Borough of Paddington. REPORT on VITAL STATISTICS and SANITARY WORK FOR THE YEAR 1898, by REGINALD DUDFIELD, M.A., M.B..D.P.H., Medical Officer of Health. Morton & Burt, Printers, 187 Edgware Road, W. Borough of Paddington. RE PORT on VITAL STATISTICS and SANITARY WORK FOR THE YEAR 1895, REGINALD DUDFIELD, M.A., M.B..D.P.H., Medical Officer of Health. CONTENTS. Page Page Population 7 Notifications 18 Density & Housing of InDeaths & Death-rates 19 habitants 9 Water Supply 109 Births & Birth-rates 13 Administrative Work, &c. 117 Vaccination 16 APPENDICES. Appendix A. Appendix B. Tables of Births,Deaths.&c. 138 Note on Factory & Work- Lists of Bakehouses shops Act, 1895 158 „ Cow-sheds & Dairies 155 „ Building Act, 1894 166 „ Slaughter-houses Summary of Analytical Work in 1895, by the Public Analyst 170 ABSTRACTS. Report on “Return” Cases, Metropolitan Asylums Board 40 „ Metropolitan Water Supply, by Prof. Frankland, F.R.S., &c 109 SPECIAL SUBJECTS. Age-group Death-rates 52 Causes of Death 57 Combined Drains 120 Condensed Milks, “starvation” brands of 96 Food Analysis, Legal Proceedings after 134 Hospital Accommodation, claims to 32 „ „ Conference re (St. Marylebone) 33 Ice-creams, manufacture of 127 „ micro-organisms in 129 Illegitimates, births of 15 „ deaths of 101 Infantile Diarrhœa, causes of 92 „ Mortality, increase in 56, 90 Infectious Diseases, amendments for checking 47 „ „ Overcrowding and 25 „ „ removal of cases of 35 Meteorology, general 103 „ in relation to Infantile Diarrhœa 94 “Return” Cases of Scarlet Fever 41 Special Streets, Deaths in 102 „ „ Infectious Disease in 27 „ „ Results of enumerating in 10 Tuberculosis, prevention and spread of 72 Water Supply, purification by sunlight 113 „ „ insufficiency of 124 TO THE CHAIRMAN AND MEMBERS OF THE SANITARY COMMITTEE OF THE VESTRY OF PADDINGTON. Gentlemen, I have the honour to present to you my Second Annual Report dealing with the Vital Statistics, &c., of the Parish for the year 1895. 1 would ask that your special attention may be given to the paragraphs dealing with the streets, the inhabitants whereof I caused to be enumerated at the close of 1894, and to the information as to the housing of families afflicted with infectious disease during the year. Taken together, the two inquiries indicate that much good would ensue from more strenuons efforts to control the overcrowding which unfortunately exists in certain parts of the Parish. It will be my duty to give attention to the subject during the current year. The subject of checking the sale of “starvation” brands of condensed skim milks is a national one, to which the attention of Parliament should be directed. It is not to be expected that infants brought up in a rough and ready manner, as only too many are, should survive the risks of such nurture when they are crippled by a lack of nourishment of which their parents are not cognisant. The regulation of the manufacture and sale of ice-cream (and other food-stuffs) will be apparent when the paragraphs dealing with these subjects have been read. Factory and Workshop legislation may be said to be “marking time.” It is probable that when the promised code is introduced a very considerable re-arrangement of the duties now shared between the Inspectors of the Home Office and those of the Local Authorities will be made. The appointment of a physician to the office of Chief Inspector of Factories cannot fail to have considerable influence on future legislation. I venture to hope that in my next Annual Report 1 shall be able to record the commencement of the erection of a disinfecting station, to be under the immediate control of the Department. In conclusion, I desire to thank the Committee and Vestry for their cordial co-operation in the carrying out of the duties of my office, and to express my satisfaction with the manner in which the Officers of the Department have discharged their respective duties. I have the honour to be, Gentlemen, Your most obedient servant, REGINALD DUDFIELD, m.a., m.b., d.p.h., Medical Officer of Health. Vestry Hall, Harrow Road, London, W. June, 1896. POPULATION. The population of the Parish was estimated to be, at the middle of the year 1895, 122,750 persons, of whom 90,577 were residents of the Sub-District of St. Mary, or North Paddington, and 32,173 of St. John, or South Paddington.* The estimated population has been obtained by the method given in the Report for 1894. A census, to the extent of a bare enumeration of the numbers of each sex, is to be held in 1896. The total of 122,750 persons is made up of 50,795 males, and 71,955 females. The estimates of the numbers living in the various age-groups given in Table 1, have been calculated on the assumption that the proportions for each group were the same in 1895 as at the Census of 1891. Table 1 also gives the sex and age-constitution of the population of London, arrived at in the same way. The sex-age "correction factor" for Paddington is 1'08070. * The dividing line between the two sub-districts begins at the centre of Praed Street, where it joins Edgware Road, and continues down the centre of the canal basin to Bishop's Road bridge, thence down the centre of Bishop's Road and Westbourne Grove, to the western boundary of the Parish. 8 TABLE 1. Age-constitution of populations at middle of 1895, Paddington and Sub-Districts, and London. Age Groups. Paddington. St. Mary. St. John. London. PERSONS. All ages 122,750 90,577 32,173 4,392,346 0-1 2,851 2,214 637 113,473 1-5 9,812 7,555 2,287 409,995 5-15 21,748 16,525 5,223 907,743 15-25 25,187 18,271 6,916 881,582 25—35 57,247 41,827 15,420 1,905,448 65 and over 5,875 4,185 1,690 174,105 0-5 12,693 9,769 2,924 523,468 5-60 100,788 74,200 26,588 3,587,862 60 and over 9,269 6,608 2,661 281,016 MALES. All ages 50,795 39,333 11,462 2,076,262 0-1 1,269 1,087 182 56,266 1-5 4,480 3,736 744 204,095 5-15 9,839 8,044 1,795 450,548 15-25 10,092 7,521 2,571 408,406 25-65 23,149 17,544 5,605 888,224 65 and over 1,966 1,401 565 68,723 0-5 5,749 4,823 926 260,361 5-60 41,837 32,218 9,619 1,700,253 60 and over 3,209 2,292 917 115,618 FEMALES. All ages 71,955 51,244 20,711 2,316,084 0-1 1,582 1,127 455 57,207 1-5 5,362 3,819 1,543 205,900 5-15 11,909 8,481 3,428 457,195 15-25 15,095 10,750 4,345 473,176 25-65 34,098 24,283 9,815 1,017,224 65 and over 3,909 2,784 1,125 105,382 0-5 6,944 4,946 1,998 263,107 5-60 58,951 41,982 16,969 1,887,609 60 and over 6,060 4,316 1,744 165,368 At the beginning of the year, the Parish was divided into five districts for sanitary supervision. The populations of these districts are at present unknown, and on this occasion, therefore, no statistics will be given in reference to these districts. When the enumeration results are published, an 9 endeavour will be made to obtain the populations of the sanitary districts. DENSITY OF POPULATION. At the date of the last census there were 95.1 persons to the acre in the whole Parish—105.8 in the Sub-District of St. Mary, and 75.8 in that of St. John. At the middle of 1895 these figures were 99.0, 116.4. and 72.4 respectively. TABLE 2. Whole Parish. St. Mary. St. John. Census Returns, 1891. Area in acres (less water) 1,239 795 444 Inhabited Houses 14,473 9,420 5,053 Houses per acre 11.6 11.8 11.3 Persons enumerated 117,846 84,159 33,687 Persons per acre 95.1 105.8 75.8 Persons per House 8.1 8.9 6.6 On Estimated Population of each Year. Persons per acre, 1892 96.2 108.3 74.6 ,, „ 1893 97.2 110.3 73.8 „ 1894 98.0 112.5 73.3 „ ,, 1895 99.0 116.4 72.4 HOUSING OF THE POPULATION. In the whole Parish, the average number of individuals per house was, at the date of the last census, 8.1. In North Paddington there were 8.9 persons per house, and in South, 6.6. Of the whole population of the Parish, 16.82 per cent, lived under conditions that constituted overcrowding, as measured 10 by the Registrar-General, i.e., with more than 2 persons per room in tenements of four rooms or less. In North Paddington the percentage of overcrowding was 2076, and in South, 6.97. At the close of 1894 and the beginning of 1895, the Inspectors were instructed to visit certain streets, and make house-to-house inquiries as to the number of inhabitants and their house accommodation. The streets visited were chosen on account of the prevalence of infectious disease to, what appeared to be, an unduly large amount. The results of the enumerations (if they can be so called) are given in Tables 3 and 4. In Table 3 will be found the numbers of rooms and of houses in each street, in occupation; the total number of persons is shown in column 5, and the numbers of persons under and above 10 years of age, in columns 3 and 4 respectively. Of the streets visited, the average number of persons per house was lowest in Andover Place, 6.0 per house, whilst the highest, 17.0, was found in Clarendon Street. All the streets mentioned in Table 3 are in North Paddington, in which the average number of persons per house was at the date of the last Census 8.9—an average which should be borne in mind in comparing the figures in the Table. With regard to the age-constitution of the populations of the streets, the percentage of children under 10 years of age varied from 30.8 in Woodchester Street, to 40.2 in John Street, the percentage for the whole of North Paddington being 20.2. Having regard to the 11 predisposition which young children manifest to the infectious fevers, the variations in these proportions should, ceteris paribus, influence the incidence of such diseases. TABLE 3. No. of Occupied Inhabitants. Persons per Percentage of Population under 10 Years. Houses. Rooms. Under 10. Over 10. Persons. House. Room. Andover Place 19 87 46 99 145 6.0 1.6 31.7 Carlton Mews, M. V. 17 64 53 80 133 7.8 2.0 39.8 Church Place 20 124 117 157 274 13.7 2.2 42.7 Cirencester Street 94 702 452 959 1,411 15.0 2.0 32.0 Clarendon Street 114 880 603 1,338 1,941 17.0 2.2 31.0 Dudley Street 29 120 99 195 294 10.1 2.4 33.6 John Street 13 54 33 49 82 6.3 1.5 40.2 Kent's Place 6 40 37 59 96 16.0 3.8 38.5 Waverley Road 76 521 286 597 883 11.6 1.6 32.3 Welling's Place 14 72 48 89 137 9.7 1.9 35.0 Woodchester Street 94 788 477 1,067 1,544 16.4 1.9 30.8 At the date of the last Census there were in North Paddington 14,328 tenements of four rooms or less, containing 49,030 inhabitants. Of these tenements 3,086 were occupied by more than two persons per room, neglecting the question of the ages of the occupants, and were therefore classed as overcrowded, the inhabitants so overcrowded numbering 19,471— equal to 20.76 per cent, of the total population of the district. In column 16 of Table 4 will be found the percentages of individuals similarly overcrowded to total populat ion of each street, the numbers varying from 12.1 per cent. in John Street, to 71.4 in Dudley Street. This state of overcrowding, theoretical though the standard be, is another factor having a considerable influence on the incidence of disease. 12 TABLE 4. 1 Room. 2 Rooms. 3 Rooms 4 Rooms. Total tenements of 4 rooms or less. Tenements of 5 rooms or more. No. of tenements. No. of inhabitants. % of inhabitants overcrowded. No. of tenements. No. of inhabitants. % of inhabitants overcrowded. No of tenements. No. of inhabitants. % of inhabitants overcrowded. No. of tenements. No. of inhabitants. % of inhabitants overcrowded. No. of tenements. No. of inhabitants. % of inhabitants overcrowded. No. of tenements. No. of inhabitants. Andover Place 15 30 46.8 9 32 56.2 8 42 40.4 5 23 — 37 127 40.8 2 18 Carlton Mews, M.V. 9 19 68.4 17 82 70.7 3 14 — 3 18 55.5 32 133 60.8 — — Church Place 59 143 63.6 20 98 74.4 1 5 — — — — 80 246 59.8 4 28 Cirencester Street 126 305 57.7 158 717 72.9 36 181 42.5 16 108 37.0 336 1,311 62.6 15 100 Clarendon Street 239 629 67.8 183 867 69.3 64 351 46.6 11 49 20.4 497 1,896 63.3 7 45 Dudley Street 46 139 75.5 20 89 78.6 2 15 100.0 7 51 39.2 75 294 71.4 — — John Street 1 2 — 11 40 25.0 2 10 - 5 26 — 19 78 12.1 1 4 Kent's Place 14 40 67.5 9 45 75.5 1 6 — 1 5 — 25 96 63.5 — — Waverley Road 60 120 50.8 113 430 45.5 34 161 21.7 17 105 19.0 224 816 38.2 9 67 Welling's Place 16 35 68.5 21 77 54.5 3 18 44.4 1 7 — 41 137 54.0 — — Wood Chester Street 130 253 41.8 204 878 62.7 55 294 41.4 11 64 — 400 1,489 50.4 7 55 13 The subject of the incidence of disease and death on the streets included in these Tables will be dealt with later on—see pages 27 and 105. BIRTHS. The births registered during the year numbered 2,979 in all, viz., 1,515 of males, and 1,464 of females. The birth-rate for the year was 24.26 per 1,000 persons, compared with one of 23.32 for 1894. The male births were equal to a rate of 12.34 per 1,000 persons, and the female to one of 11.92. The birth-rate for St. Mary's Sub-District was 27.88 per 1,000 of the population of the district, and that for the Sub-District of St. John, 14.07. In 1894 the birth-rate for St. Mary's District was 27.23, and that for the District of St. John 12.62. There was therefore an increase last year in the rates for the whole Parish and the two sub-districts. TABLE 5. Births registered in 1895. Births registered during Paddington. St. Mary. St. John. Males. Females. Total. Males. Females. Total. Males. Females. Total. 1st Quarter 412 379 791 330 323 653 82 66 138 2nd „ 383 361 744 320 312 632 63 49 112 3rd „ 390 379 769 332 321 653 58 58 116 4th „ 330 345 675 287 301 588 43 44 87 Year 1,515 1,464 2,979 1,269 1,257 2,526 246 207 453 Birth Rates* 1895 12.34 11.92 24.26 14.01 13.87 27.88 7.64 6.43 14.07 1894 11.95 11.36 23.32 13.94 13.29 27.23 6.54 6.08 12.62 * Per 1,000 of total population in each district. 14 The births registered in the whole Parish and in its northern half were above the decennial averages (see Table 6). and those registered in the southern half, below. The birth-rates were in every instance below the mean rates for the decennium. The births registered in North Paddington have been exceeded once only, in 1893, when 2,567 births were registered, whilst the total for South Paddington for 1895 is the third lowest recorded in the eleven years 1885-95, the totals for 1893 (444) and 1894 (411) being the only two below it. In London the birth-rate in 1895 was 30*5 per 1,000, 1.3 below the mean rate for the decennium, and in England and Wales, last year's rate (30.3) was 0.9 below the decennial mean rate. TABLE 6. Births and Birth-rates for period 1885-1895. Paddington. St. Mary. St. John. Birth-rates. Regd. Rates. Regd. Rates. Regd. Rates. England and Wales. London. 1895 2,979 24.26 2,526 27.88 453 14.07 30.3 30.5 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 29.5 512 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 1894 2,834 23.3 2,423 27.2 411 12.6 29.6 301 Averages for decennium, 1885-94. 2,916 24.91 2,404 29.54 511 14.43 31.2 31.8 15 Illegitimate Births. By the courtesy of the Registrar-General, the numbers of illegitimate births registered in Paddington since 1884 have been ascertained, no returns of such births having been made by the local Registrars prior to the commencement of last year. The average annual number of such births during the decennium 1885-94 was 150, the total for last year being 125. The mean rate for the decennium was 1'28 per 1,000 of the mean population, the rate for last year being l.l. For every 100 legitimate births registered between 1885 and 1894 (inclusive), there were 5.14 illegitimate, the proportion for last year being 4.19. TABLE 7.—Illegitimate Births. Year. Births Registered. Birth-rate per 1,000 of Population. Illegitimate Births to Legitimate. Legitimate= 100. Population. Births. Illegitimate. 1885 111,957 2,998 165 1.47 5.50 1886 113,198 2,898 155 1.36 5.34 1887 114,462 2,916 181 1.58 6.20 1888 115,749 2,843 149 1.28 5.24 1889 117,060 2,863 134 1.14 4.68 1890 118,736 2,901 160 1.34 5.51 1891 117,838 2,952 145 1.23 4.91 1892 119,260 2,934 142 1.18 4.77 1893 120,480 3,011 126 1.04 4.18 1894 121,500 2,834 148 1.21 5.22 Average for 10 years 116,728 2,915 ' 150 1.28 5.14 1895 122,750 2,979 125 1.01 4.19 16 Of the 125 illegitimate births registered during the year, 66 were of boys, and 59 of girls, 120 of the births (viz., 63 of boys, and 57 of girls) being registered in North Paddington, and 5 (viz., 3 of boys, and 2 of girls) in South Paddington. VACCINATION. The returns of vaccination contained in Table 8 extend from 1881 to the middle of 1895. The percentage of children “not finally accounted for” showed a marked decline in 1894, that year's record (5.5) being the lowest for the fourteen years. The percentage for the first half of 1895 (10.8) was nearly double that for 1894 (5.5). Little importance need, however, be attached to the increase manifested, as it is very likely that when the year's returns are complete there will be only a slight increase, if any. The success attending the work of vaccination in 1894 was undoubtedly largely owing to the epidemic of small-pox in the adjacent Parish of St. Marylebone. As recorded in the Report for 1894, the Guardians of this Parish instituted a house-to-house inquiry for the purpose of looking up unvaccinated children. The Royal Commission on Vaccina'ion is still sitting, but it has been announced that their Report may be expected during the current year. The Commission has been sitting seven years, during which time they have had unexceptional evidence afforded 17 them of the advantages of vaccination, by the experiences of Warrington, Sheffield, and elsewhere.* The 14th of May, 1896, will see the completion of the century since Jenner performed his first vaccination of the human subject. The occasion is to be marked by festivals in Russia, Germany, and the United States, but nothing is announced in this country. TABLE 8. Vaccination returns for years 1881-1894. Year. Births. Successfully vaccinated. Insusceptible of vaccinatiou. Had Small-pox. Died unvaccinated. Vaccination postponed. Remaining (not traced, &c., &c.)* Children not finally accou't'd for (including postpo'ed cases) % 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 2,400 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 2,421 27 ... 265 10 292 10.0 1894 2,853 2,369 24 ... 203 21 136 5.5 January to June, 1895 1,517 1,200 17 ... 135 23 142 10.8 * Gone away, false addresses, “unaccounted for.” * Since the commencement of the autumn of 1895 small-pox has been prevalent in Gloucester, one of the worst vaccinated towns in the Kingdom, and with the commencement of the current year the disease assumed the proportions of an epidemic likely to decimate the population. Needless to say that the authorities have hastened to undo a fraction of the harm they have done in refusing to enforce the Vaccination laws, and that a large increase of utaff for vaccination has been requisite. 18 NOTIFICATIONS. During the twelve months 847 cases of infectious disease were notified, 50 less than in the preceding year. The sickness-rate, based on the notifications, was 6.89 per 1,000 persons, the rate for 1894 having been 7.38. The cases notified last year were—10 of small-pox, 226 of diphtheria, 104 of erysipelas, 416 of scarlet fever, 70 of enteric fever, 11 of membranous croup, 8 of puerperal fever, and 1 each of cholera, and relapsing fever. Of the 847 cases notified, 717 were reported from the northern half of the Parish, and 130 from the southern. In Table 9 will be found the numbers of each disease reported each quarter from each portion of, and the whole Parish, together with the corresponding rates, calculated on the estimated populations of each portion, the corresponding rates for 1894 being given for the sake of comparison. The first quarter of the year was particularly free from all classes of infectious diseases (the rate for the Parish was only 3.46), the exemption being shared by both halves of the Parish almost equally. At present there is no series of meteorological records available, but it seems fair to think that the exceptionally severe winter of 1894-95 had a good deal to do with the exemption. With the second quarter there commenced an unexpected outbreak of scarlet fever, which taxed the 19 TABLE 9. Cases of sickness notified and Sickness-rates for 1895. Corrected for duplicate notifications only. Paddington. St. Mary. St. John. Quarters Quarters Quarters 1 2 3 4 Yr 1 2 3 4 Yr 1 2 3 4 Yr Smallpox 3 2 4 1 10 3 2 3 1 9 ... ... 1 ... 1 Cholera ... ... 1 ... 1 ... ... ... ... ... ... ... 1 ... 1 Diphtheria 22 64 70 70 226 18 51 64 65 198 4 13 6 5 28 Membr. Croup 2 1 6 2 11 2 1 6 2 11 ... ... ... ... ... Erysipelas 17 24 31 32 104 12 20 29 31 92 5 4 2 1 12 Fevers. Scarlet 45 86 127 158 416 37 62 115 131 345 8 24 12 27 71 Typhus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric 16 12 16 26 70 11 9 12 21 53 5 3 4 5 17 Relapsing ... ... ... 1 1 ... .. ... 1 1 ... ... ... ... ... Continued ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal 1 2 4 1 8 1 2 4 1 8 ... ... ... ... ... Totals 106 191 259 291 847 84 147 233 253 717 22 44 26 38 130 Rates for 1895 3.46 6.24 8.46 9.50 6.89 3.71 6.50 10.31 11.20 7.91 2.74 5.48 3.24 4.73 4.04 „ 1894 7.26 8.22 6.80 7.41 7.38 8.29 9.37 8.07 8.07 8.43 4.43 5.05 3.32 5.30 4.51 20 It appears, therefore, that the Parish was not infected to so great a degree as the Metropolis as a whole. Diphtheria was but little prevalent in the first quarter, and practically equally prevalent in the remaining quarters of the year. In North Paddington the joint sickness-rate from diphtheria and membranous croup was 2.3 per 1,000, in South Paddington 0.8, and in London 2.5. Enteric fever was prevalent to an almost equal degree throughout the four quarters of the year. The rates for this disease were—North and South Paddington 0.5 per 1,000 each, and London 0.8. The total sickness-rate for London was 9.4 per 1,000, 2.5 above the rate for Paddington. The first part of the Table 10 (dealing with Paddington) has been compiled from the local Registers, which during the past year have been examined, indexed, and tabulated from the commencement of notification; and the latter half (dealing with London) is, as regards the years 1890-94, taken from the Annual Report (1894) of the Statistical Committee of the Metropolitan Asylums Board, and, as regards last year, from the sheets published weekly by the Local Government Board. Five complete years having elapsed since the system was introduced, quinquennial averages have been struck for each disease and for the totals. It will be seen that the disturbing influences of epidemic years are not eliminated from these averages. Thus, by 21 TABLE 10.—Comparative Table of Notifications, corrected for duplicates. 1890. 1891. 1892. 1893. 1894. Aver. 1895. PADDINGTON. Smallpox ... 2 3 71 28 20.8 10 Cholera ... ... ... ... ... ... 1 Diphtheria 223 182 170 284 372 246.2 226 Membranous Croup. 1 2 3 10 10 5.2 11 Erysipelas 87 138 115 242 121 140.6 104 Fevers. Scarlet 212 266 539 776 289 416.4 416 Typhus ... ... ... 1 ... .2 ... Enteric 57 68 49 65 70 61.8 70 Relapsing ... ... ... ... ... ... 1 Continued ... 3 1 6 3 3.4 ... Puerperal 5 4 7 18 4 7.6 8 Total 589 665 887 1,473 897 902.2 847 Population, estim't'd 118,736 117,838 119,260 120,48C 121,500 119,564 122,750 Sickness-rates 4.9 5.6 7.4 12.2 7.3 7.5 6.9 LONDON. Smallpox 60 114 423 2,813 1,192 920.4 984 Cholera 25 23 54 86 21 41.8 27 Diphtheria 5,870 5,907 7,781 13,026 10,665 8649.8 10,787 Membranous Croup. 550 505 565 668 535 564.6 451 Erysipelas 4,598 4,764 6,934 9,700 6,080 6415.2 5,667 Fevers. Scarlet 15,330 11,398 27,095 36,901 18,440 21832.8 19,769 Typhus 35 27 20 22 21 25.0 15 Enteric 2,877 3,372 2,465 3,663 3,360 3147.4 3,513 Relapsing 7 39 7 4 2 11.8 3 Continued 237 152 147 205 162 180.6 105 Puerperal 206 221 337 397 253 282.8 236 Total 29,795 26,522 45,828 67,485 40,731 42072.2 41,557 Population 4,180,021 4,221,452 4,263,294 4,306,411 4,319,146 4,264.069 1,392,346 Sickness-rates 7.1 6.2 10.7 15.6 9.3 9.8 9.4 reason of the epidemic of scarlet fever in 1893, the average number of cases of scarlet fever in Paddington appears to be 416, the same as the total recorded last year, which, as already stated, was an exceptional one. In London the average for this disease was 21,833, and last year's total 19,769. It will, therefore, be better simply to call attention to the Table, without entering into a discussion thereon. 