KEN 16 The Royal Borough of Kensington. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH. 1907. Ordered by the Council to be printed. Vail & Co., Printers and Stationers, 170, Farringdon Road, E.C. The Royal Borough of Kensington. REPORT MEDICAL OFFICER OF HEALTH For the Year 1907. To the Mayor, Aldermen, and Councillors. Sir, and Gentlemen, The vital and mortal statistics in this report relate to the registration year, a period of fifty-two weeks, December 30th, 1906, to December 28th, 1907. For the purposes of the report the population of the Royal Borough is estimated to have numbered 180,500 at the middle of the year; the estimated population of the sub-districts, parliamentary divisions, etc., is set out in the table at page 5. The estimate of population of the borough is based on the subjoined summary table which shows the Age, and Sex Distribution of the people as ascertained at the census of 1901. Population at all Ages, March 31st, 1901. Under Five Years. 5 to 15. 15 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 to 75. 75 to 85. 85 to 95. 95 and upwards. All Ages. Females 107,544 7,092 13,805 24,769 28,482 15,877 10,953 6,985 3,818 1,515 243 5 107,544 Females Males 69,084 7,056 12,595 18,461 11,491 9,440 7,220 4,586 2,806 820 107 2 69,084 Males Excess of Females 88,460 36 710 11,808 11,991 5,937 3,738 2,899 1,512 695 186 8 38,460 Excess of Females Total of both sexes 176,628 14,148 25,900 38,280 34,973 24,817 18,173 11,571 6,124 2,885 350 7 176,628 Total of both sexes The enumerated population comprised 38,349 Families or Separate Occupiers (an increase of 2,396 on the number, 35,953, in 1891); 28,770 in the Town sub-district, 9,579 in Brompton. The tenements of less than five rooms, 20,052 in 1891, and 55.8 per cent. of total tenements, were 21,115 in 1901, and 55.1 per cent. of the entire number. In these tenements there were housed 73,425 persons (compared with 70,718 in 1891), or 41.6 per cent. of the population : the relative per centage in 1891 was 42.5. Number and Population of Tenements of Less than Five Rooms, in 1901 Tenements of — Number. Population. One Boom 5,695 11,334 Two Rooms 7,776 27,800 Three ,, 4,757 20,210 Four „ 2,887 14,081 Total 21,115 Total 73,425 It thus appears that 6.42 per cent. of the population lived in one-room tenements, compared with 8.2 per cent. in 1891; 15.74 per cent. in two-room tenements (15.6 in 1891); 11.44 per cent. in three-room tenements (10.9 in 1891); and 7.97 per cent. in four-room tenements (7.8 in 1891). 4 POPULATION AND RATEABLE VALUE. The subjoined statement exhibits the growth of population during the nineteenth century:— The Year. Population. The Year. Population. 1801 8,556 1861 70,108 1811 10,886 1871 120,299 1821 14,428 1881 168,151 1881 20,902 1891 170,071 1841 26,884 1901 176,628 1851 44,058 1907 (estimated) 180,500 The development of the Borough during the last 85 years is evidenced by the subjoined statement, showing the increase in rateable value. The present total is about one-eighteenth of that of the Administrative County of London (£44,332,032). Rateable Value of Property. The Year. Rateable Value of Property. The Year. £75,916 1828 £975,046 1878 98,897 1888 1,711,495 1888 142,772 1848 2,087,221 1898 257,108 1858 2,425,980 (October) 1907 444,080 1863 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. 1907. Increase in 51 years. Population 57,000 180,500 128,500 Number of Inhabited Houses 7,600 28,000 15,400 Rateable Value of Property £308,000 £2,425,980 £2,117,980 The increase in all respects within the last thirty-six years, 1871-1907, the period over which my official experience extends, has been very considerable, as the subjoined figures show:— 1871. 1907. Increase in 36 years. Population 121,000 180,500 59,500 Number of Inhabited Houses 15,785 28,000 7,265 Rateable Value £935,720 £2,425,980 £1,490,260 It thus appears that the population in 1907 was twenty-one times as large as in the first year of the nineteenth century, and the rateable value of property more than thirty-one times as great as in 1823, the first year in respect to which I possess information. Since 1856, the rateable value has increased nearly eight-fold; the increase in the last 36 years being nearly five times the total in 1856; since which date the population and the number of inhabited houses have increased more than three-fold. 5 AREA OF THE BOROUGH. The Borough comprises an area of 2,291.1 statute acres, an addition of 101T acres having accrued from the changes in boundaries brought about by the London Government Act, 1899. Of this addition all but 1.8 acres belongs to the Town sub-district, the area of which (including 3.8 acres of inland water) is 1,596.3 acres; the area of Brompton being 694.8 acres. The acreage of the wards is not given in the census report. REGISTRATION DISTRICT AND SUB-DISTRICTS. The "Kensington" Registration District (No. 1B in the Registrar-General's list) comprises two sub-districts, respectively named Kensington Town (hereinafter for brevity referred to as Town) and Brompton. The Town sub-district comprises all that portion of the Borough north of Kensington High-street and Kensington-road, together with a large area south of that main thoroughfare, the dividing line running, from west to east, along Pembroke-road, Stratfordroad, and south of the workhouse, through Cornwall-gardens to Queen's-gate-place, and thence northwards so as to include Queen's-gate (west side). The remainder of the Borough, south of the line indicated, forms the sub-district of Brompton. The Parliamentary Divisions are two in number; North Kensington and South Kensington—High-street, Notting-hill, and Holland-park-avenue forming the line of demarcation. The Wards are nine in number, of which four—St. Charles, Golborne, Norland, and Pembridge are in (and constitute) the Parliamentary Division of North Kensington; and five— Holland, Earl's Court, Queen's Gate, Redcliffe, and Brompton, are in (and constitute) the Parliamentary Division of South Kensington. POPULATION AND INHABITED HOUSES IN 1907. The population of the borough, estimated to the middle of the year, was 180,500.* It comprised 70,600 males and 109,900 females: excess of females, 39,300. In the Town sub-district (estimated population 130,820), the males numbered about 54,610, the females, 76,210; excess of females, 21,600. In the Brompton sub-district (estimated population 49,680), there were about 15,990 males and 33,690 females: excess of females 17,700. This population was in occupation of about 23,000 houses; equal to 7.8 persons to a house. For the purposes of this report, the population of the borough, the sub-districts, the parliamentary divisions, and the wards, will be taken to be as follows:— The Borough Sub-districts:— Kensington Town Brompton Parliamentary Divisions:— North Kensington South Kensington Wards :— St. Charles North Golborne Kensington Norland Pembridge Holland Earl's Court South Queen's Gate Kensington Redcliffe Brompton 180,500 130,820 49,680 93,070 87,430 22,420 26,900 24,000 19,750 20,860 18,440 14,580 19,090 14,460 * The Registrar-General's estimate of the population of the Royal Borough in the middle of 1907 was 181,842. i have thought it desirable to adopt the more conservative estimate given in the text. 6 MARRIAGES AND MARRIAGE RATE. The marriages in the year were 1,676, compared with 1,672, 1,574 and 1,690, in the three preceding years respectively. Of these marriages there were celebrated— By the Church (60.9 per cent. of total marriages) 1,021 At Roman Catholic places of worship . 147 At other Nonconformist places of worship (12.0 per cent.) 49 At the Jewish Synagogue 5 At the Superintendent-Registrar's Office (27.1 per cent.) 454 1,676 The subjoined table shows the Marriage-Rate in Ten Years 1897-1906, and in 1907, in Kensington, in London, and in England and Wales. YEAR. Kensington. London. England and Wales No. of Marriages. Marriage Rate. Marriage Rate. Marriage Rate. 1897 1,681 19.7 18.5 16.0 1898 1,648 19.2 18.8 16.2 1899 1,693 19.6 18.6 16.4 1900 1,543 17.8 18.0 15.9 1901 1,651 18.7 17.6 15.9 1902 1,703 19.2 17.8 15.8 1903 1,623 18.2 17.4 15.6 1904 1,672 18.7 17.0 15.2 1905 1,574 17.6 16.9 15.3 1906 1,690 18.8 17.1 15.6 Average 1897-1906 1,648 18.8 17.8 15.8 1907 1,676 18.6 17.0 15.8 In his Annual Summary for the year 1906 the Registrar-General stated that during the preceding 36 years the marriage-rate of England and Wales, based on total population, had decreased by about 12 per cent, while based on the total number of marriageable persons in the community, it had shown a decrease equivalent to a fall of nearly 21 per cent. The latter figure, he added, might be said to represent with approximate accuracy, the fall in the marriage-rate in the period under review, i.e., 36 years. These observations would appear to apply generally to 1907, the rate in which (15.8 per 1,000 of the population at all ages) was 0.2 per 1,000 above the corresponding rate in 1906; and equal to the average rate in the ten years 1897-1906. The London Marriage-rate (17.0 per 1,000 of the population at all ages) was 0.1 per 1,000 below the rate in 1906; and 0.8 below the average rate in the ten years 1897-1906. The Kensington marriage-rate (18.6 per 1,000 of the population at all ages) was 0.2 per 1,000 below the rate in 1906; and also 0.2 below the average rate in the ten years 1897-1906. 7 BIRTHS AND BIRTH-RATE. The births registered, including 140 that occurred at Queen Charlotte's Lying-in Hospital, were 3,428, the same as in 1906: Males 1779, Females 1649: in the Town sub-district (which includes the Borough Infirmary) 2,926, and in the Brompton sub-district 502. The male births were to the female births in the proportion of 1079 to 1000. The births were 310 below the corrected decennial average number (3,738), and were fewer by 613 than in the year 1872 (4,041), when the population (127,600) was 52,900 less than in 1907; 200 of them were illegitimate. The birth rate, which of late years has always been considerably below that of London (25.8 in 1907), has been declining since 1868, in which year it was 33.1 per 1,000 persons living. In 1907 it was 19.0 per 1,000, and 1.7 below the decennial average (20.7), and the lowest on record. The rates in the sub-districts were:—Town 22.4; Brompton 101 per 1000. The births in North Kensington, i.e., the part of the Borough north of Holland park-avenue and High-street, Notting-hill, were 2,453; the birth-rate 26.4 per 1,000 living, and 0.6 above the metropolitan rate. The births in South Kensington, i.e., the part of the borough south of the streets above named were 975; the birth-rate 11.2, and 14.6 per 1,000 below the metropolitan rate. The birth-rate in the several wards—after distribution of the births at the borough infirmary, and at Queen Charlotte's Hospital—was as follows:— North Kensington— St. Charles 594 births = 26.5 Golborne 900 births = 88.5 Norland 005 births = 25.2 Pembridge 354 births = 17.9 South Kensington— per 1,000 persons living. Holland 279 births = 18.4 Earl's Court 206 births = 11.2 Queen's Gate 122 births = 8.3 Redcliffe 250 births = 18.1 Brompton 118 births = 8.2, The births exceeded the deaths by 957: in the Town sub-district they were 942 more in number than the deaths, whilst in the Brompton sub-district they exceeded the deaths to the number of 15 only. In North Kensington the births exceeded the deaths by 875; in South Kensington to the number of 82 only. The excess of births over deaths in the several wards was as follows:— North Kensington. St. Charles 288 South Kensington. 'Holland 45 Golborne 408 Queen's Gate 10 Norland 162 Redcliffe 46 Pembridge 67 Brompton 7 The deaths exceeded the births by 26 in Earl's Court Ward. The registered births of illegitimate children in the borough, as a whole, were 200*—42 more than in 1906. Of these births 187 were registered in the Town sub-district, which includes the workhouse, at which institution out of 144 live births (males 84, females 60) 98 were illegitimate. In the borough generally the illegitimate births formed 5.8 per cent. of total births, as compared with rates of 45, 4.5, and 4.8, in the preceding three years. * Inclusive of 19 at Queen Charlotte's Hospital. 8 The subjoined table shows the quarterly numbers of births of males and females in the borough, including those in Queen Charlotte's Hospital, and in each of the sub-districts:— Kensington Town. Brompton. The Borough Males. Females. Total. Males. Females. Total. Total. 1st Quarter 401 869 770 73 71 144 914 2nd „ 838 866 699 69 64 183 882 3rd „ 891 830 721 62 48 110 831 4th „ 382 854 736 68 47 115 851 1,507 1,419 2,926 272 280 502 8,428 Including Illegiti. mate Births 27 21 48 1 6 7 55 84 20 54 8 1 4 58 83 14 47 1 — 1 48 14 24 38 1 — 1 89 108 79 187 6 7 18 200 The following table shows the population, the number of births, including those at Queen Charlotte's Hospital, and the birth-rate for each of the ten years, 1897-1906:— The Year. Population. Total Births. Males. Females. Birth.rate per 1.000. 1897 170,700 8,765 1,884 1,881 22.1 1898 172,000 8,715 1,869 1,846 21.6 1899 172,400 8,682 1,842 1,840 21.4 1900 173,000 8,682 1,830 1,852 21.3 1901 177.000 8,708 1,892 1,816 20.9 1902 177,500 8.599 1,800 1,799 20.3 1903 178,000 8,677 1,892 1,785 20.7 1904 178 500 8,568 1,779 1,789 20.0 1905 179,000 8,579 1,821 1,758 20 0 1906 179,500 8,428 1,752 1,676 191 Totals 86,403 18,861 18,042 Average 20.7 Excess of male births in the ten years 819 Birth.rate in the Metropolis, and in Kensington, and in certain Districts of the Borough, in each of the thirteen four.weekly periods ended December 28th, 1907, and in the Registration Year, 1907. Four Weeks ended Metropolis. Borough. Sob.Districts. Parliamentary Divisions. Wards. Kensington Town. Brompton. North. South. St. Charles. Gol. borne. Norland. Pernbridge. Holland. Earl's Court. Queen's Gate. Redcliffe. Brompton. January 26 27.6 21.8 25.6 11.8 30.0 13.1 29.0 44.9 27.6 18.8 15.6 14.8 11.6 12.9 9.0 February 28 26.4 19.6 22 6 11.8 26.3 12.5 23.2 32.4 260 21.7 16.2 11.8 6.2 19.1 6.8 March 23 26.6 20.2 23.3 12.8 26.7 18.4 26.7 83.8 24.9 19.7 18.1 12.0 11.6 18.4 10.8 April 20 26.6 20.3 28.7 11.5 28.4 11.7 26.7 82.9 32.5 191 14.3 8.5 8.9 14.8 11.7 May 18 26.9 17.1 20.2 8.9 22.9 10.9 24.4 83.8 17.9 12.5 14.8 11.8 7.1 10.2 9.9 June 15 26.1 18.9 21.7 11.5 26.3 11.0 29.0 83.3 24.4 15.8 10.0 10.6 10.7 15.7 7.2 July 18 25.6 17.4 20.5 9.4 23.8 11.2 22.0 30.9 22.7 15.1 16.2 12.0 8.9 10.2 6.8 August 10 24.8 18.4 21.3 11.0 25.4 110 27.3 32.4 22.7 17.1 12.5 10.6 6.2 14.8 9.9 September 7 25.6 18.7 22.3 9.1 26.7 10.1 29.6 30.4 27.1 17.8 13.1 9.9 8.9 8.8 9.0 October 5 24.6 17.6 21.8 6.8 26.0 8.8 26.7 29.5 27.6 18.4 8.7 11.8 8.0 9.5 5.4 November 2 25.2 19.2 23.1 8.9 29.2 8.5 29.6 36.2 25.5 23.7 10.6 12.0 2.7 11.6 2.7 November 30 25.0 20.1 24.5 8.4 28.1 11.6 26.7 85.8 25.5 22.4 175 9.9 7.1 12.9 8.1 December 28 28.0 17.6 20.5 9.9 23.5 11.8 28.8 29.0 28.8 15.8 11.8 11.3 10.7 12.8 9.9 Birth-rate for the year 1907 25.8 19.0 22.4 10.1 26.4 11.2 26.5 33.5 25.2 17.9 13.4 11.2 8.3 13.1 8.2 9 The Registrar-General states in the Annual Summary for 1907, that the London birth-rate (25.8 per 1,000 of the total population, of both sexes and at all ages) was the lowest recorded in the Metropolis since civil registration was established; it was 1.0 per 1,000 below that recorded in 1906, and was 2.8 per 1,000 below the average rate in the ten years 1897-1906. He further states that in the year 1867 the birth-rate in London attained the highest point on record, viz., 36.5 per 1,000 persons living. Since that date the ratio has, with trifling exceptions, steadily fallen. In 37 years the fall, calculated on the total population, amounted to 27 per cent. Based on the proportion of births to the number of possible mothers, i.e., the total number of women living at child-bearing ages, the fall amounted to 30 per cent. in the same period. The highest fertility rates were recorded in Stepney, Bethnal Green, Poplar, Shoreditch, Bermondsey, Finsbury and Southwark. The lowest fertility rates were recorded in Hampstead, the City of Westminster, the City of London, Holborn, Stoke Newington, St. Marylebone, Kensington, and Chelsea. The observations of the Registrar-General on this subject derive additional interest from the fact that the births in the principal lying-in hospitals are now distributed to their respective districts. Last year there were 1,618 births in Queen Charlotte's Hospital alone, including 140 to Kensington mothers. The Kensington birth-rate, corrected by the addition of these births, for the five years 1902-6 was 20 0 per 1,000 (viz., 20.3, 20.7, 20.0, 20.0, and 19 0 in the five years successively), and 19'0 per 1,000 in 1907. Calculated on the married female population per 1,000 living, aged 15-45 years, the legitimate birth-rate in the borough—after distribution of births in the principal lying-in institutions in the years 1902-6 is stated to have been 183.4, 193.9, 186.2, 183.9, and 176.4 (average 184.7), and in 1907, 174.2. Table A, Appendix II. (page 108) gives the number of births and the birth-rate for each of the fifty-two years, 1856-1907. The Registrar-General states that "during the past 37 years, approximately 19 per cent. of the decline in the birth-rate is due to the decrease in the proportion of married women in the female population of conceptive ages, and over 5 per cent. is due to the decrease of illegitimacy. With regard to the remaining 76 per cent. of the decrease there can be little doubt that much of it is due to deliberate restriction of child-bearing." DEATHS AND DEATH-RATE. The registered deaths, inclusive of 351 of parishioners at outlying public institutions, etc., but exclusive of 704 of non-parishioners at public institutions, etc., within the borough, were 2,471 (males 1,217, females 1,254), and 259 below the corrected decennial average (2,730). Of these deaths, 1,984 belong to the Town sub-district and 487 to Brompton. The death-rate, which in the preceding three years had been 14.2, 14.0 and 13.9, per 1,000 respectively, was 13.7* in 1907, and the lowest on record. It was 1.4 below the decennial average 15.1) and 0.9 below the rate in the Metropolis, as a whole, 14.6. The rates in the sub-districts were: Town 15.2, Brompton 9.8 per 1,000, as compared with 15.2 and 10.4, respectively, in 1906. The deaths in North Kensington were 1,578, and the death-rate 17.0 per 1,000. The deaths in South Kensington were 893, and the death-rate 10.2 per 1,000. The sex-rates (entire borough) were, males 17.2, females 11.4 per 1,000. The ward-rates in 1907 (entire year) are set out below; the rate in each of the thirteen fourweekly periods in the table at page 12. North Kensington: St. Charles 356 deaths = 15.9 Golborne 492 deaths = 18.3 Norland 443 deaths = 18.5 Pembridge 287 deaths = 14.5 South Kensington: per 1,000 persons living. Holland 234 deaths = 11.2 Earl's Court 232 deaths = 12.6 Queen's Gate 112 deaths = 7.7 Redcliffe 204 deaths = 10.7 Brompton 111 deaths = 7.7 The Corrected or True Death-rate.—The death-rate, 13.7 per 1,000, as calculated above, is a crude or uncorrected one, not taking cognizance of the relative numbers of the sexes, nor of the * This is the crude death-rate. The rate corrected for age and sex distribution was 14.8 per 1,000. The "true deathrate" is set out in the table at page 10. 10 age-composition of the population. Correction for these data involves addition to, or subtraction from, the "recorded death-rate," as compared with the "standard death-rate." *The necessity for such correction is obvious, having regard to the great excess of females in the population, and to the lower death rate in the female sex as compared with the rate in the male sex. That excess in 1907 was approximately 39,300. The deaths among the 70,600 males were 1,217 and those among the 109,900 females 1,254. The crude death-rate in the male sex was 17.2 as compared with the rate of 11.4 in the female sex. It is obvious, therefore, that if the numbers of the sexes had been equal, the death-rate would have been higher than the recorded rate. The Registrar-General, in his Annual Summary, gives the "factor for correction for sex and age distribution" in each of the Metropolitan Boroughs. Corrected after the manner indicated, the death-rate of Kensington in 1907 becomes, instead of 13.7, one of 14.8 per 1,000; and the rate for London, as a whole, 15.4 instead of 14.6. The "true" death-rate is that which shows the mortality per 1,000 living of each sex at different age-periods, as set out in the subjoined table. The True Death-rate of Kensington, 1907. Age-Period. Population. Deaths. Death-rate. Both Sexes. Males. Females Both Sexes. Males. Females. Both Sexes. Males. es. Under five years of age 14,457 7,209 7,248 688 405 283 476 56.2 39.0 Five and under 15 26,464 12,869 13,595 82 34 48 3.1 2.6 3.5 Fifteen and under 25 39,066 13,755 25,311 73 30 43 1.9 2.2 1.7 Twenty-five and under 35 35,740 11,742 23,998 126 70 56 3.5 5.9 2.3 Thirty-five and under 45 25,358 9,647 15,711 185 79 106 7.3 8.2 6.7 Forty-five and under 55 18,569 7,376 11,193 258 129 129 13.9 17.5 11.6 Fifty-five and under 65 11,823 4,685 7,138 337 180 157 28.5 38.4 22.0 Sixty-five and under 75 6,257 2,354 3,903 336 141 195 53.7 59.9 50.0 Seventy-five and upwards 2,766 963 1,803 386 149 237 139.6 154.7 131.4 Totals 180,500 70,600 109,900 2,471 1,217 1,254 — — — The subjoined table shows the quarterly numbers of deaths of males and females in the borough, and in each of the sub-districts:— Kensington Town. Brompton. The Borocgh. Males. Females. Total Males. Females. Total. Total. 1st quarter 815 851 666 74 87 161 827 2nd „ 216 282 448 55 69 124 572 3rd „ 219 178 897 50 42 92 489 4th „ 235 238 473 58 57 110 583 985 999 1,984 232 255 487 2,471 The Births were, of Males 1,779 The Deaths were, of Males 1,217 „ Females 1,649 „ Females 1,254 Total Births 8,428 Total Deaths 2,471 Deduct 2,471 Deaths Shows 957 excess of Births over Deaths. Table A, Appendix II. (page 108) gives the number of deaths, and the death-rate, for each of the fifty-two years 1856-1907. * The expression "standard death-rate" signifies the death-rate at all ages, calculated on the hypothesis that the rate for each sex, at each of twelve age-periods in each town, were the same as in England and Wales, during the 10 years 1891-1900; the rate at all ages in England and Wales during that period having been 18.2 per 1,000. 11 INFANTILE MORTALITY. The infantile mortality, or the proportion of deaths under one year of age to registered births, is an important factor in vital statistics. The deaths under one year, which in the three preceding years had been 503, 498, and 452, respectively, were 433 in 1907 ; being equivalent to 126 per 1,000 births, and 28 below the decennial average. The deaths under one year in the Town sub-district (385) were equivalent to 132 per 1,000 births, those in Brompton (48) to 96 per 1,000. The infantile deaths in North Kensington, after distribution of the deaths at the Borough Infirmary, were 346, or 141 per 1,000 births; those in South Kensington 87, or 89 per 1,000 births. In the several wards the rate was as follows:— North Kensington— St. Charles 73 deaths = 123 Golborne 139 deaths = 154 Norland 92 deaths = 152 Pembridge 42 deaths = 119 South Kensington— per 1,000 registered births. Holland 24 deaths = 86 Earl's Court 25 deaths = 121 Queen's Gate 7 deaths = 57 Eedcliffe 22 deaths = 88 Brompton 9 deaths = 76 The lowest rates in the Metropolitan Boroughs were: Hampstead 69, Lewisham 90, City of London 94, Wandsworth 99, Stoke Newington 100, and Greenwich 100; the highest rates: Finsbury 130, Holborn 131, Bethnal Green and Southwark 138, and Shoreditch 150. The rate in five boroughs was higher, and in twenty-three boroughs lower, than in Kensington. In all the boroughs the rates in the year 1907 were below the average in the preceding five years. In England and Wales the rate was 118, the lowest yet recorded, and 27 per 1,000 below the mean proportion in the ten years 1897-1906. In the 76 great towns of England and Wales (including London) the rate averaged 127 per 1,000. The rate in Rural England was 106 per 1,000. Infantile Mortality Rate. year. The Borough. Kensington Town. Brompton. London. Deaths under 1 year. Deaths per 1,000 births. Deaths under 1 year. Deaths per 1,000 births. Deaths under 1 year. Deaths per 1,000 births. Deaths under 1 year per 1.000 births. 1897 609 162 531 166 78 140 159 1898 655 176 593 188 62 110 167 1899 642 174 574 184 68 122 167 1900 641 174 581 187 60 104 160 1901 581 157 506 161 75 132 149 1902 515 143 449 148 66 119 141 1903 510 139 461 147 49 89 131 1904 503 141 451 148 52 98 146 1905 498 139 442 145 56 107 129 1906 452 132 414 142 38 74 131 Average 1897-1906 561 154 500 162 60 110 148 1907 433 126 385 132 48 96 116 The infantile mortality rate in London in 1907, the Registrar-General states, was 116 per 1,000. The average rate in the ten years 1896-1906 had been 147 per 1,000—128, 111, 205, and 143 in the four quarters respectively; the quarterly rates in 1907 were 132, 101, 98, and 131. 12 The Registrar.General states that "the rate in 1907 was lower than in any other year on record," and that "this was mainly due to the showery and exceedingly cool summer." He adds that, if the "proportions in the several quarters are compared with the respective decennial averages, it will at once be apparent how very largely the saving of infant life was due to the reduced mortality experienced in the third quarter of the year; for while the mortality in the first quarter was 4 per 1,000 above the average, and only 10 or 12 per 1,000 below the average in the second and fourth quarters, it was no less than 107 per 1,000 below the average in the third quarter." Table A, Appendix II. (page 108) gives the number of deaths under one year in Kensington, and the proportion to 1,000 registered births for each of the thirty.seven years, 1871.1907, during my tenure of office. The figures for the 12 years, 1896.1907, have been corrected by the addition of the births to Kensington mothers at Queen Charlotte's Hospital to those occurring, and registered, in the borough. The deaths of children over one year and under five years of age were 255; the deaths under five years, therefore, were 688, compared with 756, 757, and 693, in the preceding three years, being equal to 201 per 1,000 births; the relative proportion in London, as a whole, being 188. The deaths of illegitimate children under five, 63, 94, and 79, in the preceding three years respectively, were 57 in 1907; of which 51 were registered in the Town sub.district, and 6 in Brompton. These deaths were equal to 28.5 per cent, on the 200 births registered as illegitimate. Of the 57 children 5 only survived the first year of life. Senile Mortality.—At sixty years of age and upwards, there were 903 deaths, as compared with 883, 873, and 934, in the preceding three years respectively. These deaths were equivalent to 365 per 1,000 deaths at all ages. The relative proportion in all London was 313 per 1,000. District Rates of Mortality.—The table below shows (inter alia) the death.rate in the sub.districts, the parliamentary divisions, and the wards, for the year, and also for each of the thirteen four.weekly periods covered by the monthly reports. As usual the rate was far higher in the Town sub.district (15.2 per 1,000) than in the Brompton sub.district (9.8), and the same observation applies to the parliamentary division of North Kensington (17.0), compared with the southern division of the borough (10.2). In all of the wards in North Kensington, the death.rate exceeded that of the borough as a whole (13.7 per 1,000), whereas in each of the wards in South Kensington it was more or less largely below the rate for the borough as a whole. Death.rate in the Metropolis, and in Kensington, and in Localized Districts of the Borough, in each of the thirteen four.weekly periods ended December 28th, 1907, and in the Registration Year, 1907. Four Weeks ended. Metropolis. Borough. Sob.Districts. Parliamentary Divisions. Wards. North Kensington. Sooth Kensington. Kensington Town. Brompton. North. South. St. Charles. Gol. borne. Norland. Pem. bridge. Holland. Earl's Court. Queen's Gate. Red. cliffe. Bromp ton. January 26 20.6 17.8 19.3 13.9 22.8 12.5 19.7 26.1 20.6 24.4 8.7 16.9 11.6 12.9 12.6 February 23 19.6 19.7 22.8 11.5 25.8 18.1 27.8 26.1 29.8 19.1 19.9 14.1 6.2 12.9 9.0 March 23 17.8 17.4 19.0 13.1 20.0 14.6 19.7 16.4 21.7 23.0 16.2 211 16.0 10.2 8.1 April 20 16.9 14.9 15.6 13.1 16.8 12.9 18.8 18.8 17.9 16.5 18.1 18.4 18.4 11.6 18.5 May 18 15.4 14.7 17.0 8.6 17.6 11.6 18.0 16.9 19.5 15.8 16.8 12.7 10.7 6.8 9.9 June 16 13.4 11.5 12.5 8.6 18.4 9.4 8.1 16.4 16.2 11.8 12.5 9.9 2.7 10.9 9.0 July 13 12.3 11.5 11.3 120 180 10.0 10.4 18.4 9.8 12.5 6.9 12.7 7.1 18.6 9.0 August 10 11.9 11.2 13.1 6.3 15.6 6.8 16.8 14.0 19.0 12.5 4.4 10.6 7.1 6.1 4.5 September 7 11.8 9.7 10.5 7.3 12.4 6.7 18.8 13.0 18.0 9.9 6.9 9.2 1.8 10.9 2.7 October 5 13.0 10.7 12.3 6.3 18.5 7.6 15.1 14.0 14.1 10.5 9.8 8.5 7.1 7.6 4.5 November 2 14.4 12.7 14.0 9.2 16.1 9.1 12.2 18.8 20.4 11.8 11.8 10.6 1.8 14.8 3.6 November 30 15.1 12.5 13.4 10.2 15.1 9.8 16.8 15.0 16.2 11.8 10.0 9.2 8.0 12.9 8.1 December 28 15.7 13.8 16.8 7.3 18.8 9.1 15.7 28.7 22.2 9.2 9.3 14.8 6.2 8.2 5.4 Death rate for the Year 1907 14.6 13.7 15.2 9.8 17.0 10.2 15.9 18.3 18.5 14.5 11.2 12.6 7.7 10.7 7.7 13 SUMMARY OF VITAL AND MORTAL STATISTICS. In the table at page 14, the principal statistics have been arranged in thirteen four-weekly periods corresponding to the dates of the monthly reports. The annual birth-rate in 1907 was 19.0 per 1,000 of the population, the death rate 13.7. There were considerable fluctuations in the death-rate at the different periods, ranging between the minimum (9.7) in the ninth, ended September 7th, and the maximum (19.7) in the second, ended February 23rd. The rate in six periods was above, and in seven below the average for the year. The deaths in the two halves were 1,399 and 1,072 respectively. The deaths from the principal diseases of the zymotic class were 180: 98 fewer than in 1906, and 110 below the decennial average: 106 occurred in the first half of the year and 74 in the second. Whooping-cough was the prevalent and most fatal disease in the first half, 70 of the total deaths (81) having been registered therein. The deaths from diseases of the respiratory organs were 520, and 62 more than in 1906. Diseases of the heart were accountable for 233 deaths, compared with 220 in 1906; and phthisis for 174, as compared with 214. Other tubercular diseases claimed 90 victims, against 85 in the preceding year. COMPARATIVE VITAL AND MORTAL STATISTICS. London.—The birth-rate, 23.8 per 1,000 (2.8 below the decennial average), was the lowest on record. The rate has been declining for many years, never having been below 30 per 1,000 prior to 1898: the highest rate during my tenure of office, 35-9 per 1,000, was recorded in 1876. The adjusted death-rate was 14.6 per 1,000, and 2.7 below the average of the preceding ten years. Small-pox, the cause of 1,300, 13, 25, and 10 deaths, respectively, in 1902, 1903, 1904, and 1905, was unattended by fatality both in 1906 and in 1907. Scarlet-fever was the cause of 644 deaths, compared with 533 in 1906, and a decennial average of 532. Diphtheria was the cause of 781 deaths; 90 more than in 1906, and 545 below the decennial average. Enteric-fever was the cause of 194 deaths, 66 less than in 1906, but less than half the decennial average. The four diseases above-named, commonly spoken of as the "dangerous infectious diseases," were the causes of 1,619 deaths: the deaths from the other three principal diseases of the zymotic class totalled 5,153, being 2,905 below the decennial average; viz., measles 1,810 (average 2,209), whooping-cough 1,800 (average 1,772), and diarrhoea 1,543 (average 4,077). Kensington.—The birth-rate, 19'0 per 1,000, and the lowest on record, was 0.1 below the rate in 1906, and 1'7 below the decennial average. Having regard to the disproportion in the number of the sexes, a high birth-rate is not possible; but the fall from the maximum during my tenure of office, viz., 31.7 in 1872, is abnormally great. The death-rate, 13.7 per 1,000; was 0.2 below that in 1906, and 1.4 below the decennial average. The infantile mortality-rate, measured by the proportion of deaths under one year to 1,000 registered births, was 126; a decrease of 6 per 1,000, compared with the rate in 1906. Scarlet-fever was the cause of 9 deaths, diphtheria of 24, and enteric-fever of 5; total 38 in a population of 180,500; a surprisingly small number. The deaths from these diseases were 7, 7, and 9, respectively, below the decennial averages. The deaths from the remaining three of the principal diseases of the zymotic class were 142: viz., measles 31 (average 70), whooping-cough 81 (average 45), and diarrhœa 30 (average 112). The table at page 19 shows the number of deaths in the several Wards from the principal diseases of the zymotic class. The mean temperature of the air at Greenwich during the year was 49.8° Fahrenheit and 0.3 above the means of the preceding 50 years,—the means of the four quarters being 39.7, 52.8, 60.1 and 46.6 respectively. 14 Summary of Vital and Mortal Statistics of the Royal Borough of Kensington, 1907. During the Four Weeks ended Births. Deaths. Death.rate. Deaths at Ages. Deaths from Zymotic Diseases. Deaths from Diseases of Respiratory System Deaths from Phthisis. Deaths from Heart Disease. Deaths under Five from Tubercular Disease. Mean Temperature. Kensington. London. 1907. Decennial Average. 1907. Average 5 years, 1902.6. 0.1 1—5 60 and upwards. Totals. Small.pox. Measles. Scarlet Fever. Diphtheria. Whooping. Cough. Enteric Fever. Typhus Fever. Simple continued Fever. Diarrhoea. Totals. Bronchitis. Pneumonia. January 26 *303 247 17.8 17.6 20.6 18.1 51 25 93 12 ... 1 2 2 5 2 ... ... ... 88 42 42 12 18 4 38.3° February 23 272 273 19.7 16.8 19.6 18.3 52 24 111 12 ... ... 1 1 10 ... ... ... ... 99 49 89 19 21 2 37.2° March 23 281 241 17.4 17.4 178 18.3 37 21 98 13 ... 1 ... ... 10 ... ... ... 2 59 84 19 18 31 4 42.4° April 20 282 207 14.9 15 9 16.9 17.0 22 37 69 22 ... 8 1 2 14 1 ... ... 1 41 11 23 17 17 4 46.0° May 18 ]237 204 14.7 14.0 15.4 15.6 40 28 72 28 ... 2 ... 3 22 ... ... ... 1 43 20 19 12 21 4 51.2° June 15 2G2 159 11;5 12.8 13.4 13.8 29 15 53 13 ... 4 1 ... 8 ... ... ... ... 19 5 11 17 19 4 54.4° July 13 242 160 11:5 12.4 12.3 lo.0 20 19 56 18 ... 8 1 1 3 ... ... ... ... 17 3 13 8 19 2 56.0° August 10 256 156 11.2 15.2 11.9 14.7 27 14 51 15 ... 4 ... 2 4 1 ... ... 4 11 ... 7 12 14 5 61 1° September 7 259 134 9.7 14.4 11.8 16.7 41 13 34 9 ... 2 ... 1 2 1 ... ... 3 12 5 7 9 8 5 59 1° October 5 245 148 10.7 12.9 13.0 15.2 25 9 61 13 ... ... ... 3 ... ... ... ... 10 22 11 8 12 21 2 57.3° November 2 266 176 12.7 14.0 14.4 15.3 32 11 63 9 ... ... 1 2 3 ... ... ... 3 26 12 10 20 16 0 50.8° November 80 279 174 12.5 15.5 15.1 17.2 31 17 70 10 ... 1 2 4 ... ... ... ... 3 86 12 19 8 14 3 44.7° December 28 244 192 13.8 17.3 15.7 18.3 26 22 72 11 ... 5 ... 3 ... ... ... ... 3 47 25 18 15 14 4 42.8° Totals 3,428 2,471 13.7 15.1 14.7 16.3 433 255 903 180 ... 31 9 24 81 5 ... ... 30 520 229 235 174 233 45 49.8° * Maximum number during the year, and so throughout the table. II Including 140 which occurred at Queen Charlotte's Lying.in Hospital. Minimum number during the year, and so throughout the table. 15 Death.rate in England and Wales, and in London and other Large Towns.— The death-rate in England and Wales in 1907, was 15.0 per 1,000; 0.4 below that of 1906; 1.7 below the average rate in the preceding ten years, and the lowest yet recorded. The rate in London, was 14.6 per 1,000 of the estimated population, and 0'5 below that of 1906; IT below the average rate in the 5 years 1902.1906, and the lowest on record. 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. 1907. 1906. 1905. 1904. 1903. 1902. 1901. 1900. 1899. 1898. 1897. Kensington 13.7 13.9 14.0 14.2 13.8 15.2 15.0 15.6 17.5 16.3 15.6 London 14.6 15.1 15.1 16.6 15.7 17.7 17.6 18.8 19.8 18.7 18.2 West Districts 13.8 14.5 14.9 15.5 14.6 16.7 15.7 17.6 19.0 17.0 16.1 North „ 13.1 14.3 14.3 15.4 14.4 16.1 15.9 16.9 18.1 16.9 16.6 Central „ 17.6 20.3 19.4 20 .2 19.0 21.2 20.8 21.5 22.5 22.1 21.8 East „ 17.7 18.6 18.4 19.5 18 6 20.0 20.7 22.1 23.0 21.7 21.2 South „ 14.1 14.4 14.2 15.3 14.2 16.1 16.6 17.7. 18.5 17.7 17.2 England and Wales 15.0 15.4 15.2 16.2 15.4 16.3 16.9 18.2 18.2 17.5 17.4 Greater London.—The death.rate in "Greater London"—which is co-extensive with the "Metropolitan" and "City" Police Districts, the population of which at the middle of the year was 7,217,941 (viz. 4,758,218 in Inner or Registration London and 2,459,723 in the Outer Ring) was 13'9 per 1,000, as compared with 15.5,14.4, and 14.4, severally, in the preceding three years. In the County of London the mortality was at the rate of 14.6 per 1,000, whilst in the Outer Ring it did not exceed 12.4. Infantile mortality in Greater London was equal to 112 per 1000 births, as compared with 143, 123, and 129, severally, in the preceding three years. Last year infantile mortality was equal to 116 per 1,000 in the County of London, and to 103 in the Outer Ring. Other Large Towns.—The crude death.rate in the seventy.six large towns, including London (population 16,024,458), was 15.4 per 1,000; the rates in the preceding three years having been 17.2, 15.7 and 15.9. The death.rates of Edinburgh, Glasgow, Dublin and Belfast were severally 16.2, 18.5, 24.7, and 21.3. These rates are calculated without reference to differences between one town and another with regard to the age and sex-distribution of their respective populations. But the sex and age composition of the several populations having been ascertained at the census of 1901, suitable factors have been calculated for correcting the recorded death.rates in the large towns in order to render them fairly comparable with one another; and in his Annual Summary (page viii.) the Registrar-General furnishes a table showing the recorded and corrected death.rates per 1,000 persons living, in each of the 76 towns in 1907. Colonial and Foreign Cities.—The authorities of a large number of the principal cities supply returns of mortality to the Registrar-General. The highest death.rates recorded in 1907, were, Moscow 27.5, Trieste 26.3, and Bucharest 25.2; the lowest, Sydney 11.5, Melbourne 12.8, and Christiania 13.1. Indian Cities.—The death.rate was 37'6 per 1,000 in Calcutta, 40*5 in Madras, and 39'6 in Bombay. ASSIGNED CAUSES OF DEATH. The Registrar.General issued, in 1902, a "New List of Causes of Death," as used in the Annual Reports for England and Wales, together with " Suggestions to Medical Practitioners respecting Certificates of Causes of Death," in which it is stated to be " highly desirable that Medical Practitioners should use only those terms which are recognised by the Royal College of Physicians of London." * This List comprises " General Diseases," i.e., those in which the whole body may be said to suffer, and " Local Diseases," of various systems and organs, set out in the Table (page 105,) in which the first twenty diseases named are those formerly described as "Specific, Febrile or Zymotic Diseases;" chief among them being the nine "Principal Zymotic Diseases;" three of which were formerly associated under the generic term " Fever," which comprises Typhus.fever, Enteric.fever, and Pyrexia. * The Registrar.General placed at my disposal a sufficient number of copies of the New List to enable me to forward one to each registered medical practitioner in the Borough, which was done in October, 1902. 16 The Tables numbered I. to V. are required by the Local Government Board to be used in the Annual Report of the Medical Officer of Health. TABLE I. For Whole District. Year. Population estimated to Middle of each Year. Births. Deaths under One Year of Age. Deaths at all Ages. Total. Deaths in Public Institutions. Deaths of Nonresidents registered in District. Deaths of Residents registered beyond District. Deaths at all Ages. Nett. Number. Rate* Number. Rate per 1,000 births registered Number. Rate. Number. Rate. 1 2 5 4 5 6 7 8 9 10 11 12 13 1897 170,700 8,765 22-2 609 161. 8,025 17-7 1,164 691 888 2,667 15-6 1898 172,000 8,715 21 6 655 176 3 151 18-8 1,123 689 2«6 2,798 16-8 1899 172,400 8,682 21-4 642 174 3,422 19 8 1 320 722 821 8 021 17-6 1900 178,OuO 8.6ci2 21-8 641 174 3,087 17-7 1,182 672 288 2,698 15-6 1901 177,000 3,708 20-9 581 157 2,964 16-7 1,108 635 821 2,650 15-0 1902 177,500 8,599 20-8 515 148 3,112 17-2 1,18-' 681 815 2,746 15-2 1908 178,000 3,677 20-7 510 189 2,803 15-7 1,094 666 818 2,4S5 18-8 1904 178,500 3,568 200 508 141 2,911 16-8 1.08;) 710 889 2,540 14 2 1905 179,000 3,579 200 498 189 2,856 15 9 1.222 67 H 324 2,507 140 1906 179,500 8,428 19 1 452 132 2.811 16 2 1 222 663 849 2,497 18-9 Averages for 10 years 1897 1906. | 175,760 8,640 20-7 561 154 3,014 17-1 1,166 675 819 2 658 151 1907 180,500 8,429 190 433 126 2 824 15 6 1 240 704 851 2,471 18-7 * Rates calculated per 1,000 of estimated population. Note.—The deaths included in columns 7 and 9 of this Table are all those registered during the year within the Borough. The Deaths included in column 12 are the number in column 7, corrected by the subtraction of the number in column 10, and the addition of the number in CQlumn 11. The term "non-residents" in column 10, means persons brought into the Borough on account of illness and dying there. The term "residents" in column 11, means persons taken out of the Borough on account of illness and dying thereout. Area of Borough in acres 2,291 Total population at all ages 180,500 No. (approximate) of inhabited houses 28,000 Average number of persons per house 7.8 INSTITUTIONS WITHIN KENSINGTON RECEIVING SICK AND INFIRM PERSONS FROM OUTSIDE THE BOROUGH. 1. St. Marylebone Infirmary, North Kensington. 2. The Hospital for Consumption and Diseases of the Chest, Brompton. 3. St. Joseph's House, Notting Hill. 4. St. Luke's House, Pembridge Square. 5. Kensington General Hospital, Richmond Road, South Kensington. For Institutions without Kensington at which Sick, Insane and Infirm Persons from the Borough died, sec page 29. 17 TABLE II. Names of Localities. Kensington. Kensington Town. Brompton. Year. Population estimated to middle of each year. Births registered. Deaths at all ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all ages. Deaths under 1 year. 1897 170,700 3,765 2,667 609 122,400 3,206 2,169 531 48,300 559 498 78 1898 172,,000 3,715 2,798 655 123,600 3,150 2,302 593 48,400 565 496 62 1899 172,400 3.6S2 3,021 642 123,900 3,125 2,455 574 48,500 557 566 68 1900 173,000 3,682 2,698 641 124,300 3,106 2,193 581 48,700 576 505 60 1901 177,000 3,708 2,650 581 128,300 3,141 2,192 506 48,700 567 458 75 1902 177,500 3,599 2,746 515 128,660 3,043 2,243 449 48,840 556 503 66 1903 178,000 3,677 2,455 510 129,020 3,129 1,998 461 48,980 548 457 49 1904 178,500 3,568 2,540 503 129,380 3,037 2,045 451 49,120 531 495 52 1905 179,000 3,579 2,507 498 129,740 3,054 1,971 442 49,260 525 536 56 1906 179,500 3,428 2,497 452 180,100 2,912 1,984 414 49,400 516 513 38 Averages of 10 years 1897 1906. 175,760 3,640 2,658 561 126,940 3,090 2,155 500 48,820 550 508 61 1907 180,500 3,428 2.471 433 130,820 2,926 1,984 385 49,680 502 487 48 TABLE IV * Causes of, and Ages at, Death during the Year 1907. Causes of Death. Deaths in whole District at subjoined ages. Deaths in Localities (at all ages). Total Deaths whether of Residents or non "Residents ' in Public Institutions in the District. All Ages. Under 1 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 65 65 and upwards Kensington Town. Brompton. Small-pox ... ... ... ... ... ... ... ... ... ... Measles 31 5 25 l ... ... ... 26 5 6 Scarlet Fever 9 ... 4 5 ... ... ... 4 5 ... Whooping-Cough 81 34 42 5 ... ... ... 77 4 13 Diphtheria, Membranous Croup 24 3 11 8 l 1 ... 19 5 1 Croup 1 ... 1 ... ... ... ... 1 ... ... Fever Typhus ... ... ... ... ... ... ... ... ... ... Enteric 5 ... ... 1 ... 4 ... 3 2 3 Other continued ... ... ... ... ... ... ... ... ... ... Epidemic Influenza 63 3 2 1 l 25 31 44 19 4 Cholera ... ... ... ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... ... Diarrhoea 30 21 4 ... ... 2 3 26 4 3 Enteritis 42 16 5 ... ... 11 10 30 12 12 Puerperal Fever 3 ... ... ... ... 3 ... 3 ... 2 Erysipelas 5 1 ... ... ... ... 4 4 1 5 Other septic diseases 12 3 ... ... l 4 2 10 2 2 Phthisis 174 ... 1 2 18 143 10 139 35 224 Other tubercular diseases 90 19 25 18 6 18 4 74 16 31 Cancer, Malignant disease 201 ... 1 ... ... 124 76 152 49 133 Bronchitis 229 49 20 ... 1 49 110 205 24 154 Pneumonia 235 53 64 9 7 67 35 209 26 57 Pleurisy 12 ... ... 1 ... 8 3 10 2 6 Other diseases of Respiratory Organs 43 4 5 1 ... 19 14 33 10 10 Alcoholism 12 ... ... ... ... 12 ... 8 4 14 Cirrhosis of Liver 24 ... ... ... ... 21 3 17 7 10 Venereal Diseases 15 10 1 ... ... 3 1 15 ... 14 Premature Birth 67 67 ... ... ... ... ... 53 14 5 Diseases and Accidents of Parturition 6 ... ... ... 1 5 ... 4 2 2 Heart Diseases 233 1 1 5 7 92 127 182 51 109 Accidents 88 20 14 4 3 32 15 72 16 36 Suicides 15 ... ... ... ... 15 ... 10 5 2 All other causes 721 124 29 19 27 248 274 554 167 382 All causes 2,471 483 255 82 73 906 722 1,984 487 1,240 Note.—In these two tables, deaths of residents occurring without the Borough are included in the Table; those of non-residents occurring within the Borough are excluded, with the exception of the last column in Table IV. 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. * Table III, " Cases of Infectious Disease notified." will be found at page 34, Table V , "Infantile Mortality," at page 57, and Table in Appendix I. an expanded list of causes of death at page 105. 18 The subjoined statement, being a summary of the Table in Appendix I., page 105 shows the number of deaths from diseases comprised in the " New List of Causes of Death," as used in the Annual Reports of the Registrar-General for England and Wales, referred to in the following pages; to which I have added the deaths from violence, and certain diseases comprised in the old classification under the heading Ill-defined and Not Specified Causes, e.g., Debility, Atrophy, Inanition, terms which find no place in the New List. GENERAL DISEASES No. of Deaths 980 LOCAL DISEASES— Diseases of Nervous System 186 Diseases of Organs of Special Sense 8 Diseases of Heart 238 Diseases of Blood-vessels 145 Diseases of Bespiratory Organs 520 Diseases of Digestive System 158 Diseases of Lymphatic System 5 Diseases of Urinary System 99 Diseases of Generative System 7 Accidents of Childbirth 6 Diseases of Locomotive System 10 Diseases of Integumentary System 8 1,880 DEATHS FROM VIOLENCE— Accident or Negligence 88 Homicide — Suicide 15 103 ILL-DEFINED AND NOT SPECIFIED CAUSES 58 Total 2,471 GENERAL DISEASES. The Deaths from the "Principal Diseases of the Zymotic Class" (244, 247 and 278 in the preceding three years respectively) were 180 in 1907, and 110 below the corrected decennial average (290). These deaths, of which 155 belong to the Town sub-district and 25 to Brompton, were equivalent to 1.0 per 1,000 persons living (1.18 in the Town sub-district and 0.50 in Brompton) as compared with 1.55 in 1906 ; the decennial average being 1.60. The rate in the Metropolis, as a whole, was 1.42 per 1,000 (1.93 in 1906); the decennial average being 2.22. The subjoined table shows the number of deaths from the several diseases occurring in the sub-districts and at outlying public institutions, etc. Disease. Sub-Districts. In Hospital. Total Deaths. Decennial Average. Town. Brompton. Town. Brompton. Uncorrected. Corrected for increase of Population. Small-pox ... ... ... ... ... 1.8 1.8 Measles 25 5 1 ... 81 68.1 69.9 Scarlet Fever ... ... 4 5 9 15.8 15.7 Diphtheria 4 1 15 4 24 80.4 81.8 Whooping-cough 76 4 1 ... 81 48.5 44.7 Typhus Fever ... ... ... ... ... 0.8 0.8 Enteric Fever 2 ... 1 2 5 18.5 18.9 Pyrexia ... ... ... ... 0.2 0.2 Diarrhœa 24 4 2 ... 80 109.8 112.2 181 14 24 11 180 281.9 289.5 19 Distribution of the deaths from the Principal Zymotic Diseases :— Smallpox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Enteric Fever. Pyrexia. Diarrhœa. Total. Sub-Districts— Kensington Town ... 26 4 19 77 8 ... 26 155 Brompton ... 5 5 5 4 2 ... 4 25 Parliamentary Divisions— North Kensington 23 4 15 75 8 ... 28 143 South Kensington ... 8 5 9 6 2 ... 7 87 Wards— North Kensington St. Charles ... 10 2 4 20 ... ... 8 44 Golborne ... 4 2 8 84 1 ... 6 55 Norland ... 8 ... 3 15 2 ... 7 35 Pembridge ... 1 ... ... 6 ... ... 2 9 South Kensington Holland ... 2 ... 1 ... ... ... 1 4 Earl's Court ... 2 1 2 8 ... ... 1 9 Queen's Gate ... ... 1 2 2 ... ... 1 6 Redcliffe ... 8 2 4 1 1 ... 4 15 Brompton ... 1 1 ... ... 1 ... ... 8 District Zymotic Rate.—The deaths from these diseases in North Kensington were 143, and the rate T64 per 1,000 persons living. In South Kensington the deaths were 37, and the rate 0'42 per 1.000. The rate in the several wards was as follows: — North Kensington— St. Charles Golborne Norland Pembridge 44 deaths, = 1.96 55 deaths, = 2.04 85 deaths, = 1.46 9 deaths, = 0.46 South Kensington— Holland Earl's Court Queen's Gate Redcliffe Brompton 4 deaths, = 0.19 9 deaths, = 0.49 6 deaths, = 0.41 15 deaths, = 0.79 3 deaths, = 0.21 per 1,000 persons living. The table at page 14 exhibits the distribution of the deaths in the Borough, as a whole, from the several diseases, as recorded in the thirteen four-weekly reports. In Appendix II., statistical information is given, in Tables B, C and D, pages 109 and 110, showing the number of deaths from the several diseases during the fifty-two years, 1856-1907; viz., in Table B, the annual number of deaths from each disease and the death-rate therefrom; in Table C, the number of deaths grouped in 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 of the three non-notifiable diseases—measles, whooping-cough and diarrhoea. In England and Wales the deaths from these diseases were at the rate of 1.26 per 1,000 persons living, against 1.94, 1.52, and 1.73, respectively, in the preceding three years. In the seventy-six great towns, including London, the average rate was 1.54. The following table shows the rate of mortality per 1,000 persons living from the principal zymotic diseases in Kensington and London, and in England and Wales:— Small pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Fever Diarrhœa. Kensington 0.00 0.17 0.05 0.18 0.45 0.03 0.17 London 0.00 0.38 0.14 0.17 0.56 0.04 0.82 England and Wales 0.00 0.86 0.09 0.16 0.29 0.07 0.29 SMALL-POX. There was no case of this disease in the Borough during the year. Only one death (in 1904) has been registered in the five years 1903-7. 