KEN 18 The Royal Borough of Kensington. ANNUAL REPORT. OF THE MEDICAL OFFICER OF HEALTH. 1909. Ordered by the Council to be printed. Vail & Co., Printers and Stationers, 170, Farringdon Road, E.C II. PUBLIC HEALTH COMMITTEE, 1909-10. Chairman: Councillor A. G. McARTHUR, M.A., J.P. Vice-Chairman: Councillor J. BROOKE-LITTLE. The MAYOR (ex-offcio). Alderman the Hon. Sir WALTER G. F. PHILLIMORE, Bart., J.P. Alderman the Rev. PREBY. S. E. PENNEFATHER, D.D. Councillor F. H. ALDERSON, M.B., M.R.C.S., L.R.C.P. „ Miss A. M. ALEXANDER. „ F. H. ANDERSON, M.D. „ R. D. BAXTER. „ J. CARNEGY-ARBUTHNOT. „ H. CORRY. „ W. F. CRAIES, M.A. „ Surg.-Gen. Sir C. Mc D. CUFFE, K.C.B., J.P. „ H. FREYBERG, F.S I. „ C. G. HATT. „ Miss A. S. HAYNE. „ SIR JAMES HOME, Bart. „ W. T. KEY. „ Lt.-Col. A. W. F. LANGMAN. „ F. LIDDALL ARMITAGE. „ C. J. LOCKWOOD. „ C. G. PADDON. „ A. TISDALL. III. PUBLIC HEALTH DEPARTMENT STAFF. Chief Sanitary Inspector. George M. Pettit. Sanitary Inspectors. J. R. Bagshaw. E. J. Bennett. T. Cutting. H. Dawes. J. H. Fowles. A. E. Friend. G. W. McQuinn. N. Males. C. G. Sexton. J. Steward. Inquiry Officer (Infections Diseases). H. J. Oliver. Lady Sanitary Inspectors. Miss N. T. F. De Chaumont. Miss G. A. Looker. Health Visitors. Miss E. Mac Kay. Miss N. Stokes. Clerks in the Department. E. R. Hill. H. A. Hillam. W. J. Essex. C. S. Sewell. J. H. Wilson. Mortuary Keeper. W. Sutton. Staff for Disinfection. W. Cambridge (Engineer), F. Chillcott, A. Nunn. Medical Officer of Health. J. E. Sandilands, M.D., D.P.H. V. To the Mayor, Aldermen and Councillors of the Royal Borough of Kensington. Ladies and Gentlemen,— I have the honour to submit my first annual report which contains in accordance with the Regulations of the Local Government Board, a summary of the action taken for the prevention of disease and an account of the sanitary state of the Borough of Kensington during the year 1909. On pp. 21-23 a record will be found of the results of an inquiry in Kensington which afford evidence of the infectious nature of zymotic enteritis, a disease which kills large numbers of infants during the summer months of the year. The urgent necessity for the provision of adequate means of dealing with certain conditions of uncleanliness in children attending the elementary schools in the Borough is considered on pp. 58-60 in the section which relates to sanitation. The presentation of this report affords me the opportunity for expressing my appreciation of the assistance I have received in my work from the chairman and members of the Public Health Committee of the Council and for thanking the staff of the Public Health Department for their loyal co-operation in my first year of office. I have the honour to be, Ladies and Gentlemen, Your obedient Servant, J. E. SANDILANDS, Medical Officer of Health. Public Health Department, Town Hall, Kensington, W. 12th April, 1909. VII. TABLE OF CONTENTS. A.—Vital Statistics. Page. Population 3 Births 4 Deaths 5 „ from Zymotic Diseases 7 „ of Infants 8 Infantile Mortality, Causes of 9 Children Act, 1908 13 B.-Prevalence of Disease. Infectious Diseases 17 Small Pox 17 Diphtheria 17 Scarlet Fever 18 Enteric Fever 19 Puerperal Fever 20 Measles 20 Whooping Cough 21 Influenza 21 Epidemic Diarrhœa 21 Consumption or Phthisis 24 Other Tuberculous Diseases 28 Causes of Disablement 28 Alcoholism 28 Cancer 28 C.—Food Supply. Recent Legislation 33 Milk Shops 34 Ice Cream Vendors 34 Restaurants 34 Underground Bakehouses 35 Slaughter Houses 35 Sale of Food and Drugs Acts 35 Margarine 36 Water Supply 37 D.—Housing. Inhabited Houses 41 Council's Lodging Houses 41 Houses Let in Lodgings 41 Furnished Rooms 42 House to House Inspection 42 Overcrowding 42 Customs and Inland Revenue Acts 42 D.—Housing—continued. Page. Common Lodging Houses 42 Housing, etc., Act, 1909 43 London (General Powers) Acts 44 E.—Factories and Workshops. Women's Workshops 47 Basement Workrooms 48 Home Work 48 Men's Workshops 51 Home Office Tables 52 F.-Sanitation. Dust Removal 57 Drainage Work 57 Public Lavatories 57 Nuisance from Smoke 57 Legal Proceedings 57 Sanitary Inspection 57 Disinfection 58 Verminous Persons 58 Public Mortuary 60 Vaccination 61 G.—Appendix. Local Government Board Tables. Table I.—Vital Statistics, 1909 and Previous Years 65 Table II.—Statistics for Separate Localities 66 Table III.—Infectious Diseases 67 Table IV.—Causes of Death 68 Table V.—Infantile Mortality 69 London County Council Summary. Table VI.—Proceedings during 1909 70 Other Statistical Tables Table VII.—Work of Sanitary Inspectors 71 Table VIII.—Deaths, Sex, Age and Cause 72 Table IX.—Births and Deaths in Quinquennial Periods 80 Table X.—Zymotic Deaths in Quinquennial Periods 81 Table XI.—Zymotic Death Rates in Quinquennial Periods 81 Table XII.—Vaccination Returns, 1908 82 VIII. SUMMARY OF STATISTICS, For the year 1909. Population (Estimated) 181,500.  Area of Borough in Acres 2,291 Density of Population per Acre 79 Houses Inhabited 25,198 Persons per House 7.2 Number of Marriages 1,574 Number of Births 3,381 Birth Rate 18.6 Number of Deaths 2,449 Crude Death Rate 13.5 Corrected Death Rate 14.6 Infantile Mortality:— Deaths under 1 year 379 Infantile Deaths per 1,000 Births 112 Deaths from Phthisis 168 Phthisis Death Rate 0.93 Deaths from the Zymotic Diseases 184 Zymotic Death Rate 1.01 VITAL STATISTICS. 3 VITAL STATISTICS. The Metropolitan Borough of Kensington as constituted under the London Government Act, 1899, covers an area of 2,291 acres, and is co-extensive with the Civil Parish and Registration District of the same name. The line of demarcation formed by Holland Park Avenue, High Street, Notting Hill Gate and the Bayswater Road divides the Borough into approximately equal halves, described in previous years and in this Report as North and South Kensington respectively. The Borough is further subdivided into eight wards. South Kensington includes the wards of Holland, Earl's Court, Queen's Gate, Redcliffe and Brompton, and is co-extensive with the South Kensington Parliamentary Division. North Kensington, containing the wards of St. Charles, Golborne, Norland and Pembridge, is not co-terminous with the Parliamentary Division of the same name, in that it extends northwards to include an area of 100 acres with a population of 3,500 persons which is still allotted, for parliamentary purposes only, to Chelsea. The rateable value of the Borough is £2,447,399. Population.—The population is estimated to have numbered 181,500 in the middle of the year 1909, an estimate which assumes a loss to the Borough by excess of emigration over immigration of 432 inhabitants. The natural increase by excess of births over deaths was 932. The subjoined summary table represents the age and sex distribution of the population 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 For the year 1909 the population is assumed to have been distributed in North and South Kensington and in the several wards of the Borough as shown in the following table:— The Borough 181,500 North Kensington South Kensington 93,590 87,910 Wards:— North Kensington St. Cbarles 22,540 Golborne Norland 27,040 24,140 Pembridge 19,870 South Kensington Holland 20,980 Earl's Court 18,540 Queen's Gate 14,660 Redcliffe 19,190 Brompton 14,540 In regard to the social status of the population it may be said that the majority of the inhabitants of North Kensington live in poverty ; in South Kensington persons living in poverty constitute only a small fraction of the population. In so far as the figures are available, the population, the number of inhabited houses and the rateable value of property since 1801 have been shown in the annual reports for 1908 and previous years and need not be given again in this report. Marriages.—The marriages celebrated during the year numbered 1574. The number of marriages celebrated annually and the annual marriage rate since 1856 were given in the annual report for 1908, Appendix II., Table A, page 60. 4 Births.—The number of births registered in the district was 3,187, but this figure does not include 194 infants born of Kensington mothers in Queen Charlotte's Lying-in Hospital and other institutions beyond the Borough. The total number of births belonging to the Borough was, therefore, 3,381. The birth-rate expressed as the number of births per 1,000 of the population was 18*6. Arranged as to sex and legitimacy the births were as follows:— Male. Female. Total. Legitimate 1,646 1,552 3,198 Illegitimate 86 97 183 Total 1,732 1,649 3,381 The following table shows the number of births and the birth-rate in North and South Kensington and in the several wards, after distribution of the births at the Borough Infirmary and Queen Charlotte's Hospital:— Total Births. Birth-rate per 1,000 of the Population. North Kensington 2,460 26.3 South Kensington 921 10.5 St. Charles 649 28.8 Golborne 869 32.1 Norland 594 24.6 Pembridge 348 17.5 Holland 258 12.3 Earl's Court 223 12.0 Queen's Gate 94 6.4 Redcliffe 228 11.9 Brompton 118 8.1 The Borough 3,381 18.6 The effects of social status on the birth-rate are illustrated by the fact that the rate for South Kensington is less than half the rate for North Kensington, whilst the birth-rate for Golborne Ward in the North is more than five times as great as the rate for the Ward of Queen's Gate in the South. To a certain extent this wide discrepancy is no doubt due to differences in the numbers of married women in the districts compared. In the following table the proportion of total births to the whole population is compared with the proportion of legitimate births to married females of conceptive age in Kensington and London respectively:— Period Birth-rate per 1,000 living. Legitimate Births per 100 Married Women aged 15—45 years. London. Kensington. London. Kensington. 1890-2 31.1 22.9 25.0 21.4 1900-2 28.7 20.8 22.7 19.3 1908 25.2 19.2 19.8 17.6 5 Represented in proportion to the total population, the birth-rate in London appears to be more than 35 per cent, higher than in Kensington. When the births are shown in proportion to married women of child-bearing age, the birth-rate for London is seen to be less than 18 per cent, higher than the rate in Kensington. The discrepancy is thus materially reduced when allowance is made for the smaller proportion of married women in the community with the lower birth-rate. In both areas the birth-rate is declining and, in spite of an increasing total population, the births occurring every year in Kensington have fallen in round numbers from 4,500 in 1880 to 3,400 in the present year. The steady decline in the birth-rate is shown in Table IX. Appendix, p. 80, where the number of births and the birth-rates both for London and Kensington are given for each quinquennial period since 1856. The figures for each year were given in the Annual Report for 1908. Illegitimate Births.—The illegitimate births numbered 183, and were equivalent to a of 10 per 10,000 persons living. In the following tables the illegitimate births in London Kensington are shown in proportion to every 10,000 inhabitants and to every 1,000 unmarried widowed females aged 15—45 years. Period Illegitimate Birth-rate. Per 10,000 living. Per 1,000 Unmarried and Widowed Females aged 15—45 years. London. Kensington. London. Kensington. 1890-2 11 12 7.7 4.8 1900-2 10 10 6.4 3.8 1908 9 11 5.9 4.3 In proportion to the total population, the illegitimate birth-rate of Kensington is equal to or greater than that of London as a whole. When allowance has been made for the excess of unmarried females in Kensington, the true illegitimate birth-rate is seen to have been considerably lower than in London both in the census periods and in 1908. The London figures for 1909 are not yet available. Deaths.—The corrected number of deaths was 2,449. The corrected death-rate was 14.6 as compared with a crude death-rate of 13'5 per 1,000 living. To obtain the corrected number of deaths, which represents the true mortality among the population, it is necessary to add the deaths of Kensington "residents" occurring beyond the district to the number registered as actually occurring in the Borough, and to subtract from the total thus arrived at the deaths of "nonresidents "taking place in the institutions provided in Kensington for the reception of sick or infirm persons. For statistical purposes the Local Government Board define the term "Non-residents" as meaning "persons brought into the district on account of sickness or infirmity and dying in public institutions there;" by the term "Residents" is meant "persons who have been taken out of the district on account of sickness or infirmity, and have died in public institutions elsewhere " The following figures show how the corrected number of deaths given above has been obtained:— Total deaths registered in the Borough *Deaths of residents in public institutions beyond the Borough 2,771 371 *Deaths of non residents in public institutions within the Borough 3,141 692 Corrected number of deaths belonging to the Borough 2,449 * The great majority of these deaths occurred in institutions, but a small number were "non-institutional" The figures are based on the periodical returns received from the General Register Office, in which corrections are made in the case oi London both for institutional and non-institutional deaths. The corrected death-rate is designed to represent the mortality that would have occurred had the age and sex distribution of the population in Kensington been the same as that of the population of the country as a whole. The age and sex composition of the population in Kensington favours a low mortality, and the effect of making allowance for these disturbing factors is to raise the crude death rate of 13'5 to the corrected rate of 14 6 already given. Where comparisons are instituted between populations with a widely different age and sex composition the use of corrected deathrates is essential, but in Kensington and in the Metropolis as a whole the influence of age and sex is for practical purposes the same, and the crude death-rates shown in the following table may be accepted as roughly representing the relative mortality in the two areas. The mortality in Kensington is somewhat less than in London as a whole and in both areas the death-rate is remarkably low and has fallen steadily during the past 14 years. The number of deaths and the death-rates in Kensington and London for each quinquennial period since 1856 will be found in Table IX. Appendix, p. 80. The number of deaths occurring in each year since the same date and the annual death-rates have been published in the Appendix of the Annual Reports for 1908 and previous vears. The following table records the mortality per 1,000 living of each sex at different age-periods:— Age-Period. Population. Deaths. Death-rate. Both Sexes. Males. Females Both Sexes. Males. Females. Both Sexes. Males. Females. Under five years of age 14,537 7,249 7,288 610 322 288 41.3 44.4 39.5 Five and under 15 26,610 12,941 13,669 51 26 25 1.9 2.0 1.8 Fifteen and under 25 39,282 13,831 25,451 91 47 44 2.3 3.4 1.7 Twenty-five and under 35 35,938 11,808 24,130 109 52 57 3.0 4.4 2.4 Thirty-five and under 45 25,498 9,701 15,797 191 94 97 7.5 9.7 6.1 Forty-five and under 55 18,671 7,416 11,255 263 132 131 14.1 17.8 11.6 Fifty-five and under 65 11,889 4,711 7,178 334 162 172 28.1 34.4 24.0 Sixty-five and under 75 6,291 2,367 3,924 389 168 221 61.8 71.0 56.3 Seventy-five and upwards 2,784 976 1,808 411 144 267 147.6 147.5 147.7 Totals 181,500 71,000 110,500 2,449 1,147 1,302 135 162 11.8 6 Crude Death-rates per 1,000 living. Kensington. London. 1896-1900 16.4 18.8 1901-1905 14.1 16.4 1906 13.9 15.1 1907 13.7 14.6 1908 13.0 13.8 1909 13.5 14.0 7 At every age-period except the last males show a higher mortality than females, the discrepancy being due partly to the greater risks attending the occupations followed by men and partly to their greater tendency to intemperance. The death-rate amongst children under 5 years of age is more than twenty times as great as among older children and is not again equalled until the age period 65 to 75 has been entered upon. The number of deaths at all ages with the corresponding death-rates in the Borough, in North and South Kensington and in the several Wards was as follows:— Districts. Number of Deaths. Crude Death-rate per 1,000 inhabitants. North Kensington 1,521 16.3 South Kensington 928 10.6 St. Charles 398 17.7 Golborne 439 16.2 Norland 448 18.6 Pembridge 23G 11.9 Holland 267 12.2 Earl's Court 229 12.4 Queen's Gate 94 6.4 Redcliffe 233 12.1 Brompton 115 7.9 The Borough 2,449 13.5 The mortality in North Kensington was very much greater than in South Kensington, the difference being mainly due to the prevalence of poverty in the former area. A certain proportion of the discrepancy must be attributed to the age and sex composition of the South Kensington population, since a death-rate of less than 10 implies an average age at death of 100. The crude deathrates for Queen's Gate and Brompton indicate an average age at death of 143 and if the explanation did not rest on the age and sex distribution of the population, for those that died in early life others would be destined to live to ages exceeding 200 in order that the average might be maintained. Corrected death-rates for the several wards cannot be calculated since the census returns do not give the age and sex composition of the population except for the Borough as a whole. Causes of Death.—These are set out in detail in the appendix. The following list shows certain causes of death which are important in themselves or from the fact that they contributed a considerable share to the total mortality for the year. Principal Zymotic (or infectious) diseases 184 Epidemic influenza 75 Enteritis 22 Puerperal fever 4 Phthisis 168 Other tuberculous diseases 69 Cancer 205 Bronchitis 232 Pneumonia 253 Heart diseases 267 Bright's disease 53 Diseases and accidents of parturition 12 Premature birth 69 Accidents 70 Old age 94 All other causes 672 2449 The diseases described in the above list as the "principal zymotic diseases," are small-pox, measles, scarlet fever, diphtheria, whooping cough, enteric fever (including fever not otherwise defined) and diarrhœa. 8 It will be seen that the principal zymotic diseases were responsible for a substantial number of the total deaths and the zymotic death-rates shown in the following table may be accepted, with certain reservations, as a test of the sanitary state of the Borough. Period. Deaths from Principal Zymotic Diseases per 1,000 persons living. Kensington. London. 1896-1900 1.93 2.64 1901-1905 1.51 2.04 1906 1.50 1.90 1907 1.00 1.40 1908 0.90 1.40 1909 1.01 1.31 A steady and well marked decline in the zymotic death-rate has continued during the past 14 years and throughout this period the rate for Kensington has been considerably lower than the rate for London as a whole. The advantages enjoyed by Kensington in this respect are chiefly due to lower rates of mortality from diphtheria, diarrhoea and whooping cough. In both areas the greater part of the fall in the zymotic death rate since 1896 has been the outcome of a diminution in the death-rates from scarlet fever, diphtheria and enteric fever. The falling death-rate from enteric fever follows the diminished prevalence of the disease. The prevalence of scarlet-fever has not been materially reduced, but the type of the disease has of late years been extremely mild. The decline in the mortality from diphtheria results directly from the treatment of diphtheria patients by antitoxin. This treatment was first practised in the hospitals of the Metropolitan Asylums Board in 1895, and has now become universal. The death rates from measles and whooping cough show some tendency to decrease, but the mortality from diarrhoea in the quinquennium 1901-1905 was the highest recorded for any quinquennial period since 1880. INFANTILE MORTALITY. The deaths among infants under the age of one year numbered 379, the infantile mortality rate being 112 per 1,000 births. By expressing the number of deaths in proportion to the number of births, the influence of age distribution is eliminated and a reliable standard is afforded for measuring the comparative mortality in different districts. The following table shows a decline in the infantile death-rate from 172 in the quinquennium 1896-1900 to 112 in the present year. Deaths under one year per 1,000 Births. Period. Kensington. London. 1896-1900 172 163 1901-1905 144 140 1906 132 133 1907 126 117 1908 122 113 1909 112 108 9 Though it is true that in recent years cool summers have favoured a low mortality, there can be no doubt that the unprecedented fall in the number of deaths among infants has been very largely due to the excellent work of the lady health visitors. In the Metropolis whilst the general death- . rate has fallen steadily since 1870, the mortality amongst the infantile population, in spite of notable sanitary reforms, remained stationary until the year 1900. From this year onwards as the table shows the infant death-rate has continued to fall and some part of the decline, which was already well marked in the years 1901-05 must be attributed to indirect rather than direct administrative measures when we consider that prior to the year 1905 only one lady inspector in the whole of London was engaged in advising mothers of the poorer classes in the management of their babies. The difference between the infantile death rates recorded in the various districts of the Borough is shown in the following table: District. Deaths under one year. Deaths under one year per 1,000 Births. North Kensington 305 124 South Kensington 74 80 St. Charles 77 119 Golborne 106 122 Norland 81 136 Pembridge 41 118 Holland 18 70 Earl's Court 14 63 Queen's Gate 6 64 Redcliffe 25 110 Brompton 11 93 The Borough 379 112 The death-rate in North Kensington is 55 per cent, greater than, or more than half as high again as the rate in South Kensington. Golborne and Norland are the poorest districts and have the highest mortality. In the districts adjoining Golborne and Norland wards an excessive number of deaths masks the low mortality which prevails in the more favoured portions of the wards of St. Charles and Pembridge. Had the death-rate of South Kensington prevailed throughout the Borough the deaths in North Kensington would have numbered 397 instead of 305. The difference of 108 deaths represents the preventible waste of life which will without any doubt be prevented within the next 20 years. Causes of High Infantile Mortality.