22 TABLE 11. Age-groups. MALES. FEMALES. Totals for both Sexes. Sickness-rates per 1,000. Smallpox. Diphtheria. Membr. Croup. Erysipelas. Fevers. Totals. Smallpox. Cholera. Diphtheria. Membr. Cioup. Erysipelas. Fevers. Totals. Scarlet. Enteric. Relapsing. Scarlet. Enteric. Puerperal. 1895. 1894. PADDIN'GTON. 0-1 ... 4 1 2 5 ... ... 12 ... ... ... ... ... 1 ... ... 1 13 4.55 6.26 1-5 ... 33 5 2 60 1 ... 101 ... ... 33 1 1 57 ... ... 92 193 19.60 26.67 6-15 ... 43 ... 4 102 7 ... 156 1 ... 60 4 7 128 2 ... 202 358 16.46 17.22 15-25 5 8 ... 4 14 14 ... 45 1 ... 16 ... 9 20 17 1 64 109 4.32 3.96 25-65 1 13 ... 24 15 13 1 67 2 1 16 ... 38 14 16 7 94 161 2.81 3.08 65 and over ... ... ... 1 ... ... ... 1 ... ... ... ... 12 ... ... ... 12 13 2.21 2.27 All ages 6 101 6 37 196 36 1 382 4 1 125 5 67 220 35 8 465 847 6.89 7.38 ST. MARY. 0-1 ... 4 1 2 5 ... ... 12 ... ... ... ... ... 1 ... ... 1 13 5.87 6.89 1 5 ... 27 5 2 54 1 ... 89 ... ... 31 1 1 50 ... ... 83 172 22.63 29.24 5-15 ... 39 ... 3 88 6 ... 136 1 ... 52 4 6 101 1 ... 165 301 18.21 19.04 15-25 5 8 ... 3 11 9 ... 36 ... ... 15 ... 8 13 12 1 49 85 4.65 3.95 25-65 1 13 ... 23 10 10 1 58 2 ... 9 ... 32 12 14 7 76 134 3.20 3.11 65 and over ... ... ... 1 ... ... ... 1 ... ... ... ... 11 ... ... ... 11 12 2.86 2.43 All ages 6 91 6 34 168 26 1 332 3 ... 107 5 58 177 27 8 385 717 7.91 8.43 ST. JOHN. 0-1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2.63 1-5 ... 6 ... ... 6 ... ... 12 ... ... 2 ... ... 7 ... ... 9 21 9.18 14.29 5-15 ... 4 ... 1 14 1 ... 20 ... ... ... ... 1 27 1 ... 37 57 10.91 9.71 15-25 ... ... ... 1 3 5 ... 9 1 ... 1 ... 1 7 5 ... 15 24 3.47 3.96 25-65 ... ... ... 1 5 3 ... 9 ... 1 7 ... 6 2 2 ... 18 27 1.75 2.99 65 and over ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 0.59 1.87 All ages ... 10 ... 3 28 9 ... 50 1 1 18 ... 9 43 8 ... 80 130 4.04 4.51 23 TABLE 11 A. Sickness-rates (based on notifications) calculated on estimated numbers living in each Age-Group. Corrected for duplicates only. Age-groups. MALES. FEMALES. Smallpox. Diphtheria and Mem. Croup. Erysipelas. Fevers. Totals. Smallpox. Diphtheria and Mem. Croup. Erysipelas. Fevers. Totals. Scarlet. Enteric & Continued. Scarlet. Enteric & Continued Puerperal, PADDINGTON. 0-1 3.9 1.5 3.9 ... 9.4 ... ... ... 0.6 ... ... 0.6 1-5 ... 8.4 0.4 13.3 0.2 22.5 ... 6.3 o.1 10.6 ... ... 17.1 5-5 ... 4.3 0.4 10.3 0.7 15.8 * 5.3 0.5 10.7 0.1 ... 16.9 15-25 0.4 0.7 0.3 1.3 1.3 4.4 * 1.1 0.5 1.3 1.1 * 4.2 25-6£†§ * 0.5 1.0 0.6 0.5 2.8 * 0.4 1.1 0.4 0.4 0.2 2.7 65 & over ... ... 0.5 ... ... 0.5 ... ... 3.0 ... ... ... 3.0 0-5 ... 7.4 0.6 11.3 0.1 19.6 ... 4.8 0.1 8.3 ... ... 13.3 5 & over†§ o.1 1.4 0.7 2.9 0.7 5.9 * 1.5 1.0 2.4 0.5 0.1 5.7 All ages†§ o.1 2.1 0.7 3.8 0.6 7.5 * 1.8 0.9 3.0 0.4 0.1 6.3 „ (1891) 0.2 3.1 1.0 2.6 0.8 7.9 0.2 3.0 0.9 2.1 0.4 * 7.0 ST. MARY. 0-1 ... 4.5 1.8 4.5 ... 11.0 ... ... ... 0.8 ... ... 0.8 1-5 ... 8.5 0.5 14.4 0.2 23.8 ... 8.3 0.2 13.0 ... ... 21.6 5-15 ... 4.8 0.3 10.9 0.7 16.9 0.1 6.6 0.6 11.9 0.1 ... 19.4 15-25 0.6 1.0 0.3 1.4 1.1 4.7 ... 1.3 0.7 1.2 1.1 * 4.1 25-65† * 0.7 1.3 0.5 0.5 3.3 * 0.3 1.3 0.4 0.5 0.2 3.1 65 & over ... ... 0.7 ... ... 0.7 ... ... 3.9 ... ... ... 3.9 0-5 ... 7.6 0.8 12.2 0.2 20.9 ... 6.4 0.2 10.3 ... ... 16.9 5 & over† o.1 1.7 0.8 3.1 0.7 6.6 * 1.7 1.2 2.7 0.5 o.1 6.5 All ages† 0.1 2.4 0.8 4.2 0.6 8.4 * 2.1 1.1 3.4 0.5 o.1 7.5 „ (1894) 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 ... ... ... ... ... ... ... ... ... ... ... ... ... 1-5 ... 8.0 ... 8.0 ... 16.1 ... 1.2 ... 4.5 ... ... 5.8 5-15 ... 2.2 1.1 7.7 1.1 11.1 ... 2.3 0.2 7.8 0.2 ... 10.7 10-25 ... ... 0.3 1.1 1.9 3.5 0.2 0.2 0.2 1.6 1.1 ... 3.4 25-65§ ... ... 0.1 0.8 0.5 1.6 ... 0.7 0.6 0.2 0.2 ... 1.8 65 & over ... ... ... ... ... ... ... ... 0.8 ... ... ... 0.8 0-5 ... 6.4 ... 6.4 ... 12.8 ••• 1.0 ... 3.5 ... ... 4.5 5 & over§ ... 0.3 0.2 2.0 0.8 3.6 * 0.8 0.4 1.9 0.4 ... 3.7 All ages§ ... 0.8 0.2 2.4 0.7 4.3 * 0.8 0.4 2.0 0.3 ... 3.8 „ (1894) * 1.4 0.8 2.3 0.8 5.6 0.1 1.2 0.8 1.1 0.5 * 3.9 * Indicates a rate below 0.1 per 1,000 persons. The total rates in these groups include one case (male) Relapsing Fever from St. Mary'8 District. § The total rates include one case (female) Cholera from St. John's District. 24 In these Tables the cases notified have been distributed among the age-groups used throughout this Report, the sexes and districts being distinguished. It will be seen from Table 11 that the rates for all diseases were lower in South Paddington than in North. In 1894, the only group in the South showing a higher rate was that of "15.25." In the whole Parish the rates for all age-groups, except that of "15.25," were lower last year than in 1894. Table 11a shows a greater incidence of disease on males than on females, even in the case of diphtheria, which is usually said to be a disease to which females are specially prone. The total rates for this disease among males were 2.4 and 0-8 per 1,000 living in North and South Paddington respectively, and among females 2.1 and 0.8. In North Paddington the age-group rates for males were higher than those for females, except at ages 5-15 and 15-25; the rates for the former group being— males 4'8, and females 6'6, and for the latter group, 1.0 and 1.3. In South Paddington higher rates for females prevailed at ages 5.15 (viz., 2.3 f., and 2.2 m.), 15-25 (0.2 f., and 0.0 m.), and 25-65 (0.7 f., and 0.0 m.). With regard to scarlet fever in North Paddington, the group 5-15 alone had a higher rate among females than males; the rates being— 11.9 for females, and 10.9 for males, whilst in South Paddington the groups 5-15 and 15-25 showed the same feature, the rates being—7.7 for males, and 7.8 for females in the former group, and 25 1.6 for females, and 1.1 for males in the latter. At all other ages males suffered more than females. Males appear to be at all ages more prone to enteric fever than females, there being no exception to the rule of higher rates in the former sex. The rates given last year (see Report for 1894, Table 8a, page 35) follow much the same lines as do those in Table 11a above, except that the incidence of diphtheria was rather greater on females than on males. Endeavours will be made during the current year to get out age-group tables for the years previous to 1894, when the incidence of disease, as shown by the notifications, will be more readily apparent. OVERCROWDING AND DISEASE. Attention was called to this subject last year, when certain statistics bearing on it were given in tabular form (see Report for 1894, Table 9, page 37). The figures given in Table 12 below follow the same lines as those in last year's Table. With the single exception of the death-rate at ages of "5 years and upwards" from the Seven Principal Zymotic Diseases, the rates in North Paddington were in excess of those in the southern half of the Parish. In the last two columns of the Table the rates prevailing in St. John's District have been taken as standards of comparison (equal to 100), and the figures given show the proportions which the rates for North Paddington bear to that standard; as examples the following may be quoted:—for every 100 cases of sickness at 26 ages under 5 recorded from South Paddington, there were 264 cases in the North; there died 382 children in North Paddington at ages between 1 and 5 years, for every 100 in South; and for every 100 children dying from zymotic diseases at the same ages in South Paddington, there died 509 in North. Taken as a whole, the contrasts between the two districts were more marked in 1895 than in 1894. Should it be suggested that the fact that the proportion of children under 5 years in St. Mary's District is double that in St. John's, the answer will be that the rates given in the Table are calculated per 1,000 of the children estimated to be living, which eliminates effects of such differences in the proportions. TABLE 12.—Overcrowding Statistics, and Incidence of Disease and Mortalities. St. Mary. St. John. Comparative figures for St. Mary. St. John=100. Persons 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 Persons per acre, 1895 116.4 72.4 160.7 1895. 1895. 1894. Sickness-rate 0-6 years 18.93 7.18 263.6 203.3 „ „ 5 yrs. & upwds. 6.58 3.72 176.8 165.0 Death-rates from all causes 0-1 year 192.41 100.47 191.5 165.7 1-5 years 25.01 6.55 381.8 136.8 5 yrs. & upwds. 13.06 11.39 114.6 110.0 Zymotic death-rates 0-1 year 36.58 14.12 259.0 314.2 1-5 years 8.86 1.74 609.1 199.5 5 yrs. & upwds. 0.39 0.51 76.4 176.1 Death-rates from— Bronchitis 0-5 years 8.08 5.12 157.8 180.0 5 yrs. & over 1.98 1.74 113.6 111.1 Pneumonia 0-5 years 4.40 1.36 323.5 146.6 5 yrs. & over 0.65 0.51 127.4 100.0 27 For the purpose of extending the inquiry on this subject, some of the results of the house-to-house visitation mentioned above (see page 10, ante), have been tabulated, and are here presented in Table 13. The sickness-rates (notifications) have been calculated per 1,000 of the inhabitants of all ages, the numbers of cases in the one year, 1895, being insufficient to admit of a satisfactory division into age-groups. Owing to only one year being dealt with, to the populations of the streets in question being in a station of life much given to frequent change of residence, and to the small numbers dealt with, the results shown require to be received with considerable caution. The Table in question should be read in conjunction with Tables 3 and 4 on pages 11 and 12 of this Report. TABLE 13. Housing of Population. Sickness-rate per 1,000. Persons per house. Persons per room. Percentage of population under 10 years of age. Percentage of inhabitants of tenements of 4 rooms or less overcrowded. Andover Place 6.0 1.6 31.7 40.8 6.8 Carlton Mews, Maida Yale 7.8 2.0 39.8 60.8 7.5 Church Place 13.7 2.2 42.7 59.8 14.5 Cirencester Street 15.0 2.0 32.0 62.6 12.0 Clarendon Street 17.0 2.2 31.0 63.3 10.8 Dudley Street 10.1 2.4 33.6 71.4 3.4 John Street 6.3 1.5 40.2 12.1 ... Kent's Place 16.0 3.8 38.5 63.5 31.2 Waverley Road 11.6 1.6 32.3 38.2 5.6 Welling's Place 9.7 1.9 35.0 54.0 21.8 Woodchester Street 16.4 1.9 30.8 50.4 13.5 28 As already stated, all the streets mentioned are in the northern half of the Parish, where the notification-rate was last year 7.91, which rate was exceeded in six out of the eleven streets. It will be found that in Kent's place, where the highest rate prevailed, the average number of individuals per room was 3.8— the largest on the list; and that the percentage of inhabitants living under overcrowded conditions was 63.5 —the second highest on the list. The proportion of children under 10 years of age in this street was 38.5 - the fourth in order of magnitude. The evidence offered here as to the connection between overcrowding and disease cannot however, be received without very great reservation, as the street itself only contains something like 96 persons. It is interesting to note that all the deaths recorded in the year among the inhabitants of this street took place in public institutions, indicating a very considerable amount of destitution, which would naturally favour the occurrence of disease. It is intended to extend this inquiry, and after a suitable interval it may be possible to arrive at a safe conclusion. The same subject has been looked at from another point of view. From the inquiries made with reference to cases of all the diseases notified, except erysipelas, it has been possible to distribute the cases according to the numbers of individuals in the 29 families in connection with which the cases occurred, and the number of rooms occupied by them. The results of the distribution were tabulated on the plan adopted by the Registrar-General in stating the manner in which the population was housed at the Census. All rates were calculated on the numbers given in the Census returns, i.e., in April, 1891, and the Census standard of overcrowding was adopted. Inasmuch as this standard takes no account of the ages of the inhabitants, it is an unsatisfactory one for dealing with the incidence of infectious disease, but no other is available. On the whole, the results of the inquiries is to confirm the proposition that where overcrowding — even as measured by the RegistrarGeneral's standard—exists, there infectious disease is more prone to occur. The returns of that part of the population living in tenements containing less than five rooms show that the rate for "all diseases" for 1895 was 8.7 for the whole population, 8.5 for that part living in rooms which were not overcrowded, and 9.1 among those in overcrowded rooms. The rate for that part of the population living in five rooms or more was only 3.3. There are certain irregularities in the rates for which it is not easy to account, and for that reason the following Table of the populations, cases, and rates is appended. It is necessary in presenting this Table to 30 TABLE 14. Inhabitants. All diseases. Diphtheria. Scarlet Fever. Cases. Rates. Cases. Rates. Cases. Rates. Tenements of ONE room:— Totals 9,676 51 5.2 17 1.7 22 1.2 With 2 persons or less per room 5,040 14 2.6 4 0.6 1 0.1 „ more than 2 4,636 37 7.9 13 2.8 21 4.5 Tenements of TWO rooms:— Totals 19,589 174 8.8 63 3.2 100 5.1 With 2 persons or less per room 9,992 76 7.6 29 2.9 39 3.9 ,, more than 2 9,597 98 10.2 34 3.5 61 6.3 Tenements of THREE rooms:— Totals 19,009 195 10.2 66 3.4 116 6.1 With 2 persons or less per room 14,817 153 10.3 50 3.3 97 6.7 „ more than 2 4,192 42 10.0 16 3.8 19 4.6 Tenements of FOUR rooms:— Totals 9,824 90 9.1 28 2.8 57 5.8 With 2 persons or less per room 8,429 85 10.0 26 3.0 54 6.4 „ more than 2 1,395 5 3.5 2 1.4 3 2.1 Tenements of FOUR rooms or less :— Totals 58,098 510 8.7 174 2.9 295 5.0 With 2 persons or less per room 38,278 328 8.5 109 2.8 191 4.9 „ more than 2 19,820 182 9.1 65 3.2 104 5.2 In tenements of FIVE rooms or more 59,748 200 3.3 55 0.9 105 1.7 31 emphasize the fact that no account is taken of constitution of the populations, and the fact that children are more prone to contract infectious diseases than adults. Again, the social status of the individuals will have some influence on the occurrence of infectious disease; and lastly, the refusal to accept hospital treatment is likely to lead to further cases in some of the families. It seems fair to assume that in tenements of one or two rooms there will not usually be many children and that any children living in such tenements will for the most part be young, as most married couples of the artizan classes commence life in one or two rooms, moving into larger tenements as the family increases—being, however, in some cases moved to do so by the vigilance of the sanitary authority. In tenements of three or more rooms will be found workers of a higher class, who appreciate the value of cleanliness and will endeavour to protect their children from known sources of infection. Among these however removal to hospital will not be so frequent, which fact tends to minimise the advantages due to care and cleanliness. In other cases the members of the families thus housed will be above the ages especially liable to infectious disease. From these considerations it will be seen that the subject is one of great difficulty, and one which will require a careful comparison between a succession of 32 years. Endeavours will be made to elucidate the effect of the varying proportions of children in the tenements. HOSPITAL ACCOMMODATION. Of the 847 cases of infectious disease notified during the year, 457 were removed to hospital for isolation, equal to 51.5 per cent of all cases. From North Paddington there were removed 380 cases out of 717, equal to 52.9 per cent.; and from South Paddington, 57 out of 130, equal to 43.8 per cent. The cases removed were—10 of small-pox, 474 of scarlet fever, 126 of diphtheria (including 2 of membranous croup), 26 of enteric fever, and 1 of erysipelas. The removals of each disease were equal to the following percentages of notifications, the percentages for 1894 being shown in parentheses— small-pox 100 (92.9), scarlet fever 65.3 (82.3), diphtheria 53.0 (56.2), and enteric fever 37.1 (43.8). From the middle of July onwards to the end of November, there was very great difficulty in securing the necessary accommodation for all classes of disease, which accounts almost entirely for the smaller proportions of the removals to the notifications. In consequence of the difficulty in removing cases of infectious disease experienced throughout the Metropolis, and the refusal of the Metropolitan Asylums Board to open Gore Farm Hospital 33 for the reception of scarlet fever patients, a Conference was convened by the Vestry of St. Marylebone to discuss the actions of the Asylums Board. The Conference was attended by delegates from all, or nearly all, the sanitary authorities of London, and the following resolutions were adopted:— 1. That a communication be addressed to the Metropolitan Asylums Board, strongly urging that Board to take steps to immediately open the vacant beds of the Gore Farm Hospital at Darenth for the purpose of providing the temporary accommodation required by the London Local Authorities for the cases of scarlet fever urgently requiring removal from the crowded families and houses in which they are spreading the disease.* 2. That in the opinion of this Conference the authorities making the rate to raise the funds for the requirements of the Metropolitan Asylums Board should be entitled to be directly and adequately represented upon that Board. 3. That the President of the Local Government Board be asked to receive a deputation in support of the foregoing resolutions.† 4. That a copy of the foregoing resolutions be forwarded to the Local Government Board, the Metropolitan Asylums Board, and the several Vestries and District Boards of the Metropolis who have appointed delegates to attend this Conference, and that each of those Vestries and District Boards be asked to appoint one representative to attend the proposed deputation to the President of the Local Government Board. It is somewhat anomalous that London should be the only town where the provision of hospital accommodation for infectious disease is in the hands of a body other than the sanitary authority. The origin of the Asylums Board explains how this arose. That body was originally intended to provide accommodation for the poor sick with infectious disease, and was formed at a time when sanitation had scarcely made * Gore Farm was opened just before Christmas, † The President declined to reoeive a deputation. 34 any foothold in London. Removals were effected only through the Relieving Officers, and the patients became, if they were not so already, "pauperised" by their reception into the Board's Hospitals. The depauperisation of the Hospitals led at once to a great increase in the admissions, so that now the public are on the whole very willing to take advantage of the facilities offered for having their infectious sick cared for in hospital, whereby the other members of the patient's family can follow their avocatious without hindrance and without risk to the public generally. The removal of patients to hospital is now effected by the officers of the sanitary authorities, and the only manner in which tbe Guardians intervene is by way of constituting the Board, and in calling on their respective sanitary authorities for the amounts of the precepts issued by the Board. With the introduction of notification there was at once a further increase in the use of the Hospitals, but by the constitution of the Board, the system of notification is not so beneficial as it ought to be. The only individuals who can gauge the approximate value of notifications from any given district is the Medical Officer of Health of the district. He ought to be able to say from his knowledge of the locale of the cases what are the prospects of any considerable extension of disease, as judged from the social and other conditions of the neighbourhood from which the notification comes. It is manifest that every case of 35 disease does not present the same opportunities of spread of such disease, and that the mere numbers of cases from the whole district is but an imperfect indication of the existing risks of an outbreak on a large scale. In the provinces, where the isolation hospital is uuder the control of the sanitary authority, it is, or ought to be, much easier to prepare for an approaching epidemic—the hospital authority, i.e., the Health Committee, having the Medical Officer to advise them of such prospects. In London the notifications are sent to the hospital authority, the Asylums Board, but that authority has not the advantage of the knowledge and advice of the medical officers of health. It appears to be desirable that the hospital authority for the Metropolis should be constituted from the sanitary authorities, and that the medical officers of health should be brought into closer touch with the hospital board. At the Conference held by the Marylebone Vestry, a statement was made that the hospitals were used by many persons who should be treated at home. It is by no means easy to say who should, and who should not use the hospitals, seeing that they are maintained out of the rates. There are so many factors which must be taken into consideration in deciding the question of isolation of any given case, of which factors the simple one of ability to properly treat the patient at home is by no means the most important. Taking the number of rooms occupied 36 by each family in which a case occurred, the returns of patients removed from each class of tenement have been got out, and percentage rates calculated. These have, been tabulated in the same manner and with the same standard as was done when dealing with the incidence of disease in connection with overcrowding, see page 29, supra. TABLE 15. All diseases. Diphtheria and Memb. Croup. Scarlet Fever. Cases. Removals. Rates per cent. Cases. Removals. Rates per cent. Cases. Removals. Rates per cent. Tenements of ONE room 51 44 86.2 17 15 88.2 22 21 95.4 With 2 persons or less per room 14 9 62.4 4 3 75.0 1 1 100.0 ,, more than 2 37 35 94.6 13 12 92.3 21 20 95.2 Tenements of TWO rooms 174 135 77.5 63 43 68.2 100 86 86.0 With 2 persons or less per room 76 51 67.8 29 17 58.6 39 30 76.9 „ more than 2 98 84 85.7 34 26 76.4 61 56 91.8 Tenements of THREE rooms 195 124 63.5 66 36 54.5 116 80 68.9 With 2 persons or less per room 153 89 58.1 50 23 46.0 97 63 64.9 „ more than 2 42 35 83.3 16 13 81.2 19 17 89.4 Tenements of FOUR rooms 90 43 47.7 28 19 35.7 57 32 56.1 With 2 persons or less per room 85 40 47.0 26 9 34.0 54 30 55.5 „ more than 2 5 3 60.0 2 1 50.0 3 2 66.6 All tenements of less than FIVE rooms 510 346 67.8 174 104 59.7 295 219 74.2 With 2 persons or less per room 328 189 57.6 109 52 47.7 191 124 64.9 „ more than 2 182 157 86.2 65 62 80.0 104 95 91.3 Tenements of FIVE rooms or more 200 66 33.3 55 16 29.0 105 39 37.1 37 The figures included in this Table do not represent all the cases dealt with, as in certain instances, for various reasons, the necessary information was not obtained. As regards the general column "all diseases," it will be seen that of the cases occurring in tenements of less than five rooms, 67.8 per cent, were removed to hospital; whilst in cases of tenements of five rooms or more, 33.3 per cent, went away. A large proportion of the latter cases, and a few of the former, went to hospitals other than those of the Metropolitan Asylums Board, but the exact numbers have not been determined. In the case of tenements of five rooms or more, there is no information available as to overcrowding. In the other class of tenements, 57.6 per cent, of the patients from tenements with an average of not more than two persons per room went to hospital; whilst of those living in tenements with an average of more than two persons per room, 86.2 per cent, were removed. The need of strict isolation is not equally imperative in all the diseases notified, and therefore the figures for diphtheria and scarlet fever are more interesting in this connection. Of diphtheria patients, 59.7 per cent, of the cases occurring in tenements of less than five rooms went to hospital, and 29.0 per cent. of those in tenements of five or more rooms. In the smaller tenements, from those averaging not more than two persons per room, 47.7 per cent, went to hospital; and from tenements with the higher average, 80.0 per cent. As regards scarlet D 38 fever, a disease demanding the strictest isolation possible, 74.2 per cent, of the cases in tenements of less than five rooms were removed, and 37.1 per cent, of those in tenements of five rooms or more. Where the inhabitants averaged under two per room, 64.9 per cent, of the cases were removed, and where the average exceeded that limit, 91.3 per cent. The figures throughout the Table are to the same effect. It should be mentioned that there was no preparation for this inquiry during the year, as it was not decided to go into the matter until after the Marylebone Conference, which took place in December. There was, it is true, so much difficulty in securing accommodation during the second half of the year that many remained at home who, under more favourable circumstances would have been recommended for removal, and endeavours made to persuade the parents or others to agree thereto. Such selection has of course affected the patients living in tenements containing larger numbers of rooms, but the effect was felt down to tenements of only two rooms. During the current year records will be kept of the hospitals to which the patients are removed, and a more systematic inquiry made into the conditions of accommodation, the results being tabulated in the same or a similar manner to that presented here.