20 For the second year in succession there was no death in London from this cause, the corrected decennial average being 178. The cases notified were 4, compared with 492, 74, and 31 in the preceding three years. MEASLES. Measles was the cause of 31 deaths, compared with 67, 54, and 81, in the three preceding years successively: 26 and 5 in the Town and Brompton sub-districts respectively; the corrected decennial average being 70. Thirty of the deaths were of children under five years of age, including 5 in the first year of life. The lady sanitary inspectors visited all cases reported by school teachers, 528 in number; the schools in connection with which cases were reported were 31; the aggregate of cases in nine schools (ranging from 22, upwards to 76) was 379; in six schools (ranging from 10 to 19) 81; in the remaining 16 schools there were 67 cases. The largest numbers occurred in connection with Wornington Road C.C. School, 76; Oxford Gardens C.C., and St. John's (Church) Schools, 56 each; Sirdar Road C.C. School, 46; and Edinburgh Road C.C. School, 44. In addition to the cases reported by school teachers, other 118 were found in the 521 houses visited. Of the total cases (646 in 536 families in 521 houses), 251 were of children under five years; 460 belonged to three wards—St. Charles 155, Golborne 156, Norland 149—the population of which is approximately 73,320; and 186 to the remaining six wards—population 107,180. An advisory leaflet was left with each family visited, calling attention to the serious nature of the disease—a fact which appears to be better recognised than formerly. But even now it is no uncommon thing to find mothers visiting friends with young children in their arms, at houses where measles exists, with the not unexpected result of a spread of the disease; the imprudence being justified by them on the ground that the children must have it at some time—which is by no means necessary. Moreover, as nearly all deaths from measles occur under five years, it follows that if a child is attacked after that age, the risk of a fatal result is almost negligible. No effort, therefore, should be spared to postpone the date of attack. Disinfection was carried out at 83 houses. The deaths from measles in London, as a whole, were 1,810, and approximately 409 below the corrected decennial average (2,219). SCARLET FEVER The notified cases of scarlet fever were 522, compared with 262, 332 and 463, in the preceding three years; 345 in North Kensington and 177 in South Kensington. The deaths were 9 (a casemortality of 1.7 per cent.) and 7 below the corrected decennial average (16). All took place at outlying public institutions, to which 485 cases were removed. The deaths in the preceding three years had been 5, 21, and 11, respectively. The deaths in London, as a whole, 644, were approximately 112 in excess of the corrected decennial average: 629 of them (97.7 per cent.) took place in public institutions: the casemortality was 2.8 per cent. The cases notified during the year were 25,936, compared with 13,439 19,467, and 20,343, in the preceding three years respectively. The case-mortality was 2.5 per cent. on notifications, compared with 2.7, 2.8, and 2.6, in the preceding three years. The admissions to hospitals were 23,208, compared with 11,401, 17,230, and 18,316, in the preceding three years, and equal to 94.1 per cent. on cases notified. At the close of the year there were 4,999 cases remaining in hospital, compared with 2,386, 3446, and 3846 at the corresponding period in the preceding three years. The subjoined table shows the degree of prevalence of the disease in the borough and in London, as a whole, indicated by the number of notifications, and of deaths, etc., in thirteen four-weekly periods, as set out in my reports. Scarlet Fever in 1907. Report for four weeks ended No. of Notifications. No. of cases admitted to Hospitals. No. of Deaths. No. of cases in Hospital at the end of the period. Kensington. London. Kensington. London. Kensington. London. January 26 40 1,818 85 1,226 2 39 8,291 February 23 32 1,407 28 1,320 1 30 2,938 March 23 43 1,351 42 1,271 — 27 2,784 April 20 32 1,409 28 1,339 1 39 2,628 May 18 37 1,475 37 1,418 — 37 2,678 June 15 57 1,732 54 1,576 1 50 2,937 July 13 37 1,894 33 1,833 1 47 8,276 August 10 80 2,147 28 2,011 — 63 8,660 September 7 29 2,076 25 2,014 — 42 8,816 October 5 47 2,953 44 2,815 — 57 4,548 November 2 59 3,397 56 3,197 1 92 5,467 November 30 42 2,724 40 2,528 2 56 5,676 December 28 37 2,053 35 1,855 — 66 4,999 522 25,936 485 24,898 9 645 Note.—Correction has not been made in the table for errors in diagnosis, either with respect to notifications, or admissions to hospital. The notifications are collated from the weekly returns of the Asylums Board; the admissions to, and numbers in, the hospitals, and the deaths in London, from the weekly returns of the Registrar-General. 21 The following tables exhibit certain particulars of interest with respect to scarlet fever prevalence, &c., during 1907, and in the preceding ten years. The Year. Cases notified. Case rate per 1,000 of population. Deaths. Death rate per 1,000 of population. Case mortality per cent 1907 522 2.89 9 0.05 1.7 1906 463 2.57 11 0.06 2.4 1905 332 1.85 21 0.12 6.3 1904 262 1.47 5 0.03 1.9 1903 330 1.85 14 0.08 4.2 1902 372 2.09 21 0.12 5.6 1901 475 2.68 15 0.08 3.2 1900 367 2.12 4 0.02 1.4 1899 443 2.57 10 0.06 2.2 1898 474 2.75 23 0.13 4.8 1897 749 4.33 29 0.17 3.9 Scarlet Fever Cases Recorded in Kensington in 1907, and in the Preceding Ten 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—41 Weeks. 45—48. Weeks. 49—52. Total. 1907 40 32 43 32 37 57 37 30 29 47 59 42 37 522 1906 10 21 17 39 41 30 39' 42 31 53 73 41 26 463 1905 19 16 32 15 35 36 27 34 21 31 21 32 13 332 1904 23 18 19 15 28 25 23 26 11 22 24 12 16 262 1903 18 12 32 31 27 17 37 46 28 21 24 17 20 330 1902 36 31 27 30 33 21 32 20 26 35 37 18 26* 372 1901 26 19 22 18 31 32 45 56 46 48 52 43 37 475 1900 32 26 28 28 20 22 32 21 23 25 41 31 35 364 1899 26 20 20 27 26 38 40 47 35 47 42 55 22 445 1898 34 40 34 39 31 31 40 45 38 31 33 38 34 468 1897 43 32 40 28 33 58 68 51 55 133 88 84 34 747 Average 1897-1906 26.7 23.5 27.1 27.0 30.5 31.0 38.3 38.8 31.4 44.6 43.5 37.1 26.3 426† Return comprises five weeks † Without correction for increase in population. 22 Statistics of Scarlet Fever in Kensington in 1907, and in the Preceding Ten 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. 1907 37 485 522 93 — 9 9 — 100 1.7 644 1906 46 417 463 90 1 10 11 9 91 2.4 533 1905 31 301 332 91 — 21 21 — 100 6.3 549 1904 37 225 262 86 — 5 5 — 100 1.9 365 1903 53 277 330 84 2 12 14 14 86 4.2 362 1902 61 311 372 84 2 19 21 10 90 5.6 563 1901 92 383 475 81 4 11 15 27 73 3.2 584 1900 74 290 364 79 — 4 4 — 100 1.4 361 1899 101 344 445 77 2 8 10 20 80 2.2 398 1898 117 361 478 76 1 22 23 3.4 95.6 4.8 583 1897 188 561 749 75 3 26 29 10.3 89.7 3.9 780 The information as to scarlet-fever mortality in the Borough in the fifty-two years 1856-1907 set out in Appendix II. (Tables B, C, D, pages 109 and 110), shows the great reduction in the fatality of this disease in recent years. In view of the continued prevalence of scarlet fever in London, notwithstanding the extensive isolation accommodation provided, the Managers of the Metropolitan Asylums Board towards the end of the year passed a resolution inviting the Local Government Board to cause an inquiry to be instituted into the cause of this disease, and as to whether any, and if so what, furthermeans can be adopted for its prevention. It may not be out of place therefore to observe that, despite the keeping-up of the numbers of cases notified, the disease has of late years undergone a marked change for the better, as indicated by diminished virulence of type. This fact may be illustrated by comparison of the number of deaths in London in two years shortly before the Asylums Board provided hospital accommodation for sufferers, and the number in the last two years. The deaths in 1869 and 1870 were 5,841 and 6,040—1,839 and 1,875 per million persons living respectively—the population being approximately 3,200,000. In 1906 and 1907, the deaths numbered 533 and 644—113 and 136 per million persons living—the population being approximately 4,750,000. At page 31 a table of notifications of scarlet fever for every year since 1890 is given. The numbers fluctuate a good deal; the maximum 37,000, was attained in 1893, in which year the deaths were 1,590; the lowest number, 11,398, was recorded in 1891 (the deaths were 598), the next lowest (12,536) in 1903, in which year only 356 deaths were registered from this cause in a population of more than 4,600,000. In 1907 the notifications were 26,000; the deaths 645, and 113 above the corrected decennial average; but they were less than a thirteenth of the numbers registered in 1869 and in 1870, after correction for increase of population. Obviously, therefore, there is no cause for alarm; but the inquiry will doubtless yield interesting results—should the Local Government Board comply with the request of the Managers. DIPHTHERIA. The cases notified as diphtheria (including membranous croup, classified by the RegistrarGeneral with diphtheria) were 234; compared with 186, 125, and 164, in the preceding three years; 150 in North Kensington and 84 in South Kensington. The deaths were 24 (a case-mortality of 10.3 per cent.) and 7 below the corrected decennial average (31); 19 in the Town sub-district, and 5 in Brompton. Nineteen of the deaths took place in hospitals, to which 204 cases were removed—a case-mortality of 9.3 per cent. Fourteen of the deaths were of children under five years of age. 23 . The only noteworthy outbreak of diphtheria occurred in connection with the Gloucester GrovCounty Council School, South Kensington—which in its three departments is certified for 975 scholars. Between the middle of October and the middle of January, 1908, twenty-two cases were notified (four each in the boys' and girls' departments, and fourteen in the infants' department), of which three proved fatal. All of the sufferers were removed to hospital, and the houses disinfected. In only five instances was there more than one case to a house; and in houses where more than one case occurred, it was owing to the nature of the illness in the primary attack not having been recognised. When the first case in a family was reported promptly, there was no spread of the disease. The medical staff of the Education Committee paid much attention to the outbreak, and the staff of the Public Health Department likewise. In December the class rooms of the infants' department, five in number, were disinfected; and in several suspicious cases bacteriological examinations of throat secretions were made for the Council at the Lister Institute. The trouble was due in no slight measure to the mildness of some of the attacks, leading to failure to recognise the nature of the illness. The following table gives particulars with respect to diphtheria in North and bouth Kensington respectively. Set out in Report for Four weeks ended. Total Cases Recorded. Cases Recorded in North Kensington.* Cases removed to Hospital from— Deaths (19 in Hospital). Cases Recorded in South Kensington.* North Kensington. South Kensington. North Kensington. South Kensington. January 26 13 8 5 8 2 2 February 23 11 4 7 4 6 1 ... March 23 11 9 2 9 2 ... ... April 20 7 4 3 3 1 1 1 May 18 14 12 2 10 2 3 ... June 15 14 8 6 5 4 ... July 13 15 10 5 9 4 • . . 1 August 10 19 15 4 15 2 1 l September 7 18 16 2 14 2 1 ... October 5 18 13 5 9 5 2 l November 2 21 15 6 13 3 2 ... November 30 46 24 22 24 22 2 2 December 28 27 12 15 11 15 ... 3 234 150 84 134 70 15 9 "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. Diphtheria in Kensington, 1897-1907. Year. Cases Notified. Case rate per 1,000 of population. Deaths. Death rate per 1,000 of population. Case Mortality per cent. 1897 332 1.94 82 0.48 24.7 1898 222 1.29 26 0.15 11.7 1899 257 1.49 42 0.24 16.3 1900 332 1.92 27 0.16 8.1 1901 250 1.41 38 0.21 15.2 1902 184 1.04 20 0.11 10.9 1903 158 0.90 24 0.13 15.2 1904 186 1.04 17 0.09 9.1 1905 125 0.70 9 0.05 7.2 1906 164 0.91 19 0.11 11.6 1907 234 1.30 24 0.13 10.3 24 Detailed information in regard to diphtheria mortality in the borough in 52 years—1856-190 is set out in Appendix II., Tables B, C, and D, pp. 109 and 110. The deaths in London, as a whole, were 781—approximately 545 below the corrected decennial average—compared with 729, 533, and 691, in the preceding three years; the notifications 8,761, compared with 7,224, 6,489, and 8,035. The cases admitted to hospital were 5,782, compared with 4,739, 4,180, and 5,264, in the three preceding years; and the deaths in hospital 547 a casemortality of 9.5 per cent. At the close of the year there were 1,170 cases under treatment, compared with 807, 701, and 1,000, at the corresponding period in the preceding three years. The subjoined table, based on the thirteen four-weekly reports, set out certain particulars with regard to diphtheria, in Kensington, and in London as a whole: — Report for four weeks ended No. of Notifications. No. of cases admitted to Hospital. No. of Deaths. No. of cases in Hospital at the end of the period. Kensington. London. Kensington. London. Kensington. London. January 26 13 605 10 494 2 74 925 February 23 11 648 10 507 1 77 920 March 23 11 619 11 519 — 62 1,006 April 20 7 617 4 524 2 53 997 May 18 14 559 12 464 3 55 922 June 15 14 570 9 489 — 44 945 July 13 15 560 13 478 1 39 868 August 10 19 626 17 530 2 44 885 September 7 18 581 16 486 1 52 845 October 5 18 857 .14 745 3 76 1,065 November 2 21 940 16 769 2 64 1,256 November 30 46 850 46 716 4 92 1,279 December 28 27 729 26 620 3 63 1,170 234 8,761 204 7,341 24 785 Note.—Correction has not been made in the above table for errors in diagnosis, either with respect to notifications or admissions to hospitals. WHOOPING-COUGH. Whooping cough was the cause of 81 deaths, compared with 19, 60, and 20, in the preceding three years; 77 of them in the Town sub-district; the corrected decennial average being 45. Seventy-six of the deaths were of children under 5 years of age, including 34 in the first year of life. All of the cases reported by school teachers (385 in number) were visited by the lady sanitary inspectors. The schools in connection with which cases were reported were 26. The aggregate cases in six schools (ranging from 20, upwards to 82) were 231; in other eight schools there were 114 cases (ranging from 8 to 19); in the remaining 12 schools there were 40 cases. The largest numbers occurred in connection with Wornington Road C.C. School 82, Edinburgh Road C.C. School 49, Oxford Gardens C.C. School 34, St. Mary Abbots Church School 25, St. George's Church School 21, and Middle Row C.C. School 20. In addition to the cases reported by school teachers, other 212 were found in the 361 houses visited. Of the total cases (597 in 380 families) 340 were of children under five years of age; 457 belonged to three wards, St. Charles 142, Golborne 227, and Norland 88 (population approximately 73,320), and 140 to the remaining six wards (population 107,180). An advisory leaflet was left with each family, pointing out the serious nature of the disease—a fact which the inspectors think is becoming better recognised by mothers, leading to more care of the sufferers. Prevention of spread of whooping-cougn in the families of the poor (as in the case of measles) is almost impossible, and indeed is by many mothers hardly thought desirable. The deaths from both diseases are almost exclusively confined to the families of persons in humble circumstances; the fatal issue being usually due to some intercurrent malady, commonly of the respiratory system. The deaths from whooping-cough in London, as a whole, were 1,800, and approximately 28 above the corrected average. FEVER. Forty cases of Enteric Fever were notified, compared with 46, 49, and 38, in the preceding three years. The deaths were 5 (9 below the corrected decennial average), 3 of them belonging to 25 the Town sub-district; 3 of them took place in hospitals, to which 27 cases were removed. The deaths from this cause in the preceding three years were 6, 13, and 5, respectively. Enteric Fever in Kensington, 1897-1907. Year. Cases Notified. Case-rate per 1,000 of population. Deaths. Death-rate per 1,000 of population. Case-mortality per cent. 1897 117 0.69 21 0.12 18.0 1898 104 0.60 12 0.07 11.5 1899 107 0.62 23 0.13 21.5 1900 104 0.60 16 0.09 15.4 1901 97 0.55 11 0.06 11.3 1902 80 0.45 19 0.11 23.7 1903 61 0.34 9 0.05 14.8 1904 46 0.26 6 0.03 13.0 1905 49 027 13 0.07 26.5 1906 38 0.21 5 0.03 13.2 1907 40 0.22 5 0.03 12.5 The deaths in London, as a whole, 194, were 332 below the corrected decennial average: the notifications 1,396 compared with 1,606 in 1906; the admissions to hospitals 541 (compared with 750, 587, and 700, in the preceding three years), and the deaths thereat 72. At the close of the year 119 patients remained under treatment, as against 159, 78, and 135, at the corresponding period of the preceding three years. No case of typhus was notified in the Borough, and only three cases in all London: there was no death from this cause. No death was registered in the Borough from simple continued fever (Pyrexia); three cases were notified. The deaths and notifications in London from this cause were 4 and 35 respectively. DIARRHŒA. Diarrhoea was the cause of 30 deaths, compared with 128, 90, and 142, in the preceding three years; 26 in the Town sub-district and 4 in Brompton; the corrected decennial average being 112. The deaths registered from infantile diarrhœa in the twelve weeks July 14—October 5, a period usually of great prevalence, were 17 only, compared with a corrected decennial average of 89; in London, as a whole, the deaths were 659, the quinquennial average annual number being 2,802. If the mortality, in 1907, be compared with that in 1906—when diarrhoea was very prevalent and fatal, the contrast is even greater, the deaths in Kensington in the twelve weeks (17) having been 104 fewer than in the corresponding period in 1906 (121). In London, the deaths from this cause in the twelve weeks last year, were 3,605, whilst this year they were 659 only; a saving of 2,946 lives. The high mortality from diarrhoea in 1906, and the low mortality in 1907 is explained by the very different climatic conditions which prevailed; the summer of 1906 having been hot and dry, that of 1907 cool, and with an equal but well distributed rainfall. The general rate of mortality for the same period, in the two years, also differed considerably, having been in Kensington, 10.5 per 1,000 in 1907, compared with 14.5 in 1906; whilst in London, as a whole, it was 12.2 in 1907, compared with 16.0 in 1906. The lower rate in 1907 was due to the diminished prevalence of fatal diarrhœa. The deaths in London, as a whole, from this cause, were 1,543, and approximately 2,534 below the corrected decennial average (4,077): 1,337 of the deaths were of children under five years of age, including 1,124 of infants under one year. Of the 1,543 deaths 780 were certified Epidemic Diarrhœa or Infective Enteritis, and 763 Diarrhœa, Dysentery. 26 INFLUENZA. Sixty.three deaths were registered from Influenza, as compared with 50, 49, and 52, in the preceding three years; 44 in the Town sub.district, and 19 in Brompton. The deaths in London, as a whole, were 967, against 709, 689, and 895, in the preceding three years. DEATHS FROM OTHER "GENERAL" DISEASES. Syphilis was the cause of 15 deaths, all of them in the Town sub.district. Puerperal Diseases were the causes of three deaths—between 25 and 45 years of age—all in the Town sub.district; six deaths were registered as having occurred from accidents connected with childbirth. These nine deaths were equal to 2.6 per 1,000 live births, compared with rates of 3.5, 2.0, and 4.7, per 1,000 in the preceding three years respectively. Erysipelas was the cause of five deaths, 4 of them in the Town sub.district. The notifications were 127 in number. Tuberculosis in its various forms was the cause of 264 deaths, as compared with 342, 273, and 299, in the preceding three years; 213 in the Town sub-district, and 51 in Brompton; 46 of them under five years of age. Tubercular Phthisis (Pulmonary Tuberculosis) was the certified cause of 144 deaths (114 and 30 in the Town and Brompton sub-districts respectively), and " Phthisis " of 30; total 174, or 0.96 per 1,000 of the population. Tubercular Meningitis was the cause of 39 deaths; Tubercular Peritonitis of 12; and General Tuberculosis of 33. The deaths from tubercular diseases were, proportionately to population, not so numerous in Brompton as in the Town sub.district. The total deaths were in the proportion of 1.5 per 1,000 of the population. Deaths and Death.rate from Phthisis and other Tuberculous Diseases, in 1907. District. Phthisis. Other Tuberculous diseases. Total. No. of deaths. Rate. No. of deaths. Rate No. of deaths. Rate. Kensington Town 139 1.06 74 0.57 213 1.63 Brompton 35 0.70 16 0.32 51 1.02 The Borough 174 0.96 90 0.50 264 1.46 London 6,857 1.40 2,454 0.52 9,311 1.92 Tuberculosis in Kensington, 1897-1907. The Year. Deaths from Phthisis per 100,000 persons living. Deaths from other Tuberculous Diseases per 100.000 persons. Total deaths from Tuberculosis per 100,000 persons living. 1897 140.6 58.6 199.2 1898 126.2 67.4 193.6 1899 128.2 56.8 185.0 1900 121.4 55.5 176.9 1901 132.5 45.3 177.8 1902 123.9 50.7 174.6 1903 119.1 41.0 160.1 1904 126.6 65.0 191.6 1905 111.2 41.3 152.5 1906 119.2 47.3 166.5 1907 96.4 49.9 146.3 27 The deaths from Tubercular Diseases in London, as a whole, were 9,311; 6,857 of them were due to Phthisis, the death-rate being 1.40 per 1,000 persons living, against 1.62, 1.42, and 1.44 in the preceding three years, and a quinquennial average of 1.53. Phthisis mortality ranged from 0.70 per 1,000 persons living in Hampstead, 0.93 in Lewisham, 0.94 in Stoke Newington, 0.95 in Wandsworth, to 2.02 in the City of London, 2.03 in Southwark, 2.10 in Shoreditch, 2.33 in Finsbury, and 2.58 in Holborn. The Registrar-General states that in no fewer than 21 boroughs the rates in the metropolitan boroughs were below the average rates recorded in the preceding five years. Alcoholism, Delirium Tremens, was the cause 12 deaths; eight in the Town sub-district and 4 in Brompton. The deaths in London, as a whole, were 501. It is probable 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; many deaths due to the misuse of alcohol are certified, and necessarily classified, to visceral and degenerative diseases caused or aggravated by drink. Rheumatic Fever, Acute Rheumatism, was the cause of 6 deaths, five of them in the Town sub-district. Malignant Disease, Cancer, was accountable for 201 deaths; 152 in the Town sub-district and 49 in Brompton. Carcinoma was the registered cause in 100 cases, Sarcoma in 9, and Malignant Disease, Cancer, in 92. 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 may be due to greater accuracy in diagnosis. The deaths in Kensington in the preceding ten years were 168, 193, 169, 152, 185, 155, 187, 174, 172, and 171 respectively. The deaths in 1907 were equal to 11T per ten thousand of the population, and to 8.1 per cent, of all deaths registered. Deaths from Malignant Disease are usually more numerous, proportionately to population, in the Brompton sub-district than in the Town sub-district, cancer being quite as prevalent, probably more so 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 180 of the deaths took place at ages above forty-five, and 19 between thirty-five and forty-five years. In London, as a whole, the deaths from Malignant Disease, Cancer, were 4,904. Premature Birth was the cause of 67 deaths; 53 in the Town sub-district and 14 in Brompton; Old Age (Senile decay) of 73: 57 and 16 in the two sub-districts respectively; including 16 between 65 and 75 years, 28 between 75 and 85, and 28 at 85 years and upwards. LOCAL DISEASES. Nervous System.—The deaths from the diseases of this system were 136; 106 in the Town sub-district and 30 in Brompton—as compared with 108, 123, and 114, in the preceding three years; 40 of them occurred under five years of age. Twenty four of the deaths were due to Convulsions, and 24 to diseases which, not being named specifically in the "New List," are classified to " Other Diseases " of the System. The number of deaths from the several other diseases are set out in the Table at page 105. Circulatory System. — The deaths from Diseases of the Heart were 233—182 in the Town sub-district and 51 in Brompton—as compared with 212, 209, and 220, in the three preceding years. The larger proportion of deaths, 116, were registered from " Syncope, Heart Disease " (not specified). Valvular Disease was accountable for 57 deaths, Angina Pectoris for 10, Dilatation of Heart for 14, and Fatty Degeneration for 31. Diseases of Blood Vessels were the causes of 145 deaths ; 109 in the Town sub-district and 36 in Brompton, including 82 from Cerebral Hemorrhage, Embolism, Thrombosis; and 28 from Apoplexy, Hemiplegia, conditions which generally connote cerebral hemorrhage. Respiratory System.—The diseases of the respiratory organs (phthisis being excluded), were accountable for 520 deaths (62 more than in 1906, and 21.0 per cent, on total deaths); 458 in the Town sub-district and 62 in Brompton—as compared with 516, 537, and 458, in the preceding three years. The principal causes were Bronchitis 229 deaths, and Pneumonia, in one or other of its forms, 235 deaths. The deaths under five years of age were 196, or 37.7 per cent, of the total number, as compared with percentages of 30.6, 34.3, and 30.8, in the preceding three years; * A considerable number of deaths are certified as due to " Failure of the Heart," in persons dying in old age. These deaths are classified to " Old Age " in the Table at page 105. 28 and at 55 and upwards 234, or 45.0 per cent., against 47.9, 46.9, and 50.7, in the preceding three years. Bronchitis and Pneumonia were accountable for 464 deaths (including 186 under five years of age), of which 50 were registered in the Brompton sub-district. Digestive System.— 1 he diseases of the Digestive System were accountable for 158 deaths; 115 and 43 in the Town and Brompton sub-districts, respectively; 38 of them under five years of age. The chief causes were Cirrhosis of the Liver 24 deaths, Other Diseases of the Liver and Gall Bladder 18 deaths, Intestinal Obstruction 12, Enteritis 17, Gastric Ulcer 9, and Appendicitis 18. Urinary System.—Ninety-nine deaths were due to diseases of the urinary system; 71 and 28 in the Town and Brompton sub-districts respectively; Chronic Bright's Disease {Albuminuria), being the cause of 67 deaths, Bladder and Prostate Disease of 22, and Other Diseases of the Urinary System of 6. DEATHS FROM VIOLENCE. One hundred and three deaths, including 34 under five years of age, and 20 under one year, were caused by violence; 82 belonging to the Town sub-district, and 21 to Brompton. Accident or negligence occasioned 88 deaths; 72 in the Town sub-district, and 16 in Brompton; 34 of them under five years of age, and 20 under one year. Fractures and Contusions were responsible for 45 deaths; Burn, Scald, for 15, and Suffocation for 19—of which 16 were of infants under one year. Suicide accounted for 15 deaths; 10 and 5 in the Town and Brompton sub-districts respectively; by Gun Shot Wound 1, Cut, Stab 1, Poison 8, Drowning 1, Hanging 2, and otherwise 2. Ill-defined and Not specified Causes of death were returned in 58 cases; 53 in the Town subdistrict and 5 in Brompton; 51 were certified due to Debility, Atrophy, Inanition, all of them of infants under one year. DEATHS AT PUBLIC INSTITUTIONS. The only large public institution in which we are directly interested is the Poor-law infirmary located in the Town sub-district. There are several public institutions, at which the deaths are mainly of non-parishioners; viz., St. Marylebone Infirmary, North Kensington, St. Luke's House for the dying, Pembridge Square, the Kensington General Hospital at Brompton, the Brompton Consumption Hospital, and St. Joseph's House, Portobello Road, Notting Hill, a Roman Catholic Home for aged poor persons of both sexes. The deaths of non-parishioners at St. Marylebone Infirmary (510), at the Brompton Consumption Hospital (43), at St. Luke's House (82), at the Kensington General Hospital (18), at St. Joseph's House (28), and the Kensington Children's Hospital (2), are excluded from our Statistics. The deaths of parishioners registered at the Infirmary and Workhouse (526), at the Consumption Hospital (2), at the Kensington General Hospital (5), at Kensington Children's Hospital (8), at St. Luke's House (4), at St. Joseph's House (7), and at outlying public institutions (325), aggregate 877 ; or 35.5 per cent, of total deaths. Kensington Deaths in Public Institutions, 1897-1907. Year Total Deaths. Deaths in Public Institutions. Proportion per cent, of Deaths in Public Institutions to Total Deaths. 1897 2,667 839 31.5 1898 2,798 782 27.9 1899 8,021 942 31.2 1900 2,698 764 28.3 1901 2,650 801 30.2 1902 2,746 832 30.3 1903 2,455 772 31.4 1904 2,540 784 30.9 1905 2,507 863 34.4 1906 2,497 895 35.8 Average, 1897-1906 2,658 827 31.2 1907 2,471 877 35.5 29 The percentage proportion of deaths in public institutions in the Metropolis in 1907, was 39.8; viz., 20.5 in workhouses and workhouse infirmaries; l.9 in Metropolitan Asylums Board Hospitals; 14.2 in other hospitals, and 3.2 in public lunatic and imbecile asylums. The Registrar-General in his Annual Summary states that "about one in every five deaths occurred in a workhouse or workhouse infirmary, one in every 53 in a Metropolitan Asylums Board Hospital, one in every 7 in some other hospital, and one in every 31 in a public lunatic or imbecile asylum." The increase in the number of deaths in public institutions has been great and continuous for many years. The Borough Infirmary.—I am indebted to Dr. H. Percy Potter, the medical superintendent, for the statistics of mortality at this important institution. The deaths, the causes of which are set out in the table below, were 526, compared with 471, 552, and 541, in the preceding three years respectively, and were equal to 21.3 per cent., or more than one-fifth, of all the deaths recorded in the borough. The quarterly numbers were 168, 112, 128, and 118; 286 deaths, therefore, occurred in the first and fourth or colder quarters, and 240 in the second and third or warmer quarters of the year. The deaths included 277 of males and 249 of females. The ages at death were:—Under one year, 57 (compared with 38, 72, and 71, in the preceding three years respectively); between one and sixty, 242 (compared with 237, 270, and 231, in the preceding three years), and at sixty and upwards, 227 (compared with 198, 210, and 239, in the preceding three SUMMARY OF CAUSES OF DEATH. DISEASES. Under 1 year. Between 1 year and 60 years. At 60 years and upwards- Total. Nervous System, Diseases of 1 19 25 45 Circulatory System, Diseases of 1 26 75 102 Respiratory System, Diseases of 8 49 51 108 Digestive System, Diseases of 4 18 9 31 Urinary and Generative Systems, Diseases of — 13 14 27 Tubercular Diseases (including Marasmus) 4 78 8 90 Cancer — 22 14 36 Gangrene — — 7 7 Various other Diseases 39 17 24 80 57 242 227 526 Seventeen inquests were held: in each of four cases a verdict of " natural death " was returned ; thirteen deaths were caused by accidents. Outlying Public Institutions.—The deaths of parishioners at public institutions, etc., without the borough, which in the preceding three years had numbered 339, 324, and 349, respectively, were 351 in 1907. All of these deaths are included in the borough statistics. The deaths occurred at the several institutions as follows :— St. Mary's Hospital 57 Samaritan Free Hospital 1 St. George's Hospita 89 Homoeopathic Hospital, Great Or- West London Hospital 32 monde Street .4 Middlesex Hospital 18 Friedenheim Hospital 1 Charing Cross Hospital 5 Alexandra Hospital, Queen Square1 University College Hospital 5 St. Thomas's Home 1 St. Bartholomew's Hospital 8 St. Peter's Home 1 Guy's Hospital 2 St. Joseph's Hospice, Hackney 2 Westminster Hospital 2 Hostel of God, Clapham 1 Western Hospital 26 St. Giles'Workhouse 1 Northern Hospital 1 St. Pancras Workhouse 1 Grove Hospital 4 Paddington Infirmary4 Cancer Hospital, Chelsea 4 Children's Hospital, Paddington 9 Banstead Asylum 15 Hanwell Asylum 14 Victoria Hospital for Children 4 Horton Asylum 9 Children's Hospital, Great Ormonde Street 2 Cane Hill Asylum 5 Colney Hatch Asylum 4 Queen Charlotte's Hospital 4 Leavesden Asylum . 4 Chelsea Hospital for Women 1 Tooting Bee Asylum 4 New Hospital for Women 1 Caterham Asylum 8 German Hospital 2 Manor Asylum 8 Italian Hospital 1 Claybury Asylum 2 London Temperance Hospital 8 Dartford Asylum 2 Royal Free Hospital 2 Darenth Asylum 1 Hampstead General Hospital 1 Camberwell House Asylum 7 Mount Vernon Hospital, Hampstead 1 Birmingham City Asylum 1 Home Hospital, Fitzroy Square 2 Earlswood Asylum 1 Royal Chest Hospital, City Road 2 Peckham House Asylum 1 North Western Hospital, Hampstead 1 Throat Hospital, Golden Square 1 825 Great Northern Hospital 1 30 Other 26 deaths occurred without the borough; viz., one of a female, in the Grand Junction Canal; one of a male in Hyde Park; one of a male at Westbourne Park Station ; three of males and two of females in the street; and ten of males, and eight of females on private premises. Deaths from diseases of the zymotic class occurred at public institutions without the borough as follows:—Western Hospital 23 (diphtheria 15, scarlet fever 6, enteric fever 2); Grove Hospital 4 {scarlet fever 2, diphtheria 2); Northern Hospital 1 (scarlet fever); St. Mary's Hospital 3 (diphtheria 2, enteric fever 1); West London Hospital 1 (measles); Victoria Hospital for Children 1 (whoopingcough); Children's Hospital, Great Ormonde Street 1 (diarrhcea); and Hanwell Asylum 1 (diarrhoea). UNCERTIFIED DEATHS. There were three deaths in the borough that were not "certified," either by a registered medical practitioner or by a coroner. The causes of death were disease of the heart, premature birth, and cancer respectively. In England and Wales the deaths not certified were 1.4 per cent, of total deaths; the proportion in London was 0T, the same as in Kensington. The subject of uncertified deaths was considered, in the Session of 1893, by a Select Committee of the House of Commons, appointed " to inquire into the sufficiency of the existing law as to the disposal of the dead, for securing an accurate record of the causes of death in all cases, and especially for detecting them when death may have been due to poison, violence, or criminal neglect." The recommendations of the Committee were summed up in ten paragraphs, of which ihe first two were as follows : — " (1) That in no case should a death be registered without production of a certificate of the cause of death, signed by a registered medical practitioner, or by a coroner after inquest. " (2) That in each sanitary district a registered medical practitioner should be appointed as public medical certifier of the cause of death in cases in which a certificate from a medical practitioner in attendance is not forthcoming." No action has been taken, so far, to give effect to the recommendations. INQUESTS. Two hundred and two inquests were held on parishioners, including 46 at places without the borough, mostly at public institutions to which the deceased persons had been removed for treatment. The cause of death is stated to have been ascertained by post mortem examination in 128 cases. Forty-two inquests were held on the bodies of non-parishioners who had died in Kensington. All of the inquests in the borough were held at the coroner's court at the Town Hall The causes of death may be classified as follows: — Deaths caused by disease 99 Deaths caused by violence (103), viz.;— Accidental 88 Suicidal 15 — 108 Total ... 202 The inquests on Kensington parishioners were in the proportion of 8'2 per cent, on total deaths, the rate in the Metropolis being 9"8 percent.; in England and Wales the rate was 6*9 per cent. The relative percentages in 1906 were 8*4, 10T and 6*8, respectively. The deaths from violence (103) were equal to 0'57 per 1,000 of the population in Kensington ; the corresponding rates were 0*55 per 1,000 in London, as a whole, and 0'56per 1,000 in England and Wales. NOTIFICATION OF INFECTIOUS DISEASE. The tables at pp. 31-35 show (1) the number of notifications of all the scheduled diseases in London in the 18 years, 1890-1907; (2) the ages at notification in 1907, (3) the cases notified in the several Metropolitan boroughs, (4) the relative prevalence of the several diseases at different periods of the year, in Kensington and in London, (5) the notifications in Kensington, and in the several divisions thereof, in 1907, and (6) the notifications, gross and proportional numbers, and percentages of removals to hospital, in Kensington, in the years 1897-1907 inclusive. The Kensington notifications in 1907 were 930; 756 in the Town sub-district, and 174 in Brompton. The cases notified in London were 41,038. The Public Health Committee of the London County Council reported at the meeting held on the 26th February, that it was advisable that, for a period of six months, cerebrospinal meningitis ^popularly known as Spotted Fever) should be made compulsorily notifiable within the Administrative County; and they submitted for adoption an order under Section 56 of the Public Health (London) Act, 1891, requiring such notification. The order was adopted, and having been approved by the Local Government Board, it came into force on the 12th March. The Order ana excerpts from a memorandum on cerebro-spinal fever by the Medical Officer of the Board (July, 31 1905) were sent to all registered medical practitioners in the Administrative County of London. The Order was extended for a further period of 18 months from the 13th September. During the year 135 cases were notified; and 25 deaths were registered, including one of a Kensington person at the Paddington Green Children's Hospital. The patient, son of a boot maker, aged 4 months, was admitted in a moribund condition on 13th November and died within an hour. The family of six persons—parents and four children—had come from the Metropolitan Borough of Stepney about a fortnight previously, the infant being ill at the time. Medical advice had not been sought prior to the visit to the hospital. There was no spread of the disease in the poverty-stricken home, which is in a side street south of High Street, Notting Hill Gate. The notifications in London of each of the diseases during the seventeen years, 1890-1907, are set out in the subjoined table. Year. Smallpox. Chicken-pox. Scarlet Fever. Diphtheria. Enteric Fever. Typhus Fever Other Continued Fevers. Puerperal Fever Erysipelas. Croup. Cholera. Relapsing Fever. Total. 1890 60 ... 15,880 5,870 2,877 85 237 206 4,598 550 25 7 29,795 1891 114 ... 11,898 5,907 8,872 27 152 221 4,764 505 23 89 26,522 1892 423 ... 27,096 7,791 2,465 20 147 847 6,934 565 54 7 45,849 1898 2,818 ... 86,901 18,026 8,668 22 205 397 9,700 668 86 4 67,485 1894 1,192 ... 18,440 10,655 8,360 21 162 253 6,080 535 21 2 40,721 1895 978 ... 19,757 10,772 8,506 14 105 236 5,660 451 29 8 41,511 1896 225 ... 25,688 18,861 8,189 6 102 278 6,488 446 13 8 49,699 1897 105 ... 22,876 12,811 3,113 4 65 264 5,801 388 88 1 45,466 1898 85 ... 16,917 11,561 3,082 17 55 250 5,180 310 23 — 87,380 1899 29 ... 18,112 18,868 4.460 14 69 329 5,615 338 15 — 42,344 1900 87 ... 18,812 11,788 4,309 7 78 287 4,776 210 5 — 35,804 1901 1,702 ... 18,887 11,967 3,198 20 48 250 4,604 187 8 — 40,861 1902 7 794 25,708 18,246 10,542 8,405 4 48 318 5,587 192 1 — 71 790 1908 417 ... 12,586 7,571 2,837 22 40 231 4 876 156 — — 27,686 1904 492 10,940 18,485 7,079 1.902 8 28 274 4,952 145 1 — 29,251 1905 74 ... 19,467 6,865 1,549 9 14 291 4,987 124 — — 32,880 1906 81 ... 20,848 7,919 1,606 7 9 297 5,026 116 2 — 85,856 1907 4 25,936 8,585 1,396 3 35 257 4,511 176 — — 40,903* *In addition 135 cases of Cerebro Spinal Fever were notified vide page 32. The Ages at notification of certain of the diseases, in 1907, were as follows :— Age. Small-pox. Scarlet Fever Diphtheria. Enteric Fever. Erysipelas. Puerperal Fever. Cerebrospinal Fever 0—1 year — 269 215 — 185 — 46 1—5 2 7,560 3,872 66 218 85 5— 1 10,730 3,025 162 202 18 10— — 4,209 951 160 189 15 15— — 1,326 381 177 242 3 8 20— 4 866 284 209 287 62 3 25— — 760 360 338 543 140 6 35— 1 166 118 188 829 48 45— — 30 40 62 882 1 55— — 7 20 27 520 1 65 and upwards — 2 5 10 505 Age not stated — 0 0 — — — 32 Cases of Infectious Disease notified in the several Metropolitan Boroughs in the Fifty-two Weeks ended Saturday, 28th December, 1907. Name of Borough. Small-pox. Scarlet Fever. Diphtheria. Enteric Fever. Typhus Fever. Other Continued Fevers. Puerperal Fever. Erysipelas. Membranous Croup. Cholera. Totals. Population. 1901. West. Kensington ... 522 225 40 ... 3 2 127 9 ... 928 176,628 Paddington ... 577 162 85 ... 1 6 124 7 ... 912 148,976 Hammersmith ... 582 214 41 ... ... 7 78 1 ... 928 112,239 Fulham ... 668 604 ' 58 ... 1 15 130 1 ... 1,477 187,289 Chelsea ... 219 155 20 ... ... 4 46 8 ... 447 78,842 City of Westminster ... 419 148 51 ... 2 8 102 1 ... 721 188,011 North. 'St. Marylebone ... 436 124 81 ... ... 7 134 4 ... 736 188,801 Hampstead 1 820 111 21 ... ... 8 56 1 ... 518 81,942 St. Pancras ... 848 342 55 ... 1 5 184 7 ... 1,442 285,817 Islington ... 1,217 483 95 ... 1 28 254 ... ... a,073 884,991 Stoke Newington ... 252 113 15 ... ... 2 81 4 ... 417 51.247 Hackney ... 1,808 514 108 1 2 16 811 29 ... 2,781) 219 272 Central. Holborn ... 157 63 14 ... ... 1 40 1 ... 276 59,405 Finsbury ... 505 146 28 ... ... 3 109 9 ... 795 101,463 City of London ... 97 27 9 ... ... ... 15 1 ... 149 26,923 East. Shoreditch 1 877 220 86 ... ... 8 188 4 ... 1,279 118,687 Bethnal Green ... 1,287 281 55 1 ... 5 247 9 ... 1,885 129,680 Stepney ... 8,147 743 120 1 10 16 478 7 ... 4,517 298,600 Poplar 1 1,289 850 80 ... ... 14 187 9 ... 1,980 168,822 South wark ... 1,276 417 80 ... ... 19 259 5 ... 2,056 206,180 Bermondsey ... 1,011 820 45 ... ... 4 148 4 ... 1,582 180,760 Lambeth. ... 1,479 814 56 ... 6 28 226 18 ... 2,117 801,895 Battersea ... 976 855 44 ... 1 18 175 6 ... 1,570 169,907 South. Wandsworth ... 1,823 627 69 ... 1 28 214 9 ... 2,271 232,084 Camberwell ... 1,573 892 82 ... ... 16 264 18 ... 2,340 259,389 Deptford ... 778 305 84 ... 6 4 145 18 ... 1,285 110,898 Greenwich ... 660 255 18 ... 2 94 2 ... 1,031 95,770 Lewisham ... 604 298 82 ... ... 7 86 4 ... 1,031 127,495 Woolwich ... 1,027 280 27 ... ... 6 113 ... ... 1,458 117,178 Port of London 1 2 2 2 ... ... ... 1 ... ... 8 Grand Totals 4 25,936 8,585 1,896 8 35 257 4,511 176 ... * 40,903 * In addition, 135 cases of Cerebro-Spinal Fever were notified, viz.: —13 at Lambeth; 11 each at Islington and Poplar ; 10 each at Battersea, Southwark, and Stepney ; 8 at Bethnal Green ; 7 each at Bermondsey and Shoreaitch ; 6 at St. Pancras; 4 each at Chelsea, Hackney, Hammersmith, St. Marylebone, and Westminster; 3 each at Camberwell, Finsbury, and Fulham ; 2 each at Deptford. Holborn, Kensington, and Wandsworth ; and 1 each at Greenwich, Lewisham, Stoke Newington, and Woolwich. 33 Table showing the number of Cases of Infectious Disease Notified in Kensington, and in London, in 1907: Arranged in four.weekly periods. Date of Report. For FourWeeks ended Weeks of the Year. KENSINGTON. LONDON. Weeks of the Year. Date of Report. For FourWeeks 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 Ti.tal. January 26 1. 4 ... 40 13 4 ... ... ... 16 ... ... 73 1 1,318 588 116 ... 4 18 417 17 ... 2,479 1. 4 January 26 February23 5. 8 ... 32 11 2 ... ... ... 4 ... ... 49 1 1,407 635 108 1 ... 27 344 13 ... 2,536 5. 8 February 23 March 23 9.12 ... 43 10 ... ... ... 7 1 ... 61 ... 1,351 599 93 1 2 25 330 20 ... 2,421 9.1 March 23 April 20 13.16 ... 32 7 3 ... ... ... 6 ... ... 48 ... 1.409 601 89 1 ... 15 311 16 ... 2,442 13.16 Apiil 20 May 18 17.20 ... 37 14 3 ... ... ... 6 ... ... 60 1 1,475 547 68 ... 1 15 267 12 ... 2,3b6 17.20 May 18 June 15 21 24 ... 57 13 6 ... 1 1 8 1 ... 87 ... 1,732 555 77 ... 1 19 306 15 ... 2,705 21.24 June 15 July 18 25.28 ... 37 15 1 ... 1 ... 14 ... ... 68 ... 1,894 553 84 ... 4 19 319 7. ... 2,880 25.28 July 13 August 10 29.32 ... 30 17 1 ... ... ... 9 2 ... 59 1 2,147 616 61 ... ... 19 310 10 ... 3,164 29.32 August 10 September 7 33.36 ... 29 16 3 ... ... ... 12 2 ... 62 ... 2,076 572 112 ... 2 28 329 9 ... 3,128 33.36 September 7 October 5 37.40 ... 47 18 3 ... ... ... 8 ... ... 76 ... 2,953 838 168 ... 4 20 377 19 ... 4,379 37.40 October 5 November 2 41.44 ... 59 20 9 ... ... ... 10 1 ... 99 ... 3,397 925 152 ... 4 22 438 15 ... 4,953 41.44 November 2 November 30 45 48 ... 42 45 4 ... 1 ... 14 1 ... 107 ... 2 724 839 139 ... 7 13 399 11 ... 4,132 45.48 November 30 December 28 49.52 ... 37 26 1 ... ... 1 13 1 ... 79 ... 2,053 717 129 ... 6 17 364 12 ... 3,298 49.52 Dt cember 28 Totals ... 522 225 40 ... 3 2 127 9 ... 928 4 25,936 8,585 1,396 3 35 257 4,511 176 ... * 40,903 Totals. *In addition 135 cases of Cerebro.Spinal Fever were notified. 34 TABLE III. (Required by the Local Government Board to be used in the Annual Report of the Medical Officer of Health.) Cases of Infectious Disease notified during the Year, 1907. Notifiable Disease. Cases Notified in Kensington. Total Cases Notified in each Sub-District. Number of Cases removed to Hospital from each Sub-District. At all Ages. Under 1 1 to 5. At Ages—Years 25 to 65. 65 and upwards Kensington Town. Brompton. Kensington Town. Brompton. 5 to 15. 15 to 25. Small-Pox ... ... ... ... ... ... ... ... ... ... ... Chicken-Pox ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... Diphtheria 225 4 68 96 25 17 ... 168 57 150 46 Membranous croup 9 ... 7 2 ... ... ... 9 ... 8 ... Erysipelas 127 8 5 9 14 71 25 109 18 8 1 Scarlet fever 622 4 182 804 52 80 ... 480 92 408 82 Typhus fever ... ... ... ... ... ... ... ... ... ... ... Enteric fever 40 ... 2 8 8 20 2 88 7 22 5 Relapsing fever ... ... ... ... ... ... ... ... ... ... ... Continued fever 8 ... ... 1 ... 2 ... 8 ... 8 ... Puerperal fever 2 ... ... ... 1 1 ... 2 ... ... ... Plague ... ... ... ... ... ... ... ... ... ... ... Oerebro-Spinal Fever 2 1 ... ... ... 1 ... 2 ... 2 ... Totals 930 12 229 420 100 142 27 756 174 591 184 35 Table showing the Notifications, in 1907, in the Borough, the Sub.Districts, the Parliamentary Divisions, and the Wards. Area. Scarlet Fever. Diphtheria. Enteric Fever. Continued Fever Puerperal Fever Erysipelas. Croup. Cerebro.Spinal Fever. Totals. Population. Notifications per 1,000 of the population. The Borough 522 225 40 3 2 127 9 2 930 180,500 5.2 Sub.Districts— Kensington Town 480 168 33 8 2 109 9 2 756 130,820 5.8 Brompton 92 57 7 ... ... 18 ... ... 174 49,680 3.5 Parliamentary Divisions— North Kensington 845 141 28 8 2 90 9 1 619 93,070 6.7 South Kensington 177 84 12 ... ... 87 ... 1 811 87,430 3.6 Wards— North K. St. Charles 101 41 5 1 ... 19 2 1 170 22,420 7.6 Golborne 88 54 6 2 1 89 ... ... 195 26,900 6.9 Norland 89 81 12 ... 1 28 6 ... 162 24,000 6.7 Pembridge 72 15 5 ... ... 9 1 ... 102 19,750 5.2 South K. Holland 82 12 8 ... ... 8 ... 1 56 20,860 2.7 Earl's Court 57 17 2 ... ... 6 ... ... 82 18,440 4.4 Queen's Gate 85 12 1 • • • ... 9 ... ... 57 14,580 8.9 Redcliffe 88 84 2 ... ... 10 ... ... 79 19,090 4.1 Brompton 20 9 4 ... ... 4 ... ... 87 14,460 2.6 Table showing Number of Notifications in Kensington—gross, and per 1,000 of the Population in 1897.1907, and percentage of notified cases removed to Hospital. Year. No. of Notifications Received. Notifications per 1,000 of the Population. Percentage of Cases removed to Hospital. 1897 1,457 8.5 59.6 1898 1,004 5.8 60.3 1899 1,046 6.1 58.8 1900 986 5.7 67.1 1901 1,025 5.8 67.0 1902 939 5.3 64.2 1903 738 4.1 61.2 1904 651 3.6 64.5 1905 669 3.7 67.0 1906 826 4.6 71.3 Average of ten years, 1897.1906 934 5.3 64.1 1907 930 5.2 78 0 Note.—The notifications of chicken pox are not included ; they numbered 609 in 1902 and 271 in 1904. TABLE VI. * Comparison of Prevalence of Sickness and Death from Infectious Diseases in 1907 and the Preceding Ten Years. (Rates calculated 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. 1897 o.oo o.oo 1.39 0.05 1.94 0.48 4.33 0.17 o.oo 0.00 0.74 0.13 0.09 0.03 1898 o.oo 0.00 1.05 0.04 1.29 0.15 2.75 0.13 0.05 o.o1 0.63 0.07 0.06 0.03 1899 o.oo o.oo 1.22 0.05 1.49 0.24 2.57 0.06 o.oo o.oo 0.72 0.13 006 0.03 1900 0.03 000 0.92 0.05 1.92 0.16 2.12 0.02 o.oo o.oo 0.66 0.09 0.05 0.03 1901 0.08 o.oo 0.95 0.03 1.41 0.21 2.68 0.08 o.o1 o.oo 0.59 0.06 0.05 o.o1 1902 0.53 0.06 106 0.03 1.04 0.11 2.09 0.12 o.oo o.oo 0.47 0.11 0.08 0.03 1903 0.03 o.oo 0.99 003 0.90 0.13 1.85 0.08 o.oo o.oo 0.35 0.05 002 o.o1 1904 o.o1 o.oo 0.78 0.02 1.04 0.09 1.47 003 o.oo o.oo 0.27 001 0.06 0.03 1905 o.oo o.oo 0.88 004 0.70 0.05 1.85 0.12 o.oo o.oo 0.28 0.07 0'02 0.02 1906 o.oo o.oo 0.83 0.03 0.91 0.11 2.58 0.06 o.oo o.oo 0.21 0.03 0.07 004 1907 o.oo 0.00 0.70 0.03 1.30 0.13 2.89 0.05 0.00 0.00 0.24 0.03 0 01 0 02 •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.' 