdale Terrace „ Q G ... ... 1 ... ... ... ... ... ... 1 Scarsdale Villas „ E C ... ... ... 1 ... ... ... ... ... 1 Seymonr Place B R ... 8 2 2 ... ... ... ... ... 12 Shaftesbury Road „ E C ... ... 1 ... ... ... ... ... ... 1 Sheffield Terrace K T H ... ... 1 ... ... ... ... ... ... 1 Silchester Mews „ St C ... ... 1 ... ... ... ... ... ... 1 Silchester Road „ „ ... 6 1 ... 2 ... ... 1 ... 10 Silchester Street „ „ ... ... 2 ... ... ... ... 2 ... 4 Silchester Terrace „ „ ... 1 1 ... ... ... ... 1 ... 3 Silver Street „ H ... ... ... 1 ... ... ... ... 1 Sirdar Road „ N 1 5 ... 3 1 ... ... 5 ... 15 Southam Street „ G 2 16 11 3 2 1 ... 5 ... 40 South Row „ „ 1 1 3 ... ... ... ... 2 ... 7 South Street, St Mark's Road B R ... ... ... ... ... ... ... 1 ... 1 Stafford Terrace K T H ... 1 1 ... ... ... ... ... ... 2 Stanford Road „ Q G ... ... 1 ... ... ... ... ... ... 1 Stanhope Gardens B B ... 2 ... ... ... ... ... ... ... 2 Stanhope Mews West „ „ ... ... ... 1 ... ... ... ... 1 Continued. 151 TABLE XIV.—continued. Street or Place. Registration Sub-District. Ward. Small-pox. Chicken-pox. Scarlet Fever. Diphtheria. Enteric Fever. Continued Fever. Puerperal Fever. Erysipelas. Croup. Total. Stockton Mews K T G ... ... ... ... ... ... ... 1 ... 1 Stoneleigh Street „ N 1 4 ... ... ... ... 1 ... ... 6 Stratford Road B E C ... ... 1 ... ... ... ... ... ... 1 Sussex Mansions „ B • • • 1 ... ... 1 ... ... ... ... 2 Sussex Place „ „ ... ... 1 ... ... ... ... ... ... 1 Swinbrook Road K T G 1 4 3 2 ... ... ... 7 ... 17 Sydney Place B B ... ... 3 ... ... ... ... ... ... 3 Tabernacle Terrace K T N ... ... ... 1 1 ... ... ... ... 2 Talbot Grove „ „ 2 2 4 ... ... ... ... 1 ... 9 Tavistock Crescent „ G ... 11 4 1 1 ... ... ... ... 17 Tavistock Road „ „ 1 9 ... ... 2 ... ... 1 ... 13 Telford Road „ „ 1 ... 1 ... ... ... ... ... ... 2 Testerton Street „ St. C ... ... 3 1 ... ... ... 3 ... 7 The Boltons B R ... ... 1 ... ... ... ... ... ... 1 The Triangle K T St. C ... 1 6 ... ... ... ... ... ... 7 Thomas Place „ N ... ... 1 ... ... ... ... ... ... 1 Tobin Square „ „ ... 1 ... ... ... ... ... 1 ... 2 Tobin Street „ „ 7 ... ... 1 ... ... ... 2 ... 10 Tor Gardens „ H ... 2 ... ... ... ... ... ... ... 2 Treadgold Street „ N ... 4 3 ... ... ... ... 1 ... 8 Trebovir Road B E C ... 2 1 ... ... ... ... ... ... 3 Treverton Street K T St. C ... 2 4 2 3 ... ... 1 ... 12 Upper Addison Gardens „ H ... ... ... 1 ... ... ... ... ... 1 Upper High lever Road. „ St. c ... ... 1 ... ... ... ... 1 ... 2 Upper Phillimore Gardens „ H ... 3 ... ... ... ... ... ... ... 3 Uxbridge Street „ „ ... 2 1 2 ... ... ... ... ... 5 Victoria Dwellings „ G ... 1 8 ... ... ... ... 2 ... 11 Victoria Gardens „ P ... ... 2 ... ... ... ... ... ... 2 Victoria Road „ Q G ... ... 1 1 ... ... ... ... ... 2 Wallgrave Terrace B E C 1 ... ... ... ... ... ... ... ... 1 Walmer Road K T St. C & N 4 22 5 2 ... ... ... 6 ... 39 Walton Street B B ... ... 6 ... ... ... ... ... ... 6 Warwick Gardens K T E C ... ... 1 ... ... ... ... ... ... 1 Warwick Road B „ ... 4 2 2 ... ... ... 1 ... 9 Wedlake Street K T G ... 2 ... ... ... ... ... ... ... 2 Westbourne Grove „ P ... ... ... ... ... ... ... 1 ... 1 Western Terrace „ „ ... 4 3 ... ... ... ... 3 ... 10 Westgate Terrace, Kensal New Town „ G ... ... ... ... ... ... ... 1 ... 1 West Mall „ H ... ... ... ... ... ... ... 1 ... 1 West Pembroke Place „ E C ... ... ... ... ... ... ... ... ... 1 West Row „ G ... ... 1 ... ... ... ... ... ... 1 Wetherby Mansions B E C ... ... ... ... ... ... ... ... ... 1 Wharfedale Street „ R ... ... ... ... ... ... ... 2 ... 2 Wheatstone Road K T G 1 10 5 ... 4 ... ... 1 ... 21 Wilby Mews „ P ... ... ... ... 1 ... ... ... ... 1 Wornington Road „ G 4 27 15 5 4 ... 1 4 ... 60 Yeoman's Row B B ... 1 ... 2 ... ... 1 3 ... 