* * This same question has been considered by the Medical Officer of Health for Kensington from the standpoint of civil status. 39 From personal observations made when visiting the homes of many cases, it is clear that in by far the majority of instances where a disease such as scarlet fever occurs, home isolation is, strictly speaking, impossible in the smaller tenements. It must be remembered that the inhabitants, almost without exception, are too poor to be able to afford skilled attendants, the result being that the patient is attended by a member of the family, usually the mother, who also looks after the rest of the family, cooking dinners, etc. On several occasions the use of a special garment has been advised, as also the washing of hands before going to other duties, but, with the best intentions, it is impracticable to ensure that the full precautions necessary will be taken. The presence of a staircase used by several families resident in one house adds a further element of danger to the spread of disease. Considering all these facts, it appears to be desirable that all cases of certain disease, such as scarlet fever, should be removed to hospital where more than one family occupy the house; but that, as regards other diseases, such as enteric fever, the need of hospital isolation is not so pressing under such circumstances. So long as there is a sufficiency of accommodation available, hospital treatment ought to be offered to all patients of the first class, and even pressed as far as persuasion will go, but that in time of pressure preference must of D 2 40 course be given to patients housed in the minimum number of rooms, and it may even be necessary to refrain from pressing removal in certain cases where the tenement is occupied beyond the limit of two per room. RETURN CASES. In the Report for 1894 attention was directed to the fact that after the return of certain patients from hospital, fresh cases of disease scarlet fever and diphtheria—occasionally occurred, and an abstract of a Report by Dr. Birdwooa to the Metropolitan Asylums Board on the subject was given (see page 43, Report for 1894). In consequence of the remarks by Dr. Birdwood and of numerous complaints by medical officers of health, the Asylums Board referred the whole question to the General Purposes Committee for consideration and report. The inquiry was conducted by a subcommittee on the following lines:— 1. Communications were addressed to the various medical officers of health, asking for information as to cases in their districts. 2. A circular letter was sent to all authorities of the more important fever hospitals, to ascertain the average duration of detention in hospital of scarlet fever and diphtheria patients, excluding fatal cases. 3. The Medical Superintendents of the Board's hospitals were instructed to report as to the precautions adopted before discharging patients. 4. Attention was given to the means of disinfection adopted by the various local authorities, as detailed in the Report of the Public Health Department of the London County Council, published in December, 1894. In response to the first communication, the 41 Committee were informed of 165 cases of outbreaks of illness after the return of patients from the Board's hospitals, 10 of which occurred during the years 1891-2, 106 during 1892 and 1893, and 49 during the first half of 1895. The Committee compute the average as "1 alleged case of infection for every 285 discharged." They make no separate calculation for each group into which they divide the cases. No particulars are given as to the cases reported to the Committee, who remark that "many of these cases did not develop infection until so long a period after the return of the previous cases from hospital as to render it improbable that the discharged patient could have been the cause of the infection of the second case." The replies from the provincial hospitals showed that the average detention in hospital of scarlet fever patients varied from thirty-seven to seventytwo days, and of diphtheria patients from eighteen to forty-two days. These figures were based on the experience of 1893, and all fatal cases were excluded. In the Board's hospitals the average detention was—for scarlet fever patients, seventy days (in 1892), and for diphtheria patients, fortytwo days. It should be noted that the detention here mentioned for the Board's patients does not cover the whole period in which "return cases" were reported, and that the year 1892 was not an epidemic year, and was presumably one in which 42 there was no pressure on the accommodation provided. As regards the precautions taken prior to discharge of patients from the Board's hospitals, the Committee say, "we are of opinion that every reasonable precaution in the matter of personal ablution and disinfection has hitherto been taken to obviate the possibility of any patient being discharged whilst in a state of infection." It may be remarked that the South-Western and Fountain Hospitals are the only two at which any mention is made of a discharge ward on the "three room" system, i.e., having two dressing-rooms, one infected, and one infection-free, separated by a bathroom. Other hospitals may be provided with such accommodation, but if they are, there should have been some mention made of the provision. The "three room" discharge ward constitutes the safest outlet for patients from an infectious hospital. Lastly, the Committee call attention to the fact that in certain instances the local authorities rely on dry heat for disinfection, which, except at temperatures which are destructive to most articles, is a very unsafe process, and that in other cases the work of disinfection is done by contractors, not by the authorities. The Committee's conclusions are as follows:— (o.) That there is no evidence to show that any appreciable number of patients admitted to the Board's hospitals during the past two years have contracted infection from patients previously discharged 43 from. That there is reason to believe that of the so-called "return'' cases, some have been due to the re-introduction of infection into households owing to the disturbance of insufficiently disinfected clothes, etc., left at home and stored away during the patient's stay in hospital. (b) That it is desirable that those sanitary authorities in the Metropolitan district who have not yet provided themselves with steam disinfectors should be urged to do so with the least possible delay; and, further, that the authorities who still entrust the work of disinfection to contractors should be advised to discontinue the practice, and to have the work carried out by responsible officials. With the second conclusion every one who has studied the matter must agree, but it is not possible to accept the first without much reservation. It will be noticed that, by inadvertence or otherwise, the conclusion is limited to "patients admitted to the Board's hospitals," a limitation which is, to say the least, very unfortunate. As already stated, the Committee give no information as to the proportion which the "return" cases bear to discharges during the several periods into which they divided the cases. The average of 1 case to every 285 discharges, mentioned above, refers to the two years 1893 and 1894. In the four halfyears included therein there were 106 "return" cases; but in the one half-year of 1895 there were 49 such cases—i.e., if the cases continued at that rate for two years there would be 196 "return" cases on record as against 106. Having regard to the fact that (at all events as far as Paddington has been concerned) the return cases have occurred in the smaller tenements, there is an inherent improbability of such infection having 44 been re-introduced by "the disturbance of insufficiently disinfected clothes, etc., left at home and stored away," for the simple reason that such families as occupy the smaller tenements have no place to store things except the pegs on the doors or in cupboards, where the garments, etc., of the other members of the family are kept. It may also be pointed out that the usual practice is to remove patients as soon as ever the disease is notified, which in (say) 99 cases out of 100 would be within a few hours of the patient falling ill. It is not denied that the patient is infectious during those few hours, but there is not much chance of infection being in the clothes, as he is generally put to bed as soon as he declares ill, unless it be contended that infection commences to be given off before the patient feels ill. There have been several "return" cases in Paddington during 1895—some of scarlet fever, and some of diphtheria. Without entering into a minute account of each case, it may be stated that it has been found, as regards scarlet fever, there was in certain of the patients who had returned from hospital some trouble with either the throat, nose, or ear, and in one case with the skin of the head. One source of danger that has been suspected is catching cold during the journey home from hospital, which takes place immediately after a complete bath. In coming to the conclusion that 45 any given case has probably been due to a patient returned from hospital, care has to be taken to inquire into the disinfection of the rooms, bedding, etc.; to the washing of linen; the disposal of books and toys; and lastly, the interval that has elapsed since the patient arrived home. All cases occurring after about nine days have been excluded. The inquiries have in all cases been personally made by the medical officer of health. Finally, it may be stated that the occurrence of return cases is not an experience confined to the Metropolis, but common to almost all hospitals. It is accepted by all, or nearly all, medical officers, that such cases are frequently due to the patients returning from hospital, although it is very difficult to explain how they arise or, what is far more important, how they are to be prevented. Small-pox.—Of the 10 cases of this disease notified during the year, in two the patients were pronounced by the hospital authorities to be suffering from other diseases (chicken-pox in the one case, and enteric fever in the other.) All the 8 cases of variola were in adults who had been vaccinated in infancy only. Three cases off Westbourne Grove constituted the only group of connected cases. The dates of sickening of these patients indicated that there were two independent sources of infection. The strictest inquiries were made as to the movements of the patients but no trace of the origin could be obtained. Another patient came home ill with the disease from Westminster. The Medical Officer of that district was informed of the case, but no origin was discovered. Another patient had had a young relative staying with 46 her who had an attack of what was pronounced by the relatives to have been chicken-pox, no doctor being called in. The child returned to his home in Fulham, the Medical Officer of which district saw him at my request, but was unable, owing to the long interval, to say what the disease had really been. Cholera. —The only case notified as cholera, proved to be one of severe diarrhoea, due to an excessive consumption of vegetables and fruit. Relapsing Fever.—The patient in this case was a publican's manager, whose circumstances in life were altogether the reverse of those with which this disease is usually associated. Puerperal Fever.—There were 8 cases of this disease notified during the year, 6 of which terminated fatally. The inquiries made showed that each case was independent of the others, and that there was no community of medical attendants or midwives. There was in addition one case of this disease which was not notified, the death being registered on the Coroner's certificate, after inquest and post-mortem examination. In two other cases the certificates of notification were not received until after the deaths had been registered, when the attention of the medical attendants was called to the omission to notify. The mortality among the notified cases last year was very excessive, 75 per cent., but there is good reason to think that all cases of this disease were not notified. It is by no means easy to say what is puerperal fever. It is almost certain that there should be no fever in the puerperium, and that any fever so occurring means septic infection, unless there be an intercurrent disease, such as scarlet fever. Assuming that all febrile symptoms during this stage to be due to sepsis, there remains the difficulty of deciding what is "puerperal fever" in the strict sense of the word, as the septic infection may take a very mild form, 47 now-a-days termed "sappræmia," which many would say was not puerperal fever, and should not be notified. Scarlet Fever and Diphtheria.—It will be more convenient for the present purpose to take these diseases together. The incidence of these diseases was specially heavy on certain well defined areas of the Parish, namely the St. Peter's Park Estate, the streets around Hall Place, the area lying between the Grand Junction Canal and Westbourne Terrace North, bounded on the east by Ranelagh Road, and on the west by the railway, and the streets lying between the Harrow Road and the Canal Basin. In the absence of any information as to the population of these areas, it is impossible to state the respective rates, It must suffice to say that the "spot maps" for the year show this incidence very markedly. The houses included in these areas are for the most part occupied by two or more families, some of the tenements containing but one room. In several of the streets the houses are erected on "made ground," and, where examined, they have been found to be without any concrete under the floors. The excess of these diseases in these areas is confirmatory of the information afforded by the inquiries as to the housing of families having cases of infectious disease. (See page 29.) The inquiries made in respect of every case of these diseases did not disclose any special spread of infection by the schools or milk supplies. It may be well to indicate here certain particulars in which reforms appear desirable. On the occurrence of any of the diseases included in the schedule for notification (except erysipelas) all schools receiving children from the infected houses are informed of the occurrence of the case. They are subsequently informed of the disinfection. It 48 should be compulsory on the teachers to exclude all children from infected houses for a definite term varying for each disease, and dating from the performance of the disinfection. The duration of such exclusion should be decreed by the Education partment. This is necessary owing to the fact that it is possible for certain of the children to be in the incubation stage of the disease when the disinfection is done. Such children would be very likely to spread the disease among the rest of the school. School teachers should be required to inform the Sanitary Authority of any special amount of illness which may occur among their scholars. Half a school may be away through sickness, if the disease be not a notified one, but no information of such fact comes to the Sanitary Authority. Where the school receives scholars from two or more districts, it is possible for a large amount of notifiable sickness to prevail, of which fact the medical officer of health has only a very partial information. in the case of the infectious diseases which are notified, the medical attendant should be required to inform the medical officer of health of the recovery of patients treated at home. For such information a fee should be paid on the same scale as for notification. No such certificate would be required for cases removed to hospital or after death, and so the expense under this head would be a small one, probably less than one-fourth of the amount paid for notification. 49 All disinfection should be done by the officers of the Sanitary Authority, and the exception now existing by virtue of a medical attendant's certificate done away with. Such amendments as these would in the end almost certainly diminish the amount of infectious diseases, and so prove to be economical. DEATHS. During the year, 2,249 deaths (1,094 of males, and 1,155 of females) were registered within the Parish—equivalent to an "uncorrected" death-rate of 18.32 per 1,000 of the estimated population, the corresponding rate for 1894 having been 15.75. From the deaths registered in Paddington there must be deducted those of 306 non-parishioners who died in the local institutions, and 156 deaths of parishioners who died in other parts of the Metropolis have to be added. The corrected total thus obtained is 2,099—equal to a rate of 17.09 per 1,000, which is 2.03 above the rate for 1894. The total of 2,099 will be used throughout the remainder of this Report, unless otherwise stated, as the basis for all calculations. The corrected total included 995 deaths of males, equal to a rate of 19.58 per 1,000 males living, and 1,104 females, equal to a rate of 15.34 per 1,000 females living. The deaths of residents of St. Mary's District numbered 1,671—18.44 per 1,000 of the inhabitants of that district; and those 50 of residents in the district of St. John, 428—or 13.30 per 1,000 of the inhabitants thereof. Last year's death-rate in North Paddington was 2.15 per 1,000 in excess of the rate for 1894, and that of South Paddington, 1.57 in excess. The numbers of deaths of each sex for the whole Parish and its two divisions, in each quarter, are set forth in Table 16 below. TABLE 16.—Deaths of Parishioners in 1895. " Corrected." Deaths of Residents in Paddington. St. Mary. St. John. During Males. Females. Total. Males. Females. Total. Males. Females. Total. 1st Quarter 347 398 745 281 309 590 66 89 155 2nd „ 211 216 427 165 166 331 46 50 96 3rd „ 229 254 483 184 211 395 45 43 88 4th „ 208 236 444 167 188 355 41 48 89 Year 995 1,104 2,099 797 874 1,671 198 230 428 Death-rates per 1,000 1895 19.58 15.34 17.09 20.26 17.05 18.44 17.27 11.10 13.30 1894 17.22 13.55 15.06 17.73 15.18 16.29 15.52 9.63 11.73 Last year's death-rate for the whole Parish was 0.45 per 1,000 in excess of the decennial mean rate (16.64), and the corrected total of deaths (2,099) 150 in excess of the annual average (1,949). If the annual average be corrected for the increase in population it will be raised to 2,050 and the excess 51 of last year reduced to 49. In North Paddington the deaths last year were 14 in excess of the decennial average, corrected for increase of population, and in South Paddington 6 in excess of the average, corrected for decrease in population. The death-rate in the Northern half was 0.20, and in the Southern 0.26, above the respective decennial mean rates. The corrected totals and the corresponding rates for each year since 1885 will be found in Table 17. TABLE 17.—Deaths and Death-rates for 1885-95. Year. Paddington. St. Mary. St. John. Death-rates. Regd. Rates. Regd. Rates. Regd. Rates. England and Wales. London.* 1895 2,099 17.09 1,671 18.44 428 13.30 18.7 19.8 1885 1,877 16.76 1,394 18.60 483 13.04 19.2 20.4 1886 1,909 16.86 1,468 19.25 441 11.93 10.5 20.6 1887 1,785 15.59 1,346 17.35 439 11.90 19.1 20.3 1888 1,916 16.55 1,472 18.61 444 12.06 18.1 19.3 1889 1,664 14.21 1,266 15.76 398 10.83 18.2 18.4 1890 2,104 17.71 1,602 19.51 502 13.69 19.5 21.4 1891 2,110 17.90 1,590 18.89 520 15.43 20.2 21.5 1892 2,142 17.96 1,632 18.95 510 15.38 19.0 20.7 1893 2,153 17.87 1,680 19.16 473 14.43 19.2 21.3 1894 1,831 15.06 1,449 16.29 382 11.73 16.6 17.8 Decennial Averages 1,949 16.64 1,490 18.24 459 13.04 18.8 20.2 * The local figures are corrected for non -parishioners and deaths in outlying institutions ; those of London are not so corrected. In London, last year's death-rate was 0.4 per 1,000 below the decennial mean-rate,* and the * It will be noticed that the death-rates for London, both as regards the decennial mean rate and that for last year, in Table 17, differ from those in Table 21 below. The figures in Table 17 have been taken from the Appendix of the Registrar-General's Annual Summary, and those in Table 21 from Table 3, included in the body of the Summary, where the deaths in public institutions have been allotted to their proper districts. 52 rates for England and Wales, both for last year and for the decennium, were practically equal. The uncorrected death-rate for Paddington was last year 1.5 per 1,000 below the rate for London, and 0.4 below that for England and Wales. The foregoing comparison, however, ignores all consideration of the differences in the age and sex constitution of the various populations. The effects of such differences have been determined, and the necessary "correction factors" calculated. The corrected death-rates obtained by the use of these factors are set out below:— Comparison of Death-rates. 1895. Standard rate Recorded rate. "Corrected" rate. England and Wales 19.15 18.7 18.7 London 17.96 19.8 21.1 Paddington 17.72 18.3 19.8 The "natural increment" i.e., excess of births over deaths, in Paddington amounted to 880 lives last year, as compared with a decennial average of 996. The increment was equal to 0.71 per cent, of the estimated population, the percentage for 1894 having been 0.81. The natural increment in London was equal to 1.06 per cent, of the estimated population last year, and l.23 in 1894, whilst in England and Wales the increments in 1895 and 1894 were, respectively, equal to 1.16 and 1.29 per cent. AGE-GROUP DEATH-RATES. Tables 18 and 19 continue the series of returns, showing the deaths and death-rates for the vario usagegroups, distinguishing the sexes, in the whole Parish, and its two sub-districts. Inasmuch as this series was only commenced in the report for 1894, it has not as yet much value as a basis of comparison. 53 Considering first the figures for last year, it will be found that the death-rates for males were generally higher than those for females, the exceptions being those for the groups "5-15" in Paddington and St. Mary, and, in addition thereto, the group "1-5" in St. Mary. The rates prevailing in St. Mary's District were higher than those in St. John's (both male and female) with the exception of the group "15-25" in St. John's district, the rate being here 4.27, as compared with one of 3.72 in St. Mary's. Comparing the death-rates for 1895 with those for 1894, it will be found that the former, with one or two exceptions, are higher at the two extremes of life than the latter. To show the differences between the two years more clearly, the following ratios have been calculated for certain age-groups, the rate prevailing in 1894 in each group being taken as 100:— Males. Females. Paddington 0-5 105.0 92.2 6-60 100.9 103.5 60 and over 162.9 129.6 St. Mary 0-5 103.0 109.2 5-60 104.0 96.4 60 and over 166.2 136.1 St. John 0-5 120.6 47.7 5-60 90.2 99.1 60 and over 153.9 136.1 The 1894 death-rate for each sex age-group is taken as the standard 100. A comparison between the death-rates prevailing in certain age-groups for Paddington and London E 54 TABLE 18. Males. Age Groups. Estimated living in 1895. Deaths during 1895. Death-rates per 1,000 for 1895. Deaths per quarter Death- rate per 1,000 1894. 