PAD 1 Borough of Paddington. REPORT on VITAL STATISTICS and SANITARY WORK FOR THE YEAR 1894, by REGINALD DUDFIELD, M.A., M.B.,D.P.H., Medical Officer of Health. Morton & Edgware Road, Paddington, W. PAD 1 Borough of Paddington. REPORT on VITAL STATISTICS and SANITARY WORK FOR THE YEAR 1894, by REGINALD DUDFIELD, M.A., M.B.,D.P.H., Medical Officer of Health. CONTENTS. pages Population 7 Housing of Population 11 Births and Birth-rates 15 Vaccination 21 Notification 24 Deaths and Death-rates 48 Causes of Death 55 Water Supply 91 Sanitary Work 98 Food Analysis 107 ABSTRACTS. Report of Select Committee of House of Commons on Death Certification 87 „ „ Water Examiner (1894) 91 „ „ Statistical Committee of the Metropolitan Asylums Board (1894) 41 „ „ Medical Officer to London County Council (1893) 28, 71 Memorandum on Increased Mortality from Diphtheria 66 Abstract of Public Analyst's Quarterly Reports 130 [over, pages Births, decline in birth-rate 18 Bronchitis, mortality from 79 Cancer, mortality from 77 Correction-factor, use of 8 Deaths, age-group death-rates 51 „ certification 87 „ in outlying institutions 86 Diphtheria, increased mortality from 66 „ school attendance, effect of 71 Enteric Fever, oysters as cause of 31 House Sanitation, need of Bye-laws regulating 98 Illegitimates, mortality among 84 Infantile Mortality 54 Infectious Disease, measures to limit spread of 102 „ vagrants spreading 104 Inquests 83 Legal Proceedings 107-108 Overcrowding 12 „ and disease, &c. 37 Phthisis, mortality from 77 Pneumonia, „ 81 Population, age-constitution of 9 „ density of 10 Sand-filtration, efficiency of 97 Scarlet Fever and school attendance 28 Seven principal Zymotic Diseases, mortality from 74 Vagrants, spreading disease by 104 Violence, deaths from 81 Zymotic Diseases, mortality from 61 TO THE CHAIRMAN AND MEMBERS OF THE VESTRY OF PADDINGTON. Gentlemen, I have the honour herewith to present to you my First Annual Report dealing with the vital statistics and sanitary work for the past year. I regret the delay which has occurred in its preparation, but such delay was unavoidable and chiefly due to the time required to compile the matter necessary for the preparation of the various tables, &c. The labour expended this year will be of use in future reports, and will enable me to present them at earlier dates. I have the honour to be, Gentlemen, Your most obedient Servant, REGINALD DUDFIELD, M.A., M.B., D.P.H., &c., Medical Officer of Health. Vestry Hall, Harrow Road, W. July 1895. POPULATION. At the Census of April, 1891, the total population of the Parish was found to be 117,846 persons, viz. : 48,547 males, and 69,299 females. In 1881 the population was 107,058 persons, so that the increase during the ten years appeared to have been 10,788 persons. It is, however, probable that the population of certain parts of the Parish, notably that of the Sub-District of St. John, was under-estimated at the date of the last Census, by reason of its nearness to Easter. After the lapse of nearly four years it is almost useless to enter into this question, but that possible source of error should be borne in mind, when considering the various rates given for this Sub-District. The population of the Sub-District of St. Mary increased during the ten years, 1881-91, from 69,728 to 84,159 persons, whilst that of St. John (apparently) decreased from 37,330 to 33,687. Owing to the combined influence of this increase and decrease, it has been found to be more convenient to calculate the estimated populations for the two sub-districts, and obtain that of the whole Parish from them, than to calculate that for the Parish by a single operation, as is the usual custom. The total for the Parish at the middle of 1894 obtained by this method, was 121,500 8 persons. In the Registrar-General's Reports the estimated population (1894) of the Parish was stated to be 121,583, a difference which is not worth correction. The total first given is that used throughout this Report. In Table 1 will be found the estimated number of individuals, in each age-group of the population, distinguishing the sexes. These figures have been obtained from the percentages determined at the Census. It is essential to know the "age-group" death-rates to form sound conclusions as to the true incidence of mortality in different years, and still more so, that in different localities. In the latter case, the mere comparison between the gross deathrates is untrustworthy, on account of the disturbance caused by the different proportions of individuals living at the various ages. In 1883 the Registrar-General published certain "correction factors," based on an examination of the constitution of the population of England and Wales as regards sex and age, a deduced "standard deathrate," and the mortalities prevailing during the inter-censal period 1871-81. By the use of these factors it is possible to reduce the death-rate of any given district, as determined from the recorded rate per 1,000 of the total population to a true "corrected rate," which is strictly comparable with a similar rate of any other district. Until the Medical Officer of Health to the London County Council published his 9 Report for 1892, the factors for the districts of the Metropolis had not been officially calculated. The factor for Paddington given in that Report is 1-08070. TABLE 1. Population of Parish, estimated for middle of the year 1894. males. Paddington. St. Mary. St. John. All ages 50,222 38,626 11,596 0- 1 1,252 1,068 184 1- 5 4,422 3,669 753 5-15 9,715 7,899 1,816 15-25 9,986 7,385 2,601 25-66 22,900 17,22!) 5,671 65 and over 1,947 1,376 571 0- 5 5,674 4,737 937 5-60 41,322 31,639 9,683 60 and over 3,226 2,250 976 females. All ages 71,278 50,323 20,955 0- I 1,303 1,107 196 1- 5 4,536 3,750 786 5-15 10,425 8,329 2,096 16-25 16,019 10,556 5,463 25-65 35,229 23,847 11,382 65 and over 3,766 2,774 1,032 0- 5 5,839 4,857 982 5-60 59,562 41,229 18,333 60 and over 5,877 4,237 1,640 PERSONS. All ages 121,500 88,949 32,551 0- 1 2,555 2,175 380 1- 5 8,958 7,419 1,539 5-15 20,140 16,228 3,912 15-25 26,005 17,941 8,064 25-65 58,129 41,076 17,053 65 and over 6,713 4,110 1,603 0- 5 11,513 9,594 1,919 5-60 100,884 72,868 28,016 60 and over 9,103 6,487 2,616 10 TABLE 1A. Registration London.— Estimated Population, at the middle of 1894:— Persons 4,349,158 Males 2,055,847 Females 2,293,311 AGE CONSTITUTION. Ages. Persons. Males. Females. 0- 1 112,358 55,713 56,646 1-6 405,554 201,679 203,875 6-15 899,024 446,324 452,700 15-25 872,908 404,385 468,523 25-65 1,886,919 879,697 1,007,222 65 and over 172,395 68,049 104,346 0- 6 617,912 257,392 260,520 5-60 3,562,993 1,683,944 1,869,044 60 and over 278,263 114,511 163,742 All ages 4,349,158 2,055,847 2,293,311 DENSITY OF POPULATION. The total area of the Parish, is stated in the last Census Report, to be 1,256 statute acres, of which 17.3 are water. At the date of the Census there were 95.1 persons to the acre, whilst in 1394 the average had risen to 98.0. In April 1891 there were 13,221 " inhabited " houses, or 10.6 houses to the acre. In the Sub-District of St. Mary there were 105.8 persons and 11.8 houses per acre, and in that of St. 11 John, 75.8 and 11.4 respectively. In 1894 the numbers of persons to the acre were 111.8 in the former, and 73.3 in the latter District. TABLE 2. Whole Parish. St. Mary. St. John. Area in acres (less water) 1,239 795 444 Houses per acre, 1891 10.6 11.8 11.4 Persons „ „ 95.1 105.8 75.8 Persons per acre, 1894 98.0 109.1 78.2 HOUSING OF THE POPULATION. In 1891 the population of the Parish (117,846 persons) occupied 14,473 houses, giving an average of of 8.1 persons per house. In the Sub-District of St. Mary 84,159 persons occupied 9,420 houses (8.9 per house), and in that of St. John 33,687 persons, 5,053 houses (6.6 per house). As the term "uninhabited" is used in the Census Report in a different sense to that of the Rate-books, it is impossible to give figures for 1894 which shall be comparable. In the whole Parish the total number of "tenements" occupied in 1891 amounted to 27,201, of which 9,993 contained five rooms or more, with a population of 59,748. In the remaining 17,208 tenements, containing less than five rooms, there were housed 58,098 individuals, equal to 49.30 percent, of the whole population. There were 4,785 one-room tenements containing 9,676 inhabitants (8.20 percent, of 12 the whole population of the Parish); 5,537 tworoom, with 19,589 inhabitants (16.63 percent.); 4,858 three-room, with 19,009, (16.13 percent.) and 2,028 four-room, with 9,824 (8.34 percent.). In the Sub-District of St. Mary there were 20,397 tenements in all, containing 84,159 inhabitants, giving an average of 4.11 persons per tenement. In the St. John's District there were 6,804 tenements with an average of 4.95 persons per tenement. In St. Mary's District, 49,030 persons inhabited tenements of less than five rooms, equal to 58.2 percent, of the population of the district, whilst in the St. John's District, only 26.8 percent, of the population were housed under the like circumstances, viz.: 9,060 persons out of a total of 33,687. The inhabitants occupying one room only, constituted 9.6 percent, of the total population of the St. Mary's District, and 4.5 of the St. John's. For the two-room tenements the corresponding figures were 20.0 and 8.1; for three-room, 19.6 and 7.3; and for four-room, 8.8 and 6.8, respectively. These figures are in themselves striking evidence of the different conditions of life, as a whole, prevailing in the two districts, but the difference is shown yet more markedly if the facts implied by these figures be set out in another form, as is done in the next paragraph. OVERCROWDING. For the purpose of ascertaining the amount of overcrowding existing, the Registrar-General, has 13 selected for his standard an average of two persons per room as the maximum permissible for healthy occupation. In so doing he was obliged to neglect the effects of ventilation, light, cleanliness, &c., all of which are of the utmost' importance in deciding whether a given room be overcrowded or not. Adopting the standard just named, it appears that at the date of the last Census, 16.82 percent, of the whole population of the Parish lived in an overcrowded condition. In the District of St. Mary 20.76 percent, of the inhabitants were similarly housed, whilst in that of St. John only 6.97. For purely local purposes, the figures of the two sub-districts are the more instructive. Considering them, it appears that of the inhabitants of one-room tenements, 50.5 percent, were overcrowded in St. Mary's, and 34.0 in St. John's ; of the inhabitants of two-room tenements, 50.4 and 40.4; of those in three rooms, 22.7 and 17.0; and of those in four rooms, 14.5 and 13.1. If the housing of the population be an important factor qua health, it may well be expected that there will be marked differences in the incidence of disease and death among the inhabitants of the two districts. Evidence will be put forward of such differences as regards both infectious disease and death among the younger inhabitants. The facts set out in the preceding paragraphs are recapitulated and emphasised in Tables 3a, 3b, and 3c. 14 TABLE 3a. Whole Parish. No of rooms to a tenement. Total No. of tenements. Total No. of inhabitants. Average No. of inhabitants. % of total population living in tenements of — rooms. OVERCROWDING. No. of tenements No. of inhabitants % of — roomed tenements overcrowded. % of inhabitants of each class of tenement overcrowded. % of total population living overcrowded in each class of tenement. Per tenement. Per room. Overcrowded. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 1. 4,785 9,676 2.0 2.0 8.20 1,239 4,636 25.8 47.91 3.93 2 5,537 19,589 3.5 1.7 16.63 1,582 9,597 28.6 48.99 8.14 3 4,858 19,009 3.9 1.3 16.13 531 4,192 10.9 22.05 3.56 4 2,028 9,824 4.8 1.2 8.34 144 1,395 7.1 14.20 1.18 Total number of tenements enumerated 27,201 Do. inhabitants do. 117,846 Average number of inhabitants per tenement 4.33 Total number of inhabitants overcrowded 19,820 Equal to 16*82 per cent, of total population. TABLE 3b. St. Mary's Sub-District. No of rooms to a tenement. Total No. of tenements. Total No. of inhabitants. Average No. of inhabitants. % of total population living in tenements of — rooms. OVERCROWDING. No. of tenements. No. of inhabitants. % of — roomed tenements overcrowded. % of inhabitants of each class of tenement overcrowded. % of total population living overcrowded in each claas of tenement. Per tenement. Per room. Overcr owded. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 1 3,925 8,147 2.0 2.0 9.6 1,097 4,116 27.9 50.5 4.8 2 4,664 16,841 3.6 1.8 20.0 1,400 8,495 30.0 50.4 10.9 3 4,198 16,536 3.9 1.3 19.6 477 3,770 11.3 22.7 4.4 4 1,541 7,506 4.8 1.2 8.8 112 1,091 7.2 14.6 1.2 Total number of tenements enumerated 20,397 Do. inhabitants do. 84,159 Average number of inhabitants per tenement 4.11 Total number of inhabitants overcrowded 17,471 Equal to 20*76 per cent, of total population. 15 TABLE 3c. St. John's Sub-District. No. of rooms to a tenement. Total No. of tenements. Total No. of inhabitants. Average No. of inhabitants. % of total population living in tenements of — rooms. OVERCROWDING. No. of tenements. No. of inhabitauts. % of — roomed tenements overcrowded. % of inhabitants of each class of tenement overcrowded. % of total population living overcrowded in each class of tenement. Per tenement. Per room. Overcr owded. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 1 860 1,629 1.7 1.7 4.5 142 521 16.6 34.0 1.5 2 873 2,748 3.1 1.6 8.1 182 1,102 20.8 40.4 3.2 3 660 2,473 3.7 1.2 7.3 54 422 8.1 17.0 1.2 4 487 2,318 4.7 1.1 6.8 32 304 6.5 13.1 0.9 Total number of tenements enumerated 6,804 Do. inhabitants do. 33,687 Average number of persons per tenement 4-95 Total number of inhabitants overcrowded 2,349 Equal to 6-97 per cent, of total population. BIRTHS. During the 52 weeks making up the year 1894, 2,834 births were registered in Paddington, viz. : 1,453 males and 1,381 females. The birth-rate for the year was 23.32 per 1,000 of the estimated population. The largest number of births was registered in the first quarter of the year (733), and the smallest in the fourth (699). From the Sub-Districts of St. Mary and St. John there were registered 2,423 and 411 births, and the rates were 27.23 and 12.62 respectively. In London there were last year 130,553 births, equal to a rate of 30.1 per 1,000 of the estimated population. 16 TABLE 4. Births registered in 1894. Births registered during St. Mary. St. John. Paddington. Males. Females. Total. Males. Females. Total. Males. Females. Total. 1st Quarter 333 289 622 56 56 1ll 388 345 733 2nd 311 282 693 64 55 109 365 337 702 3rd 299 308 607 48 45 93 347 353 700 4th 297 304 601 56 42 98 353 346 699 Year 1,240 1,183 2,423 213 198 411 1,453 1,381 2,834 Birth-rates for year* 13.94 13.29 27.23 6.54 6.08 12.62 11.95 11.36 23.32 * Per 1,000 (estimated) persons in each district. The total number of births registered last year in Paddington was absolutely the smallest registered in any of the eleven years 1884-94. The only year with a total at all approximating to that of last year was 1888 (2,843), when the estimated population was 114,462, compared with 121,500 for last year. The true difference between these years is indicated by the rates, 24.6 for 1888, and 23.3 for 1894. The births registered were only 98 below the average annual number for the ten years 1884-93, but the birth-rate was 2.0 per 1,000 below the mean rate. There has been a similar fall in the rate for London (2.1 per 1,000), as will be seen by referring to Table 5. The birth-rate for England and Wales 17 for last year had not been published at the time of writing, but the rates for the succeeding years have steadily declined since 1885, when the rate was 32"9, to 30'8 for 1893, with the sole exception of that for 1891. TABLE 5. Births and Birth-rates for period 1884-1894. Paddington. St. Mary. St. John. Birth-rates. Regd. Rates. Regd. Rates. Regd. Rates. England and W ales. London 1894 2,834 23.32 2,423 27.23 411 12.62 29.5 30.1 1884 3,007 27.2 2,379 32.3 628 16.9 33.6 34.3 1885 2,998 26.3 2,379 31.8 619 16.8 32.9 33.4 1886 2,898 25.6 2,366 31.0 532 14.4 32.8 33.4 1887 2,916 25.5 2,368 30.5 548 14.9 31.9 32.9 1888 2,843 24.6 2,331 29.6 502 13.9 31.2 32.1 1889 2,863 24.5 2,346 29.2 517 14.1 31.1 31.9 1890 2,901 24.4 2,389 29.1 512 14.0 30.2 30.7 1891 2,952 25.1 2,420 28.8 532 15.8 31.4 31.9 1892 2,934 24.6 2,456 28.5 478 14.4 30.5 30.9 1893 3,011 25.2 2,567 29.8 444 13.4 30.8 30.9 Averages for ten years, 1884-93. 2,932 25.3 2,400 30.0 531 14.8 31.6 32.2 The figures for Paddington and its sub-districts (except those for 1894) are from Reports by Dr. Stevenson; those for England and Wales and London from Reports of Registrar-General. All rates are calculated per 1,000 persons estimated living at middle of each year. 18 This general diminution in the birth-rate has been frequently attributed, more or less directly, to commercial depression, and for that and other reasons, the Registrar-General has since 1860 made a tabular statement, showing the marriage and birth rates, together with certain figures dealing with the exports, imports, prices of certain commodities, etc. From an examination of the Table between the years 1860-93, the latest date available, the following facts have been noted:— 1. The highest marriage-rate was recorded in 1873, and the lowest in 1886. 2. The highest birth-rate was that for 1876, and the lowest that for 1890. 3. The proportions of male to female births were maximal in 1860 and 1863, and minimal in 1890. 4. The value of British exports per head was highest in 1872, and lowest in 1861. 5. The value of imports per head was highest in 1883, and lowest in 1860. 6. The average price of wheat per quarter was highest in 1867, and lowest in 1893. 7. The amount cleared at the Bankers' Clearing House per head of population was highest in 1890, and lowest in 1868. (The last statistics extend back to 1868 only.) It is evident that the connection, if any exist, between the first three and the remaining classes of statistics is not a simple one, and that the influence of the conditions of life which the latter indicate, have a " resultant" effect only on the birth-rate. The 19 most suggestive points are the occurrence of a high marriage-rate in 1873, immediately after a prosperous year, as judged by the high value of the exports of 1872. The maximal birth-rate followed at an interval of three years, but the minimal birth-rate was four years after the minimal marriage-rate. The association of a minimal proportion of males to females with the minimal birth-rate is suggestive of physical debility, as there are good reasons for thinking that a preponderance of male births is associated with great bodily vigour. As regards the effects of increase of value of imports, it would seem that a maximal value is not associated with a great spending power on the part of those of the marriageable ages. On the contrary, the occurrence of the minimal marriage-rate three years after this item reached its maximum is suggestive of poverty of the nation, or else the ruling of high prices, prohibitive of marriage. The connection between the price of wheat and the marriage-rate is more than obscure. If marriage be at all dependent on the price of commodities, especially the necessities of life, then when the marriage-rate is low the prices of necessities would presumably be high, yet, with wheat at a price which should indicate cheap food, the marriage-rate is one of the lowest recorded. To fully appreciate the lines of thought indicated by these remarks, it would be necessary to construct charts showing the different fluctuations in the various statistics, and to set out the variations from the means of 20 periods of successive years. Such work is, however, hardly within the scope of the present Report. From the examination of the statistics for 1860-93 the following deductions appear to be admissible:— 1. That the low birth-rate is in part, and chiefly, due to low marriage-rate; 2. That some of the reduction is due to nished vigour of the population, and 3. That there are indications that the latter cause is passing away. In connection with the subject of birth-rates it will be well to remark that they are calculated, as far as this Parish is concerned at least, on the births registered. At present no information is given as to the date of birth, so that it is impossible to draw any conclusions as to the frequency of births in any given time, or to compare corresponding periods with each other. The law allows a delay of six weeks in registering a birth, so that the interval between birth and registration may vary very considerably. Further, it is eminently desirable that the civil state of the parents should be returned, in the same manner as is done with deaths, otherwise nothing is known of the differences of birth-rates among the various classes of life. ILLEGITIMACY. It is impossible on this occasion to say anything on this subject. During the current year endeavours 21 will be made to get out the figures for the past years and to keep them up to date. VACCINATION. Table 6 contains the summary of the returns of vaccinations performed, etc., since 1881. The figures for the years 1881-91 have been taken from the Reports by the Medical Officer to the Local Government Board, those for the years subsequent to 1891 have been supplied by the Vaccination Officer for the Parish. The return for 1894 is for the first half of the year only. The last column of the Table contains the most useful information, viz.: the proportion which unvaccinated children bear to the total births registered. Such children form centres from which the infection of small-pox may spread, and in which the disease may be perpetuated. On these grounds the decrease in the proportion since 1891 is very satisfactory. During the autumn, a house-to-house inspection of certain streets was made, with reference to vaccination. The Report of the Vaccination Officer contains the following information:— 250 streets were visited, inquiries being made at each house. Of the 492 children found to be unvaccinated 275 were immigrants, of whom 120 were from St. Marylebone. Between July 27th and September 21st, 455 vaccinations and 61 re-vaccinations were performed at the station, compared with 180 vaccinations during the corresponding period of 1893. 