7 The notifications from Kensington Infirmary have, as far as possible, been allocated to the several streets from which the patients were brought. 152 APPENDIX II. TABLE A. Population of Kensington, 1856-1902; Marriages and Marriage-rate (1871-1902); Births and Birth-rate; Deaths and Death-rate 1856-1902; and Infantile Mortality (1870-1902). The Year. Population. Marriages. Marriage Rate. Births. Birth Rate. Deaths. Death Rate. Deaths under One Year. Deaths under One Year per 1,000 Births Registered. Kensington. London. Kensington. London. 1856 57,078 Information incomplete. No information. 1,804 31.6 33.6 1,285 21.6 22.0 Information incomplete. Information incomplete. / 1857 59,683 1,854 31.1 34.0 1,197 20.1 22.4 1858 62,288 1,881 30.2 33.2 1,290 20.7 23.9 1859 64,893 2,002 30.8 34.1 1,338 20.6 22.7 1860 67,498 2,016 29.9 33.6 1,480 21.9 22.4 1861 70,108 2,159 30.8 34.5 1,447 20.6 23.2 1862 76,350 1,960 25.7 34.2 1,604 21.0 23.6 1863 81,350 2,330 28.6 35.2 1,628 20.0 24.5 1864 86,350 2,494 28.9 34.7 1,849 21.4 26.4 1865 91,350 2,619 28.7 35.7 1,733 18.9 24.5 1866 96 350 3,080 31.9 35.7 1,966 20.4 26.5 1867 101,350 3,158 31.2 36.5 1,933 19.1 23.0 1868 106,350 3,522 33.1 36.3 2,232 21.0 23.5 1869 111,350 3,625 32.6 35.4 2,249 20.2 24.6 1870 116,350 3,705 31.8 35.4 2,473 21.3 24.1 1871 120,234 1,131 18.8 3,804 31.6 34.5 2,418 20.1 24.6 582 153 1872 127,606 1,132 17.7 4,041 31.7 35.6 2,256 17.7 21.5 626 155 1873 132,826 1,243 18.7 4,182 31.5 35.3 2,439 18.4 22.4 656 157 1874 138,616 1,311 18.9 4,356 31.4 35.6 2,696 19.4 22.4 762 175 1875 144,488 1,346 18.6 4,478 31.0 35.4 2,786 19.3 23.6 686 153 1876 148,338 1,417 19.1 4,499 30.3 35.9 2,896 19.5 21.9 771 171 1877 151,360 1,411 18.6 4,648 30.7 35.6 2,625 17.3 21.6 648 139 1878 154,305 1,331 17.2 4,607 29.9 35.5 3,120 20.2 23.1 823 179 1879 158,316 1,428 18.0 4,790 30.3 35.5 2,992 18.9 22.6 722 151 1880 161,462 1,483 18.4 4,605 28.5 35.3 2,884 17.9 21.7 719 156 1881 163,151 1,461 17.9 4,400 26.9 34.7 2,726 16.7 21.3 644 146 1882 163,540 1,474 18.0 4,327 26.5 34.5 2,691 16.4 21.5 635 147 1883 163,860 1,616 19.7 4,230 25.8 34.5 2,615 15.9 20.8 601 142 1884 164.180 1,498 18.2 4,394 26.7 34.3 2,638 16.1 20.9 678 154 1885 164,500 1,480 18.0 4,032 24.5 33.4 2,768 16.8 20.4 658 162 1886 164,820 1,605 19.5 4,149 25.2 33.4 2,756 16.7 20.6 636 153 1887 165,140 1,561 18.9 3,941 23.9 32.9 2,872 17.4 20.3 680 172 1888 165,450 1,497 18.1 3,776 22.8 32.1 2,825 17.1 19.3 604 160 1889 165,760 1,491 18.0 3,698 22.3 31.9 2,412 14.6 18.4 489 182 1890 166,080 1,511 18.2 3,864 23.3 30.7 2,951 17.8 21.4 651 168 1891 166,308 1,569 18.9 3,847 23.1 31.9 3,066 18.4 21.5 633 164 1892 167,200 1,584 18.9 3,718 22.2 31.0 2,882 17.2 20.7 587 158 1893 167,900 1,540 18.3 3,661 21.8 30.9 2,916 17.4 21.3 625 170 1894 168,600 1,537 18.2 3,665 21.7 30.3 2,623 15.6 17.8 636 174 1895 169,300 1,455 17.2 3,621 21.4 30.6 2,748 16.2 19.9 624 172 1896 170,465 1,706 20.1 3,717 21.4 30.2 2,891 16.7 18.6 656 176 1897 170,700 1,681 19.7 3,683 21.6 30.1 2,667 15.6 18.2 609 165 1898 172,000 1,648 19.2 3,633 21.1 29.5 2,798 16.3 18.7 655 180 1899 172,400 1,693 19.6 3,590 20.8 29.4 3,021 17.5 19.8 642 179 1900 173,000 1,543 17.8 3,586 20.7 28.6 2,698 15.6 18.8 641 179 1901 176,628 1,651 18.7 3,602 20.4 29.0 2,650 15.0 17.6 581 161 1902 177,500 1,703 19.2 3,488 19.8 28.5 2,746 15.2 17.2 515 148 Note.—The Medical Officer of Health is not responsible for the accuracy of the Kensington figures above the horizontal line between the years 1870 and 1871, excepting as to estimated population and calculation of rates. Census years are indicated by dark type. 153 TABLE B. Annual Number of Deaths in Kensington from the Principal Diseases of the Zymotic Class (1856-1902); and Zymotic Death-rate, in Kensington, and in London The Year. Population. Deaths from the Seven Principal Diseases of the Zymotic Class. Zymotic Death-rate. Small-pox. Measles. Scarlet Fever. Diphtheria. Whooping-Cough. Fever. Diarrhœa. Total. Per 1,000 persons living. Deaths per 1,000 Deaths from all Causes, Kensington. Typhus. Enteric. Simple Continued. Kensington. London. 