1 2 3 4 Paddington. 0-1 1,269 268 211.18 71 55 88 54 173.32 1-5 4,480 96 21.42 38 16 19 23 28.26 5-15 9,839 26 2.64 3 15 6 2 3.60 15-25 10,092 39 3.86 14 13 6 6 4.70 25-65 23,149 378 16.32 152 69 78 79 13.75 65 and over 1,966 188 95.62 69 43 32 44 64.66 All ages 50,795 995 19.58 347 211 229 208 17.22 0-5 5,749 364 63.31 109 71 107 77 60.27 5-60 41,837 370 8.84 138 87 77 68 8.76 60 and over 3,209 261 81.33 100 53 45 63 49.90 St. Mary. 0-1 1,087 230 211.59 62 44 75 49 182.58 1-5 3,736 90 24.08 84 16 18 22 29.98 5-15 8,041 22 2.73 3 14 3 2 3.03 15-25 7,521 28 3.72 11 12 2 3 4.73 25-65 17,544 289 16.47 116 49 65 59 13.34 65 and over 1,401 138 98.50 55 30 21 32 63.95 All ages 39,333 797 20.26 281 165 184 167 17.73 0-5 4,823 320 66.34 96 60 93 71 64.39 5-60 32,218 284 8.81 103 72 58 51 8.47 60 and over 2,292 193 84.20 82 33 33 45 50.66 St. John. 0-1 182 38 208.79 9 11 13 5 119.56 1-5 744 6 8.06 4 ... 1 1 19.92 5-15 1,795 4 2.22 ... 1 3 ... 5.50 15-25 2,571 11 4.27 3 1 4 3 4.61 25-65 5,605 89 15.87 36 20 13 20 14.63 65 and over 565 50 88.49 14 13 11 12 66.54 All ages 11,462 198 17.27 66 46 45 41 15.52 0-5 926 44 47.51 13 11 14 6 39.38 5-60 9,619 86 8.94 35 15 19 17 9.91 60 and over 917 68 74.15 18 20 12 18 48.15 55 TABLE 18 A. Females. Age Groups. Estimated living in 1895. Deaths during 1895. Death-rate per 1,000 for 1895. Deaths per Quarter. Deathrates per 1,000 for 1894. 1 2 3 4 Paddington. 0-1 1,582 222 140.32 58 43 73 48 128.93 1-5 5,362 108 20.14 33 16 38 21 29.32 5-15 11,909 35 2.93 7 9 6 13 4.68 15-25 15,095 40 2.64 12 10 9 9 2. 49 25-65 34,098 355 10.41 128 72 75 80 9.48 65 and over 3,909 344 88.00 160 66 53 65 64.25 All ages 71,955 1,104 15.34 398 216 254 236 13.55 0-5 6,944 330 47.52 91 59 111 69 51.54 5-60 58,951 377 6.39 117 101 74 85 6.17 60 and over 6,060 397 65.51 190 56 69 82 50.53 St. Mary. 0-1 1,127 196 173.91 47 37 67 45 136.40 1-5 3,819 99 25.92 30 14 36 19 30.40 5-15 8,481 30 3.53 6 8 6 10 5.04 15-25 10,750 32 2.97 9 10 7 6 2.65 25-65 24,283 268 11.03 97 53 55 63 10.56 65 and over 2,784 249 89.43 120 44 40 45 64.74 All ages 51,244 874 17.05 309 166 211 188 15.18 0-5 4,946 295 59.62 77 51 103 64 54.56 5-60 41,982 278 6.62 91 64 56 67 6.83 60 and over 4,316 301 69.74 141 51 52 57 51.21 St. John. 0-1 455 26 57.14 11 6 6 3 86 73 1-5 1,543 9 5.83 3 2 2 2 24.16 5-15 3,428 5 1.45 1 1 ... 3 3.33 15-25 4,345 8 1.84 3 ... 2 3 2.19 25-65 9,815 87 8.86 31 19 20 17 7 20 65 and over 1,125 95 84.44 40 22 13 20 63.8 All ages 20,711 230 11.10 89 50 43 48 9.64 0-5 1,998 35 17.51 14 8 8 5 36.65 5-60 16,969 79 4.65 26 17 18 1.8 4.69 60 and over 1,744 116 66.51 49 25 17 25 48.78 E 2 56 in the two last years, is instituted in the appended table:— Death-rate per 1,000 estimated persons in each age-group. Age-Groups. PADDINGTON. LONDON. 1895. 1894. 1895. 1894. 0-1 175.0 153.4 195.4 166.7 1-5 22.0 27.4 31.5 31.1 5-60 8.0 7.9 8.4 8.0 60 and over 74.4 51.1 76.7 61.8 The figures here are not strictly comparable, owing to differences in the proportions of males to females, but, as the numbers of deaths of each sex-age-group for London are not available, the rates given are the best obtainable. From the foregoing Tables it will be seen that the increase in the mortality fell specially on the males at the extremes of life. The local death-rates for the four quarters of last year were equivalent to annual rates of 24.34, 13.95, 15.78, and 14.50 for the first and succeeding quarters, and there can be no doubt that the very severe winter was in part responsible for the increase. INFANTILE MORTALITY. In the Tables given above, the death-rates at ages of one year, have been calculated on the numbers estimated to be living at those ages. It is more customary to calculate them on the number of births registered during the year. The mortality on 57 that standard was, in the whole Parish, 164, the decennial mean-rate being 143 per 1,000 births registered. Last year's rate was the highest recorded since 1885 (see Table II. in the Appendix). The infantile mortality in London was 165 per 1,000 births registered in 1895, the decennial mean rate being 153, whilst in England and Wales, last year's rate was 161, and the decennial mean rate 146. In St. Mary's District the infantile mortality was 168 per 1,000 births registered in the district, compared with a rate of 142 for 1894, and in St. John's District, last year's rate was 141, and that for 1894, 94. To Table 19 (a continuation of Table 13 in the report for 1894) two columns have been added, giving the deaths at the various ages, under 5 years, in 1893 and 1894. The distribution of the causes of death will be dealt with later on (See page 90). CAUSES OF DEATH. The rates of mortality given in Table 20 have been obtained from the numbers given in Table III. in the Appendix. With but few exceptions the rates for 1895 were higher than those for 1894, the only year available for comparison. The greatest increase among the sub-groups is shown in the rate from Diseases of the Respiratory System (Paddington, col. P.) —2.60 in 1894, 3.65 in 1895; the increase from Diarrhoeal Diseases being next—0.37 in 1894, and 0.74 in 1895. The increase in the rate 58 TABLE 19. Males. Deaths at ages under 5 years. 1895. Paddington. St. Mart. St. John. ton. Quarters. Year. Quarters. Year. Quarters. Year. 1893 1894 1 2 3 4 1 2 3 4 1 2 3 4 Days. Under 1 day 1 10 8 6 25 1 8 6 6 21 ... 2 2 ... 4 22 18 1 3 3 2 ... 8 2 2 1 ... 5 1 1 1 ... 3 7 5 2 2 3 1 2 8 2 3 1 2 8 ... ... ... ... ... 6 6 3 1 3 1 2 7 1 2 1 2 6 ... 1 ... ... 1 1 3 4 ... ... ... 1 1 ... ... ... 1 1 ... ... ... ... ... 3 1 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 2 6 ... 1 ... 1 2 ... 1 ... 1 2 ... ... ... ... ... 2 1 Weeks. 1 7 ... 4 1 12 6 ... 4 ... 10 1 ... ... 1 2 9 9 2 5 1 5 3 14 5 1 5 3 14 ... ... ... ... ... 10 10 3 1 1 3 2 7 1 1 2 2 6 ... ... 1 ... 1 9 9 Months. 1 8 3 19 9 39 8 3 16 9 36 ... ... 3 ... 3 26 19 2 4 5 6 4 19 4 3 6 2 15 ... 2 ... 2 4 23 94 3 7 ... 7 7 21 6 ... 7 6 19 1 ... ... 1 2 17 15 4 5 4 6 1 16 3 4 4 1 12 2 ... 2 ... 4 9 10 5 2 2 6 5 15 1 1 5 5 12 1 1 1 ... 3 15 14 6 6 4 6 1 17 5 3 4 1 13 1 1 2 ... 4 18 ... 7 3 4 2 3 12 3 3 2 3 11 ... 1 ... ... 1 15 15 8 4 4 1 3 12 4 4 1 2 11 ... ... ... 1 1 11 17 9 7 5 4 2 18 5 3 4 2 14 2 2 ... ... 4 13 10 10 4 1 3 ... 8 4 1 3 ... 8 ... ... ... ... ... 9 9 11 1 1 4 1 7 1 1 3 1 6 ... ... 1 ... 1 7 8 Under l year 71 55 88 54 268 62 44 75 49 230 9 11 13 5 38 236 217 Years. 1 24 10 10 15 59 22 10 10 14 56 2 ... ... 1 3 54 61 2 6 3 4 2 15 5 3 3 2 13 1 ... 1 ... 2 32 31 3 6 1 5 4 16 5 1 5 4 15 1 ... ... ... 1 25 16 4 2 2 ... 2 6 2 2 ... 2 6 ... ... ... ... ... 15 17 Aged 1 5 years 38 16 19 23 96 34 16 18 22 90 4 ... 1 1 6 126 125 Under 5 years 109 71 107 77 364 96 60 93 71 320 13 11 14 6 44 362 342 59 TABLE 19A. Deaths at ages under 5 years. Females. 1895. Paddington. St. Mary. St. John. paddinoton. Quarters. Year. Quarters. Year. Quarters. Year. 1893 1894 1 2 3 4 1 2 3 4 1 2 3 4 Days. Under 1 day 5 7 4 6 22 3 7 4 5 19 2 ... ... 1 3 14 13 1 2 3 9. ... 7 ... 3 2 ... 5 2 ... ... ... 2 2 5 2 2 2 ... ... 4 2 2 ... ... 4 ... ... ... ... ... 7 2 3 1 1 ... ... 2 1 1 ... ... 2 ... ... ... ... ... 1 5 4 2 1 ... ... 3 2 1 ... ... 3 ... ... ... ... ... 1 2 5 ... ... 1 ... 1 ... ... 1 ... 1 ... ... ... ... ... 4 1 6 1 ... 1 ... 2 1 ... 1 ... 2 ... ... ... ... ... 2 2 | Weeks. 1 4 3 4 4 15 3 3 4 4 14 1 ... ... ... 1 8 3 2 3 3 2 2 10 3 3 2 2 10 ... ... ... ... ... 13 4 3 4 2 ... ... 6 3 2 ... ... 5 1 ... ... ... 1 9 6 1 Months. 1 (5 5 13 7 31 3 5 11 7 26 3 ... 2 ... 5 23 15 2 5 4 6 5 20 5 2 6 5 18 ... 2 ... ... 2 17 20 3 3 2 9 6 20 3 2 7 5 17 ... ... 2 1 3 21 15 4 6 1 6 3 16 4 ... 5 3 12 2 1 1 ... 4 25 11 5 2 1 4 5 12 2 1 4 4 11 ... ... ... 1 1 11 9 6 1 1 3 3 8 1 1 3 3 8 ... ... ... ... ... 15 10 7 3 1 7 3 14 3 1 7 3 14 ... ... ... ... ... 7 7 8 1 2 5 1 9 1 1 5 1 8 ... 1 ... ... 1 10 7 9 2 8 1 1 7 2 1 1 1 5 ... 2 ... ... 2 11 11 10 2 1 4 ... 7 2 1 3 ... 6 ... ... 1 ... 1 6 8 11 3 ... 1 2 6 3 ... 1 2 6 ... ... ... ... ... 8 12 Under l year 58 43 73 48 222 47 37 67 45 196 11 6 6 3 26 215 168 Years. 1 17 8 23 10 58 14 6 21 8 49 3 2 2 2 9 48 53 2 8 6 6 6 26 8 6 6 6 26 ... ... ... ... ... 28 32 3 5 ... 3 1 9 5 ... 3 1 9 ... ... ... ... ... 25 28 4 3 2 6 4 15 3 2 6 4 15 ... ... ... ... ... 15 20 Aged 1 to 5 years 33 16 ... 21 108 30 14 36 19 99 3 2 2 2 9 116 133 Under 5 years 91 59 111 69 330 77 51 103 64 295 14 8 8 5 35 331 301 60 TABLE 20. Paddington. St. Mary. St. John. M. F. P. M. F. P. M. F. P. I.—Specific Febrile, or Zymotic Diseases— 1. Miasmatic Diseases 1.90 1.87 1.89 1.95 2.20 2.09 1.74 1.06 1.30 2. Diarrhœal ,, 0.92 0.62 0.74 0.96 0.81 0.88 0.78 0.14 0.37 3. Malarial ,, * - * * * - 0.01 - - - 4. Zoogenous ,, * - * * - - - * - 0.03 5. Venereal „ * 0.11 0.10 0.12 0.11 0.12 - * 0.06 6. Septic ,, 0.11 0.18 0.15 0.15 0.21 0.18 - * 0.06 Totals 3.09 2.79 2.91 3.22 3.35 3.30 2.61 1.40 1.83 II.—Parasitic Diseases - * 0.04 - * 0.05 - - - III.—Dietic Diseases 0.13 * 0.10 0.12 * 0.08 0.17 0.14 0.15 IV.—Constitutional Diseases 3.75 2.47 2.99 3.81 2.63 3.14 3.48 2.07 2.57 V.—Developmental Diseases 1.47 1.26 1.35 1.55 1.52 1.53 1.22 0.62 0.83 VI.—Local Diseases— 1. Diseases of Nervous System 2.22 1.23 1.64 2.31 1.36 1.77 1.91 0.91 1.27 2. Diseases of Organs of Special Sense - * ** - * 0.01 - - - 3. Diseases of Circulatory System 1.39 1.37 1.38 1.24 1.48 1.38 1.91 1.11 1.39 4. Diseases of Respiratory System 4.21 3.26 3.65 4.44 3.57 3.95 3.40 2.51 2.82 5. Diseases of Digestive System 1.27 1.07 1.09 1.37 1.26 1.20 0.95 0.67 0.77 6. Diseases of Lymphatic System - * 0.01 _ * 0.02 - - _ 7. Diseases of Gland-like Organs of Uncertain Use * - 0.02 * - 0.03 - - - 8. Diseases of Urinary System 0.49 0.37 0.42 0.53 0.35 0.43 0.34 0.43 0.40 9. Diseases of Reproductive System— (a) Diseases of Organs of Generation - 0.18 0.10 - 0.19 0.11 - 0.14 0.09 (£) Diseases of Parturition - 0.11 0.06 _ * 0.05 _ 0.14 0.09 10. Diseases of Bones and Joints - * 0.04 * * 0.03 * * 0.06 11. Diseases of Integumentary System * * 0.02 * * 0.03 - - - Totals 9.76 7.72 8.35 10.09 8.43 9.15 8.63 5.98 6.93 VII.—Violence— 1. Accident or Negligence 0.64 0.34 0.47 0.71 0.31 0.48 0.43 0.43 0.43 2. Homicide * * 0.03 * * 0.04 - * _ 3. Suicide 0.19 * 0.12 0.15 * 0.11 0.34 0.04 0.15 4. Execution - - - - - - - - - Totals 0.88 0.44 0.62 0.91 0.42 0.64 0.78 0.48 0.59 VII.—Ill-Defined & not Specified Causes 0.49 0.48 0.48 0.53 0.52 0.52 0.34 0.38 0.37 Gra^d Totals, 1895 19.58 15.34 17.09 20.26 17.05 18.44 17.27 11.10 13.30 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., miles. F., females. P., persons of both sexes, 61 from the Group "Local Diseases," amounted to 1.63, and in that from the Group "Specific Febrile or Zymotic Diseases," to 0.12. The rate from the Miasmatic Diseases decreased from 2.21 in 1894 to 1.89 in 1895. There was also a diminution in the rate from Group VII., "Accident and Violence," which was 0.64 in 1894, and 0.62 in 1895. In Table 21 will be found the rates per 1,000 from Zymotic Diseases, and certain other causes, for 1895, in Paddington, London, and England and Wales, contrasted with the decennial mean rates for each cause. In Table 22 the numbers of deaths of Parishioners from certain selected causes are given for each quarter during the past year. ZYMOTIC DISEASES. Small-pox.—There were no deaths from this disease during the past year, the corrected decennial average being 1.9. It will be seen on referring to Table V. in the Appendix, that there have been only 19 deaths from this cause during the past 11 years, 11 of which occurred in 1885. Measles.—The deaths from measles fell from 66 in 1894, to 18 in 1895, the corrected average being 52.5. This disease shows well-marked periodicity, and judging from the general run of the figures in Table V., a larger number of deaths from this cause may be expected in 1896. The death-rate from this 62 TABLE 21. Birth-rate per 1,000 living. Death-rates from—, per 1,000 living. Death-rates of infants under one year, per 1,000 births. All Causes. Principal Zymotic Diseases. Small-Pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Typhus Fever. Enteric Fever. Simple Continued and undefined Fever. Diarrhoea. Phthisis. Registration London 1895 30.5 19.4 2.62 0.01 0.60 0.19 0.52 0.34 o.oo 0.14 o.oo 0.82 1.77 165 1885-94 31.8 19.8 2.74 0.04 0.63 0.24 0.38 0.63 o.oo 0.14 0.01 0.67 ? 153 PADDINGTON 1895 24.2 17.0 1.68 - 0.14 0.11 0.39 0.16 - 0.12 - 0.74 1.25 164 1885-94 24.9 16.6 2.11 0.01 0.42 0.12 0.35 0.48 0.00 0.12 o.oo 0.55 1.40 143 West Group 1895 25.6 17.'8 2.07 0.00 0.24 0.16 0.48 0.31 - 0.11 o.oo 0.77 1.55 170 1885-94 271 18.4 2.39 0.02 0.54 0.18 0.36 0.52 o.oo 0.12 0.01 0.64 ? 156 North Group 1895 28.9 18.0 2.26 0.01 0.51 0.18 0.40 0.28 o.oo 0.14 o.oo 0.74 1.63 151 1885-94 30.1 18.6 2.48 0.04 0.56 0.20 0.37 0.57 o.oo 0.14 o.o1 0.59 ? 145 Central Group 1895 . 29.8 24.2 3.15 0.02 1.15 0.20 0.42 0.39 o.oo 0.16 - 0.81 2.65 185 1885-94 30.0 24.2 2.82 0.04 0.70 0.24 0.36 0.60 o.oo 0.16 0.01 0.71 ? 167 East Group 1895 37.5 23.5 3.89 0.02 1.14 0.28 0.81 0.46 - 0.16 - 1.02 2.05 178 1885-94 37.3 22.9 3.57 0.05 0.85 0.35 0.48 0.78 o.oo 0.17 o.o1 0.88 ? 163 South Group 1895 30.9 18.7 2.47 o.o1 0.51 0.17 0.51 0.33 o.oo 0.13 o.oo 0.81 1.70 161 11885-94 32.9 19.1 2.67 0.05 0.59 0.24 0.36 0.64 o.oo 0.13 0.01 0.65 ? 148 England and Wales 1895 30.3 18.7 2.14 0.00 0.36 0.14 0.25 0.29 0.17 0.88 ? 161 1885-94 31.2 18.9 2.14 0.02 0.44 0.21 0.19 0.43 0.60 1.58 146 o.oo 0.17 10.01 63 TABLE 22. 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 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 5 7 2 ... ... 3 ... ... 1 10 ... ... ... ... ... 1 ... ... ... 1 Scarlet Fever 1 2 ... 2 1 2 1 2 3 8 ... 1 ... ... 2 ... ... ... 2 1 Whooping Cough 3 ... ... ... 4 7 2 3 9 10 ... ... ... 1 ... ... ... ... ... 1 Diphtheria 4 i 5 3 5 10 8 6 22 23 1 ... ... 1 1 ... ... 1 2 2 Enteric Fever ... ... 1 1 2 1 1 2 4 4 1 ... 1 2 ... 1 2 ... 4 3 Diarrhœa ... 2 5 ... 21 33 12 6 38 41 ... ... 2 ... 7 2 ... 1 9 3 Totals 13 15 13 6 33 56 24 19 83 96 2 1 3 4 10 4 2 2 17 11 Puerperal Fever ... 1 ... ... ... 4 ... 1 ... 6 ... 1 ... ... ... ... ... ... ... 1 Other Septic Diseases 2 2 2 1 ... 1 2 1 6 5 ... ... ... ... ... ... ... 1 ... 1 Influenza 24 42 6 11 ... 2 2 4 32 59 6 11 6 1 ... 1 ... ... 12 13 Alcoholism 1 ... ... 1 1 1 ... 1 2 3 1 1 ... ... ... ... 1 ... 2 1 Malignant Disease 12 13 4 12 5 13 7 7 28 45 2 5 2 5 3 5 1 7 8 22 Phthisis 24 12 16 13 19 9 16 10 75 44 13 2 3 3 4 4 3 3 23 12 Other Tubercular Diseases 11 8 14 8 2 7 6 12 33 35 1 ... ... 1 ... 1 ... 2 1 4 Premature Birth 9 6 14 14 8 3 9 2 40 25 ... 1 2 ... 3 ... ... ... 5 1 Bronchitis 66 77 15 14 16 16 13 22 110 129 17 26 3 6 2 1 6 5 28 38 Pneumonia 22 20 12 7 7 7 11 10 52 44 4 4 2 4 ... 1 3 1 9 10 Violence of all kinds (including accidents) 8 4 10 8 11 5 6 5 35 22 1 4 2 ... 4 2 2 4 9 10 64 cause last year (0.14) was only one-third of the decennial mean rate (0.42). Scarlet fever.—From this disease there were 14 deaths during the year—nearly 2 less than the decennial average. The scarlet fever death-rate was 0.11 last year, the decennial mean rate being 0.12. Only 1 of the deaths occurred within the Parish limits, the remainder taking place in hospitals. The case mortality was 3.3 per cent, at all ages, 5 6 at ages under 5, and 2.4 at ages of 5 years and upwards. The case mortality at all ages in 1894 was 5.0 per cent. The case mortality among those removed to hospital was 4.7 per cent, in 1895, and 4.2 in 1894; whilst of the cases treated at home, 0.7 per cent, proved fatal last year, as compared with 5.8 per cent, in 1894. Diphtheria.— The deaths from this disease, which rose from 32 in 1892 to 69 in 1893 and 92 in 1894, fell to 49 in 1895. The corrected decennial average was 43—that for the first half of the decennium being 41.5, and that for the second half 54.l. The death-rate from this cause was 0.39 in 1895, compared with a decennial mean rate of 0.35. Table 23 shows the differences in incidence between the two districts of the Parish, and between the two years 1894 and 1895. The case mortality last year was 206 per cent, at all ages compared with one of 24.7 in 1894. At ages under 5 years the mortality was 41.5 per cent. 65 TABLE 23. Death-rates from Diphtheria, 1894 and 1895. Age-Group. Paddington. St. Mary. St. John. M. F. M. F. M. F. 0-1 1895 1.57 — 1.83 — — — 1894 2.39 — 2.80 — — — 1-6 1895 3.57 2.61 3.74 3.66 2.68 — 1894 4.97 7.05 6.72 8.26 1.32 1.27 5-15 1895 0.60 0.83 0.74 0.94 — 0.58 1894 0.72 2.30 0.63 2.30 1.10 1.90 Per 1,000 estimated in each age-sex-group. 1895—1 death at ages above 5 years. 1894—3 deaths ,, last year, and at ages over 5 years, 10.6. Among the patients removed to hospital the mortality was 16.6 per cent., and among those kept at home, 25.2, the corresponding percentages for 1894 being 28.1 and 20 .1.* Whooping cough.—From this disease there were 20 deaths during the year, compared with a decennial average of 54. Last year's total is the lowest recorded since 1887—when there were 19 deaths, the lowest number recorded in any year since 1885. Last year's death-rate from this cause was 0.16, just one-third of the decennial mean rate (0.48). "Fevers."—This term includes the three fevers, * This reduction in the mortality among hospital patients is worthy of comment, taking into consideration the fact that the use of the anti-toxin treatment has during the last eighteen months become general in hospitals, but is only rarely used in private practice. 66 typhus, enteric (or typhoid), and simple continued. From the first and third there were no deaths during the year. From enteric fever there were 15 deaths, a total practically equal to the decennial average (15'6). The death-rate from this cause last year was equal to the decennial mean rate (0'12). The case mortality from enteric fever last year was 21.4 per cent., that for 1894 being 32.8. Among the patients removed to hospital the mortality was 19.2, and among those treated at home, 22.7 per cent. In 1894 the mortalities were 32.3 among the former, and 33.3 per cent, among the latter. Diarrhœa.—There were 91 deaths ascribed to this cause last year—23 (approximately) in excess of the decennial average (68.4). Last year's total has been exceeded once only in the eleven years 1885-95, viz., in 1886, when there were 92 deaths. The death-rate from this cause last year was 0.74 per 1,000 of all ages, the decennial mean rate being 0.55. Of the 91 deaths from this disease, 85 occurred at ages under 5 years, 72 under 1 year of age, and 13 at ages from 1 to 5 years. The total of 72 in all probability represents only a fraction of the deaths at ages under one year from the vague disease known as "infantile diarrhœa." There can be little doubt that a certain but indeterminable proportion of the deaths ascribed to "enteritis," "convulsions," and "atrophy and debility" were in 67 fact of the same nature as those classed as "diarrhœa." This is almost certainly the case in the third quarter of the year, when the deaths from the causes mentioned are in excess of the numbers for the other quarters of the year. Diarrhoea is only a symptom of a diseased condition, and it is becoming a common practice to certify deaths which in former times would have been certified "diarrhoea," as if it were a disease, as "gastroenteritis," etc. The quarterly variations in the numbers of deaths from these causes are shown in the following Table. To determine the approximate proportion of deaths transferred from "diarrhœa" to other causes, it will be necessary to get out the figures for as long a succession of years as possible, but time will not allow of this being done for the present Report. TABLE 24. At ages under one year. St. Mary. St. John. 1 2 3 4 1 2 3 4 M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F "Diarrhœa" ... 2 4 ... 20 21 9 5 ... ... 1 ... 6 1 ... ... Convulsions 5 ... 2 3 9 1 2 4 ... ... 1 ... 1 ... ... ... Enteritis 4 2 2 2 11 13 1 5 1 ... 1 ... 1 ... ... ... Atrophy and Debility. 4 6 1 4 4 4 7 8 ... 3 1 ... 1 3 2 ... The diseases dealt with above constitute the Seven Principal Zymotic Diseases, and it is from the deaths due to them that the zymotic death- 68 rate is calculated. These diseases last year caused 207 deaths in all—equal to a death-rate of 1.68 per 1,000 persons, the mean decennial rate being 2.11. The death-rate among children under 5 years of age was 12.68 per 1,000, and at ages in excess of 5 years, 0.41. In London the death-rate last year from these causes was 2.62, and the decennial mean rate 2.74 per 1,000; the corresponding rates for England and Wales being (both) 2.14. The zymotic death-rates reduced to the standard for England and Wales were last year—Paddington 1.81, and London 2.79. The zymotic death-rate for the district of St. Mary was last year 1.90 per 1,000 of the population of the district, and that for the district of St. John, 0.87. The death-rates from the several diseases per 1,000 inhabitants, in each district, were as follows (that for St. Mary's being in each case given first):—measles 0.18, 0.03; scarlet fever 0.11, 0.09; whooping cough 0.20, 0.03; diphtheria 0.49, 0.12; enteric fever 0.08, 0.21; and diarrhœa 0.85, 0.36. Full information as to the number of deaths in the two districts in each quarter of the year will be found in Table 22, supra. Epidemic influenza caused 116 deaths in 1895, compared with 29 in 1894, 75 in 1893, 96 in 1892, 69 in 1891, and 43 in 1890. Of the deaths during last year, 44 were of males, and 72 of females, 91 of the deceased persons being inhabitants of North 69 Paddington, and 25 of South. In the first and second quarters of the year, the deaths from this cause numbered 83 and 24—107 for the half-year, and in the rest of the year, 9. The death-rate from influenza was 0.94 per 1,000 in 1895, and 0.23 in 1894. Cholera.—There was one death certified as due to this disease, but the post mortem and bacteriological examinations proved that the case was not one of true cholera. The patient's illness commenced almost immediately after cleaning out a foul gulley trap. Syphilis.—There were 12 deaths during the year from this cause—4 of males, and 8 of females. Eight of the deceased persons were infants under 1 year of age, 2 being boys, and 6 girls. In North Paddington there were 10 deaths, and in South, 2. Septic diseases.— Puerperal fever caused 7 deaths last year, compared with a corrected decennial average of 5.4. In the first half of the past decenuium the deaths from this disease averaged 7.0 a year (correcting for the increase of population), and in the second half, 4.2. 1 of the 7 deaths of last year was not notified, and the remaining 6 were equal to 75 per cent, of the notifications. From erysipelas there were 7 deaths in the year, and from pyaemia, 5. The mortality per cent, of the notified cases of erysipelas was 4.9 at all ages, 40.0 at ages under 5 years, and 5.0 at ages above 5 F 70 years. These two diseases are usually classed together under the heading "other septic diseases," and the deaths amounted to 12 last year, as compared with a corrected decennial average of 13.6. DIETIC DISEASES. Alcoholism.— Chronic alcoholism and the acute form, delirium tremens, caused 8 deaths in 1895, as Compared with 13 in 1894. The decennial average for 1885-94 (corrected for increase in population) was 7.6. In North Paddington there were 5 deaths last year, compared with averages of 6.0 for 1885-89, of 6.5 for 1890-94, and 6.3 for the whole decennium, 1885-94. In South Paddington there were 3 deaths last year, the averages being 1.9, l.3, and 1.6 respectively. These figures do not give the whole of the deaths due to "drink," as in many instances all reference to the habit is omitted, the deaths being attributed to diseases which, whilst brought on in the deceased by drink, occur in other persons from other causes. CONSTITUTIONAL DISEASES. Cancer.