22 No records are published as to re-vaccination, nor is it compulsory. It is well known that the protection afforded by vaccination tends to disappear towards adult life, of which fact there is ample proof in the Report on the Sheffield epidemic of small-pox by Dr. Barry. It is desirable that vaccination should be repeated at least once after it is done in infancy. As the object of vaccination is the prevention of the spread of disease, it is an anomaly that the duty of carrying the law into effect should rest with the Poor Law Authorities, It ought to be in the hands of the Sanitary Officers. The Report of the Royal Commission on Vaccination is still unpublished, but has been announced as almost complete. It seems well, therefore, to abstain from any further remarks on the subject until the Report is out. 23 TABLE 6. Vaccination returns for years 1881-1893. Year. Births. Successfully vaccinated. Insusceptible of vaccination. Had Small-pox. Died unvaccinated. Vaccination postponed. Remaining (not traced, &c.) Children not finally accou't'd for (including cases postpo'ed) % of births. 1881 2,845 2,415 8 ... 203 7 212 7.7 1882 2,897 2,411 8 ... 212 17 249 9.2 1883 2,873 2,381 7 ... 231 16 238 8.8 1884 2,955 2,460 13 ... 239 43 200 8.2 1885 3,019 2,489 12 ... 252 38 228 8.8 1886 2,923 2,409 7 ... 213 26 268 10.1 1887 2,915 2,440 11 ... 220 40 204 8.4 1888 2,855 2,293 22 ... 216 38 286 11.3 1889 2,870 2,275 7 ... 223 68 297 12.7 1890 2,845 2,255 7 ... 254 29 300 11.6 1891 2,968 2,172 16 ... 254 32 494 17.7 1892 2,957 2,374 7 ... 202 16 358 12.6 1893 3,015 2,437 27 ... 265 10 276 10.0 1894 (first half-year) 1,438 1,205 9 ... 105 22 97 8.2 Note.—The figures 1881-91 are from the Reports of the Local Government Board. The Returns for 1891-93 (inclusive) are subject to correction. The figures for 1894 refer to first six months of the year. 24 NOTIFICATIONS. During the year 897 cases of infectious disease were notified from the whole Parish, equal to a rate of 7.38 per 1,000 of the estimated population at all ages. From the Sub-District of St. Mary there were notified 750 cases (equal to 8.41 per 1,000), and from that of St. John, 147 (equal to 4.51). These figures are corrected for duplicate notifications only. TABLE 7. Cases of sickness notified and Sickness-rates for 1894. Corrected for duplicate notifications only. Paddington. St. Mary. St. John. Quarters Yr. Quarters Yr. Quarters Yr. 1 2 3 4 1 2 3 4 1 2 3 4 Smallpox 5 3 10 10 28 4 3 6 10 23 1 ... 4 ... 5 Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria 77 98 95 102 372 63 87 87 93 330 14 11 8 9 42 Membr. Croup 1 2 4 3 10 1 2 4 3 10 ... ... ... ... ... Erysipelas 45 31 17 28 121 37 23 15 19 94 8 8 2 9 27 Fevers. Scarlet 77 96 65 51 289 68 77 55 38 238 9 19 10 13 51 Relapsing ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Typhus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric 14 16 14 26 70 11 13 11 15 50 3 3 3 11 20 Continued ... 1 ... 2 3 ... 1 ... 1 2 ... ... ... 1 1 Puerperal 1 2 1 ... 4 ... 2 1 ... 3 1 ... ... ... 1 Totals 220 249 206 222 897 184 208 179 179 750 36 41 27 43 147 Sickness-rates per 1,000 persons in each District 7.26 8.22 6.80 7.41 7.38 8.29 9.37 8.07 8.07 6.17 4.43 5.05 3.32 5.30 4.51 25 The highest number of notifications was received in the second quarter of the year (249), when the annual sickness-rate was equivalent to 8.22 per 1,000 and the lowest in the third (206), rate 7.41. Small-pox.—This disease was prevalent to a slight extent in each of the four quarters. Of the cases in the first quarter, nothing can be said. Of those in the second, one was certified from the Ship Hospital to be "German Measles"; of those in the third, one was returned from the Wharves as "Chicken-pox"; and of those in the fourth, three were sent back as errors in diagnosis. Of the 28 cases notified, 4 were in unvaccinated persons, and in 2 cases no information could be obtained as to vaccination. The remaining patients were all vaccinated. Nothing could be ascertained as to the origins of the cases in the second quarter; of those in the third, one case came from an infected house in the East End; and of the cases in the fourth quarter, as regards two (those of F. C. and C. G.), there was evidence that the infection had been taken outside the Parish, and 3 others appeared to be secondary to cases previously notified within the Parish. The notes made on these cases are appended below:— W. B., a plumber, resident in Paddington, but working in Hampstead, was taken ill on the 8th October, and removed on the 12th. K. B., his wife, was taken ill on the 24th, and removed on the 27th. B. M., living next door to these two patients, was taken ill on the 27th October, and removed on the 3rd November. K. B. was the only person in the house where she resided, who refused to undergo vaccination after the removal of W. B. 26 F. C was taken ill on the 18th October. A sister of F. C. (M. C.), visited a family in another part of London, where the children were isolated, on account of "Chicken-pox." After her return home, some fortnight later, M. C. had a few spots about her body which were thought to be "shingles," and after another fortnight, F. C. had an attack of "modified " Small-pox. C. G., a deaf mute, resident in Paddington, but attending the Capland Street Board School, where there had been several cases of Small-pox, was taken ill on the 24th October, and removed on the 30th. M. T., resident in the same house, and attending the same School, fell ill on the 31st October, and was removed on the 6th November. About three weeks prior to the date of the case of C. G., a child, E. P. in the same house, had some three or four spots about the body which, at the time, were diagnosed to be indicative of "disordered stomach,'' but the Physician subsequently came to the conclusion that they were more probably the eruption of "modified" Small-pox. During the last quarter the following curious case came under notice:— M. D. was notified to be ill with Small-pox on September 1st, and was removed that day. He was detained at the Shelter as a doubtful case, and two unsuccessful attempts were made to vaccinate him. The Medical Superintendent of the Shelter diagnosed the case to be one of severe Chicken-pox, as "the case did not look like unmodified Small-pox, as it usually attacks a young unvaccinated child." M. D. was sent home on the 19th September, three weeks after his removal, and twentythree days later, he was removed to Hospital with a well marked attack of Small-pox. Subsequent to his return home he had been in the company of a brother who was discharged from the Ships on the 21st September, after a severe attack of Small-pox. 27 The following notes of cases illustrate how disease may be spread. The first case is an example of the difficulty in which any medical man may find himself placed when a case of infectious disease is brought to his house for a first visit. The other cases are more serious, but the difficulty in securing conviction rendered it useless to take proceedings. The parents of I. M., resident in Paddington, took her to a Physican resident in Pimlico, using a four-wheel cab. The case was diagnosed as Small-pox, and the Physician refused to allow the child to be taken home in a cab, and instructed the parents to walk home, keeping away from other passengers. No trace of the cab could be found. An elderly lady who had (what was thought to be) a slight attack of modified Small-pox, was cautioned to keep her room. Next day she went shopping at a large West End house, travelling to and from the place in omnibuses. The diagnosis was confirmed, and she was removed to Hospital on the following day. A working man, also suffering from a slight attack of modified Small-pox, was seen one evening, and cautioned to remain in his house for a consultation to be held next day. When the Physicians arrived he was out, and it was afterwards discovered that he had gone to the Outpatient Department of St. Mary's Hospital, whence he was removed to the Ships. • Diphtheria.—Of this disease there were 372 cases notified, equal to 3.06 per 1,000 of the total population. According to the figures contained in Table 10 the rates for this disease during the five years 1890-4, have been: 1890, 1.9; 1891, 1.5; 1892, 1.3; 1893, 2.3; and 1894, 3.0. Such an increase in the course of so short a period would be a very alarming matter 28 were in not for the undoubted fact that many cases of sore throat are called diphtheria where the bacillus diphtheriæ is absent. In the last months of the year the Metropolitan Asylums Board initiated a system of bacteriological examinations of material from the throats of patients admitted for this disease. As yet no results have been published, and it seems best to leave the discussion of the subject until some information on the question is to hand. It is to be desired that the Board should communicate the results of the examination of each case to the Medical Officer of Health of the district whence the patient was removed. There is good reason to believe that much expense and anxiety would be avoided if there were in London a system of official examination by bacteriology in respect of every case notified, similar to that in force in New York. Such work is done by a private Association, recently started, for private practitioners, on payment of fees. Scarlet Fever.—The notifications of this disease numbered 289, equal to 2.37 per 1,000 of the total population. According to the figures contained in Table 10, the rates for each of the five years 1890-4 were: 1.8, 2.1, 4.5, 6.4, and 2.3 per 1,000. In connection with this subject, it will not be out of place to refer to certain remarks contained in the Report of the Medical Officer of Health to the London County Council for 1893, touching the connection between school attendance and the spread of this disease. 29 The weekly average number of notifications at all ages was determined, and a curve constructed, showing the percentage variation from that mean for each week of the year. It was found that there was in that part of the curve relating to the month of August, a well-defined depression, extending from the 32nd to the 35th week. That depression occurred in the middle of a rise in the curve for the series of weeks. A similar, but less marked depression was noted in the corresponding curve for 1892. For the purpose of closer examination of the curve of 1893, the cases of scarlet fever were divided into three groups: (a) those occurring in children from 0-3 years of age, i.e., "those too young to attend school (b) those in children aged from 3-13 years of age, i.e., "those at the school-age period of life"; and (c) those of individuals aged 13 years and upwards, i.e., "those who have, in great part, left school." He goes on to say: "If curves be constructed with the cases included in these three groups, it will be seen that the August depression is much accentuated in the curve relating to children from 3-13 years of age, and that the depression in the curve relating to infants from 0-3 years occurs a little later. This striking diminution of scarlet fever in the month of August, occurring especially among children at the school-age period of life, necessarily raises the question whether disease had been spreading in schools, and whether the summer holiday has arrested the spread of disease due to this cause. "At this season of the year there is, however, another condition which deserves consideration. Coincident with 30 the closing of schools, children, in considerable numbers, migrate from London, and it may be that the diminution in the number of cases of scarlet fever in August is in some part attributable to this migration. Such inquiry as I have been able to make does not, however, lead me to the conclusion that this circumstance affords sufficient explanation of the reduction of scarlet fever during the month of August. School operations must therefore be further considered. I am not able to show for each week the number of children in London who are attending school, but so far as the operations of the schools of the London School Board are concerned, the dates at which the schools generally close and re-open can be given. It is probable that the times of the closing and re-opening of many other London schools correspond with the times of the closing and re-opening of the Schools of the Board. "In the diagram for the year 1893 the August depression is still more marked. In this year the schools generally closed on the 27th of July, i.e., nearly the end of the 30th week, and re-opened on the 28th of August, i.e., the beginning of the 35th week. Diminution in the number of cases notified might be expected therefore in the 32nd, 33rd, 34th, and 35th weeks, and the August depression in the diagram corresponds with these weeks. "If comparison be again made between three periods of four weeks, i.e., 28th-31st, 32nd-35th, and 36th-39th, the following results are obtained:— Under 3 years. 3-13 years. 13 years & above. Decrease per cent. of number of cases in 2nd period to that of 1st. —1 —26 —17 Increase per cent. of cases in 3rd period, in relation to that of 2nd +9 +65 +26 "There appears, therefore, to be a very close relation between the August holidays and the diminution in the amount of scarlet fever." 31 Enteric Fever.—Of this disease there were 70 cases during the year. By a reference to Table 10 it will be seen that there was no special prevalence to be noted. There was, however, the usual autumnal increase in the fourth quarter of the year. The inquiries made in respect of the cases failed to elicit any information as to the origins of the infection, but in respect of three patients there was evidence that they were infected whilst living outside the District. Information was also received from Medical Officers of other districts, of three cases in which the infection appeared to have been received within the Parish. The length of the "incubation period" makes inquiries into the origin of sporadic cases of this disease very unsatisfactory. In several cases the eating of oysters was alleged to be the cause of the disease, and it may be remembered that at the close of the year there was no little stir created among the oyster traders by a general scare as to the probability of infection through the bivalve in question. It will be useful to state here some of the evidence on the point. Oysters and Enteric Fever. The theory that oysters might be a channel of infection for this disease came as news to most people during the last autumn, but a suspicion of such danger has existed in the minds of many medical men for some time past. It was in Dublin that the theory 32 was first mooted, but bacteriology was then in its infancy, and no evidence could be adduced in support of the theory. There are now on record several small outbreaks of this disease among persons having nothing in common except the fact of their having eaten oysters at the same time and from the same place. The latest and most complete case was that of the students of a college at Middletown, Connecticut, U.S.A. The oysters in this case were from a fattening bed close to a sewer, known to have received the infection of enteric fever. The occurrence of such outbreaks being proved, the next point is the question of the circumstances favouring the spread of the infection. In the first place, they are stored to fatten in large beds which are almost invariably in the mouths of rivers or estuaries, which are now in most cases the recipients of the sewage of towns situated near the sea. Secondly, oysters are most commonly eaten raw. Given these facts, there remain the two arguments against the theory:— (1.) It has been stated by oyster merchants that oysters fed on sewage will either die or else be so sickly and out of condition as to be manifestly uneatable; and (2.) That no one has demonstrated the microorganism of enteric fever, either in sea water or in the oyster itself. 33 As regards the former it may be replied that whilst oysters in water highly charged with sewage may die or become uneatable, yet they undoubtedly do flourish in water containing sewage, as must be evident to any one acquainted with the chief oyster beds. The second argument is not so easily rebutted. It can only be met by a very extended series of examinations and experiments. The conclusions which appear to be the safest are that the case is "not proven," but that there is sufficient evidence to make it imperative that strict supervision should be exercised in the matter of the fattening beds, and that oysters which come from beds known to be exposed to sewage contamination, should not be eaten raw. In the quarterly reports for last year attention was called on more than one occasion to the great differences in the numbers of cases from the two SubDistricts, which differences are shown in Table 7. In Table 8 the cases have been distributed between the two Sub-districts, the two sexes and the six age-groups used in these reports. The rates shown in this Table and in Table 8a have been calculated on the numbers estimated to be living in each age-group, as shown in Table 1. 34 TABLE 8.—Cases of Infectious Disease notified in 1894, and Sickness-rates; distributed under Sex and Ages. Corrected for duplicates only. Age-groups. MALES. FEMALES. Grand Total. Sickness-rates per 1,000 individuals in each group. Smallpox. Diphtheria. Membr. Croup. Erysipelas. Fevers. Total. Smallpox. Diphtheria. Membr. Croup. Erysipelas. Fevers. Total. Scarlet. Enteric. Continued. Puerperal. Scarlet. Enteric. Continued. Puerperal. PADDINGTON. 0-1 ... 3 ... 3 3 ... ... ... 9 2 2 ... 1 2 ... ... ... 7 16 6.26 1-5 3 67 2 4 46 5 ... ... 127 ... 66 7 2 36 1 ... ... 112 239 26.67 5-15 3 64 ... 1 69 9 1 ... 147 4 97 1 4 91 3 ... ... 200 347 17.22 15-25 ... 11 ... 6 10 9 ... ... 36 4 23 ... 12 19 8 ... 1 67 103 3.96 25-65 5 13 ... 34 5 17 1 ... 75 7 26 ... 42 8 17 1 3 104 179 3.08 65 and over ... ... ... 4 ... ... ... ... 4 ... ... ... 8 ... 1 ... ... 9 13 2.27 All ages 11 158 2 52 133 40 2 ... 398 17 214 8 69 156 30 1 4 499 897 7.38 ST. MARY. 0-1 ... 3 ... 3 3 ... ... ... 9 1 2 ... 1 2 ... ... ... 6 15 6.89 1-5 3 63 2 4 38 3 ... ... 113 ... 61 7 2 33 1 ... ... 104 217 29.24 5-15 2 58 ... 1 57 8 1 ... 127 4 88 1 4 83 2 ... ... 182 309 19.04 15-25 ... 6 ... 6 6 7 ... ... 25 3 17 ... 8 10 7 ... 1 46 71 3.95 25-65 5 11 ... 25 2 13 ... ... 56 5 21 ... 30 4 9 1 2 72 128 3.11 65 and over ... ... ... 3 ... ... ... ... 3 ... ... ... 7 ... ... ... ... 7 10 2.43 All ages 10 141 2 42 106 31 1 ... 333 13 189 8 52 132 19 1 3 417 750 8.41 ST. JOHN. 0-1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 1 2.63 1-5 ... 4 ... ... 8 2 ... ... 14 ... 5 ... ... 3 ... ... ... 8 22 14.29 5-15 1 6 ... ... 12 1 ... ... 20 ... 9 ... ... 8 1 ... ... 18 38 9.71 15-25 ... 5 ... ... 4 2 ... ... 11 1 6 ... 4 9 1 ... ... 21 32 3.96 25-65 ... 2 ... 9 3 4 1 ... 19 2 5 ... 12 4 8 ... 1 32 51 2.99 65 and over ... ... ... 1 ... ... ... ... 1 ... ... ... 1 ... 1 ... ... 2 3 1.87 All ages 1 17 ... 10 27 9 1 ... 65 4 25 ... 17 24 11 ... 1 82 147 4.51 35 TABLE 8a. Sickness-rates, calculated on estimated numbers in each Age-Group. Corrected for duplicates only. MALES. FEMALES. Smallpox. Diphtheria and Mem. Croup. Erysipelas. Fevers. Total. Smallpox. Diphtheria and Mem. Croup. Erysipelas. Fevers. Total. Scarlet. Enteric & Continued. Puerperal. Scarlet. Enteric & Continued. Puerperal. PADDINGTON. 0-1 ... 2.3 2.3 2.3 ... ... 7.1 1.5 1.5 0.7 1.5 ... ... 5.3 1-5 0.6 15.6 0.9 10.4 1.1 ... 28.7 ... 16.0 0.4 7.9 0.2 ... 24.6 5-15 0.3 6.5 0.1 7.0 1.0 ... 15.1 0.3 9.4 0.3 8.7 0.2 ... 19.1 15-25 ... 1.1 0.6 1.0 0.9 ... 3.5 0.2 1.4 0.7 1.1 0.4 * 4.1 25-65 0.2 0.5 1.4 0.2 0.8 ... 3.2 0.1 0.7 1.1 0.2 0.5 * 2.9 65 & over ... ... 2.0 ... ... ... 2.0 ... ... 2.1 ... 0.2 ... 3.4 0-5 0.5 12.6 1.2 8.6 0.8 ... 23.9 0.3 12.8 0.5 6.5 0.1 ... 20.3 5 & over 0.1 1.9 1.0 1.8 0.8 ... 5.6 0.2 2.2 1.0 1.8 0.4 * 5.8 All ages 0.2 3.1 1.0 2.6 0.8 ... 7.92 0.2 3.0 0.9 2.1 0.4 * 7.00 ST. MARY. 0-1 ... 2.8 2.8 2.8 ... ... 8.4 0.9 1.8 0.9 1.8 ... ... 5.4 1-5 0.8 17.7 1.0 10.3 0.8 ... 30.7 ... 18.1 0.5 8.8 0.2 ... 27.7 5-15 0.2 7.3 0.1 7.2 1.1 ... 16.0 0.4 10.6 0.4 9.9 0.2 ... 21.8 15-25 ... 0.8 0.8 0.8 0.9 ... 3.3 0.2 1.6 0.7 0.9 0.6 * 4.3 25-65 0.2 0.6 1.4 0.1 0.7 ... 3.2 0.2 0.8 1.2 0.1 0.4 * 3.0 65 & over ... ... 2.1 ... ... ... 2.1 ... ... 2.5 ... ... ... 2.5 0-5 0.6 14.3 1.4 8.6 0.6 ... 25.7 0.2 14.4 0.6 7.2 0.2 ... 22.6 5 & over 0.2 2.2 1.0 1.9 0.9 ... 6.2 0.2 2.7 1.0 2.1 0.4 * 6.7 All ages 0.2 3.7 1.0 2.7 0.8 ... 8.6 0.2 3.9 1.0 2.6 0.3 * 8.2 ST. JOHN. 0-1 ... ... ... ... ... ... ... 5.1 ... ... ... ... ... 5.1 1-5 ... 5.3 ... 10.6 2.6 ... 18.4 ... 6.3 ... 3.8 ... ... 10.1 5-15 0.5 3.3 ... 6.6 0.5 ... 11.0 ... 4.2 ... 3.3 0.4 ... 8.5 15-25 ... 1.9 ... 1.5 0.7 ... 4.2 0.1 1.0 0.7 1.6 0.1 ... 3.8 25-65 ... 0.3 1.4 0.5 0.8 ... 3.3 0.1 0.4 1.0 0.3 0.7 * 2.7 65 & over ... ... 1.7 ... ... ... 1.7 ... ... 0.9 ... 0.9 ... 1.9 0-5 ... 4.2 ... 8.5 2.1 ... 14.9 1.0 5.0 ... 