1856 57,078 13 30 20 Not separately classified. 19 Not separately classified. 15 Not separately classified. 62 159 2.8 No Information. 129 1857 59,683 ... 15 26 37 17 83 178 2.9 149 1858 62,288 2 24 49 64 38 30 207 3.3 160 1859 64,893 11 42 53 No Information. 11 17 72 206 3.2 154 1860 67,498 18 29 86 56 25 35 249 3.7 168 1861 70,108 2 53 57 37 34 66 249 3.5 172 1862 76,350 ... 30 110 54 51 24 269 3.5 168 1863 81,350 49 83 89 22 54 54 351 4.3 215 1864 86,350 5 100 90 56 60 63 374 4.3 202 1865 91,350 18 52 31 37 77 104 319 3.5 184 1866 96,350 10 40 28 28 33 112 251 2.6 128 1867 101,350 29 19 35 68 46 78 275 2.7 142 1868 106,350 4 84 170 34 52 113 457 4.3 205 1869 111,350 6 27 106 71 42 108 360 3.3 164 1870 116,350 8 70 198 55 46 154 531 4.7 220 1871 120,234 120 64 95 11 72 6 26 16 129 539 4.5 6.0 223 1872 127,606 68 43 29 14 77 4 28 10 110 383 3.0 3.8 169 1873 132,826 1 38 10 11 44 6 27 8 145 290 2.2 3.3 119 1874 138,616 ... 121 32 26 45 9 28 15 112 388 2.8 3.3 144 1875 144,488 ... 23 83 23 107 2 21 6 107 372 2.6 3.9 133 1876 148,338 8 128 59 17 124 3 27 6 126 498 3.3 3.6 172 1877 151,360 84 54 31 10 34 2 14 5 99 333 2.2 3.5 127 1878 154,305 24 53 77 20 185 3 26 4 181 573 3.7 4.1 184 1879 158,316 24 60 51 26 93 1 14 8 71 348 2.2 3.3 116 1880 161,462 11 75 105 22 95 4 24 5 128 469 2.9 3.7 163 1881 163,151 55 67 38 8 85 2 22 5 101 383 2.3 3.6 140 1882 163,540 ... 77 62 25 119 1 25 6 61 376 2.3 3.5 139 1883 163,860 1 39 28 24 44 2 30 3 80 251 1.5 2.7 96 1884 164,180 26 32 18 17 81 ... 26 4 110 314 1.9 3.5 119 1885 164,500 25 111 7 22 98 ... 12 ... 86 361 2.2 3.0 130 1886 164,820 ... 56 11 34 82 ... 11 ... 90 284 1.7 2.8 102 1887 165,140 1 108 44 40 86 ... 11 2 124 416 2.5 3.1 145 1888 165,450 ... 124 26 89 100 ... 21 2 58 420 2.5 2.7 148 1889 165,760 ... 14 28 111 26 ... 19 ... 71 269 1.6 2.3 111 1890 166,080 ... 140 26 35 93 ... 15 ... 78 387 2.3 2.8 131 1891 166,308 ... 29 16 28 84 ... 24 1 91 273 1.6 2.3 89 1892 167,200 ... 109 36 31 63 ... 15 2 77 333 2.0 2.8 115 1893 167,900 9 18 51 83 65 ... 17 ... 98 341 2.0 3.1 117 1894 168,600 ... 108 22 75 61 ... 21 3 56 346 2.1 2.7 132 1895 169,300 ... 33 27 89 39 ... 15 1 118 322 1.9 2.6 117 1896 170,465 ... 173 39 72 99 ... 15 1 61 460 2.7 3.1 159 1897 170,700 ... 33 29 82 19 ... 21 1 125 310 1.8 2.6 116 1898 172,000 ... 120 23 26 52 2 12 ... 112 347 2.0 2.8 124 1899 172,400 ... 24 10 42 59 ... 23 ... 101 259 1.5 2.5 86 1900 173,000 ... 98 4 27 33 ... 16 ... 105 283 1.6 2.2 105 1901 176,628 1 77 15 38 62 1 11 ... 115 320 1.8 2.3 121 1902 177,500 11 93 21 20 21 ... 19 ... 78 263 1.5 2.2 96 Note --The Medical Officer of Health is not responsible for the accuracy of the figures above the horizontal line between the years 1870 and 1871, excepting as to calculation of rates. Census years are indicated by dark type. 154 TABLE C. Births, and Birth-rate; Deaths, and Death-rate; Deaths from the Seven Principal Diseases of the Zymotic Class; and Zymotic Death-rate, in Kensington, 1856-1900: Arranged in Quinquennial Periods. Quinquennial Period. Births. Birthrate. Deaths. Deathrate. Deaths from Zymotic Diseases. Zymotic Deathrate, per 1,000 persons living. Small-pox Measles. Scarlet Fever. Diphtheria WhoopingCough. Typhus Fever. Enteric Fever. Simple Continued Fever. Diarrhœa. Total. 1856-1860 9,557 30.7 6,540 21.0 44 140 234 No information. 187 Not separately classified. 112 Not separately classified. 