65943 KEN 6 Borough of Kensington. REPORT OF THE MEDICAL OFFICER oF HEALTH For the Year 1900. To the Mayor, Aldermen, and Councillors of the Borough Council. Sir, and Gentlemen, The vital and mortal statistics in this report relate to the period of fifty-two weeks, commencing December 31st, 1899, and terminating December 29th, 1900, comprised in the registration year 1900. During the year events of considerable importance occurred, viz., the abolition of the late Vestry, and the creation of the Borough Council, which took effect on the ninth day of November. This change was accompanied with numerous alterations in the boundaries of Kensington and the adjacent Boroughs of Chelsea, Paddington and Hammersmith, and the City of Westminster. For administrative purposes generally these changes date from the birth-day of the Council. But so far as they relate to registration of births, deaths, and marriages, they did not take effect until the 1st of April in the current year, the day immediately succeeding that appointed for the decennial census. In order that there might be as little disturbance as possible in the continuity of statistical information, it was arranged between the medical officers of the adjacent Boroughs and myself that, during the currency of the registration year 1900, the vital and mortal statistics should be completed for the several districts as delimited before the London Government Act, 1899, came into operation; and that with the commencement of the registration year 1901 these statistics should be compiled for the several Boroughs as newly constituted. A corresponding arrangement was made with respect to notification of infectious diseases. The interchanges of boundaries with the other Boroughs named, were set out in detail in the final report of the Special London Government Committee of the late Vestry (vide Minutes, page 604). I subjoin a summary statement of the gross number of premises transferred to or from Kensington, showing gain and loss:— Chelsea (detached) G ain by Kensington. Loss by Kensington. 445 — Paddington 200 175 Hammersmith 125 143 Westminster 46 165 Chelsea (proper) 128 27 Total 944 510 The net gain in number of premises is 434: the increase of population, estimated by the RegistrarGeneral, is approximately 3,000 : the actual increase will not be known until after the census.* Various powers previously exercised by the London County Council were transferred on 9th November, under the provisions of the London Government Act, to the Borough Council, with respect to dairies and milk, and with regard to slaughter-houses and offensive businesses. There was also a considerable displacement of premises, gain and loss, of workshops, workplaces, laundries, &c., where women are employed, under the supervision of the Council's lady inspector, to which reference is made in that officer's annual report (page 48). But the most important change brought about by the Act, and also by the Housing of the Working Classes Act, 1900, was that which enables the Borough Council, by adopting Part III. of the Housing of the Working Classes Act, 1890, to obtain concurrent powers with the County Council and to become a Local Authority under that Part—a change brought about largely as the result of action taken, on my advice, by the late *Vide Appendix III.—note on Census of 1901, page 105. Vestry of Kensington. At the present writing nothing has been done to give effect to this power, but the Council are making enquiries into the questions of housing, overcrowding, &c., properly precedent to action, In the last report I had the honour to submit to the late Vestry (No. 11, November 7th, page 117), and by way of retrospect, I gave some account of the Vital and Mortal Statistics of the Parish, and the Poblic Health and Sanitary Work carried out, during the forty-five years of that body's existence, i.e., since the defunct Sanitary Authorities were brought into being by the Metropolis Local Management Act, 1855. In order to avoid repetition, as much as practicable, I append to this report that Valedictory Address, which I doubt not will be found to possess for the Council some features of interest (vide Appendix I., page 75). With these few introductory remarks, I proceed to deal with the usual subjects of the annual report. REGISTRATION DISTRICT AND SUB-DISTRICTS. The Registration District of Kensington (No. 1 B in the Registrar-General's list) comprised, in 1900, prior to the alterations of boundaries, an area of 2,190 acres, divided into two subdistricts, respectively designated Kensington Town (hereinafter for brevity referred to as Town) and Brompton. The Town sub-district has an area of 1,497 acres, that of Brompton being 693 acres. The Town sub-district comprises all that portion of the borough north of Kensington Highstreet and Kensington-road, together with a portion of the borough south of those roads, and north of a line extending, from west to east, along Pembroke-road, Stratford-road, and south of the workhouse, then through Cornwall-gardens to Queen's-gate-place, and thence northwards so as to include Queen's-gate, Jay's-mews and Kensington-gore. The Brompton sub-district comprises the remainder of the borough south of the above described line. [Parliamentary Divisions.—North Kensington and South Kensington are the two divisions of the Parliamentary Borough, separated by High-street, Notting-hill, and Holland-parkavenue: North Kensington comprises the North, the North-east and the North-west sanitary districts, together with a portion of the Central district; South Kensington comprises the remainder of the central district, and the South-east and the South-west sanitary districts.] POPULATION, RATEABLE VALUE, etc., OF THE BOROUGH IN 1891, AND AFTER. The subjoined table shows the relative number of persons of each sex, as ascertained at the census of 1891, and grouped according to age ; (a) in the entire borough, (b) in the Kensington Town sub-district, and (c) in the Brompton sub-district. The 166,308 persons comprised in the then population were in occupation of about 22,000 houses, or an average of 7.56 to each house. The census report states that 70,718 persons, or 42.5 per cent. of the population, were living in 20,052 tenements of less than five rooms. The entire population of the borough at that date was in occupation of 35,953 tenements and certain public institutions. Of these "tenements" 6,398 consisted of a single room each; these rooms being inhabited by 13,655 persons. The two-roomed tenements were 6,965; their inhabitants numbered 26,020. The three-roomed tenements were 4,115; their inhabitants 18,119. The four-roomed tenements were 2,574; their inhabitants 12,924. Stated in another way, it would appear that 8.2 per cent. of the people lived in one-roomed tenements; 15.6 per cent. in two-room tenements; 10.9 per cent. in three-room tenements, and 7.8 per cent. in four-room tenements. In North Kensington there were approximately 8.7 persons to a house; in South Kensington about 6.7; High-street, Notting-hill, and Holland-park-avenue being the dividing line. But many houses, in North Kensington more particularly, contained, and contain now, upwards of twenty persons to a house, and some thirty persons and upwards. POPULATION, AGE, AND SEX-DISTRIBUTION IN 1891. (a) THE BOROUGH. All Ages. Under Five Years. 6 to 15. 15 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 to 75. 75 to 85. 85 to 95. 95 and upwards. All Ages. Females 100,591 7,466 14,194 24,216 21,147 13,520 9,420 5,774 3,367 1,278 202 7 100,591 Females Males 65,717 7,394 12,963 12,947 10,759 8,695 6,337 3,822 2,046 666 86 2 65,717 Males Excess of Females 34,874 72 1,231 11,269 10,388 4,825 3,083 1,952 1,321 612 116 5 34,874 Excess of Females Total of both sexes 166,308 14,860 27,157 37,163 31,906 22,215 15,757 9,596 5,413 1,944 288 9 166,308 Total of both sexes 3 (b) KENSINGTON TOWN SUB-DISTRICT. All Ages. Under Five Years. 5 to 15. 15 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 to 75. 75 to 85. 85 to 95. 95 and upwards. All Ages. Females 69,384 5,976 11,192 ' 15,483 13,330 9,172 6,592 4,060 2,450 969 154 6 69,384 Females Males 49,367 5,905 10,287 9,540 7,815 6,377 4,696 2,741 1,472 470 63 1 49,367 Males Excess of Females 20,017 71 905 5,943 5,515 2,795 1,896 1,319 978 499 91 5 20,017 Excess of Females Total of both sexes 118,751 11,881 21,479 25,023 21,145 15,549 11,288 6,801 3,922 1,439 217 7 118,751 Total of both sexes (c) BROMPTON SUB-DISTRICT. All Ages. Under Five Y ears. 5 to 15. 15 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 to 75. 75 to 85. 85 to 95. 95 and upwards. All Ages./###] Females 31,207 1,490 3,002 8,733 7,817 4,348 2,828 1,714 917 309 48 1 31,207 Females Males 16,350 1,489 2,676 3,407 2,944 2,318 1,641 1,081 574 196 23 1 16,350 Males Excess of Females 14,857 1 326 5,326 4,873 2,030 1,187 633 343 113 25 — 14,857 | Excess of Females Total of both sexes 47,557 2,979 5,678 12,140 10,761 6,666 4,469 2,795 1,491 505 71 2 47,557 Total of both sexes ** The death-rate at the different age-periods will be found on page 9. The subjoined figures exhibit the development of the borough in population and rateable value during the last century. The Year. Population. 1801 8,556 1811 10,886 1821 14,428 1831 20,902 1841 26,834 1851 44,053 1861 70,108 1871 120,299 1881 163,151 1891 166,308 1896 170,465 1900 173,000 Rateable Value of Property. The Year. £75,916 1823 93,397 1833 142,772 1843 257,103 1853 444,030 1863 975,046 1873 1,711,495 1883 2,037,221 1893 2,146,208 (October) 1900 The rateable value of property in Kensington is about one-sixteenth of that of the Metropolis as a whole. 4 The following table, brought up to date, exhibits the growth of the borough since the Metropolis Local Management Act came into operation, in 1856:— 1856. 1900. Increase in 44 years./###] Number of Inhabited Houses 7,600 22,800 15,200 Population 57,000 173,000 116,000 Rateable Value of Property £308,000 . £2,146,208 £1,838,208 The increase in all respects within the last twenty-nine years, the period over which my official experience extends, is not inconsiderable, as the subjoined figures show:— 1871. 1900. Increase in 29 years. Number of Inhabited Houses 15,735 22,800 7,065 Population 121,000 173,000 52,000 Rateable Value £935,720 £2,146,208 £1,210,483 From the foregoing figures we learn that the population in 1900 was more than twentytimes as large as in the first year of the century, and the rateable value of property more than twenty-eight times as great as in 1823, the first year in respect to which I possess information. Since 1856, the rateable value has increased nearly seven-fold; the increase in the last 29 years being nearly four-fold the total in 1856; since which date the population and the number of inhabited houses have increased three-fold. Population and Inhabited Houses in 1900.—The population of the borough, estimated to the middle of the year, was 173,000. It comprised, approximately, 68,347 males and 104,653 females; excess of females, 36,306. In the Town sub-district (estimated population 124,300), the males numbered about 51,634, the females 72,666; excess of females, 21,032. In the Brompton sub-district (estimated population 48,700) there were about 16,713 males and 31,987 females; excess of females 15,274. This population of 173,000 persons was in occupation of about 22,800 houses, equal to 7.6 persons to a house on an average. In the poorer and more densely populated parts the number of persons to a house is much in excess of the average. The same remark is applicable in the case of flats which, though groups of houses in effect, are reckoned as single houses in census enumerations. For the purposes of this report, the population of the borough, the sub-districts, the parliamentary divisions, and the sanitary districts, will be taken to be as follows:— The Borough 173,000 Sub-districts:— Kensington Town 124,300 Brompton 48,700 Parliamentary Divisions:— North Kensington 88,100 South Kensington 84,900 Sanitary Districts:— North 33,590 North-east 30,510 North-west 17,000 Central 27,390 South-east 32,350 South-west 32,160 5 MARRIAGES AND MARRIAGE-RATE. The marriages in the borough in the year were 1,543, as compared with 1,681, 1,648, and 1,693 in the three preceding years respectively. Of these marriages there were celebrated— By the Church (70.2% of total marriages) 1,083 At Roman Catholic places of worship 132 At other Nonconformist places of worship 51 At the Superintendent-Registrar's office 277 The marriage-rate (i.e., the number of persons married to 1,000 living) was 17.8, as compared with 197, 19.2 and 19.6 in the three preceding years. The marriage-rate in England and Wales was 16.2 per 1,000, as compared with 16.0, 162 and 16.5 in the three preceding years. The rate in London was 17.6 per 1,000, as compared with 18.5, 18.7, and 18.4 in the three preceding years. The general decline in the marriage-rate may not unreasonably be attributed to the war and, possibly, to the attendant increase of taxation. Table A, Appendix I (page 84) gives the number of marriages and the marriage-rate in the borough for each of the thirty years (1871-1900) during my tenure of office. BIRTHS AND BIRTH-RATE. The births registered were 3,586, viz., males 1,770, and females 1,816, the numbers being, in the Town sub-district (which includes the borough infirmary) 3,021, and in the Brompton subdistrict 565. The births were 199 below the corrected decennial average (3,785), 183 of them being of illegitimate children. The births were 4 fewer than in 1899; they were also fewer by 455 than the number in 1872 (4,041), when the population (127,400) was 45,600 less than in 1900. The birth-rate, which of late years has been always considerably below that of London as a whole, (28.6 in 1900, and the lowest hitherto recorded), has been declining since 1868, in which year it was 33.1 per 1,000 persons living. In 1900 it was 20.7 per 1,000, and 1.1 below the decennial average (21.8). The rate in the sub-districts was: Town, 24.3, and Brompton, 11.6 per 1,000. The births in North Kensington, i.e., the part of the borough north of Holland-park-avenue and High-street, Notting-hill, were 2,543, and the birth-rate 28.9 per 1,000 persons living, and 0.3 above the metropolitan rate. The births in South Kensington, i.e., the part of the borough south of those streets, were 1,043, and the birth-rate 12.3 per 1000, and 16.3 below the metropolitan rate. The birth-rate in the several sanitary districts, after distribution of the births at the borough infirmary, was as follows:— North .1,036 births, or 30.8 per 1,000 persons living. North-east 620 births, or 20.3 per 1,000 persons living. North-west 607 births, or 35'7 per 1,000 persons living. Central 545 births, or 19 9 per 1,000 persons living. South-east 351 births, or 10.9 per 1,000 persons living. South-west 427 births, or 13.3 per 1,000 persons living. The high birth-rate in the North-west district is suggestive of an under-estimate of the population, which, however, is based upon the census taken in March, 1896. The births in the entire borough exceeded the deaths by 888. In the Town sub-district, the births were 828 more in number than the deaths; in the Brompton sub-district 60, without correction for births at the infirmary. In North Kensington the births exceeded the deaths by 832; in South Kensington to the number of 56 only. The excess of births over deaths in the several sanitary districts was as follows: In the North, 452; the North-east, 201; the North-west, 103; the Central, 85; the South-east, 50. In the South-west district the deaths exceeded the births to the number of three. The registered births of illegitimate children in the borough, as a whole, were, as already stated, 183 (8 fewer than in 1899), viz., males 91, and females 92. Of these births 168 were registered in the Town sub-district, which includes the workhouse; at which institution out of 125 births, 84 were illegitimate. In the borough, generally, the illegitimate births formed 5.l per cent. of total births, as compared with rates of 5.3, 5.0, 5.3 in the three preceding years. The subjoined table shows the quarterly numbers of births of males and females in the borough, and in each of the sub-districts:— Kensington Town. Brompton. Males. Females. Total. Males. Females. Total. Borough. 1st Quarter 403 433 836 77 69 146 982 2nd „ 366 392 758 86 79 165 923 3rd „ 384 358 742 65 80 145 887 4th „ 334 351 685 55 54 109 794 1,487 1,534 3,021 283 282 565 3,586 Illegitimate 20 16 36 3 1 4 40 Births 17 24 41 1 3 4 45 21 16 37 1 2 3 40 26 28 54 2 2 4 58 84 84 168 7 8 15 183 6 The subjoined table shows the population, the number of births, and the birth-rate for each of the ten years 1890-99:— The Year. Population. Total Births. Males. Females. Birth-rate per 1.000. 1890 166,080 3,864 1,919 1,945 233 1891 166,500 3,847 1,935 1,912 231 1892 167,200 3,718 1,867 1,851 22-3 1893 167,900 3,661 1,893 1,768 21-9 1894 168,600 3,665 1,883 1,782 21-9 1895 169,300 3,621 1,861 1,760 21-4 1896 170,000 3,717 1,943 1,774 21-4 1897 170,700 3,683 1,839 1,844 21-6 1898 172,000 3,633 1,830 1,803 211 1899 172,400 3,590 1,798 1,792 20.8 Totals 36,999 18,768 18,231 Average 21.9 Excess of male births in the ten years 537 Excess of births over deaths in the ten years 8,436 Estimated increase of population in the ten years 6,640 Estimated loss of population, by migration or removals, in the ten years 1,796 Table A, Appendix I. (page 84) gives the number of births and the birth-rate for each of the forty-five years, 1856-1900. DEATHS AND DEATH-RATE. The deaths registered, inclusive of 283 deaths of parishioners at outlying public institutions, etc., but exclusive of deaths of non-parishioners at public institutions, etc., within the borough, were 2,698 (males 1,294, females 1,404), and 224 below the corrected decennial average (2,922). Of these deaths 2,193 were registered in the Town sub-district, and 505 in Brompton. The death-rate, which in the three preceding years had been 15.6, 16.3, and 17.5 per 1,000, respectively, was 15.6 in 1900*, and 13 below the decennial average (16.9), and 32 below the rate in the Metropolis, as a whole (18.8), the decennial average for the Metropolis being 19.6. The rate in the sub-districts was: Town 17.6, Brompton 103 per 1,000, as compared with 19.8, and 11.7, respectively, in 1899. The sex-rate was; males 18"9, females 13'4 per 1,000. The deaths in North Kensington were 1,711, and the death-rate 19'4 per 1,000. The deaths in South Kensington were 987, and the death-rate 11 6 per 1,000. The rate in the several sanitary districts was as follows:— North 584 deaths, or 17.4 per 1,000 persons living. North-east 419 deaths, or 13.7 per 1,000 persons living. North-west 604 deaths, or 29.6 per 1,000 persons living. Central 460 deaths, or 16.8 per 1,000 persons living. South-east 301 deaths, or 9.3 per 1,000 persons living. South-west 430 deaths, or 13.4 per 1,000 persons living. The subjoined table shows the quarterly number of deaths of males and females, in the borough, and in each of the sub-districts. Kensington Town. Brompton. Males. Females. Total. Males. Females. Total. Borough. 1st Quarter 317 343 660 71 84 155 815 2nd „ 239 271 510 63 75 138 648 3rd „ 251 242 493 62 48 110 603 4th „ 246 284 530 45 57 102 632 1,053 1,140 2,193 241 264 505 2,698 The Births were, of Males, 1,770 „ Females, 1,816 Total Births, 3,586 Deduct 2,698 Deaths The Deaths were, of Males, 1,294 „ Females, 1,404 Total Deaths, 2,698 Shows 888 excess of Births over Deaths. Table A, Appendix I. (page 84) gives the number of deaths and the death-rate for each of the forty-five years 185G-1900. * This is the crude death-rate. The rate corrected for age and sex distribution was 17.2 per 1,000. The "true deathrate " is set out in the table at page 9. † By excluding the deaths of persons ascertained to have been strangers, the death-rate of London is reduced to 18.3. 7 Infantile Mortality, or the proportion of deaths under one year of age to registered births, is an important factor in vital statistics. The deaths under one year, which in the three preceding years had been 609, 655, and 642, respectively, were 641 in 1900, being equivalent to 179 per 1,000 births, the same as in 1899. The rate in the Metropolis, always below that of Kensington, was 160 in each 1,000 births, and corresponded to the average proportion in the ten preceding years. In England and Wales, the rate was 154, which is 1 per 1,000 above the mean proportion in the ten years 1890-99. In the Town sub-district, which includes the infirmary, the deaths under one (581) were equivalent to 192 per 1,000 births, those in Brompton (60) to 106 per ,1000. The deaths in North Kensington were 512, or 201 per 1,000 ;• the deaths in South Kensington were 129, or 124 per 1,000. In the several sanitary districts the rate was as follows— North 185 deaths, or 178 per 1,000 registered births. North-east 104 deaths, or 168 per 1,000 registered births. North-west 176 deaths, or 290 per 1,000 registered births. Central 88 deaths, or 161 per 1,000 registered births. South-east 29 deaths, or 83 per 1,000 registered births. South-west 59 deaths, or 138 per 1,000 registered births. It thus appears that infantile mortality in the North and North-east districts was in excess of the London rate (160 per 1,000), but the excessive proportion in the borough as a whole was mainly due to the large number of deaths in the North-west district. Table A in Appendix I. (page 84) gives the number of deaths under one year and the rate per 1,000 of births registered (the "infantile mortality") for each of the thirty years 1871-1900, during my tenure of office. The deaths of children over one year and under five years of age were 236; the total deaths under five years, therefore, were 877, as compared with 912, 1,039, and 932 in the three preceding years, being equal to 244 per 1,000 births; the relative proportion in London as a whole being 237. The deaths of illegitimate children under five years of age, 126, 87, and 103 In the three preceding years respectively, were 86 in 1900, of which 71 were registered in the Town sub-district, and 15 in Brompton. These deaths were equal to 46.9 per cent. on the 183 births registered as illegitimate. Of the 86 children, five only survived the first year of life. Senile Mortality.—At sixty years of age and upwards there were 868 deaths, as compared with 735, 862, and 943 in the three preceding years respectively. The deaths were equivalent to 322 per 1,000 deaths at all ages. The relative proportion in all London was 263 per 1,000. District Rates of Mortality.—The table at page 10 shows (inter alia) the death-rate in the sub-districts, the parliamentary divisions, and the sanitary districts, for the year, and also for each of the thirteen four-weekly periods covered by the monthly reports. As usual, the rate was far higher in the Town sub-district (17.6 per 1,000) than in the Brompton sub-district (10.3), and the same observation applies to the parliamentary division of North Kensington (19.4), compared with the southern division of the borough (11.6). In three of the sanitary districts the death-rate exceeded that of the borough as a whole (15*0 per 1,000), viz., the Central (16'8), the North (17'4), and the North-west (29'6). The last-named district, containing a population of 17,000, includes the so-called "Notting-dale" special area. The mortal statistics of the district, as a whole, are far from satisfactory; the death-rate in 1900 was more than double the rate in the remainder of the borough (14.1 per 1,000), the zymotic death-rate (3.8 per 1,000) was more than twice as high as that of the remainder of the borough (1.4 per 1,000); the waste of infant life was also excessive, the deaths under one year (176) being equivalent to 290 per 1,000 births registered, the infantile deaths in the remainder of the borough (population, 156,000) being in the proportion of 156 per 1,000 births, or 4 per 1,000 below the corresponding rate in London as a whole. These figures show to what a large extent the statistics of this district, which contains less than a tenth of the population, spoil those of the borough generally. In the Notting-dale special area (estimated population, 4,000) the death-rate was 40.7 per 1,000, as compared with 15.6 in the borough, as a whole, and 26.2 in the North-west district less the special area; the zymotic death-rate was 4.5 per 1,000 persons living, not far short of thrice that of the borough as a whole. The deaths at all ages were 50 more than the births; the deaths of children under one year of age being in the proportion of 478 per 1,000 on the births registered. The main facts with respect to vital and mortal statistics in the distressful area, in 1900, are summarised on the following page. 8 " NOTTING-DALE "SPECIAL AREA. vital and mortal statistics, 1900. (The corresponding statistic! for the four preceding years are added for comparison.) 1900. 1899. 1898. 1897. 1896. Population (Estimated) ... 4,000 4,000 4,000 4,000 3,740 Births 113 120 117 130 118 Birth-rate 28.2 30.0 29.3 32o 316 per 1,000 persons living. Deaths 163 236 182 223 187 Death-rate 40.7 590 455 55.7 500 per 1,000 persons living. Infantile Mortality. Deaths under one year of age 54 61 49 56 51 Death-rate ... 478 508 419 431 432 per 1,000 births registered. Zymotic Diseases. Deaths from the Seven Principal 18 12 22 25 30 Death-rate from ditto 4.5 3.0 5.5 6.3 8.0 per 1,000 persons living. Causes of Death.—In 10 cases Measles; in 3 cases Whooping-cough-, in 3 cases Diarrhoea (irrespective of one from Gasiro-enteritis); and in one case each, Diphtheria, and Enteric Fever. The Death-rate per 1,000 persons living, in thirteen successive four-weekly periods, was:— (1) 45.5 (2) 35.7 (3) 29.2 (4) 55.2 (5) 42.2 (6) 26.0 (7) 42.2 (8) 52.0 (9) 48.7 (10) 35.7 (11) 48.7 (12) 22.7 (13) 45.5 Eighty-nine of the deaths occurred at the homes of the deceased persons, 65 at the Borough Infirmary (the total deaths at this institution being 476) and 9 at other public institutions; 32 of the deaths were of persons who had previously resided at common lodging-houses in the area; only two deaths took place at common lodging-houses. The deaths comprised 78 of males, and 85 of females. The ages at death were: under five years of age, 73 (including 54 under one year); between 5 and 20 years, 5 deaths; between 20 and 60 years, 63 deaths; at 60 years and upwards, 22 deaths. Among the principal causes of death were: diseases of the nervous system, 12 deaths; diseases of the respiratory system, 39 deaths; diseases of circulatory system, 10 deaths; other visceral diseases, 13 deaths; tubercular diseases, 28 deaths (including 23 from consumption); wasting diseases of infants, 11 deaths; cancer, one death; syphilis, 4 deaths; violence, 11 deaths, including 8 of infants from suffocation. Four deaths of infants prematurely born were registered, and one death from old age. Inquests were held in 26 cases. The deaths were connected with streets as follows: Bangor-street, 46 deaths; Crescentstreet, 25 deaths; St. Katharine's-road, 53 deaths; Kenley-street, 21 deaths; Sirdar-road, 18 deaths. The True Death-Rate of Kensington in 1900.—From time to time one hears observations which indicate misapprehension of the signification of the expression "death-rate" as used in the table at page 10, which shows the rate of mortality for each of the four-weekly periods covered by the monthly reports: it may be well, therefore, to explain, by an illustration, what it means. The deaths in the last four-weekly period of the year were 230, and the death-rate was stated to be 17.3 per 1,000. This statement implied, simply, that if the deaths for the whole of the year had been in the same proportion to the population as in the four weeks, the annual death-rate would have been 17.3 per 1,000 of the estimated population at the middle of the year. The estimated population in 1900 was 173,000; the deaths registered were 2,698; the death-rate therefore was 15.6 per 1,000 (2,69S÷173,000=15.6). This method of calculating the death-rate is customary, and is that used by the Registrar-General. The death-rate so calculated is, of course, a crude or uncorrected one, as it does not take cognisance of the relative numbers of the sexes, nor of the age-distribution of the population. Correction for these data involves addition to, or subtraction from, the "recorded death-rate," as compared with the " standard death-rate."* The necessity for such correction in this borough is obvious, having *The standard death-rate signifies the death-rate at all ages, calculated on the hypothesis that the rates at each of twelve age-periods in each town were the same as in England and Wales, during the 10 years 1881-90, the death-rate in England and Wales during that period having been 19.15 per 1,000. (Regutrar-General's Annual Summary.) 9 regard to the great excess of females in the population, and to the lower death-rate in the female sex as compared with the rate in the male sex. As has already been stated, females are, approximately, 36,306 in excess of males. The deaths among the 68,347 males (1,294) were only 110 fewer than the deaths among the 104,653 females (1,404). The death-rate in the male sex was 18.9 per 1,000, as compared with a rate of 13'4 per 1,000 in the female sex. It is obvious, therefore, that if the numbers of the sexes had been equal, the death-rate would have been higher than the recorded rate (15.6 per 1,000). The Registrar-General in his annual summary for 1892 dealt with the question, and gave the "factor for correction for sex and age-distribution" in the thirty-three great towns of England and Wales; and in his annual report for 1899, the medical officer of health to the County Council gave the factor for each of the sanitary districts of London. Corrected after the method indicated, the death-rate of Kensington in 1900, becomes, instead of 15'6, one of about 17'2 per 1,000; and the rate for London, as a whole, about 20'02 instead of 18'8. The true death-rate is that which shows the mortality per 1,000 living of each sex at different age-periods, and this is shown for the borough in the subjoined table. THE TRUE DEATH-RATE OF KENSINGTON, 1900. Age-Period. Population. Deaths. Death-rate. Both Sexes. Males. Females. Both Sexes. Males. Females. Both Sexes. Male Sex. Female Sex. Under five years of age 15,459 7,692 7,767 877 461 416 56.7 59.9 53.5 Five and under 15 28,251 13,485 14,766 77 40 37 2.7 2.9 2.5 Fifteen and under 25 38,643 13,453 25,190 86 42 44 2.2 3.1 1.7 Twenty-five and under 35 33,189 11,192 21,997 146 69 77 4.4 6.2 3.5 Thirty-five and under 45 ... 23,108 9,044 14,064 228 106 122 9.9 11-7 8.7 Forty-five and under 55 16,391 6,591 9,800 257 130 127 15.7 19.7 12.9 Fifty-five and under 65 9,982 3,976 6,006 325 152 173 32.6 382 28.8 Sixty-five and under 75 5,643 2,130 3,513 338 162 176 59.9 761 501 Seventy-five and upwards 2,334 784 1,550 364 132 232 155.9 1684 149.7 Totals 173,000 68,347 104,653 2,698 1,294 1,404 ... ... ... 10 Death-rate in the Metropolis, and in Kensington, and in certain Districts of the Borough, in the thirteen four-weekly periods ended december 29th, and in the registration year, 1900 (vide p. 7). Four Weeks ended. Metropolis. Borough. Sub-Districts. Parliamentary Divisions. Sanitary Districts. Kensington Town. Brompton. North. South. North. North East. NorthWtst. Central. SouthEast. SouthWest.[//###] January 27 29.9 24.3 27.6 15.7 28.3 201 '22.1 19.6 43.6 31.8 14.1 24.7 February 24 21.1 18.3 20.4 12.8 22.0 14.4 21.7 18.3 26.0 18.4 14.5 14.6 March 24 19.3 14.6 16.5 9.6 18.0 11.0 15.5 14.9 22.9 18.0 8.8 11.7 April 21 21.0 18.1 19.8 13.9 22.3 13.8 22.1 13.6 29.1 19.9 12.8 16.2 May 19 17.8 14.9 16.2 11.7 16.5 13.3 15.5 14.1 22.9 16.1 12.1 12.9 June 16 16.7 14.3 15.9 10.1 18.4 9.9 17.0 13.2 27.5 12.3 8.0 13.3 July 14 13.9 11.6 12.9 8.0 15.3 7.6 10.8 10.6 28.3 11.4 6.0 10.1 August 11 19.4 16.4 19.1 9.3 22.9 9.6 23.9 12.8 39.8 13.7 6.4 11.7 September 8 19.2 13.8 13.8 8.8 18.4 9.0 18.2 11.5 30.6 11.9 6.0 12.1 October 6 16.4 12.2 13.7 8.5 14.6 9.8 8.5 11.5 28.3 14.7 6.4 12.1 November 3 15.8 13.5 15.9 7.5 18.4 8.4 18.6 8.1 32.9 14.7 5.2 10.5 December 1 17.3 13.4 15.1 9.3 16.4 10.4 14.3 16.6 18.3 11.9 10.0 11.7 December 29 16.6 17.3 20.4 9.3 20.8 13.6 17.8 13.6 35.2 23.7 10.4 12.1 Death-rate for the Year ) 1900 18.8 15.6 17.6 10.3 19.4 11.6 17.4 13.7 29.6 16.8 9.3 13.4 SUMMARY OF VITAL AND MORTAL STATISTICS, KENSINGTON. In the table at page 11 the principal vital and mortal statistics of the year have been arranged in four-weekly periods corresponding to the dates of the monthly reports, the maxima and minima being indicated by distinctive type. We have already seen that the birth-rate in 1900 was 20.7 per 1,000, as compared with the decennial average 21.8, and that the death-rate, 15'6 per 1,000, was 1.9 per 1,000 below the rate in 1899 (17.5), and 1.3 below the decennial average (16'9). There were, as usual, considerable fluctuations in the rate at different periods of the year, the rate ranging between the minimum (11.6) in the seventh four-weekly period ended July 14th, and the maximum (24.3) in the first four-weekly period ended January 27th. The rate was in eight four-weekly periods below, and in five above the average. The deaths in the first half-period of the year (1,463) were more by 228 than those in the second half-period (1,235), the death-rate in the two halfperiods being 16.9 and 14.3 per 1,000 respectively. There was no very marked difference in the number of deaths from the principal diseases of the zymotic class in the two half-periods, the number in the first six months having been 129, compared with 154 in the latter half of the year. The 283 deaths from these causes were 24 more than the number in 1899, but 63 below the corrected decennial average (346). The deaths from the diseases of the respiratory organs (542) were 130 below the number in 1899 (672). The deaths from diseases of the heart were 202, from phthisis 210, and from tubercular diseases in children under five years of age, 55. The mean temperature of the air at Greenwich during the year was approximately, 50.4 degrees Fahr., the means of the four quarters successively being 39.2, 52.8, 61.8, and 47.6. 11 Summary of Vital and Mortal Statistics of the Borough of Kensington, 1900. During the Four Weeks ended Births. Deaths. Death-bate. Deaths at Ages Deaths from Zymotic Diseases. Deaths from Diseases of Respiratory System. Deaths from Phthisis. Deaths from Heart Disease. Deaths under Five from Tubercular Diseases. Mean Temperature. Kensington. London. 1900. Decennial Average. 1900. Decennial Average. 0—1. 1—5. 60 and upwards. Totals. Measles. Scarlet Fever. Diphtheria. WhoopingCough. Enteric Fever. Typhus Fever. Simple continued Fever. Diarrhoea. Totals. Bronchitis. Pneumonia. January 27 296 323 24.3 22.4 29.9 24.6 44 20 156 17 8 1 2 ... 4 ... ... 2 99 83 13 14 20 3 41.1 February 24 286 243 18.3 18.7 211 21 6 34 20 96 17 11 ... 2 3 ... ... ... 1 63 45 13 16 14 4 36.7 March 24 323* 194 14..6 20.0 19.3 22.3 41 23 62 14 11 ... 2 1 ... ... ... ... 48 32 8 16 19 5 40.5 April 21 292 211 18.1 17.1 21.0 19.7 42 31 77 25 19 ... 3 2 ... ... ... 1 63 89 16 17 23 9 44.7 May 19 302 199 14.9 16.4 17.8 18.5 35 20 66 21 16 ... ... 1 ... ... ... 4 48 29 16 16 12 3 49.6 June 16 271 190 14.3 15.1 16.7 17.4 39 29 42 27 22 ... 2 2 1 ... ... ... 29 12 14 18 6 5 57.5 July 14 268 154 11.6 14.9 13.9 17.1 30 12 49 15 5 1 3 1 1 ... ... 4 21 14 2 16 18 5 60.5 August 11 297 218 16.4 16.8 19.4 20.5 92 16 51 45 4 ... ... 1 1 ... ... 39 17 9 4 9 16 5 654 September 8 293 184 13.8 14.2 19.2 18.8 81 12 35 36 2 ... 2 1 1 ... ... 30 14 7 6 18 13 4 607 October 6 235 163 12.2 13.5 16.4 16.9 47 12 50 19 ... ... 2 5 2 ... ... 10 20 10 7 13 11 4 575 November 3 255 180 13.5 14.9 15.8 18.0 43 11 54 16 ... ... 2 1 3 ... ... 10 25 17 5 21 20 8 50.8 December 1 265 179 13.4 16.1 17.3 19.3 50 13 57 10 ... 1 4 3 1 ... ... 1 38 30 3 13 13 2 45.3 December 29 203† 230 17.3 19.0 16.6 21.7 63 17 73 21 ... 1 3 12 2 ... ... 3 57 43 8 23 17 3 45.7 Totals 3,586 2,698 15.6 16.9 18.8 19.8 641 236 868 283 98 4 27 33 16 ... ... 105 542 370 115 210 202 55 50.1 * Maximum number during the year, and bo throughout the table. † Minimum number during the year, and so throughout the table. 12 DEATH-RATE IN ENGLAND AND WALES, AND IN LONDON, AND IN OTHER LARGE TOWNS. The death-rate in England and Wales in 1900 was 18.3 per 1,000, the same as in 1899, but 0.1 below the average rate in the ten years 1890-99. The rate in London, as already stated, was 18.8 per 1,000, being 0'8 below the decennial average; but by excluding the deaths of persons ascertained to have been strangers, the death.rate of London is reduced to 18.3 per 1,000. The subjoined table shows the annual death-rate per 1,000 persons living in each of the last eleven years, in Kensington, in London, and in England and Wales: — 1900. 1899. 1898. 1897. 1896. 1895. 1894. 1893. 1892. 1891. 1890. Kensington 15.6 17.5 16.3 15.6 16.7 16.4 15.7 17.5 17.2 18.4 17.8 London 188 19.8 18.7 18.2 18.6 19.8 17.8 21.3 20.6 21.4 21.4 W. Districts 17.6 19.0 17.0 16.1 17.6 18.5 17.1 19.7 20.0 20.8 20.5 North „ 16.9 18.1 16.9 16.6 17.1 18 .2 16.3 20.2 19.4 20.0 19.6 Central „ 21.5 22.5 22.1 21.8 21.2 23.8 20.0 25.7 23.9 26.5 24.8 East „ 22.1 23.0 21.7 21.2 21.3 23.4 20.8 24.9 23.5 24.0 25.1 South „ 17.7 18.5 17.7 172 17.5 18.3 16.2 19.5 19.0 19.8 19.6 England and Wales 18.3 18.3 17.6 17.4 17.1 18.7 16.6 19.2 19.0 20.2 19.5 Greater London.—The death.rate in "Greater London," which is co-extensive with the Metropolitan and City Police districts, the population in the middle of the year 1900, numbering 6,652,145 (viz., 4,589,129 in inner or Registration London, and 2,063;016 in the Outer Ring), was 173 per 1,000, as compared with 16.7, 17'2, and 18.3 in the three preceding years respectively. The deaths properly belonging to the Outer Ring, as distinguished from Inner or Registration London, were equivalent to a rate of only 140, the rate in the Inner Ring having been 18.8. The death-rate from the principal diseases of the zymotic class in Inner London, was 2.21 per 1,000; in the Outer Ring 1.98, the rate in Greater London, as a whole, being 2.14 per 1,000. The infantile mortality of Greater London was 156 per 1,000 births; of Inner London, 160; of Outer London, 148. Other Large Towns.—The death-rate in the thirty-three large towns, including London, and having a population of 11,610,296, was 19.5 per thousand; ranging from 13.8 at Cardiff, 14.6 at Croydon, and 15.9 at West Ham, to 22.5 at Wolverhampton, 25.1 at Salford, and 25.7 at Liverpool. The death-rates of Edinburgh, Glasgow, and Dublin were 19.4, 22'0, and 27.6 per 1,000 respectively. These death-rates are calculated without correction for differences between one town and another in regard to the age and sex-distribution of their respective populations. This explanation is necessary because, as the Registrar-General points out, "In consequence of the great difference between one town and another, with respect to age and sex-constitution of their several populations, recorded death-rates require correction before they can be justly used for purposes of comparison." The Registrar-General, as already stated, gives in his annual summary factors by the use of which the necessary corrections can be made with approximate accuracy for each town. Colonial and Foreign Cities.—The death-rate of some of the principal foreign and colonial cities was as follows—Indian cities: Calcutta, 50.6 per 1,000; Madras, 46.2; and Bombay, 96'4. European cities: Paris, 20.6 per 1,000; St. Petersburg, 27.0; Moscow, 31.2; Berlin, 19'0; Vienna, 20.5; Rome, 19.1. American cities: New York, 20.6 per 1,000; Boston, 20.8; Philadelphia, 19.4; and New Orleans, 24.7. ASSIGNED CAUSES OF DEATH. In the annual report for 1873 (page 10) the following passage occurs:— "New Forms for Recording Vital and Mortal Statistics.—The tables in the appendix, numbered I. to VI., inclusive, have been drawn up by the Society of Medical Officers of Health, for general use throughout the country, and with a view to facilitate comparison between different districts and with standard areas. The want of uniformity in statistical returns of the medical reports had long been felt; I was induced, therefore, to bring the subject before the society, which, after a most careful consideration, and having obtained the views of a great many officers of health, settled these forms, which it is hoped will supply all the 13 information that is absolutely requisite without imposing an undue amount of work on those who may use them. Should the tables come into general use they cannot fail to invest the vital statistics in the reports of medical officers with a much greater and more universal interest than heretofore." TABLES similar to those above referred to as being numbered I. to VI. had previously been employed in my annual reports, and the Tables I. to VI. were used from 1873 onward to 1899, inclusive, in the tabulation of vital, mortal and sanitary statistics. These tables since 1894 have been supplemented by others ("A" and "B"), directed by the Local Government Board to be used, so as to secure a "tabular statement of mortality, and a tabular statement of infectious disease in all districts on a uniform plan." These latter tables have now been superseded by Tables, numbered I to IV., recently directed by the Board to be used. Table I. is subjoined ; Table II. will be found at page 14, Table III. at page 45, and Table IV. at page 15. The table on page 16, is a summary of causes of death, as set out in former reports in Table III. (now numbered VIII. and printed in Appendix II.), arranged in Classes and Orders of diseases, as in the annual reports of the Registrar-General. The other tables used in preceding annual reports, now numbered from VI. to XIV., will be found in Appendix II., pp. 87—104. TABLE I. (Required, by the Local Government Board to be used in the Annual Report of the Medical Officer of Health). For Whole District. Year. Population estimated to Middle of each Year. births. Deaths under One Year op Age. Deaths at all Ages. Total. Deaths in Public Institutions. Deaths of Nonresidents registered in District. Deaths of Residents registered beyond District. Deaths Ages. at all Nett. Number. Rate.* Number. Rate per 1,000 Births reg stored. Number. Rate.* Number. Rate.* 1 2 3 4 5 6 7 8 9 10 11 12 13 1890 166,080 3,864 23.3 651 168 3,375 20.8 1,060 635 211 2,951 17.8 1891 166,500 3,847 23.1 633 164 3,609 21.6 1,297 790 247 3,066 18.4 1892 167,200 3,718 22.2 587 158 3,272 19.6 1,055 626 236 2,882 17.2 1898 167,900 3,661 21.8 625 170 3,225 19.2 1,042 621 312 2,916 17.4 1894 168,600 3,665 21.7 636 174 2,983 17.7 1,070 613 283 2,623 15.6 1895 169,300 3,621 21.4 624 172 3,065 18.1 1,062 625 808 2,748 16.2 1896 170,000 3,717 21.4 656 176 3,158 18.6 1,065 620 353 2,891 16.7 1897 170,700 8,683 21.6 609 165 3,025 17.7 1,164 691 333 2,667 15.6 1898 172,000 3,633 21.1 655 180 8,151 18.3 1,123 639 286 2,798 16.3 1899 172,400 3,590 20.8 642 179 3,422 19.8 1.320 722 321 3,021 17.5 Averages for years 1890-1899 169,068 8,699 21.8 631 171 3,228 191 1,125 661 289 2,856 16.9 1900 173,000 3,586 20.7 641 179 3,087 17.7 1,132 672 283 2,698 15.6 * Kates calculated per 1,000 of estimated population. Note.—The deaths included in columns 5, 7 and 9 of this Table, are all those registered during the year within the Borough. The deaths included in column 12 are the number in column 7, corrected by the subtraction of the number in column 10, and the addition of the number in column 11. The term "non-residents" in column 10, means persons brought into the Borough on account of illness and dying there. The term "residents" in column 11, means persons taken out of the Borough on account of illness and dying thereout. Area of Borough in acres 2,190 Total population at all ages 173,000 No. (approximate) of inhabited houses 22,800 Average number of persons per house ... 7'6 14 TABLE II. (Required by the Local Government Board to he used in the Annual Report of the Medical Officer of Health.) Names of Localities. Kensington. Kensington Town. Brompton. Year. Population estimated to middle of each year. Births registered. Deaths at all ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all ages. Deaths under 1 year. 1890 166,080 3,864 2,951 651 118,760 3,144 2,382 546 47,320 720 569 105 1891 166,500 3,847 3,066 633 119,040 3,115 2,445 541 47,460 732 621 92 1892 167,200 3,718 2,882 587 119,600 3,071 2,254 508 47,600 647 628 79 1893 167,900 3,661 2,916 625 120,160 2,993 2,305 541 47,740 668 611 84 1894 168,600 3,665 2,623 636 120,720 3,055 2,091 552 47,880 610 532 84 1895 169,300 3,621 2,748 624 121,280 3,052 2,231 552 48,020 569 517 72 1896 170,000 3,717 2,891 656 121,840 3,101 2,344 578 48,160 616 547 78 1897 170,700 3,683 2,667 609 122,400 3,133 2,169 531 48,300 550 498 78 1898 172,000 3,633 2,798 655 123,600 3,078 2,302 593 48,400 555 496 62 1899 172,400 3,590 3,021 642 123,900 3,046 2,455 574 48,500 544 566 68 Averages of years 1890-1899. 169,068 3,699 2,856 631 121,130 3,078 2,297 551 47,938 621 558 80 1900 173,000 3,586 2,698 641 124,300 3,021 2,193 581 48,700 565 505 60 Note.—Deaths of resident parishioners occurring without the Borough are included in this table, and those of non-residents registered in the Borough are excluded (see note on Table I. as to meaning of terms "resident" and "non-resident"). Deaths of residents occurring in public institutions are allotted to the respective sub-districts (Kensington Town and Brompton) according to the previous addresses of the deceased. 15 TABLE 1Y. (Required by the Local Government Board to be used in the Annual Report of the Medical Officer of Health.) Causes of, and Ages at, Death during the Year 1900. Causes of death. Deaths in whole District at subjoined ages. Deaths in Localities (at all ages). Deaths in Public Institutions. All Ages. Under 1. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 65. 65 and upwards Kensington Town. Brompton. Small-pox — — — — — — — — — — Measles 98 26 68 4 — — — 93 5 6 Scarlet Fever 4 — 2 1 — I — 2 2 4 Typhus Fever — — — — — — — — — — Epidemic Influenza 85 — 1 3 — 39 42 60 25 2 Whooping Cough 33 17 13 3 — — — 30 3 1 Diphtheria, Membranous Croup 27 2 19 5 1 — — 25 2 21 Croup — — — — — — — — — — Enteric Fever 16 — — 2 4 10 — 14 2 12 Asiatic Cholera — — — — —' — — — — — Diarrhoea, Dysentery 104 79 12 — — — 6 98 6 9 Epidemic or Zymotic Enteritis 1 1 — — — — — — 1 — Enteritis 51 33 5 1 1 6 5 42 9 11 Other continued Fevers — — — — — — — — — — Erysipelas 9 2 — — — 6 1 6 3 4 Puerperal Fever 5 — — — 2 3 — 5 — 1 Other septic diseases — — — — — — — — — — Intermittent Fever and Malarial Cachexia — — — — — — — — — — Tuberculosis of Meninges 37 11 18 6 1 1 — 29 8 7 Tuberculosis of Lungs 210 — 3 4 21 176 6 177 33 93 Other forms of Tuberculosis 59 15 10 8 8 17 1 54 5 20 Alcoholism 19 — — — — 17 2 14 5 7 Cancer 152 — — — 2 91 59 105 47 48 Premature Birth 83 83 — — — — — 73 10 9 Developmental Diseases 140 127 12 1 — — — 120 20 33 Old Age 98 — — — — 2 96 88 10 47 Meningitis 24 9 8 3 1 3 — 20 4 2 Inflammation and Softening of Brain 3 — — — — — 3 3 — 1 Organic Diseases of Heart 60 — — 3 5 26 26 39 21 7 Acute Bronchitis 222 64 15 3 — 48 92 185 37 65 Chronic Bronchitis 53 — — — — 20 33 48 5 13 Lobar (croupous) Pneumonia 11 — — — 1 9 1 9 2 4 Lobular (broncho) Pneumonia 95 45 26 1 — 9 14 77 18 5 Diseases of Stomach 27 3 2 1 1 12 8 23 4 8 Obstruction of Intestines 18 3 1 — 1 7 6 14 4 8 Cirrhosis of Liver 25 — — — — 20 5 19 6 5 Nephritis and Bright's Disease 52 — — 1 2 27 22 38 14 10 Tumours and other affections of Female Genital Organs 6 — — — — 6 — 5 1 1 Accidents and Diseases of Parturition 19 — — — 3 16 — 16 3 2 Deaths by Accident or Negligence 88 37 6 3 5 21 16 76 12 25 Deaths by Suicide 16 — — 3 12 1 — 12 4 4 Deaths from Ill-defined Causes 3 — 1 1 — 1 — 3 — — All other causes 745 84 14 20 14 354 259 571 174 269 2,698 641 236 77 85 956 703 2,193 505 764 Note.—The deaths of residents occurring without the Borough are included in this Table, and the deaths of non-residents recorded in the Borough are excluded. (See note on Table I. as to meaning of terms "resident" and " non-resident.") Deaths of residents occurring in public institutions, are allotted to the respective sub-districts according to the addresses of the deceased as given by the registrars, and, in addition, are classified under the heading Public Institutions. 16 The subjoined table, being a Summary of Table VIII. (Table III. in preceding annual reports: vide Appendix II., page 89), shows the number of deaths from diseases in the several Classes and Orders of the classification of the Registrar-General, referred to in the following pages, 16-28. CLASS I.—SPECIFIC FEBRILE OR ZYMOTIC DISEASES. Order. No. of Deaths. 1. Miasmatic Diseases 263 2. Diarrhoeal „ 106 3. Malarial „ — 4. Zoogenous „ — 5. Venereal „ 20 6. Septic „ 14 403 II. PARASITIC DISEASES 4 III. DIETETIC DISEASES 20 IV. CONSTITUTIONAL DISEASES 514 V. DEVELOPMENTAL DISEASES 210 VI. LOCAL DISEASES— 1. Diseases of Nervous System 257 2. Diseases of Organs of Special Sense 3 3. Diseases of Circulatory System 227 4. Diseases of Respiratory System 542 5. Diseases of Digestive System 182 6. Diseases of Lymphatic System — 7. Diseases of Gland-like Organs of uncertain use 5 8. Diseases of Urinary System 82 9. Diseases of Reproductive System— a. Diseases of Organs of Generation 6 b. Diseases of Parturition 19 10 Diseases of Locomotive System 4 11 Diseases of Integumentary System 11 1,338 VII. VIOLENCE— 1. Accident or Negligence 88 2. Battle — 3. Homicide... 2 4. Suicide 16 5. Execution — - 106 VIII. ILL-DEFINED AND NOT SPECIFIED CAUSES ... 103 Total • •• 2,698 Specific Febrile or Zymotic Diseases, in the official classification, are comprised in six Orders, which include the first 17 diseases in Table IV. (p. 15). Amongst them are the nine which the Registrar-General describes as the "seven principal diseases of the zymotic class"—typhus fever, enteric fever, and simple continued fever, being grouped under the general heading "fever." The deaths from these diseases, which had been 310, 347, and 259, in the three preceding years, were 283 in 1900, and 63 below the corrected decennial average (346). These deaths, of which 262 belong to the Town sub-district, and 21 to Brompton, were equivalent to 1.63 per 1,000 living (2.11 in the Town sub-district, and 0.43 in Brompton), as compared with l-50 in 1899. The rate in the Metropolis, as a whole, was 2.21 per 1,000 (2.46 in 1899), the decennial rate being, for London 2.7, and for Kensington 2.0 per 1,000. The Kensington rate for each of the zymotic diseases during the eleven years, 1890—1900, is set out in Table V., page 46. 17 The subjoined table shows the number of deaths from the several diseases, in the sub-districts, occurring at-home, and at outlying public institutions, &c.:— Disease. Sub-Districts. In Hospital. Total Deaths. Decennial Average. Town. Brompton. Town. Brompton. Uncorrected. Corrected for increase of Population. Small-pox — — — — — 0.9 0.9 Measles 90 4 3 1 98 78.7 80.5 Scarlet Fever — — 2 2 4 27.9 28.5 Diphtheria 5 1 20 1 27 56.3 57.6 Whooping-cough. 30 8 — — 33 63.4 64.9 Typhus Fever — — — — - 0.2 0.2 Enteric Fever 3 1 11 1 16 17.8 18.2 Simple-Continued Fever — - — — — 0.9 0.9 Diarrhoea 92 7 6 — 105 91.7 93.9 220 16 42 5 283 337.8 345.6 The mortality from measles, enteric fever and diarrhoea was slightly in excess, the deaths from the other diseases having been below the average. District Zymotic Rate.—The deaths in North Kensington were 230, and the rate 2'6 per 1,000 persons living. In South Kensington the deaths were 53, and the rate 0'6 per 1,000. The rate in the several sanitary districts was as follows:— North 110 deaths, or 3.3 per 1,000 persons living. North-east 42 deaths, or 1.4 per 1,000 persons living. North-west 65 deaths, or 3.8 per 1,000 persons living. Central 38 deaths, or 1.4 per 1,000 persons living. South-east. 9 deaths, or 0.3 per 1,000 persons living. South-west 19 deaths, or 0.6 per 1,000 persons living. The table at page 11 exhibits the distribution of the deaths in the borough as a whole, from the several diseases as recorded in the thirteen four-weekly reports. In England and Wales the deaths from the principal zymotic diseases were at the rate of 2 00 per 1,000 persons living, the decennial average being about 25 per 1,000. In the thirty-three great towns, including London, the average rate was 2.5, ranging from 1.38 at Newcastle, 1.39 at Birkenhead, and 1 44 at Croydon, to 3'98 at Salford, 4.33 at Sheffield and 4.37 at Preston. In Appendix I., statistical information is given in Tables B, C, and D (pp. 85-86) showing the number of deaths from the several diseases during the forty-five years (1856-1900) of the existence of the late Vestry: in Table B, the annual number of deaths from each of the diseases and the death-rate therefrom, in Table C, the numbers of deaths grouped in quinquennial periods; in Table D, the rate per 1,000 of the population, in quinquennial periods, of the four notifiable diseases (small-pox, scarlet fever, diphtheria, and "fever"), and the three non-notifiable diseases— measles, whooping-cough, and diarrhoea. 