37 THE ROYAL COMMISSION ON TUBERCULOSIS. At the International Congress held in London in 1901, Professor Koch read a paper in which it was stated that bovine and human tuberculosis not being intercommunicable, the ingestion of the milk or the flesh of tuberculous cattle involved no practical risk of the transmission of tuberculosis to man. This view was vigorously controverted, and at the final meeting of the Congress the subjoined resolution (No. 5) was unanimously passed— " That iu the opinion of the Congress, and in the light of the work that has been presented at its sittings, medical officers of health should continue to use all the powers at their disposal, and relax no effort to prevent the spread of tuberculosis by milk and meat." A further resolution (No. 6) was adopted, viz.:— " That in view of the doubts thrown on the identity of human and bovine tuberculosis, it is expedient that the Government be approached and requested to institute an immediate inquiry into this question, which in of vital importance to the public health and of great consequence to the agricultural industry." A Royal Commission was appointed shortly after the close of the Congress. It having been suggested, by interested parties, as a result of the publication of Dr. Koch's views, that the stringency of procedures intended to prevent the sale for food of man of the milk cf tuberculous cows, and the flesh of tuberculous animals, should be relaxed, the Local Government Board, in a circular letter to Sanitary Authorities, advised that, pending the investigations and report of the Royal Commission, there should be no relaxation on their part, or on that of their officers, in the taking of proper measures for dealing with milk from tuberculous cows, and with tuberculous meat which may be intended for the food of man. The Royal Commission, appointed in August, 1901, was instructed to inquire and report— 1. Whether the disease in animals and man is one and the same ; 2. Whether animals and man can be reoiprocally infected with it; 8. Under what conditions, if at all, the transmission of the disease from animals to man takes place," and what are the circumstances favourable or unfavourable to such transmission. In a second Interim Report issued last year, the Commission submit "a detailed account of the results very briefly stated in the Interim Report of May, 1904, and of the progress which has since been made in the inquiry." In the concluding paragraph of this report " the bearings of the results " at which the Commission have already arrived, are summed up ; it being stated that— " There can be no doubt but that in a certain number of cases the tuberculosis occurring in the human subject, especially in children, is the direct result of the introduction into the human body of the bacillus of bovine tuberculosis ; and there also can be no doubt that in the majority, at least, of these cases, the bacillus is introduced through cows' milk. Cows' milk containing bovine tubercle bacilli is clearly a cause of tuberculosis, and of fatal tuberculosis in man." The facts ascertained in regard to cases of human tuberculosis investigated, " indicate that a very large proportion of tuberculosis contracted by ingestion, is due to tubercle bacilli of bovine source," " introduced through the alimentary canal" ; and the conclusion is drawn that— " A very considerable amount of disease and loss of life, especially among the young, must be attributed to the consumption of cows' milk containing tubercle bacilli." The Commission state that— " The presence of tubercle bacilli in cows' milk can be detected, though with some difficulty, if the proper means be adopted, and such milk ought never to be used as food," and that " there is far less difficulty in recognising clinically that a cow is distinctly suffering from tuberculosis, in which case she may be yielding tuberculous milk," and that " the milk coming from such a cow ought not to form part of human food, and indeed ought not to be used as food at all," and that their " results clearly point to the necessity of measures more stringent than those at present enforced being taken to prevent the sale or the consumption of such milk." In the conclusions thus arrived at by the Royal Commission, ample justification will be found for the desire of the London County Council for increased powers for preventing the spread of tuberculosis through the agency of milk. 38 THE PREVENTION OF CONSUMPTION ; AND THE FIGHT AGAINST TUBERCULOSIS. The prevention of consumption, a subject in which during the last eight years the Kensington Sanitary Authority have, on various occasions, manifested considerable interest, engaged much public attention last year; especially, as we shall see later on, in Ireland, where the disease is relatively far more fatal than in England. Of the matters which occupy the thoughts of public health administrators, none exceeds this in importance, for the " great white plague," as consumption has been well called, whilst being the cause of a vast number of deaths—forty thousand yearly in England and Wales—is both preventable and curable. A cause of untold misery to its victims, and those dependent upon them, it involves an immense drain upon the rates for the relief of the sick, the support of widows and orphans, and otherwise. The question therefore is one of National concern, and all right-thinking persons must desire that no effort should be spared to stamp out so devastating a scourge. As regards Sanatorium provision, much has been done by private enterprise to supply the needs of well-to-do persons, able to pay, and not a little by local authorities in different parts of the country. But hitherto nothing approaching a National system for coping with a National need, has been evolved. Such a system for the benefit of the chargeable poor, could be created by the classification of Poor Law Institutions, and the setting apart of some of them, in each county, as refuges for advanced, incurable cases, so dangerous to the community, and of others, as hospitals, for the treatment of recent cases in the initial stages of the disease when it admits of alleviation or cure. I do not know whether the adoption of this plan would necessitate an application to Parliament; or whether it may be within the competence of the Local Government Board : in any case, however, it would appear to be within their power, as regards the Metropolitan District,—by Section 5 of the Metropolitan Poor Act, 1867, which enables the Board " by order [to] direct that any building for the time being in use as a workhouse be, with such alterations as the Board think fit, used for [an] asylum, [i.e., for sufferers from an infectious disease, or otherwise] and thenceforth that building shall be for the common use of the district accordingly." But the simpler course would be for the Board to issue an order making section 5 applicable to the case of poor persons suffering from consumption, who would then be legally admissible to the Managers' asylums. To enable the Managers to admit non-chargeable persons legislation would be required. So much premised I propose in what follows to submit some account of the state of the " fight " against consumption as now going on in the three Kingdoms—with an ever-increasing intensity which presages ultimate victory to the cause of humanity. And first with respect to England, and as regards the official aspect of the matter, this is the least satisfactory of all. The Local Government Board, though satisfied that pulmonary phthisis (or as I shall for brevity hereinafter call it, Consumption) is an infectious disease to which the provisions of the Hospitals Isolation Act, 1893, are applicable* and that an inmate of a Poor Law establishment in a late stage of the malady with copious expectoration, being a danger to the community, may be lawfully detained by the Guardians,f nevertheless are not yet satisfied that it is one to which compulsory notification is properly applicable, or that they should sanction the establishment of sanatoria for poor inhabitants of London by the only body that could under present conditions undertake the duty, to wit, the Metropolitan Asylums Board—the only ground of objection alleged being the expense it would entail.J THE WORKERS' SANATORIUM. When we pass to the region of private effort the prospect is more hopeful, and last year I had to chronicle a very notable event—the opening of the first sanatorium erected by the National Association for the Establishment and Maintenance of Sanatoria for workers suffering from Tuberculosis. The ceremony was performed, on the 30th April, by Princess Christian, the President of the Association, Her Royal Highness having laid the foundation stone in July, 1906. The Sanatorium, at Benenden, in the County of Kent, is designed for 200 patients ; the part opened provides for about 40. The cost of the site (£5,800 for some 250 acres), and of the buildings which are of a permanent description, (£20,000 = £100 per bed) has been defrayed by voluntary subscriptions; the maintenance of the patients will be undertaken by the Friendly Societies, who have not only guaranteed expenses, by endowing beds, at a cost of 25s. per week each, but will also hand over the members' sick pay for the support of wives and families; and thus will " overcome the anxiety of working men to leave the institution before complete arrest of their malady." A notable part of the scheme is an " after-care farm colony." * Letter from Local Government Board to the late Sir William Broadbent. Vide page 42. † Letter from Local Government Board to the Bath Union Board of Guardians. Vide page 42. ‡Letter from Local Government Board to the Metropolitan Asylums Board. Vide page 42. 39 The claims of the Association which has undertaken this great work were advocated at a public dinner on the 14th May, at which the Prince of Wales took the chair. His Royal Highness, in the course of his speech, explained the position of the Societies. They can, he said, legally maintain beds in sanatoria, but cannot draw upon their capital for building purposes. If the new institution proved to be a financial, as well as an educational success, inducement would be given to form branches of the Association around London, and in different parts of the country. The after-care farm colony was an important department of the sanatorium, enabling the patient to be gradually hardened, so that he may resume full work on his discharge, with the least risk of another break down in health. 'I he working man was paying for his own cure and so rendering himself independent of charity. There were less than a thousand beds in the country for the open-air treatment of working-class sufferers, yet the fatality among the fifteen millions who were members of the friendly societies and the trade unions, was upwards of 28,000 lives per year, from the disease which slowly sapped the vitality of the bread winner: its victims in London alone being counted by thousands. Tuberculosis was a greater disaster to the national life than any war, for it caused a perennial loss. Moreover, it robbed the sufferer of his means of living; it was estimated that the working classes of London lost annually four millions in wages from this terrible scourge, which entailed misery in thousands of homes, and brought, too often, the individual sufferer to end his days in abject poverty. His Royal Highness, acclaiming the " high ideals of this great enterprise," declared that he had " never pleaded for a cause more noble and more righteous." This very interesting occurrence recalled to mind the abortive efforts of the Council, and other Public Health Authorities (1901-1905), to bring about the establishment of metropolitan sanatoria for poor persons suffering from consumption, and there having been reason in May, 1907, for thinking.that those efforts, suspended two years before, might then be renewed with more prospect of success, a resume of former proceedings was given under several headings. ACTION OF THE POOR LAW AUTHORITIES. The first step was taken, on the initiative of the Managers of the Poplar Sick Asylum District, who, in 1900, sought authority from the Local Government Board, to provide for the open-air treatment of chargeable sufferers from consumption. The Board were of opinion that if work of this sort were to be undertaken, it should be by a metropolitan authority, and for the whole of the Metropolis ; they suggested, therefore, the convening of a conference of the Boards of Guardians for consideration of the question. The conference was held in October, 1900, no fewer than 77 delegates, representing 26 out of the 32 Poor Law Authorities, being present. Perhaps the most significant incident was a speech by the chief medical inspector for Poor Law purposes of the Local Government Board ^present unofficially), who, premising that in July, 1899, there were upwards of 1,500 consumptives in the Metropolitan workhouse infirmaries, etc., of whom 400 were in the early stage of the disease, said that if sanatoria should be provided by the guardians, and he was favourable to it being done, they should be made available not only for the chargeable poor, but also " for that class above the very poor who were not able to pay for sanatorium treatment." Chargeable patients not likely to recover (he added), should be sent to institutions where facilities could be given for their friends to visit them. As an outcome of this pronouncement, provision has since been made for these hapless sufferers; some 1,500 beds, in separate wards, (including 85 in Kensington), having been allocated to their use at the Poor Law infirmaries.t The conference, by a unanimous vote, expressed the opinion that " the time had come when provision should be made for the open-air treatment of consumption " ; and " recommended the matter to the consideration of the Local Government Board, with a view to the necessary steps being taken for the carrying out of the proposal. The resolution was transmitted to the Board, who intimated that it, together with other communications of a similar nature, would receivc their consideration. ACTION OF THE PUBLIC HEALTH AUTHORITIES. At one time or another, since 1901, the Borough Councils, with a very few (neutral) exceptions I have addressed communications to the Local Government Board intimating their desire that the Metropolitan Asylums Board should be constituted Sanatorium Authority, with power to utilise their superfluous hospital accommodation for sanatorium purposes. Formal acknowledgments only were received from Whitehall; but the Managers of the Asylums Board manifested, from time to time, considerable interest in the proposal; § and in November, 1902, they signified their willingness to entertain the request that they should become the Sanatorium Authority for London, on an assurance being forthcoming that there was a " general consensus of opinion among the local authorities " that they should do so ; further consideration of the subject, meantime, being adjourned for twelve months. * What follows is mainly excerpts from a " Report of the Medical Officer of Health, on the Prevention of Consumption, and the Sanatorium Question, together with suggestions for the Utilization of the 'Southern Hospital' at Carshalton for Sufferers from Pulmonary Tuberculosis." (No. 5 Monthly Report, May 28th, 1907.J † Detailed information as to this accommodation was given in my annual Report for 1905, page 48. ‡ The list of assenting, dissenting and neutral authorities was given in my Annual Report for 1905, page 47. § The Managers it may here be mentioned have assented to the principle involved in the proposal, by establishing (with the sanction of the Local Government Board) Homes at Rustington and Margate, for the treatment of children—i.e., persons under 16 years of age, suffering from tuberculosis; medical and surgical cases respectively. 40 It was anticipated that, the desired " general consensus of opinion " having been attained, the Managers, on further consideration of the subject, in November, 1903, would have applied to the Local Government Board for the necessary powers; but whilst recognising the " vital and farreaching importance of the proposal to the community at large," they then resolved to " take no further steps in regard to it," without an " authoritative expression of opinion by the Chief Health Authority of the Country, the Local Government Board."* This decision was communicated to the Board, and to the local authorities, in December, 1903. The Board did not at that time disclose their views in regard to the matter. The Public Health Authorities continued their efforts; and at a conference of the representatives of the Borough Councils, convened by the County Council, for the consideration of the Administration of the Public Health (London), Act, 1891, held at the County Hall, in July, 1904, the subjoined resolution was unanimously adopted- " That it is desirable to make provision of sanatoria for the isolation and treatment of persons suffering from consumption, for the Metropolis, as a whole, and under one authority; and that, in the opinion of this conference, the Metropolitan Asylums Board should be such authority." By desire of the conference the resolution was forwarded by the County Council to the Local Government Board, with a request that the matter might receive their immediate attention. The views of the conference were in harmony with those of the Society of Medical Officers of Health (Metropolitan Branch), who by an unanimous vote in October, 1903, had adopted a resolution to the effect that— " By reason of practical experience in regard to provision of hospitals, and the treatment of the infectious sick, the Asylums Board were eminently qualified for the discharge of the duty [of sanatorium authority]. the effective performance of which, by any competent authority, could not fail to be attended with great advantages in the interests of public health." In 1904 increased attention was being given to the question, and the Council of the Charity Organisation Society honoured me with an invitation to read a paper on " The need, of Sanatoria for Persons suffering from Consumption, and how it may be supplied."] The discussion which followed the reading of this paper led to important results, having determined the Society of Medical Officers of Health (Metropolitan Branch) to memorialise the Asylums Board to give effect to their views, and the views of the great majority of the Public Health and Poor Law Authorities, on the subject. The Memorial, which I had been requested to draft, is subjoined, as a succinct statement of the case for sanatoria. It showed— 1. That between 7,000 and 8,000 persons (of whom the large majority are adults in the prime of life) die every year in London from pulmonary phthisis (consumption), the mortality in the male sex being some 40 per cent, greater than in the female sex; and that a much larger number of persons (also chiefly adults) suffer from ill-health arising from the same disease. fin 1899 (the only year for which reliable statistics J are available) a third of the deaths in London from pulmonary phthisis (consumption) occurred in Poor Law Institutions. Many of the sufferers might have been cured could they have obtained sanatorium treatment at the beginning of their illnesses, and a large amount of poverty and charge on the rates been thereby avoided. It is well known that many persons reduced by consumption to a state of poverty, drift into the workhouses, and become a permanent charge upon the rates, often leaving widows and orphans in a state of destitution; whereas many such persons might be cured if sanatorium treatment were made available for them in the early stages of the disease.] * The immediate occasion of this resolution was the receipt of a letter from the Local Government Board, asking to be " furnished with the Managers' observations on a suggestion, made by the Poplar Board of Guardians, that the Asylums Board be authorised to establish sanatoria for the treatment of persons suffering from phthisis, who are chargeable to the Metropolitan Unions and Parishes." The Managers'did not reply, directly, to this request; nor did the Local Government Board afford them the desired " authoritative expression " of their views on the subject. † The paper was printed in my Annual Report for 1904, page 33. ‡ The statistics were obtained by Dr. Downes, Medical Inspector of the Local Government Board for Poor Law purposes, and were communicated by him to the conference of Poor Law Authorities, in 1900, vide page 39. 41 2. That great loss accrues to the community from these deaths, and this morbidity, from pulmonary phthisis (consumption), and many deaths, and much illness and suffering might be prevented, were hospitals provided for the treatment of the disease. 3. That persons suffering from pulmonary phthisis (consumption) may be divided, roughly, into two classes; (1) Those in the primary stage of the disease, which is curable, and not specially infectious; and (2) Those in the chronic stage of the disease, which is incurable and very infectious. 4. That for those in the primary stage of the disease, hospitals are required wherein the patients may be treated with a view to cure; and for those in the chronic stage, refuges wherein the patients may be isolated so as to be prevented from spreading the disease to others. 5. That the existing provision, of hospitals for pulmonary phthisis (consumption) in London is totally inadequate; and that, in connection with such provision as there is, great difficulty (and consequent delay) is experienced in obtaining admittance thereto; more especially when, as usually is the case, the " letter " system prevails, rendering it necessary for patients not only to have to wait long for their turn, and so lose the advantage of special and valuable treatment in the early stage of the disease, but also to find that, when admitted, they are rarely kept in hospital long enough to obtain a cure. 6. That the pressing need for the moment is the provision of a hospital or hospitals, in the country, for the treatment of persons in the acute and curable stage of the disease. 7. That, having regard to the provision now made, or which could be made, in separate wards, at the various Poor Law Infirmaries, the chronic cases might, for the present at any rate, be kept in town where they could be visited by their friends. 8. That the need for Sanatoria arises from the fact that it is practically impossible to treat poor persons in their own homes, or in Poor Law Infirmaries in London, with any reasonable hope of cure. 9. That the great bulk of the cases occur amongst the poorest classes of the people, who are unable to make any contribution towards the expenses incident to sanatorium treatment. 10. That whilst the deaths in London, in 1904, from the diseases admissible to the Board's Hospitals (small-pox, scarlet fever, diphtheria and fever) aggregated only 1,415, of which 1,094 were due to scarlet fever and diphtheria (70 per cent, of them being deaths of children under the age of five years*), the deaths from pulmonary phthisis (consumption) alone, and exclusive of nil other forms of tubercular disease, were 7,738+ in number, and of these a vast proportion were deaths of adult men and women (men more especially) in the prime of life. 11. That the money value to the community of the lives lost every year from this preventable and curable disease is enormous, and immensely transcends any possible cost to the rates by sanatorium provision. Your Memorialists having given all.these points consideration, and believing that it would be in the best interests of the community, earnestly pray the Managers to take necessary steps, as they may think desirable, forthwith; and respectfully suggest the following: — 1. That an Order of the Local Government Board be obtained to make Section 5 of the Metropolitan Poor Act, 1867, applicable to the case of " poor persons " suffering from pulmonary phthisis (consumption) ; and if necessary— 2. That an Act be obtained to make the provisions of Section 80 of the Public Health (London) Act 1891, applicable to pulmonary phthisis (consumption) as if such disease were therein mentioned as well as "fever, or small-pox, or diphtheria The Memorial was presented to the Managers in April, 1905, the honour of representing the Metropolitan Medical Officers of Health having devolved on me. Speeches in support of the prayer were made by the Chairman of the Council of the National Association for the Prevention of Consumption (the lateSir William Broadbent) and the delegates of the Hospital Sunday Fund (Sir E. Hay Currie) and the Hospital Saturday Fund (Mr. W. G. Bunn). The Society was honoured on the occasion by the presence of representatives of The Royal Institute of Public Health, the Royal Sanitary Institute, and the National Health Society. The Chairman of the Board, in a sympathetic reply, acknowledged the importance of the matter, and the influential character of the deputation. A shorthand note of the proceedings was widely circulated by the Managers, who desired to elicit the views of the Public Health and Poor Law authorities on the question. The Memorial was referred to the General Purposes Committee, and forwarded subsequently to the Local Government Board, by whom in June, 1905, the Managers were informed that they were " obtaining information on the whole subject," and " were not then in a position to express * The deaths from these diseases of persons over 20 years of age, were 21 only. t Of the 7,738 deaths, 897 (12 per cent.) were of persons under 20 years of age, and 645 (8 per cent.) of persons aged 60 years and upwards. The deaths between 20 and 60 years of age were 6,196, and 80 per cent of the total number. 42 an opinion on the question as to whether the Managers should undertake the new duties suggested." The duty of " obtaining information " had been entrusted to one of the Board's medical inspectors,. Dr. H. Timbrell Bulstrode, who, so far back as 1903, in his "Milroylectures on The Causes, Prevention and Control of Pulmonary Phthisis, delivered before the Royal College of Physicians, and published in " I he Lancet" had expressed his views on the question generally; declaring sanatoria, as " curative agents," to be " almost indispensable " ; and, " in the matter of prevention," as being likely to " curtail the prevalence of the disease, by aiding education." The sanatorium question, moreover, was " not so much one of the infectivity or communicability of phthisis, as one of inability to do much good to a poor patient in his insanitary home and surroundings "—the infectivity of the disease being " proportional to bad home influences—scant accommodation, and insanitary conditions, productive of low vitality of the host of the tubercle bacillus." " In unwholesome circumstances, and prolonged exposure, it was said, pulmonary tuberculosis assumes a higher infective power than it manifests in the relatively healthy conditions of a hospital for consumption "; whilst the facts as to " cured " tuberculosis, as seen in the post-mortem room, " show how much good may be done in aiding the healing process, by sanatoriums, and by better conditions of living." Views of International Congresses and of Local Government Boards.—It may not be out of place here to mention that the International Congress on Tuberculosis, held in London, in 1901, declared sanatoria to be " an indispensable part of the measures necessary for the diminution of tuberculosis"; similar testimony was borne by the Congress held in Paris in 1905, and by the Local Government Board for Scotland, in 1906. At an earlier date the Local Government Board for Ireland had striven, by every available means, to induce the Boards of Guardians to provide separate accommodation for the isolation of consumptives, which one half of them are stated to have done. Official Action.—The Poor Law Inspectors of the Local Government Board for England, moreover, lose no opportunity for impressing on Boards of Guardians the need for isolation of consumptives; and rightly so, seeing that the Board, in 1903, informed the National Association for the Prevention of Consumption, that phthisis comes within the definition of an " infectious disease," and that provision may be made for persons suffering therefrom under the Isolation Hospitals Act, 1893—an Act " for enabling County Councils " (other than the London County Council, as the Act does not apply to London) " to promote the establishment of hospitals for the reception of patients suffering from infectious diseases"—a duty which, in the Metropolis, was devolved upon the Asylums Board by the Metropolitan Poor Act, 1867. The Board added that " although pulmonary tuberculosis is not one of the diseases [named], the provisions of the Act may, under Section 26, be applied to that disease," by an order of the County Council, which, however, requires the approval of the Board.* In July, 1905, moreover, the Board, in response to an inquiry made by the Board of Guardians of the Bath Union, informed that body that they would be justified in compulsorily detaining a person suffering from consumption, attended with copious expectoration—for the reason that he would1 be in a condition to spread this infectious disease. The Asylums Board's Decision.—In February, 1906, the General Purposes Committee of the Asylums Board reported on the reference of April, 1905, and, " in the absence of any authoritative expression of opinion by the Local Government Board, and as a result of [their] consideration of the question in all its bearings," [they] recommended— " That the Managers do forward to the Local Government Board a copy of the memorial addressed to the Managers by the Metropolitan Branch of the Incorporated Society of Medical Officers of Health on the 15th April, 1905 ... on the subject of the provision of hospital accommodation for the treatment and isolation of patients suffering from pulmonary phthisis; and " That the Local Government Board be further informed that, having regard to the uncertainty which prevails as to the probable nujnber of patients who would come under the scheme referred to in the memorial, and to the great prospective cost to the ratepayers of the Metropolis, the Managers would be glad to receive the judgment of the Local Government Board upon the prayer of the memorial referred to." The report was adopted. The Local Government Board's Decision.—In March, 1906, the long awaited decision of the Local Government Board was received; it informed the Managers that the subject [of the suggested establishment by them of sanatoria for the treatment of patients suffering from phthsis] "has received much careful consideration on the part of the Board, but that the information before them at present does not appear to afford sufficient justification for the very heavy outlay which would be involved in the proposal." * The Board's letter was published in the issue of The Times for May 23rd, 1903. 43 The accumulated experience of years, and the expression of the views of Congresses, of Public Health Authorities, and of experts like Koch, and others scarcely less eminent, as to the value of sanatoria, had not sufficed to raise the question to a higher level than one of monetary consideration ; a consideration which, nevertheless, might be pleaded as an overwhelming justification for the establishment of sanatoria, having regard to the cost of consumption to the community, through the loss of wages (to mention no other source of loss), adverted to by the Prince of Wales. Other cities, only less important than London—Liverpool, Birmingham, Edinburgh, Glasgow, Dublin,—recognise the value of the open-air treatment, and have provided, or decided to provide sanatoria. How great the need of London is may be established by a statement of the fatality of tuberculosis in 1906. The total deaths registered were 6,908, including 6,775 from pulmonary phthisis alone; and of these latter, no fewer than 5,583 (82-4 per cent, of the entire number) were of persons between the ages of 20 and 60 years,* the best working period of life; the majority of them, moreover, being of the male sex—the bread winners. In concluding this portion of my fifth monthly report (May 28th), dealing with this question, I asked: " Can nothing be done to stop the plague ?" In an earlier part of the report I had stated that there was reason for thinking that the efforts to bring about the provision of sanatoria, suspended two years previously might be renewed then, with better prospect of success: how, I proceeded to explain. THE SOUTHERN HOSPITAL. When urging the allocation of the Gore Farm hospitals to sanatorium purposes, in 1902, I referred also to the " Southern Hospital" which the Managers of the Asylums Board had decided to erect at Carshalton, for convalescent fever and diphtheria patients. From what I knew of the principle on which that hospital was designed, I expressed the opinion that it would be well suited for use as a sanatorium. It was handed over to the Board by the builders in the autumn of 1906 ; and in November a Special Committee was appointed " to consider and submit a report as to the best use to which [it] can be'put." The report submitted 27th April, 1907, was to the effect that the hospital was " not required for the presentthe Committee therefore discussed the question "whether it was desirable or expedient to use the hospital for any other purpose? " In this connexion, they said, three (but really only two) "alternatives" had been suggested. The second of these need not detain us; it was " to make use of the hospital as an industrial home for the treatment and training of sane epileptics and feeble-minded cases." The first " alternative" suggested was "To make use of the buildings for the treatment of patients suffering from consumption" (the italics are mine) " allocating a certain number of beds to each of the metropolitan parishes and unions, in proportion to their respective populations " ; but for what does not seem a very cogent reason the Committee did " not consider that the time [was] ripe for the Managers to come to a definite decision on the subject; they therefore recommended a third " alternative," namely, " to keep the hospital unoccupied for a further 12. months, and then reconsider the whole question ;"f and they asked the Managers to adopt the following recommendation— " That inasmuch as the accommodation already provided by the Board in their acute and convalescent hospitals is sufficient for their present purposes, and is likely to be sufficient for the needs of the metropolis for some time to come, the Managers are of opinion that the Southern Hospital is not now required for fever hospital purposes." * Between 20—40 years, 2,969 ; between 40—60 years, 2,614. †An ineffectual effort was made, in July, to get ths question of the use of the hospital reopened by a motion to rescind the resolution. More success attended a further effort on November 9th when the following notices of motion were considered— That the Board's resolution of the 27th April, 1907, deferring for twelve months further consideration of the question of the purpose to which the Southern Hospital should be applied, be, and is hereby rescinded. That, subject to the sanction of the Local Government Board, the Southern Hospital be opened for the accommodation and treatment of consumptive cases in the early stages, chargeable to the Metropolitan boards of guardians. The first motion was carried by 38 votes to 3, the Managers being thus set tree to consider the " purpose to which this hospital should be applied." Consideration of the second motion was deferred until 23rd November, when an amendment to it was moved as follows:— " That, inasmuch as the Local Government Board, in their letter of the 22nd March, 1906, on the subject of the proposed establishment by the Managers of sanatoria for the treatment of consumptive patients, stated definitely that the information then before them did ' not appear to afford sufficient justification for the very heavy outlay which would be involved in the proposal,' the Managers are not prepared to sanction the use of the Southern, or any other Hospital, for the accommodation and treatment of patients of this class." After a long debate the amendment was defeated on a show of hands by 28 votes to 24 and on a division by 33 to 23. A second amendment was moved, and carried, to the effect:— "That, in the absence of instructions from the Local Government Board in reply to the Managers' last communication on the subject of the provision of accommodation for tuberculous patients, this Board cannot see their way, at present, to take any useful action." On the amendment being put as a substantive motion, a further amendment, to omit the words " at present," was carried by 34 votes to 24, and the motion, as amended, by the omission of those words, was adopted. The " last communication " of the Managers to the Local Government Board, mentioned in the second amendment, was based on a report (17th February, 1906) of the General Purposes Committee (i.e., the Board, sitting in Committee) to whom the Memorial of the London Medical Officers of Health had been referred. (Vide page 42.) 44 The recommendation, moved by the Chairman of the Committee (who is now Chairman of the Board) was adopted. The "twelvemonths" have expired, but reconsideration of the question of the use to which the hospital should be put has not been resumed. Possibly it may be by the new Board. Description of the Hospital.—It may not be out of place here to say a few words in regard to the site and construction of the hospital, which is a fine structure ; and should be, indeed, seeing that it has already cost nearly a quarter of a million, and that when equipped for use each of its 800 beds will have entailed an outlay not far short of £375.* The dry and well-drained site is worthy of such buildings ; " the land lies high, a large portion of it being upwards of 300 feet above ordnance datum ; the soil is chalk with a gravel formation, and the area is about 135½ acres "; about 90 acres being enclosed within a fence, and the remainder let on an agreement terminable at short notice. Any amount of additional land is available should it be needed for an " after- care farm colony." The air on those Surrey hills is delightful and invigorating; the prospect extensive and beautiful. The unit of construction is a single storey double cottage, resembling two capital letters "L" joined together horizontally; the upright stroke representing (for each half cottage) the dormitory; the horizontal stroke the day-room. Each half of the cottage is constructed for 15 patients, and is fitted with all requisite administrative conveniences,—an airing court (with a southern aspect, 85 feet by 60 feet) lying between the two dormitories. Of these double cottages there are twenty-four, arranged (en echelon) in three groups, of four on either side of the central roadway—a " cottage staff block " being attached to each group. By reason of this arrangement sunlight falls on every building from sunrise to sunset; no shadow being cast by any one building to the detriment of any other. A space of about 55 feet separates the angle of each cottage, laterally, from the nearest point of the adjacent one—to the right or to the left, as the case may be ; and there is a space of about 250 feet between the central group of four cottages, and the adjacent group, in front and rear. At the southern and highest parts of the site, there are two isolation blocks, containing several wards of varying dimensions; but which are not likely to be required for isolation, should the hospital be used as a sanatorium. The walls of each cottage are finished with a Keene's cement dado, the upper part being painted or distempered; all corners are rounded off; the flooring is of maple, stained and polished—that of the isolation blocks being polished teak; the ceilings are plastered. Each dormitory is 58-ft. x 20-ft, x 12-ft., giving 928 cubic feet of space per patient; the day room, 33-ft. x 22-ft. x 12-ft., allows nearly 600 cubic feet per patient. The lighting, ventilation, and heating arrangements are all that could be desired. Every requisite has been provided; electric light everywhere, sewerage, water supply, etc. The land rises gradually from the entrance lodge at the north end (290 feet above ordnance datum) to the isolation blocks on a plateau 325 feet above that level. The roadways are made, but the very ample spaces between the various buildings have not been laid out, and this work, alone, would occupy many patients for months. The hospital having been designed for fever and diphtheria convalescents, mostly children, no common dining hall has been provided—a fact which may be not without influence in determining the particular class of patients to be admitted, should it be decided to use it as a sanatorium. There is, however, abundant space for any necessary additions to the existing buildings. Accommodation has been provided for a resident staff of 213 persons + ; and for 800 patients, including 720 in the cottages (a number that might be raised to 768 by utilising available rooms in the administrative section of the cottages), irrespective of 80 in the isolation blocks. As already stated, it is the dreaded "heavy outlay,"J the "increased expenditure," that would be involved, were the Local Government Board to sanction the establishment of sanatoria, that blocks the way to the realization of our desires. An interesting question therefore suggests itself, viz.—Whether, as in the case of the Benenden Sanatorium, the hospital might not be made self- * At Michaelmas, 1906, the amount borrowed totalled £245,195 ; the amount sanctioned by the Local Governmen Board being £299,664 (Annual Report of the Asylums Board, for 1906.) flncluding Medical Superintendent and four Assistant Medical Officers, Matron, assistant matron, six sub-matrons, housekeeper, 48 "house mothers" (one for each half-cottage), night superintendent, 18 night assistants, 33 male officers and servants, 24 nurses and superior servants, steward, assistant steward, engineer and gate porter. A smaller staff would suffice for a Sanatorium (Vide page 54). ‡ It is open to question whether the " outlay " would be so great as expected. Suppose my suggestion to utilize the Southern Hospital as a sanatorium were adopted, the expense there need not be greater relatively than that at Frimley Sanatorium (vide page 54). The average stay of patients at Frimley is about six months; the average weekly cost per patient twentyseven shillings. On this basis should the Southern Hospital deal with 2,000 cases yearly, the approximate cost would be £56,000—less than the amount of one third of a penny in the £ of Metropolitan rateable value. Assuming the results of treatment to be comparable to those attained at Frimley, the benefit of the hospital to the community, immediately by its operations, and indirectly as an object lesson, and as a good example sure to be followed, would be great and undeniable. So far indeed from increasing the burden to the rates (for consumptive patients in Poor Law Infirmaries must cost nearly as much as patients at Frimley) there is indeed reason for believing that, instead of imposing on the ratepayers any additional burden, the carrying out by the Managers of the " proposal " (for giving effect to which a single section Act might suffice) would prove, in the long run, a strictly economical procedure ; leading, as it should, to the saving of many lives, and the restoration to usefulness of many consumptives who, under existing conditions, constitute a serious burden to the rates—for they languish and die, leaving, often, destitute widows and orphans to be brought up, at the public charge, in the surroundings of the workhouse, or, at the best, in the suburban schools in which, happily, though at great cost, "pauper" children are now usually educated and trained to useful occupations. 45 supporting, by a charge for maintenance of, say, thirty shillings per week for each patient? This, for 800 beds, would amount to a total of £62,400 ( =⅓d. rate)—a sum which, surely, the great Friendly Societies could well afford to pay, if they cared to secure the beds. For this expenditure, allowing for an average stay of three months (the term contemplated at Benenden), upwards of 3,000 patients might be treated in the course of the year; but the labour of the patients, in cultivation of the land, should, whilst benefiting them, reduce the cost of maintenance considerably. In the alternative, the suggestion of the Special Committee, to allocate beds to each of the Metropolitan Unions and Parishes should be considered; but not on the basis suggested, for that would involve giving more beds to Hampstead, with its phthisis death-rate of 0.67 per 1,000 persons living, than to Holborn, with a rate (2.37) nearly four times as high. It may be pointed out that the Public Health Authorities could maintain beds under the provisions of section 75 of the Public Health (London) Act, 1891; and lastly, if from the design of the buildings, for a special purpose, it should be thought undesirable to admit adults, the hospital might be utilised for children suffering from tuberculosis. The adoption of either of these courses would be better than allowing the institution to lie idle. But supposing it were decided to treat patients suffering from consumption—as patients suffering from other infectious diseases are treated—without charge, a rich return would be assured by the many lives saved, and the many more prolonged, by " cure," or arrest, of this fell " white plague." I will only further say, that, in my opinion, the use of the institution should be restricted to bona-fide inhabitants of the Metropolis, and for the benefit of non-chargeable sufferers in the early stages of the disease. In other words, it should be regarded as a hospital for cases admitting of "cure" or alleviation of the disease; and not at all as a refuge for incurable patients. For advanced chargeable cases, large, and probably adequate, provision has been made at the Poor Law Infirmaries. For non-chargeable sufferers in advanced stages of the disease provision might be made in country retreats, at a cost which need not exceed £100 per bed to judge from what is being done for that amount at the Benenden Sanatorium. The Movement in Ireland.—In 1901, and again in 1903, the Local Government Board for Ireland, by the circulation of advisory letters, posters, and leaflets, impressed upon the Boards of Guardians, and all others whom it concerned, the necessity of isolation for persons suffering from consumption, and their annual report for 1906 describes a " systematic plan consisting of four elements," on which, " in the opinion of the Board's Medical Department, the prevention of consumption should be dealt with." It may be summarised as follows; viz.—(1) By segregation of advanced cases in hospitals, (2) By provision of sanatoriums for the treatment of the disease in an incipient stage, (3) By establishment of tuberculosis dispensaries, for advice and treatment, in large centres of population, and (4) By the appointment, by Sanitary Authorities, of local educative committees, and the circulation of leaflets, etc., relating to the disease. Last year important measures were taken for supplementing official action; a "Tuberculosis Exhibition " was opened at Dublin (in October) by the Lord Lieutenant, who was accompanied by the Chief Secretary; many eminent members of the medical profession and other distinguished persons from various parts of Ireland being present. The exhibition, which had for its object spread of knowledge of the means for bringing about arrest of the progress of consumption, was promoted by Lady Aberdeen, as President of the Women's National Association of Ireland, and was taken to various parts of the country, where lectures were delivered in connection with it. His Excellency, referring to the importance of improving the sanitary conditions and conveniences of the homes of the people, as a means for preventing the spread of consumption, stated that under the Labourers' Dwellings Acts, 20,000 cottages had been built in the last twenty years ; and that, arising out of recent legislation, there were applications for an additional 50,000—a splendid opportunity being thus furnished for local authorities to grapple with an important part of the great problem of the tuberculosis plague. Among the subjects which interested King Edward, one to which he gave special attention was this question of Consumption, and he read a message from His Majesty as follows:— " I am commanded by the King to express his good wishes for the success of the Tuberculosis Exhibition, the first of the kind ever held in Great Britain and Ireland, on the occasion of its being opened by you to-day. His Majesty is greatly interested in the problem of checking the progress of this disease, and he trusts that the exhibition may be the means of attracting the attention of the public to the terrible ravages caused by this scourge, and to the efforts which are now being made to arrest its progress.—Knollys." In connection with this interesting event an adress on "What the Public can do in the -fight against Tuberculosiswas delivered by Dr. William Osier, F.R.S., Regius Professor of Medicine at Oxford, his Excellency the Lord Lieutenant presiding. The lecturer emphasised the necessity for compulsory notification of consumption—" the only possible way to get at the disease being to know where it was; " the provision of separate wards for isolation of advanced cases, and of sanatoria 46 for recent cases. He referred to the victory achieved by medical science in the abolition of typhus fever, the scourge of Ireland in former days, and predicted that, if proper measures were adopted, the far more terrible scourge of tuberculosis—the cause of nearly one-sixth of the deaths in Ireland in 1904—would in one or two generations be in like manner exterminated.* Subsequently the " Consultation Committee," formed by Lady Aberdeen, held a meeting, her Excellency presiding, and delegates from all parts of Ireland being present, when a resolution was adopted urging the need for powers enabling the County Councils to erect and maintain hospitals, sanatoria, and dispensaries for the treatment of consumptives. The Chief Secretary, moreover, received a deputation from the County Councils' General Council, which laid before him the views of that body as to the measures which the Government should take for dealing with the problem of tuberculosis. Mr. Birrell, in reply, said, in effect, that the time had come when all right-minded people must do all in their power to combat consumption. Sanatoria were to be established in Belfast, Cork and Dublin. There was a considerable number of workhouses occupying healthy and isolated sites which might be utilised for sanatorium purposes, and he would suggest to the Local Government Board that they should ascertain what workhouses, no longer needed as such, might be so utilised. It was eminently desirable, moreover, that there should be a statutory obligation on medical men to notify consumption, and he would base a representation to the Treasury for assistance, on the necessities of the situation, and the urgency of destroying this dreadful disease, which, if allowed to continue at the present rate, would reduce Ireland to a very awful condition. He thought that a measure authorising the erection of sanatoria, and providing for notification would have to be introduced in the next Session of Parliament, and he hoped that, with the aid of all gentlemen of position in Ireland, they might soon be able to begin the campaign against the shocking state of affairs. [A Bill has been drafted to give effect to these views, and is to be introduced into the House of Commons during the current Session.] The Movement in Scotland.