KEN 13 THE ANNUAL REPORT ON THE HEALTH, SANITARY CONDITION, OF THE ROYAL BOROUGH OF KENSINGTON, etc., etc., FOE THE YEAR BY T. ORME DUDFIELD, M.D. Medical Officer of Health. LONDON : VAIL & Co., PRINTERS, FARRINGDON ROAD, E.C. 65944 The Royal Borough of Kensington. REPORT of the MEDICAL OFFICER OF HEALTH For the Year 1904. To the Mayor, Aldermen, and Councillors of the Borough Council. Sir, and Gentlemen, The vital and mortal statistics in this report relate to the registration year, a period of fifty-two weeks, January 3rd to December 31st, 1904. For the purposes of the report the population of the Royal Borough is assumed to have numbered 178,500 at the middle of the year; the estimated population of the sub-districts, parliamentary divisions, etc., is set out in the table at page 5. The estimate of population of the entire borough is based on the subjoined summary table which shows the Age and Sex Distribution of the people as ascertained at the census of 1901. Population 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 The enumerated population comprised 38,349 Families or Separate Occupiers (an increase of 2,396 on the number, 35,953, in 1891), 28,770 in the Town sub-district, 9,579 in Brompton. The tenements of less than five rooms, 20,052 in 1891, and 55·8 per cent. of total tenements, were 21,115 in 1901, and 55·1 per cent. of the entire number. In these tenements there were housed 73,425 persons (compared with 70,718 in 1891), or 40 per cent. of the population: the relative per centage in 1891 was 42·5. Number and Population of Tenements of less than Five Rooms in 1901. Tenements of— Number. Population. One Room 5,695 11,334 Two Rooms 7,776 27,800 Three „ 4,757 20,210 Four „ 2,887 14,081 It thus appears that 6·41 per cent. of parishioners lived in one-room tenements, compared with 8·2 per cent. in 1891; 15·73 per cent. in two-room tenements (15.6 in 1891); 10·81 per cent. in three-room tenements (10·9 in 1891); and 7·97 per cent. in four-room tenements (7·8 in 1891). 4 POPULATION AND RATEABLE VALUE. The subjoined statement 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 The development of the Borough during the last 82 years is evidenced by the subjoined statement, 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. The Year. £75,916 1823 98,397 1833 142,772 1843 257,103 1853 444,030 1863 975,046 1873 1,711,495 1883 2,037,221 1893 £2,304,595 (October) 1904 The following table, brought up to date, exhibits the growth of the borough since the Metropolis Local Management Act came into operation, in 1856:— 1866. 1904. Increase in 49 years. Population 57,000 178,600 121,500 Number of Inhabited Houses 7,600 23,000 15,400 Rateable Value of Property £308,000 £2,304,595 £1,996,595 The increase in all respects within the last thirty-four years, 1871-1904, the period over which my official experience extends, was very considerable, as the subjoined figures show:— 1871. 1904. Increase in 34 years. Population 121,000 178,500 57,600 Number of Inhabited Houses 15,735 23,000 7,265 Rateable Value £985,720 £2,304,595 £1,368,875 It thus appears that the population in 1904 was more than twenty times as large as in the first year of the nineteenth century, and the rateable value of property more than 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 34 years being more than four times the total in 1856; since which date the population and the number of inhabited houses have increased more than three-fold. 5 AREA OF THE BOROUGH. 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. 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, Stratfordroad, and south of the workhouse, 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, Brompon, and Redcliffe, are in (and constitute) the Parliamentary Division of South Kensington. POPULATION AND INHABITED HOUSES IN 1904. The population of the borough, estimated at the middle of the year, was 178,500. It comprised 69,815 males and 108,685 females: excess of females, 38,870. In the Town sub-district (estimated population 129,380), the males numbered about 54,015, the females, 75,365; excess of females 21,350. In the Brompton sub-district (estimated population 49,120), there were about 15,800 males and 33,320 females: excess of females 17,520. This population of 178,500 persons, was in occupation of about 23,000 houses; equal to 7·8 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 178,500 Sub-districts:— Kensington Town 129,380 Brompton 49,120 Parliamentary Divisions:— North Kensington 92,030 South Kensington 86,470 Wards:— St. Charles 22,180 North Golborne 26,590 Kensington Norland 23,720 Pembridke 19,540 {Holland 20,620 South {Earl's Count 18,240 {Queen s Gate 14,420 Kensington {Redcliffe 18,890 Brompton 14,300 MARRIAGES AND MARRIAGE RATE. The marriages in the year were 1,672, compared with 1,651, 1,703, and 1,623, in the three preceding years respectively. Of these marriages there were celebrated— By the Church (64·8 per cent. of total marriages) 1,084 At Roman Catholic places of worship 168 At other Nonconformist places of worship 71 At the Jewish Synagogue 8 At the Superintendent-Registrar's Office 346 6 The marriage-rate (i.e., the number of persons married to 1,000 living) was 18·7, compared with 18·7, 19·2, and 18·2 in the three preceding years. The marriage-rate in England and Wales was 15·2 per 1,000, compared with 15·9, 15·8, and 15·6, in the three preceding years, and an average of 15·7 in the ten years 1894-1903. The rate in London was 17·0 per 1,000, compared with 17·6, 17·8, and 17·4, in the three preceding years; the average in the ten years 1894-1903 being 17·9. BIRTHS AND BIRTH RATE. The births registered were 3,448; viz., males, 1,719, and females, 1,729; the numbers being, in the Town sub-district (which includes the Borough Infirmary), 2,934, and in the Brompton sub-district, 514. The births were 285 below the corrected decennial average (3,733); 156 of them were of illegitimate children; they were 117 fewer than in the year 1903; and fewer by 593 than the number in 1872 (4,041), when the population (127,400) was 51,100 less than in 1904. The birth-rate, which of late years has been always considerably below that of London, has been declining since 1868, in which year it was 33·1 per 1,000 persons living. In 1904 it was 19·3 per 1,000, and 1·5 below the decennial average (20·8). The London birth-rate, 27·9 per 1,000, the same as that of England and Wales, and 1·9 below the decennial average, was lower than in any one of the ten preceding years—and was in fact the lowest yet recorded. The rate in the sub-districts was:—Town, 22·7, and Brompton, 10·5 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 2,492, and the birth-rate 27·1 per 1,000 living, or 0·8 below the metropolitan rate. The births in South Kensington, i.e., the part of the borough south of the streets named, were 956, and the birth-rate 11·0, or 16·9 per 1,000 below the metropolitan rate. The birth-rate in the several wards—after distribution of the births at the borough infirmary— was as follows:— North Kensington St. Charles 629 births, or 28·4 per 1,000 persons living. Golborne 862 births, or 32·4 per 1,000 persons living. Norland 649 births, or 27·3 per 1,000 persons living. Pembridge 352 births, or 18·0 per 1,000 persons living. South Kensington Holland 257 births, or 12·5 per 1,000 persons living. Earl's Court 202 births, or 11·1 per 1,000 persons living. Queen's Gate 115 births, or 8·0 per 1,000 persons living. Redcliffe 254 births, or 13·4 per 1,000 persons living. Brompton. 128 births, or 9·0 per 1,000 persons living. The births exceeded the deaths by 908: in the Town sub-district they were 889 more in number than the deaths: in the Brompton sub-district the excess was 19 only, without correction for births at the infirmary. In North Kensington the births exceeded the deaths by 863; in South Kensington to the number of 45 only. The excess of births over deaths in the several wards was as follows :— North Kensington. St. Charles 257 South Kensington. Holland 6 Golborne 396 Queen's Gate 11 Norland 128 Redeliffe 65 Pembridge 82 The deaths exceeded the births by 15 in Earl's Court Ward, and by 22 in Brompton Ward. The registered births of illegitimate children in the borough as a whole were 156—five more than in 1903. Of these births 147 were registered in the Town sub-district, which includes the workhouse, at which institution out of 121 live births (males 59, females 62) 76 were illegitimate. In the borough generally the illegitimate births formed 4·5 per cent. of total births as compared with rates of 4·6, 4·6, and 4·2 in the three preceding years. 7 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 416 382 798 58 75 133 931 2nd „ 331 398 729 59 65 124 853 3rd ,, 385 344 729 67 65 132 861 4th „ 338 340 678 65 60 125 803 Illegitimate Births 1,470 1,464 2,934 249 265 514 3,448 27 19 46 — 2 2 48 18 25 43 — — — 43 18 19 37 3 2 5 42 12 9 21 1 1 2 23 75 72 147 4 5 9 156 The following table shows the population, the number of births, and the birth-rate for each of the ten years. 1894-1903. The Year. Population. Total Births. Males. Females. Birth-rate per 1,000. 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 1902 177,500 3,488 1,743 1,745 19·3 1903 178,000 3,565 1,826 1,739 20·0 Totals 36,150 18,333 17,817 Average 20·8 Excess of male births in the ten years 516. Birth-rate in the Metropolis, and in Kensington, and in certain Districts of the Borough, during the thirteen four-weekly periods ended December, 31st, 1904, and in the Registration Year, 1904. 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 30 29·1 20·8 24·6 10·8 28·4 12·8 28·7 35·2 35·1 10·6 17·0 9·3 10·8 18·8 11·8 February 27 29·6 22·5 25·7 14·0 32·6 11·7 29·3 42·0 34·5 21·3 7·6 12·8 3·6 20·0 13·6 March 26 28·2 19·6 23·7 8·7 27·1 11·6 28·1 36·2 26·3 14·6 14·5 14·3 11·7 10·3 5·5 April 23 27·8 20·5 25·1 8·5 29·5 10· 31·1 29·8 27·9 29·3 17·0 7·8 7·2 13·1 7·3 May 21 28·1 19·3 22·5 10·8 26·6 11·5 28·1 28·3 27·9 20·6 11·9 10·7 9·9 12·4 12·7 June 18 27·4 17·9 20·7 10·6 25·0 10·4 26·4 31·8 24·1 15·3 11·3 8·6 6·3 18-6 4-6 Inly 16 27·8 19·7 23·6 9·5 26·1 12·9 23·4 28·4 26·9 25·3 22·1 12·1 8·1 12·4 6·4 August 13 27·9 19·4 22·1 12·2 26·0 12·3 29·3 29·8 23·6 20·0 11·3 15·7 10·8 13·1 10·0 September 10 27·3 17·3 20·1 9·8 24·0 10·1 23·4 26·9 24·2 20·0 11·3 11·4 6·3 16·5 1·8 October 8 27·4 20·2 24·0 10·8 30·1 9.8 29·9 36·2 34·5 16·6 8·2 7·8 9·0 14·5 9·1 November 5 28·2 19·4 22·6 10·8 26·8 11· 4 30·6 34·2 25·2 14·6 13·2 15·7 6·3 10·3 10·0 December 3 27·5 17·7 20·4 10·6 25·8 9·0 29·3 34·2 24·1 12·6 6·3 11·4 3·6 11·7 11·8 December 31 25·4 16·8 19·6 9·3 23·9 9·2 31·1 28·4 20·8 13·3 101 6·4 9·9 8·3 11·8 Birth-rate for} the year 1904} 27·9 19·3 22·7 10·5 27·1 11·0 28·4 32·4 27·3 18·0 12·5 11·1 8·0 13·4 9·0 8 Table A, Appendix II. (page 117) gives the number of births and the birth-rate for each of the forty-nine years, 1856-1904. DEATHS AND DEATH-RATE. The registered deaths, inclusive of 339 of parishioners at outlying public institutions, etc., but exclusive of 710 of non-parishioners at public institutions, etc., within the borough, were 2,540 (males 1,190, females 1,350), and 279 below the corrected decennial average (2,819). Of these deaths, 2,045 were registered in the Town sub-district and 495 in Brompton. The death-rate, which in the three preceding years had been 15·0, 15·2, and 13·8 per 1,000 respectively, was 14·2* in 1904: 1·6 below the decennial average (15·8) and 2·4 below the rate in the Metropolis as a whole (16·6); the decennial average for the Metropolis being 18·3. The rate in the sub-districts was: Town 15·8, Brompton 10·1 per 1,000, as compared with 15·5 and 9·3 respectively in 1903. The deaths in North Kensington were 1,629, and the death-rate 17·7 per 1,000. The deaths in South Kensington were 911, and the death-rate 10·5 per 1,000. The sex-rate was, males 17·0, females 12·4 per 1,000. Localised Death-rates.—During some recent years the death-rate of localised portions of the borough, including the sanitary districts, was given in these reports. The rate as regarded 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 true rate. But as regarded 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; and four changes had been 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 their 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 for calculation of the death-rate, and this was done. The ward-rate is set out below; the rate for each of the thirteen four weekly periods in the table at page .12. North Kensington St. Charles 372 deaths, or 16·8 per 1,000 persons living. Golborne 466 deaths, or 17·5 per 1,000 persons living. Norland 521 deaths, or 21·9 per 1,000 persons living. Pembridge 270 deaths, or 13·8 per 1,000 persons living. Holland 251 deaths, or 12·2 per 1,000 persons living. South Kensington Earl's Court 217 deaths, or 11·9 per 1,000 persons living. Queen's Gate 104 deaths, or 7·2 per 1,000 persons living. Redcliffe 189 deaths, or 10·0 per 1,000 persons living. Brompton 150 deaths, or 10·5 per 1,000 persons living. The Corrected or True Death-rate.—The death-rate, 14·2 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-composition of the population. Correction for these data involves addition to, or subtraction from, the "recorded death-rate," as compared with the "standard death-rate."t The necessity for such correction 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 1904 was approximately 38,870. The deaths among the 69,815 males were 1,190 and those among the 108,685 females 1,350. The crude death-rate in the male sex was 17·0, as compared with the rate of 12·4 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 RegistrarGeneral, in his annual summary, gives the "factor for correction for sex and age-distribution" in each of the Metropolitan Boroughs Corrected after the manner indicated, the death-rate of Kensington in 1904 becomes, instead of 14·2, about 15·4 per 1,000; and the rate for London, as a whole, about 17·5 instead of 16·6. The "true" death-rate is that which shows the mortality per 1,000 living of each sex at different age-periods, and this is shown in the subjoined table:— *This is the crude death-rate. The rate corrected for age and sex-distribution was 15·4 per 1,000. The "true deathrate" 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 rate at all ages in England and Wales during that period having been 18 21 per 1,000." (Registrar-General's Annual Summary). 9 The True Death-rate of Kensington, 1904. Age-Period. Population. Deaths. Death-rate. Both Sexes. Males. Females. Both Sexes. Males. Females. Both Sexes. Males. Females. Under five years of age 14,298 7,130 7,168 756 415 341 52·9 58·2 47·6 Five and under 15 26,171 12,727 13,444 57 21 36 2·2 1·6 2·7 Fifteen and under 25 38,634 13,603 25,031 81 35 46 2·1 2·6 1·8 Twenty-five and under 35 35,344 11,613 23,731 139 59 80 3·9 5·1 3·4 Thirty-five and under 45 25,079 9,541 15,538 213 108 105 8·5 11·3 6·8 Forty-five and under 55 18,364 7,295 11,069 292 145 147 15·9 19·9 13·3 Fifty-five and under 65 11,693 4,633 7,060 294 147 147 25·1 31·7 20·8 Sixty-five and under 75 6,188 2,329 3,859 355 142 213 57·4 61·0 55·2 Seventy-five and upwards 2,729 944 1,785 353 118 , 235 129·4 125·0 131·7 Totals 178,500 69,815 108,685 2,540 1,190 1,350 14·2 17·0 12·4 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 274 314 588 57 102 159 747 2nd „ 203 241 444 55 64 119 563 3rd „ 257 233 490 46 41 87 577 4th „ 247 276 523 51 79 130 653 981 1,064 2,045 209 286 495 2,540 The Births were, of Males 1,719 The Deaths were, of Males 1,190 „ Females 1,729 „ Females 1,350 Total Births 3,448 Total Deaths 2,540 Deduct 2,540 Deaths Shows 908 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 117) gives the number of deaths and the death-rate for each of the forty-nine years 1856-1904. INFANTILE MORTALITY. The 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 581, 515, and 510, respectively, were 503 in 1904, being equivalent to 146 per 1,000 births; 3 per 1,000 more than in 1903. 10 In the Town sub-district the deaths under one year (451) were equivalent to 154 per 1,000 births, those in Brompton (52) to 101 per 1,000. The infantile deaths in North Kensington, after distribution of the deaths at the Borough Infirmary, were 406, or 163 per 1,000; the deaths in South Kensington 97, or 101 per 1,000. In the several wards the rate was as follows :— North Kensington St. Charles 104 deaths, or 165 per 1,000 registered births. Golborne 142 deaths, or 165 per 1,000 registered births. Norland 115 deaths, or 177 per 1,000 registered births. Pembridge 45 deaths, or 128 per 1,000 registered births. South Kensington Holland 21 deaths, or 82 per 1,000 registered births. Earl's Court 26 deaths, or 129 per 1,000 registered births. Queen's Gate 12 deaths, or 104 per 1 ,000 registered births. Redcliffe 20 deaths, or 79 per 1,000 registered births. Brompton 18 deaths, or 141 per 1,000 registered births. The infantile mortality rate in the Metropolis, usually below that of Kensington, was also 146, as compared with an average proportion of 154 per 1,000 in the ten preceding years. The lowest rates in the Metropolitan Boroughs were: St. Marylebone 94, City of London 104, Holborn 109, Hampstead 113 and Stoke Newington 114; the highest, Poplar 154, Stepney 155, Chelsea 156, Bethnal Green 157, Bermondsey 172, Southwark 174 and Shoreditch 188. In England and Wales the rate was 146, and 9 per 1,000 below the mean proportion in the ten years 1894-1903. In the 76 great towns of England and Wales (including London) the rate averaged 160, ranging from 87 at Hornsey, 100 at King's Norton, and 108 at Hastings, to 203 at Stockport, 212 at Hanley, and 229 at Burnley. The rate in Rural England was 125 per 1,000. Table A, Appendix II. (page 117) gives the number of deaths under one year in Kensington, and the proportion to 1,000 registered births (the "infantile mortality rate"), for each of the thirty-four years, 1871-1904, during my tenure of office. The deaths of children over one year and under five years of age were 253; the deaths under five years therefore, were 756, compared with 876, 790 and 768, in the three preceding years, being equal to 219 per 1,000 births; the relative proportion in London, as a whole, being 215. The deaths of illegitimate children under five years of age, 96, 67 and 79, in the three preceding years respectively, were 63 in 1904, of which 52 were registered in the Town sub-district, and 11 in Brompton. These deaths were equal to 40.4 per cent. on the 156 births registered as illegitimate. Of the 63 children 17 only survived the first year of life. Senile Mortality.—At sixty years of age and upwards there were 883 deaths, as compared with 800, 956 and 803, 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 281 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 (15·8 per 1,000) than in the Brompton sub-district (10·1), and the same observation applies to the parliamentary division of North Kensington (17·7), compared with the southern division of the borough (10·5). In three of the wards in North Kensington, viz., St. Charles (16·8), Golborne (17·5) and Norland (21·9), the death-rate exceeded that of the borough as a whole (14-2 per 1,000). The rate in Pembridge Ward (13·8) and in each of the wards in South Kensington was more or less largely below the rate for the borough as a whole. In the Notting-dale "special area" (estimated population 4,000) comprised in Norland Ward, the death-rate was 36·2 per 1,000, compared with 21·9 in the ward as a whole. The zymotic death-rate was 3·2 per 1,000 persons living, more than double that of the borough as a whole (1·37). The deaths at all ages were 32 more than the births; the deaths of children under one year of age being in the proportion of 274 per 1,000 registered births. The main facts with respect to vital and mortal statistics of this distressful area, in 1904, which are of a more favourable character than in any one of the eight preceding years, are summarised below. 11 "NOTTING-DALE" SPECIAL AREA. VITAL AND MORTAL STATISTICS, 1904. (The corresponding statistics for the eight preceding years are added for comparison.) 1904. 1903. 1902. 1901. 1900. 1899. 1898. 1897. 1896. Population (Estimated) 4,000 4,000 4,000 4,000 4,000 4,000 4,000 4,000 4,000 Births 113 136 98 112 113 120 117 130 118 Birth-rate 28·2 34·0 24·5 28·0 28·2 300 29·3 32·5 29·5 per 1,000 persons [living. Deaths 145 159 185 194 163 236 182 223 187 Death-rate 36·2 39·7 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 31 46 41 46 54 61 49 56 51 Death-rate 274 338 427 411 478 508 419 431 432 per 1,000 registered births. Zymotic Diseases. Deaths from the Seven Principal. 13 13 14 37 18 12 22 25 30 Death-rate from do. 3·2 3·2 3·5 9·2 4·5 3·0 5·5 6·3 7·5 per 1,000 persons [living. Causes of Death.—In 8 cases measles; in 4 cases diarrhoea; and in 1 case.whooping- cough. There was no death from scarlet fever, diphtheria, or typhoid fever. The general death-rate, and the infantile mortality-rate were the lowest on record. Among the other principal causes of death were:—Diseases of the nervous system, 5 deaths; diseases of the respiratory system, 38 deaths; diseases of the circulatory system, 11 deaths; other visceral diseases, 17 deaths; tubercular diseases, 29 deaths, including 23 from consumption (=5·6 per 1,000 persons living); wasting diseases of infants, 8 deaths; cancer, 8 deaths; and violence, 7 deaths. Three deaths of infants prematurely born were registered, and three deaths from old age. Inquests were held in 18 cases. The annual death-rate per 1,000 persons living, in the thirteen successive four-weekly periods, was:— (1) 48·7 (2) 22·7 (8) 45·5 (4) 68·5 (5) 32·5 (6) 29·2 (7) 32·5 (8) 42·2 (9) 32·5 (10) 35·7 (11) 16·2 (12) 29·2 (13) 45·5 Sixty-five of the deaths occurred at the homes of the deceased persons, 61 at the Borough Infirmary (more than an eighth of the total deaths at this Institution—462), and 19 at other Public Institutions; 22 of the deaths were of persons who had previously resided at common lodginghouses in the area; but only one death took place at a common lodging-house. The deaths comprised 77 of males and 68 of females. The ages at death were:—Under 5 years of age, 55 (including 31 under one year); between 5 and 20 years, 6 deaths; between 20 and 60 years, 53 deaths; at 60 years and upwards, 31 deaths. The deaths were connected with streets as follows:—Bangor Street, 37 deaths; Crescent Street, 30 deaths; St. Katharine's Road, 34 deaths; Kenley Street, 21 deaths; Sirdar Road. 23 deaths. 12 Death-rate in the Metropolis, and in Kensington, and in Certain Districts of the Borough, in each of the thirteen four-weekly periods ended December 31st, 1904, and in the Registration Year, 1904. Four Weeks ended. Metropolis. Borocgh. Sub-Districts. Parliamentary Divisions. Wards. Kensington Town. Brompton. North. South. St. Charles. Golborne. Norland. Pembridge. Holland. Earl's Court. Queen's Gate. Redcliffe. Bromp ton. January 80 18·8 18·2 19·6 14·6 22·3 13·8 19·9 17·1 30·1 22·6 18·3 13·5 4·5 12·4 19·1 February 27 17·4 13·8 14·8 11·1 17·5 9·9 16·4 19·1 18·6 15·3 10·1 11·4 5·4 9·6 12·7 March 26 18·8 17·8 19·4 13·8 21·7 13·7 21·1 22·5 29·0 12·6 15·1 16·4 9·9 12·4 13·6 April 23 17·5 16·8 18·1 13·5 19·2 11·3 14·1 21·0 27·4 12·6 12·6 20·7 9·9 13·8 13·6 May 21 15·5 12·4 13·9 8·2 15·7 8·9 16·4 14·7 19·2 11·9 8·8 9·3 7·2 10·3 8·2 June 18 13·4 10·6 11·2 9·3 11·6 9·6 7·0 16·1 11·5 10·6 8·8 .13·5 9·9 8·3 7·3 July 16 12·9 10·3 11·9 6·4 13·6 6·9 11·7 11·7 17·0 14·0 6·9 5·7 4·5 6·9 10·9 August 13 18·0 16·0 18·0 11·0 19·2 12·7 14·7 22·0 25·2 13·3 15·1 11·4 11·7 13·8 10·0 September 10 18·0 13·3 16·3 5·3 19·5 6·6 18·2 22·5 20·8 15·3 10·1 5·0 4·5 5·5 7·3 October 8 14·3 10·5 12·8 4·5 14·4 6·3 16·4 10·1 16· 4 7·3 10·1 11·4 2·7 3·4 1·3 November 5 15·1 12·5 14·2 8·2 15·9 8·9 17·6 13·2 22·5 10·0 8·2 11·4 8·1 8·3 8·2 December 3 17·7 16·5 18·0 12·7 19·2 13·7 25·8 15·6 23·6 11·3 21·4 12·1 6·3 13·8 11·8 December 31 18·9 16·1 17·4 12·7 20·2 11·7 18·8 16·1 24·1 22·6 12·6 12·8 9·0 11·7 11·8 Death rate for the Year 1904 16·6 14·2 15·8 10·1 17·7 10·5 16·8 17·5 21·9 13·8 12·2 11·9 7·2 10·0 10·5 SUMMARY OF VITAL AND MORTAL STATISTICS, KENSINGTON. In the table at page 14, the principal vital and mortal statistics of the year have been arranged in thirteen four-weekly periods corresponding to the dates of the monthly reports. The birth-rate was 19·3 per 1000; the death-rate 14·2 per 1,000. There were, as usual, considerable fluctuations in the rate at different periods of the year, ranging between the minimum (10·3) in the seventh four-weekly period, ended July 16th, and the maximum (18·2), in the first four-weekly period, ended January 30th. The rate in six of the periods was above, and in seven below, the average for the year. The deaths in the first half of the year (1,310) were 80 more than those in the second half (1,230); the death-rate in the two half-years being 14·7 and 13·8 respectively. The deaths from the principal diseases of the zymotic class were 244—twenty-two fewer than in 1903, and 84 below the decennial average; 108 of them occurred in the first half of the year, 136 in the second. Measles was the prevalent and most fatal disease in the first half; the deaths in the first sixteen weeks numbering 58 out of a total of 67 in the year. One hundred and nine of the 128 deaths (mostly infantile) from diarrhoea occurred in the second half of the year; 100 of them in twelve weeks, July 17th to October 8th. The deaths from diseases of the respiratory organs (506) were more by 27 than in 1903. Diseases of the heart were the causes of 212 deaths, compared with 192 in the preceding year. Phthisis was fatal to 226 persons against 212 in 1903; other tubercular diseases claimed 116 victims, compared with 73 in the preceding year. 13 COMPARATIVE VITAL AND MORTAL STATISTICS. London.—The birth-rate, 27·9 per 1,000 (1·9 below the decennial average), was the lowest on record. The rate has been declining for many years, never having been below 30 per 1,000 prior to 1898: the highest rate during my tenure of office, 35·9 per 1,000, was recorded in 1875. The death-rate was 16·6 per 1,000 (1·0 per 1,000 above that in 1903, which was the lowest on record) and 1·7 below the decennial average. Small-pox, the cause of 1,314 and 13 deaths, respectively, in 1902 and 1903, was fatal to 25 persons, the decennial average being 179. Scarlet-fever was the cause of 365 deaths, compared with 362 in 1903 (the lowest number on record) and a decennial average of 658. Diphtheria was the cause of 729 deaths; 23 fewer than in 1903, and 1,193 below the decennial average, 1,922. Enteric-fever shows the smallest number of deaths on record, 296, or less than half the decennial average, 632. The four diseases above-named, commonly spoken of as the "dangerous infectious diseases," were the causes of 1,415 deaths: the deaths from the other three principal diseases of the zymotic class totalled 8,569, being rather more than 300 above the decennial average; viz., measles 2,261 (average 2,598), whooping-cough 1,507 (average 1,999), and diarrhoea 4,801 (average 3,656). Kensington.—The birth-rate, 19·3 per 1,000, and the lowest on record, was 0·7 below the rate in 1903, and 1·5 below the decennial average. Having regard to the disproportion in the number of the sexes a high birth-rate is not possible; but the fall from the maximum during my tenure of office, viz., 31·7 in 1872, is unduly great. The death-rate, 14·2 per 1,000; 0·4 above that in 1903, was 1·6 below the decennial average. The infantile mortality-rate, measured by the proportion of deaths under one year to 1,000 registered births, was 146, the same as in London; an increase of 3 per 1,000 in the borough, and of 15 per 1,000 in the Metropolis, as a whole, compared with the rates in 1903. Small-pox was the cause of one death, scarlet fever of 5 deaths, diphtheria of 17, and entericfever of 6; total 29 in a population of 178,500; a surprisingly small number. The deaths from scarlet-fever, diphtheria, and enteric-fever were 16, 35, and 11, respectively, below the decennial averages. The deaths from the remaining three of the principal diseases of the zymotic class were 214: viz., measles 67 (average 82), whooping-cough 19 (average 55), and diarrhoea 128 {average 100). The table at page 19 shows the number of deaths in the several Wards of the Borough from the principal diseases of the zymotic class; the rate of infantile mortality being shown at page 10. The mean temperature of the air at Greenwich during the year was 49°·9 Fahrenheit and 0·6 above the means of the preceding 50 years: the means of the four quarters being 39·5; 53·8; 61·5 and 44·3, respectively. 14 Summary of Vital and Mortal Statistics of the Royal Borough of Kensington, 1904. During the Four Weeks ended Births. Deaths. Death-rate Deaths at Ages. Deaths from Zymotic Diseases. Deaths from Diseases of Respiratory System. Deaths from Phthisis. Deaths from Heart Disease. Deaths under Five from Tubercular Disease. Mean Temperature. Kensington. London. 1904. Decennial Average. 1904. Decennial Average. 0-1 1—5 GO and upwards. Totals. Small-pox. Measles. Scarlet Fever. Diphtheria. WhoopingCough. Enteric Fever. TyphusFever. Simple continued Fever. Diarrhoea. - Totals. Bronchitis. Pneumonia. January 30 286 250 18·2 18·4 18·8 20·8 37 38 84 25 ... 17 ... 2 3 1 ... ... 2 64 27 30 19 20 7 39·6 February 27 *309 190 13·8 18·0 17·4 20-· 30 23 73 15 ... 12 ... 1 1 ... ... ... 1 42 16 19 13 21 2 40·0 March 26 269 245 17·8 19·5 18·8 21.7 39 43 88 24 ... 15 ... 1 2 ... ... ... 6 55 28 20 25 27 8 39·5 April 23 282 231 16·8 16·2 17·5 18·9 47 32 78 25 ... 14 1 3 3 ... ... ... 4 60 31 23 19 19 6 47·2 May 21 265 170 12·4 14·9 15·5 16·9 21 15 65 8 ... 3 ... 2 1 ... ... ... 2 25 12 9 15 23 5 50·6 June 18 246 146 10·6 13·5 13·4 15·6 21 7 46 3 ... 2 ... ... ... 1 ... ... ... 18. 9 6 13 18 8 57·2 July 16 271 142 10·3 18·3 12·9 15·3 38 12 42 14 1 1 ... 1 2 1 ... ... 8 19 8 10 14 10 2 62·4 August 13 266 220 16·0 16·1 18·0 19.2 68 18 63 55 ... 55 ... 2 1 1 ... ... 49 16 3 7 16 13 5 654 September 10 287 182 18·8 13·7 18·0 18·8 65 10 44 47 ... 1 1 1 1 1 ... ... 42 17 10 5 21 11 6 58·8 October 8 278 144 10·5 13·2 14·3 16·5 31 11 49 12 ... ... ... 1 2 ... ... ... 9 25 12 8 16 9 4 53·1 November 5 266 172 12·5 14·7 15·1 17·1 33 16 58 4 ... ... 1 1 1 ... ... ... ... 40 • 24 14 18 11 4 50·5 December 3 248 227 16·5 15·7 17·7 18·2 36 13 83 8 ... ... 1 2 1 1 ... ... 3 60 30 25 21 14 4 41-8 ,, 31 †230 221 16·1 17·2 18·9 19·8 37 15 110 4 ... ... 1 ... 1 ... ... ... 2 75 46 21 16 16 6 40-4 Totals 3,448 2,540 14·2 15·8 16·6 18·4 503 253 883 244 1 67 5 17 19 6 ... 1 128 516 256 197 226 212 67 49-9 * Maximum number during the year, and so throughout the table, † Minimum number during the year, and so throughout the table. 15 Death-rate in England and Wales and in London and in other Large Towns.— The death-rate in England and Wales in 1904 was 162 per 1,000 and l·0 per 1,000 below the average rate in the preceding ten years. The rate in London, as already stated, was 16·6 per 1,000 of the estimated population—0·9 above the corresponding rate in 1903, which had been the lowest on record; it was, however, 1·7 below the average rate in the 10 years 1894-1903. 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. 1904 1903. 1902. 1901. 1900. 1899. 1898. 1897. 1896. 1895. 1894. Kensington 14·2 13·8 15·2 15·0 15·6 17·5 16·3 15·6 16·7 16·4 15·7 London 16·6 15·7 17·7 17·6 18·8 19·8 18·7 18·2 18·6 19·8 17·8 West Districts 15·5 14·6 16·7 15·7 17·6 19·0 17·0 16·1 17·6 18·5 17·1 North „ 15·4 14·4 16·1 15·9 16·9 18·1 16·9 16·6 17·1 18·2 16·3 Central „ 20·2 19·0 21·2 20·8 21·5 22·5 22·1 21·8 21·2 23·8 20·0 East „ 19·5 18·6 20·0 20·7 22·1 23·0 21·7 21·2 21·3 23·4 20·8 South „ 15·3 14·2 16·1 16·6 17·7 18·5 17·7 17·2 17·5 18·3 16·2 England and Wales 16·2 15·4 16·3 16·9 18·2 18·2 17·5 17·4 17·0 18·7 16·5 Greater London.—The death-rate in "Greater London"—which is co-extensive with the "Metropolitan" and "City" Police Districts, the population of which at the middle of the year was 6,907,756 (viz. 4,648,950 in Inner or Registration London and 2,258,806 in the Outer Ring) was 15·5 per 1,000, as compared with 16·3, 16·4 and 14·5, severally in the three preceding years. In the County of London the mortality was at the rate of 16·6 per 1,000, whilst in the Outer Ring it did not exceed 13·2. Infantile mortality in Greater London was equal to 143 per 1,000 births, as compared with 146, 135 and 126, severally in the three preceding years. Last year infantile mortality was equal to 146 per 1,000 in the County of London and to 138 in the Outer Ring. Other Large Towns.—The crude death-rate in the seventy-six large towns, including London (population 15,271,287), was 17·2 per 1,000, or 0·9 above the rate in 1903—ranging from 8·44 in Hornsey, 11·04 in King's Norton, and 120 in Willesden to 21·48 in Wigan, 21·27 in· Manchester, and 22·59 in Liverpool.* The death-rates of Edinburgh, Glasgow, Dublin and Belfast were severally 16·6, 19·2, 23·4 and 20·9. The rates are calculated without references to differences between one town and another with regard to the age and sex distribution of their respective populations. But the sex and age composition of the several populations having been ascertained at the Census of 1901, suitable factors have been calculated for correcting the recorded death-rates in the large towns in order to render them fairly comparable with one another, and in his Annual Summary the Registrar-General (page iv.) furnishes a table showing the recorded and corrected death-rates per 1,000 persons living, in each of the 76 great towns in 1904. Colonial and Foreign Cities.—The authorities of a large number of the principal cities supply returns of mortality to the Registrar-General. The highest death rates recorded in 1904 were Moscow 27.6, Trieste 25.8, St. Petersburg 23.7, and New York 22.6; the lowest, Sydney 11.2, Brisbane 11.5, Christiania 13.5, and Chicago 13.6. Indian and Egyptian Cities.—The death-rate was equal to 30.0 per 1,000 in Calcutta' 37.9 in Madras, and 55.0 in Bombay. In Cairo and Alexandria the death-rates among the native populations were 38.4 and 37.3 per 1,000 respectively; these high-rates being largely attributable to to excessive mortality from diarrhoeal diseases. ASSIGNED CAUSES OF DEATH. The Registrar-General issued, in 1902, a "New List of Causes of Death" as used in the Annual Reports of 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 takes the place of the one used in these reports for many years as 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 100, in which 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 ("Pyrexia"). *The Registrar-General placed at ray disposal a sufficient number of copies of the New List to enable me to forward one to each registered medical practitioner in the Borough, which was done in October, 1902. 16 The Tables numbered I. to IV. are required by the Local Government Board to be used in the Annual Report of the Medical Officer of Health. TABLE I. 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 at all Ages. 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 1994 168,600 3,665 21·7 636 174 2,983 17·7 1,070 643 283 2,628 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 19·3 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 1902 177,500 3,488 19·3 515 148 3,112 17·2 1,182 681 315 2,746 15·2 1908 178,000 3,565 20·0 510 143 2,803 15·7 1,094 666 318 2,455 13·8 Averages for years 1894-1903. 172,850 3,615 20·8 607 168 3,077 17·7 1,132 659 312 2,730 15·7 1904 178,500 3,448 19·3 503 146 2,911 16·3 1,089 710 339 2,540 14·2 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. The term "non-residents" in column 10, means persons brought into the Borough on 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 178,500 No. (approximate) of inhabited houses 23,000 Average number of persons per house 7.76 *Rates calculated per 1,000 of estimated population. 17 TABLE II. 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. 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 1902 177,500 3,488 2,746 515 128,660 2,956 2,243 449 48,840 532 503 66 1903 178,000 3,565 2,455 510 129,020 3,033 1,998 461 48,980 532 457 49 Averages of years 1894 1903. 172,850 3,615 2,730 607 124,402 3,052 2,222 538 48,448 563 508 69 1904 178,500 3,448 2,540 503 129,380 2,934 2,045 451 49,120 514 495 52 Note.—Deaths of residents occurring outside the Borough are included in the table; those of non-residents occurring in the Borough are excluded. Deaths of residents occurring in public institutions are allotted to the respective sub-districts according to the previous addresses of the deceased TABLE IV * Causes of, and Ages at, Death during the Year 1904. Causes of Death. Deaths in whole District at subjoined ages. Deaths in Localities (at all ages). Deaths in Public Institutions. 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 1 ... ... ... ... l ... l ... l Measles 67 11 52 3 ... l ... 61 6 9 Scarlet Fever 5 l 2 2 ... ... ... 5 ... 5 Whooping-Cough 19 7 12 . . . ... ... ... 16 3 3 Diphtheria, Membranous Croup 17 1 11 5 ... ... ... 14 3 15 Croup 1 1 ... ... ... ... 1 . . . . . . Fever Typhus ... ... ... ... ... ... ... ... ... ... Enteric 6 ... ... 1 2 3 ... 5 1 2 Other continued 1 ... ... ... ... 1 ... ... 1 ... Epidemic Influenza 50 4 ... ... 1 17 28 30 20 4 Cholera ... ... ... ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... ... Diarrhoea 130 109 12 ... ... 2 6 126 4 14 Enteritis 27 11 5 ... ... 3 8 24 3 10 Puerperal Fever 5 ... ... ... 1 4 ... 4 1 1 Erysipelas 3 1 ... ... l ... 1 3 ... 1 Other septic diseases 11 2 1 ... ... 5 3 10 1 7 Phthisis 226 1 7 8 30 167 18 194 32 120 Other tubercular diseases 116 32 39 10 6 28 1 95 21 45 Cancer, Malignant disease 174 ... 1 1 1 106 65 131 43 49 Bronchitis 256 36 23 1 1 72 123 217 39 77 Pneumonia 197 42 52 3 5 59 36 164 33 31 Pleurisy 13 ... ... ... ... 9 4 8 5 8 Other diseases of Respiratory Organs 49 3 1 ... ... 21 24 38 11 12 Alcoholism 11 ... ... ... 10 1 5 6 8 Cirrhosis of Liver 81 ... ... ... ... 24 7 23 8 12 Venereal Diseases 10 6 ... ... 2 2 ... 9 1 2 Premature Birth 71 71 ... ... ... ... ... 59 12 4 Diseases and Accidents of Parturition 7 ... ... ... 1 6 ... 5 2 ... Heart Diseases 212 1 ... 2 5 107 97 155 57 78 Accidents 75 22 7 5 1 24 16 58 17 27 Suicides 21 ... ... ... 1 19 1 17 4 7 All other causes 728 141 28 16 22 247 274 567 161 241 All causes 2,540 503 253 57 81 938 708 2,045 495 788 Note.—Deaths of residents occurring outside the Borough are included in the Table; those of non-residents occurring in the Borough are excluded. * Table III.—"Cases of Infectious Disease notified.—See page 33. GENERAL DISEASES. The Deaths from the "Principal diseases of the Zymotic Class" were 244, and 84 below the corrected decennial average (328). These deaths, of which 225 belong to the Town sub-district and 19 to Brompton, were equivalent to 1·37 per 1,000 persons living (1·74 in the Town sub-district and 0·39 in Brompton) as compared with 1·51 in 1903, the decennial average being 1·84. The rate in the Metropolis, as a whole, was 2·15 per 1,000 (1·77 in 1903); the decennial average being 2·48. The subjoined table shows the number of deaths from the several diseases occurring in the sub-districts and at outlying public institutions, etc. Disease. Sub-Districts. In Hospital. Decennial Average. Town. 3rompton. Town. Brompton. Total Deaths. Uncorrected. Corrected for increase of Population. Small-pox _ _ 1 __ 1 1·2 1·2 Measles 58 5 3 1 67 79·3 81·8 Scarlet Fever — — 5 — 5 20·4 21·0 Diphtheria 2 — 12 3 17 49·5 51·5 Whooping-cough 16 3 — — 19 53·5 55·2 Typhus Fever — — — — — 0·3 0·3 Enteric Fever 2 1 3 — 6 16·2 16·7 Simple-Continued Fever — 1 — — 1 0·6 0·6 Diarrhoea 117 4 6 1 128 96·8 99·9 195 14 30 5 244 3817·8 328·2 With the exception of diarrhoea, the mortality from all of the above-named diseases was below the average. 18 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 Appendix I., page 100 (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 1,100 LOCAL DISEASES— Diseases of Nervous System 108 Diseases of Organs of Special Sense 6 Diseases of Heart 212 Diseases of Blood-vessels 149 Diseases of Respiratory Organs 516 Diseases of Digestive System 184 Diseases of Lymphatic System 2 Diseases of Urinary System 94 Diseases of Generative System 5 Accidents of Childbirth 7 Diseases of Locomotive System 4 Diseases of Integumentary System 1 - 1,288 DEATHS FROM VIOLENCE— Accident or Negligence 75 Homicide 2 Suicide 21 ILL-DEFINED AND NOT SPECIFIED CAUSES - 98 54 Total 2,540 19 Distribution of the fatal cases of the Principal Zymotic Diseases during the year 1904:— Smallpox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Enteric Fever. Continued Fever. Diarrhoea. Total. Sub-Districts— Kensington Town 1 60 5 14 16 5 ... 124 225 Brompton ... 7 ... 3 3 1 1 4 19 Parliamentary Divisions— North Kensington ... 55 4 9 15 1 ... 119 203 South Kensington 1 12 1 8 4 5 1 9 41 Wards— North Kensington St. Charles ... 15 2 2 3 ... ... 29 51 Golborne ... 17 2 7 5 ... ... 58 89 Norland ... 21 ... ... 3 ... ... 23 47 Pembridge ... 2 ... ... 4 1 ... 9 16 South Kensington Holland ... 5 1 2 1 3 ... 1 14 Earl'sCourt ... ... ... 5 1 1 ... 5 12 Queen's Gate . ... 1 ... 1 ... ... ... 1 3 Redcliff6 ... 2 ... ... ... 1 1 ... 4 Brompton ... 4 ... ... 2 ... ... 2 8 District Zymotic Rate.—The deaths from these diseases in North Kensington were 203 and the rate 2·21 per 1,000 persons living. In South Kensington the deaths were 41, and the rate 0·47 per 1,000. The rate in the several wards was as follows:— North Kensington St. Charles 51 deaths, or 2.0 per 1,000 persons living. Golborne 88 deaths, or 3.3 per 1,000 persons living. Norland 47 deaths, or 2·0 per 1,000 persons living. Pembridge 16 deaths, or 0·8 per 1,000 persons living. South Kensington Holland 14 deaths, or 0·7 per 1,000 persons living. Earl's Court 12 deaths, or 0·7 per 1,000 persons living. Queen's Gate 3 deaths, or 0·2 per 1,000 persons living. Redclifie 4 deaths, or 0·2 per 1,000 persons living. Brompton 9 deaths, or 0·6 per 1,000 persons living. The table at page 14 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, pages 118 and 119, showing the number of deaths from the several diseases during the forty-nine years, 1856-1904; viz., in Table B, the annual number of deaths from each disease and the death-rate therefrom; in Table C, the number of deaths grouped in quinquennia! periods; in Table D, the rate per 1,000 of the population, in quinquennial periods, of the four notifiable diseases (small-pox, scarlet fever, diphtheria and "fever"), and the three non-notifiable diseases—measles, whooping-cough and diarrhoea. In England and Wales the deaths from the principal zymotic diseases were at the rate of l·94 per 1,000 persons living. In the seventy-six great towns, including London, the average rate was 2·49. In London, as a whole, the mortality from these diseases last year was 2·18 per 1,000 and 0·93 below the corrected decennial average; the total deaths were 9,990. The mortality from all of these diseases shows a considerable decrease compared with the decennial average. 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 1904:— Small pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Fever. Diarrhœa. Kensington 0·00 0·38 0·03 0·09 0·11 0·01 0·72 London 0·01 0·49 0·08 0·16 0·33 0·07 1·04 England and Wales 0·01 0·36 0·11 0·17 0·34 0·09 0·86 20 SMALL-POX. Two cases of small-pox were notified in Kensington, viz., a lift-attendant at the L.C.C. Education Committee offices, aged 25, and a man of no regular occupation, aged 56. The latter case proved fatal. Little information was forthcoming to throw light on the origin of either case. The sufferers lived rather close to one another in streets near Notting Hill Gate station, and the illness in the second case began at a date which suggested possible infection by the first case. All I could learn was that the men knew one another by sight. They might have been in contact at the critical time, but appeared not to have met consciously. The man first attacked was brought into contact with many persons in the course of his duty. Another man employed at the same establishment fell ill at about the same time, and it is a reasonable probability that both cases had a common source of infection, which could not be traced. The inmates of the house where the first local case occurred submitted to re-vaccination, which was at first refused by the wife and adult daughter of the second case, who, however, having been called to the dying man's bedside, were subsequently re-vaccinated at the hospital. Happily both of them escaped; they had been effectually vaccinated in early life. The deaths from this cause in the three preceding years respectively were 1, 11, and 0, the corrected decennial average number being 1·2. The deaths in the Metropolis as a whole were 25, the corrected decennial average being 179; 22 of the deaths occurred in the hospital at Joyce Green. The cases notified were 492 in number, compared with 417 in 1903, in which year the deaths were 13. The contributory boroughs are set out in the table at page 31. MEASLES. Measles was the cause of 67 deaths, compared with 77, 93, and 34, in the three preceding years; 61 and 6 in the Town and Brompton sub-districts respectively; the corrected decennial average being 82. Fifty-eight of the deaths were registered in the 16 weeks, January 3—April 23, and none in the last 16 weeks of the year. One hundred and seventy-one houses were disinfected after the occurrence of measles in them in conformity with the order of the London County Council, to which reference was made in the Report for 1903 (page 20). The deaths from this cause, in London, as a whole were 2,261, and 337 below the corrected decennial average (2,598): the rate of mortality was 0·49 per 1,000. SCARLET FEVER. The notifications of scarlet fever were 262, compared with 475, 372 and 330, in the three preceding years; 157 in North Kensington, and 105 in South Kensington. The deaths were 5 (a casemortality of 1·9 per cent.), and 16 below the corrected decennial average (21). All of them belonged to the Town sub-district, and all occurred at outlying public institutions, to which 225 cases were removed. The deaths in the preceding three years were 15, 21 and 14. The rate of mortality was 0·03 per 1,000 of the population. The information as to scarlet-fever mortality in the borough—1856-1904—set out in Appendix II. (Tables B, C, D, pages 118 and 119) shows the great reduction in the fatality of this disease in recent years. The deaths in London as a whole were 365, compared with 584, 563 and 362, in the three preceding years, the corrected decennial average being 658. Of the 365 deaths 336 (92 per cent.) took place in public institutions. The case-mortality was 2·9 per cent.; the rate 0·08 per 1,000 of the population. The notifications were 13,439, compared with 18,390, 18,258 and 12,536, in the three preceding years. The mortality was 2·7 per cent. on cases notified, compared with 3·2, 3T and 2·9, in the three preceding years. The admissions to hospital were 11,401, compared with 14,159, 14,883 and 10,580 in the preceding three years, or about 85·6 on cases notified. 