—Under this heading are included all the various kinds of new growths which are known to be "malignant," and the term, therefore, means much more than what the profession would imply by its strict use. In the whole Parish there were 103 deaths from malignant tumours—73 in North Paddington and 30 in South. The corrected 71 nial average of deaths from these causes was 106.3 in Pacldington—76.5 in North, and 29.9 in South. In North Paddington, the corrected annual average for 1885-89 was 74.8, and that for 1890-94, 77.7; whilst in South Paddington the corresponding averages were 27.0 and 31.4. In 1895 the deaths of males numbered 36, equal to a rate of 0.70 per ],000 males living, and those of females 77, equal to a rate of 1.07; the rates for 1894 having been— males 0.63, and females 1.23. Tubercular diseases.—In the whole Parish there were 154 deaths from phthisis, equal to a rate of 1.25 per 1,000 living—that for 1894 having been 1.20. The decennial average (corrected) was 177 (176.9). There were 56 deaths of females to 98 of males. In North Paddington the deaths amounted to 119 (1.31 per 1,000)—75 of males and 44 of females, and in South to 35 (1.08 per 1,000)—23 of males, and 12 of females. From "other tubercular diseases," including "tabes mesenterica," "tubercular .meningitis," "scrofula," etc., there were 73 deaths during the year—68 in North Paddington, and 5 in South. The deaths were distributed between the sexes in the proportion of 34 males to 39 females. The corrected annual averages are appended. Registered Corrected annual averages for the periods in 1886-89. 1890-94. 1889-94. 1895. Phthisis. St. Mary 154.0 144.4 148.3 119 St. John 29.4 26.1 28.6 35 Other Tubercular Diseases. St. Mary 57.3 61.2 59.4 68 St. John 9.5 13.9 12.0 5 P 2 72 THE PREVENTION OF TUBERCULOSIS. This subject has been brought somewhat prominently before the public by the issue of the Report of the Royal Commission on "The Effect of Food derived from Tuberculous Animals on Human Health," in April of last year. It is a matter of such vital importance that it will be well to enlarge somewhat on it. Tuberculosis is an infectious disease due to the invasion of the body by the bacillus tuberculosis,* first discovered by Koch. This bacillus is derived from two sources, viz., the human body, and from cattle, etc., affected with the disease. To prevent the spread of the disease it will, therefore, be necessary to work on two lines—(a) to regulate the lives of patients known to be ill with the disease, and (b) to prevent the flesh, etc., of diseased animals being placed on the market for consumption as food. As regards the former part of the question, there has been much discussion as to notifying the disease when once known to exist in the individual, as to isolating him to a greater or lesser extent, as is done in the case of leprosy, and as to compelling him, if allowed to mix with the rest of his fellowmen, to observe and do many things which would * There most be some non-specific (i.e., non-tuberculous) injury to a raucous surface of some organ of the body before the bacillus can secure a footing. 73 make his life a burden to him and mark him out as an "unclean" thing. It would be almost impracticable to notify the disease, nor is the advantage to accrue thereby evident. Any given case may go on for several years after it has been diagnosed, may become quiescent for a time, only to recur after some lung affection of a non-specific nature, or may recover permanently. From a tuberculous person the disease is spread by either the sputum or by discharges from specific sores—the latter source of infection being very rare and almost negligible. The source of infection is, therefore, narrowed down to the sputum, and it may be said at once that the whole question of checking the spread of this disease from individual to individual resolves itself into a question of safely disposing of the sputum. It has beeu abundantly proved that the action of direct sunlight is fatal to the bacilli of this disease, and that the dust of a room occupied by a tuberculous patient who is careless as to where the expectoration goes is full of bacilli. These two facts indicate how the disease may be dealt with to a certain degree. If the sputum be not ejected on to the floor, especially into dark corners where it can dry and become pulverised, but be destroyed by fire or disinfectants, and if the rooms of such patient be kept scrupulously clean and be exposed to as much sunshine as possible, then will a very large 74 proportion of the infection from him be destroyed. Add to these the natural precautions that his clothes, his person, and belongings of all kinds be kept clean, that his habitation be well ventilated and dry, and generally that his surroundings be in accordance with the laws of hygiene, and a further powerful agent will be created to prevent him spreading the disease. But besides setting a boundary to the dissemination of infection from the patient, it is necessary to set one round the "whole" individuals, whereby any infection escaping the confines of the former may be prevented from doing the latter any harm. Such line of defence will be the observance of the natural laws of health. Clean, airy homes, on dry sites, in situations where the light and air of heaven can gain access to all parts, healthy surroundings in the day's labours, wholesome relaxation and exercise of mind and body, with decent food—will enable any chance invasion of infection to be received with almost certain immunity. There remains yet one more question, namely, that of heredity. The disease is not inherited, i.e., the bacillus, the essential factor of the disease, is not transmitted from parent to offspring. What is inherited is an enfeebled constitution specially prone to fall a victim to the first infection with the bacillus. In the case of such an individual the 75 need of observing the laws of health is all the greater, and special care must be taken to guard against infection with zymotic diseases, such as measles, enteric fever, etc., for after these there is a liability to tuberculosis, even where the predisposition has not been inherited. It has been observed that, even under conditions which do not appear to infringe the laws of health, tuberculosis spreads from person to person, say from husband to wife. In such a case it will generally be found that the second individual has been living in very close communion with the patient, perhaps sleeping in the same room, or even the same bed, or kissing has been indulged in. Under these circumstances it is possible that the bacillus is transferred by direct contact between the persons. A little carelessness in attending to the patient's mouth or nose would suffice where kissing occurs; or the bed-linen may be soiled ; or, in a fit of severe coughing, some of the sputum may be sprayed on to the floor, to be stirred up in dusting.* Such cases do not vitiate what has been just said. Having sketched out the subject as far as it relates to the spread of infection from man to man, there remains that of the spread from animals * "Dry" dusting, under any circumstances, is a pernicious habit, and especially so when there is a tuberculous patient in the house. All dusting should bo by damp dusters, which may be followed by dry, and all sweeping should be done with damp tea leaves or other damp dust-absorbers. 76 used for food. This part of the question will be best summarised by quoting the recapitulations at the close of the Report of the Royal Commission. "We have obtained ample evidence that food derived from tuberculous animals can produce tuberculosis in healthy animals. The proportion of animals contracting tuberculosis after experimental use of such food is different in one and another class of animals; both carnivora and herbivora are susceptible, and the proportion is high in pigs. In the absence of direct experiments on human subjects, we infer that men also can acquire tuberculosis by feeding upon materials derived from tuberculous food-animals. The actual amount of tuberculous disease among certain classes of food-animals is so large as to afford to man frequent occasions for contracting tuberculous disease through his food. As to the proportion of tuberculosis acquired by man through his food or through other means, we can form no definite opinion, but we think it probable that an appreciable part of the tuberculosis that affects man is obtained through his food. The circumstances and conditions with regard to the tuberculosis in food-animals which lead to the production of tuberculosis in man are, ultimately, the presence of active tuberculous matter in the food taken from the animal and consumed by the man in a raw or insufficiently cooked state. Tuberculous disease is observed most frequently in cattle and in swine. It is found far more frequently in cattle (full grown) than in calves, and with much greater frequency in cows kept in town cow-houses than in cattle bred for the express purpose of slaughter. Tuberculous matter is but seldom found in the meat substance of the carcase; it is principally found in the organs, membranes, and glands. There is reason to believe that tuberculous matter, when present in meat sold to the public, is more commonly due to the contamination of the surface of the meat with material derived from other diseased parts than to disease of the meat itself. The same matter is found in the milk of cows when the udder has become invaded by tuberculous disease, and seldom or never when the udder is not diseased. Tuberculous matter in milk is exceptionally active in the operation upon the animals fed either with the milk or with dairy produce derived from it. No doubt the largest part of the tuberculosis which man obtains through his food is by means of milk containing tuberculous matter. The recognition of tuberculous disease during the life of an animal 71 is not wholly unattended with difficulty ; happily, however, it can in most cases be detected with certainty in the udders of milch cows. Provided every part that is the seat of tuberculous matter be avoided and destroyed, and provided care be taken to save from contamination by such matter the actual meat substance of a tuberculous animal, a great deal of meat from animals affected by tuberculosis may be eaten without risk to the consumer. Ordinary processes of cooking applied to meat which has got contaminated on its surface are probably sufficient to destroy the harmful quality. They would not avail to render wholesome any piece of meat that contained tuberculous matter in its deeper parts. In regard to milk, we are aware of* the preference by English people for drinking cow's milk raw, a practice attended by danger, on account of possible contamination by pathogenic organisms. The boiling of milk, even for a moment, would probably be sufficient to remove the very dangerous quality of tuberculous milk." (The administrative part of the subject is not dealt with in the Report ) The foregoing summary is naturally divisible into two parts, namely, that dealing with milk, and that with meat. It is unnecessary to refer to the prevalence of tuberculosis among animals beyond saying that of 300 milch cows slaughtered in Edinburgh in 1890, in consequence of an outbreak of pleuro-pneumonia, 40 per cent. were found on post mortem examination to be tuberculous. "With regard to the milk supply, there is ample proof of the danger of conveying the disease by this channel, in the frequency of tubercular disease of the bowel and mesenteric glands of young children, whose food is largely made up of milk. The Commission say "happily it (tuberculosis) can in most cases be detected with certainty in the udders of milch cows." There are, however, cases of 78 cular disease in the udder which do not show any signs of the affection, at least in the early stages, and, further, it is by no means proved that tuberculosis is conveyed by milch cows only when the udder is affected. Under these circumstances it seems desirable that more use should be made of the test by "tuberculin," Koch's preparation, which was thought would prove a specific remedy for the disease. This test has been used with great success in the United States of America. The Philadelphia Board of Health recently adopted this test as a condition precedent to registration and licence to sell milk. In this country the test was applied during the year to a large provincial herd of milch cows, and many were found to be tuberculous. The diseased animals were slaughtered and sold for food. Were the test introduced, its first result would be to weed out the diseased animals, and if applied to fresh stock, the introduction of diseased animals into the herd or dairy could be prevented. A Bill was drafted last year by M. Gadaud, the French Minister of Agriculture, proposing to make the use of the test compulsory. The following account of the provisions of the Bill are taken from the "Standard ":— Every beast presenting clinical signs of the disease (tuberculosis) is to be slaughtered by order of the Prefect. Any beast showing signs suspected to indicate tuberculosis is to be submitted to the tuberculin test, and if a reaction takes place the Prefect will order the beast to be slaughtered. All cattle which have cohabited with an animal known to be tuberculous are to be submitted to the test, and 79 those which show a reaction may not be sold except for slaughter, which must take place within a year. If any of these animals show clinical signs of the disease, the Prefect is to order them to be slaughtered. Compensation to the extent of one quarter of the value of the meat seized would be paid when the animal is tilled on the order of the Prefect, and one half when slaughtered within the year without showing clinical symptoms, but having reacted to the test. No compensation would be paid for meat condemned under any other conditions. The proposed Bill, the fate of which is unknown, did not go far enough. The test should be applied to all animals, and should be repeated at intervals in the case of cows kept in town sheds. The Royal Commission arrived at the conclusion that tuberculosis could be, and is transmitted through meat, but they thought that "provided every part that is the seat of tuberculosis be avoided and destroyed," and "provided every care be taken to save from contamination .... the actual meat substance of a tuberculous animal," much of the meat from this source could be used without risk. What does this mean? in a previous paragraph it is stated bv the Commission that the disease affects "organs, membranes, and glands"; so that to "avoid and destroy" the tuberculous parts, these organs, etc., must be "dissected" out. This cannot be done without interfering with the ordinary method of cutting up joints for the market—if such joints would be possible at all. The glands, i.e., lymphatic glands, are perhaps the commonest seat of the disease. Such glands are scattered all over 80 the carcase, yet they must be avoided and destroyed. The essential factor of the disease is the bacillus tuberculosis. It does not appear to be proved that if all affected "organs, etc.," be avoided and destroyed, that the bacillus will be thereby eliminated. Supposing that the bacillus were so eliminated, who would purchase meat which had been cut up for the purpose of dissecting out affected glands? In the last of their conclusions the Commissioners say that the ordinary methods of cooking "would not avail to render wholesome any piece of meat that contained tuberculous matter in its deeper parts." In fact, whilst arguing for the use of some portion of the flesh of tuberculous animals, the Commissioners furnish strong argument for the condemnation of the whole. Such condemnation is, indeed, the only safe course in the present state of our knowledge. The basis of opposition to the condemnation of the whole animal is the question of compensation. The argument, as usually put, is that an animal is purchased outwardly in good health and condition, yet when slaughtered it is found to be tuberculous and condemned, and the purchaser is thereby cast in damages for an offence of which he is guiltless. This may be in certain cases a fair argument, but it is vitiated by the fact that the purchaser has, as a rule, not availed himself of the means provided by science for determining whether the animal is or is not sound. A further counter 81 argument is found in the bad condition of so many cow-sheds in the country generally. Animals are subject to the ill effects of insanitation to much the same extent as human beings, and if kept in illventilated, badly lighted, and dirty stalls, they will fall victims to disease. The matter partakes of the nature of a "vicious circle." If the butcher would "test" his proposed purchases, the loss would fall (usually) on the dairy farmer; if he would provide his animals with healthy stalls, or byres, and submit his herd to the "test," then compensation might be considered. Such compensation would be required for a few years only, for there does not seem to be any reason why tuberculosis should not be stamped out as successfully as "foot and mouth" and other diseases which have been dealt with energetically. The evidence furnished to the Royal Commission is indirectly very strongly in favour of the abolition of private slaughter-houses and the provision of abattoirs, where inspection can be properly carried out whilst the carcase is being dressed. LOCAL DISEASES. The effect of sanitary reform on the diseases already dealt with is, with few exceptions, readily apparent; but with the diseases left for consideration, any influence exerted is indirect, and efficient by its action on the individual rather than on the 82 diseases themselves. In other words, with the former class we are able to check the occurrence of the disease itself, but in the latter it is by promoting the general well-being of the individual and maintaining his vital powers, that disease is to be stayed. Sanitation cannot prevent the occurrence of, say, heart affections, but if the conditions predisposing to rheumatic fever be eradicated, or if the worker be so placed that his health is not prejudiced, his vital powers fully maintained, and his heart saved from undue and unnecessary strain, such affections will become less frequent. Pulmonary affections, like bronchitis and pneumonia, are largely dependent on climatic conditions, but by keeping the habitation dry, by preventing overcrowding, and by avoiding all conditions likely to vitiate the air breathed, the lungs will be preserved in such a state that they will be able to withstand the ill effects of the variable climate of this country. Having regard to these considerations, it seems well to deal with the changes in the mortalities from these diseases somewhat more briefly than has been done with those already considered. Apoplexy.—In a certain sense this cause of death is a measure of the tension of life in the present day. The term is hardly a scientific one, as "apoplexy" is more a symptom than a disease, yet it is a very common mode of death. Some degeneration of the walls of the blood vessels of the 83 brain must precede the "stroke," and such cases ought, therefore, to be classed under diseases of the organs of circulation. Custom is, however, stronger than scientific nomenclature in this respect, and so the inexact description persists. From the various conditions implied by the term there died during the year 105 persons—47 males, and 58 females. The average annual number of deaths from this cause was approximately 102 during the ten years 1885-94, 111 during 1885-89, and 92 during 1890-94. Insanity, general paralysis of the insane.—The deaths registered under these headings by no means correspond with the numbers of persons removed to asylums, inasmuch as the larger proportion of deaths therein are certified as due to other diseases. The number of deaths of parishioners in such of the asylums as are in or near London will be found on page 89. The deaths classed under "insanity" numbered last year 23, compared with a corrected annual average of 11 (approximately). Bronchitis and pneumonia.— It will be well, owing to some change in the mode of classification, to take these two causes together, but their averages will be set out separately. There were 305 deaths due to the former disease, and 115 due to the latter, 420 in all, equal to a rate of 3.42 per 1,000. Of these deaths 236, viz., 186 of bronchitis, and 50 of pneumonia, occurred in the first quarter of the year, the corrected annual average for the quarter being 84 249, and the uncorrected, 184. The mean temperature of the quarter was 3.7° below the average, that for the month of February being as much as 9.9° below the average for the month. The average annual number of deaths from these diseases during the period 1885-94 was 417 (approximately). The subjoined statement gives the deaths from each disease in the two divisions of the Parish for last year, and the corresponding average annual numbers. Recorded, Corrected annual averages— 1895. 1885-89. 890-94. 1889-94. Bronchitis. St. Mary 239 180.9 202.2 192.4 St. John 66 40.2 53.8 48.1 Pneu-monia. St. Mary 96 121.9 148.0 135.8 St. John 19 31.5 48.3 40.7 As regards the incidence on the sexes, there died last year 138 males, and 167 females from bronchitis —and 61 males, and 54 females from pneumonia. See Table 25 for rates. Cirrhosis of the liver.— This is a disease which is usually, but not always, due to alcoholic excess. Owing, as has been already stated, to the omission to refer to the drink habit when certifying death, it may not be unfair to take all the deaths due to this cause as due to alcohol, for the present purposes. There were 14 deaths classed under this heading in the year—8 of males, and 6 of females. The decennial average is not available, but the figures for the five preceding years were—24 in 1890, and 18, 15, 18, and 19, in the succeeding years. The quinquennial average was 19.1 per annum. 85 TABLE 25. Death-rates from Bronchitis and Pneumonia per 1,000 living in each Sex-Age-group. Bronchitis. Pneumonia. Paddington (both sexes). Paddington. St. Mary. St. John. Paddington. St. Mary. St. John. M. F. M. F. M. F. M. F. M. F. M. F. 0-1 1895 25.21 11.37 23.91 14.19 32.96 4.39 15.76 6.32 16.55 7.98 10.98 2.18 17.53 10.52 1894 2653 22.25 29.02 25.29 10.86 5.10 7.98 5.37 7.49 5.42 10.86 5.10 24.26 6. 49 1-5 1895 4.91 4.10 5.08 4.71 4.03 2.59 1.78 1.67 1.87 2.35 1.34 ... 4.47 1.72 1894 2.26 3.30 2 .45 2.66 1.32 6.36 2.48 1.54 2.99 1.86 ... ... 2.78 2.00 5-15 1895 0.10 0.33 0.12 0.35 ... 0.29 0.10 0.08 0.12 ... 0.28 0.22 0.09 1894 ... 0.09 ... 0.12 ... ... ... 0.09 ... ... ... 0.47 0.04 0.04 15-25 1895 0.19 0.06 0.26 ... ... 0.23 0.29 ... 0.39 ... ... ... 0.11 0.26 1894 0.20 0.06 0.27 0.09 ... ... 0.50 0.12 0.67 0.18 ... ... 0.11 0.26 25-65 1895 1.94 1.34 2.05 1.48 1.60 1.01 0.73 0.32 0.74 0.41 0.71 0.10 1.58 0.48 1894 0.74 0.65 0.75 0.71 0.70 0.52 1.00 0.42 0.75 0.58 1.75 0.08 0.68 0.65 65 and over 1895 18.31 19.44 18.55 20.11 17.69 17.77 6.10 5.88 7.13 5.74 3.53 6.22 19.06 5.95 1894 9.75 12.74 10.17 12.80 8.75 12.59 2.56 4.51 0.72 4.02 7.00 5.82 11.72 3.85 All ages 1895 2.71 2.32 2.79 2.51 2.44 1.83 1.20 0.75 1.32 0.85 0.78 0.48 2.48 0.93 1894 1.61 1.64 1.78 1.82 1.03 1.19 1.07 0.68 0.98 0.79 1.37 0.42 1.62 0.84 G 86 Adding the deaths from this cause to those attributed to alcohol, a total of 22 is obtained as a "drink" mortality for the year—approximately 5 below the annual average for the past five years. Diseases of parturition.— The deaths from puerperal fever have already been mentioned—see page 69, above. There were in addition 8 deaths of adult females from other diseases incidental to childbirth, practically the same as the annual average for the past ten years. Adding these 8 deaths to the 7 from puerperal fever, a total of 15 deaths is obtained for the whole year which were directly attributed to labour. There were 2,979 births registered in the year, and the 15 deaths were equal to 5.0 per 1,000 births registered. Half these lives were lost by a disease which can be entirely prevented, i.e., puerperal fever. Accidental deaths.— There were 76 deaths due to all forms of accident and violence, which were distributed as follows:— "accident or negligence" 57, "homicide" 4, and "suicide" 15. Of the deceased persons 44 were males, and 32 were females. The annual averages for the past decennium were—accidents 53, suicides 15, and other forms of violent deaths 2, the nearest whole numbers being taken in each case. Fifty-seven of the deaths were from North Paddington, and 19 from South. The appended statement of the findings of the Coroners' Juries will show the distribution of the deaths. 