—The Local Government Board for Scotland, in March, 1906, issued a circular to Local Authorities on the " Administrative Control of Pulmonary Phthisis," in which they dealt with the necessity for provision of sanatoria, and announced their willingness to give favourable consideration to any application for their approval to compulsory notification, provided they were satisfied that the Local Authority making it were in a position, and were ready, to deal effectively with the cases notified to them; i.e., by provision of sanatorium accommodation for isolation and treatment of sufferers in. the different stages of the disease. In their annual report for 1906 the Board refer to various gratifying results consequent upon the issue of the circular— including sanatorium provision by iocal authorities, and the giving of their approval to applications for compulsory notification powers. With reference to this circular the Board observe that— " The most important point to which the attention of the Local Authorities was directed, was that ' pulmonary phthisis (that is tuberculosis of the lungs or consumption) is an infectious disease within the meaning of the Public Health (Scotland) Act, 1897;' and that ' the sections of that Act applicable to other infectious diseases are equally applicable to pulmonary phthisis, and the obligation resting on the Local Authority to deal with and control infectious disease extends to pulmonary phthisis.' For the effective application of the Public Health Act to pulmonary phthisis, it was pointed out that a system of notification is essential." The question in Scotland, as in Ireland, is attracting popular attention, and the opening (in October last) of additional accommodation at the Royal Victoria Hospital for Consumptives at Craigleith, gave occasion for an important speech by the Right Hon. A. J. Balfour, M.P., who performed the ceremony. In the course of his observations, Mr. Balfour said that— " If they could not destroy and expel the tubercle bacillus from among them, they could reduce its power to do evil to a degree which might seem to them at the moment incalculable. Referring to the case of typhus, he doubted whether there was a single case in Edinburgh at the moment, and it might be that their ohildren would live to see the time when consumption would be as little known in their midst as typhus was now. They had made the conditions of infection with regard to typhus so fmall that the power of resistance of the community at large was amply adequate to prevent its making any lodgment of a serious kind in their midst. That was the ideal to which they looked forward with regard to tuberculosis. Consumption was a disease which could be dealt with successfully, if taken early, but if, through ignorance or neglect, it was allowed to get a fatal grip upon the organism, all that could be done was to smooth the dving months or years of the sufferers. Sanatoria which provided something more than a personal benefit to the sufferer, ought to be regarded as a great social gain to the community at large. Poor men when attacked by this insidious maladv, were almost inevitably induced to go on with the work on which their families depended, until weakness and the progress of the disease rendered further struggle hopeless and impossible. Then came misery and bankruptcy, and society found itself charged with the maintenance of the family in relative degradation. Could any * An abstract of the address was published in the British Mcdical Journal, October, 19th. 47 benefit be conceived greater, not merely to the man affected, but to those dependent on him, and to the society of which he was a part, than if in the early stages, before he was driven by the disease from useful work, he could place himself in a sanatorium? There would then be not merely a chance, but a high degree of probability, that he would be restored to his family and to those dependent on him, as efficient a member of society, as he was when he was driven from his own roof tree.' [I may perhaps be pardoned for mentioning that in November, 1905,1 addressed a letter to Mr. Balfour, when Prime Minister, drawing attention to the great mortality from consumption, and to the fact that "the disease is preventible, often curable at the early stage, and communicable." I stated that the London Medical Officers of Health were unanimous in desiring that the Metropolitan Asylums Board should become the Sanatorium Authority for the Metropolis ; and "having regard to the national importance of the question," I transmitted a report of "the proceedings at the representative deputation to the Board in (April (1905), at which they were invited to acquire that position."] COMPULSORY NOTIFICATION OF CONSUMPTION. The views of the several Local Government Boards on the subject of compulsory notificatiou differ somewhat widely. The Local Government Board for Scotland are favourable to the practice, and in a communication I had the honour of receiving from them in November it was stated:— (1) That the Local Authorities of the Burghs of Edinburgh, Brechin, and Pennicuick have, with the Board's approval, extended the Infectious Disease (Notification Act) 1889 permanently to include pulmonary phthisis, (2) Th it the Local Authority of the Lower Ward District of Lanarkshire have extended the Act for five years, and (3) That the Cupar Burgh and the Linlithgow and Bathgate Districts of the County of Linlithgow have also extended the Act for the period of five years." Nothing to the contrary being said, it is to be presumed that the provisions of the notification sections are applicable in their entirety; but no doubt the Local Authorities are exercising their powers with discretion. The view of the Local Government Board for Ireland on the subject, as explained in a communication I had the honour of receiving from them, also in November last, is that notification "should be carried out by special legislation, and that safeguards should be provided to ensure that no unnecessary restraint is placed on the liberty of consumptive patients. If notification is used merely for the purpose of gaining information as to the locality of the disease, and helping the sufferer by giving assistance and advice which would be useful in protecting other members of his family from contracting the disease, [they consider that it would, under efficient and sympathetic administration, be a most useful public health measure." To this it may be added' that at the meeting of the " Consultation Committee," at Dublin, above referred to (page 46), at which her Excellency the Countess of Aberdeen presided, delegates from all parts of Ireland being present, the following resolution was adopted:— " That it is desirable that the Government should, without delay, introduce special legislation with the object of making it compulsory to notify all cases of pulmonary tuberculosis, taking care, at the same time, to protect consumptive patients from any undue interference with their liberty." And as we have seen (page 46) not only did the Chief Sectetary, when receiving a deputation, assent to this view, but he has prepared a Bill to provide for the compulsory notification of consumption, which he hopes to carry during the present Session. In England the opinion that in order to be effective, notification of consumption must be compulsory, seems to be gathering force. The Conference of delegates of the Metropolitan Sanitary Authorities, held at the County Hall, in July, 1904, passed a resolution in favour of compulsory notification, as did the representatives of the Borough Councils at the conference convened by the Paddington Council, and held in June last. This view, however, is not yet accepted by the Local Government Board, who some time since, in response to an application from the Barnstable Rural District Council, urging that pulmonary phthisis should be included amongst the list of notifiable diseases, intimated that it was not a disease to which compulsory notification could, with advantage, be applied. It will be interesting to see in what manner the Chief Secretary deals with the question in his promised Bill; it will probably be by special legislation, as the Local Government Board for Ireland suggest, and on the lines adopted by Parliament in giving compulsory notification power in The Sheffield Corporation Act 1903, Section 45 (s.s. 5) of which reads as follows :— " No provisions contained in any general or local Act of Parliament relating to infectious disease shall apply to Tuberculosis of the lung or proceedings relating thereto under this Section." With regard to this Act, which appears to be giving satisfaction, it may be interesting to state, briefly, the " method adopted in working the Section," as described in a communication with which I was favoured some time since by the Medical O fficer of Health of the City of Sheffield, as follows— " Two special inspectors are employed to visit houses where cases of consumption are notified. The inspector leaves a copy of instructions with the relatives, or with the patient. He also advises patients 48 with regard to keeping the windows open as much as possible, and furnishes the poorer of the patients with pocket spittoons, free of charge. On his first visit he gets all the particulars and history of the case, and pays subsequent visits as often as possible. In all cases when the house is dirty, or the patient is much confined to the house by his illness, the room is disinfected forthwith by the inspector with a formalin sprayer." This is precisely the " method " adopted in working the system of voluntary notification of phthisis, which has been in operation in the Royal Borough since January 1st, 1902. But as regards disinfection, we have no compulsory powers, such as the Section confers upon the Sheffield sanitary authority; and whereas in that City a very large proportion of cases of the disease come to the knowledge of the Medical Officer of Health, I estimate that in Kensington about one fourth only of the total number of cases are notified to me; and these, with a few exceptions, by the Poor-Law Medical Officers, the sufferers being persons in receipt of relief. With regard to the success of the system as compared with our system of voluntary notification (dealt with at page 49) it appears that at Sheffield, in a period of 3£ years ended 30th April, 1907, there were 1,773 deaths from " tuberculosis of the lung," the " number of persons who died from this cause without being notified" being 121, or a little over seven per cent.; whereas in Kensington, in the same period of time, the deaths having been 734, the number of persons who died from tuberculosis of the lung, without being notified was 387—in round figures, 53 per cent.; i.e., nearly eight times as large a proportion as in Sheffield. The Medical Officer has " no doubt there has been some little failure to notify on the part of the medical practitioners; " but this is " only what one would expect with a new Act." There is, moreover, a " small percentage of cases—about one or two per cent.—where the medical man does not wish the inspector to call [at the house of the patient], in which case the medical attendant is asked to fill in [an] enclosed form and to use a copy of [an] enclosed leaflet entitled ' Advice with regard to Consumption.' " We are told that " there has been no opposition on the part of the public, or the medical practitioners: the provisions of the Act are being carried out without friction," and the Medical Officer is of " opinion that the work is doing a considerable amount of good." As to isolation, it appears that " each of the Boards of Guardians provide accommodation for a certain amount of open-air treatment at the workhouse-hospitals," and there is no doubt that a considerable number of the advanced cases are thus isolated," whilst it has been " decided to use a pavilion in one of the City hospitals for infectious diseases for a similar purpose." Amongst the documents forwarded, was a letter addressed by the Medical Officer to medical practitioners which may be cited, as indicative, inter alia, of the considerate method adopted in execution of the exceptional powers conferred upon the Corporation. "The voluntary notification of tuberculosis [it is stated] had been extremely satisfactory," [so far as it went ] and " one of the most important reasons for seeking compulsory powers .... was to do away with any risk to the profession who, in voluntarily notifying such cases might be considered to be betraying a professional secret." It is noted that " great care has been taken in keeping all the requirements relating to [consumption] quite separate from those contained in the general Acts relating to other infectious diseases; " the object of the Corporation being to " prevent at any time injustice being done to a large number of persons suffering from tuberculosis who daily follow their employment, or of necessity must take open air exercise." Under the heading ' Special Cases,' the Medical Officer says " there will probably be a few cases where the medical practitioner desires to look after the preventive measures to be adopted by his patient. In such cases a statement to this effect should be made at the time of notifying, and an undertaking given that the practitioner will see that the required preventive measures are carried out, and will report on their fulfilment at least twice in every year .... If these conditions be fulfilled no visits will be made to the patient's house by any member of the staff of the Health Department"; and, finally, "in order that citizens may know of the obligations cast on medical practitioners, public notice [was] given of this by advertisement in the newspapers, and by handbills and otherwise in the City." Worked in so considerate a manner, it is no wonder that " the provisions of the Act are being carried out smoothly and without friction." The subjoined tabular statement will be perused with interest. 49 Deaths from Phthisis—November 1st, 1903, to April 30th, 1907. Period, No. of Deaths from Tuberculosis of the lung. No. of Persons who have died from Tuberculosis of the lung without being notified. Sheffield. Kensington. Sheffield. Kensington. Half-year to April 30th, 1904 315 108 19 61 Half-year to October 31st, 1904 241 120 19 72 Half-year to April 30th, 1905 272 108 19 67 Half-year to October 31st, 1905 232 76 11 33 Half-year to April 30th, 1906 217 108 13 57 Half-year to October 31st, 1906 211 106 19 49 Half-year to April 30th, 1907 285 108 21 48 Totals 1,773 734 121 387 It would seem to be a fair inference from the above figures that during the 3J years dealt with, about 500 cases in Sheffield, and 1,550 cases in Kensington, failed to get notified. The estimated population of Sheffield in 1907 was 456,000, that of Kensington 180,500. THE VOLUNTARY NOTIFICATION OF CONSUMPTION IN KENSINGTON. Towards the close of 1901, the Council resolved, upon the recommendation of the Public Health Committee, to make pulmonary phthisis (consumption) voluntarily notifiable by medical practitioners, as from the commencement of 1902 ; and, subsequently, with a view to the utilisation of the information thus obtained, the Committee authorised me to employ the services of the lady inspectors (Miss de Chaumont and Miss Looker) in an inquiry into the circumstances of the cases notified ; and, generally, to give effect to the recommendations of their Sub-Committee, whose report on the subject is printed in the Council's Minutes for 13th November, 1901 (pages 19 and 20). The work thus inaugurated is still going on, and in submitting the sixth annual report of the inspectors, I desire to express my appreciation of their services. The report is as follows:— " During the year 1907 we enquired into all cases of phthisis (pulmonary consumption) voluntarily notified by medical practitioners, 231 in number (compared with 252 in 1906), of which 58 proved fatal. We made enquiries also with regard to 22 deaths of persons whose illness had been notified in previous years, and of 94 deaths of persons whose illness had not been notified. The cases investigated during the year were thus 347 (males 191, females 156) ; the number of visits paid being 623. Home or other Accommodation of the Sick Person or Family. Number of Rooms Occupied. l 2 3 4 or more. Homeless Persons in the Infirmary. Common Lodginghouse Cases. No Information obtainable. Total Cases investigated. Number of cases of illness 98 80 32 57 26 30 24 347 " One hundred and ninety-one of the 231 notifications (83 per cent.), and 113 (65 per cent.), of the 174 deaths, were of persons belonging to North Kensington ; whilst 171 (74 per cent.) of the notifications were from three wards, viz.:—St. Charles (36), Golborne (47), Norland (88): 96 (55 per cent.) of the deaths (25,31, and 40, respectively) belonged to the same wards, the population of which is but little over 73,000, or 40.4 per cent, of total population. 50 " The proportion of deaths from phthisis at the Workhouse Infirmary*to deaths from this cause in the Borough, as a whole, was, as usual, large : 77 out of 174 (44.3 per cent.); males 47 and females 30. Sixty of these deaths (77.9 per cent.) were of North Kensington persons and 17 of South Kensington persons. "The notified infirmary cases were 144; males 81, females 63:115 of North Kensington persons and 29 of South Kensington persons. Thirty-eight cases were notified by the district medical officers; the majority of which were subsequently removed to the Infirmary. There was a decrease in private notifications during the year; 12 cases only (all of them in North Kensington), as against 31 cases in 1906, having been reported by other than Poor Law Medical Officers. In addition, 7 private cases were reported by Poor Law Medical Officers. Fourteen cases were brought to our knowledge from other sources—Hospital Almoners, the Charity Organization Society, the Jewish Board of Guardians and the Military Authorities. Thirteen additional cases were found by ourselves when visiting houses for other purposes. " Patients residing at home (averaging 54 in number) were kept under observation, and visited as frequently as practicable. Disinfection after death or after removal of a patient from one abode to another, was offered, and usually accepted; it was done in 139 cases, out of 265 infected rooms: in 127 by the Council's officer, in 12 under the medical attendant's direction. There were only 38 absolute refusals, on the ground that disinfection was considered " unnecessary." In 88 cases the room was in occupation. In a large majority of cases the disease was in an advanced stage when notified, the sufferers having continued to work for the support of their families, and rarely having seen a doctor till absolutely compelled. We are deeply impressed with the need for a sanatorium to which sufferers could be removed in the early stages of the disease, a course which would generally involve provision being made for the support of families during the period devoted to treatment of the breadwinners. We noted continued improvement in the ventilation of sick rooms by open windows, and an increased appreciation of the value of fresh air to phthisical persons, and of the danger arising from indiscriminate spitting. " The Council at the end of 1906 sanctioned the free distribution of sputum bottles to sufferers residing at home, and 51 were given out during the year, much to the comfort of the recipients and to the benefit of the community. Six of these bottles were subsequently returned by the relatives on the death of the patient. The comparatively small number of bottles issued, compared with the number of notified cases, was due to the fact that at about the same time the Guardians started free distribution of bottles to phthisical inmates of the Infirmary, and thus many of the cases visited were found to be already supplied. " Attention may well be drawn to the final table appended to this report which bears eloquent testimony to the fact that consumption is mainly a disease of the poor. Of the 347 cases investigated fourteen only were of persons in a more or less well-to-do position—their illness had not been notified, and all of them died—the remainder belonging to classes of the population able to contribute little, if anything, to the cost of sanatorium treatment. It appears to us hopeless to expect any material benefit when the sufferer is compelled to live with others in one or two rooms; and the ' advice ' to sleep alone is a counsel of perfection very rarely capable of being followed.) " Notifications, Deaths, and Disinfections, 1907. The District. Number of cases notified. Deaths after notification and otherwise. Disinfections by Council's officer. The Borough 231 174 127 Sub-Districts Kensington Town 212 188 104 Brompton 19 86 28 Parliamentary Divisions— North Kensington 191 118 89 South Kensington 40 61 88 Wards— N. Kens. St. Charles 36 25 18 Golborne 47 81 84 Norland 88 40 18 Pembridge 20 17 19 S. Kens. Holland 16 16 18 Earls Court 6 15 7 Queen's Gate 2 7 2 Bedcliffe 12 15 10 ^Brompton 4 8 6 * I am indebted to Dr. Potter for an interesting account of the work at the Borough Infirmary in relation to the treatment of tuberculosis in 1907. At the beginning of the year there were 81 patients (males 57, females 24) under treatment. The males admitted were 127, the females 95 (total 222) so that in all 303 cases were dealt with in the course of the year. All phthisical cases are isolated, but cases of local tuberculosis are treated in the general wards. The beds set apart for isolation are 85 in number (males 56, females 29). Dr. Potter observes that "the incidence of consumption in males appears in his statistics to be decreasing, in females to be increasing." 51 AGE AT NOTIFICATION 1907. 0-5 5-10 10-20 20-40 40-60 upwards Total cases. Male — 8 4 50 55 13 125 Female 1 4 9 45 40 7 106 AGE AT DEATH. 0-5 5-10 10-20 20-40 40-60 60 and upwards. Total casea Male 1 — 5 42 80 15 98 Female.— 1 5 34 88 3 81 Voluntary Notifications of Consumption in Kensington, 1902-7. The District. Number of Cases notified. Total in six years. 1902. 1903. 1904. 1905. 1906. 1907. The Borough 247 221 203 218 252 231 1372 Sub-Districts— Kensington Town 288 206 190 210 234 212 1290 Brompton 9 15 13 8 18 19 82 Pabllamentaby Divisions— North Kensington 218 182 169 197 216 191 1178 South Kensington 29 89 84 21 36 40 199 W ards— North K. St. Charles 25 19 25 85 80 36 170 Golborne 47 46 37 57 52 47 286 Norland 117 100 95 89 102 88 591 Pembridge 29 17 12 16 32 20 126 South K. Holland 12 13 14 8 18 16 76 Earl's Court 5 6 4 8 7 6 81 Queen's Gate 4 12 6 4 8 2 81 Redcliffe 4 4 5 4 8 12 87 Brompton 4 4 5 2 5 4 24 The Year AGE AT NOTIFICATION. Total. 0-5. 5-10. 10-20. 20 40 40-60 60 and upwards. 1902 2 2 7 117 109 10 247 1903 — 1 8 81 111 20 221 1904 2 4 10 72 96 19 208 1905 1 1 11 96 77 32 218 1906 — 1 11 104 106 80 252 1907 1 7 ] 8 95 95 20 231 Totals 6 16 60 565 594 131 1872 52 Deaths from Consumption, in the six years, 1902--7. The District. 1902. 1903. 1904. 1905. 1906. 1907. Total in six years. The Borough 226 219 285 199 914 174 1267 Sub-Districts — Kensington Town 176 197 208 166 186 188 1071 Brompton 50 22 27 88 28 86 196 Parliamentary Divisions— North Kensington 160 151 164 189 154 113 881 South Kensington 66 68 71 60 60 61 386 Wards— North K. St. Charles Golborne 19 26 88 82 84 25 174 58 41 42 87 48 31 252 Norland 66 66 62 54 52 40 340 Pembridge 22 18 22 16 20 17 115 South K. Holland 12 27 28 21 21 16 125 Earl's Court 14 5 19 10 18 15 76 Queen's Gate 12 16 4 5 7 7 51 Redcliffe 18 11 10 15 11 15 80 Brompton 10 9 10 9 8 8 54 Age at Death from Consumption in the six years, 1902-7. The Year. 0-5. 5-10. 10-20. 20 40 40-60. 60 and upwards. Totals. 1902 6 4 7 93 94 22 226 1908 4 6 16 83 94 16 219 1904 9 4 24 91 90 17 285 1905 5 2 10 90 75 17 199 1906 5 2 5 96 87 19 214 1907 1 1 10 76 68 18 174 Totals 80 19 72 529 508 109 1267 Disinfections after Consumption carried out by the Council's officer. The District. 1902. 1903. 1904. 1905. 1906. 1907. Total. Notifications and Deaths. Disinfections. Notifications and Deaths. Disinfections. Notifications and Deaths. Disinfections Notifications and Deaths. Disinfections. Notifications and Deaths. Disinfections. Notifications and Deaths. Disinfections. Notifications and Deaths. Disinfections. The Borough 894 188 874 112 871 129 355 115 886 158 847 127 2,147 779 Sub-Districts— Kensington Town 889 117 340 90 832 110 818 96 847 186 806 104 1,982 658 Brompton 55 21 84 22 39 19 87 19 89 22 41 28 245 126 Parliamentary Divisions— North Kensington 309 102 276 78 280 86 283 85 808 110 257 89 1,708 550 South Kensington 85 36 98 84 91 43 72 80 88 48 90 38 519 229 Wards — North K. St. Charles 41 18 36 14 53 23 52 24 54 29 51 18 287 121 Golborne 78 88 78 17 66 31 77 88 80 85 61 84 435 188 Norland 158 85 138 82 129 22 127 22 129 82 110 18 786 161 Pembridge 87 16 29 15 32 10 27 6 40 14 35 19 200 80 South K. /Holland 20 9 84 9 88 21 25 11 29 20 26 18 167 88 Earl's Court 16 9 11 6 22 8 11 8 19 7 20 7 99 40 Queen's Gate 16 — 28 2 10 1 9 4 8 4 9 2 80 18 Redcliffe 19 11 14 9 12 6 18 10 16 18 25 10 104 62 lBrompton 14 4 11 8 14 7 9 2 11 4 10 6 69 81 53 Number of Rooms disinfected, and not disinfected; (total infected rooms 1,704). Disinfection. 1902. 1903. 1904. 1905. 1906. 1907. Total. By Council's Disinfecting Officer 188 112 129 115 158 127 779 936 Under the direction of the Doctor 24 48 18 27 28 12 157 Disinfection refused 195 128 108 118 108 126 768 Occupation or Status (so far as could be ascertained) of persons whose illness was notified (231 cases), and of deceased persons whose illness had not been notified (116 cases):— Males (191)— No. of Cases. Labourer 37 Artisan 27 Cabman, coachman, stableman, etc. 8 Tradesman, handyman (6 each) 12 Porter, hawker (5 each) 10 Laundryman, omnibus conductor, scavenger, shop assistant (3 each) 12 Boot repairer, commercial traveller, errand boys, flower-seller, milk carrier, postman, railway employe, soldier, tailor, waiter (2 each) 20 Barman, butler, cane chair mender, caretaker, clerk, draughtsman, gardener, haddock curer, hotel cleaner, night watchman, packer, pavement artist, pianist, police constable, stevedore, street musician, sweep, theatre employe, toy modeller, woodchopper (1 each) 21 Son of blacksmith, flowerseller, gardener, painter, porter, washer-up (1 each) 6 Persons of the more prosperous classes* (all of whom died) 8 Females (156—of whom 78 were married) — Domestic servant, restaurant cook 20 Laundress 16 Charwoman 8 Dressmaker, machinist, milliner, seamstress 7 Flower-seller, school teacher (1 each) 2 Wife, or widow, of labourer (19), small tradesman (9), coachman, carman (8), artizan (5), actor, clerk, dyer's cleaner, engineer, furworker, laundryman, street musician, traveller (2 each); gardener, porter, postman, railwayman, street artist, tailor (1 each) 63 Daughter of labourer (4), billiard marker, farrier, hawker, laundryman, navvy, newspaper-seller (1 each) 10 Persons of the more prosperous classest (all of whom died) 6 Total 293 Cases not known at addresses given to the relieving officer (Males 9, females 15) 24 Cases from common lodging-houses: occupation (if any), unknown (Males 21, females 9) 30 Total 347 *Males, described as of independent means (3), medical practitioner (2), son of military officer gentleman, barrister (1 each). †Females, described as of independent means (3), wife of surveyor (2), and of a surgeon (1). 54 THE MODERN TREATMENT OF PULMONARY CONSUMPTION. In the sixth monthly report, 1905, under the heading "Life in a Sanatorium," reference was made to a report in The Times of a visit paid to the Brompton Hospital Sanatorium, near Frimley, Surrey, in which it was stated that "the aim [of treatment] is to educate patients into a condition of real bodily vigour and capacity for work; " the patients being " put through a graduated course of exercise adjusted to their physical condition." Three years having elapsed since the sanatorium was opened, by the Prince and Princess of Wales, it was satisfactory to learn from a further article in The Times (July 15th), on a then recent visit of inspection, that the experimental treatment adopted by the medical superintendent has been justified by results. The present ideas on the proper method of treatment of the disease are in remarkable contrast with those that prevailed, almost universally, not so many years ago. It is stated in the article referred to that— "The distinctive feature of the treatment "is" the graduated system of outdoor employment to which the patients are subjected "; this being the" first sanatorium for consumptives in which work ha3 been introduced into the regular routine, as an integral and prominent part of the treatment on a methodical plan of systematic adjustment of occupation to the condition and capacity of the individual." Patients are not set to work " until they are fit for it* carrying light baskets of stones or mould being the first grade in the outdoor works of utility carried on by them. Gardening operations follow in an ascending order, until the strongest met) arrive at quite heavy work. Thus, while the active mischief in the lungs is healing, their frames are built up into a robust condition which renders them at the same time fit to do regular work when discharged, and more resistent to the attacks of recurrent disease to which they may be exposed in ordinary life." A number of old patients had been brought down to Frimley for the occasion: all were very much better; many were perfectly restored to health, " including some who had been discharged for two years, and bad gone back to their former employment." The men attributed their improved health to the treatment the regular life, the outdoor work and the fresh air having, moreover, applied at home, so far as possible, what they had learnt at the sanatorium—a regular life and the open window having become habitual with them all." The patients enjoy the work, and besides "the direct effect upon their bodies it has an indirect [good] effect through their minds. It is a cure for listlessness and ennui. The results of their work are visible and tangible, and the men are interested in what they are doing they have transformed the place: the extensive grounds were a wilderness; they are now beautiful; and heavy work of a more utilitarian character has been carried out. The Sanatorium spends nothing on labour ; " the grounds would require twelve gardeners if the patients did not work: the household work is performed by two ward maids with their help." Instances are given of the economical conduct of the establishment; e.g., all the soap used is made from the refuse kitchen fat, and the exhaust steam from the engine house is used to heat the water for the laundry and the baths." The committee of Management of the Brompton Hospital issued last year a report on the sanatorium, its work and its results, in which it is stated that— "No male patient has been considered to present total arrest of the disease until all bacilli have disappeared from the expectoration, and medical examination has failed to detect any sign of active mischief, nor until he has performed the highest grade (of five or six grades) of exercise for a fortnight or three weeks, without rise of temperature or loss of weight. Such hard work (it is added) will rarely be required from the patients in after life, and there is thus a strong probability that the arrest of the disease will be permanent." Of the cases transferred (from the Brompton Hospital) to the sanatorium in 1906, "110 were discharged with 'total arrest' of disease; 21 were ' much improved ' and 25 were ' improved.' On discharge the patients are invited to report from time to time as to their condition ; and it appears that of 110 cases of total arrest, 93 are at work, 5 are not at work, 12 have failed to report; of 21 ' much improved ' cases, 10 are at work, 7 are not at work, 4 have failed to report, whilst of 25 'improved ' cases, 10 are at work, 7 are not at work, 7 have failed to report, and one has died." The Secretary of the Brompton Hospital informed me that the "average daily number of beds occupied at the sanatorium during 1906, was 102, and the average weekly cost per patient twentyseven shillings." This includes" provisions, drugs, fuel and light, wear and tear, cleaning, rates, ordinary repairs and salaries." This moderate cost the Secretary attributes to the smallness of the official staff, " very little nursing being required," so that "a staff of 4, with a Sister-in-Charge is found to meet all requirements for 108 patients. The domestic staff, moreover, is relatively small, for the reason that the patients at the sanatorium are able to give assistance in light duties which are found beneficial as an occupation." *It is stated that patients "in a weak state, or with serious or active mischief going on in the lungs, are not allowed to work": they " remain in bed and are attended as in hospital"; whilst those "who are fit to leave their beds, but are not strong enough for any exertion, rest on couches in the open air and merely occupy their hands with some light work such as making wool mats or sewing " ; work proper being applied later to building up their physical strength by degrees." 55 INFANTILE MORTALITY. The subject of infantile mortality continues to receive much attention from sanitary authorities, and there can be no doubt that public interest in it was greatly stimulated by the National Conference held in 1906, to which reference was made in the annual report for that year. No subject is more deserving of consideration, or is of more national importance, having regard to the constantly decreasing birth-rate ; which, apparently, is likely to continue and can only be compensated, it would appear, by efforts to preserve infant life, and to rear the ever decreasing number of infants born so as to ensure a healthy race. The Council exhibited their interest in this matter by appointing a " health visitor " in 1905, upon my recommendation, and were so satisfied with the result as to have resolved unanimously, in December last to appoint a second. The Registrar-General, dealing with the question of infantile mortality in the Annual Summary for 190G, observed that of the total deaths under one year of age recorded in London in that year, nearly 29 per cent, took place in the first month of life, and it will be seen from the table at page t>7 that this proportion was slightly exceeded in the borough last year. To this interesting table—which deals with deaths from stated causes in weeks and months under one year of age, having been designed by the Local Government Board to " procure periodically from Medical Officers of Health . . . special returns of mortality in the infantile portion of the community," I have added another, grouping the deaths occurring in the borough in monthly periods. From this table it appears that of the 433 deaths under one year in 1907, the numbers in the successive quarters were 150, 89, 101 and 93. Diarrhoea, which, in 1906, was the cause of 92 deaths, proved fatal to only 2.1 infants last year. Prematurity of birth was the cause of 67 deaths, including 52 in the first week, and all save one within four weeks after birth. Diseases of the lungs account for 192 deaths (pneumonia 53, bronchitis 49), atrophy, debility, marasmus for 51, whooping-cough for 34; suffocation, overlaying, for 10, other 10 deaths being due to violence of various sorts. Syphilis was accountable for 10 deaths; 12 were attributable to congenital defects. The births registered as illegitimate were 200 or 5.8 per cent. on total births; the deaths of illegitimate infants were 52 equal to 12.0 per cent. on all deaths under one year, and 26.0 per cent, on births registered as illegitimate. The Health Visitor, Miss Gauntlett, has submitted a report on her work during the year, as follows: — The Care of Infants.—I paid 2,262 visits and 725 re-visits to the homes; total visits 2,987; in North Kensington 2,473; in South Kensington 514. In 116 cases no information was obtainable. I paid a weekly visit to the Maternity Ward of the Borough Infirmary, and interviewed 66 convalescent mothers. Latterly, I have been able to assist the cause in a small way by giving brief talks to mothers while examining and weighing their infants in connection with Mrs. Prideaux's work among nursing mothers at 15, Fowell Street. Of the 2,146 infants seen by me, 1,668 were breast-fed only; 269 were partly breast-fed and partly hand-fed; 209 were entirely hand-fed—119 of them improperly. Long-tubed bottles were in use in 55 cases; many of them were in a sour and dirty condition. Seventeen hundred and sixty-four infants appeared to be in a healthy condition; 382 were suffering from various diseases, or were weaklyand ill-nourished. A large proportion of the sickly and ill-nourished infants were hand-fed; not a few of them improperly so fed. Many infants appeared to be suffering merely from the condition of the semi-starved, harassed and overworked nursing mother. Thirty-three hand-fed weakly infants died within a few months of birth; "improvement" was recorded in 107 cases. Twenty-two infants were found to be in a dirty and neglected condition, the mothers of some of these were obviously women of intemperate and undisciplined habits; many infants were the victims of dirty and incompetent foster-mothers or caretakers. It was ascertained that 501 mothers went out to work as laundresses, charwomen, scrubbers, machinists, hawkers, etc., and that 170 of the laundresses and charwomen worked up to the very day of confinement, compelled in nearly every case by urgent necessity. Far from being indifferent to the claims of the coming infant, this class of mother is usually anxious to anticipate every need; she generally has a large family, and often a husband out of work. Mothers to the number of 123 were found to be in a very weakly state of health; and by reason of consumption, anaemia, starvation, overwork, mammary abcesses, etc., 68 were unable to suckle their infants. Many others struggled on, supplementing the impoverished breast milk by 56 giving the infant two or three feeds of cow's milk,, or when it was assumed that the "twomilks" could not agree, boiled bread, etc. Not infrequently, a talk with the mother resulted in her "trying" one or other of the homely and common-sense remedies suggested with the object of improving the quality of the breast-milk—greatly to her own, and the infant's, advantage. Seventy-one strong, healthy-looking mothers declared that they were "unable" to suckle their babies, or that the milk had left them soon after "getting up." I have reason to believe that the weaning of many of the babies was due rather to choice than necessity. Twenty-eight mothers told me they did not "intend" to suckle their infants, or that their husbands had objected to their doing so. I came across 57 families in need of food. In these cases the lying-in mother appeared to be the principal sufferer. In this connection I desire to acknowledge the help and prompt attention to every request of mine, and the sympathy and courtesy invariably received from the Charity Organisation Society. Of the homes, 363 were single rooms (40 of them "furnished"); 1,140 two-roomed tenements, 577 comprised three or more rooms; 64 homes were found dirty. In 66 cases the mothers were said to have " no home "—women visited at the workhouse maternity ward. Appended is a statement of the visits paid during the year. Ward. North Kensington. South Kensington. Summary— whole Borough. St. Charles. Golborne. Norland. Pembridge. Total Visits. Holland Earl's Court. Queen's Gate Redcliffe. Brompton. • Total Visits. Visits 410 704 426 174 1,714 106 73 106 100 47 432 2,146 Re-visits 190 249 198 34 671 14 10 8 17 5 54 725 No information obtainable. 22 34 20 12 88 6 6 5 6 5 28 116 Total Visits 2,987 Infantile Mortality, 1907.—Inquiry was made in the course of the year by the Lady Sanitary Inspectors with respect to deaths of 227 children under one year, out of a total of 433 deaths at that age-period. The deaths, and the number of cases investigated in the several wards were as follows:— Wards. Deaths. Cases Investigated. North Kensington (846). St. Charles 73 47 North Kensington (201). Golborne 189 83 Norland 92 54 Pembridge 42 17 Sout.h Kensington (87). Holland 24 10 South Kensington (26). Earl's Court 25 11 Queen's Gate 7 1 Bedcliffe 22 3 Brompton 9 1 One hundred out of the 227 mothers visited admitted going out to work, leaving their infants in the charge of others; sixty-five of these were married women employed as laundresses, charwomen, flower-sellers, hawkers, etc.; and thirty-five unmarried, including domestic servants (22), laundresses, charwomen, etc. Eighty-two of the mothers had worked up to within two weeks of confinement; thirty-six of them to the day, or the day preceding confinement. Method of Feeding (227 cases).—Suckled 67, suckled and hand-fed 33, hand-fed only 63. No information 64. In 50 instances, one or other of the parents was in bad health ; in 13 cases the mothers, in 7 the fathers, and in two both parents were suffering from phthisis; 19 mothers and 3 fathers were weakly; in other six cases the mother suffered from some illness; whilst 4 mothers and 2 fathers were stated to be inebriates. 57 TABLE V. INFANTILE MORTALITY DURING THE YEAR 1907. (See page 55.) Deaths from stated Causes, in Weeks and Months, under One Year of Age. Cause of Death. Under 1 week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 1 Month. 1-2 Months. 2-3 Months. 3-4 Months. 4-5 Months. 5-6 Months. 6-7 Months. 7-8 Months. 8-9 Months. 9-10 Months. 10-11 Months. 11-12 Months. Total Deaths under One Year. Common Infectious Diseases Small-pox ... ......... ... ......... ......... .... . .... ... .... . .... ... ... ... ...... ... ... ...... ... ... Chicken-pox ..... ... ... ......... ... ......... ......... ... ... ......... ......... ......... ... ......... ......... ... ... Measles ..... ..... ....... ..... ..... ..... ..... ..... ..... ..... ..... 1 1 1 1 1 5 Scarlet Fever ..... ..... ..... ..... ..... ..... ..... ........ ..... ..... ........ ........ ..... ........ ........ ........ ........ Diphtheria: Croup ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... 2 1 ..... 8 Whooping-cough ..... ..... ..... ..... ..... 4 2 2 ..... 1 5 4 8 8 4 6 84 Diarrhceal Diseases Diarrhoea, all forms ..... ..... ..... ..... ..... 4 1 8 2 4 ..... 2 2 ..... 2 1 21 Enteritis Muco-ent ritis Gastro-enteritis ..... 1 ..... ..... 1 1 3 1 2 1 1 ..... ..... 1 1 1 13 Gastritis, Gastrointestinal Catarrh ..... ..... ..... ..... ..... 1 ..... 1 ..... 1 ..... ..... ..... ..... ..... ..... 3 Premature Birth 52 7 4 8 66 1 ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... 67 Wasting Diseases. Congenital Defects 4 3 1 2 10 1 1 ..... ..... ..... ..... ..... ..... ..... ..... ..... 12 Injury at Birth 1 ..... ..... ..... 1 ..... ..... ..... ..... ..... ..... ........ ........ ..... ..... ..... 1 Want of Breast-milk ..... ..... ..... ..... ..... ..... 8 1 2 ..... 1 ..... ..... ..... ..... ........ 7 Atrophy, Debility, Marasmus 18 5 2 2 27 8 6 8 1 1 8 1 ..... 1 ..... ..... 51 Tuberculous Diseases Tuberculous Meningitis ..... ..... ..... ..... ..... 1 1 ..... ..... 2 1 2 1 1 1 ..... 10 Tuberculous tis; Tabes Mesenterica ..... ..... ..... ..... ..... 1 ..... 1 1 ..... ..... 1 1 ..... ..... ..... 5 Other Tuberculous Diseases ..... ..... ..... ..... ..... ..... ..... 1 1 ..... 1 ..... ..... ..... ..... 1 4 Erysipelas ..... ..... ..... 1 1 ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... 1 Syphilis ..... 1 ..... ..... 1 3 1 2 2 ..... ..... ..... ..... 1 ..... ..... 10 Rickets ..... ..... ..... ..... ..... ..... ..... ..... 1 ..... ..... ..... ..... 1 ..... ..... 2 Meningitis (not Tuberculous) ..... ..... 1 ..... 1 ..... 1 1 ..... ..... ..... 1 1 ..... ..... ..... 5 Convulsions 5 1 2 2 10 4 1 ..... ..... ..... ..... 1 ..... ..... 2 ..... 18 Bronchitis 1 2 2 4 9 7 10 1 2 6 5 5 ..... 1 ..... 8 49 Laryngitis ..... ..... ..... ..... ..... ..... ..... ..... ..... 2 ..... ..... ..... ..... ..... ..... 2 Pneumonia 1 1 1 1 4 9 4 5 1 2 4 8 7 8 2 9 53 Suffocation, overlaying 1 ........ 2 1 4 1 ..... 8 1 1 ..... ..... ..... ..... ..... ..... 10 Other causes 10 8 8 4 20 9 2 8 8 1 4 1 1 1 1 1 47 98 24 18 20 155 55 86 28 19 22 25 22 17 16 15 23 438 58 TABLE V. (A.) INFANTILE MORTALITY. (See page 55.) Causes of Death of Infants under one year of age, grouped in monthly periods, 1907. Cause of Death. January. February. Mjirch. April. May. June. July. August. September. October. November. December. Totals. Small-pox .... ... ... ... ... ... ... ... ... ... ... ... — Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... — Measles ... ... 2 ... ...... 2 1 ... ... ... ... ... 5 Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... — Diphtheria ... ... ... ... 1 ... ... 1 ... 1 ... ... 3 Whooping-cough 5 8 6 8 8 1 4 1 1 2 ... ... 81 Diarrhoea ... ... 2 1 ... ... 1 8 7 4 3 ... 21 Enteritis, Muco-enteritis, Gastroenteritis 2 2 ... 1 1 ... ... 8 2 2 ... ... 13 Gastritis, Gastro-Intestinal Catarrh ... ... ... 1 1 ... ...... ... ... 1 ... ... 8 Premature Birth 5 5 4 4 5 4 7 12 4 6 9 2 67 Congenital defects 8 ... 2 ...... 1 1 2 1 1 ... 1 ... 12 Injury at birth ... ... ... ... ... ... ... ... ... 1 ... ... 1 Want of breast milk ... 1 1 ... 2 1 1 ... ... ... 1 ... 7 Atrophy, Debility, Marasmus 1 2 4 6 3 2 6 6 6 6 5 4 51 Tuberculous Meningitis 2 ... ... ... 8 1 2 2 ... ... ... ... 10 Tuberculous Peritonitis, Tabes Mesenterica 1 ... ... ... 1 ... ... ... ... 2 1 ... 5 Other Tuberculous Diseases ... ... 1 ... ... ... ... 1 ... ... 1 1 4 Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... 1 Syphilis ... ... 2 1 2 1 ... 1 1 1 1 ...... 10 Rickets ... ... ... ... ... ... ... ... ... 2 ... ... 2 Meningitis ... 1 ... 1 ... ... ... 1 ... ... 1 1 5 Convulsions ... 2 8 2 2 2 1 8 1 1 ...... 1 18 Bronchitis 16 11 5 3 2 1 ... 1 1 ... 3 6 49 Laryngitis ... ... ... ... 1 ... ... 1 ... ... ... ... 2 Pneumonia 18 11 3 5 2 2 2 8 ... 1 4 2 68 Suffocation, overlaying 4 1 1 ... ... 1 ... 2 ... 1 ... ... 10* Other causes 9 6 2 8 3 1 1 4 8 2 7 6 47 66 46 38 81 38 20 28 46 27 88 87 23 433 * There were other ten violent deaths. 59 INFANTILE MORTALITY IN THE NOTTING DALE "SPECIAL AREA" In another part of this report (page 66) the history of legislation for securing the early notification of births is set out. When the Bill was in Committee of the House of Commons, reference was made by the President of the Local Government Board to the high rate of infantile mortality prevailing in the Notting Dale Special Area; it being mentioned, as a " curious fact," that in this district of the richest borough in London the infantile mortality rate had in the last ten years ranged from 274* to as much as 508t per 1.000 births; the average for all London being 150 per 1,000. " Immediately the Bill was passed, the Royal Borough," it was observed, " would doubtless ask for the Bill being applied to their area, and if not the Local Government Board would put it upon Kensington." J Remarking on this utterance, I observed that " the benefits to be expected from immediate notification of births were considerable, I rejoiced therefore to learn that (should the Bill pass), whatever might happen in other districts, Kensington would enjoy those benefits, pending the enactment of a measure for securing earlier registration of births—a subject which had engaged the attention of the Council in 1905." At the same time, I felt it my duty to indicate how small in proportion to the whole borough was the portion referred to. In 1906 the births connected with the area were 95 only (out of 2,429 registered in the North Kensington Parliamentary Division), and the deaths under one year, 30—an infantile mortality-rate of 315 per 1,000, as compared with 155 per 1,000 in North Kensington as a whole. Particulars were given, in tabular form (vide page 60), with respect to these 30 deaths, and it was stated that all but four of the houses in which deaths occurred " at home," were let in furnished rooms. The poverty of the people was indicated by the status of the parents. Eleven of the fathers were described as " labourers" (as often as not out of work), the rest, as artisans (3), flower-seller and carman (2 each), street musician, shopkeeper, and porter, one each. Seventeen of the deaths occurred at home, and 13 in the infirmaryincluding five of infants who were born at, and never left that institution. Nine infants were the illegitimate offspring of laundresses and charwomen The causes of death were, epidemic diarrhoea and enteritis (9), tuberculosis and marasmus (5), lung diseases (7), measles (4), whoopingcough, brain disease, and want of breast milk, 1 each. Two children were born prematurely. Twins, aged 9 months, died at a house in Sirdar Road from measles. One of twins died at St. Katharine's Road of bronchitis, and the other2 5 months later, at the infirmary, of measles caught there. One death was of an infant from a common-lodging-house. In four instances no information was obtainable at the reputed homes of the deceased children. The " parish doctors " certified 7 of the deaths; and seven other doctors 1 each. Three deaths were certified by the Coroner after inquests§ Having regard to the class of persons who inhabit the area, it is little wonder that the infantile mortality-rate should be a high one; but the number of deaths under one year (30) formed but a slender basis for the wide generality deduced therefrom. It was the fact, moreover, as I have shown at page 61, that matters have considerably improved since 1896, when the late Vestry appointed a committee to consider what steps could be taken " to effect an improvement in the conditions [then] prevailing in the district in question." Particulars of the deaths of infants in the area, in 1906, are set out in tabular form on the the following page. *This was the rate in 1904: the number of births in the "Notting Dale district" was 113, and in the Borough, as a whole, 3,568. ‡This was the rate in 1899: the number of births in the "Notting Dale district" was 120, and in the parish as a whole, 3,682. ‡The Times report, June 4th, 1907. Kensington was the first Borough to adopt the Act. §Four streets only are now reckoned in the "Special Area," Kenley Street, formerly William Street, having been eliminated therefrom. Vide page 61. 60 DEATHS OF INFANTS UNDER ONE YEAlt OF AGE, IN, OR CONNECTED WITH, THE NOTTING DALE "SPECIAL AREA," IN 1906. Home Address. Sex. Age at death. Status of Father or, if Illegitimate, of Mother. Death. How fed. How Lodged. Furnished rooms (F). Unfurnished rooms (U). Remarks. Cause. Date. Where occurred. BANGOR STREET *M 39 days Laundress Tuberculosis Feb. 9 Infirmary By hand .. Born, lived and died in Infirmary. Eighth child (all illegitimate), two living. *F 35 Charwoman Want of Breast Milk June 29 „ .. .. Born, lived, and died in Infirmary. M 6 months Labourer Diarrhoea Aug. 13 At home By hand One F. R. Fifth child, one living. Mother goes out charing. *F 2 ,, Laundress Diarrhoea 17 „ " Improperly " One F. R. Inquest case. *M 49 days Charwoman Inanition Oct. 9 Infirmary By hand Born, lived, and died in Infirmary. *F ii months Servant Tuberculosis Nov. 13 At home Mother had left the district when house was visited. F 11 ,, Labourer Whooping Cough Dec. g •• Suckled and boiled bread One F. R. Eleventh child, eight living. Father in work. CRESCENT STREET I *F 14 days Laundress Premature Birth Jan 16 Infirmary .. Born,lived and died in Infirmary. Mother consumptive F 11 months Labourer Pneumonia May 4 At home Suckled to 4 One F. R. Fifth child, two living. Parents are tramps. M 11 ,, Street Musician Diarrhoea Aug. 7 „ months One F. R. Sixth child, 4 living. Taken by parents into the ttreets. *M 8 ,, Charwoman.. Diarrhoea Infirmary By hand One F. R. SIRDAR ROAD F 3 months Labourer Tuberculosis Jan. 19 Infirmary .. Mother in prison : attempted suicide. *M 6 ,, Charwoman Bronchitis Mar. 20 At home .. One F. R. Second illegitimate child, both dead. Ill 48 hours only. F 11 „ Labourer Bronchitis 31 „ Improperly Ninth child, 2 living. Mother a street singer. Parents tramps. †F 9 „ „ Measles July 17 Infirmary Suckled and Two F. R. Father in work. †M 9 „ „ Measles 22 At home Cows milk M 18 days Shop Keeper Diarrhoea Aug. 20 ,, .. Whole house M 10 months Labourer Diarrhoea Sept. 28 Infirmary .. Mother not to be found. M 6 „ Enteritis Oct. 21 ,, .. One F. R. Child removed with mother to Infirm'y soon after birth *F 14 days Charwoman Disease of Brain Nov. 8 ,, By hand Born, lived, and died in Infirmary. M 4 months Porter Pneumonia Dec. 26 At home .. One F. R. Seventh child, 4 living. Mother a flower seller and took child into the streets. Inquest case. ST. KATHARINE'S ROAD †M 3 months Plasterer Bronchitis Jan. 6 At home 3y hand Four U. R. Tenth child, 6 living. M 9 ,, Carman Bronchitis April 23 tl Suckled One F. R, Tenth child, 7 living. F 3 ,, Flower Seller Marasmus 28 Infirmary •• One F. R. Premature birth. First child. Taken by parents into the streets. †M 8 ,, Plasterer Measles June 3 „ .. .. Illness contracted in Infirmary. Mother a charwoman M 16 days Labourer Premature Birth July 15 At home .. One F. R. Second child, 1 living. Mother choreic. Father consumptive. M 2 months Flower Seller Diarrhoea 3° By hand OneF. R. Mother has disappeared. Inquest case. F 6 „ Baker Measles and Diarrhoea Aug. ,, ,, Whole house Child always weakly. F 2 ,, Labourer Diarrhoea .. Sept. 7 Infirmary .. .. Not known at address given. M 11 ,, Carman Broncho-Pneumonia .. Nov. 20 At home Suckled and boiled bread One U. R. Twin child (the other died soon after birth). Father out of work. Mother a hawker, took child into the street. * Illegitimate. f Twins. 