18 SMALL-POX. There was no death in the borough from small-pox (the corrected decennial average number being 0 9) nor had there been any death from this cause in the six preceding years. Five cases were notified. In London 87 cases were notified, against 104, 32, and 29 in the three preceding years : 66 cases were admitted to hospital; four deaths were registered, three in hospital, the corrected decennial average being 45. During the ten preceding years the deaths aggregated 431 only, the numbers being 4, 8, 41, 206, 88, 55, 9, 16, 1 and 3 in the successive years. Local outbreak in Kensington. The five cases notified had a common origin. The facts of the outbreak are here stated in the order of their occurrence, relating as they do to two groups of two and three cases in the borough, and to other groups in other districts, owning the same source of infection; viz., an unrecognized case which occurred in a flat at a block of residential buildings in Westminster, in the person of Mr. D., the valet, whose wife was housekeeper to the occupier. This man fell ill on or about April 30th, the date of infection, from an unknown source, being approximately April 16th. The disease was thought to be measles, the certified cause of the death, which took place May 9th. Mr. D.'s son, an innkeeper's manager at Wolverhampton, attended the funeral on May 11th. He was in town again May 24th, and returned home May 25th, being then very ill. His complaint was diagnosed as Eczema; but when his child, his servant, and his nurse subsequently fell ill, it was recognised that all the four had small-pox. The servant, whose illness led to discovery of the outbreak, had left the inn before she developed small-pox. The nurse also fell ill after leaving the inn. This information, supplied late in June by the innkeeper's sister, Mrs. A. (the illness of whose children will be hereafter referred to), was subsequently confirmed by the local medical officer of health.* Mrs. D., the valet's widow, was so mentally upset by her husband's death that it became necessary, on Thursday, May 10th, to place her in the observation ward at St. George's infirmary, Fulham-road, whence she was discharged on Wednesday, May 16th—but not before (by her clothing) she had conveyed the infection of small-pox to a ward attendant, who was removed to hospital on Wednesday, May 23rd. Mrs. D. went direct to a tenement occupied by her step-daughter, Mrs. A., in Barker-street, a narrow cul-de-sac in South Kensington. On Thursday, May 17th, she went to her late home, and that of her deceased husband, in Westminster, to get her clothing, which was taken to her step-daughter's abode in Barker-street, where she remained until Friday, May 18th, on which day she removed to her brother's house in Chelsea—being ill at the time. On Monday, May 21st, the medical officer of health of Chelsea reported that Mrs. D. was suffering from small-pox in the fifth day of illness : Thursday, May 17th, therefore, being the approximate date of attack. Observation was thenceforth kept of the Kensington family, comprising Mr. and Mrs. A. and their four young children, all of whom had been vaccinated. On Tuesday, May 29th, one of the children, Amy A., aged 10 years, fell ill. On Wednesday she was seen by a doctor, who thought the symptoms "suspicious." Next day when I saw the child the rash of small-pox was out, and she was removed to hospital forthwith. A second child, Muriel A., aged 8 years, was removed on Friday, June 1st, on the third day of illness. There can be little doubt that these children had been infected by their step-grandmother's clothing. The house was disinfected, and it was hoped that the outbreak was at an end: and so it appeared to be, for no other case occurred at the house, or at the infirmary, or at the house in Chelsea, or elsewhere, traceable to infection conveyed through Mrs. D. But on Monday, June 11th, a notification of small-pox was received from a house at Western-terrace, Notting-hill, in the person of Jessie M., aged 19 years, an employee at a Chiswick laundry. Five doctors had seen her; three thought the disease was chicken-pox and did not notify; the fourth notified "? small-pox," the fifth notified small-pox. The patient was not ill, in the common acceptation of the word, when I saw her (on the 11th). The rash indicated the eighth day of disease, and though neither extensive nor very characteristic, I formed the opinion that it was a case of small-pox, and certified for her removal to hospital. Enquiry disclosed the fact that a companion employee at the laundry (Harriet W.) living at Queen's-park, Chelsea, was ill and had a rash. With her doctor and the medical officer of health of Chelsea, I saw the case. The rash was smaller in quantity than in Jessie M., and even less characteristic. The conclusion arrived at, in agreement with the views of four or five other doctors who had seen the patient, was that it was a case of chicken-pox. My Chelsea colleague immediately afterwards saw Jessie M. with me, and thought the rash suspicious; but as the family occupied the whole house, and the patient was unwilling to go to hospital, as a precautionary measure, she remained at home under observation. I reported these two cases to the laundry company, whose manager called upon me on June 12th, and stated that two other employees, one at Queen's-park and one at Fulham, were *This gentleman wrote:—"A club met weekly, at the inn, whose manager (son of the deceased valet) was ill, in an upstairs room facing his bedroom, and the members used to sit on his bed and chat with him ; good testimony as to the value of copious lathering with zinc ointment applied in the treatment of supposed eczema by the nurse who died from hemorrhagic small-pox." Probably vaccination might reasonably be credited as the cause of the guests' immunity. 19 suffering from. "chicken-pox." This statement was at once reported to the medical officers of Chelsea and Fulham, who found the women to be suffering from small-pox. All four women (and they only) had been employed in the dirty-linen sorting room; and all, it may be added, fell sick on or about the same day. At this point the matter rested until Monday, June 25th, when a notification was received of small-pox in the person of a married woman, Elizabeth M., aged 32, who lived at Wornington-road, North Kensington. The surname was that of Jessie M. also (our first case), whose residence was first visited for enquiry, when it was ascertained that Elizabeth M. was sister-in-law to Jessie M., whose mother, Jane M., aged 55 years, was now ill, and had a typical rash of small-pox at an early stage. She was removed to hospital the same day. Elizabeth M. had been removed on the previous day. The date of attack in both cases indicated that the sufferers had been infected by Jessie M. about three days before the notification of that person's illness was received. On the same day, June 25th, the laundry was visited to ascertain if, perchance, the company washed for the employer of (and) the late Mr. D., the Westminster valet. They did! Three of the employees, supposed to have had chicken-pox, had, at this time, returned to their work, but were sent away forthwith. One of them admitted that her brother and sister were unwell, and had a rash. The medical officer of health of Fulham was immediately apprised, with the result that, on that day and the next, four of the inmates of the house were removed to the small-pox hospital. It cannot be doubted that the four laundry employees contracted small-pox by contact with the infected clothing of Mr. D., the deceased valet, whose employer, as before stated, lived in a flat. In the flat immediately overhead lived Emma E., aged 39 years, housekeeper to another gentleman, and who was on intimate terms with Mr. and Mrs. D. Being ill, with pneumonia following influenza, Emma E. was admitted on May 11th (the date of Mr. D.'s funeral) to St. Mary's hospital, where, on or about May 25th, she developed a fresh illness, followed on the 27th by a rash. She was placed in the isolation ward on May 28th, and died on June 4th, the cause of death, as certified, being Erythema-multiforme. The disease no doubt was small-pox; for subsequently, five persons—a nurse, a wardmaid, a patient, and two medical students—who had been in contact with Emma E., fell ill, and were removed to the small-pox hospital. It may be mentioned, as an illustration of human folly, that despite the warning given to the inmates of the Barker-street tenement house to avoid contact with Mr. A.'s family, within half-an-hour afterwards a female resident was found in the room where Amy A. was awaiting the arrival of the ambulance. Mr. A. was suspiciously ill at the time, and was told to keep his room, and yet within an hour he was seen at the front door in conversation with another man. The vaccination officer was made acquainted with the successive cases as they occurred, and revaccination was offered to the inhabitants of the infected houses. In one family three unvaccinated children were found. Proceedings were instituted against the father by the vaccination officer, and an order for the vaccination of the children was obtained. MEASLES. Measles was the cause of 98 deaths (all but four under five years of age, and 26 of them under one year), as compared with 33, 120, and 24 in the three preceding years; 93 in the town sub-district, and 5 in Brompton; the corrected decennial average being 81. All but seven of the deaths occurred in the first half-period of this year. The deaths from this cause in the metropolis, as a whole, were 1,936, and 886 below the corrected decennial average. Should Measles be made a Notifiable Disease?—This question has received consideration more than once in these reports, and the reasons which led me to an adverse decision have been fully set out. Another question was raised last year by the Public Health Committee of the County Council in a communication to the borough councils designed to elicit their views as to whether it was advisable that the Council should include "measles" in the term "dangerous infectious disease," for the purposes set out in certain sections of the Public Health (London) Act, 1891 ? The sections referred (inter alia) to the exposure of infected persons and things (68), the conveyance of infected persons in public conveyances (70), the casting of infectious rubbish into ash-pits (62), the disinfection of infected premises, articles, and public conveyances (60, 61, 65, and 74), the letting of infected houses (63 and 64), and the removal to hospital of infected persons without proper lodging (66).* In 1898 a somewhat similar communication was received from the Public Health Committee of the Council, consequent on a letter having been addressed by the School Board for London to the Council, in which it was urged that measles should be declared a "dangerous infectious disease," for the purposes of section 68 of the Act, which prohibits the exposure of infected persons, it having been alleged that children had been sent to school whilst suffering * Other sections were cited in the County Council's letter, viz., 69, 72, 73. 20 from the malady; an occurrence which I thought then, and think still, must have been inadvertent or due to ignorancc. The replies of the then existing sanitary authorities having shown a considerable divergence of opinion, the Public Health Committee thought it ''desirable to consult the Councils of the metropolitan boroughs with reference to the proposal," with a view to ascertain whether they were in favour of the extension to measles of the provisions contained in any or all of the sections above mentioned ? it being expressly observed that " these sections do not relate to the question of ' notification,' which is dealt with in sections 55 and 56." This reservation notwithstanding, it seems to me that the suggestion emanating from the School Board in 1898, and the communications addressed by the Public Health Committee to the local sanitary authorities in that year, and again recently, almost inevitably involve the question— Whether notification of measles is advisable ? for without information as to the existence of the disease it is not possible to take steps to prevent its spread. This question of notification of measles was fully considered by the Sanitary Committee of the late vestry, upon whose recommendation the Vestry, on two occasions, in 1891 and 1898, decided adversely to the principle. In 1898, moreover, the Vestry approved and forwarded to the County Council a report I submitted on the subject, as follows: — " I do not doubt that it would be useful to bring measles within the meaning of the expression, 'dangerous infectious disease,' so far as relates to exposure, and to the prohibition of the use of public vehicles for the conveyance of infected persons (Section 70); but I see no reason to modify the views adverse to the notification of measles expressed in these reports,* and approved, on more than one occasion, by your Vestry. Probably not a moiety of the cases of measles in any epidemic come to the knowledge of medical practitioners. Unless the child is obviously very ill; i.e., unless some of the complications occur to which the fatal issue in measles is usually due, the illness is allowed, very generally, to run its course without medical treatment, properly so-called, and therefore the great bulk of cases would probably escape notification. It is true that the Act requires a ' dangerous infectious disease' to be reported by the head of the family; but notification otherwise than by the medical man is of the rarest, and it would be difficult to enforce. Measles becomes epidemic about every second or third year. It rages for a few weeks; the sufferers are counted by thousands in a place like London; and then, for a time, only sporadic cases occur, the fatality being trifling. But during epidemic prevalence measles is truly a ' dangerous infectious disease,' and, taking one year with another, is the cause of greater mortality than scarlet fever or diphtheria.† In this Parish, in 1897, there were only 33 deaths from measles, whilst in 1896 there were 173 deaths, of which 160 were registered in 24 weeks, including 45 in one period of four weeks. Having regard to the low percentage mortality of measles, this number of deaths (160) indicates an immense number of cases, probably not less than 6,000, as compared with 1,780 cases of all the notifiable diseases recorded in that year.‡ To deal with such a mass of cases (if they did get notified) in so short a period as half a year—and without action mere notification is useless—would be a task of great difficulty. And what could we do? I have always held to the view that, without hospital accommodation for the bad cases which occur in the crowded and unhealthy homes of the poor, where, owing to complications induced by insanitary conditions, the disease so often proves fatal, no substantial benefit would accrue from notification. There is no such accommodation, nor is there likely to be, and therefore notification would be of little avail as a means for reducing the fatality of measles. The disease is exceedingly infectious, and once in a tenemented house, or a house let in lodgings, swarming with children, it is almost impossible to prevent it from spreading to all who are susceptible to the infection. The School Board do not allow of the attendance at school of children from infected houses, and if measles were made notifiable, the head teachers would have some increased facilities for excluding children from infected houses. But this end might be equally well attained by the adoption of a course I suggested some years ago; viz., that when measles (or, for the matter of that, any other infectious disease) threatens to become epidemic, parents should be informed that school attendance is not allowed in the case of children living in an infected house. I venture to think that this course should be adopted and proved to be ineffective before resorting to notification, which would certainly be costly, and involve much labour and trouble, probably to little purpose." I have since the publication of the above report seen no reason to alter my views on the subject, but I may add that it would be well if hospital accommodation on a moderate scale could be provided for measles, so as to permit of the removal of sufferers living in insanitary houses, where, too often, a fatal termination to the illness is due to unhealthy surroundings. Death from measles is a rare occurrence in the healthy homes of well-to-do people; and when it happens amongst the poor it is often the result of the ignorance of mothers, who, regarding the disease as inevitable and not very serious, omit too generally to obtain medical assistance till it is too late to be of any avail. * The question of the notification of measles was fully dealt with in the Annual Report for 1891 (pp. 97-106 inclusive), in which it was shown that no benefit had accrued therefrom at Edinburgh ; 30,000 cases of measles having been notified (at a cost of £3,000), in the ten years 1880-89. † The corrected annual average number of deaths in London from measles, in the ten years 1890-99, was 2,822 ; from scarlet fever, 915; from diphtheria, 2,478. In 1900 the deaths from the several diseases were 1,936, 361, and 1,609 respectively. ‡ In 1900 the notifications were only 986, including 765 from small-pox, scarlet fever, diphtheria and enteric fever; the disinfection cases. Of measles there were probably between 3,000 and 4,000 cases. 21 SCARLET FEVER. The cases notified as scarlet fever were 367, as compared with 749, 474, and 443 in the three preceding years : 233 in North Kensington, and 134 in South Kensington. The deaths were four, (the lowest number on record) and 24 below the corrected decennial average (28): 2 and 2 in the Town and Brompton sub-districts respectively. Two of the deaths were of children under five years of age. All of the deaths took place at outlying public institutions, to which 290 cases were removed. The case-mortality was only 1.4 per cent. The deaths in the three preceding years from this cause were 29, 23, and 10 respectively. Detailed information as to scarlet fever mortality in the borough, 1856—1900, is set out in Appendix I. (Tables B, C, and D, pp. 85-86), showing the remarkable reduction which has taken place in recent years: concurrently, it must be added, with an increased fatality from diphtheria. The deaths from scarlet fever in London, as a whole, were 361 (the lowest number on record) as compared with 780, 583, and 398, in the three preceding years, the corrected decennial average being 915. Of the 361 deaths, 305, or more than 84 per cent., occurred in public institutions. The cases notified numbered 13,812, as compared with 18,812 in 1899, 16,917 in 1898, 22,876 in 1897, 25,638 in 1896, 19,757 in 1895, 18,440 in 1894, and 36,901 in 1893. The mortality was 2.6 per cent. on cases notified, against 2.2 in 1899, 3 4 in 1898 and 1897 ; 3.7 in 1896; 4.1 in 1895; 5.2 in 1894, and 4.3 in 1893. Upwards of 77 per cent. of notified cases were admitted to hospitals. The case-mortality in hospitals (admissions, 10,692), was 2.94 per cent. These statistics are satisfactory, indicating as they do not merely a diminished prevalence of the disease, but a mortality so reduced as to suggest a favourable change in the type of the disease in recent years. The subjoined table shows the degree of prevalence of the disease in the borough, and in London, as a whole, as indicated by the number of notifications, and of deaths registered, in thirteen successive four-weekly periods, as set out in my reports. Scarlet Fever in 1900. Report for four weeks ended No. of Notifications. No. of cases admitted to Hospitals. No. of Deaths. No. of cases in Hospital at the end of the period./###] Kensington. London. Kensington. London. Kensington. London. January 27 31 951 26 763 1 25 2,287 February 24 28 834 18 650 — 26 2,009 March 24 27 873 22 652 — 26 1,715 April 21 29 883 23 711 — 27 1,676 May 19 21 966 18 770 — 25 1,733 June 16 22 1,063 13 823 — 31 1,766 July 14 33 1,097 29 866 1 35 1,861 August 11 21 868 18 740 — 22 1,838 September 9 23 828 20 686 — 23 1,736 October 6 25 1,348 21 1,143 — 25 2,071 November 3 40 1,634 29 1,304 — 33 2,570 December 1 32 1,365 26 1,075 1 33 2,727 December 29 35 1,102 27 899 1 30 2,535 867 13,812 290 11,078 4 361 The notifications are taken from the weekly returns of the Asylums Board ; the admissions to, and the numbers in, the hospitals, and the deaths in London, from the weekly returns of the Registrar-General. For the sake of comparison, I subjoin the corresponding table for 1899, taken from the report for that year. Scarlet Fever in 1899. Report for four weeks ended No. of Notifications. No. of cases admitted to Hospitals. No. of Deaths. No. of cases in Hospital at the end of the period. Kensington. London. Kensington. London. Kensington. London. January 28 26 1,374 19 980 1 39 2,679 February 25 20 1,284 14 961 - 26 2,575 March 25 20 1,081 16 854 1 27 2,355 April 22 26 905 18 669 1 25 2,144 May 20 25 1,167 20 915 1 27 2,161 June 17 38 1,318 29 1,029 — 21 2,280 July 15 39 1,594 33 1,251 1 31 2,601 August 12 46 1,408 38 1,123 — 27 2,674 September 9 34 1,246 27 1,020 1 25 2,550 October 7 48 1,907 38 1,570 1 26 3,003 November 4 43 2,124 33 1,647 - 36 3,539 December 2 55 1,650 43 1,249 2 41 3,445 December 30 23 1,054 15 827 1 47 2,881 443 18,112 343 14,095 10 398 Note.— Correction has not been made in the above tables for errors in diagnosis either with respect to notifications or admissions to hospital. 22 The following tables exhibit certain particulars of interest with respect to scarlet fever prevalence, &c., during 1900, and the ten preceding years, 1890-99 :— Scarlet Fever Cases recorded in Kensington in 1900, and in the Ten Preceding Years, in Thirteen Four-weekly Periods. The Year. Weeks. 1-4. Weeks. 5-8. Weeks. 9-12. Weeks. 13-16. Weeks. 17-20. Weeks. 21-24. Weeks. 25-28. Weeks. 29-32. Weeks. 33-36. Weeks. 37-40. Weeks. 41-44. Weeks. 45-48. Weeks. 49-52. Total. 1900 32 26 28 28 20 22 32 21 23 25 41 31 35 364 1899 26 20 20 27 26 38 40 47 35 47 42 55 22 445 1898 34 40 34 39 31 31 40 45 38 31 33 38 34 478 1897 43 32 40 28 33 58 68 51 55 133 88 84 34 747 1896 79 90 57 45 37 68 93 94 92 84 104 91 77* 1011 1895 20 22 20 23 22 33 39 40 24 63 91 62 66 525 1894 59 37 27 40 28 21 26 23 30 28 31 15 25 390 1893 45 60 38 34 56 84 84 110 67 113 117 88 61 957 1892 28 23 20 34 51 39 73 74 59 97 85 82 50 715 1891 38 47 18 24 23 23 13 27 17 31 23 22 17 323 1890 10 32 17 23 24 15 12 19 24 42 71 49 38* 375 Average 1890-99 38.2 40.3 29.1 31.6 33.1 41.0 48.8 58.0 44.1 66.9 68.5 58.6 42.4 597† * Return comprises five weeks. † Without correction for increase in population. Statistics of Scarlet Fever in Kensington in 1900, and in the Ten Preceding Years. The Year. No. of Recorded Cases. Total Number of Recorded Cases. Percentage of Removals to total Recorded Cases. Deaths. Total Deaths. Percentage of Deaths. Percentage of Deaths to Recorded Cases. Deaths in London from Scarlet Fever.]/###] Treated at Home. Removed to Hospital. At Home. In Hospitals At Home. In Hospitals 1900 74 290 364 79 — 4 4 — 100 1.4 361 1899 101 344 445 77 2 8 10 20 80 2.2 898 1898 117 361 478 76 1 22 23 3.4 95.6 4.8 583 1897 188 561 747 75 3 26 29 10.3 89.7 8.9 780 1896 248 763 1011 75 7 32 39 18 82 3.9 942 1895 167 358 525 68 12 15 27 44 56 5.1 829 1894 131 259 390 66 5 17 22 23 77 5.6 962 1893 389 568 957 59 10 41 51 24 76 5.3 1596 1892 259 456 715 64 9 27 36 25 75 5.0 1174 1891 117 206 323 61 3 13 16 19 81 4.9 589 1890 161 214 375 57 6 20 26 23 77 6.9 875 23 DIPHTHERIA. Cases of diphtheria and membranous croup to the aggregate number of 332 were notified, as compared with 332, 222, and 257 in the three preceding years: 233 in North Kensington, and 99 in South Kensington. The deaths registered were 27 (against 82, 26, and 42 in the three preceding years), being 31 below the corrected decennial average (58): 25 of them belong to the Town subdistrict, and 2 to Brompton ; 25 to North Kensington, and 2 to South Kensington. Twenty-one of the deaths were of children under five years of age, including two under one year. Twenty-one of the deaths took place at hospitals, to which 288 cases were removed. The case-mortality was 8.l per cent., and the lowest on record. Detailed information as to diphtheria mortality in the borough, 1871-1900, is set out in Appendix I., Tables B, C, and D, pp. 85-86. In London, as a whole, the deaths (including deaths from membranous croup), were 1,558, and 705 below the corrected decennial average, as compared with 2,261, 1,772, and 1,964, in the three preceding years. The notifications of diphtheria were 11,998, as compared with 12,811, 11,561, and 13,701 in the three preceding years successively. The cases of diphtheria admitted to hospitals are stated by the Registrar-General to have been 7,966, and the deaths in hospitals 991, a casemortality of 12.7 per cent. The above favourable statistics indicate a progressive decline in the prevalence, and especially in the fatality of this terrible disease. The following illustrative cases may be cited:—On January 3rd the illness of a man from diphtheria was notified, an address at North Kensington being given. The patient, who resided in another borough, apart from his wife, had called at her abode on New Year's Day to see his infant of eight months, whom he nursed, kissed, and infected. On the 4th the child fell ill: he was taken to a children's hospital on the 5th, but too late to be seen as an out patient. The following day, Saturday, was allowed to pass without medical help; on Sunday the child was worse, with difficulty of breathing, &c., but no doctor was called in. On Monday a medical relief order was applied for. The patient, when visited in the afternoon, was moribund, and he died the same night. The body was removed to the mortuary; but no inquest was held. Another case indicating similar neglect occurred at about the same date. The child was moribund when the doctor was called in. He notified the illness as "diphtheritic croup?", but declined to certify the cause of death. An inquest was held and a post-mortem examination was made. The jury found that the cause of death was diphtheria. The house where the child lived was inspected and found to be in an insanitary condition. An interesting group of cases occurred in April-May, in two families living in separate houses in Convent-gardens. The first case, in order of occurrence, was that of a man, John J—, a cab-washer, out of work, who began to suffer from sore throat, &c., on or about April 11. With his wife and six children he occupied two rooms. Four of his children, aged respectively, 2, 9, 6, and 12 years, were notified as suffering from diphtheria on April 19, 24, and 27, and May 5, respectively. Other two cases occurred in the family of a police-constable, who, with his wife and four children, occupied four rooms at another house. The cases, of twins, aged 6 years, were notified April 25th and 29th respectively. The several patients were removed to hospital, on receipt of the successive notifications; not one of them, fortunately, proved fatal. Five of the children had attended a church-school: but the outbreak neither originated there, nor was spread to other children in attendance; the children having been excluded immediately after the first notification. The spread of disease was due to direct infection, and to commingling of the children at play, &c. Hearing, after the fourth notification, that the man John J— had had a sore throat, a bacteriological examination was made: the bacteria of diphtheria were isolated, and the patient was forthwith removed to hospital. Convent-gardens is a cul-de-sac. There were in the street four brick catch-pit gullies of unusually large size; and the sewer was unventilated, excepting by these untrapped openings. The Sanitary Committee having viewed the street, at my request, decided to trap the gullies to ventilate the sewer at the highest point, by a pipe shaft carried up against a house, and to asphalt-pave the roadway. A great sanitary improvement was thus effected. A considerable number of cases of diphtheria occurred in streets in the vicinity of St. Marylebone Infirmary, North Kensington. The children attacked, or many of them, had been accustomed to play in a field on the St. Quintin estate, where was a foul open branch of the Counter's-creek sewer. At the instance of the Sanitary Committee, the County Council had this sewer cleared of the offensive accumulations of years, and, whether post hoc or propter hoc, the special incidence of the disease upon the locality thereupon greatly diminished, and practically ceased. 24 The following table, based on the thirteen four-weekly reports, sets out some particulars with regard to diphtheria, in Kensington and in London:— Diphtheria in 1900. Report for four weeks ended No. of Notification* No. of cases admitted to hospital. No. of deaths. No. of cases in hospital at the end of the period. Kensington. London. Kensington. London. Kensington. London. January 27 35 1,052 28 753 2 184 1,606 February 24 21 961 20 688 2 180 1,437 March 24 29 905 25 663 2 138 1,329 April 21 25 703 23 503 3 99 1,141 May 19 35 908 30 672 — 92 1,188 June 16 16 824 14 651 2 110 1,228 July 14 12 846 11 663 3 96 1,212 August 11 25 929 17 707 — 97 1,263 September 9 17 721 13 558 2 69 1,187 October 6 20 1,049 18 790 2 116 1,286 November 3 34 1,144 33 833 2 143 1,458 December 1 38 1,069 34 747 4 118 1,537 " 29 25 887 22 638 3 116 1,356 332 11,998 288 8,866 27 1,558 Note.— Correction has not been made in the above table for errors in diagnosis either with respect to notifications or admissions to hospital. Cases of membranous croup are included. The following table gives particulars with respect to diphtheria in North and South Kensington respectively. Particulars with Reference to Diphtheria in Kensington, in 1900. Set out in Report for Four weeks ended Total Cases Recorded. Cases Recorded in North Kensington.* Cases Recorded in South Kensington.* Cases removed to Hospital from Deaths (21 in hospitals). North Kensington. South Kensington. North Kensington. South Kensington. January 27 34 25 9 21 7 2 ... February 24 22 18 4 18 2 2 ... March 24 28 19 9 18 7 2 ... April 21 25 16 9 16 7 3 ... May 19 33 25 8 23 7 ... ... June 16 16 6 10 5 9 2 ... July 14 13 4 9 4 7 3 ... August 11 23 14 9 12 5 ... ... September 9 16 12 4 9 4 1 1 October 6 20 17 3. 17 1 1 1 November 3 34 27 7 27 6 2 ... December 1 38 25 13 23 11 4 ... December 29 26 21 5 18 4 3 ... 328 229 99 211 77 25 2 * North Kensington and South Kensington are the districts to the north and the south of the centre of Notting-hill, High-street, and Holland-park-avenue, respectively. Modes of Spread of Scarlet Fever and Diphtheria.— I had occasion in the third monthly report (March 28th, page 31) to advert to the spread of disease by ambulant cases of scarlet fever and diphtheria, several cases having been imported from country places. I was not in a position to prove wilful infraction of the law relating to the exposure in public places, public vehicles, etc., of persons suffering from infectious disease, but the facts suggested a reprehensible want of caution. The occurrence of feverishness, with sore throat, followed by a red rash, should awake suspicion of scarlet fever; and such symptoms being present, medical advice surely should be sought before permitting the sick person to travel. Again, when it is thought desirable to remove a person from a house where diphtheria prevails, and particularly if the person is unwell, medical advice should be obtained, and, if possible, a bacteriological examination of the throat secretion made previously. Such cases as these occur, and notification is made so quickly upon the patient's return to town, a doctor having been called in forthwith, as to suggest that the disease must have already developed before the sick person's departure from the infected house. One can understand the desire of an adult suffering from, or in apparent 25 danger of, an attack of either disease, to be at home during illness rather than amongst strangers; but protection of the public from danger, through exposure of infected persons or things, should be the paramount consideration, even when the illness has not yet assumed a more than doubtful or suspicious phase. It is, however, difficult to prove guilty knowledge on the part of persons suffering, or in charge of sufferers, so as to enable the sanitary authority to take proceedings under section 68 of the Public Health (London) Act, 1891, which reads as follows: — If any person (a) While suffering from any dangerous infectious disease wilfully exposes himself without proper precautions against spreading the said disease in any street, public place, shop, or inn; or (b) Being in charge of any person so suffering, so exposes such sufferer; or, (c) Gives, lends, sells, transmits, removes, or exposes, without previous disinfection, any bedding, clothing, or other articles which have been exposed to infection from any such disease; He shall be liable to a fine not exceeding five pounds. It is well that public attention should be drawn, from time to time, to the provisions of the law in regard to this matter. "Return Cases" of Scarlet Fever and Diphtheria.— A cause of spread of scarlet fever and diphtheria, sometimes overlooked, is the persistence of infective germs either in the throat or in a nasal discharge of a "recovered" patient. A striking group of cases of this sort was reported in the last annual report. A girl suffering from scarlet fever returned home from hospital after fourteen weeks' absence, to all appearance well, save for a nasal discharge. She resumed customary intercourse with her young friends, four of whom shortly afterwards contracted scarlet fever. They had been infected by their companion, who had kissed them, and with whom they had played in the street and within buildings. Doubtless the infectious material was contained in the matter passing from the child's nose, for desquamation of the skin had long since come to an end; the long detention in hospital having been due to the continued discharge from the nose. The same sort of thing happens, but not so frequently, after diphtheria—disease reappearing in a family soon after the return of an apparently recovered patient. Two striking illustrations of this kind were recorded during the year. In the first instance a boy aged five years was sent to hospital, February 13th, and discharged "recovered" on 6th March. Four days later his brother, aged 15 months, fell ill, dying shortly afterwards. A swab from the first boy's throat was sent to the Jenner Institute for examination; the diphtheria bacillus was isolated, and the boy was sent to hospital again, together with a sister, aged three years, who had fallen ill on the 9th March. In the second instance a boy, aged eight years, was sent to hospital on February 17th, and discharged "recovered" on 12th March. Eleven days later a younger brother was notified as suffering from diphtheria and removed to hospital. A swab from the throat of the first boy was examined at the Jenner Institute, and the bacilli were isolated. There can, I think, be no doubt that the spread of disease in the two families was due to the presence of the bacillus in the original sufferers at the time, and after their return from hospital. This important question has received attention at the hands of the Asylums Board, who, a few years ago, were disposed to attribute the occurrence of such "return cases" to any but the probable cause, viz., the continued infectiousness of an apparently recovered patient. The Managers thought it a reasonable explanation of the occurrence of such cases in this parish, to cite but one instance, that the late Yestry employed a contractor to do the work of disinfection, and that superheated steam was not employed in the process. But, resolving to make a more precise investigation of the whole subject, in 1898, they appointed a medical expert to inquire into whatever cases should be reported by the medical officers of health. The investigation was completed in 1899, but the result had not been published at the end of the year dealt with in this report. WHOOPING-COUGH. Whooping-cough was the cause of 33 deaths, against 19, 52, and 59 in the three preceding years; 30 in the Town sub-district, and three in Brompton, the corrected decennial average being 65. Thirty of the deaths were of children under five years of age, including seven under one year. The deaths in London, as a whole, from this cause, were 1,948, and 483 below the corrected decennial average. FEVER. Enteric Fever.—One hundred and four cases were notified during the year, against 117, 104, and 107 in the three preceding years. The deaths were 16 (two below the corrected average), viz., 14 in the Town sub-district, and 2 in Brompton. Twelve of the deaths took place in hospitals, to which 72 cases were removed, and 4 at home. The deaths in the three preceding years had been 21, 12, and 23. 26 In London, as a whole, the deaths from this cause were 756, and 116 above the corrected average. The cases admitted to hospitals were 1,728, the deaths in hospitals 245, a case-mortality of 14.1 per cent. The notified cases were 4,309 in number. In the autumn cases of enteric fever are not infrequently imported from the country, and from seaside and other holiday "health resorts." Several instances of this sort occurred in the borough. The infective material of enteric fever is not infrequently conveyed by shell-fish, derived from specifically contaminated water; and it is worthy of remark that in several of the cases locally recorded, the sufferers had partaken of oysters, mussels, etc., at seaside and other places within such periods of time antecedent to date of illness, as to suggest a relationship of cause and effect. There was no death in the borough from typhus fever or simple continued fever. The deaths from these causes in London were 2 and 7 respectivelys the notifications 7 and 73. In Kensington no case of typhus was notified: the notifications of simple continued fever were ten. DIARRHOEA. Diarrhoea was the cause of 105 deaths, against 125, 112, and 101 in the three preceding years ; 98 in the Town sub-district, and 7 in Brompton, the corrected average being 94. Eightynine of the deaths took place in the sixteen weeks ending November 3rd; 30, 30, 10, and 10 in the four successive four-weekly periods. These deaths were irrespective of the deaths from gastro-enteritis, which are now separately classified by the Registrar-General. The deaths from this cause were 21—17 of them under five years of age, including 16 in the first year of life. Ninety-two of the deaths from diarrhoea were of children under five years, including 80 under one year. The deaths from diarrhoea in London, as a whole, were 3,564, and 162 above the corrected decennial average. Considerable attention was given during the year to the classification of deaths commonly and somewhat indiscriminately attributed to diarrhoea. At the instance of the Society of Medical Officers of Health the matter received the attention of the Royal College of Physicians, with the result that the Registrar-General issued a fresh instruction* for the guidance of sub-district registrars when registering the causes of death, especially during the hot season of the year. A number of "causes" of death loosely used in the past were eliminated, and deaths from the said "causes" were directed to be registered as epidemic enteritis, or zymotic enteritis, or epidemic diarrhoea. INFLUENZA. Eighty-five deaths were registered from influenza, against 44, 70, and 103 in the three preceding years. Sixty of the deaths occurred in the Town sub-district, and 25 in Brompton. The deaths in London, as a whole, from this cause were 1,950 (as compared with 491, 679, and 1,817 in the three preceding years), this being the highest number recorded since 1895. OTHER DISEASES OF THE ZYMOTIC CLASS (CLASS I.). Order 5 (Venereal Diseases) includes Syphilis, Gonorrhoea, and Stricture of the Urethra. Syphilis was the registered cause of 19 deaths, against 21, 16, and 17 in the three preceding years respectively. Sixteen of the deaths occurred in the Town sub-district, and 16 of them were of children under one year of age. If the truth were known, it would probably appear that this Protean malady was accountable, directly or indirectly, for many deaths in excess of the record. There was one death from Stricture of the Urethra. Order 6 (Septic Diseases) comprises Erysipelas, Pyœmia, Septiœmia, and Puerperal Fever : the total deaths registered were 14, as compared with 21, 12, and 17 in the three preceding years respectively. Erysipelas was the cause of 9 deaths,† six of them in the Town sub-district, as compared with 9, 7, and 8 in the three preceding years. There was no death from Pyœmia or Septicaemia. Puerperal Fever was the registered cause of 5 deaths, of women between 15 and 45 years of age (as compared with 5, 5, and 5 in the three preceding years respectively), all of them in the Town sub-district. In addition to these 5 deaths, other 19 deaths (all but 3 of them in the Town sub-district) were registered as having occurred in childbed; as compared with 9, 6, and 4, in the three preceding years respectively. The deaths registered as having been caused by diseases and * The instruction was to the following effect :— " Diarrhœa.— This should be registered as the cause of death, only when diarrhoea is written alone, or when it is coupled with some ill-defined cause, such as atrophy, debility, marasmus, thrush, convulsions, teething, old age, or senile decay. In addition to deaths ascribed to diarrhoea, deaths from intestinal or enteric catarrh, from gastro-intestinal or gastro-enteric catarrh, or from epidemic enteritis or zymotic enteritis must be included under this heading ; but deaths from gastric catarrh, gastro-enteritis, or enteritis must be excluded from this heading." † The notifications of erysipelas were 159, many of the cases being of traumatic origin, unimportant in character, and such as the framers of the Act could scarcely have intended to be notified. 27 accidents associated with parturition (24 in all) were equal to 6.7 per 1,000 live births, against 3.8, 3.0, and 2.5 per 1,000 in the three preceding years respectively. The notifications of puerperal fever were 9 in number. Bearing in mind the disastrous series of cases of this disease on which I reported in 1883, when a verdict of manslaughter was returned by a coroner's jury against a midwife, under circumstances set out in the fourth and sixth reports for that year, I have since made it my duty to warn nurses, and other women concerned with these painful cases, of the responsibility they incur by attending parturient women until after a period of three or four weeks, and disinfection of their persons, clothing, &c. This course was adopted in respect of the cases notified in 1900 with satisfactory results, there having been no spread of the disease. Class III.— Dietetic Diseases. The deaths from the diseases in this Class were 20 : 15 of them in the Town sub-district. Delirium Tremens was the cause of five deaths, as compared with 4, 6, and 2 in the three preceding years respectively; Chronic Alcoholism of fourteen deaths, against 11, 18, and 17. It is scarcely necessary, perhaps, to remark that if all the deaths due, directly or indirectly, to the immoderate use of intoxicating liquors were correctly certified, alcoholism would occupy a more prominent position in the bills of mortality; but many deaths due to the misuse of alcohol get certified, and are necessarily classified, to visceral and degenerative diseases caused or aggravated by drink. Class IV.— Constitutional Diseases. This important Class comprises the causes of 514 deaths (19.1 per cent. of total deaths), including 63 of children under the age of five years; 405 of the deaths were registered in the Town sub-district, and 109 in Brompton. Rheumatic Fever and Rheumatism of the Heart caused 12 deaths, 11 of them in the Town sub-district; Rheumatism 4. Gout was the cause of 5 deaths, all of them in the Town sub-district, and Rickets of 6, five of them in the Town sub-district. Cancer, Malignant Disease, was accountable for 152 deaths : 105 in the Town sub-district and 47 in Brompton. Cancer would appear to be on the increase in the country generally: possibly, however, some portion of the apparent increase in the number of deaths classified to this cause, may be due to greater accuracy in diagnosis. The deaths in Kensington in the ten preceding years were 125, 127, 129, 140, 143, 136, 173, 168, 193, and 169 respectively. Deaths from malignant disease are usually more numerous, proportionately to population, in the Brompton subdistrict than in the relatively poorer Town sub-district, cancer being quite as prevalent, probably even more prevalent, amongst well-to-do people, than in the poorer classes. The parts of the body most commonly affected are the viscera or internal organs; in women, the uterus and the breast; the disease, moreover, being for the most part one of later life. Thus, 130 of the deaths took place at ages above forty-five, and 18 between thirty-five and forty-five years. Tubercular Diseases were the registered causes of 306 deaths (as compared with 340, 333, and 319 in the three preceding years respectively); viz., 260 in the Town sub-district, and 46 in Brompton : 57 of the deaths were of children under five years of age. In a few instances Phthisis was returned as the cause of death in infancy, a period of life at which the tubercular diathesis commonly manifests itself in other parts of the body than the lungs, e.g., the brain, bowels, &c. Such deaths have been classified with those ascribed to "Other forms of Tuberculosis," the total being 50 (of which 17 occurred under five years of age), including 46 registered in the Town subdistrict. Tabes Mesenterica, popularly known as consumption of the bowels, was the cause of 9 deaths (8 of them in the Town sub-district); 8 of them under five years of age, and 6 under one year. Tuberculosis of Meninges was the cause of 37 deaths; 8 of them in Brompton, and 29 under five years of age. Phthisis (Tuberculosis of Lungs) popularly known as decline or consumption, was the cause of 210 deaths. Of the total deaths, 177 belong to the Town sub-district, and 33 to Brompton. The deaths from tubercular diseases were, proportionately to population, not nearly so numerous in Brompton as in the Town sub-district.* Class V.—Developmental Diseases. In this Class the total deaths were 210, viz., 185 in the Town sub-district, and 25 in Brompton. Premature Birth was the assigned cause of 83 deaths, 10 of them in the Brompton sub-district; Atelectasis of 14, 13 of them in the Town sub-district; and Congenital Malformation of 15, 11 of them in the Town sub-district. Old Age was the registered cause of 98 deaths, all but two of them at ages over sixty-five: between sixty-five and seventy-five there were 16 deaths so classified; between seventy-five and eighty-five 52; and at eighty-five and upwards 28. * Under the heading " The Treatment of Consumption," further information on the subject of Tuberculosis will be found at page 31. 28 Class VI.— Local Diseases. The Diseases in this Class, which comprises eleven Orders, named after the systems or organs to which the diseases relate, were accountable for 1,338 deaths (as compared with 1,616 in 1899), or 49.6 per cent. of the deaths from all causes: 1,055 were registered in the Town sub-district, and 283 in Brompton; 313 were of children under five years of age. The deaths from the diseases comprised in the several Orders were as follows:— 1. Nervous System.— Diseases of the nervous system were the registered causes of 257 deaths (as compared with 265, 241, and 291 in the three preceding years respectively), viz., 197 in the Town sub-district, and 60 in Brompton: 62 of the deaths were of children under five years of age, and 157 occurred at ages over forty-five. The fatal diseases were, Inflammation of the Brain or Membranes, 24 deaths; Apoplexy, Softening of the Brain, Hemiplegia, Brain Paralysis, 117 deaths (82 in the Town sub-district, 35 in Brompton); Insanity, General Paralysis of the Insane, 14 (twelve of them in the Town sub-district) : Epilepsy, 9 ; Convulsions, 40 (all under five, and 39 under one year); Laryngismus Stridulus, 2; Disease of the Spinal Cord, Paraplegia, Paralysis Agitans, 7; Other Diseases of Nervous System, 44. 3. Circulatory System.— The deaths due to diseases of the organs of circulation, heart and blood vessels, were 227, as compared with 210, 200, and 256 in the three preceding years respectively: 156 were registered in the Town sub-district, and 71 in Brompton. Heart diseases proper caused 202 deaths. To specified forms of disease, 62 deaths were ascribed, viz., Pericarditis, 2; Acute Endocarditis, 5 ; Valvular Diseases of the Heart, 55. Other Diseases of the Heart caused 140 deaths. Aneurism was the cause of 7 deaths, and Embolism, Thrombosis, of 11. Other Diseases of Blood Vessels caused 7 deaths. 4. Respiratory system.— The deaths from the diseases of the respiratory organs, Phthisis being excluded, were 542 (as compared with 491, 572, and 672 in the three preceding years respectively), and 20.l per cent. of total deaths. Of these deaths 454 were registered in the Town sub-district, and 88 in Brompton. The deaths under five years of age were 171, or 31.5 per cent., as compared with 38.7, 38.3, and 27.2 per cent. in the three preceding years; and at fifty-five and upwards, 260, or 47.9 per cent., against 36.9, 40.7, and 47.5 per cent. in the three preceding years. Bronchitis was the cause of 370 deaths, Pneumonia, of 115. These diseases, therefore, were accountable for 485 deaths (including 167 under five years of age), of which 77 were registered in Brompton. 5. Digestive System.— The diseases of the various organs concerned in digestion were the causes of 182 deaths; 74 of them under five years of age; 149 in the Town sub-district, and 33 in Brompton. Dentition was the cause of 21 deaths under five, 19 of them under one year. Diseases of the Stomach caused 27 deaths; Enteritis, 30; Gastro-enteritis, 21; Obstructive Diseases of Intestine, 18; Peritonitis, 10. Cirrhosis of Liver caused 25 deaths; Jaundice and other Diseases of Liver, 19 (including three under one year); and Other Diseases of Digestive System, 11 deaths. 8. Diseases of Urinary Organs.— Of the 82 deaths ascribed to these causes, 60 were registered in the Town sub-district, and 22 in Brompton. The fatal diseases were Nephritis, 18 deaths; Bright's Disease (Albuminuria), 34; Diseases of Bladder or of Prostate, 10; and Other Diseases of Urinary System, 20 deaths. Class VII.—Deaths from Violence. One hundred and six deaths, including 43 under five years of age, and 37 under one year, are distributed over two of the four Orders comprised in this Class: 17 of them belong to the Brompton sub-district. 1. Accident or Negligence.—Total deaths, 88, including 12 in Brompton, and 43 under five years of age ; viz., from Fractures and Contusions, 40; Burn, Scald, 11; Drowning, 1; Suffocation, mostly of infants overlaid, 32; Otherwise, 4. Thirty-seven of these "accidents" occurred to children of less than one year old. Thirty-one of the deaths from suffocation were registered in the Town sub-district. 3. Suicide.— Total deaths, 16; including 4 in Brompton, viz., by Gun-shot Wounds, 5; Poison, 3; Drowning, 4; Hanging, 1; Otherwise, 3. Class VIII.— Deaths from Ill-Defined and not Specified Causes. This Class includes the causes of 103 deaths, 86 under five years of age, and 81 under one year; 89 and 14 in the Town and Brompton sub-districts respectively. The causes named were : Dropsy, 2; Debility, Atrophy, Inanition, 84 deaths (all under five years of age, and 80 under one year); Mortification, 12; Tumour, 1; and Abscess, 1. To Causes not Specified or Ill-defined, 3 deaths were ascribed. 