3.0 ... ... 9.1 5 & over * 1.2 0.9 1.7 0.7 ... 4.8 0.1 1.0 0.9 1.2 0.5 * 3.6 All ages * 1.4 0.8 2.3 0.8 ... 5.6 0.1 1.2 0.8 1.1 0.5 * 3.9 Note.—* Indicates a rate below 0.1 per 1,000 persons in each sex age-group sub-division. 36 Age-Group Incidence of Sickness. Considering first the incidence of disease as it affects the whole Parish, the rates for the age-groups 0-1, 1-5, and 25-65 were higher for males than for females. The same is observed in the rates for the extended age-groups 0-5 and "all ages." Of the diseases mentioned in the Table, the incidence of Diphtheria was greater among females than males in all the age-groups except that of 0-1. By reason of the great excess of females at ages exceeding 25 years, at which ages Diphtheria is somewhat uncommon, this predisposition to Diphtheria among females is marked in the "all ages" group. The incidence of Scarlet Fever was greater among males than among females at the ages under 15, i.e., at those ages when the disease is commonest. At the ages over 15 both sexes were affected nearly equally. In the extended age-group "5 years and upwards," the incidence was equal. Males, at all ages of life, were more prone to be attacked by Enteric Fever than were females. In comparing the rates for the two Sub-Districts, some caution must be exercised in drawing conclusions, owing to the small numbers of some of the diseases notified. For that reason, only the figures of the three extended age-groups, 0-5, 5 and upwards and 'all ages,' will be referred to on the present occasion. The rates (for all diseases) prevailing last year among children under five years of age were, in the District of St. Mary, 25.7 for males and 22.6 for 37 females; and the corresponding rates for the District of St. John were 14.9 and 9.1 At ages over five years, the rates for males were 6.2 and 4.8 in the St. Mary's and St. John's Districts, and those for females 6.7 and 3.6. At all ages of life the rates for males were 8.6 in St. Mary's, and 5.6 in St. John's; and aud those for females, in the same order, 8.2 and 3.9. Practically similar differences existed in each agegroup, and for each disease. In one of the earlier paragraphs of this Report (see page 13), the question of the connection existing between over crowding and disease was referred to. In continuation of those remarks, the appended statement showing the relative figures for overcrowding, disease, etc., has been compiled. TABLE 9. Overcrowding Statistics, and Incidence of Disease and Mortalities. St. Mary. St. John. Comparative figures for St. Mary. St. John=100. Persona per acre Census 1891 105.8 75.8 139.5 „ per house 8.9 6.6 134.8 Percentage of population overcrowded 20.8 7.0 297.1 Sickness-rate 0-5 years 24.2 11.9 203.3 „ „ 5 yrs. &upwds. 6.6 4.0 165.0 Death-rate from all causes 0-1 year 159.0 102.1 155.7 1-5 years 30.1 22.0 136.8 5 yrs. & upwds. 11.0 10.0 110.0 Zymotic death-rate 0-1 year 33.1 10.5 314.2 1-5 years 16.8 8.4 199.5 (5 yrs.& upwds. 0.7 0.4 176.1 Death-rates from— Bronchitis 0-5 years 8.1 4.5 180.0 5 yrs. & over 1.0 0.9 111.1 Pneumonia 0-5 years 2.2 1.5 146.6 5 yrs. & over 0.7 0.7 100.0 38 Although the above Table by itself is but imperfect evidence, yet attention may be drawn to the third column, in which the figures for the District of St. Mary have been reduced to values based on a standard figure of 100 for the District of St. John. Thus it appears that if the overcrowding in the St. John's District be set down as 100, the amount existing in the District of St. Mary must be stated at 297.1. The sickness-rates in St. Mary's District, on the same standard, were 203.3 at ages under 5 (both sexes combined), and 165 at ages above 5 years. For the purpose of comparing the returns for 1894 with those of 1890-93, it was thought preferable to use the figures contained in the Annual Reports of the Metropolitan Asylums Board, as they have (presumably) been kept on the same plan from the beginning. It must, however, be remarked, that although the totals in the Asylums Board's Reports do not agree with those contained in Dr. Stevenson's Reports for 3 890-92, nor with those compiled from the Register for 1894, the differences may be neglected, so long as no comparison is made between the two sets of statistics. The figures for the five years, together with those for the Metropolis, are set oul in Table 10. 39 TABLE 10. Numbers of Notifications in Paddington and London since commencement of Act of 1889. (From Reports of Metropolitan Asylums Board.) 1890. 1891. 1892. 1893. 1894. PADDINGTON. Smallpox ... ... 3 68 28 Scarlet Fever 214 259 541 778 288 Diphtheria 225 180 168 279 374 Membranous Croup 1 2 4 10 9 Enteric Fever 58 65 47 67 71 Typhus Fever ... 1 ... 1 ... Relapsing Fever ... ... ... ... ... Continued Fever 1 3 1 5 3 Cholera ... ... ... ... ... Erysipelas 90 135 115 240 123 Puerperal Fever 5 4 7 18 5 Total 594 649 886 1,466 901 Estimated population 118,736 117,838 120,421 120,421 121,583 Sickness-rate 5.0 5.5 7.5 12.1 7.4 LONDON. Smallpox 60 114 423 2,813 1,192 Scarlet Fever 15,330 11,398 27,095 36,901 18,440 Diphtheria 5,870 5,907 7,781 13,026 10,665 Membranous Croup 550 505 565 668 535 Enteric Fever 2,877 3,372 2,465 3,663 3,360 Typhus Fever 35 27 20 22 21 Relapsing Fever 7 39 7 4 2 Continued Fever 237 152 147 205 162 Cholera 25 23 54 86 21 Erysipelas 4,598 4,764 6,934 9,700 6,080 Puerperal Fever 206 221 337 397 253 Total 29,795 26,522 45,828 67,485 40,721* Estimated population 4,180,021 4,221,452 4,263,294 4,306,411 4,349,166 Sickness-rate 7.1 6.2 10.7 15.6 9.3 * Excluding 204 cases of "Diarrhœa" specially notified. From this Table it appears that the sickness-rate for Paddington was in each of the five years below that for the Metropolis, the difference varying from 3.5 in 1893, to 0.7 in 1891. In future Reports, quinquennial averages will be available for the purposes of comparison, but on this occasion it must 40 suffice to call attention to the variations in certain of the recorded totals. The Parish was free from Small-pox in 1890 and 1891, but in the three subsequent years there were 3, 68, and 28 cases notified. The cases of Scarlet Fever rose from 214 in 1890, to 778 in 1893, and stood at 288 last year. The cases of Diphtheria fell from 225 in 1890, to 168 in 1892, since which date they have risen, reaching 374 last year. The smallest number of cases of Enteric Fever was recorded in 1892, and the largest in 1894. During the five years 2 cases of Typhus Fever have been recorded in the Parish. This disease is supposed to be practically extinct in London, but the figures in the second half of the Table show that a small number of cases occur annually. The notifications of Erysipelas show an apparent increase of the disease, both in the Parish and in the Metropolis. Of the 897 cases of infectious disease notified in 1894, 420 were removed to Hospital for treatment. The removals were equal to 46.8 per cent. of the whole. Of the diseases received into the Hospitals of the Metropolitan Asylums Board, 413 cases were removed (not all, however, to those Hospitals), equal to 53.4 per cent. of such diseases. The cases removed included 26 of Small-pox, 238 of Scarlet Fever, 213 of Diphtheria, 4 of Membranous Croup, 31 of Enteric and one of Continued Fever. The percentages of removals in respect of each disease were: Small-pox 41 92.9, Scarlet Fever 82.3, Diphtheria (including Membranous Croup), 56.2, and Enteric Fever (including Continued), 43.8. In this connection it may be not out of place to give a short abstract of the chief items in the Report of the Metropolitan Asylums Board for 1894. Report of the Asylums Board, 1894. Fever Statistics.—At the end of 1893 there were 3,270 fever patients in the various Hospitals. During 1894, 16,667 patients were admitted, 15,426 discharged, and 1,999 died. The case mortality for the year was 11.73 per cent., compared with 10.53 for 1893. The largest number of admissions was recorded in November, and the smallest in February. The admissions of Scarlet Fever cases constituted 62.9 per cent. of the notifications; of Diphtheria 32.8, and of Enteric Fever 15.9. The percentages of admissions to notifications show increases for the first two diseases, but not for Enteric Fever. See appended statement. ADMISSIONS TO BOARD'S HOSPITALS. Per cent. of notifications. Scarlet Fever. Diphtheria. Enteric Fever. 1890 42.6 14.7 17.3 1891 46.1 20.4 22.3 1892 48.3 24.1 17.4 1893 39.4 20.8 14.8 1894 62.9 32.8 15.9 42 As regards Scarlet Fever and Diphtheria in 1893, the large number of cases caused the Hospitals to be full for so long, that many cases which would otherwise have been admitted, had to be treated at home; and in respect of Enteric Fever, arrangements for admission to General Hospitals have been in force since 1891, to relieve the pressure in the Asylum Board's Hospitals. Since the Hospitals were first opened, there have been admitted 81,350 cases of Scarlet Fever, with a case mortality of 8.0 per cent.; of Diphtheria— including Membranous Croup, 11,598 cases, with a mortality of 30.3; of Enteric (or Typhoid) Fever, 9,233 cases, mortality 17.4; and of Typhus Fever, 2,166 cases, mortality 20.2. During the last year, for the purpose of verifying diagnosis and fixing the time for safe discharge, systematic examinations of the membrane, etc., from the throats of diphtheria patients, for the determination of the micro-organisms present, have been inaugurated. The treatment of this disease by means of antitoxin was commenced in October last, but no statistics of the results of the new treatment were included in the Report. Of the 16,667 patients admitted during the year, 864, or 5.2 per cent., were found to be suffering from diseases other than those shown on the certificates under which the patients were admitted. 43 It is the intention of the Board to erect new permanent Hospitals for scarlet fever and diphtheria patients at Shooter's Hill, Hither Green, and Lower Tooting. "When these are completed, the beds for diseases "other than small-pox," will number 5,900, in addition to which there are the Ships, and the proposed Land Hospital, for smallpox cases. The Royal Commission of 1882 recommended that 3,000 beds should be provided for "fever" cases, and 2,700 for small-pox. At that date diphtheria cases were not received into the Board's Hospitals. The population of London in 1882 was 3,862,876, and in 1894, 4, 349, 166. The question of floor and cubic space, etc., has occupied the attention of a Committee of the Board during the year. The minima recommended for each bed were 104 square ft. of floor, and 8 lineal ft. of wall. The spaces to be allotted to each bed at the new hospitals are 156 sq. ft. of floor for scarlet fever, and 195 sq. ft. for diphtheria and enteric fever; and of wall, 12 ft. lineal for the first disease, and 15 for the two others. It is hardly necessary to say that much of the success attending hospital treatment of infectious disease is due to the benefits of free air space and ventilation. Among the many items of interest included in the Reports by the Medical Superintendents of the Hospitals, Dr. Bird wood's notes on "return cases" are perhaps the most interesting. The term "return 44 cases," it may be explained, is applied to those cases of infectious disease, of the same nature, which occur after the return home of a patient from Hospital, and are nearly always considered by the laity to be due to laxity on the part of the Hospital Staff in discharging patients. Dr. Birdwood writes that on 61 occasions it was reported that infectious illness followed the return home of patients from the Board's Hospitals. The intervals between the return of the patients and the new cases were as follows:— The same day, 2 cases. Within 1 week, 24 cases. Within 1 month, 29 cases. After 5 weeks, 3 cases. After 6 weeks, 3 cases. He goes on to say: " That the second outbreak is not always due to the original patient being in an infectious condition on discharge, is demonstrated by the following considerations :— 1st. The interval between the discharge of the original patient and the initial illness of the others, is either too short or too long in three out of every five of them. 2nd. Several of the original patients, and some of the others, were not suffering from Scarlet Fever. 3rd. Some of the houses seem to keep up a regular supply of patients. Their relatives have also told me that their sanitary environment at home was faulty. 4th. Light is shed on how the disease is spread, by even the little we are able to find out at the Hospital. For instance, a boy went from here to join his brothers and sisters at the sea-side; he was intimately associated with them there, and they were all quite well till a week after their return home. Scarlet Fever then broke out in that family. 45 Again, two patients went from here to a Convalescent establishment, as they were unable to return to their lodgings direct. Not being able to take their goods with them when admitted here, these things had been forwarded to a friend. The lady wrote me from the Convalescent Home, 'The friend to whom I sent on the trunk has taken Scarlet Fever, and they protest my things have conveyed it. It is most unfortunate, but as they were all disinfected by the Sanitary people, I cannot see how it can be.' Clearly, in neither of these instances, quoted as examples, was infection caused by the discharged patient." Small-pox.— During the year 1,264 cases of this disease were received at the Wharves. In 152 instances the patients were found to be free from the disease, and were sent back to their homes, some at once, others after detention at the Wharves for varying periods. The total number of instances of erroneous diagnosis of this disease numbered 155, or 12.2 per cent. There were admitted to the Hospital Ships, 1,133 cases (most of the patients coming from the Wharves) and three infants were born on the Ships. The deaths during the year numbered 102, equal to a gross mortality among the patients on the Ships of 8.65 per cent. Of the 1,136 patients, 1,109 had small-pox on admission, and of these, 98 died, giving a corrected mortality of 8.45 per cent. The total number of cases of (undoubted) smallpox admitted to the Board's Hospitals during 1894 was 1,117. In 797 of these patients, marks of vaccination were present; in 68 there was "no evidence" as to vaccination, and in 252 were 46 unvaccinated, i.e., there were no marks present. Of all the patients admitted, 71.3 were vaccinated, and 22.5 unvaccinated. The deaths from this disease numbered 102, including 2 deaths among patients admitted in 1893. The deceased persons included 38 who were vaccinated, 8, in respect of whose vaccination there was "no evidence," and 56 were unvaccinated. The mortality among the vaccinated was 4.5, among those with "no evidence," 11.2, and among the unvaccinated, 19-9 per cent. Since the date of the opening of the Board's Hospitals, 62,150 cases of small-pox have been admitted with a case mortality of 16.7. During the 23 years preceding the opening of the Hospitals, i.e., from 1848-70, the average annual mortality per 1,000 of the estimated population of London was 0.29, and that of the subsequent 23 years, i.e., from 1872-94, 0.16. In his Report to the Board, Dr. Ricketts remarks, that whereas the outbreak of this disease in 1893 was, in the earlier part of the year, chiefly among the vagrant class, towards the end of that year, and in 1894, it was confined to the "poorer settled" population. The Report contains particulars of several small outbreaks of the disease in different Unions of London during the year, of which that in Marylebone is perhaps the most interesting. On the 23rd of July four cases were removed; on the 47 24th, 14; and on the 25th, 36. Between the 23rd and 31st of July, 124 cases in all were removed from this District alone. Previous to the 23rd of July, only 3 cases bad occurred since the beginning of the year. The origin of the outbreak was the case of a young man, son of a grocer in Henry Street, who was notified to be ill with the disease on the 6th of July. He was not removed, on account of the severity of his case. Many of the earlier cases were in persons accustomed to deal at the grocer's shop in question. In August, 87 cases were removed from Marylebone, but the majority of these were from another part of the Parish. This second outbreak appears to have been due to neglect of precautions in respect of a case in the person of a youth of weak intellect. Such neglect does not appear to have occurred in the former case in Henry Street. For the protection of the districts in the Bast of London, the Board received cases from West Ham, which is outside the Metropolitan area. Ambulance Work.—The Board is, under the 79th section of the Public Health (London) Act, 1891, the Ambulance Authority for the Metropolis, for the removal of infectious cases to all places in or outside the Metropolitan area, as well as to the Board's Hospitals. During the year, 29,688 removals were made by the Land Service, involving 19,796 journeys, with a mileage of 203,820 miles. The 48 Steamers of the Board conveyed 7,614 passengers, including 1,101 patients to the Hospital Ships, and 1,009 from them. DEATHS. The deaths registered within the Parish amounted to 1,918 in all, viz.: 947 males and 971 females. The uncorrected death-rate was 15.78 per 1,000 of the estimated population, the rate for males being 18.85, and that for females, 13.62. In the subjoined Table will be found the numbers for each quarter of the year registered in each Sub-District, distinguishing the sexes. TABLE 11. Deaths registered in 1894. "Uncorrected." Deaths Registered in St. Mary. St. John. Paddington. During Males. Females. Total. Males. Females. Total. Males. Females. Total. 1st Quarter 170 206 376 97 94 191 267 300 567 2nd „ 139 154 293 93 64 157 232 218 450 3rd „ 135 171 306 82 61 143 217 232 449 4th „ 156 146 302 75 75 150 231 221 452 Year 600 677 1,277 347 294 641 947 971 1,918 Uncorrected deathrates, 1894* 15.53 13.25 14.35 29.92 14.03 19.69 18.85 13.62 15.78 * Per 1,000 (estimated) individuals of each sex in each district. 49 Included in the above figures are the deaths of of 280 non-parishioners, the majority of whom died in St. Mary's Hospital. Further, there have to be added 193 deaths of parishioners who died in "outlying institutions" and elsewhere, whose deaths are returned through Somerset House. The corrected number of deaths of parishioners during the year was, therefore, 1,831, and the corresponding death-rate 15-06 per 1,000. The corrected rates for males were 17.73 in St. Mary's, and 15.52 in St. John's District; those for females were 15.18 and 9.63 respectively. The corrected totalrates for the two Districts were 16.29 for St. Mary's and 11.73 for St. John's. TABLE 11a. Deaths in 1894. "Corrected." Deaths of Residents in St. Mary. St. John. Paddington. During Males. Females. Total. Males. Females. Total. Males. Females. Total. 1st Quarter 185 225 410 50 64 114 235 289 524 2nd „ 156 177 333 54 50 104 210 227 437 3rd „ 164 195 359 46 38 84 210 233 443 4th „ 180 167 347 30 50 80 210 217 427 Year 685 764 1,449 180 202 382 865 966 1,831 Corrected deathrates, 1894* 17.73 15.18 16.29 15.52 9.63 11.73 17.22 13.55 15.06 * Per 1,000 (estimated) individuals of each sex in each district. 50 In Registration London the death-rate last year was 17.4 per 1,000, after allotting the deaths of residents who died in outlying institutions to their proper districts, and that for England and Wales, 16.59. As mentioned in an earlier paragraph (page 8), the rates given above are not strictly comparable, owing to the fact that no account is taken of the differences of the compositions of the populations quâ age and sex. The following statement shows the true rates for Paddington and London : — Standard rate. Recorded rate, commonly called "Uncorrected" rate. "Corrected" rate. Paddington 17.72 15.78 17.05 London 17.96 17.76 18.93 England and Wales 19.15 16.59 16.59 In Paddington the average annual number of deaths during the decennium 1884-93 was 1,945, which becomes on correction for the increase in the population, 2,053. The corrected total of last year (1,831) was, therefore, 222 below the corrected average; that is to say, if the death-rate of last year had been the same as the mean rate for the last ten years, 222 more individuals would have passed away. In London the saving of life amounted to 11,660 persons. The "natural increment," i.e., the excess of births over deaths, was 1,003 last year, as compared with a decennial average of 986. The increment of last year was equal to 0.81 per cent. of the estimated population at the middle of the year. 51 The natural increment-rates (on same basis) for London and England and Wales were 1.23 and 1.29 respectively. In Paddington the average of the corrected death-rates for 1884-93 was 16.8, and the rate for last year, 15.06, showing a reduction in the past twelve months of l.7 per 1,000. In London, the mean of the uncorrected rates in the decennium was 20.5, and the rate of last year, 17.8, a reduction of 2.7. In England and Wales, the mean annual death-rate for the period 1884-93 was 19.2, and that for last year, 16.6, a reduction of 2.6. AGE-GROUP DEATH-RATES. Believing that the true criterion of the incidence of death is to be found in the age-group mortality, Tables 12 and 12a have been drawn up, the former dealing with the deaths of males, the latter with those of females. No such Tables have been preserved for previous years. Although the death-rate at all ages among males was lower in St. John than in St. Mary, the rates prevailing at ages 5-15, 25-65, and 65 and upwards were higher in the former district. As regards the three condensed age-groups 0-5, 5-60, and 60 and upwards, the first and last rates were lower in St. John than in St. Mary, but the second somewhat higher. Among females, the rates in St. John were throughout lower than those in St. Mary. 52 TABLE 12. Deaths Registered and Mortalities among Males. "Corrected." Age Groups. Estimated living in 1894. Deaths in year. Mortality per 1,000 living. Deaths per quarter. 