282 999 3.20 1861-1865 11,562 28.5 8,261 20.4 74 318 377 206 276 311 1,562 3.85 1866-1870 17,090 32.1 10,853 20.4 57 240 537 256 219 565 1,874 3.52 1871-1875 20,861 31.4 12,595 18.9 189 289 249 85 345 27 130 55 603 1,972 2.97 1876-1880 23,149 29.9 14,517 18.8 151 370 323 95 531 13 105 28 605 2,221 2.87 1881-1885 21,383 26.1 13,438 16.4 107 326 153 96 427 5 115 18 438 1,685 2.05 1886-1890 19,428 23.5 13,816 16.7 1 442 135 305 387 ... 77 4 421 1,772 2.14 1891-1895 18,512 22.1 14,285 16.9 9* 297 152 306 312 ... 92 7 440 1,615 1.92 1896-1900 18,209 21.2 14,075 16.4 ... 448 105 249 262 2 87 2 504 1,659 1.93 Note.—The Medical Officer of Health is not responsible for the accuracy of the figures above the horizontal line between 1866-1870 and 1871-1875, excepting as to calculation of rates. * All in 1893. TABLE D. Death-rate in Kensington, per 1,000 persons living, from each of the Seven Principal Diseases of the Zymotic Class; Arranged also, in two groups; viz. (1) The four notifiable infectious diseases-Smallpox, Scarlet Fever, Diphtheria, and "Fever"; and (2) The three non-notifiable diseases—Measles, Whooping-Cough, and Diarrhœa. Quinquennial Period. 1 2 3 4 5 1. 6 7 Death-rate per 1,000 from— Smallpox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. "Fever." Diarrhœa. The Seven Diseases. The Four Notifiable Infectious Diseases. (Columns 1, 3, 4, and 6.) The three Non-notifiable Infectious Diseases. (Columns 2, 5, and 7.) 1856-1860 0.13 0.45 0.75 No information. 0.60 0.36 0.91 3.20 1.25 1.95 1861-1865 0.18 0.78 0.93 0.51 0.68 0.77 3.85 1.79 2.06 1866-1870 0.11 0.45 1.01 0.48 0.41 1.06 3.52 1.53 1.99 1871-1875 0.28 0.44 0.37 0.13 0.52 0.32 0.91 2.97 1.11 1.86 1876-1880 0.19 0.48 0.42 0.12 0.69 0.19 0.78 2.87 0.92 1.95 1881-1885 0.13 0.39 0.19 0.12 0.52 0.17 0.58 2.05 0.60 1.45 1886-1890 0.00 0.53 0.16 0.37 0.47 0.10 0.51 2.14 0.63 1.51 1891-1895 0.02 0.35 0.18 0.36 0.37 0.12 0.52 1.92 0.67 1.25 1896-1900 0.00 0.52 0.12 0.29 0.31 0.11 0.59 1.98 0.52 1.41 INDEX. Age and Sex-Distribution of the Population of the Borough, in 1901 3 Ambulance Service (Asylums Board); The Work of the, in 1901 77 „ „ Arrangements for the Removal of Patients 79 „ „ New Ambulance Station (the "Mead'') provided for West London 83 „ „ Transport of Small-pox Patients to Gore Farm by road, proposed 83 Appendix I. Statistical Tables, Nos. VI.—XII., 1902; and 1892—1901 130-142 „ II. Statistical Tables, 1856—1902; Marriages, Births, Deaths, Zymotic Mortality, &c. (Tables A, B, C and D) 152-154 Asylums Board; The Work of the, in 1901; Annual Report of the Statistical Committee ... 76 Asphalte; Hygienic Paving of Streets 119 Bakehouse Legislation (1863—1901); The History of 95 Bakehouses, Underground; List of 103 „ „ May be closed in 1904, if not Suitable in Construction, Light, Ventilation, and in all other respects 98 „ „ Council's Requirements with respect to, Precedent to Grant of Certificate of Suitability under Section 101 of the Factory and Workshop Act, 1901 102 „ „ Report on, by the Public Health Committee 99 Baths and Washhouses, Public; Number of Bathers and Washers, 1902—3 119 Births and Birth-rate in 1902, in the Borough, in the Sub-Districts, &c. (Table, page 7) 5 Births; Excess of, over Deaths 6 Births; Illegitimate 6 Births and Birth-rate, 1856—1902 (Tables A and C) 152,154 Borough; Development of the, since 1856, and since 1871 4 Brompton Consumption Hospital; Deaths at the 42 By-laws for Houses let in Lodgings; The advantages of 88 Cancer, Malignant Disease; Deaths from 40 Census (1901), The Kensington; Note on 3 Chapel of Rest for the Dead to be Provided for North Kensington 124 Chicken-pox made a Notifiable Disease, temporarily 32 Cleansing of Persons Act; Practically Inoperative in the Borough 120 Combined Drainage: Sewer or Drain ? 