29 BUBONIC PLAGUE. Considerable alarm was caused in August owing to the occurrence at Glasgow of cases of bubonic plague—a disease which was last epidemic in England in 1665 (the year preceding the Great Fire of London) and of which a graphic account is contained in De Foe's " History of the Plague," a work probably based on contemporary records. Plague is a highly infectious fever closely resembling typhus in its symptoms, but distinguishable from it by the absence of any true rash, and by the development of buboes and carbuncles. Due to a specific organism, bacillus pestis, it affects chiefly the poor, is eminently contagious, and spreads rapidly under the conditions of privation, filth, and overcrowding, characteristic of slum areas. The infection may be conveyed by breath, by fomites, and by inoculation. Rats have been credited (and not without reason) with a large share in the transmission of the infective matter. The presumption is that the disease was introduced to Glasgow by shipping, but the source of the original case or cases was not traced. The first known cases were of a child and her grandmother who died after short illnesses on 7th and 9th August respectively, the cause of death, as certified, being, in the child's case, zymotic enteritis; in the woman s case, acute, gastro-enteritis. Wakes were held over both bodies, and to this cause the spread of infection was attributed. The woman was buried 11th August. Next day the husband, a dock labourer, fell ill, having apparently contracted the disease from his wife or his grandchild. He was admitted to hospital on August 28th. Prior to this, however, four members of another family had fallen ill—on the 19th, 20th, 22nd and 23rd August respectively. The first of these cases was medically attended ten minutes only before death, which was attributed to acute pneumonia. It chanced that the other three patients were seen, independently, by two medical men, who, on comparing notes, recognised that they had to do with an infectious disease of an unusual kind, and in order to secure admittance of the sufferers to hospital, notified the illnesses as "enteric fever?" The cases were admitted 25th August; the characteristic buboes were observed; microscopic and bacteriological examination of blood from them was made, the bacillus pestis was isolated, and plague was diagnosed. All the subsequent cases were removed to hospital, and persons who had been present at the wakes, or had otherwise been brought into contact with the sick ("contacts" these are called) were placed in "reception houses," and kept under observation. A few of these persons subsequently developed plague, the cases for the most part being of a fairly mild type. None of the medical men or nurses were attacked, they (and the "contacts" also) having been inoculated with anti-plague serum obtained from the Pasteur Institute at Paris. Happily the disease did not spread widely, and, thanks to the energy with which the emergency was met, the disease did not become epidemic. Needless to say, the Glasgow authorities took every possible precaution with the view to prevent spread of the malady. The insanitary area in which the first known cases occurred received special attention, and efforts were made to exterminate rats in the infected houses, though no evidence was forthcoming to show that they were affected. Plague has an incubatory period (i.e., the time between exposure to infection and development of illness) of about four to fourteen days. The onset of illness is sudden, the earlier and more prominent symptoms being shivering, general malaise, hot and dry skin, quick pulse, sighing breathing, headache, nausea and vomiting, diarrhoea, pain in the abdomen, tongue furred in the centre, clean at edges, etc. The fever, as before stated, is of the type observed in typhus. Prostration comes on rapidly, and is great. The face is of a greyish colour, the aspect dull and anxious; and there is stupor with delirium, proportional to the gravity of the attack. These symptoms are not necessarily all present in every case, and they vary in degree in different cases: the most characteristic, and that which gives name to the disease, is the presence of swellings of the lymphatic glands—of the neck, arm-pit, groins, etc.— "buboes." These buboes vary in size. Always more or less tender, they are in many cases exquisitely painful and intensely inflamed. Death may ensue within a day or two. Usually the fatal result happens at a later period. In severe cases that recover there is a crisis on the 12th to the 20th day of disease, marked by fall in temperature and pulse, diminution of local pain and headache; the patient " feels much better." Precautions in London.—The Local Government Board, in the exercise of the powers given to them by the Public Health (London) Act, 1891, added plague to the list of notifiable diseases; and in conformity with the requirement of their Order, dated September 19th, circular letters were sent by the late Vestry to all legally qualified medical practitioners in Kensington, informing them of their duties under the regulations comprised in the said Order. The Board, moreover, issued an advisory circular letter to the sanitary authorities (9th October), together with "Memoranda with respect to Plague," comprising— (a) Plague Memorandum, (1) Administrative Considerations, (2) Symptoms of Plague. (b) Directions for obtaining and forwarding for Bacterioscopic examination Material from Suspected Plague Cases. (c) General Memorandum on the Proceedings which are advisable in Places attacked or threatened by Epidemic Disease. 30 On 10th October I reported on the subject as follows: "With reference to the letter and memoranda received to-day from the Local Government Board—the matter, moreover, being one of urgency—I think it right to direct the attention of your Vestry to the advice tendered by the Board to Sanitary Authorities generally on the subject of proceedings which are advisable with a view to the prevention of epidemic disease, including plague. "The Board observe that if the plague obtains foothold in any district, it will specially affect insanitary areas such as are peopled by the poorest class, and where overcrowding of persons in houses, and dirt and squalor of dwellings and of inhabitants, tend to prevail; and they advise that— ' Wherever there is nuisance of any sort, it should, as promptly as possible, be abated, and precaution should be taken not to let it recur.' "The Board, while urging that Local Authorities should be on their guard against plague, add that it is not intended to suggest that there at present exists any cause for alarm; but they evidently consider that means of prevention should be adopted forthwith— viz., by putting insanitary areas and poor districts into the best practicable sanitary condition. "All this is very much what I said in my ninth report (dated 13th September), which was referred to the Sanitary Committee, as I had recommended the employment, temporarily, of additional Sanitary Inspectors to make special inspections and assist in the enforcement of the law with regard to the cleanliness of premises, overcrowding, &c." The Committee not having submitted any recommendation for the appointment of temporary inspectors, I again called attention to the desirability of such appointments being made, in view of the advice given by the Local Government Board, and the action taken by the Asylums Board in making hospital provision, etc., and by the County Council, who had arranged to provide reception houses for "contacts," i.e., persons who have been in contact with actual or suspected cases of plague. The Vestry decided forthwith to appoint four temporary inspectors for a period of six weeks, the result being that a good deal of house-to-house inspection was carried out in the poorer part of the borough, especially in North Kensington, efforts being specially directed to cleansing of rooms, the removal of filth and rubbish from, and the disinfection of unpaved yards—suitable breeding-grounds for the bacillus pestis. The Public Health Committee of the London County Council gave much attention to the subject, and their report on "Precautions against Plague in London" (26th September) was adopted by the Council. This report set out the action recommended with respect to the provision of "isolation homes" for persons who had been in contact with cases of plague, and advised that the Council should provide all necessary accommodation" rather than that the duty should be divided among a number of local sanitary authorities." The Council had been asked by the Local Government Board, How long it would take to" get such accommodation ready for immediate use—say for 1,000 persons in 200 families"? The Committee stated that the Council had properties available, "some of which could at a few hours' notice be rendered fit for occupation, while the repairs at the others would not take more than a few days;" they were willing, moreover, to" provide or obtain any further accommodation that might be necessary." "The actual cases of plague would be sent to the hospitals of the Metropolitan Asylums Board," while " the medical inspection of infected areas, and disinfection of premises and articles after cases of plague, would........be undertaken by the sanitary authorities." The Council, moreover, made arrangements, with a view to cases or suspected cases of plague being inquired into by a medical man familiar with the disease, and for bacteriological examination in suspected cases. It may be mentioned that under section 13 of the London County Council (General Powers) Act, 1893, the Local Government Board have power to " assign to the Council any powers and duties under epidemic regulations made in pursuance of the Public Health Act, 1875, which they may deem it desirable should be exercised and performed by the Council." But the Board, while deeming it desirable that preparations should be made, did not think it necessary to issue such regulations. A few cases of plague subsequently occurred at different places, but the symptoms of the disease as observed at Glasgow had been described so fully in the medical press that it was speedily recognised, precautionary measures were adopted, and there was no spread. At all ports vigilance was exercised. In London the Asylums Board set apart wards at the SouthEastern Hospital (at Deptford) for the reception of possible sufferers, this hospital being the nearest to the river. So far, happily, the country has escaped any serious outbreak, and the machinery for dealing with such a possible contingency is kept in readiness for any emergency. 31 ARSENICAL POISONING BY BEER. Considerable alarm was created throughout the country at the latter part of the year owing to an outbreak of a disease, known as peripheral neuritis, in certain towns in the northern counties and the Midlands. The disease consists mainly in an inflammation of the nerves of the extremities, chiefly below the knees and the elbows, and is marked by weakness, or want of power, in the limbs, with pain and abnormal sensations; pigmentation of the skin and many other symptoms, varying in different cases; some of them, however, being characteristic of chronic arsenical poisoning. The first cases were observed at Manchester, where the trouble appeared to have been going on for some months, and to have affected many hundreds of persons. The one feature in the previous history of the sufferers, common to all, was that they were beer drinkers. Analytical examination of draught and bottled beers and stouts revealed the presence of arsenic in numerous samples, and subsequent investigations led to the conclusion that this poisonous mineral had found its way into the beer as an abnormal constituent of the materials used as substitutes for malt in the preparation of the "national beverage"—viz., invert sugar and glucose. In the manufacture of these substances, sulphuric acid is used. The cheap, commercial form of this acid is prepared from iron pyrites, which is known to contain arsenic. To the use of such acid the mischief was due. The glucose containing the poison was manufactured chiefly, if not wholly, by a limited liability company in a northern town, and had been supplied to some two hundred breweries. This company lost no time, after discovery, in warning their customers not to use their glucose, and to destroy all beer prepared therefrom. In the Metropolis there was no evidence of unusual prevalence of peripheral neuritis, either in hospital returns or in the bills of mortality. There is a glucose manufactory in Fulham, but the material is not supplied to any brewery in this borough. The Medical Officer of Health informed me that he had had the company's products examined, with satisfactory results. I advised the collection of samples of beer for analysis in our poorer districts. This was done, and in no case was arsenic found in the beers, or in any glucose. It should be understood that arsenical contamination would not constitute an offence under the Adulteration Acts; but the continued sale of poisonous drink would involve serious consequences to the vendor. As to the future, provision should be made, by legislation, to secure the freedom from arsenic of the sulphuric acid used in the manufacture of malt substitutes. It would be an advantage to the country, in many ways, should the recent unfortunate occurrences lead to diminished use of such materials, and were the " national beverage " to become once more for those who desire it a decoction of malt and hops only. THE TREATMENT OP CONSUMPTION. In the first report for 1899 (January 31st, page 5), "The Prevention of Consumption," was dealt with—a subject then and since much in evidence in the medical and general Press. The report was referred to the sanitary committee, and by them to a sub-committee, whose report, "with slight modifications" by the committee, was submitted to the late Vestry and adopted (vide Minutes, page 1,037). The subject was further referred to in the third report (March 29th, 1899, page 31), but no action was then taken thereon. It was also dealt with in the annual report for 1899 (pp. 113 —130, inclusive). A resume of the late Vestry's proceedings in relation thereto will not be out of place here. I had prepared for the consideration of the sub-committee a draft report, which contained the following paragraph:— "Consumption is not merely preventable; in its early stages, more especially, it is also curable. But to the generality of sufferers the means of cure are not available, for few of them, probably, possess the means to obtain facilities for the ' open air treatment'—the segregation, 'the constant exposure to fresh air, light, sunshine, &c., necessary to secure the end in view. Happily it is in the power of the Metropolitan Sanitary Authorities to provide these facilities for those who need their help; viz., by the exercise of the powers conferred on them by Section 75 of the Public Health (London) Act, 1891, which enable them to provide hospitals for the inhabitants of their districts, or make other arrangements for the purpose." This paragraph was not embodied in the report of the sub-committee, nor the consequential recommendation, that consumption should be dealt with " by provision of a hospital or hospitals, or by making other arrangements so as to enable poor consumptive persons to be isolated and treated, under the best attainable conditions to secure restoration to health." The report of the subcommittee, however, contained the subjoined paragraph, the excision of which constituted one of the " modifications " made by the committee:— " (6) It is perhaps almost needless to observe that Consumption is a common cause of pauperism. The bread-winner works while he can, but the time arrives when he can work no longer. Then, too often, he has to 'come on the rates.' Many such cases find their way to the Workhouse Infirmaries—with disease hopelessly advanced and beyond remedy. They become a source of danger to other persons, and, no doubt, spread infection more or less. It is a question whether it would not be well for Boards 32 of Guardians to make special provision for housing such cases away from other inmates, and, preferably, in establishments quite distinct. Different Boards might be enabled to unite for such a purpose, and also for the purpose of providing country hospitals for the treatment, with a view to the cure, of the disease. Expenditure for such purposes would probably be a profitable investment of public moneys. The Kensington Guardians might be approached on the subject by the Vestry, as Sanitary Authority. The present time would seem to be an appropriate one to do so, as the Guardians are contemplating the erection of an additional block (at an estimated cost of £13,000) to provide improved and increased accommodation for women and children at the workhouse. It is just . possible that, by making provision for consumptives away from the workhouse and infirmary, the additional accommodation thus set free would, in part at least, obviate the necessity for the proposed expenditure. But, apart from this point altogether, the matter is one in regard to which the sanitary and the poor-law authorities might take counsel together with advantage." The recommendations of the committee, in the report, as finally settled, were to the effect that the Vestry" do adopt means* for the prevention and cure of consumption and tubercular diseases generally, e.g.:— "(1) By spreading information as to the nature and cause, the preventability and curability of tuberculosis, and especially of consumption; and by inculcating the necessity of thorough cooking of meat, and the boiling of milk. "(2) By disinfection of houses after the occurrence of fatal cases of consumption, and after removal of consumptives to new abodes." The report of the committee having been referred back, in order to give effect to these recommendations, the sub-committee requested me to state my views as to the action that should be taken by the Vestry. Briefly, I advised the preparation of a leaflet for distribution to medical men, clergymen, head teachers of schools, &c. I also advised disinfection of infected houses, and a system of voluntary notification (vide Report, in Minutes of the Vestry, June 14th, page 204). A leaflet (" The Prevention of Consumption ") was duly prepared and circulated (vide Minutes of the Vestry, page 206). I estimated that disinfection would be required in from 200 to 300 cases annually, at an average cost of one pound per case, and stated that "further assistance would be necessary in the disinfecting department." I also expressed the hope that an effort would be made to secure, as recommended by the sub-committee, " enforcement of the provisions of sanitary law for the prevention of overcrowding, and the abatement of nuisances generally, so as to secure healthy homes for the poorer classes." But beyond circulation of the leaflet nothing was done. The subject of "Tuberculosis" was again dealt with in the first monthly report in 1900 (January 31st, page 7); the following paragraph referring to the matter dealt with in the deleted par. 6, in the sub-committee's report above cited :— "No additional accommodation has been, or is to be, provided at the workhouse, the Local Government Board having refused their sanction to the projected extension, on the ground that already there was a sufficient number of persons on the space occupied by the workhouse and infirmary. Possibly the Guardians, if their attention were called to the subject by the Vestry, as sanitary authority, might entertain favourably the suggestion to provide, apart from their present infirmary, requisite accommodation for consumptive persons dependent on their assistance." No action having been taken on this report, I addressed a communication to the Clerk to the Board of Guardians (February 15th, 1900), as follows :— " I am sending you a copy of my report submitted to the Vestry yesterday, and desire to call your attention to par. 7, page 7, on the subject of ' Tuberculosis.' I also send you a copy of the report of a sub-committee of the Sanitary Committee, dated March, 1899, dealing with 'The prevention of Consumption and other forms of Tuberculosis.' I think it would be well to invite the attention of the Guardians to the subject. In some parts of the country, I believe, action has been taken by the Poor Law Authority to secure separation of consumptives from other sick persons. I should be glad if the Kensington Guardians, alone or in combination with other Boards, could see their way to adopt this plan. I dealt with the subject in two of the monthly reports last year, and should the Guardians take up the matter, than which I can conceive of none other more important, I shall be pleased to furnish copies of the reports, and to assist them in any way within my power." This communication was referred to the Infirmary Committee for consideration, and their report thereon was adopted by the Guardians as follows:— "Report of the Infirmary Committee with respect to the separate treatment of Tubercular diseases. "Your Committee have had under consideration the letter from the Medical Officer of Health for Kensington upon the subject of the prevention of Consumption and other forms of Tuberculosis, together with his suggestions as to the treatment of tuberculous cases separate from other patients, either by the Guardians in their own Infirmary, or in combination with other Boards in separate Institutions specially provided for the purpose. * The sub-committee recommended " all practicable means." The words in italics were deleted by the committee. 33 "The question of the special treatment of tuberculous cases in the Infirmary has already engaged the attention of your Committee, upon the request from the Medical Superintendent for the provision of a glass verandah, under which he could try the experiment of the effect of such open-air treatment as may be possible in the neighbourhood of the metropolis, upon the female patients in the Infirmary suffering from tuberculous disease, and they recommend that such a verandah or screen be fixed on. the south side of Ward IX., and that this ward be set apart, so far as its accommodation admits, for the separate treatment of women and children suffering from these diseases. "The suggestion of Dr. Dudfield is a very large one, necessarily involving a very large expenditure in the provision of special institutions in suitable selected localities, and until the result of the experiment proposed to be tried on a small scale here, as well as of other experiments which your Committee believe are in contemplation, for the separate and ' open-air' treatment of tuberculous diseases has been ascertained, your Committee do not feel justified in recommending the Guardians to proceed further in the direction indicated by the Medical Officer of Health. "Should the results of the experiment proposed to be made with the female patients prove satisfactory, your Committee will consider how far it may be practicable to make a similar provision in connection with the men's side." The ward selected for the experiment has a south aspect and is light and sunny: the value of pure air, light, and sunshine, in the treatment of consumption, cannot be over-estimated. Combined action of the London Poor-Law Authorities.—On October 15th, 1900, a Poor Law Conference was held at St. Martin's Town Hall, " to consider the general question of establishing hospitals for the open-air treatment of consumption." No fewer than 77 delegates were present, 26 out of the 32 Poor Law Authorities of the Metropolis being represented ; Kensington, among them, by Mr. Rutherglen, Clerk to the Guardians, and Dr. Potter, Medical Superintendent of the Infirmary. Sir William Broadbent, chairman of the National Association for the Prevention of Consumption, took part in the proceedings, as did (but unofficially), Dr. Downes, Medical Inspector to the Local Government Board. Correspondence was read showing that the Local Government Board, on the matter having been brought before them, expressed sympathy with the Managers of the Poplar and Stepney Sick Asylum District (to whose initiative the holding of the Conference was due) in regard to provision being made for the open-air treatment of Phthisis, but intimated their opinion that such provision, if made at all, should be for the Metropolis as a whole, and be under the management and control of a Metropolitan authority. The Board also suggested the holding of a conference of Metropolitan Poor Law Authorities. An interesting discussion took place, in which Mr. Rutherglen took part, stating that " Kensington had arrived at the conclusion that separate treatment of consumption was desirable " ; expressing the opinion that "provision would have to be made for about 1,000 persons," for all London, and suggesting that " the Local Government Board should be approached with the view of obtaining from them the necessary Order for such provision." He pointed out, as the aforementioned sub-committee of the late vestry had done, in March, 1899, that " by providing separate sanatoria for consumption, the infirmaries would have a portion of their accommodation set free for other purposes," and he recommended enquiry to be made by the Poor Law authorities in London, as to " the number of cases of phthisis chargeable to them which would be fit subjects for treatment in the way proposed," and that " the Local Government Board should then be asked to give to the Asylums Board the requisite powers to carry the proposals into effect"; a suggestion which was favourably received. Sir William Broadbent expressed his " admiration of the proposal," which had brought the meeting together, and his " sympathy with the objects of the movement"; for "nothing could be said that could exaggerate the importance of the project which, he hoped, would be initiated at that Conference." He approved " a movement on the part of London as a whole," and cited what had been done at Liverpool, with the approval of the Local Government Board. He also commended the system of house-to-house visitation by " Women Health Visitors, " as at Manchester and elsewhere (a subject dealt with at page 52 of the present report), whereby cases of consumption would become known ; he thought, moreover, that it would be necessary to have some kind of voluntary notification of phthisis. " Everything," he added, " that tended to prevent consumption, by removing the hygienic conditions which contributed to it, also tended to check the prevalence of other diseases." Dr. Downes agreed with Mr. Rutherglen's figure of 1,000 cases " as that for which separate accommodation of the kind suggested would probably have to be provided," and should, I may observe, be provided in at least four or five hospitals. He said that on July 7th last, there were 1,562 consumptive patients in Metropolitan institutions, of whom 1,000 could be moved to a sanatorium or sanatoria within 50 miles of London, and of the total number 400 were in the initial stages of the disease. The meeting unanimously resolved— "That this Conference of Poor Law Authorities, having discussed the question of the open-air treatment of Consumption, are of opinion that the time has come when provision should be made for the treatment by this method of the sick poor of the Metropolis suffering from phthisis, and it recommends the matter for the consideration of the Local Government Board with a view to the necessary steps being taken by that Board for the carrying out of the proposal." A deputation was appointed to bring the matter before the President of the Local Government Board; but, so far as I am aware, nothing has yet been done to give practical effect to the decision of the conference. Time is necessarily required for preliminary enquiry and organisation, and possibly legislation may be necessary. 34 DEATHS IN PUBLIC INSTITUTIONS. The only large public institution in which we are directly interested, is the borough infirmary and workhouse, situated in the Town sub-district. There are several minor public or quasi-public institutions, but, with one exception, they do not furnish occasion for special remark. The excepted institution is St. Joseph's House, Portobello-road, Notting-hill—a Roman Catholic Home for aged poor persons of both sexes, brought from various parts, largely from Ireland; but which is not classed by the Registrar-General as a public institution. The deaths of non-parishioners at the Marylebone Infirmary, Notting-hill (521), at the Brompton Consumption Hospital (96), and at St. Joseph's House (34), are excluded from our statistics, but will furnish occasion for a few remarks later on. The deaths of parishioners at the Parish Infirmary and Workhouse (476), at the Consumption Hospital (2), at St. Joseph's House (2), St. Marylebone Infirmary (1), and at outlying institutions, &c. (283), were 764, or 28.3 per cent. on total deaths; the percentage proportion of deaths in public institutions in the Metropolis, generally, being 30.5, viz., 15.8 in Workhouses and Workhouse Infirmaries ; 2.0 in Metropolitan Asylums Board Hospitals ; 10.3 in other hospitals, and 2.4 in Public Lunatic and Imbecile Asylums. The Registrar-General in his Annual Summary states that "about one in every six deaths occurred in a workhouse or workhouse infirmary, one in 51 in a Metropolitan Asylums Board Hospital, one in ten in some other hospital, and one in 42 in a public lunatic or imbecile asylum." The increase in the number of deaths in public institutions has been great and continuous for many years. The Parish Infirmary and Workhouse.— I am indebted to Dr. H. Percy Potter, the medical superintendent, for the statistics of mortality at these important institutions. The deaths set out in the Table below were 476, as compared with 493, 497, and 603, in the three preceding years respectively, and were equal to 17.6 per cent., or more than one-sixth of the deaths in the borough. The quarterly numbers were 152, 102, 111, and 111 : 263 deaths, therefore, occurred in the first and fourth or colder quarters, and 213 in the second and third or warmer quarters of the year. The deaths included 240 of males, and 236 of females. The ages at death were:—Under one year, 58 (as compared with 81, 64, and 73, in the three preceding years respectively); between one and sixty, 213 (as compared with 255, 221, and 309, in the three preceding years), and at sixty and upwards, 205 (as compared with 157, 212, and 221, in the three preceding years). SUMMARY OF CAUSES OF DEATH, 1900. DISEASES. Under 1 year. Between 1 year and 60 years. At 60 years and upwards. Total.[/##] Nervous System, Diseases of — 20 13 33 Circulatory System, Diseases of — 18 30 48 Respiratory System, Diseases of 8 44 59 111 Digestive System, Diseases of 4 7 16 27 Urinary System, Diseases of — 13 9 22 Tubercular Diseases (including Marasmus) 28 77 6 111 Cancer — 13 10 23 Erysipelas — 3 — 3 Cellulitis — 1 2 3 Rheumatism and Gout — 2 1 3 Syphilis 8 1 — 9 Gangrene — 1 3 4 Premature Birth 8 — — 8 Delirium Tremens and Alcoholism — 4 1 5 Bones and Joints, Injuries and Diseases of — 3 6 9 Various other Diseases 2 6 1 9 Senile Decay — — 48 48 58 213 205 476 Thirteen inquests were held: the cause of death was natural in 4 cases; and injury, in some form, in 9 cases. 35 The Hospital for Consumption and Diseases of the Chest.—In the Kensington portion of the Brompton Hospital there were 98 deaths, including two of parishioners. The remaining 96 deaths, of non-parishioners, are excluded from the borough statistics. St. Marylebone Infirmary, Notting Hill.— At this institution 522 deaths were registered, all of which, except one of a parishioner, are excluded from the borough statistics. St. Joseph's House, Notting Hill.— The deaths at this quasi-public institution, with the exception of 2, of parishioners, are excluded from our statistics. They were 36 in number. Outlying Public Institutions.— The deaths of parishioners at public institutions, &c., without the parish, which in the three preceding years had numbered 333, 286, and 321, were 283 in 1900. All of these deaths are included in the borough statistics. The deaths occurred at the several institutions as follows:— St. Mary's Hospital 51 Heart Hospital, Soho 1 St. George's Hospital 81 Hospital for Women, Euston Road 1 West London Hospital 14 Great Northern Central Hospital 1 Charing Cross Hospital 5 Throat Hospital, Golden Square 1 St. Thomas's Hospital 5 Friedenheim 4 Middlesex Hospital 4 St. John's Home, Lewisham 1 King's College Hospital 2 St. Peter's Home 1 Guy's Hospital 2 Hostel of God 1 St. Bartholomew's Hospital 2 Home of the Good Shepherd, Clapham 1 University Hospital 1 H.M. Prison, Holloway 2 Westminster Hospital 1 H.M. Prison, Wormwood Scrubbs 1 Western Hospital 26 Paddington Workhouse 1 North-Western Hospital 4 Paddington Infirmary 1 Grove Hospital 3 Chelsea Infirmary 1 Fountain Hospital 2 Banstead Asylum 14 South-Western Hospital 1 Hanwell Asylum 12 London Fever Hospital 1 Colney Hatch Asylum 6 Cancer Hospital, Chelsea 3 Leavesden Asylum 6 Brompton Hospital (south wing) 3 Dartford Asylum 5 North-London Consumption Hospital 1 Darenth Asylum 4 Children's Hospital, Paddington 4 Caterham Asylum 4 Children's Hospital, Great Ormond Street 2 Ilford Asylum 4 Yictoria Hospital for Children 2 Manor Asylum, Epsom 3 German Hospital 2 Cane Hill Asylum 2 National Hospital 2 Clay bury Asylum 1 Queen Charlotte's Hospital 2 Salvation Army Home, Hackney 3 Bolingbroke Hospital 1 Incubators, Earl's Court Exhibition 2 Bethlem Hospital 1 264 French Hospital 1 Hampstead Home Hospital 1 Other 19 deaths occurred without the borough, viz.: two of females by drowning, in the Thames and Grand Junction Canal respectively; three of males in the streets; two of males on railway premises; and seven of males, and five of females, on private premises. Deaths from diseases of the zymotic class occurred at public institutions, without the borough, as follows:—Western Hospital, 24 (diphtheria, 15; enteric fever, 4; scarlet fever, 3; measles, 2); Grove Hospital, 3 (enteric fever); North-Western Hospital, 3 (diphtheria, 2; enteric fever, 1); St. Mary's Hospital, 3 (enteric fever, 2; diarrhoea, 1); St. George's Hospital, 3 (enteric fever, 2; measles, 1) ; Fountain Hospital, 2 (diphtheria); Children's Hospital, Paddington, 2 (diarrhoea); Children's Hospital, Great Ormond-street, 1 (measles); West London Hospital, 1 (diphtheria); London Fever Hospital, 1 (scarlet fever); South-Western Hospital, 1 (diphtheria); and Ilford Asylum, 1 (diarrhoea). UNCERTIFIED DEATHS. Two deaths were uncertified either by a registered medical practitioner or by a coroner. The cases were reported to the coroner. In England and Wales the deaths not certified were 1.9 per cent. of total deaths ; the proportion in London was 0.6; in Kensington, less than 0.1. The subject of uncertified deaths was considered, in the session of 1893, by a Select Committee of the House of Commons, appointed " to enquire into the sufficiency of the existing law as to the disposal of the dead, for securing an accurate record of the causes of death in all cases, and especially for detecting them when death may have been due to poison, violence, or criminal neglect." The recommendations of the Committee were summed up in ten paragraphs, of which the first two were as follows:— " (1) That in no case should a death be registered without production of a certificate of the cause of death, signed by a registered medical practitioner, or by a coroner after inquest. " (2) That in each sanitary district a registered medical practitioner should be appointed as Public Medical Certifier of the cause of death in cases in which a certificate from a medical practitioner in attendance is not forthcoming." No action has been taken by the House, so far, to give effect to the recommendations. 36 INQUESTS. Two hundred and thirty-five inquests were held on parishioners, including 34 at places without the parish, mostly at public institutions to which the deceased persons had been removed for treatment. The cause of death is stated to have been ascertained by post-mortem examination in 100 cases. Thirty-three inquests were held on the bodies of non-parishioners who had died in Kensington. All inquests in the parish were held at the coroner's court at the Town Hall. The causes of death in inquest cases may be classified as follows :— Deaths caused by disease 129 Deaths caused by violence (106), viz. :— Accidental 88 Suicidal 16 Murder 1 Manslaughter 1 106 Total 235 Of the 16 suicidal deaths, 4 belong to the Brompton sub-district and 12 to the Town sub-district. The inquests on Kensington parishioners were in the proportion of 8.7 per cent. on total deaths, the rate in the metropolis being 9.4 per cent.: in England and Wales the rate was 6.3 per cent. The relative percentages in 1899 were 8.8, 9.2, and 6.3 respectively. The deaths from violence (106) were equal to 0.61 per 1,000 of the population in Kensington ; 0'81 per 1,000 in London, as a whole, and 0.64 per 1,000 in England and Wales. VACCINATION. The table at page 37 is a return respecting vaccination in Kensington in 1899 (the complete return for 1900 not being yet due) compiled by Mr. Shattock, the vaccination officer, whose diligent discharge of the onerous duties of his office under the new Act, and previously, deserves recognition. It appears that of 3,584 infants whose births were returned in " Birth List Sheets " (col. 2) during the year, 2,804 were successfully vaccinated, and 38 were returned as " insusceptible of vaccination." In 23 cases vaccination was postponed by medical certificate : 376 infants died before attaining the age for vaccination ; in 38 cases infants were removed to other districts, the vaccination officers of which were duly notified of the fact; whilst some 260 cases from " removal to places out of the parish unknown, or which cannot be reached, and cases not having been found," were unaccounted for. These cases are, with those of "conscientious objectors" (31, against 55 in 1898, and 5 in 1897), equivalent to a "loss" of 8.1 per cent., as compared with the number of births registered; the losses in the preceding ten years having been 6.5, 6.7, 8.0, 8.7, 7.7, 8.4, 9.0, 10.1, 10.7, and 12.7 per cent. Kensington occupies a position superior to that of the Metropolis, as a whole, for, as stated in the annual report of the Local Government Board for 1898-99, the average of lost cases in the metropolitan district so far back as 1896, was 26.4 per cent.*—a bad lookout, truly, as showing that at that date more than one-fourth of the children born were without the protection against smallpox afforded by vaccination; the proportion at the present time probably being higher. It is but too probable, moreover, that a large proportion of the children not vaccinated prior to the new Act coming into operation, will remain unvaccinated, and be liable to small-pox. Mr. Shattock states that false registration, i.e., wrong addresses entered on the birth list sheets, is his greatest difficulty: the children cannot be traced. But on the whole the tide appears to have turned, the " loss " of cases, in Kensington, having been sensibly less in 1899 than in 1898. One good feature in the new Act, apart from its relatively greater success in increasing the number of vaccinations, is that it provides for the use of glycerinated calf-lymph, and so cuts the ground from under the feet of those who objected to vaccination because of the possibility of enthetic disease being conveyed in humanised lymph. Public vaccination stations have been abolished by the Act, which is entailing considerably increased expenditure upon the ratepayers. * The actual figures, showing loss, both for town and country, during the twelve years 1885-96, as set out in the report, are as follows :— Metropolis. Cases lost. Rest of England. Cases lost. Metropolis. Cases lost. Rest of England. Cases lost 1885 7.0 per cent. 5.5 per cent. 1891 16.4 per cent. 12.9 per cent. 1886 7.8 „ 6.1 „ 1892 18.4 „ 14.3 „ 1887 9.0 „ 6.7 „ 1893 18.2 „ 15.7 „ 1888 10.3 „ 8.2 „ 1894 20.6 „ 19.0 „ 1889 11.6 „ 9.6 „ 1895 24.9 „ 19.8 „ 1890 13.9 „ 10.9 „ 1896 26.4 „ 22.3 „ 37 Vaccination Officer's Return respecting the Vaccination of Children whose Births were Registered in 1899.* (Vide page 86.) DATE. Registration Sub-Districts comprised in Vaccination Officer's District. Number of Births returned in Birth List Sheets. Number of these Births duly entered in Columns 10, 11 and 13 of the Vaccination Register (Birth List Sheets), viz. : Number of these Births which are not entered in the Vaccination Register, on account, (as shown by Report Book) of Column 10 Successfully Vaccinated. Column 11. Column 13 Dead, Unvaccinated, Postponement by Medical Certificate. Removed to other District and notified to Vaccination Officer of this District. Removal to places unknown, or which cannot be reached, and cases not having been found. Cases still under Proceedings, by Summons and Otherwise. Total Number of Certificates of Successful Vaccinations received during each of the Calendar Tears Insusceptible of Vaccination. Certificate of Conscientious Objection. 1899. 1900. 1899. 1 2 3 4 5 6 7 8 9 10 11 12 1st January to 31st Dec. Kensington Town 3,038 2,367 27 28 322 20 29 228 14 3,412 3,187 Brompton 546 437 11 3 54 3 9 32 — Total 3,584 2,804 38 31 376 23 38 260 14 3,412 3,187 * The complete Return for 1900 will not be due until February, 1902. 38 THE METROPOLITAN ASYLUMS BOARD. Under the provisions of the (now repealed) Sanitary Act, 1866 (sec. 37), the local sanitary authority was endowed with power to provide, for the use of the inhabitants within its district, hospitals for the reception of the sick; a provision re-enacted in section 75 of the Public Health (London) Act, 1891. But, excepting in a few districts, and for a limited period, in time of emergency, e.g., when small-pox was epidemic, this power was not exercised, despite the pressure brought to bear to induce sanitary authorities to erect local hospitals. The late Vestry led the opposition to the establishment of such hospitals, with little support at first, but ultimately with complete success ; and no one now doubts that the policy of that body, adopted in 1877, was wise, and fruitful in benefit to the entire Metropolis. In 1867, the Metropolitan Poor Act brought the Asylums Board into existence, and this body soon set to work to provide infectious disease hospitals for the " sick poor," i.e., paupers. As a matter of fact, however, and despite the disabilities attaching in theory to the use of these hospitals, they were largely used from the beginning by non-paupers ; and in course of time legislation gradually secured to the inhabitants of the Metropolis all the advantages desired and contended for by the late Vestry. The hospitals are now free to all, no disability of any kind attaching to the use of them by any person whatsoever. The Managers, as the central authority, have fulfilled their duties admirably, and have created for London a hospital system unequalled elsewhere, and which, it is perhaps not too much to say, is the admiration of foreign nations. Be this as it may, the Managers fulfil the duties originally devolving upon local sanitary authorities; duties which those authorities would undoubtedly have had to perform, but for the creation of the Board, and the subsequent legislation which has so enhanced their powers as to leave almost nothing to be desired. Report of the Statistical Committee for 1899.—Prior to 1898 the work of the Asylums Board was summarized annually in three reports, prepared respectively by the Chairman of the Board, the Ambulance Committee, and the Statistical Committee. The three reports overlapped in many directions. For 1899 a single report issued by the Statistical Committee covers the entire ground. The report is comprised in two volumes ; the second volume, treating of matters relating to the work of the Managers as the Hospital and Ambulance Authority for London, having naturally the greater interest for sanitary authorities. From this report the following statement of facts in regard to 1899 is summarized: the report for 1900 had not been published when the present report went to press. Notification Statistics show that 42,285 cases of infectious disease were reported in London during the year, an increase of 4,969 upon the total in 1898. Of these cases, 36,388 (increase 4,567) were legally admissible to the hospitals; the remainder, mainly cases of erysipelas, included 326 cases of puerperal fever. Of the admissible cases, 24,732 (increase 4,243) were admitted, the proportion being 68.08 per cent., as against 65.5 per cent. in the preceding year. In 1890, the first complete year in which compulsory notification was in force, the proportion of admissions to admissible cases was only 33.59 per cent., or less than one-half of the proportion attained in 1899. A table (" A," at pp. 13-14) shows the number of notifications and deaths from admissible diseases; the ratio of such notifications and deaths to the population; the number of notifications of other notifiable diseases, and the grand total of notifications, in 1899. The increase in the ratio of diphtheria to scarlet fever, which has been a marked feature for some years past, again shows further progress, particularly in the eastern and south-eastern districts. In seven districts the number of diphtheria notifications actually exceeded those of scarlet fever, viz.:—Mile End, St. Saviour, St. George (Southwark), Newington, Bermondsey, Lambeth, and Camberwell. Charts and Spot Maps.—The course throughout the year of scarlet fever, diphtheria, and enteric fever, respectively, is traced in charts; each showing, week by week, (a) the notifications of the disease to which it relates, (b) the admissions, and (c) the number of patients under treatment. Great variations are shown from week to week in the percentages of cases admitted to hospital—ranging from 63.05 to 87.40 in the case of scarlet fever; from 56.91 to 83.55 in the case of diphtheria, and from 20.63 to 75.00 in the case of enteric fever. Naturally, the proportion which the hospital admissions bear to the total number of cases is of great importance to the Managers in considering the question of the amount of accommodation which should be provided to meet the wants of the metropolis. In this connection it may be stated that since 1890 the proportion of admissions to notifications has risen as follows: —Of scarlet fever cases from 42.82 to 74.34 per cent.; of diphtheria cases, from 17.87 to 69.69, and of enteric fever cases, from 22.49 to 40.78. Enteric fever was more prevalent in 1899 than in any previous year since the introduction of compulsory notification. The course of scarlet fever, diphtheria, and enteric fever, month by month, during each year from 1890 to 1899, traced in chart form, brings out the fact that, notwithstanding that the Managers have more than doubled their accommodation for fever cases during the past few years, it may still become necessary to make further provision, as the present accommodation would prove inadequate should scarlet fever and diphtheria again become as prevalent as they were in the year 1893, when the Board's hospital accommodation was quite inadequate, only 39.68 and 24.52 per cent. of notified cases of the two diseases, respectively, having been admitted. Spotted maps show the distribution of the principal fevers throughout the metropolis; and tables exhibit the age and sex of cases notified as scarlet fever, diphtheria, and enteric fever, respectively, during the year. The two former diseases are most prevalent amongst children, over two-thirds of the cases being under ten years of age; but whereas scarlet fever is most prevalent amongst children from five to ten years of age, diphtheria is most so amongst those under five years. Ambulance Work.—During the year, 24,945 fever, diphtheria, and small-pox patients were conveyed to the various hospitals of the Managers, an increase of 3,986 upon the total in 1898, there having been a corresponding increase in the number of transfers to the 39 convalescent hospitals, and of removals of recovered patients from these hospitals to London. During the year 369 private persons were removed on payment to other places than the Managers' hospitals : 144 persons were taken from the out-patient departments of general hospitals to their homes, and 247 enteric fever patients were removed from their homes to the general hospitals at which arrangements for their reception had been made by the Managers. Altogether, 42,119 removals were effected by the land ambulance service, an increase of 7,076 compared with the year 1898: the various vehicles made 28,184 journeys (increase 5,064), and ran 260,367 miles (increase 45,690). The steamboats of the river ambulance service conveyed 1,468 passengers to and from the hospital ships at Long Reach; but of this number only 11 were patients taken to the ships, and 6 were recovered patients brought back to London; the remaining 1,451 being visitors, staff, workmen, &c. Hospital Accommodation: Fever and Diphtheria.—The new Grove Hospital at Tooting and the new isolation blocks at the Eastern and Northern Hospitals were brought into use during the year. The normal accommodation at the fever hospitals open at the end of the year was for 5,183 patients; for small-pox patients the hospital ships provide 300 beds.* Hospital Statistics: Fever.—On the last day of 1898 there were 4,377 patients in the fever hospitals then open. By April 29th, 1899, the number under treatment had fallen to the minimum, 3,208; the number then rose until November 21st, when the maximum for the year, 5,710, was attained. The extra accommodation required by this number of patients—it being in excess of the total normal accommodation in the fever hospitals (5,183)— was obtained by placing additional beds in the wards of some of the hospitals, and by utilising the Gore Farm Hospital. At the end of the year 4,895 cases remained under treatment. During the year 29,469 patients were under treatment, including those who were in hospital at the end of 1898. Scarlet fever admissions numbered 13,290 (increase, 1,165), and the deaths were 353, or 2.65 per cent. (4.2 in 1898). Diphtheria admissions, 8,673 (increase, 2,107); deaths, 1,182, or 13.95 per cent., the lowest rate on record (15 37 in 1898). Enteric fever admissions, 1,535 (increase, 666); deaths, 240, or 16 47 per cent.—the same rate, practically, as in 1898. Of typhus there were 11 admissions, and no death. " Other diseases " admissions numbered 1,583 (increase, 95), the deaths being 160, or 10.05 per cent. The mortality on all admissions was 7.79 per cent., the lowest yet recorded. At the end of the year 4,895 cases remained under treatment. The monthly admissions (all diseases) were lowest in April (in February in 1898). In both years the highest number of admissions was attained in October. In several districts the admissions were considerably in excess of those of the previous year, the most notable instances being, as regards scarlet fever cases, Greenwich 829 (399 in 1898), Woolwich 810 (640 in 1898), and Lewisham 401 (167 in 1898); and, as regards diphtheria, Shoreditch 240 (148 in 1898), Mile End 202 (100 in 1898), St. Saviour 1,012 (559 in 1898), St. Olave 542 (201 in 1898), Lambeth 690 (447 in 1898), Camberwell 734 (326 in 1898), and Lewisham 402 (213 in 1898). Diphtheria Mortality.-—The admissions, deaths, and mortality per cent. of patients, divided according to age and sex, for the year, and in groups of years, &c., in respect of the several diseases, are set out in a variety of tables, of which not the least interesting are those (at page 27) containing particulars of diphtheria patients in the years 1888 to 1894; before antitoxic serum was generally used, and in the years from 1895 (when the serum was first generally used) to 1899. In the first period the admissions were 11,598, the deaths 3,516, the mortality per cent. feeing 30.3. In the second period the admissions numbered 29,055, the deaths 4,929, the mortality being at the rate of only 17 per cent. The difference in the mortality rates during the two periods is particularly striking as regards young children. Amongst cases in the first year of life the rate has fallen from 61.8 to 37.8, in the second year from 63.1 to 35.5, in the third year from 55.1 to 26.5, in the fourth year from 48.3 to 23.0, and in the fifth year from 39.0 to 20.7. Amongst cases from 5 to 10 years of age it has fallen from 28.1 to 15.0. The mortality per cent. of females in both periods was less than that of males. The Medical Superintendent of the Northern Hospital draws special attention (page 62) to the value of antitoxin in the treatment of post-scarlatinal diphtheria cases. During the five years immediately preceding the introduction of the serum treatment the mortality amongst these cases was 61.9 per cent., and during the succeeding five years only 1.5 per cent. Besidence in Hospital.