1 2 3 4 St. Mary. 0-1 1,068 195 182.58 48 43 60 44 1-5 3,669 110 29.98 25 32 25 28 5-15 7,899 25 3.03 5 9 6 5 15-25 7,385 35 4.73 12 2 11 10 25-65 17,229 232 13.34 65 56 46 65 65 and over 1,376 88 63.95 30 14 16 28 All ages 38,626 685 17.73 185 156 164 180 0-5 4,737 305 64.39 73 75 85 72 5-60 31,639 266 8.47 76 62 57 71 60 and over 2,250 114 50.66 36 19 22 37 St. John. 0-1 184 22 119.56 4 7 7 4 1-5 753 15 19.92 7 4 2 2 5-15 1,816 10 5.50 4 5 1 - 15-25 2,601 12 4.61 3 5 3 1 25-65 5,671 83 14.63 18 24 26 15 65 and over 571 38 66.54 14 9 7 8 All ages 11,596 180 15.52 50 54 46 30 0-5 937 37 39.38 11 11 9 6 5-60 9,683 96 9.91 22 32 28 14 60 and over 976 47 48.15 17 11 9 10 Paddington. 0-1 1,252 217 173.32 52 50 67 48 1-5 4,422 125 28.26 32 36 27 30 5-15 9,715 35 3.60 9 14 7 5 15-25 9,986 47 4.70 15 7 14 11 25-65 22,900 315 13.75 83 80 72 80 65 and over 1,947 126 64.66 44 23 23 36 All ages 50,222 865 17.22 235 210 210 210 0-5 5,674 342 60.27 84 86 94 78 5-60 41,322 362 8.76 98 94 85 85 60 and over 3,226 161 49.90 53 30 31 47 53 TABLE 12 A. Deaths Registered and Mortalities among Females. "Corrected." Age Groups. Estimated living in 1894. Deaths in year. Mortality per 1,000 living. Deaths per Quarter. 1 2 3 4 St. Mary. 0-1 1,107 151 136.40 41 30 51 29 1-5 3,750 114 30.40 31 31 34 18 5-15 8,329 42 5.04 9 12 14 7 15-25 10,556 28 2.65 9 6 7 6 25-65 23,847 252 10.56 72 63 52 65 65 and over 2,734 177 64.74 63 35 37 42 All ages 50,323 764 15.18 225 177 195 167 0-5 4,857 265 54.56 72 61 85 47 5-60 41,229 282 6.83 79 71 64 68 60 and over 4,237 217 51.21 74 45 46 52 St. John. 0-1 196 17 86.73 6 4 6 1 1-5 786 19 24.16 4 7 5 3 5-15 2,096 7 3.33 5 1 1 — 15-25 5,463 12 2.19 4 2 3 3 25-65 11,382 82 7.20 18 19 14 31 65 and over 1,032 65 63.08 27 17 9 12 All ages 20,955 202 9.64 64 50 38 50 0-5 982 36 36.65 10 11 11 4 5-60 18,333 86 4.69 22 22 14 28 60 and over 1,640 80 48.78 32 17 13 18 Paddington. 0-1 1,303 168 128.93 47 34 57 30 1-5 4,536 133 29.32 35 38 39 21 5-15 10,425 49 4.68 14 13 15 7 15-25 16,019 40 2.49 13 8 10 9 25-65 35,229 334 9.48 90 82 66 96 65 and over 3,766 242 64.25 90 52 46 54 All ages 71,278 966 13.55 289 227 233 217 0-5 5,839 301 51.54 82 72 96 51 5-60 59,562 368 6.17 101 93 78 96 60 and over 5,877 297 50.53 106 62 59 70 54 In the whole Parish, the rates among males were in excess of those among females at ages included in all groups except those of 1-5 and 5-15. On the other hand, in the condensed age-groups 0-5, 5-60, and 60 and upwards, the rate among females exceeded that among males in the last group. The following statement shows the incidence of death on the three condensed age-groups (both sexes) in Paddington and London, based on the imcorrected totals. Rates per 1,000 persons living in each age-group. Paddington. London. Paddington. London 0-1 153.4 166.7 5-60 7.9 8.0 1-5 27.4 31.1 60 and over 51.1 61.8 0-5 55.5 60.5 INFANTILE MORTALITY. The infantile mortality of last year was 135 per 1,000 births registered, the average mortality for the decennium having been 143. The years 1887 and 1888 are the only two with lower rates, viz.: 122 and 123 respectively. (See Table II. in the Appendix.) In London, the mortality last year was 143, compared with an average rate for 1884-93 of 154. In England and Wales, the rate for last year was 137, 9 below the average. Comparing the mortalities of the two SubDistricts, it appears that the mortality among male infants was 157 per 1,000 births in St. Mary, and 103 in St. John, whilst those among female infants were 127 and 85 respectively. The total mortalities at this age were 142 and 94 for the respective districts. For the purposes of future comparison, the two following Tables (13 and 13a) have been prepared. 55 CAUSES OF DEATH. In Table III. in the Appendix will be found all information as to the numbers of deaths from each class of disease subdivided into twelve age-groups, separate Tables being given for each sex. From the numbers contained in Table III. the rates in Table 14 have been computed. For certain of the more important causes of death, decennial figures have been compiled, those for the Seven Principal Zymotic Diseases being given in Table V. in the Appendix. In Table 15 will be found the numbers of deaths recorded from certain diseases in each quarter of the past year, and in Table 16 the death-rates per 1,000 of the estimated populations from the zymotic diseases, etc., together with the average annual rates for the nine years 1885-93, for London and the groups of Registration Districts making up the Metropolis. Lastly, in Table 17 are given the numbers of deaths from the principal zymotic diseases registered in England and Wales during the past year, together with certain rates. 56 TABLE 13. Deaths in 1894 at various ages under 5 years. Males. "Corrected." Ages. St. Mary. St. John. Paddington. Quarters. Year. Quarters. Year. Quarters. Year. 1 2 3 4 1 2 3 4 1 2 3 4 Days. Under 1 day 2 7 5 2 16 ... 1 1 ... 2 2 8 6 2 18 1 3 ... ... 2 5 ... ... ... ... ... 3 ... ... 2 5 2 1 2 1 2 6 ... ... ... ... ... 1 2 1 2 6 3 1 ... ... 1 2 ... 1 ... ... 1 1 1 ... 1 3 4 ... ... ... 1 1 ... ... ... ... ... ... ... ... 1 1 5 1 ... ... l 2 ... ... ... ... ... 1 ... ... 1 2 6 ... 1 ... ... 1 ... ... ... ... ... ... 1 ... ... 1 Weeks. 1 1 3 1 3 8 ... ... 1 ... 1 1 3 2 3 9 2 3 2 ... 4 9 ... ... 1 ... 1 3 2 1 4 10 3 3 1 1 4 9 ... ... ... ... ... 3 1 1 4 9 Months. 1 4 4 5 3 16 ... 1 1 1 3 4 5 6 4 19 2 5 4 6 2 17 2 2 1 2 7 7 6 7 4 24 3 5 1 4 5 15 ... ... ... ... ... 5 1 4 5 15 4 l 1 4 2 8 1 ... ... 1 2 1 4 3 10 5 l 2 5 4 12 ... 1 1 ... 2 1 3 6 4 14 6 3 1 6 1 11 ... ... 1 ... 1 3 1 7 1 12 7 1 4 8 2 15 ... ... ... ... ... 1 4 8 2 15 8 5 5 4 2 16 ... 1 ... ... 1 5 6 4 2 17 9 3 3 3 1 10 ... ... ... ... ... 3 3 3 1 10 10 3 1 3 1 8 1 ... ... ... 1 4 1 3 1 9 11 2 1 5 ... 8 ... ... ... ... ... 2 1 5 ... 8 Under 1 year 48 43 61 43 195 4 7 7 4 22 52 50 68 47 217 Years. 1 14 20 9 12 55 4 1 1 ... 6 18 21 10 12 61 2 6 6 8 6 26 2 2 1 ... 5 8 8 9 6 31 3 3 5 3 3 14 ... 1 ... 1 2 3 6 3 4 16 4 2 1 5 7 15 1 ... ... 1 2 3 1 5 8 17 Aged 1 and under 5 years 25 32 25 28 110 7 4 2 2 15 32 36 27 30 125 Under 5 years 73 75 86 71 305 11 11 9 6 37 84 86 95 77 342 57 TABLE 13a. Deaths in 1894 at various ages under 5 years. "Corrected." Females. Ages. St. Mary. St. John. Paddington. Quarters. Year. Quarters. Year. Quarters. Year. 1 2 3 4 1 2 3 4 1 2 3 4 Days. Under 1 day 4 2 1 4 11 1 ... ... 1 2 5 2 1 5 13 1 2 1 2 ... 5 ... ... ... ... ... 2 1 2 ... 5 2 1 ... 1 ... 2 ... ... ... ... ... 1 ... 1 ... 2 3 1 1 ... 2 4 ... 1 ... ... 1 1 2 ... 2 5 4 ... ... 1 1 2 ... ... ... ... ... ... ... 1 1 2 5 ... 1 ... ... 1 ... ... ... ... ... ... 1 ... ... 1 6 1 1 ... ... 2 ... ... ... ... ... 1 1 ... ... 2 Weeks. 1 ... 1 1 1 3 ... ... ... ... ... ... 1 1 1 3 2 1 ... 2 ... 3 ... 1 ... ... 1 1 1 2 ... 4 3 ... 1 2 2 5 1 ... ... ... 1 1 1 2 2 6 Months. 1 4 3 4 3 14 ... 1 ... ... 1 4 4 4 3 15 2 5 1 5 6 17 1 1 1 ... 3 6 2 6 6 20 3 6 3 5 1 15 ... ... ... ... ... 6 3 5 1 15 4 4 1 3 2 10 ... ... 1 ... 1 4 1 4 2 11 5 2 ... 4 1 7 1 ... 1 ... 2 3 ... 5 1 9 6 1 2 7 ... 10 ... ... ... ... ... 1 2 7 ... 10 7 3 2 1 1 7 ... ... ... ... ... 3 2 1 1 7 8 1 1 1 2 5 1 ... 1 ... 2 2 1 2 2 7 9 ... 5 3 ... 8 1 ... 2 ... 3 1 5 5 ... 11 10 2 ... 5 1 8 ... ... ... ... ... 2 ... 5 1 8 11 3 4 3 2 12 ... ... ... ... ... 3 4 3 2 12 Under 1 year 41 30 51 29 151 6 4 6 1 17 47 34 57 30 168 Years. 1 12 13 12 6 43 2 4 3 1 10 14 17 15 7 53 2 8 7 8 4 27 1 2 1 1 5 9 9 9 5 32 3 7 5 8 8 28 ... ... ... 7 5 8 8 28 4 4 6 6 ... 16 1 1 1 1 4 5 7 7 1 20 Aged 1 to 5 years . 31 31 34 18 114 4 7 5 3 19 35 38 39 21 133 Under 5 years 72 61 85 47 265 10 11 11 4 36 82 72 96 51 301 58 TABLE 14.—Death-rates (corrected) for 1894, according to Groups of Diseases. Condensed from Table III. St. Mary. St. John. Paddington. M. F. P. M. F. P. M. F. P. I.—Specific Febrile, or Zymotic Diseases— 1. Miasmatic Diseases 2.6 2.6 2.6 1.5 0.8 1.1 2.3 2.1 2.21 2. Diarrhoeal ,, 0.5 0.4 0.4 * - * 0.4 0.2 0.37 3. Malarial ,, - - - - - - - - - 4. Zoogenous ,, * - * - - - * - ** 5. Venereal „ * 0.1 0.1 0.1 - * * 0.1 0.10 6. Septic „ 0.1 * * * * * 0.1 * 0.09 Totals 3.44 3.29 3.36 1.89 0.90 1.22 3.08 2.59 2.79 II.—Parasitic Diseases * * * - * * * * 0.04 III.—Dietic Diseases * 0.1 0.1 * * * * 0.1 0.11 IV.—Constitutional Diseases 3.6 3.1 3.3 3.1 2.0 2.4 3.5 2.8 3.10 V.—Developmental Diseases 1.4 1.1 1.2 0.7 0.6 0.6 1.2 0.9 1.09 VI.—Local Diseases— 1. Diseases of Nervous System 1.6 1.2 1.3 1.2 1.0 1.1 1.5 1.1 1.31 2. Diseases of Organs of Special Sense 0.1 - * - - - * - 0.03 3. Diseases of Circulatory System 1.1 1.1 1.1 1.8 0.9 1.2 1.3 1.0 1.18 4. Diseases of Respiratory System 2.9 2.7 2.8 2.6 1.6 1.9 2.8 2.3 2.60 5. Diseases of Digestive System 0.9 0.7 0.8 1.1 1.3 1.2 1.0 0.9 0.97 6. Diseases of Lymphatic System - * * - - - - * ** 7. Diseases of Gland-like Organs of Uncertain Use * * * - - - * * 0.02 8. Diseases of Urinary System 0.4 0.3 0.4 1.1 0.2 0.5 0.6 0.3 0.45 9. Diseases of Reproductive System— (a) Diseases of Organs of Generation - * * - * * - * 0.05 (b) Diseases of Parturition - 0.1 0.1 - 0.1 * - 0.1 0.09 10. Diseases of Bones and Joints * * * - - - * * 0.04 11. Diseases of Integumentary System * * * * - * * * 0.02 Totals 7.48 6.61 6.99 7.93 5.48 6.35 7.58 6.28 6.82 VII.—Violence— 1. Accident or Negligence 0.7 0.3 0.4 1.1 0.2 0.5 0.8 0.3 0.52 2. Homicide - - - - - - - - - 3. Suicide 0.1 0.1 0.1 0.1 - * 0.1 * 0.12 4. Execution - - - - - - - - - Totals 0.9 0.43 0.64 1.29 0.28 0.64 0.99 0.39 0.64 VII.—Ill-Defined & not Specified Causes 0.6 0.3 0.5 0.3 0.2 0.2 0.5 0.3 0.45 Totals (from all causes) 17.73 15.18 16.29 15.52 9.63 11.73 17.22 13.55 15.06 Note. - indicates no deaths recorded. * indicates rates under 0.1 per 1,000. ** indicates rates under 0.01 per 1,000 (last column only). M., males. F., females. P., persons of both sexes. 59 TABLE 15. Comparative Statement of Deaths from selected causes. From Quarterly Reports, 1894. "Corrected." ST. MARY'S. ST. JOHN'S. Quarters. The Year. Quarters. The Year. 1 2 3 4 1 2 3 4 M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Smallpox ... 1 ... ... ... 1 ... 1 ... 3 ... ... ... ... ... ... ... ... ... ... Measles 4 2 10 14 9 10 5 4 28 30 ... 1 2 4 ... 1 ... ... 2 6 Scarlet Fever 2 1 2 1 2 3 ... ... 6 5 ... l 1 ... ... ... ... ... 1 1 Whooping Cough 4 11 7 6 4 5 1 2 16 24 ... ... ... 2 1 1 ... ... 1 3 Diphtheria 4 10 11 16 8 17 8 9 31 52 2 3 1 2 ... ... 1 ... 4 5 Enteric Fever 2 2 4 1 2 2 1 3 9 8 1 ... 1 ... 2 ... ... 2 4 2 Diarrhœa 1 1 2 ... 19 18 1 2 23 21 ... ... ... ... ... ... 1 ... 1 ... Totals 17 28 36 38 44 56 16 21 113 143 3 5 5 8 3 2 2 2 13 17 Puerperal Fever ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... Other Septic Diseases 2 1 1 ... 1 1 1 ... 5 2 1 2 ... ... ... ... ... ... 1 2 Influenza 4 7 1 2 2 1 4 2 11 12 3 ... ... ... 1 ... 2 ... 6 ... Alcoholism 1 1 1 3 ... 3 1 1 3 8 1 ... ... ... ... 1 ... ... 1 1 Malignant Disease 7 12 3 15 7 17 8 19 25 63 1 5 1 10 4 3 1 7 7 25 Phthisis 16 15 16 14 15 10 17 15 64 54 1 1 7 3 9 1 2 5 19 10 Other Tubercular Diseases 5 7 8 6 14 7 10 5 37 25 3 4 3 ... 3 1 ... ... 9 5 Premature Birth 10 8 10 5 5 6 11 4 36 23 ... ... 1 2 2 ... ... 1 3 3 Bronchitis 30 46 15 13 7 10 17 23 69 92 7 13 2 3 1 2 2 7 12 25 Pneumonia 19 18 6 4 3 8 10 10 38 40 6 4 8 3 ... 1 2 1 16 9 Violence of all kinds (including accidents) 9 10 9 2 7 3 10 7 35 22 3 2 5 ... 5 1 2 3 15 6 60 TABLE 16.— Birth and Death-rates (per 1,000 living) in the Groups of Sanitary Areas, with average annual rates for Nine Years, 1885—1893. (From Registrar-General's Annual Summary.) Hospital cases distributed. Birth-rate. Death-rates from—, per 1,000 living. Death-rates of infants under one year, per 1,000 births. All Causes. Principal Zymotio Diseases. Small-Pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Typhus. Enteric Fever. Simple Continued and undefined Fever. Diarrhœa. Phthisis. Registration London 1894 30.1 17.4 2.64 0.02 0.76 0.22 0.61 0.48 0.00 0.14 0.00 0.41 1.69 143 1885-93 32.0 20.1 2.75 0.04 0.61 0.24 0.36 0.64 0.00 0.14 0.01 0.71 ? 154 PADDINGTON 1894 23.3 15.0 2.35 0.02 0.54 0.10 0.75 0.36 - 0.18 - 0.37 1.20 135 1885-93 25.1 16.8 2.09 0.01 0.41 0.12 0.35 0.45 0.00 0.11 0.00 0.59 1.49 143 West Group 1894 25.4 16.2 2.40 0.01 0.74 0.16 0.58 0.41 - 0.13 0.01 0.36 1.55 145 1885-93 27.3 18.6 2.39 0.02 0.51 0.18 0.34 0.54 0.00 0.12 0.01 0.67 ? 157 North Group 1894 28.5 26.2 2.32 0.04 0.59 0.23 0.55 0.44 0.00 0.14 0.00 0.33 1.60 131 1885-93 30.3 18.8 2.50 0.04 0.56 0.19 0.34 0.58 0.00 0.14 0.01 0.64 ? 146 Central Group 1894 29.3 20.6 2.21 0.01 0.52 0.13 0.42 0.57 - 0.17 - 0.39 2.58 147 1885-93 30.0 24.5 2.88 0.04 0.72 0.25 0.35 0.61 0.00 0.15 0.01 0.75 ? 169 East Group l894 36.4 20.9 3.52 0.03 1.11 0.29 0.77 0.61 0.00 0.15 0.00 0.56 2.00 158 1885-93 37.4 23.2 3.58 0.05 0.82 0.36 0.45 0.80 0.00 0.18 0.01 0.91 ? 163 South Group 1894 30.7 16.7 2.64 0.01 0.76 0.23 0.62 0.47 0.00 0.13 0.00 0.42 1.54 139 1885-93 33.1 19.4 2.68 0.05 0.57 0.24 0.33 0.86 0.00 0.12 0.01 0.70 ? 149 Note.— In this Table 0.00 indicates that the deaths were too few to give a rate of 0.005; when no deaths occurred, — is inserted. 61 TABLE 17. England and Wales. Zymotic Deaths and Death-rates in 1894. (From Registrar-General's Quarterly Returns.) Deaths Registered. Death-rates. Quarters. Year. 1894. Variations from mean of 1884-93. 1 2 3 4 Small-Pox 308 268 164 78 818 0.02 — 0.01 Measles 2,228 4,109 2,092 3,087 11,516 0.38 — 0.07 Scarlet Fever 1,417 1,291 1,023 1,204 4,935 0.16 — 0.08 Diphtheria 2,462 1,826 1,845 2,311 8,444 0.28 0.09 Whooping Cough 4,100 3,323 2,371 1,933 11,727 0.39 — 0.04 "Fever" 1,271 950 1,142 1,550 4,913 0.16 — 0.04 Diarrhœa 1,234 1,124 5,891 2,163 10,412 0.34 — 0.33 Totals 13,020 12,891 14,528 12,326 62,765 1.76 — 0.46 Zymotio Death-rate 1.76 1.72 1.92 1.63 1.76 .. .. Variation from mean of ten years 1884-93 — 0.07 — 0.09 — 1.04 — 0.40 — 0.46 •• •• Note. + indicates excess above decennial mean. — indicates defect from „ „ ZYMOTIC DISEASES. The deaths in the whole Parish from these causes amounted to 340, equal to 2.79 per 1,000 persons. These deaths constituted 18.5 per cent. of the corrected total number of deaths. In St. Mary's District the zymotic deaths numbered 299 (or 20-6 per cent, of the whole) and the rate was 62 3.36, whilst in that of St. John there were only 41 deaths (10.9 per cent.), with a rate of 1.22. Among the males of the Parish, the death-rate from this class of diseases was 3.08, and among the females, 2.59. The corresponding rates in St. Mary's District were 3.44 and 3.29; those for St. John's, 1.89 and 9.90. Small-pox.—There were 3 deaths from this disease, all being females of St. Mary's District. The death registered in the fourth quarter took place 18 months after the acute attack, and was caused by disease of the joints. The death-rate from this disease was 0.02 per 1,000, compared with an average of 0.01 for the previous nine years. The corrected decennial average number of cases was 1'7. One of the three deceased persons was unvaccinated, one vaccinated, and in the third case there was no statement on the point. Measles.—The corrected decennial average number of deaths from this cause was 49.3, as compared with a total of 66 last year. In St. Mary's District there were 58 deaths, equal to 0.65 per 1,000, and in St. John's 8, equal to a rate of 0.24. The death-rate in the Parish from this cause was 0.54 per 1,000; that in London was 0.76. The largest number of deaths occurred in the second quarter of the year, and the smallest in the first. All the deaths were in the first three age-groups, i e., under 63 the age of 15, the mortality being heaviest between the ages of 1 and 5 years. In 36 cases the deceased were girls. Scarlet Fever.—There were 13 deaths from this disease last year, the corrected decennial average number being 16.2. The cases were divided among the sexes in the proportion of 7 males to 6 females. Among the boys the deceased were aged from 1 to 5 years, and among the girls from 1 to 15. Eleven of the deaths were among residents of the St. Mary's District, and only two among those of St. John. The mortality in the whole Parish was 0.10 per 1,000, the average rate for the previous nine years having been 0.12. In London the rate for 1894 was 0.22, and that for the years 1885-93, 0.24 per 1,000. In Paddington the case mortality from this disease was equal to 5.02 per cent. of the notifications, and that for all London (on the same basis), 5.21. Of the local cases, 238 were removed to Hospital, 10 of which ended fatally, equal to 4.20 per cent., whilst among the cases treated at home the mortality was 14.27 per cent. Diphtheria.—The corrected total of deaths in 1894 from this cause was 92, equal to a death-rate of 0.75 per 1,000. The corrected average annual number of deaths during the decennium 1884-93 was 41.7, and the mean death-rate for the nine 64 years 1885-93, 0.35 per 1,000. Last year's total is equivalent to an increase of 120.6 per cent, above the average for the ten years, which means that for every 5 deaths recorded during that period, 11 deaths were recorded in 1894. The percentage increases for last year, as compared with the annual averages for the two five-year periods included in the decennium, were 151.3 for the first, and 116.9 for the second. These figures may be expressed in a simpler form by saying that for every 2 deaths recorded during 1884-88, 5 deaths occurred in 1894, and for every 6 during the years 1889-93, 13 in 1894. Previous to 1894, the highest number recorded in any year since 1884 was 75, in 1888, the total (69) for 1893 being the next. From the St. Mary's District 83 deaths were recorded, equal to 0.93 per 1,000 of the estimated population of the District, and from that of St. John, 9 deaths, equal to a rate of 0.27. The number of deaths registered in each quarter of the year will be found in Table 15. The death-rates among males of all ages were in Paddington 0.69, in St. Mary's 0.80, and in St. John's 0.34 per 1,000 of the estimated population (male) of each area. The corresponding figures for females, based on the estimated numbers living in each area, were 0.79, 1.03, and 0.23 respectively. The difference of incidence quâ sex in the two SubDistricts is remarkable. 65 Of the total 92 deaths, only 3 occurred at ages exceeding 15 years. The remaining 89 deaths were distributed as follows (the death-rate, per 1000, corresponding to each number, calculated on the estimated numbers of individuals living in each group, being set forth on the line below):— [See also Table III. in the Appendix.] TABLE 18. Sex and Age Mortality from Diphtheria, at ages under 15 years. Age-Group. Paddington. St. Mary. St. John. M. F. M. F. M. F. 0-1 Deaths 3 — 3 — — — Mortality 2.39 — 2.80 — — — 1-5 Deaths 22 32 21 31 1 1 Mortality 4.97 7.05 5.72 8.26 1.32 1.27 5-15 Deaths 7 24 5 20 2 4 Mortality 0.72 2.30 0.63 2.30 1.10 1.90 Inasmuch as no classification of the mortality from diphtheria has been made on these lines in past years, it is impossible to comment on them on the present occasion. It may be remarked that it would be unsafe to attach too much weight to the figures for the St. John's District (standing alone), owing to the small numbers of both the population and deaths. 66 In London the death-rate from diphtheria in 1894 was 0.61 per 1,000, the mean rate for the preceding nine years having been 0.36, or rather more than half the rate for last year. In England and Wales the death-rate from this cause was 0.28 per 1,000, 0.09 above the mean rate for the ten years 1884-93. Of the 372 cases notified in Paddington 213 were removed to hospital for treatment, and among those patients there were 60 deaths, equal to a case mortality of 28.1 per cent. Among the cases treated at home, the case mortality was 20.1 per cent. During the past year the Medical Officer of Health to the London County Council presented a "Preliminary Memorandum on the increase of Diphtheria in London," which contains a large amount of statistical information concerning the prevalence of this disease, not only in London but also in the whole country. A few short abstracts from that report have been thought to be instructive and are here inserted. Abstract. Between 1872 and 1881 the death-rate from diphtheria averaged 0.13 per 1,000 per annum in London; in 1882 the rate was 0.22, and in 1883 and 1884, 0.24. In 1885 it fell to 0.22, and in 1886 was still lower, viz., 0.20. Since that latter date it 67 has steadily risen to 0.44 in 1892 and 074 in 1893. These rates are set forth in another way as follows:— Average annual death-rate for 1861-70, 0.18; for 1871-80, 0.12; for 1881-90, 0.26; for 1891, the rate was 0.31; for 1892, 0.44; and for 1893, 0.74. In the case of the last three years, the rates are slightly increased by the distribution of hospital cases. In 1887 Dr. Longstaff drew attention to the change which was taking place in the incidence of mortality from this disease, in places classed as sparsely, medium, and densely inhabited.* He adduced the following figures in proof thereof:— Rates per 1,000,000 of population. Sparse. Medium. Dense. 1855-60 248 182 123 1861-70 223 164 163 1871-80 132 125 114 Tables and diagrams are included in the Memorandum, showing the great reduction in the rate of mortality which takes place about the 4th and 5th years of life, both in England and "Wales and in London, the drop being rather greater in the latter case. The following Tables are so valuable that they are here reprinted in full. *See his paper included in the Supplement in continuation of the Report of the Medical Officer of the Local Government Board for 1887. The subject is to be continued as soon as the next decennial supplement to the RegistrarGeneral's Reports is published. 