—The principal causes of high infantile mortality are to be sought in the conditions which accompany poverty. Lack of food both for mother and child, improper food, crowding of persons in rooms, want of air, uncleanly homes, neglect deliberate or inevitable and ignorance are perhaps the conditions which chiefly affect the health of infants in the homes of the poor. To pay rent for the minimum of cubic space allowed by the law, to live on insufficient food and to supplement the weekly income by sending their wives out to work are the means by which numbers of casual labourers keep themselves and their families from the workhouse. If the mother is obliged to go out to work, the neglect I have described as inevitable must follow. There are then certain injurious influences, the direct outcome of poverty, which the Council's visitors can do but little to alleviate. On the other hand, in giving advice as to feeding, cleanliness and the necessity of fresh air, especially to the teachable mothers of first babies, an immense amount of good can be and is effected by the Health Visitors. 10 The effect of want of breast milk and the artificial feeding which it entails is shown in the following table:— Method of Feeding, Infants visited at Age 3 to 4 months. Infants who died before the age of 6 months. Breast alone, Number Fed on 276 54 Artifically Fed, Number 107 43 Breast alone, Percentage Fed on 72 56 Artifically Fed, Percentage 28 44 The figures show that the percentage of artificially fed children among those who died before the age of six months was very much higher than in the infant population at large at the same ages. In the following table the infants visited and the infants who died are classified according to the number of the rooms in the tenements occupied by their parents. Number of Rooms in Tenement, l 2 3 4 or more. Infants Visited, Number ... 133 281 97 36 Infants who died, Number 36 68 16 8 Infants Visited, Percentage 24 51 18 7 Infants who died, Percentage 28 53 12 7 Contrary to what might have been expected, the percentage of children in one-room tenements among those who died only exceeds the percentage among the infant population at large by a very small figure. The explanation probably lies in the fact that many of the babies born in the one-room tenements are first babies with a better chance of surviving than the children of parents whose circumstances are straitened by the necessity of paying rent for a second room and providing food for a large family out of slender earnings. The chief diseases registered as the cause of deaths in infants were as follows:— Disease. Number of deaths. Common infectious diseases 33 Diarrhoea (including enteritis, etc.) 46 Premature birth 69 Congenital defects 16 Wasting diseases 57 Tuberculous diseases 20 Syphilis 16 Bronchitis and pneumonia 62 Overlaying 10 Other causes 50 379 12 Of the causes specified premature birth claimed the largest number of victims, bronchitis and pneumonia coming second. From the following table it will be seen that the death rate from prematurity has not participated in the very remarkable diminution in the mortality from all causes:— Infantile Deaths per 1,000 Births. 1901—5. 1909, All causes 144 112 Prematurity 20 20 Prematurity.—Information was obtained as to the past histories of 30 mothers whose children died from prematurity in 1909. Occupation. Number of Mothers. Laundry Women 5 Dyeing and Cleaning 2 Charwoman 1 Waitress 1 General Servant 1 House work only 18 Total 30 Only two of the children were illegitimate. The alleged causes of premature labour were:— Fright or shock 6 cases Washing at home or in laundry 5 ,, Falls down stairs or steps 3 „ Railway journey, moving house 2 „ Strain 1 ,, Scarlet Fever (1) Erysipelas (1) 2 „ In eleven cases a history was obtained of previous pregnancies which had ended in premature birth, still birth or miscarriage:— CASE NUMBER. I II III IV V VI VII VIII IX X XI Premature living births 1 0 1 3 0 1 0 3 0 0 1 Still births 3 1 0 0 0 0 0 0 0 1 1 Miscarriages 0 0 0 3 1 0 1 0 5 0 0 Total 2 1 1 6 1 1 1 3 5 1 2 Full time living births 0 4 8 1 1 0 0 3 3 4 5 Total previous pregnancies 2 5 9 7 2 1 1 6 8 5 7 The total number of previous pregnancies in the thirty cases investigated is shown in the following table:— Previous pregnancies None 1 2 3 4 5 6 7 8 9 11 16 Number of cases 5 5 4 3 1 3 3 2 1 1 1 1 12 Deductions cannot be legitimately drawn from so small a number of cases and in the present year it is not possible to do more than note that the total number of 69 deaths attributed to "premature birth" represents only a part of the loss of life and damaged physique resulting from prematurity. Many of the deaths returned as due to "wasting" occur in children prematurely born, and wasting in its turn predisposes to death from respiratory disease. Bronchitis and Pneumonia caused 62 deaths in infants. For practical purposes the terms "bronchitis" and "pneumonia" may be taken as indicating the same disease in infants, since the causes of both conditions are the same, and post mortem examination of large numbers of cases has shown that for every 100 babies dying of pneumonia (broncho-pneumonia) only 6 die of true bronchitis.* The heavy death roll from these diseases is commonly attributed to "colds" resulting from the repeated exposure of young infants to inclement weather in the streets or to draughts in the passages and staircases of their homes. In his report to the Local Government Board Dr. Foulerton has shown that these supposed exciting causes are negligible in comparison to the fundamental predisposing causes to be found in conditions of feebleness and malnutrition. Thus information was obtained as to 30 children dying of bronchitis and pneumonia in Kensington with the following results:— Four children were prematurely born and one was born with congenital defects. In 4 cases the parents were noted as living in great poverty. Five children had ailed for many weeks or months before the onset of pneumonia. Three were noted as insufficiently or improperly fed, one having been reared on a diet of Nestle's milk and boiled bread. Many of the causes of malnutrition are preventible and for this reason there is good hope that the work of the Health Visitors will bring about a further diminution in the death-rate from respiratory diseases among infants. It should be added that chronic tuberculosis of the lungs or consumption is extremely rare as a cause of death in children under the age of 5 years and cannot be held responsible for more than the smallest fraction of the total number of infantile deaths attributed to pneumonia and bronchitis.* The following figures show that the reduction in the infantile death-rate from pneumonia and bronchitis has kept pace with the reduction in the death-rate from all causes :— Diarrhœal Diseases.—These diseases caused 46 deaths, and are dealt with in a special report under the section headed "Diarrhœa" (p.p. 21-23). Wasting Diseases caused 57 deaths. Of these a certain number were no doubt due to congenital syphilis, whilst others probably occurred in children prematurely born. Improper feeding is obviously a preventible cause of wasting, and much valuable work has been done in the past year in referring to charitable agencies cases which, from a medical point of view, if not from the point of view of the Poor Law Authority, may be correctly described as cases of starvation. PREVENTION OF INFANTILE MORTALITY. Notification of Births Act, 1907.— Under this Act, which has now been adopted throughout London, every birth should be notified to the Medical Officer of Health for the district within thirty-six hours of its occurrence. Of 3,187 births registered as having occurred within the borough only 2,258 have been notified. The very general failure on the part of the better classes to notify the" births of their children is receiving the attention of the Public Health Committee. In the meantime, the children of the poor are, with few exceptions, notified within the time appointed by the Act. Work of the Health Visitors.—Two lady Health Visitors appointed by the Council are engaged in the work of visiting newly-born babies. In every case where the parents may be reasonably supposed to be earning less than 40s. per week, the child is visited between the ages of 10 and *Foulerton, A. G. R. " Pnuemonia in Children." 38th Annual Report of the Local Government Board, 1908-9. Infantile Deaths per 1,000 Births. 1901—5. 1909. All causes 144 112 Bronchitis and Pneumonia 26 18 13 20 days, provided the midwife or doctor has ceased attending. With each mother is left a printed card of instructions, which are fully explained on the first visit. The second visit, which is timed under the present arrangement to take place at the age of three months, is made with a view to ascertaining whether the instructions given are being acted upon. Where the child is unsatisfactory or the mother is in need of further advice in infant management, interim visits between the ages of one and three months are paid according to the necessities of each case. The total number of infants visited was 1,968, and the total number of visits and re-visits mounted to 4,018. The following information was obtained as to the feeding of 987 infants visited before the age of two months and in the great majority of cases at ages between 10 and 20 days:— Method of Feeding. Number of Infants. Percentage. Cows' Milk 62 6 Condensed Milk 20 2 Artificially fed 82 8 Breast alone 905 92 Totals 987 100 In no less than 139 out of 987 homes visited the husband was out of work. Of the mothers, 130 had been employed in laundries and 23 in dressmaking or other trades during pregnancy. During the latter half of the year 56 necessitous cases were referred to the Charity Organisation Society, and 40 mothers were recommended to the cheap dinners provided in the Bramley Road for nursing women of the poorest class. Valuable help is rendered by various voluntary agencies. For the Kensington Health Society Dr. Carter holds weekly infant consultations in the Norland Ward. The number of mothers advised during a year averages 160, the number of attendancies in a year being 580. In the same ward a society, presided over by Mrs. Prideaux, provides fifty dinners daily for expectant and nursing mothers, the charge made being 1d. a meal. St. James's Nursery, under the exceptionally capable Management of Mrs. O'Dell, takes in fifteen babies daily, and provides dinners for mothers who come from their work to nurse their babies in the dinner hour. Payment for the babies taken in is insisted on. In Golborne Ward, where work of the kind was much needed, Miss Burness, with a committee of ladies, has established infant consultations in connection with dinners for necessitous nursing mothers, advice in infant management being given by Dr. Warner. The voluntary workers of the Health Society have also done valuable work in visiting mothers referred to them by the Public Health Department as requiring periodical supervision in the management of their infants. With these societies the Council's visitors work under a scheme of co-operation which cannot fail to enhance the value of official and voluntary effort alike, and to bring about a material improvement in the physique of the children of the poorer classes. Children Act, 1908.—The provisions of this Act, which supersedes the Infant Life Protection Act, 1897, came into force on 1st April, 1909. In future foster mothers will be under the supervision of the inspectors of the London County Council, even if they take in only one child "for reward" for a longer period than forty-eight hours. The premises where children are received must be sanitary, and the persons in whose care they are placed must be fit to have the care of infants. Similar supervision over persons who take in children for reward by the day is urgently needed in Kensington. THE PREVALENCE OF DISEASE. 17 THE PREVALENCE OF DISEASE. The Infectious Diseases.—For administration purposes the infectious diseases are divided into two classes, those which the householder is obliged by law to notify to the Medical Officer of Health and those which are not compulsorily notifiable. Notifiable Infectious Diseases.—In Kensington the following diseases are compulsorily notifiable:— Small-pox Plague. Cholera. Diphtheria. Erysipelas. Scarlet Fever. Typhoid or Enteric Fever Typhus Fever. Relapsing Fever. Puerperal Fever. Cerebro-spinal Fever. Glanders. Anthrax. Hydrophobia. Glanders, Anthrax and Hydrophobia in man were made notifiable on April 26th, 1909, with a view to affording further facilities for dealing at the earliest possible opportunity with the animal sources from which human beings almost invariably acquire the infection of these diseases. Only one case of glanders was notified during the year, the patient being a man who had suffered from a chronic form of the disease for several years. Cerebro-spinal fever was again made notifiable for a further period of 12 months from March 13th, 1909. SMALL POX. No case of Small Pox occured in Kensington during the year, but a patient suffering from erythema was notified as small pox in error. 16 cases of small pox were notified in London and of these eight occurred in the Borough of Stepney. A young man who had been in contact with small pox came daily to a workshop in Kensington where one other person was employed. He was vaccinated on my recommendation on the evening of the first day following the receipt of the notification and was kept under supervision for 14 days. DIPHTHERIA. During the year 169 cases of diphtheria were notified and of these 19 proved fatal. The disease was sporadic in its incidence, and showed no excessive prevalence save in the month of August when 24 cases were notified as compared with the monthly average of 14. Diphtheria in 1909. Report for four weeks ended No. of Notifications. Kensington. London. January 30. 17 642 February 27 14 645 March 27 14 581 April 24 13 512 May 22 10 490 June 19 10 467 July 17 9 494 August 14 24 440 September 11 12 429 October 9 13 534 November 6 15 555 December 4 12 452 January 1,1910 6 429 169 6,670 18 From the following table it will be seen that the disease has not been mild in type, the case mortality being 11.2 per cent.: the actual number of cases has on the other hand been well below the average for the past ten years. Diphtheria in Kensington, 1899-1909. Year. Cases Notified. Case rate per 1,000 of population. Deaths. Death rate per 1,000 of population. Case Mortality per cent. 1899 257 1·49 42 0·24 16·3 1900 332 1·92 27 0·16 8·1 1901 250 1·41 38 0·21 15·2 1902 184 1·04 20 0·11 10·9 1903 158 0·90 24 0·13 15·2 1904 186 1·04 17 0·09 9·1 1905 125 0·70 9 0·05 7·2 1906 164 0·91 19 0·11 11·6 1907 234 1·30 24 0·13 10·3 1908 230 1·27 26 0·14 11·3 1909 169 0·93 19 0·10 11·2 In doubtful cases the Council undertake to arrange for the bacteriological examination of material taken from the throats of suspects free of charge ; the number of examinations made at the Council's expense has amounted to 30 in 12 months. An arrangement has been come to with the Medical Officer (Education) of the London County Council, whereby all children excluded from school by the head teachers for suspicious sore throats are now notified to the Medical Officer of Health of the district in which the school is situated. The children excluded are visited and are not re-admitted to school except with a medical certificate stating that they may return without danger to their school fellows. Co-operation on these lines between the Education and Sanitary authorities should do much to diminish the prevalence of Scarlet Fever and Diphtheria. SCARLET FEVER. During the year 417 cases of Scarlet Fever were notified, and of these only 9 proved fatal. As will be seen from the following table a marked increase in the prevalence of the disease occurred both in Kensington and London during the months of October and November. Scarlet Fever in 1909. Report for four weeks ended No. of Notifications. Kensington. London. January 30 30 1,470 February 27 32 1,259 March 27 27 1,179 April 24 25 1,100 May 22 27 1,344 June 19 27 1,432 July 17 31 1,652 August 14 26 1,296 September 11 29 1,286 October 9 51 1,620 November 6 41 1,358 December 4 31 1,176 January 1, 1910 40 1,086 417 17,258 19 The number of cases was slightly above the average number notified in the past ten years. The deaths were considerably below the average number, and the type of the disease as indicated by the case mortality in the following table was extremely mild. Scarlet Fever in Kensington, 1899-1909 The Year. Cases notified. Case rate per 1,000 of population. Deaths. Death rate per 1,000 of population. Case mortality per cent. 1899 443 2·57 10 0·06 2·2 1900 367 2·12 4 0·02 1·4 1901 475 2·68 15 0·08 3·2 1902 372 2·09 21 0·12 5·6 1903 330 1·85 14 0·08 4·2 1904 262 1·47 5 0·03 1·9 1905 332 1·85 21 0·12 6·3 1906 463 2·57 11 0·06 2·4 1907 522 2·89 9 0·05 1·7 1908 439 2·43 9 0·05 2·1 1909 417 2·30 7 0·04 1·7 The source of infection was discovered in 99 cases. Ten patients are known to have been infected in places beyond the Borough. Six cases occurred in homes to which convalescent scarlet fever patients had recently returned. In twenty cases the infection appeared to have been acquired in school. ENTERIC FEVER. The number of cases of enteric fever notified during the year was 47, the number of deaths being 8. The case-mortality, 17 per cent., shows the disease to have been severe in type. Among other points of interest in the following table will be noted the very remarkable decline in the prevalence of enteric fever which has taken place during the last ten years. Enteric Fever in Kensington, 1899-1909. Year Cases Notified. Case-rate per 1,000 of population. Deaths. Death-rate per 1,000 of population. Case-mortality per cent. 1899 107 0·62 23 0·13 21·5 1900 104 0·60 16 0·09 15·4 1901 97 0·55 11 0·06 11·3 1902 80 0·45 19 0·11 23·7 1903 61 0·34 9 0·05 14·8 1904 46 0·26 6 0·03 13·0 1905 49 0·27 13 0·07 26·5 1906 38 0·21 5 0·03 13·2 1907 40 0·22 5 0·03 12·5 1908 36 0·20 5 0·03 13·9 1909 47 0·22 8 0·04 17·0 20 Of the cases notified, two were due to contact with patients suffering from typhoid fever and two were due to infection acquired beyond the Borough. Three cases were attributed to the consumption of oysters and four to mussels or other kinds of shell fish. In three houses where typhoid fever occurred the drains were found to be defective. Early in the year the Local Government Board undertook an investigation into the protracted infectivity displayed by certain persons after an attack of typhoid fever. In Kensington two patients whose tissues were known still to contain typhoid bacilli were discharged to their homes after a prolonged period of detention in hospital. In each case bacteriological examinations were made once a month for 6 months, but no typhoid bacilli were found. Recent researches in the Indian Army and elsewhere have shown that although a small number of outbreaks of typhoid have been proved to have been due to the protracted infectivity of typhoid convalescents, such examples of protracted infection are in all probability extremely rare. PUERPERAL FEVER. Seven cases of puerperal fever were notified during the year, and of these four proved fatal. The number of deaths from puerperal fever in the years 1901 to 1905 averaged between three and four. Of the 3,000 births occurring every year a certain number are attended by complications which necessitate instrumental delivery or other operations involving an added risk of infection, whilst others occur in homes which are the reverse of cleanly . When the varied circumstances of normal and abnormal labours are taken into account, the proportion of four fatal cases of puerperal fever to 3,381 births in the present year must be considered as not far from representing the proportion of unavoidable accident. CEREBRO- SPINAL FEVER. Four cases of cerebro-spinal fever, resulting in two deaths, occurred during the year. In the four families attacked eight adults and 13 children were exposed to contact with infected persons without acquiring the disease, and in no family did more than one case occur. The disease followed on an attack of measles in a child aged 14 months, and one child aged three months was suffering from a nasal discharge when the first symptoms of cerebro-spinal meningitis appeared. Infectious Diseases not Notifiable.—Under this heading are included Measles, Whooping Cough and Influenza, intensely infectious diseases, and Epidemic Diarrhoea, a disease the infectious nature of which cannot be said to have been fully established. They are responsible for a very much larger number of deaths than the notifiable diseases, as the following figures show. Number of Deaths. Notifiable Infectious Diseases 53 Non-notifiable Infectious Diseases 223 Notification without skilled medical supervision at home or in hospital would probably do but little to lessen the prevalence and mortality from these diseases, but treatment in hospital either with or without notification could hardly fail to diminish the mortality from Measles and Whooping Cough in young children. At the present time children suffering from the worst forms of Measles and Whooping Cough are rigidly excluded from hospital and left to their fate in surroundings which often preclude the possibility of any treatment worthy of the name. MEASLES. The deaths from Measles numbered 58, and of these 57 occurred in children under five years of age. All cases of Measles in children attending the elementary schools are notified by the Head Teachers and visited by the Lady Sanitary Inspectors. During the year 480 cases were notified ; 62 additional cases were found in the homes visited, the total number of cases coming to the notice of the Public Health Department being 542. Out of this number only 139 had received medical advice before they were visited by the inspectors. A leaflet is left with the mother of each family attacked calling attention to the serious nature of the disease and insisting on precautions being taken to prevent the spread of infection. The largest number of cases occurred in the Wornington Road School, where 108 children were attacked. 