—The average duration of stay in the different hospitals varies considerably. Taking the cases at all the hospitals, the average time in scarlet fever is about 70 days at the London hospitals, and a week longer at the convalescent hospitals, this extended residence being due to the selection of cases in which recovery was expected to be the most protracted owing to the severity of the disease, complications, &c. The average length of residence of diphtheria patients at the London hospitals was 51.2 days, including deaths, and 59.2 if the fatal cases be omitted. The variations in length of residence at different hospitals ranged from 49.3 days at the North-Western Hospital, about ten days below the average, to 70 days at the South-Eastern Hospital, or nearly 11 days above the average. The average residence of enteric fever patients was 50.7 days, including deaths, and 58.6 days if the fatal cases be excluded. The shortest residence of recovered cases was 47 days, or 11.6 days below the average, at the North-Western Hospital, and the longest, 74.5 days, or 15.9 days above the average at the Western Hospital. Of the cases of miscellaneous diseases (cases of mistaken diagnosis) the average residence of each patient was 25.2 days, including deaths, and 27.1 days if the fatal cases be excluded. The shortest residence was at the Fountain Hospital, 181 days, or 9 days below the average, and the longest at the Brook Hospital, 36.3 days, or 9.2 days above the average. The duration of residence, as the Committee point out, is of the utmost importance from an economical point of view, as not only would any shortening of the period of residence effect a saving in the cost of maintenance, but it would also enable the Managers to treat a larger number of patients without increasing the number of feeds, which is of much greater importance. The subject, as the Committee say, is a very complex one, and is receiving careful consideration. [It would be interesting to learn whether there is any marked relation between the duration of the stay of patients at the different hospitals and the proportion of " return cases" connected with the several institutions.] * For detailsof the present amount of accommodation at the several hospitals, vide pages 41-2. 40 Mistaken Diagnosis.— No fewer than 1,583 patients (1,488 in 1898), or 6.3 per cent. (7.2 in 1898), were, after admission at the fever hospitals, found not to be suffering from the diseases mentioned in the medical removal certificates. As usual, the proportion— 240 cases, or 10.2 per cent. of the total admissions—was greatest at the Eastern Hospital. The percentage on the total scarlet fever cases was 3.9, diphtheria cases 7.4, and enteric fever cases 17.3; the relative percentages in 1898 having been 4.7, 8.3, and 23.3 respectively. Amongst the 542 cases wrongly certified as scarlet fever, there were 53 of measles, 120 of tonsillitis, and 100 of erythema, whilst 102 had no obvious disease. Amongst the 693 cases wrongly certified as diphtheria were 38 of measles and 491 of tonsillitis. Amongst the 322 cases wrongly certified as enteric fever were 25 of influenza, 76 of pneumonia, and 15 of bronchitis. Of the 28 patients removed to the Wharves with certificates of small-pox the mistaken diagnoses numbered 18, or 64.3 per cent. Annual Admissions, 1870-1899 : Reduction in Mortality.—A return is given (page 36) showing the annual admissions and deaths of patients at the Managers' fever hospitals, with the mortality per cent., since the opening of the first hospital in 1870, together with excerpts from the Registrar-General's annual summaries, showing the annual mortality per 1,000 persons living of the population of the metropolis from scarlet, typhus, and enteric fevers, and diphtheria. The decreasing percentage of the mortality amongst scarlet fever patients treated in the Managers' hospitals continues to be a noticeable feature. More noticeable, however, is the decline in the percentage mortality amongst diphtheria patients from 40.74 in 1889 to 29.9 in 1894, to 22.85 in 1895 (when the antitoxic serum treatment was first adopted), to 21.2 in 1896, to 17.69 in 1897, to 15.38 in 1898, and to 13.95 in 1899. The rate of mortality of this disease to 1,000 persons living had for some years been steadily advancing prior to 1893, in which year it had attained the high figure of 0.76. Since that year there has been a considerable fall, coincident with the introduction and increasing use of the antitoxic serum treatment, the rate in 1899 having been only 0.43 per 1,000 of the estimated population. Staff.—No fewer than 4,765 persons were employed in 1899 at the fever hospitals, including those employed at the Gore Farm Hospital, of whom 243, or 5.1 per cent., fell ill with fever or diphtheria, and 3 died; while 1,280, or 26.8 per cent., suffered with other forms of illness. None of the 88 persons employed on the hospital ships contracted smallpox. The Committee, in their report for 1892, observed that " nurses and other members of a hospital staff can be brought with almost absolute impunity into contact with small-pox provided they are properly protected by vaccination." The evidence of each succeeding year has but confirmed them in that opinion. Kensington Cases.—The admissions of Kensington patients were 585, viz., scarlet fever, 381; diphtheria, 166; enteric fever, 55; " other diseases," 33. The deaths, from all diseases combined, were 53, or 5.64 per cent. on admissions. Removal of the Sick to Hospital.—The removal of the sick to hospital, whether by land or by water, is now effected in a satisfactory manner. The use of public vehicles by or for persons suffering with infectious disease is unlawful. Occasionally we hear of the use of a cab, wittingly or unwittingly, and in such cases the vehicle is usually lost sight of before discovery of the nature of the illness, and so does not get disinfected. This is no doubt a danger to the public, but it is of rare occurrence, as compared with the time before the passing of the Public Health (London) Act, 1891, the 70th section of which forbids the employment of public vehicles. No case of wilful breach of the law came to my knowledge during the year. Ambulance Arrangements.—Kensington patients are removed by the staff at the Western Station, which adjoins the Western Hospital, at Seagrave-road, Fulham. In the early part of 1900 the Managers, on removing to their newly erected offices on the Victoria Embankment, at the corner of Carmelite-street, E.C., arranged for the reception of applications for the removal of the sick to hospital between the hours of 9 in the morning and 8 in the evening, on all days of the year, so that it is now necessary to apply at the ambulance stations between 8 in the evening and 9 in the morning only. It cannot be too widely known that the sick are admitted to hospital on the application of any person whatsoever, the sole condition being the presentation of a certificate signed by a registered medical practitioner, showing the nature of the disease, and the fitness of the patient for removal. The application may be made personally, or by letter, or by telegram, or by telephone. The telegraphic address is " Asylums Board London " : the telephone numbers are 1601 and 1602 " Holborn." HOSPITAL ACCOMMODATION. In the annual report for 1893 (pages 117—130 inclusive), I dealt with "The needs of the Metropolis in respect of Hospital Accommodation for the Infectious Sick"; detailed the steps taken by the Asylums Board to supply the then existing deficiencies, and referred to the difficulties by which their efforts had been confronted and, to a certain extent, foiled. Those difficulties have been now largely overcome; and the needs of the Metropolis have been met to an extent beyond my estimate of them, made in the tenth monthly report for 1892, which, at the time, was thought to be excessive, viz.; " at least 5,000 beds for scarlet fever, ' fever,' diphtheria, and isolation." Fever Hospital Accommodation.—It is an accepted axiom that provision for the isolation of infectious disease should be made at the rate of not less than one bed for each thousand of the population. The subject, as regards the Metropolis, was dealt with by the Royal Commission in 41 1881-2, and the Commissioners stated in their report (1882) that the then provision of hospitals should be extended so as to provide 5,700 beds at the least; viz., 3,000 nominally for "Fever," and 2,700 for Small-pox. Diphtheria cases were not at that time admissible to the hospitals. The population of London in 1882 was a little under 4,000,000 ; consequently the recommendation of the Commissioners went, to the extent of 1,700 beds, beyond the theoretical requirements of the day. The Commissioners, presumably, desired that provision should be made for a lengthened period in advance, and the amount of accommodation they advised as necessary, is even now in excess of the standard requirement, the estimated population being under 4,600,000. But circumstances they could scarcely have anticipated have led to largely increased demands on the Managers' resources ; not only by the sanitary authorities, but also by private medical practitioners and others. Among these circumstances may be mentioned, the depauperisation of medical relief in the hospitals, and the opening of the several institutions to all classes of the people (measures advocated in these reports many years before they formed the subject of legislation); the admission of patients, on whatever form of application, subject only to the production of a medical certificate; gratuitous treatment; the popularity of the hospitals themselves; and the increasing recognition by the public of the advantages accruing from the isolation of the infectious sick. The operation of compulsory notification, moreover, has had great effect; for now that the sanitary authorities become acquainted with, practically, all cases of infectious disease, they are able to secure the admittance to hospital of numbers of cases, such as in pre-notification days they would probably never have so much as heard. In connection with this important question it may be mentioned that so far back as the end of 1893 the Managers had provided normal accommodation to the extent of about 3,000 beds, for fever and diphtheria patients, by the erection of additional temporary hospitals at Tottenham and Lower Tooting. Since that date the Brook Hospital, for upwards of 500 patients, has been erected and opened at Shooter's-hill, and the Park Hospital at Hither-green, Lewisham, also for upwards of 500 patients. An equally large hospital, the " Grove," was opened in 1899 at Tooting, adjoining the "Fountain" hospital. These three hospitals for acute cases of fever, scarlet fever, and diphtheria, and isolation wards, have added upwards of 1,600 beds to those previously provided by the Managers, who, moreover, have acquired a site of 135 acres at Carshalton, Surrey, for a convalescent fever hospital for 800 patients,* having already, at Winchmore-hill, north of the Thames, at the Northern Convalescent Hospital, accommodation for about 650 patients. In addition to the new hospitals on new sites, previously existing accommodation has been extended and improved by the more or less complete reconstruction, with additions, of some of the older hospitals. Small-Pox Hospital Accommodation.—As regards accommodation for small-pox, the Managers have not hitherto provided anything like the amount recommended by the Royal Commission in 1882, viz., 2,700 beds. The Hospital Ships at Long Reach, on the River Thames, furnish 300 beds for acute cases; whilst for mixed cases there is accommodation for about 1,200 patients at the Gore Farm Hospital, which, at the present time, is being utilised for scarlet fever convalescents. The accommodation on this site could be materially increased, in case of emergency, by the erection of temporary buildings, as also at the Joyce-green estate. Summary.—I am indebted to Mr. T. Duncombe Mann, Clerk to the Asylums Board, for the subjoined statement of existing and projected accommodation for various classes of the infectious sick : it cannot fail to be read with interest. " Return showing the permanent Fever Hospital Accommodation existing and projected:— (i.) Accommodation existing— Beds. Eastern Hospital 362 North-Eastern Hospital 406 North-Western Hospital 460 Western Hospital 450 South-Western Hospital 366 Fountain Hospital 402 Grove Hospital 522 South-Eastern Hospital 432 Park Hospital 548 Brook Hospital 560 Northern Hospital 652 Total 5,160 (ii.) Accommodation projected— North-Eastern Hospital 128 Southern Hospital 800 Total 928 Grand total 6,088 * The building of this hospital will shortly b3 put in hand; it will comprise detached blocks, each to contain moderate number of patients, a desirable arrangement as it will diminish opportunities for the spread of disease, such post-scarlatinal diphtheria. The estimated cost is £204,548. 42 " For Small-Pox Patients the existing accommodation is as follows :— Hospital Ships 300 Gore Farm, Upper Hospital 1,000 (At present occupied by Scarlet Fever patients.) Gore Farm, Lower Hospital (Wooden buildings) 192 Total 1,492" Joyce Green Estate.—On this site, adjacent to the river Thames, some three hundred acres in extent, which (with considerable additions of intervening land connecting the estate with the hospital ships) the Managers have acquired, they are building a hospital for 400 patients, at a cost of £220,000. It thus appears that the Metropolis is endowed, in possession or in early prospect, with accommodation for at least 6,000 patients suffering from fever and diphtheria, a number precisely double that recommended by the Royal Commission, irrespective of many hundred beds at Gore Farm generally available for convalescent cases in the abeyance of small-pox. Time only can determine whether this provision will suffice for the requirements of the metropolis. For small-pox patients the accommodation is, or will be, to the extent of some 1,900 beds : a number, I repeat, considerably below the recommendation of the Royal Commission (2,700), but which I believe will suffice, seeing how much more effectually this disease has been controlled since the practice was adopted of removing the sick out of London for isolation and treatment, initiated, upon my advice, in May, 1881, and subsequently perfected by the Managers, who, since 1884, have ceased to use the town hospitals for small-pox, removing, direct from their homes, to the ships, all patients suffering from this disease—with beneficent results as the statistics of mortality eloquently testify. NOTIFICATION OP INFECTIOUS DISEASE. The tables at pages 43-46 show (1) the number of notifications in London in 1900, (2) the relative prevalence of the several diseases at different periods of the year, in Kensington and in London, (3) the notifications in the sanitary districts, &c., of the borough, and (4) the case and death-rate of infectious diseases in Kensington, 1890-1900. The Kensington notifications were 986, viz., in the Town sub-district 801, and in Brompton 185. The notifications in the seven preceding years were 1,811, 972, 1,289, 1,781, 1,457, 1,004, and 1,046 respectively. Table XIV. (appendix, p. 99) shows the streets, &c., where cases of the scheduled diseases occurred in 1900. The cases notified in London, 35,304, were 7,000 fewer than in 1899. The notifications of each of the scheduled diseases during the eleven years, 1890-1900, are set out in the subjoined table. Year, Small pox. Scarlet Fever. Diphtheria. Enteric Fever. Typhus Fever. Other Continued Fevers. Puerperal Fever. Erysipelas. Croup. Cholera. Relapsing Fever. Total. 1890 1891 1892 1893 1894 1895 1896 1897 1898 1899 1900 60 114 423 2,813 1,192 978 225 105 35 29 87 15,330 11,398 27,096 36,901 18,440 19,757 25,638 22,876 16,917 18,112 13,812 5,870 5,907 7,791 13,026 10,655 10,772 13,361 12,811 11,561 13,363 11,788 2,877 3,372 2,465 3,663 3,360 3,506 3,189 3,113 3,032 4,460 4,309 35 27 20 22 21 14 6 4 17 14 7 237 152 147 205 162 105 102 65 55 69 73 206 221 347 397 253 236 278 264 250 329 237 4,598 4,764 6,934 9,700 6,080 5,660 6,438 5,801 5,180 5,615 4,776 550 505 565 668 535 . 451 446 388 310 338 210 25 23 54 86 21 29 13 38 23 15 5 7 39 7 4 2 3 3 1 29,795 26,522 45,849 67,485 40,925 41,511 49,699 45,465 37,380 42,344 35,304 Note.—The form for Table III. (page 45) was prescribed by the Local Government Board in order that a "tabular statement of infectious sickness should be made in all districts on a uniform plan." 43 Cases of Infectious Disease notified to the several Metropolitan Medical Officers of Health, under the provisions of the Public Health (London) Act, 1891, in the Fifty-two Weeks ended Saturday, 29th December, 1900. Name of District. Small-pox. Scarlet Fever. Diphtheria. Enteric Fever. Typhus Fever. Other Continued Fevers. Puerperal Fever. Erysipelas. Croup. Cholera. Totals. Population, 1896. West Districts. Kensington 5 367 328 104 ... 10 9 159 4 ... 986 170,465 Paddington 5 306 153 56 2 3 6 123 2 ... 656 124,506 Hammersmith 2 352 252 103 ... 2 6 113 ... ... 830 104,199 Fulham 9 550 635 92 ... 2 9 153 9 ... 1,459 113,781 Chelsea 2 233 179 81 1 3 7 71 2 1 580 96,646 St. George, Hanover Sq. 2 167 89 55 ... 3 1 47 3 ... 367 79,967 Westminster ... 122 104 32 ... ... 4 53 1 ... 316 53,234 St. James, Westminster. ... 62 39 12 ... ... ... 16 ... ... 129 23,050 North Districts. St. Marylebone 5 382 214 82 ... ... 5 200 3 ... 891 141,188 Hampstead ... 224 156 50 ... ... 4 50 4 ... 488 75,449 St. Pancras 7 658 584 356 ... 1 11 234 6 ... 1,857 240,764 Islington 2 1,039 628 267 1 6 16 294 9 ... 2,312 336,764 Stoke Newington ... 126 127 24 ... ... 4 30 3 ... 314 33,485 Hackney 16 694 615 228 1 5 15 232 7 ... 1,813 218,044 Central Districts. St. Giles, Bloomsbury ... 98 58 33 ... ... 1 51 2 ... 243 38,237 St. Martin-in-the-Fields ... 24 14 10 ... ... ... 4 ... ... 52 18,077 Strand ... 79 37 10 ... 1 ... 9 1 ... 137 23,782 Holborn ... 100 67 25 ... 1 ... 41 ... 234 31,208 Clerkenwell ... 138 120 60 ... 1 1 76 1 ... 397 66,202 St. Luke, Middlesex ... 96 75 32 ... ... 1 58 1 ... 263 41,527 City of London ... 83 66 29 ... ... 21 ... ... 199 30,970 East Districts. Shoreditch 3 327 344 126 ... 2 8 171 10 ... 991 122,348 Bethnal Green 4 370 391 153 ... 1 8 234 16 ... 1,177 129,162 Whitechapel 1 399 257 79 1 ... 6 129 5 ... 877 77,717 St. George in-the-East 7 138 114 65 ... ... 8 86 4 ... 422 47,506 Limehouse 1 172 180 75 ... ... 2 107 ... ... 537 58,305 Mile End 1 334 289 119 ... ... 6 176 8 ... 933 111,060 Poplar 2 500 620 270 1 2 10 194 25 ... 1,624 169,267 South Districts. St. Saviour, Southwark ... 82 115 27 ... ... 2 23 1 ... 250 25,365 St. George, Southwark ... 251 216 179 ... 1 2 75 5 ... 729 60,278 Newington 1 356 438 101 ... ... 10 135 10 1 1,052 120,939 St. Olave, Southwark ... 37 14 7 ... ... ... 9 ... ... 67 11,731 Bermondsey ... 258 347 120 ... ... 6 60 5 ... 796 85,475 Rotherhithe ... 102 107 77 ... ... 3 71 6 ... 366 40,379 Lambeth 1 825 843 279 ... 17 12 238 6 2 2,223 295,033 Battersea ... 545 310 205 ... 1 6 164 6 ... 1,237 165,115 Wandsworth 4 673 447 153 ... 1 15 206 6 ... 1,505 187,264 Camberwell 3 817 891 • 187 ... 6 10 215 10 ... 2,139 253,076 Greenwich ... 685 508 177 ... 2 11 239 19 ... 1,636 175,774 Lewisham ... 418 307 59 ... ... 4 70 4 ... 862 83,213 Woolwich 2 134 98 23 ... ... 2 39 1 ... 299 41,314 Plumstead ... 298 238 39 ... 2 4 73 4 ... 658 59,252 Lee ... 137 162 18 ... ... 2 25 1 ... 345 38,588 Port of London 2 4 17 30 ... ... ... 2 ... 1 56 Grand Totals 87 13,812 11,788 4,309 7 73 237 4,776 210 5 35,304 44 Table showing the number of Cases of Infectious Disease Notified in Kensington and in London, in 1900: Arranged in four-weekly periods. Date of Report. For Four Weeks ended Weeks of the Year. KENSINGTON. LONDON. Weeks of the Year. Date of Report. For Four Weeks ended. Small-pox. Scarlet Fever. Diphtheria. Enteric Fever. Typhus Fever. Other Continued Fevers. Puerperal Fever. Erysipelas. Croup. Cholera. Total. Small-pox. Scarlet Fever. Diphtheria. Enteric Fever. Typhus Fever. Other Continued Fevers. Puerperal Fever. Erysipelas. Croup. Cholera. Total. January 27 1- 4 ... 31 85 9 ... 2 2 13 ... ... 92 19 951 1,036 381 1 7 18 439 16 ... 2,868 1- 4 January 27 February 24 5- 8 ... 28 21 5 ... 2 ... 14 ... ... 70 5 834 946 309 1 6 22 371 15 ... 2.509 5- 8 February 24 March 24 9-12 ... 27 29 6 ... 1 ... 19 ... ... 82 5 873 886 275 ... 2 18 347 19 ... 2,425 9-12 March 24 April 21 18-10 ... 29 25 3 ... ... ... 14 ... ... 71 3 883 686 221 ... 4 15 306 17 ... 2,135 13-16 April 21 May 19 17-20 ... 21 38 5 ... ... ... 13 2 ... 74 7 966 887 186 1 6 19 368 21 ... 2,461 17-20 May 19 June 16 21-24 2 22 16 7 ... ... 1 7 ... ... 55 19 1,063 809 218 ... 5 18 318 15 ... 2,465 21-24 June 16 July 14 25-28 3 3 11 4 ... 1 ... 9 1 ... 62 18 1,097 829 170 1 5 9 304 17 1 2,451 25-28 July 14 August 11 29-82 ... 21 25 7 ... ... 1 10 ... ... 64 4 868 917 195 ... 6 10 290 12 1 2,303 29-32 August 11 September 8 33-86 ... 23 17 4 ... ... 1 11 ... ... 56 3 828 714 264 2 5 15 324 7 ... 2,162 33-36 September 8 October 6 37-40 ... 25 20 12 ... 1 1 7 ... ... 66 ... 1,348 1,034 541 ... 10 17 391 15 3 3,859 37-40 October 6 November 3 41-44 ... 40 34 12 ... 1 1 13 ... ... 101 1 1,634 1,133 543 1 8 28 463 11 ... 3,822 41-44 November 3 December 1 45-48 ... 32 37 15 ... ... 2 18 1 ... 105 3 1,365 1,046 570 ... 5 29 4 38 23 ... 8,529 45-48 December 1 December 29 49-52 ... 35 ' 25 15 ... 2 ... 11 ... ... 88 ... 1,102 865 486 ... 4 19 867 22 ... 2,815 49-52 December 9 Totals 5 367 328 104 ... 10 9 159 4 ... 986 87 13,812 11,788 4,309 7 73 237 4,776 210 5 35,304 Totals. 45 TABLE III. (Required by the Local Government Board to be used in the Annual\ Report nf the Medical Officer of Health.) Cases of Infectious Disease notified during the Year 1900. Notifiable Disease. Cases Notified in KensiDgton. Total Cases Notified in each Sab-District. Number of Cases removed to Hospital from each Sub-District. At all Ages. At Ages—Year3. Kensington Town. Brompton. Kensington Town. Brompton. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 65. 65 and upward. Small-pox 5 ... ... 2 1 2 ... 3 2 3 2 Cholera ... ... ... ... ... ... ... ... ... ... ... Diphtheria 828 6 105 149 38 29 1 272 56 245 42 Membranous croup 4 ... 8 1 ... ... ... 2 2 ... ... Erysipelas 159 4 2 11 22 107 18 128 31 2 2 Scarlet fever 367 8 88 185 55 86 ... 290 77 233 55 Typhus fever ... ... ... ... ... ... ... ... ... ... ... Enteric fever... 104 ... 3 19 31 51 ... 88 16 65 7 Eelapsing fever ... ... ... ... ... ... ... ... ... ... ... Continued fever 10 ... ... 2 1 7 ... 10 ... 6 ... Puerperal fever 9 ... ... ... 3 6 ... 8 1 ... ... Plague ... ... ... ... ... ... ... ... ... ... ... Totals 986 13 201 369 151 238 14 801 185 554 108 Table showing the Notifications, in 1900, in the Borough, the Sub-Districts, the Parliamentary Divisions, and the Sanitary Districts. Area. Smallpox. Scarlet Fever. Diphtheria. EntericFever. Tvphus Fever. Continued Fever. Puerperal Fever. Erysipelas. Croup. Totals. Population. Notifications per 1,000 of the population. The Borough 5 867 328 104 ... 10 9 159 4 986 173,000 5.7 Sub-Distbicts— Kensington Town 3 290 272 88 ... 10 8 128 2 801 124,300 6.4 Brompton 2 77 56 16 ... ... 1 31 2 185 48,700 3.8 Parliamentary Divisions— North Kensington 3 233 231 72 ... 10 7 104 2 662 88,100 7.1 South Kensington 2 134 97 32 ... ... 2 55 2 324 84,900 3.8 Sanitary Districts— North 1 122 117 41 ... 5 3 28 2 319 33,590 9.5 North-East 2 49 79 12 ... 2 4 19 ... 167 30,510 5.5 North-West ... 27 21 10 ... 1 ... 49 ... 108 17,000 6.3 Central ... 61 36 17 ... 2 ... 19 ... 135 27,390 4.9 South-East ... 57 32 12 ... ... ... 14 1 116 32,350 3.6 South-West 2 51 43 12 ... ... 2 30 1 141 32,160 4.4 46 TABLE V.* Comparison of Prevalence of Sickness and Death from Infectious Diseases. (Rates calculated per 1,000 persons on the population estimated to the middle of each year.) Year. Small-pox. Erysipelas. Diphtheria and Membranous Croup. Scarlet Fever. Typhus Fever. Enteric and Continued Fever. Puerperal Fever. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. 1890 0.00 0.00 0.76 0.05 1.31 0.21 2.26 0.16 0.00 0.00 0.52 0.09 0.06 0.06 1891 0.00 0.00 1.22 0.05 1.19 0.17 1.94 0.09 0.00 0.00 0.64 0.15 0.03 0.03 1892 0.00 0.00 1.15 0.06 1.15 0.18 4.28 0.21 0.02 0.00 0.36 0.10 0.02 0.05 1893 0.57 0.05 1.68 0.10 2.19 0.49 5.69 0.30 0.00 0.00 0.64 0.10 0.05 0.06 1894 0.11 0.00 1.09 0.02 1.65 0.44 2.31 0.13 0.00 0.00 0.58 0.14 0.05 0.03 1895 0.03 0.00 1.59 0.05 2.23 0.53 3.10 0.16 0.00 0.00 0.61 0.09 0.04 0.02 1896 0.07 0.00 1.03 0.02 2.18 0.42 5.95 0.23 0.00 0.00 0.59 0.09 0.05 0.04 1897 0.0 0.00 1.39 0.05 1.94 0.48 4.33 0.17 0.00 0.00 0.74 0.13 0.09 0.03 1898 0.00 0.00 1.05 0.04 1.29 0.15 2.75 0.13 0.05 0.01 0.63 0.07 0.06 0.03 1899 0.00 0.00 1.22 0.05 1.49 0.24 2.57 0.06 0.00 0.00 0.72 0.13 0.06 0.03 1900 0.08 0.00 0.92 0.05 1.92 0.16 2.12 0.02 0.00 0.00 0.66 0.09 0.05 0.03 * This table is recommended for use by the Society of Medical Officers of Health, as a record of " the frequency and mortality of infectious diseases in the whole district for a series of years." 47 A question as. regards the desirability of making Contagious Ophthalmia notifiable, was raised by the Board of Guardians in a communication addressed to the late Vestry. A child under their care in a public institution had been forcibly removed by relations whilst suffering from this complaint, and it was pointed out that the Guardians, in the present state of the law, could neither punish the people who had acted so foolishly nor enforce isolation of the child. Under these circumstances, the Guardians asked to be informed—Whether it would not be desirable to declare ophthalmia a notifiable disease under the provisions of the Public Health (London) Act, 1891. The Vestry, on the recommendation of the Sanitary Committee, informed the Guardians that action could not be taken on the lines indicated in their letter. I may add that I know of no district where ophthalmia has been made a notifiable disease, and I need hardly say that good cause would have to be shown before the Local Government Board would " approve" (under sec. 56) the addition of any disease to the scheduled list—supposing a sanitary authority to be desirous to make such addition ; I' question, moreover, whether the Board would in any case approve the addition of ophthalmia, which is not a disease ejusdem generis with the diseases scheduled in Section 55, any more than, say, venereal disease. Already considerable expense is incurred, with problematical benefit, with respect to notification of erysipelas, and if ophthalmia were made notifiable, a much larger expense would arise—with even less appearance of utility. The matter, nevertheless, is important, and the difficulty referred to by the Guardians might be met by legislation authorising the detention in a public institution of a child suffering from contagious ophthalmia, and placed therein by the Poor-law authority for isolation and treatment. It should not be difficult to satisfy the Local Government Board as to the desirability of such a course. FACTORY AND WORKSHOP ACTS, 1878 to 1895. The duties devolving upon the sanitary authority under the Factory Acts with respect to workshops, were set out in the annual report for 1896 (pp. 97—103 inclusive). An effort to cope with these responsibilities was made by the late Vestry, on my recommendation, in October, 1893, by the appointment of two ladies as inspectors of workshops, workplaces, and laundries, where women are employed. These ladies, Miss Deane and Miss Squire, are now factory inspectors under the Home Office. Miss Deane's successor, Miss Duncan, who ceased to hold office in July, 1895, is factor}* inspector to the Government of New South Wales. The appointment held by her in this borough was not filled. The present lady inspector, Miss de Chaumont, was appointed on Miss Squire's resignation. There is nothing conflicting in the duties of factory inspectors and of inspectors appointed by the sanitary authority: the duties of the respective offices are reciprocal. It is the duty of the medical officer of health under the Public Health (London) Act, 1891 (sec. 27) to " give written notice to the factory inspector" of " any child, young person, or woman employed in a workshop," and this has been done, since October, 1893, in a large number of instances, upon information acquired for me by the lady inspectors. I report, moreover, to His Majesty's Superintending Inspector of Workshops, &c., every workshop and workplace newly opened or discovered by the inspector; and, reciprocally, that gentleman forwards to me all written notices received by him from persons who intimate their intention to occupy premises as workshops or workplaces. The Superintending Inspector reports to me cases of overcrowding discovered by his assistants, and cases of dirty and insanitary premises observed by those officers, and requiring to be dealt with under the Acts, it being the duty of the sanitary authority to take steps to abate such nuisances. The sanitary authority and their officers possess "all such powers of entry, inspection, taking legal proceedings or otherwise," as a factory inspector has under the principal Act, i.e., the Act of 1878. The powers of the sanitary authority in regard to the inspection and supervision of workshops, in order to the enforcement of the law, are ample. But lest they should be allowed to fall into desuetude, or be wilfully neglected, power is given, by Sections 1 and 2 of the Factory and Workshop Act, 1891, which enables the factory inspector to supersede a defaulting authority in the execution of their duties in respect of workshops or laundries, and to recover from the authority, in whose district the workshops or laundries are situated, " all such expenses in and about any proceedings .... as he may incur." It is a matter for satisfaction that there has become manifest, on the part of employers, an increasing willingness to conform to the requirements of the law, with which many of them had been more or less unacquainted, until they were made known by the visits of the first lady inspectors, and by the notices issued by the sanitary committee. The inspector's visits are now received, as a rule, with cordiality. In no respect have they done greater good than by the prevention of overcrowding, and the improvements effected with regard to the warming of workrooms, and the ventilation of gas iron-lieaters, &c. The good work begun by Miss Deane, Miss Squire, and Miss Duncan, has been efficiently carried on by Miss de Chaumont, who has performed her duties with tact and discretion. The initiative of the late Vestry in employing women to assist in the work of sanitary administration, is being followed by other metropolitan sanitary authorities, aud by many provincial sanitary authorities. 48 Work of the Lady Inspector.—With respect to this borough, it was stated in the twelfth report for 1900, that a considerable addition had been made to the number of premises where women are employed, and which are under the supervision of the Council's lady inspector; the net increase in such establishments (after deducting the number transferred to other boroughs) being 132 : the present known total is 845 ; constant additions moreover are being made to the list by discovery of establishments, and as the result of Miss de Chaumont's labours many establishments, previously unknown and unvisited by factory inspectors, have been reported to the Home Office. Without further preface I submit— Miss de Chaumont's Annual Report. "At the beginning of the year, 708 workshops, &c., where women are employed, were on the register. During the year, 195 new premises were placed on the register, and 85 were removed therefrom. The particulars in regard to existing establishments are as follows :— Workshops, &c. North Kensington. South Kensington. Total for Borough. Dressmakers. Laundries. Miscellaneous. Total. Dressmakers. Laundries. Miscellaneous. Total. Added to Register 27 105 19 151 37 2 5 44 195 Removed from Register. 18 13 5 36 48 3 3 49 85 " The great increase in the number of registered workshops, &c., is owing to the readjustment of the borough boundaries consequent on the passing of the London Government Act, 1899. By this readjustment a considerable addition has been made to the number of premises in this borough where women are employed. "The following is a summary of the establishments transferred:— North Kensington :— Dressmakers. Laundries. Miscellaneous. Total. From Chelsea 2 109 7 118 „ Hammersmith 4 8 2 14 ,, Paddington 10 3 2 15 16 120 11 147 South Kensington :— From Chelsea 6 1 2 9 „ Westminster 2 — 2 4 8 1 4 13 Total 24 121 15 160 " To adjoining boroughs establishments have been transferred from Kensington as follows:— Dressmakers. Laundries. Miscellaneous. Total. To Hammersmith 1 5 — 6 „ Paddington 12 — — 12 ,, Chelsea 1 — 1 2 „ Westminster 7 — 1 8 Total 21 5 2 28 "The nominal increase of establishments in Kensington is : Dressmakers 3, Laundries 116, Miscellaneous 13 ; Total 132. But on inspection some of the premises were found to be no longer occupied as 'workshops.' The net result for the year, therefore, is an increase of 115 registered workshops, &c., in North Kensington, and a decrease of 5 in South Kensington; showing a net increase of 110 for the whole borough; Holland-park-avenue and Notting-hill High-street separating the two districts. At the end of the year, 818 places (comprising an aggregate of 1,704 rooms) were on the register, viz.:— Workshops, &c. North Kensington. South Kensington. Total for Borough. Dress- Laun- Miscel- total makers, dries. laneous Dress- Laun- Miscel- total makers, dries. laneous Number on Register 128 300 44 472 288 23 35 346 818 Number of Rooms therein. 156 867 62 1,085 525 52 42 619 1,704 The known number of establishments, therefore, is now 818, in which are employed, on an average, upwards of 10,000 women and girls. There is reason to believe that in Kensal New 49 Town district there are in addition many 'outworkers'—women who take in ironing for the large laundries. Further enquiry is being made as to these persons and their abodes, which, as ' workplaces,' will have to be registered, inspected, and supervised. "Cubic Stace.—In the 195 workshops, etc., newly registered, 179 rooms only (out of about 700) have as yet been measured, in order to ascertain the number of persons who may lawfully occupy each room, upon the scale of 250 cubic feet per person, in conformity with the requirements of the Factory and Workshop Act, 1895, section 1; which accords with the scale adopted by the late vestry in 1893. The small number of rooms hitherto measured, compared with the number of newly registered workshops, is owing to the fact that though the new premises transferred to the Borough of Kensington have been visited, in order to ascertain the exact number of workshops, etc., requiring to be registered, time has not yet permitted the whole number of rooms to be systematically inspected and cubed. Numerous rooms in workshops already registered were measured during the year, such rooms having been enlarged, or newly opened as additional workrooms. "Overcrowding.—Twenty-three workrooms were found to be overcrowded, being three in excess of the number in 1899. The cases in North Kensington occurred entirely in workshops recently transferred to the borough. It is satisfactory to note that in no case was a workroom found so much overcrowded as during the preceding year; and the nuisance has not been observed this season in the two cases that were last season specially reported to the Sanitary Committee. It is also interesting to note the diminution of overcrowding in workrooms that has taken place since female inspectors were appointed for this duty in 1893, in which year out of 1,061 workrooms inspected, 56 were found to be overcrowded. In 1895, out of 2,656 workrooms inspected, 66 were found to be overcrowded; in many cases to the extent of three or four persons beyond the .permissible number. In 1900, out of 2,710 workrooms inspected, only 23 were found to be overcrowded, and none seriously. " Defective Workshops, Yards, etc.—At many of the registered premises, chiefly laundries, roofs and floors were found in a defective state. In several cases the necessary work of reparation was carried out after service of written intimations only; in other cases after service of statutory notices. Several yards and washliouse floors have been levelled and repaired, much to the benefit of employers and employed alike. In numerous instances staircases leading to workrooms were found dilapidated and unsafe. These have been repaired, and in three cases (laundries) almost entirely renewed. "Cleansing, Whitewashing, etc.—Two hundred and twenty-five rooms, with staircases and passages connected therewith, were cleansed and whitewashed, or re-papered, on service of intimations or notices. " Sanitary Conveniences.—Three water-closets with no direct light or ventilation to the outer air, have been much improved; in the one case by a window through the outer wall, and in the other two by ventilating shafts. Seventy water-closets, found to be either dirty or dilapidated, or defective in water supply, were renovated, more or less satisfactorily. "Warming of Workrooms.—The provisions of the Factory and Workshop Act, 1895, Section 32 (which enacts that ' in every factory and workshop adequate measures shall be taken for securing and maintaining a reasonable temperature in each room in which any person is employed ') are now very fairly carried out, with great addition to the comfort of the workers, and, I believe, with advantage to the employers. I am pleased to report that in several cases, fires have been substituted for the injurious open gas-jets formerly employed to heat the rooms by day. I regret, however, to find that there is still a small minority of employers who do not realise the importance of efficiently warming their workrooms. One would have expected that consideration for the success of their business, if not for the health of their employees, would have induced them to provide means of warming, as, in dressmaking businesses especially, much time must be lost if the workers' hands are cold. I may instance one case of neglect in regard to this matter, at an establishment where between 60 and 70 women and girls were employed, in numerous workrooms, without means of warming in any room. On my visiting the place, I found the employees blue with cold, and frequently stopping their work to try to rub warmth into their hands. The temperature of the rooms varied from 42° to 48° Fahr. These rooms are now all warmed by good fires. "Ventilation.—In the report of the Women Inspectors for 1894, mention is made of the vitiated state of the atmosphere of workrooms, particularly in dressmaking and tailoring establishments, owing chiefly to the use of gas iron-heaters in the rooms, unprovided with means of carrying away the fumes. Much was done to improve matters in this respect by my 50 predecessors, who advised the ventilation of the iron-heaters, either by placing them under the chimney openings, or by providing special hoods and flues to carry off the fumes; or, where this was not feasible, by the entire removal of the iron-heater to a separate room or passage. I have endeavoured to carry on the good work initiated by them, and am pleased to observe that in all cases where dressmakers have changed houses, they have arranged for the gas iron-heaters to be placed outside the workrooms, thus tacitly acknowledging the value of the advice given to them, and the benefit accruing therefrom. " Excessive Moisture.—In some of the newly-registered laundries recently transferred to the borough, I have found the washhouses to be filled with steam to an unnecessary extent. Notice has been served on the owners to remedy this defect by providing additional means of ventilation. " Tidiness.—Though I am able to report a distinct improvement during the last five years, there is still a good deal to be desired with regard to the sweeping and' tidying of workroom floors. That this is an improvement easy of attainment is evidenced by the many wellkept workshops in both districts. " Complaints.—These are usually received from workers, visitors, or societies, such as the Industrial Law Committee, the Women's Industrial Council, etc. Complaints relating to sanitary matters in connection with workshops, etc., are always attended to as soon as practicable. Whether anonymous, or otherwise, they generally prove to be well founded. Complaints regarding long hours of work are referred to the Lady Factory Inspectors' Department at the Home Office. His Majesty's Superintending Inspector of Workshops has forwarded complaints of nuisances observed by the factory inspectors, all of which have been dealt with. " General.—I am pleased to report that my visits, as a rule, are welcomed by employers, who recognise, when informed, the propriety of carrying out the duties devolving upon them under the Acts of Parliament, and the Orders issued by the Factory Department of the Home Office. It is satisfactory to notice that, so far, in no case have I experienced any difficulty in obtaining admission to any of the workshops recently transferred to the borough. It is to be regretted that there are no means at present available—e.g., by public notice—of bringing to the attention of employers the obligations and duties devolving upon them. Frequently, on first visits, when I find defects, especially with regard to overcrowding, the offence appears to have arisen not from wilful disregard of regulations, but from want of knowledge of the existence of regulations." Miss de Chaumont appends to her report a Table (vide page 51) setting out particulars of her work during the year, so far as it admits of tabulation. But probably the most valuable service she renders to the Council and the community arises from the exercise of moral influence, leading to the due carrying out of the requirements of legislation devised for the protection of women, " young persons," and children. 51 FACTORY AND WORKSHOP ACTS, 1878-1895. Summary Report of Work done during the year 1900. North Kensington. South Kensington. Total for whole Borough Dressmakers. Laundries. Miscellaneous. Total. Dressmakers Laundries. Miscellaneous. Total. Workshops, Number of visited .and inspected 154 561 86 801 393 15 65 473 1,274 Workshops, Number of re-inspected 29 228 10 267 68 1 11 80 347 Workrooms, Number of inspected 176 1,865 72 2,113 499 35 63 597 2,710 Workrooms found to be overcrowded 1 4 — 5 18 — — 18 23 Workrooms found to be insufficiently ventilated 4 29 2 35 20 — 1 21 56 Workrooms found to be in a dirty condition 5 210 3 218 32 9 1 42 260 Workshops, &c., newly discovered and registered 27 105 19 151 37 2 5 44 195 Workshops : Workrooms therein measured 29 70 18 117 50 5 7 62 179 Workshops reported to H.M. Inspector, on discovery 22 23 9 54 38 1 4 43 97 Workshops reported by H.M. Inspector 1 2 3 6 5 — — 5 11 Workshops removed from Register 18 13 5 36 43 3 3 49 85 Houses visited where no female hands were employed* 24 14 31 69 48 3 20 71 140 Written Intimations and Statutory Notices issued 15 240 3 258 26 2 1 29 287 Works carried out under supervision:— (a) Additional means of ventilation provided — 11 — 11 — — 1 1 12 (ft)' Rooms cleansed and white.washed 2 200 3 205 10 3 1 20 225 (c) Yards, floors, roofs, &c., repaired — 72 — 72 — 1 — 1 78 (d) Sanitary conveniences, dirty, ill-lighted, unventilated, or defective in water Bupply 4 57 — 61 6 1 2 9 70 (e) Dust-bins wanting or defective 1 12 — 13 1 — — 1 14 (f) Miscellaneous defects remedied 3 57 — 60 1 1 — 2 62 Nuisances referred to Medical Officer of Health 3 25 — 28 3 — 3 6 84 Cases of overcrowding of workrooms abated 1 4 — 5 18 — — 18 23 Cards distributed showing Number of persons who may be employed 16 — 5 21 68 — 4 72 93 * Houses where the business plate, or the local directory, or advertisements in newspapers implied a probability that female workers would be employed, but at which none were found. 52 WOMEN HEALTH VISITORS. The following observations, being an excerpt from my fifth monthly report (May 24th, 1900, page 50) deal with an interesting question that will probably be deemed deserving of the attention of the Council— " The practice of employing women in sanitary administration, originated by the late Vestiy in respect to inspection of workshops, laundries, etc., wrhere women and children are employed, has undergone interesting development by the appointment by certain provincial sanitary authorities of ' women health visitors.' Manchester led the way, and in 1899 Birmingham adopted the system. The duties of the visitors are sufficiently indicated by the directions given to those (four in number) appointed by the Corporation of Birmingham, as follows: — ' To visit from house-to-house ill such localities as the Medical Officer of Health shall direct. To carry with them disinfectant powder, and use it when required. To direct the attention of those they visit to the evils of bad smells, want of fresh air, and dirty conditions of all kinds. To give hints to mothers on the feeding and clothing of their children, and to use their influence in getting children sent regularly to school. In cases of sickness, to assist in promoting the comfort of the invalid by advice and personal help. To urge, on all possible occasions, the importance of cleanliness, thrift, and temperance. " The visitors are instructed to note ' (1) The general sanitary condition of the house, (a) The number of rooms and of occupants. (6) The existence of bad smells, and whether they arise from deficient ventilation, from bad drainage, or from accumulations of filth, (c) The state of the walls and floors; whether dirty from the tenant's or landlord's neglect, or in need of repair. (2) The general mode of living, particularly with regard to personal and domestic cleanliness. (3) The feeding and clothing of children, especially of those under two years old. Whether the baby is nursed by the mother or fed by hand j if the latter, what it is fed upon. (4) Any cases of illness in the house, (o) Nature of the disease. (6) Whether there is a medical man in attendance, (e) How far the necessary sanitary precautions are being carried out.' " A hand-bill relating to cleanliness, ventilation, etc., is distributed, containing advice to householders—(a) as to the house, (b) as to the yard, closets, dust-bins, etc., and (c) as to food. Naturally the poorest streets receive the attention of the visitors, who, to the end of 1899, had visited nearly 12,000 houses with excellent effect. The medical officer of health concludes his observations on the subject, in the annual report for 1899, by stating that it is ' the unanimous opinion of all who are brought into contact with the visitors that the work they do is urgently needed and has already proved very beneficial.' He adds that ' the general uplifting of the life of the very poor has been obtained '—and assuming this to be a correct statement of the result of the movement in the capital of the Midlands, there can be no doubt that the moderate expenditure entailed by the appointment of the visitors has been amply justified. The movement may be expected to extend; and, personally, I should be gratified should your Vestry (or the Kensington Council of the near future) see fit to appoint women, with the status of sanitary inspectors, to do the work of ' health visitors.' The matter, I may mention, is receiving attention from an organisation recently formed in London, one of whose meetings I was lately privileged to attend. On that occasion I ventured to express the opinion that it would be well to impress on school boards and the managers of other primary schools the importance of adding to their subjects of teaching, elementary information on matters relating to health, sanitation, and domestic management, cookery, etc. The best hope of bringing home to the minds of the next generation of men and women the hygienic importance of cleanliness, would be to teach the children of to-day the evils of uncleanliness. Needless perhaps to add that it would be well to inculcate the happiness which attends good management, in the attainment of a well-ordered and healthy home." The consideration of the report led to an interesting debate at the meeting of the late Vestry held on the 18th July, but the proposal to appoint two health visitors was negatived. PUBLIC HEALTH (LONDON) ACT, 1891. The need of amendments to this Act is recognised, and it was expected that the County Council would have introduced a Bill for the purpose during the ordinary session of 1900. In February, 1899, a letter was received by the late Vestry, from the Public Health Committee of the Council, asking for information as to any amendments, which, in their opinion, should be made. The communication was referred to a sub-committee of the sanitary committee, together with reports by the vestry clerk, the surveyor, and the medical officer of health; and also a communication from the Society of Medical Officers of Health, embodying suggestions for amendments and additions to the Act. The sub-committee made suggestions for amendment of section 2, especially for the definition of " overcrowding," corresponding to the provisions of the Borough Council's second bye-law for registered houses. They also proposed that section 5 should be amended, so as to enable the sanitary authority, upon obtaining a closing order, to evict the tenants. Other proposed 53 amendments dealt with offensive trades, slaughter-houses, cow-sheds and dairies; with the disposal of refuse ; regulations as to water-closets, unsound food, notification of infectious disease, cleansing and disinfection of premises after infectious disease; isolation in hospital; exposure of infected persons, &c. A number of additions to the Act were suggested, especially with regard to the control of infectious disease. The report, subject to a slight variation in regard to proposed amendments to section 55 (notification of infectious disease) was approved by the committee, and submitted to the Vestry. Some of the amendments were adopted; others, and all but two of the proposed additions, were rejected. THE WORK OF THE SANITARY INSPECTORS. The Table at page 54 contains a summary of the work of the sanitary inspectors during the year—so far as it admits of tabulation. The duties of these officers were carried out under the supervision of the sanitary committee, the late Vestry having conferred on that body power to enforce the provisions of the Public Health (London) Act, 1891, the Housing of the Working Classes Act, 1890, and the Factory and Workshop Acts, 1878 to 1895. The staff in 1900 comprised a chief inspector, six district inspectors, and the lady inspector of workshops, laundries, &c. Two " street inspectors " superintended the carrying out of the regulations for the periodical removal of stable refuse. The Sanitary Districts are delimited as follows :— The North Sanitary District comprises the portion of the borough to the north of the Hammersmith and City railway, with the exception of a few streets at the south-west corner of that area. The North-west Sanitary District includes the streets above referred to, its northern and eastern boundaries extending in a somewhat curved line from Latimer-road, along Waimerroad to St. Katharine's-road ; it is bounded on the west by St. Ann's-road (even numbers) to Latimer-road. The North-east Sanitary District comprises the remainder of the area between the railway (north), and a line running through Clarendon-place, St. John's-road, Kensington-parkgardens, and Chepstow-villas (south); it is bounded on the west by Walmer-road, and on the east by the borough boundary. The Central Sanitary District takes in the area between High-street. Notting-hill, and Holland-park-avenue (north), and Kensington High-street and Kensington-road (south) ; it also comprises the streets in North Kensington to the south of the north- west and north-east districts respectively. The South-east and the South-west Sanitary Districts, south of Kensington High-street and Kensington-road, lie east and west of a line running along Wright's-lane, Marloes-road, Lexham-gardens, Collingham-road, The Boltons, and Gilston-road, to Fulham-road. Written Intimations of nuisance were served by the inspectors, under section 3 of the Public Health (London) Act, 1891, to the number of 2,607. As a result of these intimations, many works of sanitary amendment were carried out forthwith, thus realising the intention of the Legislature, and obviating necessity for the service of statutory notices. On the intimation form, and on the statutory notice, a red ink note confers on the person liable to abate a nuisance the right to make what, for convenience, may be called an " appeal" to the sanitary committee, against the requirements of the sanitary inspector and the committee, respectively. Appeal, which is of rare occurrence, usually takes the form of an application for extension of time for carrying out works. Statutory Notices for the abatement of nuisances to the number of 788 were issued during the year, by the direction of the sanitary committee, and 1,234 notices were served under the bye-laws for houses let in lodgings. Supervision of reconstruction and trapping of drains, and of underground sanitary work generally, is exercised by the Borough Engineer, and information on the subject must be sought in that officer's report. Many drains were reconstructed by the owners or occupiers of houses, without the issue of sanitary notices, on the deposit of plans for approval. Particulars on this head also will be found in the Borough Engineer's report. 