87 TABLE 26. Inquests on Parishioners, 1895. 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 29 16 12 4 12 6 16 6 101 By Misadventure 1 — 1 — — 1 — 2 5 Accidental Death* 9 5 10 2 12 — 7 2 47 Manslaughter 1 — 1 — — — — — 2 Wilful Murder — — — — 1 — 1 — 2 Suicide 1 — 6 — 2 4 1 1 15 Open — — — — 1 1 3 1 6 Totals 41 21 30 6 28 12 28 12 178 Note—In Table III. (Appendix) deaths "by misadventure" and deaths where "open verdicts" are returned are classified under "accident and neglect." * One case where Septicæmia followed injury to hand is classified under "Pyæemia." G 2 88 The accidents of the year were due to, or occurred in connection with, the following:— In building operations 2 Through neglect at birth 3 By horses, vehicles, &c. 6 By falls, not specified 10 On railways 3 „ poison (oxalic acid) 1 By suffocation (including laid" 14, & accidents at birth 2) 17 „ injury (not stated what) 1 Through exposure to weather 1 By the clothes catching fire (not conflagrations) 3 Verdicts of "misadventure" were returned in connection with the following deaths:— By poison 3 viz., opium 2, and cocaine 1. „ suffocation 1 "probably an epileptic fit in bed." „ fire at sea 1 on s.s. "Iona." Death was declared to have been due to violence, but how, or by whom caused, was not set forth in 3 cases of drowning in the canals, in respect of 2 deaths of children who died at, or immediately after birth, and 1 death by a fall. The suicides were effected in the following manner:— By hanging 3 all men. „ cutting the throat 1 a woman. „ pistol shot 2 both men. „ poison 5 3 men and 2 women; carbolic acid used 4 times, and opium once. „ drowning 2 1 man and 1 woman. "Otherwise" 2 1 woman threw herself out of window, 1 man threw himself under a train. The cases of manslaughter were both the results of fighting. The murder cases were those of a woman aged 30, shot by her husband, and a newborn infant, suffocated. In respect of 2 deaths there was neither medical 89 certificate nor inquest. The probable causes of death were stated to be "premature birth" (f., 1 hr.), and "pneumonia" (m., 30). Such deaths are in this Report classed as "uncertified." DEATHS IN INSTITUTIONS. Of the deaths of parishioners during the year, 346 took place in the local institutions, and 156 in outlying, making a total of 502, equal to 23.9 per cent. of all deaths. The numbers of deaths, with certain of the causes are set out below:- Local Institutions. Paddington Workhouse & Infirmary 204, including 15 non-parishioners. Lock Hospital 1, „ 1 „ Children's Hospital, Paddington Green 17, „ 11 „ St. Mary's Hospital 332, „ 181 „ Outlying Institutions. Hospitals of the Metropolitan Asylums Board, 32: scarlet fever 11 enteric fever 3 diphtheria 16 erysipelas 1 other diseases 1. General Hospitals, 21: cancer 7 tubercular disease 1 other diseases 13. Special Hospitals, 20: diarrhœa 2 cancer 2 scarlet fever 2 tubercular disease 8 other diseases 6. " Homes," 10: cancer 2 tubercular disease 2 other diseases 6. Lunatic Asylums, 59: cancer 2 tubercular disease 2 other diseases 55. Poor Law Institutions, 5. "Elsewhere," 9: cancer 1 other diseases 8 90 CAUSES OF DEATH AMONG INFANTS, In view of the rise in the death-rate among infants under one year of age, Table 27 has been prepared showing the annual average of deaths from certain selected causes in the whole Parish during the past decennium. In the last column the averages have been multiplied by 1.022, the ratio of the births in 1895 to the average annual number of births during 1885-94. TABLE 27. Deaths under 1 Year of Age—Whole Parish. 1895. Average per Year 1885-94. Average increased for increase in births. Measles 3 10.6 10.8 Scarlet Fever ... 1.0 1.0 Whooping Cough 13 19.6 20.0 Diphtheria 2 3.5 3.5 Diarrhœa 72 52.0 53.1 Syphilis 8 9.4 9.6 Other Zymotic Diseases 6 3.7 3.7 Total Zymotic Diseases 104 99.8 101.9 Want of Breast Milk 4 2.9 2.9 Tubercular Diseases 22 29.0 29.6 Premature Birth 71 49.5 50.3 Congenital Malformations 22 10.5 10.7 Convulsions 29 35.8 36.5 Bronchitis and Pneumonia 80 69.3 70.8 Dentition 10 8.5 8.6 Enteritis 43 5.3 5.4 Suffocation, includg. "overlaid" 18 10.6 10.8 Other forms of Violence 6 4.5 4.5 Atrophy and Debility 48 59.2 60.5 All other causes 33 30.9 31.5 Total deaths 490 415.8 424.9 Births registered 2,979 2,915.0 ... 91 It is satisfactory to note that, with the exception of "Diarrhœa" and "Other Zymotic Diseases," there was during last year a general reduction in the deaths from zymotic diseases. Five of the 6 deaths from "Other Zymotic Diseases" last year were due to epidemic influenza. There was also a considerable reduction in the number of deaths from "Tubercular Diseases." Very little importance can be attached to the reductions in deaths from "Convulsions" and "Atrophy and Debility," inasmuch as the major part of such reductions is due to greater care in the diagnosis of disease and most probably neutralised by the increases manifested under diarrhoea and pulmonary diseases. There was a very large increase in the deaths from the developmental diseases, "Premature Birth" and "Congenital Malformations." The death-rate from these causes in 1895 was 31.2 per 1,000 births, as compared with an average rate of 20.5. Last year these deaths constituted 18.9 per cent. of all deaths under 1 year, the average proportion being 14.4. It is impossible to account for so great an increase. It may be accidental or it may be due to some change in the conditions of life. The increase in the number of deaths from Bronchitis and Pneumonia, amounting to (approximately) 14 per cent., was almost certainly due to the severe winter, and may, therefore, be regarded as accidental. 92 Of the diseases already touched on, it will be seen that there were last year reduced mortalities from those which may be called controllable, with the exception of diarrhœa, and increased mortalities from those which appear to be, at present, beyond the influence of sanitation. There remain yet certain diseases with excessive mortalities during the past year, over which a very considerable control can be exercised. The loss of life through these diseases represents the price paid for ignorance and the neglect of the laws of hygiene. The death-rate last year from "Diarrhœa" and "Enteritis" was 38.6 per 1,000 births, compared with an average of 9.6, the deaths last year constituting 23.4 per cent. of the deaths under one year, compared with an average of 13.7. There is little doubt that some proportion of the deaths from "Dentition" and "Want of Breast Milk," was due to the causes which gave rise to the high death-rate from diarrhœa and enteritis. As has already been stated, diarrhœa is but a symptom of a diseased condition, but for brevity's sake that term will be used, in considering the causes of those diseases, to include the various diseases giving rise to the symptom. It will be impossible on this occasion to do more than indicate those causes, without endeavouring to assign to each cause its proper share of the mortality. The origins of the diseases will be considered under three heads, viz., (a) insanitary 93 conditions, (b) climatic influences, and (c) errors in feeding, but they will not be taken separately. It has been shown by English observers that diarrhœa does not become epidemic until the temperature of the earth, as indicated by underground thermometers, has reached a definite point, about 60° F. at 1 ft. and 56° at 4 ft. This fact appears to be independent, to a certain extent, of the air temperature, i.e., that high air temperatures are efficient in producing diarrhœa only so far as they cause high temperatures of the soil. It has been observed that the temperature of the soil does not follow that of the air in a regular manner, and there is little doubt that the amount of moisture in the soil influences the effect of the high air temperatures. The evidence as to the connection between the soil and this disease is as yet incomplete, but it would appear that in addition to a definite maximum temperature there must be pollution of the soil with either sewage or garbage or both. The disease is undoubtedly due to micro-organic life, and therefore it may be supposed that the micro-organism multiplies in the soil when it is at or near its maximum temperature, and by some means or other the organism or its products finds its, or their, way into the human body.* Granting that the disease is due to a filth * The curve of the disease follows that of the temperature of the earth at an interval of about a week, a fact which supports the view that the disease is due to the development of a micro-organism in the soil. 94 polluted soil raised to a definite temperature, it is easy to indicate routes which the products of such growth find only too often open to them. Badly constructed drains laid in at a slight depth under or near houses built on "made up" soil, without an impervious layer of concrete over the site; waste-pipes connected to drains with no traps to keep the up-draught out of the houses; soil-pipes with defective joints, placed near to the windows of the larder or living room, perhaps inside the house and without any ventilation, and so on ad nauseam. The products of micro-organic life may be called the exciting cause of the disease to which there must be added one or more predisposing. These will be found in such insanitary conditions as narrow streets and courts, absence of direct sunshine to the tenements, deficiency in air currents round the houses, and in dirty and overcrowded rooms. To these there must be added yet another cause, due to weakly health inherited through the parents living in insanitary homes or to inherited disease or diathesis. So that it appears that all those conditions included in the term "bad hygienic surroundings" will act directly on the infant himself and indirectly by inheritance through the parent. The effects of high temperatures as regards diarrhoea have been referred to in the preceding paragraph, and it now remains to see how far the 95 meteorological conditions of the past year, based on the observations taken at Greenwich, support what has been said. For this purpose the results of the observations during the third quarter of the year will be examined. The mean air temperature for the quarter was 62º.3, 2º.2 above the average for the preceding 54 years, but was only slightly above the average in July and August. The mean daily range was 20º.7 for the quarter, lº.0 above the average, being, however, below the average in July and August. The mean of the daily maxima was below the average in July, and above it in August and September, especially in the latter month. The mean of the daily minima was above the average in each of the three months. These facts are set out in the appended statement:— TEMPERATURE OF AIR (Degrees Fahrenheit). Mean 1895. temperature. Departure from Average.* Mean of 1895. Maxima. Departure from Average. Mean of 1895. Minima. Departure from Average. Mean of 1895. Daily Range. Departure from Average. July 62.6 + 0.6 72.8 -1.1 54.2 +1.1 18.6 -2.3 August 62.2 + 0.8 73.0 +0.2 53.7 +0.7 19.3 -0.5 September 62.2 + 5.2 75.4 +8.1 51.3 +2.3 24.1 +5.9 The Quarter 62.3 +2.2 The variations in the temperature can be more closely followed in the following scheme, where the quarter is divided into successive periods according * Averages are based on observations for past 54 years. + Indicates excess over average; - indicates defect below average. 96 as the mean daily temperature was above or below the average temperature for each day. Excess above Period. or defect from Average. F.º July 1st—11th +2.1 „ 12th—23rd -1.0 „ 24th—27th +2.2 „ 28th—Aug. 15th -2.7 Aug. 16th—Sept. 11th +4.3 On Aug. 22nd, Sept. 7th and 9th, excess 8.8, 9.7, and 8.6 respectively. Sept. 12th—21st -0.6 „ 22nd—30th +10.4 Excess for Sept. 24th—29th, 12.9. The rainfall for the quarter (6.46-in.) was 0.83-in. below the average, being, however, above the average in July (to the amount of 0.80-in.) and below in August (to the amount of 0.24-in.) and September (to the amount of l.39-in.). The foregoing observations show that the quarter was on the whole characterised by temperatures in excess of the average and a rainfall below the average, conditions which favour a rise in the temperature of the earth. It is unfortunate that there are no observations recorded of the underground temperatures. From inquiries made in Paddington and elsewhere it has been ascertained that a very large proportion of the infants dying of "infantile diarrhœa" were fed by bottle. This special predisposition on the part of children artificially fed has been noted by others. Want of cleanliness in the bottle has, undoubtedly, a large share in causing sickness among such children, but of recent years another source of 97 danger has arisen by the placing on the market of brands of condensed milk made from skim milk, which recommend themselves to the poorer classes by reason of their cheapness (?). As will be shown, or endeavoured to be shown, children fed on such food are all the time underfed, in addition to being exposed to the risks of poisoning by bad milk. The proper standard for all infant's foods is naturally human milk. This contains in 100 parts, 2.29 of proteids (nitrogenous elements), 2.81 of fats, 6.20 of carbohydrates (non-nitrogenous elements), and 0.30 of mineral salts. The proportion of nitrogenous to non-nitrogenous elements is as 1 to 4.4. When lactation is at its full, i.e., in the fifth month after delivery, about 2 litres of milk are secreted, containing approximately 45 grammes of proteids, 80 grammes of fats, 125 grammes of carbohydrates, and 6 grammes of salts. These are, therefore, the standard requirements of an infant in its fifth month. Cow's milk has an average composition of 3.55 parts of proteids, 3.69 of fats, 4.88 of carbohydrates, and 0.71 of salts. The ratio of nitrogenous to nonnitrogenous elements is as 1 to 2.5. The proper dilution to render such milk similar to the standard of human milk is the addition of 2 parts of water to 3 of milk, with the addition of some "milk sugar," about three-fifths of an ounce to a pint of mixture. The addition of water is useful to check the 98 tion of large curds in the stomach, thereby aiding digestion.* There is considerable divergence in the results of analyses of condensed milks, and those used here have been taken from "The Analyst," December, 1895. Two brands have been selected which appear to be about the best and the worst in the list. Brand A is endorsed on the label as "prepared from pure milk of Swiss cows." It contains in 100 parts, 9.7 of proteids, 13.7 of fats, 52.2 of carbohydrates (37.2 of added cane sugar), and 1.6 of "ash," i.e., of salts. Neglecting the added sugar, the proportion of nitrogenous to non-nitrogenous elements is 1 to 2.9. The dilution recommended for infant feeding varies from 5 parts of water to 1 of condensed milk, to 14 to 1. In the case of an infant requiring 2 litres, the amount of food-stuffs given in the 24 hours would be, Do. excluding Dilution. Proteids. Fats. Carbohydrates. Cane Sugar. Salts. 1 to 5 32.3 45.6 173.8 49.9 5.3 1 to 14 10.5 18.2 69.4 19.9 2.1 Brand B is endorsed "made from skimmed milk." In 100 parts it contains 8.5 of proteids, 1.0 of fats, 15.4 of milk sugar (or 45.8 of milk and cane sugar together), and 1.6 of salts. The proportion of nitrogenous to non-nitrogenous elements is 1 to 1.58, if the cane sugar be included, but only 1 to * The analyses, &c., given above are taken from the "Theory and Practice of Hygiene," by Lane and Notter. 1896. 99 1.9 if it be excluded. This brand is not labelled as recommended for the feeding of infants, but in the course of inquiries made it was found to be very extensively used. With the same dilutions as those given in the preceding case, the amounts of food-stuffs given, made up to 2 litres in the 24 hours, would be— Do. excluding Dilution. Proteids. Fats. Carbohydrates. Cane Sugar. Salts. 1 to 5 28.3 3.3 165.8 66.2 8.3 1 to 14 11.3 1.3 66.2 20.4 3.3 It will be seen on comparing the figures for the condensed milks with those for human milk, that the amount of nutritive material contained in the standard allowance of 2 litres in the 24 hours falls considerably short of that contained in 2 litres of human milk. To any suggestion that some of the deficiency can be made up by giving more of the mixture, the answer is that the infant's stomach cannot receive more than a certain quantity of food, whatever its composition, without causing indigestion and sickness. In the use of condensed milks, or of the majority of them, there is the further disadvantage of the presence of the added cane sugar. This is not only prone to ferment if the diluted mixture be kept after making, but also to cause indigestion in the child. The use of condensed milk has for the poorer classes the advantages of small price, especially the "starvation" brands of skim milks, and of ease of preparation, so that it would appear to be an almost 100 hopeless task to eradicate the habit of its use. Much good would probably be effected if the information given above, presented in a simpler form, were circulated by district visitors, clergy, and others coming into contact with the poorer classes. It might be advantageous to prepare a fly-leaf dealing with the matter of artificial feeding of infants, to be given away by the registrars when the parents come to register the birth of the child. A similar slip could also be circulated by means of the hospitals. As the law stands at the present time, there is no power to compel the makers of the "starvation" brands to label their tins in so conspicuous a way that it should be patent to all that the milk has been skimmed of some, oftener of all, of its cream. There should be legislation on the lines of that regulating the sale of margarine, and the tins should be labelled, in letters of not less than one inch square, "made of milk deprived of ... of its cream" and "not fit for the food of infants." The last cause of death of infants under 1 year which remains to be considered is that of " violence and accidents." There were 24 deaths during the year falling under this classification, 18 of them being due to suffocation. The average annual number of deaths from this cause (suffocation) being 11 approximately. The majority of deaths from 101 cation were due to "overlying," 14 children under 1 year of age being killed in this manner. The deaths are due to the practice of having the infants in bed for the purpose of nursing, or to keep them warm. The safer plan is to have the child in a crib alongside the bed; but this is not always possible, owing either to inability to meet the necessary outlay or to want of space in the room. If the child must be taken into the bed, some frame, such as that used in Italy, should be placed over it. In that country the fact of a child dying through being overlaid is a disgrace to the parents in the eyes of the neighbours, and brings down on them the power of the Church as well as that of the State. The law of this land needs amendment to bring parents who kill their children in this manner within its grasp. At present they escape with nothing worse than a reprimand from the Coroner for their "carelessness," when they should be charged with "culpable negligence" and punished accordingly. Of the 490 children who died at ages under 1 year in 1895, 51 were illegitimates, or 10.4 per cent. of all the deaths at this period. The illegitimate deaths were equal to a rate of 408 per 1,000 illegitimate births registered, compared with a rate of 164 for all deaths at this age per 1,000 births, and to one of 150 from deaths of legitimates per 1,000 legitimate children born. Six deaths at B 102 ages between 1 and 5 years were also registered during the year. The causes of death among illegitimate children are set out below:— Under 1. 1—5. M. F. M. F. Zymotic Diseases Measles 0 0 0 3 Diarrhœa 2 3 0 0 Vaccination 1 0 0 0 Dietic Diseases Want of breast milk 0 1 0 0 Constitutional „ Tubercular diseases 1 1 0 2 Developmental „ Premature birth 4 4 0 0 Atelectasis 3 0 0 0 Congenital malformation 1 0 0 0 Local Diseases Convulsions 1 1 0 0 Spasm of glottis 1 0 0 0 Bronchitis 4 0 0 1 Sore throat 0 1 0 0 Gastro-enteritis 2 2 0 0 Accident & Violence Suffocation... ... 0 2 0 0 Neglect 0 1 0 0 Ill-defined Causes Atrophy & debility Haemorrhage from 4 4 0 0 cus 0 1 0 0 Totals 24 21 0 6 An analysis of the occupations of the parents of the deceased shows that 34 of the children were the offspring of domestic servants of one kind or another, 1 each of a charwoman and laundress, 3 of dressmakers, 4 of women engaged in commerce or of no occupation, and that in 4 cases there was no information given as to the status of the parent. THE DEATHS IN THE STREETS ENUMERATED IN 1894-95. The deaths in the streets visited from house-tohouse, (see page 10, above), have been analysed and 103 divided into certain groups, the results of the analysis being set out in Table 28. The highest death-rate from all causes recorded was that of Wellings Place (65.6), and the lowest that of Andover Place (6.8). Much importance cannot, however, be attached to these rates, owing to the very small numbers dealt with. The rates prevailing in such streets as Clarendon Street (36.0), Cirencester Street (24.0), and Woodchester Street (21.3), are more worthy of attention. In these three streets the death-rates at ages under 10 years varied from 59.7 in Clarendon Street, to 27.2 in Woodchester Street; whilst at ages over 10 years they ranged from 25.4 in Clarendon Street to 18.7 in Cirencester Street. There are no death-rates at these ages for the remainder of the Parish for comparison. The death-rate from the principal zymotic diseases varied from 3.5 in Cirencester Street to l.9 in Woodchester Street. The percentage of deaths in institutions was highest in Cirencester Street (38.2) and lowest in Woodchester Street. Deaths from tubercular disease constituted nearly 15 per cent. of all deaths both in Cirencester and Clarendon Streets. METEOROLOGY. The meteorology for the year, as compiled from the Weekly Returns of the Registrar-General, will be found in Table VII. in the Appendix. The only h 2 104 TABLE 28. 1895. Deaths at Ages. Death-rates pel 1,000 Principal Zymotic Diseases. Other Causes of Death. Percentage of deaths in Institutions. Total Deaths. Under 1. 1—10. 10—60. 60 and over. Institutions Total. Under 10. Over 10. 1 Measles. Whooping Cough. Diphtheria. Enteric Fever. Diarrhoea. Death rates. Erysipelas. Influenza. Syphilis. Tubercular Dis. Respiratory Dis. Deathsby Violence. All other causes. Andover Place 1 ... ... ... ... ... 6.8 ... 10.1 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... Carlton Mews 5 ... ... 3 2 4 37.5 ... 62.5 ... ... ... ... ... ... 1 ... ... ... ... ... 4 80 Church Place 15 5 1 6 3 3 54.7 51.2 57.3 ... 1 ... ... ... 3.6 ... 1 ... 2 3 2 6 20 Cirencester Street 34 9 7 10 8 13 24.0 35.3 18.7 ...1 ... 1 ... 2 3.5 ... 2 ... 6 12 1 8 382 Clarendon Street 70 14 22 24 10 24 36.0 5.7 25.4 2 ... 3 ... ... 2.5 ... 4 2 11 21 2 25 34 1 Dudley Street 13 7 1 2 3 5 44.2 80.8 25.6 ... ... 1 ... 1 6.7 ... ... ... 2 1 1 7 386 John Street... 3 1 1 ... 1 24.3 30.3 20.4 ... ... ... ... ... ... ... ... ... 2 ... ... ... 50 Kent's Place 1 1 ... ... 1 10.4 2.0 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 100 Waverley Road 17 7 2 4 4 3 19.2 31.4 13.4 1 ... ... ... 2 3.3 ... 1 ... 1 4 ... 8 17 6 Wellings Place 9 3 1 3 2 ... 65.6 83.3 56.1 ... 2 ... ... ... 14.5 ... ... ... 2 3 ... 2 ... Woodchester Street. 33 7 6 9 11 9 21.3 27.2 18.7 ... 2 ... ... 1 1.9 ... 1 ... 