21 At the close of the year there were 2,386 cases remaining in hospital compared with 3,080, 2,327 and 1,632, at the corresponding period in the three preceding years. 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 1904. 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 30 23 819 21 744 — 39 1,651 February 27 18 696 17 624 — 21 1,587 March 26 19 774 16 666 — 17 1,585 April 23 15 751 12 676 1 25 1,543 May 21 28 1,023 25 888 — 25 1,630 June 18 25 924 20 800 — 25 1,630 July 16 23 1,070 18 951 — 27 1,698 August 13 26 931 22 832 — 23 1,763 September 10 11 1,037 11 961 1 21 1,816 October 8 22 1,580 19 1,430 — 30 2,341 November 5 24 1,557 23 1,365 1 38 2,782 December 3 12 1,192 10 1,062 1 41 2,625 December 31 16 1,081 11 948 1 33 2,386 262 13,435 225 11,947 5 365 For the sake of comparison, I subjoin the corresponding table for 1903, taken from the report for that year. Scarlet Fever in 1903. 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. Kensingt on. London. Kensington London. Kensington. London. January 31 18 1,082 13 869 — 37 2,019 February 28 12 944 10 857 1 26 1,756 March 28 32 989 25 837 — 31 1,851 April 25 31 851 24 794 1 19 1,698 May 23 27 1,094 25 934 — 37 1,759 June 20 17 913 16 750 1 23 1,649 July 18 37 1,050 37 971 4 26 1,710 August 15 46 1,022 38 897 3 31 1,758 September 12 28 936 21 865 — 29 1,772 October 10 21 1,133 21 1,029 1 23 1,881 November 7 24 969 18 840 3 33 1,854 December 5 17 827 13 694 — 26 1,715 January 2, 1904 20 776 16 697 — 21 1,632 330 12,636 277 11,034 14 362 Note.—Correction has not been made in the above tables for errors in diagnosis, either with respect to notifications, or admissions to hospital The notifications are taken from the weekly returns of the Asylums Board; the admissions to, and numbers in, the hospitals, and the deaths in London, from the weekly returns of the Registrar-General. 22 The following tables exhibit certain particulars of interest with respect to scarlet fever prevalence, &c., during 1904, and the ten preceding years, 1894-1903:— Scarlet Fever Cases Recorded in Kensington in 1904, 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. 1904 23 18 19 15 28 25 23 26 11 22 24 12 16 262 1903 18 12 32 31 27 17 37 46 28 21 24 17 20 330 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 34 468 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 Average 1894-1903 37•3 32•9 30•7 30•9 28•8 34•1 45•2 44•3 39•7 51•5 54•3 45•4 37•6 513† * Return comprises five weeks. † Without correction for increase in population. Statistics of Scarlet Fever in Kensington in 1904, and in the Ten Preceding Years. The Year. No. of Recorded Cases. Total Number of Recorded Cases Percentage of Removals to total Recorded Cases. Deaths. Total Deaths. Percentage of Deaths. Percentage of Deaths to Recorded Cases. Deaths in London from Scarlet Fever. Treated at Home. Removed to Hospital. At Home. In Hospitals. At Home. In Hospitals. 1904 37 225 262 86 — 5 5 — 100 1•9 365 1903 53 277 330 84 2 12 14 14 86 4•2 362 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 23 DIPHTHERIA. The cases notified as diphtheria and membranous croup (classified by the Registrar-General as diphtheria) were 186, compared with 250, 184 and 160, in the three preceding years; 99 in North Kensington, and 87 in South Kensington. The deaths registered were 17 (a case-mortality of 91 per cent.), and 35 below the corrected decennial average (52); 14 in the Town sub-district, and 3 in Brompton. Fifteen of the deaths took place in hospitals, to which 158 cases were removed—a case-mortality of 9•5 per cent. Twelve of the deaths were of children under five years of age, including one under one year. The rate of mortality was 0•09 per 1,000 of the population. Detailed information in regard to diphtheria mortality in the borough—1871-1904—is set out in Appendix II., Tables B, C, and D pp. 118-119. The deaths in London, as a whole, were 729, and considerably less than a moiety of the corrected decennial average number (1,922), compared with 1,344, 1,181, and 752, in the three preceding years. The rate of mortality was 0•16 per 1,000 of the population. The notifications were 7,224 in number, compared with 12,154, 10,735, and 7,727, in the three preceding years. The cases admitted to hospital were 4,739, compared with 9,090, 8,086, and 5,113, in the three preceding years ; and the deaths in hospital 471, a case-mortality of 9•9 per cent. At the close of the year there were 807 cases under treatment in the hospitals, compared with 1,369, 927, and 739, at the corresponding period in the three preceding years. The subjoined table, based on the thirteen four-weekly reports, set out certain particulars with regard to diphtheria, in Kensington, and in London as a whole:— Diphtheria in 1904. Report for four weeks ended No. of Notifications. Kensington. London. No. of cases admited to Hospital. Kensington. London. No. of Deaths. Kensington. London. No. of cases in Hospital at the end of the period. January 30 11 528 10 391 2 60 760 February 27 14 534 9 436 1 60 787 March 26 9 475 8 373 1 70 776 April 23 17 492 14 381 3 57 719 May 21 21 596 15 467 2 63 767 June 18 15 465 14 375 — 36 696 July 16 15 523 12 447 1 39 764 August 13 16 545 16 474 2 36 780 September 10 11 588 10 482 1 56 814 October 8 13 650 11 556 1 64 892 November 5 21 714 20 582 1 57 979 December 3 14 593 12 470 2 66 892 December 31 9 521 7 401 — 65 807 186 7,224 158 5,835 17 729 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. 24 The following table gives particulars with respect to diphtheria in North and South Kensington respectively. 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 (15 in Hospitals). North Kensington. South Kensington. North Kensington. South Kensington. January 30 11 7 4 6 4 1 1 February 27 14 7 7 6 8 1 ... March 26 9 6 3 6 2 1 ... April 23 17 9 8 7 7 1 2 May 21 21 11 10 10 5 2 ... June 18 16 9 6 9 5 ... ... July 16 15 8 7 6 6 • • • 1 August 13 16 10 6 10 6 1 l September 10 11 7 4 6 4 1 ... October 8 14 7 7 6 5 1 ... November 5 23 6 17 5 15 ... 1 December 8 14 7 7 6 6 ... 2 31 9 5 4 4 8 ... ... 189 99 90 87 71 9 8 *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. WHOOPING-COUGH. Whooping-Cough was the cause of 19 deaths compared with 62, 21, and 90, in the three preceding years; 16 in the Town sub-district, and 3 in Brompton; the corrected decennial average being 55. All of the deaths were of children under five years of age, including 7 under one year. The rate of mortality was 0.11 per 1,000 of the population. The deaths in London, as a whole, were 1,507, and 492 below the corrected decennial average (1,999). The rate of mortality was 0•33 per 1,000 of the population. FEVER. The notified cases of Enteric Fever were forty-six in number, compared with 97, 80, and 61, in the three preceding years. The deaths were 6 (11 below the corrected decennial average and the smallest annual number on record); 5 of them belong to the Town sub-district. Three of the deaths took place in hospitals, to which 29 cases were removed. The deaths from this cause in the three preceding years were 11, 19, and 9, respectively. In a few of the cases there was ground for suspicion that the illness had been caused by the eating of shell-fish—oysters in seven instances. The deaths in London, as a whole, were 296 (the smallest number on record), and 336 below the corrected decennial average (663). The notifications were 1,902 (2,237 in 1903): the admissions to hospitals 750 (compared with 1,480, 1,806, and 967, in the three preceding years). At the close of the year there remained 159 cases under treatment, against 195, 210, and 246, at the corresponding period of the three preceding years. The rate of mortality was 0•07 per 1,000 of the population. No cases of Typhus Fever was notified in the Borough; and 3 cases only in London, as a whole, there being no death from this cause. One death occurred in the Borough from simple continued fever (Pyrexia); three cases were notified. The deaths and notifications in London, as a whole from this cause, were 6 and 28 respectively. 25 DIARRHŒA. Diarrhœa was the cause of 128 deaths, compared with 115, 78, and 97, in the three preceding years; 123 in the Town sub-district and 5 in Brompton; the corrected decennial average being 100. The diarrhœal rate of mortality was 0 72 per 1,000 of the population. The deaths in London, as a whole, were 4,801, and 1,145 above the corrected decennial average (3,656): 4,428 of the deaths were of children under five years of age, including 3,721 of infants under one year. The rate of mortality was 104 per 1,000 of the population. The advice given by the Registrar-General in 1901, as to certification of fatal cases of this disease,* is being followed to an increasing extent by medical practitioners in the Borough, and it may be anticipated that in course of time the object of the Royal College of Physicians and the Registrar-General, accuracy in nomenclature, will be attained. In this connection it is interesting to note that in London, as a whole, of the 4,801 total deaths from this cause 2,856 were certified as Epidemic Diarrhoea, or Infective Enteritis, and 1,945 as Diarrhoea, Dysentery. INFLUENZA. Fifty deaths were registered from influenza, as compared with 28, 68, and 41, in the three preceding years; 30 in the Town sub-district, and 20 in Brompton. The deaths in London, as a whole, from this cause were 709, against 664, 1,073, and 644, in the three preceding years; and 441 below the decennial average. OTHER "GENERAL DISEASES." Syphilis was the cause of 10 deaths, 9 of them in the Town sub-district. Puerperal Diseases were the causes of five deaths—between 15 and 45 years of age—four of them in the Town subdistrict. Seven deaths, five of them in the Town sub-district, were registered as having occurred from accidents connected with childbirth. The deaths registered as having been caused by diseases and accidents associated with parturition (twelve in all), were equal to 3•5 per 1,000 live births, compared with rates of 3•1, 2•9, and 2•2, per 1,000 in the three preceding years respectively. 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 1904 with satisfactory results, there having been no spread of the disease. Erysipelas was the cause of three deaths, all of them in the Town sub-district. The notifications of Erysipelas were 140; some of the cases were 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 342 deaths, as compared with 314, 310, and 285, in the three preceding years; 289 in the Town sub-district, and 53 in Brompton; 79 of them under five years of age. Tubercular Phthisis (Pulmonary Tuberculosis) was the certified cause of 176 deaths (153 and 23 in the Town and Brompton sub-districts respectively), and "phthisis" of 50: total 226, or 1•27 per 1,000 of the population. Tubercular Meningitis was the cause of 37 deaths; Tubercular Peritonitis of 14; and General Tuberculosis of 41. The deaths from Tubercular Diseases were, proportionately to population, not so numerous in Brompton as in the Town sub-district The total deaths were in the proportion of 1.9 per 1,000 of the population. [Under the headings—"The Prevention and Treatment of Consumption"; and "Notificartion of Consumption," further information on the subject of Tuberculosis will be found at pp. 35 and 42.] The deaths from Tubercular Diseases in London, as a whole, were 10,359, the decennial average being 10,904. Of these deaths, 7,738 were due to Phthisis, the corrected decennial average being 8,097. The death-rate from Phthisis in London, in 1904, per 1,000 persons living, was 1•67, against 1•71, 1•64 and 1•60, in the three preceding years. • Vide Annual Report of the Medical Officer of Health for 1902, page 38. 26 Alcoholism, Delirium Tremens, was the cause of 11 deaths, five in the Kensington Town sub-district, and 6 in Brompton. The deaths in London, as a whole, were 576. 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 3 deaths, all of them in the Town sub-district. Malignant Disease, Cancer, was accountable for 174 deaths; 131 in the Town sub-district and 43 in Brompton. Carcinoma was the registered cause in 80 cases, Sarcoma in 11, and Malignant Disease, Cancer, in 83. 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 143, 136, 173, 168, 193, 169, 152, 185, 155, and 187, respectively. The deaths in 1904 were equal to 9•7 per ten thousand living, and to 6•9 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 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 148 of the deaths took place at ages above forty-five, and 18 between thirty-five and forty-five years. In London, as a whole, the deaths from Malignant Disease, Cancer, were 4,636, and 544 above the decennial average. Premature Birth was the cause of 71 deaths, 59 in the Town sub-district and 12 in Brompton; Old Age (Senile decay) of 82, 66 and 16, in the two sub-districts respectively; including 12 between 65 and 75 years, 40 between 75 and 85, and 29 at 85 years and upwards. LOCAL DISEASES. Nervous System.—The deaths from the diseases of this system were 108; 84 in the Town sub-district and 24 in Brompton—as compared with 246, 146, and 123, in the three preceding years —37 of them occurred under five years of age. Twenty-four of the deaths were due to Convulsions (an objectionable term), and 25 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 100. Circulatory System.—The deaths from Diseases of the Heart were 212; 155 in the Town subdistrict and 57 in Brompton—as compared with 236, 251 and 196, in the three preceding years. The larger number of the deaths, 110, were registered from "Syncope, Heart Disease (not specified).* Valvular Disease was accountable for 68 deaths, Angina Pectoris for 11, Dilatation of Heart tor 9, and Fatty Degeneration for 9. Diseases of Blood Vessels were the causes of 149 deaths; 117 in the Town sub-district and 32 in Brompton, including 83 from Cerebral Hemorrhage, Embolism, Thrombosis; and 41 from Apoplexy, Hemiplegia, conditions which generally connote cerebral hemorrhage. Respiratory System.—The diseases of the Respiratory organs (phthisis being excluded), were accountable for 516 deaths; 428 in the Town sub-district and 88 in Brompton—as compared with 511, 626, and 482, in the three preceding years. The principal causes were Bronchitis 256 deaths, and Pneumonia, in one or other of its forms, 197 deaths. The deaths under five years of age were 158, or 30.6 per cent, of the total number, as compared with 32 9, 318, and 381, per cent, in the three preceding years; and at 55 and upwards 247, or 47•9 per cent., against 44•2, 44•9, and 43•1 in the three preceding years. Bronchitis and Pneumonia were accountable for 453 deaths (including 153 under five years of age), of which 72 were registered in the Brompton sub-district. Digestive System.—The diseases of the Digestive System were accountable for 184 deaths; 142 and 42 in the Town and Brompton sub-districts, respectively; 40 of them under five years of age. The chief causes were Cirrhosis of the Liver 31 deaths, Other Diseases of the Liver and Gall Bladder 25 deaths, Intestinal Obstruction 16, Enteritis 22, Gastric Ulcer 16, and Appendicitis 16. Urinary System.—Ninety-four deaths were due to diseases of the urinary system; 71 and 23 in the Town and Brompton sub-districts respectively; Chronic Bright's Disease (Albuminuria), being the cause of 59 deaths, Nephritis (Acute), of 6, Bladder and Prostate Disease of 9, and Other Diseases of the Urinary System, 18. * A considerable number of deaths are certified as due to "Failure of the Heart," in persons dying in old age. These deaths are classified to " Old Age " in Table viii., page 100. 27 DEATHS FROM VIOLENCE. Ninety-eight deaths, including 31 under five years of age, and 24 under one year, were caused by violence ; 77 belong to the Town sub-district, and 21 to Brompton. Accident or Negligence occasioned 75 deaths; 58 in the Town sub-district, and 17 in Brompton; 29 of them under five years of age, and 22 under one year. Fractures and Contusions were responsible for 37 deaths, Burn, Scald for 8, and Suffocation for 26—of which 22 were of infants under one year. Suicide accounted for 21 deaths, 17 and 4 in the Town and Brompton sub-districts respectively; viz., from Gun Shot Wounds 3, Cut, Stab 5, Poison 7, Drowning 3, and Hanging 3. Ill-defined and Not specified Causes of death were returned in 54 cases; 50 in the Town subdistrict and 4 in Brompton: 47 were certified due to Debility, Atrophy, Inanition, all 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 foraged 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 St. Marylebone Infirmary, Notting Hill (536), at the Brompton Consumption Hospital (57), and at St. Joseph's House (14) are excluded from our statistics, but will furnish occasion for a few remarks later on. The deaths of parishioners registered at the Infirmary and Workhouse (463), at the Consumption Hospital (2), at St. Marylebone Infirmary (1), at St. Joseph's House (2), and at outlying institutions, etc. (339), were 807, or 31•8 per cent, on total deaths; the percentage proportion of deaths in public institutions in the Metropolis generally being 35•0; viz., 18•1 in workhouses and workhouse infirmaries; 1•4 in Metropolitan Asylums Board Hospitals; 12•7 in other hospitals, and 2•8 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 every 70 in a Metropolitan Asylums Board Hospital, one in every 8 in some other hospital, and one in every 36 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 471*, compared with 497, 528, and 460, in the three preceding years respectively, and were equal to 18•5 per cent., not far short of one-fifth of all the deaths recorded in the borough. The quarterly numbers were 130, 113, 102 and 126; 256 deaths, therefore, occurred in the first and fourth or colder quarters, and 215 in the second and third or warmer quarters of the year. The deaths included 251 of males and 220 of females. The ages at death were:—Under one year, 36 (compared with 66, 61, and 65, in the three preceding years respectively); between one and sixty, 237 (compared with 234, 254, and 218, in the three preceding years), and at sixty and upwards 198 (compared with 197, 213, and 177 in the three preceding years). SUMMARY OF CAUSES OF DEATH. DISEASES. Under 1 year. Between 1 year and 60 years. At 60 years and upwards. Total. Nervous System, Diseases of 1 16 13 30 Circulatory System, Diseases of 1 22 54 77 Respiratory System, Diseases of 6 45 64 115 Digestive System, Diseases of 2 13 19 34 Urinary and Generative Systems, Diseases of — 14 7 21 Tubercular Diseases (including Marasmus) 12 106 3 121 Cancer — 10 14 24 Measles 2 3 — 5 Gangrene — — 8 8 Premature Birth 4 — — 4 Various other Diseases 8 8 4 20 Senile Decay — — 12 12 36 237 198 471 * This figure represents the deaths actually occurring during the year. The number registered was 463. 28 Nine inquests were held; the cause of death was natural in one case, and injury in some form in eight cases. The Hospital for Consumption and Diseases of the Chest.—In the Kensington portion of the Brompton Hospital there were 59 deaths, including two of parishioners. The remaining 57 deaths, of non-parishioners, are excluded from the borough statistics. St. Marylebone Infirmary, Notting Hill.—At this institution 537 deaths were registered, all save one of which are excluded from the borough statistics. St. Joseph's House, Notting Hill.—The 16 deaths at this quasi-public iustitution, with the exception of 2 of parishioners, are excluded from the borough statistics. Outlying Public Institutions.—The deaths of parishioners at public institutions, etc., without the borough, which in the three preceding years had numbered 321, 315, and 318, respectively, were 339 in 1904. All of these deaths are included in the borough statistics. The deaths occurred at the several institutions as follows:— St. Mary's Hospital 65 St. George's Hospital 35 West London Hospital 22 Middlesex Hospital 6 Charing Cross Hospital 6 St. Thomas's Hospital 5 King's College Hospital 4 St. Bartholomew's Hobpital 4 University Hospital 3 London Hospital 2 Westminster Hospital 2 {Western Hospital 22 {North-Western Hospital 3 M.A.B {South-Western Hospital 1 {Northern Hospital 1 {Joyce Green Hospital 1 Cancer Hospital, Chelsea 6 Brompton Hospital (south wing) 2 Children's Hospital, Paddington 12 Children's Hospital, Great Ormonde Street 5 Victoria Hospital for Children 2 French Hospital 2 Homoeopathic Hospital 1 Chelsea Hospital for Women 1 Look Hospital, Dean Street 1 Queen Charlotte's Hospital 4 Mount Vernon Hospital, Hampstead 1 London Throat Hospital, Great Portland Street 1 Home Hospital, Fitzroy Square 1 National Hospital 2 Convent Hospital, Shoreditch 1 Friedenheim 4 Hostel of St. John and St. Elizabeth 2 Invalids' Home, Highbury 1 St. Peter's Home 1 Royal Home for Incurables 1 Home for the Blind, Tollington Park 1 Public Baths, Queen's Road, Bays- water 1 Holloway Prison 2 Chelsea Workhouse 1 Fulham Infirmary 1 Paddington Infirmary 1 Banstead Asylum 20 Horton Asylum 15 Han well Asylum 11 Norwood Asylum 7 Cane Hill Asylum 2 Claybury Asylum 2 Manor Asylum 2 Tooting Bee Asylum 2 Caterham Asylum 1 Colney Hatch Asylum 1 Darenth Asylum 1 Dartford Asylum 1 Ilford Asylum 1 Leavesden Asylum 1 Camberwell House Asylum 2 Peckham House Asylum 2 Bethnal House Asylum 2 Bookbinders' Asylum, Balls Pond Road 1 Central London Sick Asylum 1 Sick Asylum, Hendon 1 316 Other 23 deaths occurred without the borough, viz.: two of males by drowning in the Thames and the Grand Junction Canal respectively; one of a male on the railway, and one of a male and one of a female on railway premises; three of males and two of females in the street; and eight of male and five of females on private premises. 29 Deaths from diseases of the zymotic class occurred at public institutions without the borough .as follows:—Western Hospital 20 (diphtheria 13, scarlet fever 5, measles 2); South-Western Hospital 1 (enteric fever); North-Western Hospital 1 (enteric fever); Northern Hospital 1 (diphtheria); Joyce Green Hospital 1 (small-pox); St. Mary's Hospital 3 (measles 1, diarrhoea 2); St. George's Hospital 2 (measles 1, diarrhoea 1); West London Hospital 2 (diarrhoea); London Throat Hospital, Great Portland Street 1 (diphtheria) One death from enteric fever took place in a private nursing institution in Camden Road. UNCERTIFIED DEATHS. There was not one death in the borough that was not "certified," either by a registered medical practitioner or by a coroner. In England and Wales the deaths not certified were l'6per cent, of total deaths; the proportion in London was 0.2. The subject of uncertified deaths was considered, in the Session of 1893, by a Select Committee of the House of Commons, appointed "to inquire into the sufficiency of the existing law as to the disposal of the dead, for securing an accurate record of the causes of death in all cases, and especially for detecting them when death may have been due to poison, violence or criminal neglect." The recommendations of the Committee were summed up in ten paragraphs, of which 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 three inquests were held on parishioners, including 42 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 90 cases. Forty-nine 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 105 Deaths caused by violence (98), viz.:— Accidental 77 Suicidal 21 — 98 Total 208 Of the 21 suicidal deaths, 4 belong to [the Brompton sub-district and 17 to the Town sub-district. The inquests on Kensington parishioners were in the proportion of 8•0 per cent, on total deaths, the rate in the Metropolis being 9•6 per cent.; in England and Wales the rate was 6•5 per cent. The relative percentages in 1903 were 8•2, 10•2 and 6•9 respectively. The deaths from violence (98) were equal to 0•55 per 1,000 of the population in Kensington; the corresponding rates were 0•64 per 1,000 in London, as a whole, and 0•57 per 1,000 in England and Wales. NOTIFICATION OF INFECTIOUS DISEASE. The tables at pp. 31-34 show (1) the number of notifications of all the scheduled diseases in London in 1904; (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 comprised in the Borough, and (4) the case-rate and the death-rate of infectious diseases in Kensington in the year 1904, and in the ten preceding years. 30 The Kensington notifications were 922; viz., 746 in the Town sub-district, and 176 in Brompton. The notifications in the ten preceding years were 972, 1,289, 1,781, 1,457, 1,004, 1,046, 986, 1,025, 1,608, and 738 respectively. The notifications included 271 of chicken-pox (669 in 1903), a disease only temporarily made notifiable. Omitting these cases the notifications were 651, the lowest number on record. Table XII. (Appendix I., p. 112) shows the streets, etc., where cases of the scheduled diseases occurred. The cases notified in London were 39,251, including 10,940 from chicken-pox. The notifications of scarlet fever were 13,435, of diphtheria 7,079, of enteric fever 1,902 (the smallest number on record), of erysipelas 4,952, and of croup 145 (the lowest on record). The notifications of puerperal fever (274) were the lowest yet recorded save in the three years 1890 (206), 1891 (221), and 1903 (231). Notification has been in force since October, 1889. The notifications of each of the diseases during the fifteen years 1890-1904 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 ... 11,898 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 1898 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 33506 14 105 236 5,660 451 29 8 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 3,032 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 1903 417 ... 12,536 7,571 2,337 22 40 231 4,376 156 — — 27,686 1904 492 10,940 13,435 7,079 1,902 3 28 274 4,952 145 1 — 39,251 The Ages at Notification of certain of the diseases, in 1904 were as follows:— Age. Small-pox. Scarlet Fever. Diphtheria. Enteric Fever. Erysipelas. Puerperal Fever. 0—1 year 15 165 193 4 175 — 1—5 29 4,345 2,868 77 209 — 5— 58 5,652 2,316 237 221 — 10— 37 1,780 747 294 220 — 15— 61 582 321 257 291 10 20— 65 439 281 286 312 68 25— 116 376 299 401 688 144 35— 61 79 134 205 870 50 45— 27 19 39 96 879 1 55— 15 2 13 28 596 — 65 and upwards 5 — . 8 11 482 — 489 13,439 7,219 1,896 4,943 273 31 Cases of Infectious Disease notified in the several Metropolitan Boroughs in the Fifty-two Weeks ended Saturday, 31st December, 1904. 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 2 271 262 185 46 ... 3 11 140 1 1 922 176,628 Paddington 4 276 364 141 48 ... ... 11 118 2 ... 964 143,976 Hammersmith ... 206 285 202 41 ... 1 12 122 2 ... 871 112,239 Fulham ... 358 295 297 39 ... ... 8 130 3 ... 1,130 137,289 Chelsea ... 70 108 60 13 ... ... 7 45 1 ... 304 73,842 City of Westminster 7 178 313 145 51 1 2 5 127 ... ... 829 183.011 North. St. Marylebone 8 309 295 117 50 ... ... 3 187 1 ... 970 133,301 Hampstead 1 191 169 57 27 ... 1 6 56 1 ... 509 81,942 St. Pancras 7 407 848 342 186 ... ... 10 259 8 ... 2,017 235,317 Islington 18 792 1151 347 128 1 ... 24 281 ... ... 2,742 334,991 Stoke Newington 8 131 155 59 14 ... ... 3 53 2 ... 425 51,247 Hackney 15 502 855 560 185 ... 3 23 267 12 ... 2,422 219,272 Central. Holborn 6 61 98 45 41 ... ... 7 76 1 ... 335 59,405 Finsbury 15 202 330 144 46 ... ... 5 106 1 ... 849 101,463 City of London 2 25 32 39 14 ... ... ... 21 1 ... 134 26,923 Shoreditch 14 304 343 179 48 ... 2 5 177 7 ... 1,079 118,637 East. Bethnal Green 127 476 661 413 58 ... 4 13 226 13 ... 1,991 129,680 Stepney 89 901 1,261 801 199 1 ... 15 466 20 ... 3,753 298,600 Poplar 42 512 548 654 94 ... ... 15 205 18 ... 2,088 168,822 Southwark 28 484 406 274 92 ... ... 12 298 8 ... 1,552 206,180 Bermondsey 19 288 454 192 73 ... 1 5 186 2 ... 1,220 130,760 South. Lambeth 27 564 658 315 100 ... 4 16 248 12 ... 1,944 301,895 Battersea 7 566 385 222 63 ... 2 7 162 6 ... 1,420 169,907 Wandsworth 6 895 774 398 71 ... 3 14 270 6 ... 2,437 232,034 Camberwell 19 662 958 262 78 ... 1 13 329 8 ... 2,330 259,339 Deptford 11 341 405 191 32 ... ... 10 151 4 ... 1,145 110,398 Greenwich 1 339 213 149 50 ... ... 2 86 3 ... 843 95,770 Lewisham ... 341 339 129 29 ... ... 7 84 1 ... 930 127,495 Woolwich 8 338 469 160 27 ... 1 5 75 1 ... 1,084 117,178 Port of London 1 ... 1 ... 9 ... ... ... 1 ... ... 12 Grand Totals 492 10,940 13,435 7,079 1,902 3 28 274 4,952 145 1 39,251 *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 30. 32 Table showing the number of Cases of Infectious Disease Notified in Kensington, and in London, in 1904: Arranged in four-weekly periods. Date of Report. For FourWeeks ended Weeks of the Year. KENSINGTON. LONDON. 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. Weeks of the Year Date of Report. For FourWeeks ended January 30 1- 4 ... ... 23 10 2 ... ... ... 9 1 ... 45 17 ... 819 511 130 ... 1 23 299 17 ... 1,817 1-4 January 30 February27 5-8 ... ... 18 14 1 ... ... 1 8 ... ... 42 19 ... 696 519 111 ... ... 21 339 15 ... 1,720 5-8 February 27 March 26 9-12 ... ... 19 9 3 ... ... 2 11 ... ... 44 106 ... 774 466 94 ... ... 30 305 9 ... 1,784 9-12 March 26 April 23 13-16 ... 41 15 17 2 ... ... 1 11 ... ... 87 124 1,506 751 475 82 ... 1 18 266 17 ... 3,240 13-16 April 23 May 21 17-20 ... 65 28 21 1 ... ... ... 7 ... ... 122 66 2,001 1,023 585 79 2 3 17 339 11 ... 4,126 17-20 May 21 June 18 21-24 2 42 25 15 5 ... ... 1 12 ... ... 102 74 1,972 924 457 91 ... 1 17 314 8 ... 3,858 21-24 June 18 July 16 25-28 ... 46 23 15 3 ... ... ... 10 ... ... 97 41 1,767 1,070 520 92 ... 1 11 335 3 ... 3,840 25-28 July 16 August 13 29-32 ... 36 26 16 2 ... 1 3 8 ... 1 93 15 1,123 931 533 118 ... 1 25 366 12 1 3,125 29-32 August 13 September 10 33-36 ... 11 11 11 3 ... ... ... 11 ... ... 47 6 563 1,037 580 259 1 2 18 434 8 2,908 33-36 September 10 October 8 37-40 ... 9 22 13 7 ... 1 ... 13 ... ... 65 2 691 1,580 636 295 ... 2 12 538 14 ... 3,770 37-40 October 8 November 5 41-44 ... 20 24 21 5 ... 1 2 15 ... ... 88 ... 1,194 1,557 700 217 ... 9 37 581 14 ... 4,309 41-44 November 5 December 3 45-48 ... 1 12 14 3 ... ... ... 12 ... ... 42 6 104 1,192 585 172 ... 3 23 466 8 ... 2,559 45-48 December 3 „ 31 49-52 ... ... 16 9 9 ... ... 1 13 ... ... 48 16 19 1,081 512 162 ... 4 22 370 9 ... 2,195 49-52 „ 31 Totals ... 2 271 262 185 46 ... 3 11 140 1 1 922 492 10,940 13,435 7,079 1,902 3 28 274 4,952 145 1 39,251 Totals. 33 TABLE III. (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, 1904. 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. Under 1 1 to 5. At Ages—Years 25to 65. 65 and upwards Kensington Town. Brompton. Kensington Town. Brompton. 5to 15. 15 to 25. Small-Pox 2 ... ... ... ... 2 ... 2 ... 2 ... Chicken-Pox 271 31 120 94 20 6 ... 230 41 ... ... Cholera 1 ... ... ... ... 1 ... 1 ... ... ... Diphtheria 185 4 66 72 23 19 1 145 40 126 31 Membranous croup 1 ... 1 ... ... ... ... ... 1 ... 1 Erysipelas 140 3 8 9 10 93 17 118 22 3 1 Scarlet fever 262 3 59 141 36 23 ... 206 56 181 44 Typhus fever ... ... ... ... ... ... ... ... ... ... ... Enteric fever 46 ... ... 10 14 20 2 32 14 22 6 Relapsing fever ... ... ... ... ... ... ... ... ... ... ... Continued fever 3 ... ... 1 ... 2 ... 2 1 1 ... Puerperal fever 11 ... ... ... 2 9 ... 10 1 1 1 Plague ... ... ... ... ... ... ... ... ... ... • •• Totals 922 41 254 327 105 175 20 746 176 336 84 Table showing the Notifications, in 1904, 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. Cholera. Totals. Population. Notifications per 1.000 of the population. The Borough 2 271 262 185 46 3 11 140 1 1 922 178,500 5•2 Sub-Districts— Kensington Town 2 230 206 145 32 2 10 118 ... 1 746 129,380 5•8 Brompton ... 41 56 40 14 1 1 22 1 ... 176 49,120 3•6 Parliamentary Divisions— North Kensington ... 202 157 99 22 ... 9 100 ... 1 590 92,030 6•4 South Kensington 2 69 105 86 24 3 2 40 1 ... 332 86,470 8•8 Wards— North K. St. Charles ... 62 45 19 3 ... 2 24 ... ... 145 22,180 6•5 Golborne ... 59 65 44 8 ... 2 27 ... ... 205 26,590 7•7 Norland ... 63 22 24 6 ... 3 40 ... 1 159 23,720 6•7 Pembridge ... 28 25 12 5 ... 2 9 ... ... 81 19,540 4•1 South K. Holland 2 17 25 32 5 1 1 10 ... ... 93 20,620 4•5 Earl's Court ... 15 29 20 7 ... ... 7 1 ... 79 18,240 4•8 Queen's Gate ... 11 14 9 3 1 ... 6 ... ... 44 14,420 3•1 Redcliffe ... 21 21 14 7 1 ... 12 ... ... 76 18,890 4•0 Brompton ... 5 16 11 2 ... 1 5 ... ... 40 14,300 2•8 34 TABLE V.* Comparison of Prevalence of Sickness and Death from Infectious Diseases in 1904, and the Ten Preceding Years. (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. 1894 0•1 0•00 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 o•oo 1•63 0•02 2•18 0•42 5•95 0•23 o•oo o•oo 0•59 0•09 0•05 0•04 1897 o•oo o•oo 1•39 0•05 1•94 0•48 4•33 0•17 o•oo o•oo 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 o•o1 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 o•o1 o•oo 0•59 0•06 0•05 o•01 1902 0•53 0•06 1•06 0•03 1•04 0•11 2•09 0•12 o•oo o•oo 0•47 0•11 0•08 0•03 1903 0•03 o•oo 0•99 0•03 0•90 0•13 1•85 0•08 o•oo o•oo 0•35 0•05 0•02 o•o1 1904 0•01 0•00 0•78 0•02 1•04 0•09 1•47 0•03 0•00 0•00 0•27 0•04 0•06 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." 35 THE PREVENTION AND TREATMENT OF CONSUMPTION. In the report for 1903 (pp. 37-43), and under the above heading, I submitted a resume of the history of the movement to constitute the Metropolitan Asylums Board the Sanatorium Authority for London. Success has not yet been obtained; but progress has been made by sustained efforts to form and educate public and professional opinion with regard to it. At present London is dependent, as regards "chargeable" consumptives, on the accommodation provided at Poor Law Infirmaries and Workhouses. The provision made in special hospitals for non-chargeable persons is small, quite inadequate, and difficult of access under the system of subscribers' letters which generally prevails, a system which necessarily entails delay in getting suitable cases, in the early stages of the disease, under hospital treatment. An increased amount of public attention to the need for extending sanatorium accommodation was brought about in the autumn of last year by the holding of a largely attended meeting of the Council of the Charity Organisation Society, convened for the discussion of a paper I had been invited to read on "The Need of Sanatoria for Persons suffering from Consumption, and how it may be supplied." The paper is reproduced here as furnishing a summary of the history of the movement to date, and of my views on the subject, which is one of great and national interest from the public health standpoint. The Council of the National Association for the Prevention of Consumption and other Forms of Tuberculosis, in a leaflet entitled "How to prevent Consumption," state that "Consumpton (with other forms of tuberculosis) causes one death in every eight in this country," and that "of all deaths in the United Kingdom between the ages of twenty-five and thirtyfive, nearly one half are due to consumption." They estimate, moreover, that " in Great Britain, at the present moment, at least a quarter of a million persons are suffering from consumption." It would be difficult to find words more suitable to express the importance of the subject, which is truly one of national importance. In 1902, more than 57,000 deaths in England and Wales, and 10•7 per cent. of the mortality from all causes, were due to tuberculous diseases, the deaths being equal to a rate of 1,741 per million of the population at all ages and of both sexes; the mortality amongst males being 42 per cent. in excess of that amongst females. Consumption alone was the cause of nearly 41,000 of the deaths, and of 71 per cent. of the total mortality from tuberculosis; the deaths being equal to a rate of 1,233 per million living. In London the deaths from tuberculosis were 10,337, and 12•5 per cent. of total deaths; those from consumption 7,621, and nearly 74 per cent. of the mortality from ail tuberculous diseases. Great, however, as is the mortality from this cause, it is continuously declining, and has diminished to the extent of at least one-half during the last fifty years, thanks to sanitary legislation, more efficient sanitary administration, improvement in the housing of the people, and a general uplifting of the condition of the poorer classes. But a still greater reduction has occurred in regard to the "principal infectious diseases," small-pox, scarlet fever, enteric fever, etc., the deaths from which, and diphtheria, in London, in 1903, aggregated 1,523 only; scarcely more than a fifth of the number from consumption alone.* The reduced mortality from these diseases is due, in part, to the causes that have led to the diminished fatality of consumption; but more largely to the provision of isolation hospitals, since 1871, and, since 1889, to the operation of compulsory notification. When the same measures shall have' been adopted in regard to consumption, not less favourable results may be confidently anticipated. *By way of illustrating the relative importance of phthisis and the so-called dangerous infectious diseases, the subjoined figures relating to the mortality in London, and in Kensington, in 1903, may be cited. The deaths in London from consumption were 7,124, those from small-pox, scarlet fever, diphtheria, and fever, 1,487. The deaths in Kensington from consumption were 212, those from the four zymotic diseases, 47. The death-rate in London from consumption was 1•55 per 1,000 of the population, that from the four zymotic diseases, 0•32 per 1,000. The death-rate in Kensington from consumption was 119 per 1,000 persons livine, that from the four zymotic diseases, 0•26. The percentage of deaths in London from consumption to deaths from all causes was 10•2, that from the four zymotic diseases, 21. The percentage of deaths in Kensington from consumption to deaths from all causes was 8•6, that from the four zymotic diseases, 1•9. It thus appears that, judged from the standpoint of fatality, consumption is nearly five times more important than the four named zymotic diseases combined. It has to be observed, moreover, that whilst one attack—of small-pox, for example, usually confers life-long immunity from the disease, the recovered patient, moreover, as a rule, being none the worse for it, the unfortunate person who contracts pulmonary tuberculosis (consumption) is, in default of opportunity for getting open-air treatment, condemned to a more or less lingering, and almost certainly fatal, illness; becomes a misery to himself, a constant anxiety to his friends, and, too often, a burden to the community. 36 Sanatoria are, indeed, as the International Congress on Tuberculosis, in 1901, declared them to be, an "indispensable part of the measures necessary for the diminution of tuberculosis;" and yet it appears that, apart from what little has been done by the Poor Law authorities, only 2,800 beds have been provided, in about seventy institutions, despite the strenuous labours of the National Association; whereas for London alone upwards of 2,000 beds have been provided for small-pox, and nearly 6,300 in hospitals for fevers and diphtheria. Needless to say, vast sums have been expended in the construction of these unequalled institutions, and in the maintenance of the 400,000 patients admitted to them since the Metropolitan Asylums Board began its beneficent work in 1870. But the money has nob been spent in vain, having regard to the results achieved—typhus practically extirpated; and, comparing the quinquennia 1899-1903 and 1871-1875, a reduction, after correction for increase of population, of 87 per cent. in the mortality from the aggregate of the diseases admissible to the hospitals; 51 per cent. in the case of enteric fever, and 115 per cent. in the case of scarlet fever, which was the cause in 1903 of only 362 deaths in a population of more than 4,600,000, as compared with 6,040 deaths in 1870 in a population of less than 3,250,000. Praiseworthy efforts are being made in various directions to increase sanatorium accommodation, but the utmost efforts of philanthropy, self-help, and commercial enterprise will be found unequal to the task. Consumption being, in the main, a disease of the poorer classes, who comprise a vast proportion of the population, and are totally unable to pay for sanatorium treatment, the need will have to be supplied, at the public cost, by sanitary and Poor Law authorities. But, so far, few of the sanitary authorities have undertaken the work, whether by the erection of sanatoria for the treatment of curable and relievable cases, or of refuges for the incurable; and, as regards the 695 unions and parishes in England and Wales, the Boards of Guardians of 576 of them have done nothing, and the remainder—less than 18 per cent.—but little in the aggregate compared with the need. Ireland has a better record, more than one-half of the Boards of Guardians having made provision for the separate treatment of consumptives, under the stimulus of the Local Government Board for Ireland, who in 1901, and again in 1903, by the circulation of advisory letters, posters, and leaflets, impressed upon the Guardians, and all others whom it concerned, the necessity of isolation.* In England and Wales the Local Government Board do not appear to have taken any initiative, but they entertain favourably applications by Boards of Guardians for authority to expend money in making provision of separate accommodation for consumptives; and there is no reason to doubt that the same consideration would be extended to sanitary authorities, and " hospital committees," in counties, in regard to any such applications. That so little has been done by sanitary authorities, must be attributed rather to failure to appreciate the importance of the matter than to want of power to cope with it; for outside the Metropolis these bodies possess power to erect and maintain hospitals for the use of the inhabitants of their districts, under Section 131 of the Public Health Act, 1875. This power, exercised hitherto for the establishment of hospitals for "infectious" diseases only— small-pox, diphtheria, and fevers—is equally available for the building and maintenance of sanatoria by sanitary authorities, singly or in combination. The County Councils, moreover (other than the London County Council), are empowered, under the Isolation Hospitals Act, 1893, to constitute " hospital districts," to appoint "hospital committees," and to "promote the establishment of hospitals for the reception of persons suffering from infectious diseases." The provisions of the Act, so the Local Government Board have informed the Council of the National Association,†" may be applied to any other infectious diseases" than those that are notifiable; in like manner "as if a County Council were a local authority under the Act relating to the notification of infectious disease"; and "although pulmonary tuberculosis is not one of these diseases, the provisions of the Act may, under Section 26, be applied to that disease" by an Order of the Countv Council, which, however, "requires the approval of the Board." *The following extract from the circular letter issued in 1901 will suffice to show the spirit in which the Local Government Board for Ireland approached the matter: "The Board consider that the most necessary step to commence with is to educate the people in the best means of guarding against the disease and, with this object in view, they would suggest that the local authorities should endeavour to enlist the sympathy and support of the clergy of all denominations, managers of schools, schoolmasters, and all persons whose duties bring them intimately in contact with the people, and more particularly with the poor, and to supply them, for distribution, with copies of the leaflet entitled ' Information for Consumptive People, and for those who live with them.' The Board would suggest that Boards of Guardians, and sanitary authorities, throughout the country, would do well to have the posters printed and exhibited in prominent places in their districts, such as the Union Boardroom, the various dispensary waiting-rooms, schools, and other public places. Copies of the leaflets might also with advantage be obtained and sent to medical practitioners, clergymen, relieving officers, all sanitary officers and sub-officers, school teachers and others." † In a letter dated April 1st, 1903, from which the quotations in the text are made. A fuller abstract of the letter was printed in my report for 1903 (page 42.) 