54 Summary of tiie Work of the Sanitary Inspectors during the Year 1900. Sanitary Districts.* No. of Complaints made by Inhabitants, 4c. No. of Houses, Premises, &c., inspected. No. of Re-inspections of Houses, Premises, &c. Results of Inspection. House Drain? Water Closets. Dust Receptacles. Water Supply. Miscellaneous. Written Intimations of Nuisance served.‡ Notices served by order of the Sanitary Committee. Notices served under the Lodging-House Bye-laws. Final Notices (signed by Medical Officer) served. Houses, Premises, &c., Cleansed, Repaired, Whitewashed, & c. Houses disinfected after illness: Infectious disease.‡ Repaired, Cleansad, &c. Ventilated, Trapped, & c. Repairs, Ax. Supplied with Separate Water Service. Soil-pipes Ventilated. New provided. Repaired, Covered, Ac. Cisterns erected. Cisterns Cleansed, Repaired, Covered, &c. Waste-pipes connected with drains, &c., abolished. No. of Lodging Houses newly Registered under !)4th Section of the Public Health (London) Act, 1S91.§ Yards and Areas paved and drained. Animals removed, being improperly kept. Regularly Inspected. Legal proceedings, i.e , Summonses. Bakehouses. Licensed Cow-houses. Licensed Slaughter-houses. North 174 1,076 2,699 468 190 297 52 271 265 87 47 303 15 55 100 97 2 111 — 17 139 19 21 — 1 4 N.E. 153 1,014 2,273 533 152 142 53 174 129 98 50 189 37 51 33 12 24 73 — — 52 7 27 1 3 9 N.W. 176 1,115 2,672 352 147 431 82 346 54 73 42 344 40 7 96 98 3 72 1 1 112 6 13 2 2 17 Central 196 1,144 1,983 473 102 178 49 212 116 72 45 136 63 25 18 44 5 58 — — 171 — 26 1 6 9 S.E. 140 1,312 1,767 322 65 58 15 60 93 50 38 91 18 40 18 18 19 73 — — 16 — 24 — — 3 S.W. 231 1,184 2,272 459 132 128 82 188 108 90 87 178 108 74 46 28 13 47 3 — 146 3 23 — 1 3 1,070 6,845 13,666 2,607 788 1,234 283 1,201 765 470 259 1,241 281 252 311 297 66 434 4 18 636 35 134 4 13 45 * For a description of the Sanitary Districts, see page 53. †Under the provisions of sec. 3 Public Health (London) Act, 1891. ‡ Done under the supervision of a Special Officer. § The total number of houses on the Register in December, 1900, in round figures, was 1,700. ( Vide page 66.) 55 Legal Proceedings.—In 45 cases proceedings were taken before the magistrates: in 13 instances for offences under the bye-laws for registered houses; fines to the aggregate amount of £7 5s. being imposed. Fines were inflicted in other cases as follows :—For failure to periodically remove manure, in six cases, the fines amounting to £11 13s.; in one case of unsound food, 10s.; in one case for failure to comply with the magistrates' orders, £3; in four cases for non-compliance with Vestry's notices, £2, £3, £1, and 10s.; in one case for removing offensive matter during prohibited hours, £1; and in one case for failing to provide a proper receptacle for manure, £2. The fines in all amounted to £31 18s. Neglect of the notices of the sanitary authority is somewhat common, the result being that the time of the inspectors is wasted in fruitless visits to premises. In every such case—as when the work has not been put in hand at a date when it should have been completed—application for the fine prescribed by section 4(4) of the Act of 1891 should be made: disobedience to notices leads to waste of the officers' time, and is also disrespectful to the sanitary authority. Offensive Businesses.—The only business coming under the statutory description " offensive," other than that of a slaughterer of cattle, carried on in the borough, is that of a Fat Extractor, at Tobin-street, in the Potteries, Notting-dale. The conduct of this business still gives rise to more or less effluvium nuisance at times, despite improved arrangements, care on the part of the proprietor, and supervision by the Council's inspector, as well as by the inspector of the County Council. The improvements carried out consequent on proceedings instituted by the County Council in 1899, included the provision of a scour, or condensing apparatus, and elevation of the chimney shaft. Complaints have been less frequent since these works were completed. Fried-Fish Shop Nuisance.—In connection with proposed amendments to the Public Health (London) Act, 1891, already mentioned, the sanitary committee of the late Vestry, in a special report, expressed the opinion that the business of a fried-fish seller should be added to the list of the businesses specified in section 19; this being the only means of bringing about the regulation of the conduct of the business, so as to prevent it from being an annoyance to adjoining occupiers. The business gives rise to nuisance when carelessly carried on, and without necessary precautions to prevent escape of effluvia, and it is a not infrequent subject of complaint; decided cases, moreover, class it as an "offensive business." The latest of such cases, Duke of Devonshire v. Brooksliaw, was tried, in 1899, in the Chancery Division, by Mr. Justice Kekewich, the plaintiff claiming an injunction to restrain the defendant from carrying on, at Eastbourne, the business of a fried-fish seller, or using the house for the business of a fried-fish seller, in breach of a covenant not to carry on any offensive trade or business on the premises. The business, it appeared, had been carried on since 1887, and in 1892 the Corporation took proceedings, but discontinued them on certain alterations being made. The defendant relied on laches and acquiescence on behalf of the plaintiff; but the judge decided that there had been a breach of the covenant, in the original conveyance, not to carry on an offensive trade or business, and granted an injunction. Marine Stores.—The business of a marine store dealer is not scheduled in the Public Health (London) Act, 1891, as an offensive business, but it gives rise to offensive smells, and has been held by the Appeal Court to be ejusdem generis with the businesses scheduled, originally, in the (now repealed) Slaughter-houses (Metropolis) Act, 1874. Acting upon my representations, the late Vestry made application to the late Metropolitan Board of Works in 1883, and subsequently, to schedule the business under that Act, but without success. And in 1896, upon receipt of complaints of nuisance arising in the conduct of the business, an application was made to the County Council to schedule the business under the provisions of section 19 of the Public Health (London) Act, 1891. This application, likewise, was unsuccessful. The subject was dealt with fully in my annual report for 1896—pages 119-123. 1 have only to add that the premises where the business is carried on are regularly visited by the several sanitary inspectors. 56 LICENSED SLAUGHTER-HOUSES. Thirteen premises were licensed by the County Council in October—seven in North Kensington and six in South Kensington. The names of the licensees and the localities of the premises are set out below. The several premises were regularly visited by the sanitary inspectors, and were inspected in July by the sanitary committee. The business of a slaughterer of cattle has not been established anew in the borough since the passing of the Slaughter-houses (Metropolis) Act, 1874, in which year there were 56 licensed premises. The number of slaughter-houses in the metropolis, as a whole, has undergone a considerable diminution, viz., from 1,500 in 1874, to 397 in 1900. In the annual report for 1898 (pp. 98-102) I dealt with the subject of "Abattoirs versus Private Slaughter-houses," in connection with an abortive attempt by the Public Health Committee of the County Council to substitute public for private slaughter-houses. The report of the committee (dated 21st July, 1898), containing the recommendation, was shelved by the Council on a motion to proceed to the next business; to my regret, as an advocate, for nearly 30 years, of public abattoirs. No further action in the matter has since been taken. (Vide also page 81.) The names of the licensees and the localities of the licensed premises are as follow :— North Kensington. South Kensington. Lonsdale Mews 13, Archer Mews 10, Edenham Mews 61, Silchester Road 195, Clarendon Road 235, Walmer Road 4, Royal Crescent Mews Mr. Grove. „ Bawcombe. „ Goddard. „ Shattock. „ Simmons. Mrs. Van. Mr. Brooker. 60, Kensington High Street 85, Earl's Court Road 21, Peel Place, Silver Street 25, Silver Street 133, High Street, Notting Hill 118, Holland Park Avenue Mr. Evans. Mrs. Matson. Mr. Osborne. „ Wright. „ Candy. „ Holloway. LICENSED COW-HOUSES. pour premises were licensed by the County Council in October—three in North Kensington, and one in South Kensington. The names of the licensees and the localities of the premises are set out below. The several premises were regularly visited by the sanitary inspectors, and were inspected in July by the sanitary committee. There were only five cows in the sheds; not many years ago there were 28 sheds, containing about 500 cows. There has been a considerable reduction in the number of cow-houses in the Metropolis, as a whole; viz., from 1,044 in 1880, to 319 in 1900. The County Council have intimated to cowkeepers that the Public Health Committee are of opinion that in the case of premises newly licensed the recommendation of the Royal Commission on tuberculosis that no cow-shed should be erected within 100 feet of a dwelling-house should be observed. The Council can, of course, enforce this condition. (Vide also page 81.) The names of the licensees and the localities of the licensed premises are as follow :— North Kenfington. South Kensington. 187, Walmer Road Mr. Arnsby. Campden Street (Yard in) Mr. Lunn. 5, Ledbury Mews „ Liddiard. 23, Bramley Road „ Tame. BAKEHOUSES. The bakehouses, to the number of 134, viz., 74 in North Kensington and 60 in South Kensington, were regularly inspected, and action was taken, when necessary, to ensure compliance with the sanitary provisions of the Factory and Workshop Acts, 1878 to 1895, and the Public Health (London) Act, 1891. In the annual report for 1894 (pp. 152—166 inclusive), when treating of the " regulation of bakehouses, " I described the proceedings of the County Council in the effort to secure amendment of the law to enable the sanitary authority to exercise efficient control over bakehouses. The Council were of opinion that the Factory and Workshops Bill, to be brought in by the Government in 1895, would afford an opportunity for amending the law relating to bakehouses, and the Public Health Committee of that body waited upon the President of the Local Government Board to explain their views. The President said it was improbable that any clause would be inserted in the proposed Bill dealing with London bakehouses, as the Bill would have reference to the whole country, and he suggested that the Council itself should introduce a Bill. In accordance with the committee's recommendation, the Parliamentary Committee was (in January, 1895) instructed to prepare a Bill in accordance with the Council's views, but no Bill was introduced. One provision with reference to bakehouses is contained in the Factory and Workshop Act, 1895, section 27(3), to the effect that " a place underground shall not be used as a bakehouse unless it is so used at the commencement of this Act," i.e., at the beginning of the year 1896; but magisterial rulings have made this provision inoperative. (Vide also page 82.) 57 REFUSE MATTER. The prevention of nuisance in connection with the storage, collection, and conveyance through streets of offensive substances coming under the general description, Refuse, which was formerly a matter of no little difficulty, has been facilitated by the County Council's bye-laws made in 1893, under the provisions of section 16 of the Public Health (London) Act, 1891. But in order to prevent nuisance in the conveyance of offensive matter through streets, supervision is necessary; and as the police have constant opportunities for observing breaches of the bye-laws, it appeared to the Public Health Committee of the Council that it would be useful if they were instructed to take note of offences, and to give information to the sanitary authority of the district. The committee communicated their views to the Commissioner, who thereupon issued an instruction to the police to report to the sanitary authorities any breach of the bye-laws, and this is sometimes done. House Refuse.—The work of collection of ashes and miscellaneous rubbish from the 23,000 inhabited houses, ha3 been systematised by division of the borough into districts, and provision has been made for inspection of dust-bins, and oversight of the dusting-gangs, the arrangements being under the supervision of the Borough Engineer. A call is made at every house once a week, and further improvement is scarcely possible, until the objectionable practice of refuse-harbourage shall have given place to the more rational system of daily collection from movable receptacles. Nuisance from house refuse does not arise from the proper contents of the receptacle—ashes—but from the addition thereto of matters of organic origin. With the object of preventing nuisance from this cause, a printed notice was periodically issued by the late Vestry to every householder, calling attention to the danger to public health arising from the deposit of vegetable and other objectionable refuse in the dust-bin, and requesting that directions might be given for all such refuse to be burned. A portion of the refuse, from the northern part of the borough, is conveyed out of London on the Grand Junction Canal, the refuse from the southern part of the borough being taken, by the contractor, down the Thames; but not to the Council's Purfleet depot, which lies below high-water mark, and is let to the contractor for the deposit of other matter of a presumably less objectionable sort. The time will probably come when the refuse will be cremated in or near the borough, and the heat thus generated be employed for the production of " current" for the illumination of the streets by electricity—a practice which has already been adopted with success in other districts. The Council possess a site at Wood-lane, Hammersmith, where, it would seem, a " destructor" and an electric-light installation might be advantageously located. Stable Refuse.—In former reports I had to note the frequency of complaints of effluvium nuisance arising in the storage, and especially in the removal of stable refuse from pits underground. Thanks to the operation of the County Council's bye-law, which has been carried out effectually in this borough, complaints in respect to private premises are now relatively few in number; and as a principal cause for comp'aint, the sunken dung-pit, is almost a thing of the past, we may reasonably hope to have little cause for annoyance on this score in the future. The subject was fully dealt with in my annual report for 1894 (pp. 184—189), to which I would refer anyone desirous of knowing what a serious difficulty the question involved, until we were able, generally, to abolish the brick receptacle, above or below ground, and to substitute the iron cage now so familiar an object in the mews in this borough, not far short of two hundred in number. The following statement shows the work done in giving effect to the bye-law:— North Kensington. South Kensington. t otal. Iron cages erected 564 999 1,563 Brick receptacles abolished 171 554 725 Brick receptacles constructed or reconstructed 281 45 326 Sunken pits, improved, allowed to remain 86 88 74 Sunken pits abolished 132 484 566 Sunken pits were allowed to remain in certain instances simply because, owing to the construction of the stable premises — the entire frontage being occupied by doors—it was impracticable to provide any other form of receptacle. In each such case the pit was reconstructed to a reduced depth (the sides and floor being cemented) and drained to the sewer. A few complaints having been received in the summer of effluvia from peat stable refuse, the sanitary committee of the late Vestry reissued the regulations relating to the periodical removal of manure, &c., and a copy, in bill form and bold type, was posted in ever}' mews. These regulations, require removal three times in each week, viz., on Monday, Wednesday, and Friday, or on Tuesday, Thursday, and Saturday. Discretion is used, the regulation being strictly enforced only in cases where such frequency of removal is necessary on sanitary grounds. Where straw is used as litter, the refuse being stored in an iron cage receptacle, the quantity moreover, being small, it is not necessary to insist on such frequent removal. 58 Conveyance of Offensive Matter Through Streets.—Reference has been made in these reports, on several occasions, to nuisance from peat stable refuse, and to the necessity of depositing such refuse in a suitable carriage on removal from the stable, so as to allow of its conveyance from the premises without disturbance, such as necessarily takes place when the manure is stored in an ordinary brick receptacle, the stenches complained of bsing due to such disturbance. Reference, moreover, has been made to nuisance in connection with the storage and removal of other offensive matter—more particularly that of the trades of fishmonger, game dealer, poulterer, &c. Refuse of this description is required by the bye-law of the County Council to be removed in a " suitable carriage or vessel properly constructed," and covered " SO as to prevent the escape" of any of the contained matter, " and so as to prevent any nuisance arising therefrom." The time prescribed for removal is from 4 to 10 a.m. in summer, and from 6 a.m. to noon in winter. Much of the offensive matter is conveyed to West Ham, where a bye-law is in force prohibitive of the conveyance of such material through the streets during the daytime. These contradictory bye-laws place the people engaged in the business of removal in an awkward position. For some years, at the instance of the late Vestry, peat manure at the large stable yards occupied by omnibus companies and other large proprietors of horses, has been stored in waggons, and removed in them, without giving rise to serious complaint. With regard to other forms of offensive matter, the views expressed in these reports indicate the desirability of fish offal, and such like matters, being removed from the tradesman's premises in the storage vessels, and not, as now, in tank-vans, the use of which involves more or less nuisance, both when the contents of the shop receptacles are tipped into the tank, and in transit through the streets. Given properly covered, externally clean, and sound metal receptacles, no nuisance is likely to arise in transit through the streets, at whatever time of day removal may be effected, and on purely sanitary grounds there need be no limitation of time for removal. The views thus briefly set out having been approved by the late Vestry, and submitted to the County Council on more than one occasion, appear not to have been without effect, for the subject generally was dealt with by the Public Health Committee of that body last year in connection with a proposed amendment of the Council's byedaw with regard to the removal of offensive matter. An amended bye-law was prepared, and, pursuant to section 114 of the Act, forwarded to the sanitary authorities to enable them to make any representation thereon to the Council for its consideration. The proposed amended bye-law reads as follows:— " Every person who shall remove or carry, or cause to be removed or carried, by road or water in or through London, any faecal or offensive or noxious matter or liquid, whether such matter or liquid shall be in course of removal or carriage from within or without or through London, shall use or cause to be used therefor, a suitable carriage or vessel properly constructed, and furnished with a sufficient covering, so as to prevent the escape of any matter or liquid therefrom, and so as to prevent any nuisance arising therefrom. " Such person shall not remove or carry, or cause to be removed or carried, such matter or lioi'.id by road in or through London except during the following periods, viz.:— "Between 5 o'clock a.m. and 10 o'clock a.m., or during the period commencing two hours before sunset and ending one hour after sunset, in any day during the months of March, April, May, June, July, August, September, and October. "Between 6 o'clock a.m. and 11 o'clock a.m., or during the period commencing two hours before sunset and ending one hour after sunset, in any day during the months of November, December, January, and February. " Such person shall not remove or carry, or cause to be removed or carried, such matter or liquid by water in or through London except during the period commencing at sunrise and ending at sunset in any day. "This bye-law shall not apply to any person removing or carrying manure consisting only of horse dung, with a sufficient proportion of straw, and shall not apply to any person removing or carrying in a suitable vessel, as aforesaid, manure consisting of horse dung and litter other than straw." The County Council's Public Health Committee in their report stated that the Local Government Board did not "see their way to allow removal either during the night or during hours of the day, when the streets are crowded, especially during the heat of summer." They added that " the extension of hours . . . would be of substantial benefit, although it would not remove all the difficulties " to which their attention had been called, and which " could only be overcome by allowing removal during the night," a course to which the Board " object, as it is then impossible to see that the refuse is not slopped or spilled, and that the vehicles conveying it are properly covered." It will be observed that the proposed amended bye-law would deal effectively with the nuisance from peat moss litter, which would be required to be removed in properly covered carriages. When reporting on the subject in the second monthly report (February 28th, page 21), I anticipated that the necessary consent of the Local Government Board to the proposed amended bye-law would not be withheld; I regret to say that consent has not yet been given. It must be added that the extended hours proposed to be allowed for the transit through streets of offensive matter will not get over the difficulty in regard to West Ham, where, as already stated, a bye-law is in operation prohibiting the conveyance of offensive matter through streets in the day time. It is matter for 59 satisfaction that the views approved by the late Vestry in regard to the storage and removal of peat moss litter have so far prevailed; but it is to be regretted that the Council have not seen their way to adopt the views set out in these reports with regard to the removal of fish offal, and other like refuse, in the shop receptacles, rather than in tank-vans. OFFENSIVE SMELLS IN STREETS. As usual, during the summer months complaints were received, from different parts of the borough, of stinks, which were usually traced to the presence of untrapped street gullies or sewer ventilators in the roadway. The offending apertures were in connexion with sewers under the jurisdiction of the County Council and the Borough Council alike. The worst spot, perhaps, was that in Warwick-road where there is a large circular ventilator to the Counter's-creek sewer, near to the entrance to the Earl's Court Exhibition, which has formed the subject of many complaints at different periods of the year, even when the Exhibition has not been open. This subject has been referred to in several previous reports, but no effectual remedy of general application has been found for the nuisance. (Vide also, page 69, " Untrapped Street Gullies.") Effluvium Nuisance at Earl's Court Exhibition.—During several years complaints have been made by residents in the vicinity of objectionable smells of a special sort, differing from sewer smells, perceived intermittently, and only when the Exhibition was open. Smells having been located to the electric lighting installation, in ] 898, the directors of the Company, at the joint request of the medical officer of health of Fulham and myself, erected (in 1899) a lofty chimney shaft to carry off the vapours to which the smells were believed to be due. Nevertheless, again, last year, complaints were received, and it was believed that the nuisance was due, in part, at least, to the burning of fat, &c., in the kitchen of the refreshment department. Almost immediately after the show was opened, complaints began to come in, and the directors were requested to enjoin care on the part of the refreshment contractors to prevent the spilling of fat on the cooking stoves, or the burning of animal or vegetable refuse therein. This was done, a notice having been printed and displayed in the kitchens as follows :— " No grease or rubbish of any kind may be burned in the stove, and care must be taken not to spill boiling fat or anything likely to create an offensive smell. Anyone offending in this way is liable to instant dismissal." In June, I received information of the existence at a remote part of the Exhibition premises, and in the Fulham district, of a refuse destructor, which it was thought might be responsible, more or less, for the nuisance. The medical officer of health of Fulham made an inspection with me, and a small " bee-hive " shaped brick structure was found, in which refuse of various kinds was undergoing slow combustion. In a heap near the fire, bones, sawdust from the lions' den, and various other matters were observed in readiness to be put on the fire. The entire arrangement was of the most primitive description—a gehenna; which in all probability had been smouldering since the exhibition opened, in May, and, possibly, in preceding years, during the season, from May to October. The locality in which smells were noticed outside the premises, would naturally vary with change in the direction of the wind. Many persons had complained of the smells in the vicinity of the " Imperial Court," and the furnace was quite near to the said Court, but not accessible therefrom. My Fulham colleague, who was not aware of the existence of the apparatus, decided to have all refuse removed from the premises, and to have the brick structure pulled down, to prevent the possibility of further nuisance. This was done, and complaints ceased. I may mention that I had not long before this discovery addressed a communication to the director-general of the Exhibition on the subject of the complaints, as follows:— " Whenever I have written you on this subject, you have expressed desire to abate and prevent nuisance, and have given facilities to the sanitary staff. But the smells are intermittent, and the cause and locality of them have not been certainly ascertained by us. Many persons on your staff, assuming the Exhibition to be to 'blame, must know all about the matter; and I venture to submit that I am entitled to look for all such information from you as may enable me and my staff to deal with the nuisance. But no information or assistance, by way of disclosure, has ever been given." A member of the staff, who subsequently called upon me, stated that the directors were unable to throw any light upon the cause of the nuisance, if any existed ; and it is quite within the bounds of probability that they were ignorant of what was going on. But members of the working staff were not ignorant, for one of them admitted that the smell from the cremator was " very bad at times," depending doubtless upon the quality of the matters burned (which had recently included a lion cub), and upon the fact that no effort was made to secure active combustion, the rubbish to be burned being simply placed on the ground, and fresh matter piled on the fire from time to time. It is improbable that the nuisance should have been allowed to continue so long, if anyone in authority had been aware of the cause of the objectionable effluvia. THE HOUSING 01' THE WORKING CLASSES. No subject during the year received greater attention from the sanitary authorities of London than the housing of the working classes, which is now engaging the attention of some of the borough councils. Hitherto, what has been done tinder schemes framed under Part I. of the Act of 1890, promoted by the late Metropolitan Board of Works, and since 1889 by the County Council, has 60 scarcely touched the fringe of this the most difficult of sanitary problems; the principal result of the operations of those bodies having been the eviction of the indigent poor by the pulling down of their wretched abodes to provide space for the building of more or less elaborate " Dwellings," let at rents beyond the means of the previous inhabitants. The most ambitious of the schemes carried out so far by the Council—"The Boundary Street Scheme"—was referred to, on completion, in the third monthly report (March 28th, page 35). At the time of its inception in 1890, in the eleventh monthly report (Nov. 3rd, page 118), I gave some account of this scheme, stating that it dealt with an area partly in Shoreditch, but mainly in Bethnal Green, having originated in an "official representation" of the slum as an " unhealthy area" by the medical officer of health of the latter district. The annual rate of mortality in the streets dealt with in the four years, 1886—9, had been 4.0 per 1,000; the zymotic death rate 8.6 per 1,000; the rate of infantile mortality being also high. The area—15 acres in extent—comprised 20 streets, ranging in width from 20 to 28 feet. There were also many small courts of a bad class. The houses were 730 in number, of which 652 were occupied, wholly or partly, by persons of the working classes. The population, exclusive of persons in two registered lodging houses, was 5,566 (= 373 per acre); viz., 3,370 adults and 2,196 children, who were in occupation of 2,545 rooms. Including those in the common lodginghouses, the number of persons of the labouring classes displaced was 5,719; comprised in about 860 families. The estimated nett cost of the scheme was £300,000, of which about one-eighth part, it was stated, would fall on the City, one-sixteenth part on Kensington, and one-eightieth part on the parish mainly benefited. The scheme, carried to completion last year, was described in a pamphlet prepared by the Housing Committee of the County Council, prior to the opening ceremony by H.R.H. the Prince of Wales, to the following effect: The area is approached by an avenue 60 feet wide, leading direct from Shoreditch High-street to a central open space; streets 50 feet wide, planted with trees, radiate from this centre to the limits of the area, these streets being connected with the streets bounding the area by branch streets 40 feet wide, whilst the four streets bounding the area have been widened to 40 feet. Upon the building sites created, blocks of dwellings are so arranged that the living-room of every tenement receives the benefit of sunlight at some time during the day. Twenty-three blocks of dwellings provide accommodation for 5,380 persons, in flats—15 of one room, 533 of two rooms, 388 of three rooms, 98 of four rooms, 7 of five rooms, and 3 of six rooms—in all 925 tenements, in lieu of the 730 houses formerly existing. A central laundry was provided (which, however, is little used); the laundry building containing baths and two good-sized club-rooms. Baths, with hot and cold supply of water, are provided in one of the blocks of buildings. Between the various blocks of buildings there are large paved yards which form playgrounds for the children, and one of these is laid out as an ornamental garden. There is a central open space, circular in shape, formed in terraces, and provided with seats, shrubs being planted on its slopes. There are 77 workshops, and 18 shops for the use of the occupants of the buildings; a central workshop was also fitted for the execution of works of repairs on the estate. The aim of the Council was that the dwellings, while let at rents not exceeding those ruling in the neighbourhood, should be so designed as to be self-supporting. The rents are sufficient to pay all out-goings, including interest on the capital expended on land (at its value for housing purposes, £63,010), and buildings, and to provide a sinking fund for the repayment of the capital within a period of sixty years. Obviously, a great local improvement has been effected, and comfortable homes provided for nearly as many persons as were evicted. But none of these unfortunates are to be found amongst the occupants of the flats. What has become of them? One asks in vain. But it may safely be assumed that many have gone to increase overcrowding in other already overcrowded slums. It is always so. The late Metropolitan Board of Works carried out some 22 schemes of a similar sort; 59 acres of land were acquired and cleared, on which accommodation was provided for upwards of 38,000 persons. The amount expended exceeded a million and a half sterling (about £40 per head), this amount being irrespective of the outlay on model dwellings erected on some of the cleared sites by bodies like the Peabody Trustees. The Board, after taking steps for giving effect to eight additional schemes, stayed proceedings on account of the tremendous cost to the ratepayers that would have been involved in carrying them into effect. It was alleged that a third part of the cost of acquiring sites was due to excessive valuation of property so bad that demolition was the only possible remedy for the evils to which it gave occasion. When referring to the Boundary-street scheme in 1890, I said it was to be feared that the cost would be even greater, relatively, than that of the aggregate of schemes carried through by the Metropolitan Board. It now appears that the cost of purchasing the slum properties, including the land, was £333,000, or about £20 per head of the displaced population (5,566). The families turned out were 860; the expenditure on properties and land was therefore equal to £387 per household. For a smaller outlay, as I remarked in 1890, "freehold cottages and gardens might be provided, a little way out of London, and handed over, free of cost, to the dispossessed people, whose travelling expenses to and fro would amount to less than they now pay in rent for the dens in which they rot, and will have to pay for the rent of rooms in the new 'Dwellings' — should they ever set foot therein." But, as already said, the old tenants do not return. The scheme is admirable in 61 itself, but it contributes in no appreciable degree to the solution of the difficulty of housing the poorest, a difficulty never likely to be effectually dealt with under Part I. of the Act of 1890, but which might possibly be to, some extent solved under the provisions of Part III., should Parliament see fit to enable the borough councils to acquire slums at their nroper value—that is, the value of the land, as housing sites, plus the value of the materials of the buildings thereon. There is the more reason for a drastic measure of this sort, as it would appear that the County Council, alarmed at the cost of acquisition of properties, is not likely to undertake other such large and expensive schemes. It will be remembered that the Council would not entertain the request of the late Vestry to deal with our " Special Area" (no" slum"!) under Part III., though there was every reason to believe that the properties proposed to be acquired as lodging-houses might have been purchased on terms to yield a good profit in rent. and although the death-rate of the district exceeds that of the Boundary-street area—40 per 1,000—a rate whioh was deemed to justify the gigantic outlay on the scheme, made at the charge of the Metropolis generally, and mainly for the benefit of Bethnal-green and Shoreditch. The descriptive pamphlet relating to the Boundary-street scheme referred to, furnished information with respect to other schemes completed, or in course of execution, by the Council. It stated that in the clearance only of insanitary areas, the Council was spending £1,114,800, for which some 35 acres of old, dilapidated and insanitary dwellings would be demolished, 16,160 persons being displaced. About 1,900 tenements, affording accommodation for 10,060 persons, were already completed and occupied; these buildings, including the value of the land, cost £609,438. Nearly 1,200 tenements, affording accommodation for 5,900 persons, were in course of construction, at a cost for building, including value of land for housing purposes, of £327,000. Plans, moreover, were being prepared for 3,718 tenements, for 19,990 persons, at a cost for buildings and land estimated at £1,008,799. In all, the Council had provided, or were providing, accommodation, in 6,810 tenements, for 35,950 persons at a total outlay of £1,945,277. In addition, 5,251 persons were to be accommodated in areas to be cleared ; but the cost of this work had not been estimated. In the aggregate of the schemes, it was stated, buildings equivalent to a town of nearly 36,000 inhabitants, that is of the size of Macclesfield, in Cheshire, will have been constructed at the expenditure of nearly two millions sterling—say, £55 per head of the population housed. Some of the improvements carried out by the Council comprise very limited areas, and possibly proceedings could have been taken under Part III. of the Housing of the Working Classes Act, 1890, which consolidates and amends the Acts, 1851 to 1885, commonly known as Shaftesbury's Acts, its object being the provision of suitable houses and cottages for the working classes, whether by acquiring land and erecting new buildings, or by the purchase of existing lodging-houses by the " Local Authority." The late Vestry, on more than one occasion, as already stated, requested the Council to purchase the lodging-houses in the " Notting Dale" special area with this object. The borough council may, by adopting Part III., become a local authority under the Act, and will have power to purchase, and arrange for the management of, these houses under bye-laws, as explained in the annual report for 1897 (page 142). Under Part I. of the Act of 1890, special provision is made (in Sec. 21) as to compensation, with the object of limiting the amount to be paid for a house or premises, the rental of which had been enhanced by reason of the same being used for illegal purposes ; or in case of the premises being so overcrowded as to be dangerous or injurious to the health of the inmates; or in such a condition as to be a nuisance ; or in a state of defective sanitation ; or not in reasonably good repair. Should the house or premises be unfit, and not reasonably capable of being made fit, for human habitation, the compensation to be awarded by the arbitrator is based on " the value of the land, and of the materials of the buildings thereon." Under Part III., however, it would appear that, in the present state of the law, whatever the condition or the mode of occupation of the houses acquired, full compensation, with allowance for compulsory purchase,, must be awarded, a defect in the law which calls for amendment. All that has been here said goes to show the practical impossibility of giving effect to the provisions of the Act, under Part I., to any adequate extent, excepting at a prohibitive cost. The more hopeful plan for dealing with the question of the housing of the working classes would seem to be that of securing a reduction of rents in town, by bringing the country into competition; by the erection of cottages, and by increased travelling facilities, a subject to which attention has been called in these reports on more than one occasion, and long ago. The Amending Act of 1900 affords facilities to the County Council, and to any borough council which may adopt Part III. of the Act of 1890, for the acquisition of land outside the county, and beyond the district of the borough council; and it may be expected that steps will be taken, ere long, to give at least experimental trial to the plan which, if associated with increased travelling facilities, may do something towards the solution of the most difficult sanitary problem of the new century. Bye-Laws for Houses Let in Lodgings or Occupied by Members of more than One Family.—Under the provisions of the Sanitary Acts of 1866 and 1874, regulations were made by the late Vestry, in 1885, and upwards of 1,700 houses have been registered thereunder. The said 62 Acts having been repealed, and modified provisions in respect to bye-laws enacted in the Public Health (London) Act, 1891, the Local Government Board addressed a circular letter on the subject to the sanitary authorities in 1892, and again in 1894. The Board pointed out that the powers conferred by the new Act (section 94) " differ in some respects from those exercisable under section 35 of the Sanitary Act, 1866, and section 47 of the Sanitary Law Amendment Act, 1874, in pursuance of which the regulations now in force in (this) district were made"; inasmuch as section 94 of the new Act, " no longer provides that such matters as the enforcement of privy accommodation, the paving of premises, the notices to be given in case of infectious or contagious disease, the cleansing of cisterns, or the keeping of water-closets in good order, &c., shall be dealt with by regulations applicable to houses let in lodgings. These matters," it was added, "can be otherwise dealt with : in some cases by bye-laws made by the sanitary authority, and applicable generally to all houses in the district, whether let in lodgings or not, and in others by bye-laws made by the London Count}' Council." The Board at the same time forwarded " a model series of bye-laws, which they had caused to be prepared for the use of sanitary authorities, under section 94 of the Act, drawn up after very careful consideration of the regulations which might be properly enforced in the case of the class of houses to which the enactment applies ;" and it was suggested that existing regulations should be modified on the basis of the model clauses. The matter was referred to the sanitary committee to consider, and report what modifications were necessary or desirable to bring the existing regulations into conformity with the provisions of the Act of 1891. The subject being new to many members of the late Vestry, I gave an outline of former proceedings with regard to it, in the annual report for 1894. To what was then said (pp. 191-199) there is little to add now, inasmuch as the matter stands practically where it did six years ago, when the sanitary committee approved a modified series of bye-laws I had drafted for their consideration. The committee had forwarded the proposed bye-laws to the Local Government Board, tentatively, with the view of ascertaining whether they were such as the Board would be prepared to sanction. After a long wait, and no reply being forthcoming, the bye-laws were submitted to the Vestry for approval, and referred to the law and parliamentary committee and the sanitary committee, jointly, for further consideration. With a view to lighten the labours of the joint committees, 1 prepared a report (No.4, April 25th, 1895, pp. 50—60 inclusive) showing " generally, in what respects the proposed new bye-laws differ from the existing bye-laws, and from the model series framed for the guidance of the sanitary authorities by the Local Government Board." To this report was subjoined a list of streets, showing the number of houses in each which had been registered since 1885, and a further list of some of the principal streets, the houses in which, so far as they were let in lodgings or occupied by members of more than one family, appeared to be proper to be registered under the provisions of the Act. The joint committees submitted their report, July 31st, 1895, and the bye-laws in the form recommended by them were, on that day, adopted by the late Vestry, and ordered to be sent to the Local Government Board for their sanction. On the self-same day a communication was received from the Board intimating their willingness to approve, with a few, mostly verbal, amendments, the bye-laws which I had drafted and the sanitary committee had approved and forwarded for the consideration of the Board five months previously, and which differed in some material respects from those adopted by the Vestry. After a further long interval the Board returned the second draft of proposed bye-laws, with suggested amendments. To some of the Board's suggestions the Vestry demurred; and a further communication was made to the Board, urging, inter valia, the desirability of a proposed bye-law requiring the landlord of a registered house to give notice to the sanitary authority when intending to carry out the annual cleansing, so as to enable the sanitary inspector to supervise the execution of the work. The Board had expressed doubt as to the competency of the sanitary authority to make such a bye-law,* the desirability of which does not admit of question. Proposed additional bye-laws. — It is a common practice with people having large families to conceal the number of their children until after taking possession of their lodging—often a single room ; and then, should it be desired to get rid of them, the tedious process, by notices and policecourt proceedings, described in the annual report for 1889 (page 119), has to be gone through, consuming, many (at least six) weeks before possession can be obtained, during which interval the unfortunate landlord may not receive rent on peril of failure to obtain an ejectment order. In regard to registered houses, the "keeper" is equally liable with the "lodger" for the offence of overcrowding, and as I pointed out in the ninth report for 1896 (August 13th, page 111), it would be well if a bye-law were made requiring him, under penalty, to report to the sanitary authority any case of overcrowding coming to his knowledge. On consideration of the report, the Vestry decided to apply to the Local Government Board for sanction to a bye-law requiring the keeper to report overcrowding, as follows :— " If any lodger in a registered house cause or suffer any room under his control to be occupied by a greater number of persons than is allowed by this bye-law, it shall be the duty of the keeper of the registered house, upon his becoming aware of the fact, to notify such fact to the medical officer." * The Board's suggestion was that a definite period should be fixed for the execution of the works of cleansing, kc., namely, one month, so that the sanitary authority, knowing at about what time the work would be in progress, should have a chance of being able to exercise supervision. The period limited by the proposed bye-law, " March 1st to August 1st inclusive," being the same as in the existing bye-law (No. 7), is so prolonged that it is practically impossible to supervise, as the inspectors seldom know when work is likely to be in progress. 63 In my sixth report for 1897 (25th June, page 79), a further suggestion for a new bye-law was made with a view to secure the provision and maintenance at " furnished " rooms in registered houses, of bedding which should be clean and wholesome, and free from noxious insects. The matter was referred to the sanitary committee, who (on 6th October, 1897) recommended, and it was resolved— " That the Vestry do approve of a draft bye-law in the following terms, and that the same be submitted to the Local Government Board for their approval, viz. : — "The landlord or keeper of a registered house in which rooms are let in furnished lodgings, shall cause the bedding and other articles in such rooms to be at all times maintained in a clean and wholesome condition and free from noxious insects." The Local Government Board's views on the subject of these proposed new bye-laws have not yet been received, and the bye-laws adopted in 1885 are still in force: they have worked well, and, personally, I could be content that they should continue unaltered. It is true that certain matters with which they deal are " otherwise " (but not differently) " dealt with " in the Public Health Act, and in bye-laws framed by the County Council and the sanitary authority. There is, nevertheless, a manifest advantage in dealing with such matters in the lodging-house bye-laws, for the information of owners, keepers, and lodgers having duties in regard to them, with which they will not otherwise become acquainted, the general bye-laws not being circulated. As t-lsewhere stated, moreover, sanitary administration in relation to registered houses is facilitated by the bye-laws which enable the Council to secure conditions necessary to healthiness of the habitation, without recourse to the tedious process of proving nuisance to the satisfaction of tiie justices, by proceedings under the second section of the Public Health Act. Registeiiable Lodging-Houses.—An interesting question in connection with the registration of houses let in lodgings or occupied by members of more than one family, raising the point whether Hats or rooms in artizans' dwellings can be brought, as lodging-houses, within the provisions of Sec. 94 of the Public Health (London) Act, 1891, came before the sitting magistrate at the Southwark police-court. The case arose out of the decision of the late Vestry of St. George-the-Martvr, to register Gun's buildings in that district, and the refusal of the agent of the owner to furnish particulars with respect to the tenements, and the manner of occupation, and the names, sex, etc., of the occupants—in a word the particulars set out in the Council's first bye-law. These particulars, which the learned magistrate who granted the summons characterised as " most inquisitorial," are specified in the model bye-laws of the Local Government Board on which the local bye-laws are framed.