61 THE NOTTING DALE SPECIAL AREA The attention of the late Vestry was drawn, in 1896, to the unsatisfactory vital and mortal statistics of a limited portion of North Kensington, known thereafter as the "Notting Dale Special Area"*: it comprised a population of about 4,0 00 persons in five streets; viz. Bangor Street, Crescent Street, Sirdar Roadt (part of), St. Katharine's Road, and Kenley Street.‡ I had, on more than one occasion,§ reported on the unsatisfactory condition of the district, as indicated by the high rate of mortality—general, infantile, zymotic—and otherwise2 and in March, 1896, it was resolved— "That the several reports which th6 Medical Officer of Health has submitted to the Vestry relating to the Notting Dale Special Area, be referred to a special committee for consideration, and report as to whether any steps can be taken by the Vestry, either singly or in conjunction with some other authority, to effect an improvement in the conditions at present prevailing in the district in question." * The Committee, which had for its Chairman Mr. T. W. (now his Honour Judge) Wheeler, K.C., and for one of its most active and interested members, the then Chairman of the Vestry (nowthe Lord Bishop of Peterborough), held several meetings, inspected the locality, and received evidence as to the condition of the inhabitants, from resident clergymen, Poor Law and School Board officials, the inspector of police, and others. The report of the Committee, to which reference will be made later on, was in due course submitted to the Vestry and unanimously adopted. My attention continued to be directed to the condition of the district and its inhabitants, and in 1897 I made an inquiry with respect to sickness of persons in receipt of medical relief, dealing separately with the statistical records kept by the Medical Superintendent of the Infirmary, relating to in-door cases, and those of the Relieving Officers and the District Medical Officers, relating to out-door cases, for the official year 1896-7. The results of the inquiry were set out in the annual report for 1897, pages 132-140. Ten years having elapsed, I thought it would be interesting to make a similar inquiry for the official year 1906-7, with a view to ascertaining what improvement, if any, had taken place in the district, as indicated by the number of admissions to the infirmary therefrom, and of medical orders issued for home, and for Poor Law dispensary cases respectively. I now submit the comparative results of the two inquiries; and firstly with regard to— The In-door Sick.—In the annual report for 1897, it was stated that during the Poor Law year ended 31st Marchj there had been 681** admissions to the infirmary from four of the streets above named; 467 upon Relieving Officers' orders, the remaining 214 representing transfers from the workhouse, and admissions otherwise than by such orders. Of these admissions 243 were from common-lodging-houses in Bangor Street, Crescent Street, and St. Clement's Road. The total admissions to the infirmary during the year, (less 38 from Kenley Street) were 3,421, so that the streets constituting the Special Area, which comprised only one forty-seventh of the population of the parish, as a whole, contributed one-fifth of the total number of in-door sick. In the official year 1906-7, the admissions to the Infirmary from the same streets were 580f+,of which 473 were bv Relieving Officers' orders, the remaining 107 representing transfers from the workhouse, and admissions otherwise than by sucn orders. Of these admissions 202 were from common lodging-houses. The total admissions to the infirmary during the year (less 13 from Kenley Street) were 3,511; so that the four streets estimated to comprise about one-fiftieth of the population of the Borough, as a whole, contributed one-sixth of the total number of in-door sick. The reduction in admissions to the infirmary in 1906-7, compared with 1896-7, was 101, or about 15 per cent. The admissions to the infirmary from the district, which in 1896-7 had been 19.68 per cent, of the total number, were only 16-50 per cent in 1906-7. The Out-door Sick.—The statistics with respect to the out-door sick in 1906-7, compare not less favourably with those of 1896-7. In the latter year the Relieving Officers issued medical orders to the number of 1,500,$ J including 467 for the infirmary, the remaining 1,033 patients having been treated locally, either at Mary Place Poor Law Dispensary or at home. * See Note 1, page 65, " Origin of the Special Area." †Sirdar Road was known as " St. Clement's " Road in 189(5. ‡Kenley Street was known as " William" Street in 1896 Since then nearly all of the properties in the street have been acquired by the Council; the houses on the north side having been remodelled, and practically reconstructed, those on the south side having been demolished and replaced by six blocks of artisans' dwellings. The street has therefore been eliminated from the "Special area." § In monthly reports dated January 9th and 31st, and March 2nd, 1896. ** The number given in the report, 723, included 42 from Kenley Street. ††The number given in the report, 596, included 16 from Kenley Street. ‡‡The orders actually issued in 1896-7 (1,689) included 189 for inhabitants of Kenley (then William) Street, now no longer reckoned as part of the special area. 62 In 1906-7 the medical orders issued were 1,024,* including 473 for the infirmary, the remaining 551 patients having been treated locally—at the dispensary, or at home. The reduction in dispensary and home orders in the latter year was thus 482 (47 per cent.), compared with the number in 1896-7. The subjoined statement exhibits the vital and mortal statistics of the Special Area, as a whole, in 1896 and in 1906. 1896 1906 Births 118 104 Birth-rate 29.5 26.0 per 1,000 persons living. Deaths 187 121 Death-rate 46.8 30.2 per 1,000 persons living. Infantile Mortality-rate 432 308 per 1,000 registered births. Zymotic death-rate 7.5 5.7 per 1,000 persons living.* Death-rate from Tubercular and Wasting diseases 110 8.0 per 1,000 persons living. The Causes of Death were— 1896 1906 Tubercular and Wasting Diseases 44 32 Zymotic Diseases 30 + 23: Syphilis 6 — Cancer 7 2 Violence 7 2 Heart and lungs, Diseases of 49 40 Nervous system, Diseases of 17 5 Visceral and other Diseases, various 23 17 Old Age 4 — Total Deaths 187 121 The Ages at Death were— 1896 1906 Under one year 51 32 § (Total under 5 years, in 1896, 82) 1—5 years 31 18 (Total under 5 years, in 1906, 50) 5—20 years 6 4 20—60 years 70 41 60 years and upwards 29 26 187 121 In 1896, of 187 deaths, 77 took place at home, 98 at the Infirmary (21-4 per cent, of all deaths in that institution), 5 in the Western Fever Hospital, 4 in other public institutions, and 3 elsewhere. In 1906, of 121 deaths, 47 took place at home, 67 at the Infirmary (12 4 per cent, of all deaths in that institution), and 7 at other public institutions. In 1896 the deaths exceeded the births to the number of 69; in 1906 to the number of 17 only. The proportional numbers of deaths from violence, and of inquests held, in the Special Area, in 1896 and in 1906, were not in excess of those in Kensington as a whole. The Special Committee's Inquiry. 1896.—The witnesses, clerical and lay, attributed the evil condition of the Area mainly to drunkenness, leading to squalor, immorality, brawling and violence. The Roman Catholic clergyman in charge of the Church of St. Francis, stated that fourfifths of the people were of Irish nationality, and that most of their earnings went in drink. Opinions were divided as to the extent and character of immorality, but it was generally allowed that prostitution was not practised in the district—fallen women plied their avocation outside (See Note 3, page 65). There was a consensus of opinion in regard to the ill-effects of the "furnished room system "; the furnished rooms were said to be " the source of more evils than the common * The orders issued in 1906-7 (1,06'2) included 38 for inhabitants of Kenley (then William) Street, †Whooping-cough 9, Measles 7, Diarrhoea 7, Scarlet fever 5, Enteric fever and Diphtheria 1 each. ‡Measles 9, Diarrhoea 12, Scarlet Fever and Whooping-cough 1 each. The notifications of infectious disease in the Area, 66 in 1896, were 31 only in 1906. § The subject of infantile mortality, in the Area, in 1906 is dealt with at page 59. 63 lodging-houses," and the official witnesses were agreed that they "should be registered and controlled like common lodging-houses." The house-farmers, it was alleged, did not care as to the respectability of the lodgers—they preferred those from whom they could get the most money. Overcrowding was suspected rather than proved to exist; but one clerical witness said he had observed it at night—it being due, however, to the largeness of families rather than to excess in number of adults. There was little complaint of unwholesome conditions within the power of the sanitary authority to ameliorate. Few male adults, it was stated, were regular workers; but there were many women workers. Medical and other witnesses alleged considerable neglect of young •children whose parents were away from home during the day. The Report of the Special Committee attributed prevalent evils to the vicious proclivities and bad habits of the people themselves (See Note 2, page 65); drunkenness being a principal factor in bringing about the sad condition of affairs described. The Committee made a number of recommendations with the object of improving the state of the locality; e.g., by the paving of yards in the rear of the houses ; the asphalte paving of the roadway of "one or two streets " ; the efficient trapping of street gullies, and the more frequent removal of house refuse. These matters had long engaged the attention of the public health department, and it may be convenient here to state what had been done, or shortly afterwards was done, in consonance with the views of the Committee. Yards were paved as far as practicable (i.e., the portion immediately behind the houses); the roadways of all the streets were paved with asphalte, so as to allow of thorough cleansing by washing; street gullies were syphon-trapped; surface sewer ventilating openings were closed, pipe-shafts carried up against houses being substituted, and house refuse was removed twice in the week, instead of once as elsewhere. The Committee further recommended attention to cases where bedding was in an unwholesome or verminous condition, with a view to the cleansing or destruction of such articles—a matter of more difficulty, the sanitary committee not having seen their way to cleanse or replace at the public cost. Additional powers, since conferred upon the sanitary authority facilitate measures of this description—under the London County Council (General Powers) Act, 1904, and the Borough Council's new by-laws* for houses let in lodgings or occupied by members of more than one family—and, with few exceptions, the houses are so let, and are registered under the provisions of Section 94 of the Public Health (London) Act, 1891. The Committee commented on the number of children seen playing in the streets during school hours, and the bad school attendance—matters in regard to which improvement has taken place. Common Lodging-Houses.—The Committee referred to the relatively satisfactory condition of the Common Lodging-houses, which are under the jurisdiction of the County Council. These establishments, nevertheless, tend to bring "undesirables" into the district; but in this respect, also, improvement has taken place. In 1896 there were 23 common lodging-houses, with accommodation for 703 persons; 617 in single beds, and 86 persons in double beds; single beds for females, and double beds for " married" couples being provided in the same house in some instances. In 1906 there were only 17 of these establishments, and no double bedsf; persons of different sexes, moreover, not being received at any common lodging-house. The accommodation, moreover, was for 467 persons only; 238 males and 229 females.* But notwithstanding this diminished provision (33 per cent.), the number of common "lodgers" admitted to the infirmary continues very high; 202 in 1906-7 compared with 243 in 1896-7—a reduction of 17 per cent only. The admissions to the infirmary from the common lodging-houses in 1896-7, and in 1906-7, respectively, were 35-7 and 34-8 per cent, of total admissions from the Area; whilst the deaths thereat of persons from common lodging-houses, which in 1896-7 constituted 52-4 per cent, of total deaths connected with the Area, rose to 55-4 per cent in 1906-7. Furnished Rooms, as already intimated, were, and they still are, the bane of the Area. In a majority of houses (107 out of 208) the rooms are so let, and in many instances by the night—the so-called " furniture " being usually of a wretched description. Acting upon my instructions, the *In 1897 the late Vestry made and submitted to the Local Government Board a by-law as follows:—"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 by-law was not confirmed. †The abolition of "double beds" for "married" couples took effect in 1905, and was consequent to proceedings by the County Council arising out of proved immoral use of two lodging-houses. See note 3, page 65. ‡In 1899 and 1900 there were 730 beds : in 1901 and 1902 the number decreased to 706 ; in 1904 to 559, and in 1905 to 467, the existing number. 64 Sanitary Inspector made a house-to-house inspection of the district in March, 1907, and prepared the subjoined table showing the mode of letting:— Name of street. Houses in street exclusive of Public Houses* and Common Lodging Houses, f No. of Houses let. No. of Unoccupied. In furnished rooms. In unfurnished rooms. Furnished rooms. Unfurnished rooms. St. Kathaiine's Road 109 81 70 41 41 Crescent Street 29 22 4 42 4 Bangor Street 34 84 82 - Sirdar Road (part of) 86 20 12 30 9 Totals 208 107 86 195 54 The Inspector reported that the number of empty rooms—furnished and unfurnished alike— had latterly been above the average. The "trade" in furnished rooms was " bad " ; and the same remark applied to the common lodging-houses. The number of persons seeking accommodation for a single night only, fluctuates considerably, but it appeared (in March, 1907) to be on the increase. The landlords were looking for better times to the establishment of a street-market in Princes Road. Evidences of Improvement.—What was said anent the evil condition of the Area in the 1896 reports, was based, largely, upon the indications furnished by the statistics of mortality. It has been shown that in regard to these, much improvement was observable in 1906, as compared with 1896; I thought it well, therefore, to ascertain from such of the witnesses as were still connected with the district whether there were any corresponding indications of improvement in the current social state of the inhabitants. The Superintendent Relieving Officer, who had charge of a part of the Area in 1896, replied to my inquiry as follows: "I am glad to say that there is a decided improvement in the condition of the people, generally, residing in the [four] streets mentioned"; adding however, that " there is still ample scope for future labour in that direction." The District Medical Officer wrote:— "There has been very marked improvement; there seems to be less poverty, less disease and very marked improvement in the moral aspect of the place; in fact, it hardly seems the same district"; adding, that " the Kensington Borough Council, and the Public Health Department, are to be heartily congratulated for the very able manner in which they have tackled what seemed so difficult a task." The Sanitary Inspector in charge of the district is of the opinion that improvement has taken place all round; and notes, especially, the improvement in school attendance, evidenced by the smaller number of children of school age seen in the streets during school hours. The cause or causes of the improvement. Assuming the improvement to be real, it becomes an interesting question—To what cause or causes is it due? From the social side I would attribute it, in a measure, to the labours of the clergy, the district visitors, and philanthropic agencies generally. To the sustained efforts of the Board of Guardians and their staff—whose courtesy in facilitating the inquiry, by information supplied, and permitted access to official records, I desire to acknowledge—the reduction in pauperism may fairly be credited; whilst the services of the London County Council, through their official staff concerned with the supervision of common lodginghouses, should not be ignored; the successful efforts to secure cleanliness of houses, bedding, etc.; the practical extermination of "vermin," and the prevention of overcrowding, are specially deserving of mention. Lastly, it may be claimed that no effort has been spared by the Sanitary Authority, and the staff of the public health department, to carry out the provisions of law, and, generally, to raise the character of the district. The state of the drainage leaves nothing to be desired. The water supply is fairly satisfactory—though I could wish for abolition of cisterns for Note.—At the date of the enquiry, there were (in addition) twelve houses occupied each by one family, and three empty houses. *There are three beer-houses; a fourth was closed in 1906. In the Area, and vicinity, there were 17 public houses in 1906, of which four were closed, and one other will be closed, as the result of the Council's opposition to the renewal of the licenses. †Of the 17 common lodging houses, 8 are in Crescent Street, 5 in Bangor Street and 4 in Sirdar (formerly St Clement's) Road. 65 potable water, and provision of a tap on the rising main to each floor of every house let in lodgings. To none of these causes, however, do I attach greater importance than to the work of the Council for improving the housing of the people in Kenley Street. The good effect of this work is not limited to that street; for the frequent visits of the Housing Sub-Committee to the locality, during its reconstruction, have tended to make owners of property in adjacent streets more circumspect in regard to the condition of their houses (which with few exceptions are let in tenements), and the character of the tenants. It has, moreover, had the further effect of making the locality a less congenial resort for " undesirables." The result of the several beneficent influences brought to bear upon the locality and the people, is seen in lessened sickness and lowered rate of mortality, through which expenditure on Poor Law relief has been materially reduced*—a fact that may tend to reconcile ratepayers to the temporary excess of outgoings over incomings consequent to the Council's housing scheme, which will ultimately endow the Borough with a valuable and unencumbered freehold estate. NOTES. The Origin of the Notting Dale Special Area was referred to in the annual report for 1892-3 is follows:— 1. "It began with the clearances in the District of St. Giles (Bloomsbury) when the slums were swept away to make room for New Oxford Street. This was followed by other clearances in St. Giles's, and in ' Camden Place ' off Notting Hill High Street, where ' Clanricarde Gardens ' now stands, and in 'Jennings's Buildings,' off Kensington High Street, which was demolished by Baron Grant. The houses in (the five streets in) the district indicated, were built for a class of people superior to those who now, for the most part, inhabit them ; and it is to be presumed that, not finding suitable tenants, they gradually got to be occupied, to a greater or less extent." by the class of undesirables referred to in the report of the Special Committee of 1896. It is probable that many of the immigrants found their way, in the first, instance, to the adjacent " Potteries " which formed the subject of an article by Charles Dickens, in the issue of "Household Words," dated 10th August, 1850 (five years before the passing of the Metropolis Management Act), descriptive of the wretched condition of the place and people." Excerpt from the report of the Special Committee dated 18th June, 1896. 2. " The area in question is not an insanitary or unhealthy area as such. The situation is open, the houses as structures are not bad, nor are the streets narrow or dark, the northern side of William (now Kenley) Street, and the eastern side of St. Clement's (now Sirdar) Road, actually abut upon Avondale Park. The situation is a healthy one, and in no way accounts for the high death rate of the place," which is " due to the habits and conditions of the people themselves "—characterised as " overcrowding, drunkenness and prostitution," with the result that " undoubtedly a deplorable state of things exists . . . the ordinary laws of decency being disregarded. . . . The locality (nevertheless), while containing some genuine poor, cannot be described as a very poor one . . . Nor can the people be described as a flitting population . . . Many persons have been resident in the place for years ; many go fruit picking, hopping, &c., in the season . . . some work people and their families find homes here ; but this does not leaven the mass ... A great number of rooms in the district are let out as ' furnished apartments,' and as there is no legal control over the habits of the people occupying rooms so let out, the result is as indicated. Houses of this kind and character should be brought under control and registered as ' common lodging houses.' . . . It is but right to say that, in condition, the common lodgiDg-houses are superior to those which are not, and cannot be so, registered ; and for which, until quite recently, the Metropolitan Police were the executive authority for carrying out the provisions of the Common Lodging Houses Acts . . . but in 1894 a new Act was passed . . . and the powers theretofore possessed by the Police were transferred to the London County Council." 8. The Question of Immorality. The late Vestry in their day made persistent efforts to deal with houses suspected to be " disorderly," but with little success. The district was placed under special nightly observation for a lengthened period in 1891-2, for the express purpose of discovering whether any of the houses were used as brothels; but no evidence on which to found proceedings was forthcoming. The assistance of the Police was sought in 1891, and subsequently. In May, 1898, the Commissioner of Police wrote that observation had been kept by the Police but no evidence had been obtained which would be of any use to the Vestry, f In May, 1905, however, complaint having been received with regard to the character of two common lodging-houses—one in Crescent Street, the other in Sirdar Road, the Council's Law Committee approached the Commissioner of Police, whose co-operation having been obtained, and evidence been forthcoming, " proceedings were taken against the (women) Deputies in charge of the two houses mentioned, for permitting them to be used for immoral purposes." Convictions were obtained, the maximum penalty was imposed, and in default the women were sent to gaol; the magistrate, however, stating that he '• found it impossible to believe that the prisoners acted otherwise than with the full knowledge of their employer," the " keeper," who owned other common lodging-houses in the Area. The facts of the cases were brought to the attention of the County Council, and ultimately licenses were granted to another person for all of the man's houses upon condition that the two in regard to which the proceedings were instituted should be utilised for persons of the male sex only. (Vide Mayoral Minute 1904-5, page 40.) *The estimated reduction of expenditure in regard to the indoor sick, alone, in 1906, as compared with 1896, was approximately £550. †Vide Annual Report for 1903, pp. 160-61. 66 Summary of Statistics of Poor Law Medical Relief in the Special Area (less Kenley Street) in 1896-7 and 1906-7. Indoor Sick. Admissions to the Infirmary, 1896-7 681. 1906-7 580. Reduction, in 1906-7, of 101, say 15 per cent. The admissions to the Infirmary from the Area in 1896-7, were 19-68 per cent, of total admissions ; in 1906-7, only 16-45 per cent. In other words, the admissions to the Infirmary from the Area, which in 1896-7 were a fifth of total admissions, were only about a sixth in 1906-7. Outdoor Sick. Relieving Officers' Orders jssued 1896-7 1,033. 1906-7 551. Reduction in 1906-7, of 482, or 47 per cent. Admissions to the Infirmary from the Special Area (less Kenley Street). From Total Admissions. Inclusive of Common Lodging House Cases. 1896-7. 1906-7. 1896-7. 1906-7. Bangor Street 178 . 192 98 78 Crescent Street 186 163 109 98 St. Katbarine's Boad 205 116 Sirdar Road (part of) 112 109 86 26 Totals 681 580 243 202 Patients, how admitted to the Infirmary. 1896-7. 1906-7. Streets. By Relieving Officers' Orders. Otherwise. Total. By Relieving Officers' Orders. Otherwise. Total. Bangor Street 120 58 178 148 44 192 Crescent Street 127 59 186 130 33 168 St. Katharine's Road 147 58 205 108 8 116 Sirdar Road (part of) 73 39 112 87 22 109 Totals 467 214 681 473 107 580 Medical Orders issued by Relieving Officers at Mary Place. Street. Total Orders. Inclusive of Infirmary Cases. Home Cases. Common Lodging House Cases. 1896-7. 1906-7. 1896-7. 1906-7. 1896 7. 1906-7. 1896-7. 1906-7. Bangor Street 845 306 120 148 225 158 68 71 Crescent Street 336 287 127 130 209 107 79 85 St. Katharine's Road 564 329 147 108 417 221 — — Sirdar Road (part of) 255 152 73 87 182 65 24 26 Totals 1500 1024 467 478 1088 551 171 182 THE NOTIFICATION OF BIRTHS. In the eleventh monthly report (November 9th), 1905 I brought to the attention of the Council the need for earlier registration of births as a means for bringing about a reduction of infantile mortality through the agency of female health visitors. " In the interests of public health," I observed, "the law (Births and Deaths Registration Act) should be amended so as to ensure registration of births within a much shorter period than six weeks," and I recommended that the Local Government Board be " approached with a view to amending legislation in this direction." The report was referred to the Public Health Committee, to whom I addressed a supplementary 67 report, on 28th November, recommending that the Board " be requested to introduce a Bill with the object of reducing the period within which a birth should be registered to twenty-one days next after such birth"—as required by Section 27 of The Registration of Births, etc. (Scotland) Act; at the same time stating that it would be " desirable, on public health grounds, to provide for registration within a still shorter period." The Committee recommended (a) That representations be addressed to the Local Government Board urging them to promote legislation in the direction indicated, and (b) That a circular communication be addressed to the Metropolitan Borough Councils inviting their co-operation in the matter. The report was adopted, and effect was given to the recommendations. An important step was taken in 1906 by the Corporation of Huddersfield, who obtained, by a local Act, powers providing for the compulsory notification of births within the borough, by notice to the Medical Officer of Health, within forty-eight hours. At the National Conference on Infantile Mortality (1906), moreover, a resolution was adopted to the effect " That notification of all births [should] be given within 48 hours to the Medical Officer of Health of the district in which they occur." Another resolution affirmed the necessity for the registration of still births. There was ground for believing that the President of the Local Government Board (who was the President of the Conference) was favourably disposed towards these proposals, to which he made reference when, with the Prime Minister, he received the Executive Committee appointed to submit the resolutions of the Conference, and generally to urge the necessity of Government action in relation to the question of infantile mortality. The matter underwent further development in 1907, a Bill having been introduced in the Commons House of Parliament, by Lord Robert Cecil, K.C.," to Provide for the early Notification of Births." It proposed that within 48 hours of the birth of every child a notification of that birth should be given to the Medical Officer of Health of the district in which the child was born; the " duty of notifying being thrown, in the first place, on the father of the child, and, failing him, on anyone who had been in attendance on the mother at the time of the birth or within six hours thereafter." The Bill had the good fortune to be taken up by the President of the Local Government Board, and with the approval of all Parties, was passed in the last week of the Session. The Act is adoptive; but " the resolution of adoption " by the local authority does not take effect " until the consent of the Local Government Board has been obtained thereto." After obtaining the said consent, the local authority is required to " bring the provisions of the Act to the attention of all medical practitioners and midwives practising in their area." In London, moreover, the Medical Officer of Health of every borough in which the Act is in force is required to send weekly to the County Council, on a form prescribed by the Local Government Board, a list of all notices of births received by him under the Act during the past week. As the Council were pleased, in 1905, to approve my action for securing early notification of births by midwives practising in the borough (a course adopted a few months later for the whole of London by the County Council), I anticipated that they would be among the first, if not the first of the Metropolitan Sanitary Authorities, to oass the required resolution for the adoption of the Act, and to obtain the consent of the Local Government Board thereto. I was not disappointed, for, at the first meeting after the summer vacation the matter was dealt with by the Public Health Committee, who brought up a report as follows:— " We have had before us the Notification of Births Act, 1907, which provides for the notification to the Medical Officer of Health for the district within thirty-six hours of the birth of any child ; the duty of giving the necessary information being placed upon the father of the child if residing in the house where the birth takes place, and upon any person who may be in attendance on the mother within six hours after the birth. " The Act is an adoptive one, and in view of the probable discontinuance of the present system of voluntary notification by midwives, inaugurated by our Medical Officer of Health in the year 1905, and subsequently adopted by the London County Council, we are of opinion that the Council should proceed to the adoption of the new Act. " We have accordingly authorised the Town Clerk to issue the required Statutory notice to Members of the Council in order that, should the Council approve of the subjoined recommendation, they may pass the necessary formal resolution at their meeting on the 22nd October, 1907, adopting the said Act. "We accordingly recommend— (a) That this Council do, under and pursuant to the provisions of the Notification of Births Act, 1907 (7 Edward VII., cap. 40), hereby adopt the said Act within the Borough. (J) That this resolution of adoption of the Act be forthwith advertised as provided by the Act, and that a copy of the same be also sent to the Local Government Board with a request that they will fix the 2nd December, 1907, or some other date not later than the 1st January, 1908, as the time when such resolution of adoption shall come into operation in thft Borough." 68 At the meeting of the Council on 22nd October, the Chairman of the Committee moved, and it was unanimously resolved, that" the report be received and the recommendations contained therein be adopted." The "resolution of adoption" was forwarded to the Local Government Board, 24th October, and the Board's consent was received, 25th November, the date fixed for the coming into operation of the Act being the 1st day of January, 1908. The Act was made generally known by posters setting out its provisions being affixed to the notice-boards of all churches and other places of worship within the borough, and by advertisement in local newspapers. Under date 27th December a letter was addressed by the Town Clerk to medical practitioners and midwives known to be practising in Kensington, as follows:— Notification of Births Act, 1907.— Dear Sir or Madam,—I beg to inform you that the Local Government Board have consented to the adoption of the Notification of Births Act, 1907, within the Royal Borough of Kensington, and have appointed 1st January, 1908, as the date on which the Council's resolution of adoption of the Act shall come into operation. " The Act requires that the Council, as Local Authority, shall bring the provisions of the Act to the attention of all Medical Practitioners and Midwives practising in their area. " These provisions may be briefly summarised as follows:— The duty of notifying a birth to the Medical Officer of Health devolves, in the first place, upon the father of the child, and if he be non-resident in the house at the time of the occurrence of the birth, then upon any person in attendance upon the mother at the time of, or within six hours after, the birth. The notice must be given by posting a prepaid letter or postcard within tbirty-six hours after the birth, or by delivering a written notice of the birth at the office or residence of the Medical Officer within the same time. The local authority are required to supply without charge addressed and stamped postcards, containing the form of notice, to any medical practitioner or midwife, residing or practising in their area, who applies for the same. The notification is in addition to, and not in substitution for, the requirements of any Act relating to the registration of births, and it applies to any child born " after the expiration of the twenty-eighth week of pregnancy, whether alive or dead." Liability to a penalty not exceeding twenty shillings is incurred by any person who fails to give notice of a birth. " The Council will, upon application, supply you with addressed and stamped postcards for the purpose of notification—as per pattern enclosed herewith. "Will you please inform the Medical Officer of Health, whose office is at the Town Hall, Kensington, what number of cards you require at the present time, and renew the application for a further supply of cards, from time to time, as may be necessary. " I have only to add that the Council will be obliged if you will kindly make known the provisions of the Act to anyone whom it may concern." It was thought desirable to use a letter-card for the purpose of notification, the form adopted being as follows:— THE ROYAL BOROUGH OF KENSINGTON. Notification of Births Act, 1907. No. I hereby give you notice of the birth of a live (or stillborn) child* at (Address) Surname of Child Sex Date of Birth Father's occupation Name of person giving the Notice [Please state whether:—Father or Doctor or Midwife or other Person ] Address Date of Notice •This notice applies to any child born " after the expiration of the 28th week of pregnancy, whether alive or dead." 69 The Town Clerk's letter and the form of notification card were communicated to the several Medical Officers of Health, with the hope of securing uniformity of practice throughout the Metropolis. Weekly lists of births notified are sent to the County Council on the form prescribed by the Local Government Board. Early in January, 1908, I addressed a communication to every Vicar, and to each Minister in the borough as follows:— " Notification of Births Act, 1907.—Bev. and Dear Sir.—I enclose, for information, a letter recently sent by the Council to local medical men and midwives, setting out the provisions of the above-named Act. " Having regard to the prevailing high rate of infantile mortality, it is needless to insist on the importance of early information of births. Hitherto, we have been dependent for information on the weekly returns of the registrars; and registration of births being commonly delayed for weeks—and sometimes even for months—visitation of the mothers, by the Council's Health Visitor—for the giving of advice with respect to the feeding and care of babies, has been correspondingly delayed. It is hoped, an a result of the new Act, that, in suitable cases, mothers will henceforth be visited in the second week after confinement, "As, however, it will naturally take time to bring the requirements of the Act to the knowledge of the public—especially of the poorer classes, I am writing to request the favour of your assistance to make them known in whatever ways you may deem best. But I would especially beg you to interest district visitors in this good work by inviting them to call the attention of the father of any newly-born child to his statutory duty of intorming me of the birth within thirty-six hours after its occurrence." One vicar and one nonconformist minister acknowledged receipt of the letter and promised assistance. [It may be interesting to give a few particulars of the working of the Act in the Borough in the first thirteen weeks in 1908, completing the official year 1907-8, which may be summarised as follows:— Letters sent (with pattern notification letter-card) to doctors in number 342 Applications for Cards received from doctors „ 39 Letters sent (with pattern notification letter-card) to midwives „ 23 Applications for Cards received from midwives „ 17 Estimated number of births to March 28th, 1908 (13 weeks) 858 Notifications received to March 28th, 1908 (viz.:) 412 Notifications by parents 178 Notifications by doctors „ 75 Notifications by midwives 121 Notifications by Queen Charlotte's Hospital (St. Marylebone) 31 Notifications by other persons 7 Registrations of birth occurring in 13 weeks to March 28th, 1908 465 Notifications received of such registered births to March 28th, 1908 200 Notifications made on Council's Cards supplied to doctors and midwives 340 Notifications made by letters and post-cards 41 Notifications made by weekly lists from Queen Charlotte's Hospital 31 Notifications made by parents on Council's Cards supplied to doctors 31 Notifications made by parents on Council's Cards supplied to midwives 117 Notes.—The notified births were about 49 per cent, of births occurring. [In the year 1907 the notices of births received from the London County Council were 721, and 21 per cent, of the births registered.] The notified births were to mothers who, with few exceptions, were suitable subjects for visitation by the Council's health visitor. With rare exceptions the notifications were made accurately; the Cards, probably, having been, in most of the cases notified by parents, filled up under the guidance of doctors or midwives. 70 Twenty-five (additional) notifications were received, on Council's Cards, of births occurring in other boroughs, from midvvives residing in Kensington. These cards were forwarded to the Medical Officers of Health of the several boroughs where the births took place. On the whole I think we may be satisfied with the working of the Act so far, and reasonably hope for a gradually increasing percentage of notifications. It is undeniable, however, that the Act is not popular with medical practitioners, only a tenth of whom have made application for the Council's Cards. The figures cited would appear to indicate that of the 412 notified births in the borough, 106 were attended by doctors and 238 by midwives; so many notifications having been made on the Council's Cards supplied to those practitioners.] THE KENSINGTON HEALTH SOCIETY. Since the establishment of this Society in 1905, certain lady members of it have been good enough to supplement the work of the Council's Health Visitor by undertaking to follow up her primary visits to babies by re-visits. Last year a communication was received from the Society suggesting a Conference between their representatives and representatives of the Public Health Committee, with a view to fuller co-operation. The Committee authorised their Infectious Diseases Sub-Committee to receive the Society's delegates, and to confer with them as to the establishment of a scheme by means of which the visitors of the Society would be enabled to act in conjunction with the officers of the Public Health Department. The Conference took place and the Subcommittee in due course presented a report which, having been approved by the Committee, was submitted to the Council and adopted : it reads as follows:— " Adverting to the report presented by us to your Committee at the last meeting, relative to the representations made by the KensiDgton Health Society in favour of a fuller co-operation being established between that Society and the Sanitary Authority of the Borough, in connrction with the voluntary work undertaken by them, we have now had the advantage of meeting in conference Alderman Percy Gates (Chairman of the Society) and Alderman Sir Arthur Clay and Miss Eaton, the delegates appointed by the Society to interview us in the matter. " At this Conference the following series of suggestions which had been drawn up by the Medical Officer of Health were discussed and approved, viz.:— (i.) That communications from the Society be addressed to the Medical Officer of Health by the Hon. Secretary, or her authorised representative, and that communications to the Society be addressed by the Medical Officer of Health to the Hon. Secretary, or her authorised representative. (ii.) That the Kensington Health Society be asked to communicate to the Medical Officer of Health from time to time— (a) The name and address of any lady willing to co-operate as a voluntary worker with the Public Health Department, in measures for the prevention of Infantile Mortality, by following up the visits of the Official Health Visitor to mothers recently confined, and to babies during the first year of life. (b) The number of babies she is willing to have on her visiting list at any one time, and (c) The pari of the Borough in which she desires to work. (iii.) That the Society be further asked— (d) To forward to the Medical Officer of Health monthly, on an approved form, a statement of visits paid by each voluntary health worker with any remarks she may deem necessary; and (e) To inform the Medical Officer when, from any cause, any such worker finds it necessary to discontinue the work either permanently or for a stated period of time. Note.—It will be of assistance to the Medical Officer of Health if the Society's voluntary health workers will report direct to him any nuisance or other matter coming under their notice which may appear to require the attention of the Public Health Department. " We are glad to recognise the evident disposition there is on the part of the Society to co-operate with the Public Health Department in the voluntary efforts which the Society are putting forth to deal with the infantile mortality which prevails in certain districts of the Borough, and we feel quite sure that there will be the strongest desire on the part of the Council and their Public Health Committee to avail themselves of the assistance which the Society may be able to offer in this direction, 71 " We therefore hope that in the future there will be established, by giving effect to the foregoing suggestions, a satisfactory co-operation between the Health Society and the Public Health Department which will astist in reducing infantile mortality. " We recommend— That a letter based on the lines of this report be addressed to the Hon. Secretary of the Kensington Health Society as an answer to the representations received from them on the subject." The scheme took effect on the first day of July, between which date and 28th December 57 " case-papers" (specially prepared for the purpose) were forwarded to the Hon. Secretary of the Society on request. Of the said papers, 18 had been returned, with the voluntary health workers' reports thereon, and 39 were outstanding at the close of the year. I gladly bear testimony to the zeal and interest taken in their duties by the Voluntary Health Workers. VACCINATION. The table at page 72 is a return respecting vaccination in Kensington in 1906, for which I am indebted to Mr. King, the vaccination officer. It shows that out of 3,330 infants, whose births were returned in the " Birth List Sheets" (col. 2), during the year, 2,832 were successfully vaccinated, and that 14 were returned as " insusceptible of vaccination." In 6 cases vaccination was postponed by medical certificate; 243 infants died unvaccinated ; in 20 instances infants were removed to other districts, the vaccination officers of which were duly notified of the fact; whilst 163 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 " (47, against 25, 37, and 32, in the preceding three years respectively), equivalent to a "loss" (i.e. cases not finally accounted for) of 6*3 per cent., as compared with the number of births returned in the Birth List Sheets ; the loss in the preceding ten years having been 10*7, 10T, 12*7 (1898), 8*1, 6'8, 7'6, 6*1, 5"8, 5*8 and 5'4 per cent. The Vaccination officer attributes " many of the lost cases to false registration and non-registration of births." Be this as it may, the Kensington returns compare favourably with those for the Metropolis as a whole. The Vaccination Act, 1907.—This measure, as explained in a circular letter issued by the Local Government Board (25th September), provides, as a means of obtaining exemption from penalties for the non-vaccination of a child (where the parent or other person having the custody of the child conscientiously believes that vaccination would be prejudicial to the health of the child) for procedure by statutory declaration in substitution for that prescribed by the vaccination Act, 1898, under which it was necessary to obtain a certificate of conscientious objection from justices or a magistrate. On 23rd December the Board issued a new Vaccination Order to the Boards of Guardians throughout England and Wales, prescribing a fresh form of notice of the requirements of vaccination, containing the necessary references to the new method of obtaining exemptions. The Order came into force on 1st January, 1908. The Act of 1898 led to a large increase in the number of vaccinations in proportion to births registered, due, as the Board observed in their report for 1901-2, to the altered conditions under which, consequent to the Act and their regulations made thereunder, vaccination is now performed, and the increased facilities which now exist for its performance." It remains to be seen whether the additional facilities for obtaining exemption provided by the Act of 1907 will lead to any material increase in the number of exemptions. Vaccination Officer's Return. 72 Vaccination Officer's Return respecting the Vaccination of Children whose Births were Registered in 1906. (Vide page 71.) DATE. Registration Sub-Districts comprised in Vaccination Officer's District Number of Births returned in Birth List Sheets. Number of these Births duly entered in Columns 1, 2, 4. and 5 of the Vaccination Register (Birth List Sheets), viz : Number of these Births which are not entered in the Vaccination Register, on account, (as shown by Report Book) of Column I. Successfully Vaccinated. Column II. Column V. Dead, Un vaccinated. Postponement by Medical Certificate. Removed to other Districts, and notified to Vaccination Officers of the Districts. Removal to places unknown, or which cannot be reached, and cases not having been found. Total Number of Certificates of Successful Vaccinations received during each of the Calendar Years. Insusceptible of Vaccination. Certificate of Conscientious Objection. 1906. 1907. 1906. 1 2 3 4 6 7 8 9 10 12 13 1st January to 31st Dec. Kensington Town 2,822 2,399 7 38 218 5 14 137 2,936 2,855* Brompton 508 433 7 9 25 1 6 26 Total 3,330 2,832 14 47 243 6 20 163 * This figure is irrespective of 195 vaccinations of children born in other districts. The complete Return for 1907 will not be due until February, 1908. Legal proceedings were taken in fiye cases for default in 1906, 73 THE METROPOLITAN ASYLUMS BOARD. Under the provisions of the (now repealed) Sanitary Act, 1866, the local sanitary authority was endowed with power to provide, for the use of the inhabitants of their district, hospitals for the reception of the sick; a provision re-enacted in section 75 of the Public Health (London) Act, 1891. But, excepting in a few districts, and for limited periods in time of emergency; e.g., when small-pox was epidemic, this power was not exercised, notwithstanding official pressure brought to bear to induce sanitary authorities to erect local hospitals. The late Vestry originated opposition to the establishment of such hospitals; and no one now doubts that the policy of that body was wise, and fruitful of benefit to the entire Metropolis. In 1867 the Metropolitan Poor Act brought the Asylums Board into existence, and this body set to work forthwith to provide infectious disease hospitals, nominally for paupers only. As a matter of fact, however, and despite the disabilities attaching, in theory, to the use of the hospitals, they were largely used from the beginning by non-paupers; and in course of time legislation secured to the inhabitants of the Metropolis all of the advantages for which, at my instance, the late Vestry contended—from 1877 onwards. The hospitals are now free to all, no disability attaching to the use of them. The Managers have carried out their work admirably, and having created for London an unequalled hospital service, fulfil the duties originally devolved upon the local sanitary authorities; duties which those authorities would undoubtedly have had to perform but for the creation of the Board, and the subsequent legislation which has so enhanced their power as to leave little to be desired. The Institutions administered by the Board are 51 in number, amongst them being 16 hospitals for infectious disease—including the Southern Hospital, which has not been used hitherto (Vide page 43). There are three Homes for children, a land ambulance service (8 stations) and a river ambulance service (3 wharves, 5 steamers). The Board's properties comprise an area of about 1,500 acres. The work of the Board is set out in an annual report which had not been published when this report went to press; I am debarred, therefore, from giving much of the customary information of the operations of the Managers in respect to the hospital treatment of infectious disease, subjects naturally of interest to Sanitary Authorities. But I have been favoured by the Clerk to the Board with the following short summary of the operations of the year, and other particulars qu& infectious disease. Notifications. Admissions to hosnitals. Death-rates, 1907. (i.) Scarlet fever 25,925 22,764 2-80 (ii.) Diphtheria 8,598 5,744 9*58 (Hi.) Enteric fever 1,894 541 18*15 (iv.) Typhus fever 5 8— (v.) Smallpox 8* 8 — (»».) Cerebro-spinal meningitis 182 4 25.00 Number notified in year—all infectious diseases—41,023; of these 36,271 were legally admissible to the Managers'hospitals, and 31,068 were admitted—85-7 per cent.: 37,100 patients were treated at the fever hospitals; 1,405 persons died, 6,193 remaining at end of year. Maximum number under treatment was recorded 19th November 7,158 Minimum number under treatment was recorded 11th May 3,563 Seaside Homes.