7 6 1 15 272 105 year for which a similar Table exists is 1894, the figures for which year are set out in the two last columns of Table VII. Table 29 has been compiled from certain of the Tables in the Registrar-General's Annual Summary, and shows some of the chief variations during last year from the averages for different periods of years. In spite of the phenomenal winter, the mean temperature for the year was only 00.1 below the average for the preceding 54 years. The variations from the mean for different periods, divided off by changes between excess and defect therefrom, are set out in Table 30. The greatest variation in defect from the mean was shown during the ten days February 5th—14th, when the mean daily temperature was on an average 160.6 below the average mean temperature for those days. On May 13th the mean day temperature was 150.3 above the average for the day, and there were excesses to as nearly a large amount on May 30th (130.8), May 12th (130.7), and December 30th (13°.1). The mean temperature of the air was phenomenal in January (33°"8)—the lowest since 1881, in February 280,9—the lowest since 1771, in June (610,4)—which has been exceeded on twelve occasions only since 1771, in September (620-2)— which has been exceeded twice only since 1771, 106 TABLE 29. 1895. Reading of Barometer (Corrected) inches. Temperature F?. Daily Range of Temperature F°. Sunshine (Hours.) Humidity of Air (Saturation = 100.) Rainfall inchei. Grass Thermometer—No. of Nighti it was Relative proportion Hourly Velocity of Wind. Mean. Diff. from Average 54 years. Mean. Diff. f rom Average 54 years. Mean. biff, from Average 54 years. Recorded. Diff. from Average 10 years. Mean. Diff. from Average 64 years. Amount. Diff. from Average 80 years. At or below 30° F. Between 30° & 40°. Above 40°. N. E. S. w. M ean. Diff. from Average 10 years. Jan., Feb., and Mar. 29.664 -0.109 35.2 -4.6 11.8 0.0 143.2 ? 81 -4 3.27 -1.68 55 33 2 27 18 26 19 12.3 ? April, May, and June 29.846 +0.064 55.1 +2.2 20.9 +0.8 457.8 ? 71 -7 1.91 -3.79 6 43 42 31 18 22 20 10.2 ? July, Aug., and Sept 29.812 +0.019 62.3 +2.2 20.7 +1.0 503.2 ? 73 -5 6.46 -0.83 0 7 85 11 14 36 31 11.0 ? Oct., Nov., and Dec. 29.671 -0.079 44.7 +1.0 11.5 0. 121.2 ? 87 -3 8.09 +0.97 27 47 18 13 22 23 34 13.4 ? Year 29.748 -0.023 49.3 -0.1 16.2 +0.4 1,225 -12.4 78 -4 19.73 -5.33 88 130 147 82 72 107 104 11.6 +0.1 * The quarterly totals in these columns are compiled from the Weekly Returns of the Registrar-General and are for 13 weeks, not the three months, Averages for the quarters are not at present available. The signs + and -, respectively indicate that the number in the preceding column is above or below the average to the amounts indicated. 107 TABLE 30. Mean daily Variation. Jan. 1st—13th -5°.9 6th (-9°.1); 10th (-10°.3); 11th (-10°.7); 12th (-9°.9). 14th—20th +3°.4 21st—Mar. 9th -6°.8 Feb. 5th—14th (-16°.6). Mar. 10th—28th +4°.3 March 22nd (+10°.6). 29th—31st -3°.6 April 1st—7 th -4°.4 8th—12th +4°.1 13th—16th -3°.4 17th—May 15th +4°.9 May 12th (+13°.7); 13th (+15°.3); 14th (+12°.1). May 16th—25 th -4°.1 May 17th (-10°.4). 26th—June 11th +3°.9 May 30th(+13°.8); Ju.9th(+11°.5). June 12th—19th -l°.8 20th—30th +3°.9 July 1st—11th +20,1 12th—23rd -1°.0 24th—27th +2°.2 28th—Aug. 15th -2°.7 Aug. 16th—Sept. 11th +4°.3 Aug. 22nd (+8°,8); Sept. 7th (+9°.7); 9th (+8°.6) Sept. 12th—21st -0°.6 22nd—30th +10°.4 Sept. 24th—29th (+12°.9). Oct. 1st +9°.3 2nd—11th - 2°.0 12th-15th +3°.1 16th—Nov. 3rd -6°.2 Oct. 24th—30th (-10°.8). Nov. 4th—22nd +6°.2 Nov. 6th (+10°.5); 7th (+10°.7); 16th (+13°.0). 23rd—27th -l°.7 28th—Dec. 18th +2°.1 Nov.29th(+9°.6); Dec.5th(+ll°.9). Dec. 19th—28th -3°.8 29th—31st +10°0 Dec. 30th (+13°.1). 108 namely, in 1815, when the mean temperature for the month was 620.3, and in 1865, when it was 63°.9. The sunshine recorded during the year amounted to 1,225 hours out of 4,447 hours during which the sun was above the horizon, or 27.5 per cent. of the amount which could be recorded. In 1894 there was a record of 23.6 per cent. of the "possible." Last year's total of bright sunshine was 12.4 hours below the average for the past ten years. The mean humidity of the atmosphere was 4 degrees below the average (54 years). A reduction in the amount of moisture in the air enables the sun to have more effect in warming the superficial layers of the earth, which is of importance in connection with the prevalence of "summer diarrhoea." The rainfall for the year was 5.33 inches below the average (80 years), the deficiency for the second quarter of the year amounting to no less than 3.79 inches. This implies a great loss of cleansing of the air from pollutions of all kinds, and would favour the spread of certain of the infectious diseases. Fog of varying amount was recorded on 52 occasions during the year, as compared with 55 during 1894, No record has been made of the frequency of smoke fog as distinguished from white or sea fog. 109 WATER SUPPLY.* Much of what was said on this subject in the Report for 1894 holds good for 1895, and it will be unnecessary to do more than direct attention to those particulars in which 1895 differed fron 1894. Professor Frankland observes that the raw material from which the companies drew their supplies was more favourable for purification in 1895 than it was in 1894, and that the Thames water, as distributed to consumers, was of a better average quality last year than in any of the four years immediately preceding. All the samples from the mains of the "West Middlesex and Grand Junction Water Companies were found to be "clear and transparent" when examined for transparency. The results of the chemical analyses of the waters of these two companies during 1895 are set out in Table 31, the average results for 1894 and 1895 being contrasted in Table 32. From the figures given above it appears that last year's supplies were chemically purer than those of 1894, "nitrites and nitrates" being the only organic constituents with higher results last year than in the year before. These nitrites and nitrates are evidences of pollution which has * Abstracted from the Report on the Chemical, Physical, and Bacteriological Examination of the Water supplied by the Metropolitan Water Companies during the year 1895, by Prof. E. Frankland, D.O.L., &c. The full Report is given in the Registrar-General's Annual Summary. 110 TABLE 31. Comparative Analyses of Water Supply to Paddington. (Compiled from Registrar-General's Annual Summary.) 1895. Thames (unfiltered water.) From Mains of West Middlesex Co. Grand Junction Co. Temperature (degrees Centigrade) mean 11.0 9.8 11.8 max. 18.9(6) 16.1(7) 19.50(8) jnin. 1.1(2) 1.4(2) 0.9(2) Total Solids mean 29.68 28.57 28.74 max. 33.88(1)(12) 34.50(1) 35.42(1) jnin. 26.40(8) 23.52(8) 24.38(8) Parts per 100,000 of water, Organic Carbon mean 0.233 0.159 0.147 max. 0.545(11) 0.308(11) 0.274(11) mill. 0.135(2) 0.099(7) 0.099(7) Organic Nitrogen mean 0.039 0.021 0.019 max. 0.071(11) 0.039(11) 0.039(11) min. 0.021(2) 0.013(6) 0.011(6) Ammonia mean 0.009 0.000 0.000 max. 0.017(8) 0.000 0.000 min. 0.006* 0.000 0.000 Nitrogen as Nitrites and Nitrates mean 0.233 0.233 0.239 max. 0.364(2) 0.423(2) 0.430(2) min. 0.132(8) 0.139(8) 0.143(7) Chlorine mean 1.8 1.8 1.8 max. 1.9(10) (11) 1.9(8)(11) 1.9(11)(12) min. 1.6(7) 1.6(5) 1.7** Degrees of Hardness (l°=l pt. Ca CO3 per 100,000) mean 19.5 19.3 19.6 max. 23.0(12) 22.7(2)(12) 22.7(12) min. 16.9(8) 16.6(8) 17.1(7) The figures shown ( ) indicate the months when the respective maxima and minima were observed. * In April, September, October, and November. ** In February, April, May, June, and July. 1ll TABLE 32. Comparison of Means of Analyses made during 1894 and 1895. Temperature C0. Per 100,000 pts. of Water. Total Solids. Organic. Ammonia. Nitrogen as Nitrites and Nitrates. Chlorine. Hardness 1D°=1 pt. Ca Cos. Carbon. Nit'g'n. West Middlesex Water Co. 1894 10.9 28.12 0.207 0.024 0.000 0.216 1.9 18.4 1895 9.8 28.57 0.159 0.021 0.000 0.233 1.8 19.3 Grand Junction Water Co. 1894 12.3 28.96 0.202 0.024 0.000 0.226 1.9 18.9 1895 11.8 28.74 0.147 0.019 0.000 0.239 1.8 19.6 undergone decomposition. Both supplies were slightly harder last year than in 1894. From a bacteriological point of view the filtration during last year was not up to the usual standard, which fact appears to have been partly due to the prolonged frost. Last year the average percentage of microbes removed by filtration was, in the case of the West Middlesex Company 99.29, and in that of the Grand Junction Company 97.57. The corresponding figures for 1894 were 99.65 and 98.06. This is a matter of such great importance that no apology need be offered for the inclusion of the appended Table showing the variations in the number of microbes per cubic centimetre in the samples examined each month of the year. (See Table 33, p. 114.) 112 With regard to the West Middlesex Company, Prof. Frankland remarks—" Except in the months of January, February, and March, when intense cold prevailed, this Company delivered water of a high degree of organic purity, rivalling that of the deep-well water of the Kent Company. In November, the number of microbes was only 12 per c.c., when the raw water at the intake contained 29,260." The storage capacity of this Company is 6.3 days' supply. Of the Grand Junction he says—"The small amount of storage possessed by this Company renders it difficult for them at all times to maintain efficient bacterial filtration, and six out of the thirteen samples collected at Hampton Works during the year contained an excess of microbes or their spores—over 100 per c.c.; whilst four out of the twenty-five samples collected at the New Works also contained an abnormal number of microbes. Most of the abnormal results occurred when the raw river water was bacterially in a bad condition, and during severe frost." The storage capacity of this Company is 3.5 days' supply. The comparison instituted in Table 33 shows that the supply given by the West Middlesex Company was superior to that given by the Grand Junction Company, except in the first three months of the year, when the frost deranged filtration. In the Ileport for 1894 a summary was given of 113 Prof. Frankland's observations on the connection between the flow of the Thames and its bacteriological purity. The variations in the volume of the river in 1895 are incorporated in Table 33, and it will be seen that the number of microbes per c.c. varies with the flow as measured at the Teddington "Weir. It will be noted that in storage the number of microbes is reduced, and it is generally said that sunshine plays an important part in such reduction. In connection with this, the results of certain experiments detailed in the Report are of interest. The details of the experiments are as follows:— A sterile bottle was half filled with Thames water and violently agitated for five minutes to ensure equal distribution of the organisms. Immediately afterwards a number of sterile glass tubes were partially filled with this water and hermetically sealed. Three of these tubes were immediately packed in ice and the remainder were attached in duplicate, at different distances apart, to a light wire frame which was then suspended vertically in the river. The experiments were made near the Grand Junction Water Company's intake at a place favourable for the sun's rays to fall on the river without any obstruction. The river was at the time in a very clear condition and contained but little suspended matter whilst the day was fine, although clouds obscured the sun occasionally. The tubes were exposed to light in the river 4½ hours (from 10.30 a.m. to 3 p.m., on May 15th, 1895). At the end of this time the tubes were packed in ice for transport to the laboratory, where the cultivations were started immediately. The colonies were counted on the fourth day, and yielded the following numbers:— No. of Colonies per c. c. Thames Water packed in ice immediately after collection 2,127 „ „ after exposure to sunlight for 4½ hours „ „ „ „ at surface of River 1,140 „ „ „ „ 6 in. below surface 1,940 1ft. „ „ 2,150 „ „ „ „ 2 ft. „ „ 2,430 „ „ „ „ 3 ft. „ „ 2,440 114 115 TABLE 33. Volume of Thames and numbers of Microbes in unfiltered Thames water, and in the supplies of the West Middlesex and Grand Junction Water Companies. "V » 1895. Volume of Thames at Teddington Weir Million gallons per day January* 4th—2,086, 21st—5,436. February 4th—2,445. March 11th—2487. April 19th—826. May 16th—661.6 June 1st—442.7 July 1st—279.6. August 12th—348.8. September 23rd—210.4 October 16th—350.9. November 18th—2,144. December 9th—1,121.8. Mean Microbes To B To B To B To B To B To B To B To B To B To B To B To B per CC. Thames Water unfiltered 3'1 33,280 08 34,220 55 36,560 12 3 4,160 18 1 2,127 18-9 3,140 18-7 1,320 18-5 1,100 150 1,480 11-5 2,480 8-6 29,260 4-8 14,630 13,646 West Middle sex Co. After 6.3 days) Storage only — — — — 4'3 1,620 11-3 500 16 3 440 17*8 260 187 880 17'8 180 15-3 200 110 220 8-3 2,900 5-5 2,510 971 After Filtration. IS-7 01) 16 16 2 16 17*0 12 1 19'2 28 17'7 g 12-5 1,236) Grand Junction Co. After short Storage - - - - - 4,700 11 5 180 169 420 - - 119.5 140 18.8 160 16.4 240 8.9 840 6.3 690 After filtration- . 198 340 19.0 460 16.3 340 12.5 340 9.0 1,160 15.0 860 917 Hampton, General Well 1.5 176 76 14.3 894 1.1 4,944 5.2 996 12.5 72 17.9 48 18.8 19.3 312 18.5 52 15.1 28 12.1 16 8.5 476 5.3 64 635 Kew Bridge, General Well 3.5 48 0.5 0.8 52 116 5.4 220 11.3 96 14.5 196 17.9 108 195 44 18.4 28 15.7 12 12 0 44 8.8 32 5.9 24 78 Kew Bridge, South Well 3.7 44 0.5 11.1 46 36 - - 11.6 36 14.8 16 18.0 8 19.7 44 18.8 24 16.3 16 120 4 90 28 6.3 16 25 T° = Temperature in degrees, Centigrade Scale. B = number of Microbes per cubic centimetre. * This reads thus—" On January 4th the volume of the Thames, measured by the flow over the Teddington Weir, amounted to 2,086,000,000 gallons in the 24 hours. 116 Commenting on these results, Prof. Frankland says "These experiments show that, on the 15th May, the germicidal effect of sunlight on Thames microbes was nil at depths of one foot and upwards from the surface of the water. It cannot, therefore, excite surprise that the effect of sunshine upon bacterial life in the great river mass of the Thames should be nearly, if not quite, imperceptible." Such a conclusion appears to assume that water which is at any given instant at an inert depth below the surface always remains at that depth. The disturbing influences of heating of the surface of the water, eddies in stream, &c., would, however, favour the assumption that the strata of water are constantly interchanging, and that the liquid which is at one instant at an inert depth may shortly after be much nearer the surface of the stream, i.e., subject to the germicidal influence of the sun. In the experiments an exposure of four hours and a half under the artificial conditions of the intervention of glass between the sun's rays and the water, was able to reduce the microbes by rather more than 50 per cent. The balance of evidence would appear to favour the view that the sun has a very considerable influence in purifying the Thames water. The reason for the failure of the filter beds in the very cold weather is obscure. Mr. Fuller, official bacteriologist to the Massachusetts Board of Health, 117 thinks it is due to difficulty in scraping off the layers of dirty sand, &c., from the top of the filter beds; Prof. Frankland attributes it to "suspended animation of the microbes in ice cold water, which causes them to be helplessly carried through the interstices of the filter; whilst at higher temperatures they possess active vitality and cling to the sand near the surface." Inasmuch as the efficiency of the filter depends on the character of the green "slime," a bacterial product, it seems reasonable to think that the failure is due to some check in the formation of this slime or (and) to alterations in its character due to the cold. ADMINISTRATIVE WORK. The success or failure of the work of the Sanitary Department is indicated by the vital statistics of a succession of years, and it will be neither interesting nor useful to dwell on the actual administration to any great length. Some idea of the amount of work got through during the year can be obtained from Table VI. in the Appendix. Of the routine work only a few points, in respect of which improvements appear to be desirable, will be touched on. At the close of 1894, two additional Inspectors were appointed, making five in all. With the commencement of 1895, the Parish was divided into five districts, one to each Inspector. These districts were divided by means of the map and rate-books, and made as nearly equal as possible. When the I 118 enumeration of the current year is published, the populations of the districts will be obtained, and certain of the statistics for 1896 collated with reference thereto. During 1895 an additional clerk was appointed for a period of six months. There are no true "cellar dwellings" in the Parish, but there are many "underground rooms," i.e., rooms whose floors are 4-feet or more below the surface of the adjoining ground. Such rooms require systematic inspection with (in the first instance) measurements for the purpose of ascertaining whether the rooms are in accordance with the specification laid down in the 96th section of the Public Health (London) Act, 1891. Unfortunately it has not been possible to give that attention to the matter which its importance demands. The law as to underground rooms practically stultifies itself in that it is possible to inhabit such room as a dwelling if it be occupied in conjunction with any other room (not being an underground room) in the same house. There are many houses in the northern half of the Parish which are built on artificial soil, and so arranged that the front basement rooms are underground rooms, some with the ceiling less than 1-foot above the footway, but the back basement rooms have their floors a few inches above the surface of the yard. The front rooms can be used for all the purposes to which they would be put were they 119 occupied "separately," yet, being occupied conjointly with the back rooms, nothing can be done to prevent such occupation. "Houses let in lodgings" would be more correctly described as " tenement houses." Efforts were made during the year to place some of the houses in North Paddington on the Register, but the work was pushed aside by pressure of other matters. The results of the examination into the question of housing families in which cases of infectious disease occurred during the past year, indicate that the control over overcrowding, which it would be possible to exercise by attending to these dwellings, may fairly be expected to assist in the reduction in the amount of infectious sickness. House Drainage.—After cases of diphtheria, membranous croup, enteric and puerperal fevers, the drainage, etc., of the houses infected receive very minute attention, and are generally overhauled. It is this class of work which occupies the greater portion of the time of the Inspectors ; they not only examine and report on the conditions constituting the nuisance, if any, but they supervise the work of abating such nuisance. A very considerable proportion of the 11,809 visits of re-inspection represents work of supervision of repairs and alterations to sanitary fittings. There are good reasons for holding that the officials indicating the t 2 120 nuisance ought to see that that nuisance is properly abated ; but on the other hand it is open to argument whether the Inspectors could not be more profitably employed if relieved of this duty. Bye-laws to regulate the work of amendments and alterations to existing drainage, &c., are still wanted. The London County Council were approached during the year by the Incorporated Society of Medical Officers of Health and urged to put in force their powers under Sec. 202 of the "Metropolis Local Management Act, 1855," so as to regulate these matters. The Council have drafted a series of bye-laws, but there does not appear to be any immediate prospect of their early issue. The question of "combined drains" has become a very pressing one during the year. Two leading cases were decided in the summer of 1895, viz., Kersliaw v. Taylor, and Florence v. The Vestry of Paddington. The cases were not identical, but the tenour of the decisions is the same. From them it appears that if anyone, without notice to the local authority, arrange or re-arrange the drains so that two or more houses are connected to one system, emptying into the public sewer, that system is a "sewer," repairable by the local authority. If, on the other hand, the local authority, either by direct resolution or by implication through consent, sanction a drainage system on lines identical with 121 the former system, such system is a private drain, repairable by the owner or owners of the houses.* At present the onus of proof that any given system is a private drain rests on the local'authority, and as most of such combined systems were constructed before 1855, a search of the records of the Commissioners of Sewers is necessary before disputing the case. These records are in the possession of the London County Council, fill many volumes, and are without indices. To trace any given case, the volumes of plans have to be gone through, and then the minutes searched for the resolution. A record may be found in one or other places, or, more commonly, in neither. A Conference of Delegates from the Metropolitan Vestries and Local Boards was convened by the Holborn Board of Works, and a deputation from the Conference attended before the Main Drainage Committee of the London County Council. In the end a Bill was drafted by the County Council for presentation before Parliament, by the provisions of which every drainage system which had not been by express order of the local authority constructed, or taken over, as a public sewer, would be a private drain, #In the extra-metropolitan districts a further complication is created by the 19th sec. of the Public Health Amendment Act, 1890, whereby the "drain" receiving drainage from two or more houses belonging to different owners is a private drain, whilst the definition clauses of the Public Health Act, 1875, declare such a drain (without any conditions as to ownership) to be a public sewer. 122 repairable by the owner of the house connected, therewith.* It is not clear what the intention of the Legislature was when the 250th Sec. of the Metropolis Local Management Act, 1855, was amended by the 112th Sec. of the Act of 1862, but it may be supposed that it was taken for granted that the records of the Commissioners of Sewers had been properly kept, and that no drains had been laid without their order, such order being recorded in each case. Had that been done, the present difficulty would not have arisen, and all, or almost all, existing combined drains would be at law private drains, repairable by the owners of the houses connected thereto. If that be the case no hardship will be inflicted in making the houseowners responsible for the repairs of such drains, as that was the intention of the legislature. Dairies, slaughter-houses, &c.—These are licensed by the London County Council and periodically visited by the Inspectors of the Council. The Vestry's Inspectors visit all dairies, cow-sheds, and slaughter-houses twice a year. Bakehouses.—Half-yearly visits are made to these. Considerable improvement has been effected in the bakehouses as a whole since they were first * A Bill on practically the same lines as that of the London County Council has been prepared by the Town Council of Worcester to amend the Acts of 1875 and the amending Acts thereof. This Bill has been presented in the House of Lords. 123 inspected in 1894. By the "Factory and Workshop Act, 1895," no underground bakehouse may be opened or re-opened, if closed on the first day of January, 1896. In the list of bakehouses in the Appendix, the underground bakehouses so occupied are indicated, also the underground bakehouses not in use. There is one detail in baking, very harmful to the bakers, to remedy which no serious effort appears to have been made. To secure the proper "rising" of the dough, every aperture is closed, and the bread room becomes almost as hot as an oven. The "rising'' could be effected with more certainty, which would improve the bread, if the dough were placed in a closed receptacle, somewhat on the lines of an incubator, heated from the oven. The men could then work in a place which could be fairly cool and decently ventilated. Lung diseases from working in hot vitiated air are now only too common among journeymen bakers. Removal of Refuse.