68 TABLE 19. Death-rates from Diphtheria prevailing in Groups of Years, at "all ages," and three special age-groups. Area. Death-rate per 1,000,000. 1855-60. Death-rate per 1,000,000. 1861-70. Death-rate per 1,000,000. 1871-80. Death-rate per 1,000,000. 1881-90. Death-rate per 1,000,000. 1891-93. All ages. Under 3. 3-10. 10 & upwards All ages. Under 3. 3-10. 10 & upwards All ages. Under 3. 3-10. 10 & upwards All ages. Under 3. 3-10. 10 & upwards All ages. Under 3. 3-10. 10 & upwards England and Wales 178 660 516 49 184 757 512 46 121 415 373 30 163 572 557 31 ... ... ... ... Urban 114 564 311 23 166 912 426 29 114 483 347 22 ... ... ... ... ... ... ... ... Rural 203 695 591 58 193 686 549 54 125 374 388 34 ... ... ... ... ... ... ... ... Urban (excluding London) 102 480 272 20 159 851 401 27 109 474 310 21 ... ... ... ... ... ... ... ... London 126 658 337 27 176 990 458 32 122 498 409 23 260 1197 921 31 521 2706 1877 49 69 TABLE 20. Decrease or Increase per cent, in Diphtheria Death-rates between Area. 1855-60 and 1861-70. 1861-70 and 1871-80. 1871-80 and 1881-90. 1881-90 and 1891-93. All ages. Under 3. 3-10. 10 & upwards All ages. Under 3. 3-10. 10 & upwards All ages. Under 3. 3-10. 10 & upwards All ages. Under 3. 3-10. 10 & upwards England and Wales + 3 +15 — 1 — 6 —34 —45 —27 —35 + 35 + 38 + 49 + 3 ... ... ... ... Urban +46 +62 +37 +26 —31 -47 —19 —24 ... ... ... ... ... ... ... ... Rural — 5 — 1 — 7 — 7 —35 —45 —29 —37 ... ... ... ... ... ... ... ... Urban (excluding London) +56 +77 +47 +35 -31 —44 —23 —22 ... ... ... ... ... ... ... ... London +40 +50 +36 +19 —31 —50 —11 —28 +113 +140 +125 +35 +100 +126 +104 +58 Note.—The sign + indicates an increase in the second period, and that of — a diminution. In all cases the increase or decrease is shown as a percentage of the rate prevalent in the first of the two periods compared. 70 On these Tables, Mr. Murphy remarks:— Tables V. (a) and (b) (here Tables 19 and 20), serve to bring out conspicuously the following facts :— 1. That antecedent to 1871-80, in groups of population where the diphtheria death rate at all ages was rising, the rate at ages 3-10 years, though generally rising also, rose in a less degree than the all-age rate; and that when the all-age rate was falling, the rate at ages 3-10 years fell in greater degree than the all-age rate. 2. That in 1871-80, with a general decline of the Diphtheria mortality at all ages, in the several groups of population, there occurred in each group at ages 3-10 years a relatively higher Diphtheria death-rate than before; that is, the Diphtheria mortality at ages 3-10 years did not fall in 1871-80 in anything like the same degree as the Diphtheria mortality at all ages. It will be noted that in the incomplete comparisons for the two last groups of years, this increased incidence of mortality is maintained. Further, in former years, the mortality from this disease was greater among females than among males, the difference being specially marked at the school-ages of life, but that difference of incidence is now disappearing. The Elementary Education Act was passed in 1870, and since that date there has been a greatly increased attendance enforced on the children, accompanied by, as the figures given show, an enhanced death-rate from this disease, falling more equally on both sexes at what may be called the school-ages of life. It may here be remarked that the connection between school attendance and the spread of Diphtheria has been pointed out by many observers, but 71 it is probable that the case has not been so clearly put before the publication of this Memorandum. Further evidence on the point is contained in Mr. Murphy's Report for 1893, which may be briefly summarised as follows:— Curves of the weekly percentage variations from the weekly mean number of notifications of diphtheria in 1893 were constructed when the same depression in that part of the curves relating to August was observed, as was noted in the case of scarlet fever. (See page 29 ante). In the case of the all ages curve the depression was not so marked in diphtheria as in scarlet fever, or rather the depression in the former instance was a broken one, but the fall greater. At ages 3-13 the fall took place at exactly the same time (but was more marked) as in the case of scarlet fever. In connection with the facts disclosed by these curves, Mr. Murphy remarks— In the year 1893, the schools closed generally on the 27th of July, i.e., near the end of the thirtieth week, and reopened on the 28th of August, i.e., at the beginning of the thirty-fifth week. If comparison be made between the three periods, (1) 28th-31st weeks, (2) 32nd-35th weeks, and (3) 36th-39th weeks, the following results are obtained:— Under 3 yeare. 3-13 years. 13 years & above. Increase or decrease per cent. of number of cases in 2nd period, in relation to that of the 1st +8 —27 +1 Increase or decrease per cent. of number of cases in 3rd period, in relation to that of 2nd +6 +81 +33 72 There was in effect a decrease following the commencement of the holidays, and an increase after the re-opening of the schools, exactly similar to those noted in the case of scarlet fever. One conclusion indicated by these figures is the need of a very generous allowance of fresh air in schools, not merely by ventilation, but also by ample floor space per scholar, the latter not being so much insisted on as thought to be. It has been observed by several that a rainfall of a certain severity, not exactly determined, is followed by an increase in the number of notifications of diphtheria. This point has yet to be elucidated, and in all probability such connection indicates one way in which schools may be responsible for some of the diphtheria. Whooping Cough.—The deaths from this disease numbered 44 last year, equal to a rate of 0*36 per 1,000, compared with one of 0-45 for the previous nine years. The corrected decennial average number for the whole Parish was 54-8. The mortality from this cause was in London 0'48 in 1894, and (mean rate) 0*64 for 1885-93. In England and Wales, the rate for last year was 0-39, 0*04 below the mean for the previous decennium. Of the 44 deaths in the Parish, 40 took place in the St. Mary's Sub-District, and 4 in that of St. John. The deaths in each quarter of the year were as follows:— 73 1st quarter, 15. 2nd quarter, 15. 3rd „ 11. 4th „ 3. The deaths all took place in the three first agegroups, i.e., under the age of 15 years, and 17 were boys and 27 girls. "Fever."—By this term is meant the three Fevers, "Typhus," "Enteric, or Typhoid," and "Simple Continued." From the first and last there were no deaths last year. From Enteric Fever there were 23 deaths, 8.1 above the decennial annual number, equivalent to a rate of 0.18 per 1,000. Of the deceased, 13 were males, and 10 females. From St. Mary's District there were 17 deaths, and from St. John's, 6. The death-rate from this disease was the same in the two districts. The numbers registered in each of the quarters of the year (whole Parish) were 5 in the first, and 6 in each of the others. The mean annual death-rate for the previous nine years was 0.11. In London the rate in 1894 was 0.14, the same as the mean annual rate for 1885-93, and the rate for England and Wales (from "Fever"), 0.16, 0.04 below the decennial average rate. Of the local cases, the mortality per cent. of cases treated in hospital was 32.3; that among home cases, 33.3; and the total case mortality, 32.8. Diarrhœa.—The corrected number of cases last year was 45, and the mortality 0.59 per 1,000 of the 74 total population. The corrected decennial average number of deaths was 72.4, and the mean mortality for the previous nine years, 0.59. This disease was, therefore, below the average. In London, the mortality last year was 0.41; that for 1885-93, 0.71, and that for England and Wales (1894), 0.34, 0.33 below the decennial mean rate. Of the local deaths, 44 occurred among the inhabitants of St. Mary's District, equal to a rate of 0.49 per 1,000 inhabitants, and 1 among those of St. John, equal to a rate of 0.03. In the first and second quarters of the year 2 deaths were registered, in the third, 37, and in the fourth, 4. As regards sex, 24 of the deceased were males, and 21 females, whilst as regards age, 38 (viz., 17 girls and 21 boys) died at ages under 1 year, 4 (2 of each sex) between the 1st and 5th years of life, and 3 (males 1, and females 2), at greater ages. The death-rate from this cause among male infants amounted to 14.45, and that for females, 12.31 per 1,000 births registered in the Parish. The diseases specified in the preceding paragraphs are known as the Seven Principal Zymotic Diseases, and it is customary to take the death-rate from them as one of the standards of salubrity of a district. The total deaths of parishioners last year from these causes amounted to 286 (see Table Y. in the Appendix), equal to a rate of 2.35 per 1,000 of the estimated population. The corrected 75 nial average number of deaths was 251.9, and the mean rate for the ten years, 2.2, that for the past nine years, 2.09. In London, the death-rate from these diseases was 2.64, and the mean rate for the nine preceding years, 2.75. The rate for 1894 in England and Wales was 1.75, 0.46 below the decennial mean rate. Of the 286 deaths of parishioners, 214 occurred at ages under 5 years, 76 of these being infants under 1 year. The zymotic death-rate at ages under 5, was 18.58 per 1,000 estimated living at those ages, and the rate among infants, 26.81 per 1,000 births. In St. Mary's Sub-District, the deathrates from these diseases, calculated on the estimated numbers living in each age-group were, at ages 0-1, 33.10; at ages 1-5, 16.84; and at ages exceeding 5 years, 0.74. The corresponding rates for the SubDistrict of St. John were 10.52, 8.44, and 0.42. By the use of the "correction factor," the true zymotic death-rate for the Parish is found to be 2.53, and that for London, 2.81. Septic Diseases.—Puerperal Fever caused one death only last year, when 2,834 births were registered. From Erysipelas there were 6 deaths, equal to 4.9 per cent, of the cases notified, and from Pyaemia, 4. This latter disease is not included in the schedule of diseases to be notified The deathrate from these diseases was 0*08 per 1,000 of the estimated population. 76 Venereal Diseases.—There were 13 deaths in all from this group of diseases, all from Syphilis. Bight of the deaths were of infants under 1 year, and of the remaining 5, 4 were of females. Epidemic Influenza.—There were 29 deaths (17 males and 12 females) from this disease, and the death-rate was equal to 0.23. From St. Mary's Sub-District, 23 deaths were recorded, and from St. John's, 6. In 1893 there were 75 deaths; in 1892, 96; and in 1891, 69; and in 1890, 43. Dietic Diseases. Alcoholism.—In 13 instances death was attributed to the two forms of Alcoholism, viz., 11 to chronic, and 2 to the acute, more commonly known as "Delirium tremensThese cannot, however, be considered to be all the deaths due to drink, as certain of the deaths are returned as due to "cirrhosis of the liverothers, again, to various other diseases, without any reference being made to the habits of the deceased. Of the 13 cases recorded last year, 9 were females (all chronic cases), and 4 males, 2 chronic, and 2 acute cases. Constitutional Diseases. The deaths from this group of diseases numbered 377, equal to a rate of 3.10 per 1,000 (3-5 for males and 2.8 for females). The death-rates in the two Sub-Districts were 3.8 in St. Mary's, and 2.4 in St. John's. 77 Cancer, or Malignant disease.—There were 120 deaths from various forms of malignant disease, equal to a rate of 0.98 per 1,000. From St. Mary's Sub-District there were 88 deaths (25 male and 63 female), equal to a rate of 0.98, and from that of St. John, 32 (7 male and 25 female), equal to a rate of 0.98. The corrected annual average number of deaths was 100.5, that for the first half of the decennium, 95.6, and for the second half, 104.2. These figures indicate at first glance an increased mortality from this disease, but more examination is required than can be given now, before a definite opinion can be expressed. It may, however, be remarked, that there is a fairly general suspicion that "Cancer" (whatever may be included under that term) is on the increase. In the whole Parish, the mortality among males was 0.63, and that among females, 1.23 per 1,000 of each sex at all ages. Phthisis.—To this disease there were due 147 deaths, viz., 83 males and 64 females. The deathrate from this cause amounted to 1.20 per 1,000. The corrected average annual number for the previous decennium was 179.8, that for the first half being 190.2, and that for the second, 170.1. Taking phthisis and " other tubercular diseases" together, the joint mortality in the Parish stood at 1.83, that for St. Mary's Sub-District being 2.02, and that for St. John's, 1.32. Among the females of the whole Parish, the mortality from these combined causes 78 was 1.31, and that among males, 2.56 per 1,000 in each sex. Developmental Diseases. From these diseases, if the conditions included in this group can be properly so called, there were 133 deaths last year, equal to a rate of l.09 per 1,000 of the total population. Premature birth.—In respect of 65 infants, death was ascribed to this cause, 39 being males, and 26 females. In the whole Parish, the mortality from this cause was equal to 22.93 per 1,000 births registered, 26.84 for males, and 18.82 for females. Of the infants born in the District of St. Mary, the mortality among males was 29.03, and that among females, 19.44, the corresponding figures for the District of St. John being 14.07, and 15.15. In London there were 2,361 deaths from premature births, 140 in excess of the corrected annual average number, and equal to a rate of 18.07 per 1,000 births. Local Diseases. There were 829 deaths from diseases limited (more or less) to special organs, equal to 45.2 per cent, of all deaths, and a rate of 6.82 per 1,000. Among the inhabitants of the St. Mary's District, there were 622 deaths (42.9 per cent, of all the deaths in this District), equal to a rate of 6.99 per 1,000 of the population thereof. In the St. John's District, the deaths from these diseases (207) were 79 equal to 7.58 per cent. of all the deaths therein, and to a rate of 6.35 per 1,000 of the local population. The death-rates among males and females were practically equal, both for the whole Parish and the two sub-districts In London the deaths in this group numbered 34,626, and were equal to 44.9 per cent, of all deaths, and a rate of 7.96 per 1,000 of the estimated population. Bronchitis.—There were 198 deaths at all ages from this cause (including those from bronchopneumonia) in the whole Parish, equal to a death-rate of 1.62 per 1,000. The deaths of males numbered 81, and the mortality 1-61 per 1,000, the number of females being 117, and the mortality 164. In London the deaths from this cause numbered 7,816, equal to a rate of l.79. In the District of St. Mary, the deaths from Bronchitis numbered 161 (equal to 1.81 per 1,000), of which number 69 were males, and 92 females. The mortalities for the two sexes were 1.78 and l-82 respectively. In the St. John's District there were 37 deaths, viz., 12 males, and 25 females, and the mortalities were 1.13 for both sexes, T03 for males, and 1.19 for females. In the following Table are given the number of deaths in each age-group of each sex in the two sub-districts, and in each age-group (both sexes) in the Parish. 08 TABLE 21. Deaths aud Death-rates from Bronchitis and Pneumonia in 1894, distributed into Sex and Age-groups, for Parish and two Sub-Districts. Bronchitis. Pneumonia. Paddington (both sexes). St. Mary. St. John. Paddington. St. Mary. St. John. Paddington. Bronohitis. Pneumonia. M. F. M. F. M. F. M. F. M. F. M. F. Deaths. 0—1 31 28 2 1 33 29 8 6 2 1 10 7 62 17 1—5 9 10 1 5 10 15 11 7 — — 11 7 25 18 5-15 — 1 — — — 1 — — - 1 — 1 1 1 15—25 2 1 - - 2 1 5 2 - - 5 2 3 7 25—65 13 17 4 6 17 23 13 14 10 1 23 15 40 38 65 and over 14 35 5 13 19 48 1 11 4 6 5 17 67 22 All ages 69 92 12 25 81 117 38 40 16 9 54 49 198 103 Rates. 0-1 29.02 25.29 10.86 510 26.53 22.25 74.9 5.42 10.86 5.10 7.98 5.37 2.42 6.65 1—5 2.45 2.66 1.32 6.36 2.26 3.30 2.99 1.86 0 0 2.48 1.54 2.77 2.00 5—15 0 0.12 0 0 0 0.09 0 0 0 0.47 0 0.09 0.04 0.04 15—25 0.27 0.09 0 0 0.20 0.06 0.67 0.18 0 0 0.50 0.12 0.11 0. 26 25—65 0.75 0.71 0.70 0.52 0.74 0.65 0.75 0.58 1. 75 0.08 1.00 0.42 0.68 0.65 65 and over 10.17 12.80 8.75 12.59 9.75 12.74 0.72 4. 02 7.00 5. 82 2.56 4.51 11.72 3.85 All ages 1.78 1.82 1.03 1. 19 1.61 1.64 0.98 0.79 1.37 0.42 1.07 0.68 1.62 0.84 Note.—Rates are calculated per 1,000 living in each Age-group. 81 Pneumonia.—Under this title are classed all deaths certified to have been due to “Pneumonia,” “Congestion” and “Inflammation of the Lungs,” and “Pleuro-pneumonia.” From these causes, 103 deaths took place, equal to a rate of 0.84-per 1,000. In London, the deaths under this heading numbered 5,321, 311 below the corrected annual average, and equal to a rate of 1.22 per 1,000. From St. Mary's District, there were 78 deaths, equal to 0.87 per 1,000, and from St. John's, 25 deaths, equal to 0.76 per 1,000. Among males, the mortality from these diseases was 0.98, 1.37, and 1.07, in St. Mary's and St. John's Districts and the Parish respectively, whilst the corresponding rates for females were 0.79, 0.42, and 0.68. For information as to age distribution, reference can be made to Table 21. Deaths from Accidents and Violence. The total number of deaths from violence of all descriptions, including accidents, was 78, viz., 50 males and 28 females. The death-rate from these causes was 0.64 for the whole parish and for each of the sub-districts. In London there were 3,147 deaths, equal to a rate of 0.72 per 1,000, the total for last year being 53 below the corrected decennial annual average. 82 Inquests.—In Paddington 195 inquests were returned during the year, or one inquest for every 9.8 deaths. In all London there were 6,261 inquests, or one for every 12.3 deaths. The actual number of inquests held during the past year on Parishioners was 138, in respect of which the findings of the Juries were “natural causes” in 62 cases, “accidental death” in 52, “death by misadventure” in 6, “suicide” in 15, “no evidence to show how the death was caused” in 3. The subjoined table shows the number of inquests held in each quarter of the year, and the findings thereof. 83 TABLE 22. Quarterly numbers of Inquests on Parishioners. Quarter 1. 2. 3. 4. Paddington Finding of Jury. St. Mary. St. John. St. Mary. St. John. St. Mary. St. John. St. Mary. St. John. Year. Natural Causes 19 2 13 3 9 2 11 3 62 Accidental Death 11 4 7 3 7 5 11 4 52 Misadventure 2 1 1 2 6 Suicide 7 1 1 1 2 3 15 Open 1 1 1 3 Totals. 38 7 23 8 19 8 28 7 138 84 The 52 deaths by accidents were due to the following:— By railways 1 „ vehicles or horses 9 In building operations 3 By burns, scalds, and explosions 6 „ drowning 3 „ suffocation in bed 8 From other or not stated causes 22 Of the 15 suicides, 5 were by poisoning, carbolic acid being used in 2 cases, preparations of opium in 2, and hydrochloric acid (spirits of salt) in one. There was one death under chloroform (a male infant aged 3 months), in which case no reason could be discovered for the death although a post mortem examination was made. Uncertified Deaths.—There were three deaths registered without medical certificate or Coroner's inquest, all being under the age of 5 years. Deaths op Illegitimates. The fact of illegitimacy can only be determined in the case of children and of the illegitimates whose deaths were registered last year, all were under the age of five years, and only 10 (5 of each sex) were over one year of age. The corrected number of deaths last year under this head, was 64, viz., 28 males and 36 females. The proportion of illegitimate deaths under one year to all deaths at that 85 age was 1 to 6.2, and that at ages 1.5 years, 1 to 22.4. Of the 64 deaths, 6 were (theoretically) residents in the St. John's District. St. Mary. St. John. Paddington. 0—1: 1—5 0—1: 1—5 0—1; 1—5 Males 20 5 3 0 23 5 Females 28 5 3 0 31 5 The causes of death were—Zymotic Diseases 14, Parasitic 1, Constitutional 7, Developmental 11, Local 20, Violence 1, and Til-defined Causes 10. Further details are given in the appended statement. Under One 1—5 year. years. M. F. M F. Zymotic Diseases Measles 1 1 1 0 Scarlet Fever 0 0 1 0 Whooping Cough 0 0 0 3 Diarrhœa 1 2 0 1 Syphilis 0 2 0 0 Erysipelas 1 0 0 0 Parasitic „ Thrush 0 1 0 0 Constitutional „ Tubercular Disease 2 2 2 0 Purpura 0 1 0 0 Developmental,, Premature Birth 4 3 0 0 Atelectasis 12 0 0 Congenital Malformation 10 0 0 Local „ Cerebral Hæmorrhage 0 1. 0 0 Bronchitis 4 8 0 1 Pneumonia 3 3 0 0 Accident & Violence 0 0 1 0 Ill-defined Causes Atrophy & Debility 4 5 0 0 Under Chloroform 1 0 0 0 Totals 23 31 5 5 86 An analysis of the occupations of the mothers of the deceased shows that in 47 cases they were domestic servants of various kinds, in 5 workers in laundries, in 4 charwomen, in 3 each dressmakers and “of no occupation,” and in 2 cases no information was given. Deaths in Outlying Institutions. The deaths of Parishioners in institutions, &c., beyond the limits of the Parish, numbered 193, and were from the following:— Hospitals of the Metropolitan Asylums Board—70. Smallpox 2 Measles 2 Scarlet Fever 10 Diphtheria 54 Tubercular disease 1 Bronchitis 1 General Hospitals—38. Enteric Fever 3 Cancer 10 Phthisis 4 Tubercular disease 3 Violent death 3 Other causes 15 Special Hospitals—18. Cancer 5 Phthisis 4 Tubercular diseases 1 Other causes 8 “Homes”—15. Cancer 2 Phthisis 4 Other causes 9 Asylums—40. Enteric Fever 1 Cancer 1 Phthisis 4 Other causes 34 Poor Law Institutions—6. “Elsewhere”—6. 