—Amongst the most interesting of the Board's institutions, I rank the Children's Homes—" Millfieid," at Rustington, near Littlehampton, and " East Cliff House," Margate. These Homes are for children "requiring either special treatment during convalescence, or the benefit of seaside air—including children suffering from tubercular diseases of bones, joints, or glands, and pulmonary phthisis." Millfieid Home, to which medical cases of tuberculosis are sent, was improved in 1906 " by the provision of a sun room . . . and new verandahs, 8 feet wide, projecting from dormitories on the first floor of two of the blocks, with provision thereon of 18 beds for outdoor sleeping. This is said to " materially contribute " to the facilities for the treatment of pulmonary tuberculosis. Children " rapidly become accustomed to sleeping in the open, ana do not appear in any way to suffer from this apparent exposure; the balconies only being closed for extreme stress of weather." East Cliff Home " accommodates all cases of tubercular bones and glands, including many requiring operative treatment." A verandah facing south, and fitted with 35 beds, is in constant use all the year round. The results of treatment at these institutionsi is most satisfactory; the pity of it is that the benefits of the Managers' care for sufferers from tuberculosis should be limited to persons under the age of 16 years. Gore Farm Hospitals, Upper and Lower, were utilized for convalescent scarlet fever cases, as also was, during several months at the height of the epidemic, the Joyce Green Small-pox Hospital. * Six not suffering from small-pox. 74 HOSPITAL ACCOMMODATION It is an accepted axiom that provision for the isolation of infectious disease should be made at the rate of not less than one bed for each thousand of the population. The subject, as regards the Metropolis, was dealt with by the Royal Commission, in 1881-2, who, in their Report (1882) recommended, that the provision of hospitals should be extended so as to provide 5,100 beds; viz.: 3,000 nominally for " fever," and 2,100* for small-pox. Diphtheria cases were not at that time admissible to the hospitals. The population of London in 1882, was a little over 3,860,000 ; consequently the Commissioners' recommendation went, to the extent of 1,240 beds (at the least) beyond the theoretical requirements of the day. But they desired, doubtless, that provision should be made for probable requirements, for a lengthened period in advance; and the amount of accommodation advised is even now in excess of the standard, the estimated population being 4,700,000. Circumstances, however, not then anticipated, have led to largely increased demands on the resourced of the Asylums Board ; not only by the sanitary authorities, but also by private medical practitioners and others. Among these circumstances may be mentioned—the depauperization of medical relief in the hospitals, and the opening of the several institutions to all classes of the people (measures advocated in these reports many years before they formed the subject of legislation); the admittance of patients, on whatever form of application, subject only to the production of a medical certificate; gratuitous treatment; the populaxity of the hospitals themselves; and the increasing recognition by the public of the advantages accruing from the isolation of the infectious sick. Compulsory notification, moreover, has been very effective; for now that the sanitary authorities become acquainted with, practically, all cases of infectious disease, they are able to secure the admittance to hospital of numbers of cases, of which in pre-notification days they would probably never have heard. I am indebted to Mr. Duncombe Mann, Clerk to the Metropolitan Asylums Board, for the subjoined- Return of Hospital Accommodation. (1) For Fever and Diphtheria, Acute Cases— Beds. Eastern Hospital 868 North-Eastern Hospital 662 North-Western Hospital 460 Western Hospital 452 South-Western Hospital 889 Fountain Hospital 405 Grove Hospital 518 South-Eastern Hospital 488 Park Hospital 548 Brook Hospital 568 4,808 (2) For Fever and Diphtteria, Convalescent Cases— Northern Hospital (at Winchmore Hill) 738 Gore Farm, Upper Hospital (near Dartford) 922 Gore Farm, Lower Hospital „ 610 2,270 Total 7,078 For Smallpox Patients : — Long Reach Hospital 300 Orchard Hospital 800 Joyce Green Hospital 940 Total 2,040 (8) Southern Hospital (at Carshalton) (about) 800 beds.* It is thus seen that the accommodation far exceeds the theoretical requirement of one bed for each thousand of the population : on that scale London would require not more than 4,700 beds; it has nearly 10,000, irrespective of the Southern Hospital. *The ordinary provision for small pox was to be 2,100 beds, but capable of being increased on an emergency to 2,700. *Vide page 44. 75 THE AMBULANCE SERVICE. The annual report of the Ambulance Committee had not been published when the present report went to press, but I have been favoured with a short statement of removals effected in 1907, as follows:— Removals of patients to Fever Hospitals 32,037 Removals of patients to Smallpox Hospital 15 Removals of private infectious cases 454 Removals of private non-infectious cases 841 Removals of Imbeciles 807 Removals of Ophthalmia cases (children) 452 Removals of Ringworm cases 28 Removals of Defective children 165 The aggregate of all removals was 64,058 The mileage run was... 462,758 The mileage by Motors (included in total mileage) was 71,786 I need hardly say that it is not the duty of the Board to remove private »o«-infectious cases; nor was the service established by law for the removal of any other than infectious cases to the Board's hospitals; but power to remove private infectious cases (on payment) was conferred on the Managers some years since with great public advantage. It will be noted that 1,452 removals of non-infectious cases of persons for whom the Managers are responsible were effected during the year. In all, the removals of non-infectious cases were 2,293. For the removal of "private" wowinfectious cases a charge is made sufficient to cover expenses, LOCAL AMBULANCE ARRANGEMENTS. Kensington patients are removed to hospital by the staff at the Western Station, which adjoins the Western Hospital, Seagrave Road, Fulham. In 1900, the Managers, on removing to their new offices, Victoria Embankment (corner of Carmelite Street, E.C.), arranged for the reception there of applications for the removal of the sick to hospital between the hours of 9 in the morning and 11 aj night, on all days of the year. Between 11 p.m. and 9 a.m., the ambulance stations are switched on to the public telephone exchanges, so that " by making use of the telephone, persons may obtain an ambulance at any hour of the day or night." It cannot be too widely known that the sick are admitted on application, the sole condition being the presentation of a certificate signed by a registered medical practitioner, as evidence of the nature of the disease and the fitness of the patient for removal. The application may be made by anyone; personally, or by letter, or by telegraph, or by telephone. The telegraphic address is "Asylums Board London"; the telephone numbers are 2461 " Holborn," and 7181 " Central." METROPOLITAN STREET AMBULANCE SERVICE. Reference was made in the report for 1906 to the appointment by the Home Secretary of a Departmental Committee to " inquire as to the provision made for dealing with cases of accident and sudden illness occurring in streets and public places within the Metropolis, and to report." The first meeting of the Committee was held on 14th February, 1907; at the end of April, 1908, their report had not been published. CITY OF LONDON STREET ACCIDENT AMBULANCE SERVICE. In the report for 1906 reference was made to the intention of the Corporation of the City of London to provide means for the safe and speedy removal to hospital of the victims of street accidents, and it is satisfactory to note that an electro-motor ambulance service controlled by the City Police was inaugurated in May, 1907. The temporary ambulance station is located on ground belonging to St. Bartholomew's Hospital, in King Edward Street, Newgate Street. The permanent station will be in a block of buildings which is being added to the hospital. At present only one ambulance—of eight-horse power—has been provided; it can carry two patients in a recumbent position, and three others in a sitting posture. Fifty-two call boxes have been erected in the most convenient parts of the City, and by means of these the police on duty at the spot where the accident happens are able to communicate with head quarters, and with the ambulance station, and thus the patient can be removed to the nearest hospital with the least possible delay and risK—nearly all of the members of the City Police Force being efficient "first-aid" men. Should the working of the ambulance prove the success which is anticipated, two others, it is stated, will be established on the eastern side of the City. Between 13th May, 1907, and 13th February, 1908, 944 cases were dealt with, 64 from buildings, and 880 from streets. The average time taken for run, from time of call to arrival at hospital, is under 10 minutes. The Departmental Committee recently visited the Station. 76 THE HOUSING OF THE WORKING CLASSES. Railway Companies and Housing.—Reference was made in the annual report for 1906 to an important scheme initiated by the Great Western Railway Company under their Additional Powers Act, 1897, which enables them to acquire about 100 houses at North Kensington—in Wornington Road, Admiral Terrace, Admiral Place and Admiral Mews—for the purpose of widening their line. The Company had acquired land in the vicinity with a view to compliance with their statutory obligation to provide new dwellings for such number of persons as the Local Government Board should, after inquiry, deem necessary, "having regard to the number of persons on or after" December 15th, 1896, residing in the houses to be acquired, "and working within one mile therefrom. . ." The Act requires that "the new dwellings to be provided under the scheme" shall be "completed fit for occupation before the persons residing in the houses . . . are displaced." The Local Inquiry necessarily precedent to sanction to the scheme was held, in February, 1906, by an engineering inspector of the Local Government Board, who informed the Company that accommodation should be provided for 706 persons dut of the estimated number to be displaced, (1038.) The Company submitted plans of proposed new dwellings showing accommodation for 670 persons in tenements of two, three, and four rooms—two persons to a room, the number of rooms being 335. The Board required certain modifications of the plans, to which the Company agreed, the carrying out of which will improve the scheme materially. At the present writing, however, no steps have been taken by the Company to give effect to the scheme : it is a question of time only, and ultimately some 300 persons will be displaced and not rehoused in the new dwellings. And worse is to follow, for further proposed widenings of the line will involve a still larger number of displacements—in Southam Street and St. Ervan's Road, in which the Company will, under their Act of 1900, take 138 houses, the inhabitants of which, at the census in 1901, numbered over 2,000. It is probable that under the two schemes a thousand persons will be displaced and not rehoused. Stockton Mews: Houses Unfit for Habitation.—The Sanitary Inspector of No. 2 district reported 8 houses in Stockton Mews, North Kensington, to be, by reason of insanitary conditions and structural defects, unfit for human habitation, and I certified them as such. The Public Health Committee viewed the several premises, and by their direction application was made for closing orders which, with the consent of the owner, were made in the month of June. The premises remain closed. The Council's Housing Schemes.—In the report for 1905 reference was made to the Council's scheme for improving the housing of the working classes in Kenley Street, one of the five streets comprised in what is popularly known as the Notting Dale "special area," a scheme initiated by Sir Seymour King, K.C.I.E., M.P., the first Mayor of the Royal Borough of Kensington. With a few exceptions the houses in the street were acquired; those on the north side, 26 in number, were remodelled, (two were rebuilt) and provision was made of 58 self-contained suites, of two and three rooms which are now occupied by persons of the working classes in receipt of incomes not exceeding thirty shillings a week. The houses on the south side were demolished and replaced by six blocks of residences of three storeys, each block containing 6 suites of two rooms. In Thomas Place and Hesketh Place, moreover, two considerable blocks containing 26 single room tenements have been erected which should prove a great boon, and supply to some extent a much felt want. The Housing Sub-Committee of the Public Health Committee, in a report published in 1906, gave a full account of their proceedings, with details of cost of acquiring the several properties, amount expended in remodelling and in building, with estimates of incomings, &c.. to which reference may be made for details of the scheme which cannot fail to have an excellent effect in raising the character of the district. (See also page 65.) REGISTERED HOUSES. At the close of the year there were 2,028 houses on the register of "houses let in lodgings or occupied by members of more than one family" (Public Health (London) Act, 1891, Section 94), of which 53 were newly registered during the year. Inspections of these houses to the number of 9,304 were made by the Sanitary Inspectors, including 1,185 inspections of those which are let in "furnished" rooms. Twelve hundred and thirty-four notices were issued in the course of the year, and the provisions of the by-law for annual cleansing were duly carried out by the several landlords under the supervision, so far as practicable, of the inspectors. At the request of the Housing Sub-Committee a return was made showing:— 1. Registered Houses let in furnished tenements or furnished lodgings. 2. Names of Landlords or Occupiers. 3. Number of rooms in the several houses, occupied and empty. 4. Number of inhabitants at date of inspection. 77 The facts elicited may be summarised as follows:— Name of Street. No. of houses let in furnished Rooms. Number of Occupied Rooms. Number of Inhabitants. Number of Empty Rooms. Bangor Street 34 321 592 64 Crescent Street 23 168 330 25 St. Katharine's Road ... 27 196 324 39 Kenley Street 2 13 22 3 Sirdar Road 20 144 268 31 St. Ann's Road 5 30 55 4 Raymede Street 1 8 16 1 Treverton Street 3 24 47 2 Edenham Street 2 12 18 3 Blechynden Street 6 28 72 1 Bramley Road 2 12 20 2 Lockton Street 3 24 60 5 Manchester Roa'l 3 18 39 2 Princes Road 2 12 21 5 Portland Road 15 88 175 14 Bolton Road... 16 155 237 20 Lonsdale Road 3 22 33 8 Peel Street ... 1 5 3 1 Campdeu Street 1 8 6 3 Totals 169 1,288 2,338 233 COMMON LODGING-HOUSES. The County Council in 1894, took over from the police the supervision of common-lodginghouses, under the circumstances set out in my annual report for 1893 (p. 207). I am indebted to the Council's Medical Officer of Health for the subjoined return of the common lodging-houses in the borough, which are 24 in number, and contain accommodation for 711 persons. Ward. Name of Keeper. Address of Common Lodging-House. No. of Lodgers, for which licensed, in 1907. Male. Female. Total. Golborne Madden, James 194, Kensal Road 75 ... 75 Norland Rusha, Alfred 18, Bangor Street ... 24 24 „ Do. 20, do. ... 45 45 ,, Reynolds, Charles35, do. 26 ... 26 „ Phillips, Edward Sanders 5, do. „ Do. 7, do. 52 ... 52 Hankins. George 10. Crescent Street ... 25 25 ,, Do. 28, do. ,, Do. 80, do. 54 ... 54 Do. 40, do. ... 25 25 „ ; Ruslia, Alfred 25, do. ,, Do. 27, do. ... 57 57 „ Do. 31, do. ,, Do. 33, do. 58 ... 58 „ Simpson, James 87, Mary Place „ Do. 35, do. 26 ... 26 ,, Davis, bagel 66, St. Ann's Road 66 ... 66 „ Rusha, Alfred 34, Sirdar Road „ Do. 36, do. ... 53 53 ,, Do. 38, do. ,, Do. 40, do. 48 ... 48 „ Code, Greorge 12, St. John s Place ... 43 43 Holland Redman, Emma 24, Peel Street ,, Do. 22, do. 84 ... 34 Seventeen of the common lodging-houses, with accommodation for 467 persons, are comprised in the Notting Dale "special area." Salvation Army shelters are now annually licensed, but there are none in the borough. 78 FACTORY AND WORKSHOP ACT, 1901. Subjoined will be found the report of the Lady Inspectors of workshops, workplaces and laundries where women are employed, and the report of the Chief Sanitary Inspector with respect to men's workshops, comprising information required by Section 132 to be set out in the Annual Report of the Medical Officer of Health. In connection with the first-named report, it may be mentioned that it was in Kensington that the services of women were first enlisted, in 1893, in the work of sanitary administration. Now almost all of the Metropolitan Borough Councils and many provincial sanitary authorities have appointed women inspectors. The work of the Kensington Inspectors (Miss de Chaumont and Miss Looker) under the Factory and Workshop Act, in 1907, is as follows:— "The number of workshops, etc , at which female labour was employed, at the end of 1907, was 920; viz., 435 (mostly laundries) in North Kensington, and 485 (mostly dressmakers) in South Kensington. During the year, 72 new workshops were added to the register and 78 were removed therefrom. "The subjoined table summarises particulars of the workshops on the Register at the end of the year, in North Kensington and South Kensin'gton respectively—Holland Park Avenue and High Street, Notting Hill, constituting the dividing line. Workshops, etc. North Kensington. Sodth Kensington. Total for Whole Borough Dressmakers. Laundries. Miscellaneous. Total. Dressmakers. Laundries. Miscellaneous. Total. No. on Register 77 269 89 435 324 13 148 485 927 No. of Rooms therein 125 785 129 1,039 647 34 183 864 1,903 " The number of persons employed varies with the period of the year, being, of course, greatest during the ' season': it exceeds 10,000. The businesses carried on at the registered premises are set out in the subjoined list:— Trade or Business. North Kensington. South Kensington. Total in the Borough. Art needlework — 3 3 Blind-maker — 1 1 Blouse-maker 1 8 9 Boot header 1 — 1 „ closer 2 — 2 Colour printer 1 — 1 Corset maker 2 6 8 Cracker maker 1 — 1 Dressmaker and ladies' tailor 77 309 386 Dyer and cleaner 4 5 9 Eyelet hole finisher 1 — 1 Florist — 4 4 Furrier 1 4 5 Hair wash manufacturer 1 — 1 Hosier — 1 1 Lace worker — 1 1 Lamp shade maker 1 1 2 Laundry (workshop) 203 13 216 ,, (factory) 66 — 66 Machinist — 1 1 Mantle maker — 4 4 Milliner 5 44 49 Outfitter — 3 3 Photographer 2 12 14 Pickle manufacturer 1 — 1 Printer — 2 2 Eag-sorter 2 — 2 Restaurant and dining room keeper 38 42 80 Silversmith — 1 1 Tailor 21 5 26 Typist — 2 2 Umbrella manufacturer — 1 1 Upholsterer 1 10 11 Violin string manufacturer 1 — 1 Waistcoat maker 2 — 2 Wig maker — 2 2 Total 435 485 920 79 "The several premises were inspected more or less frequently according to the needs and circumstances of individual cases, and all complaints, whether made by H.M. Inspector or otherwise, received immediate attention. At several workshops improvements to ventilation, a matter within the jurisdiction of the Council, were carried out. In one case proceedings were taken against an employer, who was fined £5 and a prohibition Order granted to prevent him from wanning his workroom by means of an unventilated gas ironheater. "Overcrowding.—We are glad to report a continued decrease in the number of instances in which this 'nuisance' was observed: nine only, compared with 23 in 1906 and 36 in 1905. The season,'however was a bad one from the dressmakers' point of view, and a smaller number of hands' than usual were employed in consequence. "Sanitary Conveniences.—Where persons of both sexes are, or are intended to be employed at any factory, workshop or workplace, the provision of sufficient and suitable accommodation in the way of sanitary conveniences, separate accommodation for persons of each sex, as required, by Section 38 of the Public Health (London) Act, 1891, and is enforced—not always without difficulty, of which instances occurred during the year. "Outworkers.—Lists of outworkers are required to be sent in twice a year—in February and August, and reminder notices having been sent to all known employers of outworkers, there was no failure to comply with the requirements of the order during the year. The names and addresses of 708 outworkers working for firms within the Borough were forwarded to the Medical Officer of Health of the several boroughs in which they resided; the names and addresses of 315 out-workers residing in Kensington, but working for firms in other boroughs, were received from Medical Officers of Health. "Infectious Disease.—Cases of notifiable diseases occurred at thirty-nine workshops or outworkers' homes; scarlet fever in 21 instances; diphtheria in 7; erysipelas in 4; enteric fever in one. The sufferers from scarlet fever and diphtheria were removed to hospital; in one case pressure had to be employed to secure removal. Disinfection was carried out in every case, and happily there was no spread of disease. "Home Office Cases.—Fifty-five cases of failure to affix the "Abstract" in workshops were reported to the Home Office, and also five complaints re working overtime. Thirty cases of alleged insanitary conditions in workshops received from the Home Office, were investigated forthwith, and dealt with as found necessary. Sixteen reports with reference to these cases were forwarded to His Majesty's Inspectors. "For some years past we have experienced almost invariable willingness on the part of employers to conform to the requirements of the law when attention has been called to any default, and we gladly testify to the courtesy with which our visits and suggestions are received. "The table appended to this report summarises the work of the year, so far as it is capable of being expressed in this form. "We may mention that, as usual, we kept under observation the lavatory accommodation for women at the railway stations; thirteen in number, an increase of two—at Gloucester Road, and at Brompton Road on the Piccadilly tube, respectively—all of which were, as a rule, found in good order." [Summary return o1 work. 80 SUMMARY RETURN OF WORK OF LADY INSPECTORS OF WORKSHOPS, ETC. 1907. North Kensington. Sooth Kensington. Total for Borough. Dressmakers. Laundries. Miscellaneous Total Dressmakers Laundries. Miscellaneous Total. 1. Workshop inspections, No. of 140 287 220 647 791 19 258 1,068 1,715 2. „ re-inspections „ 30 92 10 132 119 6 47 172 304 8. Workrooms inspected 191 1,427 246 1,864 1,222 40 284 1,546 3,410 4. Workrooms found overcrowded 1 — — 1 7 — 1 8 9 5. „ insufficiently ventilated 3 9 2 14 14 — 1 15 29 6. ,, in a dirty condition 3 92 5 100 18 — 2 20 120 7. ,, measured; Number of 26 5 4 85 76 — 3 79 114 8. Workshops, &c., reported to H.M. Inspector 8 2 5 15 30 — 10 40 55 9. Workshops, &c., reported by H.M. Inspector 11 10 11 32 42 — 13 55 87 10. Workshops, &c., newly discovered and registered 9 6 5 20 37 — 15 52 72 11. Workshops, &c,, removed from register 11 12 8 31 42 1 4 47 78 12. Domestic workshops and workplaces inspected 38 103 97 238 19 — 101 120 358 18. Written intimations issued 6 38 2 46 52 1 11 64 110 14. Statutory notices issued — 13 — 13 10 — 6 16 29 15. Sanitary defects remedied:— (a) Additional means of ventilation provided 1 — 1 5 12 — — 12 17 (b) Rooms cleansed and whitewashed 3 81 5 89 15 — 4 19 108 (c) Yards, floors, roofs, &c., repaired 1 15 — 16 — — — — 16 (d) Sanitary conveniences; defects remedied 1 13 1 15 21 1 4 26 41 (e) Dustbins provided or repaired — 2 — 2 6 — 3 9 11 (f) Miscellaneous defects remedied 3 10 1 14 9 — 1 10 24 16. Nuisances reported to Medical Officer of Health 1 1 2 4 1 1 3 5 9 17. Workroom cards distributed; Number of 20 1 2 23 77 — 3 80 103 81 WORKSHOPS WHERE MEN ARE EMPLOYED. Considerable improvement with regard to workshop inspection, generally, took place in 1902 consequent on the appointment of additional male inspectors, which permitted of men's workshops being brought under supervision. Men's workshops (i.e. workshops conducted on the system of not employing any woman, young person or child therein) are in a somewhat different position to those where women are employed, inasmuch as (inter alia) the sections in Part I. of the Act relating to temperature, thermometers, means of ventilation, drainage of floors, sanitary conveniences, etc., are not applicable to them. I have received from the Chief Sanitary Inspector the subjoined account of the administration of the Act in relation to men's workshops, in 1907. "The businesses carried on at the workshops where men are employed, 784 in number, are set out in the subjoined list, compiled from the register, in which the trades are classified, columns being provided for the address, and the name, of the occupier, and a column for the "number of protected persons "employed at the date of inspection of the premises. Trade or Business. North Kensington. South Kensington. Borough. Baker 62 36 98 Basket-maker 8 - 8 Blacksmith 18 21 39 Bootmaker 75 41 116 Builder 55 48 103 Cabinet-maker and Joiner 23 20 43 Carver and Gilder 1 5 6 Coach-builder 31 8 39 Cycle-maker 9 11 20 Firewood-manufacturer 21 - 21 French Polisher 1 2 3 Marble Mason 5 3 8 Printer 3 3 6 Saddler 7 9 16 Tailor 46 20 66 Trunk-maker 5 6 11 Umbrella-maker 3 2 5 Undertaker 7 4 11 Upholsterer 10 6 16 Watchmaker 20 20 40 Wig Maker - 13 13 Sundry businesses 57 39 96 Total 467 317 784 82 The subjoined table, dealing with persons of both sexes employed at workshops, etc., is prescribed by the Local Government Board to be inserted in the annual report of the Medical Officer of Health. FACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES, AND HOMEWORK. 1.—Inspection. Premises. Number of Inspections. Written Notices. Prosecutions. Factories (including Factory Laundries) 144 9 - Workshops (including Workshop Laundries) 2819 354 - Workplaces (other than Outworkers' premises included in part 3 of this Report) 348 7 - Total 3311 370 - 2.—Defects Found. Particulars. Number of Defects. Number of of Prosecutions Found. Remedied. Referred to H.M. Inspector. Nuisances under the Public Health Acts:—* Want of cleanliness 235 221 -.. - Want of ventilation 31 22 - - Overcrowding 8 8 - - Want of drainage of floors 19 19 - - Other Nuisances 137 137 - - Sanitary accommodation insufficient 6 6 - - unsuitable or defective 84 84 - - not separate for sexes 6 5 - - Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouse (S. 101) - - - - Breach of special sanitary requirements for bakehouses (SS. 97 to 100) 6 6 - - Other Offences (Excluding offences relating to outwork which are included in Part 3 of this Report.) 5 - 5 - Total 537 508 5 - *Including those specified in Sections 2, 3, 7 and 8, of the Factory and Workshop Act as remediable under the Public Health Acts. 3.—HOME WORK. NATURE OF WORK. OUTWORKERS' LISTS, SECTION 107. Inspections of Outworkers premises. Outwork in Unwholesome Premises, Section 108. Outwork in Infected Premises, Sections 109, 110. Lists received from Employers. Addresses of Outworkers. Prosecutions. Instances. Notices served. Prosecutions. Instances. Orders made (S. 109). Prosecutions (Sections 109, 110) Twice in the year. Once in the year. Received from other Councils. Forwarded to other Councils. Failing to keep or permit inspection of lists. Failing to send lists. Lists.† Outworkers.† Lists. Outworkers.† Contractors. Workmen. Contractors. Workmen. 1. 2 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. Wearing Apparel— (1) making, etc. 49 ... 767 9 ... 39 304 681 ... ... 280 1 1 ... 8 ... ... (2) cleaning and washing 38 ... 93 1 ... 3 3 25 ... ... 185 ... ... ... 9 ... ... Lace, lace curtains and nets ... ... ... ... ... ... 6 ... ... ... 2 ... ... ... ... ... ... Artificial flowers ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... Nets, other than wire nets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tents ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Sacks ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Furniture and Upholstery 2 ... 7 ... ... ... 1 1 ... ... 3 ... ... ... ... ... ... Fur pulling ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Feather sorting ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Umbrellas, etc. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Carding, etc., of buttons, etc. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Paper Bags and Boxes ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Basket making ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Brush making ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... Racquet and tennis balls ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Stuffed Toys ... ... ... ... ... ... l ... ... ... 1 ... ... ... ... ... ... File making ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Electro Plate ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cables and Chains ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Anchors and Grapnels ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cart Gear ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Locks, Latches and Keys ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pea picking ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Total 89 ... 867 10 ... 42 317 707 ... ... 473 1 1 ... 17 ... ... * If an occupier gives out work of more than one of the classes specified in column 1, and sub-divides his list in such a way as to show the number of workers in each class of work, the list should be included among those in column 2 (or 5 as the case may be) against the principal class only, but the outworkers should be assigned in columns 3 and 4 (or 6 and 7) into their respective classes. A footnote should be added to show that this has been done. † The figures required in columns 2, 3 and 4 are the total number of lists (received from employers who sent them both in February and August as required by the Act) and of the entries of names of outworkers in those lists. They will, therefore, usually be double of the number of such employers and (approximately) double of the number of individual outworkers whose names are given, since in the February and August lists of the same employer the same outworker's name will often be repeated. 83 84 4.—Registered Workshops. Workshops on the Register (s. 131) at the end of the Year. Number. Important classes of workshops, such as workshop bakehouses, may be enumerated here. Dressmakers and Ladies' Tailors' 401 Workshop Laundries 216 Factory Bakehouses 2 Workshop Bakehouses 96 Other Workshops 928 Total number of workshops on Register 1,688 5.—Other Matters. Class. Number. Matters notified to H.M. Inspectors of Factories:— Failure to affix Abstract of the Factory and Workshop Act (s. 133) 55 Action taken in matters referred by H.M. Inspectors as remediable under the Public Health Acts, but not under the Factory and Workshop Act (s. 5) Notified by H.M. Inspectors 30 Reports (of action taken) sent to H.M. Inspectors 16 Other 5 Underground Bakehouses (s. 101):— Certificate granted during the year — In use at the end of the year 75 PUBLIC HEALTH (LONDON) ACT, 1891. The need for amendments to this Act is recognised, and it was expected that the County Council would have introduced an amending Bill ere now. In February, 1899, a letter had been received by the late Vestry from the Public Health Committee of that body, desiring information as to amendments which in their opinion should be made. The communication was referred to a sub-committee of the Sanitary Committee, together with reports by the vestry clerk, the surveyor, and the medical officer of health, and certain amendments and additions to the Act were suggested. The somewhat barren result of the inquiry was communicated to the County Council. No legislation dealing with the points raised has so far been secured. In 1904, however, the Council convened a Conference of delegates of the Metropolitan Asylums Board, and of the Metropolitan Borough Councils (twenty-five of which were represented), to consider "the administration of the 85 Public Health (London) Act, 1891." The Conference was held at the County Hall, Spring Gardens. The resolutions adopted, 49 in number, were grouped under the following headings:— 1. Housing (1-18).—Houses Let in Lodgings, Underground Rooms, Water Supply, Factories and Workshops, Shops. 2. Food (14-25).—Premises where Food is prepared for sale, Abolition of Private Slaughter- houses, Inspection of Meat killed in Private Slaughter-houses, Inspection of Slaughter-houses, Cow-houses, Dairies, Milk Shops and Milk Stores, Registration of Milk Shops, Sale of Milk, Municipal Milk Depdts, Sale of Food and Drugs Acts, Cisterns. 8. Prevention of Disease (26-43).—Disinfection, Provision of Laundry, Provision of Permanent Shelter Accommodation, Precautionary Measures against Phthisis, Hospital Accommodation, Offensive Trades, House Refuse, Collection of Fish Offal and other Offensive Trade Refuse, Sanitary Inspection. 4. Miscellaneous (44-49).—Municipal Creches, Smoke Nuisances, Metropolitan Ambulance Service, etc. The County Council forwarded to the Metropolitan Borough Councils a transcript of the shorthand note of the proceedings at the Conference, and asked to be furnished with the views of those bodies on such of the resolutions as proposed legislation. I made a report to the Council (November 15th), expressing concurrence with the said resolutions, which dealt with the following subjects: — (a) The formulation of by-laws for the regulation of the structure of premises where food is prepared for sale, and the certification of the suitability of such premises by the Borough Councils. (b) The formulation of by-laws for the regulation by the Borough Councils of the conduct of the business carried on in premises where food is prepared for sale. (c) The acquisition of powers to enable the Borough Councils to refuse registration of premises as milk shops where, in their opinion, the premises are unfit. (d) The introduction of legislation providing for the penalising of persons selling filthy milk in London. (e) The acquisition of powers to enable the Borough Councils, at their discretion, to provide depots for the preparation and sale of sterilised and humanised milk for infants. (f) The introduction of legislation for the repeal of the warranty sections of the Sale of Food and Drugs Acts (sections 25 of the Act of 1875, and 20 of the Act of 1889). (g) The acquisition of powers to enable the Borough Councils, at tbeir discretion, to establish creches, and to make reasonable charges for the accommodation and food provided thereat. (h) The amendment of the law so as to provide that disinfection shall be carried out without the intervention of a contractor, and to the satisfaction of the Medical Officer of Health. (i) The acquisition of powers to enable the Metropolitan Asylums Board to extend the operations of their ambulance service so as to include the transport of medical, surgical and mental cases. My report was referred to the Public Health Committee, who intimated that, whilst in general sympathy with the majority of the resolutions, they felt a little hesitancy in expressing an opinion thereon until they should have had before them the Bill which would, no doubt, be introduced into Parliament, embodying the various suggestions dealt with. The Committee therefore decided to defer the further consideration ot the matter until such a measure had been formulated ; they recommended that a communication be addressed to the London County Council on these lines, and this was done. No amending Bill has been introduced to date. PUBLIC HEALTH LEGISLATION ; LONDON COUNTY COUNCIL (GENERAL POWERS) ACT, 1907. This Act confers upon the County Council certain powers deserving of mention, and first of all reference may be made to— Part IV. Milk Supply (Tuberculosis). Power to take Samples of Milk. Section 24 (1) empowers the County Council's Medical Officer of Health to take at railway stations within the County, for examination, samples of milk, produced or sold, or intended for sale, within the County. The Council may (under sub-section (2)) if they think fit, by resolution authorise any Sanitary Authority through their Medical Officer of Health, to take samples for examination by the Council—for the purpose of sub-section (1). 86 Power to inspect Cows and to take samples of Milk. Section 25.—The County Council's Medical Officer may (if accompanied by a properly qualified Veterinary Surgeon), enter a "dairy," and inspect the cows kept therein—if milk therefrom is being sold, or is suffered to be sold, or used within the County—and if he has reason to suspect that any cow is suffering from tuberculosis of the udder, he may require the cow to be milked in his presence and take samples of the milk (sub-section (1)); and if he is of opinion that tuberculosis is, or is likely to be caused from the consumption of milk supplied from a dairy within, or outside, the County, measures necessary for the protection of public health are to be taken, whicb, with consequent procedure, are set out in sub-sections (2) to (10). Provision is made in section 26 for appeal by the dairyman against an order which may be made by the Council under sub-section (2) requiring him not to supply milk, within the County, from the dairy, or from any specified cow or cows, until the order has been withdrawn; and, in section 27, for compensation to the dairyman if an order is made without due cause, or if the Council unreasonably refuse to withdraw the order. Liability to a penalty not exceeding ten pouuds is incurred by any person knowingly selling, or suffering to be sold, or used for human consumption, within the County, the milk of any cow which is suffering from tuberculosis of the udder (section 28); and liability to a penalty not exceeding five pounds for failing to isolate diseased cows (section (29)), and to one not exceeding forty shillings for failing to give written notice to the Medical Officer of any cow affected with, or suspected to have, tuberculosis of the udder (30). The remaining sections of Part IV have reference to Notice of the provisions of the Act to be given by advertisement, etc. (31); to Procedure (32); Expenses (33): Execution of the Part (iv) by a Committee (34), and as to exercise of powers within the City of London (35).* Part XII.—Miscellaneous. Supply of Water in tenement houses.—Section 48 of the Public Health (London) Act, 1891, enacts that "an occupied house without a proper and sufficient supply of water shall be a nuisance liable to be dealt with summarily "under the Act. This enactment has received an important extension, as regards tenement houses, by Section 78 of the County Council (General Powers) Act, 1907, which (inter alia) enacts that— "A tenement house shall be deemed to be a house without a proper and sufficient supply of water unless there shall be provided on the storey or one of the storeys in which the rooms or lodgings in the separate occupation of each family occupying such house are situate a sufficient provision for the supply of water for domestic purposes "Provided that this section shall not apply to any tenement house in respect of which it can be shown that any such provision for the supply of water as aforesaid is not reasonably necessary." Contradictory decisions had been given by magistrates as to what constitutes a "proper and sufficient supply of water" in a tenement house. In December, 1904, the Woolwich Borough Council obtained a conviction and an order in a case where a three-storeyed tenement house, having six rooms occupied by five families, was supplied with water from a stand-pipe in a yard approached from the rear of the premises. The magistrate ruled that this was not a "proper and sufficient supply," and directed that there should be a separate supply to each floor. In 1905 the same question having been raised at St. Marylebone Police Court, on proceedings taken at the instance of the Public Health Committee of the Paddington Borough Council, a decision adverse to the views of the Woolwich magistrate was given, the summons being dismissed. The Paddington Council thereupon urged the County Council to "take the necessary steps to secure an adequate and accessible supply of water to floors in tenement houses," and 1 advised the Council to support that body, by requesting the County Council to introduce a clause in their next General Powers Bill to attain the object now, in principle, secured. Part V.—Cleansing of Verminous Persons. This subject was somewhat fully dealt with in the Annual Report for 1906, in connection with the announced intention of the County Council to apply to Parliament for compulsory powers to secure the cleansing of verminous school children, and inmates of common lodging-houses, classes of the population under their jurisdiction. The powers conferred on the Council by their General Powers Act, 1907, may be briefly summarised as follows:— Cleansing of Children attending School, and of Inmates of Common Lodging-houses. Power is given to the County Medical Officer (or his deputy) to examine the person and clothing of any child in any school within the County, provided or maintained by the Council as Local Education Authority; and if the person or clothing of any such child is found to be infested with vermin, or is in a foul or filthy condition, to require, by notice in writing, the parent or guardian to cleanse properly the person and clothing of such child within 24 hours. In default, the Medical Officer may remove the child from the school, and "may cause the * In the County Council (General Powers) Bill, 1908, additional powers in regard to the milk-snpply of the Metropolis were sought, but, at the second reading stage, the clauses were ordered to be struck out, the President of the Local Government Board having announced his intention to bring in a general Bill dealing with the milk supply. 87 person and clothing of such child to be properly cleansed in suitable premises, and with suitable appliances, and if necessary for that purpose may, without any warrant other than this Act, convey to such premises, and there detain such child until such cleansing is effected" (section 36). Section 37 confers similar power on the Medical Officer witti regard to the inmates of Common Lodging Houses; notice in writing to be given to the verminous inmate "requiring him, within 24 hours, to submit his person and clothing to be cleansed in such suitable premises as may be specified in the notice, and by means of any suitable appliances available thereat for that purpose." In default, the Medical Officer (or his deputy) may convey to suitable premises, and there detain such inmate until the cleansing is effected. For obstructing the entry of the Medical Officer into a common lodging-house, for the purpose, or for refusal of the verminous inmate to allow examination of his person or clothing, or to allow his person or clothing to be cleansed, the penalty, on summary conviction, is forty shillings. Power is given to the Council and to Sanitary Authorities, by section 38, to make and carry into effect agreements and arrangements for the purposes of this Part of the Act, "for, or with respect to the cleansing of the person or clothing of verminous persons, and for the use by the Council, for the purpose of effecting such cleansing of any persons, or appliances adapted for such purpose, and belonging to or used by such Sanitary Authority." Liability to a penalty not exceeding forty shillings is incurred by any person obstructing the entry of the Medical Officer into a common lodging-house, or refusing to allow his person or clothing to be examined, and if necessary cleansed. The examination and cleansing of females is to be effected by females only; i.e., "by a person duly qualified as a medical practitioner, or by a female person duly authorised" (39). The Council are empowered (by Section 40) to make Regulations with respect to the mode of carrying into effect the provisions of this part of the Act; but regulations will have no force or effect until they have been submitted to and confirmed by the Local Government Board. It will be observed that the compulsory powers conferred by the Act apply to two classes of persons only—public elementary school children, and inmates of common lodging-houses, both being under the jurisdiction of the County Council, who addressed to the Metropolitan Borough Councils a communication setting out the provisions of Part V., in which it was stated that— "Before making any definite arrangements to put the Act into force, it [was] necessary that the Council should obtain the fullest possible information as to the extent of the provision already existing, the method of disinfection of verminous clothing and of dealing with a verminous condition of the hair; the arangements in regard to the supervision by the cleansing staff; and the facilities which the Metropolitan Borough Councils would be prepared to afford the Council in the matter." The Borough Council were invited to favour the County Council with information on various points referred to in the communication, and to "indicate also what facilities [could] be afforded to the Council in its administration of the sections of the Act in question" (36 and 37), the provisions of which were recited. In reporting on this communication, I pointed out that " as regards [verminous] children, no provision for cleansing had been made in the borough, whilst as regards adults—common lodgers and others, very little use had been made of the facilities provided by the Kensington Sanitary Authority under the Cleansing of Persons Act, 1897, under a still subsisting arrangement with the Board of Guardians for the cleansing, by their staff at the casual ward, Mary Place, of verminous adults." The report continued as follows:—"Such being the state of the case, it is open to consideration whether the Council might not co-operate with the County Council, in regard to the cleansing at the casual wards, of inmates of common-lodging-houses, under the arrangement with the Guardians—so long as it may be practicable, i.e., until the work, which may be expected to increase under the operation of compulsory powers, shall have become too great for the staff there to cope with. As regards school children; this is a work for which, it is to be assumed, provision will be made by the County Council, and which, presumably, will be carried out under the supervision of the Education Committee's school nurses. I do not think it will entail any serious difficulty. . . . Probably one cleansing station would suffice for the needs of the schools in the northern division of the borough—where it will be most (if not exclusively) wanted. The nucleus of such a station exists at the Council's schools, Sirdar Road, where on the playing roof of one of the buildings, baths supplied with hot and cold water were provided some years ago, but are not now in use." The Council may be reminded that they possess powers for enforcing cleansing of houses infested with vermin, under Section 20 of the London County Council (General Powers) Act, 1904 —powers which were exercised last year in respect to 137 houses, to some of which the attention of the sanitary inspectors had been directed by head teachers, and the school nurse, in reports with respect to verminous children. 