117 Common Lodging-houses; List of 90 Conference of the Sanitary Authorities with reference to Small-pox 31 Consumption; The Prevention and Treatment of 49 „ Resolutions of the International Congress relating to 50 „ Resolution of Conference of Poor Law Authorities (1900) on Open-air Treatment of 49 „ Action of the Kensington Sanitary Authority, Past and Present, in respect to the Prevention of 49-50 Report of the Public Health Committee on the Prevention of 50 „ Made Voluntarily Notifiable in Kensington 50 „ Separate Wards Provided at the Borough Infirmary for 49 „ Asylums Board Proposed as Hospital Authority for 51 „ Sanatoria, the Need of, for the Isolation and Treatment of Cases of 51 „ Council recommend Utilisation of.Small-pox Hospitals as Sanatoria for 51 „ „ National Association for the Prevention of Consumption Support the Council's Action in respect to Provision of Sanatoria for 52 „ Notification of, in Kensington; Special Report on the 56 Coroner's Court; Number of Inquests held at the 43 Coroner's Districts 123 Counter's Creek Sewer; Ventilation of the 116 „ „ Nuisance, and Flooding of Houses, in connection with the 117 Cow-houses, Licensed 110 Cremation Act, 1902; Provisions of the 127 Dairies Order; Registration of Milk Shops, &c , by the Council as Local Authority 110 Death; New List of Causes of, issued by the Registrar-General 15 „ Assigned Causes of (Tables, pages 15-16) 14 „ Summary of Causes of 17 Death-Rate; The Corrected or True, in 1902 8 „ Annual, 1856-1902 (Tables A and C) 1524154 „ from Zymotic Diseases, arranged in Quinquennial Periods, 1856-1900 (Table D) 154 „ „ „ „ in the Borough, the Sub-Districts, &c., &c. 18 Death-Rate of England and Wales; and of Inner, Outer, and Greater London, and other Large Towns, and of Colonial and Foreign Cities 14 ii. Page Deaths and Deatli-Rate; In the Borough, Sub-Districts, Parliamentary Divisions and Wards (Table, page 12) 8 Deaths at Public Institutions within the Borough 41 „ of Parishioners at Public Institutions, &c., without the Borough 42 „ of Illegitimate Children under One Year 63 Diarrhoea; Mortality from, in Kensington and in London 38 „ Mortality from, in Kensington, 1856—1902 (Tables B, C and D) (Appendix) 158 4 „ Classification (Amended) of Deaths attributed to; Recommended for use by the Registrar-General 38 Digestive System; Mortality from Diseases of the 40 Diphtheria; Mortality from, in Kensington and in London, 1871-1902 (Tables B, C and D, (Appendixl 86 Disinfecting Station; Proposed Borough 122 Disinfection; Cost of, in 1902 and in 1891 121 District Rates of Mortality (Table, page 12) 10 England and Wales; Death-Rate of, in 1902 14 Enteric Fever; Mortality from, in Kensington and in London 38 „ Mortality (Kensington), 1856—1902 (Tables B, C and D, Appendix) 168-4 Factory and Workshop Act, 1901; Report of Proceedings under the 90 „ „ „ Chief Sanitary Inspector's Report on Men's Workshops 94 „ „ „ Lady Inspectors' Report on Women's Workshops 91 Fever; Mortality from, in Kensington and in London 38 „ Mortality (Kensington), 1856—1902 (Tables B, C and D, Appendix) 153-4 Fever Hospital Accommodation 79 „ „ „ Proposed Increase of 80 Foreign and Colonial Cities; Death-Rate of, in 1902 14 Fried Fish Seller; An Un-scheduled "Offensive Business": Judicial Decision 110 Gas-Works; Effluvium Nuisance at the 120 General Diseases (other than Zymotic); Mortality from 89 Hospital Accommodation for Infectious Disease 79 ,, ,, Fever 79 „ „ „ „ Proposed Increase of 80 „ „ „ „ „ Report of the Public Health Committee on 81 „ „ „ Small-pox 81 „ „ „ „ Cost of providing Additional, in 1901-2 (foot-note) 82 „ „ for Consumption, Need for Provision of 58 Hospitals (Outlying, etc.); Deaths at 42 House Refuse; Proposed Bi-weekly Removal of 111 Houses (Inhabited) Increase in Number of, since 1856, and since 1871 4 „ Let in Lodgings; Number of Registered 87 „ „ „ The Question