87 In closing this portion of the Report, it seems desirable to call attention to certain of the recommendations contained in the Report of the Select Committee on Death Certification which was published at the close of 1893. The recommendations are summed up at the close of the Report 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, or in Scotland, by a Procurator Fiscal. (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. (3.) That a medical practitioner in attendance should be required, before giving a certificate of death, to personally inspect the body, but if, on the grounds of distance or for other sufficient reason, he is unable to make this inspection himself, he should obtain and attach to his certificate of the cause of death a certificate signed by two persons, neighbours of the deceased, verifying the fact of death. (4.) That medical practitioners should be required to send certificates of death to the Registrar, instead of handing them to representatives of the deceased. (5.) That a form of certificate of death should be prescribed, and that, in giving a certificate, medical practitioners should be required to use such form. (6.) That it should be made a penal offence to bury or otherwise dispose of a body, except in time of epidemic, without an order from the Registrar, stating the place and mode of disposal, which order, after it has been acted upon, should be returned to the Registrar who issued it. 88 (7.) That it should be made an offence to retain a dead body unburied or otherwise legally disposed of beyond a period not exceeding eight days, except by permission of a Magistrate. (8.) That the practice of burial in pits or common graves should be discontinued. (9.) That still-births which have reached the stage of development of seven months should be registered upon the certificate of a registered medical practitioner, and that it should not be permitted to bury or otherwise dispose of the still-birth until an order for burial has been issued by the Registrar. (10.) That, subject always to the discretion of the Crown Office, the result of precognitions taken by the Procurators Fiscal in Scotland, or the precognitions themselves, should be communicated to the representatives of deceased, when application is made for the same. The system of death certification is primarily a legal procedure devised to secure satisfactory proof that every death is due to what may be called natural causes with the secondary intention of checking and preventing crime. With the growth of sanitation and the introduction of vital statistics, which form so important a branch of the subject, the certificates have acquired great value as the units on which the most important statistics are based. The Select Committee was appointed “to inquire into the sufficiency of the existing Law as to the Disposal of the Dead, for securing an accurate Record of the Cause of Death in all cases, and especially for detecting them where death may have been 89 due to Poison, Violence, or Criminal Neglect.” The reference appears, therefore, to have been limited to the legal aspect only, but the recommendations, if carried out, would in all probability have a considerable effect on the accuracy of certification from a medical and statistical point of view. In dealing with the compiling of vital statistics, much difficulty has been experienced, from the fact that on some certificates the causes of death are stated in such an order that it is impossible to say what was the “efficient” cause, i.e., the cause which immediately led to death; in others they are in an order which a knowledge of pathology enables one to say is wrong; and in other certificates the most important cause is omitted. As an example of the last may be quoted a certificate which stated that the death was due to “post-pharyngeal abscess,” in which case there was reason to believe that the death was due to diphtheria. The truth of that belief was proved after correspondence. Another source of error lies in the practice which some medical men make of not stating that death was due to causes to which disgrace is attached, such as intemperance, venereal diseases, &c., but of stating the sequelae only. If then all these inaccuracies are liable to, and do occur in the certificates, what is the reliance to be placed on the statistics compiled from them? or on the deductions drawn from the statistics? If recommendations 4 and 5 were carried out, 90 and the present form of certificate (which is optional) were amended, there would be more exactitude in defining what was the cause of death, and the temptation to omit stating unpleasant facts removed. It is to be regretted that the Committee could not recommend (1) that there should be a fee for each certificate, and (2) that superintendentregistrars should be medical men. As regards the former, the payment of fees for notification is good precedent, even if the duty of certification be classed as a duty due from medical men to the State, and as to the latter, which is rather more concerned with the statistical side of the question, it is certainly desirable that the decision whether a certificate dealing with medical facts be sufficient, should be left in the hands of medical men. It is also possible that the knowledge that the information contained in the certificate would be liable to be reviewed by a confrere might encourage medical men to be more painstaking in filling up that document. Recommendation 9, would present several difficulties, which it would not be easy to get over. Who is to decide the age of the still-birth? If the delivery has been effected under the charge of a midwife, what is to be the check if she pronounce the still-birth to' be under seven months ? and if she do declare the same to be seven months old, what is to happen when the medical man is called in, after death ? It seems according to 91 tion 1 that an inquest must be held. Further, what is to constitute a still-birth? Is it a foetus born dead? or is it a foetus which dies after birth, sayafter an interval of five minutes? Recommendation 7 is also a sanitary one, but the interval proposed is too long, especially in summer. It would have been better to make the interval much shorter, and, if a longer interval be desired or required, to allow the same only when the body shall have been removed to a public mortuary. WATER SUPPLY. The water supply of the Parish is derived from the Thames, through the mains of the Grand Junction and West Middlesex Water Companies, both having their “intakes” at Hampton Wick. The following information as to the characters of the water supplied is taken from the Report by Professor E. Frankland, D.C.L., F.R.S., etc., included in the Registrar-General's Annual Summary for last year. It should be noted that the water samples were “taken directly from the mains of the several Companies at places recommended by their respective engineers.” As the source of the water supplied by the two Companies is the same, any differences in the results of analysis must be due to variations in the treatment it is subjected to for 92 purification. The only means adopted for that purpose are storage, when some purification by subsidence and the action of sunlight takes place, and filtration through sand. The storage capacity of the West Middlesex Company's reservoirs amounts to 6'3 days' supply, and that of the Grand Junction Company to 3-4. The larger the storage capacity, the easier it is for the Company to avoid taking water during floods, when there is always present a larger proportion of impurities, both organic and mineral. The filter beds of the West Middlesex Company have an average thickness of 2.6-ft., and those of the Grand Junction, one of' 1.9-ft. The former company filter water at the rate of 1.3 gallons per hour per square foot of the filter, and the latter company at the rate of 1.9 gallons. On a priori grounds, therefore, the water supplied by the former company should be better filtered. The efficiency of the processes of purification are measured (1) by the transparency of the filtrate; (2) by the chemical parity of the same; and (3) by the diminution observed in the number of microorganisms after filtration. The observations as to transparency are classified under four heads. These, together with the results of the examinations made last year, are given below:— 93 Results of Examinations in 1894. West Middlesex Company. Grand Junction Company. “Clear and transparent” 10 (12) 12 (9) “Slightly turbid” 2 (0) 0 (2) “Turbid” 0 (0) 0 (1) “Very turbid” 0 (0) 0 (0) Note.—The figures shown thus () are for 1868. One sample per month from each company was examined. Out of the 12 samples from the West Middlesex Mains, 10 were “clear and transparent,” and 2 “slightly turbid,” whilst of the samples from the Grand Junction Mains all were in the first category. These examinations were commenced in 1868, and the improvement which has taken place in the appearance of the water supply since that date is commented on by Professor Frankland as follows:— “In that year (i.e. 1868), seven samples were so turbid as to be highly repulsive in appearance, nine samples were turbid, and no less than 20 slightly turbid, whereas during the year 1894 not one of the samples of filtered water was turbid, and only two, out of 84 examined, slightly so.” As regards the results of chemical analysis, Table 23 gives the composition of the unfiltered water from the Thames, and of the filtered waters from the mains of the two Companies, the average composition and the best and worst results being set out. By comparing the two last columns with the second it is possible to decide which Company is most successful with its filtration. The amounts of “organic carbon,” “organic nitrogen” may be 94 taken as indicators (they are not the only two) of the amount of animal contamination. The mean amount of “organic carbon” in Thames water during the year was 0.307 parrs per 100,000, which quantity was reduced to 0.207 by tbe West Middlesex Company, and to 0.202 by the Grand Junction Company. The average amount of “organic nitrogen” present in Thames water was 0.051 parts per 100,000, reduced to 0.024 by both companies. The Thames water contained 0.011 parts per 100,000 of ammonia, usually due to decomposed organic matter, which was entirely removed by both companies. Of “nitrogen as nitrates and nitrites,” the unfiltered water contained an average amount of 0.217 parts per 100,000, which after filtration was reduced to 0.216 by the West Middlesex, but increased to 0.226 by the Grand Junction Company. The examination of water by bacteriology is of recent introduction, and the results obtained have yet to be interpreted. The ever accumulating evidence of infection being conveyed in drinking water enhances the value of such examination, in view of the acknowledged connection between micro-organisms and disease. The samples of water for this examination are taken immediately after the water leaves a filter-bed, and by this means it is possible to say that the filtered water at that point is (more or less) sterile, and in certain cases to determine whether each filter-bed is doing its work efficiently. 95 TABLE 23.—Comparative Analyses of Water Supply. (Compiled from Registrar-General's Annual Summary.) Thames (unfiltered water.) From Mains of West Middlesex Co. Grand Junction Co. O) ~cJ Ss •M o a) Is o, o © © o o *- a. £ li ■ a. d Temperature (degrees Centigrade) 'mean 10-9 10-9 12-3 max. 18-7(8) 16-7(e) 19-1(8) _min. 5-2(1) 6-5(1 8) 6-30 Total Solids ...•< 1 'mean 30-09 28-12 28-96 max. 36-40(u) 34-50 (0 34-64(13) ^min. 26-24(') 23-30(8) -25-64(8) 'mean 0-307 ' 0-207 0-202 Organic Carbon ...< max. 0-733(ii) 0-415(11) 0-333(11) min. 0-179(13) 0-1260 0-1420 mean 0-051 0-024 0-024 Organic Nitrogen...< max. 0-121(ii) 0-0430 0-038(11) _min. 0-028(1') 0-016(« ') 0-0170 'mean 0-011 0-000 0-000 Ammonia « max. 0-032(1) 0-000 0 000 _min. 0-005(* •) 0000 0-000 Nitrogen as NUrates , and Nitrites 'metin 0-217 0-216 0-226 max. 0-358(1") 0-345(») 0-357(1') _iiiin. 01300 0-117(8) 0-1300 Chlorino « 'mean 1-9 1-9 1-9 max. 2-30 2-2(1) 2-20 tmin. 1-7(4 11) 1-7(1 u is) 1-7(4 U) Degrees of Hardness (1"=1 pt. Ca C03 per 100,000) 'mean 19-0 18-4 18-9 max. 23-0(1') 227(H) 22-7(0 Diin. 16-60 15-4(8) 171 C«) Note.—The nmall figures shown ( ) indicate the month when the maximum or minimum was observed. 96 TABLE 24. Year. Day of Month. Temp. of Thames Co Hours of Sunshine at Staines during 3 days. Hrs. Mts. Flow of River at Teddington Weir, 1,000,000 galls, per 24 hours. No. of Microorganisms per c.c. 1892. May 20 14.8 13 10 480.0 631 June 20 16.2 23 30 335.0 1,658 July 13 17.2 11 10 385.2 2,268 Aug. 25 19.1 9 55 276.3 2,421 Sep. 12 16.6 3 15 270-0 947 Oct. 17 10.5 9 15 501.3 2,316 Nov. 22 6.7 ... ... 1,845.0 1,868 Dec. 15 5.6 5 20 2,105.0 11,158 1893. Jan. 9 0-0 ... ... 915.0 8,210 Feb. 4 7.6 l 20 3,255.0 13,947 Mar. 20. 7.2 21 30 1,175.0 3,737 Apr. 5 11.6 24 30 985.0 1,763 May 16 17.6 14 30 428.0 2 052 June 20 20.4 27 25 277.2 2,789 July 19 18.2 15 55 330.0 2,l32 Aug. 10 21.3 29 55 264.6 1,895 Sep. 25 13.8 14 5 159.3 1,158 Oct. 19 12.5 11 5 542.7 13,790 Nov. 9 5.6 7 45 249.3 1,789 Dec. 7 5.4 5 45 375.0 6,316 1894. Jan. 15 5.2 2 45 1,510.0 56,630 Feb. 13 6.9 7 0 1,140.0 6,947 Mar. 13 8.0 13 40 1,600.0 9,480 Apr. 13 14.0 16 20 690.0 2,520 May 3 12.5 7 30 740.7 2,880 June 11 14.1 6 35 745.2 1,840 July 16 16.7 8 45 369.9 2,860 Aug. 11 18.7 13 55 360.9 2,080 Sep. 7 13.8 11 50 336.6 3,080 Oct. 10 12.2 ... ... 396.0 3,800 Nov. 5 12.3 9 50 4,462.2 20,080 Dec. 10 5.5 2 15 2,058.3 16,300 Note.—The hours of sunshine were recorded at Staines, and the duration given in each instance represents the total amount recorded on the day of taking the sample and during the two days immediately preceding. From an examination of the figures contained in the above Table, after they had been set out as curves, Professor Frankland concludes that "the number of microbes in Thames water is determined mainly by the rate of flow of the river, or, in other words, by the rainfall, and but slightly, if at all, by 97 either the presence or absence of sunshine, or high or low temperature.” Bearing in mind the numbers of microbes found in the unfiltered water, the efficiency of the filtration carried out by the water companies is clearly demonstrated when it is found that the filters of the West Middlesex Water Company remove on an average 99.65 per cent. (99.98 as a maximum and 99.04 as a minimum) and those of the Grand Junction Company, 98.06 as an average, 99.85 as a maximum and 84.89 as a minimum. It has already been stated that the Grand Junction Company filters at the rate of 1.9 gallons per hour per square foot of bed, against 1.3 in the case of the West Middlesex, but on this point the experiments made by Professor Frankland, confirmed by a very elaborate and lengthy series of observations in Massachusetts, show that the rate of flow through the filters, if uniform, has scarcely any effect on the purification. In the series of experiments in Massachusetts, the subjects of inquiry were:— 1. The effect, upon bacterial purification, of rate of filtration; 2. The effect of size of sand grains upon bacterial fication; 3. The effect of depth of material upon bacterial purification; 4. The effect of scraping the filters upon bacterial fication. The results of the experiments, so far, is to show that the first three have but little influence on the process, but that the fourth does cause a reduction in the number of bacteria arrested. This is in 98 cord with other observations, made in England and elsewhere, that the green slimy deposit which forms on the surface of the filter-beds after they have been at work for a short time, is the most important factor in the filtration. SANITARY WORK, &c. In the Appendix will be found a tabular statement of the work of the Department during the past year (Table VI.) and lists of the Common Lodging Houses, Bakehouses, Slaughterhouses, &c., as known at the end of the year. House-to-House Inspection.—At the time when these inspections were made at the end of the year, an enumeration was made of the inhabitants of each tenement therein contained. The results of the work have not yet been tabulated, but a large number of improvements have been effected. The streets taken were those in the neighbourhood of the Lock Bridge, whence an unduly large number of cases of infectious sickness were being returned. House Sanitation.—A considerable amount of friction between owners and the Sanitary Authority would be avoided if a complete series of bye-laws dealing with this subject were in existence. Certain of the Local Authorities of the Metropolis have special regulations, which, however, have not the status of bye-laws, and, inasmuch as such a system of 99 purely local regulations introduces much diversity of practice, it is highly desirable that the County Council should exercise their power of making bye-laws for the Metropolis, as is provided by Section 202 of the Metropolis Local Management Act, 1855, which enacts that “the said Metropolitan Board (now County Council) may also from time to time make, alter, and repeal bye-laws for regulating the dimensions, form, and mode of construction, and the keeping, cleansing, and repairing of the pipes, drains, and other means of communicating with sewers and the traps and apparatus connected therewith.” The bye-laws at present in force, deal only with soil-pipes and water-closets, and owing to the uncertainty which exists as to the mode of construction which can be enforced in other respects, the work is done in many cases according to the private views of the owner or his builder, with the result that it becomes necessary for the Department to interfere within a longer or shorter period to complete, remedy, and correct what ought to have been done properly in the first instance. It is not the first demand by the Sanitary Authority which is resisted by the property-owners, but the second and succeeding, which are frequently due to the incompleteness with which the first demand was complied with. The question of combined drainage was the subject of a Conference in the summer of last year, at which delegates from the various Metropolitan Local 100 Authorities were present. This class of drainage has arisen in part from want of supervision in the past, in part from surreptitious alterations in building plans sent in, and by additions made to existing drainage, converting what was a single drain into a combined drain. Under the existing law, laid down in Sections 74 and 250 of the Metropolis Local Management Act, 1855, and Section 112 of the Metropolis Local Management Act, 1862, such combined drains are vested in the Local Authority, but the decisions of the Courts on the point have been (apparently) so contradictory that it is difficult to say in any given case who is responsible for a particular drain. An attempt will undoubtedly be made to secure some change in the law, but the only change that would effectually clear up the difficulty would of necessity be retrospective to a degree which it is against the usual practice of Parliament to sanction. Manure Receptacles.—The bye-laws of the County Council require that the receptacles shall be above the ground level, and the Department has endeavoured to have the existing dung-pits re-constructed in accordance with that requirement. There are, however, many mews where the whole of the roadway between the stables is public thoroughfare, and the erection of an above-ground bin, or guard, would constitute an obstruction. In other instances it has been found that the whole frontage of the stable is taken up for doors, leaving no space available for a bin. To 101 viate these difficulties, the use of metal bins on wheels has been recommended, but such bins would be kept in the stable and would probably cause as much nuisance as the old dung-pit. The difficulty of getting rid of the manure increases each year, and makes the matter of its proper storage the more important. It is at present impossible to offer any suggestion for dealing satisfactorily with the matter. Factory Acts.—The complaints received from the Chief Inspector of Workshops during the past year have been almost exclusively of overcrowding, mostly during the “season.” Under the 1891 Act, there is no standard for overcrowding during day hours, but one of 250 cubic feet per person has been taken as a working rule. Owing to the great differences which exist in the manner and efficiency of ventilation, it seems desirable that some other standard than cubic space should be adopted as a guage of overcrowding. There should be no difficulty in estimating the chemical impurity of the air at the time of inspection and using the result of such examination, as the basis for further action. Bake-houses.—All the bake-houses of the district have been inspected twice during the past year, and many improvements effected in their sanitary arrangements. In the future they will be inspected quarterly and at such other intervals as may appear to be necessary. 102 Slaughterhouses.