37 Resolutions of four County Councils extending tlie provisions of the Act to pulmonary tuberculosis, have been approved by the Local Government Board, but I am not aware that any County Council has yet formed a "hospital district" with a view to the isolation of phthisis. It is not improbable that County Councils generally, and sanitary authorities likewise, may be unacquainted with the extent of their powers, and that their inaction is largely due to this circumstance. Be this as it may, if only the County Councils, the sanitary authorities, and the Boards of Guardians could be made to appreciate the importance of the matter, and, under the stimulus of the Local Government Board, to exercise their statutory powers, the land might, ere long, be studded with sanatoria bearing some reasonable proportion to the greatness of the need. As regards the Metropolis, under the Public Health (London) Act, 1891 (Section 75), sanitary authorities possess the same powers, qua provision of hospitals, as extra-Metropolitan sanitary authorities. But there should be no occasion for the exercise of them, London having in the Metropolitan Asylums Board a central hospital authority admirably qualified for the work. The Managers have been pressed, again and again, to undertake the duty, by Public Health and Poor Law authorities alike, by the Metropolitan medical officers of health, and by the National Association for the Prevention of Consumption. They are sensible of the importance of the matter; and, recognising the "widely spread movement amongst public authorities for some special provision for consumptive cases," they have lately established a seaside Home ("Millfield") at Rustington, near Littlehampton, for one hundred chargeable children under sixteen years of age, "suffering from pulmonary tuberculosis in its early stages." To enable the Managers to provide sanatoria for chargeable adults, an Order of the Local Government Board would appear to be all that is necessary; and probably this might be had for the asking; but an Act of Parliament would be required to enable the Local Government Board, by an Order, to authorise the Managers to provide for non-chargeable sufferers. It is to be hoped that the Managers will see fit, ere long, to apply for an Order, and that an Act may be obtained by the President of the Local Government Board,* himself a convinced believer in the open-air treatment, which he has done not a little to promote. I come now to a consideration of the movement which has brought about that "general consensus of opinion amongst the Metropolitan authorities" desired by the Asylums Board as a condition precedent to their undertakng the care of patients suffering from consumption; or, in other words, to their becoming the sanatorium authority for the whole Metropolis. The primary impetus may be said to have been given by the formation, under the auspices of His Majesty King Edward VII., when Prince of Wales, of the National Association for the Prevention of Consumption, one of its objects being "to promote the erection of sanatoria for the open-air treatment of tuberculous disease." The first to move in the matter were the Managers of the Poplar and Stepney Sick Asylum District, who, in 1900, waited upon the Local Government Board to ask for authority to establish a separate hospital for the treatment of their consumptive patients. The Board, whilst expressing sympathy with the object, deprecated individual action, the question, in their opinion, "having a Metropolitan rather than a local character"; so that "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 furthermore suggested that a Conference of representatives of the Poor Law authorities "should be invited to meet and discuss the subject, and in the event of such Conference considering the provision of the proposed accommodation desirable, it should address the Board, and thus give the views of the Metropolis generally on the question."† The Managers convened a Conference (held in October, 1900), at which twenty-six out of the thirty-two Boards of Guardians were represented, and to which representatives of the National Association and other experts were invited. Dr. Downes, medical inspector of the Local Government Board (for Poor Law purposes), who was present, but not in an official capacity, gave the Conference much valuable information, stating, among other things, that on July 7th, 1900, there were 1,300 patients suffering from consumption in Metropolitan institutions (that is, parochial infirmaries and workhouses), of whom 1,000 could be moved to a sanatorium within fifty miles of London; and that of the total number, 400 were in the initial stage of the disease; that the deaths from tuberculosis in those institutions in 1899, were 3,000, including 2,800 from consumption; or 33 per cent. of the total mortality *The reference was to the Right Hon. Walter Long, who ceased to hold that important office in March of the current year. †The quotations in the text are from the letter addressed by the Clerk to the Managers to the several Boards of Guardians, when convening the Conference. 38 from this disease in London—a fact which indicates an enormous flow of sufferers through the sick wards in the course of the year. The inspector was laudably insistent that sanatorium provision should be made for the non-chargeable poor, and that cases not likely to recover should be sent to places where facilities could be given for friends to visit them. Sir William Broadbent, Dr. J. E. Squire, Dr. Nathan Raw, and other expert authorities took part in the deliberations, and ultimately the Conference, by an unanimous vote, affirmed the necessity for open-air treatment, and resolved to "bring the matter to the consideration of the Local Government Board, with the view to the necessary steps being taken by that Board for the carrying out of the proposal." A deputation was appointed to wait upon the Board, it being understood that the Metropolitan Asylums Board would be designated as the proper body to act as hospital authority for the Metropolis. The deputation was not received; the Board contenting themselves by stating, in reply to the communication from the Conference, that it would "receive attention together with applications of a similar nature which had been received from other public bodies.'' In the earlv part of 1902, many of the Borough Councils and Boards of Guardians intimated to the Local Government Board and the Metropolitan Asylums Board, their opinion that sanatoria should be provided for all classes in need of help, and that the Managers should be the hospital authority. The several communications addressed to the Asylums Board were referred, in July, to the General Purposes Committee (i.e., the Board sitting in Committee), who in November reported that— "Having regard to the important issues involved and to the fact that there was not yet a general consensus of opinion amongst the Metropolitan authorities in favour of the Board undertaking the treatment of consumptive patients "— they had "deferred consideration of the matter for twelve months." The report was adopted. At about this time a definite suggestion had been made that some of the disused smallpox hospitals should be utilised for sanatorium purposes. The small-pox epidemic was at an end, and for much of the accommodation provided, there was no longer (and, in fact, never had been) any need. The suggestion was approved by many of the Public Health and Poor Law authorities, and by the National Association for the Prevention of Consumption, in communications addressed to the Local Government Board and the Asylums Board. It found favour, moreover, with no small number of the Managers themselves, by whom, on five separate occasions, unsuccessful efforts were made to re-open the subject prior to the date fixed by the Board. Shortly before that date—viz., in October, 1903—the Metropolitan medical officers of health met to consider the subject, and, by an unanimous vote, passed a resolution to the effect that— By reason of practical experience in regard to provision of hospitals, and the treatment of the infectious sick, the Asylums Board were eminently qualified for the discharge of the duty [of sanatorium authority], the effective performance of which, by any competent authority, could not fail to be attended with great advantage in the interests of public health. By a further resolution the Managers were invited to oonsider the suitability for the purpose of a sanatorium of Gore Farm— Seeing that it could be brought into use at an early date, and that the utilisation of the buildings would save an otherwise necessarily large expenditure for the provision of hospitals specially erected for the purpose. On November 28th, 1903, the General Purposes Committee of the Asylums Board brought up their long deferred Report. They stated that they had had before them, in addition to the numerous communications above adverted to, one, dated November 20th, from the Local Government Board, in which the Board forwarded "oopy of a letter on the subject of the provision of suitable institutions for the treatment of pauper patients suffering from phthisis," which the Board had received from the Guardians of the Poplar Union; and asked "to be furnished with the observations of the Managers on the suggestion in the Guardians' letter, as to the Managers being authorised to establish sanatoria for the treatment of persons suffering from phthisis, who are chargeable to the Metropolitan unions and parishes." The Committee made no recommendation with reference to this communication, but recommended the Managers to adopt a resolution on the general question as follows— "That the Managers, having duly considered the question of the proposed establishment of sanatoria for consumptive patients, and the letters received from the Local Government Board, and the various Metropolitan local authorities, and medical officers of health, in regard thereto, are of opinion that the matter is one of such vital and 39 far-reaching importance to the community at large, and the proposal one which, if adopted by the Managers, would entail so considerable an extension of their duties and responsibilites, and so large an increase in their expenditure, as to call for some authoritative expression of opinion by the chief health authority of the country, viz., the Local Government Board, before the Managers are asked to take any definite action in the matter, or to make any further inquiries in regard thereto; and that the Local Government Board, the several Boards of Guardians, the Borough Councils, and the Medical Officers of Health be so informed." The Report was adopted. The Managers are still awaiting the desired "authoritative expression of opinion" by the Local Government Board, who, presumably, are likewise awaiting the observations of the Managers on the suggestion in the Poplar Guardians' letter, as to the Managers being authorised to establish sanatoria. One further incident deserves mention. In July, 1904, the London County Council convened a Conference of delegates of the Metropolitan Asylums Board, and of the Metropolitan Borough Councils, "On the Administration of the Public Health (London) Act, 1891." Among the subjects considered was that of hospital accommodation for persons suffering from consumption, in regard to which a resolution was unanimously adopted, as follows— "That it is desirable to make provision of sanatoria for the isolation and treatment of persons suffering from consumption, for the Metropolis, as a whole, and under one authority; and that, in the opinion of this Conference, the Metropolitan Asylums Board should be such authority." By desire of the Conference the resolution was sent to the Local Government Board, with a request that the matter might receive their immediate attention. With reference to the suggestion that Gore Farm Hospitals might be applied to sanatorium uses, it may be mentioned that, before endorsing the suggestion, the Council of the National Association for the Prevention of Consumption had the site and buildings inspected by an expert representative, who reported favourably on their suitability for the purpose; and there can, I think, be no reasonable doubt that, with some additions and adaptations of no very costly character (already upwards of £300,000 has been expended on site and buildings), the hospitals would suffice for the object in view. The site of 160 acres—larger, therefore, than that of the King's sanatorium at Midhurst —open and beautiful in itself, is not less charming in its surroundings. The two hospitals, "upper" and "lower," are entirely distinct, and practically invisible the one from the other, a fact of some importance in view of classification of patients. The upper hospital, now perfectly equipped* in all respects, and ready for immediate use, was constructed (mainly on two floors, and of brickwork) under the supervision of the late Sir Douglas Galton and the late Chairman of the Asylums Board (Sir Robert Hensley). It is the more important of the two, and the most suitable for patients of the classes for whose service the King's sanatorium is designed. The lower hospital, comprising single-floor wards, would serve well for the chargeable poor, to whom it would afford a welcome change from the parochial infirmaries in London, or the more dreary surroundings of the workhouses. The wards of both hospitals are well lighted and well ventilated. The upper hospital provided accommodation for over 1,000 small-pox patients, allowing to each little (if any) less cubic space than will be given to the patients in the King's sanatorium. The same may be said of the lower hospital which, designed for the reception of 850 small-pox patients, has never received one, and will never be required for small-pox isolation. The floor-space in both hospitals is ample. The general lie of the wards of the upper hospital is north and south; that of the lower hospital northeast and south-west. The upper hospital stands on a plateau between 200 and 300 feet above Ordnance datum, the elevation of the site of the lower hospital ranging from 100 to 200 feet. In connection with both hospitals there is abundant space for open-air shelters, gardens, graded walks, etc. The grounds, well wooded with chestnuts, oaks, silver birches, are carpeted in summer with wild flowers and beautified by shrubs. The locality is bracing, the air pure, the site dry, the chalk coming to within a little distance of the surface, over most of the estate. The water supply is good and assured, the drainage satisfactory. The hospitals are well sheltered from north and east winds: and it may be taken as reliable evidence of the healthiness of the site and buildings, that in the year 1900, of 3,220 fever convalescents treated in the upper hospital, not one died. Gore Farm, it may be added, is only two miles distant from Dartford; and, therefore, not too far from the Metropolis—a motor ambulance could easly perform the double journey in one day—but it is far enough away to be out of the London soot and fog area, a matter of no little consideration in dealing with a disease whose most fatal incidence is upon the respiratory organs. *The unused furniture of the lower hospital was transferred to the " Orchard " small-pox hospital, Joyce Green, in 1902. 40 The upper hospital has been empty of small-pox patients for upwards of two years, and by resolution of the Asylums Board the hospitals are "no longer reckoned as small-pox hospitals." No other use for them has been suggested, and if they could be devoted to the relief of persons suffering from consumption, the sanatorium question, so far as London is concerned, would probably be settled—for some years, at any rate. It will have been noted that the Managers, whilst admitting that the question of the proposed establishment of sanatoria for consumptive patients is one of "vital and far-reaching importance to the community at large," hesitate to undertake the task for the reason (among others) that it would entail a " large increase in thir expenditure." Have they ever considered what consumption costs London? It has been stated, in the "British Medical Journal," that "Dr. Darlington, the Chief Commissioner of the Health Department of New York, estimates the annual loss caused to that city by tuberculosis at £4,600,000." The loss caused to London cannot be less; and, as regards England and Wales, a considerable part of the expenditure on poor relief—twelve or thirteen millions in 1903—is due to the sickness and the deaths caused by consumption. Millions have been expended by the Asylums Board on the isolation and treatment of infectious diseases, with the result of a large reduction in the mortality—the saving annually of a very large number of lives. But compared with the lives of those who perish from consumption, how relatively small the value to the community of the lives of the victims of scarlet fever and diphtheria! In 1903, there were 1,114 deaths in London from these diseases, of which 750 were of children under the age of five years, and 27 only of persons over twenty. Contrast this mortality with the deaths from consumption, 7,347 in number; of which 6,437 took place between the ages of twenty and sixty years. Think of the men and women—the bread-winners—husbands, wives, fathers, mothers, snatched away in the prime of life: think of the many widows and orphans, and calculate, if it be possible to do so, the money loss to the community of the precious lives that might have been saved or usefully prolonged! The "increase of expenditure" that would be entailed by the establishment of sanatoria for the curable, and of refuges for the safe housing of those beyond hope of recovery, would be a mere bagatelle in comparison with the money that would be saved to the community—to put the matter upon no higher ground—if only a tithe of the lives sacrificed every year to this fell disease could be preserved, to say nothing of the national benefit that would accrue from its ultimate extinction. A discussion followed the reading of the paper; opened by Sir William Broadbent, Chairman of the Council of the N.A.P.C., who was followed, among others, by the President of the Society of Medical Officers of Health, the Chairman (and an ex-chairman) of the Works Committee of the Metropolitan Asylums Board, the Secretary of the Hospital Sunday Fund, Sir Edmund Hay Currie, and the Secretary of the Hospital Saturday Fund (Mr. W. G. Bunn). On the motion of Sir William Broadbent the paper and the discussion upon it were referred to the Administrative Committee for consideration and report thereon to the Council of the Charity Organization Society at some subsequent meeting. The Committee subsequently convened a meeting of Medical Officers of Health, Medical Superintendents of Poor Law Infirmaries, Guardians and others, Sir William Broadbent being in the chair, at which the following resolutions were passed:— 1. "That it is of urgent importance that further and more complete public provision be made for cases of phthisis." 2. "That it is desirable that provision be made by the Metropolitan Asylums Board for persons suffering from phthisis who are, or may from time to time become, chargeable to the poor rates." 3. "That the Council of the Charity Organization Society approach the following societies, amongst others, with a view to these, or similar, resolutions being submitted to the Local Government Board, jointly; viz., the Society of Medical Officers of Health, the National Association for the Prevention of Consumption, the National Health Society and the Royal Sanitary Institute." The resolutions were communicated by the Secretary of the Society to the various bodies represented at the meeting with a covering letter, as follows:— " I am desired to ask whether resolutions 1 and 2 approve themselves to your Society, and whether you would co-operate with the Charity Organization Society and other bodies with a view to their submission to the Local Government Board, by deputation or otherwise ? 41 "It will be seen that the resolutions adopted do not deal with the large number of phthisical cases which are to be found outside the poor-law. The Conference, however, was of opinion that it would be best to deal with the question of poor-law cases only, in the first instance." Nothing, so far, has come of the meeting—at which I deprecated the proposal to approach the Local Government Board alone, being of the opinion that the Metropolitan Asylums Board were pre-eminently the body to deal with the matter; and, further, that the effort to obtain sanatoria for persons suffering from consumption should have greater regard to the needs of the non-chargeable poor than to those of persons in receipt of relief, and for whom some provision, of a sort, is now made by the Boards of Guardians in the Poor Law Infirmaries. THE MILLFIELD HOME. Reference has already been made to this Sea-side Home, at Rustington,near Littlehampton, which was established by the Metropolitan Asylums Board, under the powers conferred by an Order of the Local Government Board, dated 2nd April, 1897, which declared it to be "expedient" to include among the "classes of poor chargeable to Unions and Parishes in the Metropolitan Asylums District, for whose reception and relief the said district should be deemed to be formed, children requiring either special treatment during convalescence, or the benefit of sea-side air." The Managers, some time since, decided to devote the Home for the treatment of children, of both sexes, under 16 years of age, in the early stage of pulmonary phthisis (consumption), for whose reception it was opened last year. By this act, they have, in principle, constituted themselves a Sanatorium Authority; an important new departure to which the Local Government Board have not taken exception. The Home comprises four blocks, with twenty beds in each, and was opened in April last year. The area of the site is 5½ acres. It is intended for the use of children able to avail themselves freely of the open-air either on the sea-beach, or in the grounds, or on the verandahs. The cost of site and buildings was about £25,000. As elsewhere stated, the Managers could, with the sanction of the Board, and without fresh legislation, make provision for chargeable adults, under Section 5 of the Metropolitan Poor Act, 1867, which enacts that "Asylums may be provided under this Act for Reception and Relief of the Sick, Insane or Infirm, or other Class or Classes of the poor, chargeable in Unions and Parishes in the Metropolis." THE IDENTITY OF THE TUBERCLE BACILLUS: PRELIMINARY REPORT OF THE ROYAL COMMISSION. At the International Congress held in London in 1901, a profound sensation was created by a paper read by Professor Koch, in which he stated that bovine tuberculosis is not transmissible to man, the necessary corrollary being that, qua. tuberculosis, no danger need be apprehended from the drinking of tuberculous milk or the eating of the fiesh of tuberculous cattle. The views expressed by Dr. Koch contravened the general belief in the practical identity of human and bovine tuberculosis, and led to a suggestion, by interested persons, that the stringency of the procedures intended to prevent the sale for food of man of the milk of tuberculous cows, and the flesh of tuberculous animals, should be relaxed, notwithstanding that the Congress (in resolution 5*) had deprecated any relaxation, by medical officers of health, of efforts to prevent the spread of tuberculosis through the agency of meat and milk. But, while Dr. Koch's views could not be accepted, the Congress was so far impressed by them as to have passed a resolution to the effect— "That, in view of the doubts thrown on the identity of human and bovine tuberculosis, it is expedient that the Government be approached and requested to institute an immediate inquiry into this question, which is of vital importance to the public health, and of great consequence to the agricultural industry." This weighty declaration had the desired effect, a royal commission having been appointed— "To inquire and report (1) whether tuberculosis in animals and man is one and the same disease; (2) whether animals and man can be reciprocally infected with it; (3) under what conditions, if at all, the transmission of the disease from animals to man takes place, and what are the circumstances favourable or unfavourable to such transmission." *The resolution read as follows :—" That in the opinion of the Congress, and in the light of the work that has been presented at its sittings, medical officers of health should continue to use all the powers at their disposal, and relax no effort, to prevent the spread of tuberculosis by milk and meat." 42 Meanwhile, the Local Government Board, in a circular letter to the Metropolitan Borough Councils and other sanitary authorities, advised that, pending the investigations and report of the Royal Commission, there should be no relaxation on their part, or on that of their officers, in the taking of proper measures for dealing with milk from tuberculous cows, and with tuberculous meat, which might be intended for the food of man. The inquiry by the Royal Commission, put in hand forthwith, is still in progress, but the Commissioners, having arrived at certain conclusions of importance, deemed it right to issue an interim report, in which they state that, having very carefully compared the disease experimentally set up in the bovine animal by tuberculous material of human origin, with that set up by the bovine animal by material of bovine origin, they have, so far, found the one, both in its broad general features, and in its fine histological details, to be identical with the other. They have failed, moreover, to discover any character by which they could distinguish the one from the other; their records containing accounts of the post-mortem examinations of bovine animals infected with tuberculous material of human origin, which might be used as typical descriptions of ordinary bovine tuberculosis. Having come to the conclusion that "tubercle of human origin can give rise in the bovine animal to tuberculosis identical with ordinary bovine tuberculosis," it seemed to the Commission that it "would be most unwise to frame or modify legislative measures in accordance with the view that human and bovine tubercle bacilli are specifically different from each other, and that the disease caused by the one is a wholly different thing from the disease caused by the other." The evidence on which the Commission arrived at these striking results will be published later. NOTIFICATION OF CONSUMPTION, 1904. Towards the close of 1901, the Council resolved, upon the recommendation of the Public Health Committee, to make pulmonary phthisis (consumption) voluntarily notifiable by medical practitioners as from the commencement of 1902; and, subsequently, with a view to the utilisation of the information thus obtained, the Committee authorised me to employ the services of the lady inspectors in an inquiry into the circumstances of the cases notified; and, generally, to give effect to the recommendations of their Sub-Committee, whose report is printed in the Minutes of the Council's proceedings for 13th November, 1901 (pages 19 and 20). The work thus inaugurated is still going on, and in submitting the report of the lady inspectors for 1904, I desire to express my appreciation of their services. I have only to add that to secure coherence to the inquiry, information was obtained in each case notified under the subjoined headings. Case of Phthisis. Ward Sanitary District Date of notification. Date of death, if case not notified. Patient's name. Age. Sex. Occupation. Present address and length of residence. Previous residences— Duration of illness. Number in family. Any other cases in family, now or formerly. No. of Case Probable source of infection. Number of rooms occupied. Room occupied by patient. How many sleep in patient's bedroom. Has or had patient a separate bed. Sanitary condition of habitation. Sanitary condition of room. Light. Ventilation. Sputa, how treated. Disinfection done by on Cleansing done by on Remarks:— The Inspectors' report is as follows :— "During the year 1904, we enquired into all cases of phthisis (consumption) voluntarily notified by medical practitioners, 203 in number (compared with 221 in 1903, and 247 in 1902), of which 67 proved fatal. We made enquiries also with regard to 14 deaths of persons whose cases had been notified in 1903, to 11 deaths of persons whose cases had been notified in 1902, and to 143 deaths of persons whose illness had not been notified. The cases investigated during the year were 371, of whom 212 were males and 159 were females. "Thirty-seven of the cases notified were of persons who had resided at common lodginghouses, with respect to whom little or no information could be obtained. These cases had been notified from 18 houses; the largest numbers to a house being, respectively, 7 cases in one house, and 5 cases in each of other two houses. 43 "The subjoined table shows the distribution of phthisis in the Borough: notified cases, and fatal cases not notified:— Cases Notified. Total Notifications in 1904. Deaths of Cases previously Notified— Deaths of Cases not Notified. Total Deaths. Total Number of Cases Investigated. Newly in 1904. In 1903 and re-notified in 1904. In 1902 and re-notified in 1904. In 1904.* In 1903. In 1902. Number of Cases in— The Borough 168 18 17 203 67 14 11 143 235 371 Sub-districts :— Kensington Town 156 17 17 190 66 13 10 119 128 332 Brompton 12 1 – 13 1 1 1 24 27 39 Parliamentary Divisions :— North Kensington 138 15 16 169 53 9 9 93 164 280 South Kensington 30 3 1 34 14 5 2 50 71 91 Wards : — North Kensington St. Charles 22 2 1 25 10 1 3 24 38 53 Golborne 30 4 3 37 13 2 2 25 42 66 Norland 78 7 10 95 28 4 3 27 62 129 Pembridge 8 2 2 12 2 2 1 17 22 32 Holland 12 1 1 14 9 2 – 17 28 33 South Kensington Earl's Court 4 4 1 1 1 16 19 22 Queen's Gate 5 1 6 1 – 3 4 10 Redclifie 4 1 – 5 3 1 – 6 10 12 Brompton 5 – – 5 1 – 1 8 10 14 "It will be observed that of the 168 cases newly notified in 1904, 130 were from three wards in North Kensington, St. Charles (22), Golborne (30) and Norland (78), arid that of the deaths, 142 (38, 42 and 62) belonged to the same wards, the^population of which aggregates 72, 300; and 92 to the remaining six wards; population 105,700. "One hundred and sixty-nine of the 203 notifications, and 164 of the 235 deaths, related to persons belonging to North Kensington; 34 notifications, and 71 deaths, to persons belonging to South Kensington—after allocation to their previous residences of the cases and deaths at the Borough Infirmary and Workhouse. "The proportion of deaths at the Infirmary to total deaths from phthisis, was large; 98 out of 235: males 59, and females 39. Seventy-two of the deaths were of North Kensington persons, and 26 of South Kensington persons. The notified cases were 136; males 76, females 60: 109 of North Kensington persons, and 27 of South Kensington persons, High Street, Notting Hill, and Holland Park Avenue constituting the dividing line. Fifty cases were notified by District Medical Officers, the majority of which were subsequently removed to the Infirmary. Seven cases only (4 in North Kensington and 3 in South Kensington) were notified by other than Poor Law doctors. "All notified cases residing at home were kept under observation, having been visited as frequently as practicable. Disinfection after the death of a sufferer, or after removal of a patient from one abode to another, generally to the Borough Infirmary, was offered and usually accepted: in some cases it was refused, either as being deemed unnecessary, or because of the resultant inconvenience. The refusals numbered 23 only, as against 60 in 1903, and 46 in 1902. *The figures in this column are not included in the total number of cases investigated (set out in the last column), being already counted in the first column. 44 "The number of persons in receipt of parochial relief out of the 371 cases investigated was 243, as against 128 non-chargeable persons: but of these 128 cases a considerable number subsequently became chargeable and were admitted to the Borough Infirmary. The following notified cases seem worthy of a passing notice : "A laundry girl aged 15½, died after two years' illness of phthisis, said to have resulted from catching cold at work; on visitation of the home, the father was found dying of the same disease, which had previously proved fatal to an aunt; it being alleged, moreover, that five or six of her brothers had died in infancy of tuberculous disease. "A tailor, aged 52, without a phthisical family history, who died after a few months' illness, attributed the disease to the bad ventilation of the workshop where he was employed, in the Borough. Enquiry elicited the fact that the means of ventilation were ample, but were all kept closed by the employes themselves. "A labourer, aged 42 (whose wife's father had died of phthisis), succumbed after nine months' illness. He had slept for two years in a dark and poorly-ventilated basement room. The wife stated that her husband had enjoyed good health till they came to live in this room. "A charwoman, aged 45, died after a year's illness. There was no phthisis in the family, but she had worked at a house for some time before being taken ill, and had charge of the room of the phthisical master of it. "An artist-painter, aged 29, died of phthisis. There was a phthisical family history, and the deceased had suffered from Potter's Asthma for some years. "A watchmaker, aged 54, without family history of phthisis, and who had been ill for a year,, attributed the disease to the bad ventilation of a workshop, where, owing to the darkness, artificial light (gas) was used all day. The facts of this case were communicated to the Medical Officer of Health of the Borough in which the workshop is situated. "In the majority of notified cases the rooms occupied by the sick persons were found to be fairly clean and ventilated. In others, the rooms were close and dirty. Speaking generally, we noted with satisfaction a continued improvement (as compared with 1902-3) in ventilation, by open windows, and an increasing appreciation of the value of fresh air to phthisical persons, as also of the danger arising from indiscriminate ' spitting.' "In each case instructions were given to the patient, or the relatives, enjoining the necessity of wet-cleansing of rooms, furniture, etc.; and also with respect to the treatment of sputa. "The Council's leaflet on ' The Cause and Prevention of Consumption ' was left at each infected house, as also was a card containing clear and simple rules for preventing the spread of infection, such as could be carried out without interfering with the patient's daily avocations. "We desire to acknowledge the courtesy with which our visits and enquiries were received, and the general willingness of persons concerned, sufferers and relatives alike, to carry out the advice and instructions given. "The appended tables, summarizing the more salient results of the enquiry, are self explanatory." Sex of Sufferers. Number of Deaths. Males. Females. Total. Sex of persons notified 118 85 203 Number of deaths ensuing 33 34 67 Number of deaths ensuing after notification, in 1903 8 2 10 Number of deaths ensuing after notification, in 1902 9 2 11 Number of deaths of persons not notified 78 65 143 45 Sex and Age of 203 Notified Cases. Sex. 0-5 5-10 10-20 20-40 40-60 60 and upwards. Total. Males 1 1 4 39 59 12 116 Females 1 3 6 33 37 7 87 Sex and Age at Death of 143 not Notified Cases. Sex. 0-5 5-10 10-20 20-40 40-60 60 and upwards. Total. Males 4 1 9 29 27 9 79 Females 5 1 8 26 18 6 64 Sex and Age at Death ; All Cases (235). Sex, 0-5 5-10 10-20 20-40 40-60 60 and upwards. Total. Males 4 1 10 47 57 10 129 Females 5 3 14 44 33 7 106 Status of the Sick. Males. Females. Total. Persons in receipt of parochial relief 141 102 243 Persons not originally in receipt of parochial relief 71 57 128 Home Accommodation of the Sick Person or Family. Number of Rooms Occupied. 1 2 3 4 or more. Homeless Persons in the Infirmary. Common Lodginghouse Cases. No Information obtainable. Total Cases. Number of cases of illness 95 64 31 62 29 37 53 371 Disinfection, Cleansing, etc. Number of infected rooms 256 Number of rooms disinfected by the Council's Officer 129 „ „ occupier, and re-papered, whitewashed, etc. 18 Number of rooms in occupation, and therefore not disinfected 86 Number of cases in relation to which disinfection was refused 23 46 The occupations of the sufferers, so far as could be ascertained, were as follows:— Males— No. of Cases. Artizan 34 Labourer 32 Cabman, coachman, stableman, etc. 21 Clerk 12 Shopman, hawker (5 each) 10 Porter 4 Tailor 3 Farrier, gardener, laundryman, costermonger, omnibus conductor, metal-caster, potman, scavenger, sewerman (2 each) 18 Engineer, lather, butler, baker, handyman, common lodging-house keeper, lead-shot maker, sculleryman, waiter, soldier, potman, window-cleaner, farm bailiff, licensed victualler, cartridge maker, packer, letter sorter, barman, milk-carrier, accountant, solicitor (one each) 21 Children 11 Unknown 46 212 Females (of whom 63 were married) — Laundress 23 Domestic servant 21 Charwoman 10 Dressmaker, tailoress, milliner 5 Governess, nun, hawker (one each) 3 Children 13 No occupation, or occupation unknown 84 159 Grand Total 371 The list of "occupations" of the sufferers shows to what a preponderating extent consumption is a disease of the poorer classes, who are unable to defray the cost of sanatorium treatment. INFANTILE MORTALITY. This question, which formed the subject of special enquiries by the lady inspectors in 1902, and 1903, attracted considerable attention in connexion with the annual report of those officers for 1903, published in my first monthly report for 1904. The question derived increased importance from the public attention drawn to it by a series of four articles published in The Times (September 17 and 22, November 1 and 9), followed by a leading article on 10th November. The writer of the special articles expressed the opinion that— "The unnatural concurrence of a stationary or increasing infantile-mortality with a falling birth-rate, which so seriously threatens the national vitality, finds its true explanation neither in external circumstances nor in the employment of women, but in the habits of the people. Throughout the scale, from mere thoughtlessness to actual murder, the same elements are seen to be at work, and to tend, in varying degrees, towards repudiation of the duties of life, and their subordination to ease, comfort, pleasure, and self-indulgence." 47 The writer did not appear to attach any great importance to " such remedies as creches and municipal supplie s of sterilized milk"— "Far better is the plan adopted by some towns of appointing lady inspectors, who may be reinforced, indefinitely, by voluntary assistants, to pay nursing visits. The mothers are said to welcome the attention and the help, and most of them are found teachable; not only in regard to the details of feeding and nursing—ignorance and neglect of which are the great immediate causes of death—but also in regard to the whole maternal duty. The sense of responsibility is awakened in them, no doubt, by the sympathetic interest taken in their affairs by the visitor. The remedy is not complete, but it is real; and, so far as it goes, it touches the root of the matter, and it illustrates, once more, the value of personal service, which is still the great force in human affairs." The above quotations express, in terms more impressive than any at my command, the considerations which led me, in May, 1900, to report, to the late sanitary authority of Kensington, on the desirability of appointing "Women Health Visitors," a subject dealt with below. "Particulars of Births."—In connexion with the subject of infantile-mortality, reference may be made to an interesting correspondence between the Southwark Borough Council and the Local Government Board, communicated to the several sanitary authorities in November last. The chief difficulty besetting the efforts of sanitary authorities in their endeavours to reduce infantile mortality, arises from ignorance with regard to the occurrence of births. With a view to the removal of this hindrance, the Southwark Council petitioned the Local Government Board "to allow sub-district registrars to supply information as to the locality of births, to the Medical Officer of Health, in the same way as he receives the locality of deaths." The Local Government Board stated, in reply, that they had " already, after communication with the Registrar-General, approve d of an arrangement for the supply to local authorities, by registrars of births and deaths, of particulars as to births within their sub-districts." The value of such information will be by no means inconsiderable; but registration is, as a rule, delayed so long, that " particulars as to births " of infants who die within the first month of life, will not usually reach the Medical Officer of Health any sooner than particulars as to their deaths.* This, at any rate, has been our experience during the period (since January 1st, 1903), that we, in this Borough, have received the particulars as to births which will, henceforth, be accessible to any local authority willing to incur the small cost of the returns. The value of such particulars would be greatly enhanced could registration be made compulsory within, say, seven days after birth. Meantime, efforts are being made to obtain the desired information at the earliest possible date after the birth of children to the poorest classes, through the agency of medical men, registered midwives, district visitors, and others. The importance of early information may be emphasised by the fact that of the deaths of infants under one year in Kensington, in 1902, 35 per cent, occurred within the first four weeks, and 50 per cent, within three months after birth. WOMEN HEALTH VISITORS. In 1900, I recommended the appointment of women to assist in sanitary administration by the performance of duties analogous to those discharged by "Health Visitors" at Manchester, Birmingham, etc., some account of which was set out in my annual report for that year. The Sanitary Committe of the late Vestry reported sympathetically on the subject, as being "deserving of the careful attention of Sanitary Authorities;" but they felt that, having regard to the Vestry's " waning existence," it was "undesirable that any new office should be created." Nevertheless, at the meeting of the Vestry (18th July), on consideration of the Committee's report, there was a strong expression of opinion that action should be taken, forthwith, in the direction recommended by me: ultimately, however, a motion to that effect was negatived. In the first monthly report in 1904, I renewed the proposal when dealing with the question of Infantile Mortality, and the report was referred to the Public Health Committee. In a memorandum submitted to the Committee for their further information, I recommended the appointment of Health Visitors, for work primarily in three of the Northern Wards, St. Charles, Golborne and Norland, the population of which is 72,300—22,180, 26,500, and 23,720, respectively. *Births should be registered within 42 days, and may be registered, without fee, within three months. Of the 243 births chronicled in the twelfth monthly report in 1904, 7 were registered in the first week of life, and 11, 7 and 17 in the second, third and fourth weeks, respectively: total 42. The registrations in the fifth and sixth weeks were 35 and 81 respectively ( = 116). Between the seventh and twelfth weeks inclusive, 85 births were registered. The deaths registered within the same period included twelve within the first month of age, those in the second and third months being seven and three respectively. The numbers of deaths at these ages are far greater in summer, when diarrhoea is prevalent, and during epidemics of other infantile diseases. 48 The deaths under one year of age in these wards, in 1903, were 366: the Infantile Mortalityrate (i.e. the proportion of deaths under one year to 1,000 registered births) being 167; viz., 143, 166, and 190, respectively; compared with 109 in Pembridge, 131 in Holland, 126 in Earl's Court, 57 in Queen's Gate, 97 in Redcliffe, and 66 in Brompton. The rate for the borough as a whole was 143, the London rate being 131. The subject was referred by the Public Health Committee to a sub-committee, for whose further information I supplemented the foregoing particulars of child mortality, showing— 1. That diarrhceal mortality was excessive in the three wards relatively to the other wards. Thus in 1903, out of 74 deaths under one year from this cause, registered between July 12th and December 5th, 67 occurred in North Kensington (population 92,030); 63 of them in the three wards—St. Charles 25, Golborne 20, Norland 18. In 1904, out of 86 deaths under one year from this cause, between June 19th and September 10th, 75 were registered in the three wards—St. Charles 22, Golborne 36 and Norland 17. The population of the three wards being 41 per cent. of that of the borough, as a whole; and their infantile diarrhceal mortality 85 per cent. 2. Of the deaths in the borough from measles, 83 per cent., and of the deaths from whoopingcough, 80 per cent., were registered in the three wards—all with one or two exceptions of children under five years of age. 3. The zymotic death-rate in the three wards was excessive: 2.8 per 1,000 of the population in St. Charles Ward; 3'4 per 1,000 in Golborne, and 2T per 1,000 in Norland; the rate in the remaining six wards ranging downwards, from 1.2 per 1,000 in Pembridge, to 0.8 in Holland and Earl's Court, 0.6 in Redcliffe, 0.2 in Queen's Gate, and zero in Brompton. 4. The notifications of infectious diseases in the three wards (410) were 56 per cent, of the total number; those from the other six wards (328), 44 per cent. only. 5. Of the notifications of consumption, 74 per cent, came from the three wards. 6. The general death-rate of the three wards, in 1903, was 17'8 per 1,000 living (St. Charles 15.2, Golborne 18.0, Norland 20.8); that of the rest of the borough being 10.9 per 1,000. The conditions generally in the three wards were thus obviously such as to justify, and require, a special effort on the part of the health authority to bring about a reduction in the amount of infantile mortality—in other words to continue and extend the work already being carried out by the Lady Inspectors. The specific recommendation made to the Public Health Committee was, that three Health Visitors, with the status of Sanitary Inspector, should be appointed; and the sub-committee reported in favour of this proposal; but ultimately the Public Health Committee presented a report as follows— We have had before us, pursuant to the reference by the Council of the 16th February last, the appendix to the report of the Medical Officer of Health, dated 4th February, 1904, under the heading " Infantile Diarrhceal Mortality, 1903," together with a memorandum on the subject subsequently prepared by that Officer; and having carefully considered as to the steps which should be taken to reduce, as far as possible, the high rate of infantile mortality which does undoubtedly exist in parts of Kensington, we are ot opinion that it is desirable, temporarily to appoint a properly qualified woman to act in the capacity of " Health Visitor," at a salary not exceeding £2 per week, and to circulate leaflets for the guidance of mothers with regard to the feeding, clothing, &c., of young children, and the management of the home. We recommend— That, subject to the submission bv the Finance Committee of the necessary estimate, the proposal as to the temporary appointment of one Health Visitor be acted upon, and that it be referred to us to prepare leaflets, and generally to formulate the details of a scheme to give effect to the new departure. The report was adopted by the Council on the 20th December; a Lady Health Visitor was appointed early in the current year, and a "leaflet" was prepared containing " Advice for the guidance of Mothers on the Feeding and Care of their Babes." 