21 WHOOPING COUGH. The deaths from Whooping Cough numbered 40; the number of cases brought to the notice of the Public Health Department by the schools being 218. In the homes visited 74 additional cases were discovered; the total number of cases dealt with by the Sanitary Inspectors being 292. An advisory leaflet was left with the mother of each family visited. The Wornington Road School reported 63 cases, and 39 cases were notified from the school in Portobello Road. INFLUENZA. Influenza, which is apt to be considered a trivial ailment, caused 75 deaths, a number which is very much in excess of the number of deaths causcd by any other infectious disease, if consumption be excepted. The bulk of the deaths occurred in late middle life or old age, 58 out of the total number of 75 deaths being registered in persons over 55 years of age. The 17 remaining deaths occurred in childhood or during the working years of life, and were nearly equal in number to the deaths attributed to diphtheria. Section 68 of the Public Health (London) Act, 1891, which forbids any person suffering from a dangerous infectious disease to expose himself in any street, public place or shop, might with advantage be made applicable to an infectious disease so dangerous to life as influenza. EPIDEMIC DIARRHOEA. During 1909 there were 50 deaths attributed to diarrhœa, of which 36 occurred in infants under one year of age. The death-rate from diarrhœa was 0·27 per 1,000. The number of deaths in previous years has been as follows:— Year. Deaths from Diarrhœa. 1905 90 1906 142 1907 30 1908 88 1909 50 The above totals do not include deaths certified as due to enteritis. Owing to a comparatively cool summer the number of deaths has been well below the average for the past five years. Detailed information was obtained as to the circumstances attending the occurrence of 35 cases of fatal diarrhœa. The ages of the persons attacked were as follows:— Age Number attacked. Under 1 year 26 1 to 2 years 5 2 to 5 years 1 25 years and upwards 3 Total 35 Of the 26 infants who died, none were being reared on breast milk alone at the time when they fell ill. 19 were being fed on new milk and seven on a sweetened brand of condensed milk. No less than 16 cases occurred in houses where other persons were attacked with diarrhoea either in the same family or in other families in the same tenement dwelling. Details as to the occurrence of multiple cases in the same house are given in the following table:— 22 Dates of Onset of Cases of Diarrhoea in Houses and Families experiencing multiple invasion. House No. Family surname. Sex. Age (years). Date of onset. Date of death or recovery. 1 B F. 1 2/12 August 1 Sept. 11, R. A m. 1 August 21 Sept. 10, D. 2 A F. 1 4/12 August 13 Aug. 15, D. B M. 10 August 21 — R. 3 A m. 2/12 August 13 Aug. 20, D. B F. 1/2 August 22 — R. 4 A F. 2 August 13 Aug. 17, R. A F. 8/12 August 17 Aug. 21, D. B F. 25 + August 22 — R. 5 B m. 6/12 September 1 Sept. 3, R. A F. 1/1 1/2 September 8 Sept. 12, D. 6 A F. 4/12 September 1 Sept. 6, D. A M. 2 September 8 — R. 7 A M. 1 4/12 September 6 Sept. 23, D. A F. 25 + September 16 — R. B F. 10 September 21 — R. B M. 3 September 21 — R. A M. 4 September 24 — R. 8 B F. 25 + September 9 Sept. 29, R. A F. 8/12 September 24 Sept. 27, D. A F. 50 + October 1 — R. 9 B m. 2 September 1 Sept. 14, R. B F. 1 2/12 September 6 — R. A F. ft September 5 Sept. 29, D. 10 A F. 6 September 1 — R. A F. 6/12 September 12 Oct. 7, D. A F. 2 September 12 Sept. 19, R. 11 A F. 6/12 September 16 Oct. 11, D. B F. 1 1/2 September 16 — R. 12 A F. 2 September 26 — R. A M. 4 September 28 Sept. 30, D. 13 A m. 8/12 October 5 Oct. 13, D. A F. 35 + October 17 — R. 14 A m. 5 October 8 — R. A F. 4 October 8 — R. A F. 30 + October 8 — R. A F. 3/112 October 15 Oct. 16, D. 15 A m. 2 October 15 — R. A m. 9/12 October 22 Oct. 24, D. 16 B F. 60 + October 20 — R. B F. 30 + October 24 — R. B M. 8/12 October 25 — R. B — — — — R. B — — — R. B F. 7 October 30 — R. A M. 3/12 October 29 Oct. 31, D. The houses invaded are designated by the numbers in the first column. Members of the same family are designated by the same-letter A or B. 23 The following case-histories illustrate the very strong probability that diarrhœa under certain circumstances becomes capable of spreading from the sick to the healthy. Case 9. On September 1 a boy, aged 2, developed diarrhœa and attended as an out-patient at St. Mary's Hospital. On September 6 his baby-sister was seized with diarrhœa and vomiting. On the previous dav, September 5, the baby of a woman in the next room developed an attack of diarrhœa, which ended fatally on September 29. Since the middle of August this child had been left during the whole day with the family in which the boy was taken ill on September 1. The secondary cases appear to have been infected simultaneously by the boy aged 2. One was fed on cow's milk, the other on Nestle's milk. In case 14 two young children and their mother developed diarrhœa on the same date, October 8. They took condensed milk in tea, but no cow's milk. On October 15 the baby, aged 2 months— a healthy, strong child—was seized with diarrhœa and died within forty-eight hours. It was fed on the breast and occasionally given a little new milk. Case 13 is of interest because it did not occur in the usual environment, but in a large house in one of the best parts of Kensington. A baby, aged 8 months, was taken ill with diarrhœa on October 5, and died on October 13. Five days later a lady, who had removed the soiled napkins from the sick room and washed them, was seized with violent diarrhœa. In Case 16 a woman, aged about 55 or 60, living in a basement with her son's family, developed . diarrhoea on October 20. On October 24 the mother of the family fell ill. Her four children, including a babv, aged 8 months, developed diarrhœa within the next few days. The baby was fed on the breast with a little beef tea, but no cow's milk. A child, aged 3 months, living on the ground floor of the same house, fell ill with diarrhœa on October 29 (five days after the second case in the basement) and died within three days. This child was fed on condensed milk. In Case 1 a baby, aged 16 months, living on the ground floor, was attacked with profuse diarrhœa on September 10, and was treated by a medical man on September 17. A father and a child aged 2, living on the third floor in the same house, fell ill with diarrhœa on September 23. The attack in the father was accompanied by vomiting, and he was so bad that his wife does not know how he continued to work. She herself was taken ill on September 30, and was up all night with diarrhœa. By a very remarkable coincidence, a woman, age 52, living two doors off on the same side of the street, was removed to the infirmary on September 25 with the most violent purging and vomiting. She died within three days, the cause of death on the death certificate being returned as " Simple enteritis." The details of Case 2 are as follows: A girl, aged 2, living on the first floor, fell ill at the end of the first week in September, the approximate date of onset being arrived at from the fact that she was known to have been suffering from diarrhœa on the day when her mother was confined— namely, September 9. The child was subsequently notified to me by the almoner of St. Mary's Hospital. She was looked after by a neighbour, occupying the ground floor in the same house, until her mother was able to return to her household duties after her confinement. On September 15 the neighbour's son, a boy age 16, was seized with the most violent diarrhœa. On the same day, or the day following, the sister of the primary case, a girl aged 8, was attacked with diarrhœa. On September 28 her baby-brother, aged 2, developed diarrhœa, and the following day the mother of the primary case failed with the same disease in a severe form. Prevention.—The infection of diarrhœa, whatever may be its source, is almost invariably conveyed to the person attacked in food, and the food is more frequently contaminated in the home than elsewhere. All milk should therefore be boiled and kept covered in a cool place. Since infants fed on condensed milk are many times more liable to fatal diarrhœa than those who are fed on new milk, the use of tinned milk in the diarrhœa season should be absolutely prohibited. Frequent and thorough scavenging is another factor in the control of diarrhœa which is of the first importance. The Medical Officer of the Local Government Board,* as the result of a detailed inquiry, has shown that towns with the most perfect scavenging arrangements have the least epidemic diarrhœa. Including the removal of house refuse and street washing under the head of scavenging, he found that the removal of house refuse was the more important of the two, and suggested that it would not be possible for local authorities to content themselves much longer with a removal of house refuse at weekly intervals. On this evidence it must be admitted that so long as the present system of weekly removal continues one of the most effective weapons for preventing a disease which caused more than 1,000 deaths in the decennium 1896-1905 is being neglected. In the City of Westminster daily removal has been substituted for weekly removal without any extra cost, and in Wimbledon a similar change has been attended by an actual saving in the cost of dust collection. * " Public Health", vol. xii., p. 155. Study of Epidemic Diarrhoea, by A. Newsholme, M.D. 24 Tuberculous Diseases.—The number of deaths from tuberculosis was 237, and the deathrate was 1.31 per 1,000. The number of deaths and the death-rates per 100,000 persons living in the years 1898 to 1909 were as follows :— Tuberculosis in Kensington, 1898-1909. The Year. Deaths from Phthisis per 100,000 persons living. Deaths from other Tuberculous Diseases per 100,000 persons. Total deaths from Tuberculosis per 100,000 persons living. 1898 126·2 67·4 193·6 1899 128·2 56·8 185·0 1900 121·4 55·5 176·9 1901 132·5 45·3 177·8 1902 123·9 50·7 174·6 1903 119·1 41·0 160·1 1904 126·6 65·0 191·6 1905 111·2 41·3 152·5 1906 119·2 47·3 166·5 1907 96·4 49·9 146·3 1908 100.0 44·2 144·2 1909 92·6 38·0 130·6 The death rates for pulmonary and other forms of tuberculosis in 1909 were lower than in any of the preceding eleven years shown in the table. PHTHISIS. Pulmonary phthisis, or consumption, caused 168 deaths, the death rate being 0'93 per 1,000. From 1898 to 1906 the death rate fluctuated but showed no marked downward tendency. Since January 1st, 1902, cases of consumption have been visited by the Council's lady sanitary inspectors, who have given advice as to the precautions to be taken to prevent the spread of infection. The work of educating the public by these means could hardly fail to produce results, as knowledge of the treatment and prevention of consumption became more widely spread, and after five years the death rate suddenly fell from 119 per 100,000 in 1906 to 96 in the year 1907. For the past three years the rate has now been less than 101 as compared with rates varying between 111 and 132 in the years 1898 to 1906. The following table shows the death rates and the number of deaths in North and South Kensington respectively. Deaths From Phthisis. District. No. of Deaths. Death Rate. North Kensington 120 1·28 South Kensington 48 0·54 The Borough 168 0·93 25 The close relationship between phthisis and poverty is illustrated by this table, in which the death rate from consumption in North Kensington is more than twice as high as the rate recorded for South Kensington. Tuberculosis Regulations, 1908.—In December, 1908, the Local Government Board issued the new Tuberculosis Regulations, under which all cases of consumption in " poor persons " have been made compulsorily notifiable. The Regulations came into force on 1st January, 1909. " Poor persons " are defined as persons in receipt of relief from the Poor Rate, and it is only to this class of the population that the Public Health (Tuberculosis) Regulations 1908 will apply. Boards of Guardians through their officers are required to furnish to Medical Officers of Health the following information in respect to consumptive persons in receipt of relief, namely:— 1. The addresses from which consumptive persons have been admitted to the infirmary. 2. The addresses to which consumptive persons go on their discharge from the infirmary. 3. The addresses of consumptives who are being attended in their homes by the District Medical Officer, and 4. Any change of address by a poor person who has been previously certified as suffering from consumption. For the purpose of preventing the spread of infection from pulmonary Tuberculosis, sanitary authorities are empowered to disinfect rooms, to disinfect or destroy infected articles, and to provide sputum bottles and disinfectants for the private use of consumptives in their homes. Article IX provides that no Medical Officer of Health or Council shall put into force any enactment which subjects any person notified under these regulations to any restriction or disability affecting himself, his employment or his residence on the ground that he is suffering from consumption. Compulsory powers of removal to or detention in hospital are thus deliberately withheld, neither will it be possible to forbid the employment of consumptive persons on premises, such as dairies, where their presence is a danger to large sections of the community. Nevertheless a large field for useful work remains, and public opinion will no doubt approve the provision of reasonable safeguards against the excessive hardship. which might otherwise result from compulsory notification. The total number of notifications received from officers of the Board of Guardians was 446, the total number of consumptive persons notified being 230. Of this number 100 were notified in the first instance by the district medical officers and 130 by the medical superintendent of the infirmary. Seventy-three of the persons certified as consumptive by the district medical officers were subsequently admitted to the infirmary and re-notified. The Public Health Department thus received information of the admission to the infirmary of 203 consumptive patients during the year. Twenty-five patients were admitted twice, six were admitted three times and one patient was admitted no less than four times during the year. In many instances these unfortunate people tiring of institutional life return to different lodgings each time they take their discharge and passing in and out of the infirmary in an advanced stage of consumption which may last for several years they cannot fail to spread infection broadcast. Since compulsory detention would involve unjustifiable cruelty to the individual the remedy must be sought in increasing the popularity of institutions for incurable cases. Voluntary Notification.—Consumption has been voluntarily notifiable in Kensington since 1902. The number of voluntary notifications received in 1909 and previous years was as follows:— Year. Number of Notification. 1902 247 1903 221 1904 203 1905 218 1906 252 1907 231 1908 229 1909 14 Total 1615 Under the voluntary system practically the whole of the notifications received came from the District Medical Officers or from the Medical Superintendent of the Infirmary. With the introduction of compulsory notification of poor law cases, the number of voluntary notifications has been reduced from more than 200 to 14, a clear indication that private practitioners do not wish to bring their consumptive patients to the notice of the Health Authority. 26 Brompton Hospital.—Since November, 1908, patients residing in Kensington and attending the Brompton Hospital have been notified to the Medical Officer of Health with a view to affording them the benefit of the advice and assistance of the Council's lady inspectors in carrying out the instructions given them at the hospital. As part of their notification scheme, the hospital authorities have generously undertaken to examine without a subscriber's letter any person in the families of the patients visited who appear to be in ill health and possibly suffering from consumption. Should a person under these circumstances prove to be phthisical, he can obtain a letter entitling him to treatment from the Kensington Borough Council who are subscribers to the hospital. It must be clearly understood in reference to this scheme, that no patient is notified except with his express consent. Only 33 notifications from the Brompton Hospital were received during the year. Three suspects from the families of the phthisical persons notified were referred to the staff ot the hospital for medical examination. Work of the Lady Inspectors.—The total number of cases of consumption coming to the notice of the Public Health Department under the new Public Health (Tuberculosis) Regulations from voluntary agencies and through death certificates was 387, and of these 168 terminated fatally during the year. For the purpose of giving advice and of making inquiries 331 first visits and 352 re-visits were made to the homes of persons who have died or were suffering from consumption. A printed card of advice was left with each notified case and sputum flasks were supplied to 40 of the patients visited. A large number of the patients had already been supplied with flasks at the infirmary or at the Brompton Hospital. From the following table it will be seen that 79 deaths occurred in persons who had been previously notified. Deaths in 1909 of persons previously notified Date of previous notification. Number of Deaths in 1909. 1902 1 1903 1 1904 1 1905 1 1906 2 1907 4 1908 18 1909 51 Total deaths of persons previously notified 79 Eighty-nine fatal cases occurred in persons not previously notified as suffering from consumption and 51 consumptive persons were not notified until the year in which they died. Thus more than half the fatal cases were not notified at all, whilst the remainder were not reported until the disease was far advanced. Some indication of the duration of certain cases of phthisis may be gathered from the above table which shows that four persons dying in 1909 were known to have suffered from consumption for more than three years and that two persons were known to have suffered for more than five years. Since early notification is the exception, it may be safely assumed that the average duration of phthisis is far greater than the figures in the table suggests, and is probably not less than three years. It is estimated on good authority at 10 years, but, taking the lower estimate, there must be living in the Borough of Kensington at the present moment not less than 500 consumptive persons. The probable number of cases is arrived at by multiplying the deaths in one year (168) by the figure 3, which represents the assumed duration of the disease in years. The duration of consumption cannot be ascertained with any degree of accuracy by inquiry into the past histories of the cases visited, but the approximate dates of onset obtained by the lady inspectors have a relative value and indicate an average duration of three to four years. 27 The number of rooms occupied by the consumptive persons visited and their families were as follows :— Home or other Accommodation of the Sick Person or Family. Number of Rooms Occupied. 1 2 3 4 or more. Homeless Persons in the Infirmary. Common Lodging house Cases. No Information obtainable. Total Cases investigated. Number of consumptive patients 100 83 55 43 31 19 48 379 The necessity for urging the adoption of precautions and the difficulty of preventing infection in the homes of the poor, are illustrated in the above table which shows that when information as to house accommodation was obtained, more than half the patients (or 183 out of 331) were occupying or had occupied small tenements of one or two rooms. In 71 instances the patient had undoubtedly become infected by contact with consumptive relatives occupying the same room. In one case at least the infection appears to have been acquired by contact with a fellow-worker who was suffering from consumption, and in the families of the patients visited 27 further cases of phthisis were reported. Disinfection by spraying with formalin and fumigation was carried out by the Council's Disinfecting Staff in 180 rooms vacated by consumptive persons and in the majority of cases the patient's bedding was disinfected by steam at the Council's disinfecting station. The occupation or status of the persons who died from consumption during the year was as follows:— Social Status of Consumptive Persons. Males— No. of Deaths. Labourer 11 Artizan 17 Cabman, coachman, stableman 7 Tradesmen 6 Laundryman, gardener, salesman (3 each) 9 Porters, errand boys, hawkers 12 Potman, commercial traveller, electrician, clerk, caretaker, soldier son of a waiter (2 each) 14 Chemist, publican, servant, street artist, superintendent of police tailor, bath-chairman, bank manager, watchman, nurse, engineer, baker, furrier, policeman, wood-chopper, son of butler professor of music (1 each) 17 Independent means 3 No information 2 98 Females— Domestic servants 10 Washerwomen, ironers 4 Wives or daughters of labourers 9 Dressmakers, needlewomen, tailoress 7 Charwomen 3 Wives or daughters of porter, horsekeeper (2 each) 4 Wives or daughters of insurance agent, tailor, wood-chopper pavement artist, baker, ticket collector, shopkeeper, gravedigger, caneworker, shoemaker, timekeeper, painter, coachbuilder (1 each) 13 Teacher, daughter of charwoman (l each) 2 Independent means 3 No information 15 70 Total number of Deaths 168 The above details are given in the case of deaths only, since the occupations of notified patients are those followed by patients in receipt of relief from the Guardians, and afford no index of the social status and employment of the total number of consumptives in the Borough. 28 OTHER TUBERCULOUS DISEASES. Other forms of tuberculosis not included under the head of phthisis caused 69 deaths, and of these 47 occurred in children under the age of 5 years. The death-rate was 38 per 100,000. It is satisfactory to note that the mortality from these diseases has shown a definite tendency to decline in the past three years, although the fall has not been so marked as in the case of phthisis. Of the children who die from tuberculosis-meningitis, or tuberculosis of the intestines and peritoneum, many are probably infected by consumptive relatives whilst others are not improbably infected through tuberculous cow's milk. During the last quarter of the year, the officials of the London County Council, under the powers conferred by Part IV of the General Powers Act, 1907, took 810 samples of milk sent to London from various parts of the country. In 73 of the samples taken the bacilli of tuberculosis were shown to be present. During the same quarter out of 4,455 cows inspected on farms supplying milk to London, 74 were found to be suffering from tuberculosis of the udder. The penalty for selling milk from a cow with tuberculosis of the udder is £10. The action of the London County Council and other authorities, notably Manchester and Birmingham, may be expected to reduce the amount of tuberculous milk put on the market, to diminish the prevalence of tuberculosis among children, and to lead to the adoption by farmers of more effective measures for the prevention of tuberculous disease among cattle. Other Causes of Death or Disablement.