—The control of these is vested in the County Council, but they have been periodically inspected by the Department. No opposition was offered to tlie licensing of any of them at the last meeting of the Licensing Committee. In connection with this subject may be mentioned the matter of inspection of meat. This is practically impossible except it be done whilst the animal is being dressed for the market. There can be no doubt that all slaughtering should be done in a central market, under the immediate supervision of properly qualified officers, and that all meat should be properly marked, to show that it is fit for food. Such a system was inaugurated by that able sanitarian, “Moses,” many of whose precepts, after having been scoffed at for generations, are now accepted as framed on the safest lines. Dairies and Milk Shops.—The dairies are controlled by the County Council, but are periodically inspected by this Department. Of the milk shops in the district, but little is known. They are registered by the Council, and complaints are occasionally received of insanitary conditions existing in them, but beyond that, this Department exercises no control or supervision over them. Infectious Disease.—Inquiries have been made in respect of all cases of infectious disease notified, except Erysipelas, and the results recorded on proper 103 cards for future reference. The heads of all schools have been informed of cases occurring among the members of families of their scholars, and also the date of disinfection. Six hundred and thirty-three (633) rooms have been disinfected during the year, and bedding, etc., to the weight of 27½ tons, removed for purification, at a cost of £875 4s. 7d. After certain of the infectious diseases, the houses have been specially inspected, to ascertain the existence of insanitary conditions, the underground drains being exposed and tested with water. Last year 231 houses were so examined. At present the method of disinfection employed is that of sulphur fumigation, after carefully closing all openings and crevices. The process, judged by the absence of recurrence of disease, appears to be effectual, but it is somewhat too long to be convenient. From the time of lighting the sulphur to the opening of the room, it is necessary to allow 24 hours at least to pass. This explains the need of temporary shelter during disinfection, especially when the family occupies a one-room tenement. In Paris an air spray is used, by which it is said that 4 hours is sufficient to purify the room ; but the process cannot be considered to be absolutely safe, as it has been tested in England, and living germs have been detected on the walls sprayed over. The disinfection of bedding, etc., is done by a Contractor, who does the work well. It is, however, 104 desirable that the work should be in the hands of the Department, and such an arrangement will, it is believed, lead to economy. It has not been necessary to close any of the schools during the past year, nor has any school shown a marked incidence of disease. On one or two occasions, when visiting schools, a tendency to crowd the scholars into a small space for the purposes of teaching has been observed, a practice which, on sanitary grounds, can hardly be condemned too strongly. It is by such close aggregation that disease spreads from child to child. Vagrants and Infectious Disease.—The fact that disease is spread by vagrants and other users of casual wards, shelters, etc., has occupied the attention of Sanitary authorities for some years. In 1893 a report was presented to the Corporation of Newcastle by the Medical Officer of Health for the Borough which attracted considerable attention, and was one of the causes for holding the Conference of Delegates from the Metropolitan Boards which took place last June. The following resolutions were passed on that occasion:— Resolutions passed at the Conference held at the County Hall, on 19th July, 1894. 1. “That common shelters which are not subject to the law relating to common lodging-houses should be made subject to such law. 105 2. “That there should be power given to the local ties to require medical examination of all persons entering common lodging-houses and casual wards. 3. “That each inmate of a common lodging-house or casual ward should on admission have a bath of fresh water. 4. “That the local authority should have the power to order the keeper of a common lodging-house, in which there has been infectious disease, to refuse fresh admissions for such time as may be required by the authority. 5. “That the local authority should be empowered to require the temporary closing of any common lodginghouse in which infectious disease has occurred. 6. “That the local sanitary authority should have power to require the detention of any inmate of a common lodging-house or casual ward who may reasonably be suspected of being liable to convey infectious disease. 7. “That means should be provided for the detention and isolation of any vagrant found wandering in a public place, if reasonably suspected of being liable to convey infection. 8. “That the local authority should have full power to require the disinfection of the person and clothes of any person in a common lodging-house or casual ward, whether infected or exposed to infection. 9. “That arrangements should be made by which the occurrence of infectious disease in common lodginghouses or casual wards should be made known by the local authority of the district to the local authorities of other districts. 10. “That the local authorities should be empowered to require the vaccination or re-vaccination of persons in common lodging-houses or casual wards who are exposed to the infection of small-pox.” 106 Whilst the regulations indicated in the above resolutions would undoubtedly be of use for checking the spread of infection, they would greatly interfere with the “liberty of the subject,” and would certainly press very hardly on many of the more respectable class of vagrants, using the word in its true sense of “wanderers.” It appears that much benefit would be gained if the workman out of work, who really is on the tramp to find employment, could have a “worker's ticket,” vouching for his respectability, and entitling him to] better quarters and food than falls to his lot at present. Such a system would enable a proportion of vagrants to be traced throughout their tramps, would lead to the separation of many from any chance sources of infection, and would leave a residuum of individuals qf the lowest class, who would suffer a minimum of hardship through any interference with their liberty. As an illustration of the manner in which some “Refuges” are carried on, may be mentioned the case of a Church Refuge in this Parish, which was brought under the notice of the Sanitary Committee at the close of the year, where from 500 to 600 men were received nightly, without any selection, into one large loft. The accommodation provided amounted to a low bench and table, and the air space was something under 75 cubic ft. per man. The men must have been sitting in contact with each other, and the danger of spread of disease under such circumstances is very real. 107 Food Analysis.—At the end of the Appendix will be found an abstract of the work done by the Public Analyst during the year ended 25th March, 1895. The total number of samples (333) given in Table VI., is for the year ended 29th December, 1894. During the year 1894, there were 28 prosecutions under the Sale of Foods and Drugs Act, all but two dealing with milk. The offences and the results of the prosecutions are set out below:— Food Stuff. Offence. Result. Milk Refusal to serve Inspector Fined 20/- & 2/- costs. „ 7 per cent, added water „ 10/- „ 12/- „ „ 20 do. do. „ £3 „ 2/- „ „ 10 do. do. „ £2 „ 2/- „ „ 12 do. do. „ £2 „ 2/- „ „ 14 do. do.„ £2 „ 2/- „ Butter 90 do. Margarine „ 1/- Milk 7 do. added water „ 10/- „ 2/- „ „ 15 do. do. „ 7/-„ 2/- „ „ 27 do. of cream extracted „ 20/- „ 5/- „ „ 30 do. do. „ £2 „ 6/- „ „ (2 churns) 7 and 10 per cent, added water „ 10/- „ 33 do. of cream extracted „ £2 ,,19/6 „ „ 20 do. added water „ £2 „ 19/6 „ „ 10 do. do. „ 10/- „ 12/6 „ „ 6 do. do 20/- „ 28/- „ „ 17 do. do. „ 20/- „ 2/- „ „ 8 do. do. „ 5/- „ 2/- „ „ 7 do. do. „ 1/- „ 2/- „ „ 17 do. do. „40/- „ 2/- „ „ 30 do. of cream extracted „ £3 „ 23/- „ „ 9 do. added water „ 7/- „ 5 do. do. „ 20/- „ 12/6 „ 108 Food Stuff. Offence. Result. Coffee 50 do. chicory „ £3 & 12/6 costs. Milk 48 do. of cream extracted „ £10 „ 7/- „ „ 20 do. added water 5/- „ 2/- „ Butter 90 do. Margarine Dismissed. Milk 11 do. added water Lost through delay in service of summons. Coffee 50 do. Chicory Dismissed. Milk 9 do. added water Case withdrawn. The fines cannot be said to err on the side of severity when one considers that the detected cases of adulteration form but a very small proportion of all such cases, and takes into account the large profits which result from the sale of say 10 per cent, of water added to milk, or 20 per cent, of cream abstracted for sale at an enhanced value. The injury done by such fraud to infants who are fed on milk deprived of its nutritive properties must be very great and lasting. It seems probable that nothing short of imprisonment without the option of a fine will check adulteration. Sanitary Legal Proceedings.—There were 8 cases last year which were taken before the Magistrate, viz.:— Bad eggs found in a bakehouse, fined £4 and costs. Unsound meat at a butcher's shop, fined £2 and costs. Non-compliance with Notices, 5 cases:— Work done before case heard, summons withdrawn, one case; 109 Non-compliance with Notices, 5 cases (continued):— Undertaking given to do work, Vestry awarded costs, three cases; Summons dismissed, with eosts, against the Vestry, one case. Alleged non-notification of disease, case lost, with costs against the Vestry. Meteorology.—Table VII. in the Appendix contains the quarterly totals and means of the chief meteorological elements for the past year. The question of the interrelation between climate, or weather, and disease and mortality, cannot be discussed on this occasion, from want of information as to previous years. APPENDIX. 112 TABLE I. Estimated Populations. No. of Houses in whole Parish. Births Registered. Deaths, corrected. St. Mary. St. John. St. Mary. St. John. St. Mary. St. John. 1894 88,949 32,551 15,610 2,423 411 1,449 382 1893 87,708 82,772 15,543 2,567 444 1,668 487 1892 86,111 33,149 15,464 2,456 478 1,632 510 1891 84,156 33,682 15,321 2,420 532 1,590 520 1890 82,091 36,645 15,164 2,389 512 1,602 502 1889 80,324 36,736 15,083 2,346 517 1,266 398 1888 78,939 36,810 14,995 2,331 512 1,472 444 1887 77,578 36,884 14,864 2,368 548 1,346 439 1886 76,240 36,958 14,774 2,366 532 1,468 441 1885 74,925 37,032 14,680 2,379 619 1,394 483 1884 73,633 37,106 14,608 2,379 628 1,331 471 Averages for 1884-93 79,872 35,127 15,049 2,400 532 1,476 469 113 TABLE II. Table showing Annual Birth and Death Rates, Deaths of Children and Deaths registered in Institutions for year 1894 and 10 years preceding. Year. Birth-rate per 1,000 of Estimated Population. Corrected Death-rate per 1,000 of Estimated Population. Deaths of Infants under 1 year. Death at ages under 5 years per 1,000 total Deaths. Deaths in Public Institutions. Per 1,000 Births Registered. Per 1,000 total Deaths. Workhouse and Infirmary. St. Mary's Hospital. Lock Hospital. Children's Hospital. Outlying Institutions. 1894 23.3 15.0 135 210 351 165 347 3 * 193 1893 25.2 18.0 152 212 323 204 399 3 * 172 1892 24.6 18.0 148 203 319 236 355 7 12 120 1891 25.1 17.9 148 207 298 257 371 5 62 105 1890 24.4 17.7 157 216 347 172 358 3 57 100 1889 24.5 14.2 138 238 333 172 344 2 70 70 1888 24.6 16.6 133 193 343 207 334 5 64 78 1887 25.5 15.6 122 200 316 181 347 6 50 67 1886 25.6 16.9 148 225 354 161 250 5 53 81 1885 26.8 16.8 145 231 365 158 192 3 38 78 1884 27.2 16.3 144 241 360 193 263 3 34 ** Averages for decennium, 1884-1893 25.3 16.8 143 216 335 194 321 4 48 nine year 96 averages Notes.—*Closed during re-building. ** No return made until 1885. 114 TABLE III. WHOLE PARISH—MALES. Deaths Registered from all Causes during the Year 1894. Note.—The Deaths of Non-Residents occurring in Public Institutions situated in the District are excluded, and the Deaths of Residents occurring in Public Institutions situated beyond the limits of the District are included. Cause of Death. AGES. 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 & up|wards. Totals. 55 to 60 Classes. I. Specific Febrile, or Zymotic Diseases 48 63 13 8 6 6 3 5 2 ... 1 155 2 II. Parasitic Diseases 2 ... ... ... 1 ... ... ... ... ... ... 3 ... III. Dietic Diseases ... ... ... ... 1 1 1 1 ... ... ... 4 ... IV. Constitutional Diseases 18 23 8 17 24 31 27 20 6 3 ... 177 10 V. Developmental Diseases 45 2 ... ... 1 ... ... ... 5 9 3 65 ... VI. Local Diseases 75 31 7 16 15 47 52 45 51 42 10 381 25 VII. Deaths from Violence 5 4 7 6 5 9 7 4 3 ... ... 50 2 VIII. Deaths from Ill-defined and Not Specified Causes 24 2 ... ... 1 1 ... 1 ... 1 ... 30 ... Totals 217 125 35 47 54 95 90 76 67 45 14 865 39 I.—SPECIFIC FEBRILE, OR ZYMOTIC DISEASES. 1.—Miasmatic Diseases. Smallpox Vaccinated ... ... ... ... ... ... ... ... ... ... ... ... ... Unvaccinated ... ... ... ... ... ... ... ... ... ... ... ... ... No Statement ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 9 19 2 ... ... ... ... ... ... ... ... 30 ... Scarlet Fever 1 6 ... ... ... ... ... ... ... ... ... 7 ... Typhus ... ... ... ... ... ... ... ... ... ... ... ... ... Epidemic Influenza 3 4 ... 2 1 1 1 3 1 ... 1 17 ... Whooping Cough 6 9 2 ... ... ... ... ... ... ... ... 17 ... Diphtheria 3 22 7 1 ... 1 1 ... ... ... ... 35 ... Simple Continued and Ill-defined Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric or Typhoid Fever ... 1 2 4 4 1 ... 1 ... ... ... 13 1 Other Miasmatic Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... 2.—Diarrhœal Diseases. Simple Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhœa, Dysentery 21 2 ... ... ... ... ... 1 ... ... ... 24 1 115 TABLE III. WHOLE PARISH.—FEMALES. Deaths Registered from all Causes during the Year 1894. Note.—The Deaths of Non-Residents occurring in Public Institutions situated in the District are excluded,' and the Deaths of Residents occurring in Hospitals and Public Institutions situated beyond the limits of the District are included. AGES. 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 85 185 & up1 wards TOTALS 55 to 60 I. Specific Febrile, on Zymotic Diseases 41 79 32 6 9 2 5 2 4 5 ... 185 ... II. Parasitic Diseases 2 ... ... ... ... ... ... ... ... ... ... 2 ... III. Dietic Diseases 1 ... ... ... 2 4 2 1 ... ... ... 10 ... IV. Constitotional Diseases 14 14 6 16 26 31 33 28 24 7 1 200 17 V. Developmental Diseases 30 1 ... ... ... ... ... 1 6 20 10 68 ... VI. Local Diseases 55 34 9 17 30 40 41 62 64 74 22 448 27 VII. Deaths from Violence 8 2 2 1 3 2 2 3 2 2 1 28 ... VIII. Deaths from Ill-Defined and Not Specified Causes 17 3 ... ... ... 1 2 2 ... ... ... 25 ... Totals 168 133 49 40 70 80 85 99 100 108 34 966 44 I.—SPECIFIC FEBRILE, OR ZYMOTIC DISEASES. 1.—Miasmatic Diseases. Smallpox Vaccinated ... ... ... ... 1 ... ... ... ... ... ... 1 ... Unvaccinated ... ... 1 ... ... ... ... ... ... ... ... 1 ... No Statement ... ... 1 ... ... ... ... ... ... ... ... 1 ... Measles 7 28 1 ... ... ... ... ... ... ... ... 36 ... Scarlet Fever ... 3 3 ... ... ... ... ... ... ... ... 6 ... Typhus ... ... ... ... ... ... ... ... ... ... ... ... ... Epidemic Influenza ... ... ... ... ... 1 3 1 3 4 ... 12 ... Whooping Cough 12 14 1 ... ... ... ... ... ... ... ... 2/ ... Diphtheria ... 32 24 ... 1 ... ... ... ... ... ... 57 ... Simple Continued and Ill-defined Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric or Typhoid Fever ... ... 1 4 5 ... ... ... ... ... ... 10 ... Other Miasmatic Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... 2.—Diarrhœal Diseases. Simple Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhœa, Dysentery 17 ... ... ... ... ... 1 ... ... 1 ... 21 ... 116 Table III.—Whole Parish. —Males (continued). Cause of Death. ages. 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 & upwards. Totals. 55 to 60 SPECIAL FEBRILE, OR ZYMOTIC DISEASES (continued). 3.—Malarial Diseases. Remittent Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Ague ... ... ... ... ... ... ... ... ... ... ... ... ... 4.—Zoogenous Diseases. ... ... ... ... ... ... ... ... ... ... ... ... ... Cowpox and effects of Vaccination ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases (e g., Hydrophobia,Glanders, Splenic Fever) ... ... ... ... ... 1 ... ... ... ... ... 1 ... 5.—Venereal Diseases. Syphilis 4 ... ... ... 1 ... ... ... ... ... ... 5 ... Gonorrhœa, Stricture of Urethra ... ... ... ... ... ... ... ... ... ... ... ... ... 6.—Septic Diseases. Erysipelas 1 ... ... 1 ... 1 ... ... ... ... ... 3 ... Pyæmia, Septicaemia ... ... ... ... ... 1 1 ... 1 ... ... 3 ... Puerperal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... II.—PARASITIC DISEASES. Thrush, and other Vegetable Parasitic | Diseases 2 ... ... ... ... ... ... ... ... ... ... 2 ... Worms, Hydatids, and other Animal Parasitic Diseases ... ... ... ... 1 ... ... ... ... ... ... 1 ... III.—DIETIC DISEASES. Want of Breast Milk, Starvation ... ... ... ... ... ... ... ... ... ... ... ... ... Scurvy ... ... ... ... ... ... ... ... ... ... ... ... ... Chronic Alcoholism ... ... ... ... 1 ... 1 ... ... ... ... 2 ... Delirium Tremens ... ... ... ... ... 1 ... 1 ... ... ... 2 ... IV.—CONSTITUTIONAL DISEASES. Rheumatic Fever, Rheumatism of the Heart ... ... 1 1 1 ... 1 ... ... ... ... 4 ... Rheumatism ... ... ... ... ... ... ... ... ... ... ... ... ... Gout ... ... ... ... ... 1 ... 1 ... ... ... 2 ... Rickets ... 3 ... ... ... ... ... ... ... ... ... 3 ... Cancer, Malignant Disease ... ... ... 1 1 7 8 10 3 1 1 32 5 Tabes Mesenterica 5 3 ... ... ... ... ... ... ... ... ... 8 ... Tubercular Meningitis, Hydrocephalus 11 13 5 ... ... ... ... ... ... ... ... 29 ... Phthisis ... ... 2 13 19 22 17 7 3 ... ... 83 5 Other forms of Tuberculosis, Scrofula 2 3 ... l 2 1 ... ... ... ... ... 9 ... Purpura, Hæmorrhagic Diathesis ... 1 ... ... ... ... ... ... ... ... ... 1 ... Anæmia, Chlorosis, Leucocythæmia ... ... ... 1 ... ... ... ... ... ... ... 2 ... Glycosuria, Diabetes Mellitus ... ... ... ... 1 ... 1 2 ... ... ... 4 ... Other Constitutional Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... 117 Table III.—Whole Parish.—Females (continued). Cause of Death. AGES. 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 & upwards. Totals. 55 to 60 SPECIAL FEBRILE, OR ZYMOTIC DISEASES (continued). 3.—Malarial Diseases. Remittent Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Ague ... ... ... ... ... ... ... ... ... ... ... ... ... 4.—Zoogenous Diseases. Cowpox and effects of Vaccination ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases (e.g., Hydrophobia,Glanders, Splenic Fever ... ... ... ... ... ... ... ... ... ... ... ... ... 5.—Venereal Diseases. Syphilis 4 ... ... 1 1 1 1 ... ... ... ... 8 ... Gonorrhœa, Stricture of Urethra ... ... ... ... ... ... ... ... ... ... ... ... ... 6.—Septic Diseases. Erysipelas 1 ... ... 1 ... ... ... ... 1 ... ... 3 ... Pyæmia, Septicaemia ... ... ... ... ... ... ... 1 ... ... ... 1 ... Puerperal Fever ... ... ... ... 1 ... ... ... ... ... ... 1 ... II—PARASITIC DISEASES. Thrush, and other Vegetable Parasitic Diseases ... ... ... ... ... ... ... ... ... ... ... 2 ... Worms, Hydatids, and other Animal Parasitic Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... III.—DIETIC DISEASES. Want of Breast Milk, Starvation ... ... ... ... ... ... ... ... ... ... ... 1 ... Scurvy ... ... ... ... ... ... ... ... ... ... ... ... ... Chronic Alcoholism ... ... ... ... 2 4 2 1 ... ... ... 9 ... Delirium Tremens ... ... ... ... ... ... ... ... ... ... ... ... ... IV.—CONSTITUTIONAL DISEASES. Rheumatic Fever, Rheumatism of the Heart. ... ... ... 1 ... 2 1 ... 1 ... ... 5 ... Rheumatism ... ... ... ... ... ... ... ... ... 1 ... 1 ... Gout ... ... ... ... ... ... ... ... ... ... ... ... ... Rickets 1 1 ... ... ... ... ... ... ... ... 2 ... Cancer, Malignant Disease ... ... ... ... 3 13 24 22 19 6 1 88 12 Tabes Mesenterial 4 ... ... ... ... ... ... ... ... ... ... 4 ... Tubercular Meningitis, Hydrocephalus 7 7 2 ... ... ... ... ... ... ... ... 16 ... Phthisis ... 2 2 11 21 15 7 5 1 ... ... 64 4 Other forms of Tuberculosis, Scrofula 1 4 2 2 ... ... ... 1 ... ... ... 10 1 Purpura, Hæmorrhagic Diathesis 1 ... ... ... ... ... ... ... ... ... ... 1 ... Anæmia, Chlorosis, Leucocythæmia. ... ... ... 1 ... ... ... ... 2 ... ... 3 ... Glycosuria, Diabetes Mellitus ... ... ... 1 1 1 1 ... 1 ... ... 5 ... Other Constitutional Diseases ... ... ... ... 1 ... ... ... ... ... ... 1 ... 118 Table III.—Whole Parish.—Males (continued). Cause of Death. AGES. 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 & upwards. Totals. 55 to 60 V.-DEVELOPMENTAL DISEASES. Premature Birth 39 ... ... ... ... ... ... ... ... ... ... 39 ... Atelectasis 3 ... ... ... ... ... ... ... ... ... ... 3 ... Congenital Malformations 3 2 ... ... 1 ... ... ... ... ... ... 6 ... Old Age ... ... ... ... ... ... ... ... 5 9 3 17 ... VI.—LOCAL DISEASES. 1.—Diseases op Nebvous System. Inflammation of Brain or Membranes 4 1 1 1 ... ... ... ... ... ... ... 7 ... Apoplexy, Softening of Brain, Hemiplegia, Brain Paralysis ... ... ... ... ... 2 6 8 10 4 ... 30 3 Insanity, General Paralysis of the Insane ... ... ... ... 1 3 3 ... 1 ... ... 8 ... Epilepsy ... ... ... 1 ... ... 1 1 1 ... ... 4 1 Convulsions 11 3 ... ... ... ... ... ... ... ... ... 14 ... Laryngismus Stridulus (Spasm of Glottis) l ... ... ... ... ... ... ... ... ... ... 1 ... Disease of Spinal Cord, Paraplegia, Paralysis Agitans ... 1 ... 2 ... 1 2 1 ... ... ... 7 1 Other Diseases of Nervous System ... ... ... ... 1 1 1 1 ... 1 ... 5 1 2.—Diseases op Organs op Special Sense. (e.g., of Ear, Eye, Nose) ... 