49 MUNICIPAL MILK DEPOTS. There appears to be a growing feeling that municipal authorities should possess discretionary power to establish depots for the sale of pure milk—whether sterilised and "humanised" or not—for the food of babies, with the view of reducing the rate of infantile mortality which is a standing opprobrium and a danger to the community in these days of a constantly declining birth-rate. The subject was dealt with in the tenth monthly report, 1902, which was referred by the Council to the Public Health Committee who, after giving the matter careful consideration, reported 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 was not adopted. In the first monthly report, 1904, the subject was again adverted to in connexion with remarks on infantile diarrhceal mortality, and on the ground that it is practically impossible for poor people to obtain, from existing sources, a regular supply of pure milk for the sustenance of their bottle-fed babies. Liquid milk, it was said, under ordinary circumstances, furnishes an admirable medium for the growth of bacteria, which multiply in it with amazing rapidity. Milk seldom arrives to the consumer before twelve or more hours after the 'milking,' and no adequate measures are taken, as a rule, to keep it cool, at the farm, or on the railway journey. It is liable to be fouled in every stage of its collection and progress; and in poor localities it is stored and vended at places where it becomes exposed to additional pollution; sustaining yet further contamination in the more or less squalid homes of the poor. Condensed milk, on the other hand, is usually heavily and injuriously loaded with sugar, and when exposed to the air suffers bacterial infection. When one reflects on these things, and on the conditions of infant life, generally, amongst the poor; the lack, too often, of maternal care, and the general denial to the babe of its natural food, etc., the wonder is, not that so many infants die, but that so many survive the age of infancy—often only to die, from one cause or another, before attaining the age of five years. It may be asked how can this sacrifice of life be prevented or diminished ? So many children, born weakly or prematurely, hold to life by such a weak thread, that infantile mortality must needs be high, always. But that there are many preventable deaths admits of no doubt, and I am persuaded that the remedies for the evil must be sought in improved homes, better training of girls to fit them for their duties as wives and mothers; and, if mothers cannot be induced to suckle their babes, in a purer milk supply. Probably, for the present, at least, the means last named is the more easily to be attained, and pre-eminently by the institution of " Municipal Milk Depots." But the Local Government Board, so far, have not given authority for provision of these establishments, and dairymen have taken no steps to supply the want, and appear not to be favourably disposed to the adoption of the system by public health authorities. Municipal milk is provided, in London, in one borough only—that of Battersea. The milk is sterilized and sent out in stoppered bottles, each of which contains the exact dose required for a meal; the bottle is not opened until it is wanted, and what milk is not consumed at the time is not given to the infant. This question was considered at the Conference of delegates of the Borough Councils, convened by the London County Council, and held at the County Hall, in July, when the following resolution was unanimously adopted :— "That having regard to the declining birth-rate, and the high rate of infantile-mortality in the Metropolis, it is desirable that the Metropolitan Borough Councils should be empowered, at their discretion, to provide, in their respective districts, depots for the preparation and sale of sterilised and humanised milk for the food of infants, and that the London County Council be requested to insert a clause in their General Powers Bill for the Session of 1905 to confer such power upon the said Borough Councils." 50 The subject is not dealt with in the County Council's General Powers Bill for the current session, but a private Bill is before the House which proposes to confer on the Metropolitan Borough Councils discretionary power to establish milk depots. Without waiting for legislation, however, some of the Borough Councils are considering the desirability of establishing depots in their districts. Meantime, the Government Auditor regularly surcharges the Battersea Council on account of the expenses incurred by them in connection with their depot: but, so far, the Local Government Board, in the exercise of their equitable jurisdiction, have remitted the surcharges made; as I am informed by Dr. McCleary, the Medical Officer of Health, to whom I am indebted for the following observations on the subject which will be read with interest:— "The first surcharge was made at the audit in November, 1902, on account of expenditure incurred during the year ending March 31st, 1902: that is to say, expenditure incurred before the depot was open. We appealed against the surcharge; and, in October, 1903, the Board informed us that they confirmed the auditor's decision but remitted the disallowance. We then appealed to the Local Government Board to allow the expenses, under the Local Authorities Expenses Act, 1887. On February 16th, 1904, we received a letter from the Board declining to sanction the expenditure, so as to withdraw it from the district auditor's jurisdiction. We were again surcharged, on March 30th, 1904, and on April 27th, 1904, the surcharge was remitted in a letter from the Board, a copy of which I enclose herewith." The letter of the Local Government Board, addressed to the Town Clerk and the Accountant of the Council, was as follows:— "I am directed by the Local Government Board to inform you that they have considered your appeal against the surcharge of sums amounting to £320 17s. lid., made by Mr. A. C. Roberts, District Auditor, at his audit for the year ended the 31st March, 1903, of your Accounts, as Clerk and Accountant, respectively, of the Council of the Metropolitan Borough of Battersea, together with his reason for making such surcharge. "The sum in question represents charges in your accounts, in respect of wages and disbursements, in respect of the provision and maintenance of a depot for the sale of sterilised milk; and, as in regard to the surcharge made at the same audit on certain members of the Borough Council who authorised expenditure in connection with the same matter, so, in the present instance, the Board confirm the Auditor's decision as lawful. They are prepared in your case, also, to remit the surcharge in the exercise of the equitable jurisdiction conferred upon them, and a certificate to that effect is enclosed." I think it may be confidently anticipated that in the Parliamentary Session of 1906 this subject will be dealt with, and brought to a satisfactory conclusion, in a General Powers Bill, promoted by the London County Council, should the Bill now before the House fail to pass. Unclean Milk.—The Islington Borough Council, early in the year, communicated to the Metropolitan Borough Councils a report by their Medical Officer of Health on the subject of the London Milk supply, stating that they had addressed a letter to the London County Council suggesting that they should obtain powers to prevent the introduction into the Metropolis of milk containing sediment of a dirty character, and had communicated with the Local Government Board with a view to the better enforcement, outside London, of the Dairies, Cowsheds, and Milkshops Order, and of the regulations made thereunder. They also expressed the opinion that the London County Council might with advantage apply to Parliament for such additional powers as would enable them to inspect dairies, cowsheds and cattle from which milk is supplied to the County of London; or, as an alternative, for powers to prevent the introduction of milk from such districts as do not enforce the aforesaid Order and regulations. The communication was referred to the Public Health Committee, who reported that, whilst in sympathy with the object of the Islington Borough Council, they were not prepared to advise the Council to adopt in their entirety the suggestions put forward; they recommended however, and the Council directed, that " a communication be addressed to the Local Government Board urging them to secure, as far as possible, the better enforcement by the provincial District Councils of the Dairies, Cowsheds, and Milkshops Order, and the regulations made thereunder." In the interests of the public health, action in this direction should assuredly be taken; it being manifest that not sufficient care is taken to protect milk from contamination before it reaches the consumer. 51 MUNICIPAL CRECHES. In the annual report for 1902, when dealing (pp. 60-68) with the subject of infantile mortality, and considering a means for reducing it, I drew attention to the question of day nurseries for the safe keeping of the babes of poor women compelled to earn their living away from home. This subject also was dealt with at the Conference of delegates of the Borough Councils in July, 1904, adverted to in the section on Milk Depots, and a resolution thereon was passed as follows:— "That having regard to the declining birth-rate, and the large infantile mortality-rate of the metropolis, it is desirable that the Metropolitan Borough Councils should be empowered, at their discretion, to establish creches for the reception of young children during the hours their mothers are employed in work away from home, and to make reasonable charges for the accommodation so provided, and for the food of the children; and that the London County Council be requested to insert in their General Powers Bill for the Session of 1905, a clause to confer such power upon the said Borough Councils." In a recent Session of Parliament, a Bill was introduced at the instance of the Acton Urban District Council to confer discretionary power on sanitary authorities to establish creches, the want being very pronounced in that important centre of the laundry industry. Approval of the principle was expressed in the Committee room; but the Bill was thrown out—apparently on the ground that there was no precedent for legislation of the sort. This subject came before the Public Health Committee last year, on a reference by the Council of a letter from the Acton Council suggesting the introduction into Parliament of an Adoptive Act empowering Sanitary Authorities to establish creches. The Committee recommended that a communication be addressed to the London County Council in the sense of the above-quoted resolution of the Conference. The Committee, however, went further, having expressed the Opinion that means should be taken to protect young children from possible danger to health when under the charge of caretakers acting in a private capacity, during the time the mothers are employed at work away from home, and they recommended—"That the London County Council be requested to promote legislation for the amendment of the Infant Life Protection Act, 1897, so as provide for the registration of persons who take charge of young children whilst their mothers are employed away from their homes." The report was adopted. FOOD AND DRUGS ADULTERATION ACTS. The Public Health Committee had before them, in April, on a reference by the Council, a letter from the Board of Agriculture and Fisheries expressing a doubt as to whether, having regard to the variety of articles liable to adulteration, or likely to be sold under false descriptions, the number of samples taken yearly under the " Sale of Food and Drugs Acts" in Kensington, was sufficient to test, adequately, the purity of the food supply of the distiict; and suggesting that the Council might with advantage consider whether they should not cause more samples to be taken in their district. The letter was referred to a Sub-Committee, who were requested to deliberate upon the whole question of the procedure adopted in the taking of samples under the Acts. The scheme submitted by the Sub-Committee, and approved by the Committee, was adopted by the Council, as follows:— 1. The control of fche taking of samples for analysis to be vested as heretofore in the Town Clerk. 2. The Town Clerk to determine, from time to time, in consultation with the Chairman of the Public Health Committee, the Public Analyst, and if deemed necessary the two Inspectors taking the duty for the time being, as to the number and description of the samples to be taken. The Town Clerk will in performing this duty, arrange with the Medical Officer of Health as the head of the Public Health Department, as to the times at which the Inspectors shall be liberated from their other duties for the purpose of taking samples under the Acts, and will also see that effect is given to any direction which, at any time, may be given by the Public Health Committee, as regards the taking of samples of any particular food or drug under the Acts. 3. The Town Clerk will furnish the Public Analyst, from time to time, with a memorandum showing the number and description of the samples which it is proposed should be taken; and to the Inspectors taking the duty, memoranda containing the same particulars, with the addition of a number of addresses at which specified articles are to be purchased. These instructions to the Inspectors will be given in sealed envelopes on the morning of the day on which the samples are to be taken. 52 4. Whilst it is proposed that definite instrutions shall be given the Inspectors as to the premises from which a certain number of purchases shall be made, a reasonable margin of purchases will be left to the discretion of the Inspectors, particularly in regard to the samples of milk, many of which it is desirable should be purchased from men on their rounds in the streets. 5. The general principle will be recognised that, where a sample has proved on analysis to be adulterated, a further sample is to be taken from the vendor thereof. At present no decision has been arrived at for taking an increased number of samples as suggested by the Board of Agriculture and Fisheries. Boric Acid in Milk.—The Council received, and referred to the Public Health Committee a letter from the Camberwell Borough Council, forwarding copy of a report made by their Medical Officer of Health with reference to boric acid in food, intimating that they had requested the Local Government Board to take such steps as might be neccssary in order that a limit should be fixed to the amount of boric acid that might be mixed with food, and asking the Council to take similar action. A joint report dealing with the subject was submitted (14th June) by the Medical Officer of Heath and the Public Analyst as follows:— "With reference to the letter from the Town Clerk of the Borough of Camberwell, enclosing a report of the Medical Officer of Health upon Food Preservatives, referred to us for our observations, we beg to report on the subject as follows: — "The report and recommendations of the Departmental Committee of the Local Government Board have made it perfectly clear that the addition of Boric Acid and its compounds, in any quantities, to milk at any rate, should not be allowed, and that, as regards other foods, the practice, where not prohibited, should only be permitted on condition that full disclosure is made, and that the amount of the adulterant should not exceed specified percentages to be fixed by the Local Government Board, or the Board of Agriculture, for the various foods. "We do not agree with the suggestion contained in the letter from the Town Clerk of Camberwell, that the Local Government Board should be asked to fix a limit of permitted additions of Boric Acid to milk. We think that the recommendations of the Departmental Committee should be supported, and that absolute prohibition should be asked for; i.e., that the recommendations should be made legal regulations. The view we take about the use of antiseptic chemicals in food is, that when the drug is present in sufficient amount to exert its specific effect on the food (i.e., to ' preserve' it—apparently), the chemical and physiological processes involved in digestion and assimilation are of necessity injuriously affected." The Committee endorsed the views expressed in the foregoing report and recommended that a communication be addressed to the Camberwell Borough Council on the lines indicated; and this was done. VACCINATION. The table at page 54 is. a return respecting vaccination in Kensington in 1903, for which I am indebted to Mr. King, the vaccination officer. It shows that out of 3,596 infants, whose births were returned in the "Birth List Sheets" (col. 2), during the year, 3,061 were successfully vaccinated, and that 19 were returned as " insusceptible of vaccination." In 16 cases vaccination was postponed by medical certificate; 279 infants died unvaccinated: in 12 cases infants were removed to other districts, the vaccination officers of which were duly notified of the fict; whilst some 183 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" (25 against 40, 46 and 23 in the preceding three years respectively), equivalent to a "loss" (i.e. cases not finally accounted for) of 5.8 per cent., as compared with the number of births returned in the Birth List Sheets; the loss in the preceding ten years having been 7.7, 8.4, 9.0, 10.1, 10.7, 12.7, 8.1, 6.8, 7.6 and 6.1 per cent. Kensington, in this respect, always compares favourably with the Metropolis, as a whole; for, according to the most recent return, it appears that the '"loss" in the Metropolis in 1901, was 24.1 per cent., as compared with 5.8 per cent. in Kensington. False registration, i.e., fictitious addresses entered in the birth list sheets, largely accounts for the "loss;" the children cannot be traced. 53 The actual figures, showing loss, both for the Metropolis and the rest of England, during the twenty years 1882-1901, as set out in the report of the Local Government Board for 1902-3, are as follows:— Metropolis. Cases lost. Rest of England. Cases lost. Metropolis. Cases lost. Rest of England. Cases lost. 1882 6.6 per cent. 4.5 per cent. 1892 18.4 per cent. 14.3 per cent. 1883 6.5 „ 4.9 „ 1893 18.2 „ 15.7 „ 1884 6.8 „ 5.3 „ 1894 20.6 „ 19.0 „ 1885 7.0 „ 5.5 „ 1895 24.9 „ 19.8 „ 1886 7.8 „ 6.1 „ 1896 26.4 „ 22.3 „ 1887 9.0 „ 6.7 „ 1897 29.1 „ 21.6 „ 1888 10.3 „ 8.2 „ 1898 33.0 „ 19.6 „ 1889 11.6 „ 9.6 „ 1899 27.7 „ 15.4 „ 1890 13.9 „ 10.9 „ 1900 25.8 „ 13.9„ 1891 16.4 „ 12.9 „ 1901 24.1* „ 11.2 „ These figures show both the great increase in annual " loss," from 1882 onward to 1898, and that the new Act, which came into operation in 1899, has brought about a considerable increase in the number of primary vaccinations. The cost to the country has been great, but the Act clearly has justified the policy of the Local Government Board, at whose instance it was introduced. The Board, in their annual report for 1901-2, referring to the vaccination returns for 1899, observed that "the increased acceptance of primary vaccination "—at a time precedent to the last epidemic of smallpox—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 made for the use of glycerinated 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. Vaccination Authority.—The question as to the future vaccination authority was brought to public attention in the early part of 1903, by a deputation of the Imperial Vaccination League to the President of the Local Government Board. The deputation and the President were agreed as to the desirability of transferring the administration of vaccination law from the Boards of Guardians to some other authority. The President, however, did not commit himself as to what that other authority should be; and, with other questions, this one stands in abeyance, pending fresh legislation. Calf Lymph.—The statutory duty of the Local Government Board in respect to the supply of lymph, only requires them to provide for the needs of public vaccinators for primary vaccinations; but the Board in practice provide the lymph required for re-vaccinations also. And this is a necessity; for arm-to-arm vaccination, i.e., the use of humanized lymph, is discouraged, and indeed is now impracticable owing to the abolition, generally, since 1899, of public vaccination stations. The President of the Board informed the deputation referred to in the preceding paragraph, that it would be impossible to supply lymph to all medical men. But having regard to the enormous production of the lymph during the small-pox epidemic in 1901-2, one cannot but think that such a supply as was indicated by the President—50,000 charges a week—equal to 2,600,000 charges a year, would suffice for all requirements. In 1902, public vaccinators made 82,214 applications for calf-lymph, and 962,000 charged capillary tubes were sent out. These officers were accountable for just under 50 percent, of the vaccinations performed in that year at the public expense, and I think it reasonable to assume that the needs of private practitioners would have been amply met by the balance of more than one and a half million tubes. Re-vaccinaiion.—The most pressing need of the time, as regards protective measures against small-pox, is a provision for promoting re-vaccination of children at twelve or thirteen years of age —a time of life at which the protection afforded by infant vaccination is beginning to be, or has been, largely impaired. This question also was dealt with by the deputation to the President of the Local Government Board from the Imperial Vaccination League in 1903. The plan has long been practised in Germany with the result that small-pox amongst the natives of that empire is almost unknown. The President made no revelation of the intentions of the Government, nor, indeed, of his own views, which he thought it more prudent to suppress till the time for action should have come. *This is the percentage for the Metropolis as a whole. In several of the unions the percentage of cases not finally accounted for was exceedingly high : for instance, in Mile End Old Town it was 65 8, in Bethnal Green 518, in Poplar 48 7, in Shoreditch, 44-4, and in Stepney 43-9. 54 Vaccination Officer's Return respecting the Vaccination of Children whose Births were Registered in 1903.* (Vide page 52.) DATE. 1903. Registration Sub-Districts comprised in Vaccination Officer's District 1 Number of Births returned in Birth List Sheets. 2 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. 3 Column II. Column V. Dead, Un vaccinated. 7 Postponement by Medical Certificate. 8 Removed to other Districts and notified to Vaccination Officers of the Districts. 9 Removal to places unknown, or which cannot be reached, and cases not having been found. 10 Total Number of Certificates of Successful Vaccinations received during each of the Calendar Years. Insusceptable of Vaccination. 4 Certificate of Conscientious Objection. 6 1903. 12 1904* 13 1st January to 31st Dec. Kensington Town 3,058 2,610 13 19 246 12 9 148 3,369 3,268 Brompton 538 451 6 6 33 4 3 35 Total 3,596 3,061 19 25 279 16 12 183 3,369 3,268 * The complete Return for 1904 will not be due until February, 1906; but (to February 16th, 1905) it will be seen that 3,268 certificates of successful vaccinations in 1904 had been received 55 Vaccination Law.—Small-pox, almost non-existent in the County of London last year, prevailed, though not to any great extent, in certain parts of the North of England. The town of Dewsbury, in the West Riding of Yorkshire, suffered more, perhaps, than any other locality, and acquired an unenviable notoriety through the ineptitude of its sanitary authority in regard to the means of isolation for the sick, and of its Poor Law authority in regard to vaccination—the guardians having " refused to aid the administration of vaccination, by opening stations at which vaccination and re-vaccination could be performed expeditiously, conveniently, and economically."* But out of evil good came, the Local Government Board, after almost incredible patience, having issued an Order— "Dewsbury (Small-pox Prevention) Order, 1904"—which imposed the administration of vaccination upon the Corporation ; and, furthermore, the Board, by virtue of the powers which they possess under the provisions of sections 130 and 134 of the Public Health Act, 1872, and of the Public Health Act, 1896, issued regulations for the prevention of small-pox, which entitled the Medical Officer of Health to vaccinate and re-vaccinate any person in immediate danger of contracting small-pox, and placed the Corporation under an obligation, forthwith to provide a "vaccination centre" for the performance of vaccination and re-vaccination, and to provide such other "centres" as the Medical Officer might deem necessary. For each such " centre" the Corporation were required to employ a medical practitioner to vaccinate and re-vaccinate; the public vaccinator, however, not being superseded if willing to accept employment under the Corporation. The Order is thus seen to be comprehensive, in regard to the provisions for securing vaccination and re-vaccination, the only means whereby an epidemic can be quickly and effectively brought to a close. "Two special small-pox officers (it may be added) were appointed, one to take charge of the small-pox hospital, and the other to deal with contacts and other matters."+ I refer to the subject to show that the Local Government Board have powers for dealing effectively with a recalcitrant vaccination authority, powers which, in the interests of public health, it is to be desired that they may in future exercise at an earlier date than in the case of Dewsbury, which had been acting for a long time as a centre for the spread of small-pox to other districts. London was by no means uninterested in the matter, a small outbreak of small-pox at Willesden having been attributed to importation of a case from Yorkshire. The action taken by the Local Government Board in this instance is likely to be of historical interest, it being, apparently, the first exercise of their latent and apparently sufficient powers in this regard. THE METROPOLITAN ASYLUMS BOARD. Under the provisions of the (now repealed) Sanitary Act, 1866, the local sanitary authority was endowed with power to provide, for the use of the inhabitants of 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 smallpox 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 was wise, and fruitful of benefit to the entire Metropolis. In 1867 the Metropolitan Poor Act brought the Asylums Board into existence, and this body set to work forthwith 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 the 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 of the advantages 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. 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 power as to leave little to be desired. Details of the work of the Managers as hospital and ambulance authority in respect to infectious disease, are set out in an annual report, which (for 1904) had not been published when this report went to press. * The Lancet, October 29th. † The British Medical Journal, November 12th. 56 AMBULANCE SERVICE. Ambulance Arrangements.—Kensington patients are removed to hospital by the staff at the Western Station, which adjoins the Western Hospital, 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 there 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 application, 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 by anyone, personally, or by letter, or by telegraph, or by telephone. The telegraphic address is " Asylums Board London "; the telephone numbers are 2461, 2462, 2463, 2464, and 2465 " Holborn," and 456 '"'Central." 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, for this purpose. In such a case the vehicle is usually lost sight of before discovery of the nature of the illness, and so does not get disinfected. This is no doubt a danger to the public, but it is of rare occurrence 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 in this respect came to my knowledge last year. Extended Use of the Ambulances.—In October, 1903, the Managers of the Asylums Board decided to allow the free use of their ambulances for the conveyance from the general hospitals to their homes of persons suffering from measles. The question had come before the Board upon an application, from the East Londcn Children's Hospital, that children taken to that institution for treatment in the out-patient department, and found to be suffering from measles, might be conveyed to their homes in the Board's ambulances free of cost, the parents not being in a position to defray the ordinary charge of five shillings. Last year, a similar application with respect to persons suffering from erysipelas, made to the Board by the Secretary-Superintendent of the Middlesex Hospital, received equally favourable consideration, the Managers having resolved, upon the recommendation of the Ambulance Committee, to authorise the Committee to " allow the use of the ambulances for the free conveyance of persons suffering from erysipelas who are not in a position to pay the ordinary charge for the service." The concession, as in the former instance, applies to the case of all general hospitals. Proposed Metropolitan Ambulance Service for the Non-Infectious Sick, etc.— The many references in former reports to the Ambulance Service of the Metropolis, had relation to the conveyance of persons suffering from dangerous infectious diseases to the hospitals of the Asylums Board, or to the conveyance, on payment of a prescribed fee, of persons so suffering, to and from hospitals and places other than hospitals provided by the Managers, as authorised by the Public Health (London) Act, 1891, section 79 (3). But there are other sides to the Ambulance question, one of which was dealt with in a report by the Medical Officer of Health of the London County Council at the latter end of 1902, and in a prefatory note thereto by Sir William J. Collins, Chairman of the Ambulance Sub-Committee of the General Purposes Committee ; that, namely, of the conveyance to hospitals, or elsewhere, of persons seized with illness, or meeting with accidents, in the streets or other public places, a duty hitherto discharged mainly by the police. Consideration of the subject by the Committee arose out of an offer made by a gentleman, in the earlier part of 1901, to " present to the Council an electric ambulance to be used for the conveyance of persons injured in the street." The report of the Committee, dated 8th December, 1902, was considered by the Council, December 16th, when the following resolution was adopted :— " That the course taken by the General Purposes Committee in obtaining information with reference to the ambulance provision in London for dealing with cases of accident or sudden illness in the streets or other public places, be approved; and that it be an instruction to the Committee to report further on the subject." 57 In the first monthly report for 1903 (February 5th), after referring to the proceedings of the County Council in regard to the Street Ambulance service, I dealt with another branch of the subject; that, namely, which concerns persons who, owing to non-infectious illness, or accident, require facilities for conveyance to hospitals, or from house to house. It was pointed out that for the indigent poor requiring to be removed to the parochial infirmaries, the arrangements made by the boards of guardians are fairly satisfactory, but that for sick persons of a higher class, and for private lunacy cases, " needing to be removed from home, or school, or place of business, to a hospital, nursing home, asylum, or any other place, and able to pay a moderate fee for such service, no adequate provisions exists." The need of a service for these classes of cases came before the Metropolitan Asylums Board shortly afterwards, and on March 7th, 1903 they adopted a motion to the effect— " That it be referred to the General Purposes Committee to consider and report on the question of the desirability and practicability, or otherwise, of extending the operations of the Managers' ambulance service so as to include the transport of medical cases and surgical cases and persons of unsound mind ; and—if considered desirable and practicable—to suggest) what steps should be taken to place the Board's ambulances at the service of the public, and upon what terms." The General Purposes Committee, on 16th March, requested the Ambulance Committee to submit to them a report on the question. On the 2nd November this Committee presented their report, in which they set out the steps taken by them to ascertain the views of the Metropolitan Public Health and Poor Law Authorities, and showed that 33 of these bodies would support an application by the Managers to the Local Government Board, for the necessary legal authority to enable them to use their ambulance carriages for the conveyance of non-infectious cases: only 16 of these bodies were adverse to the proposal. The Committee, moreover, having enquired of the secretaries of 33 London hospitals whether it would be of advantage to the public if the Asylums Board were empowered to place ambulance carriages at the. service of the public at moderate charges ? received replies which, with one exception, were emphatically in favour of the proposal. The conclusion at which the Committee arrived was, that an ambulance service for the purposes in question was desirable, and that, " on the grounds of efficiency and economy," it would be advisable for the Board to undertake the proposed work, which it would be practicable for them to do " immediately the necessary legal authority could be obtained." The report, having been approved by the General Purposes Committee, was submitted to the Managers, with a recommendation in favour of the proposals contained therein being adopted ; and on the 28th November the subjoined resolutions were passed:— "That, in the opinion of the Managers, it is desirable and practicable to extend the operations of their ambulance service so as to include the transport of medical, surgical, and mental cases, for which application may from time to time be made by any authority or person within the Metropolis; provided that such extension of the ambulance service shall not be held to include the removal of cases of street accident, nor of patients to and from the several lunatic asylums under the control of the London County Council, unless bv special sanction of the Ambulance Committee, or, in emergency, of the Chairman of that Committee, or the Clerk to the Board." " That, upon the necessary legal authority being obtained for the Managers by the Local Government Board, the work be immediately undertaken, and a charge of 7s. 6d. made in respect of each removal, and, in addition, a mileage of Is. 6d. beyond the boundary of the Metropolis." The resolution was communicated to the Local Government Board forthwith, and it was naturally hoped that power would be obtained in the Parliamentary Session of 1904, to enable the Managers to extend the use of their ambulance service in the direction suggested. But as the question of providing a street ambulance service was known to be receiving consideration at the hands of the General Purposes Committee of the County Council, it appeared to the Local Government Board desirable that the Managers should, in the first instance, place themselves in communication with the Council on the subject. In pursuance of this suggestion, the Asylums Board authorised their Ambulance Committee to seek a conference with the Council, and a proposal to this effect was made in February 1904. Here it may be mentioned, that in May (1904), a deputation, organised by the Metropolitan Street Ambulance Association, waited upon the General Purposes Committee of the Council to urge the necessity for an ambulance service to deal with street accidents and cases of sudden illness occurring in the public thoroughfares ; the Association was of the opinion that the proposed service might be worked in connection with the Fire Brigade. The matter was referred, for inquiry and report, to the Ambulance Sub-Committee. 58 In July, at a Conference of Delegates of the Metropolitan Asylums Board and the Borough Councils, "on the administration of the Public Health (London) Act, 1891," convened by the County Council, and held at the County Hall; the Conference, " taking note that the Asylums Board were prepared to extend the operations of their ambulance service as to include the transport of medical, surgical, and mental cases," resolved, by an unanimous vote, to request the Local Government Board to "obtain for the Managers the requisite legal authority to enable them to do so." The opinion, moreover, was expressed that "should the County Council not be able to provide for a Street Ambulance Service," this duty also "should be undertaken by the Board." In November, the Asylums Board reminded the Council that it was upwards of nine months since their Ambulance Committee had sought a conference with the Council on the question of London's Ambulance Services, and no conference had taken place. Reference was made in this communication to disclosures at recent inquests, from which it was evident that much suffering would have been prevented if the Board's ambulances had been .employed for the removal to hospital of certain injured persons. The disclosures in question " had caused much concern to the Ambulance Committee," who were in a position to undertake the conveyance of accident cases immediately upon the necessary legal authority being obtained. The Committee, regarding the delay as " deplorable," and understanding that the Council were considering the establishment of an ambulance service which would deal with street accidents only, asked to be informed if that were the case, for if it were, they would renew their application to the Local Government Board for the legal authority necessary to enable them to place their ambulances at the disposal of the public, "for the conveyance of mental, medical and surgical cases." The Council, in their reply, expressed the hope that they would be in a position tc confer with the Asylums Board on the subject "shortly after the Christmas recess," which terminated at the end of January 1905. In the last week of that month, the Board wrote to say that they would be glad to know if the Council were then able "to name a date for the proposed conference" ? If not, the Ambulance Committee desired to press for a reply to the question addressed to the Council in November, 1904, namely, " whether the Council was considering the question of establishing an ambulance service which would deal with street accidents only ? " The correspondence was brought to a close by a letter from the Council (28th January, 1905), in which it was stated that " the question of the desirableness of undertaking the provision and management of an ambulance service for the conveyance of street accidents, was still under the consideration of a Committee, and it was hoped that a report would be made to the Council at an early date." The letter continued—"At the present moment, the question of undertaking the conveyance of cases other than those arising from accidents or casualties in the streets was not under consideration ; it would therefore appear that any action which the Council might take would have regard to such different classes of cases to those of mental, medical and surgical patients, with which the Metropolitan Asylums Board intended to deal, that no useful purpose was likely to be served by such conference as had been proposed." All which could have been said just as well eleven months before; the limitation of the Board's scheme having been explained in their first letter to the Council, in February 1904. The Asylums Board, on the 6th February, forwarded a copy of the correspondence to the Local Government Board, and again urged them to "sanction the utilisation of the Managers' ambulances for the conveyance of medical, surgical and mental cases, upon the terms set forth in their letter to the Board, dated 30th November, 1903." The decision of the Local Government Board had not been received by the Managers when this report went to press. It only remains to say that, in the interests of the inhabitants of the Metropolis, it is to be desired that their decision will authorise the Managers to undertake the duty. It is to be hoped, moreover, that the County Council will see their way to establish an efficient street ambulance service, the need for which was strongly urged upon the candidates at the election in 1904, by the Metropolitan Street Ambulance Association. It may be mentioned that the question of an ambulance service for non-infectious cases attracted public attention at the end of 1904, consequent on the appearance in The Times of an article (" The Legal Poor of London "), in which the hope was expressed that those concerned in making provision of the sort would " hasten the completion of such formalities as were necessary for putting into operation a suitable scheme." In a similar article, at the end of 1903, the hope had been expressed that the Asylums Board were " taking steps which would remove from London the reproach of its backwardness, as compared with English provincial towns, in regard to ambulance provision for general medical and surgical cases." As, a month before the publication of the last named article, viz., on 28th November, 1903, the Managers had passed the resolution (cited above). 59 expressive of their willingness to undertake the duty, the Chairman of the Board addressed a letter to The Times (28th December, 1904), in deprecation of any assumption that the delay in the establishment of a complete ambulance service was, in " anyway the result of the Board's apathy or neglectthe Managers being, in fact, " very anxious to do all in their power to relieve the sufferings of the sick and afflicted, and having the means to commence the service immediately the necessary power is given to them." The matter being to all appearance at a standstill, it appeared good to the Council, in February last, to address communications to the Asylums Board and the County Council, intimating the opinion that the "provision of an efficient and adequately equipped ambulance service for London " was a matter of the utmost importance," and urging that " a definite decision should be arrived at in regard to it as soon as practicable." The Managers lost no time in explaining their position —showing that they had been striving for sixteen months to attain the desired object, as regarded medical, surgical, and mental cases. What course the County Council will ultimately adopt remains to be seen. The deputation, in May, 1904, were of the opinion that a Street Ambulance Service could and should be worked in connection with the Fire Brigade; but it has long been known that the Fire Brigade were averse from undertaking the duty; for reasons, doubtless, of weight and validity, and there is ground for believing that it has now been definitely settled that the duty will not be devolved on the Brigade. But how, otherwise, the Council will achieve the purpose to which they are desirous to give effect, is at present unknown. That the difficulty is great may be inferred from the fact that the labours of four years have not sufficed for the attainment of a solution. The simplest course, in my humble opinion, would be to have a single ambulance authority for London, as a whole, the Asylums Board to wit, their experience in such work, for some twenty years, having been on a scale of unparalleled magnitude. Given the necessary legal authority, they could commence operations forthwith. They are, in fact, effecting no inconsiderable number of removals of non-infectious cases at the present time—utilising some of the spare time of their large staff; and, if empowered, would be able, at short notice, to organise a service for street accidents and casualties. That the Managers would do this branch of the work efficiently goes without saying; and surely, it would be the more economical course for the same authority to undertake the other. From motives of delicacy, presumably, the Asylums Board have never put themselves forward as being desirous to provide a street service ; but, in the interests of the public, it is to be wished that they should signify their willingness to do so, and so solve the difficulty, and remove the reproach of London's Municipal Administration. 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; but the Commissioners stated in their Report (1882) that the provision of hospitals should be extended so as to provide 5,100 beds; viz.: 3,000 nominally for " fever," and 2,100* 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 1,240 beds (at the least), beyond the theoretical requirements of the day. But the Commissioners, presumably, desired that provision should be made for a lengthened period in advance, and the amount of accommodation they advised, is even now in excess of the standard requirement, the estimated population being under 4,700,000; but circumstances not then 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 depauperization of medical relief in the hospitals, and the opening of the several institutions to all classes of the people (measures advocated in these reports many years before they formed the 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. 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. *The ordinary provision for small-pox was to be 2,100 beds, but capable of being increased on an emergency to 2,700. 