of the Registration of; Counsel's Opinion 89 „ „ „ Proposed Amended By-Laws for 86 Housing of the Working Classes 86 n „ „ Report of Joint Select Committee of both Houses on 86 Hygienic (Asphalte) Paving of Streets 119 Ice Creams; Legislation with respect to Preparation and Sale of 60 Illegitimate Children under Five Years; Deaths of 10 Indian, Colonial and Foreign Cities; Death-Rate of, in 1902 14 Infantile Mortality 9 ,, „ High Rate of, in Kensington; Special Report on the Causes of 60 „ „ „ „ Remedial Measures Suggested 67 1871—1902 (Table A) 152 Infectious Disease and the Milk Supply 59 Infectious Diseases; Sickness and Death-Rate from the Dangerous (Table D) 48 ,, „ Cases of, Notified in London, Kensington, and the other Metropolitan Boroughs (Tables) 44-47 Infirmary; Deaths at the 41 Influenza; Mortality from, in Kensington, and in London 89 Inquests 43 Lady Inspectors of Workshops; Appointment of, in 1893 90 t> „ „ Annual Report of the, 1902 91 Legal Proceedings (Summonses, &c.) 109 Local Diseases; Mortality from 40 Local Government Board's New Statistical Forms (Tables I.—IV.) 15,16,47 Lodging-Houses; Counsel's Opinion with reference to Registration of 89 London, Inner and Outer, and Greater; Death-Rate of, in 1902 14 Main Drainage; Insufficiency of: Flooding of Basements of Houses 117 Marine Stores; An Un-scheduled "Offensive Business" Ill Marriages and Marriage-Rate, 1902 5 Annual, 1871—1902 (Table A) 152 iii. Page. Marylebone Infirmary (North Kensington); Deaths of Non-Parishioners at 42 Measles; Mortality from, in Kensington and in London 34 „ Proposed to be Scheduled, for certain purposes, as a " Dangerous Infectious Disease " 34 Metropolitan Asylums Board; Report of the Statistical Committee of the, for 1901 76 Midwives Act, 1902; The Provisions of the 70 Milk Supply and Infectious Disease 59 „ Sterilized; Municipal Provision of, for Infants, recommended 68 Mortality; District Rates of 10 „ Infantile 9 „ Senile 10 „ Zymotic 17 Mortuary, Public; Number of Bodies deposited at the 123 „ „ Limitation of the Powers of the Council to remove Bodies to the 123 „ Chapel of Rest for the Dead for North Kensington to be provided 124 Municipal Supply of Sterilised Milk for Infants recommended 68 Nervous System; Mortality from Diseases of the 40 Notification of Infectious Disease; Local and Metropolitan (Tables, pages 44-7) 43 „ Voluntary, of Phthisis, in Kensington 56 Notting-Dale Special Area; Statistics of the 11 Offensive Businesses 109 Offensive Matter; New By-Law for regulating Conveyance of, through Streets 115 Outlying Public Institutions, Deaths of Parishioners at 42 Overcrowding 120 Parliamentary Divisions of the Borough 3 Paving of Streets (Hygienic); Roads paved with Asphalte in 1902 119 Phthisis; Voluntary Notification of, in Kensington 56 Population of the Borough at the Census of 1901; Age and Sex-Distribution of the 3 „ „ „ „ Decennial Censuses, 1801—1901 4 „ „ „ Estimated Annual; 1856—1902 (Table A) 152 in 1902 5 Public Baths and Washhouses; Number of Bathers and Washers, 1902—3 119 Public Health (London) Act, 1891; Proposed Amendment of the 105 Public Institutions; Deaths at 41 Public (and Public-house) Sanitary Conveniences llw Public Mortuary; Number of Bodies deposited at the 123 „ „ Limitation of Power of Council to remove Bodies to the 123 „ „ ("Chapel of Rest for the Dead") to be provided at North Kensington 124 Puerperal Mortality 39 Rateable Value of Kensington; Increase in Seventy-nine years, 1823—1902 4 Refuse; House 111 „ Peat Stable; New By-law to regulate the Conveyance of, through Streets 115 „ Stable; The Borough Engineer recommends the Removal of, by the Council 114 Registered Houses; Number of 87 „ „ Proposed Amended By-laws for 86 Registrar-General's Statistics of Small-pox Mortality in