1 1 1 1 ... ... ... ... ... ... 4 ... 3.—Diseases of Circulatory System. Pericarditis ... ... 1 ... ... ... ... ... ... ... ... 1 ... Acute Endocarditis ... ... ... ... 1 1 1 ... 1 ... ... 4 ... Valvular Diseases of Heart ... ... 1 1 1 3 5 ... 3 2 ... 16 ... Other Diseases of Heart 1 ... ... ... 1 8 3 5 4 7 3 32 4 Aneurism ... ... ... ... ... 1 1 3 ... ... ... 5 3 Embolism, Thrombosis ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of Blood Vessels ... ... ... ... ... ... .. 1 3 4 1 9 ... 4—Diseases of Respiratory System. Laryngitis l 1 1 ... ... 1 ... ... ... ... ... 4 ... Croup ... ... ... ... ... ... ... ... ... ... ... ... ... Emphysema, Asthma ... ... ... ... ... 1 ... ... ... ... ... 1 ... Bronchitis 33 10 ... 2 1 6 6 4 10 5 4 81 3 Pneumonia 10 11 ... 5 3 8 7 5 2 3 ... 54 3 Pleurisy ... ... ... ... 1 1 1 ... 2 ... ... 5 ... Other Diseases of Respiratory System ... ... ... ... ... ... ... ... ... ... ... ... ... 5.—Diseases of Digestive System. Dentition 3 1 ... ... ... ... ... ... ... ... ... 4 ... Sore Throat, Quinsy ... 1 ... ... ... ... ... ... ... ... ... 1 ... Diseases of Stomach 2 ... ... ... ... ... 2 ... ... ... 1 5 ... Enteritis 5 ... 1 ... ... 1 1 1 1 ... ... 10 1 Obstructive Diseases of Intestine 1 1 ... ... ... ... ... 1 ... 1 ... 4 ... 119 Table III.—Whole Parish.—Females (continued). Cause oe Death. ages. 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 & upwards. Totals 55 to 60 V.-DEVELOPMENTAL DISEASES. Premature Birth 26 ... ... ... ... ... ... ... ... ... ... 26 ... Atelectasis 3 ... ... ... ... ... ... ... ... ... ... 3 ... Congenital Malformations 1 1 ... ... ... ... ... ... ... ... ... 2 ... Old Age ... ... ... ... ... ... ... 1 6 20 10 37 ... VI.-L0CAL DISEASES. 1.—Diseases of Nervous System. Inflammation of Brain or Membranes 1 1 ... ... ... ... ... ... ... ... ... 2 ... Apoplexy, Softening of Brain, Hemiplegia, Brain Paralysis 1 ... ... 1 2 1 3 8 8 20 2 46 4 Insanity, General Paralysis of the Insane ... ... ... ... 3 3 5 1 ... 1 ... 13 1 Epilepsy ... ... ... ... ... 3 ... ... ... ... ... 4 ... Convulsions 9 2 ... ... ... ... ... ... ... ... ... 11 ... Laryngismus Stridulus (Spasm of Glottis) 1 ... ... ... ... ... ... ... ... ... ... 1 ... Disease of Spinal Cord, Paraplegia, Paralysis Agitans ... ... ... ... 1 1 1 ... 1 1 ... 5 ... Other Diseases of Nervous System ... ... ... ... ... 1 ... 1 ... ... ... 2 ... 2.—Diseases of Organs of Special Sense. (e.g., of Ear, Eye, Nose) ... ... ... ... ... ... ... ... ... ... ... ... ... 3.—Diseases op Circulatory System. Pericarditis ... ... ... ... ... ... ... ... ... ... ... ... ... Acute Endocarditis ... ... ... 1 ... ... 1 ... 1 ... ... 3 ... Valvular Diseases of Heart ... ... 2 ... 2 3 1 3 5 4 2 22 1 Other Diseases of Heart ... 1 1 3 1 5 6 10 2 13 1 43 6 Aneurism ... ... ... ... ... ... ... ... ... ... ... ... ... Embolism, Thrombosis ... ... ... ... 1 1 ... ... 1 1 ... 4 ... Other Diseases of Blood Vessels ... ... ... ... ... ... ... ... ... 3 2 5 ... 4.—Diseases of Respiratory System. Laryngitis ... 1 ... ... ... ... 1 ... ... ... ... 2 ... Croup ... 1 ... ... ... ... ... ... ... ... ... 1 ... Emphysema, Asthma ... ... ... ... ... ... 1 ... 1 ... ... 2 ... Bronchitis 29 15 1 1 ... 3 4 16 21 19 8 117 5 Pneumonia 7 7 1 2 2 6 2 5 6 6 5 49 2 Pleurisy ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of Respiratory System ... ... ... ... ... ... ... ... ... ... ... ... ... 5.—Diseases of Digestive System. Dentition 1 1 ... ... ... ... ... ... ... ... ... 2 .. Sore Throat, Quinsy ... 1 ... 1 ... ... ... ... ... ... ... 2 ... Diseases of Stomach 4 2 ... 2 4 1 3 ... 1 ... 1 18 ... Enteritis ... 1 ... 1 1 1 ... 1 1 ... ... 6 ... Obstructive Diseases of Intestine ... ... ... ... ... 1 4 2 4 1 ... 12 1 120 Table III.—Whole Parish.—Males (continued). Cause of Death. AGES. 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 & upwards. Totals. 55 to 60 LOCAL DISEASES.—Continued. 5.—Diseases of the Digestive Ststem. (Continued.) Peritonitis ... ... ... ... ... 1 ... ... ... ... ... 1 ... Ascites ... ... ... ... ... ... ... ... ... ... ... ... ... Cirrhosis of Liver ... ... ... ... ... 3 4 4 2 ... ... 13 3 Jaundice and other Diseases of Liver 2 ... ... ... 1 1 3 1 3 1 ... 12 1 Other Diseases of Digestive System ... ... ... ... ... ... ... ... ... 1 ... 1 ... 6.—Disbases of Lymphatic System. e.g., of Lymphatics and of Spleen) ... ... ... ... ... ... ... ... ... ... ... ... ... 7.—Diseases op Gland-like Organs of Uncertain Use. (e.g., Bronchocele, Addison's Disease) ... ... ... ... ... ... ... 1 ... ... ... 1 ... 8.—Diseases op Urinary System. Nephritis 1 ... 1 ... ... 1 ... 1 ... ... ... 4 ... Bright'g Disease, Albuminuria ... ... ... ... 2 3 3 5 4 1 ... 20 2 Disease of Bladder or of Prostate ... ... ... ... ... ... 1 1 2 2 1 7 ... Other Diseases of the Urinary System ... ... ... ... ... ... ... ... 1 ... ... 1 ... 9.—Diseases oi Reproductive System. A. Of Orgam of Generation. Male Organs ... ... ... ... ... ... ... ... ... ... ... ... ... Female Organs ... ... ... ... ... ... ... ... ... ... ... ... ... B. Of Parturition. Abortion, Miscarriage ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Convulsions ... ... ... ... ... ... ... ... ... ... ... ... ... Placenta prævia, Flooding ... ... ... ... ... ... ... ... ... ... ... ... ... Other Accidents of Child-Birth ... ... ... ... ... ... ... ... ... ... ... ... ... 10.—Diseases of Bones and Joints. Caries, Necrosis ... ... ... l 1 ... 1 ... ... ... ... 3 ... Arthritis, Ostitis, Periostitis ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of Bones and Joints ... ... ... ... ... ... ... ... ... ... ... ... ... 11.—Diseases op Integumentary System. Carbuncle, Phlegmon ... ... ... ... ... ... ... ... 1 ... ... 1 ... Other Diseases of Integumentary System ... ... ... ... ... ... ... 1 ... ... ... 1 1 121 Table III.—Whole Parish.—Females (continued). Cause of Death. AGES. 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 & upwards. Totals. 55 to 60 LOCAL DISEASES.—Continued. 5.—Diseases of the Digestive System. (Continued.) Peritonitis ... ... 2 1 ... 2 1 1 1 ... ... 8 ... Ascites ... ... ... ... ... ... ... ... ... ... ... ... ... Cirrhosis of Liver ... ... ... ... ... 2 1 2 1 ... ... 6 ... Jaundice and other Diseases of Liver ... ... 1 ... ... 1 ... 6 4 2 ... 14 3 Other Diseases of Digestive System ... ... ... ... ... ... ... ... ... ... ... ... ... 6.—Diseases of Lymphatic System. (e.g., of Lymphatics and of Spleen) ... ... ... ... 1 ... ... ... ... ... ... 1 ... 1.—Diseases of Gland-like Organs of Uncertain Use. (e.g., Bronchocele, Addison's Disease) ... ... ... ... ... ... 1 1 ... ... ... 2 ... 8.—Diseases of Urinary System. Nephritis 2 1 ... ... 1 ... ... 1 ... ... ... 5 1 Blight's Disease, Albuminuria ... ... ... ... ... 1 4 3 4 2 1 15 2 Disease of Bladder or of Prostate ... ... ... ... ... ... ... ... 1 ... ... 1 ... Other Diseases of the Urinary System ... ... ... ... ... ... ... ... 1 1 ... 2 ... 9.—Diseases of Kepboductive System. A. Of Organs of Generation. Male Organs ... ... ... ... ... ... ... ... ... ... ... ... ... Female Organs ... ... ... 1 3 1 1 1 ... ... ... 7 1 B. Of Parturition. Abortion, Miscarriage ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Convulsions ... ... ... 1 ... ... ... ... ... ... ... 1 ... Placenta prævia, Flooding ... ... ... 1 1 1 ... ... ... ... ... 3 ... Other Accidents of Child-Birth ... ... ... ... 6 2 ... ... ... ... ... 8 ... 10.—Diseases of Bones and Joints. Caries, Necrosis ... ... ... 1 1 ... ... ... ... ... ... 2 ... Arthritis, Ostitis, Periostitis ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of Bones and Joints ... ... ... ... ... ... ... ... ... ... ... ... ... 11.—Diseases of Integumentary System. Carbuncle, Phlegmon ... ... ... ... ... ... ... ... ... ... ... 1 ... Other Diseases of Integumentary System ... ... ... ... ... ... 1 ... ... ... ... 1 ... 122 Table III.—Whole Parish.—Males (continued). Cause of Death. AGES. 0 to 1 1 to 5 5 to 15 15 to 25 26 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 & upwards. Totals. 55 to 60 VII.—DEATHS FROM VIOLENCE. 1.—Accident or Negligence. Fractures and Contusions ... 2 3 4 3 4 4 2 1 ... ... 23 1 Gunshot Wounds ... ... ... ... ... ... ... ... ... ... ... ... ... Cut, Stab ... ... ... ... ... ... 1 ... ... ... ... 1 ... Burn, Scald ... 2 1 ... ... ... ... ... 1 ... ... 4 ... Poison ... ... ... ... ... 1 ... ... 1 ... ... 2 ... Drowning ... ... 3 ... 1 ... ... ... ... ... ... 4 ... Suffocation 5 ... ... ... ... ... 1 1 ... ... ... 7 ... Otherwise ... ... ... ... ... ... ... ... ... ... ... ... ... 2.—Homicide. Manslaughter ... ... ... ... ... ... ... ... ... ... ... ... ... Murder ... ... ... ... ... ... ... ... ... ... ... ... ... 3.—Suicide. Gunshot Wounds ... ... ... 1 1 ... 2 ... ... ... ... 4 1 Cut, Stab ... ... ... ... ... 1 ... ... ... ... ... 1 ... Poison ... ... ... 2 ... 1 ... ... ... ... ... 3 ... Drowning ... ... ... ... ... 1 ... ... ... ... ... 1 ... Hanging ... ... ... ... ... ... ... ... ... ... ... ... ... Otherwise ... ... ... ... ... ... ... ... ... ... ... ... ... 4.—Execution. Hanging ... ... ... ... ... ... ... ... ... ... ... ... ... VIII.—DEATHS FROM ILL-DEFINED AND NOT SPECIFIED CAUSES Dropsy ... ... ... ... ... ... ... ... ... ... ... ... ... Debility, Atrophy, Inanition 22 2 ... ... ... ... ... ... ... ... ... 24 ... Mortification ... ... ... ... ... ... ... ... ... ... ... ... ... Tumour ... ... ... ... ... ... ... ... ... ... ... ... ... Abscess ... ... ... ... ... ... ... ... ... ... ... ... ... Hæmorrhage ... ... ... ... ... 1 ... ... ... ... ... 2 ... Sudden Death (cause not ascertained) 1 ... ... ... ... ... ... ... ... ... ... 1 ... Causes not Specified or Ill-defined ... ... ... ... 1 ... ... ... ... 1 ... 2 ... Not Certified 1 ... ... ... ... ... ... ... ... ... ... 1 ... 123 Table III.—Whole Parish.—Females (continued). Cause of Death. ages. 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 & upwards. Totals. 55 to 60 VII-DEATHS FROM VIOLENCE. 1.—Accident or Negligence. Fractures and Contusions 3 1 2 ... 1 ... ... 3 1 2 1 14 ... Gunshot Wounds ... ... ... ... ... ... ... ... ... ... ... ... ... Cut, Stab ... ... ... ... ... ... ... ... ... ... ... ... Burn, Scald ... 1 ... ... ... ... ... ... 1 ... ... 2 ... Poison ... ... ... ... ... ... ... ... ... ... ... ... ... Drowning ... ... ... 1 ... ... ... ... ... ... ... 1 ... Suffocation 5 ... ... ... ... ... ... ... ... ... ... 5 ... Otherwise ... ... ... ... ... ... ... ... ... ... ... ... ... 2.—Homicide. Manslaughter ... ... ... ... ... ... ... ... ... ... ... ... ... Murder ... ... ... ... ... ... ... ... ... ... ... ... ... 3.—Suicide. Gunshot Wounds ... ... ... ... ... ... ... ... ... ... ... ... ... Cut, Stab ... ... ... ... 1 ... ... ... ... ... ... 1 ... Poison ... ... ... ... 1 1 ... ... ... ... ... 2 ... Drowning ... ... ... ... ... ... ... ... ... ... ... ... ... Hanging ... ... ... ... ... 1 2 ... ... ... ... 3 ... Otherwise ... ... ... ... ... ... ... ... ... ... ... ... ... 4.—Execution. Hanging ... ... ... ... ... ... ... ... ... ... ... ... ... VIII.—DEATHS FROM ILL-DEFINED AND NOT SPECIFIED CAUSES. Dropsy ... ... ... ... ... ... ... 1 ... ... ... 1 ... Debility, Atrophy, Inanition 16 2 ... ... ... ... 1 ... ... ... ... 19 ... Mortification ... ... ... ... ... ... ... ... ... ... ... ... ... Tumour ... ... ... ... ... ... 1 ... ... ... ... 1 ... Abscess ... ... ... ... ... ... ... ... ... ... ... ... ... Hæmorrhage ... ... ... ... ... ... ... ... ... ... ... ... ... Sudden Death (cause not ascertained) ... ... ... ... ... ... ... ... ... ... ... ... ... Causes not Specified or Ill-defined ... ... ... ... ... ... ... ... ... ... ... ... ... Not Notified 1 1 ... ... ... ... ... ... ... ... ... 2 ... 124 TABLE IV. Showing the Number of Deaths at all ages in 1894, from certain groups of Diseases, and proportions to 1,000 of Population, and to 1,000 Deaths from all causes; also the Number of Deaths of Infants under one year of age from other groups of Diseases, and proportions to 1,000 Births and to 1,000 Deaths from all causes under one year. Division I. (all ages). Total Deaths. Death-rate per 1,000 of Population, at all ages. Deaths per 1,000 of Total Deaths, at all ages. 1. Principal Zymotic Diseases 286 2.35 156.19 2. Pulmonary Disease 316 2.60 172.58 3. Principal Tubercular Diseases 183 1.50 99.94 Division II. (Infants under One Year). Total Deaths. Deaths per 1,000 of Births. Deaths per 1,000 of Total Deaths under One Year. 4. Wasting Diseases 104 36.69 270.12 5. Convulsive Diseases 42 14.84 109.09 NOTICE. 1. Includes Smallpox, Measles, Scarlet Fever, Diphtheria, Whooping Cough, Typhus, Enteric (or Typhoid), and Simple Continued Fevers, and Diarrhcea. 72 of the deaths occurred in Hospitals situated beyond the limits of the District. 3. Includes Phthisis, Scrofula, Tuberculosis, Rickets, and Tabes. 4. Includes Marasmus, Atrophy, Debility, Want of Breast Milk, and ture Birth. 5. Includes Hydrocephalus, Infantile Meningitis, Convulsions, and Teething. SET TABLE V. Table showing the Number of Deaths from the principal Zymotic Diseases in the Ten Years 1884 to 1893, and in the Year 1894. DISEASE. 1884.* 1885. 1886. 1887. 1888. 1889. 1890. 1891. 1892. 1893. Annual Averages, 1884—93. Total Deaths in 1894. Uncorrected. Corrected. Smallpox ... 11 ... ... 1 ... ... ... ... 4 1.6 1.7 3 Measles 31 63 66 33 66 11 77 7 81 32 46.7 49.3 66 Scarlet Fever 20 8 11 35 14 8 6 7 17 28 15.4 16.2 13 Diphtheria 28 25 28 27 75 39 45 27 32 69 39.5 41.7 92 Whooping Cough 48 59 55 19 74 26 82 67 29 60 51.9 54.8 44 Fever. Typhus ... 1 ... ... ... ... ... ... ... ... 0.1 0.1 ... Enteric 16 17 15 10 15 16 10 17 7 19 14.2 14.9 23 Simple Continued 1 3 1 ... ... ... 1 ... ... ... 0.6 0.6 ... Diarrhœa 64 65 92 63 38 63 62 76 82 81 68.6 72.4 45 Totals. Paddington 208 252 268 187 283 163 283 201 248 293 238.6 251.9 286 London 13,629 11,261 11,121 ' 12,684 10,803 9,709 12,279 9,675 11,983 13,223 11,636.7 12,148.7 11,544 England & Wales 71,762 57,726 62,859 64,676 50,684 61,027 59,698 53,221 58,824 84,433 62,491. 0 66,240.4 52,765 * Deaths of Parishioners in outlying Institutions not included in the figureB for this year. 126 TABLE VI. Report of the Works of the Sanitary Department during the Year 1894. No. of Complaints received. Inspections of Dwelling Houses. Houses Let in Lodgings. Sanitary Worka completed In Dwelling Houses. To Regulate Keeping of Animals. Trade Supervision. Foods. Canal Boats. Drainage, Ac. Water Supply. Dust Receptacles. Miscellaneous. “House-to-House.” On Complaint or after illness. Cellar Dwellings. Re-inspections of all kinds. Houses placed on Register. Registered Houses Inspected. Entire Reconstruction. Drains trapped and (or) ventilated. Waste-pipes disconnected. Rain-water-pipes disconnected. W.C. New provided, repaired, Ac. Soil-pipes ventilated. Service Separated. Supplies Reinstated. Cisterns New provided. Cisterns cleansed, repaired, &c. Cisterns overflow disconnected. New provided. Repaired, &c. Houses cleansed. Cases of overcrowding abated. Cellar-dwellings closed. j Yards and Areas Paved and Drained. Manure Receptacles Reconstructed, Ac. Accumulations Removed. Improperly kept Removed. j Slaughterhouses. Cowhouses. Bakehouses. Offensive Trades. Seizure of Unsound Food. Samples taken for Analysis. Registered. Inspected. Quarters. 1 332 .. 603 .. 2251 .. .. 71 92 27 30 58 20 34 17 .. 13 .. 6 3 51 6 .. 9 .. 15 2 8 3 17 .. .. 107 .. 25 2 426 .. 658 1 2039 .. .. 119 88 59 70 68 44 32 18 2 6 .. 1 6 25 23 1 11 3 16 2 2 1 30 .. .. 105 .. 4 3 295 .. 621 1 2150 .. .. 125 32 8 17 31 19 22 3 3 2 .. 2 .. 6 5 .. 2 .. 3 .. .. .. .. 1 1 80 .. 26 4 208 353 714 .. 2191 .. .. 97 26 6 7 32 12 14 3 .. 2 .. 2 .. 3 3 .. 2 26 .. .. 10 3 74 .. .. 41 2 44 Year 1261 353 2596 2 8631 .. .. 112 238 100 124 189 95 102 41 5 23 .. 11 9 85 37 1 24 29 34 4 20 7 121 1 1 333 2 99 127 TABLE VII. Meteorology for 1894, as observed at Greenwich. Compiled from the Registrar-General's Weekly Returns. Quarters. Year. 1 2 3 4 Means. Totals. Barometer.—Mean 29.798 29.768 29.805 29.815 29.796 — Total Oscillation 24.59 13.2 12.23 23.11 — 73.05 Thermometer—Mean 41.2 53.2 55.5 46.7 49.1 — Absolute Maximum 68.0 82.1 86.0 64.9 86.0 | Absolute Headings ,, Minimum 12.8 32.3 33.3 30.3 12.8 Mean Daily Range 12.9 19.4 16.5 10.4 14.8 — Sunshine.—Hours recorded . 237.6 386.7 308.3 119.0 1,051.6 “Possible” Record 911.7 1,391.5 1,311.2 831.8 — 4,446.2 Percent. of “Possible” recorded 26.6 27.7 23.5 14.3 — 23.6 No. of days of record 62 83 72 51 — 268 Humidity.—Mean 82 76 81 86 81 — Rainfall, &o.—Total 5.38 4.57 7.56 8.93 26.44 No. of days of fall 46 43 53 52 — 194 „ „ Snow 5 — — 5 „ with Fog 18 2 15 20 — 55 „ „ Thunder — 6 10 3 — 19 „ „ Lightning — — 4 5 — 9 „ „ Hail 2 4 1 — — 7 Hoar frost observed 16 2 — 5 — 23 Wind.—Mean direction S.W. S.W. S.W.& N.E. S.W. & N.E. s.w. Mean Hourly Velocity 15.4 11.4 10.3 12.1 12.3 — No. of observations of calm 6 ? ? 18 — ? 128 Extract from Return of Registered Common Lodging Houses within the Jurisdiction of the London County Council. Registered No. Name and Residence of Keeper. Situation of Common Lodging House. Authorized No. of Lodgers. Particulars of Inspection as to Fitness. Date when Registered. Name. No. of House. Street or Place. Parish. No. of House. Street or Place. Sanitary District. Approved or not. Date of Approval. 6130 23 Oct., 1894 Frank Stevens 48 Cirencester-st. Paddington 46 Cirencester-at. Paddington 21 Approved 18 Oct., 1894 5958 19 Oct., 1888 Raisbeck Chapman 212 Harrow-road ” 357 Edgware-road ” 34 ” 8 Oct., 1888 4384 9 Nov., 1888 Enoch Levell 4 Carlton-bridge ” 13 Kensal-road ” 11 ” 29 Oct., 1888 4271 30 June, 1871 James Buddry 2 &3 Charles-mews ” 2 & 3 Charles-mews ” 7 ” 23 June, 1871 129 BAKE-HOUSES. NORTH. 62 Alfred Road 59a Femhead Road 27 Kensal Road 94 Bishop's Road 75 „ „ 37 Kilbum Park Road 8 Bristol Gardens 14 Formosa Street 68 Ledbury Road 4 Carlton Bridge 72 Hall Place 227 Maida Vale 60 Carlton Vale 29 Harrow Road 2 Mozart Street 23 Chichester Street 90 „ „ 3 Norfolk Road 1 Chippenham Road 143 „ „ 24 Porchester Road 41 „ „ 241 „ „ 10 Richmond Road 99 „ „ 265 „ „ 76 102 Church Street 292 „ „ 57 Shirland Road 113 Cirencester Street 303 „ „ 125 „ „ 52 Clarendon Street 330 „ „ 195 „ „ 67 Cornwall Road 365 „ „ 41 Tavistock Crescent 319 Edgware Road 436 „ „ 117 Walterton Road 349 „ „ 500 „ „ 56 Westbourne Grove 377 „ „ 534 „ „ 23 Westbourne Terrace 401 „ „ 560 „ „ North 55 Elgin Avenue 24 Hereford Road 37 „ „ 237 „ „ 19 Kensal Road 20 Woodchester Street SOUTH. 47 Cambridge Street 189 Edgware Road 72 Princes Square 57 „ „ 9 London Street 80 Queen's Road 17-19 Chilworth Street 67 Moscow Road 157 „ „ 32 „ „ 7 Praed Street 3 Spring Street 46 Craven Road 53 „ „ 91 Star Street 16 Craven Terrace 86 „ „ SLAUGHTER-HOUSE S. NORTH. Wm. Spink 14 Celbridge Mews George James Ariss 275 Edgware Road Joseph Hall Hagger Hero Place, Edgware Road Alfred Stanbridge Ginger Portsdown Mews Henry Anness 18 Chippenham Mews Wm. J. Sack Jonson's Mews Lewis Eleazor White 125 Harrow Road John Joseph Cridlan Bishop's Mews SOUTH. Frank Pain 15 South wick Mews Henry Thomas Matthews 6 Upper Brook Mews COW-HOUSES. NORTH. John Welford & Sons 97 Elgin Avenue John Smith 7-8 Chichester Mews SOUTH. Jane Spring 39 Star Street 130 ABSTRACT OF THE QUARTERLY REPORTS OF THE PUBLIC ANALYST, For the Year ending March 25th, 1895. The total number of samples of food analyzed was 371, consisting of Milk 203 samples, Butter 69, Groceries 50, Lard 31, Bread and Flours 10, and Spirits 8. Of all these, only 15 samples of Milk, 2 of Butter, and 2 of the Groceries, were found to be adulterated. This shows a diminution of adulteration in this Pairsh as compared with last year; this year only 5 per cent, of the articles sold to the Inspector proved to be adulterated, last year the percentage was 15. Milk continues, as in former years, to be the most adulterated article, per cent, of the samples proving to be either watered or skimmed. This is, however, much below the general average for London which is 25 per cent. The extent of adulteration ranged from the addition of from 5 to 20 per cent. of water, and the abstraction of from 15 to 48 per cent. of cream. 131 The street dealers on Sundays were found to be the most frequent offenders, selling a large amount of water for the poorer classes to make “milk puddings” with. Very numerous samples taken at the railway stations showed that the country farmers were, many of them, by no means “rustic innocents.” Butter, owing to the large importations from our colonies, has been plenitful and cheap, hence it has been comparatively little adulterated; only 3 per cent, of the samples contained Margarine. The average proportion of Margarine present was 90 per cent. Groceries generally, were very free from adulteration, 4 per cent, of the samples only being adulterated; these samples were, all of them, however, samples of Coffee, to which from 50 to 70 per cent, of Chicory had been added. Cereals. It is very satisfactory to find these to be in all cases absolutely pure. Spirits. Only 8 samples of these were purchased; they were all found to be up to the legal standard, and free from adulteration. Lard. Of the 31 samples, none were found adulterated, either with Cotton-seed oil or with Beef fat. 132 The total amount for fines ordered to be paid into the Yestry's account was £23. Paddington, with its 5 per cent, of adulterated samples, compares well with the Metropolis, with its 17 per cent, of articles adulterated. ALFRED W. STOKES, F.C.S., F.I.C., Public Analyst. May, 1895. TABULATED LIST OF ARTICLES ANALYZED. Articles analysed. Total number. Number adulterated. Milk 203 15 Butter 69 2 Lard 31 0 Cheese 1 0 Coffee 28 2 Tea 5 0 Spirits 8 0 Oatmeal 6 0 Arrowroot 4 0 Ginger 4 0 Mustard 3 0 Pepper 3 0 Vinegar 3 0 Salad oil 3 0 371 19