60 I am indebted to Mr. Duncombe Mann, Clerk to the Metropolitan Asylums Board, for the subjoined statement, showing the existing and projected accommodation : it leaves out of consideration the Gore Farm Hospitals (1,850 beds), not now in occupation, and in regard to which no decision has been arrived at as to their future use (but see pages 38 and 39). Return showing the permanent Fever Hospital Accommodation, existing and projected:— (i.) Accommodation existing:— Beds. Eastern Hospital 362 North-Eastern Hospital 600 North-Western Hospital 460 Western Hospital 450 South-Western Hospital 366 Fountain Hospital 402 Grove Hospital 518 Park Hospital 548 Brook Hospital 560 Northern Hospital 752 Total 5,018 (ii.) Accommodation projected— Southern Hospital (now being constructed) 800 South-Eastern Hospital (now being reconstructed) 488 Grand Total 6,296 "For Small-pox Patients the existing accommodation is as follows:— Beds. Long Reach Hospital 300 Orchard Hospital 800 Joyce Green Hospital 940 2,040 It is thus seen that the accommodation far exceeds the theoretical requirement of one bed for each thousand of the population. On that scale London would require not more than 4,700 beds; it has, or soon will have, more than 10,000 beds. THE HOUSING OF THE WORKING CLASSES. (Housing of the Working Classes Act, 1890, Part III.) The Council took an important step, last year, in regard to this important question, by acquiring a considerable number of houses in Kenley Street, Notting Dale, in the exercise of their powers under Part III. and adapting them for occupation by persons of the poorer classes. In view of this new departure, a retrospect of previous proceedings of the Kensington Sanitary Authority in regard to the housing question, may not be out of place. For the purpose of elucidation it is desirable to go back to the meeting of the late Vestry, held 11th March, 1896, when the following resolution was unanimously passed:— " That the several reports which the Medical Officer of Health has submitted to the Vestry relating to the Notting Dale Special Area be referred to a Special Committee for consideration and report, as to whether any steps can be taken by the Vestry, either singly or in conjunction with some other authority, to effect an improvement in the conditions at present prevailing in the district in question." A Special Committee was appointed forthwith, which included the Rev. the Hon. E. C. Glyn, Chairman of the Vestry, Vicar of Kensington, and Rural Dean, and Mr. T. W. Wheeler, Q.C. (the mover of the resolution), who was elected Chairman of the Committee, and subsequently became Chairman of the Vestry. The Committee visited the locality, inspected some of the houses, took evidence, oral and documentary, of the clergy, poor law medical officers, relieving officers, School Board superintendent and attendance officers, the inspector of police for the district, and the County Council inspector of common lodging-houses; and having considered the reports of the medical officer of health, and a report of the Sanitary Committee, dated 14th March, 1893, submitted a report which is printed in the Minutes of the Vestry, 15th July, 1896 (page 257). 61 The report, which was signed by all the members, and was unanimously adopted, embodied a number of recommendations,* some of which were carried into effect. But the Vestry had no power to adopt the course on which the Council have now entered—for practical purposes the most useful course—of acquiring houses for use as lodging-houses ; the power to do this having been at the time vested in the London County Council, as sole local authority under Part III. of the Act of 1890. In 1897, the year of Queen Victoria's Diamond Jubilee, the Vestry appointed a Special Committee to " consider and report what action should be taken to commemorate in the Parish of Kensington " that most auspicious occasion. The Committee thought it desirable to elicit the views of "representative inhabitants," and at a public meeting held at the Town Hall, 15th March, it was unanimously resolved— " To give effect to the loyal feelings of the parishioners by the promotion of a scheme having for its object the amelioration of the condition of the inhabitants of that limited district in the parish to which public attention has for some time been drawn "—the " Notting Dale Special Area," to wit. A representative Committee having been appointed with this object, I took advantage of the opportunity to suggest t the direction in which it appeared to me action might most usefully be taken; viz., by the creation of a Trust, for the acquisition of houses in the several streets, and their adaptation as residences for the working classes. " Any scheme for pulling down the houses," was deprecated on the ground that "the cost would be too great," and that the existing evils would be increased by driving the people into adjoining streets, many of which (as the Special Committee of 1896 had stated) were already overcrowded and degenerating in character. " In order to the raising of the locality," it was stated to be " not necessary to destroy, but only to improve the existing houses, and to enforce the by-laws applicable to registered" premises, and the by-laws for the enactment of which provision is made in Part III. Attention was drawn to the fact that the property " paid its owners well," and that there was "no reason why it should not be made to pay reasonable interest upon any funds invested by Trustees in the purchase of houses; " the contemplated improvements, therefore, might be carried out " at little ultimate cost " to the promoters of the scheme. A further and subsidiary suggestion made was, that some of the houses acquired might be utilised as " relief" houses, into which people could be drafted from " registered" houses, so as to give the owners of such houses vacant possession during the time necessary for the periodical cleansing required by the Vestry's by-laws for houses let in lodgings or occupied by members of more than one family. The opinion was expressed that if rooms in the acquired houses " were let on low terms, the lodgers would find it to their interest to keep them in decent order," whilst the work of the Sanitary Inspector would naturally be " supplemented by the oversight of the person or persons whom the Trustees should appoint as caretakers." The Sanitary Authority and the Trustees having thus done what they could, might (it was hoped), "confidently appeal to the London County Council for their co-operation," which, " if given heartily in the spirit of Part III. . . . should prove effective " in securing the object aimed at—" the provision of suitable homes for the working classes." This hope, as will be seen, was doomed to disappointment. The representative Committee did not entertain the proposals submitted to them, but decided that," in the first instance, their scheme should embrace the provision of a Creche, and club rooms for men and women, and the erection of a People's Hall for entertainments, music, gymnastics and classes "—very excellent things in their way, as " supplementary to the provision of healthy homes for the persons proposed to be benefited." But the scheme was too ambitious, and ultimately the modest sum subscribed was applied to the erection of the Home, in Kenley Street, for Nurses who are now doing good work in North Kensington. The proposals having fallen through, I called attention in more than one report (in 1897), to the powers conferred by Part III. on the "local authority" (the County Council), by the exercise of which they could, " without entailing any great ultimate expense (on the rates) ameliorate the condition of the inhabitants " of Notting Dale. This Part of the Act has for its *The recommendations had reference (inter alia) to the asphalte paving of streets and yards, the trapping of street gullies, the closing of surface sewer ventilating openings, the cleansing of bedding, and the more frequent removal of house refuse. † Monthly Reports, No. 3, page 32, and No. 4, page 47. 62 object precisely what was desiderated—" the provision of suitable lodging-houses for the working classes "; " separate houses, or cottages, whether containing one or several tenements," by the purchase or lease of any lodging-houses already, or subsequently to be, built, or by building on any land acquired or appropriated by them. In the words of Section 69, the County Council could— Erect any buildings suitable for lodging-houses for the working classes; alter, enlarge, repair, and improve the same respectively, and fit up and furnish and supply the same respectively, with all requisite furniture, fittings and conveniences." The general management, regulation, and control of the lodging-houses, established or acquired, vested by Section 61 in the " local authority," enables them to " make such reasonable charges for the tenancy or occupation " of the rooms or houses "as they may determine, by regulations," which, by Section 62, they are empowered to make " for the management, use, and regulation of the lodging-houses." This section, moreover, makes it obligatory on the local authority, " except in the case of a lodging-house which is occupied as a separate dwelling," to make sufficient provision by by-laws for the following purposes:— " For securing that the lodging-houses shall be under the management and control of the officers, servants, or others appointed or employed in that behalf by the local authority; For securing the due separation, at night, of men and boys above eight years old, from women and girls; " For preventing damage, disturbance, interruption and indecent and offensive language and behaviour and nuisances; " For determining the duties of the officers, servants, and others appointed by the local authority." It may be mentioned, in passing, that by Section 63, tenants of the lodging-houses become disqualified for continuing in that capacity by the receipt of parochial relief, " other than relief granted on account only of accident or temporary illness." It was further pointed out that, failing action by the " Representative Committee," or the County Council, there was yet a third course open; the Public Works Loan Commissioners being authorised (by Section 67) to lend money to any " company, society or association established for the purpose of constructing or improving or facilitating or encouraging the construction or improvement of dwellings for the working classes: " any such company, etc., being authorised to acquire land, and " for the purpose of holding such land," if not already a body corporate, was nevertheless, to be " deemed a body corporate with perpetual succession." On the question of "cost," it was observed that "one of the most satisfactory features " of the proposed scheme was, that it might be made " nearly if not quite self-supporting; nay, in good business hands, should produce a profit that might be applied to the extension of it to neighbouring streets, almost as much in need of the benefits it was calculated to confer as the inhabitants of Notting Dale itself." Confidence, moreover, was expressed that " properly gone about by an association, with the powers of the Act behind them," no insuperable difficulty should be experienced in obtaining the houses at their fair market value, plus ten per cent, for compulsory purchase. The suggestion fell flat; no action was taken; but shortly afterwards a philanthropic lady began to acquire houses in the Special Area, and ever since has continued to increase the number, and to let them in tenements to respectable lodgers at moderate but remunerative rents. In other reports—No. 5, page 58, No. 6, page 75, and No. 7, page 86 (1897), evidence was furnished of the deplorable condition of the " Special Area," and the enormous expense entailed upon the ratepapers by reason of the poverty and sickness of the inhabitants, 4,000 in number; only a forty-fourth of the population of the parish, as a whole, though contributing one-fifth of the total admissions to the parochial infirmary. These reports were not without effect, for the Vestry decided to request the County Council to acquire the houses in the five streets constituting the "Special Area," viz., St. Katharine's Road, Sirdar Road, Bangor Street, Crescent Street, and Kenley Street. The Vestry's action was endorsed in memorials* from influential inhabitants, Members of Parliament, the Board of Guardians, and the Ruri-decanal Chapter; but the County Council, through its Housing of the Working Classes Committee, turned a deaf ear to all representations, alleging that the sanitary authority could do all that was necessary to be done by exercising their * The correspondence between the Vestry and the County Council, and the memorials referred to, were published in No. 10 report, 1897, page 118. 63 powers under Section 94 of the Public Health (London) Act, 1891, and enforcing their by-laws for houses let in lodgings. It was to no purpose that the Council were informed that these powers had been exercised, and found ineffectual, as a remedy for the evils so vividly portrayed by the Special Committee of 1896, appointed, as before said, at the instance of the Chairman of the Vestry (now the Lord Bishop of Peterborough), whose interest in the unhappy district—stigmatized in a London daily paper, in January 1893, as a " West-End Avernus"—had been deeply stirred by the harrowing statistics set out in my reports. The County Council having so far failed us, the Vestry subsequently requested them to promote legislation to give the sanitary authorities power to adopt Part III., and to this they consented. Intervention on their part, however, became unneccessary, for the London Government Act, 1899, which brought the Borough Councils into existence, in November 1900, conferred on these authorities the desired power, and gave them the right, subject to certain conditions, to exercise the powers of the County Council, under the then existing Acts, in their respective Boroughs; powers which were subsequently extended by the Housing of the Working Classes Acts, 1900 and 1903. Action of the Borough Council.—The Council lost no time in taking action on this housing question, having, at their meeting on December 19th, 1900, unanimously passed a resolution to the effect— " That a full enquiry and investigation be made into the nature and extent of overcrowding in the Borough, and that a report thereon be presented to the Council, at the earliest possible date, with a view to the speedy adoption of remedial measures, if necessary." The inquiry was set on foot forthwith, and in July 1901, I presented a report,* setting out the results of inspection of upwards of 900 houses in 25 streets; comprising detailed accounts of the mode of occupation, the number of families, and of persons—adults and children—rents of tenements, etc. The Public Health Committee approved the report and submitted it to the Council, in October, with the result that, on the 30th day of that month, the Council, by an unanimous vote, adopted Part III. of the Housing of the Working Classes Act, 1890. A "Housing Sub-Committee" appointed shortly afterwards, held many meetings, devoted much and anxious consideration to the subject, with, for a long time, little or no apparent progress towards the desired end. But, meanwhile, the first Mayor of Kensington, Sir H. S. King, K.C.I.E., M.P., was patiently and secretly devoting himself to the acquisition of the freehold and leasehold interests in a considerable number of houses, and maturing the scheme which, having received the unanimous approval of the Public Health Committee, was adopted by the Council on 16th February, 1904. The Council thus became the landlords of nearly all the houses in Kenley Street, in the Notting Dale Special Area, and of some others in the locality, upon terms which enabled them to provide lodging-houses for a considerable body of the working classes, at reasonable and reduced rents, and with but a small annual charge upon the rates. It is hoped that the Council may see their way gradually to extend this work, on the same lines, until a great body of the working classes, and of the poorer inhabitants of the Royal Borough generally, shall have been provided with healthy and home-like homes on terms which will involve no. loss of self-respect to the tenants, and to the ratepayers no serious burden. It may be allowable to express satisfaction that the scheme adopted by the Council follows on the lines of the recommendations made in 1897, and that my anticipation that schemes of this nature could be carried to a successful issue upon a commercial basis, appears likely to be realised. Subjoined are the " Regulations as to Tenancy" of the Council's houses in Kenley Street. 1. The weekly rent shall-become due on the Saturday in each week and shall be paid by the tenant, on the following Monday, to the authorised collector of the Council, who will call on that day, and will enter in the rent book the amount paid. 2. The tenant shall not assign his agreement, underlet, or take in lodgers, or use his tenement as a shop or workshop, except with the written consent of the Council, and shall not, without such consent, offer any goods or materials for sale or hire therein, or affix thereto any advertisement or notice. * The report is printed as an appendix to my Annual Report for 1901, page 125. 64 3. The tenant shall pay to the Council the cost of replacing any windows broken, or keys lost, and of repairing any other damage done to the tenement, not being ordinary wear and tear, and of clearing the pipes and drains if choked by materials improperly allowed to pass into them. No nails may be driven into the walls except with the permission of the Council. 4. The tenant shall cause the floors, stairs, and windows of every part of his tenement to be thoroughly washed and cleansed at least once in every week, the tenants * to be responsible in alternate weeks for the cleansing of the entrance hall. 5. The tenant shall not beat any carpets or mats in the landings or passages, nor after 10 a.m. on the balconies. 6. The tenant shall not keep any animals, fowls, or pigeons in a manner not approved by the Council. 7. The tenant shall not erect any shed-buildings, or other structure on his tenement. 8. The tenant 6hall place dust and refuse in the bins provided for that purpose, and on the days fixed by the Council for the removal of refuse shall place the bins outside the street door of the house. 9. The tenant shall immediately report to the Medical Officer of Health, at the Town Hall, Kensington, any case of small-pox,chicken-pox, cholera, diphtheria, croup, erysipelas, scarlatina (or scarlet fever), typhus fever, typhoid fever, consumption, measles, or whooping cough, occurring in his tenement; and, if required, shall permit the patient to be removed to a proper hospital. 10. The tenancy may be put an end to (a), by the tenant, on giving one week's previous notice in writing, such notice to expire on a Saturday, (b) by the Council, on giving one week's previous notice in writing, such notice to expire on a Saturday; or, in case of breach of any of these regulations, by notice in writing that the tenancy is put an end to as from the date of the notice. 11. The Council by their officers or agents shall be at liberty to enter the tenement at all reasonable hours of the day to inspect its state of repair, or for any other purpose. 12. Entry into possession by the tenant shall be conclusive that he has accepted these regulations. 13. The tenant shall be liable for any breach of these regulations by any person living in his tenement. Note.—The Council will pay all local rates, property tax, inhabited house tax, and water rate. By-laws for Houses let in Lodgings.—The negotiations with the Local Government Board with reference to the proposed new by-laws, commenced some years ago, have not yet been completed, the result being that no houses were placed on the register in 1904. The number now on the register is 2,050. The existing by-laws, framed in 1885, have worked satisfactorily ; but a need for some modification of them has arisen as the result of decisions of the High Court (King's Bench Division), to the effect that certain by-laws made by the Stepney and the Islington Metropolitan Borough Councils, with regard to the cleansing of houses let in lodgings, are invalid as they do not provide for notice to be given before action is taken. In the first of the cases referred to, Stiles v. Galinski, the appellant was a sanitary inspector of the Stepney Borough Council, and the respondent a landlord within the meaning of the by-laws in force in Stepney as to houses let in lodgings. At the Thames Police Court, on 23rd June, 1903, an information was preferred by the appellant against the respondent, that he, being the landlord of a lodging-house, did not in the first week of April, cause every part of the premises to be cleansed, as required by the by-laws in such case made and provided. In this case the magistrate dismissed the summons. In the second case, Noakes and Noakes v. the Mayor, Aldermen and Councillors of Islington, the appellants were the landlords within the meaning of the by-laws; the information preferred was similar to that in the first case, and the magistrate sitting at the Clerkenwell Police Court convicted the appellants, and fined them 10s. and costs. The Lord Chief Justice, in delivering judgment, in both cases, stated (inter alia) that in his opinion the by-laws were bad, because they did not provide that the persons who were made responsible for seeing that the things were done, should receive the necessary notice. In his opinion, the by-laws, in both cases, required remodelling, with the point of view, not of removing the liability of the landlord, but of giving him notice before subjecting him to penalties. Mr. Justice * Each house comprises two self-contained flats. 65 Wills was of the same opinion with regard to the by-law not providing for notice being given to the persons made responsible. Mr. Justice Kennedy agreed that the by-laws could not be supported for the reasons given by the Lord Chief Justice. The appeal in the first case was dismissed with costs: the appeal in the second case was allowed with costs.* The by-laws which were the subject of the above decisions, were made under section 94 of the Public Health (London) Act, 1891, which provides that every sanitary authority shall make and enforce such by-laws as are therein specified, as to houses let in lodgings. Section 114 of the Act, provides, moreover, that all by-laws made by any sanitary authority under the Act, shall be made subject and according to the provisions with respect to by-laws, contained in sections 182 to 186 of the Public Health Act, 1875 ; and under section 184 of that Act, the by-laws require the approval of the Local Government Board. The Council's by-laws, made by the late Vestry, and approved by the Local Government Board, in 1885, are to the like purport as those above adverted to, but were made under powers conferred by now repealed Acts, the provisions of which were re-enacted in the Act of 1891. They make no provision for notice to be given, as now ruled to be necessary; notice, however, is invariably given; but this fact does not give validity to the particular by-laws. The defect should be cured by amended by-laws as soon as practicable, seeing that notices for the periodical cleansing of houses let in lodgings cannot be enforced, legally, under the by-laws as they now stand. Certain by-laws made by the County Council, ultra vires in the same sense, have been amended so as to conform with the dictum of the Court. 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 28 in number, and contain accommodation for 803 persons. COMMON LODGING-HOUSES. Ward. Name of Keeper. Address of Common Lodging-House. No. of Single Lodgers, for which licensed, in 1904. No. of Double Beds Authorised. Male. Female. Total. Golborne Phipps, William 194, Kensal Road 75 ... 75 ... Norland Boasley, Richd. Thos 21, Bangor Street 24 ... 24 ... „ Do. 23, do. ... 48 48 ... „ Do. 25, do. ... ... ... 10 „ Do. 29, do. „ Phipps, William 18, do. ... 24 24 ... „ Do. 20, do. ... 45 45 ... „ Reynolds, Charles 35, do. 26 ... 26 ... „ Phillips. Thos. Jno. 5, do. 52 ... 52 ... „ Do. 7, do. „ Hankins, George 10, Crescent Street 25 ... 25 ... „ Do. 28, do. ... ... ... 18 „ Do. 30, do. 28 ... 28 ... „ Do. 40, do. ... 25 25 ... „ Phipps, William 25, do. ... 57 57 ... „ Do. 27, do. „ Do. 31. do. ... ... ... 29 „ Do. 33, do. „ Simpson, James 37, Mary Place 26 ... 26 ... „ Do. 35, do. „ Davis, Sagel 66, St, Ann's Road 66 ... 66 ... „ Phipps, William 34 Sirdar Road ... 26 26 ... „ Do. 36, do. 27 ... 27 ... „ Do. 38, do. ... ... ... 11 „ Do. 40, do. ... ... ... 18 „ Campbell, Colin F. 12, St. John's Place ... ... 48 48 ... Holland Redman, John 24, Peel Street 34 ... 34 ... „ Do. 22, do. Twenty-one of the common lodging-houses, with accommodation for 559 persons (152 of them in double beds) are comprised in the " Notting-dale " special area. • A full report of these cases, and of the judgments pronounced by the Court, is set out in my first monthly report for 1904, page 6, together with an account of the Council's by-laws, and the procedure adopted in giving effect to them. 66 THE WORK OF THE LADY INSPECTORS. (Factory and Workshop Act, 1901.) Subjoined will be found the report of the lady inspectors of workshops, workplaces and laundries where women are employed, and the report of the chief sanitary inspector, comprising information which, by section 132 of the Act, is required to be set out in the annual report of the Medical Officer of Health. In connexion with the first-named report.it may be mentioned that it was in Kensington that the services of women were first enlisted in the work of sanitary administration. The seed planted in 1893 has prospered, for already the City of London and 21 of the 29 Borough Councils have appointed women inspectors; and, ere long, it may be anticipated that such appointments will be made in the remaining boroughs; the conference of delegates of the borough councils, convened by the County Council, and held in July last at the County Hall, having passed an unanimous resolution expressive of the opinion "that female inspectors should be employed in each borough." The circumstances under which the first appointments in Kensington came to be made, being probably unknown to the majority of the Council, may be thought deserving of mention. The Factory and Workshop Act, 1891, had transferred to the Health authority certain powers and duties in regard to the supervision of premises where women are employed, previously vested in the factory inspectors; and both in 1891 and 1892, cases of overcrowding had been brought to my attention by Her late Majesty's Superintending Inspector of Workshops. On this account, and, generally, in the discharge of the new duties imposed on the sanitary staff, many visits were made to workshops in the occupation of dressmakers, milliners, and ladies' tailors, especially in South Kensington ; and to laundries in North Kensington, with the result of satisfying me of the necessity for systematic inspection, and that some of the duties involved were of too special and delicate a nature to be properly discharged by male inspectors. The matter was brought to the attention of the Sanitary Authority in a report dated June 26th, 1893, which was referred to the Sanitary Committee, who shortly afterwards recommended the tentative appointment of two ladies to inspect and supervise workshops, workplaces, and laundries where women were employed. The recommendation was adopted in July, and in the following October the first appointments were made, of Miss Deane and Miss Squire, ladies who quickly justified the selection of the Sanitary Authority. With their assistance a register and other forms were settled. One of the first points requiring consideration was that of cubic space. Overcrowding obviously existed in many of the workrooms, but there was no standard for our guidance in dealing with the nuisance. With the approval of the Vestry, air-space was required in the proportion of 250 cubic feet for each worker; an amount subsequently legalised by Section 3 of the Factory and Workshop Act, 1901. Impiovements were effected in many workshops in regard to means of warming and ventilation, cleanliness, sanitary conveniences, etc.; and at the end of the probationary period of six months, the Vestry were so satisfied with the work done, that it was unanimously resolved to renew the appointments of the lady inspectors. Miss Deane, however, was unable to accept re-appointment having been selected by the Home Secretary for appointment as a lady factory inspector, a position which also had been created in 1893. The vacancy thus created was filled by the election of Miss Duncan, a capable inspector, now doing good work at Sydney, New South Wales, in a capacity corresponding to that of factory inspector. The vacancy caused by this lady's retirement, in 1895, was not filled up, much to my regret. In 1896, Miss Squire, having been appointed to the position of factory inspector, was succeeded by Miss de Chaumont, who worked alone for five years. In 1901, I recommended the appointment of a second inspector; the Public Health Committee endorsed the recommendation, and Miss Looker was elected. The status of Sanitary Inspector was conferred on Miss Squire when re-appointed, in 1895, her appointment being confirmed by the Local Government Board, as were those of Miss de Chaumont and Miss Looker. The ladies appointed in 1893, were, on the whole, well, and increasingly well, received by the occupiers of workshops; some of whom, at first, had been disposed to resent a supervision to which they had not been accustomed; for inspection of workshops, prior to 1893, was necessarily infrequent, the factory inspectors being few in number. Whatever difficulties existed were speedily surmounted, and now, not only are the visits of the inspectors received with cordiality, but the occupiers of workshops, having become acquainted with the law, show an increasing willingness to conform to its requirements. Overcrowding, the most frequent cause of complaint at the first going-off, is rarely found now, whilst much has been done to improve sanitary conditions at workshops, and to increase the comfort of workers. 67 In 1901, a new duty, of a cognate character, was undertaken by the lady inspectors— inspection of the kitchens of restaurants and eating-houses, which may be regarded as "workplaces" —an expression not defined in the Act. The results of the inspection were summarised in my first monthly report for 1902, which came under the notice of the Public Health Committee of the County Council, who, in January of that year, had been instructed to "consider and report as to the best means to exercise periodical inspections of restaurants and eating-houses." The Committee expressed the opinion that it would be advisable for the Council to send a copy of their report, and to address a circular letter, to each of the Borough Councils (except Kensington), expressive of the Council's hope that they would cause the kitchens of hotels and restaurants in their districts to be inspected, and exercise their power under the Public Health (London) Act, 1891, for the removal of any insanitary conditions that might be found. This was done, and now such kitchens, in most of the districts, if not in all, are under supervision. The County Council, it may be mentioned, in their General Powers Bill of 1904, made an unsuccessful effort to obtain increased powers for the sanitary authorities in regard to places where food is stored or prepared for sale: such powers, we may be sure, will, sooner or later, be obtained. In the year 1902, the workshops in the Borough having become well-ordered, and requiring less frequent inspection, the Public Health Committee, and the Council, assented to my proposal to employ a portion of the time of the lady inspectors on other duties, of not less importance than those for the discharge of which they had been appointed—to wit, investigations with respect to infantile mortality and consumption, to which references are made in other parts of this report. With this introduction, I submit the report of the lady inspectors, as follows:— " We beg to submit our report for the year 1904, during which 69 new workshops were added to the Register, and 114 were removed therefrom; the net result being a decrease of 46—all in South Kensington. This decrease was chiefly due to discontinuance of dressmakers' and ladies' tailors' businesses, a considerable number of which, opened in Coronation year, ceased to be carried on, owing, apparently, to depression of trade, which further led to an appreciable reduction in the number of ' hands' employed at the registered premises. "The subjoined table summarises particulars of the workshops on the Register at the end of the year, in North Kensington and South Kensington respectively—Holland Park Avenue and High Street, Notting Hill, constituting the dividing line. Workshops, etc. North Kensington. South Kensington. Total for Whole Borough Dressmakers. Laundries. Miscellaneous Total. Dressmakers. Laundries. Miscellaneous. Total. No. on Register 95 300 87 482 303 15 125 443 925 No. of Rooms therein 129 893 116 1,138 552 54 163 769 1,907 "The number of persons employed varies with the period of the year, being, of course, greatest during the ' Season.' It exceeds 10,000. "The several premises were inspected by us with variable frequency, according to the needs and circumstances of individual cases; all complaints, and they were not many, received immediate attention. 68 The businesses carried on at the registered premises are set out in the subjoined list:— Trade or Business. North Kensington. South Kensington. Total in the Borough. Art needlework 1 2 3 Blind-maker 2 2 Blouse-maker 3 3 6 Boot header 1 — 1 ,, closer 2 — 2 Cardboard box maker 1 1 Corset maker 2 3 5 Cracker maker 1 1 Dressmaker and ladies' tailor 93 296 389 Dyer and cleaner 3 4 7 Eyelet hole finisher 1 — 1 Firewood manufacturer 1 — 1 Furrier 2 2 4 Hair wash manufacturer 1 — 1 Hosier 1 1 Lamp shade maker 1 1 2 Laundries (workshop) 240 15 255 „ (factory) 60 — 60 Machinist — 1 1 Mantle maker 4 4 Milliner 3 36 39 Outfitter — 8 3 Photographer 3 10 13 Printer — 2 2 Restaurant and dining room keeper 40 38 78 Silversmith 1 1 Spice merchant 1 — 1 Tailor 20 5 25 Typist — 8 3 Upholsterer 1 9 10 Waistcoat maker 2 2 Wig maker — 1 1 Grand total 482 443 925 "Ventilation and Warming of Workshops.—In several instances we were able to bring about improvements in the ventilation of workrooms, a matter which the Factory and Workshop Act, 1901, places under the control of the Council, and in a considerable number of cases we succeeded by persuasion in effecting improvement with regard to temperature also. This, however, is a matter over which the Council have no direct control, the Act making the factory inspectors responsible in regard to it. Altogether, in only 28 workrooms (compared with 83 in 1903 and 53 in 1902), was our intervention necessary on account of insufficient warming, or of warming effected by the use, in the day time, of open gas burners or gas iron heaters, which impair the purity of the air. The occupiers of the workshops, as a rule, take our suggestions in good part and act on them, but in three cases it became necessary to appeal to H.M. Inspector of Factories, who gladly receives and acts upon our representations. "Sanitary Conveniences.—Our efforts are directed to secure an adequate number, and maintenance of cleanliness, efficient ventilation, and a good supply of water to the conveniences provided for the employees. In the course of the year, defects of one sort or another, were found in 77 instances, compared with 69 in 1903. Three new closets were erected in North Kensington; and one closet, opening directly out of a milliner's workroom, was partitioned off, and separated from the room by a ventilated lobby. Insufficient sanitary accommodation for the number of women clerks employed, was observed at a large establishment, which we regarded as a "workplace"; our intervention resulted in the erection of sixteen additional closets. "Overcrowding.—We had seldom to complain of overcrowding, partly, we think, because the year was not a very prosperous one. But considerable overcrowding was observed at the large "workplace" referred to in the preceding paragraph, which was ultimately discontinued, additional rooms having been allocated to the typists and other clerks; for whose use, morever, a "rest" room was provided. The employees now have at least as much air-space (250 cubic feet each) as the occupants of "workshops" under the provisions of Section 3. "Outworkers.—Little improvement has been manifested in regard to the returns of outworkers, required to be made by the occupiers of workshops, twice in every year. As it is important on public health grounds that the required information should be forthcoming, and apparently hopeless to expect to get it otherwise, we propose in future to apply to the employers of outworkers for the statutory half-yearly lists, due in February and August respectively. 6g "The subjoined table summarises the work of the year in regard to workshops, capable of being expressed in this form. so far as it is North Kensington. Sodth Kensington. Total for Borough. Dressmakers. Laundries. Miscellaneous Total. Dressmakers Laundries. Miscellaneous Total. 1. Workshop inspections 148 520 223 891 893 26 227 1,146 2 037 2. „ re-inspections 25 203 9 237 165 2 85 202 489 8. Workroom inspections 184 2,188 243 2,615 1,550 76 314 1,940 4,555 4. Workrooms found overcrowded 4 1 — 5 12 — 5 17 22 5. ,, insufficiently ventilated 8 10 — 18 16 3 2 21 39 6. ,, in a dirty condition 1 165 3 169 20 — 7 27 196 7. ,, measured; number of 40 18 7 65 121 — 11 132 197 8. Workshops, &c., reported to H.M. Inspector 3 9 3 15 37 — 5 42 57 9. Workshops, &c., reported by H.M. Inspector 4 8 2 14 9 — 1 10 24 10. Workshops, &c., newly discovered and registered 6 2 5 13 49 1 6 56 69 11. Workshops, &c., removed from register . 1 9 3 13 74 7 20 101 114 12. Houses visited for enquiry* 2 — 109 111 45 8 12 60 171 18. Domestic workshops and workplaces inspected 20 18 26 64 40 2 — 42 106 14. Written intimations issued 2 88 5 95 36 — 12 48 143 15. Statutory notices issued — 29 1 30 3 — 6 9 89 16. Sanitary defects remedied :— (a) Additional means of ventilation provided — 3 — 3 8 — 2 10 13 (b) Rooms cleansed and whitewashed 1 181 3 185 9 — 2 11 196 (c) Yards, floors, roofs, &c., repaired 1 61 — 62 1 — 1 2 64 (d) Sanitary conveniences; defects remedied 2 37 12 51 21 5 26 77 (e) Dustbins provided or repaired — 2 1 3 — — 1 1 4 (f) Miscellaneous defects remedied 1 22 — 23 4 — 1 5 28 17. Nuisances reported to Medical Officer oi Health 2 9 4 15 4 4 8 23 18. Cases of overcrowding of workshops abated 4 1 - 5 12 - 5 17 22 19. Workroom cards distributed; Number of 34 — 4 38 116 — 5 121 159 "We may add that, as usual, we kept the public lavatories provided for women under supervision : they are but three in number, two in North Kensington, at Westbourne Grove and Talbot Road respectively, and one in Brompton Road, by the Oratory, which was opened in the course of the year. We likewise kept under observation the accommodation provided at the eleven railway stations in the Royal Borough." 70 WORKSHOPS WHERE MEN ARE EMPLOYED. 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. Men's workshops (i.e. workshops conducted on the system of not employing any woman, young person or child therein) are in a sumewhat different position to those where women are employed, inasmuch as (inter alia) the sections in Part I. of the Act 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. I have received from the Chief Sanitary Inspector the subjoined account of the administration of the Act in relation to men's workshops, in 1904. The businesses carried on at the workshops where men are employed, 752 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 61 38 99 Basket Maker 7 - 7 Blacksmith 16 20 36 Bootmaker 70 39 109 Builder 54 53 107 Cabinet-maker and Joiner 21 20 41 Carver and Gilder 1 5 6 Coach-builder 28 8 36 Cycle Maker 9 11 20 Firewood Manufacturer 17 — 17 French Polisher 1 2 3 Marble Mason 6 2 8 Printer 3 3 6 Saddler 6 10 16 Tailor 41 18 59 Trunk Maker 6 6 12 Umbrella Maker 3 2 5 Undertaker 7 4 11 Upholsterer 11 6 17 Watchmaker 20 20 40 Wig Maker - 12 12 Sundry businesses 50 25 85 Grand Total 438 314 752 The subjoined table dealing with persons of both sexes employed at workshops, &c., is prescribed by the Local Government Board to be inserted in the annual report of the Medical Officer of Health. 71 FACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES AND HOMEWORK. 1.—Inspection. Including Inspections made by Sanitary Inspectors. Premises. Number of Inspections. Written Notices. Prosecutions. Factories (including Factory Laundries) 162 19 — Workshops (Including Workshop Laundries) 3,935 476 — Workplaces 22 2 — Homeworkers' Premises 73 — — Total 4,192 497 — 2.—Defects Found. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. Nuisances under the Public Health (London) Act, 1891 Want of cleanliness 368 368 — — Want of ventilation 52 52 — — Overcrowding 24 24 — — Want of drainage of floors 23 23 — — Other Nuisances 295 295 — — Sanitary accommodations insufficient 18 18 unsuitable or defective 133 133 not separate for sexes 13 13 — — Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouse (S. 101) - - _ Breach of special sanitary requirements for bakehouses (SS. 97 to 100) 11 11 - Failure as regards lists of outworkers (S. 107) 59 — - — Giving out work to be done in premises which are unwholesome (S.108) — — - — infected (S. 110) 9 9 - — Allowing wearing apparel to be made in premises infected by scarlet fever or small-pox (S. 109) - - - - Other Offences — — - — Total 1,005 946 - - * Including those specified in Sections 2, 3, 7 and 8, of the Factory Act as remediable under the Public Health Act. 72 3.—Other Matters. Class. Number. Matters notified to H.M, Inspectors of Factories:— Failure to affix Abstract of the Factory and Action taken in matters referred by H.M. Inspectors as remediable under the Public Health Acts, but not under the Factory Act (S. 5) Workshop Act (S. 133) 57 Notified by H.M. Inspector Reports (of action taken) 16 sent to H.M. Inspectors 12 Other 4 Underground Bakehouses (S. 101):— In use during 1903 95 Certificates granted in 1903 10 in 1904 67 In use at the end of 1904 78 Number of Homework:— Lists. Outworkers. Lists of Outworkers (S. 107):— Lists received 95 599 Address of outworkers forwarded to other Authorities 415 received from other Authorities 151 Wearing Apparel. Other. Homework in unwholesome or infected premises:— Notices prohibiting homework in unwholesome premises (S. 108) — — Cases of infectious disease notified in homeworkers' premises 9 — Orders prohibiting homework in infected premises (S. 110) — — Workshops on the Register (S. 131) at the end of 1904:— Workshop Laundries 255 Workshop Bakehouses 97 Factory Bakehouses 2 Other Workshops 1,189 Total number of workshops on Register 1,543 BAKEHOUSES; RESTAURANT-KITCHENS, ETC. The bakehouses in the Borough, 99 in number, were periodically inspected during the year, with a view to enforcing compliance with the provisions of Sections 97 and 100 of the Factory and Workshop Act. 1901, which re-enacted provisions contained in the several Acts repealed by the consolidating Act. Underground Bakehouses.—The labours of the Sub-Committee of the Public Health Committee with respect to underground bakehouses, commenced in 1902, were prolonged far into 1904. When the Act was passed there were 95 underground premises in use; now there are 78 only, in regard to which the requirements of the Council were fully and satisfactorily carried out. 73 In six cases the business was given up voluntarily, the premises having been converted to other uses; in six cases bakehouses above ground were erected in lieu of unsatisfactory bakehouses underground, whilst in five cases the occupiers decided, for one reason or another, not to apply for the Council's certificate. Great improvements were effected at the certified premises at considerable expense; but the bakers are well pleased with the results; the benefits conferred upon the operatives, moreover, being duly appreciated. It may be doubted whether there is a better set of underground bakehouses than those in Kensington, of which it may be said that they are "suitable" for the purpose, "as regards construction, light, ventilation and in all other respects." All practicable measures should be taken to maintain the several premises in their present satisfactory condition, and to prevent danger to health from contamination of food. Chief among these measures I would place the framing of by-laws for ensuring cleanliness in the conduct of the business—an observation which applies equally to hotel and restaurant-kitchens—a matter dealt with in clauses in the County Council (General Powers) Bill, 1904, that were thrown out. The Bill proposed to make provision with respect to sanitary conveniences, ash-pits, cisterns, drains, and sleeping places. Clause 23 wound up by proposing that, "No actor thing shall be done or permitted in any such room or place {i.e., where food is prepared for sale) likely to expose any such article (of food) to infection or contamination." All the objects contemplated by the Bill could, I think, be secured more effectually by by-laws than by the direct provisions of an Act; and I submit that the precedents established by legislation, with respect to cow-houses, dairies, milkshops, etc., which are under regulation, and in other instances, might be followed with respect to bakehouses, restaurantkitchens, etc., with advantage to the health of the community generally, and the health of the persons employed at these establishments. As respects bakehouses, a proposal with respect to by-laws made by me, in 1881, was endorsed by the late Vestry in that year, and on subsequent occasions when legislative proposals relative to these establishments were before Parliament. The Sub-Committee appointed to deal with underground bakehouses, submitted a report, approved by the Public Health Committee, and adopted by the Council on 17th February, 1903, in which it was pointed out that the "requirements only very indirectly referred to the user of the bakehouse," and that "the question of the necessity for by-laws regulating such user should in (their) opinion receive the attention of the Committee." The Public Health Committee, in presenting the final report on their proceedings with regard to underground bakehouses, 7th June, were pleased to place on record their "appreciation of the valuable assistance rendered to them by the Medical Officer of Health, in connection with their carrying out of the Council's requirements; and especially of the tactful manner in which he had secured the execution of the works necessary to the attainment of the high standard now established throughout Kensington." They were further pleased to bring to the notice of the Council the efficient manner in which the Chief Sanitary Inspector, Mr. Pettit, had supervised the various alterations. In expressing my thanks to the Committee, and the Council, who adopted their report, I desire to signify my entire approval of the work of all the members of the inspectorial staff, and my sense of the valuable assistance rendered by Mr. Sadler, of the Town Clerk's department, who acted as clerk to the Sub-Committee from the inception of their labours in 1902. PUBLIC HEALTH (LONDON) ACT, 1891. {Conference of Delegates of the Metropolitan Borough Councils.) The need of amendments to this Act is recognised, and it was expected that the County Council would have introduced an amending Bill long ere now. 