* But this by the way. The agent was summoned for refusing to furnish the required particulars. At the hearing it was contended on behalf of the Vestry, that the occupants of the one and two-roomed tenements were really lodgers, and that each block was a lodging-house within the meaning of the Act—i.e., it was " a house or part of a house which is let in lodgings, ,or occupied by members of more than one family." For the defendant it was claimed that each tenement, though it might comprise only one room, was a separate dwelling-house, and that the occupiers were not lodgers but "occupying tenants." Their names, it was stated, were on ihe rate books, and although they compounded with their landlord for the payment of the rates, they were in possession of the parliamentary franchise, and were in a similar position to the holders of West-end fiats, or chambers in the Temple. This view was controverted bv the Vestry's representative, who argued that registration law was not relevant to the administration of the Public Health Act, and, if it were, places which were not called lodgings under the Registration Acts were so called under the Lodgers' Goods Protection Act. The learned magistrate dismissed the summons, following, as he stated, the decisions of the judges of the Supreme Court, as it appeared that the landlord did not reside on the premises, and did not exercise any control over them either by himself or his servants (it was stated, however, that a caretaker lived on the premises, collected the rents, and exercised control as the servant of the landlord), and therefore the premises could not be said to be " lodgings " in anv meaning of the word. The tenements appear to have been regarded by the learned magistrate as separate houses, and I suppose they are, qua the parliamentary franchise. The same contention, possibly, is tenable in respect to individual rooms let to lodgers in ordinary tenement houses—that class of house which the late Vestry thought to be pre-eminently proper to be registered under the bye-laws. In the Southwark case there appears to have been no question— whether regard be had to the character of the property, or the character of the inhabitants, that the tenements were such as would have been properly subject to registration, had they not come under the definition " artizans' dwellings." In connection with the census, it may be * Moreover, in the High Court of Justine. Queen'B Bench Division, April 6th, 1886—Roots (Appellant) v. Beaumont (Respondent)—Respondent being charged with infringing bye-laws of a Local Board, in not attending to slate the particulars of her lodging-house, it was held that where part of the house was let to one family, and the landlady occupied the rest, this was a lodging-house, and there was nothing unreasonable in the bye-law requiring the attendance of the landlady to give particulars such as are required by the Council's first bye-law. (Vide my Annual Report for 1885-86, page 130.) 64 tioned, in passing, that the Registrar-General regards as a house any building approached by a single entrance—a front door. Thus the seven blocks of buildings known as Campden Houses, in Peel-street, in this borough, are regarded as seven houses for census purposes, although they comprise upwards of 100 separate tenements. But the tenements are not self-contained to the extent of each possessing separate sanitary conveniences, water supply, ash-pit, etc., this accommodation being common to the inhabitants of all of the dwellings on each of the several floors. In the case referred to, the Southwark Vestry gave notice of appeal against the learned magistrate's decision, which, in effect, makes registration law over-ride and practically repeal public health law. Registered Houses.—By request of the sanitary committee of the late Vestry a return was prepared in 1896, showing the streets in which houses had been registered, and the number of the houses registered, and the number not registered in each street. This return is here submitted, corrected to date, for each of the sanitaiy districts, as follows: — North Sanitary District. Name o£ Street. Number of Houses in Street. N umber of Houses Registered. N umber of Houses not Registered. Adair Road 83 26 7 Admiral Terraeo 11 10 1 Appleford Road 58 55 8 Bransford Street 13 11 2 Branstone Street 11 10 1 Bosworth Road 83 28 10 Edenham Street 88 81 2 Edinburgh Road 10 7 8 Golborne Gardens 51 43 8 Southam Street 129 125 4 Treverton Street 62 8 59 Totals 444 344 100 North-East Sanitary District. Name of Street. Number of Houses in Street. Number of Houses Registered. Number of Houses not Registered. Bolton Road 33 29 4 Convent Gardens 28 22 6 Lonsdale Road 54 2 52 Portland Road 95 70 25 Totals 210 128 87 North-West Sanitary District. Name of Street. Number of Houses in Street. Number of Houses Registered. Number of Houses not Registered. Bangor Street 39 32 7 Barandon Street 18 10 8 Calverley Street 13 11 2 Crescent Street 39 24 15 Grenfell Road 27 12 15 Kenley Street 51 39 12 Martin Street 15 5 10 St. Katharine's Road 112 102 10 Sirdar Road 93 60 33 Totals 407 295 112 65 Central Sanitary District. Name of Street. N umber of Houses in Street. Number of Houses Registered. Number of Houses not Registered. . Campden Street 68 59 9 Cousins Terrace 7 5 2 Dartmoor Street 60 57 3 Dnke's Lane 10 10 — Edge Street 35 19 16 Ernest Street 21 20 1 Farmer Street. 26 20 6 Jameson Street 31 29 2 Johnson Street 26 16 10 Kensington Place 44 36 8 Lome Gardens 32 23 9 Newcombe Street 18 16 2 Peel Street 70 44 26 Uxbridge Street 44 22 22 William Street 17 15 2 Totals 509 391 118 South-east Sanitary District. Name of Street. Number of Houses in Street. N umber of Houses Registered. Number of Houses not Registered. Clifton Place 8 8 — Merton Road 33 32 1 South End 11 2 9 South End Row 6 4 2 St. Alban's Road 17 10 7 Trafalgar Place 5 3 2 Yeoman's Row 48 41 7 Totals 128 100 28 South-west Sanitary District. Name of Street. Number of Houses in Street. Number of Houses Registered. N umber of Houses not Registered. Ashley Cottages 27 15 12 Barker Street 16 8 8 Blithfield Street 17 17 Childs Place 21 16 5 Childs Stree 20 11 9 Fenelon Road 36 26 10 Ifield Road 152 136 16 North Row 21 15 6 North Street, St. Mark's 15 15 Pembroke Place 11 9 2 Pembroke Road 16 12 4 Prince Teck Buildings 12 6 6 Radnor Terrace 5 4 1 Seymour Place 56 35 21 Shaftesbury Road 25 16 9 South Street, St. Mark's 19 16 3 St. Mark's Road 22 16 6 Stamford Cottages 10 7 3 Wallgrave Road 27 23 4 Wallgrave Terrace 13 13 Warwick Road (late Lily Terrace) 6 5 1 Warwick Road (late Warwick Terrace) 25 15 10 West Pembroke Place. 16 14 2 Totals 588 450 138 66 SUMMARY. District. Number of Streets dealt with. Number of Houses in Streets. Number of Houses Registered. Number of Houses not Registered. North Sanitary District 11 444 344 100 North-East Sanitary District 4 210 123 87 North-West Sanitary District 9 407 295 112 Central Sanitary District 15 509 891 118 South-East Sanitary District 7 128 100 28 South-West Sanitary District 23 588 450 138 Totals 69 2286 1703 583 Many houses included in the last column of the return were not let in lodgings or occupied by members of more than one family, when other houses in the same street, so let, were registered between 1885 and 1889. Inspections made in 1895 showed that many of the nonregistered houses were then let in lodgings, and a report to this effect was made to the sanitary committee. The committee, however, decided, at that time, not to register any more houses pending the confirmation by the Local Government Board of the proposed new bye-laws. Subsequently, however, a considerable number of the houses were registered, the committee having resolved to register tenemented houses. In 1899, 48 houses were registered, 40 in North Kensington and 8 in South Kensington ; and last year 18 houses. In the fourth monthly report for 1895 a list was submitted of some of the principal streets, the houses in which, so far as they were let in lodgings or occupied by members of more than one family, appeared to be proper to be registered; but no action was taken. The Advantages of Registration.—Whilst facilitating the work of the public health department, registration of houses let in lodgings has given rise to none of the evils feared by the owners and occupiers of houses proposed to be registered; the bye-laws, moreover, have worked smoothly and practically without objection by any of the parties affected by them. The extension of the operation of bye-laws to all tenemented houses, and other houses occupied in lodgings by the poorer classes, would, with an adequate inspecting staff, and systematic inspection at frequent intervals, be an unmixed benefit, from the public health point of view, by enabling the sanitary authority to maintain the conditions necessary to secure healthy homes for the people who, in regard to such matters, have little p>ower to help themselves. Common Lodging-Houses.—The County Council in 1894 took over from the police the supervision of common lodging-houses, under the circumstances set out in my annual report for 1893 (p. 207). I am indebted to the Council's medical officer of health for the Return on page 67 of the common lodging-houses in this borough, which are 34 in number, and contain accommodation for 1,043 persons. In connection with the inquiry by the special committee of 1896, as to the causes of the high death-rate in the " Notling-dale " special area, an application was made to the County Council to define the meaning of the term " common lodging-house," to which a reply was received to the following effect:— "The Council is advised that in order to bring a house within the operation of the Common Lodging-Houses Acts, 1851 and 1853, it is essential that the following facts should exist: — "1. The house must be kept by somebody for the purpose of gain. " 2. It must be open for the reception of all comers as lodgers. "3. The persons resorting to the house must be of such a class as, if left to themselves, would either be unwilling or unable to secure cleanliness and prevent overcrowding. " 4. Some one room or rooms in the house must be used in common by all the lodgers. "A large variety of circumstances might arise in any particular case which might come before the Council, but it is safe to say that if in any case one of the four facts abovementioned were absent, it would be a doubtful question whether the house could be regarded as a common lodging-house within the meaning and intention of the statutes, and such a case would need special and particular consideration. " This opinion has been come to after a careful study of the decisions in the following cases : — " Booth v. Ferrett.—Decision by Lord Chief Justice Coleridge and Mr. Justice Mathew. " Langdon v. Broadbent.—Decision by Mr. Justice Grove and Mr. Justice Lindley." It thus became manifest that houses in the " Notting-dale " special area could not be dealt with as common lodging-houses, excepting in so far as they should have been registered as such by the County Council upon the application of the owners, a fact which the " special committee " had recognised in their report. 67 COMMON LODGING-HOUSES. Sanitary District. Name of Keeper. Address of Common Lodging-House. No. of Single Lodgers, for which registered, in 1900. No. of Double Beds Authorised. Male. Female. Total. N. Phipps, William 194, Kensal Road 75 ... 75 ... ,, Marsh, Hy. Chas 88, Wornington Road 35 ... 35 ... N.W. Moore, John 21, Bangor Street 30 ... 30 ... 1 Do. 23, do. ... 9 9 10 ,, Do. 25, do. ... 18 18 5 ,, Do. 29, do. ... 21 21 5 ,, Newman, Boasley 10, do. 24 ... 24 ... ,, Phipps, William 18, do. 82 ... 32 ... ,, Do 20. do. 54 ... 54 ... ,, Reynolds, Charles . 35, do. 35 ... 35 ... ,, Phillips, E. S. 5, do. 25 ... 25 ... ,, Do. 7, do. 29 ... 29 ... ,, Do. 9, do. 24 ... 24 ... ,, Hankins, George 10, Crescent Street 32 ... 32 ... ,, Do. 28, do. 30 ... 30 ... ,, Do. 80, do. 30 ... 30 ... ,, Do. 40, do. 24 • •• 24 ... ,, Phipps, William 25, do. 39 39 ... ,, Do. 27, do. ... 16 16 5 ,, Do. 81, do. 34 ... 34 ... ,, Do. 88, do. 20 ... 20 7 ,, Hallett, Thomas 4, Hesketh Place 13 ... 13 3 ,, Do. 6, do. ... 6 6 3 ,, Do. 8, do. 14 ... 14 3 ,, Simpson, James 1, Mary Place... 16 ... 16 ... ,, Do. 2, do 21 ... 21 ... ,, Hartwell, Wm. 66, St. Ann's Road 43 7 50 11 ,, Phillips, Thos. Jno. 34, Sirdar Road 13 ... 13 7 ,, Do. 36, do. 35 ... 35 ... ,, Do. 38, do. ... ... ... 11 ,, Do. 40, do. ... 26 26 ... Do. 81, do. 30 ... 30 ... C. Redman, John 24, Peel Street 20 ... 20 ... ,, Do. 22, do 23 ... 23 ... Twenty-four of the common lodging-houses, with accommodation for 730 persons (100 of them in double beds) are comprised in the " Notting-dale " special area. Control of Common Lodging-Houses.—A communication was received, in 1897, from the late Vestry of the district of St. Margaret and St. John (now merged in the city of), Westminster, expressing the opinion that the want of effective control over common lodging-houses was a serious defect in the existing law, and urging the desirability of representations being made to the Home Secretary with a view to the introduction of a Bill to consolidate, and transfer to the local (i.e., the sanitary) authorities, the administration of the law relating to common lodging-houses, and to give such authorities power to license such houses annually, with the consequent right to withhold any license in the event of mismanagement or other sufficient reason. These views were endorsed by the late Vestry of Kensington, and a communication to this effect was made to the Home Secretary, and to the sanitary authorities. The Home Secretary, in reply, stated that he had referred the communication to the Local Government Board, as he was of opinion that the question was one which should be dealt with by that Board. Nothing further was done in the matter, nor is the matter dealt with in the Local Government Act, 1899, which leaves the common lodging-houses under the jurisdiction of the County Council. 68 THE JAMES STREET AREA. The improvement of the James-street area, which, it was hoped, would have been completed long ago, under the private Act obtained by the promoters, still hangs fire. The time allowed for Compulsory purchase of properties required for the improvement expired in August, 1899, and the time allowed for the completion of the scheme will expire in August, 1901. James-street is in a woe-begone condition: many of the houses have been pulled down, and few of the old inhabitants remain. The need for a street improvement in the locality, to establish easy communication between South Kensington and Kensington High-street, west of the church, has long been felt, and happily this part of the scheme will ere long be carried into effect. UNDERGROUND ROOMS ILLEGALLY OCCUPIED. In a number of instances rooms" underground" were found to be illegally occupied—in Sirdar-road, in the special area, and in other parts of the borough. The illegal occupation was in each case discontinued on the service of a written intimation or a statutory notice. OVERCROWDING AND PAUPERISM. Statements having been made that the action of the sanitary authority for the abatement of overcrowding, and other nuisances, frequently became the means of driving people into the workhouse, and so conduced to pauperism, the matter was investigated, so far as practicable having regard to the generality of the statements and the want of information as to specific cases. In one case only, were necessary details furnished so as to enable a decisive opinion to be formed on the subject. It was the case of a family alleged to have been driven into the workhouse owing to the action of the sanitary committee, through which the home had been broken up and lost, notice to carry out certain works of cleansing at the (registered) house having been served on the landlord. The name of the head of the family (which comprised a wife and eight children) and his late address, having been obtained, the case was investigated by the clerk to the guardians, who informed me that the man, who bore a very bad character, had been ejected from his lodging by the police for rent due to his landlord, amounting to about £6. The case illustrates the unreliability of statements made by able-bodied persons when questioned as to the cause for their entering the workhouse. Overcrowding is, occasionally, brought about by the action of railway companies, who are not required to provide for the rehousing of persons displaced by the pulling down of their houses, provided that fewer than twenty are compulsorily acquired at any one time. This subject was brought to the attention of the sanitary authorities in February, by the late Vestry of St. Georgethe-Martyr, Southwark, the suggestion being made that the School Board should be compelled to provide housing accommodation for persons displaced by their action: the Vestry, moreover, advocated an amendment of the Standing Order of the House of Commons, so that all classes of " Promoters" should be required to make provision for rehousing, even where a smaller number than twenty houses are taken. The said Vestry, however, had overlooked the fact that Parliament had dealt with the subject, in the Session of 1899, by bringing the School Board for London under the Standing Order, as regards liability for rehousing persons displaced, a clause with this object having been inserted in their Provisional Order Confirmation (London) Act, 1899; the clause, moreover, being made retrospective in its operation : it being provided therein that all houses or lands occupied by persons of the labouring class taken by the Board in the previous five years, should be regarded as acquired under that Act. No houses have been so acquired in the borough within that period, but the subject is of interest to the Borough Council in view of demolitions shortly expected—at Southam-street and Wornington-road more particularly—in connection with the proposed widening of the Great Western Railway in that locality. HYGIENIC STREET PAVING. During the year some progress was made in the paving with asphalte of streets in poor localities, where traffic is small; such streets, moreover, being largely used by children as playgrounds. This practice, commenced in the Potteries district, and carried out completely in the " Notting-dale " special area, with great and manifest advantage in every respect, will, I hope, be largely extended. In December, 1899, upon the report of the sanitary committee that " it was desirable on sanitary and economical grounds," the late Vestry resolved to asphalte-pave five additional streets, viz., Mary-place, Lockton-street, Hesketh-place, Testerton-street, and Mersey-street, all in North Kensington. These streets were paved in 1900, and, in addition, Aldermaston-street, Bramleystreet and St. George's-road, in North Kensington; Child-street, and the passage at the rear of Rich-terrace, in South Kensington. 69 INSUFFICIENCY OF THE MAIN SEWERS. I have had occasion more than once in these reports to refer to the flooding of basements of numerous houses in the borough on the occurrence of heavy storms. The most notable inundation was that of October, 1898, referred to in the annual report for 1898 (page 129). The attention of the County Council was at that date urgently directed to the matter with the view to expedite the commencement of the pumping station at Lot's Road, Chelsea, designed to prevent recurrence. The nuisance is due to the insufficiency of the main sewers, more particularly the Counter's-creek sewer, to carry off storm water. It has been the subject of complaint during many years ; and it is really surprising with what patience people have borne repetition of an infliction than which one can hardly imagine any more trying. It is to be hoped that these floodings will soon be a thing of the past, the County Council having last year commenced the relief works at Lot's-road; the decision to provide these works having been formed in the year 1895. The Council, moreover, have resolved to expend three millions in the construction of new main line sewers in different parts of the metropolis, which, it may be hoped, will prevent the nuisance in other districts. So large a work will necessarily extend over several years. SEWERAGE OF ROYAL CRESCENT. Cases of diphtheria having been notified at Royal-crescent, from time to time, investigation led to the inference that the occurrence and recurrence of the malady was probably due to the position and character of the sewer in that street. The disease had attacked residents in several houses at the east end of the western section of the Crescent, nearest to the highest portion of the sewer, adjacent to Darnley-road. The sewer at this point was close up to the vaults of the houses; it was of a great size, far beyond requirements, and of antiquated type. Bad smells, previously, and for a long time complained of by the inhabitants, had been due to the untrapped gratings over the channels leading direct into the sewer. The trapping of these gullies, and the ventilation of the sewer, by a pipe carried up against a house, did not suffice to remove cause for complaint, and the late Vestry, upon the recommendation of the Sanitary Committee, decided to abolish the sewer, and to construct a pipe-sewer in lieu thereof. This was done; the old sewer was broken up, and the part nearest to the houses, where the disease had appeared, was removed. Since the work was completed, in the autumn, there has been no case of diphtheria in the street, and no complaint. UNTRAPPED STREET GULLIES. The Sanitary Committee of the late Vestry gave attention to this subject in connection with my recommendation, in the twelfth report for,1899 (December 7th, page 126), that, "as soon as practicable, the brick flap-trapped street gullies should be replaced by pan syphon-trapped gullies." The Committee in their report, dated 14th February, recommended, and it was subsequently resolved, " that the Vestry do adhere to the course hitherto adopted of dealing with each complaint of smells from gullies on its merits." In the report referred to, I had suggested that, at the earliest practicable date, all brick, flap-trapped gullies, should be abolished in favour of pan syphon-trapped gullies. The Surveyor reported that there were about 5,000 brick flap-trapped gullies in the parish, and that the cost of fixing syphon-trapped pan gullies in lieu thereof would amount to about £3 per gully—say, £15,000 in all; a large sum, but considerably less than that about to be expended on wood-paving in one street—Cromwell-road. The Committee stated that under orders of the Vestry, all brick gullies which had been proved to be offensive, were replaced with the newer pattern of gully; that any new gullies constructed are of this type, and that pan gullies are also fixed in roads converted from macadam to asphalte, or wood paving. They further observed that with the question of syphon-trapping street gullies, is closely involved the question of sewer ventilation, and that until some solution has been found of the difficulties encountered in dealing with this latter question, they could not see their way to advise the adoption of the scheme indicated in my report. For what it is worth, it may be mentioned that in some towns the gullies are trapped although the sewers are not ventilated. Bristol is a notable instance, and that city is by no means an unhealthy one. Means of ventilation, in any case, could surely be devised, and I am still of opinion that brick flap-trapped gullies should be displaced by syphon-trapped gullies. The so-called " flap-trap " is not a trap at all, in the sanitary sense of apparatus for preventing the escape of sewer gas. DRAINAGE BYE-LAWS. Towards the close of the year 1896, forty years after the passing of the Metropolis Management Act, 1855, and many years after I had first called attention to the subject (in 1885), the County Council made, and transmitted for the information of the sanitary authorities, draft bye-laws under section 202.* The matter was referred to the sanitary committee of the late Vestry, whose proposed * The proposed bye-laws are : "for regulating the dimensions, form, and mode of construction, and the keeping, cleansing, and repairing of the pipes, drains, and other means of communicating with sewers, and the traps and apparatus connccted therewith." 70 amendments of the bye-laws were embodied in a report (dated 29th January, 1897), which was forwarded to the Local Government Board and the Council. The bye-laws have not yet been confirmed by the Board. It is to be hoped that there will not be much further delay in bringing the matter to a settlement, in the interests of property owners and sanitary authorities alike. COMBINED DRAINAGE. Several of the metropolitan sanitary authorities made representations to the County Council, in 1894, on the need of legislation, "with a view to an alteration in the definition of the word drain and the word sewer," in the Metropolis Management Act, 1855 (sec. 250); and ultimately a deputation representing the vestries and district boards waited upon the main drainage committee with reference to the subject. This committee reported (7th July, 1894), that "a grievance exists, and that a heavy responsibility is thrown upon the local authorities to repair combined drains which were laid down for the benefit of the owners of houses, and with the intention that the owners should be held responsible for their maintenance." The committee further came to the conclusion that "the Council should, as the central authority, promote legislation in accordance with the views of the local authorities," and upon their recommendation it was resolved: "That the Council do apply to Parliament for an amendment of the definition of the word sewer and drain in the Metropolis Local Management Act in the way desired by the local authorities, and that it be referred to the Parliamentary Committee to prepare a Public Bill and take such other steps as may be necessary for that purpose." Such a bill (Metropolitan Sewers and Drains) was brought in on behalf of the Council in 1896, the special object being to obtain an amendment of the definition of the word " drain " in the Metropolis Management Acts : but it did not become law. The Borough Councils have power to promote bills in Parliament, and it may be anticipated that they will, ere long, take joint action in this matter, as the County Council apparently do not propose to repeat their effort to obtain an amendment of the Act. Legislation is certainly necessary, seeing that in the past, many sanitary authorities have shown unwillingness to repair, as " sewers," conduits which they consider should be regarded as " combined drains," repairable at the expense of the owners of the houses drained in common thereby. Cases moreover are not unknown in which a sanitary authority failed to abate nuisance in connection with drainage, upon the refusal of the owners of houses to comply with notices requiring them to execute work which, in the present state of the law, has been held by the highest legal authorities to be the duty of the sanitary authority. Some authorities, on the other hand, have expended large sums of money in the repair, as sewers, of combined sj'stems of drainage. With the view to facilitate inquiries as to whether any such system had been sanctioned by the late Commissioners of Sewers, the predecessors to the late vestries, &c., and so to determine, when practicable, whether it constitutes a " sewer" repairable by the sanitary authority, or is a combined " drain " repairable by the owner or owners of the houses drained thereby, the sanitary committee of the late Vestry, upon my advice, resolved, in July, 1898, to obtain an abstract of the records of the Commissioners relating to this borough. The abstract has proved of great service, by saving the labour of a search at Spring Gardens upon each occasion of dispute ; and it has already far more than repaid the cost of preparation, by throwing upon owners the responsibility for repair, or reconstruction, of combined drains which, without the information afforded by it, would have devolved upon the sanitary authority. THE PAYING OF YARDS. During the year, a considerable number of yards were paved more or less satisfactorily— or unsatisfactorily; for it is not the rule to require the entire surface of the small yards at the rear of houses, inhabited by the poor, to be paved; and too commonly the paving is far from what it should be in material and workmanship. It would be well if work of this sort could be carried out systematically throughout the borough ; but individual cases only can be dealt with as they arise out of casual or special inspections, or in the case of house-to-house inspections. The committee on "Notting-dale," in their report (June 18th, 1896), referring to the state of the vards in the special area, stated they were " saturated with human ordure and filth of every description." They were of opinion " that the yards should be asphalted or paved," and the first of their recommendations, all of which were approved by the late Vestry, was to the following effect:— "That it be referred to the Works and Sanitary Committee to have notice served upon the owners or occupiers of the houses in the several streets .... requiring them to asphalte, or pave with impervious material, the yards in the rear of such houses which are not in proper condition." Effect has, in a measure, been given to this recommendation. 71 The paving of yards is one of the matters dealt with in the Council's bye-laws, the tenth of the series requiring, in respect of "any yard or open space, where it is necessary for the prevention or remedy of insanitary conditions that all or part of such yard or open space shall be paved," that it be paved forthwith, by the owner of the dwelling-house with which such yard or open space is connected. It will be observed that the paving of yards is prescribed" for the prevention or remedy of insanitary conditions," a fact which is often lost sight of. That paving is "necessary" for this purpose is indubitable, and the subject is deserving of the utmost attention of sanitary authorities, by whom, generally, I venture to think, more would be done if due weight were attached to the hygienic importance of cleanliness and dryness in the surroundings of dwellinghouses—a matter to which attention was specially directed in the annual report for 1897 (page 146) ; the authority of the late medical officer of the Local Government Board being cited in support of the views therein expressed. In connection with the foregoing subject, reference may be made to the rubbish, often the accumulation of years, so frequently seen in the yards of houses let in tenements to the poorer classes: such as broken bedsteads, rotten straw palliasses, and other things of no value, once the "property," it may be, of dead or departed lodgers. In the report for 1899 it was observed, that "it is nobody's business to remove the things, which simply serve as harbourage for collections of filth." The yards where they exist can not be properly cleansed, and might fairly be regarded as premises "in such a state as to be a nuisance or dangerous to health." The importance of the matter gets lost sight of in ordinary times, but let there be a cholera-scare, and everybody forthwith recognises the propriety and necessity of that general clearance of filth and litter which should be effected systematically at all times. In October, 1900, plague having broken out at Glasgow, the late Yestry, upon my recommendation, and as a measure of precaution, appointed six temporary sanitary inspectors for a few weeks, whose chief duty, in house-to-house inspections, was to enforce a general clean-up of premises ; an instruction, moreover, was issued authorising the surveyor to remove from yards (with the necessary consents) all useless articles, rubbish, &c. Some work of this kind was done; but unremitting attention is necessary to the attainment of the object in view, to wit, the preservation of cleanliness in the surroundings of dwelling-houses—an object of much importance from the public health point of view—"dirt," defined by the late Lord Palmerston as " matter in the wrong place," being a fertile source of unhealthiness, and conducive to disease. NUISANCE FROM GAS WORKS. Complaints, but in number fewer than usual, were received during the year, of nuisance from the gas workg at Kensal-green—a subject dealt with in the annual report for 1894 (page 166). There can be no doubt as to the genuineness of the complaints, which receive confirmation from Willesden, the inhabitants of that district suffering when Kensington people have no ground for complaint, and vice versd; the incidence of nuisance varying with change in the direction of the wind. The matter having been referred to the law and parliamentary committee of the late Vestry, they reported that— "By Section 29 of the Gas Works Clauses Act, 1847, which applies to the Gas Light and Coke Company, the company is not to be exempted from indictment for nuisance, or any other legal proceeding to which they may be liable in consequence of making or supplying gas; and in a case decided in 1877 it was held that a gas company was not entitled to create a nuisance in exercising their statutory powers or in carrying out their statutory obligations (Attorncy-Qeneral v. Gas Light and Coke Company, 7 Ch. D. 217)." The committee therefore advised the sanitary committee that— "If there be evidence of a substantial public nuisance caused by the Gas Light and Coke Company, the Vestry are entitled to proceed by indictment, or for an injunction to secure its abatement." The Vestry accordingly addressed a communication to the company intimating that observation would be kept up, and that on any recurrence of the nuisance proceedings would be instituted. A reply was received to the effect that, while objectionable smells did proceed at times from the company's works, such smells being caused by the elimination of sulphur impurities from the gas, according to the stringent requirements of the metropolitan gas referees, every known appliance for the prevention of nuisance was adopted. The company suggested a reference to the gas referees, being of opinion that they would be able to satisfy the Vestry that the best possible system was being carried out; but, in the event of improvement being suggested, the directors signified willingness to adopt and to carry out any recommendation. The Vestry adhered to the position taken up with regard to the legal responsibility of the company, to see that no nuisance should arise from smells from their works, and left it to the company to appeal to the gas referees, if they 72 PUBLIC MORTUARY. Bodies were deposited at the Mortuary during the year to the number of 317, upon application, as follows:— 1. At the request of the relatives of the deceased 5 2. At the request of undertakers 62 3. At the request of the coroner (inquest cases):— Cases of sudden death 139 226 Cases of violent death 87 4. Brought in by the police Found dead 17 Accident case ... 1 18 5. On account of death due to infectious disease 6 817 thought any useful purpose would be served by their so doing. That the cause of nuisance is more or less within control would appear from the intermittency of the complaints, and as the smells are at times not perceptible to any noxious degree in the vicinity of the works. No proceedings, whether by indictment or for an injunction, have hitherto been taken. In 106 of the above cases post-mortem examinations were made under the coroner's warrant. CORONER'S COURT. The coroner's court in the Town Hall Extension Building, completed and brought into use in 1899, affords necessary accommodation for all parties concerned in the holding of inquests. For the use of the court the County Council pay an agreed rent under an arrangement authorised by section 92 of the Public Health (London) Act, 1891. DISINFECTION. The Public Health (London) Act, 1891, imposed additional duties on the sanitary authority in the matter of disinfection, the practical effect of the legislation of late years having been to throw upon the rates the cost of disinfecting houses, and of the cleansing and disinfecting of bedding, clothing, &c. The cost of this work has increased since the Act came into operation in 1892 : the amount expended in 1900 was £790, as compared with £381 in 1891. In the latter year the weight of the articles disinfected was under 20 tons, their number being about 9,400 only, whereas in 1900, 22,174 articles were dealt with, of an aggregate weight of 40 tons 18 cwt. Eight hundred and forty rooms, in 765 houses, were disinfected after infectious disease, as compared with 364 in 1891. In the report for 1893 (pp. 215-217), under the heading "Duties of the Sanitary Authority with respect to Disinfection," I explained the state of the law, and described the late Vestry's practice in regard to the matter. The expenditure on disinfection, including cleansing of clothing, bedding &c., varies from year to year, in proportion to the relative prevalence of infectious disease. Very few disinfections are now done at the cost of the occupiers of the houses, or owners of clothing, bedding, &c. I append a statement of the monthly cost of this work in 1900, which is irrespective of the wages of the disinfector. £ s. d. January 85 1 3 February 46 10 6 March 62 15 1 April 59 3 3 May 67 6 10 June 52 19 11 July 57 6 5 August 58 17 10 September 65 19 1 October 69 5 0 November 91 15 1 December 73 10 0 The expenditure might, I think, be reduced, were the work done without the intervention of a contractor, as recommended by the London County Council and the Metropolitan Asylums Board. Disinfecting Station.—The question of the "desirability of erecting a disinfecting station, and providing a shelter for persons dispossessed of their homes during the progress of disinfecting work," was referred by the late Vestry to the sanitary committee, who reported thereon, in July, 1896. A sub-committee had been appointed to view stations and shelters. One of the places 73 visited was Islington, where, as the sub-committee reported, "the Vestry have provided a most complete station, comprising two Nottingham disinfectors, and ample laundry accommodation for washing and cleansing articles, when necessary. A shelter-house to accommodate four families has also been provided, and a small house erected for the use of the engineer and his wife, who are in charge of the station. The total cost of this station," it was added, "without charge for land, amounted to about £4,500, made up as follows:—disinfectors, laundry, chimney shaft, paving and drainage, £3,500; shelter and caretaker's house, £1,000. The annual expenditure amounts to £350 per annum." The report further stated that the cost of disinfecting and cleansing of infected articles in Kensington, in the three years 1893-95, had been £2,988, or, on an average, about £1,000 a year (irrespective of the wages of the disinfecting officer), a sum which was largely exceeded in 1896, £1,361 having been paid to the contractor in that year. The committee, however, came to the conclusion, upon what grounds I do not know, that it was not desirable that the Vestry should provide a disinfecting station, but that the disinfecting and cleansing of clothing, bedding, &c., should continue to be entrusted to the present contractors. They accordingly recommended that no variation be made in the arrangements at present in force for the execution of this work, and their report was adopted. TEMPORARY SHELTER OR HOUSE ACCOMMODATION. The Public Health (London) Act, 1891 (section 60, sub-section 4), imposes on the sanitary authority the duty of making provision for housing poor persons during the time necessary for disinfection of rooms after infectious disease. The sub-section is to the following effect: — "The sanitary authority shall provide, free of charge, temporary shelter or house accommodation, with any necessary attendants, for the members of any family in which any dangerous infectious disease has appeared, and who have been compelled to leave their dwellings for the purpose of enabling such dwellings to be disinfected by the sanitary authority." The need for such provision is sufficiently indicated by the fact that in this borough last year, 123 cases of infectious disease occurrred in families in occupation of three rooms, 239 cases in families occupying two rooms, and 53 cases in families herded in single rooms. Of the sufferers in families living in single rooms, 22 had scarlet fever, 22 had diphtheria, and 9 had typhoid fever. The need of shelter is more especially obvious in the case of families living in single rooms. The only satisfactory mode of dealing with the matter would be to erect a shelter and provide it with a proper equipment. Such provision could be economically made in connection with a disinfecting station. In the absence of accommodation, the sanitary inspectors are authorised to provide lodging money; it is, however, not easy to find accommodation for the people, many of whom object to go to a common lodging-house, where, indeed, they would be neither welcome nor, in their possibly infective condition, desirable guests. CLEANSING OP PERSONS ACT. An Act thus intituled, passed in 1897, gives power to the sanitary authority to permit any person infested with vermin to have the use of the apparatus which the authority may possess, for cleansing the body and clothing, and provides for the expenditure of any reasonable sum on buildings, appliances, and attendants that may be required for the carrying out of the Act. Nominal effect was given to the Act by an arrangement with the Guardians, whereby cleansing and disinfecting apparatus at the able-bodied workhouse at Mary-place, in the Potteries, was made available on payment of a small fee by the late Vestry—an arrangement still in force. Little use has been made of the apparatus, owing possibly to ignorance of the arrangement on the part of the public, and probably to some extent owing to the locality and ownership of the apparatus. In the borough of St. Marylebone, a proper equipment having been provided, thousands of cleansing operations are carried out in the course of the year; much, doubtless, to the comfort of dirty and verminous persons, who for the most part, I believe, come from a Salvation Army shelter. PUBLIC BATHS AND WASHHOUSES. The baths and washhouses at the junction of Lancaeter-road and Silchester-road, Notting-hill, opened in April, 1888, are well supported; the washers in the twelve months ended 31st March, 1901,* were 70,869, an approximate increase of 5,550 compared with the number in the preceding official year; the bathers, 93,822 (including 3,155 bathers of the School Board Evening Continuation Classes), a decrease of 9,031. Eor the majority of parishioners the site of the establishment is not sufficiently central for baths, and is too remote for use by would-b? * Until this year (1900-1901) the yearly statement was made up to 25th March; the present statement is for a period of 53 weeks ended 31st March. 74 washers. The same objection would apply, more or less, to any single site in the borough. Much good might be effected by the provision, in convenient localities, of buildings, on a modest scale, to which the poor in the central and southern districts of the borough might resort for the purpose of washing clothing, etc. PUBLIC SANITARY CONVENIENCES. There are only 22 public urinals in the parish—an inadequate provision, but supplemented, in a measure, by about 170 external urinals at public-houses. This latter accommodation is not of a satisfactory sort, as a rule, but it is better than none, and was improved as the result of proceedings taken by the late Vestry in 1888, and subsequently. There are four sets of public water-closets, for the male sex only, situated at the rear of the central public library, Kensington High-street; at the west-end of Westbourne-grove, Notting-hill; in Thurloeplace, opposite the "Bell and Horns" tavern; and at Lancaster-road, Notting-hill, adjoining the public library. Sanitary authorities have ample power; section 8S of the Metropolis Management Act, 1855, enabling them "to provide and maintain urinals, water-closets, and like conveniences for both sexes in situations where they deem such accommodation to be required." Suitable sites exist, none better, perhaps, or where provision of the kind is more needed, than in Kensington High-street, opposite the parish church. Here an underground retiring place for both sexes might be constructed without giving rise to nuisance in any sense of the word. Increased powers were conferred by the Public Health (London) Act, 1891, section 44 (2), which vests the subsoil of roadways in the sanitary authority, who, moreover, have power to compensate persons injured by the erection of these conveniences near to their houses, etc. WATER SUPPLY. No complaint was received during the year with respect to the quality of the water supplied by the companies who serve the borough. The West Middlesex, the Grand Junction, and the Chelsea supplies are examined monthly by the public analyst, whose reports thereon are duly published in the minutes of the proceedings of the Council. Constant supply is given in all parts of the borough. There is nothing to be added to what was said in the last report in regard to the cutting-off powers of the companies, which, in my opinion, should be abolished. The London County Council are still of the opinion that they should be empowered to buy out the companies who supply the metropolis, and a very great deal more than the metropolitan area; and no doubt will persist in endeavours to acquire the position of water authority until the question shall have been settled in some other way. The President of the Local Government Board has announced his intention to introduce a Bill on the subject in 1902. For the present it may suffice to say, that the water supplied by the several companies is good enough to satisfy the reasonable requirements of the consumers, if one may judge from the absence of complaints. CONCLUSION. In bringing this report to a conclusion, I desire to acknowledge the valuable assistance received from Mr. E. R Hill (lately promoted to the position of chief clerk in succession to Mr. Rudman, resigned), in the collation of statistics, and generally. I desire also to bear testimony to the good work of the staff, as a whole, and especially to that of the chief sanitary inspector, Mr. Pettit, and the inspectors generally, which has been carried out efficiently, regard being had to their limited number, and to the magnitude and variety of the duties devolved on the sanitary authority by Parliament. I have the honour to be, Mr. Mayor and Gentlemen, Your most obedient Servant, T. ORME DUDFIELD, Medical Officer of Health. Public Health Department, Town Hall, Kensington, W., April, 1901. APPENDIX I. (Vide Page 2.) At the last meeting of the late Vestry of Kensington, held on November 7th, 1900, two days before the first regular meeting of the Borough Council, I submitted the following VALEDICTORY REPORT, which, I hope, will be deemed of sufficient interest to justify its reproduction in this my first annual report to the Council. In order to a complete statement, covering the whole period of the late Vestry's administration, the statistical part of the report in the appended tables has been made to include the figures for the year 1900. A Retrospect, 1855-1900.—This being the last report I shall have the honour to submit to your Vestry, it may not be without interest for me to make a few observations, by way of Retrospect, on the" Vital and Mortal Statistics, the Public Health and Sanitary Work of the forty-five years since the present Sanitary Authorities of London were brought into being by the Metropolis Local Management Act, 1855. The available information for the fifteen years, 1856-1870, is scanty. Since 1871 it has been my privilege, under the Vestry, to direct the sanitary administration of the parish. Area: Sub-Districts, etc.—The District, "Kensington," has an area of 2,190 acres, and for registration purposes comprises two sub-districts: Kensington Town (area, 1,497 acres) and Brompton (area, 693 acres). In this brief review it will not be possible to give detailed statistics of the sub-districts ; for the most part the parish must be dealt with as a whole. And first of all, I would draw attention to the Tables (at pages 84 and 85), hereinafter referred to as Table A and Table B, in which the Vital and Mortal Statistics of the period, 1856-1900, have been summarised. Population.—The population in the census year 1851, was 44,053 : in the Town sub-district, 29,183 (males, 11,908, females, 17,275); in Brompton, 14,870 (males, 6,021, females, 8,849). The excess of females over males, for which the parish has always been remarkable, was nearly as great in 1851 as in 1900, relatively to population. In 1851 the excess was 8,095: in 1896 (quinquennial census year) it had increased to 36,461. It is difficult to form reliable estimates of population at intercensal periods. Since 1871, the attempt has been facilitated by information obtained from the rating department of the number of inhabited houses.* The result is set out in Table A, and may be deemed fairly accurate, corrected as it has been, decennially, on the basis of the census returns. Between 1851 and 1861 the population increased at the rate of 2,600 per annum; it is assumed to have numbered 57,000 in 1856 ; the estimate for the present year (1900) is 173,000 : (Town subdistrict, 124,300, Brompton 48,700), an increase of 116,000 in the forty-five years. During these years, the excess of births over deaths was 51,421; the balance of increase (64,579) represents excess of immigration over emigration. Density of Population.—In 1856, twenty persons per acre; in the present year, 79. At the former date, large areas in both sub-districts were fields or market gardens; now, Brompton is practically covered with buildings, but in the Town sub-district some open spaces remain, notably Holland-park and fields in North-West Kensington. The subjoined figures illustrate the development of the borough between 1856 and 1900:— 1856. 1900. Increase. Number of Inhabited Houses 7,600 22,800 15,200 Population 57.000 173,000 116,000 Rateable Value £308,000 £2,146,208 £1,838,208 A seven-fold increase, nearly, during the period of the Vestry s administration. •Building operations on a large but variable scale were going on during the years 1871-81, which witnessed an increase of nearly 43,000 to the population. The increases to the number of inhabited houses on the rate books varied much from year to year, having been, approximately, 456, 471, 714, 747, 777, 500,396,389, 491. and 490, in the successive years: total in the ten years, 5,431. Previous to 1871, no information of yearly increases is forihcoming ; but it would appear that between 1851 and 1871, i.e., in 20 years, there was an increase of 9,599 houses, including 6,261 in the decade 1861-71, during which the population underwent an increase of 50,000. The average number of persons to a house appears to have ranged between seven and eight in each census year, 1851 to 1891, inclusive. 76 Marriages.—Between 1871 and 1900 (inclusive), i.e., in 30 years, 44,383 marriages were registered in Kensington, whose marriage-rate is always high, and above that of the Metropolis generally. The number of marriages, and the marriage-rate, in the successive years, are set out in Table A (page 84). Births and Birth Rate*—During the forty-five years, 1856.1900, the births of 159,751 children were registered. The number of births, and the birth-rate in the successive years, are set out in Table A. In 1856, and many succeeding years, births were fairly numerous in proportion to population: in other words, Kensington had a fairly high birth-rate, though never so high as London as a whole (Table A). Of late years it has been far otherwise. The decline in births may be illustrated by the fact that, whereas 4,790 were registered in 1879, when the population was 158,000, only 3,586 were registered in 1900 in a population of 1.73,000. In 1879, the birth-rate was 30.3 per 1000 persons living; in 1900 only 20.7: 24.3 in the Town sub-district; 11.6 in Brompton. Had the births in 1900 been as numerous in proportion to population as in 1879, some 5,234 children would have been born, or 1,648 more than the registered number of births. The birth.rate in 1900 was the lowest on record, both in Kensington (20.7) and in London (28'6). The highest rates recorded during my tenure of office, were, Kensington, 31.7 in 1872; London, 35.9 in 1876. Deaths and Death-Ratet—During the forty-five years 1856-1900, the deaths of 108,330 persons were registered. The number of deaths, and the death-rate, in the successive years, are set out in Table A. The death-rate of Kensington is consistently below that of London generally, as might reasonably be expected. But an unsatisfactory feature in our statistics is the high death-rate of infants under one year, calculated with reference to the number of births registered (Table A). The death.rate amongst the aged is high—a testimony to the favourable circumstances of many parishioners and the healthiness of the district. On the whole a satisfactory reduction in the general rate of mortality has characterised the regime of the present Sanitary Authorities, in Kensington and in London as a whole (Table A). Dividing the forty.five years into three periods, the mean, the minimum, and the maximum death.rates in Kensington were as follows:— Years. Mean. Minimum. Maximum. 1856.70 20.5 19.1 (in 1867) 21.9 (in 1860) 1871.85 17.9 15.9 (in 1883) 20.2 (in 1878) 1886.1900 16.4 14.6 (in 1889) 18.4 (in 1891) Zymotic Mortality.