—The deaths attributed to bronchitis and heart diseases numbered 500, but of this number no less than 262, or more than half, occurred in persons aged 65 years and upwards, and should be regarded as incidental to old age rather than as the outcome of preventible disease. Rupture does not figure among the causes of death, save in a small number of cases where the condition was followed by strangulation of the intestine, but it is nevertheless a frequent source of disablement. The same may be said of chronic rheumatism, which caused only seven deaths, and of varicose veins. As a fertile source of disablement and consequent pauperism, these three diseases inflict far greater injury on the individual and the community than many of the conditions shown in the Appendix as comparatively frequent causes of death. ALCOHOLISM. Cirrhosis of the Liver, a disease intimately associated with alcoholism, caused 20 deaths. In only three instances was death certified as directly due to the abuse of alcohol. The death returns thus afford no index of the amount of disease and social inefficiency caused by alcohol in the Borough. CANCER. The total number of deaths certified as due to various forms of cancer was 205. Of this number 122 were attributed to carcinoma, 14 to sarcoma and 69 to cancer, or malignant disease. The parts of the body affected are shown in the following table :— Deaths from Cancer 1909. Parts Affcted. Sex. Total. Male. Female. Head, Face, Eye, Orbit, Nose, Ear 1 1 2 Jaws 3 — 3 Skin - Axilla - — - Mouth, Tongue, Lips 14 1 15 Neck, Throat, Tonsils, Larynx 8 3 11 Lung, Chest, Mediastinum, Heart 3 1 4 Oesophagus 5 3 8 Breast — 27 27 Abdomen — 3 3 Stomach and Pylorus 9 11 20 Liver and Gall Bladder 7 15 22 Peritoneum, Mesentery, Omentum — 7 7 Pancreas — 2 2 Spleen — 1 1 Intestines (excluding Rectum) 8 14 22 Rectum 4 10 14 Uterus — 22 22 Ovaries — 2 2 Vulva — 1 1 Pelvis, Kidney, Bladder, Prostate, Urethra, Penis 11 3 14 Spinal Cord — — — Groin, Leg, Foot 1 1 2 Parts unspecified 2 1 3 Totals 76 129 205 29 The death-rate from cancer was 1.13 per 1,000, and showed no relationship to social status, as will be seen from the following table in which the mortality in North Kensington is represented both for cancer and for all causes of death by the figure 100. In the second line of the table will be found the corresponding comparative figures for South Kensington. Mortality from Cancer. Deaths from All Causes Cancer. North Kensington 100 100 South Kensington 61 141 In the wealthier district the deaths from all causes were 40 per cent. fewer and the deaths from cancer were 40 per cent. more numerous than in the poorer district of North Kensington. Cancer is a disease of late middle life and old age, and causes many more deaths among women than men. In the absence of knowledge of the age and sex distribution of the population in the districts compared, no deduction can be made from this table except that poverty plainly does not predispose to malignant disease. The opposite inference that the wealthy are especially liable is not justified, and is probably contrary to the facts. THE FOOD SUPPLY. 33 THE FOOD SUPPLY. Under Part II. of the London County Council (General Powers) Act, 1908, considerable reforms have been effected in the conditions to which food stored or in course of preparation for sale is exposed on various premises in the Borough. The Act came into force on August 1st, 1908, and contains the following sanitary provisions:— London County Council (General Powers) Act, 1908. Part ii. Sanitary Provisions. 5.—(1) Notwithstanding anything contained in the Dairies Cowsheds and Milkshops Order of 1885 any sanitary authority may remove from the register kept by them of persons carrying on in their district the trade of purveyors of milk or may refuse to enter upon such register the name of any person proposing to carry on the trade of a purveyor of milk upon premises which are in the opinion of such sanitary authority for any reason unsuitable for the sale of milk therein Provided that for the purposes of this section premises shall not be deemed to be unsuitable for the sale of milk on any ground inconsistent with the provisions of any order or regulation which is applicable to such premises. Section 6 does not relate to food, but may be conveniently mentioned here. It authorises the appointment of women as health visitors and provides for the repayment of part of their salaries bv the London County Council. Section 7 requires the provision of suitable and sufficient accommodation for cooking for each of the families occupying tenement houses. This section is not retrospective and does not apply to houses which were let in tenements before the 1st day of August, 1908. 8.- (1) From and after the passing of this Act the following provisions shall apply to any room shop or other part of a building within the county in which any article whether solid or liquid intended or adapted for the food of man is sold or exposed for sale or deposited for the purpose of sale or of preparation for sale or with a view to future sale :— (a) No urinal water-closet earth-closet privy ashpit or other like sanitary convenience shall be within such room shop or other part of a building or shall communicate therewith except through the open air or through an intervening ventilated space ; (b) No cistern for supplying water to such room shop or other part of a building shall be in direct communication with and directly discharge into any such sanitary convenience ; (o) No drain or pipe for carrying off fœcal or sewage matter shall have any inlet or opening within such room shop or other part of a building ; (d) No such room shop or other part of a building shall be used as a sleeping place and so far as may be reasonably necessary to prevent risk of the infection or contamination of any such article as aforesaid no sleeping place shall adjoin such room shop or other part of a building and communicate therewith except through the open air or through an intervening ventilated space ; (e) Refuse or filth whether solid or liquid shall not be deposited or allowed to accumulate in any such room shop or other part of a building except so far as may be reasonably necessary for the proper carrying on of trade or business ; (f) Due cleanliness shall be observed in regard to such room shop or other part of a building and all articles apparatus and utensils therein and shall be observed by,persons engaged in such room shop or other part of a building. (is) If any person occupies or lets or knowingly sutlers to be occupied any such room shop or other part of a building wherein any of the conditions prohibited by this section exist or does or knowingly permits any act or thing therein in contravention of this section he shall be liable on summary conviction to a fine not exceeding for a first offence twenty shillings and for every subsequent offence five pounds and in either case to a daily penalty not exceeding twenty shillings. 9.—(1) The Council may make byelaws for regulating the conduct of the businesses of a vendor of fried fish a fish-curer and a rag and bone dealer or any of them and with respect to the premises in or upon which any such business is carried on and tho apparatus utensils and appliances used for the purposes of or in connection with any such business. The bye-laws to be made under this section will not be retrospective and will not apply to any of the places under consideration which were in use at the time of the passing of the Act (August 1st, 1908), provided that if alterations are made in the fittings, apparatus, etc., of existing premises, they shall be made in accordance with the bye-laws. Draft bye-laws have been submitted by the Council for consideration by the various Metropolitan Boroughs, but have not yet received the sanction of the Local Government Board. 34 MILK SUPPLY. During the year a record has been made in the Council's Register of Milk Purveyors of the immediate source of the milk supplied to the retail traders in Kensington. The only milk produced within the Borough comes from a cowshed containing three cows in the Walmer Road. These premises have been regularly inspected, particular attention being paid to the condition of the milch cows. Milkshops.—In addition to routine visits by the Sanitary Inspectors, a systematic inspection of all the milkshops in the Borough has been made by the Chief Inspector and myself. Of the general shops where milk was sold 101 were removed from the register under the powers conferred by the London County Council (General Powers) Act, 1908, as unsuitable for the sale of milk. Five shops communicated directly with bedrooms, one communicated with a barber's shop, the occupiers of three milkshops held off licenses for the sale of beer, and on the remainder of the premises removed from the register, coal blocks, loose pickles, paraffin oil or other objectionable articles were sold. The oil shops for the most part were small, ill ventilated, crowded with a great variety of general goods and often very dirty. The names of the occupiers of 20 general shops were subsequently restored to the register on their undertaking to give up the sale of objectionable articles, and where necessary to provide additional means of ventilation. At the present time the number of persons registered as selling milk on premises within the Borough is 190. The premises may be classified as follows:— A. Milkshops or Dairies where no general goods are sold 123 B. General shops where milk is sold 43 C. Restaurants where milk is sold 24 Total number of premises where milk is sold 190 Ice Cream.—The number of ice cream merchants or manufacturers in the Borough is 177. The trade is regulated under the London County Council (General Powers) Act, 1902, Part vii., Sections 42-45, and a register is kept of premises where ice cream is sold. Both the premises and barrows of ice-cream vendors have been frequently inspected during the year. PLACES WHERE FOOD IS PREPARED. As in the case of milkshops, special inspections of these premises with a view to ensuring compliance with the General Powers Act, 1908, were deferred until the end of the first quarter of the year under consideration. The total number of inspections made amounted to 803. Restaurants, Eating Houses, etc.— In addition to restaurants and eating houses there are in the Borough a considerable number of provision shops where sausage meat is made or where meat is cured by various processes. The number of these premises on the register is 216, and among this number are included 32 butchers' shops, 147 restaurants and 37 fried fish shops. As the result of the inspections made during the year, the following work has been carried out on premises where food is prepared. Twelve defective drains have been repaired, 24 gullies have been removed, 33 new ashpits have been provided and 127 premises have been cleansed. Two w.c's. communicating with places where food is stored have been dealt with ; in one case an intervening ventilated space has been constructed, in the other the w.c. has been abolished. Food Stalls.—In Portobello Road, Clarendon Road and Golborne Road a considerable trade is carried on in food which is sold from costermongers' barrows and from stalls. The stalls are regularly inspected, occasional visits being paid on Saturday nights. Fried Fish Shops— Visits were paid to a large number of fried fish shops and places where fish is cured, with a view to advising the Public Health Committee on the bye-laws for the regulation of these premises submitted by the London County Council. In the majority of instances 35 satisfactory provision had been made for the disposal of fish offal, but in many cases the wooden benches on which the fish are gutted were in an objectionable state. The substitution of some impervious material will remedy the nuisance which inevitably arises when fish are dealt with on a bench made of an absorbent material such as wood. In many fried fish shops the hoods are placed unnecessarily high above the furnace and so permit the acrid fumes generated in the process of frying to escape into the shop and from the shop into the street. Should the proposed bye-laws be sanctioned in their present form, it will unfortunately only be possible to require the hood to be placed in a more effective position on premises which were not in use as fried fish shops on August 1st, 1908. Underground Bakehouses.— The number of underground bakehouses in use at the end of the year was 75. Some difficulty has arisen in regard to stall board ventilation which was prohibited by the Council in the regulations under which certificates were granted in 1902. Eleven bakehouses were found to be admitting air through openings in the stall board situated a few inches above or in one case actually below the pavement level. It is unnecessary to point out that air admitted at this level cannot fail to be contaminated with the dust from road sweepings which inevitably alights on the dough itself or on various surfaces with which the dough comes in contact in the course of preparation for the oven. In response to representations from the Public Health Committee the stall boards in these bakehouses have now been closed. Slaughter Houses.— At the end of the year there were ten slaughter houses in the Borough. Applications for the licensing of eleven slaughter houses were received by the London County Council in October. Ten were granted and one was refused on the ground that no slaughtering had been carried out on the premises in respect of which the application was made for a period of more than 6 months. Periodical inspection of the slaughter houses shows that the amount of killing done in the Borough is insignificant. The names of the licensees, and the localities of the premises, are as follows:- Lonsdale Mews Mr. Grove. 273, Kensal Road Mr. Miles. 13, Archer Mews Mr. Bawcombe. 35, Earl's Court Road Mr. Matson. 10, Edenham Mews Mr. Gibson. 115, Church Street Mr. Csborne. 195,Clarendon Road Mr. Simmons. 133, High Street, Notting Hill Miss Candy 235, Walmer Road Mrs. Van. 113, Holland Park Avenue Mr. Holloway. Unsound Food.—Applications were made for the removal of the following articles of food which were unsound and unfit for the food of man :— Bullock's liver 1. Coal Fish 1 case. Skate 1 case. Oranges 20 boxes. No food was seized under Section 47 of the Public Health (London) Act, 1891. SALE OF FOOD AND DRUGS ACTS. Each of the ten Sanitary Inspectors is appointed as an inspector under the above Act and is instructed to take samples in any place in the Borough which is not within his own sanitary district. During the year the Inspectors collected 700 samples, of which 50 (or 8 per cent.) were adulterated. Proceedings were taken against 19 persons for adulteration or other offences under the Act, the fines and costs inflicted amounting to £'27 13s. 36 The samples collected were as follows :— Samples Collected by the Sanitary Inspectors. Name of Sample. Number Taken. Number Adulterated. Milk 244 13 Skimmed Milk 2 ... Separated Milk 1 1 Condensed Milk 6 • • • Cream 13 8 Butter 160 2 Margarine 1 ... Cheese 22 ... Pepper 24 ... Flour 6 ... Sago 12 1 Scones 12 ... Arrowroot 12 ... Corn Flour 12 ... Oatmeal 6 ... Olive Oil 6 1 Coffee 6 ... Preserved Peas 6 6 Gherkins 6 ... Sausages 6 2 Vinegar 16 1 Mustard 10 ... Spirits 64 10 Beer 12 ... Drugs 35 5 Total 700 50 Margarine and Butter Substitutes.— Under Section 9 of the Margarine Act, 1887, and Section 7 (4) of the Sale of Food and Drugs Act, 1899, manufacturers and wholesale dealers in margarine and margarine cheese are required to register their premises with the local authority. By Section 1 (1) of the Butter and Margarine Act, 1907, these requirements were extended to butter factories and to the premises of wholesale dealers in milk-blended butter. The following premises in the Borough are registered in accordance with the requirements of the above Acts:— Lipton, Ltd. 210, Portobello Road. „ 129, Brompton Road. E. C. Nicholls 19, Church Street. C. E. Webb & Sons 39-41, Brompton Road. Pearks, Ltd. 165, Portobello Road. The above premises have been registered as those of wholesale dealers in margarine. The premises of Pearks, Ltd., have also been registered as those of wholesale dealers in mixtures of butter and milk. In a considerable number or shops in Kensington the Sanitary Inspectors have found margarine without any label kept side by side with butter on a marble slab which is concealed from the view of the purchaser by a screen. Under similar circumstances it has been held by the Divisional Court that a label was unnecessary, but even if a label were provided it would afford no protection to the purchaser who cannot see whether the article with which he is served is taken from the parcel of butter or of margarine behind the screen. The fact that these screened slabs are commonly used by dairymen who sell no margarine shows that they are designed for convenience and no other purpose, but if the existing legislation is necessary which requires margarine exposed for sale to be labelled, then it is obviously still more necessary to obtain legislation for preventing the vendor from serving butter and margarine from a place on the counter which is concealed from the view of the purchaser. 37 WATER SUPPLY. The water supply of Kensington is derived from the following sources, which are under the control of the Metropolitan Water Board. The northern half of the Borough lies within the Grand Junction division of the Western district, which is supplied mainly from the Thames at Hampton. The southern half of the Borough and a small area north of the Great Western Railway are supplied from the same source and lie within the West Middlesex division of the Western district. The area south of the Brompton Road lies within the Chelsea division of the Western district, and is supplied entirely from the Thames at West Molesey. To every house in the Borough the water supply is now constant. The following tables, which afford an index of the water supply, are based on Dr. Houston's Report to the Metropolitan Water Board for the twelve months ended 31st December, 1909. TABLE A.—Microbes per c.c. in Raw Waters. Source of Water. Number of Microbes. Average. Highest. Lowest. New River 2,335 14,989 515 Thames 3,900 19,794 913 Lee 10,318 105,750 1,679 The table shows that the impurity of the raw Thames water as judged by the number of microbes is greater than that of the New River, but very much less than that of the Lee. As has already been pointed out, it is from the Thames that the filtered water supplied to Kensington is originally derived. TABLE B.- Microbes per c.c. in Filtered Waters. Source of Water. Microbes per c.c. New River 8·9 Grand Junction 12·2 West Middlesex 12·5 Chelsea 16·1 Kempton Park 22·0 Of the three sources supplying filtered water to Kensington, that of Chelsea contains the greatest number of microbes. For the purpose of comparison, the New River and Kempton Park filtered waters have been added as examples of the best and the least satisfactory water supplied by the Water Board. 38 TABLE C.— Percentage of First Class Filtered Waters. Source of Water. Number of Samples. Per cent. First Class. Kempton Park 353 87 Chelsea 450 86 Grand Junction 858 83 West Middlesex 832 74 East London 144 56 In the above table water is reckoned to be " first-class " if on examination it proves to contain no typical colon bacilli in 100 c.c. By this test the Chelsea filtered water compares favourably with the best water examined during the year. The West Middlesex supply is capable of improvement, but shows results which are markedly superior to the unsatisfactory analyses of the East London water. TABLE D.— Filtered Waters. Albumenoid Nitrogen Test. Source of Water. Albumenoid Nitrogen. Parts per 100,000 New River ·0031 Grand Junction ·0058 Chelsea ·0062 West Middlesex ·0066 Kempton Park ·0070 The Kensington supplies maintain a mean position on the list, the West Middlesex water, as judged by the chemical test, being the least satisfactory. Speaking of the London supply as a whole, Dr. Houston says, " Having regard to the bad quality of the raw waters, the average quality of the water as delivered to consumers during the year was not unsatisfactory." So far as Kensington is concerned, the results set forth in the tables show that both the raw waters from which the supply is drawn and the filtered water furnished to consumers compare favourably with the water supplied to certain other districts in London. Water Supply to New Houses.— During the year 41 newly erected houses were inspected and certified before occupation under section 48 (2) of the Public Health (London) Act, 1891, as having a proper and sufficient supplv of water. HOUSING OF THE WORKING CLASSES. 41 HOUSING OF THE WORKING CLASSES. In the census year 1901, the tenements of less than five rooms numbered 21,315, and accommodated a population of 73,425 persons distributed as follows:— Rooms in Tenement. Number of Tenements. Number of Persons. 1 5,695 11,334 2 7,776 27,800 3 4,757 20,210 4 2,887 14,081 Totals 21,115 73,425 The total number of inhabited houses in the Borough in 1909 was 25,198. The supply of small tenements is considerably in excess of the demand, but the accommodation where houses originally let to a single householder have been converted into tenements is necessarily unsuitable for working-class families. At the same time the state of cleanliness or filthiness in which rooms are kept bears a much closer relationship to the character of the occupiers than to the nature of the accommodation provided. In Virginia Place and other block dwellings, where each family has a separate w.c. and where water is laid on to each floor, tenements are frequently found on inspection to be kept in a disgraceful state of domestic uncleanliness. Temporary improvement follows the service of notices, but no permanent change for the better is likely to be effected except through the education of the poorest classes in the elementary principles of cleanly living. Lodgings provided by the Council.