relation to Vaccination 74 Registration District and Sub-Districts 3 Restaurants and Dining-rooms; Report on, by the Lady Inspectors 92 Rc-vaccination; The Protective Effect of 28 & 74 St. Joseph's House; Quasi-public Institution; Number of Deaths at 42 Sanatoria for Consumption; The Need of 51 „ „ „ Proposal to utilise empty Small-pox Hospitals as 51 „ „ „ Action of the Council with reference to the Provision of 51 Sanitary Conveniences; Public, and Public-House 118 Sanitary Inspectors; The Work of the (Statistical Table, page 108) 106 „ „ Metropolitan; Increase in the Number of the 106 Scarlet Fever; Mortality from, in Kensington and in London (Tables, pages 34-36) 34 „ „ Mortality, in Kensington; 1856—1902 (Tables B, C and D) 153-4 Senile Mortality 10 Sewer Smells, from Untrapped Street Gullies 117 Sewer Ventilation; Ventilating Lamp Columns erected 110 Sex and Age-Distribution of the Population of the Borough, in 1901 3 Shelter for Persons during Disinfection of Rooms: A Desideratum 122 „ „ „ „ „ „ Statistical Evidence of the Need of 122 Slaughter-houses; Licensed 109 Small-pox; The Epidemic of, 1901-2 (Tables, pages 20-23) 19-27 „ Diagnosis of Doubtful Cases of 29 „ Mistaken Diagnosis 30 „ Preventive Measures with respect to 27 iv. Page. Small-pox •" Contacts Circular Letter of the Local Government Board on the Isolation of 31 „ Epidemic of 1871; Note on the 32 „ Conference of the Sanitary Authorities with reference to 31 „ and Vaccination; Report by the Asylums Board on 74 „ Patients; Proposed Transport of, by Road to the Country Hospitals 83 „ „ „ „ Report on, by the Public Health Committee 85 „ Provision of Extended Shelters for, recommended in lieu of proposed Land Transport of Patients suffering from 84 „ Spread of, in the Provinces, due to Visitation of Patients in Asylums Board Hospitals 30 „ Hospital Accommodation for; Cost of providing Additional, in 1901—2 82 „ „ „ „ Views of the Royal'Commission, 1882, on the required Amount of Provision of 82 „ Mortality, Annual; 1856—1902 (Tables B, C and D, Appendix) 153 4 Special Area (Notting Dale); Statistics of the 11 Stable Refuse; By-law with Reference to Conveyance through Streets, of Offensive 115 Statistical Committee of the Asylums Board; Report of, for 1901 76 Statistical Tables; Forms for, Prescribed by the Local Government Board 14 „ „ Nos. vi.—xiv. (Appendix I.) 180-151 „ „ Of Marriages, Births, Deaths, &c., 1856—1902 (Appendix II.) 152 Statutory Notices; Number of, Issued 107 Streets, &c., in which Cases of Infectious Disease were Notified, in 1902, List of 146 „ „ in which Deaths from Zymotic Diseases occurred, in 1902, List of 143 „ Asphalte-paved, in 1902 119 Tables prescribed by the Local Government Board to be used: — (i.) Population, Births, Deaths under One Year, and at All Ages, and in Public Institutions, &c.; in 1902, and ten preceding years 15 (ii.) Population, Births, Deaths at All Ages, and under One Year; in the Borough, and the Sub-Districts; in 1902, and ten preceding years 16 (iii.) Death; Causes of, and Ages at, in 1902 16 (iv.) Infectious Diseases; Cases of, Notified at different Ages, in the Borough, and the Sub-Districts, and Cases removed to Hospital 47 Tables (Other) in the Report: — Population; Age and Sex-Distribution of, in 1901 3 „ At the Censuses, 1801—1901 4 Birth-rate in the Metropolis, and in the Borough, the Sub-Districts, &c. 7 Death-rate in the Metropolis, the Borough, the Sub-Districts, the Parliamentary Divisions, and the Wards, in 1902 12 Death; Summary of Causes of, in the Borough; in 1902 17 Zymotic Diseas es; Deaths from, in the Borough and the Sub-DistrictS; occurring at Home and at Hospitals 17 Scarlet Fever: Notifications, Removals, Deaths, &c.; in four-weekly Periods in 1902, and in ten preceding years 34-36 Diphtheria: Notifications, Removals, Deaths, &c., in four-weekly Periods in 1902 37 Infectious Disease Notification (London), 1890—1902) 44 „ „ „ Kensington; Sickness and Death-rate, 1902 48 Vaccination Officer's Return for 1901; and Statistics of Vaccination, in London, and England and Wales, 1885—1899 75 Lady Inspectors of Workshops, &c.; Summary of the Work of the 93 Sanitary Inspectors; Summary of the Work of the 108 Tables in Appendix I.