—The seven principal diseases of the zymotic class maybe divided into two groups; the notifiable—small.pox, scarlet fever, diphtheria, and "fever"—which are admissible to the hospitals of the Metropolitan Asylums Board—and the non.notifiable which are not admissible. The latter group comprises measles, whooping.cough, and diarrhoea, which were the causes of 9,952 deaths in the 4.5 years, viz.:—2,870, 2,913, and 4,169 from the several diseases respectively. Illness from diarrhoea does not come to the knowledge of the sanitary authority; nevertheless, the mortality exhibits a slight decline proportionally to population. Some control is exercisable by the sanitary authority in respect to measles and whooping.cough, information of the existence of disease, especially of measles, being communicated by school.teachers, with whom there is a measure of co.operation with a view to the exclusion from school of children living in houses where the disease exists. The notifiable diseases were the causes of 5,436 deaths in the 45 years, viz. smallpox, 632 ; scarlet fever, 2,265 ; diphtheria, 1,165 ; and "fever," 1,374. Smail.Pox, the dread of sanitary authorities in by.gone days, has now well.nigh lost its terrors for London, where an excellent hospital and ambulance service supplements the preventive work of public health officials. Table B shows a great reduction in mortality, especially since 1885, when full effect was given by the Asylums Board to the plan of removing cases of the disease out of London, for isolation and treatment, initiated, upon my recommendation, in 1881. The deaths from this cause in Kensington in the 15 years, 1886.1900, were ten only: one in 1887, and nine in 1893, in which year the disease, imported into North Kensington from an adjoining district, had spread somewhat extensively before the first notification was received. Scarlet Fever is of sufficiently frequent occurrence still, but the mortality therefrom has undergone great reduction in recent years (Table B). In the last three quinquennial periods (1886. 1900), the deaths in Kensington from this cause were 135, 152, and 105, respectively, as compared with 234, 377, and 537, in the three quinquennial periods between 1856 and 1870; and this without * Prior to 1874, Registration of Births was voluntary, but, judging from the figures in Table A, must have been generally practised. f Prior to 1883, no information was obtainable of deaths of parishioners at Public Institutions without the parish. By way of compensation, the deaths of non.parishioners within the parish were retained in the statistics. Since 1883, particulars of deaths of parishioners without the parish have been supplied weekly from Somerset House, by authorisation of the Registrar.General. These deaths largely exceed the deaths of non.parishioners within the parish—leaving out of consideration those at the St. Marylebone Infirmary, established at North Kensington in 1880, which have always been disregarded. It would thus appear that the Kensington death.rate for the years 1856.1882, was a little higher than as set out in Table A. 77 reference to increase of population. Since 1871, when the hospitals became available, in one year only (1880) in this parish, have the deaths exceeded 100; whereas in the three consecutive years 1868-69-70, the numbers were 170, 106, and 198, respectively. Had the deaths from scarlet fever in 1900 been as numerous in proportion to population as in 1870, not four persons would have died from this cause, but 294. Diphtheria* during the last twelve or thirteen years, has given the greatest concern to all engaged in public health work in the Metropolis; having previously been regarded rather as a rural disease, of late years it has fastened upon town populations. The deaths from this cause, happily, are now declining, largely as the result of antitoxic serum treatment carried out extensively at the hospitals of the Asylums Board, to which sufferers from the disease were first admitted in 1889. "Fever," in the Registrar-General's classification, includes typhus, enteric, and simple continued fevers; these diseases were not separately classified before 1871. During the seventeen years 1884-1900, typhus, in a fatal form, occurred but once in this parish, viz., in 1898, when a group of cases occurred at "fiats" at North Kensington, under circumstances set out in the report for that year: two deaths were registered. Most of the cases had occurred before the disease was recognised and notified—some weeks after its first appearance. Enteric (or typhoid) fever, during the last fifteen years, exhibits a mortality reduced by more than one-half, as compared with that in the years 1856-1870, and without correction for increase of population. It is probable that some of the deaths certified as "simple continued fever" between 1871-1885, were really due to enteric fever. The appended tables B, C, and D (pages 85 and 86), exhibit in a compendious form statistical information regarding the various matters dealt with in the preceding pages. Public Health and Sanitary Work.—Notable work, of more than local interest and importance, was undertaken and carried through by the late Vestry during many years, from 1871 onwards. Detailed account of the said work is set out in the successive annual reports of the medical officer of health: in this place only brief reference can be made to the several matters referred to, the most important being that of— Hospital Accommodation for Infectious Disease.—In 1871 small-pox was raging, the most serious epidemic of modern times having begun in 1870, in which year the first hospitals, for small-pox and "fever," established by the Metropolitan Asylums Board, were brought into use—at Hampstead (N.W. district), at Stockwell (S.W. district), and at Homerton (E. district) respectively. Strictly, these hospitals were pauper institutions, intended for persons in receipt of, or entitled to " relief." But this class of persons never furnished a tenth part of the patients, many boards of guardians wisely assisting the sanitary authorities by affording facilities for the admission of any sick person, on the certificate of their medical officer and the order of their relieving officer. In this parish the good offices of the guardians and their officers were never wanting, and, so far as accommodation allowed, the hospitals were accessible to all whom the vestry desired to isolate. Difficulty occasionally arose from the demand of payment for smallpox patients, who, not seldom, had been induced to go to hospital for the protection of the public, and so as not to endanger the spread of disease, being themselves too slightly indisposed to require medical treatment, or even confinement to the house. At my request, the guardians instructed the relieving officers to cease making such applications; and not only so, but they tacitly allowed these officers to accept the certificate of any medical man as evidence of the nature of the infectious illness, thus doing away with the necessity of a visit by the "parish doctor" (held to be objectionable in the case of non-paupers), and so removing the appearance of pauperisation, which had been a let and hindrance to isolation in hospital of persons, often indeed in poor circumstances but not of the pauper class. Thus we got on very well for several years, after the epidemic of small-pox ceased in 1872, there being thereafter a restricted demand for isolation, and, in fact, a somewhat general unwillingness to make use of the hospitals, accommodation being in excess of the demand for scarlet fever and enteric fever: diphtheria cases were not admissible. But in 1876, small-pox having again become epidemic, and sufferers and their friends being only too glad to make use of the hospitals, available accommodation speedily became exhausted. The Local Government Board, thereupon, in a communication dated 2nd January, 1877 (having defined "the classes for which the hospitals were intended") enquired—What provision the Vestry (and other local authorities) had made, or proposed to make for non-paupers under the provisions of the 37th section of the Sanitary Act, 1866? It became my duty to report on the subject, and on the 10th January, and again subsequently in a communication (by way of reply) to the Asylums Board, whilst deprecating the * Prior to 1859, diphtheria deaths were classified to scarlet fever. During the last few years the Registrar-General has classified deaths from membranous croup to diphtheria. Deaths classified to croup are now few ; in the earlier years of the period under consideration they were numerous, and nearly all of them, probably, might properly have been classified to diphtheria. 78 provision of local or district hospitals, I expressed views (which in 1882 were endorsed by the Royal Commission in their report on infectious disease hospitals) in favour of— (1) A single hospital authority for London; the Asylums Board as a matter of venience; (2) Free admittance to the hospital for all classes of the people; (3) Depauperisation of medical relief in the hospitals; and (4) Maintenance of the hospitals out of the Common Poor Fund created by the politan Poor Act, 1807.* The opposition to local or district hospitals was successful, and the views above set out, having received the approval of the Vestry, were made the basis of efforts which never ceased until every principle contended for in respect to hospital accommodation for the infectious sick had, in successive Acts, received the sanction of Parliament. To.day, as the result of the labours of those years, the hospitals are open to all without charge, admission being obtainable upon the application of any person whatsoever, the only condition being the production of a medical certificate of disease: no disability of any kind attaches to the use of the hospitals, diphtheria, moreover, being admissible, largely as the result of the vestry's efforts in 1889. The Vestry may well look back with satisfaction to the labours of the years 1877.1891, which brought such a rich harvest of benefit to the inhabitants of London, and indirectly to the people of England generally; by legislation promoted, largely at their instance, by the Local Government Board, with the approval of the Asylums Board and all sanitary authorities. The old prejudice against the hospitals has ceased; little difficulty is now experienced in getting the sick, or the friends of the sick, to accept the means of isolation; and accommodation which, prior to 1887, was far in excess of the demand, although the beds for fever did not then exceed 1,400, is now scarcely adequate, although nearly quadrupled. As regards small.pox, the accommodation, 1,500 beds, though far below the recommendation of the Royal Commission in 1882 (viz., 2,700 beds), is greatly in excess of the demand, as the result of the removal of cases out of London, a system commenced in 1881, and perfected in 1885 ; since when all cases of the disease have been treated at the hospital ships at Long Reach, on the River Thames, or at the adjacent convalescent hospital at Gore Farm. Notification of Infectious Disease.—The small.pox epidemic of 1870.72, which in 1871 proved fatal to 8,000 persons in London alone, convinced me of the necessity for compulsory notification of infectious disease, which was advocated in the annual report for that year. Meantime, efforts to procure voluntary notification were set on foot; an arrangement was made with the registrars for a daily return of deaths from small.pox, scarlet fever, diphtheria, and "fever"; and an appeal was made to the guardians, medical men, the School Board, the police and postal authorities, etc., which elicited a large amount of information of infectious sickness. The value of the information thus obtained was enhanced by reason of the facilities for isolation then recently provided by the Asylums Board. In 1883 I was enabled to show, by a comparison of the deaths in 12 years (1859.1870), before hospitals had been provided, or any attempt to obtain voluntary notification of infectious sickness had been made, with the deaths in 12 years (1871.1882), after these helps had been secured, a large reduction in the number of deaths from small.pox, scarlet fever, and "fever"—about 120 per annum, after correction for increase of population. In 1876 the first Act providing for compulsory notification was obtained by Huddersfield, and in successive years thereafter numerous other towns secured similar powers. In 1880 I brought the subject to the attention of the Vestry, with the result that steps were forthwith taken to unite the sanitary authorities in an effort to obtain notification powers. The Vestry convened a conference, which was held at the Town Hall in March, 1881, and was of a very representative character. The way to a successful issue had been paved by sending to each member of every sanitary authority in London a Memorandum on the subject which I had prepared, together with a copy of resolutions which the Vestry had approved as suitable to be proposed on the occasion. The conference, largely attended by delegates and medical officers of health, adopted the several resolutions,† and recommended a deputation to the Local Government Board, to request that effect might be given to them by legislation. The sanitarv authorities on the occasion of the deputation, in May, 1881, were supported by the British Medical Association, the Society of Medical Officers of Health, and other influential bodies. Small.pox was raging at the time; the hospitals were full to overflowing; hundreds * I had already in 1875 suggested to the Local Government Board that the certificate of any registered medical practitioner should be accepted as evidence of the nature of the infectious disease. In 1887 the Board issued an Order authorising this procedure, which hail then been for several years in practice with the approval of the Asylums Board. † The resolutions were in favour of (1) compulsory notification. (2) compulsory removal of the sick to hospital, when necessary. (3) free treatment of the sick in hospital, (4) depauperisation of medical relief in hospital, and (5) maintenance of the hospitals to be a charge on the Metropolitan Common Poor Fund. All of these objects have long since been secured. 79 of home-patients were spreading the disease, and the President's chief anxiety was to be advised —How the "hospital question, which," he said, "underlay the whole of the subjects brought to his notice," was to be dealt with ? Then it was that I made the recommendation for removal of the sick to hospitals without London, which, carried into effect within a few days, mid perfected bv the Asylums Board in 1885, has had such remarkable results in reduction of smallpox prevalence and mortality. But for notification London had yet to wait eight years. In 1887 the Vestry initiated a further attempt to procure notification by legislation, by an appeal to the Local Government Board, which was supported by sanitary authorities, the Asylums Board, the Society of Medical Officers of Health, the Association of Municipal Corporations, etc. The Vestry's communication was simply acknowledged, and as it seemed that the effort was not likely to have the desired result, the Vestry, at my suggestion, resolved to institute a system of paid voluntary notification. This was carried into execution forthwith, and proved very successful. Medical practitioners were at the same time invited to make direct application to the Asylums Board for the removal of their patients, upon their own certificates, a service for which they were paid an additional fee, and expenses out of pocket, for telegrams, etc. At this time the Asylums Board were admitting patients upon the application of medical men whose certificates they had long since accepted, although it was not until this year (1887) that the Local Government Board, by an Order, authorised the admittance of patients upon such certificates. The system of removal of patients to hospital by private practitioners, upon their own certificates, has been in operation ever since in this parish, with incalculable advantage to the sick and the public.* But to resume. The Local Government Board, at the end of 1887, instituted an inquiry in towns where compulsory notification was in force, with results entirely satisfactory; and in 1888 the President announced at Sheffield, where small.pox was rampant, his intention to bring in a Bill, and he did so in 1889. The Act passed with practical unanimity. Compulsory for the Metropolis alone, it was made adoptive for the rest of England and "Wales, and by request of the Irish members was extended to the sister island. From the first it proved a success, and when, in 1899, notification was made universally compulsory by the Infectious Disease (Notification) Extension Act, only a small residuum of the sanitary authorities remained to be coerced. Results of Compulsory Notif cation and Provision of Hospital Accommodation.—Whilst it would be wrong to ignore the beneficial effect upon public health, qua infectious disease, arising from improved sanitary administration, consequent upon the creation of the vestries, etc., in 1856; provision of hospitals, since 1870, and compulsory notification, since 1889, must be credited with the largest share in the remarkable reduction in mortality signalising the last thirty, and particularly the last ten years. The two systems may be regarded as complementary. Singly, I attach the greater value to hospitals, for means of isolation leads to disclosure of sickness, whilst without hospitals, notification would be of minor usefulness For hospitals and notification alike, we are largely indebted to the terror inspired by small.pox, and it is in respect to this loathsome disease that their combined effect has been most manifest, as the following figures eloquently testify: — It thus appears that in the fifteen years 1871.85, during which small.pox was treated in London —wholly until nearly the middle of 1881, and partly thenceforth until the middle of 1885—the deaths from this cause were 21,118; whereas in the fifteen years 1886.1900, during which patients have been treated out of London, the deaths were only 477. The comparison between the first quinquennial period (1871.75) and the last (1896.1900) is very striking. Suffice it to say that if the deaths in the last five years had been as numerous, in proportion to population, as in the first five years, not 33 persons, but 14,131 persons would have died from this disease in London, including 244 in Kensington, in which district there was not one death from this cause. Very striking, too, has been the reduction in scarlet fever mortality. In 1900 the deaths in London from this cause were 361; in 1870 they were 6,040. In the quinquennium 1896. 1900, the deaths were 3,039: had they been as numerous, in proportion to population, as in the five years, 1866-70, preceding the hospital regime, more than 26,000 persons would have died. The reduction in "fever" mortality is also eminently satisfactory; for during the five years 1896-1900 only 3,363 persons died from the diseases grouped under this heading, the calculated mortality, on the scale of the years 1866-70, after correction for increase of population, being 16,918. Typhus, which in the first year of its separate classification (1871) was accountable for 716 deaths, has become an almost extinct disease, having been the registered cause of only 61 * For example : In ordinary circumstances a notification male on Saturday does not reach the office until Monday. Very generally the sick person in such a case is admitted to hospital on Saturday on the notifying practitioner's application : about forty.eight hours before he would have been admitted on an application from the office made on Monday. Deaths in London from small.pox in six quinquennial periods—1871.1900 :— Period, 1871.75 1876.80 1881.85 1886.90 1891.95 1896.1900. Deaths 9,914 5,625 5,579 46 398 83. 80 deaths in London in the ten years 1891.1900. Diphtheria is the only disease in regard to which, so far, no very large impression has been made. Mainly a rural disease until within the last thirteen or fourteen years, it has since been very prevalent in urban districts and in London. Notified it has always been since 1889, but it was not until 1889 that, as already stated, sufferers from it were admitted to the Asylums Board hospitals. Since 1888 the deaths from this cause have more or less largely exceeded the deaths from scarlet fever, but happily the mortality since* 1898 has been on the decline, and the process, there is reason to hope, will continue, under the combined influences of notification, isolation, and antitoxic treatment. Disinfection.—A disinfecting station, and a shelter for persons unhoused during the disinfection of their homes, yet remain desiderata, and without them the sanitary equipment of the parish will not be complete. But during the last, thirty years disinfection has been effectually carried out, rooms being disinfected by a special officer, and the clothing, bedding, etc., being disinfected and cleansed by a contractor. The cost has been great, especially since, in 1889, notification came into force, and still more so since the passing of the Public Health (London) Act, 1891, which, with the view of preventing the spread of disease, practically threw upon the sanitary authority the duty of disinfecting infected houses and articles free of charge. The annual payment to the contractor varies considerably in different years: the maximum payment, £1,361, was made in 1896. Public Mortuary, etc.—Amongst "desiderata" specified in the early reports (1871.2) were a public mortuary, a coroner's court, and baths and washhouses. A mortuary was provided in 1883, and in 1900 317 bodies were admitted thereto. A makeshift coroner's court was provided at the Town Hall in 1888: in 1899 an excellent court, satisfying all requirements, was erected in the extension buildings. Baths and washhouses were opened in 1888. Housing of the Working Classes.—The Vestry made regulations in 1884 (under the provisions of the Sanitary Act, 1866, and the Sanitary Law Amendment Act, 1874), in respect to houses let in lodgings or occupied by members of more than one family, for the various purposes set out in the Acts, and re.enacted in the Public Health (London) Act, 1891—a course which had been recommended to their attention in the Annual Report for 1872. Upwards of 1,700 houses have been registered with great advantage. In 1885 the Vestry approved " Instructions for the guidance of the Sanitary Inspectors," under which the drains of many thousands of houses have been re.constructed, trapped, ventilated, and provided with inspection chambers. Practically, moreover, all waste. pipes of sinks, cisterns, baths, &c., have been disconnected and made to discharge over, or near surface gratings outside the house. Very many yards have been more or less efficiently paved and drained, and altogether a great improvement has been effected in the condition of the houses inhabited by the poor and working classes. Women Inspectors.—In 1893 the Vestry, upon my recommendation, initiated a new departure in sanitary administrative work, by appointing two ladies as inspectors of workshops, laundries, &c., where women are employed. I had caused inspection to be made of dressmakers' and milliners' establishments in South Kensington. The need for supervision, in order to enforcement of the sanitary provisions of the Factory and Workshop Acts, became apparent; but it was not work suited to male inspectors. I therefore advised the appointment of women. The report having been referred to the Sanitary Committee, they recommended the Vestry to appoint two female inspectors. The recommendation was adopted almost unanimously, and in due course Miss Lucy Deane and Miss Rose Squire were appointed. A great amount of thought and labour (vide Annual Report for 1893, page 157), was devoted to organisation of a scheme of administration, preparation of books, forms, &c., work in which I was ably assisted by the capable ladies whose services the Vestry had been so fortunate as to secure. Ere many months Miss Deane was appointed factory inspector, by the Home Secretary in the late Government, and Miss Duncan took her place. The Home Secretary in the present Government subsequently deprived us of Miss Squire's services by making her also a factory inspector. Previously to her departure I had been deprived of the greatly valued services of Miss Duncan, who now holds the position of factory inspector to the Government of New South Wales. The vacancy caused by Miss Squire's retirement was filled by the appointment of Miss de Chaumont. The initiative of the Vestry in this matter has been followed by numerous sanitary authorities in town and country, and the position of women workers in sanitary administration is now thoroughly recognised and appreciated. Water Supply.—Matters relating to the water supply of the metropolis engaged the Vestry's attention from the year 1872, when the Water Companies' regulations were framed. The Vestry contended that the sanitary authority should have power to enforce such of the regulations as had been framed in the interests of public health, especially Regulation 14 which enables the Companies to cut off all connections of waste.pipes of cisterns connected to drains. The Vestry, supported by other sanitary authorities, made an unsuccessful appeal to the Local Government Board to 81 promote legislation to give the desired powers. Constant service, advocated in the Annual Report for 1872, is now universally given. Strenuous efforts were made to deprive the Companies of their power to cut-off the supply to an inhabited house, the Vestry's contention being that they should be left to their remedy, as traders, to recover payment of the rate as a debt; or should exercise their power to require payment in advance. Cutting.off was a frequent practice, houses being left without water, often for lengthened periods, without the knowledge of the sanitary authority. The Vestry, in 1882, urged that the Companies should be required to give notice of the cutting.off, and such notice is now given, having been made compulsory by Section 49 of the Public Health (London) Act, 1891, under a heavy fine for default. The Vestry petitioned in favour of Mr. (now Sir) Forrest Fulton's Bill, Water Companies (Regulation of Powers), which became law in 1887, and prohibits the cutting.off of the water of houses inhabited by persons who pay for supply in rent. The Royal Commission on the Housing of the Working Classes, in their report (1885) had recommended that the Companies be deprived of their summary power to cut.off the water supply, their attention having been called to the matter by the Vestry, on the occurrence of a striking example of the misuse of this power, whereby eighty persons living in a mews, were deprived of water, the landlord having failed to pay the rate. Cutting.off powers are seldom exercised now, and some of the Companies have generally ceased to exercise them ; notably the East London Water Company. Licensed, Slaughter Houses.—The fifty.fifth section of the Metropolitan Buildings Act, 1844, made provision for the abolition, in 1874, of private slaughter.houses in London. These establishments were numerous in 1873, and were admittedly unsatisfactory in nearly every respect; but no provision had been made of public abattoirs to take their place. In Kensington, out of 48 slaughter houses, only one had been built for the purposes of the business. In 1873 a Select Committee of the House of Commons, appointed to consider the subject of "noxious businesses "generally, reported that, subject to proper regulations, the slaughter.houses might be allowed to continue. In view of probable legislation, I had read a paper before the Society of Medical Officers of Health (March 21st, 1874), on " Private Slaughter Houses considered with reference to the report of the Select Committee on Noxious Businesses," in which I specified the requirements essential to a sanitary slaughterhouse ; indicated the conditions necessary to be enforced by bye.laws; predicted that suitable regulations would lead to the closing of many of the existing premises, and insisted on the necessity for a heavy and irreducible penalty for breach of the regulations. The Slaughter Houses (Metropolis) Bill was introduced in the House of Commons towards the end of the Session (1874), but failed to excite interest: there was, practically, no discussion on it; and, to use a common expression, the Bill was "rushed" through the House. The Vestry, almost alone, took steps to obtain amendments to the Bill, in the Upper House—not without a measure of success. The Metropolitan Board of Works, the constituted Local Authority for carrying out the Act, subsequently framed regulations, practically embodying the conditions the Vestry had previously adopted as suitable to be enforced by the Justices, the then licensing authority. The regulations, however, were by no means perfect: no provision was made for separate lairage, nor for an entrance to the slaughter.house independent of the dwelling.house or shop. The Vestry contended successfully for these and other points before the Justices, and the Local Authority subsequently adopted their views. In 1875 I made proposals for amendment of the bye.laws, which were approved by the Society of Medical Officers of Health ; and in 1891 a new and improved code was framed by the Local Authority, the County Council. The main defect of the Act was, that it ignored the sanitary authorities, whose medical officers of health and sanitary inspectors should have been mode available for the purposes of inspection and supervision. Such inspection and supervision were maintained in Kensington, although the Vestry had no statutory authority, excepting such as was indirectly derived from power to oppose the renewal of the annual licence of the premises. The granting of the licence was transferred in 1889 to the County Council. In 1898 the Public Health Committee of the County Council made a strenuous effort to obtain the substitution of a limited number of public abattoirs for the private slaughter.houses. But the influence of the Butchers' Trade Protection Society, so efficiently exercised before the Select Committee in 1874, again proved too strong, and the question was shelved by the Council. London in sanitary matters generally lags behind the great provincial towns! As foretold in 1874, the enforcement of the regulations led to a great reduction in the number of licensed premises. In 1874 some 1,500 were licensed, in 1900 only 397; in Kensington 59 were licensed in 1869, and 48 in 1873; now there are only 13 slaughter.houses; and the business has not been established anew since 1874. The Act of that year was superseded by the Public Health (London) Act, 1891. The London Government Act of 1899 endows the Borough Council with authority to inspect the premises, and enforce the bye.laws. Licensed Cow.Houses, Dairies, &c.—In 1875 I called attention to the cow.houses and dairies, in a paper read before the Society of Medical Officers of Health. I urged the necessity, in the interests of public health, of regulating the structure of the premises and the conduct of the businesses by bye.laws uniform for the Metropolis, and submitted a draft code of bye.laws. Legislation was shown to be necessary, and it was recommended that the Metropolitan Board of Works should be the "Local Authority" for the purpose of making bye.laws uniform for the whole of London; but that the duty of supervision should devolve upon the local sanitary authorities. The proposed code, with slight modifications, was adopted, and published by the Society as "Model 82 Bye-laws." In 1878, the Metropolitan Board was constituted Local Authority in respect to cowhouses, dairies, etc., by section 34 of the Contagious Diseases (Animals) Act: the Privy Council framed the first Dairies and Cow-Sheds Order in 1879, and regulations, based upon the model Code, were made by the Board, under the operation of which great improvements in the condition of the cow.sheds and dairies have been effected. Soon after promulgation of the Order, the Vestry, which had vigorously supported my views, successfully prosecuted a dairyman who had carrried on business whilst his house was practically a small.pox hospital. One of the regulations relating to cow.sheds provided for a definite allowance of cubic or air.space for each animal. Long before they existed, the Vestry, at my instance, had contended for 800 cubic feet, and the Justices (the licensing authority at the time) coinciding, that amount became a standard in the parishes and districts comprised in the Kensington Division, and was enforced, although the regulations of the Board required only 600 cubic feet, in certain circumstances. The 800 cubic feet standard has since become general, and is the amount recommended in the Model Bye.laws of the Local Government Board. In 1885, a new Dairies Order was issued, which enabled the Local Authority to frame more stringent provisions, especially for the prevention of contamination of milk, and the spread of infectious disease through the agency of milk. The defect in legislation, as in the cognate case of the Slaughter.Houses Act, 1874, was, that no attempt was made to utilise the services of medical officers of health and sanitary inspectors for the purposes of supervision. Supervision of cow.houses, however, continued to be exercised in Kensington, with manifest advantage, although the Vestry had no statutory authority, excepting such as it derived from power to oppose the renewal of the annual licence, which, since 1899 has been granted by the County Council. The powers of the Council, with regard to inspection and enforcement of regulations, will shortly be transferred to the Sanitary Authorities—i.e., the future Borough Councils, by the London Government Act, 1899 ; the power to frame regulations, and the licensing of cow.houses, being properly reserved to the Council. The bye.laws will thus continue to be uniform for the metropolis, as recommended in 1875. There has been a great reduction in the number of cow.houses in London since the passing of the Act; viz., from 1044, in 1880 to 319 in 1900. At one time (1862) there were 53 in Kensington ; in 1878 the number was 26; now there are only four. Within my personal recollection 500 cows were kept in the parish; in 1900 the number was five only. Bakehouses.—The need for legislation to secure the proper sanitary condition of bakehouses, was brought to the attention of the Vestiy in 1881. The sanitary authority had been made the inspecting authority by the Bakehouse Regulation Act, 1863; but at the instance of the Factory Department this duty was, by the Factory and Workshop Act, 187$, transferred to the factory inspectors, who were few in number, and over.burdened with other duties. The bakehouses, for the most part, as stated in the report of the chief inspector for 1881, fell into a deplorable condition. In Kensington supervision, but without legal authority, had been kept up by the Vestiy, and the premises, although they could not be improved structurally, were at least kept clean, and in a fairly good sanitary condition. Ultimately, the Factory Department became convinced of their inability to perform the duty, and in 1883, by the Factory and Workshop Act of that session, the duty of supervision was re-transferred to the sanitary authority. The Vestry, realising the necessity for increased powers, had in 1882 organised an appeal to the Local Government Board, which was largely supported by the sanitary authorities and by the Society of Medical Officers of Health. I had long contended that what was wanted was an Act " providing for the licensing of bakehouses, and conferring on sanitary authorities the power of regulating the trade by bye.laws, uniform for the metropolis "(to be made by the Metropolitan Board of Works) "dealing with (1) the position and construction, including the lighting and ventilation of bakehouses, (2) the periodical cleansing of the premises, and (3) the materials and utensils employed in the manufacture of bread." Some improvements in the law were effected by the Act of 1883, and later by the Public Health (London) Act, 1891. The County Council in 1894 made an effort to promote legislation, and approached the Local Government Board on the subject, but without success. Even now the desired power to enable the Council to frame bye.laws, to be enforced by the sanitary authorities, has not been obtained. The annual report for 1894 (pp. 152.166 inclusive) contains a resume of the Vestry's action and a history of the movement for bakehouse reform between 1881 and 1894. Effluvium Nuisance: Ref use Matters.—Probably no greater improvement has been effected by the vestry than in relation to nuisance from the refuse of stables, etc., under the powers conferred by the bye.laws of the County Council, made under the provisions of the Public Health (London) Act, 1891. Many hundreds of brick receptacles and offensive underground pits have been abolished, and some 1,600 iron cage receptacles substituted therefor. Nuisance, especially during the removal of the refuse, formerly the commonest cause of complaint, is now of rare occurrence. The first bye.law, dealing with the removal of offensive refuse, requires amendment, to secure the transit of peat manure through the streets in properly covered vehicles, and such amendment of it is in contemplation. 83 Offensive Businesses.—In regard to nuisance from the refuse of offensive businesses, the Vestry, since 1878, have taken the lead in measures to secure amendment of the law, in order to the mitigation of nuisance, in the storage, collection, and transit through streets, of offensive matter, a subject fully dealt with in the annual report for 1887 (page 176), among others. During many years the Vestiy have made efforts to get the business of a marine-store dealer added to the list of offensive businesses, scheduled, originally, in the Slaughter Houses (Metropolis) Act, 1874. But the Metropolitan Board of Works, in 1883, and the County Council in 1896, declined to take steps to this end, although the High Court had decided that the said business is ejusdem generis with the scheduled businesses. Nuisance from the Keeping of Swine, in the Potteries District, long since abolished, involved great labour and difficulty in the early years of the Vestry's administration. Some 2,000 pigs were formerly kept in the district, which, moreover, reeked with effluvia from the boiling of domestic refuse in the preparation of food for the pigs. The bye.laws of the Metropolitan Board of Works, made under the provisions of the Slaughter Houses (Metropolis) Act, 1874, enabled the Vestiy, with the aid of the " Local Authority," to put an end to the latter nuisance: now only one fat.melting business remains, and it is carried on, not indeed without causing occasional nuisance, but under conditions designed to prevent nuisance. Coeval with the nuisances incidental to the keeping of swine was the nuisance at Tucker's candle factory and tallow melting works, in Kensington Higli.street, the cause of great annoyance and incessant complaints during many years, but long since a thing of the past. Tirickburning, a fertile cause of complaint in by.gone years, has, through the Vestiy's proceedings, ceased to be a nuisance in Kensington. Glanders.—The late Metropolitan Board of Works was constituted Local Authority for London under the Contagious Diseases (Animals) Act, 1878, glanders being one of the diseases that came under their cognisance. The provisions of the Act in respect to this disease were scandalously disregarded by many horse owners. A glaring instance occurred at Colville-mews, in this parish, in 1879. A large number of horses, victims to glanders and farcy, at a cab proprietor's stables, had been illegally removed to another mews, and to Wandsworth, where they were slaughtered, without the knowledge of the local authority. A deplorable incident, which led to discovery of the outbreak, was the illness of two children of a horsekeeper who had contracted the disease. One died at home, the other at St. Mary's Hospital. The coroner for West Middlesex declined my request for an inquest. The coroner for Central Middlesex, realising the gravity of the occurrence, held an enquiry, at which the Privy Council, the Metropolitan Board, and the Vestry were represented. Surprising facts came to light: it was proved that nearly every provision of the law had been violated. A number of prosecutions followed; heavy fines were inflicted upon offenders, and the magistrates expressed their determination to inflict the maximum penalty for offences tinder the Act. The proceedings led to increased activity by the Local Authority and the disclosure of large numbers of cases of glanders—990 in 1879, the largest total then ever recorded—followed by a considerable decline in subsequent years. I received a letter of thanks from the Lords of the Council for my services in the matter. Particulars of the outbreak, and the resultant proceedings, were given in the annual report for 1878.79, page 48. Conclusion.—It is only since 1889 that London has had the advantage of possessing a medical officer of health for purposes of central sanitary administration. Previous to that year, the Vestry made up, in some sense, for the want of such an officer, by efforts to bring about uniformity of action on the part of the Sanitary Authorities; chiefly by circulating the reports in which the subjects referred to in this valedictory supplement had been dealt with. That so many of the objects contended for, in respect to public health and sanitary administration, have been attained, as the result of such action, is surely a matter on which the Vestry, at this its last meeting, may be congratulated. At the same time, a due meed of acknowledgment should be made of the work of the Metropolitan Asylums Board, as Hospital and Ambulance Authority. With rare and brief periods of prudent hesitation, the Managers ever rose to the level of their great opportunities, and did service to London, and by their example to the country at large, of which the value can hardly be overestimated. For my own part, I can but express regret to have found it impossible to do justice to the theme of this Retrospect ; the subjects of which, and many another contained in nearly four hundred monthly, and thirty annual reports, are too important to be adequately dealt with, in the time and space, at my disposal. Thanks are due to the Vestry for the support without which my power for usefulness would have been small indeed, and to every member of the Staff placed at my disposal, for loyal service, at all times, and in all the work of the Public Health Department. [TABLES. 84 TABLE A. Population of Kensington, 1856.1900; Marriages, and Marriage-rate (1871.1900); Births, and Birth-rate; Deaths, and Death-rate (1856.1900); and Infantile Mortality (1870-1900). The Year. Population. Marriages. Marriage Rate. Births. Birth Rate. Deaths. Death Rate. Deaths under One Year. Deaths under One Year per 1,000 Births Registered. Kensington. London. Kensington. London. 1856 57,078 Information incomplete. No Information. 1,804 81.6 33.6 1,235 21.6 22.0 1857 59,683 1,854 81.1 34.0 1,197 20.1 22.4 244 182 1858 62,288 1,881 30.2 83.2 1,290 20.7 23.9 298 158 1859 64,893 2,002 80.8 84.1 1,888 20.6 22.7 268 184 1860 67,498 2,016 29.9 33.6 1,480 21.9 22.4 805 151 1861 70,108 2,159 80.8 84.5 1,447 20.6 28.2 302 139 1862 76,350 1,9G0 25.7 34.2 1,604 21.0 28.6 No Information. 1863 81,350 2,830 28.6 35.2 1,628 20.0 24.5 1864 86.350 2,494 28 9 34.7 1,849 21.4 26.4 1865 91,350 2,619 28.7 85.7 1,733 18.9 24.5 1866 96,350 3,080 31.9 85.7 1,966 20.4 26.5 1867 101,350 8,158 31.2 36.5 1,933 19.1 23.0 1868 106,350 3,522 88.1 36.8 2,282 21.0 23.5 1869 111,350 8,625 82.6 85.4 2,249 20.2 24.6 1870 116,350 3,705 81.8 85.4 2,473 21.3 24.1 604 168 1871 120,234 1,131 18.8 3,804 31.6 34.5 2,418 20.1 24.6 582 158 1872 127,606 1,132 17.7 4,041 31.7 35.6 2,256 17.7 21.5 626 155 1873 132,826 1,243 18.7 4,182 81.5 85.8 2,439 18.4 22.4 656 157 1874 138,616 1,811 18.9 4,856 31.4 35.6 2,696 19.4 22.4 762 175 1875 144,488 1,346 18.6 4,478 31.0 35.4 2,786 19.3 23.6 686 153 1876 148,338 1,417 19.1 4,499 30.3 35.9 2,896 19.5 21.9 771 171 1877 151,860 1,411 18.6 4,648 80.7 85.6 2,625 17.8 21.6 648 139 3878 154,305 1,331 17.2 4,607 29 9 35.5 3,120 20.2 28.1 823 179 1879 158,316 1,428 18.0 4,790 80.8 35.5 2,992 18.9 22.6 722 151 1880 161,462 1,483 18.4 4,605 28.5 35.3 2,884 17.9 21.7 719 156 1881 163,151 1,461 17.9 4,400 26.9 84.7 2,726 16.7 21.8 644 146 1882 163,540 1,474 18.0 4,827 26.5 34.5 2,691 16.4 21.5 685 147 1883 163,860 1,616 19.7 4,230 25.8 34.5 2,615 15.9 2J.8 601 142 1884 164,180 1,498 18.2 4,394 26.7 34.8 2,638 16.1 20.9 678 154 1885 164,500 1,480 18.0 4,082 24.5 33.4 2,768 16.8 20.4 658 162 1886 164,820 1,605 19.5 4,149 25.2 33.4 2,756 16.7 20.6 686 158 1887 165,140 1,561 18.9 8,941 23.9 32.9 2,872 17.4 20.3 680 172 1888 165,450 1,497 18.1 8,776 22.8 32.1 2,825 17.1 19.3 604 160 1889 165,760 1,491 18.0 8,698 22.8 31.9 2,412 14.6 18.4 489 132 1890 166,080 1,511 18.2 3,861 23.3 30.7 2,951 17.8 21.4 651 168 1891 166,308 1,569 18.9 3,847 23.1 31.9 3,066 18.4 21.5 688 164 1892 167,200 1,584 18.9 3,718 22.2 31.0 2,882 17.2 20.7 587 158 1893 167,900 1,540 18.3 3,661 21.8 30.9 2,916 17.4 21.8 625 170 1894 168,600 1,537 18.2 8,665 21.7 80.3 2,623 15.6 17.8 636 174 1895 169,300 1,455 17.2 3,621 21.4 30.6 2,748 16.2 19.9 624 172 1896 170,465 1,706 20.1 8,717 21.4 30.2 2,891 16.7 18.6 656 176 1897 170,700 1,681 19.7 3,683 21.6 30.1 2,667 15.6 18.2 609 165 1898 172,000 1,648 19.2 8,683 21.1 29.5 2,798 16.8 18.7 655 180 1899 172,400 1,693 19.6 8,590 20.8 29.4 3,021 17.5 19.8 642 179 1900 173,000 1,548 17.8 3,586 20.7 28.6 2,698 15.6 18.8 641 179 Note. The Medical Officer of Health is not responsible for the accuracy of the Kensington figures above the horizontal line between the years 1870 and 1871, excepting as to estimated population and calculation of rates. Census years are indicated by dark type. 85 TABLE B. Annual Number of Deaths in Kensington from the Principal Diseases of the Zymotic Class (1856.1900); and Zymotic Death.rate, in Kensington, and in London. The Year. Population. Deaths from the Seven Principal Diseases of the Zymotic Class. Zymotic Death.Rate. Small.pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Fever. Diarrhoea. Total. Per 1,000 persons living. Deaths, per 1,000 Deaths from all Causes, Kensington Typhus. Enteric. Simple Continued. Kensington. London. 1856 57,078 13 80 20 Not separately classified. 19 Not separately classified. 15 Not separately classified. 62 159 2.8 No Information. 129 1857 59,688 ... 15 26 87 17 83 178 2.9 149 1858 62,288 2 24 49 64 88 80 207 8.8 160 1859 64,898 11 42 58 No Information. 11 17 72 206 8.2 154 1860 67,498 18 29 86 56 25 85 249 8.7 168 1861 70,108 2 53 57 87 84 66 249 8.5 172 1862 76,350 ... 80 110 54 51 24 269 8.5 168 1868 81,850 49 88 89 22 54 54 851 4.8 215 1864 86,850 5 100 90 56 60 68 874 4.8 202 1805 91,850 18 52 81 87 77 104 819 8.5 184 1866 96,850 10 40 28 28 88 112 251 2.6 128 1867 101,350 29 19 85 68 46 78 275 2.7 142 1868 106,850 4 84 170 84 52 118 457 4.3 205 1860 111,850 6 27 106 9 71 42 108 869 8.8 164 1870 116,350 8 70 198 14 55 46 154 545 4.7 220 1871 120,234 120 64 95 11 72 6 26 16 129 589 4.5 6.0 223 1872 127,606 68 43 29 14 77 4 28 10 110 383 8.0 8.8 169 1878 132,826 1 88 10 11 44 6 27 8 145 290 2.2 8.8 119 1874 188,616 ... 121 82 26 45 9 28 15 112 888 2.8 3 8 144 1875 144,488 ... 28 83 28 107 2 21 6 107 872 2.6 8.9 183 1876 148,838 8 128 59 17 124 3 27 6 126 498 8 3 3.6 172 1877 151,360 84 54 81 10 34 2 14 5 90 833 2.2 8.5 127 1878 154,805 24 58 77 20 185 8 26 4 181 578 8.7 4.1 184 1870 158,816 24 60 51 26 93 1 14 8 71 848 2.2 8.8 116 1880 161,462 11 75 105 22 95 4 24 5 128 469 2.9 8.7 163 1881 163,151 55 67 88 8 85 2 22 5 101 888 2.3 3.6 140 1882 168,540 ... 77 62 25 119 1 25 6 61 876 2.8 8.5 189 1883 163,860 1 89 28 24 44 2 80 8 80 251 1.5 2.7 96 1884 164,180 26 82 18 17 81 ... 26 4 110 814 1.9 3.5 119 1885 164,500 25 111 7 22 98 ... 12 ... 86 861 2.2 8.0 130 1886 164,820 ... 56 11 84 82 ... 11 ... 90 280 1.7 2.8 102 1887 165,140 1 108 44 40 86 ... 11 2 124 416 2.5 8.1 145 1888 165,450 ... 124 26 89 100 ... 21 2 58 420 2.5 2.7 148 1889 165,760 ... 14 28 111 26 ... 19 ... 71 269 1.6 2.8 111 1890 166,080 ... 140 26 85 93 ... 15 ... 78 887 2.8 2.8 131 1891 166,308 ... 29 16 28 84 ... 24 1 91 273 1.6 2.8 89 1892 167,200 ... 109 86 81 63 ... 15 2 77 883 2.0 2.8 115 1898 167,900 9 18 51 88 65 ... 17 98 841 2.0 8.1 117 1894 168,600 ... 108 22 75 61 ... 21 8 56 846 2.1 2.7 182 1895 169,300 ... 83 27 89 39 ... 15 1 118 822 1.9 2.6 117 1896 170,465 ... 173 89 72 99 ... 15 1 61 460 2.7 8.1 159 1897 170,700 ... 83 29 82 19 ... 21 1 125 810 1.8 2.6 116 1898 172,000 ... 120 23 26 52 2 12 ... 112 347 2.0 2.8 124 1899 172,400 ... 24 10 42 59 ... 23 ... 101 259 1.5 2.5 86 1900 178,000 ... 98 4 27 88 ... 16 ... 105 283 1.6 2.2 105 Note.—The Medical Officer of Health is not responsible for the accuracy of the figures above the horizontal line between the years 1870 and 1871, excepting as to calculation of rates. Census years are indicated by dark type. 86 TABLE C. Births, and Birth-rate; Deaths, and Death-rate; Deaths from the Seven Principal Diseases of the Zymotic Class ; and Zymotic Death-rate, in Kensington, 1856-1900 : Arranged in Quinquennial Periods. Quinquennial Period. Births. Birthrate. Deaths. Deathrate. Deaths from Zymotic Diseases. Zymotic Deathrate, per 1,000 persons living. Small-pox. Measles. Scarlet Fever. Diphtheria, WhoopingCough. Typhus Fever. Enteric Fever. Simple Continued Fever. Diarrhoea, Total. 1856-1860 1861-1865 9,557 11,562 30.7 28.5 6,540 8,261 21.0 20.4 44 74 140 318 234 377 No information. 187 206 Not separately classified. 112 276 Not separately classified. 282 311 999 1,562 3.20 3.85 1866.1870 17,090 32.1 10,853 20.4 57 240 537 256 219 565 1,874 3.52 1871.1875 20,861 31.4 12,595 18.9 189 289 249 85 345 27 130 55 603 1,972 2.97 1876.1880 23,149 29.9 14,517 18.8 151 370 323 95 531 13 105 28 605 2,221 2.87 1881.1885 21,383 26.1 13.438 16.4 107 326 153 96 427 5 115 18 438 1,685 205 1886.1890 19,428 23.5 13,816 16.7 1 442 135 305 387 ... 77 4 421 1,772 2.14 1891.1895 18,512 22.1 14,235 16.9 9* 297 152 306 312 ... 92 7 440 1,615 1.92 1896.1900 18,209 21.2 14,075 16.4 448 105 249 262 2 87 2 504 1,659 1.93 Note.—The Medical Officer of Health is not responsible for the accuracy of the figures above the horizontal line between 1866.1870 and 1871.1875, excepting as to calculation of rates. * All in 1893. TABLE D. Death-rate in Kensington, per 1,000 persons living, from each of the Seven Principal Diseases of the Zymotic Class; Arranged, also, in two groups; viz. (1) The four notifiable infectious diseases—Small-pox, Scarlet Fever, Diphtheria, and" Fever"; and (2) The three non-notifiable diseases—Measles, Whooping. Cough, and Diarrhoea. 1 2 3 4 5 6 7 Death-rate per 1,000 from— Quinquennial Period. Smallpox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. "Fever." Diarrhoea. 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 013 0.45 0.75 No information. 0.60 0.36 0.91 3.20 1.25 1.95 1861.1865 0.18 0.78 0.93 0.51 0.68 0.77 8.85 1.79 2.06 1866.1870 0.01 0.45 101 0.48 0.41 1.06 8.52 1.58 1.99 1871.1875 0.28 0.44 0.37 0.13 0.52 0.82 0.91 2.97 1.11 1.86 1876.1880 0.19 0.48 0.42 012 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 0.81 0.01 0.59 1.93 0.52 1.41 87 APPENDIX II. (Vide page 13.) TABLE VI. (Table I. in preceding Annual Reports.) Showing Population, Inhabited Houses, Marriages, Births, and Deaths, in 1900, and in the ten preceding years : gross numbers. The Year. Estimated Population.* No. of Inhabited Houses.f Marriages. Registered Births. Deaths. Total, all Ages.t Under One Year. Under Five Years. At Public Institutions. § 1900 173,000 22,800 1,543 3,586 2,698 641 877 764 1899 172,400 22,750 1,693 3,590 3,021 642 932 942 1898 172,000 22,700 1,648 3,633 2,798 655 1,039 782 1897 170,700 22,669 1,681 8,683 2,667 609 912 889 1896 170,000 22,576 1,706 3,717 2,891 656 1,111 817 1895 169,300 22,488 1,455 8,621 2,748 624 951 762 1894 168,600 22,390 1,537 8,665 2,623 636 1,022 749 1898 167,900 22,297 1,540 3,661 2,916 625 965 740 1892 167,200 22,204 1,584 3,718 2,882 587 972 687 1891 166,500 22,084 1,569 3,847 3,066 633 968 773 1890 166,080 21,800 ** 1,511 ** 3,864 ** 2,951 651 1,095 612 Average, 10 years 1890-1899. 169,068 — 1,592 8,699 2,856 631 996 770 Notes.