— In October, 1901, under the power conferred by Section 5 of the London Government Act, 1899, the Council adopted part III, of the Housing of the Working Classes Act, 1890. As amended by the Housing Act, 1900, this part of the principal Act enables local authorities to establish or acquire lodging houses for the working classes either within or without their district. The total number of tenements provided by the Council for the working classes under the Housing Acts is shown in the following table :— Council's Lodging Houses. Rooms in a Tenement. Number of Tenements. Rent per Week Tenements Let. Tenements Empty. 1 26 3/- to 3/6 20 6 2 62 6/- to 7/- 42 20 3 32 7/- to 8/- 30 2 Totals 120 3/- to 8/- 92 28 The above tenements provided by the Council are all within the Borough. Houses Let in Lodgings.—During the year 20 tenement houses were added to the register, the total number of registered lodging houses in the Borough being 2,076. These houses are regularly inspected, and in every case where the class of tenant renders it desirable they are cleansed and limewashed throughout in the spring of each year. 42 Furnished Rooms.—Of these houses 158 are let in furnished rooms, the usual charge per room being 1s. per night or at the rate of 6s. per week, since lodgers who stay for more than 7 days make no payment for Sunday. A certain number of the tenants of furnished rooms belong to the genuine working classes, and have occupied the same lodging for one or two years, or even longer periods. Others are of the common lodging house type and only stay for a few nights. By constant inspection and the service of notices considerable improvement has been effected during the year in the bedding supplied to the tenants, but the furniture with which the Council have no power to deal remains scanty and dilapidated. In response to notices, bedding was cleansed in 114 rooms and 24 beds were destroyed. House to House Inspection.— The duty of causing systematic inspections to be made with a view to ascertaining whether any dwelling house in their district is unfit for human habitation is imposed on local authorities by Section 32 of the Housing of the Working Classes Act, 1890. The number of house to house inspections made during the year was 4,163. Some of the basement rooms and mews dwellings in the Borough are unsatisfactory, and a certain number of houses are without back yards. On the other hand, narrow streets or courts, blind alleys, and houses huddled together on insufficient space are conspicuous by their absence. Overcrowding.— During the year 56 cases of overcrowding were abated in response to notices served by the sanitary inspectors. For the most part the cases dealt with were trivial and arose from the occupation of rooms by families containing one or two children in excess of the number allowed by the Council's bye-laws. Gross overcrowding is probably rare, if it be permissible to judge by the results of an inspection of the furnished rooms in the Bolton Road which was carried out between 5 and 7 a.m. on March 23rd, 1910. In 141 tenements visited 47 cases of technical overcrowding (that is to say, of rooms containing one or two more than the number of persons permitted) were discovered, but in no instance was a family found to be taking in adult lodgers and in no instance were two families found to be occupying the same room. Underground Rooms.—Seventeen underground rooms were found to be illegally occupied during the year. In each case the illegal occupation ceased on the service of a notice, and in no instance was it found necessary to take proceedings. Customs and Inland Revenue Acts.—Under these Acts 10 certificates were issued by the Medical Officer of Health during the year, in respect to 31 tenements in ten houses containing a total number of 51 separate dwellings. Common Lodging Houses.—The common lodging houses in the Borough number 24, and contain accommodation for 701 persons. From the following table it will be seen that more than 20 of these houses are situated in the Norland Ward. Common Lodging Houses. Ward. Name of Keeper. Address of Common Lodging-House. No. of Lodgers, for which licensed, in 1909. Male. Female. Total. Golborne Madden, James 194, Kensal Road 75 ... 75 Norland Rusha, Alfred 18, Bangor Street ... 24 24 ,, Do. 20, do. ... 45 45 ,, Reynolds, Charles 35, do. 26 ... 26 ,, Phillips. Edward Sanders 5, do. 42 ... 42 ,, Do. 7, do. ,, Hankins, George 10, Crescent Street ... 25 25 ,, Do. 28, do. 54 ... 54 ,, Do. 30, do. ,, Do. 40, do. ... 25 25 ,, Rusha, Alfred 25, do. ... 57 57 ,, Do. 27, do. ,, Do. 31, do. 58 ... 58 ,, Do. 33, do. ,, Simpson, James 37, Mary Place 26 ... 26 ,, Do. 35, do. ,, Davis, Sagel 66, St. Ann's Road 66 ... 66 ,, Rusha, Alfred 34 Sirdar Road ... 53 53 ,, Do. 36, do. ,, Do. 38, do. 48 ... 48 ,, Do. 40, do. ,, Code, George 12, St. John's Place ... 43 43 Holland Redman, Emma 24, Peel Street 34 ... 34 ,, Do. 22, do. 43 In three streets in the Notting Dale area there are six houses capable of receiving 229 single women and eleven houses licensed to accommodate 228 single men. It is difficult to avoid the conclusion that the presence of this population of 500 persons, who for the most part come from the lowest ranks of society, must necessarily constitute an effective bar to the progress of social reform in the neighbourhood where the common lodging houses are situated. HOUSING, TOWN PLANNING, ETC., ACT, 1909. This Act came into force on December 3rd, 1909. It is divided into four Parts and six Schedules, but Parts II. and III., which relate to town planning and other matters, do not directly affect Kensington. Part IV. is supplemental and contains in Sec. 75 and Schedule VI. provisions repealing various portions of the Housing of the Working Classes Acts. Part I. contains provisions of the first importance for securing reasonably suitable housing conditions for the poorer classes. Section 14.—By this section the condition implied under the principle Act of 1890 that at the commencement of the holding a house or part of a house let for habitation should be in all respects reasonably fit for human habitation is in London extended from tenements let at £20 to include houses or tenements where the rent does not exceed £40. This condition is not, however, implied when a house or part of a house is let for a term of not less than three years upon the terms that it be put by the lessee into a condition reasonably fit for occupation, and the lease is not determinable at the option of either party before the expiration of that term. Section 15 establishes a new principle in regard to contracts for letting houses to which Sec. 14 applies. It requires not only that a house should be in repair at the commencement of the holding, but also that it should be kept by the landlord in all respects fit for human habitation so long as the holding may last. Landlord Defined. —For the purposes of Sections 14 and 15 the expression " landlord" may be briefly defined as meaning any person who after December 3rd, 1909, lets for habitation a house or tenement at a rent not exceeding £40 for a term of less than three years. The full definition is contained in Section 15 (7) and must be read in conjunction with Section 14. Notices under Section 15 may be sent by post in a registered letter to the landlord or his agent at his usual or last known residence or Dlace of business. By Sub-section (3) the duty is laid on the Council of requiring the landlord to execute any work which may appear to them to be necessary in order to render a house fit for habitation. If their requirements are not carried out the Council may themselves do the work and recover the cost from the landlord forthwith or by annual instalments extending over a period of five years. Section 16. Houses Let in Lodgings.—This section is important and enables the Council to amend the existing bye-laws as to houses let in lodgings to the working classes so as to impose any duty involving the execution of work on the owner within the meaning of the Public Health (London) Act, 1891. Under Section 94 of the same Act the Council are empowered to make bye-laws for enforcing drainage and for securing the cleaning and limewashing at stated intervals of houses let in lodgings. Since the duties of providing drainage and of limewashing both involve the execution of work, they may in future be imposed by bye-law on the owner, " in addition to or in substitution for any other person having an interest in the premises." Section 17 simplifies and amends the procedure prescribed by the principal Act in regard to the closing and demolition of dwellings which are unfit for human habitation. Underground Rooms.—Sub-section (7) Section 17 forbids the habitual use of underground rooms as sleeping places unless they are at least 7 feet in height and unless they comply with regulations to be made by the Council for securing ventilation, light and protection from dampness. 44 Section 17 also provides that where on the representation of the Medical Officer of Health any house appears to be in a state so dangerous or injurious to health as to be unfit for human habitation, it shall be the duty of the Council to make an order closing the house. When a closing order has been made it then becomes the duty of the owner to render the house fit for human habitation, and if he fails to do so the house must be demolished by the Council. The obligations of landlords and owners respectively under Sections 15 and 17 are as follows :—If a landlord receives notice from the Council that a house is not in all respects reasonably fit for human habitation he can adopt one of the three following courses: — (a) He can himself execute the necessary work. (b) He can refuse, when the Council are empowered to do the work and charge him with the cost, which he can pay in annual instalments extending over 5 years, or, (c) He can avoid all further liability by evicting his tenants and declaring the house to be closed. If he adopts the latter course, it will then fall to the owner to decide whether he will execute the necessary work or leave the house to be demolished by the Council. Owner Defined.—For the purposes of Section 17 and other Sections deemed to be part of Part II. of the principal Act, Section 49 (2) provides that the expression owner shall include all lessees except those who hold premises under a lease of which the original term was less than 21 years (vide Sections 47 and 49 Housing Act, 1909). Section 18 supersedes Section 33 of the principal Act, and provides that demolition shall in every case follow the closing of a dwelling house unless steps are taken to render it fit for habitation. The demolition of a house which has been closed and has remained unfit for human habitation cannot under any circumstances be deferred for a period exceeding 9 months, and if at the end of the first three months after the making of a closing order no undertaking is given by the owner for the execution of the necessary work, it becomes the duty of the Council to demolish the house forthwith. Section35 exempts from Inhabited House Duty any house occupied for the sole purpose of letting lodgings to the working classes at a charge of not more than sixpence a night, provided a certificate is furnished by the Medical Officer of Health to the effect that suitable accommodation is available for the lodgers and that due provision is made for their sanitary requirements. LONDON (GENERAL POWERS) ACTS. The London County Council (General Powers) Acts, 1907-8-9, contain important requirements as to tenement houses. Water Supply.—Section 78 of the 1907 Act is retrospective, and requires a supply of water to be provided on each storey of a tenement house, unless it can be shown that such a supply is not reasonably necessary. Cooking Stoves.—Section 7 of the 1908 Act requires suitable accommodation for cooking to be provided in tenement houses for the use of each family. The Section is not retrospective. Storage of Food.—Section 16 of the 1909 Act requires suitable accommodation for the storage of food to be provided on one of the storeys occupied by each family "in a tenement house. The Section is not retrospective. FACTORIES AND WORKSHOPS. 47 FACTORIES AND WORKSHOPS. Section 132 of the Factory and Workshop Act,1901, requires the Medical Officer of Health of evjry District Council to report specifically on the workshops and workplaces in his district, and to send a copy of his annual report to the Secretary of State. The total number of workshops on the Council's register is 1,668. Workshops where men are employed are placed under the supervision of the sanitary inspector in whose district they are situated; workshops where women are employed are inspected by the two lady sanitary inspectors, who also visit the premises of homeworkers and inspect the sanitary conveniences reserved for women in workshops, railway stations and other public places in Kensington. WOMEN'S WORKSHOPS. Report of Lady Inspectors.—"The number of workshops at which female labour was employed at the end of 1909, was 857; 354 (mostly laundries) being in North Kensington, and 503 (mostly dressmakers) in South Kensington. During the year 76 workshops were added to the register and 65 were removed. "The subjoined table summarises particulars of the factories and workshops on the Register at the end of the year, in North Kensington and South Kensington respectively. Workshops, etc. North Kensington. South Kensington. Total for Whole Borough Dressmakers. Laundries. Miscellaneous. Total. Dressmakers. Laundries. Miscellaneous. Total. No. on Register 69 234 54 354 366 12 125 503 857 No of Rooms therein 104 688 89 881 690 33 198 921 1,802 " The number of persons employed varies with the period of the year, being, of course, greatest during the ' season': it exceeds 10,000. 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 3 3 Blind-maker ─ 1 1 Blouse-maker 3 7 10 Boot header 1 — 1 „ closer 2 — 2 Colour printer (Factory) 1 — 1 Corset maker 2 6 8 Cracker maker 1 — 1 Dressmaker and ladies' tailor 66 350 416 Dyer and cleaner (Factories) 2 5 7 Eyelet hole finisher (Factory) 1 — 1 Florist — 8 8 Furrier — 6 6 Hair wash manufacturer 1 — 1 Hosier — 1 1 Lamp shade maker — 2 2 Laundry (workshop) 176 12 188 „ (factory) 58 — 58 Machinist — 1 1 Mantle maker — 4 4 Milliner 4 55 59 Outfitter — 4 4 Photographer 2 13 15 Pickle manufacturer 1 — 1 Printer (Factories) — 2 2 Silversmith — 1 1 Tailor 28 5 33 Typist — 3 3 Umbrella manufacturer — 1 1 Upholsterer 1 10 11 Violin string manufacturer 1 — 1 Waistcoat maker 8 — 3 Wig maker — 3 3 Total 354 503 857 48 Routine inspections of these workshops were made, and complaints, from His Majesty's inspectors or anonymous sources, received immediate attention. " Ventilation and Warming of Workrooms.—It was found necessary in 18 cases to serve notices to abate nuisances, arising from the improper use of gas ironheaters or of gas jets to warm workrooms. It has been our experience that a large percentage of the women employed in workrooms where heat is generated by gas without means to carry off the noxious fumes, suffer from headache, cold feet and shivering, and, further, we have found in many instances that these symptoms disappear if the gas heaters are removed or if proper provision is made for carrying off the products of combustion. " Overcrowding.—Fifteen cases of overcrowding occurred during 1909, compared with 12 in 1908, and 23 in 1906. On the whole there has been a marked improvement in this respect during the last few years, and employers are now generally found anxious to have and display the cards distributed by the Council showing the maximum number of workers allowed in each workroom. " Sanitary Conveniences.—In 25 instances notices were served to remedy defects in connection with sanitary conveniences. One complaint was received from His Majesty's Inspector of insufficient accommodation at a factory where 40 women were employed. In response to a notice the necessary additional accommodation was without delay provided by the employer. In certain basement workrooms which may be satisfactory in other respects, the provision of separate conveniences for the sexes cannot be made without infringing the Bye-Laws of the London County Council as to the construction of water-closets. In such workrooms, if the nature of the work necessitates the employment of both sexes, the enforcement of the letter of the law inflicts considerable hardship on employers whose staff is limited to three or four workers. On the other hand the use of outside accommodation is in itself unsatisfactory, and any undertaking that outside accommodation will be used is unsatisfactory, because there are no means of ascertaining whether such undertakings are fulfilled. " Basement Workrooms.—Following on the erection of blocks of flats in which the ground floors and basements are let for business purposes, there has been a large increase in the number of basement workrooms in the Borough. These basements, let at a high rental, are not designed for use as workrooms; in many instances they are without flues, badly ventilated and so dark as to render the use of artificial light necessary throughout the working day. By extensive alterations they are brought into such a state that their occupation as workrooms cannot be prohibited under the existing law, but it is much to be regretted that vested interests are in this manner being newly created in a class of workroom which is the reverse of satisfactory. HOME WORK. " An analysis of the return made to the Home Office on " Home Work " will show that 1,035 addresses and names of outworkers were received on the lists sent in by the employers residing in this Borough, and of these 876 were forwarded to the Councils of the respective districts in which they were situated; the remaining 159 being in Kensington. These 159 names and addresses, together with 314 received from other Councils, will, when divided by half (since most, if not all are duplicates sent in twice in the year) give approximately the number of homeworkers on the register of the Borough of Kensington. Of the 241 out-workers so registered, some are employed on premises which are factories or workshops within the meaning of the Factory and Workshop Act, 1901; others work in domestic workshops, whilst the remainder are the genuine "Home Workers" engaged in their homes on the work given out to them by various firms and contractors in Kensington and other districts. The number of outworkers belonging to each of these three classes is shown in the following table:— Home Work. Outworkers in Workshops or Factories 84 Outworkers in Domestic Workshops 15 Outworkers in their own Homes 142 Total number of Outworkers 241 49 The factories and workshops on the above list are included in the tables, which show the trades carried on in the workshops on the Council's register. " The nature of the work given out to the homcworkers in the 142 homes on the register is as follows: — Home Work. Nature of Work. No. of Premises. Tailoring 36 Ironing 36 Outfitting 24 Boot making 19 Dressmaking, Blousemaking 10 Shirt making 4 Waistcoat making 4 Upholstery 4 Millinery 1 Brush making 1 Lace mending 1 Umbrellas 1 Fur making 1 Total 142 In 74 instances in the course of inspection, addresses were found incorrectly given, or the outworker had left or given up work. " Condition of Homes Visited.—The following Table shows the circumstances of the 142 homes where work is caried on: — Nature of Room used for Work. Condition of Rooms. Total Number of Rooms. Clean. Fairly Clean. Dirty. Rooms used for work only 40 4 3 47 „ for work and as living rooms 64 5 2 71 ,, for work and as bed and living rooms 22 2 — 24 Totals 126 11 5 142 The sanitary defects remedied in the 142 homes were as follows: — Rooms cleansed 4 Ceilings whitewashed 5 W.C.'s found defective and remedied 2 Number of Defects Remedied 11 On the whole the homeworkers, many of whom are women, belong to a respectable thrifty class and keep their rooms in a clean and tidy state. Their homes compare favourably with those of the lower labouring classes, and instances of persons in great poverty carrying on work for an insufficient wage in insanitary surroundings are in Kensington practically unknown. The foreign outworkers are for the most employed in registered workshops which are regularly inspected, and the practice of letting out sittings in workshops, which leads to grave abuses in certain districts, does not prevail in the Borough of Kensington. 50 " Infectious Disease.—Infectious disease occurred in 10 premises where home work was carried on. In no instance was it found necessary to make an Order under Section 109 to stop the work, nor to prosecute under Sections 109-110 as the infected persons were immediately removed to hospital, and disinfection carried out. In no case had there been any contact with the work carried on. " Failure to send Lists.—It is still necessary to remind the majority of employers of their duty to send in twice a year the names and addresses of the outworkers to whom work is given out. During the year 119 notices of failure in this respect were sent, but since in reply to the notices, the necessary lists of outworkers were in every case promptly forwarded, no legal proceedings were instituted. " In conclusion, we gladly testify to the almost invariable willingness of Employers to conform to the requirements of the law when attention is called to any default, and to the courtesy with which our visits and suggestions are received." The appended table summarises the work of the year, so far as it is capable of being expressed in this form. Inspection of Women's Workshops. 1909 North Kensington. South Kensington. Total for Borough. Dressmakers. Laundries. Miscellaneous Total. Dressmakers Laundries Miscellaneous Total. 1. Workshop inspections, No. of 252 266 431 949 790 14 849 1,158 2,102 2. ,, re-inspections „ 23 54 24 101 131 2 61 194 295 3. Workrooms inspected ,, 281 1,025 421 1,727 1,184 53 431 1,668 3,395 4. Workrooms found overcrowded 1 — 3 4 11 — — 11 15 5. ,, insufficiently ventilated 4 5 2 11 16 — 2 18 29 6. ,, in a dirty condition 11 46 5 62 4 — 2 6 68 7. ,, measured; Number of 32 6 7 45 70 — 15 85 130 8. Workshops, &c., reported to H.M. Inspector 12 2 8 22 42 — 18 60 82 9. Workshops, &c., reported by H.M. Inspector - 17 7 4 28 36 1 19 56 84 10. Workshops, &c., newly discovered and registered 16 2 9 27 37 — 12 49 76 11. Workshops, &c., removed from register . 