88 Education (Administrative Provisions) Act, 1907. Section 13 of this Act, dealing with Medical Inspection of Children in Public Elementary Schools, formed the subject of an important memorandum by the Board of Education, in which it is stated that— "The fundamental principle [of the section] is the medical examination and supervision not only of children known, or suspected to be weakly or ailing, but of all children in the elementary schools, with a view to adapting and modifying the system of education to the needs and capacities of the child, securing the early detection of unsuspected defects, checking incipient maladies at their onset, and furnishing the facts which will guide Education Authorities in relation to physical and mental development during school life. "The duty of carrying out the actual inspection has necessarily [the Board say] been entrusted by Parliament to the Local Education Authorities, and not to the Board. Each Authority must therefore in due course appoint such Medical Officers or additional medical assistance as may be required for the purpose." In London the County Council is the Education Authority, and the question was raised, By whom shall the actual work of inspection be carried out and supervised? The Metropolitan Branch of the Incorporated Society of Medical Officers of Health intimated to the County Council their view— (i.) That it is desirable "on the grounds of efficiency, economy and harmony, that the work of medical inspection should be carried out in intimate conjunction with public health authorities, as enunciated in paragraphs 5 and 6 of the memorandum of the Board of Education, and that the metropolitan cities and boroughs should for this purpose be made the units of administration; (ii.) that the medical officers of health of the metropolitan cities and boroughs be appointed by the London County Council as the local administrative officers, co-operating for this purpose with the medical officer of health of the county of London; (iii.) that it is desirable that the necessary executive assistants should be appointed by the London County Council and allocated to the metropolitan cities and boroughs, such assistants to be under the control of, and to receive instructions from and to report directly to the medical officers of health of the cities and boroughs; (iv.) that it is desirable that the medical officers of health should report directly to the London County Council in all matters relating to the administration of the Education (Administrative Provisions) Act." The Education Committee, however, were of opinion that "It [would] be necessary for the Council to retain in the hands of officers directly responsible to it, and whom it appoints and pays, the direction and supervision of the whole of this work," and they submitted recommendations as to the staff—medical, surgical and nursing—which would be necessary for "giving effect to the requirements of the Act in connection with the medical inspection of children attending public elementary schools maintained by the Council." The Memorandum of the Board of Education, expressly states that "The Act is not intended to supersede the powers which have long been exercised by Sanitarv Authorities under various Public Health Acts, but is meant to serve rather as an amplification and a natural development of previous legislation." The section cannot be regarded otherwise than as an important piece of legislation calculated to have far-reaching and benehcial effects upon the health of future generations. PUBLIC HEALTH (REGULATIONS AS TO FOOD) ACT, 1907. This Act confers power on the Local Government Board to make regulations as to the importation, preparation, storage and distribution of articles of food for the prevention of danger arising to public health. The regulations may— (a) Provide for the examination and taking of samples of any such articles; (b) Apply, as respects any matters to be dealt with by the regulations, any provision in any Act of Parliament dealing with the like matters, with the necessary modifications and adaptations; (c) Provide for the recovery of any charges authorised to be made by the regulations for the purposes of the regulations or any services performed thereunder. Regulations are in course of being prepared. The Act is likely to prove of considerable value, 89 PROPOSED PUBLIC HEALTH LEGISLATION, SESSION 1908. A communication was received from the County Council asking the Council to furnish them with their views on the subject of legislation to be promoted during the Session of 1908, the subjects mentioned being as follows:— (a) To enable the sanitary authorities in London to refuse to register, or to remove from the register, cowkeepers, dairymen, or purveyors of milk whose premises are unsuitable for the sale of milk thereon. (b) To regulate the sanitary conditions prevailing at premises on which food is sold or prepared for sale. (c) To enable sanitary authorities to require the surrender, for the purposes of destruction, of unsound food. (d) To enable sanitary authorities to require the surrender of offensive trade refuse, and to arrange for the temporary storage and systematic removal thereof. (e) To enable the Council to make by-laws, to be enforced by sanitary authorities, with regard to the proper regulation of the businesses of a seller of fried fish, fish curer, and marine store dealer. (f) To enable the Council to pay one-half of the salaries of Female Health Visitors appointed by sanitary authorities in London. The communication in question was referred to the Infectious Diseases sub-Committee, to which I reported recommending:— (1) Acquiescence with the views of the County Council as to the desirability of representing to the Local Government Board the necessity for the promotion of general legislation to secure efficient inspection of dairies and cowhouses throughout the country as the best means for obtaining for London a pure milk supply. (2) That sanitary authorities should have power to refuse to register, and power to disregister occupiers of premises unsuitable for the sale of milk thereon. [This proposal was in harmony with the views of the Public Health Committee; but the Public Health Committee of the County Council thought the object sought could bo obtained by an amendment of the Dairies Order of 1885, which was expected ere long.] (3) That it is desirable power should be given to regulate the sanitary conditions at premises on which food is sold or prepared for sale, on the lines of a clause which had been, withdrawn from the County Council's (General Powers) Bill of 1904. (4) That probably no necessity existed for legislation to enable sanitary authorities to require the surrender of unsound food for the purpose of destruction, as the object sought would be attained by regulations to be made by the Local Government Board under the Public Health (Regulations as to Food) Act, 1907. (5) That the sanitary authority should have power to require the surrender of offensive trade refuse, and to arrange for its temporary storage and its systematic removal at the reasonable cost of the producer. [A course I had advocated for many vears, it being only reasonable, seeing that the producers can require the sanitary authority to remove such refuse from premises on payment.] (6) That the business of marine stores should be scheduled as an offensive business within the meaning of Section 19 of the Public Health (London) Act, 1891, as had bees recommended by the Kensington Sanitary Authority, upon my advice, to the late Metropolitan Board of Works and also to the County Council, and that the same course should be adopted as respects the other businesses mentioned—those of seller of fried fish and fish curer. (7) That it was desirable the County Council should be enabled to pay one half of the salaries of female health visitors. A valuable report on this subject was prepared by the Infectious Diseases Sub-Committee which having been approved by the Public Health Committee and adopted by the Ccuncil was forwarded to the London County Council as a reply to the communication of their Public Health Committee (vide Minutes of the Council, October 22nd, 1897, page 546). 90 THE WORK OF THE SANITARY INSPECTORS. The Sanitary Inspecting Staff comprises a chief inspector, ten male inspectors, and two lady inspectors of workshops, workplaces and laundries where women are employed. The table at page 92 contains a summary of the work of the male inspectors (so far as it admits of tabulation) in their several districts ; of which six are in North Kensington; i.e., north of High Street, Notting Hill, and Holland Park Avenue; and four in South Kensington, three of them to the south of Kensington High Street and Kensington Road; the remaining district lying between the main thoroughfares named The work of the inspectors is carried out under the supervision of the Public Health Committee, the Council having conferred on that body authority to enforce the provisions of the Public Health (London) Act, 1891, the Housing of the Working Classes Acts, 18901903, and the Factory and Workshop Act, 1901, etc. Supervision of underground work—reconstruction and trapping of drains, etc., was, as from the beginning of 1905, transferred from the Borough Engineer's department and placed under the Sanitary Inspectors, who during the year supervised the reconstruction of the drainage systems of 111 premises. The Sanitary Inspectors are charged with the further duty of collecting samples of food and drugs for analysis by the public analyst; the number of samples collected last year was 700. written Intimations of nuisances were served by the inspectors to the number of 2,'212. As a result of these intimations, many works of sanitary amendment were carried out forthwith, thus realising the object of the legislature, and obviating, in many instances, the necessity for service of statutory notices. On the intimation form a red ink note authorises the person liable to abate a nuisance to make what, for convenience, may be called an "appeal" to the Committee against the requirements of the sanitary inspector. Appeal, which is of rare occurrence, usually takes the form of an application for an extension of the time specified for carrying out works. statutory Notices for the abatement of nuisances to the number of 429 were issued by direction of the Committee. Notices under the by-laws for houses let in lodgings, to the number of 1,234, were served. Legal Proceedings.—In seventeen cases proceedings were instituted: in seven instances, for offences under the by-laws for registered houses, the fines in six cases amounting, in all, to £11; the other case being withdrawn, the required work having been executed. In other ten cases, the summonses were for non-compliance with the Council's notices, closing orders being made in seven and three being withdrawn, the required work having been carried out. The subjoined table recommended for use by the Metropolitan Branch of the Society of Medical Officers of Health is inserted at the request of the Medical Officer of Health of the London County Council. PROCEEDINGS DURING 1907. PREMISES. NUMBER OF PLACES. Number of inspections, 1907. Number of notices, 1907. Number of prosecutions, 1907. On register at end of 1906. Added in 1907. Removed in 1907. On register at end of 1907. Milk premises 299 14 34 279 1,519 54 — Cowsheds 1 — — 1 41 — — Slaughter-houses 12 — — 12 217 — — Other offensive trade premises 1 — — 1 37 — — Ice cream premises 146 19 — 165 312 37 — Registered houses let in lodgings 1,981 53 6 2,028 9,304 (a)* 47 (b)† 1187 (a)* (b)† 7 Total number of intimation notices served for all purposes, 2212. * (a) For overcrowding †(b) For other conditions. 91 Overcrowding—1907. Number of dwelling rooms overcrowded 40 Number remedied 40 Number of prosecutions — Underground rooms— Illegal occupation dealt with during year 14 Number of rooms closed 14 Insanitary houses— Number closed under the Public Health (London) Act, 1891 8 Number closed under the Housing of the Working Classes Act. — Number of premises cleansed under Sec. 20 of L.C.C. (General Powers) Act, 1904 137 Shelters provided under sec. 60 (4) of the Public Health (London) Act, 1891— Number of persons accommodated during the year No shelter Revenue Acts— Number of houses for which applications for certificates were received during year 22 Number of tenements comprised therein 74 Number of tenements for which certificates were (a) granted 72 (b) refused 2 Number of prosecutions under By-laws under Public Health Act, 1891. (a) For prevention of nuisance arising from snow, ice, salt, filth, etc., — (b) For prevention of nuisance arising from offensive matter running out of any factory, etc. — (c) For the prevention of keeping of animals in such a manner as to be injurious to health — (d) As to paving of yards, etc., of dwelling houses — (e) In connection with the removal of offensive matter, etc — (f) As to cesspools and privies, removal and disposal of refuse, etc. — (g) For securing the cleanliness of tanks, cisterns, etc. — (h) With respect to water closets, earth closets, etc. — (i) With respect to sufficiency of water supply to water closets — ('j) With respect to drainage, etc., (Metropolis Management Act, section 202) — (k) With respect to deposit of plans as to drainage, etc. (Metropolis Management Acts Amendment (By-laws) Act, 1899) — Mortuaries— Total number of bodies removed 340 Total number of infectious bodies removed 2 9-2 Summary of the Work of the Sanitary Inspectors during the Year 1907. (See page 90.) Sanitary Districts. No. of Complaints made by Inhabitants, &c. No. of Houses, Premises, &c., inspected. No. of Re-inspections of Houses, Premises, &c. Results of Inspection. House Drains. Water Closets. Dust Receptacles. Water Supply. Miscellaneous Written Intimations of Nuisance served.* Notices served by order of the Public Health Committee. Notices served under the Lodging-House By-laws Final Notices (signed by Medical Officer) served. Houses, Premises, &c., Cleansed, Repaired, Whitewashed, &c. Houses disinfected after illness : Infectious disease,. † Reconstructed, Repaired, Cleansed, &c. Ventilated, Trapped, &c. Repaired. Supplied with Water. Soil-pipes ventilated. New provided. Repaired, Covered, &c. Cisterns erected. Cisterns Cleansed, Repaired, Covered, &c. Waste-pipes connected with Drains, &c., abolished. No. of Lodging Houses newly Registered under 94th Section of the Public Health (London) Act, 1891} Yards and Areas paved and drained. Animals removed, being improperly kept. Bakehouses, No. of. Bakehcuses, No. of Inspections of. Dairies, Milkshops, No. of. Dairies, Milkshops, No. of Inspections of. Mews, No. of Inspections of. Legal proceedings, i e., Summonses. No. I. District 105 1,942 1,043 285 51 140 5 280 123 56 2 213 8 — 39 98 6 90 — 42 75 15 7 71 39 267 883 — No. II. „ 76 2,125 1,702 343 81 199 39 434 79 166 3 24 172 2 37 6 7 68 — — 64 3 9 49 31 167 878 7 No. III. „ 37 2,044 1,994 290 48 249 36 289 90 49 5 74 21 2 47 10 — 7 — — 50 4 6 31 44 141 528 3 No. IV. „ 83 1,389 1,141 265 47 111 11 153 136 45 11 51 48 5 34 5 — 12 5 11 14 1 16 77 53 189 492 — No. V. „ 67 1,764 953 214 36 65 15 159 122 17 1 47 33 — 12 1 — 7 — — 5 1 13 89 35 230 727 2 No. VI. „ 59 1,428 1,611 143 46 71 16 133 90 32 9 63 9 1 22 2 7 3 — — 33 1 11 44 23 128 714 5 No. VII. „ 71 1,792 805 169 26 225 22 252 94 32 12 80 78 5 27 22 4 20 — — 27 6 8 55 23 93 339 — No. VIII. „ 64 1,242 1,161 113 33 40 11 148 105 36 — 73 21 2 15 3 1 7 — — 10 1 8 25 19 125 930 — No. IX. 69 1,662 865 274 37 94 9 172 128 28 9 63 47 6 14 21 3 51 1 — 47 2 13 44 27 146 743 — No. X. „ 56 995 1,277 116 24 40 6 69 75 36 10 52 7 2 16 2 — 6 — — 24 4 7 31 20 33 355 — 687 16,383 12,552 2,212 429 1,234 170 2,089 1,012 497 62 740 444 25 263 170 28 271 6 53 349 38 98 516 314 1519 6589 17 * 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, 1907, was 2,028. 93 LICENSED SLAUGHTER-HOUSES. Twelve slaughter-houses were licensed by the County Council in October—six in North Kensington and six in South Kensington. The several premises were regularly visited by the sanitary inspectors, and were inspected, in September, by the Public Health Committee. The business of a slaughterer of cattle has not been established anew in the Borough since the passing of the (now repealed) Slaughter-houses (Metropolis) Act, 1874, in which year there were 48 licensed premises. The names of the licensees, and the localities of the premises, are as follows : — North Kensington. Lonsdale Mews Mr. Grove. 13, Archer Mews Mr. Bawcombe. 10, Edenham Mews Mr. Gibson. 195, Clarendon Road Mr. Simmons. 235, Walmer Road Mrs. Van. 273, Kensal Road Mr. Miles. South Kensington. 35, Earl's Court Road Mr. Matson. 11, Peel Place, Silver Street Mr. Csborne. 25, Silver Street Mr. Bounds. 133, High Street, Notting Hill Miss Candy. 113, Holland Park Avenue Mr. Holloway. 128, Marlborough Road Mr. Little. PUBLIC ABATTOIRS versus PRIVATE SLAUGHTER HOUSES. The Public Health Committee of the County Council, in 1898, made recommendations which, had they been adopted, would, before now, have provided the Administrative County with public slaughter-houses, and accelerated the reduction in the number of private slaughter-houses which has been going on since the passing of the (now repealed) Slaughter-houses (Metropolis) Act, 1874. In that year there were 1,500 private slaughter-houses in London, or one to 2,300 inhabitants; whereas in 1905, only 317 were licensed,* equal to one to 15,000 inhabitants.t The Committee had been moved to make the recommendation referred to, by a report of the Medical Officer of Health of the County Council, in which it was pointed out that to prevent the importation of diseased meat, and for the protection, especially, of the poorer inhabitants, who are the purchasers of the cheaper meat, it was necessary that a system of inspection of all dead meat introduced into London, and which had not been examined in a public slaughter-house, should be instituted; whilst in order to ensure the inspection of meat killed in London, it was absolutely necessary that all animals should be killed in public slaughter-houses, in which alone due inspection of the meat is practicable. The Committee endorsed the view that systematic inspection of the animals is impossible in view of the numerous premises (438 in 1898) in London, in which they are killed. They strengthened their case by a reference to the report of the Royal Commission on Tuberculosis as to the necessity for public slaughter-houses, and facilities for the inspection of meat. The resolutions submitted for adoption by the Council were:— (a) "That in the opinion of the Council it is desirable that, as a first step towards ensuring the proper inspection of meat, private slaughter-houses should cease to exist in London, and that butchers should, in substitution, be afforded such facilities as are necessary for the killing of animals in public slaughter-houses to be erected by the Council." (b) Intimated the Council's readiness "to acccpt such responsibilities as may be necessary to give effect in London to the recommendations of the Royal Commission on Tuberculosis," and proposed to ask the Local Government Board "whether they will include in any legislation introduced by them in connection with the Royal Commission's report, the provisions which would be necessary for this purpose." The Council ultimately disposed of the matter by passing a motion to "proceed to the next business"—a course by which a like recommendation of the Committee was laid to rest in 1906—notwithstanding that a petition referred to them, "signed by 100 persons, amongst whom were several of the leading members of the medical profession," had urged the Council to take steps for the establishment of public slaughter-houses. *In 1906 only 305, and in 1907 292. †In 1874 there were 48 licensed slaughter-houses in Kensington, or one to 2,785 inhabitants; in 1905 only 12, or one to 15,000 inhabitants. In the latter year there were about 120 butchers' shops in the borough, at 90 per cent. of which business was carried on without the aid of a private slaughter-house: comparatively little slaughtering, moreover, being done on any of the licensed premises. 94 Public slaughter-houses have been established at many provincial towns; and it is to be hoped that provision of the sort may, ere very long, be made for the Administrative County of London. It may be mentioned that the representatives of the Sanitary Authorities at the Conference on the Administration of the Public Health (London) Act, 1891, held at the County Hall, in July, 1904, unanimously passed a resolution—"That the time has arrived when private slaughter-houses should cease to exist in London." The action of the City Corporation.—The part taken by the Kensington Sanitary Authority, in, and since, 1874, in the movement for substituting public abattoirs for private slaughter-houses in the Metropolis* should accentuate the interest of the Council in the action by the Corporation of the City of London who have recently opened a public abattoir for the Metropolitan Cattle Market on a site two acres in extent.t LICENSED COW HOUSE One cow house was licensed by the County Council, in October, for the keeping of three cows. The licensee is Mr. Arnsby, and the premises are located at 187, Walmer Road. In bygone days, within my experience, there were 28 licensed premises, containing 500 cows, in Kensington. There has been a considerable reduction in the number of cow houses in the Administrative County: viz., from 1,044 in 1880, to 233 in 1907. The County Council intimated to cowkeepers, some years since, that their Public Health Committee were of opinion that, in the case of premises newly licensed, the recommendation of the Royal Commission on Tuberculosis, that no cow house should be erected within 100 feet of a dwelling-house, should be observed. The Council can, of course, enforce the condition, if they think fit. dairies Order.—The Council, as Local Authority in regard to milkshops, etc., received last year 16 applications for registration. At the close of the year 279 premises were on the register. The several premises are regularly inspected. At many small general provision shops, milk is sold in small quantity, usually from a glazed earthenware vessel standing on the counter, and mainly for the convenience of customers; but also in self-defence, lest customers should be induced to transfer their dealings to other shops where this necessary food can be obtained. The containing vessels at these shops are kept clean; but the air of the premises is far from "pure"; the commonly prevailing odour being that of mineral oil, or of some one or other of the miscellaneous articles of food, cooked or uncooked, groceries, etc., vended thereat. i should be glad to see a better state of things; but the Local Authority appear to have no power at present to refuse registration to would-be vendors of milk. MUNICIPAL MILK DEPOTS. One of the resolutions of the National Conference on Infantile Mortality (1906) was to the effect— That . . . immediate legislation is required enabling Sanitary Authorities to establish or support depots for the supply of pure, or modified or sterilized milk, and to defray any cost out of the monies available for public health purposes." When (in November, 1906) the Executive Committee waited upon the Prime Minister and the President of the Local Government Board to present the resolutions of the Conference, the President expressed sympathy with the views set out in this resolution. Incalculable good (he said) had been done in those districts which had adopted the system of supplying sterilized milk, and he had decided to introduce a Bill sanctioning what was doubtful and illegal in the action of the local authorities in establishing milk depots. In the Session of 1907, accordingly, the President brought in a Bill "to authorise and regulate the establishment of milk depots by certain local authorities, and for matters incidental thereto." The Bill did not become law. In the current Session the President purposes to deal with the whole question of the milk supply of the country generally, and possibly the clauses of the " Municipal Milk Depots Bill, 1907," may find a place therein. OFFENSIVE BUSINESSES. The only business coming within the statutory description " offensive," other than that of a slaughterer of cattle, carried on within the Borough, is that of a Fat Extractor, at Tobin Street, Notting Dale. In connection with this factory, a certificate of inhabitants, under Section 21 of the Public Health (London) Act, 1891, was received, and, at the instance of the Public Health * Vide annual report for 1874. page 22. The subject had also been dealt with in the annual report for the preceding year, page 26. fAn illustrated description of the abattoir appeared in the Sanitary Record, January 16th, 1908. 95 mittee, referred to the Law and General Purposes Committee, with the result that proceedings were initiated for obtaining an injunction under sub-section (3). Negotiations were thereupon entered into with the proprietors which terminated in a satisfactory arrangement for discontinuance of the use of the premises for melting purposes before the end of 1907. The proceedings were thereupon stayed. Subsequently an extension of time was sanctioned by the Court, with the consent of the Council, which will have expired before publication of this report. fried Fish Shop Business.—In connection with proposed amendments to the Public Health (London) Act, 1891, elsewhere referred to (page 84), the Sanitary Committee of the late Vestry expressed the opinion that the business of a fried fish seller should be added to the list of those specified in Section 19, in order to the regulation of the conduct of the business, and so as to prevent it from being an annoyance to adjoining occupiers. This business gives rise to nuisance when carried on without precautions to prevent the escape of effluvia, and it is a not infrequent subject of complaint: decided cases, moreover, class it as an "offensive business." In many of these reports, it has been urged that the business should be added to the list, not with any intention of unduly interfering with, but rather with the object of regulating, the conduct of it, so as to prevent nuisance. It may be mentioned that a Conference of Delegates of the Borough Councils, held in July, 1904, adopted a resolution (No. 36) to the effect "That the business of a fried fish shopkeeper should be aaded to the list of offensive businesses specified in Section 19 of the Public Health (London) Act, 1891." marine Stores.—The business of a marine store dealer is not scheduled in the Public Health (London) Act, 1891, as an "offensive business," though it gives rise to offensive smells, and has been held by the Court of Appeal to be ejusdem generis with the businesses originally scheduled as "offensive" in the (now repealed) Slaughter-houses (Metropolis) Act, 1874. Acting upon my advice, the late Vestry made application to the late Metropolitan Board of Works, in 1883, to schedule the business under that Act, but without success; and in 1896, upon receipt of complaints of nuisance arising in the conduct of the business, a similar application was made to the County Council under the provisions of Section 19 of the Public Health (London) Act, 1891. This application, likewise, was unsuccessful. The subject was dealt with fully in the annual report for 1896—pages 119-123. The premises where the business is carried on, to the number of 17, are kept under observation. The Conference of Delegates of the Borough Councils held in July, 1904, (vide page 84), adopted a resolution (No. 35) to the effect "That the business of a marine store dealer should be added to the list of offensive businesses specified in Section 19 of the Public Health (London) Act, 1891." The County Council were requested by the Conference to make "Orders" to carry out the foregoing resolutions with respect to Fried Fish Shops and Marine Stores. Their Public Health Committee dealt with the subject in a report on legislative proposals for the Session of 1907, in which they said— "There can be no doubt as to the desirableness of regulating the conditions under which the trades in question are pursued," and that "this could best be done if the Council were empowered to make, for the conduct of the businesses, by-laws to be enforced by the borough councils. Such by-laws (they added) would in the case of fried fish shops and fish curers' premises, deal with such matters as the prevention of nuisance arising from the escape of vapour, and conditions which may involve risk of contamination of the fish; and in the case of marine stores the proper cleansing and ventilation of such stores, and the storage under proper conditions of perishable and offensive articles." The recommendation the Committee submitted to the Council, was that application be made to Parliament for authority— "Enabling the Council to make by-laws, to be enforced by sanitary authorities, with regard to the proper regulation of the businesses of a seller of fried fish, fish-curer, and marine store dealer." Application is being made to Parliament in the County Council's (General Powers) Bill for the current Session, for authority "To enable the Council to make by-laws." The better course, I think, would have been to add the businesses to the list of offensive trades, as recommended by the Conference. SEWER SMELLS. The summer months were unusually cool, and the rainfall, of average amount, was fairly evenly distributed, the result being a satisfactory condition of the sewers and a minimum of offensive emanations therefrom. I do not recall any summer so marked by relative absence of complaints. Many complaints, however, were received in the month of February from inhabitants on the line of the "Relief" sewer—from Cornwall Road, North Kensington, where it commences at the middle level sewer to Upper Addison Gardens—where it joins the Counters Creek sewer. A communition was addressed to the County Council, which elicited an explanation from the Chief Engineer to 96 the effect that it had been "necessary, owing to certain work having to be carried out in another part of the district, to divert the sewage down [the relief] sewer temporarily. The work was completed at date of letter (25th February), and the sewage reverted to its usual course." A suggestion was made in the Council's letter for the closing of the sewer ventilators—in Cornwall and Clarendon Roads—which was done, and the Chief Engineer stated that the County Council had "agreed to erect a ventilating column over the [relief] sewer in Norland Square "; and this has been done. No further complaints have been received. FLOODING OF BASEMENTS OF HOUSES. On two occasions—in June and December—I had to report the occurrence of serious floodings of houses in streets in drainage connection with the Counters Creek sewer. In 1906 the County Council's relief sewer connecting the Middle Level sewer at Basing Road, Cornwall Road, to the Counters Creek Sewer at Upper Addison Gardens was completed, and, as regards North Kensington, it appears to have served its intended purpose, no complaint of flooding having been received from north of Uxbridge Road since. But after a heavy fall of rain on 29th June, numerous houses were flooded at Russell Gardens, Russell Road, Elsham Road, Holland Road, and Napier Road. The depth of the water in the houses in the streets named ranged from three inches and four inches in Napier Road and Holland Road respectively, to twenty-one inches in Elsham Road, and twentythree inches in Russell Road and Russell Gardens. I put myself in communication with the Chief Engineer of the London County Council, asking whether he could suggest any explanation of the occurrence, and say whether it was due to any local and temporary cause not likely to recur when the works in hand at Holland Road should have been completed? The Chief Engineer expressed a fear that the area referred to " will not be afforded any great relief by the works [then] being carried out at Holland Road "; adding that " when the next section of this sewer through the Borough is completed, relief should be afforded to the district in which the floodings have occurred." In the second week of December there was a recurrence of the nuisance, restricted to Russell Road. Not so many houses in this street were flooded, nor to the same extent, as in bygone years—a fact which testifies to a considerable degree of success of the remedial works; the rainfall on several successive days had been exceptionally heavy. Occupiers of houses in Russell Road were, as usual, under the impression that the nuisance was attributable to defect in the Council's sewer, whereas it is really due to the basements of the houses being at a lower level than the crown of the sewer. Measures for minimising the risk of inundation carried out at some of the houses, have proved largely successful, and it is hoped that similar measures, recommended for adoption at other houses, will be undertaken ere long. In June I addressed a report to the Works Committee with reference to complaints of inhabitants of Stanley Gardens as follows:— "I have received several complaints recently from inhabitants of houses in Stanley Gardens of offensive effluvia which they believe to be sewer smells proceeding from openings connected with the sewers in the vicinity. The cause for complaint was especially connected with the pipe ventilator carried up St. Peter's Church, Kensington Park Road, some time since. On the 19th June the Borough Engineer closed this pipe, but the complaints did not cease. There is a pipe ventilator carried up above the windows at No. 10, Stanley Crescent, erected a good many years ago by the late Vestry. I think it desirable that this pipe be examined to ascertain whether it is acting*, as it may not improbably be choked with rust. Personally, I find it difficult to believe that the pipe at St. Peter's Church can have been the cause of the recent complaints. I think it desirable to close surface ventilators and to syphon-trap any brick gullies in Kensington Park Road near Stanley Gardens, and to depend for the ventilation of the sewers in the vicinity on the two ventilating shafts adverted to, and I beg to recommend accordingly." A good deal of work of the sort indicated was carried out in the vicinity by the order of the Committee; but I had my doubts whether the smells complained of emanated from the sewers. COMBINED DRAINAGE. Several of the metropolitan sanitary authorities made representations to the County Council, in 1894, on the need of legislation, "with a view to an alteration in the definition of the word drain and the word sewer" in the Metropolis Management Act, 1855 (sec. 250), and ultimately a deputation representing the Vestries and District Boards waited upon the Main Drainage Committee with reference to the subject. This Committee reported (July 7th, 1894), that "a grievance exists, and that a heavy responsibility is thrown upon the local authorities to repair combined drains which were laid down for the benefit of owners of houses, and with the intention that the *It was found to be defective. 97 owners should be held responsible for their maintenance." The Committee further came to the conclusion that "the Council, as the central authority, should promote legislation in accordance with the views of the local authorities," and upon their recommendation it was resolved — "That the Council do apply to Parliament for an amendment of the definition of the word sewer and drain in the Metropolis Local Management Act, in the way desired by the local authorities, and that it be referred to the Parliamentary Committee to prepare a Public Bill, and take such other steps as may be necessary for that purpose." Such a Bill ("Metropolitan Sewers and Drains") was brought in, on behalf of the Council, in 1896, but it did not become law. The subject is one deserving of further attention, and having regard to the large interests involved, it would seem desirable that the Borough Councils should take joint action to promote legislation, as the County Council will take no further action in the matter, and the Local Government Board do not seem inclined to deal with it. The subject was brought to the attention of the Sanitary Authorities in 1905, by the Battersea Borough Council, who stated that the President of the Board had expressed the opinion that it was unnecessary to trouble a proposed deputation to wait upon him with regard to it. In accordance with the suggestion of the Battersea Council, and upon the recommendation of the Public Health Committee, the Council addressed a communication to the Board, pointing out that, owing to the present unsatisfactory state of the law with regard to combined drainage, the Borough Councils throughout the Metropolis are now frequently called upon to carry out, at the public expense, works of reparation and reconstruction tending solely to improve the private property of the individual owner, at a great and constantly increasing cost to the ratepayers, and urging him to do all in his power to remedy, by early legislation, the injustice at present suffered. Nothing came of the action taken. A Conference of Metropolitan Sanitary Authorities, convened by the St. Pancras Borough Council, for the consideration of the subject, was held on the 24th June last, at which the following resolutions were passed:— (a) That every effort should be made by the Metropolitan Sanitary Authorities to relieve the ratepayers from the heavy, inequitable and accumulatiug burden of the maintenance of combined drains originally laid as drains and not approved as sewers. (b) That it be referred to a Committee of this Conference to prepare for presentation to the President of the Local Government Board a Petition or draft Bill dealing with the law relating to Combined Drainage. A Committee, consisting of eleven delegates, was thereupon formed, the three representatives of Kensington, viz., Councillor J. V. Vesey-Fitzgerald, K.C., (Chairman of the Conference) the Town Clerk, and the Borough Engineer being appointed to serve thereon. The Public Health Committee, in their report submitting the resolutions of the Conference, expressed the hope "that the further representations which it is proposed to make to the President of the Local Government Board, may have the desired effect, and that legislation may very shortly be introduced which may provide a satisfactory solution of the difficulties with which Metropolitan Local Authorities have at present to contend, owing to the anomalous state of the law bearing upon the subject." A further meeting of the Conference was held on the 6th December, 1907, when a Bill "to amend the Metropolis Management Acts with respect to Sewers and Drains" was unanimously adopted: it is adapted for the purposes of London from the section of a West Ham Corporation Act. "This course was thought advisable because, in the first place, the operation of this Section in West Ham has proved successful, and secondly, because it was believed that, by following existing legislation, Parliament would be more ready to extend powers to London."* The Bill, i am informed (April '27th, 1907) "has been before the House of Commons for second reading for some time." Twenty Boroughs have addressed communications to the President of the Local Government Board "impressing upon him the desirability of the Government taking charge of the Bill, or granting facilities for its passage into law during the present Session of Parliament." There would appear to be reason to hope that the President will be influenced by the representations made, and will decide to take charge of the Bill—but after the many disappointments of the last twelve years—since the London County Council introduced into the House of Commons the first Public Bill, in 1896, one does not like to be too sanguine. * "Combined Drainage: A Review of Attempted Reforms," by Alfred Powel Coke, Chief Clerk St. Pancras Public Health Department, Honorary Secretary to St. Pancras Conference. 98 PUBLIC SANITARY CONVENIENCES. There are only 18 public urinals in the borough—an inadequate provision; supplemented, however, by about 170 external urinals at public-houses. This latter accommodation is not of a satisfactory sort, as a rule, but it is better than none: it was improved, moreover, as the result of proceedings taken by the late Vestry in 1888, and subsequently. There are two sets of public water closets, for the male sex only, situated, respectively, at the rear of the central public library, Kensington High-street; and at Lancaster-road, adjoining the public library ; and three for both sexes; viz: at Brompton-road by the Oratory; at the west end of Westbourne-grove, and at Talbotroad. Sanitary authorities have power (under Section 88 of the Metropolis Management Act, 1855), "to provide and maintain urinals, water closets, and like conveniences, for both sexes, in situations where they deem such accommodation to be required." Increased powers were conferred by the Public Health (London) Act, 1891; Section 44 (2) of which vests the subsoil of roadways in the sanitary authority, who, moreover, have power to compensate persons injured by the erection of these conveniences near to their houses, etc. Public Lavatories for Women.—Arising out of a complaint by one of the Council's lady sanitary inspectors, with reference to the improper use, as water-closets, of the free urinettes provided for women at the lavatory at Talbot-road, an enquiry was made as to the extent of free accommodation provided in other boroughs, which resulted in the submission of a report by Miss de Chaumont, printed in my annual report for 1905 (page 102). In the result the Works Committee decided to provide free accommodation at each of the underground conveniences for women professing inability to pay the usual fee. Domestic Sanitary Conveniences.—The 26th by-law of the County Council requires the landlord or owner of any lodging-house to provide and maintain in connection with such house, water-closet . . . accommodation in the proportion of not less than one water-closet . . . for every twelve persons. At a certain number of houses, the inhabitants of which exceeded twelve in number a second water-closet was provided. In some instances owners preferred to reduce the number of persons to twelve, or fewer, rather than incur the expense of erecting a second closet. Separate Sanitary Conveniences for the Two Sexes.—Section 38 of the Public Health (London) Act, 1891, enacts that where persons of both sexes are employed at a factory, workshop, or workplace, separate sanitary conveniences for persons of each sex shall be provided; but no standard of requirement has been made as regards London. The Home Secretary has issued an Order prescribing the accommodation to be provided in extra-Metropolitan factories and workshops. This subject was dealt with by the delegates of the Metropolitan Borough Councils at the Conference in July 1904, and a resolution passed recommending standards desirable to be adopted by sanitary authorities in enforcing the provisions of the section. The more satisfactory course would be to obtain an Order from the Home Secretary applicable to the Metropolis. HYGIENIC STREET PAVING. Little progress was made during the year in giving effect to recommendations made by the Public Health Committee for the paving with asphalte of roads named in preceding annual reports, but in connection with the refuse destructor, machinery has been provided for the manufacture of "clinker-asphalte" blocks, for the paving of roads in lieu of asphalte. An experimental piece of paving laid down at Ledbury road appears to be wearing satisfactorily. It is an interesting development, for should expectations be realized there would appear to be almost no limit to the use of this material for the paving of the roadways in side streets. As regards the cost of hygienic street paving, a report presented to the Council by the Works Committee in 1906 shows that a tender from the French Asphalte Company for laying compressed asphalte in certain streets was, for 1½ inches of asphalte on concrete 9s. 6d. per yard, or 2 inches of asphalte 11s. 6d. per yard, the Council executing any necessary excavating and carting; the Company moreover undertaking to maintain the roadways for a period of five years free of charge. The Company's tender was accepted subject to their undertaking to maintain the roadways (save in exceptional cases) for a period of ten years free of charge. It remains to be seen what is the relative cost of the clinker-asphalte paving, which time alone can show, the question of durability being an essential item in the calculation. PAVING OF YARDS. A good many yards were paved," in conformity with the provisions of the Council's tenth by-law. This is a work that might with advantage be considerably extended as being necessary "for the prevention or remedy of insanitary conditions"—a fact sometimes lost sight of. That paving is "necessary" for this purpose is indubitable, and the subject is deserving of the attention of sanitary authorities; by whom, probably, more would be done, were due weight attached to the 99 hygienic importance of cleanliness and dryness in the surroundings of dwelling houses—a matter to which attention was specially directed in my annual report for 1897 (page 146); the authority of the [then] late medical officer of the Local Government Board being cited in support of the views therein expressed. PUBLIC BATHS AND WASHHOUSES. I am indebted to Mr. Buck, Superintendent, for the subjoined particulars:—The washers in the year ended 31st March, 1908, were 73,302, compared with 69,787 in the preceding twelve months; the bathers 136,695 (males 98,648, females 38,047), compared with 135,895 in 1906-7. The total includes pupil teachers 747 (males 360, females 387); members of evening continuation classes 2,272 (males 1,124, females 1,148); school chjldren 34,938 (boys 18,054, girls 16,884), and members of boys' and girls' clubs, 1,089 (males 851, females 238). I can only repeat here what has been remarked in many previous reports, that, for the majority of parishioners, the site of the establishment is not sufficiently central for bathers, and is too remote for would-be washers. The same objection would apply to any single site in the Borough. What is wanted is the provision, in convenient localities, of buildings on a modest scale to which the poor in the central and southern districts might resort for laundry purposes. UNDERGROUND ROOMS ILLEGALLY OCCUPIED. In 14 instances rooms "underground" were found to be illegally occupied. The illegal occupation was in each case discontinued on the service of a written intimation, or a statutory notice. DISINFECTION. The work of disinfection at the new disinfecting station, an illustrated description of which was given in the report for 1906, went on in an entirely satisfactory way throughout the year 1907. A tabular statement of it is subjoined :— Return of work done at the Disinfecting Station, 1st January to 31st December, 1907. Scarlet Fever. Diphtheria. Enteric Fever. Other. Total No. of Disinfections. No. of. Articles. Weight. Description of "Other" Cases (77). tons cwts. qrs. lbs. January 50 12 5 4 71 2,123 3 15 l 13 Cancer (2), Loan bedding (1), Phthisis (1). February 37 11 1 8 57 2,709 4 8 2 21 Cancer (4), Measles (2), Phthisis (1), Bedding (1). March 41 9 ... 10 60 1,251 2 15 1 9 Bedding (5), Cancer (2), Phthisis (1), Erysipelas (1), Croup (1). April 38 8 2 7 55 1,375 2 7 ... 5 Bedding (4), Measles (2), Cancer (1). May 59 10 1 7 77 1,778 3 15 2 14 Bedding (4), Septic (3). June 38 19 4 4 65 1,358 3 1 2 ... Bedding (3), Cancer (1) July 46 30 1 10 87 1,538 3 15 ... 9 Bedding (5), Cancer (3), Measles (1), Itch (1). August 25 13 3 3 44 749 1 14 2 6 Measles (1), Bedding (1), Destroying (1). September 59 16 3 6 84 1,533 3 9 3 21 Cancer (2), Erysipelas (2), Itch (1), Measles (1). October 67 27 5 9 108 2,044 4 9 ... 19 Cancer (3), Itch (2), Ringworm (1), Phthisis (1), Maternity case (1), Blood-poisoning (1). N ovember 53 45 2 4 104 2,193 4 11 1 4 Phthisis (2), Cancer (2). December 37 24 1 5 67 1,470 2 14 3 12 Cancer (1), Phthisis (1), Erysipelas (1), Vermin (1), Boodpoisoning (1). Totals 550 224 28 77 879 20,121 40 18 1 21 100 With few exceptions the disinfected articles were also cleansed, and in a certain number of instances, moreover, washing of infected articles of clothing, etc., was undertaken, week by week, for the convenience of householders, during the continuance of infectious disease treated at home; a charge being made for the service: 1,168 rooms in 1,042 houses were disinfected in the course of the year. Residences for Employes.—Deeming it desirable for the disinfecting staff to be resident at the depot, adjacent to the disinfecting station, i recommended (November 2nd, 1905) provision of cottages for them, and on 13th March, 1906, the Council adopted reports by the Public Health Committee and the Finance Committee, as follows:— Public Health Committee Report (6th March. 1906).—"We are of opinion that it is desirable that the staff should reside on the premises, and we have therefore considered a proposal for the erection of a block of four cottages, each containing four rooms, to be rented by the employes at the disinfecting station. We now submit a sketch plan, prepared by the Borough Engineer, showing the proposed cottages, and recommend, That the said plan be provisionally approved, and that, subject to the sanction of the Local Government Board being obtained to the borrowing of the sum required for the erection of the said cottages the Works Committee be authorised to have the necessary specification and working drawings prepared, and to invite tenders for the erection of the cottages for submission to the Council." The Finance Committee (under date 7th March, 1906) reported that the Public Health Committee had submitted— "Particulars of the proposal which they are bringing before the Council, for the erection of four cottages to be occupied by the staff to be employed at the Disinfecting Station at Wood Lane Depot, and as the adoption of the recommendation of the Committee is made subject to the Local Government Board sanctioning the raising of a loan to meet the expenditure proposed to be incurred, we recommend, 'That the necessary application be made to the Local Government Board for their sanction to the Council borrowing the sum required for the erection of the said cottages, [and for the carrying out of the further works which the Public Health Committee are recommending] in connection with the Disinfecting Station.'" Application was made to the Local Government Board (12th April, 1906) for sanction to the borrowing of about £1,350, the estimated cost of the four cottages—plans of which were forwarded for approval, and on 4th July, an inquiry was held in regard to this, as part of a larger, application, by one of the Board's medical inspectors. On October 13th the Board signified their objection to the plans, on the grounds that the bedrooms were too large, and the cost excessive, although the scheme was designed to be self-supporting. The Board's letter came before the Public Health Committee at the first meeting after the triennial election of the Council, in November, when it was resolved, without discussion that— "In view of the objection taken by the Local Government Board to the plans and estimates submitted to them, the further consideration of the question of erecting the proposed cottages be deferred for six months " The report of the Committee was adopted by the Council, without debate, and no further action has been taken in the matter to date. TEMPORARY SHELTER OR HOUSE ACCOMMODATION. The Public Health (London) Act, 1891, section 60, sub-section (4), requires the sanitary authority to make provision for housing persons during the time necessary for the disinfection of their rooms after infectious disease. The need for this provision is shown by the fact that last year 121 cases of infectious disease occurred in families m the occupation of three rooms; 230 cases in families occupying two rooms, and 51 cases in families herded in single rooms. Of the sufferers in families occupying single rooms, 30 had scarlet fever, 15 had diphtheria, and 6 had enteric fever. In the report for 1904, a statement, prepared for the information of the Public Health Committee, exhibited the number of cases of infectious disease which had occurred in tenements of less than four rooms in the eleven years 1894-1904, and the diseases from which the persons suffered who had resided in single room tenements. The figures indicated an improved state of affairs in recent years. Now, however, that formalin is so much used for disinfecting, the need of a shelter is less felt than formerly; it is the fact, moreover, that people generally prefer to make their own arrangements, rarely makinc use of the shelter where provided. 