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 by-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— slaughter-houses; with cow-houses and dairies; 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 74 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 proposals for legislation dealing with the points raised have so far been made. Last year, however, the Council convened a Conference of Delegates of the Metropolitan Asylums Board, and of the Metropolitan Borough Councils (twenty-five of which were represented), to consider "the administration of the Public Health (London) Act, 1891." The Conference was held at the County Hall, Spring Gardens. The resolutions adopted, 49 in number, were grouped under the followfng headings:— 1. Housing (1-18).—Homes Let in Lodgings, Underground Rooms, Water Supply, Factories and Workshops, Shops. 2. Food (14-25).—Premises where Food is prepared for sale. Abolition of Private houses, Impection of Meat killed in Private Slaughter-houses, Inspection of Slaughter-houses, Cow-homes, Dairies, Milk Shops and Milk Stores, Registration of Milk Shops, Sale of Milk, Municipal Milk Depots, Sale of Food and Drugs Acts, Cisterns. 3. Prevention of Disease (26-48).—Disinfection, Provision of Laundry, Provision of Permanent Shelter Accommodation, Precautionary Measures against Phthisis, Hospital Accommodation, Offensive Trades, House Refuse, Collection of Fish Offal and other Offensive Trade Refuse, Sanitary Inspection. 4. Miscellaneous (44-49).—Municipal Criches, Smoke Nuisances, Metropolitan Ambulance Service, etc. References to certain of the resolutions will be found under appropriate headings in other parts of this report; it may be convenient, nevertheless, to give here a summary account of those of them which deal with subjects in regard to which the Council have at one time or another taken a somewhat special interest. Thus the Conference, by an unanimous vote, recognising the desirability of provision being made of— (1.)—Sanatoria for Persons suffering from Consumption, &c., for the Metropolis, as a whole, and under one authority, affirmed the view that "the Metropolitan Asylums Board should be such authority." It will be rememberd that the hesitancy of the Board in regard to taking up this work was based on the want of a "general consensus of opinion on the part of the Metropolitan authorities" on the subject. Whatever may have been the state of matters when that resolution was arrived at, in November, 1902, the circumstances, as is shown at large at page 37, are wholly different now. At present, however, the question rests where it was when the Asylums Board, in November, 1903—regarding it as "one of vital and far-reaching importance to the community at large"—applied to the Local Government Board, as "chief health authority of the country," for "some authoritative expression of opinion," before they should be "asked to take any definite action in the matter." To the appeal then made, the Managers have not yet received any reply, despite the fact that the President of the Board had, on more than one occasion, expressed himself as being favourably disposed to the establishment of sanatoria for the open-air treatment of consumptives. (2.)—Ambulance Service.—The Conference "taking note that the Metropolitan Asylums Board are prepared to extend the operations of their ambulance service so as to include the transport of medical, surgical, and mental cases," by an unanimous vote requested the Local Government Board "to obtain for the Managers the requisite legal authority to enable them to do so." The opinion, moreover, was expressed that "should the London County Council not be able to provide for a Street Ambulance Service," this duty also "should be undertaken by the Metropolitan Asylums Board." This subject is more fully dealt with at page 56. (3.)—Municipal Creches.—" Having regard to the declining birth-rate, and the large infantile mortality-rate in the Metropolis," the Conference held it to be "desirable that the Borough Councils should be empowered, at their discretion, to establish creches for the reception of young children during the hours their mothers are employed in work away from home, and to make reasonable charges for the accommodation so provided, and for the food of the children." A resolution was passed requesting the County Council "to insert in a 'General Powers' Bill, a clause to confer such discretionary power upon the Borough Councils." This subject is further dealt with at page 52, (4.)—Municipal Milk Depots—A resolution, in similar terms, was adopted, requesting the County Council to obtain powers to enable the Borough Councils to "provide in their respective districts, depots for the preparation and sale of sterilized and humanised milk for the food of infants," which would be particularly useful in connection with the work of creches. This subject is more fully dealt with at page 49. 75 (5.)—Premises where Food is prepared for sale, etc.—The Conference requested the County Council to insert a clause in their next General Powers Bill providing that no such premises should be used unless certified by the Borough Council to be suitable for the purpose; enabling them to make by-laws for the regulation of the structure of such premises, and by-laws for regulating the conduct of the business carried on thereat—all such by-laws to be enforceable by the Borough Councils. (6.)—Registration of Milkshops.—The Conference requested the County Council to obtain Powers to enable the Borough Councils to refuse registration of premises, and to disregister premises, unfit for the sale of Milk. (7.)—Sale of Food and Drugs Acts.—The Conference resolved that Section 25 of the Act of 1875, and Section 20 of the Act of 1899 "operate to the prejudice of the purchaser and of public health, and should be repealed." The County Council was requested to communicate the resolution to the President of the Local Government Board with a view to legislation. The Board, and the Board of Agriculture also, were asked to take steps to fix a limit as to the amount of boric acid (i.e. free or combined boric acid), or other preservatives, which may be mixed with food other than milk. (8.)—Houses let in Lodgings.—The Conference declared against any rental limit of exemption, and expressed its sense of the importance of an efficient administration of by-laws framed under the provisions of Section 94. (9.)—Offensive Trades.—The Conference expressed the opinion that the business of a marine store dealer, and the business of a fried fish shopkeeper, should be added to the list of offensive trades specified in Section 19. In this connection it may be mentioned that the Kensington Sanitary Authority requested the late Metropolitan Board of Works, in 1883, to schedule the business of a marine store dealer, and that in 1889, the Sanitary Committee of the late Vestry recommended that the business of a fried fish shop keeper also should be added to the list. It was not desired to place any unnecessary impediment in the way of persons carrying on the said businesses; but thai, as nuisance may arise, through carelessness, or otherwise, in the conduct of them, they should be regulated by by-laws. Both of the businesses have been declared by decisions of the High Court to be "offensive trades," and ejusdem generis with certain of the businesses specified in Section 112 of the Public Health Act, 1875, and Section 19 of the Public Health (London) Act, 1891. (10.)—Abolition of Private Slaughter-houses.—The Conference expressed the opinion that the time had come when private slaughter-houses should cease to exist in London, and that all meat should be officially inspected. Among other matters that engaged the attention of the Conference, and in regard to some of which the County Council was requested to promote legislation, the following may be named as having formed the subjects of resolutions:— The desirability of appointing female inspectors in every Borough. The provision of a water supply, and a sink, for the tenants on each floor of a tenement house; cisterns to be restricted to hot-water services and sanitary conveniences. Underground rooms. Standards with regard to provision of sanitary conveniences for persons of different sexes employed in factories, workshops, &c. Inspection of sleeping accommodation in shops where the assistants are boarded-in. Disinfection, and cleansing (by provision of laundries), after infectious disease, without the intervention of a contractor. Disinfection after measles. Shelters for persons unhoused during the disinfection of their rooms after infectious disease. Voluntary notification of, and disinfection after, phthisis. Collection of stable refuse, fish offal, and other offensive trade refuse. Collection of house refuse by the Sanitary Authority only, and removal thereof in properly covered vehicles. Smoke nuisance. Application of Acts to Government property. 76 The Conference, which extended over two days (July 7th and 18th), was opened by the Chairman of the County Council, and ably managed by Mr. Henry Jephson, one of the members for North Kensington, and the Chairman of the Public Health Committee, who presided on both days. SANITARY LEGISLATION. (The London County Council (General Powers) Act, 1904.) This measure, certain clauses of which, in "Part IV.—Sanitary," received much attention in the consideration of the Draft Bill by a special committee of the Council in 1903, became law on the 15th August. The provisions of interest to Sanitary Authorities are contained mainly in that Part. Section 19 enables the Sanitary Authority, at their own expense, to cleanse, purify, or destroy any articles in any house, or part thereof, if in such a filthy or unwholesome condition as to affect or endanger health, or if such purification is requisite to prevent risk of, or to check, infectious disease. The Sanitary Authority will have to compensate the owner if unnecessary damage be done, and reasonably to compensate him for any articles destroyed. Section 20 enables the Sanitary Authority to enforce the cleansing of houses infected with vermin—upon notice in writing to the owner or occupier of a house, or part thereof, requiring him, within a specified period, to cleanse such house or any portion thereof; and, if so required, to remove the wall-paper, and to take such other steps for the purpose of destroying and removing vermin as the case may require. The person on whom the notice is served becomes liable, on summary conviction, to a fine not exceeding ten shillings for every day during which he makes default in complying with the requirements of the notice; and the Sanitary Authority may, after the expiration of the period specified in the notice, do any work required by the notice, and recover all reasonable costs and expenses incurred in so doing from the person making default. Section 21 enacts that section 59 of the Public Health (London) Act, 1891, "shall, for the purposes" of the aforementioned sections 19 and 20, "extend and be applicable to the provision of means" for giving effect to them "as if the said section were re-enacted herein and in terms made applicable thereto." Section 22 enables the Sanitary Authority to require the removal or alteration of sanitary conveniences (urinals, etc.) accessible from any street, if so placed or constructed as to be a nuisance or offensive to public decency. The owner on whom the notice is served, becomes liable, on summary conviction—for failure to comply therewith within a reasonable time—to a fine not exceeding five pounds, and to a further fine not exceeding twenty shillings a day for continued default after such conviction. Section 23 enables the Sanitary Authority to enforce the removal of a fixed ash-pit where a moveable ash-pit, "conforming with the requirements of any by-law or order made under any statutory power or authority in that behalf," shall have been provided. Fine, on summary conviction, for default in complying with the notice within the prescribed period, not exceeding twenty-shillings, and a further penalty not exceeding ten shillings a day, for continued default after such conviction. The Sanitary Authority may, if they think fit, bear part or all of any reasonable costs and expenses incurred in executing work under this Section. Section 24 gives the Sanitary Authority power of entry if they have reasonable cause to suppose any house, or part thereof, contains filthy, dangerous, or unwholesome articles, requiring to be purified (Section 19), or is "infested with vermin" (Section 20). It also gives power of entry to any house, premises, etc., for the purpose of examining whether there is any contravention of the provisions of this Part of the Act, or any non-compliance with the requirements of any notice given thereunder. Section 48 enacts that any pecuniary penalty inflicted, in consequence of proceedings taken by a Sanitary Authority against any person, in respect of any offence under "Part VIII. (Icecreams)" of the County Council's (General Powers) Act, 1902, shall be payable and paid to such Sanitary Authority. Part V. of the Act, dealing with "Tuberculosis of the Udder in Cows," enables the County Council's veterinary surgeon to cause any cow suspected by him to be suffering from that disease, to be removed from any dairy farm, or cowshed, situate in the County, and—after valuation, with a view to settling the amount of compensation payable to the owner—to be slaughtered. 77 Among "Miscellaneous Provisions," mention may be made of Section 49, which enables the Council of any Metropolitan Borough to cause trees to be planted in any highway within their Borough, to maintain any trees planted, or to be planted, and to erect and maintain guards, or fences, for the protection of the same, subject to certain provisos. The foregoing provisions are to be enforced by the Sanitary Authority (Section 25). Various expressions used in the Act are interpreted in Section 26. Several matters dealt with in the Biil find no place in the Act, having been withdrawn or rejected: e.g., the proposal to give power to the County Council to make by-laws as to the paving and drainage of stables, and the prohibition of sorting or sifting of house refuse by hand. It is to be regretted that the proposal to enable the County Council to make by-laws with respect to the structure of premises within the County where food is prepared for sale, and for the regulation of the conduct and the business carried on at bakehouses, restauraunts, &c., did not meet with acceptance. With respect to restaurant-kitchens, and places generally where food is prepared for sale, the provisions of sub-sections (2) and (4) of section 101 of the Factory and Workshop Act, might with advantage, be made to apply, so that, after a given date, places (in the Metropolis), where food is prepared for sale, should not be used "unless certified by the District Council to be suitable for that purpose," and that any such place should "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." By-laws would naturally make provision for periodical cleansing, painting, limewashing, etc., of the premises where food is prepared for sale, and for the daily cleansing, removal of refuse, etc., necessary for the maintenance of good sanitary conditions, and to prevent contamination of food. They would also give the sanitary authority the right of entry to all such places which the Council's officers now possess with regard to bakehouses. THE WORK OF THE SANITARY INSPECTORS. The Sanitary Inspecting Staff comprises a chief inspector, ten male inspectors, and two lady inspectors of workshops, workplaces and laundrieswhere women are employed. The table at page 78 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, 18901903, and the Factory and Workshop Act, 1901, etc. Supervision of underground work, reconstruction and trapping of drains, having been up to the end of the year exercised by the Borough Engineer, 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, after 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. Written Intimations of nuisances were served by the inspectors to the number of 2,306. As a result of these intimations, many works of sanitary amendment were carried out forthwith, thus realising the intention of the legislature, and obviating, in many instances, the necessity for service of statutory notices. On 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 an extension of the time specified for carrying out works. statutory Notices for the abatement of nuisances to the number of 611, were issued by direction of the Committee; and 992 notices under the by-laws for houses let in lodgings. legal Proceedings.--In ten cases proceedings were instituted: in four instances, for offences under the by-laws for registered houses, the fines inflicted amounting to £5 2s. 6d.; in one case for failure to remove manure periodically, the fine inflicted being £1 2s. 6d.; and in five cases for non-compliance with the Council's notices, orders being made in four cases, the other case being withdrawn. The fines in all amounted to £6 5s. Od. Summary of the Work of the Sanitary Inspectors during the Year 1904. (See page 77.) 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 Public Health Committee. Notices served under the Lodging-Houses 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-house. Licensed Slaughter-houses. No. I. District 105 879 2,388 336 77 48 10 178 88 83 18 238 — 2 64 57 2 100 — — 97 8 7 87 — — 1 No. II. ,, 109 1,271 2,263 374 152 203 86 531 118 829 15 188 225 82 161 34 15 112 4 — 192 22 9 36 — 2 2 No. III. ,, 58 691 2,513 218 76 207 40 217 75 35 12 55 11 9 89 18 1 20 2 — 50 6 6 39 1 1 2 No. IV ,, 91 747 1,785 309 74 71 17 138 84 87 4 69 2 8 84 6 1 16 1 — 82 7 16 48 — 1 2 No. V. ,, 71 1,025 1,182 243 24 20 7 125 82 14 — 56 25 — 9 5 — 8 — — 16 — 18 38 — — — No. VI ,, 92 770 2,096 177 49 67 22 121 88 71 11 89 18 6 4 5 7 6 — — 24 4 10 22 — 2 8 No. VII ,, 97 939 1,395 160 43 99 80 120 118 40 25 70 42 17 6 85 1 81 1 — 48 — 7 22 — 4 — No. VIII ,, 88 982 1,649 119 18 78 10 108 66 51 2 38 22 6 21 16 3 17 — — 25 4 8 17 — 1 — No. IX. ,, 91 963 1,926 278 57 162 14 181 84 44 7 146 65 8 21 14 18 49 — — 75 1 16 25 — — — No. X. „ 48 746 1,335 92 41 47 18 87 48 45 16 71 18 5 8 3 — 7 — — 20 8 7 17 — 1 — 845 9,013 18,532 2,306 611 992 199 1,756 786 749 105 965 418 98 367 193 43 866 8 — 579 60 99 291 1 12 10 * Under the provisions of sec. 3 Public Health (London) Act, 1891. † Done under the supervision of a Special Officer. ‡ The total number of houses on the Register in December, 1904, in round figures, was 2,050, vide page 64, 78 79 OFFENSIVE BUSINESSES. The only business coming within 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 sanitary 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 the 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 names of the licensees, and the localities of the premises, are as follows: — North Kensington. Lonsdale Mews Mr. Grove. 13, Archer Mews Mr. Bawcombe. 10, Edenham Mews Mr. Goddard. 195, Clarendon Road Mrs. Simmons. 235, Walmer Road Mrs. Van. 273, Kensal Road Mr. Miles South Kensington. 35, Earl's Court Road Mr. Matson. 21, Peel Place, Silver Street Mr. Osborne. 25, Silver Street Mr. Wright. 133, High Street, Notting Hill Mr. Candy. 113, Holland Park Avenue Mr. Holloway. 128, Marlborough Road Mr. Little. The number of slaughter-houses in the administrative county has undergone a considerable diminution; viz., from 1,500 in 1874 to 333 in 1904. 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 bring about the substitution of public for private slaughter-houses. The report of the Committee (21st July, 1898), containing the recommendation, was shelved—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 by the County Council. The Conference of Delegates of the Borough Councils (referred to at page 74) adopted, unanimously, a resolution on the subject of slaughter-houses as follows:—" That the time has arrived when private slaughter-houses should cease to exist in London." LICENSED COW-HOUSE. One-cow house, in North Kensington, was licensed by the County Council in October for the keeping of three cows. The licensee is Mr. Arnsby, and the premises are located at 187, Walmer Road. 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 administrative county: viz., from 1,044 in 1880, to 261 in 1904. The County Council intimated to cowkeepers, some years 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 the condition if they think fit. Dairies Order.—The Council, as Local Authority for the registration of milkshops, etc., received last year 6 applications for registration. At the close of the year 291 premises were on the register. The several premises are regularly inspected. At many small general provision shops milk is sold in small quantity, usually from a glazed earthenware vessel standing on the 80 counter, and mainly for the convenience of customers; but also in self-defence, lest customers should be induced to transfer their general dealings to other shops where this necessary article of diet can be obtained. The containing vessels at these little shops are kept clean; but the air of the premises is far from "pure;" the commonly prevailing odour being that of mineral oil, or of 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 things; but the Local Authority appear to have no power to refuse registration to would-be vendors of milk. Fried-Fish Shop Business.—In connection with proposed amendments to the Public Health (London) Act, 1891, elsewhere referred to (page 75), 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 gives rise to nuisance when carried on negligently, without necessary precautions to prevent the escape of effluvia, and it is a not infrequent subject of complaint; decided cases, moreover, class it as an " offensive business." The several premises are kept under observation. The Conference of Delegates of the Borough Councils held in July last (vide page 75), adopted a resolution (No. 36) with regard' to fried-fish shops as follows:—"That the business of a fried-fish shopkeeper should be added to the list of offensive businesses specified in Section 19 of the Public Health (London) Act, 1891." 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 offensive smells, and has been held by the Court of Appeal to be ejusdem generis with the businesses originally scheduled as "offensive" 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, 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. The Conference of Delegates of the Borough Councils held in July last (vide page 75), adopted a resolution (No. 35) with regard to marine stores as follows:—" That the business of a marine store dealer should be added to the list of offensive businesses specified in Section 19 of the Public Health (London) Act, 1891." The County Council were requested to make Orders to carry out the resolntions, 35 and 36. REFUSE. 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 oversigxit of the dusting gangs, the arrangements being under the supervision of the Borough Engineer, subject to the control of the Works Committee. 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 usually unsatisfactory, the receptacles being placed in unsuitable positions: complaints are common. In some instances, the Works Committee have made arrangements for clearing the receptacles more often than once a week. Nuisance from house refuse does not arise from ashes, the proper contents of the receptacle, but from the addition thereto of matters of organic origin. An interesting question arose last year with respect to the storage of house refuse at stables in a mews. The rooms were let independently of the stables: there was no suitable place for standing dust-bins, and the occupiers of the stables refused to allow the refuse to be deposited in the manure cages. The Public Health Committee, having viewed the mews, solved the difficulty by erecting a public receptacle for the common use of the inhabitants. 81 Removal of House Refuse.—In the annual report for 1903, reference was made to the views on this subject of a Conference of delegates of the Metropolitan Borough Councils, held in 1900, a resolution having been adopted that "house refuse should be removed daily when practicable." The Public Health Committee of the County Council subsequently stated the reasons which, in their judgment, made removal at frequent intervals necessary. They did not think it practicable to make a by-law requiring a universal daily collection, but thought a bi-weekly removal should be made compulsory. A by-law to this effect was drafted and submitted to the several Borough Councils for their observations, pursuant to section 114 of the Public Health (London) Act, 1891; but the proposal did not meet with a favourable reception, and no further action was taken in the matter. The subject was dealt with, again, at the Conference of delegates of the Borough Councils held at the County Hall in July last—to which reference has already been made, and the following resolution thereon was adopted: — " That the daily removal of house refuse in suitable districts is advisable." The Conference passed other resolutions relative to house refuse, as follows : — "That dust collection should be carried out by the responsible officers of the sanitary authority without the intervention of a contractor; "That improved dust carts should be adopted, so covered as to minimise annoyance caused to passers-by during collection of house-refuse, especially in crowded thoroughfares; and "That the method of destruction of house-refuse by fire should be universally adopted in London." . Removal of Offensive Trade and. Other Refuse.—At the Conference above adverted to, the delegates of the Borough Councils adopted a resolution to the effect— "That the collection of ash offal and other offensive trade refuse should be undertaken by the Sanitary Authorities at the expense of the producers." In the preceding month of June, the County Council, upon the recommendation of the Public Health Committee, decided to apply to Parliament, in the Session of 1905, for powers— "Enabling sanitary authorities to undertake, if they think fit, the collection and removal of offensive trade refuse; and empowering them to require payment of a reasonable sum by the owner or occupier of any premises from which such refuse is removed." The matter, however, is not dealt with in the Council's General Powers Bill now before Parliament. In the annual report for 1903, the history of this question of removal of refuse matters was given at length, it having been dealt with on many occasions in these reports, more especially in and since the year 1887, when the late Metropolitan Board of Works first took it into consideration. Nuisance From Stable Refuse.—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 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 the 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, made a new by-law in 1901, requiring removal of this description of refuse under the conditions applicable to the removal of offensive matter generally. But nuisance will not cease so long as peat refuse, on removal from stables, is placed in a fixed receptacle, from which it must needs be transferred to the carriage provided for its conveyance through the streets. Intolerable stink arises in the turning over of the refuse, and the only remedy, long practised in the borough, is by the immediate deposit of it in the vehicle in which removal is to be effected. I fear, however, that nuisance in connection with peat refuse will never be wholly prevented until sanitary authorities shall have obtained power, and be required, to remove stable refuse 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 * About 1,600 stables in the Borough have been provided with these iron cage receptacles; whilst upwards of 700 brick receptacles above ground, and nearly 600 sunken pits have been abolished in the mews, which are not far short of 200 in number. 82 owner; 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. The law obviously requires amendment. FLOODING OF BASEMENTS OF HOUSES. In March, 1904, I reported the completion of the Lots Road Pumping Station—a costly and even splendid piece of work, carried out by the County Council at the'riverside at Chelsea; designed for the prevention of flooding of basements of houses, on occasion of heavy rainfall in the district of North Kensington, etc., drained by the Counter's-creek sewer and its affluents. I remarked that the County Council did not appear to be sanguine as to the sufficiency of the new works, judging from a report by their Main Drainage Committee (4th February, 1904), on further "proposed relief works," as follows:— "The floodings in North Kensington have been very severe, the reason being that there is a storm overflow from the middle level Bewer to the Counter's-creek sewer, but instead of this storm water being carried by a special sewer, it reaches the Counter's-creek sewer by going through a number of local sewers. All the floodings occur on each side of these local sewers, and as it is obvious that these latter become surcharged very quickly, a new 6torm water sewer ought to be constructed from the middle level sewer near Netting Hill to the Counter's-creek sewer. The total cost of constructing such a sewer is estimated at £20,000." The report was adopted. In August, I had to report that a considerable number of houses had been flooded, on July 25th, in streets at North Kensington; to wit, South Row (Kensal District), St. Mark's Road, St. George's Road, Silchester Road, Talbot Grove, Clarendon Road, Bomore Road, Lancaster Road, Cornwall Road, Ladbroke Grove, Basing Road, Colville Road, and Elgin Crescent. The only street in the southern division of the borough known to have been affected on the day in question, was Russell Road. There had been two separate storms of no very great intensity, and of no long duration; the first between 7 and 8 p.m., at the time of low water, when the contents of the Counter's-creek sewer would flow by gravitation into the Thames, and the second and more severe one, between 10 and 11 p.m., when the storm water and sewage had to be pumped into the river. Flooding of houses occurred in connection with both storms in some streets; but only on the occurrence of one storm in other streets. The chief engineer of the London County Council informed me that "the first engine on the Counter's-creek sewer at Lots Road Station was started at 10.20 p.m., the second at 10.45, and a third at 10.50." He added that "the greatest height of water on invert at the pumping station was 9 ft. 6 in., at 11 p.m., which represents the sewer flowing just full. The first engine was stopped at 12.50 a.m., the second at 2.20 a.m., and the third at 4 a.m., on the 26th July." The engineer, when I wrote to him for information, on the 30th July, "was not aware that there had been any floodings" in Kensington, and requested to be informed of the streets that suffered, as he was "anxious to see whether this flooding will be relieved by the proposed storm-water sewer between the Middle Level and Counter's-creek." When sending the desired information, I inquired "whether these floodings would be prevented by the proposed new sewer ?" to which he replied that he "certainly anticipated" that relief would be afforded to the neighbourhood of the streets affected; and as "no complaints" had been received from either Hammersmith or Fulham "it would appear that pumping at Lots Road had relieved those districts." With respect to the "Proposed Relief Works," and having regard to the apparent insufficiency —not to say inefficiency—of the Lots Road Pumping Station to preserve the North Kensington Districts from the floodings, so dangerous to health, so disastrous to property, and the cause of grievous inconvenience to the residents in many streets, I expressed the hope, when reporting on the subject in August, that there would be no long delay in constructing the sewer, and suggested the desirability of an inquiry being made, and that the County Council be urged to give immediate effect to the approved recommendation of their Main Drainage Committee. And in November I had the satisfaction of reporting that the Council had accepted a tender "for the construction of a relief sewer from Cornwall Road, Notting Hill, to Upper Addison 83 Gardens," at the sum of £30,713 8s. 7d., the total estimated cost being £32,000, which will raise the expenditure on local "Relief Works" (including the cost of Lots Road Pumping Station) to nearly £100,000. "The proposed sewer forms part of the scheme for the construction of additional sewers and pumping stations for the purpose of relieving the main sewers of storm water;" the estimated cost of which, as originally submitted, was £795,000. It is to be hoped that the new sewer, plus the pumping station, may prove effectual for the purpose and justify the large expenditure entailed upon the ratepayers. SEWER SMELLS. As was to be expected, having regard to the high temperatures prevalent for many weeks in the summer, numerous complaints were received of offensive smells proceeding from untrapped street gullies and sewer ventilating openings at street level, which, having been brought to the attention of the Public Health Committee, were referred to the Works Committee for abatement of the nuisance. In this connexion, I had occasion, in July, to report to the Public Health Committee that the large ventilating grating over the Counter's-creek sewer adjacent to the Warwick Road entrance to the Earl's Court Exhibition, so often the subject of complaint, and which had been closed at the request of the Council had been temporarily re-opened, but had had to be closed again on speedy recurrence of complaints. It may be mentioned that the Standing Orders of the late Vestry with respect to the sewer smells, made, in 1897, on the recommendation of the "Works and Sanitary" Committee (after reference to the "Law and Parliamentary" Committee), and never abrogated, are as follows:— "Gullies.—(a) That offensive street gullies be efficiently trapped. (b) That all new gullies to be constructed in the parish be pan-gullies with syphon-trapped outlets. (c) That the County Council be requested to trap with syphon-traps all offensive gullies on the main line sewers. "Sewer Ventilators.- In cases where complaints are made of nuisance, or annoyance is caused by offensive smells from sewer ventilators, efforts are to be made to obtain consent for the fixing of shafts up adjacent houses, and where such consent is obtained, the objectionable ventilators are to be abolished." The Committee were of opinion that it was "most desirable . . . that action should be taken to secure a more efficient and less offensive mode of ventilating the sewers of the Metropolis," than by open street gratings. At the date of the reports of the two Committees, there were about 6,400 untrapped gullies in the Borough, liable to emit offensive smells, and a large number of sewer ventilating grids at street level. In reporting on the subject, in August last, I observed that it would be interesting to know how many of these have been dealt with during the seven vears that had elapsed since 1897. ? Whilst not underrating the difficulties involved in the efficient ventilation of the sewers, I saw no reason why the proposed palliatives should not be adopted in all practicable positions, subject to the necessary consents, and recommended the erection of lofty ventilating columns, at suitable sites, such as the County Council have provided for the purpose on their main line sewers. The street gullies being so much nearer to houses, and so much more numerous, should be dealt with on a large, not to say wholesale, scale, as I had observed, many years ago, when pointing out that the entire number could be trapped at a less cost than had been incurred in the paving with wood of a single street—Cromwell Road. No action was taken. Reference having been made to the proceedings of the "Law and Parliamentary" Committee in relation to this subject, it may be well to recall the views of that body, as set out in a report,* printed in the minutes of the late Vestry, 6th October, 1897, page 399. The report was as follows "Your Sub-Committee have had before them the correspondence between the Vestry and the London County Council on this subject, and the report of the Medical Officer of Health on offensive smells in streets. They have also considered the various sections in different Acts of Parliament bearing on the same subject, and advise the Committee that, as to gullies, traps, and ventilators of sewers, the property of the Vestry, there is a clear liability upon the Vestry in respect of nuisance arising therefrom. *The Committee had appointed a Sub-Committee consisting of Mr. (now Councillor) Craies, Mr. (now Councillor) Whitaker Thompson and Mr. R. C. Glen to consider the matter, whose report they deemed of "sufficient importance" to be snbmitted in its entirety to the Sanitary Authority. 84 "It must not be forgotten that the duty to cleanse every prating or gully in a street (except in streets cleansed by the Council), whether the gratings and gullies belong to the Council or the Vestry, is by the London County Council (General Powers) Act, 1894, transferred to the Vestry. "As to sewers vested in the London County Council, the obligation 'to cover and keep so as not to be a nuisance or injurious to health,' is upon the Council, under section 135 of the Act of 1855. "Power is given to the Vestry, (but only with the consent of and after notice to the Council), to prevent effluvia from exhaling from main sewers, and in respect of these London County Council sewers, we advise that the London County Council are liable for nuisance occasioned by smells, and not the Vestry. " We recommend that the Works and Sanitary Committee be informed— "1. That they are bound to prevent the Vestry sowers, gully holes, and traps from being a nuisance, and must take all precautions to avoid the same, otherwise the Vestry may be liable at the suit of anyone showing injury, or the Vestry may be ordered to comply with their statutory duty by mandamus. "With regard to the London County Council sewers, the Vestry may, upon a flagrant case of nuisance being proved, through the Attorney-General proceed against the London County Council by information, or in the alternative, apply for a mandamus to compel the Council to comply with Section 135 above referred to. "It has been suggested that a Council sewer (looking to the width of the definition clause) may come within the term 'premises' in Section 2 of the Act of 1891; but, without giving a contrary opinion, we consider that a recent decision leaves it in considerable doubt whether the nuisance section in this Act alters or adds anything to the previous law as to sewers. "Before taking action against the Council, the Works Committee would probably recommend that a further communication be addressed to the Council, pointing out the gravity of the nuisance, and the obligation the Vestrv feel themselves under to protect residents by any means which they may be advised are available. " All which is submitted." The foregoing report was made on the reference by the Works and Sanitary Committee adverted to. This Committee, subsequently presented the report containing the recommendations above set out, dealing with the trapping of street gullies and the abolition of surface sewer ventilators. The report, which was adopted, was printed in the minutes of the Vestry, 6th October, 1897, page 530; having been made "pursuant to the reference by the Vestry of the 22nd September," of certain "recommendations embodied in the ninth report of the Medical Officer of Health, dated 16th September, 1897." The subject is deserving of the careful consideration of the Council, so little, relatively, having been accomplished by way of giving effect to the recommendations of the late Sanitary Authority, the importance and value of which do not admit of question. Bead. Ends of Sewers.—In the twelfth report, 1904 (page 173) reference was made to what is considered to be a main cause of offensive smells in streets: viz., the existence of "dead (unventilated) ends of sewers—a subject on which I had reported in the annual report for 1874 (page 43), and on other occasions; notably in the annual report for 1898 (pp. 106-118), in connection with a discussion on the ventilation of sewers, a question then engaging the attention of the Sanitary Committee of the late Vestry. The question cropped up again in December last, in connexion with a communication from the Lewisham Borough Council forwarding a report by their Borough Engineer on the subject of sewer ventilation, which was referred to the Public Health Committee and the Works Committee for consideration, the upshot being that that good might result from a Conference of the set out in the Lewisham communication, thought each Committee, whilst dissenting from the views Metropolitan Borough Councils, for consideration of the whole question of sewer ventilation. The Council approved the suggestion, and the County Council was approached; but there was no Conference. 85 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 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. The subject is one deserving of further attention, and having regard to the large interests involved, it would seem desirable that the Borough Councils should take joint action to promote legislation, as the County Council will take no further action in the matter, and the Local Government Board do not seem inclined to deal with it. The subject was brought to the attention of the Sanitary Authorities last year, by the Battersea Borough Council, who stated that the President of the Board had expressed the opinion that it was unnecessary to trouble a proposed deputation to wait upon him with regard to it. In accordance with the suggestion of the Battersea Council, and upon the recommendation of the Public Health Committee, the Council addressed a communication to the Board, pointing out that, owing to the present unsatisfactory state of the law with regard to combined drainage, the Borough Councils throughout the Metropolis are now frequently called upon to carry out, at the public expense, works of reparation and reconstruction tending solely to improve the private property of the individual owner, at a great and constantly increasing cost to the ratepayers, and urging him to do all in his power to remedy, by early legislation, the injustice at present suffered. Supervision of Re-Construction and Repair of House Drains.—The Council made an important new departure last year, in regard to this matter, by adopting a report of the Public Health Committee, dated 13th December, as follows:— " We have had before us the subject of the supervision of drainage works executed under statutory notice, and having referred the same to a Sub-Committee for consideration, have received a report, dated 6th December, from such Sub-Committee, as follows:— "We have had before us, pursuant to the reference by your Committee of the 15th ultimo, the question as to the supervision of drainage works executed under statutory notice, and after careful consideration have decided to recommend— "That in the case of all ordinary statutory notices to abate nuisances, the supervision of all sanitary works to be executed thereunder, be left in the hands of the Public Health Department; and where such works entail a reconstruction, or material alteration, of the drainage system, all plans and sections required to indicate the work to be done under the statutory notice shall be submitted to the Borough Engineer for his inspection and approval, and for the purpose of the necessary record, and that, in special cases, such as combined drains or complicated blocks of flats, the question of supervision be referred to the Public Health Committee. "In submitting the above recommendation, we are fully alive to the necessity which exists for fixing the responsibility for the due supervision of the various works upon the heads of the respective departments, and for an adequate check being instituted upon the officers actually carrying out such supervision; and we therefore suggest that it should be made clear that the Medical Officer of Health, as head of his department, should be responsible, in cases where works are supervised by the Public Health Department, in the same manner as the Borough Engineer accepts responsibility for works executed under his department; and that Mr. Pettit, the Chief Sanitary Inspector, should check the work of the Sanitary Inspectors, where necessary, in the same way that Mr Hill, the Chief Drainage Inspector, controls the work of the staff under him." 86 The Committee recommended that the instruction passed by the Council in this matter, on the 27th October, 1903, be rescinded, and that the procedure suggested in the foregoing report be adopted. The new order of things came into operation in January, last. The Council's practice in regard to the matter is now in line with the practice in vogue in the Metropolis generally. SMOKE NUISANCE. In a few instances complaints were made of nuisance from emission of black smoke—by the London County Council, private persons, and the Sanitary Inspectors. Cautionary letters were addressed to the occupiers of the premises to which the complaints related. No further proceedings became necessary. It will be remembered that Sections 23 and 24 of the Public Health (London) Act, 1891, apply only to the emission of "black" smoke. Several complaints were made by the occupiers of private houses of annoyance from smoke from chimneys of adjacent business premises drifting in through their open windows; but in no case was the smoke "black," and we had, therefore, no power to deal with the matter which in one sense of the expression, is an undoubted and really serious nuisance. SANITARY CONVENIENCES. There are only 19 public urinals in the borough—an inadequate provision; supplemented, however, 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 two sets of public water closets, for the male sex only, situated, respectively, at the rear of the central public library, Kensington High Street; and at Lancaster Road, adjoining the public library; and three for both sexes, viz.: at Brompton Road, by the Oratory; at the west end of Westbourne Grove, and at Talbot Road. Sanitary authorities have power (under 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." 