—Census Population in 1861, 70,108 ; in 1871, 120,299 ; in 1881, 163,151 ; in 1891, 166,308 ; in 1896, 170,465. Average Number of Persons to each house at Census : in 1861, 7.4 ; in 1871, 7.6 ; in 1881, 8.1 ; in 1891, 7.53. Area of Borough, 2,190 acres. Number of persons to an acre (1900) 79. * For statistical purposes the population is estimated to the middle of the year, on the basis of the rate of increase in the preceding inter-censal period, checked by the number of inhabited houses, and by the average number of persons per house, as ascertained at the last census. f The data are somewhat unreliable. J Inclusive of the deaths of parishioners at public institutions without the Borough, but exclusive of the deaths of non-parishioners at public institutions within the Borough. § Viz.: At the Borough infirmary and outlying public institutions, including the Asylums Board Hospitals. ** In 53 weets. 88 TABLE VII. (Table II. in preceding Annual Reports.) Showing the Annual Birth-rate and Death-rate ; Death-rate of Children ; and proportion of Deaths at Public Institutions, to 1,000 Deaths, for the year 1900 and the ten preceding years. The Year. Birth-rate per 1,000 of the Population. Death-rate per 1,000 of the Population. Deaths of Children under one year; per 1,000 of Registered Births. Deaths of Children under one year ; per 1,000 of Total Deaths. Deaths of Children under five years ; per 1,000 of Total Deaths. Deaths at Public Institutions; Per 1,000 of Total Deaths.* 1900 207 156 179 238 325 283 1899 20.8 17.5 179 218 309 811 1898 21.1 16.3 180 234 871 279 1897 21.6 15.6 165 229 342 815 1896 21.4 16.7 176 227 884 283 1895 21.4 16.2 172 227 846 277 1894 21.7 15.6 174 242 389 285 1893 21.8 17.4 170 214 881 254 1892 22.2 17.2 158 204 387 238 1891 28.1 18.4 164 206 815 252 1890 23.3 178 168 221 871 207 Average of 10 years, 1890.1899. 21.8 16.9 171 222 849 270 * Includes Deaths of Parishioners at outlying Public Institutions, but excludes Deaths of Non.Parishioners at Brompton Consumption Hospital, St. Marylebone Infirmary, Notting.hill, &c. TABLE IX. (Table IV. in preceding Annual Reports.) Showing the number of Deaths in the Borough at all ages, in 1900, from certain groups of Diseases, and proportions to 1,000 of Population, and to 1,000 Deaths from all causes: also the number of Deaths of Infants under one year of age, from other groups of Diseases, and proportions 1,000 Births, and to 1,000 Deaths from all causes under one year. Division I. (At all Ages.) Total Deaths. Deaths per 1,000 of Population. Deaths per 1,000 of Total Deaths. 1. Principal Zymotic Diseases 283 1.6 105 2. Pulmonary Diseases 542 8.1 201 3. Principal Tubercular Diseases 275 1.6 102 Division II. (Infants under one year.) Total Deaths. Deaths per 1,000 of Births. Deaths per 1,000 of Total Deaths under one year. 4. Wasting Diseases 168 45.5 254 5. Convulsive Diseases 69 19.2 108 NOTES. 1. Includes Small-pox, Measles, Scarlet Fever, Diphtheria, Whooping.cough, Typhus Fever, Enteric (or Typhoid) Fever, Simple Continued Fever, and Diarrhoea. Forty-five of the deaths occurred in Hospitals without the Borough. 3. Includes Phthisis, Scrofula, Tuberculosis, Rickets, and Tabes. 4. Includes Debility, Atrophy, Inanition, Want of Breast.milk, and Premature Birth. 5. Includes Hydrocephalus, Infantile Meningitis, Convulsions, and Teething. (In Table VIII., Hydrocephalus and Infantile Meningitis are classified with tubercular diseases, Convulsions with diseases of the nervous system, and Teething with diseases of the digestive system.) 89 TABLE X. (Table V. in preceding Annual Reports.) Showing the Number of Deaths from the Principal Diseases of the Zymotic Class in the ten years, 1890-1899, and in the year 1900. Diseases. 1890. 1891,. 1892. 1893. 1894. 1895. 1896. 1897. 1898. 1899. Annual Average of ten years, 1890-99. Proportion of Deaths to 1000 Deaths from all causes in ten years, 1890-99. Deaths in 1900. Proportion of Deaths to 1000 Deaths from all causes in 1900. Small-pox ... ... ... 9 ... ... ... ... ... ... 0-9 0.8 ... ... Measles 140 29 109 18 108 83 173 83 120 24 78.7 27.6 98 36.3 Scarlet Fever 26 16 36 51 22 27 39 29 23 10 27.9 9.8 4 1.5 Diphtheria 85 28 81 83 75 89 72 82 26 42 56.3 19.7 27 10.0 Whooping-cough 93 84 63 65 61 39 99 19 52 59 63.4 22.2 33 12.2 Typhus Fever ... ... ... ... ... ... ... ... 2 ... 0.2 01 ... ... Enteric Fever 15 24 15 17 21 15 15 21 12 23 17.8 6.2 16 5.9 Simp. Continued Fever ... 1 2 8 1 1 1 ... ... 0.9 0.3 ... ... Diarrhœa 78 91 77 98 56 118 61 125 112 101 91.7 32.1 105 88.9 TOTALS. Kensington. 887 273 833 341 346 322 460 810 847 259 838 118.3 283 104.8 London. 12,279 9,675 11,983 13,223 11,544 11,544 14,100 11,525 12,565 11,228 11,966 188.7 10,187 118.5 England & Wales. 59,698 53,221 56,032 73,499 52,771 64,901 66,936 67,051 69,714 69,820 63,364 114.2 64,059 109.0 90 91 TABLE VIII. (Table III. in precedinq Annual Reports.) Deaths registered from all causes in the Year 1900. (Exclusive of the Deaths of Non-Parishioners at Public Institutions within the Borough, but inclusive of the Deaths of Parishioners at Public Institutions, &c., without the Borough.) For a Summary of this Table, see page 16. CAUSES OF DEATH. AGES. Total under Five Years of Age. Grand Total all 1 Ages. Sub-district. 0 to 1. 1 to 6. 5 to 15. 15 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 to 75. 75 to 85. 85 and upwards. Kensington Town. Brompton. CLASSES. I SPECIFIC FEBRILE or ZYMOTIC DISEASES... 144 116 18 8 13 17 15 22 18 23 9 260 403 351 52 II. PARASITIC DISEASES 3 ... ... ,,, ... ... 1 ... ... 3 4 4 ... III. DIETETIC DISEASES ... 4 7 5 1 2 1 ... ... 20 15 5 IV CONSTITUTIONAL DISEASES 28 35 22 35 61 93 91 75 45 27 2 63 514 405 109 V DEVELOPMENTAL DISEASES 109 2 1 2 16 52 28 111 210 185 25 VI. LOCAL DISEASES 239 72 32 33 57 106 130 218 243 174 34 311 1338 1055 283 VII. DEATHS FROM VIOLENCE 37 6 3 8 11 3 16 4 11 6 1 43 106 89 17 VIII. DEATHS FROM ILL-DEFINED AND NOT SPECIFIED CAUSES 81 5 1 1 ... 2 2 1 3 4 3 86 103 89 14 641 236 77 85 116 228 259 323 339 287 77 877 2698 2193 505 I. SPECIFIC FEBRILE or ZYMOTIC DISEASES. Order 1.—Miasmatic Diseases. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 26 68 4 ... ... ... ... ... ... ... ... 94 98 93 5 Scarlet Fever ... 2 1 ... 1 ... ... ... ... ... ... 2 4 2 2 Typhus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping-cough 17 13 3 ... ... ... ... ... ... ... ... 30 33 30 3 Diphteria 2 19 5 1 ... ... ... ... ... ... ... 21 27 25 2 Simple Continned or Ill-defined Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric or Typhoid Fever ... ... .2 4 6 2 1 1 ... ... ... ... 16 14 2 Other Miasmatic Diseases—Influenza ... 1 3 ... 3 11 8 17 12 21 9 1 85 60 25 2.—Diarrheal Diseases. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Simple Cholers 1 ... ... ... ... ... ... ... ... ... ... 1 1 1 ... Diarrhoea, Dysentery. 80 12 ... ... 1 2 2 2 4 2 92 105 98 7 3.—Malarial Diseases. Remittent Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4.—Zoogenous Diseases. Cow-Pox, and effects of Vaccination ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases (e.g., Hydrophobia, Glanders, Splenic Fever) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5.—Venereal Diseases. Syphilis 16 1 ... 1 ... ... 1 ... ... ... ... 17 19 16 3 Gonorrhoea, Stricture of the Urethra ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 ... 6.—Septic Diseases. Erysipelas 2 ... ... ... ... 1 3 2 1 ... ... 2 9 6 3 Pyaemia, Septicaemia . ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever ... ... ... 2 2 1 ... ... ... ... ... ... 5 5 ... 144 116 18 8 13 17 15 22 18 23 9 260 403 351 52 II.—PARASITIC DISEASES. Thrush, and other Vegetable Parasitic Diseases 3 ... ... ... ... ... ... ... 1 ... ... 3 4 4 ... Worms, Hydatids, and other Animal Parasitic Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... ... ... ... ... ... ... 1 ... ... 3 4 4 III.—DIETETIC DISEASES. Want of Breast Milk—Starvation ... ... ... ... ... ... ... ... • •• ... ... ... ... ... Scurvy ... ... ... ... ... ... ... ... ... 1 ... ... 1 1 ... Chronic Alcoholism ... ... ... ... 3 5 3 1 2 . . . ... ... 14 11 3 Delirium Tremens ... ... ... ... 1 2 2 ... ... ... ... ... 5 3 2 ... ... ... ... 4 7 5 1 2 1 ... ... 20 15 5 IV.—CONSTITUTIONAL DISEASES. Rheumatic Fever, Rheumatism of the Heart ... ... 3 3 2 1 2 1 ... ... ... ... 12 11 1 Rheumatism ... ... ... ... 1 1 2 ... ... ... 4 2 2 Gout ... ... ... ... ... 1 1 2 ... 1 ... ... 5 5 ... Rickets 2 4 ... ... ... ... ... ... ... ... ... 6 6 5 1 Cancer, Malignant Disease ... ... ... 2 2 18 29 42 37 21 1 ... 152 105 47 Tabes Mesenterica 6 2 1 ... ... ... ... ... ... ... ... 8 9 8 1 Tubercular Meningitis, Hydrocephalus 11 18 6 1 ... 1 ... ... ... ... ... 29 37 29 8 Phthisis 3 4 21 46 66 43 21 4 2 ... 3 210 177 33 Other forms of Tuberculosis, Scrofula 9 8 7 8 6 4 6 1 1 ... 17 50 46 4 Purpura, Haemorrhagic Diathesis ... ... ... ... ... ... ... ... ... ... ... ... ... ... Anaemia, Chlorosis, Leucocythaenia ... ... ... ... 1 1 2 2 1 ... ... ... 7 5 2 Glycosuria, Diabetes Mellitus ... ... 1 ... 2 6 6 1 2 1 ... 19 10 9 Other Constitutional Diseases ... ... ... ... 1 1 1 ... ... ... ... ... 3 2 1 28 35 22 35 61 93 91 75 45 27 2 63 514 405 109 Continued. 92 93 TABLE VIII.—continued. CAUSES OF DEATH. AGES. Total under Five Years of Age. Grand Total All Ages. Sub-District. 0 to 1. 1 to 5. 5 to 15. 15 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 to 75. 75 to 85. 85 and upwards. Kensington Town. Brompton. V.—DEVELOPMENTAL DISEASES. Premature Birth 88 ... ... ... ... ... ... ... ... ... ... 83 88 73 10 Atelectasis 14 ... ... ... ... ... ... ... ... ... ... 14 14 13 1 Congenital Malformation 12 2 1 ... ... ... ... ... ... 14 15 11 4 Old Age ... ... ... ... ... ... ... 2 16 52 28 ... 98 88 10 109 2 1 ... ... ... 2 16 52 28 Ill 210 185 25 VI.—LOCAL DISEASES. 1.—Diseases of Nervous System. Inflammation of Brain or Membranes 9 8 8 1 ... I ... 2 ... ... ... 17 24 20 4 Apoplexy, Softening of the Brain, Hemiplegia, Brain Paralysis 2 ... ... ... 2 9 12 27 32 24 9 2 117 82 35 Insanity, General Paralysis of the Insane ... ... ... ... ... 2 2 3 4 2 1 ... ... 14 12 2 Epilepsy ... ... 1 2 1 2 1 2 ... ... ... ... 9 9 ... Convulsions 89 1 ... ... ... ... ... ... ... ... ... 40 40 88 2 Laryngismus Stridulus (Spasm of Glottis) 2 ... ... ... ... ... ... ... 2 2 1 1 Diseases of Spinal Cord, Paraplegia, Paralysis Agitans ... ... ... 1 1 1 2 ... 2 ... ... 7 4 8 Other Diseases of Nervous System 1 ... 8 2 1 4 7 11 11 4 ... 1 44 31 13 2.—Diseases of Organs of Special Sense. (e.g., of Eye, Ear, Nose.) ... ... 1 1 ... 1 ... ... ... ... ... ... . 8 2 1 3.—Diseases of Circulatory System. Pericarditis ... ... 1 ... ... ... ... 1 ... ... ... ... 2 1 1 Acute Endocarditis ... ... 2 1 ... ... 1 ... ... 1 ... ... 5 4 1 Valvular Diseases of Heart ... ... 1 4 8 6 9 7 18 11 1 ... 55 85 20 Otber Diseases of Heart ... 1 3 5 6 9 16 29 88 32 1 1 140 98 42 Aneurism ... ... ... ... 1 1 2 2 1 ... ... ... 7 6 1 Embolism, Thrombosis 1 ... ... ... 1 ... 2 8 2 2 ... 1 11 7 4 Other Diseases of Blood Vessels ... ... ... ... 1 1 1 ... 2 1 1 ... 7 5 2 4.—Diseases of Respiratory Organs. Laryngitis ... 2 ... ... ... ... ... ... ... ... ... 2 2 2 ... Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Emphysema, Asthma ... ... ... ... 1 ... 1 2 5 1 ... ... 10 7 8 Bronchitis 109 41 4 ... 1 10 15 51 64 63 12 150 870 310 60 Pneumonia 10 7 5 3 16 18 21 18 14 4 4 17 115 99 17 Pleurisy ... ... ... ... 2 1 9 2 1 ... ... 15 15 ... Other Diseases of Respiratory System 1 1 ... ... ... 4 9 4 2 7 2 2 30 li 8 5.—Diseases of Digestive System. Dentition 19 2 ... ... ... ... ... ... ... ... 21 21 19 2 Sore Throat, Quinsy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diseases of Stomach 8 2 1 1 8 4 8 2 6 ... 2 5 27 28 4 Enteritis 17 4 ... 1 1 ... 1 2 8 1 ... 21 30 26 4 Gastro -Enteritis 16 1 1 ... 1 ... ... 1 ... 1 ... 17 21 16 5 Obstructive Diseases of Intestine 3 1 ... 1 ... 1 ... 6 4 2 ... 4 18 14 4 Peritonitis ... ... 2 4 2 1 ... ... 1 ... ... ... 10 7 8 Ascites ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cirrhosis of Liver ... ... ... ... 2 6 7 5 4 1 ... ... 25 19 6 Jaundice and other Diseases of the Liver 8 ... 1 ... 3 4 5 1 2 ... 3 19 16 8 Other Diseases of Digestive System 1 1 2 ... ... 1 ... 1 8 2 ... 2 11 9 2 6.—Diseases of Lymphatic System. (e.g., of Lymphatics and of Spleen.) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 7.—Diseases of Gland-like Organs of Uncertain Use. (e.g., Bronchocele, Addison's Disease) ... ... ... ... ... 1 .. 2 2 ... ... ... 5 8 2 8.—Diseases of Urinary System. Nephritis ... ... 1 ... 2 5 ... 8 6 1 ... ... 18 13 5 Bright's Disease, Albuminuria ... ... 2 1 2 6 8 11 8 i ... 84 25 9 Disease of Bladder or of Prostate ... ... ... ... ... ... 1 1 4 4 ... ... 10 9 1 Other diseases of the Urinary System ... ... ... 1 ... ... 8 8 7 ... 1 ... 20 18 7 9.—Diseases of Reproductive System, a. Of Organs of Generation. Male Organs ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Female Organs ... ... ... ... ... 2 1 8 ... ... ... ... 6 5 1 b. Parturition. Abortion, Miscarriage ... ... ... ... ... 2 ... ... ... ... ... ... 2 2 ... Puerperal Convulsions ... ... ... ... 1 ... ... ... ... ... ... 1 1 ... Placenta Praevia, Flooding ... ... ... ... 1 1 ... ... ... ... ... ... 2 1 1 Other accidents of Childbirth ... ... ... 8 5 5 l ... ... ... ... ... 14 12 2 10.—Diseases of Bones and Joints. Caries, Necrosis ... ... ... ... • » . ... ... 1 ... 1 ... ... 2 2 ... Arthritis, Ostitis, Periostitis ... ... ... ... ... 1 ... ... ... 1 1 ... Other diseases of Bones and Joints ... ... 1 ... ... ... ... ... ... ... ... ... 1 1 ... 11.—Diseases of Integumentary System. Carbuncle, Phlegmon... ... ... 1 ... ... 1 2 1 ... ... 5 4 1 Other Diseases of Integumentary System 3 ... ... ... ... 1 l ... 1 ... 3 6 5 1 239 72 32 33 57 106 180 218 243 174 34 811 1388 1055 288 Continued. 94 TABLE VIII.—continued. CAUSES OF DEATH. AGES. Total under Five Years of Age. Grand Total all Ages. Sub-district. 0 to 1. 1 to 5. 5 to 15. 15 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 to 75. 75 to 85. 85 and upwards. Kensing. ton Town. Brompton. VII.—DEATHS FROM VIOLENCE. 1.—Accident or Negligence. Fractures and Contusions 8 2 1 1 4 8 10 2 8 5 1 5 40 33 7 Gun-shot Wounds ... ... ... ... ... ... ... ... ... ... ... ...... ...... ... ... Cut, Stab ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...... Burn, Scald 2 4 1 2 ... 1 1 ... 6. 11 7 4 Poison ... ... ... ......... ... ... ... ... ... ... ... ...... ... ... ... Drowning ... ... 1 ... ... ... ... ... ... ... ... ...... 1 1 ...... Suffocation 30 ... ... 1 ... ... ... ... ... 1 ... 80 32 81 1 Otherwise 2 ... ... 1 ... ... ...... 1 ... ...... ... 2 4 4 ... 2.—Homicide. Manslaughter ... ... ... ... ... ... 1 ... ... ... ... ...... 1 1 ...... Murder ...... ... ... ... ... ... ... ... 1 ... ... ... 1 ...... 1 8.—Suicide. ... ... ... Gun-shot Wounds ...... ... ... 2 1 ... 1 ... 1 ...... ... ...... 5 4 1 Cut, Stab ... ... ... ...... ... ... ... ... ... ...... ... ...... ... ... Poison ... ... ... ... 2 ... 1 ... ... ...... ... ...... 3 1 2 Drowning ...... ... ... ...... 2 ...... 1 1 ... ... ... ...... 4 3 1 Hanging ... ... ... ...... 1 ... ...... ... ... ... ... ...... 1 1 ...... Otherwise ...... ... ... 1 1 ... 1 ..."... ... ...... ... ...... 3 3 ...... 4.—Execution. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Hanging ... ...... ...... ...... ...... ...... ...... ... ...... ...... ... ...... ...... ... ... 87 6 8 8 11 8 16 4 11 6 1 43 106 89 17 VIII.—DEATHS FROM ILL-DEFINED AND NOT SPECIFIED CAUSES. Dropsy ... ... ...... ...1 ... ...... ...... ...... ... ... 1 ... 2 1 1 Debility, Atrophy, Inanition 80 4 ... ... ... ... ... ... ... ... ... 84 84 72 12 Mortification ... ... ... ... ... 1 1 1 8 4 2 ... 12 11 1 Tumour ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 ... Abscess 1 ... ... ... ... ... ... ... ... ... ... 1 1 1 ... Hemorrhage ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Sudden Death (cause not ascertained) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Causes not specified or ill-defined ... 1 1 ... ... 1 ... ... ... ... ... 1 3 3 ... 81 5 1 1 ... 2 2 1 8 4 3 86 103 89 14 95 TABLE XI. (Table VII. in preceding Annual Reports.) Showing the Death-rate per 1,000 persons living; the Kate per 1,000 from the principal Diseases of the Zymotic Class; and the proportion of Deaths from these Diseases to total Deaths, in Kensington and in all London ; in 1900, and in the ten preceding years, 1890-1899. The Year. Deaths per 1,000 living. Total Deaths from seven principal Zymotic Diseases, Kensington. Annual rate of mortality per 1,000 living, from seven principal Zymotic Diseases. Proportion of Deaths to 1,000 Deaths, from seven principal Zymotic Diseases. The Year. Kensington. London. Kensington. London. Kensington. London. 1890 17.8 21.4 387 2.3 2 9 131 134 1890 1891 18.4 21.5 273 1.6 2.8 89 107 1891 1892 17.2 20.7 333 2.0 2.8 115 136 1892 1898 17.4 21.3 841 2.0 8.1 117 136 1893 1894 15.6 17.8 346 2.1 2.7 132 150 1894 1895 16.2 199 322 1.9 2.6 117 133 1895 1896 16.7 18.6 460 2.7 8.1 159 169 1896 1897 15.6 18.2 810 1.8 2.6 116 142 1897 1898 16.3 18.7 347 2.0 2.8 124 150 1898 1899 17.5 19.8 259 1.5 2.5 86 125 1899 Average of Ten Years 1890.1899 169 19.8 838 20 2.7 119 138 Average of Ten Years 1890.1899. 1900 156 188 283 16 2.2 105 119 1900 TABLE XII. (Table VIII. in preceding Annual Beports.) Comparative Analysis of the Mortality in all London, and in Kensington, in 1900. Annual Death.rate per 1,000 living, from all causes. Annual Death.rate per 1,000 living, from seven principal Zymotic diseases. Percentage of Deaths under 1 year to Births Registered. Percentage of Deaths to Total Deaths. Under 1 year of age. At 60 years of age and upwards. From seven principal Zymotic diseases. From Violence. Registered upon information of Coroners. (Inquests.) Registered at Public Institutions.* Uncertified London 18.8 2.2 160 24.3 26.8 11.9 4.3 9.4 30.5 0.6 Kensington 15.6 . 1.6 17.9 28.8 32.2 10.5 3.9 8.7 28.3 0.0 * Viz.—Borough Infirmary and Workhouse, Brompton Consumption Hospital, so far as relates to Deaths of Parishioners therein, and Outlying Public Institutions, i.e., General and Special Hospitals, he. 96 TABLE XIII. (Table IX. in preceding Annual Reports.) Names of Streets, etc., in the Registration Sub-Districts, and in the Sanitary Inspecting Districts in which occurred the 283 fatal cases of the Principal Zymotic Diseases during the year 1900. The Registration Sub-Districts are Kensington Town (= K T), and Brompton (= B). For list of Sanitary Districts, see page 53. Street ok Place. Registration Sub-District. Sanitary District. Measles. Scarlet Fever. Diphtheria. Whooping-cough. Enteric Fever. Diarrhoea. ./ Abingdon Road K T SW ... ... ... ... 1 ... 1 Acklam Road .„ JJ N 2 ... ... ... ... 1 3 Adrian Terrace B SW ... ... 1 ... ... ... 1 Aldermaston Street K T NW 1 ... ... ... ... l 2 Appleford Road ... " N ... ... ... ... 1 3 4 Archer Mews " NE ... ... ... ... ... 2 2 Archer Street " " ... ... ... ... ... 1 1 Argyll Road " C ... ... ... ... 1 1 Ashburn Mews B SE ... ... ... ... 1 ... 1 Bangor Street K T NW 2 ... I 1 ... ... 4 Barkston Gardens ... B SW ... ... ... ... ... 1 1 Bassett Road K T N ... ... ... ... 1 1 2 Bedford Gardens ... 99 C ... ... ... ... ... 1 1 Bevington Road ... 99 N 1 ... ... ... ... ... 1 Blagrove Road JJ „ 1 ... ... ... ... ... 1 Blechynden Street 99 NW 1 ... ... ... 1 ... 2 Bolton Gardens Mews B SW 1 ... ... ... ... ... 1 Bolton Road K T NE ... ... 1 ... ... ... I Bomore Road „. JJ NW 1 ... ... ... ... 1 2 Bonchurch Road ... J J N ... ... ... ... I 1 Bosworth Road >J JJ 2 ... ... ... 1 l 4 Bramley Road JJ N W ... ... ... ... ... l 1 Bran stone Street ... K T N ... ... l ... ... ... 1 Campden Houses ... K T C ... ... ... 1 ... ... 1 Campden Street ... 99 99 i ... ... ... 1 2 Chepstow Mews ... 99 >J ... ... ... ... ... I 1 Chesterton Road ... 99 N ... ... ... ... ... 2 2 Church Street JJ C ... ... ... ... ... 1 1 Clarence Mews JJ 99 l ... ... ... ... ... 1 Clarendon Road ... J> N E l ... ... ... ... 1 2 Clydesdale Road ... 99 99 ... ... ... ... ... 1 1 Convent Gardens ... 97 99 2 ... ... 1 ... ... 3 Cornwall Road J? 79 ... ... ... 2 ... 1 3 Crescent Street J> N W 1 ... ... ... ... ... 1 Dartmoor Street ... K T C ... 1 ... ... ... ... 1 Edenham Street ... K T N ... ... ... 1 ... ... 1 Elgin Crescent 99 NE ... ... ... ... ... 1 1 Elgin Mews JJ 1 ... ... ... ... ... 1 Elsham Road 99 C ... ... ... ... ... 1 1 Ernest Street 99 JJ ... ... ... ... 1 ... 1 Evelyn Gardens ... B SE ... ... ... ... ... 1 1 Faraday Road K T N ... ... ... ... ... 3 3 Finborough Road ... B SW ... ... 1 ... ... ... 1 Fopstone Road )> JJ ... ... ... ... ... 1 1 Foulis Terrace JJ SE 1 ... ... ... ... ... 1 Fowell Street K T NW 3 ... ... ... ... ... 3 Fulham Road B SE&SW ... ... ... ... 1 1 2 Continued. 97 TABLE XIII.—Continued. Street or Place. Registration Sub-District. Sanitary District. Measles. Scarlet Fever. Diphtheria. Whooping-cough. Enteric Fever. Diarrhœa. Total. Golborne Gardens K T N 1 ... 1 2 ... 1 5 Golborne Road ,, ,, ... ... 1 ... ... 2 3 Gorham Place ,, N W ... ... ... ... ... 1 1 Gregory Place K T C 1 ... ... ... ... ... 1 Grenfell Road ,, N W ... ... ... ... 1 ... 1 Hazlewood Crescent K T N ... ... 2 1 ... 2 5 Hesketh Place ,, N W ... ... ... ... ... 1 1 Hewer Street ,, N ... ... ... 1 ... ... 1 High Street, Notting Hill ,, C ... ... 1 ... ... ... 1 Holland Park Avenue ,, ,, ... ... ... ... ... 2 2 Holland Road ,, ,, ... ... ... ... 1 ... 1 Hurstway Street ,, N W 1 ... ... ... ... ... 1 Ifield Road B S W ... ... ... 2 ... 1 3 Jameson Street K T C 1 ... ... ... ... ... 1 Johnson Street ,, ,, 1 ... ... ... ... ... 1 Kenley Street K T N W 3 ... ... ... ... 2 5 Kensington Infirmary ,, S W ... ... ... ... ... 2 2 Kensington Park Mews ,, N E ... ... 1 ... ... ... 1 Kensington Park Road ,, ,, 1 ... ... ... ... ... 1 Ladbroke Grove K T N ... ... ... ... ... 2 2 Ladbroke Road ,, C ... ... 1 ... ... ... 1 Lambton Mews ,, N E 1 ... ... ... ... ... 1 Lancaster Mews ,, ,, 1 ... 1 ... ... ... 2 Lancaster Road ,, N W 2 ... ... ... ... 1 3 Ledbury Road ,, N E ... ... ... ... ... 1 1 Lockton Street ,, N W 1 ... ... ... ... ... 1 Lonsdale Road ,, N E ... ... ... 2 ... 2 4 Lorne Gardens ,, C 2 ... ... 1 ... 1 4 Mary Place K T N W 1 ... ... ... ... ... 1 Mersey Street ,, ,, ... ... ... ... 1 ... 1 Montpelier Row B S E 1 ... ... ... ... ... 1 Pamber Street K T N W ... ... 1 ... ... ... 1 Peel Street ,, C 1 ... ... ... ... 1 2 Pelham Mews ,, ,, ... ... ... ... ... 1 1 Phillimore Mews ,, ,, ... ... ... 1 ... ... 1 Portland Road ,, ,, ... ... ... ... ... 1 1 Portobello Road ,, N & N E 2 ... ... 1 3 6 12 Pottery Lane ,, C 2 ... ... ... ... ... 2 Prince's Place ,, ,, ... ... ... ... 1 ... 1 Prince's Road ,, ,, 2 ... 1 ... ... ... 3 Queen Ann's Terrace K T N 1 ... ... 2 ... ... 3 Queen's Gate Mews ,, S E 1 ... ... ... ... ... 1 Queen's Road ,, C 1 ... ... ... ... ... 1 Rackham Street K T N 4 1 ... 1 ... 2 8 Redfield Lane B S W 1 ... ... ... ... ... 1 St. Alban's Road K T S E ... ... 1 ... ... ... 1 St. Ann's Road ,, C ... ... ... ... ... 1 1 St. Ervan's Road ,, N 1 ... 1 ... ... 3 5 St. George's Road ,, N E 3 ... ... ... ... 1 4 St. Katharine's Road ,, N W 4 ... ... 1 1 1 7 St. Mark's Road ,, N ... ... ... 1 ... ... 1 Scarsdale Villas ,, S W ... ... ... ... ... 1 1 Seymour Place B S W ... ... ... ... ... 1 1 Continued. 98 TABLE XIII.—continued. Street or Place. Registration Sub-District. Sanitary District. Measles. Scarlet Fever. Diphtheria. Whooping-cough. Enteric Fever. Diarrhœa. Total. Silchester Road K T N W ... ... ... ... ... 1 1 Silchester Terrace ,, ,, ... ... ... ... ... 2 2 Sirdar Road ,, ,, 1 ... ... 1 ... 1 3 Southam Street ,, N 5 ... 2 4 ... 5 16 Swinbrook Road ,, ,, 2 ... ... 1 ... 3 6 Talbot Grove K T N E 5 ... ... ... ... ... 5 Tavistock Mews ,, ,, 1 ... ... ... ... ... 1 Tavistock Road ,, ,, 1 ... ... ... ... 1 2 Templeton Place B S W ... 1 ... ... ... ... 1 Testerton Street K T N W 1 ... ... ... ... ... 1 Thorpe Mews ,, N 1 ... ... ... ... ... 1 Thresher's Place ,, N W ... ... ... ... ... 1 1 Tobin Street ,, ,, 3 ... ... ... ... 1 4 Treadgold Street ,, ,, 1 ... ... ... ... ... 1 Treverton Street ,, N 3 ... 3 1 ... 2 9 Uxbridge Street K T C 1 ... ... ... ... 1 2 Victoria Dwellings K T N ... ... 1 ... ... ... 1 Wallgrave Road B S W 1 ... ... 1 ... ... 2 Walmer Road K T N W 6 ... 1 1 ... 6 14 Warwick Road B S W ... 1 ... ... ... ... 1 Wellington Mews K T N E ... ... 1 ... ... ... 1 Western Terrace ,, ,, ... ... ... 1 ... ... 1 West Pembroke Place ,, S W 2 ... ... ... ... ... 2 Wheatstone Road ,, N ... ... 2 ... ... 1 3 Wornington Road ,, ,, ... ... ... 1 ... 7 8 Yeoman's Row B S E ... ... ... ... ... 1 1 Totals ... ... 98 4 27 33 16 105 283 Note.—The deaths occurring in the Borough Infirmary have been allocated to the streets from which the patients had been removed to the Infirmary. 99 TABLE XIV. (Table IXa. in preceding Annual Reports.) Names of Streets, etc., in the Registration Sub-Districts, and in the Sanitary Inspecting Districts, from which the 986 cases of Infectious Disease were notified, under the provisions of the Public Health (London) Act, 1891, during the year, 1900. The Registration Sub-Districts are Kensington Town (= K.T.), and Brompton (= B). For list of Sanitary Districts see page 53. Street or Place. Registration Sub-District. Sanitary District. Small-pox. Scarlet Fever. Diphtheria. Enteric Fever. Continued Fever. Puerperal Fever. Erysipelas. Croup. Total. Abingdon Road K T S W ... ... ... 1 ... ... ... ... 1 Acklam Road ,, N ... 7 ... ... ... ... 1 ... 8 Adair Road ,, ,, ... 1 1 ... ... ... 1 ... 3 Addison Gardens ,, C ... ... ... 1 ... ... 1 ... 2 Admiral Mews ,, N ... 1 ... ... ... ... ... ... 1 Adrian Terrace B S W ... 1 ... ... ... ... 1 1 3 Albion Place K T N E ... ... 1 ... ... ... ... ... 1 Alfred Place West B S E ... ... ... 1 ... ... 1 ... 2 All Saints Road K T N E ... ... 6 2 ... ... ... ... 8 Appleford Road ,, N ... ... 1 1 ... ... 1 ... 3 Archer Street ,, N E ... 1 1 ... ... ... ... ... 3 Argyll Road ,, C ... 1 ... ... ... ... 1 ... 2 Arundel Gardens ,, N E ... ... ... ... ... ... 1 ... 1 Ashburn Mews B S E ... ... ... 1 ... ... ... ... 1 Ashburn Place ,, ,, ... ... ... ... ... ... 1 ... 1 Ashley Cottages ,, S E ... ... ... 1 ... ... 1 ... 2 Astwood Road ,, S E ... ... 1 ... ... ... ... ... 1 Ball Street K T S E ... ... ... 1 ... ... ... ... 1 Bangor Street ,, N W ... ... 1 ... ... ... 4 ... 5 Barandon Street ,, ,, ... ... ... ... ... ... 1 ... 1 Barker Street B S W 2 ... ... ... ... ... ... ... 2 Barkston Gardens ,, ,, ... 1 2 ... ... ... ... ... 3 Basing Road K T N E ... ... ... 3 ... ... ... ... 3 Bassett Road ,, N ... ... ... 1 ... ... 1 ... 2 Beaufort Gardens B S E ... 1 ... ... ... ... ... ... 1 Bevington Road K T N ... 5 ... ... ... ... ... ... 5 Bina Gardens B S E ... 1 ... ... ... ... ... ... 1 Blagrove Road K T N ... 3 ... 1 ... ... 1 ... 5 Blechynden Street ,, N W ... 5 2 1 ... ... 2 ... 10 Blenheim Crescentz ,, N E ... ... ... 1 ... ... 1 ... 2 Blithfield Street ,, S W ... ... 1 ... ... ... ... ... 1 Bolton Gardens B ,, ... 1 ... ... ... ... ... ... 1 Bolton Gardens West ,, ,, ... ... 2 ... ... ... ... ... 2 Bolton Mews ,, S E ... 1 ... ... ... ... ... ... 1 Bolton Road K T N E ... ... 1 ... ... ... 1 ... 2 Bonchurch Road ,, N ... 1 ... ... ... ... ... ... 1 Bosworth Road ,, ,, ... 1 ... 2 ... ... ... 1 4 Bramham Gardens B S W ... 2 ... ... ... ... ... ... 2 Bramley Mews KT N W ... ... ... ... ... ... ... ... 1 Bramley Road ,, ,, ... 1 2 ... ... ... ... ... 3 Bransford Street ,, N ... 3 2 1 ... ... ... ... 6 Branstone Street ,, ,, ... 1 2 ... ... ... ... ... 3 Brechin Place B S E ... ... 1 ... ... ... ... ... 1 Brompton Road ,, ,, ... 3 ... ... ... ... ... ... 3 Brompton Square ,, ,, ... 2 ... ... ... ... ... ... 2 Brunswick Mews K T N E ... ... ... ... ... ... ... ... 1 Buckingham Terrace ,, ,, ... ... ... ... ... ... ... ... 1 Bute Street B S E ... 2 ... ... ... ... ... ... 2 Calverley Street K T N W ... ... ... ... ... ... 3 ... 3 Cambridge Gardens „ N ... 3 ... ... ... ... 2 ... 5 Continued. 100 TABLE XIv.—continued. Street or Place. Registration Sub-District. Sanitary District. Small-pox. Scarlet Fever. Diphtheria. Enteric Fever. Continued Fever. Puerperal Fever. Erysipelas. Croup. Total. Cambridge Place K T SE ... ... 1 ... ... ... ... ... 1 Campden Grove „ C ... ... ... 1 ... ... ... ... 1 Campden Hill Road „ „ ... 3 ... ... ... ... ... ... 3 Campden House Road „ „ ... ... ... ... ... ... 1 ... 1 Campden Houses „ „ ... 2 1 ... ... ... ... ... 3 Campden House Terrace „ „ ... ... 1 ... ... ... ... ... 1 Campden Street „ „ ... 1 4 ... ... ... ... ... 5 Cathcart Road B s w ... 1 ... ... ... ... ... ... 1 Chapel Place „ S E ... ... ... ... ... ... 1 ... 1 Chesterton Road K T N ... 5 1 2 ... ... ... ... 8 Childs Passage B S W ... ... 1 ... ... ... ... ... 1 Childs Place „ „ ... 2 ... ... ... ... ... ... 2 Childs Street „ „ ... 1 ... ... ... ... ... ... 1 Church Street KT C ... ... 1 ... ... ... ... ... 1 Clanricarde Gardens „ „ ... ... ... 1 ... ... ... ... 1 Clarendon Place „ „ ... ... 1 ... ... ... ... ... 1 Clarendon Road „ C&NE ... ... 3 ... ... ... 1 ... 4 Clareville Grove B S E ... ... ... ... ... ... ... 1 1 Clifton Place „ „ ... 1 ... ... ... ... ... ... 1 Colbeck Mews „ „ ... 1 ... ... ... ... ... ... 1 Collingham Place „ S W ... ... 1 ... ... ... ... ... 1 Collingham Road „ „ ... ... ... ... ... ... ... ... 1 Colville Square K T N E ... 2 1 1 ... ... ... ... 4 Colville Square Mews „ „ ... ... 2 ... ... ... ... ... 2 Colville Square Terrace „ „ ... ... 2 ... ... ... ... ... 2 Colville Terrace „ „ ... ... 1 ... ... ... ... ... 1 Convent Gardens „ „ ... ... 12 ... ... ... 1 ... 13 Cornwall Gardens B S E ... ... 2 ... ... ... ... ... 2 Cornwall Mews K T „ ... ... 1 ... ... ... ... ... 1 Cornwall Road „ N E ... 2 2 ... ... ... 2 ... 6 Courtfield Gardens B SE ... 1 ... ... ... ... ... ... 1 Cranley Gardens „ „ ... 1 1 ... ... ... ... ... 2 Crescent Place „ „ ... 1 1 ... ... ... ... ... 2 Crescent Street K T N W ... 1 ... ... ... ... 2 ... 3 Cromwell Houses B S E ... 1 ... ... ... ... ... ... 1 Dartmoor Street K T C ... 2 2 ... ... ... 1 ... 5 Denbigh Terrace „ N E ... 1 ... ... ... ... ... ... 1 Durham Place „ C ... 1 ... ... ... ... ... ... 1 Earl's Court Road KT&B s w ... ... 2 1 ... ... ... ... 3 Earl's Court Square B „ ... 1 1 ... ... ... ... ... 2 East Road Mews KT N W ... ... ... ... ... ... 1 ... 1 Edenham Mews „ N ... 1 1 ... ... ... ... ... 2 Edenham Street „ „ ... ... ... 1 ... ... 3 ... 4 Edinburgh Road „ „ ... 3 3 ... ... ... ... ... 6 Egerton Gardens B S E ... 1 ... ... ... ... ... ... 1 Egerton Place „ „ ... 1 ... ... ... ... ... ... 1 Elgin Crescent KT N E ... 2 1 1 ... ... ... ... 4 Elgin Mews „ „ ... ... 6 ... ... ... 1 ... 7 Elsham Road „ C ... ... ... 1 ... ... ... ... 1 Elvaston Mews „ S E ... ... 1 ... ... ... ... ... 1 Ernest Street „ C ... ... ... 1 ... ... ... ... 1 Evelyn Gardens B S E ... 1 2 ... ... ... ... ... 3 Exmoor Street KT N ... ... 1 ... ... ... ... ... 1 Faraday Road KT N ... 2 1 ... 1 ... ... ... 4 Fenelon Road B SW ... ... ... ... ... ... 1 ... 1 Finborough Road „ „ ... 1 6 ... ... ... ... ... 7 Fopstone Road „ „ ... ... ... ... ... ... 1 ... 1 Fulham Road „ SE & SW ... 3 1 1 ... ... 3 ... 8 Gaspar Mews B S E ... 1 1 ... ... ... ... ... 2 Continued. 101 TABLE XIV.—continued. Street or Place. Registration Sub-District. Sanitary District. Small-pox. Scarlet Fever. Diphtheria. Enteric Fever. Continued Fever. Puerperal Fever. Erysipelas. Croup. Total. Gledhow Gardens B S E ... 1 ... ... ... ... ... ... 1 Glendower Place „ „ ... 1 ... ... ... ... ... ... 1 Golborne Gardens KT N ... 5 8 ... ... ... 1 ... 14 Golborne Road „ „ ... 9 2 1 ... ... ... ... 12 Golden Mews „ N E ... 2 1 ... ... ... ... ... 3 Grenville Place B S E ... ... 2 ... ... ... ... ... 2 Harrington Gardens B S E ... ... ... 2 ... ... ... ... 2 Harrington Road „ „ ... 2 l ... ... ... ... ... 3 Hayden's Place KT N E ... ... 2 ... ... ... ... ... 2 Hazlewood Crescent „ N ... 2 6 3 ... ... ... ... 11 Hewer Street „ „ ... ... 2 1 ... ... ... ... 3 High Street, Notting Hill K T C ... 3 1 ... ... ... ... ... 4 Hogarth Road B S w ... 1 ... ... ... ... ... ... 1 Holland Park KT C ... 3 ... ... ... ... ... ... 3 Holland Park Avenue „ „ ... 4 2 ... ... ... l ... 7 Holland Park Mews „ „ ... 1 ... ... ... ... ... ... 1 Holland Road „ „ ... ... 1 1 ... ... ... ... 2 Holland Street „ „ ... ... 1 1 ... ... ... ... 2 Holland Villas Road „ „ ... ... ... ... ... ... 1 ... 1 Hurstway Street „ N W ... ... ... ... ... ... l ... 1 Hyde Park Gate „ SE ... ... 1 1 ... ... ... ... 2 Ifield Road B S W ... 2 ... ... ... ... 2 ... 4 James Street K T S E ... 1 ... ... ... ... ... ... 1 Jameson Street „ C ... 3 ... ... ... ... ... ... 3 Kelfield Gardens KT N ... 1 ... ... ... ... ... ... 1 Kempsford Gardens B S w ... 1 ... 1 ... ... l ... 3 Kenilworth Street K T N W ... 1 ... ... ... ... ... ... 1 Kenley Street „ „ ... 2 ... 1 ... ... 4 ... 7 Kensal Road „ N ... ... 2 ... ... ... ... ... 2 Kensington Gore „ S E ... ... 1 ... ... ... ... ... 1 Kensington High Street „ SE&SW ... 2 1 ... ... ... ... ... 3 Kensington Infirmary „ S W ... 5 ... 7 ... 3 35 ... 50 Kensington Mansions B „ ... 2 ... ... ... ... ... ... 2 Kensington Park Gardens Mews KT N E ... ... 5 ... ... ... ... ... 5 Kensington Park Road „ NE & C ... 4 2 ... ... ... ... ... 6 Kensington Place „ C ... . . . 2 ... ... ... ... ... 2 Kensington Square „ S E ... ... 1 ... ... ... ... ... 1 Ladbroke Dwellings K T N ... ... 1 ... ... ... ... ... 1 Ladbroke Grove „ N, NE & C ... 9 5 2 ... ... 4 ... 20 Ladbroke Square „ C ... 3 ... ... ... ... ... ... 3 Lancaster Mews „ N E ... ... 2 ... ... ... 1 ... 3 Lancaster Road „ NE&NW ... 6 ... 1 ... ... 3 ... 10 Langham Mansions B S W ... 1 ... 1 ... ... ... ... 2 Lansdowne Crescent KT NE ... 1 ... ... ... ... 1 ... 2 Lansdowne Road „ „ ... 4 ... ... ... ... ... ... 4 Ledbury Road) „ „ ... 2 2 ... ... ... ... ... 4 Lexham Gardens B S W ... ... 2 ... ... ... 1 ... 3 Linden Mews KT C ... 1 1 ... ... ... ... ... 2 Lionel Mews „ N ... ... ... 1 ... ... ... ... 1 Longridge Road B S w ... 1 1 ... ... ... 1 ... 3 Lonsdale Road KT N E ... . . . 10 ... ... ... 1 ... 11 Lome Gardens „ C ... ... ... ... ... ... 1 ... 1 Lorton Terrace „ „ ... 1 ... ... ... ... ... 1 Lower Phillimore Place „ „ ... 2 ... ... ... ... ... ... 2 Lucerne Mews „ „ ... 1 ... ... ... ... ... ... 1 Mall Chambers K T c ... ... 1 ... ... ... ... ... 1 Manchester Road „ N W ... ... ... 1 ... ... ... ... 1 Continued, 102 TABLE XIV.—continued. Street or Place. Registration Sub-District. Sanitary District. Small-pox. Scarlet Fever. Diphtheria. Enteric Fever. Continued Fever. Puerperal Fever. Erysipelas. Croup. Total. Manson Place B S E ... ... 1 ... ... ... ... ... 1 Mary Place KT N W ... ... ... ... ... ... 1 ... 1 Mersey Street „ „ ... 3 ... 1 ... ... 2 ... 6 Middle Street B S E ... ... 1 ... ... ... ... ... 1 Moreton Mews „ „ ... 1 ... ... ... ... ... ... 1 Munro Mews KT N ... 3 2 2 ... ... ... ... 7 Newcombe Street KT C ... 1 ... ... ... ... ... ... 1 Norfolk Road Villas „ N E ... ... ... ... ... 1 ... ... 1 Norland Square „ C ... 5 1 ... ... ... ... ... 6 North Street B S w ... ... 1 ... ... ... ... ... 1 Oakfield Street B S w ... 1 ... ... ... ... ... ... 1 Onslow Gardens „ S E ... 1 1 ... ... ... ... ... 2 Onslow Square „ S E ... ... ... ... ... ... 1 ... 1 Oxford Gardens K T N ... 3 ... ... ... ... ... ... 3 Palace Gardens Terrace K T C ... 1 ... ... ... ... ... ... 1 Pamber Street „ N W ... ... 1 ... ... ... ... ... 1 Peel Street „ C ... ... ... ... ... ... 1 ... l Pembridge Mews „ „ ... ... ... 1 ... ... ... ... l Pembroke Gardens „ S W ... ... ... 1 ... ... ... ... l Pembroke Mews „ „ ... 1 l ... ... ... ... ... 2 Pembroke Road B „ ... 5 l . . . • •• ... ... ... 6 Pembroke Square K T „ ... ... l ... ... ... 1 ... 2 Pembroke Place „ „ ... 1 ... ... ... ... ... ... 1 Penywern Road B „ ... 1 l ... ... ... ... ... 2 Petersham Mews K T SE ... 1 ... ... ... ... ... ... 1 Petersham Terrace „ „ ... 1 ... ... ... . . . ... ... 1 Philbeach Gardens B S W ... 1 l ... ... ... 1 ... 3 Phillimore Gardens K T c . . . 1 ... ... ... ... 1 ... 2 Phillimore Mews „ „ ... ... l ... ... ... ... ... 1 Phoenix Place „ „ ... 1 ... 1 ... ... ... ... 2 Pitt Street „ „ ... ... ... ... ... ... 1 ... 1 Portland Road „ NE & C ... 2 2 8 1 • •• 8 ... 11 Portobello Mews „ C ... ... 1 ... ... ... ... ... 1 Portobello Road „ N&NE ... 14 8 4 1 • •• 1 ... 29 Powis Gardens „ N E ... ... ... ... ... ... 2 ... 2 Powis Square „ „ ... 1 1 ... ... ... ... ... 2 Princes Gate Mews B SE ... 4 1 1 ... ... . . . ... 6 Princes Place K T C ... 6 ... 2 ... . .. ... ... 8 Princes Road „ C ... 6 ... ... 3 . . . . . . ... 8 Prince Teck Buildings B S W ... ... 1 ... ... ... ... ... 1 Queen Ann's Terrace K T N ... 2 ... ... ... ... ... ... 2 Queensberry Mews, East B SE ... ... l ... ... ... ... ... 1 Queen's Gate KT&B SE ... 4 l 2 ... ... 2 ... 9 Queen's Gate Mews KT „ ... ... 2 1 ... ... ... ... 3 Queen's Gate Terrace „ „ ... 1 1 ... ... ... ... ... 2 Queen's Road „ C ... 1 1 ... ... ... ... ... 2 Rackham Street KT N ... 6 2 ... • • • ... 1 ... 9 Raddington Road „ „ ... ... ... ... ... ... 1 ... 1 Raymede Street „ „ ... 4 1 ... ... ... ... 5 Redcliffe Gardens B S W ... ... 1 1 ... ... ... ... 2 Redcliffe Mews „ „ ... 1 ... ... ... ... ... ... 1 Redcliffe Road „ „ ... 1 ... ... ... ... ... ... 1 Redcliffe Square „ „ ... 1 ... 1 ... ... ... ... 2 Redfield Mews „ „ ... ... 1 ... ... ... ... ... 1 Rendle Street KT N ... 3 5 2 1 ... ... ... 11 Richmond Road B S W ... ... 1 ... ... ... ... ... 1 Rillington Place KT N E ... 1 ... ... ... ... ... ... 1 Rosary Garden B S E ... 1 ... ... ... ... ... ... 1 Continued. 103 TABLE XIV.—continued. Street or Place. Registration Sub-District. Sanitary District. Small-pox. Scarlet Fever. Diphtheria. Enteric Fever. Continued Fever. Puerperal Fever. Erysipelas. Croup. Total. Roxburgh Mansions KT S E ... ... ... ... ... ... 2 2 o Royal Crescent „ c ... ... 2 ... ... ... ... A 1 Royal Crescent Mews „ „ ... ... ... 1 ... ... 1 Rutland Street. B S E ... ... ... ... ... ... 1 1 St. Alban's Road KT S E ... 7 2 ... ... ... 1 9 St. Ann's Road „ N W&C ... 2 3 ... ... ... 6 St. Charles's Square „ N ... ... 2 ... ... ... 2 St. Ervan's Road „ „ ... 2 4 1 ... ... 2 9 St. George's Road „ N E ... 2 1 ... ... ... 1 4 o St. Helen's Gardens „ N ... ... 1 ... ... ... 1 A St. James's Place „ C ... 1 ... ... ... ... 1 St. Katharine's Road „ N W ... 2 1 1 ... ... 1 5 St. Lawrence Road „ N ... ... ... ... ... ... 1 1 St. Luke's Mews „ N E ... 2 ... ... ... ... ... 2 St. Mark's Grove B S W ... ... 1 ... ... ... 1 St. Mark's Road K T N& N E ... ... 2 2 ... ... 1 5 St. Marylebone Infirmary „ N ... 1 ... 1 ... ... ... 2 1 Scampston Mews „ „ ... 1 ... ... ... ... ... i o Scarsdale Terrace „ S W ... 1 ... ... ... ... 1 A Scarsdale Villas „ „ ... ... 1 ... ... ... 1 Selwood Terrace B S E ... ... l ... ... ... ... 1 Seymour Place „ SW ... ... l ... ... ... ... 1 Shaftesbury Road „ „ ... 1 3 ... ... ... 1 5 Sheffield Terrace K T C ... ... ... 1 ... ... ... 1 Silchester Road „ N W ... 1 5 2 ... ... 1 9 Silchester Street „ „ ... ... 1 ... ... ... 1 2 Silver Street „ C ... 1 ... ... ... ... ... 1 Sirdar Road „ NW ... ... ... 1 ... ... 3 4 Southam Street „ N ... 4 7 7 ... ... 2 21 South Street, St. Mark's B S W ... 8 ... ... ... ... 1 3 Spear Mews „ „ ... ... ... ... ... ... 1 Stanhope Gardens „ S E ... ... ... 1 ... ... ... 1 Stockton Mews K T N ... 1 ... ... ... ... 1 2 Stoneleigh Street „ N W ... 1 1 ... ... ... 2 Stratford Road B s w ... 1 ... ... ... ... ... 1 Sussex Mansions „ SE ... 1 ... ... ... ... ... i Swinbrook Road K T N ... 2 3 l ... ... ... 6 Talbot Grove KT N E ... 8 ... ... ... ... 1 4 Tavistock Crescent „ „ ... 5 2 ... ... ... 1 8 Tavistock Mews „ „ ... ... 1 ... ... ... 1 Tavistock Road „ „ ... 1 5 l ... ... ... Telford Road „ N ... 3 ... ... ... ... ... Templeton Place B S W ... 1 ... ... ... ... ... 1 Testerton Street K T NW ... ... 1 ... ... ... ... 1 The Boltons B S E ... 1 ... ... ... ... ... 1 The Mall K T C ... ... ... 1 ... ... ... 1 Thomas Place „ N W ... ... ... ... ... ... 1 1 Thurloe Square B S E ... 2 ... ... ... ... Tobin Cottages K T N W ... ... ... ... ... ... 1 1 Tobin Street „ „ ••• ... ... ... ... ... ... 1 Tobin Square „ „ ... 2 1 ... ... ... 1 Tottenham Street „ N ... ... ... ... ... ... 1 Treadgold Street „ N W ... 1 ... ... ... ... ... ... 1 Treverton Street „ N ... 10 24 ... ... ... 1 ... 35 Uxbridge Houses K T C ... ... ... ... ... ... 1 ... 1 Uxbridge Street „ „ ... ... 1 ... ... ... ... ... 1 Vicarage Gardens K T C ... ... 2 ... ... ... ... ... 2 Victoria Dwellings „ N ... ... 5 ... ... ... ... ... 5 Victoria Gardens „ C ... l ... ... ... ... ... ... 1 Continued. 104 TABLE XIV.—continued. Street or Place. Registration Sub-District. Sanitary District. Small-pox. Scarlet Fever. Diphtheria. Enteric Fever. Continued Fever. Puerperal Fever. Erysipelas. Croup. Total. Virginia Place K T c ... 1 ... ... ... ... 1 ... 2 Vine Terrace ,, ,, ... ... 1 ... ... ... ... ... 1 Wall grave Road B S W ... ... 1 ... ... ... ... ... 1 Wallgrave Terrace ,, ,, ... ... ... ... ... ... 1 ... 1 Walmer Road K T N W ... 2 5 ... ... ... 1 ... 8 Warwick Gardens K T & B S W ... 2 1 ... ... ... ... ... 3 Warwick Road ,, ,, ... 4 3 ... ... ... ... ... 7 Warwick Street K T ,, ... 1 ... 1 ... ... ... ... 3 Wellington Mews ,, N E ... ... 1 ... ... ... ... ... 1 Westbourne Grove ,, ,, ... ... 1 ... ... ... ... ... 1 West Cromwell Road B S W ... ... 2 ... ... ... ... ... 2 Western Dwellings K T N ... ... 1 ... ... ... ... ... 1 Western Terrace ,, N E ... 4 3 ... ... ... ... ... 9 West Pembroke Place ,, S W ... 1 ... ... ... ... ... ... 1 Wetherby Mansions B ,, ... 1 ... ... ... ... ... ... 1 Wharfedale Street ,, ,, ... ... ... ... ... ... 1 ... 1 Wheatstone Road N ,, ... 6 6 ... ... ... ... ... 12 Wornington Road ,, ,, 1 4 8 4 ... 2 l ... 20 Yeoman's Row B S E ... ... 1 ... ... ... ... ... 1 105 APPENDIX III. THE CENSUS OF 1901. (Preliminary Note.) I am indebted to Mr. Rutherglen, Superintendent-Registrar for the subjoined statement of the results of the Census taken on April 1st, 1901, relative to the population of the Borough at that date. Population. 1896. 1901. Increase. Kensington Town sub-district 122,164 128,025 5,861 Brompton sub-district 48,301 48,598 297 Borough 170,465 176,623 6,158 Parliamentary Divisions. North Kensington 91,014 South Kensington 85,609 176,623 There has been an addition to the population resulting from adjustments of boundaries with adjacent districts, to the number of 7,179, viz.: in North Kensington Parliamentary Division 5,591 (from Kensal Town, Chelsea, 3,274; from Paddington 1,370; and from Hammersmith 947); and in South Kensington Parliamentary Division 1,588 (from Paddington „; from Hammersmith 93; from Westminster 538; and from Chelsea 858). To the City of Westminster, and to each of the boroughs named, there has been a transfer of population from Kensington; but to what precise number is unknown at the present time.* The net increase of the population of the borough is 6,158 since 1896, and 10,315 since the previous decennial census in 1891; the population at that date having been 166,308. But within the boundaries of the borough as it is now constituted, the Registrar-General states that in 1891 the population numbered 170,071. From this point of view the increase in the ten years, after correction for gain and loss, would be 6,552 only. In these ten years the births in the borough exceeded the deaths by about 8,400. The subjoined figures show the population of the borough, the sub-districts and the Parliamentary divisions at the middle of the year, as estimated for the purposes of the monthly reports. To the enumerated population, 250 may be added, representing the natural increase between April 1st and July 1st, thus raising the total to 176,873, or only 127 below the estimate, 177,000. The matter may be expressed as follows:— Population of Borough As estimated. 177,000 Population as enumerated. 176,873 Population above or below estimate. — 127 Population of sub-districts— Kensington Town —40 Brompton 48,700 48,613 —87 Parliamentary Divisions— North Kensinston 92,000 91,264 —816 South Kensington 85,000 85,689 +689 The enumerated population differs so slightly from the estimated population, that there is no necessity for modifying the statistics contained in the published reports or in the present Annual Report. *The population of the parts of Kensington transferred to the boroughs of Paddington and Hammersmith respectively was 917 and 1,356, total 2,273. I have not yet been able to ascertain the population of the parts transferred to the City of Westminster and the Borough of Chelsea. [INDEX. INDEX. Page. Age and Sex-Distribution of the Borough Population, in 1891 2 Ambulance Service (Asylums Board); Work of the 38 ,, ,, Arrangements for Removal of the Kensington Infectious Sick 40 Appendix I. Valedictory Report to the late Vestry 75 ,, II. Statistical Tables 87 „ III. Preliminary note on the Census, 1901 105 Arsenical Poisoning by Beer 31 Asylums Board; The work of the 38 Bakehouses: The need of Legislation for the Regulation of 56,82 Baths and Washhouses 73 Beer, Arsenical Poisoning by 31 Births, and Birth-rate, 1856—1900 (vide Tables A and C, pages 84 and 86) 76 Births and Birth-rate in 1900 5 Births; Excess of, over Deaths 6 Births; Illegitimate 5 Borough Boundaries, Alterations in 1 Borough; Development of the, since 1856 4 Boundary Street Scheme: Housing of the Working Classes 60 Brickburning Nuisance Abolished (1895) 83 Brompton Hospital; Deaths at the 35 Bubonic Plague at Glasgow: Precautionary Measures in London 29 Cancer, Malignant Disease 27 Census, 1901; Preliminary Note on the: Appendix III 105 Circulatory System; Deaths from Diseases of the 28 Cleansing of Persons Act 73 Combined Drainage: Sewer or Drain? 70 Common Lodging-Houses; List of 67 ,, „ „ Control of 67 Constitutional Diseases; Deaths from 27 Consumption and other forms of Tuberculosis; The Treatment of 31 „ Conference of Metropolitan Poor Law Authorities with reference to the Treatment of 33 Coroner's Court 72 Cow-Houses; In 1900 and in 1880 56, 81 Deaths and Death-Rate; In Borough, Sub-Districts, Parliamentary Divisions and Sanitary Districts (Table) 10 ,, „ „ 1856—1900 (vide Tables A, C and D, pages 84 and 86) 76 „ „ ,, from Zymotic Diseases (Table) 17 „ ,, „ „ ,, ,, In Sub-Districts, Sanitary Districts, etc. 17 Death; Assigned Causes of (vide Tables, pages 13, 15 and 89) 12 „ Summary of Causes of (Tables)15,16,90 Deaths in Public Institutions 34 Death-Rate (Kensington) ; The True, in 1900 9 „ „ In England and Wales ; Greater London, Inner, and Outer London 12 ,, ,, Colonial and Foreign Cities 12 Developmental Diseases; Deaths from 27 Diarrhoœa; In Kensington, and in London 26 ,, Amended Classification of Deaths Attributed to 26 ,, Mortality from, in Kensington, 1856—1900 (vide Tables B, C and D, pages 85 and 86) 76 Dietetic Diseases; Deaths from 27 Digestive System; Deaths from Diseases of the 28 Diphtheria; In Kensington, and in London 33 ,, ,, 1871—1900 (vide Tables B, C and D, pages 85 and 86) 77 „ Illustrative cases of 23 ,, "Return Cases" of 25 Disinfecting Station; A Desideratum 71,80 Disinfection; Cost of 72 District Rates of Mortality 7 Drainage Bye-laws 69 Effluvium Nuisance 82 Enteric Fever; In Kensington, and in London 25 ,, „ ,, ,, 1856—1900 (vide Tables B, C and D, pages 85 and 86) 77 ii. Page. Factory and Workshop Acts 47 Fat-Extractor; Nuisance from Business of a 55 Fever Hospital Accommodation 40 Fever; Deaths from, In Kensington, and in London 25 „ Mortality (Kensington) 1856—1900 (vide Tables B, C and D, pages 85 and 86) 79 Fried Fish Shop; A Nuisance; Judicial Decision 55 Gas-works; Effluvium Nuisance at 71 Glanders; An old Story re-told 83 Health-Visitors (Women); Appointment of, Recommended 52 Hospital Accommodation for Infectious Disease 41 „ „ Beneficial Results of Provision of 77 Hospitals; Deaths of Parishioners at Outlying 35 Houses, Inhabited; Number of, in 1891 2 „ Increase in Number of, since 1856 4,75 ,, Gain and Loss in Number of, under London Government Act, 1899 1 Housing of the Working Classes; The Boundary Street Scheme; Completion 59 „ „ „ ,, Registration of Houses Let in Lodgings, &c. 61,80 Infantile Mortality 7 „ „ (1871—1900 Table A) 84 Infirmary; Mortal Statistics of the 34 Influenza; In Kensington, and in London 26 Iuquests 36 James Street Area; Abortive Improvement Scheme 68 Lady Inspector of Workshops, &c.; Annual Report of the 48 Legal Proceedings (Summonses, &c.) 55 Local Diseases; Deaths from 28 Local Government Board direct the use of New Statistical Forms (vide Tables I.—IV., pages 13, 14, 15, and 45) 13 London Government Act, 1899, Effect of: Alterations of Boundaries, &c. 1 Main Drainage; Insufficiency of: Flooding of Houses 69 Marine Stores; An offensive Business 55 Marriages and Marriage-rate 5 ,, ,, 1871—1900 (vide Table A, page 84) 76 Marylebone Infirmary; Deaths at 35 Measles; In Kensington, and in London 19 „ Should it be made Notifiable? 19 Metropolitan Asylums Board: Report of the Statistical Committee 38 Mortality; Districts Rates of 6 „ Infantile 7 ,, Senile 7 Mortuary, Public 72,80 Nervous System; Deaths from Diseases of the 28 Notification of Infectious Disease; Local and Metropolitan 42 ,, ,, „ The History of 78 ,, ,, ,, Beneficial Results of 79 "Notting-Dale" Special Area; Statistics of the 8 Offensive Businesses 55,83 Offensive Smells; Earl's Court Exhibition 59 „ „ In Streets 59 Offensive Substances; Proposed new Bye-law for regulating the Conveyance of, through Streets 58 Overcrowding and Pauperism 68 Parliamentary Divisions of the Borough 53 Paving of Streets, Hygienic; Increasing use of Asphalt 68 Plague (Bubonic); Outbreak of, at Glasgow 29 ,, Precautionary Measures Adopted in London 29 Population of the Borough— 3 „ „ „ Density of (1856 and 1900) 4 „ „ 1856-1900 (vide Table A page 84) 75 „ 1801—1900 3 ,, ,, ,, Age and Sex-Distribution of; in 1891 2 Powers; Transfer of, to the Borough Council, under London Government Act, 1899 1 Public Health (London) Act, 1891; Proposed Amendment of the 52 Public Institutions; Deaths at 34 Public, and Public House Sanitary Conveniences 74 Public Mortuary 72 Puerperal Mortality 26 iii. Page. Rateable Value of the Borough; Growth of (1823—1900) 3,4 Refuse; Proposed New Bye-law dealing with Conveyance of, through Streets 58 „ House 57 „ Nuisance from 57 ,, Stable 57 Registered Houses 61 „ „ Proposed New Bye-laws for 62 ,, „ List of the Streets Containing 64 Registration Districts and Sub-Districts 2 Registration of Houses Let in Lodgings; The Advantages of 66 Retrospect of Public Health and Sanitary Work (1871—1900) 75 "Return Cases" of Scarlet Fever and Diphtheria 25 Royal Crescent; Sewerage of 69 St. Joseph's House; Deaths at 35 Sanitary Conveniences; Public and Public-House 74 Sanitary Inspecting Districts 53 „ „ „ Deaths and Death-rate in the 6 Sanitary Inspectors; The Work of the 53 Scarlet Fever; In Kensington, and in London 21 „ „ Low rate of Mortality from 21 „ „ "Return Cases" of 25 „ ,, Mortality, 1850—1900 (vide Tables B, C and D, pages 85 and 86) 76,79 Senile Mortality 7 Septic Diseases; Deaths from 26 Sewerage of Royal-crescent 69 Sex and Age-Distribution of Population of Borough 2 Shelter for Persons during Disinfection of rooms: A Desideratum 73 Slaughter-Houses; In 1900 and in 1874 56,81 Small-pox 18 ,, Local Outbreak of 18 ,, Reduced Mortality from, in London 76,79 ,, Hospital Accommodation for 41 Mortality-1856—1900 (Tables B. C, and D) 85-86 Statistical Committee of the Asylums Board; Annual Report of the 38 Statistical Tables ; New (Nos. i.—iv.) Directed by the Local Government Board to be used 13 ,, ,, Other (Nos. vi.—xiv., Appendix II.) 87-99 Statutory Notices; Number of, Issued 53 Tables (Statistical) Nos. i.—iv.; Directed to be used by the Local Government Board 13, 14, 15, 45 ,, ,, Other (Nos. vi.—xiv., Appendix II.) 87-99 Tenements of less than Five Rooms; Number of in 1891 2 Tuberculosis (Consumption, &c.); The Treatment of 31 ,, ,, ,, Conference'of Metropolitan Poor-law Authorities on 33 Uncertified Deaths 35 Underground Rooms 68 Untrapped Street Gullies 69 Urinary System; Deaths from Diseases of the 28 Vaccination Statistics (1899) 37 "Valedictory Report to the late Vestry: A story of Thirty Years' Public Health Administrative Work 75 Venereal Diseases; Deaths from 26 Violence; Deaths from 28 Vital and Mortal Statistics (1900) 10 Water Supply 74,80 Whooping-cough; In Kensington, and in London 25 Women Health Visitors; Appointment of, Recommended 52 Women Inspectors; Appointment of (in 1893) 80 Working Classes; The Housing of the 59 Workshops, &c.; Annual Report of the Lady Inspector of 48 Written Intimations; Number of, Issued 53 Yards; Hygienic Importance of proper Paving of 70 Zymotic Diseases; Deaths and Death-rate from 16 Zymotic Death-rate; In Sub-districts, Sanitary Districts, &c. 17 Zymotic Mortality; In Kensington, 1856-1900 (vide Tables B, C, and D, pages 85-86) 76