19 16 8 43 17 — 5 22 65 12. Domestic workshops and workplaces inspected 32 65 71 168 36 — 70 106 274 13. Written intimations issued 8 28 12 58 48 1 14 63 181 14. Statutory notices issued 4 5 1 10 7 — 8 10 20 15, Sanitary defects remedied:— (a) Additional means of ventilation provided 1 ─ 1 2 14 — 4 18 20 (b) Rooms cleansed and whitewashed 2 43 7 52 1 — 4 5 57 (c) Yards, floors, roofs, &c., repaired — 4 2 6 1 1 2 4 10 (d) Sanitary conveniences; defects remedied 6 9 3 18 17 1 7 25 43 (e) Dustbins provided or repaired — 2 1 3 3 — 1 4 7 (f) Miscellaneous defects remedied 4 5 3 12 6 1 — 7 19 16. Nuisances reported to Medical Officer of Health 2 2 4 — — 4 4 8 17. Workroom cards distributed ; Number of 33 — 7 40 71 — 13 84 124 51 MEN'S WORKSHOPS The number of workshops at which men were employed at the end of the year 1909 was 811. It should be noted that by Section 157, the provisions of the Factory and Workshop Act, 1901, relating to temperature, ventilation, drainage of floors, the exhibition of abstracts and certain other matters do not apply to workshops conducted on the system of not employing children, young persons or women. In London both in men's and women's workshops the provision of sanitary conveniences is regulated by Section 38 of the Public Health (London) Act, 1891, the standard adopted being that prescribed by the Sanitary Accommodation Order of 4th February, 1903. The following table shows the various trades and occupations carried on in the men's workshops now on the register : — Trade or Business. North Kensington. South Kensington. Borough. Baker 60 38 98 Basket-maker 8 — 8 Blacksmith 18 21 39 Bootmaker 77 47 124 Builder 54 48 102 Cabinet-maker and Joiner 22 20 42 Carver and Gilder 1 5 6 Coach-builder 32 8 40 Cycle-maker 9 11 20 Firewood-manufacturer 22 — 22 French Polisher 1 2 3 Marble Mason 5 3 8 Printer 3 5 8 Saddler 7 9 16 Tailor 53 23 76 Trunk-maker 5 6 11 Umbrella-maker 3 2 5 Undertaker 7 4 11 Upholsterer 10 6 16 Watchmaker 20 20 40 Wig Maker — 13 13 Sundry businesses 62 41 103 Total 479 332 811 HOME OFFICE TABLES. The following tables are supplied by request of the Secretary of State and contain a summary of the inspections made and the defects found and remedied in workshops and factories within the Borough where men, women, young persons or children are employed. In Table IV. the chief classes of workshops are set forth. Table V. shows the number of cases in which action was taken in matters referred to the Council by H.M. Inspectors. 52 FACTORIES, WORKSHOPS, WORKPLACES AND HOMEWORK. I.—Inspection. Premises. Number of Inspections. Written Notices. Prosecutions. Factories (including Factory Laundries) 94 20 — Workshops (including Workshop Laundries) 3,313 357 — Workplaces (other than Outworkers' premises included in part 3 of this Report) 49 — — Total 3,456 377 — II.—Defects Found. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. Nuisances under the Public Health Acts:—* Want of cleanliness 166 165 — — Want of ventilation 21 20 — — Overcrowding 15 15 — — Want of drainage of floors 26 26 — _ Other Nuisances 72 72 — — Sanitary accommodation insufficient 20 20 — — unsuitable or defective 96 96 — — not separate for sexes 8 8 — — 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) 8 8 — — Other Offences (Excluding offences relating to outwork which are included in Part 3 of this Report.) — — — — Total 432 430 — — *Including those specified in Sections 2, 3, 7 and 8, of the Factory and Workshop Act as remediable under the Public Health Acts. III.—Home Work. OUTWORKERS' LISTS, SECTION 107. Outwork in Unwholesome Premises, Section 108. Outwork in Infected Premises, Sections 109, 110. NATURE OF WORK.* Lists received from Employers. Addresses of Outworkers.§ Notices served on Occupiers as to keeping or sending lists. Prosecutions. Inspections of Outworkers premises. Instances. Notices served. Prosecutions. Instances. Orders made (S. 110). Prosecutions (Sections 109, 110) Twice in the year. Once in the year. Received from other Councils. Forwarded to other Councils. Falling to keep or permit inspection of lists. Failing to send lists. Outworkers.† Outworkers. * Lists, † Contractors Workmen. Lists. Contractors. Workmen. 1. 2 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. Wearing Apparel— (1) making, etc. 100 122 744 14 ... 16 305 804 110 .... ... 219 8 8 ... 6 ... ... (2) cleaning and washing 40 17 84 2 ... 5 6 30 9 ... ... 52 ... ... ... 4 ... ... Lace, lace curtains and nets ... ... 8 ... ... ... 1 8 ... ... ... 1 ... ... ... ... ... ... Artificial flowers ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Nets, other than wire nets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tents ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Sacks ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Furniture and Upholstery 4 ... 10 ... ... ... 1 3 ... ... ... 8 ... ... ... ... ... ... Fur pulling ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Feather sorting ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Umbrellas, etc. ... ... ... ... ... ... ... 3 ... ... ... ... ... ... ... ... ... ... Carding, etc., of buttons, etc. ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... Paper Bags and Boxes ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Basket making ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Brush making ... ... ... ... ... ... 1 ... ... ... ... 1 .... ... ... ... ... ... Racquet and tennis balls ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Stuffed Toys ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... File making ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Electro Plate ... 16 5... ... ... ... ... 20 ... ... ... 1 ... ... ... ... ... ... Cables and Chains ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Anchors and Grapnels ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cart Gear ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Locks, Latches and Keys ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pea picking ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Total 144 155 851 16 ... 21 314 869 119 ... ... 283 8 8 ... 10 ... ... * If an occupier gives out work of more than one of the classes specified in column 1, and sub-divides his list in such a way as to show the number of workers in each class of work, the list should be included among those in column 2 (or 5 as the case may be) against the principal class only, but the outworkers should be assigned in columns 3 and 4 (or 6 and 7) into their respective classes. A footnote should be added to show that this has been done. † The figures required in columns 2, 3 and 4 are the total number of lists received from those employers who comply strictly with the statutory duty of sending two lists each year and of the entries of names of outworkers in those lists. The entries in column 2 must necessarily be even numbers, as there will be two lists for each employer—in some previous returns odd numbers have been inserted. The figures in columns 3 and 4 will usually be (approximately) double of the number of individual outworkers whose names are given, since in the February and August lists of the same employer the same outworker's name will often be repeated †Two occupiers in column 2 give out work in other classes. See columns 3 and 4 and 9. § In view of the wide discrepancies found to exist between the totals in the two columns when the returns are added together, it is desired that care may be taken to give exact figures. Only those addresses should be counted which have actually been received from or forwarded to other Councils during the year covered by the report. 54 IV.—Registered Workshops. Workshops on the Register (s. 131) at the end of the Year. Number. Important classes of workshops, such as: workshop bakehouses, may be enumerated here. Dressmakers and Ladies' Tailors' 416 Workshop Laundries 188 Factory Bakehouses 3 Workshop Bakehouses 95 Other Workshops 966 Total number of workshops on Register 1,668 v.—Other Matters. Class. Number Matters notified to H.M. Inspectors of Factories :— Failure to affix Abstract of the Factory and Workshop Act (s. 133) 82 Action taken in matters referred by H.M. Inspectors as remediable under the Public Health Acts, but not under the Factory and Workshop Act (s. 5) Notified by H.M. Inspectors 20 Reports (of action taken) sent to H.M. Inspector 12 Other 3 Underground Bakehouses (s.101):— Certificate granted during the year ─ In use at the end of the year 75 SANITATION. 57 SANITATION. Dust Removal.—House refuse is collected once a week and is either disposed of by cremation in the Council's destructor at Wood Lane or removed by barge from the wharf in Kensal Road. The period of seven days is the maximum period during which the Council are permitted by the Public Health (London) Act, 1891, to allow refuse to accumulate on premises within their district. Trade refuse is removed by the Council on payment of a fee in accordance with the provisions of Section 33 of the same Act. Fish offal and other offensive trade products, which could be removed on application as trade refuse, are for the most part removed and sold by the persons to whom this class of refuse belongs. Where movable ashpits have been provided, fixed ashpits have been removed in accordance with the requirements of the London County Council (General Powers) Act, 1904, Part IV., Sec. 23. Drainage Work.—All drainage work in connection with new buildings is carried out under the supervision of the Borough Engineer, who also supervises the reconstruction of drains on existing premises where the work is undertaken by the owner on his own initiative. The reconstruction of drains found to be defective by the sanitary inspectors is carried out under their supervision, plans of any proposed alteration being submitted in the first instance to the Borough Engineer and then handed on to the Public Health Department. Public Lavatories —The Lady Inspectors' report on lavatories reserved for women is as follows :─ " We have kept under observation the lavatory accommodation at the eleven railway stations in the Borough, and in that part of Earl's Court Exhibition which is situated in Kensington. As a rule the lavatories are well kept and clean, especially in those cases where a woman is constantly in attendance during the hours when the stations are open to the public. At two station lavatories where no attendant is kept serious nuisances have been found on more than one occasion during the year. The railway company concerned sends a woman twice during the day to inspect the station lavatories and to carry out any cleansing that may be necessary, but in response to representations which have been made to the managers, no steps have so far been taken to provide the constant supervision which is necessary if nuisance is to be avoided. The three public lavatories provided by the Council for women have also been inspected from time to time." Nuisance from Smoke.- Notices were served in two instances in which "black" smoke was observed issuing from chimneys in such quantity as to be a nuisance. In no instance was it found necessary to institute legal proceedings. The new London County Council (General Powers) Bill, 1910, seeks to empower the London County Council to enforce the provisions of the Public Health (London) Act, 1891, as to nuisance from smoke on request by the sanitary authority affected, and Section 20 of the Bill proposes the omission of the word " black " in paragraph (b) of Section 24 of the Act of 1891. Sub-section (4) Section 21 of the Bill reads as follows: " For the purposes of this Section the (County) Council may institute any proceedings and do any act as if within the meaning of the Act of 1891 the Council were a Sanitary Authority and the county were their district. Legal Proceedings.—Summonses were issued in 11 cases for offences under the Public Health Acts. A penalty of £5 was inflicted for the removal of offensive matter during prohibited hours. The occupier of a basement room in a house let in lodgings was fined £3 for failing to keep the room in accordance with the bye-laws, the fine to be remitted in the event of the requirements of the sanitary inspector being carried out within seven days. In the remaining cases the summonses were withdrawn, the necessary work having been carried out in each instance before the date upon which the summons was heard. SANITARY INSPECTION. A complete list of the members of the staff of the Public Health Department will be found on the page following the title page of this report. For the purposes of sanitary inspection the Borough is divided into ten districts, one of which is allotted to each of the ten male sanitary inspectors, who carry out duties under the Public Health Act, the Sale of Food and Drugs Acts, the London County Council General Powers Acts and so far as men's workshops are concerned under the Factory and Workshop Act, 1901. A special inquiry officer has been appointed for the investigation of infectious disease and the supervision of disinfection. There are two female sanitary inspectors, whose duties consist in the inspection of workshops where women are employed and 58 in visiting cases of measles, whooping cough and consumption. The work of the two health visitors consists in visiting mothers of the poorer class and advising them in the care and management of their infants. A summary of the work of the sanitary inspectors will be found in Table VII., Appendix, p. 71. DISINFECTION Bedding is disinfected at the Council's disinfecting station by exposure to steam under a pressure varying between 15 and 18 lbs. for 20 minutes. Soiled linen is disinfected by boiling under a pressure of 10 lbs. for ten minutes in the rotary washing machine. Cloth stuffs, dresses, etc.,. are disinfected by formalin vapour in the heated chamber of the steam disinfector. A formalin cupboard has been ordered by the Public Health Committee to be constructed for the disinfection by formalin of leather, furs and other articles which cannot be exposed to high temperatures. Rooms are disinfected by fumigation with the formalin vapour generated by the volatilisation of 30 tablets of paraform. Thirty tablets are guaranteed by the makers to produce 29 grammes of gaseous formaldehyde, an amount of vapour which is sufficient to disinfect a room of 1,000 c.ft. Rooms vacated by consumptive persons are first sprayed with per cent, solut'on of formic aldehyde (formalin 2 ounces to 1 gallon of water), and then sealed and fumigated with formalin vapour. The following table shows the number of disinfections carried out for various diseases during the year:— Disinfection, 1909. Disease. Number of Disinfe:tions. Scarlet Fever 407 Diphtheria 167 Enteric Fever 35 Phthisis 92 Puerperal Fever 13 Measles 14 Cancer 20 Scabies, Vermin 9 Other Diseases 19 Loan Bedding 10 Total Disinfections 786 The total number of articles disinfected was 13,847 ; the total weight of the articles dealt with was 33 tons 5 cwt. 2 qrs. 23 lbs. With few exceptions the disinfected articles were also cleansed, and in a certain number of instances washing of infected articles of clothing, etc., was undertaken, week by week, for the convenience of householders, during the continuance of infectious disease treated at home; a charge being made for the service: 1,118 rooms in 878 houses were disinfected in the course of the year. VERMINOUS PERSONS The medical inspection of school children has revealed the fact that the number of verminous persons in the Borough of Kensington is very much in excess of the number that might have been anticipated, and probably attains amongst children alone, who are by no means always of the poorest class, a figure which does not fall short of 1,000. For a proper appreciation of the position it must be clearly understood that many of these children are verminous through no fault of their parents, and, further, that in any case when once they have become infested it is absolutely impossible for the parents to rid their children's bodies and clothes of lice without the use of a disinfecting station. 59 In the second place it is important to remember that verminous persons infect clean persons with whom they associate, and, thirdly, that body lice attach themselves to persons of all ages, For this third reason any attempt to deal with verminous conditions in school children alone could only result in a great waste of public money. If any advantage to the community is to result verminous families must be dealt with as a whole by the Sanitary Authority, who are in every way better suited than the Education Authority to undertake comprehensive measures for protecting the public from the filthy conditions which result from contact with verminous people. The following Acts of Parliament contain provisions for dealing with verminous persons: — I.—The Cleansing of Persons Act, 1897 confers on the Council " the power, when in their discretion they shall see fit, to permit any person infested with vermin to use free of charge, the apparatus (if any) which the Council possess for cleansing himself and his clothing from vermin." The Council is authorised to expend money on providing the necessary apparatus. II. The London County Council (General Powers) Act, 1904.—This Act does not apply to the cleansing of persons. It empowers the Borough Council to give notice In writing to the owner or occupier of any room or house certified to be verminous by the Medical Officer of Health to cleanse the house and, if necessary, to strip the walls. Under Section 19 any articles in a house which are in a filthy state may be destroyed, provided reasonable compensation is made to the owner of the articles. III. -The London County Council (General Powers) Act. 1907. Part V. of this Act empowers the County Council to enter into agreements and arrangements for the use of any appliances for the cleansing of verminous persons, which belong to or are used by the Borough Councils. The Borough Council of Kensington do not possess any such appliances, and the Act confers no powers over verminous persons unless they are either children attending the elementary schools or inmates of common lodging houses. The County Medical Officer has power to examine the clothes and persons of children in school and to convey any child found to be verminous to suitable premises where the child may be detained until it has been cleansed. Authority is also given to the County Medical Officer to examine the person and clothing of any inmate of a common lodging-house who is suspected to be verminous, but a lodger found to be infested with vermin can only be compulsorily removed to a cleansing station, if he fail to go of his own accord within 24 hours after the receipt from the Medical Officer of notice requiring him to submit himself and his person to be cleansed in such suitable premises as may be available. Children Act. 1908 -Section 122(3) provides that where any Sanitary Authority have provided, or are entitled to the use of premises for cleansing the person or clothing of persons infested with vermin, the Sanitary Authority shall allow the local Education Authority to use such premises for the cleansing of school children upon such payment (if any) as may be agreed upon between the two authorities. Summary of Enactments.—The Cleansing Act, 1897, empowers the Council to expend money on providing a cleansing station. The General Powers Act, 1907, confers compulsory powers on the County Medical Officer for the removal of verminous school children and verminous inmates of common lodging houses to cleansing stations. The Children Act, 1908, obliges the Sanitary Authority to permit the use of any cleansing station they may possess by the Local Education Authority. The same Act also enables the Sanitary Authority to claim reasonable payment for the cleansing of school children, and this payment is to be made by the Education Authority. Cost of Cleansing Stations.—In reply to a circular on this question, 16 Metropolitan Medical Officers of Health stated that cleansing stations had been provided in their Boroughs. Certain particulars were furnished as to cost, but their value is diminished by the fact that the greater number of the premises have been provided in connection with existing shelters or disinfecting stations and are served, in part or entirely, by the same staff. The cost, per annum, appears to average about £250, and the cost, per bath, is about one shilling. The initial cost of erecting a shelter and cleansing station in Marylebone was returned as £1,080. At three stations more than 1,000 adult persons are bathed in the year. In several stations the attendances of children exceed 1,200. It is understood that the London County Council would be willing to pay the Borough Councils at the rate of 2s. 6d. per head, that is to say, per child cleansed. At least two or three baths would be necessary for the cleansing of each child, and presumably a second payment would be made in respect of any child who became re-infested after the lapse of any considerable interval of time. 60 Provision in Kensington.—Under an arrangement with the Board of Guardians verminous persons can be cleansed at the expense of the Council, at the Able-bodied Workhouse in Mary Place. The number of persons cleansed under this arrangement is a negligible quantity, and only amounted to 18 during the year 1909. The use of premises attached to a workhouse cannot be properly offered except to the semi-destitute inmates of common lodging houses, and for school children the use of such premises is needless to say out of the question. Should the Council erect their own station, the facilities offered will become widely known to adults through the school children who are sent to be cleansed, and the task of eradicating vermin will be dealt with comprehensively by a single authority. Should the London County Council on the other hand be driven, by the failure of the Borough Councils, to make their own provision for school children, they cannot deal with adults, and the children will become re-infested after each cleansing by contact in their homes with verminous members of their families who are not of school age, and for this work which would be bound to fail in its object, the Borough Council would pay as heavily through the Education Rate as they would through the Borough Rate in the event of a station of their own being provided, with the added disadvantage of having no direct control over the amount spent. Verminous Rooms.—260 verminous rooms were cleansed during the year in response to notices served under the powers conferred by the London County Council General Powers Act, 1904. PUBLIC BATHS AND WASHHOUSES. I am indebted to Mr. Buck, superintendent, for the subjoined particulars as to the use made of the Public Baths and Washhouses during 1909 and the two preceding years by washers and bathers: Year. Washers. Bathers.[.