101 PUBLIC MORTUARY. Bodies were deposited at the Mortuary to the number of 274, compared with 334, 338, and 341, in the preceding three years respectively; upon applications as follows :— 1. At the request of the relatives of the deceased 3 2. At the request of undertakers, mainly at the instance of the relieving officers 75 3. At the request of the coroner (inquest cases):— Cases of sudden death 89 Cases of violent death 85 174 4. Brought in by the Police—Persons found dead 13 Accident cases 7 20 5. On account of death due to infectious disease 2 274 In 112 of the above cases post-mortem examinations were made under the coroner's warrant. Annual Number of Bodies taken into the Mortuary, 1897—1907. Year. No. of bodies received at the Mortuary. No. of bodies upon which Coroner's inquests were held. No. of bodies upon which post mortem examinations were made. 1897 290 234 118 1898 275 215 111 1899 342 259 129 1900 317 244 106 1901 295 221 115 1902 273 187 92 1903 300 207 77 1904 334 206 90 1905 338 202 119 1906 341 217 127 1907 274 194 112 Complaint is occasionally made of improper detention in houses of the bodies of deceased persons, on the supposition that the Council possess power to remove bodies to the public mortuary at will. What the law enables the Council to do, is set out in the 89th section of the Public Health (London) Act, 1891, which provides that— " When either— (а) The body of a person who has died of any infectious disease is retained in a room in which persons live or sleep ; or (b) The body of a person who has died of any dangerous infectious disease is retained,. without the sanction of the medical officer of health, or any legally qualified medical practitioner, for more than 48 hours, elsewhere than in a room not used at the time as a dwelling place, sleeping place, or workroom; or (c) Any dead body is retained in any bouse or room so as to endanger the health of the inmates thereof, or of any adjoining or neighbouring house or building; a jastice may, on a certificate signed by a medical officer of health, or other legally qualified medical practitioner, direct that the body be removed, at the cost of the sanitary authority, to any available mortuary, and be buried within the time limited by the justice." Many of the cases of improper deposit of dead bodies in living rooms, occur in connection with removals for private burial from the borough infirmary. 102 CHAPEL OF REST FOR THE DEAD. With a view to correct the evil dealt with in the preceding paragraph, I recommended (No. 3 report, 29th March, 1902), the provision of a mortuary chapel at North Kensington. The grounds for this recommendation were fully set out in the annual report for 1902, page 124. The Council, upon the advice of the Public Health Committee, adopted the recommendation ; and also my further recommendation to place the building at the south-east corner of Avondale Park, adjacent to the park-keepers residence. The building, completed at a cost of about £1,300, comprises a mortuary chapel, two waiting rooms for mourners, suitably furnished, sanitary conveniences, etc. During the year 66 bodies were admitted. The regulations framed for the management of the chapel, which is under the charge of the park-keeper, were printed in the annual report for 1904. WATER SUPPLY. Metropolitan Water Board: Their Cutting-off Powers and Practice.—Reference has been made in these reports extending over 26 years, to the objectionable practice of the (late) Waterworks Companies of cutting off the domestic supply of water from dwellinghouses on account of non-payment of the rate—a subject fully dealt with in the annual report for 1906 (page 115). The matter had been brought to the attention of the Metropolitan Borough Councils towards the close of 1906 by the Islington Borough Council, and an explanation by the Metropolitan Board was shortly after addressed to the Borough Councils. Under date 25th February, 1907, the Board circulated an "Extract from report of Finance Committee," on "Withdrawal of Supplies" the material portion of which was as follows:— "It is a fact, no doubt, that to some extent, the Board are continuing the practice of the Metropolitan Water Companies in this matter, but we think there is an essential difference in the present practice, inasmuch as the power of cutting off for non-payment of rates is now very sparingly used, whereas with the Companies it was almost the only method of recovery. " We are fully alive to the objections against the practice of cutting off supplies, and our Sub-Committee, who examine the list of defaulters, at once recognised the force of the objections by instituting, as far as circumstances would permit, legal proceedings in lieu thereof, and arrangements are being made whereby summary proceedings for the recovery of arrears will be taken in the great majority of cases. " Considerable administrative changes have had to be adopted in order to modify the practice of the Companies, and these are being carried out as rapidly as possible with the view of reducing the necessity of disconnecting supplies. " We would, however, point out that the effect of our operations has been to considerably reduce the number of cutting off notices issued, and that the process of reduction will be continued as rapidly as circumstances permit. " We would suggest that if at any time the local authorities find that the disconnection of a supply is likely to occasion the slightest danger to the public health, they should direet their officials to communicate with the Board's officials, who would promptly act in concert with them in order to obviate the possibility of the danger referred to." The Finance Committee further state that— "No supply is cut off for non-payment of rates— (a) Without an order of the Committee after a full enquiry into the whole of the circumstances. (b) Where the premises are known to be occupied by more than one family. (c) Where inability to pay by reason of real poverty is established. (d) When the owner and not the occupier is responsible by law or agreement for the payment of the water rate." They add (inter alia)— (1) " That notice to cut off is sent to both the Clerk and the Medical Officer of Health of the Local Authority concerned, instead of to one of those officers as formerly.* (3) That with a view to giving the Local Authority information as to the reason for disconnection [they] have arranged that the notice sent to them shall in future declare in all cases the reason for the withdrawal." The Board made a point of the smallness of the number of the cuttings-off for non-payment of the rate, and these cases are few in comparison with the cuttings-off for other causes; e.g. defective fittings leading to waste of water. But they apparently overlooked the fact that not only is " an occupied house without a proper and sufficient supply of water" a " nuisance liable to be * The Board are required, " in any case, within 24 hours after exercising " the right to cut off, to " give notice thereof in writing to the Sanitary Authority of the District in which the house is situated," under liability to a fine not exceeding ten pounds for default. 103 dealt with summarily under the [Public Health] Act," (Section 48), but also that the definition of " Nuisances " (General) Section 2 (/) includes— "Any such absence from premises of water fittings as is a nuisance by virtue of Section 33 of the Metropolis vVater Act, 1971, set out in the first schedule to this the [Public Health] Act." It is the duty of the Sanitary Authority by their officers to take proceedings for the abatement of the " nuisance," not only in the case of a house being " without a proper and sufficient supply of water," but also when it is due to the " absence from premises " of the " prescribed fittings," although the house may have a supply of water. In the official year ended 30th March, 1907, I received notices from the Water Board (or their officials, rather), that they had " been under the necessity of ceasing to supply water " to 374 houses ; in all but a very few of these cases the water had been cut off for reasons other than non-payment of the rate*; but in no case was notice received by me of the " necessity" having arisen for cutting-off, until after disconnection and withdrawal of supply had been effected. In reporting on this subject (No. 3, 1907), I observed that " it would be a more excellent way to forestall the occurrence of nuisance ; and to that end the assistance of the inspecting staff would be gladly devoted, much to the advantage of the Water Board. As it is, they are not put in motion until after the Board, through the lawful (but inexpedient) action of their officials have created the nuisance." The report was referred to the Public Health Committee who, concurring with my views, recommended— " That representations be made to the Metropolitan Water Board urging the desirability of their giving intimation beforehand to the local sanitary authorities of their intention to cut off the water supply of any house or other building, so as to afford an opportunity to the sanitary authority for the district of taking any steps which may be open to them to prevent a nuisance arising from the action of the Board." A courteous reply was received from the Board's Finance Committee intimating their regret at finding it " impracticable to accede to the precise suggestion contained in the [Council's] letter, in dealing with cases of" [withdrawal of supplies] and that they had " given instructions that, wherever possible, the notice of disconnection is to be sent on the same day upon which the supply is cut off to both the Clerk and the Medical Officer of Health of the Local Authority," and they ventured to " express the hope that these arrangements will result satisfactorily to all parties concerned "—as I think they have. It may be mentioned that in the civil year 1907,1 received from the Metropolitan Water Board notices of withdrawal of supplies to the number of 296, viz : in respect of empty houses, 236 ; on account of a broken pipe, 18 ; waste of water, 16; non-payment of rate, 2 ; miscellaneous causes, 7 ; no reason stated, 17. No complaints were received during the year of deficiency in quantity or of defective quality of the water supply for which the Water Board could be held responsible. Public Health (London) Act, 1891, Provisions as to Water.—In accordance with the instructions of the Public Health Committee, houses newly erected are now inspected before being occupied, in order to effect being given to Section 48 (2) of the Act, which reads as follows:— "A house which after the commencement of thi3 Act is newly erected, or is pulled down to or below the ground floor and rebuilt, shall not be occupied as a dwelling house until the sanitary authority have certified that it has a proper and sufficient supply of water, either from a water company or by some other means." Sixty houses were certified in 1907. Amongst other buildings certified, " Hornton Court," Kensington High Street, may be mentioned. It contains about fifty separately rated flats, which in the eye of the law are " houses." There are two supplies from cisterns placed on the roof, each " house" having a stop cock, by means of which the water can be turned on and off. The owners make themselves responsible for the supply. I was in doubt whether in the circumstances one certificate should be given for the " Court," or one in respect to each of the fifty " houses." The Committee directed the issue of a single certificate in respect of the water supply at the premises, such certificate to specify the numbers of the several houses in respect of which it had been given. * No cause for cutting off was assigned in 153 cases; in 194 instances the houses were "apparently empty"; "broken supply pipe" was the reason assigned for disconnection on 14 occasions, and "waste of water ' on 4. Nine premises were coming down. 104 In bringing this report to a conclusion, I have pleasure in acknowledging the able assistance received from Mr. E. R. Hill, chief clerk in the Public Health Department, in the collation of the statistical matter, and generally in the preparation of the Report. I desire also to bear testimony to the good work of the staff, as a whole, and particularly of the inspecting staff, male and female alike. Mr. Pettit, the chief sanitary inspector, as usual, rendered me most valuable help, of which it affords me great satisfaction to make acknowledgment. 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, May, 1908. 105 APPENDIX I. Deaths registered from all causes in the Year 1907. (Exclusive of the Deaths of Non-Parishoners at Public Institutions within the Borough, but inclusive of the Deaths of Parishioners at Public Institutions, &c., without the Borough.) For a Summary of this Table see page 18. CAUSES OF DEATH. AGES. Total under Five Years of Age. Grand Total all Ages. subdistrict. Kensington Town Brompton. 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. GENERAL DISEASES 196 122 49 29 74 68 108 112 94 87 41 318 980 777 203 LOCAL DISEASES 165 119 29 41 43 108 136 207 240 191 51 284 1330 1072 258 DEATHS FROM VIOLENCE 20 14 4 3 8 9 14 16 1 11 3 34 103 82 21 DEATHS FROM ILL-DEFINED AND NOT SPECIFIED CAUSES 52 ... V 1 ... ... 2 1 2 52 58 58 5 488 255 82 73 126 185 258 837 836 291 95 688 2471 1984 487 GENERAL DISEASES Small-pox Vaccinated ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Not Vaccinated ... ... ... ... ... ... ... ... ... ... ... ... ... ... . . . Doubtful ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cow-pox, Effects of Vaccination ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox . . . ... ... ... ... ... ... ... ... ... ... ... . . . ... Measles (Morbilli) 5 25 1 ... ... ... ... ... ... ... ... 30 31 26 5 Epidemic Rose Rash, German Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... 4 5 ... ... ... ... ... ... ... ... 4 9 4 5 Typhus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Influenza 3 2 1 1 2 4 8 11 9 17 5 5 63 44 19 Whooping-Cough 34 42 5 ... ... ... ... ... ... ... ... 76 81 77 4 Mumps ... ... ... ... ... ... ... ... ... ... ... ... ... • • . Diphtheria, Membranous Croup 3 11 8 1 1 ... ... ... ... ... ... 14 24 19 5 Cerebro-Spinal Fever 1 ... ... ... 1 ... ... ... ... ... ... 1 2 2 ... Simple Continued Fever "Pyrexia" ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever ... ... 1 ... 2 ... ... ... ... ... ... ... 5 8 2 Asiatic Cholera ... ... ... ... ... ... ... ... ... ... ... • . ' ... ... Epidemic Diarrhœa: Epidemic (or Zymotic) Enteritis 13 2 ... ... ... ... ... ... ... ... ... 15 15 14 1 Diarrhœa, Choleraic Diarrhœa 8 2 ... ... ... ... ... 1 ... ... 3 10 14 11 3 Dysentery ... ... ... ... ... ... ... 1 ... ... ... ... 1 1 ... Malarial Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Hydrophobia ... ... ... ... ... ... ... ... ... ... ... ... ... Glanders, Farcy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Anthrax, Splenic Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tetanus ... ... ... ... ... ... ... ... ... ... ... ... ... ... Syphilis 10 1 ... ... 1 ... 2 ... ... 1 ... 11 15 15 ... Gonorrhœa, Stricture of Urethra ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Septicaemia, Sapraemia ... ... ... ... 2 1 ... ... ... ... ... ... 3 3 ...... Puerperal Pyaemia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Phlegmasia Dolens ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... Infective Endocarditis 1 ... 1 ... ... ... ... ... ... ... 1 2 1 1 Epidemic Pneumonia,Pneumonic Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas l ... ... ... ... ... ... ... 2 2 ... 1 5 4 1 Septicasmia (not Puerperal) l ... 2 ... 1 1 ... ... ... ... ... 1 5 5 ... Pyæmia (not Puerperal) l ... ... ... ... ... ... ... ... ... ... 1 1 1 ... Phlegmon, Carbuncle (not Anthrax) ... ... ... ... ... ... ... 2 ... 2 ... ... 4 3 1 Phagedæna ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Septic Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculous Phthisis (Pulm. Tubercul.) ... 1 2 14 45 25 32 17 7 1 ... 1 144 114 30 "Phthisis" ... ... ... 4 6 6 9 3 2 ... ... ... an 25 5 Tuberculous Meningitis 10 16 11 ... 1 ... 1 ... ... ... ... 26 36 3 Tuberculous Peritonitis 5 5 1 1 ... ... ... ... ... ... ... 10 1 9 10 2 Tabes Mesenterica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Lupus ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... Tubercle of other Organs 1 ... ... 1 1 ... 1 1 ... ... ... 1 5 4 1 General Tuberculosis 3 4 6 4 5 8 4 1 2 1 ... 8 33 23 10 Scrofula ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Parasitic Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Starvation ... ... ... ... ... ... ... ... ... ... ... ... ''' ... ... Scurvy ... ... ... 1 ... ... ... ... ... ... ... ... 1 ... ... Alcoholism, Delirium Tremens ... ... ... ... 2 3 5 2 ... ... ... ... 12 8 l Opium, Morphia Habit ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ptomaine Poisoning ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Industrial Poisoning By .Lead ... ... ... ... 1 1 ... ... ... ... ... 2 2 ... By Phosphorus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... By Arsenic & other Metals ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Rheumatic-Fever, Acute Rheumatism ... ... 4 1 1 ... ... ... ... ... ... 6 5 1 Rheumatism of Heart ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chronic Rheumatism ... ... ... ... ... ... ... ... ... 2 ... ... 2 2 ... Rheumatic Arthritis, Rheumatic Gout ... ... ... ... ... ... ... ... ... 2 ... ... 3 3 ... Gout ... ... ... ... ... ... ... 2 2 1 1 ... 6 4 2 Carcinoma ... ... ... ... ... 8 21 36 1 9 14 2 ... 100 76 24 Carried forward 100 115 47 28 72 54 84 77 45 43 11 215 676 546 130 106 CAUSES OF DEATH. AGES Total under Five Years of Age. Grand Total all Ages. Subdistrict. 0 to 1. 1 to 5. 5 to 15. 15 to 25. 25 to 35. i 35 to 45. 45 to 55. 55 to 65. 65 to 75. 75 to 85. 85 and upwards. Kensington Town. Brompton. Brought forward 100 115 47 28 72 54 84 77 45 43 11 215 676 546 130 GENERAL DISEASES.—continued. Sarcoma ... 1 ... ... .... 2 1 1 3 1 1 9 8 1 Malignant Disease, Cancer ... ... ... ... 1 9 17 28 25 10 2 ... 92 68 24 Rickets 2 2 ... ... ... ... ... ... ... ... ... 4 4 3 1 Purpura ... 1 1 ... ... ... 1 ... ... ... ... 1 3 3 ... Hæmophilia, Hæmorrhagic Diathesis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Anæmia, Leucocythæmia ... ... ... ... 1 1 1 1 ... 1 ... ... 5 3 2 Diabetes Mellitus ... ... ... 1 ... 2 4 4 5 4 ... ... 20 11 9 Premature Birth 67 ... ... ... ... ... ... ... ... ... ... 67 67 53 14 Congenital Defects 12 ... 1 ... ... ... ... ... ... ... ... 12 18 9 4 Injury at Birth 1 ... ... ... ... ... ... ... ... ... ... 1 1 ... 1 Atelectasis 5 ... ... ... ... ... ... ... ... ... ... 5 5 5 ... Want of Breast Milk 7 ... ... ... ... ... ... ... ... ... ... 7 7 6 1 Teething 2 3 ... ... ... ... ... ... ... ... ... 5 5 5 ... Old Age ... ... ... ... ... ... ... 1 16 28 28 ... 73 57 16 LOCAL DISEASES. 196 122 49 29 74 68 108 112 94 87 41 318 980 777 203 Diseases of Nervous System. Meningitis, Inflammation of Brain 5 7 ... 1 1 1 ... 2 ... ... ... 12 17 13 4 Softening of Brain ... ... ... ... ... ... 1 4 5 1 2 ... 18 11 2 General Paralysis of Insane ... ... ... ... ... 5 7 1 ... ... ... ... 13 11 2 Insanity (not Puerperal) ... ... ... .... ... 1 ... 1 ... ... ... ... 2 1 1 Chorea ... ... ... ... ... .... ... ... ... ... ... ... ... ... ... Epilepsy ... 1 ... 3 2 3 ... 3 1 ... ... 1 13 10 3 Convulsions 18 6 ... ... ... ... ... ... ... ... ... 24 24 21 3 Laryngismus Stridulus 1 ... ... ... ... ... ... ... ... ... ... 1 1 ... 1 Locomotor Ataxy ... ... ... ... ... ... 3 2 1 1 1 ... 8 6 2 Paraplegia and Disease of Cord ... ... ... ... ... ... 2 4 2 3 ... ... 11 9 2 Neuritis, Periph, Poly-Neuritis ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 Brain Tumour (not specific) ... ... ... 3 1 3 1 1 ... ... ... ... 9 6 8 Nervous System, Other Diseases 1 1 ... 2 ... ... 6 5 3 4 2 2 24 18 6 Diseases of Organs of Special Sense. Otitis, Mastoid Disease 2 ... 3 2 ... 1 ... ... ... ... ... 2 8 6 2 Epistaxis, Nose Disease ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ophthalmia, Eye Disease ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diseases of Heart. Valve Disease, Endocarditis (not infective) ... ... 2 2 4 8 5 8 15 12 1 ... 57 42 15 Pericarditis 1 1 ... ... ... .... 1 ... 1 ... ... 2 4 4 ... Hypertrophy of Heart ... ... ... 1 ... ... ... ... ... ... ... ... 1 1 ... Angina Pectoris ... ... ... ... ... ... 1 3 5 ... 1 ... 10 6 4 Dilatation of Heart ... ... ... ... ... 1 1 3 3 5 1 ... 14 10 4 Fatty Degeneration of Heart ... ... 1 ... 1 2 1 3 11 8 4 ... 31 23 8 Syncope, Heart Disease (not specified) ... ... 2 4 5 8 13 24 37 18 5 ... 116 96 20 Diseases of Blood Vessels. Cerebral Hæmorrhage, Embolism, Thrombosis 1 ... ... ... 3 3 6 17 30 18 4 1 82 57 25 Apoplexy, Hemiplegia ... ... ... ... ... 2 3 6 7 7 3 ... 28 21 7 Aneurysm ... ... ... ... 1 1 4 8 1 1 ... ... 11 10 1 Senile Gangrene ... ... ... ... ... ... ... 2 2 5 ... ... 9 9 ... Embolism, Thrombosis (not Cerebral) ... ... ... ... 1 1 ... ... ... ... ... ... 2 2 ... Phlebitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Varicose Veins ... ... ... 1 ... ... ... ... ... ... ... ... 1 1 ... Blood Vessels, Other Diseases ... ... ... 1 ... ... ... 1 7 3 ... ... 12 9 3 Diseases of Respiratory Organs. Laryngitis 2 4 ... ... ... 1 1 ... ... ... ... 6 8 7 1 Membranous Laryngitis (not Diphtheritic) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Croup (not Spasmodic or Membran u s ... 1 ... ... ... ... ... ... ... ... ... 1 1 1 ... Larynx, Other Diseases (not specified) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Bronchitis 49 20 ... 1 ... 4 11 34 49 45 16 69 229 205 24 Lobar, Croupous-Pneumonia ... ... ... ... ... 5 1 2 1 2 ... ... 11 11 ... Broncho, Catarrhal, Lobular Pneumonia 32 43 6 ... 1 1 2 5 6 4 3 75 103 91 12 Pneumonia 21 21 3 7 4 16 11 19 7 11 1 42 121 107 14 Emphysema, Asthma ... ... 1 ... 1 1 4 7 2 2 1 ... 19 16 8 Pleurisy ... ... 1 ... 3 2 ... 3 1 ... 2 ... 12 10 2 Fibroid Disease of Lung ... ... ... ... ... ... 1 ... 2 1 ... ... 4 1 3 Respiratory Diseases, Other" 2 1 ... ... ... 1 ... 2 1 5 ... 3 12 9 3 Diseases of Digestive System. Tonsillitis, Quinsy ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 ... Mouth, Pharynx, Disease (not Specific) 1 3 ... 1 ... 1 ... ... ... ... ... 4 6 4 2 Gastric Ulcer ... ... ... 1 4 2 1 1 ... ... ... ... 9 8 1 Gastric Catarrh 1 1 ... ... ... ... ... ... ... ... ... 2 2 2 ... Stomach, Other Diseases (not Malignant) 5 ... ... ... 2 2 1 2 2 ... 5 14 8 6 Enteritis (not epidemic) 5 3 ... ... ... 3 ... 1 1 4 ... 8 17 15 2 Gastro-Enteritis 8 1 ... ... ... ... ... 1 1 ... ... 9 11 7 4 Appendicitis, Perityphlitis ... 1 5 3 1 2 2 1 2 1 ... 1 18 9 9 Hernia ... ... ... ... 2 2 2 ... 1 2 ... 9 8 1 Carried forward 155 115 24 33 33 83 94 172 207 164 49 270 1129 928 206 107 CAUSES OF DEATH. AGES. Total under Five Years of Age Grand Total all Ages. Subdistrict. Kensington Town. Brompton. 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. Brought forward 155 115 24 33 33 83 94 172 207 164 49 270 1129 923 206 LOCAL DISEASES.—continued. ntestinal Obstruction 2 1 ... ... 2 ... 3 2 1 1 ... 3 12 9 3 ther Diseases of Intestines ... ... ... ... 2 ... 1 2 1 ... ... ... 6 4 2 eritonitis (not Puerperal) 1 ... 1 ... 1 2 2 ... ... 1 ... 1 8 6 2 irrhosis of Liver ... ... .... ... 2 4 8 7 2 1 ... ... 24 17 7 aver and Gall Bladder, Other Diseases 5 ... ... 1 ... 2 3 3 ... 3 1 5 18 15 3 igestive System, Other Diseases ... ... ... ... ... ... ... 1 1 1 ... ... 3 2 1 Lymphatic Diseases. pleen Disease ... ... ... ... ... ... ... ... ... ... ... ... ... ... ymphatic System, Other Diseases hyroid Body Disease ... ... 1 1 ... ... 1 ... ...... ... ... ... 3 2 1 ... ... .... ... ... .... .... ... ... ... ... ... ...... ... ...... upra-Renal Capsules Disease ... ... ... ... ... 1 .... 1 ... ... ... ... 2 2 ... Diseases of Urinary System. ephritis, Acute ... 1 ... .... ... 1 1 ... ... ... ... 1 3 3 ... hronic Bright's Disease, Albuminuria ... ... 1 4 2 7 17 16 12 7 1 ... 67 47 20 alculus (not Biliary) ... ... .... ... ... ... 1 ... ... ... ... ... 1 ... 1 ladder and Prostate Disease ... ... ... ... ... 1 ... 2 7 12 ... ... 22 16 6 rinary System, Other Diseases ... ... ... ... ... ... ... 1 5 ... ... ... 6 5 1 Diseases of Generative System. varian Tumour (not Malignant) ... ... ... ... ... l ... ... ... ... ... ... 1 1 ... ther Diseases of Ovary ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... terine Tumour (not Malignant) ... ... ... ... ... ... ... ... ... 1 ... ... 1 1 ... ther Diseases of Uterus and Vagina ... ... ... ... ... l 2 ... 1 ... ... ... 4 2 2 isordera cf Menstruation ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... renerative and Mammary Organs, Other Diseases ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 1 Accidents of Childbirth. bortion, Miscarriage ... ... ... ... ... l ... ... ... ... ... ... 1 1 ... uerperal Mania ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... uerperal Convulsions ... ... ... 1 ... ... ... ... ... ... ... ... 1 1 ... lacenta Prævia, Flooding ... ... ... ... ... l ... ... ... ... ... ... 1 1 ... ther Accidents of Pregnancy and Childbirth ... ... ... ... 1 2 ... ... ... ... ... ... 3 1 2 Joint Diseases. aries, Necrosis ... 1 ... ... ... ... ... ... ... ... ... 1 1 1 ... rthritis, Periostitis ... ... ... 1 ... 1 ... ... 2 ... ... ... 4 4 ... ther Diseases of Locomotor System ... 1 2 ... ... 2 ... ... ... ... 1 5 5 ... Skin Diseases. lcer, Bedsore ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 .... czema ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... emphigus 1 ... ... ... ... ... ... ... ... ... ... 1 1 1 ... kin Diseases, Other 1 ... ... ... ... ... ... ... ... ... ... 1 1 1 ... DEATHS FROM VIOLENCE. 165 119 29 41 43 108 136 207 240 191 51 284 1330 1072 258 1.—Accident or Negligence ractures and Contusions 2 5 3 1 3 4 5 10 1 8 3 7 45 9 unshot Wounds ... ... ... ... ... ... ... ... ... ... ... ... ... 36 ... ut, Stab ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... urn, Scald ... 9 ... 2 ... 2 ... ... ... 2 ... 9 15 ... 3 oison ... ... ...... ... ... ... 1 1 ... 1 ... ... 3 12 1 rowning ... ... ... ... ... ... 2 ... ... ... ... ... 2 2 1 iffocation 16 ... ... ... 1 1 1 ... ... ...... ... ... 19 1 1 therwise 2 ... 1 ... ... 1 ... ... ... ... ... 16 4 18 1 2.—Homicide. anslaughter ... ... ... ... ... ... ... ... ... ... ... 2 ... 3 ... urder ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3.—Suicide. unshot Wounds ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... it, Stab ... ... ... ... ... ... ... 1 ... ... ... ... 1 1 ... ison ... ... ... ... ... ... ... I ... ... ... ... 1 1 ... rowning ... ... ... ... 2 1 2 3 ... ... ... ... 8 5 3 anging ... ... ... ... ... .... 1 ... ... ... ... ... 1 ... 1 therwise ... ... ... ... 1 ... 1 .... ... ... ... ... 2 1 1 4.—Execution. ... ... ... ... 1 .... 1 ... ... ... ... ... 2 2 ... anging ... ... ... ... ... ... ... ... ... ... ... ... ... ... EATHS FROM ILL-DEFINED ND NOT SPECIFIED CAUSES. 20 14 4 3 8 9 14 16 1 11 3 34 103 82 21 1 1 ... opsy ... ... ... ... ... ... ... 1 ... ... ... ... 51 48 3 ibility, Atrophy, Inanition mour 51 ... ... ... ... ... ... ... ... ... ... 51 3 2 1 scess ... ... ... ... ... ... ... 1 1 1 ... ... 2 1 1 emorrhage 1 ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... dden Death (cause not ascertained) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... uses not Specified or Ill-defined ... ... ... ... 1 ... ... ... ... ... ... ... 1 1 ... 52 ... ... ... l ... ... 2 1 2 ... 52 58 53 5 [Appendix II. 108 APPENDIX II. TABLE A. Population of Kensington; Marriages and Marriage-rate; Birth and Birthrate, and Deaths and Death-rate 1856-1907 ; and Infantile Mortality (1871-1907). The Year. Population Marriages. Marriage Rate. Births. Birth Rate. Deaths. Death Rate. Deaths under One Year. Deaths under One Year per 1,000 Registered Births. Kensington. London. Kensington. London. 1856 57,078 443 15.5 1,804 31.6 33.6 1.235 21.6 22.0 Information incomplete. Information incomplete. 1857 59,683 509 17.1 1,854 31.1 34.0 1,197 20.1 22.4 1858 62,288 480 15.4 1,881 30.2 33.2 1,290 20.7 23.9 1859 64,893 577 17.8 2,002 30.8 34.1 1,338 20.6 22.7 1860 67,498 605 17.9 2,016 29.9 33.6 1,480 21.9 22.4 1861 70,108* 683 19.5 2,159 30.8 34,5 1,447 20.6 23.2 1862 76,350 727 19.1 1,960 25.7 34,2 1,604 21.0 23.6 1863 81,350 809 19.9 2,330 28.6 35,2 1,628 20.0 24.5 1864 86,350 881 20.4 2,494 28.9 34,7 1,849 21.4 26.4 1865 91,350 996 21.8 2,619 28.7 35,7 1,733 18.9 24.5 1866 96,350 1,118 28.2 3,080 31.9 35.7 1,966 20.4 26.5 1867 101,350 1,066 21.0 3,158 31.2 36.5 1,933 19.1 23.0 1868 106,350 1,109 20.9 3,522 33.1 36.8 2,232 21.0 23.5 1869 111,350 1,028 18.4 3,625 32.6 35.4 2,249 20.2 24.6 1870 116,350 1,054 18.1 3,705 31.8 35.4 2,473 21.3 24.1 1871 120,234 1,131 18.8 3,804 31.6 34.5 2,418 20.1 24.6 582 158 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 31.5 35.3 2,439 18.4 22.4 656 157 1874 138,616 1,311 18.9 4,356 31.4 35.6 2,696 19.4 22.4 762 175 1875 144,488 1,346 18.6 4,478 31.0 35.4 2,786 19.3 23.6 686 153 1876 148,338 1,417 19.1 4,499 30.3 35.9 2,896 19.5 21.9 771 171 1877 151,360 1,411 18.6 4,648 30.7 35.6 2,625 17.3 21.6 648 139 1878 154 305 1,331 17.2 4,607 29.9 35.5 8,120 20.2 23.1 823 179 1879 158,316 1,428 18.0 4,790 30.8 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 34.7 2,726 16.7 21.3 644 146 1882 163,540 1,474 18.0 4,327 26.5 34.5 2,691 16.4 21.5 635 147 1883 163,860 1,616 19.7 4,230 25.8 34.5 2,615 15.9 20.8 601 142 1884 164,180 1,498 18.2 4,394 26.7 34.3 2,638 16.1 20.9 678 154 1885 164,500 1,480 18.0 4,032 24.5 33.4 2,768 16.8 20.4 653 162 1886 164,820 1,605 19.5 4,149 25.2 33.4 2,756 16.7 20.6 636 153 1887 165,140 1,561 18.9 3,941 23.9 32.9 2,872 17.4 20.3 680 172 1888 165,450 1,497 18.1 3,776 22.8 32.1 2,825 17.1 19.3 604 160 1889 165,760 1,491 18.0 3,698 22.3 31.9 2,412 14.6 18.4 489 132 1890 166,080 1,511 18.2 3,864 23.3 30-7 2,951 17.8 21.4 651 168 1891 166,308 1,569 18.9 3,847 28-1 81-9 8,066 18-4 21-5 683 164 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 3,665 21-7 80-8 2,628 15 6 17*8 686 174 1895 169,300 1,455 17.2 3,621 21-4 80 6 2,748 16-2 19-9 624 172 +1896 170,465 1,706 20-1 3,821 22.5 30.2 2,891 16.7 18.6 656 172 1897 170,700 1,681 19 7 3,765 22.1 301 2,667 15.6 18.2 609 162 1898 172,000 1,648 19-2 3,715 21.6 29.5 2,798 16.3 18.7 655 176 1899 172,400 1,698 19 6 3,682 21.4 29.4 3,021 17.5 19.8 642 174 1900 173,000 1,548 17-8 3,682 21.3 28.6 2,698 15.6 18.8 641 174 1901 176,628 1,651 18.7 3,708 20.9 29.0 2,650 150 17.6 581 157 1902 177,500 1,703 19.2 3,599 20.3 28.5 2,746 15.2 17.2 515 143 1903 178,000 1,623 18.2 3,677 20.7 28.4 2,455 13.8 15.7 510 189 1904 178,500 1,672 18.7 3,568 20.0 27.9 2,540 14.2 16.6 503 141 1905 179,000 1,574 17.6 3,579 20.0 27.0 2,507 14.0 15.1 498 139 1906 179,500 1,690 18.8 3,428 19.1 26.5 2,497 13.9 15.1 425 132 1907 180,500 1,676 18.6 3,428 19.0 25.8 2,471 13.7 14.6 433 126 Note.—I am indebted to Dr. Tatham, Superintendent of Statistics in the Department of the Registrar-General. tor many of the figures in the columns 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. From 1896, the number of births, the birth rate and the infantile mortality rate in Kensington have been corrected by the addition of the births at Queen Charlotte's Hospital. 109 TABLE B. Annual Number of Deaths in Kensington from the Principal Diseases of the Zymotic Class (1856-1907) and Death-rate from these Diseases, in Kensington, and in London. The Year. Population. Deaths from the Seven Principal Diseases of the Zymoiic Class. Zymotic Death-rate. Small-pox. Measles. Scarlet Fever. Diphtheria. Whooping-Cough. Fever. Diarrhoœa. Total Per 1,000 persons living. Deaths per 1,000 Deaths from all Causes, Kensington. Typhus. Enteric. Pyrexia. Kensington. London. 1856 57,078 13 35 Not separ- 15 ately classified. 27 62 178 3.1 4.3 144 Not separately classified. 26 Not separately classified. 1857 59,683 1 20 28 50 32 79 210 3.5 4.3 176 1858 62,288 2 26 61 63 38 80 220 3.5 5.1 171 1859 64,893 10 42 76 10 23 71 232 3.6 6.1 173 1860 67,498 18 30 89 7 56 23 36 259 3.8 3.8 175 1861 70,108 2 57 51 14 37 32 65 258 3.7 4.5 178 1862 76,350 ... 30 110 28 54 51 24 297 3.9 5.1 185 1863 81,350 49 83 89 22 22 54 54 373 4.6 5.9 229 1864 86,350 5 100 90 16 56 60 63 390 4.5 5.6 211 1865 91,350 20 55 31 18 37 78 103 342 3.7 4.9 197 1866 96,350 11 49 21 13 58 44 106 302 3.1 6.7 154 1867 101,350 25 22 26 9 76 53 89 300 3.0 3.9 155 1868 106,350 4 84 169 33 34 52 113 489 4.6 4.8 219 1869 111,350 7 83 104 11 79 51 112 397 3.6 5.6 177 1870 116,350 8 70 198 14 55 5 24 17 154 545 4.7 5.2 220 1871 120,234 120 64 95 11 72 6 26 16 129 539 4.5 6.0 223 1872 127,606 68 43 29 14 77 4 28 10 110 383 3.0 3.8 169 1873 132,826 1 38 10 11 44 6 27 8 145 290 2.2 3.3 119 1874 138,616 ... 121 32 26 45 9 28 15 112 388 2.8 3.3 144 1875 144,488 ... 23 83 23 107 2 21 6 107 372 2.6 3.9 133 1876 148,338 8 128 59 17 124 3 27 6 126 498 3.3 3.6 172 1877 151,360 84 54 31 10 34 2 14 5 99 333 2.2 3.5 127 1878 154,305 24 53 77 20 185 3 26 4 181 573 3.7 4.1 184 1879 158,316 24 60 51 26 93 1 14 8 71 348 2.2 3.3 116 1880 161,462 11 75 105 22 95 4 24 5 128 469 2.9 3.7 163 1881 163,151 55 67 38 8 85 2 22 5 101 383 2.3 3.6 140 1882 163,540 ... 77 62 25 119 1 25 6 61 376 2.3 3.5 139 1883 163,860 1 39 28 24 44 2 30 3 80 251 1.5 2.7 96 1884 164,180 26 32 18 17 81 ... 26 4 110 314 1.9 3.5 119 1885 164,500 25 111 7 22 98 ... 12 ... 86 361 2.2 3.0 130 1886 164,820 ... 56 11 34 82 ... 11 ... 90 284 1.7 2.8 102 1887 165,140 1 108 44 40 86 ... 11 2 124 416 2.5 3.1 145 1888 165,450 ... 124 26 89 100 ... 21 2 58 420 2.5 2.7 148 1889 165,760 ... 14 28 111 26 ... 19 ... 71 269 1.6 2.3 111 1890 166,080 ... 140 26 35 93 ... 15 ... 78 387 2.8 2.8 131 1891 166,308 ... 29 16 28 84 ... 24 1 91 273 1.6 2.3 89 1892 167,200 ... 109 36 31 63 ... 15 2 77 333 2.0 2.8 115 1893 167,900 9 18 51 83 65 ... 17 ... 98 341 2.0 3.1 117 1894 168,600 ... 108 22 75 61 ... 21 3 56 346 2.1 2.7 132 1895 169,300 ... 33 27 89 89 ... 15 1 118 322 1.9 2.6 117 1896 170,465 ... 173 39 72 99 ... 15 1 61 460 2.7 3.1 159 1897 170,700 ... 33 29 82 19 ... 21 1 125 310 1.8 2.6 116 1898 172,000 ... 120 23 26 52 ... 12 ... 112 847 2.0 2.8 124 1899 172,400 ... 24 10 42 59 2 23 ... 101 259 1.5 2.5 86 1900 178,000 ... 98 4 27 33 ... 16 ... 105 283 1.6 2.2 105 1901 176,628 1 77 15 38 62 1 11 ... 115 320 1.8 2.3 121 1902 177,500 11 93 21 20 21 ... 19 ... 78 263 1.5 2.2 96 1903 178,000 ... 34 14 24 90 ... 9 ... 97 268 1.5 1.8 109 1904 178,500 1 67 5 17 19 ... 6 1 128 244 1.4 2.2 96 1905 179,000 ... 54 21 9 60 ... 13 ... 90 247 1.4 1.7 99 1906 179,500 ... 81 11 19 20 ... 5 ... 142 278 1.5 1.9 111 1907 180,500 ... 31 9 24 81 ... 5 ... 30 180 10 1.4 73 Note.--The Medical Officer of Health is not responsible for the accuracy of the figures above the horizontal line between the years 1870 and 1871, excepting as to estimated population and to calculation of rates. Census years are indicated by dark type. [Table C. 110 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, 1856-1905: 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. Pyrexia. Diarrhœa. Total. 1856-1860 9,557 30.7 6,540 21.0 44 153 276 - 206 Not separately classified. 142 Not separately classified. 278 1,099 3.53 1861-1865 11,562 28.5 8,261 20.4 76 325 371 98 206 275 309 1,660 4.09 1866 1870 17,090 32.1 10,853 20.4 55 258 518 80 302 224 574 2,011 3.78 1871-1875 20,861 31.4 12,595 18.9 189 289 249 85 345 27 130 55 603 1,972 2.97 1876-1880 23,149 29.9 14,517 18.8 151 370 323 95 531 13 105 28 605 2,221 2.87 1881-1885 21,383 26.1 13,438 16.4 107 326 153 96 427 5 115 18 438 1,685 2.05 1886-1890 19,428 23.5 13,816 16.7 1 442 135 305 387 ... 77 4 421 1,772 2.14 1891-1895 18,512 22.1 14,235 16.9 9* 297 152 306 312 ... 92 7 440 1,615 1.92 1896-1900 18,665 21.8 14,075 16.4 ... 448 105 249 262 2 87 2 504 1,659 1.93 1901-1905 18,131 20.4 12,898 14.4 13 325 76 108 252 1 58 1 508 1,842 1.51 *All in 1893. TABLE D. Death-rate in Kensington, per 1,000 persons living, from each of the Seven Principal Diseases of the Zymotic Class ; Arranged also, in two groups ; viz. (1) The four notifiable infectious diseases—Smallpox, Scarlet Fever, Diphtheria, and "Fever"; and (2) The three non-notifiable diseases—Measles, Whooping-Cough, and Diarrhœa. Quinquennial Period. l • 2 3 4 5 6 7 Death-rate per 1,000 from— Smallpox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. "Fever." Diarrhœa. The Seven Diseases. The Four Notifiable Infectious Diseases. (Columns 1, 3, 4, and 6.) The three Non-notifiable Infectious Diseases (Columns 2, 5. and 7). 1856-1860 0.14 0.49 0.89 — 0.66 0.46 0.89 3.53 1.48 2.05 1861-1865 0.19 0.80 0.91 0.24 0.51 0.68 0.76 4.09 2.02 2.07 1866-1870 0.10 0.49 0.97 0.15 0.57 0.42 1.08 3.78 1.65 2.13 1871-1875 0.28 0.44 0.37 0.13 0.52 0.32 0 .91 2.97 1.11 1.86 1876-1880 0.19 0.48 0.42 0.12 0.69 0.19 0.78 2.87 0.92 1.95 1881-1885 0.13 0.39 0.19 0.12 0.52 0.17 0.53 2.05 0.60 1.45 1886-1890 0.00 0.53 0.16 0.37 0.47 0.10 0.51 2.14 0.63 1.51 1891-1895 0.02 0.35 0.18 0.36 0.37 0.12 0.52 1.92 0.67 1.25 1896-1900 0.00 0.52 0.12 0.29 0.31 0.11 0.59 1.93 0.52 1.41 1901-1905 0.01 0.37 0.09 0.12 0.28 0.07 0.57 1.51 0.29 1.22 INDEX. Page. Abattoir; Provision, by the Corporation of London, of a Public 94 Abattoirs (Public) v. Private Slaughter-houses 98 Age and Sex constitution of the Population at the Census of 1901 3 Alcoholism; Deaths from 27 Ambulance Arrangements; Local 75 Ambulance Service for Street Accidents, in the City of London 75 „ „ The Home Secretary appoints a Departmental Committee to inquire as to the need of a Metropolitan Street 75 Appendix I. New List of Causes of Death 105 ,, II. Statistical Tables A, B, C. and D : Marriages, Births, Deaths, Infantile and Zymotic Mortality, etc., 1856—1907 108-110 Area of the Borough 5 Asylums Board ; Work, in 1907, of the Metropolitan 78 Baths and Washhouses ; Number of Bathers and Washers, in the year 1907-8, at the Public 99 Births and Birth-rate ; in the Borough, the Sub-Districts, etc. (Table, page 8) 7 Births, Number of and Birth-rate, in 10 years, 1897-1906, and in 1907 8 Births in 1907; Number of Illegitimate 8 Births ; Annual Number of, and Birth-rate, 1856-1907 (Tables A and C, Appendix II.) 108-110 Births ; Act passed providing for Notification of 66 Birth-rate ; Fall in the 9 Borough ; Development since 1856, and since 1871, of the 4 Cancer, Malignant Disease ; Deaths from 27 Care of Infants; Report of the Health Visitor on the 55 Census of 1901; Population of the Borough at the 3 Cerebro-Spinal Fever ; London County Council issue an order for the Compulsory Notification of 30 Chapel of Rest for the Dead ; Number of Bodies deposited at the 102 Circulatory System ; Deaths from Diseases of the 27 Cleansing of Verminous School Children, and Inmates of Common Lodging-houses; Power conferred on the County Council for 86 Combined Drainage ; Conference of Sanitary Authorities with respect to 96 ,, ,, Bill introduced (Session of 1908) with respect to 97 Common-Lodging-Houses ; List of the 77 Consumption (Pulmonary Phthisis) ; The Prevention of, and the Fight against Tuberculosis 38 „ Action of the Poor Law Authorities with respect to the Prevention of 39 ,, Action of the Public Health Authorities with respect to the Prevention of 39 „ Asylums Board's decision with respect to provision for hospital treatment of 42 „ Compulsory Notification at Sheffield of 47 ,, Council's action (Voluntary Notification, etc.) for the prevention of 49 „ Deaths and Death-rate in Kensington and in London from 26 ,, Modern treatment (at Frimley Sanatorium) of 54 „ Movement in Ireland in connection with the Prevention of 45 » » Scotland „ „ „ 46 „ Southern Hospital: Proposed use of, in connection with the treatment of 43 ,, Views of the Local Government Boards for England, Scotland, and Ireland "on the subject of Compulsory Notification of 47 „ Workers' Sanatorium at Benenden for the treatment of 38 Consumptives; Local Government Board's Decision with respect to Asylums Board's communication regarding provision of sanatoria for 42 Cow-house, Licensed 94 Cutting-off Water Supply to houses 102 Dairies Order ; Registration of Milk Shops under the 94 Death ; Assigned Causes of (Tables, page 17 and page 105) 15 ,, Summary of causes of 18 Death-rate, Annual 1856-1907 (Table A, Appendix II.) 108 ,, from Zymotic Diseases ; Arranged in Quinquennial Periods, 1856-1905 (Table D) 110 ,, in 1907 ; in the Borough, the Sub-Districts, etc. 12 „ in 1907 ; The Corrected or True 10 ,, of England and Wales ; and of Inner, Outer, and Greater London 15 ,, of Foreign, Colonial, and Indian Cities 15 Deaths and Death-rate ; in Borough, Sub-Districts, Parliamentary Divisions and Wards (Table, page 12) 9 Deaths at Public Institutions within the Borough 28 ,, of Parishioners at Public Institutions, etc., without the Borough 29 ii. Page. Diarrhœa Deaths in Kensington and in London from 25 ,, Deaths in Kensington, 1856-1907, from (Tables B, C and D, Appendix II.) 109-110 Digestive System; Deaths from Diseases of the 28 Diphtheria Deaths in Kensington, and in London, from 22 ,, Deaths in Kensington, 1860-1907 from (Tables B, C and D, Appendix II.) 109-110 Diseases Deaths from General 18 Disinfection after Consumption 52-58 Disinfecting Staff Proposal to erect Cottages for the 100 Disinfecting Station The Work of the year at the 99 District Rates of Mortality 12 Drainage; Supervision of Reconstruction and Repair of defective House 90 England and Wales Death-rate of 15 Enteric Fever; Deaths in Kensington and in London, from 24 ,, ,, Deaths in Kensington, 1856-1907, from (Tables B. C and D, Appendix II.) 109-110 Erysipelas; Deaths from 26 Factory and Workshop Act, 1901 Proceedings under the (Tables pp. 78, 80, 81, 82, 88 and 84) 78 „ ,, „ Chief Sanitary Inspector's Report on Men's Workshops 81 ,, ,, ,, Lady Inspectors' Report on Women's Workshops 78 Females Enumerated at the Census, 1901 Number of 8 Fever Deaths in Kensington and in London, in 1907, from 24 ,, Deaths in Kensington, 1856-1907, from (Tables B, C and D, Appendix II.) 109-110 Fever Hospital Accommodation 74 Flooding of Basements of Houses 96 Fried Fish Shops; Proposed legislation for regulation of business at 95 General Diseases; Deaths from 18 Health Visitor Report on the Care of Infants, by the 55 Health Visitors London County Council promote legislation for the appointment of 89 Hospital Accommodation for Infectious Disease 74 Hospitals Deaths at Outlying 29 Houses (Inhabited) Number of, in 1907, and Increase of, since 1856, and since 1871 4 ,, Let in Lodgings Number of Registered 76 ,, Unfit for habitation 76 Housing of the Working Classes; Action of the Borough Council with respect to the 76 Housing of the Labouring Class Local Government Board Inquiry with respect to scheme of Great Western Railway Company under their Additional Powers Act, 1897, and the 76 Hygienic Paving of Streets 98 Illegitimate Children under Five Years of Age; Deaths of 12 Infantile Mortality in Kensington, in London, and in England and Wales 11 Infantile Mortality; 1871-1907 (Table A, Appendix II.) 108 ,, ,, Local Government Board prescribe, for use by Medical Officers of Health, a form of table of deaths under one year, from stated causes (Tables, pp. 57 and 58) 55 ,, ,, President of the Local Government Board on the prevention of 59 „ „ Report of the Lady Sanitary Inspectors on 56 Infantile Summer Diarrhœa, in 1906 and 1907 25 Infectious Diseases in London, in 1907 Ages at Notification of 31 ,, ,, Cases Notified in London, 1890-1907 Annual Numbers of 31 ,, ,, Notifications of in London, and in Kensington, and in the several Metropolitan Cities and Boroughs of (Tables) 31-35 ,, ,, Sickness and Death-rate from (Table) 36 Infirmary Deaths at the Borough 29 Influenza Deaths in Kensington, and in London, from 26 Inquests 30 Kensington Health Society 70 Lady Inspectors of Workshops, etc.; Annual Report of the (Tables, pp. 78 and 80) 78 ,, ,, First Appointments, in 1893, of 78 ,, ,, Report on Voluntary Notification of Consumption by the 49 ,, ,, Measles and Whooping-cough by the 20 & 24 Legal Proceedings 90 oq Legislative Proposals of the London County Council for the Session of 1908 89 Local Diseases; Deaths from 27 Local Government Board for Scotland, and the Prevention of Consumption 46 iii. Page. London County Council (General Powers) Act, 1907 85 „ „ „ ,, Provisions with respect to Milk Supply (Tuberculosis) of the 85 „ „ ,, ,, Provisions with respect to Water Supply to tenement houses of the 86 „ „ ,, ,, Provisions with respect to Cleansing of Verminous Persons of the 86 Males, Enumerated at the Census, 1901 ; Number of 8 Marine Stores ; Proposed legislation for regulation of business at 95 Marriage-rate ; Fall in the Marriages (and Marriage-rate) in 1907, and the preceding ten years ; Number of 6 „ ,, 1856-1907 ; Annual Number of (Table A, Appendix II.) 108 Measles, in Kensington and in London ; Deaths from 20 ,, Lady Inspectors' report on inquiry with regard to 20 Medical Inspection of School Children 88 Metropolitan Asylums Board ; The Work of the 78 Metropolitan Asylums Board's Ambulance Service; The Work of the 75 Metropolitan Water Board ; Powers and Practice, with respect to the cutting-off of water supply to houses, of the 102 Milk Supply of London ; Legislation with respect to the 85 Mortality ; District Rates of 12 ,, Infantile ,, Senile 12 ,, Zymotic 18 Mortuary; Use made of the Public 101 Municipal Milk Depots ; President of Local Government Board introduces a Bill with respect to 94 Nervous System ; Deaths from Diseases of the 27 Notification of Births ; Act passed to provide for the early 66 „ ,, Action of the Borough Council in connection with the Act for the .. 68 ,, of Infectious Disease in Kensington and in London (Tables, pp. 31—35) 80 ,, of Phthisis, in Kensington ; Voluntary 49 Notting Dale Special Area; Statistics (1896 and 1906) of the 61 ,, ,, Infantile Mortality (1906) in the 59 Offensive Businesses 94 Offensive Businesses ; London County Council's proposed legislation with regard to Fried Fish Shops, Fish curer, and Marine Stores as 89 Outlying Public Institutions, etc.; Deaths at 29 Outworkers 79 & 83 Parliamentary Divisions of the Borough 5 Paving of Streets; Hygienic 98 Phthisis ; Deaths and Death-rate in Kensington and in London, from Pulmonary 26 ,, Voluntary Notification of Pulmonary 49 Population of the Borough at the Census of 1901 ; Age and Sex Distribution of the 8 ,, ,, Decennial Censuses, 1801-1901 4 ,, ,, 1856-1907 ; Estimated Annual (Table A, Appendix II.) 108 ,, ,, in 1907 ; Estimated 5 Public Baths and Washhouses ; Number of Bathers and Washers in the year 1907-8, at the 99 Public Health Legislation : London County Council (General Powers) Act, 1907 85 ,, „ ,, in the Session of 1908 ; Proposals of the London County Council with respect to 89 Public Health (London) Act, 1891 ; Proposals for the Amendment of the 84 Public Health (Regulations as to Food) Act, 1907 88 Public Institutions; Deaths at 28 Public Mortuary ; Use made of the 101 Public (and Public-house) Sanitary Conveniences ; Number of 98 Puerperal Mortality 26 Rateable Value of the Borough (1823-1907) ; Increase of the 4 Registered Houses ; Number of 76 „ „ Let in " Furnished" rooms ; Return of 77 Registration District and Sub-Districts 5 Relief Sewer for prevention of flooding of basements of houses 96 Respiratory System ; Deaths from Diseases of the 27 Royal Commission on Tuberculosis 37 Sanitary Conveniences ; Public, and Public House 98 Sanitary Inspectors ; The Work of the (Statistical Tables, pages 90—92) 90 iv. Page. Scarlet Fever, in Kensington and in London ; Deaths from (Tables, pages 20—22) 20 „ „ in Kensington, 1856-1907 ; Deaths from (Tables B, C and D, Appendix II.) 109-110 Senile Mortality 12 Sewer Smells 95 Sex and Age Constitution of the Population, in 1901 8 Shelter for Persons during Disinfection of Rooms ; No provision made of 100 Slaughter-houses; Licensed 98 Small-pox, 1856-1904 ; Annual Number of Deaths from (Tables B. C and D, Appendix II.) 109-110 ,, Views of the Royal Commission on Hospital Accommodation for 74 Southern Hospital ; Completion of the 48 „ ,, Proposed use as a Sanatorium of the 48 Special Area (Notting Dale) ; Statistics of sickness and fatality (1896 and 1906) 61 Statistical Tables ; The Local Government Board's prescribed Forms for 16, 17, 84, 57 ,, ,, New List of Causes of Death (Appendix I.) 105 ,, ,, Births, Deaths, etc., 1856-1907 (.Table A, Appendix II.) 108 Statutory Notices issued ; Number of 90 Street Accident Cases: Inquiry by Departmental Committee with respect to proposed Ambulance Service for 75 Street Ambulance Service; City Corporation establish a 76 Syphilis ; Deaths from 26 Tables prescribed by the Local Government Board to be used :— (i.) Population, Births, Deaths under One Year, and at all Ages, and in Public Institutions, etc.; in 1907 and the preceding ten years—whole District 16 (ii.) Population, Births, Deaths at All Ages, and under One Year ; in the Borough, and the Sub-Districts ; in 1907 and the preceding ten years 17 (iii.) Infectious Disease ; Cases of, Notified at different Ages, in the Borough, and in the Sub-Districts; and Cases removed to Hospital 84 (iv.) Death ; Causes of, and Ages at, in 1907 17 (v.) Infantile Mortality ; Deaths from stated causes 57 (vi.) Factories, Workshops, Laundries, Workplaces and Homework 82-84 Tenement Houses ; Legislation with respect to the Water Supply of 86 Tenements of less than five Rooms, in 1901; Number and Population of Tuberculosis ; Deaths and Death-rate, in Kensington and in London, from 26 Uncertified Deaths ; in Kensington, in London, and in England and Wales 80 Underground Rooms Urinary System; Deaths from Diseases of the 28 Vaccination Act, 1907 71 Vaccination Officer's Report for 1906 (Statistical Table, page 72) 71 Verminous School Children, and Inmates of Common-Lodging-Houses ; Legislation with respect to the Cleansing of 86 Violence ; Deaths, and proportion of to 1,000 of the Population in 1907, from 28,80 Vital and Mortal Statistics (1907) ; Summary of (Table, page 14) 18 Wards ; Number and Names of the 5 Water Supply to Houses ; Metropolitan Water Board's powers and practice, with respect to the cutting-off of the 102 „ „ „ Provisions of London County Council (General Powers) Act, 1907, with respect to 86 Water supply of occupied houses ; Provisions of the Public Health (London) Act, 1891, with respect to the 103 Water Supply of Tenement Houses ; Legislation with respect to the 86 Whooping-cough ; Deaths in Kensington, and in London, from 24 ,, Lady Inspectors' report on enquiry with regard to 24 Workshops ; Annual Report of the Chief Sanitary Inspector on Men's 81 „ Laundries, etc.; Annual Report of the Lady Inspectors of 78 Working Classes ; Housing of the 76 Written Intimations of Nuisances 90 Yards ; Paving of 98 Zymotic Diseases ; Deaths and Death-rate, in the Sub-Districts, the Parliamentary Divisions, and the Wards, from 19 „ „ Death-rate, in Kensington, in London, and in England and Wales, from 19 Zymotic Mortality in Kensington, 1856-1907 (Tables B, C and D, Appendix II.) 109-110