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. An interesting question was raised last year as to the right of a beer-house keeper to make an opening through a wall abutting on the street, to give access to a sanitary convenience (urinal) he was desirous of erecting for the convenience of his customers, and the avoidance of nuisance committed against the said wall and the flank of his house. The matter is dealt with in the Public Health (London) Act, Section 45 (2), which reads as follows:—"No public . . sanitary convenience shall be erected in or accessible from any street without the consent in writing of the sanitary authority. . ." It is also dealt with in the London County Council's (General Powers) Act, 1904 (Section 22). Mr. Macmorran in his book on the firstnamed Act, says that the sub-section "applies only to public conveniences erected by private persons." The last-named Act deals with the case of any sanitary convenience "now or hereafter erected which is so placed or constructed as to be a nuisance or offensive to public decency." The Public Health Committee viewed the premises, and intimated to the proprietor that they were not "prepared to approve the plan (submitted) so long as an entrance was shown from the public thoroughfare." Objection had been raised to the proposed erection by inhabitants of the street. The occupier's position was rather a hard one, if it is correct, as stated, that the justices required him to provide a convenience as a condition of his license. Some rather nice questions of law seem to be involved in this matter, and I do not offer any opinion on them. It only remains to be said that the landlord erected the convenience, but at the present writing, has not opened it for the use of the public. Domestic Sanitary Conveniences.—The 26 th 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 Council's bylaws 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. 87 Separate Sanitary Conveniences for Persons of each Sex.— 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; but no standard of requirement has been made as regards London. The Home Secretary, however, has issued an Order prescribing the amount of accommodation to be provided in extra-Metropolitan factories and workshops. This subject was dealt with by the delegates of the Metropolitan Borough Councils at the Conference in July last, a resolution having been passed recommending certain standards which it was thought desirable that the sanitary authorities should adopt in enforcing the provisions of the Section. The more satisfactory course would be to obtain an Order from the Home Secretary applicable to the Metropolis. THE PAVING OF YARDS. The paving of yards is one of the matters dealt with in the Council's by-laws, the tenth by-law 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, probably, more would be done, 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. HYGIENIC STREET PAVING. The question of the paving of carriageways, was dealt with, some twelve years since, by the Surveyor to the defunct Holborn District Board of Works, in a paper read before the Society of Arts. 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 noiselessness, 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 ont acquainted with thtt 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 would have for its justification the admirable virtue of economy. Some progress has been made in this direction by the paving of streets in poor localities where traffic is small; particularly in streets 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. I have reported on this subject to the Public Health Committee on several occasions, and particularly on January 26th, 1904, when certain streets were named as being suitable for asphalte paving when they should stand in need of extensive repairs, viz.: — West Mall. Uxbridge Street. Buckingham Terrace. Southam Street (in part). Edenham Street. Calderon Place. Snarsgate Street. Park Street, Latimer Road. Fenelon Road. Kenway Road and North Row. St. Mark's Grove. South Street and North Street. Seymour Place, Fulham Road. The Public Health Committee viewed certain of these streets on 29th January, 1904, and recommended: (1) That the paving of West Mall be deferred until the rebuilding of the premises on the north side thereof shall have been completed; (2) That the Works Committee be recommended to make provision in the estimates for 1904-5 for the paving of Uxbridge Street, Fenelon Road, Buckingham Terrace, and Kenway Road, when those thoroughfares should be in 88 need of extensive repairs; (3) That no action be taken at the (then) present time in the direction, of recommending the paving of Southam Street, Calderon Place, Park Street (Latimer Road), Edenham Street, or Snarsgate Street. The Committee were unable to view St. Mark's Grove, South Street, North Street, and Seymour Place (Fulham Road); but they expressed the hope that the Works Committee might see their way to view the same, and, if they thought it desirable, to give directions for provision to be made, in the estimates for 1904-5, for those streets being paved with asphalte,should extensive repairs be needed thereto. The Works Committee deferred for six months consideration of the recommendations of the Public Health Committee with reference to the eight streets above named, and on 19th September resolved to postpone action with reference to the paving of the said streets until the Council should have manufactured its own clinkerasphalte blocks in connexion with the Destructor of house-refuse. The Council's destructor will shortly be brought into use, and should the manufacture of clinker-asphalte blocks be as successful as the Borough Engineer anticipates, it is to be presumed that extensive paving works of a hygienic character will ere long be initiated. Work for the Unemployed.—In December, when the outcry for work by the unemployed was most pressing, I invited attention (in the twelfth four-weekly report) to this question of asphaltepaving as affording the means of providing a considerable amount of employment; recalling the recommendations I had made in a report to the Public Health Committee in January, 1903, of certain streets as being suitable for the purpose. The streets named are of moderate length, the traffic over them not great, and they are much used as playgrounds by the children of the inhabitants. The report which was approved by the Committee was referred by them to the Works Committee The Borough Engineer (who had reported in favour of asphalte-paving of streets in suitable localities, as an economical as well as a hygienic course to be adopted), further recommended the asphaltepaving of additional streets at a total estimated cost of about £5,200. The Works Committee reported recommending that no action be taken in the matter. In the report of January 26th, 1904, I renewed the recommendation for the paving of the same and other streets—with what result has been explained above. At the meeting on December 20th, 1904, a deputation of the unemployed waited upon the Council to request (inter alia) that with a view to finding work, Golborne Road, Bosworth Road, Adair Road, Southam Street, Appleford Road and Edenham Street should be paved with asphalte forthwith. The streets were viewed on 19th December, but the only one recommended to be paved, at an early suitable opportunity ,was Snarsgate Street, and this work will soon be put in hand. Ventilation of Sewers.—At the same meeting I recommended for the abatement of offensive smells, in streets, viz., by improving ventilation of sewers, a further means of finding work for the unemployed to wit the abolition of dead-ends of sewers, about 300 in number, but no action has hitherto been taken in that direction (see further on this subject, page 84.) PUBLIC BATHS AND WASH-HOUSES. The washers in the year ended 31st March, 1905, were 71,448, compared with 71,709 in the preceding twelve months; the bathers 104,913 (males 81,544, females 23,369) compared with 94,050 in 1903-4. The total of males includes pupil teachers 390 (males 159, females 231), members of evening continuation classes 2,731 (males 1,577, females 1,154), school children 9,795 (males 2,569, females 7,226), and 958 members of a boys' club. I can only repeat here what has been remarked in many previous reports, that for the majority of parishoners the site of the establishment is not sufficiently central for bathers, and is too remote for would-be washers. The same objection would apply to any single site in the borough. What is wanted 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, 1897. This Act 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 made by the late Vestry 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—an unsatisfactory arrangement which is still in force. Little use has been made of the apparatus, owing, probably, to ignorance of the arrangement on the part of the poor intended to be benefited; and probably, to some extent, owing to the locality and owner- 89 ship of the apparatus. The Act is practically a dead letter, save in the Boroughs of St. Marylebone and St. Pancras, where, proper equipments having been provided, several thousand cleansing operations are carried out in the course of the year; much to the comfort, doubtless, of dirty and verminous persons, who, in St. Marylebone, come, for the most part, from an adjacent Salvation Army Shelter. UNDERGROUND ROOMS ILLEGALLY OCCUPIED. In a number of instances rooms "underground" were found to be illegally occupied. The illegal occupation was in each case discontinued on the service of a written intimation or a statutory notice. NUISANCE FROM GAS WORKS. Complaints were occasionally received of nuisance from the gas works at Kensal Green—a subject that was fully dealt within the annual report for 1894 (page 166). There can be no doubt as to the genuineness of the complaints, which receive confirmation from Willesden, the inhabitants of that district suffering when Kensington people have no ground for complaint, and vice versd; the incidence of nuisance varying with change in the direction of the wind. That the cause of nuisance is more or less under 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 an 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 of disinfecting and cleansing of bedding, clothing, ate. The cost of this work has largely increased since the Act came into operation, in 1892; the amount expended in 1904 was £746, 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 1904 some 19,533 articles were dealt with, of an aggregate weight of 41 tons 4 cwt, -whilst eight hundred and eighty-three rooms, in 786 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 houses, or the owners of clothing, bedding, etc. I append a statement of the monthly cost of this work in 1904, which is irrespective of the wages of the disinfecting officer. £ a. d. January 57 8 8 February 52 8 10 March 59 8 10 April 46 1 0 May 86 17 8 June 71 1 10 July 71 12 0 August 59 6 7 September 57 5 8 October 73 9 1 November 64 6 11 December 47 0 3 In previous reports an opinion was expressed that the expenditure on disinfection might, possibly, be reduced, were the work done without the intervention of a contractor: this opinion will be subjected to the test of experience, when the Council's station at Wood Lane, Shepherd's Bush, shall have been built and brought into operation. *In the report for 1893 (pp. 215-217), under the heading "Duties of the Sanitary Authority with respect to Disinfection," I explained the state of the law, and described the late Vestry's practice in regard to the matter. 90 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 the housing of poor persons during the time necessary for the disinfection of their rooms after infectious isease. The need for this provision is shown by the fact that last year 58 cases of infectious disease occurred in families in occupation of three rooms ; 116 cases in families occupying two rooms, and 23 cases in families herded in single rooms. Of the sufferers in families occupying single rooms, 11 had scarlet fever, and 12 had diphtheria. The subjoined statement, now brought up to date, was originally prepared for the information of the Public Health Committee when considering the question of providing a shelter, in regard to which no action has been taken hitherto. Cases of Infectious Disease which occurred in Tenements of less than Four Rooms, During the Years 1894-1904. 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 1903 70 167 40 277 1904 58 116 23 197 Totals in 11 years 1,566 2,499 800 4,865 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 1903 — 19 16 — 5 40 1904 — 11 12 — — 23 Totals in 11 years 30 414 255 2 99 800 91 As stated in preceding reports, the only satisfactory way of dealing with this matter would be to erect and equip a shelter which could be "most economically done in connection with a disinfecting station." The Council, however, have decided, rightly, I think, that the depot at Wood Lane, where the disinfecting station is about to be erected, is not a suitable situation for a shelter. I recommended the Wharf at Kensal Road, as a suitable and convenient site for the disinfecting station and a shelter, as well as for carrying out the provisions of the Cleansing of Persons Act, all under a single management, but the recommendation did not commend itself to the Council. PUBLIC MORTUARY. Bodies were deposited at the Mortuary during the year to the number of 334, upon applications as follows:— 1. At the request of the relatives of the deceased ... 2. At the request of undertakers, mainly at the instance of the relieving officers 117 3. At the request of the coroner (inquest cases):— Cases of sudden death 118 Cases of violent death 60 4. Brought in by the Police Found dead 23 178 Accident cases 5 5. On laccount of death due to infectious disease ... 28 3 334 In 90 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 which it becomes necessary to hold inquests, are removed to Paddington for the purpose. A communication was addressed to the London County Council, in January, 1902, calling attention to the desirability of steps being taken to secure the adjustment of boundaries of the coroners' districts, so that every borough should be wholly situated in one of such districts. The matter remains in statu quo; but it is to be presumed that the desired re-arrangement of the districts will be taken in hand ere long. People sometimes complain of the improper detention at the homes of the poor, of the bodies of deceased relatives, on the supposition that the Council possess power to remove bodies to the public mortuary at will. 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 (e) 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, and be buried within the time limited by the justice." Many of the cases of improper deposit of dead bodies in living rooms, occur in connexion with removals for private burial from the borough infirmary. 92 CHAPEL OF REST FOR THE DEAD. With a view to correct the evil dealt with in the preceding paragraph, I recommended (No. 3 report, 29th March, 1902) the provision of a mortuary chapel at North Kensington. The grounds for this recommendation were fully set out in the annual report for 1902, page 124. The Council, upon the advice of the Public Health Committee, adopted the recommendation; and also my further proposal to place the building at the south-east corner of Avondale Park adjacent to the park keeper's residence. The building has now been completed, at a total cost of about £1,300. It comprises a mortuary chapel, two waiting rooms for mourners, suitably furnished, sanitary conveniences, etc. It was opened in June, and at the end of the year 26 bodies had been deposited. Regulations were framed for the management of the Chapel, which is under the care of the park superintendent, as follows:— 1. Application for permission to deposit a body in the Chapel shall be made to the Custodian, at the Lodge, Avondale Park. 2. A body may be deposited between the hours of eight o'clock in the morning and eight o'clock in the evening. 3. A body, except in case of emergency, shall be enclosed before admittance to the Chapel in a pitched shell or coffin. 4. Every person depositing a body shall enter the necessary particulars, or furnish the information for entry, in a book kept for that purpose, and shall sign the book. 5. Every person for the time being employed in depositing a body in the Chapel, or in removing a body therefrom, shall, while so employed, conduct himself in all respects with decency and propriety. 6. A body having been brought to the Chapel, shall not be removed therefrom, except for burial. 7. Should any shell or coffin sent with a body prove to be in a defective condition, a sound and larger shell (in which the defective shell can be enclosed) must, on notice, be supplied to abate the nuisance. 8. When the body is in an offensive condition from decomposition or other causes, the coffin must be filled in with a disinfecting powder, and screwed down, before admittance to the Chapel, and the coffin shall not be re-opened without the consent of the Medical Officer of Health. 9. It 6hall be the duty of the Medical Officer of Health to give notice to the person responsible, in order to secure the immediate burial of a body when, from decomposition or other causes, it shall be considered necessary on grounds of public health. 10. Every person who has caused a body to be deposited in the Chapel shall cause the body to be removed therefrom, for the purpose of burial, within a period not exceeding six days from the date of death. 11. In any case when a body has been deposited in the Chapel, and the relatives or friends of the deceased person shall, after notice in writing, refuse or neglect to remove such body for burial in accordance with these regulations, notice shall be given to the Relieving Officer, and the body handed over for burial to the Guardians of the Poor, who may recover the expense incurred by them, in a summary manner, from any person legally liable to pay the expense of such burial. 12. A body shall be removed from the Chapel in a decent and proper manner, enclosed in a pitched shell or coffin, and the person removing the body shall sign an acknowledgment of the receipt thereof, in a book provided for the purpose. 13. A body may be viewed by relatives or friends between the hours of eight o'clock in the morning and eight o'clock in the evening. 14. Every person who, being a friend or relative of one whose body has been deposited in the Chapel, has been admitted to view the bodv, shall conduct himself in all respects with decency and propriety. 15. No large assemblage of persons shall be allowed within the Chapel on the admission or removal of a body. The only persons to be admitted shall consist of the relatives and friends of the deceased, the undertaker, and the bearers of the body. 93 16. It shall be the duty of the Custodian to see that these regulations are duly complied with. It may be mentioned that the body of a person who had died from any of the following diseases; viz., diphtheria or membranous croup, erysipelas, puerperal fever, scarlet fever, small-pox, typhoid fever, or typhus fever; or on which an inquest is to be held, would not be admitted to the Chapel: provision for such cases is made at the Mortuary, in the Churchyard adjacent to the Town Hall, Kensington High Street. It only remains to hope that, by the combined influence of ministers of religion, medical men, district visitors, the Poor-Law and Sanitary Authorities, etc., the people may be induced to avail themselves of the accommodation provided for their benefit, and for the reverent care of the dead, and so put some limit to a state of things inimical to health, and, from a social point of view, scandalous. CREMATION. In the report for 1902, reference was made to the passing of the Cremation Act, 1902, described as "an Act for the burning of Human Remains, and to enable Burial Authorities to establish Crematoria." The Act, the provisions of which were summarised in the preceding report, came into operation 1st April, 1903. It imposes on the Secretary of State the duty of making regulations, "prescribing in what cases, and under what conditions, the burning . . . may take place . . . and the forms of the notices, certificates and declarations to be given or made before any such burning is permitted to take place." A Departmental Committee appointed to consider the subject reported that the point they had considered of "prime importance," was, to "frame regulations which, whilst 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 Burial Authorities and others proposing to "run" a crematorium. It is not to be expected that the practice of cremation will make rapid progress in this conservative 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 combined districts. DESTITUTION AND SICKNESS There was a widespread apprehension in the autumn of 1904 that the coming winter would witness a large accession to the numbers of the unemployed, which would entail a considerable strain upon the resources of the Metropolitan Boards of Guardians. In view of this contingency, the President of the Local Government Board—who had "received from many sources numerous suggestions as to the measures which might be taken" in the circumstances; and "although he was not himself disposed to take any pessimistic view of the situation"—had thought that "some advantage might accrue if a Conference of Guardians were to take place at the Offices of the Board, at which any practical proposals which the Guardians might wish to lay before him, might be discussed and considered." Mr. Long therefore invited the several Boards to appoint delegates to meet him on the 14th October. This matter was referred to in my tenth report, because, in the event of the gloomy anticipations being realised, there certainly would have been a considerable increase to the number of the sick in need of medical relief at the parochial infirmaries, with consequent, and probably a great, strain on those establishments. Matters, happily, did not turn out so badly as had been feared; partly by reason of the steps taken by individual 'Borough Councils to find work for the local unemployed, and partly by reason of the work found for many others by the Joint Committee of Public Health and Poor Law authorities, formed at the request of the President. Over fifty thousand pounds was subscribed by the public in aid of the proceedings of the Committee, whose meetings were held at the Mansion House. In my twelfth report I suggested two directions in which work might be found locally for a not inconsiderable number of skilled and unskilled unemployed persons, viz., in the ventilation of the dead ends of sewers (some 300 in number), and in the asphalte-paving of certain roads, to which references are made at page 88. 94 CONVEYANCE OF THE CARCASES OF DEAD HORSES ALONG PUBLIC STREETS. Many years ago I called attention to the distressing spectacle presented by the removal of dead horses through the streets, usually in unsuitable carriages, the head of the animal hanging out at the back, near to the ground, and sometimes dripping blood. This sad sight it may be hoped will be seen no more in London, the County Council having exercised their power under Section 54 of their General Powers Act, 1903, and framed a by-law dealing with the matter, which having been approved by the Local Government Board, is now in force, and reads as follows:— "By-Law with respect to the mode of conveying the carcases of dead horses through and along public streets in the County of London.—Any person who shall convey the carcase of a dead horse through or along a public street in the County of London, shall use for such purpose a vehicle constructed and closed in such manner that such carcase shall be completely concealed from public view, and the body of such vehicle shall be made of or lined with impervious material so as to prevent any liquid or discharge from the said carcase escaping from such vehicle. "He shall so convey such carcase along the public streets with all reasonable dispatch, and so as to prevent any nuisance arising therefrom. "Any person who shall offend against this by-law shall be liable for each breach of such by-law to a penalty of forty shillings. " This by-law shall not extend to the City of London." Section 55a of the Act in question places the duty of enforcing the by-law upon the Metropolitan Borough Councils. WATER SUPPLY. The Water Bill introduced in the Session of 1902, became law, and in conformity with the provisions of the Act, a representative "Water Board" has taken over the undertakings of the several waterworks companies. With respect to the supply by the three companies (Chelsea, Grand Junction, and West Middlesex) which serve Kensington, there has been no complaint on the score of quantity; but the Council's Public Analyst has not been able to report so favourably as could be desired with regard to the quality of the water. No complaints on the subject were received by the Council, and certainly there was no evidence forthcoming of injury to health from the use of the water. Constant supply has long been given in all parts of the borough. What policy the Water Board will adopt in regard to the duties devolved upon them by the legislature, remains to be seen; it is to be hoped, in any case, that they will find means of avoiding the practice of cutting-off the supply to houses for non-payment of rates—a practice which, happily, has for some years been largely on the decline, consequent on remonstrances addressed to the companies by the late Vestry, at my instance, and by other public bodies. Water Supply of Tenement Houses.—Under date 7th February of the present year, the County Council addressed a communication to the Metropolitan Borough Councils calling their attention to a decision by a Metropolitan police magistrate, as the result of proceedings taken, in December last, by the Woolwich Borough Council, with regard to the water supply of a three-storeyed tenement house, having six rooms occupied by five families, and supplied with water from a stand-pipe in a yard approached from the rear of the premises. The Borough Council had served the owner of the premises with a statutory notice requiring him to provide a water supply to the first and second floors of the house, with properly fitted stoneware sinks and trapped waste-pipes to discharge over the yard gully. The magistrate ruled that the stand-pipe in the yard was not a "proper and sufficient supply of water" within the meaning of Section 48 of the Public Health (London) Act, 1891, and that there should be a separate supply to each floor: an order made to abate the nuisance was carried out. The decision in the particular case may be regarded as reasonable, but I fear the Public Health Committee of the County Council adopted too broad a generalisation in assuming that it might be regarded as a sufficient substitute for the legislation which the Council had resolved to promote—to enable sanitary authorities to require a supply of water to the tenants of each floor in tenemented houses—although the Parliamentary Committee had advised that it was by no means clear that the present law was not sufficient to meet the case. 95 The magisterial decision is not without interest, but it is not binding upon any other court of summary jurisdiction; it remains to be seen, moreover, whether it will be followed by other magistrates, should other Borough Councils adopt the advice of the County Council, and "take all possible steps to secure the provision of a proper and sufficient supply of water for the tenants of every floor of a tenemented house," under Section 48. I am in agreement with the Public Health Committee of the County Council as to the inadequacy of the arrangements for the supply of water to the tenants of the upper floors in tenemented houses; there being, as they say, in many, if not most, of such houses, but a single tap, and that in the basement or on the ground floor. It would be a great convenience to tenants to have a water supply on every floor; but if this were given, it would be necessary to provide sinks with waste-pipes, to carry off drippings, and to prevent injury to the premises from damp, should a tap be left running. In this connection it may be mentioned that at the Conference of Delegates of the Borough Councils, held at the County Hall in July last, a resolution was unanimously adopted—" That a draw-off tap from the rising main, and a sink, should be provided on every floor of a tenement house." It may be mentioned that the County Council placed themselves in communication with the Metropolitan Water Board, desiring to know whether they would acquiesce in, or obtain, the removal of the existing restrictions in their Acts of Parliament, with regard to the height of the water supply ? The Board, without prejudice to their statutory right, signified their willingness to co-operate, as far as possible, in the direction desired by the Council, and to accept in tenement houses similar arrangements to those adopted in the case of blocks of houses constructed by the Council. This is satisfactory as far as it goes, but it may be doubted whether it will be practicable to enforce provision of a water supply to the upper floors of tenemented houses without fresh legislation on the lines of the resolution of the Conference. 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 connectien with the important work devolved upon the Council, under the Factory and Workshop Act, in relation to the Underground Bakehouses, a subject dealt with elsewhere in 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 April 1905. [Appendices. appendices and index. 98 APPENDIX I. TABLE VI. (Table I. in Annual Reports prior to 1900.) Showing Population, Inhabited Houses, Marriages, Births and Deaths in 1904, and in the preceding ten years; gross numbers. The Year. Estimated Population.* No. of Inhabited Houses.† Marriages. Registered Births. Deaths. Total, all Ages. ‡ Under One Year. Under Five Years At Public Institutions.§ 1904 178,500 23,000 1,672 3,448 2,540 503 756 784 1903 178,000 23,000 1,623 3,565 2,455 510 768 772 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 Average 10 years 1894-1903. 172,850 – 1,624 3,615 2,730 607 929 806 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: in 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. 99 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 1904, and the preceding ten years. The Year. Birth-rate per 1,000 of the Population. Death-rate per 1,000 of the Population. Deaths of Children under one year; per 1,000 of Registered Births. Deaths of Children under one year; per 1,000 of Total Deaths. Deaths of Children under five years; per 1,000 of Total Deaths. Deaths at Public Institutions; per 1,000 of Total Deaths.* 1904 19·3 14·2 146 198 298 309 1903 20·0 13·8 143 208 313 314 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 Average of 10 years. 1894-1903. 20·8 15·7 167 222 340 295 * Includes Deaths of Parishioners at outlying Public Institutions, but excludes Deaths of Non-Parishioners at Brompton Consumption Hospital, St. Marylebone Infirmary, Notting-hill, &c. TABLE IX. (Table IV. in Annual Reports prior to 1900.) Showing the number of Deaths in the Borough at all ages, in 1904, 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 244 1·4 96 2. Pulmonary Diseases 516 2·9 203 3. Principal Tubercular Diseases 347 1·9 137 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 119 34·5 236 5. Convulsive Diseases 46 13·3 91 NOTES. 1. Includes Small-pox, Measles, Scarlet Fever, Diphtheria, Whooping-cough, Typhus Fever, Enteric (or Typhoid) Fever, Simple Continued Fever, and Diarrhœa. Thirty-five 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.) 100 101 TABLE VIII. (Table III. in Annual Reports prior to 1900.) Deaths registered from all causes in the Year 1904. (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 18. 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 285 148 32 48 70 92 114 88 98 84 41 433 1100 904 196 LOCAL DISEASES 146 96 20 31 60 106 162 200 254 167 46 242 1288 1014 274 DEATHS FROM VIOLENCE 24 7 5 2 9 13 15 6 3 7 7 31 98 77 21 DEATHS FROM ILL-DEFINED AND NOT SPECIFIED CAUSES 48 2 ... … ... 2 1 ... ... … 1 50 54 50 4 503 253 57 81 139 213 292 294 355 258 95 756 2540 2045 495 GENERAL DISEASES. Small-pox Vaccinated ...... ...... ... ... ... ... ... 1 ... ... ... ... 1 1 ... Not Vaccinated ...... ...... ... ... ... ... ... ... ... ... ... ... ... ... ... Doubtful ...... ...... ... ... ... ... ... ... ... ... ... ... ... ... ... Cow-pox, Effects of Vaccination ...... ...... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ...... 1 ...... ... ... ... ... ... ... ... ... 1 1 1 ... Measles (Morbilli) 11 52 3 ... ... ... ... 1 ... ... ... 63 67 61 6 Epidemic Rose Rash, German Measles ...... ...... ... ... ... ... ... ... ... ... ... ...... ...... ... ... Scarlet Fever 1 2 2 ... ... ... ... ... ... ... ... 3 5 5 ... Typhus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Relapsing Fever ... ... ... ... ... ... ...... ... ...... ... ... ...... ... ... ...... Influenza 4 ... ... 1 1 2 4 10 11 13 4 4 50 30 20 Whooping-Cough 7 12 ... ... ... ... ..... ... ... ... ... 19 19 16 3 Mumps ... ... ...... ...... ...... ...... ... ... ...... ... ... ... ... ...... ...... Diphtheria, Membranous Croup 1 11 5 ... ... ... ... ... ...... ... ... 12 17 14 3 Cerebro-Spinal Fever ... ...... .... . . ... ...... ... ... ...... ... ... ...... ... ... ...... ...... Simple Continued Fever "Pyrexia" ... ... ... ... 1 ... ...... ... ... ... ... ... 1 ...... 1 Enteric Fever ...... ... 1 2 1 2 ... ... ... ... ... ... 6 5 1 Asiatic Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... . . .... ...... Epidemic Diarrhœa, Epid. (or Zym.) Enteritis 75 6 ... ...... ... ...... ... ... ... ... ... 81 81 80 1 Diarrhœa, Choleraic Diarrhœa 34 6 ... ... ... 1 1 ... 3 1 ... 40 46 43 3 Dysentery ...... ... ... 1 ... ...... ...... ...... 1 1 ...... ...... 3 3 ...... Malarial Fever ... ...... ... ... ... ... ...... ... 1 ... ... ...... 1 1 ...... Hydrophobia ... ... ... ... ... ... ...... ... ...... ... ... ...... ... ...... ... Glanders, Farcy ...... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Anthrax, Splenic Fever ...... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tetanus ... ... ... ... ... ... ... ... ... ... ... ... ... ... .. Syphilis 6 .... . . ... 2 ... 1 1 ... ... ... ... 6 10 9 1 Gonorrhœa, Stricture of Urethra ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Septicæmia, Sapræmia ... ... ... ... 1 1 ... ... ... ... ... ... 2 1 1 Puerperal Pyæmia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Phlegmasia Dolens ... ...... ... ... ... ... ... ... ... ... ... ... ... ...... ... Puerperal Fever .... ... ... 1 1 1 ... ... ... ... ... ... 3 3 ... Infective Endocarditis ... ... ... ... 1 ... ... ... ... ...... ...... ...... 1 1 ... Epidemic Pneumonia, Pneumonic Fever ... ... ... ... ... ... ... ... ...... ...... ... ... ...... ... ...... Erysipelas 1 ... ... 1 ... ... ... ... ... ... 1 1 3 3 ...... Septicæmia (not Puerperal) ... ... ... ... ... ... ... 2 ... .... . . ... ... 2 2 ...... Pyæmia (not Puerperal) ... ... ... ... ... ... ... ... ...... ... ... ...... ... ... ...... Phlegmon, Carbuncle (not Anthrax) 2 1 ... ... ... 1 1 ... 1 2 ...... 3 8 7 1 Phagedæna ... ...... ... ... ... ... ... ... ... ...... ... ... ...... ...... ...... Other Septic Diseases ...... ... ... ... ... ... ... ...... ... ...... ...... ...... ...... ...... ...... Tuberculous Phthisis (Pulm. Tuberculosis) 1 6 7 22 37 48 34 14 7 ... ... 7 176 153 23 "Phthisis" ... 1 1 8 11 7 10 6 5 ...... 1 1 50 41 9 Tuberculous Meningitis 12 19 5 1 ... ...... ... ... ...... ...... ...... 31 37 32 5 Tuberculous Peritonitis 6 2 1 ...... 2 2 1 ...... ... ... ...... 8 14 12 2 Carried forward 161 119 25 39 56 66 52 34 29 17 6 280 604 524 80 Continued 102 103 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 161 119 25 39 56 66 52 34 29 17 6 280 604 524 80 GENERAL DISEASES.—continued. Tabes Mesenterica 6 5 ... ... ... ... ... ... ... ... ... 11 11 8 3 Lupus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tubercle of other Organs 3 3 1 ... ... 1 1 2 ... ... ... 6 11 11 ... General Tuberculosis 5 9 2 5 6 2 9 2 1 ... ... 14 41 30 11 Scrofula ... 1 1 ... ... ... ... ... ... ... ... 1 2 2 ... Parasitic Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Starvation ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scurvy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Alcoholism, Delirium Tremens ... ... ... ... ... 1 8 1 1 ... ... ... 11 5 6 Opium, Morphia Habit ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ptomaine Poisoning ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Industrial Poisoning by Lead ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... by Phosphorus ... ... ... ... ... .... ... ... ... ... ... ... ... ... ... by Arsenic and other Metals ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Rheumatic Fever, Acute Rheumatism ... ... 2 1 ... ... ... ... ... ... ... ... 3 3 ... Rheumatism of Heart ... ... ... 1 1 ... ... ... ... ... ... ... 2 1 1 Chronic Rheumatism ... ... ... ... ... ... ... ... ... 3 ... ... 3 3 ... Rheumatic Arthritis, Rheumatic Gout ... 1 ... ... ... 1 ... ... 1 4 1 7 4 3 Gout ... ... ... ... ... ... 1 ... 2 1 ... ... 4 2 2 Carcinoma ... ... ... 1 2 8 18 22 19 8 2 ... 80 58 22 Sarcoma ... 1 1 ... 1 1 2 1 3 ... 1 1 11 8 3 Malignant Disease, Cancer ... ... ... ... 2 9 17 23 22 7 3 ... 83 65 18 Rickets 3 2 ... ... ... ... ... ... ... ... ... 5 5 5 ... Purpura 1 ... ... ... ... ... ... ... ... ... ... 1 1 1 ... Hæmophilia, Hæmorrhagic Diathesis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Anæmia, Leucocythæmia ... 1 ... ... 1 ... 2 ... ... ... ... 1 4 3 1 Diabetes Mellitus ... ... ... 1 1 3 4 2 8 4 ... ... 23 11 12 Premature Birth 7l ... ... ... ... ... ... ... ... ... ... 71 71 59 12 Congenital Defects 11 1 ... ... ... ... ... ... ... ... ... 12 12 11 1 Injury at Birth 2 ... ... ... ... ... ... ... ... ... ... 2 2 2 ... Ateleetasis 9 ... ... ... ... ... ... ... ... ... ... 9 9 7 2 Want of Breast Milk 3 ... ... ... ... ... ... ... ... ... ... 3 3 1 2 Teething 10 5 ... ... ... ... ... ... ... ... 15 15 14 1 Old Age ... ... ... ... ... ... ... 1 12 40 29 ... 82 66 16 285 148 32 48 70 92 114 88 98 84 41 433 1100 904 196 LOCAL DISEASES. Diseases of Nervous System. Meningitis, Inflammation of Brain 4 3 3 1 ... ... ... ... ... ... ... 7 11 9 2 Softening of Brain ... ... ... ... ... ... 2 2 2 3 ... ... 9 6 3 General Paralysis of Insane ... ... ... ... ... 9 6 2 ... ... ... ... 17 13 4 Insanity (not Puerperal) ... ... ... ... ... 1 ... ... ... ... ... ••• 1 1 ... Chorea ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Epilepsy ... ... 1 ... 1 1 ... ... ... ... ... ... 3 3 ... Convulsions 20 3 1 ... ... ... ... ... ... ... 23 24 20 4 Laryngismus Stridulus 3 ... ... ... ... ... ... ... ... ... 3 3 2 1 Locomotor Ataxy ... ... ... ... ... ... 3 1 1 ... ... ... 5 3 2 Paraplegia and Disease of Cord ... ... ... ... ... ... ... 3 2 1 ... ... 6 5 1 Neuritis, Periph, Poly-Neuritis ... ... ... ... ... 1 ... ... ... ... ... ... 1 1 ... Brain Tumour (not specified) ... 1 ... ... ... 1 ... 1 ... ... ... 1 3 3 ... Nervous System, Other Diseases 2 1 ... 1 5 1 5 2 4 4 ... 3 25 18 7 Diseases of Organs of Special Sense. Otitis, Mastoid Disease 1 ... 1 2 ... 1 ... 1 ... ... ... 1 6 4 2 Epistaxis, Nose Disease ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ophthalmia, Eye Disease ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diseases of Heart. Valve Disease, Endocarditis (not infective) ... ... ... ... 5 9 10 13 21 10 ... ... 68 51 17 Pericarditis 1 ... ... ... 1 ... ... 1 1 ... ... 1 4 3 1 Hypertrophy of Heart ... ... ... ... 1 ... ... ... ... ... ... ... 1 1 ... Angina Pectoria ... ... ... ... ... 2 3 2 4 ... ... ... 11 5 6 Dilatation of Heart ... ... ... ... ... ... ... 4 4 ... 1 ... 9 6 3 Fatty Degeneration of Heart ... ... ... ... 1 ... 1 2 3 1 1 ... 9 9 ... Syncope, Heart Disease (not specified) ... ... 2 5 2 10 21 19 26 24 1 ... 110 80 30 Carried forward 31 8 8 9 16 36 51 53 68 43 3 39 326 243 83 Continued. 104 105 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. Kensing ton Town. Brompton. Brought forward 31 8 8 9 16 36 51 53 68 43 3 39 326 243 83 LOCAL DISEASES.—continued. Diseases of Blood Vessels. Cerebral Hæmorrhage, Embolism, Thrombosis ... 1 ... ... 2 5 11 19 26 13 6 1 83 62 21 Apoplexy, Hemiplegia ... ... ... ... ... 1 4 10 15 9 2 ... 41 33 8 Aneurysm ... ... ... ... ... ... 2 2 ... ... ... ... 4 4 ... Senile Gangrene ... ... ... ... ... ... ... 2 1 6 1 ... 10 9 1 Embolism, Thrombosis (not Cerebral) ... ... ... ... ... ... ... ... ... ... 2 ... 2 2 ... Phlebitis ... ... ... ... 1 ... ... 2 ... ... ... ... 3 3 ... Varicose Veins ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 Blood Vessels, Other Diseases ... ... ... ... ... ... ... 1 3 ... 1 ... 5 4 1 Diseases of Respiratory Organs. Laryngitis 1 ... ... ... ... ... ... 1 1 ... ... 1 3 2 1 Membranous Laryngitis (not Diphtheritic) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Croup (not Spasmodic or Membranous) 1 ... ... ... ... ... ... ... ... ... ... 1 1 1 ... Larynx, Other Diseases (not specified) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Bronchitis 36 23 1 1 4 11 24 33 60 50 13 59 256 217 39 Lobar, Croupous-Pneumonia ... 2 ... 1 1 1 2 ... ... 1 ... 2 8 7 1 Broncho, Cotarrhal, Lobular Pneumonia 28 39 1 1 3 ... 2 l 7 9 3 67 94 76 18 Pneumonia 14 11 2 3 9 13 15 12 8 6 2 25 95 81 14 Emphysema, Asthma ... ... ... ... 2 1 4 5 6 1 1 ... 20 14 6 Pleurisy ... ... ... ... 1 1 2 5 2 1 1 ... 13 8 5 Fibroid Disease of Lung ... ... ... ... ... ... 2 1 1 ... ... ... 4 2 2 Respiratory Diseases, Other 2 1 ... ... ... 2 1 2 4 5 5 3 22 20 2 Diseases of Digestive System. Tonsillitis, Quinsy ... 1 ... ... ... ... ... ... ... ... ... 1 1 1 ... Mouth, Pharynx, Disease (not Specific) 3 1 ... ... ... ... ... ... ... ... ... 4 4 3 1 Gastric Ulcer ... ... ... 3 2 4 2 3 1 1 ... ... 16 10 6 Gastric Catarrh 2 ... ... 1 ... ... ... ... ... ... ... 2 3 3 ... Stomach, Other Diseases (not malignant) 5 1 1 ... ... 1 ... 1 2 3 ... 6 14 9 5 Enteritis (not epidemic) 8 5 ... ... ... 1 1 1 5 ... 1 13 22 19 3 Gastro-Enteritis 3 ... ... ... ... ... ... ... 1 1 ... 3 5 5 ... Appendicitis, Perityphlitis ... ... 5 3 4 2 ... 2 ... ... ... ... 16 12 4 Hernia 1 ... ... ... ... ... 3| 2 2 2 2 1 12 8 4 Diseases of Digestive System.—continued. Intestinal Obstruction 1 ... ... ... ... 1 4 ... 6 1 ... 1 16 13 3 Other Diseases of Intestines ... ... ... ... 1 ... ... 1 ... ... ... ... 2 ... 2 Peritonitis (not Puerperal) 3 ... 1 2 ... ... 2 1 l 1 ... 3 11 9 2 Cirrhosis of Liver ... ... ... ... ... 4 8 12 6 1 ... ... 31 23 8 Liver and Gall Bladder, Other Diseases 5 ... ... 1 ... 2 4 4 4 5 ... 5 25 22 3 Digestive System, Other Diseases 1 ... ... ... ... 2 ... ... 2 1 ... 1 6 5 1 Lymphatic Diseases. Spleen Disease ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Lymphatic System, Other Diseases ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 ... Thyroid Body Disease ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 ... Supra-Renal Capsules Disease ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diseases of Urinary System. Nephritis, Acute ... 1 ... 1 1 1 ... 1 1 ... ... 1 6 3 3 Chronic Bright's Disease, Albuminuria ... ... 1 2 5 11 12 13 9 4 2 ... 59 45 14 Calculus (not Biliary) ... ... ... ... ... 1 ... ... 1 ... ... ... 2 1 1 Bladder and Prostate Disease ... ... ... ... ... ... 1 ... 6 2 ... ... 9 9 ... Urinary System, Other Diseases ... 2 ... 1 3 2 2 5 2 ... 1 2 18 13 5 Diseases of Generative System. Ovarian Tumour (not Malignant) ... ... ... ... ... ... 2 ... ... ... ... ... 2 ... 2 Other Diseases of Ovary ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Uterine Tumour (not Malignant) ... ... ... ... ... 1 ... 1 ... ... ... ... 2 2 ... Other Diseases of Uterus and Vagina ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Disorders of Menstruation ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Generative and Mam. Organs, Other Diseases ... ... ... ... ... 1 ... ... ... ... ... ... 1 1 ... Accidents of Childbirth. Abortion, Miscarriage ... ... ... ... 3 ... ... ... ... ... ... ... 3 2 1 Puerperal Mania ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Convulsions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Placenta Prævia, Flooding ... ... ... ... ... 1 ... ... ... ... ... ... 1 1 ... Other Accidents of Pregnancy and Childbirth ... ... ... 1 2 ... ... ... ... ... ... ... 3 2 1 Joint Diseases. Caries, Necrosis ... ... ... 1 .. ... ... ... ... ... ... ... 1 1 ... Arthritis, Periostitis ... ... ... ... ... ... ... 1 1 1 ... ... 3 1 2 Other Diseases of Locomotor System ... ... ... ... ... ... ... ... ... ... ... ... ... ... • •• Carried forward 145 96 20 31 60 106 162 200 254 167 46 241 1287 1013 274 Continued. 106 107 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 145 96 20 31 60 106 162 200 254 167 46 241 1287 1013 274 LOCAL DISEASES.—continued. Skin Diseases. Ulcer, Bedsore ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Eczema 1 ... ... ... ... ... ... ... ... ... ... 1 1 1 ... Pemphigus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Skin Diseases, Other ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 146 96 20 31 60 106 162 200 254 167 46 242 1288 1014 274 DEATHS FROM VIOLENCE. 1.—Accident or Negligence. Fractures and Contusions ... 2 4 1 3 3 7 3 2 6 6 2 37 25 12 Gunshot Wounds ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cut, Stab ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Burn, Scald ... 4 1 ... ... ... ... 1 ... 1 1 4 8 8 ... Poison ... ... ... ... ... 2 ... ... ... ... ... ... 