###] 1907 73,302 136,695 1908 71,321 130,088 1909 70,472 127,607 The diminution in the number of persons making use of the facilities provided is attributed by the superintendent to the fact that new baths and washhouses have been opened at no great distance in the neighbouring Borough of Hammersmith. MORTUARY AND CHAPEL OF REST During the year 263 bodies were deposited at the Mortuary under the following circumstances : — 1. At the request of the relatives of the deceased 35 2. At the request of undertakers, mainly at the instance of the relieving officers 45 3. At the request of the coroner (inquest cases):— Cases of sudden death 84 Cases of violent death 78 162 4. Brought in by the Police—Persons found dead 15 Accident cases 4 19 5. On account of death due to infectious disease 2 Total number of bodies received 263 In 110 of the above cases post-mortem examinations were made under the coroner's warrant. 61 The number of bodies deposited in 1909 and the four preceding years, together with the number of inquests held and the number of post-mortem examinations made in the Mortuary is shown in the following table : — Number of Bodies taken into the Mortuary. Year. No. of bodies received at the Mortuary. No. of bodies upon which Coroner's inquests were held. No. of bodies upon which post mortem examinations were made. 1905 338 202 119 1906 341 217 127 1907 274 194 112 1908 251 174 107 1909 263 181 110 Unnecessary inconvenience having been caused by numerous applications from undertakers for the reception of bodies late at night, the period during which bodies will be received, except in case of emergency, has been limited on the recommendation of the Cemetery and Open Spaces Sub-committee to the hours between 8 A.M. and 8 P.M., and undertakers have been notified to this effect. During the year 60 bodies were deposited in the Chapel of Rest, Avondale Park. SixtyTour bodies were deposited in the previous year. VACCINATION. Through the courtesy of Mr. King, the vaccination officer, I am able to" publish in the Appendix, Table XI., the official returns respecting the vaccination of children whose births were registered in 1908. Out of a total number of 3,309 infants born 117 were not vaccinated on account of " conscientious objection " on the part of the parents, and 157 remained unvaccinated through " removal to places unknown." The total number of cases not finally accounted for or not vaccinated through "conscientious objection" on the part of the parents thus amounted to 274 or to 8.3 per cent, of the births registered as compared with losses of 10.1, 12.7, 8.1, 6.8, 7.6, 6.1, 5.8, 5.8, 5.4, 6.3 and 6.8 per cent, of the births registered in the preceding eleven years. APPENDIX. 65 APPENDIX. Local Government Board Tables I.-V. Table I. For Whole District. Year. Population estimated to Middle of each Year. Births. Deaths under One Year of Age. Nett. 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 1899 172,400 3,682 21.4 642 174 3,422 19.8 1,320 722 321 3,021 17.5 1900 173,000 3,682 21.3 641 174 3,087 17.7 1,132 672 283 2,698 15.6 1901 177,000 3,708 20.9 581 157 2,964 16.7 1,108 635 321 2,650 15.0 1902 177,500 3,599 20.3 515 143 3,112 17.2 1,182 681 315 2,746 15.2 1903 178,000 3,677 20.7 510 139 2,803 15.7 1,094 666 318 2,455 13.8 1904 178,500 3,568 20.0 503 141 2,911 16.3 1,089 710 339 2,540 14.2 1905 179,000 3,579 20.0 498 139 2,856 15.9 1,222 673 324 2,507 14.0 1906 179,500 3,428 19.1 452 132 2,811 16.2 1,222 663 349 2,497 13.9 1907 180,500 3,428 19.0 433 126 2,824 15.6 1,240 704 351 2,471 13.7 1908 181,000 3,504 19.0 428 122 2,757 14.9 1.268 713 354 2,398 13.0 Averages for 10 years 1899- 1908. 177 640 3,586 20.2 520 145 2,955 16.6 1,188 684 328 2.598 14.6 1909 181,500 3,381 18.6 379 112 2 770 15.3 1,270 692 371 2,449 13.5 * Rates calculated per 1,000 of estimated population. 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 elsewhere. Area of Borough in acres 2,291 Total population at all ages 181,500 No. (approximate) of inhabited houses 25,198 Average number of persons per house 7.2 INSTITUTIONS WITHIN KENSINGTON RECEIVING SICK AND INFIRM PERSONS FROM OUTSIDE THE BOROUGH. 1. St. Marylebone Infirmary, North Kensington. 2. The Hospital for Consumption and Diseases of the Chest, Brompton. 3. St. Joseph's House, Notting Hill. 4. St. Luke's House, Pembridge Square. 5. Kensington General Hospital, Richmond Road, South Kensington. 66 TABLE II. For Separate Localities. Names of Localities. Borough of Kensington. North Kensington. South Kensington. 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. 1899 172,400 3,682 3,021 642 87,800 2,592 1,897 496 84,600 1,090 1,124 146 1900 173,000 3,682 2.698 641 88,100 2,607 1,711 512 84,900 1,075 987 129 1901 177,000 3,708 2,650 581 91,250 2,646 1,769 447 85,750 1,062 881 134 1902 177,500 3,599 2,746 515 91,510 2,560 1,768 386 85,990 1,039 978 129 1903 178,000 3,677 2,455 510 91,770 2,679 1,559 411 86,230 998 896 99 1904 178,500 3,568 2,540 503 92,030 2,572 1,629 406 86,470 996 911 97 1905 179,000 3,579 2,507 498 92,290 2,561 1,565 395 86,710 1,018 942 103 1906 179,500 3,428 2,497 452 92,550 2,421 1,564 365 86,950 1,007 933 87 1907 180,500 3,428 2,471 483 93,070 2,453 1,578 346 87,430 975 893 87 1908 181,000 3,504 2,398 428 93,830 2,487 1,529 333 87,670 1,017 869 95 Averages of 10 years 1899 -1908. 177,640 3,586 2,598 520 91,370 2,558 1,657 410 86,270 1,028 941 110 1909 181,500 3,381 2,449 379 93,590 2,460 1,521 305 87,910 921 928 74 67 TABLE III. Cases of Infectious Disease notified during the Year, 1909. Notifiable Disease. Cases Notified in Kensington. Total Cases Notified in each District. Number of Cases removed to Hospital from each District. At all Ages. At Ages—Years. North Kensington, South Kensington. North Kensington. South Kensington. Under 1 1 to 5. 5 to 15. 15 to 25. 25 to 65. 65 and upwards Small-Pox ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... Diphtheria (including Membranous croup) 169 8 57 67 21 16 ... 102 67 93 54 Erysipelas 134 4 5 3 16 78 28 99 35 4 2 Scarlet fever 417 3 103 222 59 29 1 307 110 268 94 Typhus fever ... ... ... ... ... ... ... ... ... ... ... Enteric fever 47 ... ... 9 10 27 1 29 18 21 12 Relapsing fever ... ... ... ... ... ... ... ... ... ... ... Continued fever ... ... ... ... ... ... ... ... ... ... ... Puerperal fever 7 ... ... ... 1 6 ... 6 1 ... 1 Plague ... ... ... ... ... ... ... ... ... ... ... Glanders 1 ... ... ... ... 1 ... 1 ... 1 ... Cerebro-Spinal Fever 4 2 2 ... .. ... ... 4 ... 4 ... Totals 779 17 167 301 107 157 30 548 231 414 163 68 TABLE IV. Causes of, and Ages at, Death during the Year 1908. Causes of Death. Deaths in whole District at subjoined ages. Deaths in Localities (at all ages). Total Deaths whether of Residents or non "Residents" in Public Institutions in the District. All Ages. Under 1 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 65 65 and upwards North Kensington. South Kensington. Small-pox ... ... ... ... ... ... ... ... ... ... Measles 58 12 45 1 ... ... ... 54 4 26 Scarlet Fever 9 ... 6 3 ... ... ... 8 1 ... Whooping-Cough 40 17 21 2 ... ... ... 40 ... 18 Diphtheria, Membranous Croup 19 4 11 4 ... ... ... 13 6 1 Croup ... ... ... ... ... ... ... ... ... ... Fever Typhus ... ... ... ... ... ... ... ... ... ... Enteric 8 ... ... • • • 8 5 ... 3 5 ... Other continued ... ... ... ... ... ... ... ... ... ... Epidemic Influenza 75 2 1 ... 6 19 47 33 42 6 Cholera ... ... ... ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... ... Diarrhoea 50 36 10 ... ... 2 2 40 10 13 Enteritis 22 9 3 ... 1 7 2 13 9 11 Gastritis 3 1 ... ... ... 2 ... 2 1 3 Puerperal Fever 4 ... ... ... 4 ... ... 2 2 ... Erysipelas 10 2 ... ... ... 2 6 8 2 6 Phthisis, Pulmonary Tuberculosis 168 1 3 2 24 124 14 120 48 221 Other tubercular diseases 69 19 28 9 1 10 2 53 16 29 Cancer, Malignant disease 205 1 ... • • • 1 126 77 85 120 139 Bronchitis 232 32 15 ... 1 49 135 161 71 157 Pneumonia 253 30 46 5 9 98 65 166 87 79 Pleurisy 13 ... 1 ... 1 6 5 7 6 4 Other diseases of Respiratory Organs 26 ... 1 ... ... 16 9 20 6 6 Alcoholism 25 ... ... ... ... 23 2 13 12 21 Cirrhosis of Liver Venereal Diseases 23 16 2 ... ... 4 1 18 5 29 Premature Birth 69 69 ... ... ... ... ... 56 13 10 Diseases and Accidents of Parturition 12 ... ... ... 4 8 ... 7 5 1 Heart Diseases 267 2 1 7 13 113 131 152 115 123 Accidents 70 17 7 5 2 24 15 43 27 19 Suicides 16 ... ... 2 13 1 6 10 3 All other causes 703 109 30 18 19 246 286 398 305 345 All causes 2,449 379 231 51 91 897 800 1,521 928 1,270 69 TABLE V. INFANTILE MORTALITY DURING THE YEAR 1909. Deaths from stated Causes, in Weeks and Month:, under One Year of Age. Cause of Death. 1 Under 1 week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 1 Month. 1-2 Months. 2-3 Months. 3-4 Months. 4-5 Months. 5-6 Months. 6-7 Months. 7-8 Months. 8-9 Months. 9-10 Months. 10-11 Months. 11-12 Months. otal Deaths onder One Year. All Causes. Certified 79 16 18 12 125 32 36 34 27 17 15 13 30 18 13 18 378 Uncertified 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 Common Infectious Diseases Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... 1 ... 5 2 ... 3 12 Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria: Croup ... ... ... ... ... ... ... ... ... ... ... ... 3 1 ... ... 4 Whooping-cough ... ... ... ... ... 1 1 2 ... 2 1 2 2 2 2 2 17 Diarrhceal Diseases Diarrhoea, all forms ... 1 ... ... 1 2 7 4 4 1 6 1 4 4 ... 2 36 Enteritis Muco-enteritis Gastro-enteritis ... 1 1 1 3 1 ... 1 ... 1 ... ... 1 ... 1 1 9 Gastritis, Gastrointestinal Catarrh ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 Premature Birth 50 5 5 4 64 1 2 1 ... 1 ... ... ... ... ... ... 69 Wasting Diseases. Congenital Defects 9 1 1 ... 11 1 1 ... ... 1 ... 1 ... ... 1 ... 16 Injury at Birth 5 ... ... ... 5 ... ... ... ... ... ... ... ... ... ... ... 5 Want of Breast-milk ... ... ... 1 1 1 ... ... ... ... ... ... ... ... ... ... 2 Atrophy, Debility, Marasmus 6 5 3 4 18 8 6 6 6 3 2 ... ... ... 1 ... 50 Tuberculous Diseases Tuberculous Meningitis ... ... ... ... ... ... ... 1 2 ... ... 2 ... 2 1 ... 8 Tuberculous Peritonitis; Tabes Mesenterica ... ... ... ... ... 1 ... 1 1 1 1 1 ... 1 1 ... 8 Other Tuberculous Diseases ... ... ... ... ... ... 1 1 ... ... 1 ... 1 ... ... ... 4 Erysipelas ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... 2 Syphilis 1 1 1 ... 3 2 3 3 2 ... 1 1 ... ... 1 ... 16 Rickets ... • •• ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 Meningitis (not Tuberculous) ... ... 1 ... 1 ... 2 1 1 1 ... 2 ... ... 1 ... 9 Convulsions 1 1 ... ... 2 1 2 1 ... ... ... ... ... ... ... ... 6 Bronchitis . . . ... ... ... ... 4 6 4 4 3 1 1 7 2 ... ... 32 Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 Pneumonia ... ... 2 ... 2 4 2 1 5 1 1 1 4 1 1 7 30 Suffocation, overlaying 1 ... 1 2 4 2 2 2 ... ... ... ... ... ... ... ... 10 Other causes 7 1 8 ... 11 2 1 5 2 2 ... 1 2 2 2 1 81 80 16 18 12 126 32 36 34 27 17 15 13 30 18 13 18 379 legitimate, 8,198. Clegitimate infants, 824. Births in the year Deaths in the year of (illegitimate, 183. (illegitimate infants, 55. Deaths from all Causes at all Ages, 2,449. 70 TABLE VI—PROCEEDINGS DURING 1909. PREMISES. NUMBER OF PLACES. Number of inspections, 1909. Number of notices, 1909. Number of prosecutions, 1909 On register at end of 1908. Added in 1909. Removed in 1909. On register at end of 1909. Milk premises 284 14 108 190 1,574 36 — Cowsheds 1 — — 1 47 — — Slaughter-houses 11 — 1 10 246 — — Other offensive trade premises — — — — — — — Ice cream premises 165 12 — 177 165 35 — Registered houses let in lodgings 2,056 20 — 2,076 9,484 (a)*112 (b)†1180 (a)*— (b)†9 Total number of intimation notices served for all purposes, 2405. *(a) For overcrowding †(b) For other conditions. Overcrowding—1909. Number of dwelling rooms overcrowded 56 Number remedied 56 Number of prosecutions — Underground rooms— Illegal occupation dealt with during year 17 Number of rooms closed — Insanitary houses— Number closed under the Public Health (London) Act, 1891 — Number closed under the Housing of the Working Classes Act — Number of premises cleansed under Sec. 20 of L.C.C. (General Powers) Act, 1904 260 Shelters provided under sec. 60 (4) of the Public Health (London) Act, 1891— Number of persons accommodated during the year No shelter Revenue Acts— Number of houses for which applications for certificates were received during year 10 Number of tenements comprised therein 51 Number of tenements for which certificates were (a)-granted 31 (6) refused — Number of prosecutions under By-laws under Public Health Act, 1891. (a) For prevention of nuisance arising from snow, ice, salt, filth, etc., — (b) For prevention of nuisance arising from offensive matter running out of any factory, etc. — (c) For the prevention of keeping of animals in such a manner as to be injurious to health — (d) As to paving of yards, etc., of dwelling houses — (e) In connection with the removal of offensive matter, etc. 1 (/) As to cesspools and privies, removal and disposal of refuse, etc. — (g) For securing the cleanliness of tanks, cisterns, etc. 1 (h) With respect to water closets, earth closets, etc. — (i) With respect to sufficiency of water supply to water closets 3 (j) With respect to drainage, etc., (Metropolis Management Act, section 202) — (k) With respect to deposit of plans as to drainage, etc. (Metropolis Management Acts Amendment (By-laws) Act, 1899) — Mortuaries— Total number of bodies removed 323 Total number of infectious bodies removed 2 71 TABLE VII. Summary of the Work of the Sanitary Inspectors during the Year 1909. Sanitary Districts. No. of Complaints made by Inhabitants, &c. No. of Inspections of Houses, Premises, &c. 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-House By-laws Final Notices (signed by Medical Officer) served. Houses, Premises, &c., Cleansed, Repaired, Whitewashed, &c. Houses disinfected after infectious disease. Reconstructed, Repaired, Cleansed, &c. Ventilated, Trapped, &c. Repaired. Supplied with Water. 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. Bakehouses, No. of. Bakehouses, No. of Inspections of. Dairies, Milkshops, No of. Dairies, Milkshops, No. of Inspections of. Mews, No. of Inspections of. Legal proceedings, i.e., Summonses. No. I. District 84 2,249 1,042 326 50 185 10 262 107 54 8 221 7 — 59 45 1 51 — 3 56 4 7 84 40 266 1040 — No. II. „ 69 2,240 1,065 292 74 230 47 377 81 208 — 32 186 1 75 7 9 61 — — 51 2 8 73 32 187 751 7 No. III. „ 36 2,269 894 275 77 281 68 274 66 32 3 70 26 4 54 7 — 18 — 7 51 4 5 28 33 58 612 — No. IV. „ 78 1,431 974 254 39 160 20 113 129 49 15 71 66 — 57 5 — 15 1 10 25 5 16 86 45 153 489 — No. V. „ 68 1,413 1,060 231 41 73 8 126 107 19 6 72 81 2 18 5 — 3 — — 11 1 13 73 31 240 907 3 No. VI. „ 60 1,274 1,282 201 59 64 10 48 71 71 27 77 8 1 10 1 4 4 — — 30 6 10 90 17 132 564 — No. VII. „ 75 1,380 1,066 167 35 92 7 336 79 55 22 82 120 7 29 15 — 35 — — 38 — 8 73 20 93 413 — No. VIII. „ 71 1,366 983 143 15 43 7 133 54 45 4 38 12 2 10 4 — 5 1 — 14 — 8 105 17 216 835 — No. IX. „ 70 1,777 1,143 381 54 126 12 188 121 56 12 105 77 4 41 25 6 68 4 — 65 — 15 38 29 147 702 — No. X. „ 44 1,211 1,201 135 33 38 3 78 63 50 10 67 12 5 21 7 — 8 — — 24 — 7 44 19 82 653 1 655 16,610 10,701 2,405 477 1,292 192 1,935 878 639 107 835 595 26 374 121 20 268 6 20 365 22 97 694 283 1574 6966 11 • Under the provisions of sec. 3 Public Health (London) Act, 1891. t The total number of houses on the Register in December. 1909, was 2,076. 72 TABLE VIII. Causes of Death at different periods of life in the Year 1909. CAUSES OF DEATH. Totals— All Ages. Under 1 year. 1 and under 5 years. Totals— Under Five Years. 5 and under 15 years. 15 and under 25 years. 25 and under 35 years. 35 and under 45 years. 45 and under 55 years. 55 and under 65 years. 65 and under 75 years. 75 and under 85 years. 85 years and upwards. Totals— Above Five Years. Total M F M F M F M F Total M F M F M F M F M F M F M F M F M F M F Total GENERAL DISEASES. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 58 32 26 6 6 26 19 32 25 57 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 Scarlet Fever 9 6 3 ... ... 4 2 4 2 6 2 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 1 3 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Epidemic Influenza 75 30 45 1 1 1 ... 2 1 3 ... ... 3 3 ... 1 2 1 2 2 ... 7 9 14 6 12 2 28 44 72 Whooping-Cough 40 17 23 8 9 8 13 16 2 2 38 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 2 Diphtheria, Membranous Croup 19 8 11 3 1 5 6 8 7 15 ... 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 4 Enteric Fever 8 4 4 ... ... ... ... ... ... ... ... ... 1 2 2 ... 1 1 ... ... ... 1 ... ... ... ... ... ... 4 4 8 Asiatic Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhoea, Dysentery 21 11 10 8 5 3 1 11 6 17 ... ... ... ... ... ... ... ... ... 2 ... ... ... 2 ... ... ... ... ... 4 4 Epidemic or Zymotic Enteritis 29 9 20 7 16 2 4 9 20 29 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebro-Spinal Fever 2 1 1 1 ... ... 1 1 1 2 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Varicella 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 Hydrophobia ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Glanders, Farcy 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 Tetanus 2 l 1 ... 1 ... ... ... 1 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 Anthrax, Splenic Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cow-pox, Accidents of Vaccination ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Syphilis 22 13 9 10 6 1 1 11 7 18 ... ... ... ... ... ... 1 ... 1 1 ... 1 ... ... ... ... ... ... 2 2 4 Gonorrhœa 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 1 Phagedæna ... ... • • • ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas 10 5 5 2 ... ... ... 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... 1 2 1 ... 3 ... ... 3 5 8 Puerperal Fever 4 ... 4 ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... 4 4 Pyæmia, Septicæmia 8 3 5 1 1 ... ... 1 1 2 1 ... ... 1 ... ... ... ... 1 1 ... 2 ... ... ... ... ... ... 2 4 6 Spetic, Ulcerative or Infective Endo- carditis 2 ... 2 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 2 2 Canerum oris 1 1 ... ... ... 1 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Stomatitis 2 2 ... 1 ... 1 ... 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Carbuncle 3 1 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... 1 ... ... ... ... 1 2 3 Cellulitis 9 4 5 1 ... ... ... 1 ... 1 ... ... ... ... ... 1 1 1 1 ... ... ... ... 2 1 1 ... ... 3 5 8 Carried forward 327 150 177 49 46 52 47 101 93 194 4 8 4 7 4 4 5 5 6 7 5 13 12 20 7 16 2 4 49 84 133 73 TABLE VI11.—continued. CAUSES OF DEATH. Totals— All Ages. Under 1 year. 1 and under 5 years. Totals— Under Five Years. 5 and under 15 years. 15 and under 25 years. 25 and under 35 years. 35 and under 45 years. 45 and under 55 years. 55 and under 65 years. 65 and under 75 years. 75 and under 85 years. 85 years and upwards. Totals— Above Five Years. Total M F M F M F M F Total M F M F M F M F M F M F M F M F M F M F Total Brought forward 327 150 177 49 46 52 47 101 93 194 4 8 4 7 4 4 5 5 6 7 5 13 12 20 7 16 2 4 49 84 133 GENERAL DISEASES.—continued. Malarial Fever 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... 1 Bheumatic Fever 2 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... ... ... 1 1 2 Rheumatism of the Heart ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tubercular Meningitis 33 19 14 5 3 11 7 16 10 26 3 3 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 3 4 7 Tuberculosis of Larynx 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... 2 ... 2 Phthisis, Phthisis Pulmonalis 168 98 70 ... 1 ... 3 ... 4 4 1 1 12 12 16 15 32 15 14 12 14 6 8 4 1 1 ... ... 98 66 164 Tuberculosis of Intestines, Tabes Mes- enterica 12 9 3 5 3 3 ... 8 3 11 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 General Tuberculosis 16 12 4 1 1 4 2 5 3 8 2 ... 1 ... 3 ... 1 1 ... ... ... ... ... ... ... ... ... ... 7 1 8 Other forms of Tuberculosis, Scrofula 6 2 4 ... 1 ... 1 ... 2 2 1 ... ... ... 1 1 ... ... ... ... ... ... .... 1 ... ... ... ... 2 2 4 Scurvy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ptomaine Poisoning 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... 1 Acute Alcoholism, Delirium Tremens 2 l 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... 1 1 2 Chronic Alcoholism 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 1 Osteo-arthritis, Rheumatoid Arthritis 7 l 6 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 2 1 3 ... ... ... ... 1 6 7 Gout 4 3 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 2 1 ... ... ... ... 3 1 4 Carcinoma 122 41 81 ... ... ... ... ... ... ... ... ... ... ... 1 2 5 7 8 19 11 19 12 19 4 15 ... ... 41 81 122 Sarcoma 14 7 7 1 ... ... ... ... ... ... ... ... ... ... ... ... 2 1 3 1 1 2 ... 1 ... ... ... 1 6 7 13 Cancer, Malignant Disease 69 28 41 ... ... ... ... ... ... ... ... ... ... ... ... 3 1 2 7 8 11 12 4 9 4 7 1 ... 28 41 69 Diabetes Mellitus 24 14 10 ... ... ... ... ... ... ... ... 1 2 ... 2 ... ... ... 3 3 2 3 5 ... ... 3 ... ... 14 10 24 Purpura Hsemorrbagica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Haemophilia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Anaemia, Leucocythæmia 7 4 3 ... ... ... ... ... ... ... ... ... 1 ... ... 1 1 ... ... 1 ... ... 2 1 ... ... ... ... 4 3 7 Lymphadenoma, Hodgkin's Disease 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 Premature Birth 69 35 34 35 34 ... ... 35 34 69 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Injury at Birth 5 1 4 1 4 ... ... 1 4 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Debility at Birth 4 1 3 1 3 ... ... 1 3 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Carried forward 897 431 466 98 96 70 60 168 156 324 11 13 20 20 27 26 49 33 44 53 45 58 47 60 17 42 3 5 263 310 573 74 TABLE VIII.—continued. CAUSES OF DEATH. Totals— All Ages. Under 1 year. 1 and under 5 years. Totals— Under Five Years. 5 and under 15 years. 15 and under 25 years. 25 and under 35 years. 35 and under 45 years. 45 and under 55 years. 55 and under 65 years. 65 and under 75 years. 75 and under 85 years. 85 years and upwards. Totals— Above Five Years. Total M F M F M F M F Total M F M F M F M F M F M F M F M F M F M F Total Brought forward 897 431 466 98 96 70 60 168 156 324 11 13 20 20 27 26 49 33 44 53 45 58 47 60 17 42 3 5 263 310 573 GENERAL DISEASES—continued. Atelectasis 7 3 4 3 4 ... ... 3 4 7 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Malformation of Heart 2 2 ... 2 ... ... ... 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Malformation of Larynx 1 ... 1 ... 1 ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Spina Bifida 2 ... 2 ... 2 ... ... 1 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Hydrocephalus 2 1 1 1 ... ... 