— (vi.) Population (Estimated), Inhabited Houses, Marriages, Births, Deaths, &c., in 1902, and ten preceding years 130 (vii.) Birth-rate and Death-rate; Death-rate of Children; and Deaths in Public Institutions; in 1902, and ten preceding years 181 (viii.) Deaths, from all Causes, in 1902 (Summary of Table viii., page 17) . 182 (ix.) Deaths from the Principal Diseases of the Zymotic Class; Pulmonary and Tubercular Diseases; and Wasting and Convulsive Diseases of Infants: Gross and Proportional Mortality 140 (x.) Deaths, in 1902, and ten preceding years; from the Principal Diseases of the Zymotic Class; in Kensington, and in London, and in England and Wales 141 (xi.) Death-rates, General and Zymotic; in Kensington, and in London, and Proportion of Deaths from Zymotic Diseases to Total Deaths, in 1902, and ten preceding years 142 (xii.) Mortality, in London and in Kensington, from Various Causes, in 1902; Comparative Analysis of the . 142 Tables in Appendix II.: — (a) Population (1856—1902); Marriages and Marriage-rate, and Birth-rate (1871—1902); Births and Birth-rate; Deaths and Death-rate (1856—1902) and Infantile Mortality (1870—1902) 152 v. Page. Tables in Appendix II. (continued): — (b) Zymotic Diseases (Principal); Annual Number of Deaths from, in Kensington; and Death-rate from, in Kensington and London (1856—1902) 153 (c) Births ancj Birth-rate; Deaths and Death-rate; Deaths from the Principal Zymotic Diseases, and Zymotic Death-rate in Kensington, 1856—1900: Arranged in Quinquennial Periods 154 (d) Zymotic Diseases; Death-rate from each of the Principal; in Quinquennial Periods (1856—1900), Grouped to show the Rate from the Four Notifiable, and the Three Non-Notifiable Diseases 154 Towns (Large) in England and Wales, &c., Death-rate of, in 1902 14 Tuberculosis; Deaths and Death-rate from, in Kensington and in London 39 „ Resolutions of the London International Congress (1901) with respect to 50 „ Prevention and Treatment of 49 Typhus Fever 38 Uncertified Deaths; in London,- and England and Wales 42 Underground Bakehouses; Report of Public Health Committee on 99 Underground Rooms; Illegally Occupied 120 Untrapped Street Gullies; Nuisance from 117 Urinary System; Deaths from Diseases of the 40 Vaccination Authority; Proposal to make Borough Councils the 73 „ Officer's Report for 1901 (Statistical Table, page 75) 71 „ Statistics; London, and England and Wales, 1886—1899 71 „ Supply of Calf Lymph 72 „ and Small-pox Mortality; Report of the Registrar-General on 74 „ Security against Small-pox conferred by Successful: Report on by the Asylums Board 74 „ Transference of Control of, to a Central Authority, recommended in 1877 73 Ventilation of Sewers: Lamp and other Ventilating Columns erected for the 116 Violence; Deaths from 40 Vital and Mortal Statistics (1902); Summary of (Table, page 13) 12 Wards; Names of the 3 Water Supply 127 Whooping-cough; Mortality from, in Kensington, and in London 37 Working Classes, Housing of the 86 Workshops, Laundries, &c.; Annual Report of the Lady Inspectors of 91 Written Intimations of Nuisances; Number of, issued in 1902 107 Yards; Hygienic Importance of the Paving of 118 Zymotic Diseases; Deaths and Death-rate from 17 „ „ Death-rate from; in Kensington, London, and England and Wales 18 Zymotic Mortality; in Kensington, 1856—1902 (Tables B, C, and D) 153-4