2 2 ... Drowning ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Suffecation 22 1 ... ... 2 1 ... ... ... ... ... 23 26 22 4 Otherwise ... ... ... ... ... 1 1 ... ... ... ... ... 2 1 1 2.—Homicide. Manslaughter 1 ... ... ... ... ... ... ... ... ... ... 1 1 1 ... Murder 1 ... ... ... ... ... ... ... ... ... ... 1 1 1 ... 3.—Suicide. Gunshot Wounds ... ... ... ... 2 1 ... ... ... ... ... ... 3 1 2 Cut, Stab ... ... ... 1 1 ... 3 ... ... ... ... ... 5 4 1 Poison ... ... ... ... 1 3 2 1 ... ... ... ... 7 6 1 Drowning ... ... ... ... ... 2 1 ... ... ... ... ... 3 3 ... Hanging ... ... ... ... ... ... 1 1 1 ... ... ... 3 3 ... Otherwise ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4.—execution. Hanging ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 24 7 5 2 9 13 15 6 3 7 7 31 98 77 21 DEATHS FROM ILL-DEFINED AND NOT SPECIFIED CAUSES. Dropsy ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 ... Debility, Atrophy, Inanition 45 2 ... ... ... ... ... ... ... ... ... 47 47 45 2 Tumour ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Abscess 2 ... ... ... ... 1 ... ... ... ... ... 2 3 3 ... Hæmorrhage 1 ... ... ... ... ... ... ... ... ... 1 1 2 1 1 Sudden Death (cause not ascertained) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Causes not Specified or Ill-defined ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... 1 48 2 ... ... ... 2 1 ... ... ... 1 50 54 50 4 108 TABLE X. (Table V. in Annual Reports prior to 1900.) Showing the Number of Deaths from the Principal Diseases of the Zymotic Class in the ten years, 1894-1903, and in the year 1904. diseases. 1894. 1895. 1896. 1897. 1898. 1899. 1900. 1901. 1902. 1903. Annual Average of ten years, 1894-1903. Proportion of Deaths to 1000 Deaths from all causes in ten years, 1894-1903. Deaths in 1904. Proportion of Deaths to 1000 Deaths from all causes in 1904. Small-pox ... ... ... ... ... ... ... 1 11 ... 1.2 0.4 1 0.4 Measles 108 33 173 33 120 24 98 77 93 34 79.3 29.0 67 26.4 Scarlet Fever 22 27 39 29 23 10 4 15 21 14 20.4 7.1 5 1.9 Diphtheria 75 89 72 82 26 42 27 38 20 24 49.5 18.1 17 6.7 Whooping-cough 61 39 99 19 52 59 33 62 21 90 53.5 19.6 19 7.5 Typhus Fever ... ... ... ... 2 ... ... 1 ... ... 0.3 0.1 ... ... Enteric Fever 21 15 15 21 12 23 16 11 19 9 16.2 5.9 6 2.4 Simp. Continued Fever. 3 1 1 1 ... ... ... ... ... ... 0.6 0.2 1 0.4 Diarrhœa 56 118 61 125 112 101 105 115 78 97 96.8 35.5 128 50.4 TOTALS. Kensington 346 322 460 310 347 259 283 320 263 268 317.8 115.9 244 96.1 London 11,544 11,544 14,100 11,525 12,565 11,228 10,187 10,203 10,393 8,166 11,145 135.5 9,990 129.6 England & Wales 52,771 64,901 66,936 67,051 69,714 69,820 64,059 66,531 53,795 49,150 62,472 114.4 65,633 119 109 TABLE XI. (Table IX. in Annual Reports prior to 1900.) Names of Streets, etc., in the Registration Sub-Districts, and in the Wards, in which occurred the 244 fatal cases of the Principal Zymotic Diseases during the year 1904. 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. Measles. Scarlet Fever. Diphtheria. Whooping-cough. Enteric Fever. Continued Fever. Diarrhoæa. Total Abingdon Court K T E C ... ... ... ... ... 1 ... ... 1 Acklam Road „ G ... ... 1 1 ... ... ... 1 3 Adair Road „ „ ... 1 ... ... ... ... ... ... 1 Adela Street „ „ ... 1 1 ... ... ... ... 1 3 Appleford Road „ „ ... ... ... ... ... ... ... 2 2 Archer Mew „ P ... ... ... ... ... ... ... 1 1 Aubrey Road „ H ... ... ... ... ... 1 ... ... 1 Bangor Street „ N ... 1 ... ... 1 ... ... 2 4 Barker Street B R ... 1 ... ... ... ... ... ... 1 Barkston Gardens „ „ ... ... ... ... ... 1 ... ... 1 Bassett Road K T St. C ... ... ... ... ... ... ... 1 1 Bevington Road „ G ... ... ... ... ... ... ... 2 2 Blechynden Street „ St. C ... ... ... ... ... ... ... 5 5 Blenheim Crescent „ P ... ... ... ... ... ... ... 1 1 Bomore Road „ N ... ... ... ... ... ... ... 1 1 Bosworth Road „ G ... 3 ... ... ... ... ... 6 9 Bramley Road „ St. C ... 3 ... ... 1 ... ... 3 7 Branstone Street „ „ ... 1 ... ... ... ... ... 1 2 Campden Street „ H ... ... ... 1 ... ... ... ... 1 Cathcart Road B R ... ... ... ... ... ... 1 ... 1 Chesterton Road K T St.C ... ... ... ... 1 ... ... ... 1 Clarendon Road „ N ... 2 ... ... 1 ... ... ... 3 Colville Mews „ P ... ... ... ... 1 ... ... 1 2 Colville Square Mews „ „ ... ... ... ... 1 ... ... ... 1 Cornwall Mews „ Q G ... ... ... 1 ... ... ... ... 1 Cornwall Road „ N & P ... 1 ... ... ... 1 ... ... 3 Crescent Place B B ... 2 ... ... ... ... ... ... 2 Crescent Street K T N ... 2 ... ... ... ... ... 1 3 Cromwell Mews B B ... ... ... ... ... ... ... 1 1 Dartmoor Street K T H ... 1 ... ... ... ... ... ... 1 Dulford Street „ N ... 1 ... ... ... ... ... ... 1 Eardley Crescent B E C ... ... ... 1 ... ... ... ... 1 Earl's Court Road „ „ ... ... ... ... ... ... ... 1 1 East Row K T G ... ... ... ... ... ... ... 1 1 Edenham Mews „ „ ... ... ... ... ... ... ... 1 1 Edenham Street „ „ ... 1 ... 1 ... ... ... 6 8 Edge Street „ H ... ... ... ... 1 ... ... ... 1 Edinburgh Road „ St. C ... ... ... ... ... ... ... 2 2 Elgin Mews „ P ... ... ... ... 1 ... ... ... 1 Fowell Street „ N ... ... ... ... ... ... ... 1 1 Golborne Gardens „ G ... 1 ... ... ... ... ... 1 2 Golborne Road „ „ ... ... ... ... ... ... ... 4 4 Grenfell Road „ N ... ... ... ... ... ... ... 1 1 Handover Dwellings „ G ... ... ... ... ... ... ... 1 1 Hazlewood Crescent „ „ ... ... ... ... ... ... ... 1 1 Continued. 110 TABLE XI.—continued. Street or Place. Registration Sub-District. Ward. Small-pox. Measles. Scarlet Fever. Diphtheria. Whooping-cough. Enteric Fever. Continued Fever. Diarrhæa. Total. Hogarth Road B E C ... ... ... ... 1 ... ... ... 1 Holland Park K T H ... ... ... ... ... ... ... ... 1 Hurstway Street „ St. C. ... 1 ... ... ... ... ... ... 1 Jameson Street „ H ... 1 ... ••• ... ... ... ... 1 Kenley Street „ N ... 2 ... ... ... ... ... ... 2 Kensal Road „ G ... 1 ... ... 2 ... ... 5 8 Kensington Infirmary „ Q G ... ... ... ... 1 ... ... 1 2 Kensington Place „ H ... 1 ... ... ... ... ... ... 1 King Street „ Q. G. ... ... ... ... ... ... ... 1 1 Kramer Mews B E C ... ... ... ... ... ... ... 1 1 Ladbroke Grove K T St. C ... 3 ... ... ... ... ... ... 3 Lancaster Road „ St. C & N ... ... ... 1 ... ... ... 2 3 Ledbury Mews North „ P ... ... ... ... ... ... ... 1 1 Linden Mews „ „ ... ... ... ... ... ... ... 1 1 Lonsdale Mews „ „„ ... ... ... ... ... ... ... 1 1 Lonsdale Road „ „ ... 2 ... ... ... ... ... 3 5 Mall Chambers „ H ... ... ... ... ... 1 ... ... 1 Manchester Road „ St. C ... 1 ... ... ... ... ... 1 2 Manson Mews B B ... ... ... ... ... ... ... 1 1 Martin Street K T St. C ... ... ... ... ... ... ... 1 1 Mary Place „ N ... 1 ... ... ... ... ... ... 1 Mersey Street „ St. C ... ... ... ... ... ... ... 2 2 Norland Road „ N ... ... 1 ... ... ... ... 1 2 Pembroke Mews „ E C ... ... ... 1 ... ... ... 1 2 Pembroke Place „ „ ... ... ... ... ... ... ... 1 1 Pembroke Place West „ „ ... ... ... ... ... ... ... 1 1 Pembroke Square „ „ ... ... ... ... ... ... ... ... 1 Phillimore Mews „ H ... ... ... ... ... ... ... 1 1 Phænix Place „ N ... 1 ... ... ... ... ... ... 1 Portland Road „ „ ... 1 ... ... ... ... ... 4 5 Portobello Road „ G ... ... ... ... ... ... ... 3 3 Pottery Lane „ N ... 1 ... ... ... ... ... ... 1 Prince's Road „ „ ... ... ... ... ... ... ... 1 1 Queen's Place „ „ ... 1 ... ... ... ... ... ... 1 Queen's Road „ „ ... 1 ... ... ... ... ... ... 1 Rabbit Row „ H ... 1 ... ... ... ... ... ... 1 Rackham Street „ St. C ... 1 ... ... ... ... ... 2 3 Redfield Lane B E C ... ... ... 2 ... ... ... ... 2 Rillington Place K T St. C ... ... ... ... ... ... ... 1 1 Russell Road „ H ... 1 ... ... ... ... ... ... 1 St. Ervan's Road „ G ... 2 ... ... 1 ... ... 1 4 St. James's Place „ N ... 1 ... ... ... ... ... 1 2 St. Katharine's Road „ „ ... 1 ... ... ... ... ... 2 3 St. Mark's Road, Not ting Hill „ „ ... ... ... ... ... ... ... 1 1 Seymour Place B R ... 1 ... ... ... ... ... ... 1 Silchester Terrace K T St. C ... ... ... ... ... ... ... 2 2 Silver Street „ H ... ... ... 1 ... ... ... ... 1 Sirdar Road „ N ... 1 ... ... ... ... ... ... 1 Southam Street „ G ... 4 ... 3 1 ... ... 6 14 Stanhope Mews East B B ... 1 ... ... ... ... ... ... 1 Stockton Mews K T G ... ... ... ... ... ... ... 1 1 Swinbrooke Road „ „ ... ... ... ... ... ... ... 3 3 Continued. 111 TABLE XI.—continued. Street or Place. Registration Sub-District. Ward. Small-pox. Measles. Scarlet Fever. Diphtheria. Whooping-cough. Enteric Fever. Continued Fever. Diarrhæa. Total. Talbot Grove K T N ... ... ... ... 1 ... ... 2 3 Talbot Mews „ „ ... ... ... ... ... ... ... 1 1 Tavistock Road „ G ... 1 ... ... ... ... ... 1 2 Telford Road „ „ ... 1 ... ... ... ... ... ... 1 Testerton Street „ St. C ... 2 ... ... ... ... ... 1 4 Thorpe Mews „ „ ... ... 1 ... ... ... ... 1 2 Thresher's Cottages „ N ... 1 ... ... ... ... ... ... 1 Thresher's Place „ „ ... 1 ... ... ... ... ... ... 1 Thurloe Mews B B ... ... ... ... 2 ... ... ... 2 Tobin Square K T N ... ... ... ... ... ... ... 1 1 Trafalgar Place „ Q G ... 1 ... ... ... ... ... ... 1 Treadgold Street „ N ... ... ... ... ... ... ... 1 1 Treverton Street „ St. C ... 1 ... ... ... ... ... 5 6 Walmer Road „ St. C & N ... 2 1 ... 1 ... ... 1 5 Wedlake Street „ G ... . . . ... ... ... ... ... 2 2 Western Dwellings „ „ ... 1 ... ... ... ... ... 1 2 Wheatstone Road „ „ ... ... ... ... ... ... ... 3 5 William Street „ H 1 ... ... ... ... ... ... ... 1 Wornington Road „ G ... ... ... ... ... ... ... 3 3 Yeoman's Row B B ... 2 ... ... ... ... ... 1 3 Note.—The deaths occurring in the Borough Infirmary have been allocated, where possible, to the streets from which the patients had been removed to the Infirmary. 112 TABLE XII. (Table IXa. in Annual Reports, prior to 1900.) Names of Streets, etc., in the Registration Sub-Districts, and in the Wards, from which the 922 cases of Infectious Disease were notified, chicken-pox being omitted, when in a street a single case of that disease only was notified under the provisions of the Public Health (London) Act, 1891, during the year 1904. 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. Cholera. Total. Abingdon Court K T E C ... ... ... ... 1 ... ... ... ... ... 1 Abingdon Road „ „ ... ... 1 ... ... ... ... ... ... ... 1 Abingdon Villas „ „ ... ... ... ... ... ... ... 1 ... ... 1 Acklam Road „ G ... 2 1 8 ... ... ... 1 ... ... 12 Adair Road „ „ ... ... 3 ... ... ... ... 1 ... ... 4 Adam and Eve Mews „ E C ... ... 1 ... ... ... ... ... ... ... 1 Addison Road North „ N ... ... ... 1 ... ... ... ... ... ... 1 Adela Street „ G ... ... 1 ... ... ... ... ... ... ... 1 Admiral Terrace „ St. C ... ... ... ... ... ... ... 1 ... ... 1 Adrian Terrace B R ... ... ... ... ... ... ... l ... ... 1 Airlie Gardens K T H ... ... 1 ... ... ... ... ... ... ... 2 Alderson Street „ G ... ... ... 1 ... ... ... ... ... ... 1 All Saints Road „ G & P ... ... 3 2 ... ... ... 1 ... ... 6 Appleford Road „ G ... 3 ... 2 ... ... ... 2 ... ... 7 Argyll Road „ H ... 2 ... 1 ... ... ... ... ... ... 3 Arundel Gardens „ P ... ... ... ... ... ... 1 ... ... ... 1 Ashburn Mews B R ... ... 1 ... ... ... ... ... ... ... 1 Aubrey Road K T H ... ... ... 1 1 ... ... ... ... ... 2 Bangor Street „ N ... 7 2 2 ... ... ... 6 ... ... 17 Barker Street B R ... 1 5 ... 2 ... ... 1 ... ... 9 Barkston Gardens „ „ ... ... 1 2 l ... ... ... ... ... 4 Basing Road K T P ... ... 3 ... l ... ... ... ... ... 4 Bassett Road „ St. C ... ... ... 2 ... ... ... ... ... ... 2 Baxter's Cottages „ E C ... ... 1 ... ... ... ... ... ... ... 1 Beauchamp Place B B ... ... ... 1 ... ... ... ... ... ... 1 Bedford Gardens K T H ... 1 ... 2 ... ... ... ... ... ... 3 Bedford Terrace „ „ ... ... ... ... ... ... ... 1 ... ... 1 Bevington Road „ G ... ... l ... ... ... ... 1 ... ... 2 Blagrove Road „ „ ... ... ... 1 ... ... ... ... ... ... 1 Blechynden Mews „ St. C ... ... 1 ... ... ... ... ... ... ... 1 Blechynden Street „ „ ... 2 ... 1 ... ... ... ... ... ... 3 Blenheim Crescent „ N & P ... 2 ... ... ... ... 1 ... ... ... 3 Bolton Gardens B R ... 2 ... ... ... ... ... ... ... ... 2 Bolton Gardens West „ „ ... ... ... 1 ... ... ... ... ... ... 1 Bolton Road K T P ... 2 ... ... ... ... ... ... ... ... 2 Bomore Road „ N ... ... ... ... ... ... ... 1 ... ... 1 Bosworth Road „ G ... 1 1 2 1 ... 1 1 ... ... 7 Bramley Mews „ St. C ... ... ... ... ... ... ... l ... ... 1 Bramley Road „ St. C & N ... 2 5 2 l ... ... l ... ... 11 Bramley Street „ St. C ... ... ... ... ... ... ... l ... ... 1 Bransford Street „ „ ... ... ... 1 ... ... ... ... ... ... 1 Branstone Street „ „ ... ... ... ... ... ... ... 2 ... ... 2 Bulmer Place „ P ... ... ... 1 ... ... ... ... ... ... 1 Bulmer Terrace „ „ ... ... ... 1 ... ... ... ... ... ... 1 Cambridge Gardens „ St. C ... ... 2 ... ... ... ... 1 ... ... 3 Campden Grove „ H ... ... ... 1 ... ... ... ... ... ... 1 Campden Hill Road „ „ ... ... 1 1 ... ... ... ... ... ... 2 Campden Street „ „ ... 1 3 1 ... ... ... ... ... ... 5 Carlyle Mansions „ „ ... ... 1 ... ... ... ... ... ... ... 1 Continued. 113 TABLE XII.—continued. Street or Place. Registration Sub-District. Ward. Small-pox. Chicken-pox. Scarlet Fever. Diphtheria. Enteric Fever. Continued Fever. Puerperal Fever. Erysipelas. Croup. Cholera. Total. Cathcart Road B R ... ... ... ... ... 1 ... ... ... ... 1 Charles Street, Notting Hill K T N ... 2 ... ... ... ... ... 1 ... ... 3 Chesterton Road „ St. C ... 4 6 1 ... ... ... ... ... ... 11 Childs Place B E C ... ... 3 ... ... ... ... ... ... ... 3 Clilds Street „ „ ... ... 1 1 ... ... ... 1 ... ... 3 Church Street K T H ... ... 1 2 ... ... ... ... ... ... 3 Clarence Mews „ „ ... ... ... 4 ... ... ... ... ... ... 4 Clarendon Mews „ Q G ... ... 1 ... ... ... ... ... ... ... 1 Clarendon Road „ N ... ... 1 1 ... ... ... 1 ... ... 3 Clareville Grove B B ... ... ... ... 1 ... ... ... ... ... 1 Clydesdale Mansions K T P ... ... 1 ... ... ... ... ... ... ... 1 Coleherne Court B R ... ... ... 1 1 ... ... ... ... ... 2 Colville Mews K T P ... ... ... ... ... ... ... 1 ... ... 1 Colville Square Mews „ „ ... ... ... ... ... ... ... 1 ... ... 1 Colville Terrace „ „ ... ... ... ... 1 ... ... ... ... ... 1 Convent Gardens „ „ ... 2 ... ... ... ... ... ... ... ... 2 Cornwall Mews „ Q G ... ... 1 2 ... ... ... ... ... ... 3 Cornwall Road „ N & P ... 3 3 2 l ... ... 3 ... ... 12 Courtfield Gardens B R ... ... 1 ... l ... ... ... ... ... 2 Courtfield Road „ „ ... ... ... 1 ... ... ... ... ... ... 1 Courtland Terrace K T H ... ... 1 ... ... ... ... ... ... ... 1 Cranley Mews B R ... ... 1 1 ... ... ... ... ... ... 2 Crescent Street K T N ... 4 2 ... ... ... ... 3 ... 1 10 Cromwell Crescent B E C ... ... 1 1 ... ... ... ... ... ... 2 Cromwell Mews „ B ... ... 5 ... ... ... ... ... ... ... 5 Cromwell Road „ EC & QG ... 1 2 1 l ... ... ... ... ... 5 Dartmoor Street K T H ... ... 1 ... ... ... 1 ... ... ... 2 Denbigh Terrace „ P ... ... 2 ... ... ... ... ... ... ... 2 De Vere Mews „ Q G ... ... ... 1 ... ... ... ... ... ... 1 Drayson Mews „ H ... ... ... l ... ... ... ... ... ... 1 Drayton Gardens B R ... 2 2 l ... ... ... ... ... ... 5 Durham Villas K T H ... ... ... 2 ... ... ... ... ... ... 2 Eardley Crescent B E C ... 1 ... 2 ... ... ... ... ... ... 3 Earl's Court Road K T & B „ ... ... ... 3 ... ... ... 1 ... ... 4 Earl's Court Square B „ ... 1 ... ... 1 ... ... ... ... ... 2 East Row K T G ... ... ... ... ... ... ... 1 ... ... 1 Edinburgh Road „ St. C ... ... 2 ... ... ... ... 1 ... ... 2 Edge Street „ H ... ... 1 2 ... ... ... 3 ... ... 6 Egerton Gardens B B ... ... ... 1 ... ... ... 1 ... ... 2 Egerton Place „ „ ... ... 1 ... ... ... ... ... ... ... 1 Elgin Crescent K T N ... ... 1 1 ... ... ... ... ... ... 2 Emma Place „ E C ... ... ... 1 ... ... ... ... ... ... 1 Ernest Street „ H ... ... ... 2 ... ... ... ... ... ... 2 Faraday Road K T G ... 3 2 ... ... ... ... ... ... ... 5 Farmer Street „ H ... ... ... 1 ... ... ... ... ... ... 1 Finborough Road B R ... 4 1 ... 1 ... ... 2 ... ... 8 Fopstone Road „ E C ... ... 1 ... ... ... ... ... ... ... 1 Fulham Road „ R ... ... 1 ... ... ... ... 1 ... ... 1 Gadsden Mews K T G ... ... ... ... ... ... ... 1 ... ... 1 Gledhow Gardens B R ... 2 ... ... ... ... ... ... ... ... 2 Golborne Gardens K T G ... 3 ... 3 ... ... ... 1 ... ... 7 Golborne Road „ „ ... ... 1 1 ... ... ... 1 ... ... 3 Gordon Place „ H ... ... 3 ... l ... ... ... ... ... 4 Grenfell Road „ N ... 3 1 ... ... ... ... ... ... ... 4 Hans Mansions B B ... 1 ... 1 ... ... ... ... ... ... 2 Hans Road „ „ ... ... 1 ... ... ... ... ... ... ... 1 Harrington Gardens „ R ... ... 1 ... ... ... ... ... ... ... 1 Continued. 114 TABLE XII.—continued. Street or Place. Registration Sub-District Ward. Small-pox. Chicken-pox. Scarlet Fe\er. Diphtheria. Enteric Fever. Continued Fever. Puerperal Fever. Erysipelas. Croup. Cholera. Total. Harrington Road B R ... ... 1 1 ... ... ... ... ... ... 2 Harrow Road K T St. C ... ... ... ... ... ... ... 1 ... ... 1 Hazlewood Crescent „ G ... ... 2 1 ... ... ... ... ... ... 3 Hereford Square B R ... ... 1 1 ... ... ... ... ... ... 2 Hewer Street K T St. C ... ... 2 1 ... ... ... ... ... ... 3 High Street, Notting Hill „ P ... ... 1 1 ... ... ... ... ... ... 2 Hippodome Stables „ N ... ... 1 ... ... ... ... ... ... ... 1 Holland Park „ H ... ... 1 ... 1 ... ... ... ... ... 2 Holland Park Road „ „ ... ... ... ... 1 ... ... 1 ... ... 2 Holland Road „ „ ... 5 1 ... ... ... ... ... ... ... 6 Holland Street „ „ ... ... 2 ... ... ... ... ... ... ... 2 Holland Villas Road „ „ ... ... ... 1 ... ... ... ... ... ... 1 Hollywood Road B R ... ... 1 ... ... ... ... ... ... ... 1 Hurstway Street K T St. C ... 2 1 2 ... ... ... ... ... ... 5 Ifield Road B R ... 4 ... ... ... ... ... 3 ... ... 7 Iverna Gardens K T E C ... ... ... 1 1 ... ... ... ... ... 2 Jameson Street „ H 1 ... ... ... ... ... ... ... ... ... 1 Johnson Street „ „ ... ... ... 1 ... ... ... ... ... ... 1 Kenley Street „ N ... ... ... ... ... ... ... 1 ... ... 1 Kensal Road „ G ... 7 2 1 ... ... ... 4 ... ... 14 Kensington Buildings „ E C ... ... 2 ... ... ... ... ... ... ... 2 Kensington Court „ Q G ... 2 ... ... ... ... ... ... ... ... 2 Kensington Crescent „ E C ... ... ... ... 1 ... ... ... ... ... 1 Kensington High Street „ H ... ... 1 ... ... ... ... ... ... ... 1 Kensington Infirmary „ Q G ... 6 ... ... ... ... ... 4 ... ... 10 Kensington Palace Stables „ H ... ... ... 2 ... ... ... ... ... ... 2 Kensington Palace Gardens „ „ ... ... 1 ... ... ... ... ... ... ... 1 Kensington Park Gardens „ P ... ... ... 1 ... ... ... ... ... ... 1 Kensington Park Road „ „ ... 2 4 1 ... ... ... ... ... ... 7 Kensington Place „ H ... ... ... 1 ... ... ... ... ... ... 1 Kensington Square „ Q G ... ... 1 ... ... ... ... ... ... ... 1 King Street „ „ ... ... 1 1 1 ... ... ... ... ... 3 Kramer Mews B E C ... ... 1 ... ... ... ... ... ... ... 1 Ladbroke Crescent K T N ... 1 1 ... ... ... ... ... ... ... 2 Ladbroke Grove „ St. C, N & P ... 9 5 3 1 ... 1 2 ... ... 21 Langham Mansions B E C ... 2 ... ... 1 ... ... ... ... ... 3 Lancaster Road K T St. C, N & P ... 7 4 2 ... ... 2 7 ... ... 22 Lansdowne Crescent „ N ... ... ... ... ... ... ... 1 ... ... 1 Lansdowne Road „ „ ... ... 1 2 ... ... ... ... ... ... 3 Latimer Road „ St. C ... ... ... ... 1 ... ... ... ... ... 1 Ledbury Mews „ P ... ... ... ... ... ... ... 1 ... ... 1 Ledbury Road „ „ ... 3 ... ... ... ... ... ... ... ... 3 Lexham Mews B E C ... ... ... ... 1 ... ... ... ... ... 1 Lloyd's Place „ B ... ... 1 ... ... ... ... ... ... ... 1 Lockton Street K T St. C ... 1 1 ... ... ... ... 1 ... ... 3 Logan Mews B E C ... ... ... 1 ... ... ... ... ... ... 1 Long's Terrace K T „ ... ... 1 ... ... ... ... ... ... ... 1 Longridge Road B „ ... ... ... ... 1 ... ... ... ... ... 1 Lonsdale Road K T P ... 1 ... ... ... ... 2 ... ... 3 Lorne Gardens „ H ... ... ... ... ... ... ... 2 ... ... 2 Mall Chambers „ H ... ... ... ... ... 1 ... ... ... ... 1 Manson Mews B B ... ... ... 1 ... ... ... ... ... ... 1 Marloes Road K T & B EC & QG ... ... 1 ... ... 1 ... ... ... ... 2 Continued. 115 TABLE XII.—continued. Street or Place. Registration Sub-District. Ward. Small-pox. Chicken-pox. Scarlet Fever. Diphtheria. Enteric Fever. Continued Fever. Puerperal Fever. Erysipelas. Croup. Cholera. Total. Martin Street K T St. C ... 2 ... ... ... ... ... ... ... ... 2 Mary Place „ N ... ... ... ... ... ... ... 3 ... ... 3 Melon Place „ H ... ... 1 ... ... ... ... ... ... ... 1 Mersey Street „ St. C ... 1 1 ... ... ... . . . ... ... ... 2 Moreton Mews B R ... ... ... ... ... ... ... 1 ... ... 1 Munro Mews K T G ... ... 1 ... ... ... ... ... ... ... 1 Nevern Square B E C ... ... 1 ... ... ... ... ... ... ... 1 Newcombe Street KT H ... ... 1 ... ... ... ... ... ... ... 1 Norland Road North „ N ... ... ... 1 ... ... ... ... ... ... 1 North Street B R ... ... ... 1 ... ... ... ... ... ... 1 Oakwood Court K T H ... ... 1 1 ... ... ... ... ... ... 2 Onslow Gardens B B ... ... 1 ... ... ... ... ... ... ... 1 Onslow Mews „ „ ... ... ... ... ... ... 1 ... ... ... 1 Onslow Square „ „ ... ... ... 1 1 ... ... ... ... ... 2 Osten Mews „ Q G ... ... 1 ... ... ... ... ... ... ... 1 Oxford Gardens K T St C ... 6 l ... ... ... ... 1 ... ... 8 Palace Gardens Terrace „ H ... ... ... ... ... ... ... 1 ... ... 1 Peel Street „ „ ... ... ... 1 ... ... ... 1 ... ... 3 Pelham Street B B ... ... ... ... ... ... ... 1 ... ... 1 Pembridge Gardens K T P ... ... l ... ... ... ... ... ... ... 1 Pembridge Road „ „ ... ... ... 1 ... ... ... ... ... ... 1 Pembridge Square „ „ ... ... l ... ... ... ... ... ... ... 1 Pembridge Villas „ „ ... ... l 1 ... ... ... ... ... ... 2 Pembroke Mews „ E C ... ... ... 8 ... ... . . . ... ... ... 3 Pembroke Square „ „ ... ... ... 1 ... ... ... ... ... ... 1 Pennant Mews B Q G ... ... ... 1 ... ... ... ... ... 1 Penywern Road „ E C ... ... ... ... ... ... ... 1 ... ... 1 Philbeach Gardens „ „ ... ... l ... ... ... ... ... ... ... 1 Phillimore Mews K T H ... ... l 1 ... ... ... ... ... ... 2 Portland Road „ N ... 8 ... 8 1 ... ... 2 ... ... 9 Portobello Road „ St. C, G, & P ... 12 9 8 2 ... ... 4 ... ... 30 Powis Square „ P ... . . . 1 ... ... ... ... ... ... ... 1 Prince's Place „ N ... 2 ... 1 ... ... ... ... ... ... 3 Prince's Road „ N ... 2 ... ... ... ... ... 1 ... ... 3 Queensberry Place B B ... ... ... ... ... ... ... 1 ... ... 1 Queen's Gate K T & B Q G & B ... ... 5 ... i ... ... 1 ... ... 7 Queen's Gate Mews K T QG ... ... 2 ... ... ... ... ... ... ... 2 Queen's Gate Place B „ ... ... 1 ... ... ... ... ... ... ... 1 Queen's Gate Terrace K T „ ... ... 1 ... ... ... ... ... ... ... 1 Rackham Street „ St. C ... 1 2 ... ... ... ... 2 ... ... 5 Radnor Terrace „ E C ... ... 1 ... ... ... ... ... ... ... 1 Raymede Street „ St. C ... 2 ... ... ... ... ... ... ... ... 2 Redcliffe Gardens B R ... ... 1 1 ... ... ... 2 ... ... 4 Redcliffe Road „ „ ... ... 1 ... ... ... ... ... ... ... 1 Redcliffe Square „ „ ... ... 1 ... ... ... ... ... ... ... 1 Redfield Lane „ E C ... ... 2 1 ... ... ... ... ... ... 4 Rendle Street K T G ... 2 1 ... ... ... ... ... ... ... 3 Richmond Road B E C ... 4 ... 1 ... ... ... 1 ... ... 6 Royal Crescent K T N ... 2 ... ... ... ... ... ... ... ... 2 Royal Crescent Mews „ „ ... ... 1 ... 1 ... ... ... ... ... 1 Russell Gardens Mews „ H ... ... 1 ... ... ... ... ... ... ... 1 St. Alban's Road „ Q G ... ... 2 ... ... ... ... 2 ... ... 4 St. Ann's Road „ N ... 1 1 4 ... ... ... 1 ... ... 7 St. Ann's Villas „ „ ... ... 1 ... ... ... 1 ... ... ... 2 St. Ervan's Road „ G ... 2 3 ... ... ... ... ... ... ... 5 Continued. 116 TABLE XII.—continued. Street or Place. Registration Sub-District. Ward. Small-pox. Chicken-pox. Scarlet Fever. Diphtheria. Enteric Fever. Continued Fever. Puerperal Fever. Erysipelas. Croup. Cholera. Total. St. George's Road KT N ... 3 1 ... ... ... ... 2 ... ... 6 St. Helen's Gardens „ St. C ... ... ... 1 ... ... ... ... ... ... 1 St. James's Place „ N ... ... 1 ... ... ... ... 1 ... ... 2 St. James's Square „ „ ... 1 1 ... ... ... ... ... ... ... 2 St. Katharine's Road „ „ ... 7 1 1 1 ... ... 4 ... ... 14 St. Luke's Road „ P ... ... 1 ... ... ... ... ... ... ... 1 St. Mark's Road, Notting Hill „ St. C & N ... 1 2 ... 1 ... ... 1 ... ... 5 St. Quintin Avenue „ St. C ... ... 1 ... ... ... ... ... ... ... 1 Scarsdale "Villas „ E C ... ... 1 ... ... ... ... ... ... ... 1 Seymour Place B B ... ... 1 1 ... ... ... ... ... ... 2 Shaftesbury Mews KT E C ... ... 1 1 ... ... ... ... ... ... 2 Shaftesbury Villas „ „ ... ... 1 ... ... ... ... ... ... ... 1 Sheffield Terrace „ H ... 1 ... 1 ... ... ... ... ... ... 2 Silchester Mews „ St.C ... ... ... 1 ... ... ... ... ... ... 1 Silchester Road „ „ ... 1 ... ... ... ... ... 1 ... ... 2 Silchester Terrace „ „ ... ... ... 1 ... ... ... ... ... ... 1 Silver Street „ H ... ... ... 1 ... ... ... ... ... ... 1 Sirdar Road „ N ... 4 ... ... 1 ... ... 2 ... ... 8 Snarsgate Street „ St C ... . . . ... ... ... ... ... 1 ... ... 1 Southam Street „ G ... 6 4 7 ... ... ... 1 ... ... 18 Southend Mews „ Q G ... ... ... 1 ... ... ... ... ... ... 1 South Row „ G ... 1 ... ... ... ... ... 1 ... ... 2 Spear Mews B E C ... ... 1 1 ... ... ... ... ... ... 2 Stanhope Mews East „ B ... ... ... 1 ... ... ... ... ... ... 1 Stanley Crescent K T P ... ... 3 ... ... ... ... ... ... ... 3 Stoneleigh Street „ N ... 1 3 1 ... ... ... 2 ... ... 7 Sumner Place B B ... ... 2 ... ... ... ... ... ... ... 2 Swinbrook Road K T G ... 4 3 1 ... ... ... 2 ... ... 10 Tabernacle Terrace „ N ... ... ... ... ... ... ... ... ... ... 1 Talbot Grove „ „ ... ... ... ... ... ... ... 2 ... ... 2 Talbot Road „ P ... ... ... ... ... ... ... 1 ... ... 1 Tavistock Crescent „ G ... ... 2 ... ... ... ... ... ... ... 2 Tavistock Mews „ P ... 2 ... ... ... ... ... ... ... ... 2 Tavistock Road „ G ... 1 1 ... ... ... ... ... ... ... 2 Telford Road „ St. C & G ... 1 2 1 ... ... ... ... ... ... 4 Testerton Street „ St. C ... 10 ... 2 ... ... ... 1 ... ... 13 The Grove, Boltons B B ... ... ... ... 1 ... ... ... ... ... 1 Thorpe Mews KT St. C ... 1 2 ... ... ... ... ... ... ... 3 Tobin Street „ N ... ... ... 1 ... ... ... ... ... ... 1 Trebovir Road B E C ... ... 1 1 ... ... ... ... ... ... 2 Tregunter Road „ B ... 2 1 ... ... ... ... ... ... ... 3 Treverton Street K T St.C ... 2 2 1 ... ... ... 1 ... ... 6 Upper Addison Gardens „ H ... 3 ... ... ... ... ... ... ... ... 3 Upper Phillimore Gardens „ „ ... ... ... ... ... ... ... 1 ... ... 1 Uxbridge Street „ „ ... ... ... 1 ... ... ... ... ... ... 1 Vicarage Gate „ „ ... ... 1 ... ... ... ... ... ... ... 1 Victoria Dwellings „ G ... ... ... ... 1 ... ... 2 ... ... 3 Victoria Road „ Q G ... ... ... 2 ... ... ... ... ... ... 2 Wallgrave Road B E C ... 3 ... ... ... ... ... ... ... ... 3 Walmer Road K T St. C & N ... 10 5 1 1 ... ... ... ... ... 17 Walton Street B B ... ... ... 2 ... ... ... ... ... ... 5 Warwick Road KT &B E C ... ... 4 1 ... ... ... 2 ... ... 7 Wedlake Street K T G ... 1 ... ... ... ... ... 1 ... ... 2 Westbourne Grove „ P ... 2 1 ... ... ... ... ... ... ... 3 West Cromwell Road B E C ... ... ... 2 ... ... ... ... ... ... 2 Western Dwellings KT G ... ... 1 ... ... ... ... ... ... ... 1 Westgate Terrace B B ... ... ... 1 ... ... ... 1 ... ... 2 West Row KT G ... ... 1 ... ... ... ... ... ... ... 1 Wheatstone Road „ „ ... 2 1 8 ... ... ... ... ... ... 12 William Street 9„ H ... ... ... ... ... ... ... ... ... ... 1 Wornington Road „ G ... 10 25 5 6 ... ... 2 ... ... 48 Yeoman's Bow B B ... ... ... 2 ... ... ... 1 ... ... 3 The notifications from the Borough Infirmary have, as far as possible, been allocated to the several streets from which the patients were admitted. 117 APPENDIX II. TABLE A. Population of Kensington, 1856-1904; Marriages and Marriage-rate (1871-1904); Births and and Birth-rate, and Deaths and Death-rate 1856-1904; and Infantile Mortality (1871-1904). The Year. Population. Marriages. Marriage Rate. Births. Birth Rate. Deaths. Death Rate. Deaths under One Year. Deaths under One Year per 1,000 Registered Births. Kensington. London. Kensington. London. 1856 57,078 Information incomplete. No information. 1,804 31.6 33.6 1,235 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 168,540 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 20.4 653 162 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 18.4 489 132 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 21.3 30.9 2 916 17.4 21.3 625 170 1894 168,600 1,587 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 19.3 28.5 2,746 15.2 17.2 515 148 1903 178,000 1,623 18.2 3,565 20.0 28.4 2,455 13.8 15.7 510 143 1904 178,500 1,672 18.7 3,448 19.3 27.9 2,540 14.2 16.6 503 146 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. 118 TABLE B. Annual Number of Deaths in Kensington from the Principal Diseases of the Zymotic Class (1856-1904); and Death-rate from these Diseases, 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. Pyrexia. 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 1903 178,000 ... 34 14 24 90 ... 9 ... 97 268 1.5 1.8 109 1904 178,500 1 67 5 17 19 ... 6 1 128 244 1.4 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 estimated population and to calculation of rates. Census years are indicated by dark type. 119 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. Whooping Cough. Fever. Diarrhœa. Total. Typhus Enteric Pyrexia 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 14,235 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 6 7 Death-rate per 1,000 from— Small-pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough "Fever." Diarrhœa. The Seven Diseases. The Four Notifiable Infections 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 0.53 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. INDEX. Page. Adulteration Acts, Food and Drugs; Mode of Procedure under the 51 Age and Sex Distribution of the Population of the Borough at the Census of 1901 3 Ambulance Service (Asylums Board) for Removal of Non-infectious Cases; Proposed Extension of 56 „ „ for Street Accident and Emergency Cases; Action of London County Council with reference to Need of 56 „ „ Arrangements for the Removal of Patients by the Metropolitan Asylums Board 56 Appendix I. Statistical Tables, Nos. VI.—XII. 98 „ II. Statistical Tables, A, B, C, and D: Marriages, Births, Deaths, Infantile and Zymotic Mortality, &c., 1856—1904 117 Area of the Borough 5 Asylums Board; The Metropolitan 55 Asphalte; Recommendation for Paving of certain Streets with 87 Bakehouses, Underground; Proceedings with respect to 72 „ „ The Number of, Certified, Closed, &c. 73 „ The Need of By-laws with Respect to 73 Baths and Washhouses; Number of Bathers and Washers in the year 1904—5 at the 88 Births and Birth-rate; in the Borough, the Sub-Districts, the Parliamentary Divisions, and the Wards. (Table, page 7) 6 Births; Number of, and Birth-rate, in 10 years, 1894-1903 7 Births, Illegitimate; Number of, in 1904 6 Births; Annual Number of, and Birth-rate, 1856—1904 (Tables A and C, Appendix II.) 117-119 Births; Particulars with respect to now obtainable by Public Health Authorities 47 Boric Acid, as a Preservative of Food; Report by the Public Analyst and the Medical Officer of Health on 52 Borough; Development of the; since 1856, and since 1871 4 Brompton Consumption Hospital; Deaths at the 28 By-law, regulating Conveyance through Streets of the Carcases of Dead Horses 94 By-laws for Houses let in Lodgings; Judicial Decisions with Respect to 64 „ for Bakehouses and other Places where Food is Prepared for Sale; The Need of 73 Calf-lymph; The Supply to Public Vaccinators of 53 Cancer, Malignant Disease; Deaths from 26 Census of 1901; Population of the Borough at the 3 Chapel of Rest for the Dead, provided at North Kensington 92 Characteristics of the Vital and Mortal Statistics in 1904 13 Cleansing of Persons Act; Practically inoperative in the Borough 88 Combined Drainage ("Sewer" or "Drain" ?): Need of amending Legislation in respect of 85 Common Lodging-houses; List of the 65 Consumption; The Prevention and Treatment of 35 „ The Need of Sanatoria for the Isolation and Treatment of 35,40&74 „ The Metropolitan Asylums Board Proposed as Sanatorium Authority for 37 „ The Metropolitan Asylums Board provide Seaside Home for Treatment of Children suffering from 41 „ Proposed Utilisation of Gore Farm Hospitals as Sanatoria for 38 „ Voluntarily Notifiable in Kensington 42 „ Lady Inspectors' Report on the Notification of 42 „ Report of the Royal Commission: On the Identity of Bacillus (Human and Bovine) of 41 Coroner's Court; Number of Inquests held at the 91 Coroners' Districts 91 Counter's Creek Sewer; Flooding of Houses due to Insufficiency of 82 County Council (General Powers) Act, 1904; Sanitary Provisions of the 76 Cow-house, Licensed 79 Crèches Municipal); Recommendation of Establishment of 51 Cremation; Note on 93 Dairies Order; Registration of Milk Shops, &c., by the Council, as Local Authority under the 79 Death; Registrar-General's New List of Causes of 15 „ Assigned Causes of (Tables, page 17 and page 100) 15 „ Summary of Causes of 18 Death-rate; Annual, 1856—1904 (Table A, Appendix II.) 117 „ from Zymotic Diseases; Arranged in Quinquennial Periods, 1856-1900 (Table D) 119 „ „ „ „ in 1904, in the Borough, the Sub-Districts, &c. 19 „ in 1904; The Corrected or True 9 „ of England and Wales; and of Inner, Outer, and Greater London 15 „ of Foreign and Colonial, Indian and Egyptian Cities 15 ii. Page. Deaths and Death-rate; In the Borough, the Sub-Districts, the Parliamentary Divisions and the Wards (Table, page 12) 8 Deaths at Public Institutions within the Borough 27 „ of Parishioners at Public Institutions, &c., without the Borough 28 „ of Illegitimate Children, under Five Years of Age 10 Destitution and Sickness 93 Diarrhœa; Mortality in Kensington and in London from 25 „ Mortality in Kensington, 1856—1904, from (Tables B, C and D, Appendix II.) 118-119 Digestive System; Mortality from Diseases of the 26 Diphtheria; In Kensington and in London in 1904 23 „ Mortality in Kensington, 1871—1904, from (Tables B, C and D. Appendix II.) 118-119 Diseases; Deaths from General 18 & 25 Disinfection, in 1904 and in 1891; The Cost of 89 Disinfecting Station 89 District Rates of Mortality (Table, page 12) 10 Drainage; Supervision of Reconstruction and Repair of House 85 England and Wales; Death-rate, in 1904, of 15 Enteric Fever; Mortality, in Kensington and in London, in 1904, from 24 „ Mortality (Kensington), 1856—1904 (Tables B, C and D, Appendix II.) 118-119 Factory and Workshop Act, 1901; Proceedings under the (Tables, 68-72) 66 „ „ „ Chief Sanitary Inspector's Report on Men's Workshops 70 „ „ „ Lady Inspectors' Report on Women's Workshops 67 „ „ „ Proceedings with respect to Underground Bakehouses under the provisions of the 72 Female Persons; Number of, Enumerated at the Census, 1901 3 Fever; Mortality, in Kensington and in London, in 1904, from 24 „ Mortality (Kensington), 1856—1904 (Tables B, C and D, Appendix II.) 118-119 Fever Hospital Accommodation 59-60 Flooding of Basements of Houses; Insufficiency of Main Sewers the Cause of 82 „ „ „ „ Relief Works (New Sewer) to be constructed for preventing the 82 Food and Drugs Adulteration Acts; Mode of Procedure under the 51 „ „ „ „ Note with reference to use of Boric Acid 52 Fried Fish Shop; An Un-scheduled "Offensive Business" 80 „ „ Business of, recommended for Scheduling under Public Health Act 75 Gas-Works; Effluvium Nuisance at the 89 General Diseases, Zymotic; Mortality from 18 „ „ (other than Zymotic); Mortality from 25 Gore Farm Hospitals recommended for Use as Sanatoria for Consumption 38 „ „ no longer reckoned as Small-pox Hospitals 40 Horses; By-law made for Regulating the Conveyance through streets of the carcases of dead 94 Hospital Accommodation for Infectious Disease 59-60 „ „ for Consumption; Need for Provision of 35 Hospitals; Deaths at Outlying 28 House Drainage; New Departure in Respect of Supervision of Reconstuction and Repair 85 House Refuse; Proposed Bi-weekly Removal of 81 Houses (Inhabited); Number of, in 1904, and Increase of, since 1856, and since 1871 4 „ Let in Lodgings; Number of Registered 64 „ „ „ The Need of Amended By-laws for: Judicial Decisions 64 Housing of the Working Classes 60 „ „ „ Action of the Borough Council with respect to the 63 Hygienic (Asphalte) Paving of Streets 87 Illegitimate Children under Five Years of Age; Deaths of 10 Infantile Mortality in the Borough, the Metropolis, and in England and Wales 10 „ „ 1871—1904 (Table A, Appendix II.) 117 „ „ The Times Articles on 46 Infectious Diseases; Ages at Notification of, in London; in 1904 30 „ „ Cases of, Notified in London, and in Kensington, and the Metropolitan Cities and Boroughs (Tables, pp. 30—33) 29 „ „ Cases of, Notified in London, 1890—1904 (Annual Number) 30 „ „ Sickness and Death-rate from (Table) 34 Infirmary; Deaths at the Borough 27 Influenza; Mortality, in Kensington, and in London, from 25 Inquests; Proportion of Deaths Certified by Coroners; in Kensington, in London, and in England and Wales 29 iii. Page. Lady Inspectors of Workshops; Annual Report, for 1904, of the 67 „ „ „ First Appointments of, in 1893 66 „ „ „ Report on Notification of Consumption by the 42 Legal Proceedings (Summonses, etc.) 77 Local Diseases; Mortality from 26 Local Government Board's New Statistical Forms (Tables I.—IV.) 16 London; Inner and Outer and Greater; Death-rate, in 1904, of 15 Main Drainage; Flooding of Basements of Houses, due to Insufficiency of 82 Male Persons, Enumerated at the Census, 1901; Number of 3 Marine Stores; Business of, recommended for Scheduling under the Public Health Act 75 & 80 Marriages and Marriage-rate in 1904 5 „ „ „ Annual Number of, 1871—1904 (Table A, Appendix II.) 117 Marylebone Infirmary (North Kensington); Deaths of Non-Parishioners at 28 Measles; Mortality, in Kensington and in London, from 20 Metropolitan Asylums Board 55 Milk; Boric Acid in 52 „ for Infants; Need of Municipal Provision of 49 „ Unclean; Note on 50 Mortality; District Rates of 10 „ Infantile 9 „ Senile 10 „ Zymotic 18 Mortuary; Number of Bodies deposited at the Public 91 „ „ „ „ „ Chapel of Rest, North Kensington 92 „ Limitation of the Power of the Council to remove Bodies to the 91 Municipal Crèches; The Need of 51 Municipal Milk Depôts; The Need of 49 Nervous System; Mortality from Diseases of the 26 Notification of Infectious Disease; Local and Metropolitan (Tables, pages 30—33) 29 „ Voluntary, of Phthisis, in Kensington 42 Notting-Dale Special Area; Statistics of the 11 Offensive Businesses 79 „ „ Fried Fish Shop and Marine Stores; Proposed, for Scheduling under the Public Health Act as 75 & 80 Offensive Trade and other Refuse; Removal of 81 Offensive Smells in Streets; Reports of Committees of the late Vestry with reference to 83 Outlying Public Institutions, &c.; Deaths at 28 Outworkers; Provisions of Section 107 of Factory and Workshop Act, 1901, generally disregarded by Occupiers of Workshops, with respect to 68 Parliamentary Divisions of the Borough 4 Paving of Streets, Hygienic 87 Phthisis, Pulmonary; Deaths and Death-rate, in Kensington and in London, from 25 „ Voluntary Notification, in Kensington, in 1904, of 42 Population of the Borough at the Census of 1901; Age and Sex Distribution 3 „ „ „ „ Decennial Censuses, 1801—1901 4 „ „ „ Estimated Annual; 1856—1904 (Table A, Appendix II.) 117 „ „ „ „ in 1904 5 Public Baths and Washhouses; Number of Bathers and Washers in the year 1904—5 at the 88 Public Health (London) Act, 1891; Conference of Delegates of the Metropolitan Borough Councils on the Administration of; and proposed Amendment of the 73 Public Institutions; Deaths at 27 „ „ Deaths at Outlying 28 Public (and Public-house) Sanitary Conveniences 86 Puerperal Mortality in 1904 25 Rateable Value of Kensington in 1904; and Increase of, in Eighty-two Years, 1823—1904 4 Refuse; House, and Removal of 80 & 81 „ Nuisance from Stable 81 iv. Page. Registered Mouses; Number of 64 „ „ The Need of Amended By-law for: (Judicial Decisions) 64 Registration District and Sub-Districts 5 Restaurant-kitchens, Bakehouses, etc.; The Need of By-laws with respect to 73 Re-vaccination; Need of Legislation for Compulsory 53 St. Joseph's House; a quasi-public Institution; Deaths at 28 Sanatoria for Consumption; The Need of 35 „ Action of the Council and other Public Bodies with reference to the provision of 38 „ Proposal to utilise Gore Farm Hospitals as 38 & 39 Sanitary Conveniences, Public; and at Public-Houses; Number of 86 Sanitary Inspectors; The Work of the (Statistical Table, page 78) 77 Sanitary Legislation; Provisions of the London County Council (General Powers) Act, 1904 76 Scarlet Fever; Mortality, in Kensington and in London, in 1904, from (Tables, pages 21—22) 20 „ Mortality, in Kensington; 1856—1904 (Tables B, C and D, Appendix II.) 118-119 Senile Mortality 10 Sewers; Recommendation to improve the Ventilation by abolishing "dead ends," of 84 „ „ „ Reports of Committees of the late Vestry on 83 Sewer Smells in Streets: Untrapped Street Gullies and Surface Ventilators, the Causes of 83 Sex and Age Distribution of the Population of the Borough, in 1901 3 Shelter for Persons during Disinfection of Rooms: The Need of a 90 „ „ „ „ „ Statistical Evidence of the Need of 90 Slaughter-houses; Licensed 79 Small-pox; in Kensington, and in London, in 1904 20 „ Mortality, Annual; 1856—1904 (Tables B, C and D, Appendix II.) 118-119 „ Views of the Royal Commission of 1882 on the Required Amount of Hospital Accommodation for 59 Smoke Nuisance 86 Special Area (Notting Dale); Statistics of the 11 Statistical Tables; The Local Government Board's prescribed Forms for 16,17 & 33 „ „ Nos. vi.—xii. (Appendix I.) 98 „ „ Of Births, Deaths, &c., 1856—1904 (Table A, Appendix II.) 117 Statutory Notices issued in 1904; Number of 77 Street Ambulance Service; Action of the County Council and of the Metropolitan Asylums Board with respect to a 56 Streets, &c., in which Cases of Infectious Disease were notified, in 1904; List of 112 „ in which Deaths from Zymotic Diseases occurred, in 1904; List of 109 Streets; Asphalte recommended for Hygienic Pavng of 87 Syphilis; Deaths from 25 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 1904 and the preceding ten years; for whole District 16 (ii.) Population, Births, Deaths at All Ages, and under One Year; in the Borough, and the Sub-Districts; in 1904 and the preceding ten years 17 (iii.) Infectious Disease; Cases of, Notified at different Ages, in the Borough, and in the Sub-Districts; and Cases removed to Hospital 33 (iv.) Death, Causes of, and Ages at, in 1904 17 Tables (Other), in the Report:— Population; Age and Sex Distribution of; in 1901 3 „ At the Censuses, 1801—1901, inclusive 4 Birth-rate in the Metropolis, and in the Borough, the Sub-Districts, &c.; in 1904. 7 Death-rate in the Metropolis, the Borough, the Sub-Districts, the Parliamentary Divisions, and the Wards; in 1904 12 Death; Summary of Causes of, in the Borough; in 1904 18 Zymotic Diseases; Deaths from, in the Borough and the Sub-Districts; occurring at Home and at Hospitals; in 1904 (Table) 18 Scarlet Fever; Notifications, Removals, Deaths, &c.; in four-weekly Periods; in i 904, and in the preceding ten years 21 & 22 Diphtheria; Notifications, Removals, Deaths, &c., in four-weekly Periods; in 1904. 28 & 24 Infectious Disease Notification (London); 1890—1904 30 „ „ Sickness and Death-rate in Kensington; in 1904 and ten preceding Years (Table V.) 34 Vaccination Officer's Return for 1903; and Statistics of "Lost" Cases in London and England and Wales; 1882—1901 52 Lady Inspectors of Workshops, &c.; Report of the 67 Sanitary Inspectors; Summary of the Work of the 78 v. Page. Tables inl Appendix I.: — (vi.) Population (Estimated), Inhabited Houses, Marriages, Births, Deaths, &c.; in 1904, and in the preceding ten years 98 (vii.) Birth-rate and Death-rate; Death-rate of Children; and Deaths in Public Institutions; in 1904, and in the preceding ten years 99 (viii.) Deaths, from all Causes, in 1904 (Summary of Table viii., page 18) 100 (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; in 1904 99 (x.) Deaths; in 1904, and in the preceding ten years; from the Principal Diseases of the Zymotic Class; in Kensington, and in London, and in England and Wales 108 Tables in Appendix II.: — (a) Population (1856—1904); Marriages and Marriage-rate (1871—1904); Births and Birth-rate, and Deaths and Death-rate (1856—1904), and Infantile Mortality (1871—1904) 117. (b) Zymotic Diseases (Principal); Annual Number of Deaths, in Kensington; and Death- rate, in Kensington and in London (1856—1904), from 118 (c) Births and Birth-rate; Deaths and Death-rate; Deaths from the principal Zymotic Diseases, and the Zymotic Death-rate in Kensington, 1856—1900. Arranged in Quinquennial Periods 119 (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, respectively 119 Tenement Houses; The Water Supply of 94 Tenements of less than five Rooms in 1901; Number and Population of 3 Tubercle Bacillus; Identity of the Human and the Bovine 41 Tuberculosis; Deaths and Death-rate, in Kensington and in London, from 25 „ Prevention and Treatment of 35 „ Pulmonary; Deaths and Death-rate, in Kensington and in London, from 25 „ Metropolitan Asylums Board provides a Seaside Home for the Treatment of Children in the early stages of 41 Uncertified Deaths; in London, and in England and Wales, in 1904 29 Underground Bakehouses; Results of Proceedings with respect to 73 Underground Rooms, illegally occupied; Closure of 89 Unemployed; Recommendations with respect to Work for the 88 Untrapped Street Gullies; Effluvium Nuisance from 83 Urinary System; Deaths from Diseases of the 26 Ventilation of Sewers; Recommendation to abolish "dead ends" to improve the 84 Vaccination Authority; The Future 53 „ Law 55 „ Officer's Report for 1903 (Statistical Table, page 54) 52 „ Statistics; "Lost" Cases in London, and in England and Wales, 1883—1901 53 „ Supply of Calf Lymph for 53 Violence; Deaths, and proportion of, to 1,000 of the Population, in 1904, from 29 Vital and Mortal Statistics (1904); Summary of (Table) 14 Wards; High rate of Mortality in certain 48 „ Number and Titles of the 5 Water Supply 94 „ of Tenement Houses 94 Whooping-cough; Mortality in Kensington, and in London, in 1904, from 24 Woman Health Visitor appointed 48 Women Health Visitors; Appointment of, recommended 47 Working Classes; Acton of the Council with respect to the Housing of the 63 Workshops, Laundries, &c.; Annual Report of the Lady Inspectors of 67 Written Intimations of Nuisances issued in 1904; Number of 77 Yards; Hygienic Importance of the Paving of 87 Zymotic Diseases; Deaths and Death-rate, in the Sub-Districts, the Parliamentary Divisions, and the Wards, from 19 „ „ Death-rate, in Kensington, in London, and in England and Wales, from 19 Zymotic Mortality; in Kensington, 1856—1904 (Tables B, C, and D, Appendix II.) 118 &119