1 1 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cleft Palate l 1 ... 1 ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Icterus Neonatorum 3 ... 3 ... 3 ... ... ... 3 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Want of Breast Milk 2 1 1 1 1 ... ... 1 1 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Atrophy, Debility Marasmus 44 25 19 21 18 4 1 25 19 44 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Indigestion 7 6 1 6 1 ... 1 6 1 7 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Dentition 3 ... 3 ... 2 ... ... 3 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Rickets 3 2 1 1 ... 1 1 2 1 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 94 Old Age, Senile Decay 94 37 57 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 8 9 15 24 13 24 37 57 Total for General Diseases 1068 509 559 134 128 75 64 209 192 401 11 13 20 20 27 26 49 33 44 53 46 58 55 69 32 66 16 29 300 367 667 DISEASES OF NERVOUS SYSTEM. Convulsions 7 1 6 1 5 ... ... 1 5 6 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 Meningitis 16 10 6 4 5 ... ... 9 5 14 1 ... ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 1 2 Apoplexy 20 6 14 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 3 1 1 1 4 2 4 1 1 6 14 20 Softening of Brain 4 1 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 2 ... ... 1 3 4 Hemiplegia, Brain Paralysis 18 10 8 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 4 2 3 2 4 ... ... 10 8 18 General Paralysis of Insane 15 11 4 ... ... ... ... ... ... ... ... ... ... 2 ... ... 3 1 7 ... 1 ... ... 1 ... ... ... ... 11 4 15 Other forms of Insanity 9 2 7 ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 1 1 ... ... 1 1 1 ... 2 ... ... 2 7 9 Chorea 2 ... 2 ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 2 Cerebral Tumour 4 3 1 ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... 3 1 4 Epilepsy 14 8 6 3 1 1 ... 4 1 5 ... ... 1 ... ... ... ... ... 1 3 ... 1 1 ... 1 ... ... 1 4 5 9 Laryngismus Stridulus 1 ... 1 ... 1 ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Locomotor Ataxy 6 3 3 ... ... ... ... ... 2 2 1 3 3 6 Paraplegia, Diseases of Spinal Cord 13 8 5 ... ... ... ... ... ... ... ... ... 1 1 1 ... 1 ... 1 ... 3 1 ... 2 1 1 ... ... 8 5 13 Nervous System, Other Diseases 16 6 10 ... ... ... 1 ... 1 1 1 ... ... ... ... ... ... 1 1 ... 2 3 1 1 ... 4 1 ... 6 9 15 Total for Disesase of Nervous System 145 69 76 8 12 6 1 14 13 27 2 2 4 5 1 3 5 3 15 8 11 11 8 12 7 17 2 2 55 63 118 Carried forward 1213 578 635 142 140 81 65 223 205 428 13 15 24 25 28 29 54 36 59 61 57 69 63 81 39 83 18 31 355 430 785 75 TABLE VIII.—continued. CAUSES OF DEATH. Totals— All Ages. Under 1 year. 1 and under 5 years. Totals— Under Five Years. 5 and under 15 years. 15 and under 25 years. 25 and under 35 years. 35 and under 45 years. 45 and under 55 years. 55 and under 65 years. 65 and under 75 years. 75 and under 85 years. 85 years and upwards. Totals— Above Five Years Total M F M F M F M F Total M F M F M F M F M F M F M F M F M F M F Total Brought forward 1213 578 635 142 140 81 65 223 205 428 13 15 24 25 28 29 54 36 59 61 57 69 63 81 39 83 18 31 355 430 785 DISEASES OF ORGANS OF SPECIAL SENSE. Otitis, Mastoid Disease 7 3 4 ... ... 2 2 2 2 4 ... 2 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Epistaxis, Nose Disease ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ophthalmia, Eye Disease ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Total for Diseases of Organs of Special Sense 7 3 4 ... ... 2 2 2 2 4 ... 2 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 2 3 DISEASES OF THE HEART AND BLOOD-VESSELS. Pericarditis 2 2 ... ... ... 1 ... 1 ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 Endocarditis, Valvular Diseases of the Heart 71 31 40 ... ... ... ... ... ... ... 4 1 2 1 1 4 2 5 4 5 8 2 6 11 3 9 1 2 31 40 71 Hypertrophy of Heart ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... *•* Angina Pectoris 10 8 2 ... • • • ... ... ... ... ... ... ... 1 ... 1 ... ... ... 2 ... 2 ... ... ... 2 2 ... ... 8 2 10 Aneurism 9 5 4 ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... 1 1 1 2 ... 1 ... ... ... ... 5 4 9 Senile Gangrene 4 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 1 1 2 2 4 Embolism, Thrombosis 23 8 15 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 2 ... 1 2 4 4 3 1 5 8 15 23 Phlebitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Varicose Veins 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 Fatty Degeneration of Heart 53 18 35 ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 4 1 2 2 5 4 10 7 11 2 3 18 35 53 Cardiac Dilatation 5 2 3 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 2 1 ... 1 ... ... ... 2 3 5 Rupture of Heart 2 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... 1 1 2 Atheroma 7 6 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 4 ... 1 ... ... ... 6 1 7 Cerebral Hemorrhage 52 22 30 ... ... ... ... ... ... ... ... 1 ... ... ... ... 2 3 2 5 3 8 9 5 5 6 1 2 22 30 52 Arterio-Sclerosis 13 9 4 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 2 ... 1 1 2 3 3 ... ... ... 9 4 13 Heart Disease, not specified 124 50 74 1 1 ... ... 1 1 2 1 1 4 4 3 2 4 6 9 13 12 8 10 22 6 16 ... 1 49 73 122 Total for Diseases of the Heart and Blood-Vessels 376 164 212 1 1 1 ... 2 1 3 6 3 8 5 7 7 12 18 21 29 31 29 38 59 33 47 6 14 162 211 373 Carried forward 1596 745 851 143 141 84 67 227 208 435 19 20 33 30 35 36 66 54 80 90 88 98 101 140 72 130 24 45 518 643 1161 76 TABLE VIII.—continued. CAUSES OF DEATH TotalsAll Ages. Under 1 year. 1 and under 5 years. Totals— Under Five Years. 5 and under 15 years. 15 and under 25 years. 25 and under 35 years. 35 and under 45 years. 45 and under 55 years. 55 and under 65 years. 65 and under 75 years. 75 and under 85 years. 85 years and upwards. Totals— Above Five Years. Total M F M F M F M F Total M F M F M F M F M F M F M F M F M F M F Total Brought forward 1596 745 851 143 141 84 67 227 208 435 19 20 33 30 35 36 66 54 80 90 88 98 101 140 72 130 24 45 518 643 1161 DISEASES OF THE LARYNX AND TRACHEA. Laryngitis 5 3 2 ... 1 2 ... 2 1 3 ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... 1 1 2 Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Total for Diseases of the Larynx and Trachea 5 3 2 ... 1 2 ... 2 1 3 ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... 1 1 2 DISEASES OF RESPIRATORY ORGANS. Acute Bronchitis 67 27 40 11 21 6 9 17 30 47 ... ... ... ... ... ... ... 1 ... ... 4 4 4 ... 2 5 ... ... 10 10 20 Chronic Bronchitis 165 67 98 ... ... ... ... ... ... ... ... ... ... 1 ... ... 2 3 7 3 9 16 25 29 17 34 7 12 67 98 165 Lobar, Croupous, Acute Pleuro-Pneumonia 22 17 5 1 ... 1 ... 2 ... 2 ... 1 1 ... 2 ... 3 ... 4 1 3 2 2 1 ... ... ... ... 15 5 20 Lobular,Catarrhal, Broncho-Pneumonia 91 49 42 15 7 20 9 35 16 51 3 ... ... ... 1 1 1 3 3 4 3 6 1 6 2 4 ... 2 14 26 40 Pneumonia, form not stated 140 65 75 5 2 10 6 15 8 23 ... 1 6 2 5 5 4 9 4 6 12 16 10 13 6 9 3 6 50 67 117 Emphysema, Asthma 22 11 11 ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 3 2 3 4 3 4 ... 1 ... ... 11 11 22 Pleurisy 13 6 7 ... ... 1 ... 1 ... 1 ... ... ... 1 1 ... ... 1 3 1 ... ... 1 3 ... 1 ... ... 5 7 12 Fibroid Phthisis 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... 2 2 Respiratory Organs, Other Diseases 2 1 1 ... ... ... 1 ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 1 Total for Diseases of Respiratory Organs 524 243 281 32 30 38 25 70 55 125 3 2 7 4 9 6 12 17 24 18 34 49 47 56 27 54 10 20 173 226 399 DISEASES OF DIGESTIVE SYSTEM. Diseases of Mouth and Annexa ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diseases of Pharynx ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diseases of Œsophagus 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 Ulcer of Stomach and Duodenum 7 2 5 ... ... ... ... ... ... ... ... ... 1 1 ... 1 ... ... 1 1 ... 1 ... 1 ... ... ... ... 2 5 7 Other Diseases of Stomach 8 2 6 1 1 ... 1 1 2 3 ... ... ... ... ... ... ... 1 ... 1 1 1 ... ... ... ... ... 1 1 4 5 Enteritis 22 11 11 7 2 ... 3 7 5 12 ... ... 1 ... 1 1 ... 1 1 2 1 ... ... 2 ... ... ... ... 4 6 10 Carried forward 2163 1006 1157 183 175 124 96 307 271 578 22 22 42 35 45 44 78 73 107 113 124 149 148 199 99 185 34 66 699 886 1585 77 TABLE VIII.—continued. CAUSES OF DEATH. Totals— All Ages. Under 1 year. 1 and under 5 years. Totals— Under Five Years. 5 and under 15 years. 15 and under 25 years. 25 and under 35 years. 35 and under 45 years. 45 and under 55 years. 55 and under 65 years. 65 and under 75 years. 75 and under 85 years. 85 years and upwards. Totals— Above Five Years. Total M F M F M F M F Total M F M F M F M F M F M F M F M F M F M F Total Brought forward 2163 1006 1157 183 175 124 96 307 271 578 22 22 42 35 45 44 78 73 107 113 124 149 148 199 99 185 34 66 699 886 1585 DISEASES OF DIGESTIVE SYSTEM—continued. Appendicitis 9 3 6 ... ... 1 ... 1 ... 1 ... ... 1 ... ... 2 1 1 ... 3 ... ... ... ... ... ... ... ... 2 6 8 Obstruction of Intestine 22 5 17 1 ... ... ... 1 ... 1 ... ... ... 1 ... 1 1 2 1 1 ... 2 ... 5 1 3 1 2 4 17 21 Other Diseases of Intestine 2 ... 2 ... ... ... 1 ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 Cirrhosis of Liver 22 12 10 ... ... ... ... ... ... ... ... ... ... ... ... ... 2 1 4 2 6 5 ... 2 ... ... ... ... 12 10 22 Other Diseases of Liver 14 5 9 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 3 3 4 1 2 ... ... ... ... 5 9 14 Peritonitis 7 2 5 ... ... 1 1 1 1 2 ... 1 ... ... ... ... 1 ... ... ... ... 1 ... 2 ... ... ... ... 1 4 5 Total for Diseases of Digestive System 114 42 72 9 3 2 6 11 9 20 ... 1 3 2 1 5 6 6 7 13 11 14 1 15 1 4 1 3 31 63 94 DISEASES OF LYMPHATIC SYSTEM. Adenoma of Thyroid 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 1 Myxœdema 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... 2 2 Addison's Disease 2 2 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 2 ... 2 Grave's Disease 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 1 Total for Diseases of Lymphatic System 6 2 4 ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 2 ... ... ... 1 ... 1 ... ... ... ... 2 4 6 DISEASES OF URINARY AND GENERATIVE SYSTEM. Acute Nephritis 11 8 3 ... ... ... ... ... ... ... ... ... ... 1 2 ... 1 2 1 ... 3 ... 1 ... ... ... ... ... 8 3 11 Bright's Disease, Albuminuria 53 26 27 ... ... ... ... ... ... ... ... ... ... 1 2 ... 1 3 7 6 8 6 6 4 2 6 ... ... 23 27 53 Calculus 3 2 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... 1 ... ... ... ... ... ... 2 1 3 Diseases of Bladder and Prostate 13 13 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 5 ... 5 ... 1 ... 1 ... 13 ... 13 Pyelitis 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... 2 2 Villous Growth of Bladder 3 ... 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... ... ... 3 3 Urinary System, Other Diseases 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... 1 Diseases of Ovaries 4 ... 4 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 ... ... ... 1 ... ... ... ... ... 4 4 Diseases of Uterus and Appendages 7 ... 7 ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 4 ... ... ... 1 ... ... ... ... ... ... ... 7 7 Diseases of Vagina and External Genital Organs 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 1 Total for Diseases of Urinary and Generative System 98 50 48 ... ... ... ... ... ... ... ... 1 ... 2 4 4 4 11 9 7 17 9 12 5 3 9 1 ... 50 48 98 Carried forward 2343 1085 1258 184 175 126 98 310 273 583 22 24 44 38 49 51 89 90 121 129 150 171 161 217 103 197 36 68 775 985 1760 78 TABLE VIII.—continued. CAUSES OF DEATH. TotalsAll Ages. Under 1 year. 1 and under 5 years. Totals— Under Five Years. 5 and under 15 years. 15 and under 25 years. 25 and under 35 years. 35 and under 45 years. 45 and under 55 years. 55 and under 65 years. 65 and under 75 years. 75 and under 85 years. 85 years and upwards. Totals— Above Five Years. Total M F M F M F M F Total M F M F M F M F M F M F M F M F M F M F Total Brought forward 2343 1085 1258 184 175 126 98 310 273 583 22 24 44 38 49 51 89 90 121 129 150 171 161 217 103 197 36 68 775 985 1760 ACCIDENTS OF CHILDBIRTH. 2 2 Abortion, Miscarriage 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... 2 2 Puerperal Convulsions 2 ... 2 ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 3 Placenta Prævia, Flooding 3 ... 3 ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 1 Puerperal Thrombosis 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 1 Extra Uterine Pregnancy 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 3 3 Other Accidents of Childbirth 3 ... 3 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... Total for Accidents of Childbirth 12 ... 12 ... ... ... ... ... ... ... ... ... ... 4 ... 4 ... 4 ... ... ... ... ... ... ... ... ... ... 12 12 DISEASES OF JOINTS. 1 1 2 Arthritis, Ostitis, Periostitis 2 1 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... 1 Other Diseases of Osseous System 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 3 Total for Diseases of Joints 3 2 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... ... 2 1 3 DISEASES OF SKIN. Ulcer, Bedsore ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Eczema 1 ... 1 ... 1 ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Total for Diseases of Skin 1 ... 1 ... 1 ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ACCIDENTS AND NEGLIGENCE. In Vehicular Traffic 12 10 2 ... ... ... ... ... ... ... 2 ... 1 ... ... ... 1 1 2 ... 2 ... 1 1 1 ... ... ... 10 2 12 In Building operations 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... 1 Burns and Scalds 8 5 3 ... ... 1 3 1 3 4 ... ... ... ... ... ... ... ... 2 ... ... ... 1 ... 1 ... ... ... 4 ... 4 Poisons, Poisonous Vapours 6 4 2 ... ... ... ... ... ... ... ... ... 1 ... ... 1 2 ... ... 1 ... ... ... ... 1 ... ... ... 4 2 6 Drowning 3 3 ... ... ... 1 ... 1 ... 1 ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... 2 ... 2 Suffocation, overlaid in bed 10 3 7 3 7 ... ... 3 7 10 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Suffocation, otherwise 7 3 4 2 3 ... ... 2 3 5 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... 1 1 2 Falls, not specified 20 14 6 ... 1 1 ... 1 1 2 2 1 ... ... 3 ... ... ... 1 ... 2 1 3 2 1 1 1 ... 13 5 18 Otherwise, and not stated 3 2 1 1 ... 1 ... 2 ... 2 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 Total for Accidents and Negligence 70 45 25 6 11 4 3 10 14 24 4 1 2 ... 3 1 3 2 6 1 7 1 5 3 4 2 1 ... 35 11 46 Carried forward 2429 1132 1297 190 187 130 101 320 288 608 26 25 47 42 52 56 93 96 127 130 157 172 166 221 107 199 37 68 812 1009 1821 79 TABLE VIII.—continued. CAUSES OF DEATH. Totals— All Ages. Under 1 year. 1 and under 5 years. Totals— Under Five Years. 5 and under 15 years. 15 and under 25 years. 25 and under 35 years. 35 and under 45 years. 45 and under 55 years. 55 and under 65 years. 65 and under 75 years. 75 and under 85 years. 85 years and upwards. Totals— Above Five Years. Total M F M F M F M F Total M F M F M F M F M F M F M F M F M F M F Total Brought forward 2429 1132 1297 190 187 130 101 320 288 608 26 25 47 42 52 56 93 96 127 130 157 172 166 221 107 199 37 68 812 1009 1821 HOMICIDE. Murder 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... 1 Total for Homicide 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... 1 SUICIDE. By Poison 4 2 2 ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... 1 1 ... ... ... ... ... ... 2 2 4 By Asphyxia 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... 1 By Hanging 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... 2 ... 2 By Drowning 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... 1 By Shooting 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... 1 By Cut or Stab 4 3 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 2 ... ... ... ... ... ... ... 3 1 4 By Precipitation from Elevated Places 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 By Crushing 2 1 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 1 2 Total for Suicide 16 11 5 ... ... ... ... ... ... ... ... ... ... 2 ... 1 1 1 5 1 4 ... 1 ... ... ... ... ... 11 5 16 Ill-defined and Not Specified Causes 8 3 ... 2 ... ... ... 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 1 Grand Totals 2449 1147 1302 192 187 130 101 322 288 610 26 25 47 44 52 57 94 97 132 131 162 172 168 221 107 199 37 68 825 1014 1839 80 TABLE IX. Births and Deaths in Kensington; Birth-rates and Death-rates 1856-1909; and Infantile Mortality 1871-1909 in Kensington and London; Arranged in Quinquennial Periods. Period. Number of Births. Birth Rate per 1,000 living. Number of Deaths. Death Rate per 1,000 living. Deaths under One Year. Deaths under One Year per 1,000 Births. Kensington. London. Kensington. London. Kensington. London. 1856-1860 9,557 30•7 33•7 6,540 21•0 22•7 — — 154 1861 1865 11,562 28•5 34•8 8,261 20•4 24•4 — — 158 1866-1870 17,092 32•1 35•8 10,853 20•4 24•3 — — 166 1871 1875 20,861 31•4 35•3 12,595 18•9 22•9 3,312 158 161 1876-1380 23,149 29•9 35•5 14,517 18•8 22•2 3,683 159 154 1881-1885 21,383 26•1 34•3 13,438 16•4 21•0 3,211 150 150 1886-1890 19,428 23•5 32•2 13,816 16•7 20•0 3,060 157 154 1891-1895 18,512 22•1 30•9 14,235 16•9 20•2 3,105 167 156 1896-1900 18,665 21•8 29•6 14,075 16•4 18•8 3,203 172 163 1901-1905 18,131 20•4 28•2 12,898 14•4 16•4 2,607 144 140 1906 3,428 19•1 26•5 2,497 13•9 15•1 425 132 133 1907 3,428 19•0 25•8 2,471 13•7 14•6 433 126 117 1908 3,504 19•0 25•8 2,398 13•0 13•8 428 122 113 1909 3,381 18•6 24•2 2,449 13•5 14.0 379 112 108 81 TABLE X. Deaths from the Seven Principal Diseases of the Zymotic Class; and Zymotic Death-rate, in Kensington and London, 1871-1909: Arranged in Quinquennial Periods. Quinquennial Period. Deaths from the Seven Principal Zymotic Diseases. Zymotic Death-rate, per 1,000 persons living. Small-pox. Measles. Scarlet Fever. Diphtheria WhoopingCough. Typhus Fever. Enteric Fever. Pyrexia. Diarrhoea. Total. Kensington. London. 1871-1875 189 289 249 85 345 27 130 55 603 1,972 2•97 4•06 1876-1880 151 370 323 95 531 13 105 28 605 2,221 2•87 3•64 1881-1885 107 326 153 96 427 5 115 18 438 1,685 2•05 3•26 1886-1890 1 442 135 305 387 ... 77 4 421 1,772 2•14 2•74 1891-1895 9 297 152 306 312 ... 92 7 440 1,615 1•92 2•70 1896-1900 ... 448 105 249 262 2 87 2 504 1,659 1•93 2 •64 1901-1905 13 325 76 108 252 1 58 1 508 1,842 1•51 2 •04 1906 ... 81 11 19 20 ... 5 ... 142 278 1•55 1.•90 1907 ... 31 9 24 81 ... 5 ... 30 180 100 1.•40 1908 ... 32 9 26 7 5 ... 88 167 0•92 1•40 1909 ... 58 9 19 40 ... 8 ... 50 184 1•01 1•.31 TABLE XI. 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—Small. pox, Scarlet Fever, Diphtheria, and "Fever"; and (2) The three non-notifiable diseases—Measles, Whooping-Cough, and Diarrhœa. uinquennial Period. 1 2 3 4 5 6 7 Death-rate per 1,000 from— Smallpox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. " Fever." Diarrhœa. The Seven Diseases. The Four Notifiable Infectious Diseases. (Columns 1, 3, 4, and 6. ) The three Non-notifiable Infectious Diseases (Columns 2, 5, and 7). 1856-1860 0•14 0•49 0•89 - 0•66 0•46 0•89 3•53 1•48 2•05 1861-1865 0•19 0•80 0•91 0•24 0•51 0•68 0•76 4•09 2•02 2•07 1866-1870 0•10 0•49 0•97 0•15 0•57 0•42 1•08 3•78 1•65 2•13 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•93 0•52 1•41 1901-1905 0•01 0•37 0•09 0•12 0•28 0•07 0•57 1•51 0•29 1•22 82 TABLE XII. Vaccination Officer's Return respecting the Vaccination of Children whose Births were Registered in 1908. (Vide page 61.) DATE Registration Sub-Districts comprised in Vaccination Officer's District Number of Births returned in Birth List Sheets. Number of these Births duly entered in Columns 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 II. Removed to other Districts, and notified to Vaccination Officers of the Districts. Removal to places unknown, or which cannot be reached, and cases not having been found. Total Number of Certificates of Successful Vaccinations received during each of the Calendar Years. Column I. Successfully Vaccinated. Insusceptible of Vaccination. Certificate of Conscientious Objection. Column V. Dead, Unvaccinated. Postponement by Medical Certificate. 1908. 1909. 1908. 1 2 3 4 6 7 8 9 10 12 13 1st January to 31st Dec. Kensington Town *2,800 2,314 8 97 218 11 12 138 2,823 2,659 Brompton 509 422 5 20 30 5 8 19 Total 3,309 2,736 13 117 248 16 20 157 * Includes 2 dealt with by summons. INDEX. Page. Adulteration of Food 85-86 Age and Sex constitution of the Population 3 Alcoholism 28 Appendix 65-82 Area of the Borough 8 Baths and Washhouses 60 Births and Birth Rates 4 Births, Notification of 12 Births and Birth Rates, Tables I, II and IX 65-66-80 Cancer 28 Chapel of Rest for the Dead 60 Children Act, 1908 18, 59 Common Lodging Houses 42 Consumption 24 Cow House 84 Customs and Inland Revenue Acts 42 Dairies and Milkshops 84 Deaths and Death Rates— By Sexes at Ages 6 In Districts 7 From Principal Causes 7 From Zymotic Diseases 7 Among Infants 8 Deaths and Death Rates, Tables— 1899—1909 Table I 65 1899—1909 in Districts, Table II 66 Causes of at Ages, Summary, Table IV 68 Infantile Mortality, Table V 69 Causes of by Sexes at ages, Table VIII. 72 In Quinquennia, 1856—1909 Table IX. 80 Zymotic Diseases, Deaths from, Table X. 81 Zymotic Death Rates, Table XI 81 Diarrhoea 21 Diphtheria 17 Disinfection 58 Dust, Removal of 57 Enteric Fever 19 Factories and Workshops 47 Food Supply 88 Food, Adulteration of 85 Furnished Rooms 42 Health Visitors 12 Home Office Tables 52 Home Work 48 Houses let in Lodgings 41 Housing, Town Planning, etc. Act, 1909 48 Ice Cream Vendors 84 Illegitimate Births 5 Infantile Mortality 8 Infectious Diseases 17 Notification and Removal, Table III. 67 Influenza 21 Inspection, Sanitary 57 Inspectors, Work of, Summary, Table VII 71 Inquests 61 ii. Page. Local Government Board Tables I.—V. 65-69 London County Council Summary of Work, Table VI. 70 London County Council (General Powers) Act, 1908 33-44 „ „ „ „ „ 1909 44 Margarine 36 Marriages 3 Measles 20 Milkshops 34 Milk Supply 34 Mortuary 60 Notifiable Diseases 17 Notification of Births 12 Outworkers' Premises 48 Phthisis 24 Places where food is prepared 34 Population- - Sex and Age Distribution 3 Distribution in Wards 3 Prosecutions 57 Public Health (Tuberculosis) Regulations, 1908 25 Puerperal Fever 20 Registered Lodging Houses 41 Restaurants 34 Sanitary Inspection 57 Sanitary Inspectors' Work, Table VII. 71 Scarlet Fever 18 School Children, Cleansing of 58-59 Slaughter Houses 35 Small Pox 17 Smoke Nuisances 57 Tuberculous Diseases 24 Tuberculosis Regulations, 1908 25 Vaccination Returns, Table XII. 61-82 Verminous Persons 58 Water Certificates 38 Water Supply 37 Whooping Cough 21 Workshops and Factories 47 Zymotic Diseases 7 Deaths from in Quinquennial Periods, Table X 81 Death Rates from in Quinquennial Periods, Table XI 81