—The work of dusting, slopping, etc., is not under the supervision of the Department. The refuse first conies within the purview of the sanitary officials when it reaches the wharves. The past year has made it clear that the canals cannot be relied upon at all times as channels for the removal of refuse out of the Parish. For six weeks in the first quarter of the year not a boat left the canal basin, yet all this time the refuse of this and certain other 124 parishes was being brought to the wharves. The last of the accumulation was not got away much before June. If there had been a destructor at work in the Parish there would still have been an accumulation of clinker to deal with, but such clinker would be quite innocuous and would have amounted to only a fraction of the bulk of the sorted refuse. A Committee was appointed during the year to consider the subject of the erection of a destructor. The Committee have had several sittings on the question, and inspected certain of the destructors in use in the Metropolis. The removal of manure is attended with considerable difficulty, as there are only a few firms who will undertake the work, and much difficulty is experienced in disposing of the manure when carted away. As soon as the hay harvest commences complaints of non-removal are received, just at a time when the stuff smells most. There is somewhat less difficulty in dealing with the straw manure than with that of peat-moss, the latter being the more offensive when removed. If the Vestry would exercise their powers under Sec. 36 of the Public Health (London) Act, 1891, and undertake the removal of all manure, the difficulty, as far as the removal from the Parish is concerned, would be at an end. Insufficiency of Water Supply.—During June and July there was a very general complaint of want of water in the houses in Bravington and Portnall Roads, and in St. Luke's Terrace, West Kilburn. Similar com- 125 plaints were made in 1892, when the London County Council informed the Vestry that the West Middlesex Water Company were preparing to put in a constant service and that "the district in question will probably be dealt with in the course of the ensuing twelve months," i.e., before July, 1893. In consequence of the complaints made last summer, communications were addressed to the principal house owner in the streets affected, who was also the builder of the majority of the houses, to the London County Council, and to the West Middlesex Water Company. The Water Company attributed the insufficiency of supply to want of proper cisterns (each house has a cistern of from 40 to 100 gallons), but the builder stated that the Company's officials passed the cisterns and fittings when the houses were first built, and that the fittings, especially the servicepipe, were for a constant service. The real cause of the insufficiency was more probably the small size of the mains in the street, as the Surveyor stated that the delivery was too slow to enable the water carts to be filled in a reasonable time. The occupants alleged that the water never came into the houses during the day, as distinguished from the night, so that the size of the house cistern would not have much influence under such circumstances. It should further be noted that the complaints were made at a time when the roads required constant watering. The Water Company did not allege that the insufficiency of the supply was in any way attributable to the drought. According to a Report presented to the Public Control Committee of the London County Council, dated July 19th, 1895, the Water Company "will be prepared to receive notices for Districts numbered 24 and 22 to be constantly supplied from 1st February next, and Districts numbered 34 and 21 as from 1st June, 1896." This would include the area affected last year, where constant service is even now supposed to be in use. Whether the additional pressure which is to be expected will remedy the deficiency in supply, remains to be seen. This subject cannot be left without a reference to the "East London Water Inquiry," the Report of which, dated November last, was published early in the current year. The sum and substance of that Report is that if there had been storage cisterns in the houses in the area affected by the "water famine," there would have been no real inconvenience from the deficiency in the supply. The deficiency was partly due to the delay in providing increased storage at the waterworks, consequent on the opposition by the London County Council to the East London Water Company's Bill of 1893. The opinion of the Metropolitan Medical Officers of Health as to the need of cisterns is embodied in the following resolution, adopted in October last, and submitted to the Local Government Board. 127 That the Metropolitan Branch of the Incorporated Society of Medical Officers of Health is of opinion that in London storage cisterns should be retained, for domestic purposes, in occupied dwelling-houses supplied with water on the constant service system, and that a drawoff tap should be affixed on the rising main for the supply of water for dietetic purposes. Nothing was said as to the size of the cistern to be provided, as that must depend on the number of persons in each house. Where the cistern is used solely for feeding •water-waste-preventers of W.C.'s, a very small one will suffice. It is to be understood that any interruption in the service should be for a few hours only, as it would be absurd to arrange a system which should be adequate for both constant and intermittent supplies. Ice and Ice Cream.—During the winter of 189495 large quantities of ice were taken from the canals, and it was thought that the use of such ice, derived from water of a highly-polluted character, would lead to a large amount of enteric fever. The experience of the year had not justified those fears. The bulk of the ice stored in this Parish is used in the manufacture of ice cream by the Italians. From inquiries made it appears that no ice enters into the composition of ice cream and that it is used solely as a freezing mixture with salt. The vessels in which the cream is kept are of sheet metal, with lids that fit as closely as they can be made to do. In making "water ices," rough ice is sometimes used, but such ice must be of the cleanest description or else the "ice" is too uninviting to be sold. 128 The bacterial examination of ices has received a large amount of attention during the year, two or three of the Metropolitan Authorities having had careful estimations made of the microbes present in samples from various sources. It will be interesting to review the information obtained. Ice creams are of two kinds, in one, the cheaper form, the basis is custard flavoured with essences or jam, and in another, the dearer, cream and fruit are the chief ingredients. In making the first variety the ingredients, after being mixed, are boiled for so long as may be necessary to obtain the proper consistency. After cooling, for which several hours are allowed, the mixture is frozen. In the cream variety the mass is frozen as soon as the ingredients are thoroughly mixed. In the custard variety all the microbes present in the ingredients would be destroyed by boiling, and any present in the finished article would be due to contamination after such boiling. The danger of bacterial pollution would here arise from dirty vessels used for cooling or storage, and from the settlement of dust from the places where it is cooled or stored. This variety is the kind sold in the streets and is usually made in the living rooms of the vendors. Supervision of the homes of the makers and regulations as to cleanliness of the vessels would reduce the chances of dangerous pollution to a minimum. In the cream kind, the dangers are rather greater, as the bacteria present in milk tend to multiply whilst the cream is rising and 129 to rise with the cream, so that the ice contains a larger number of microbes than the custard kind. There are of course the additional risks from dirty vessels and from contamination by dirty storage. On the whole the richer variety, i.e., the more expensive, is somewhat the more dangerous. It should be noted that freezing the mixture does not destroy the vitality of the microbes therein. Water ices are made from fruits, sugar, and flavours, with or without the white of eggs, or the equivalent thereof. Ice is sometimes added to hasten the freezing. Bacteria would be introduced in this variety in the water or through uncleanliness in the vessels or storage. These ices are usually less highly coloured than cream ices, and therefore the makers have to be more careful in respect of gross dirt otherwise the ice would be unappetising. It would be useless to enumerate the varieties of microbes which have been found in the ices examined, as they would not be exactly the same in any given series examined. Suffice it to say that almost all the kinds of microbes present in the dust of living rooms have been found, together with such refuse as lice, bugs, fleas, hairs of all descriptions, fragments of straw, fibres from fabrics, &c., &c. It is needless to say that the grosser impurities were found in ices procured from small vendors in the lower strata of life. No organism known as the cause of disease has been found. The bacillus coli communis, an inhabitant of the intestines, 130 has been found in all, or almost all, specimens. In a sample, purchased in the streets, some five million microbes were found in a cubic centimetre of ice cream, and in another sample, purchased from a high-class confectioner, the microbes varied from eight to fourteen millions in the cubic centimetre. As to the ices sold in the street, and perhaps to others, a further and more serious danger exists in the water and cloth used in cleansing (!) the glasses used for eating the ice. In the street barrow the same pail of water and dirty rag may be, and often are, used throughout the day. The small boy purchaser seems to prefer to lick out the ice rather than use a spoon, a method very favourable to the transference of disease. The pail of water after a short time affords plenty of pabulum for microbes introduced into it, and standing in the sun the water speedily attains a temperature at which such microbes flourish. The same may be said of the towel or rag. At present there is no legislation to regulate the manufacture and sale of ices. Certain authorities have endeavoured to apply the regulations applicable to dairies to bear on the manufacturers, but it has been decided that in so doing they were acting ultra vires. Manufacturers and vendors of ices should be licensed, and regulations are required in respect of the materials to be used, the cleanliness of vessels, the proper storage of the ices whilst in the course of manufacture and alter- 131 wards, and in respect of the sale, as regards the cleanliness of glasses, water, and cloths.* Infectious disease.— The total weight of bedding, etc., removed by the Contractor for disinfection was 586 cwt. 1 qr. 15 lbs., and the total cost for such work, £881 2s. 1d. The average expenditure for each lot of disinfection was £1 10s. Bedding and other goods are disinfected as a matter of routine after all the diseases notified, except erysipelas—when it is done on request only. Disinfection is also done on request of the medical attendant, after certain other diseases, such as measles, phthisis, etc. In a very few instances the work was done privately at the expense of the owner, but it is becoming more common each year for the Vestry to be called on to do it. All work done by the Vestry is done free of charge. The average annual expenditure under this head from 1891—the first complete year after the commencement of notification—to 1895 has been £805 1s. 5d., the largest amount in any one year being £1,216 15s. 3d. This is a charge which may be expected to expand as time goes on, and it is practically certain that there will be greater demand for disinfection after diseases which are not in the schedule of notification. Were the work done by the Vestry * In the matter of glass washing, it is to be feared that some hotels and restaurants are not so careful as they ought to be. Glasses are washed at some of these places in a small tub of water, the changing of which is by no means sufficiently frequent. All vessels for drinking and eating ought to be washed in running water. 132 an average annual economy of something like £400 might fairly be expected, and in years of epidemics much more. There would be the additional satisfaction of having the work under the immediate supervision of the Vestry's officials. The disinfection of rooms is carried out in the old style, viz., with sulphur fumes from cake sulphur or bisulphide of carbon ; the latter is used now only when it is desirable to hasten the process of disinfection. As a rule the room is kept closed for twenty-four hours after igniting the sulphur. This practice has been pretty generally abandoned on the continent, spraying with a solution of corrosive sublimate being used instead. Such spraying takes, on an average, about two hours to complete, and according to the published observations appears to be more certain in its action. Bugs and fleas have been observed alive after a full exposure for twenty-four hours to sulphur fumes, so that the process is somewhat discredited. No case of recurrent infection attributable to failure of the process of disinfection, has been observed, but there have been instances in which its efficiency has been doubted. In September last a "family shelter" was opened for the reception of persons who were dispossessed of their rooms whilst disinfection was in progress. The house is an ordinary six-roomed cottage which has been fitted with a bath and furnished with such things as were absolutely necessary. The annual expenditure, including rent, rates, and taxes, is estimated at 133 something like £50. There is a care-taker, who looks after the place in consideration of his living rent free. The house has proved useful, not only as a temporary home during disinfection, but also for the accommodation of healthy persons from families with disease among their members, for whom hospital accommodation could not be obtained. The cost of disinfectants in the shape of fluid, powder, and soap distributed gratis, and of sulphur candles, during the year, amounted to £64 19s. 9d. in all. Factory and Workshop Supervision. — A new "Factory and Workshop Act," was added to the legislation dealing with this subject during the year. A short account of the chief sanitary provisions of the new Act will be found in Appendix B. During the year fifteen notices were received from the Factory Inspector dealing with the following insanitary conditions:- bakehouses requiring lime washing (2); workrooms overcrowded (5); ditto dirty (8); ditto dilapidated (1); and ditto without sufficient water-closet accommodation (1). All the above received the attention of the Department. Legal Proceedings.—There were ten cases taken before the Magistrate during the year, viz.:— Bad meat and rabbits, fined £5 and £3 3s. costs. Bad fish, fined £1 and costs. For non-compliance with notices to abate nuisances, three cases, orders made in each case, costs being obtained to the amount of 23/in one case. For non-compliance with the Magistrate's order, one case, costs imposed 8/-. Premises unfit for human habitation, one case. Closing order issued. K 134 For accumulations of manure on a wharf, two cases (same defendant). One case dismissed with costs against the Vestry, the second, fined 10/- and 2/- costs. There was also the case against the Vestry (Florence v. The Vestry of Paddington) respecting a combined drain, heard in the Chancery Division of the High Courts. The judgment was against the Vestry with costs. Food Analysis.—During the year, ended December 28th last, 363 samples were submitted to the Public Analyst, viz.: Milk (including condensed) 196 samples; groceries, 68; butter, 55; spirits, 17; lard, 16; ices, 7; and bread, 4. The adulterated samples numbered 15 (4 per cent.), viz.:— milk, 10; groceries and butter, 2 each; and spirits 1. The percentage of adulterated samples was the lowest recorded. The cases of adulteration heard in the Police Court were as follows, the result and legal expenses of each prosecution being stated:— Offence. Result. Fine. Costs. Legal Expenses Incurred. 1. Butter, 60 per cent, margarine 1/- 2/- 2 10 0 2. Milk, 7 per cent, added water 10/- 12/6 2 13 6 3. „ 13 „ 20/- 12/6 2 10 0 4. „ 15 „ cream abstracted £20 33/6 6 15 0 5. „ 18 „ added water 20/- 12/6 2 6 6 6. „ 7 „ „ 10/- 12/6 2 17 8 7. „ 12 „ „ 40/- 2/- 3 18 4 8. „ 10 „ „ 101- 2/- 2 17 8 9. „ 10 „ 10/- 2/6 3 5 10 10. Coffee, 75 „ chicory 10/- 2/- 2 18 2 11. Butter, 40 „ margarine 20/- 12/6 2 18 2 12. Coffee, 45 „ chicory {dismissed with costs (£1 1s ) against the Vestry } 13. Milk, 8 „ added water 5/- 12/6 2 3 2 Received £27 16s. £5 19s. Paid £1 1s. £40 13 6 135 The result of the year's work is that there were twelve convictions during the year, the total amount of the fines inflicted being £27 16s., and of costs, £5 19s. In one case the Vestry failed to secure a conviction, and was mulcted in costs to the amount of £l 1s. Leaving out cases Nos. 4 and 12, the average fine for the remainder was 14s. 2d., and the average costs, 7s. l0d. The market values of the adulterants indicate roughly the profits derived from adulteration: thus very fair butter can be got wholesale for l0d. per lb., whilst margarine varies from 2½ to 4d.; coffee averages l/4d. per lb., chicory 4d.; milk, at the dearest retail price, 5d. per quart, water 0d. In each case the adulterated article is sold to the consumer for the price of the genuine. From the preceding notes it will be seen that the illegal profits to be obtained by adulteration are very great. A balance sheet giving the fines and costs paid by defendants on the credit side, and the expenses incurred by the Vestry on the debit side, would show a very considerable deficit. The ratio of fines and costs to profits derived by adulteration is absurdly small, but in certain of the cases some loss of custom follows conviction. Such loss, however, has no deterrent effect in very many instances, as the same defendant appears time after time in the Courts. There is no power to commit to gaol, as there is for cases of unsound food, but until K 2 136 such punishment is inflicted adulteration will flourish exceedingly. The "label" clause of the Food and Drugs Act affords ample room for evasion of the law. The words "this is sold for a mixture," or the like, may be microscopic or so concealed as to be unseen until the parcel is opened, and yet the vendor escapes. Such margin of safety to the adulterator should not stand on the statute book. Building Act, 1894.—Some account of the provisions which may be termed specially sanitary will be found in Appendix B at the end of the Report. APPENDICES. 138 table i. Year. Estimated Populations at Middle of each Year. No. of Houses in the whole-Parish.* Births Registered. Deaths of Parishioners. Appendix A. St. Mary. St. John. St. Mary. St. John. St. Mary. St. John. 1895 90,577 32,173 15,645 2,526 453 1,671 428 1894 88,949 32,551 15,610 2,423 411 1,449 382 1893 87,708 32,772 15,543 2,567 444 1,680 473 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 Averages for 1885-94 81,702 35,322 15,150 2,405 510 1,490 459 * Taken from Rate Books. "Empties" included. 139 table ii. Year. Per 1,000 of Estimated Population. Deaths of Infants under 1 year. Deaths of Children aged under 5 years per 1,000 Deaths at all ages. Deaths in Public Institutions. Birth-rates Corrected Deathrates. Per 1,000 Births Registered. Per 1,000 Deaths at alt ages. Paddington Workhouse and Infirmary. St. Mary's Hospital. Lock Hospital. Children's Hospital, Paddington Green. Outlying Institutions. 1895 24.26 1709 164 233 330 204 332 1 17* 156 1894 23.3 15.0 135 210 351 165 347 3 ** 193 1893 25.2 17.9 148 209 321 204 399 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 Averages for 1885-1894 24.96 16.64 143 213 335 191.3 329.7 4.2 50.7 (8 years) 106.4 * Hospital recommenced work in 3rd quarter of the year. ** Closed during re-construction. 140 TABLE III. WHOLE PARISH—MALES. Deaths Registered from all Causes during the Year 1895. 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 & upwards. Totals. 55 to 60 Classes . I. Specific Febrile, or Zymotic Diseases 54 31 8 7 9 7 15 8 8 8 2 157 4 II. Parasitic Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... III. Dietic Diseases 3 ... ... ... ... ... 1 3 ... ... ... 7 3 IV. Constitutional Diseases 11 13 8 16 28 32 24 29 22 7 ... 190 13 V. Developmental Diseases 57 ... ... ... ... ... ... 1 3 8 6 75 1 VI. Local Diseases 108 49 6 14 13 41 62 85 71 40 8 497 34 VII. Deaths from Violence 13 2 4 2 3 5 6 4 4 1 ... 44 2 VIII. Deaths from Ill-defined and Not Specified Causes 22 1 ... 1 ... 1 ... ... ... ... 25 ... Totals 268 96 26 39 54 85 109 130 108 64 16 995 57 I.—SPECIFIC FEBRILE, OR ZYMOTIC DISEASES. 1.—Miasmatic Diseases. Smallpox Vaccinated ... ... ... ... ... ... ... ... ... ... ... ... ... Unvaccinated ... ... ... ... ... ... ... ... ... ... ... ... ... No Statement ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 1 6 ... ... ... ... ... ... ... ... ... 7 ... Scarlet Fever ... 2 2 1 ... ... ... ... ... ... ... 5 ... Typhus ... ... ... ... ... ... ... ... ... ... ... ... ... Epidemic Influenza 2 1 ... 2 6 3 10 6 5 7 2 44 3 Whooping Cough 6 3 ... ... ... ... ... ... ... ... ... 9 ... Diphtheria 2 16 6 ... ... ... ... ... ... ... ... 24 ... Simple Continued and Ill-defined Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric or Typhoid Fever ... ... ... 3 1 2 1 1 ... ... ... 8 1 Other Miasmatic Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... 2.—Diarrhœal Diseases. Simple Cholera ... ... ... ... ... ... ... ... ... ... ... ••• ... Diarrhoea, Dysentery 40 3 ... ... ... ... 1 1 1 1 ... 47 ... l4l TABLE III. WHOLE PARISH.—FEMALES. Deaths Registered from all Causes during the Year 1895, 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. 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 totai£ 55 to 60 I. Specific Febrile, or Zymotic Diseases 50 45 14 6 10 6 11 16 23 13 7 201 8 II. Parasitic Diseases i> 5 III. Dietic Diseases 1 1 1 2 1 6 IV. Constitutional Diseases 13 20 6 16 17 18 34 26 16 10 2 178 14 V. Developmental Diseases 36 1 1 b 32 15 91 VI. Local Diseases 74 39 12 16 30 30 52 83 llf 86 18 556 32 VII. Deaths from Violence 11 1 2 2 3 2 9 32 2 VIII. Deaths from Ill-Defined and Not Specified Causes 32 2 1 35 Totals 222 108 35 40 61 57 108 129 161 141 42 1104 56 I.—SPECIFIC FEBRILE, OR ZYMOTIC DISEASES. 1.—Miasmatic Diseases. Smallpox Vaccinated ... ... ... ... ... ... ... ... ... ... ... ... ... Unvaccinated ... ... ... ... ... ... ... ... ... ... ... .. ... No Statement ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 2 8 ... ... ... 1 ... ... ... ... ... 11 ... Scarlet Fever ... 5 4 ... ... ... ... ... ... ... ... 9 ... Typhus ... ... ... ... ... ... ... ... ... ... ... ... ... Epidemic Iufluenza 3 2 ... 1 2 2 8 13 22 12 7 72 6 wooping Cough 7 4 ... ... ... ... ... ... ... ... ... 11 ... Diphtheria ... 14 10 3 ... ... ... ... ... ... ... 25 ... Simple Continued and Ill-defined Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric or Typhoid Fever ... ... ... 2 2 1 1 1 ... ... ... 7 ... Other Miasmatic Diseases ... ... ... ... ... ... ... ... ... ... ... ... .. 2.—Diarrhœl Diseases. Simple Cholera ... ... ... ... ... ... ... 1 ... ... ... 1 1 Diarrhœa, Dysentery 32 10 ... ... ... ... 1 ... ... 1 ... 44 ... 142 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. 65 to 60 SPECIAL FEBRILE, OR ZYMOTIC DISEASES (continued). 3.—Malarial Diseases. Remittent Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Ague ... ... ... ... ... ... 1 ... ... ... ... 1 ... 4.—Zoogenous Diseases. Cowpox and effects of Vaccination 1 ... ... ... ... ... ... ... ... ... ... 1 ... Other Diseases (e.g., Hydrophobia,Glanders, Splenic Fever) ... ... ... ... ... ... ... ... ... ... ... ... ... 5.—Venebeal Diseases. Syphilis 2 ... ... ... 1 1 ... ... ... ... ... 4 ... Gonorrhœa, Stricture of Urethra ... ... ... ... ... ... 1 ... ... ... ... 1 ... 6 —Septic Diseases. Erysipelas ... ... ... ... 1 1 1 ... 2 ... ... 5 ... Pyaemia, Septicaemia ... ... ... 1 ... ... ... ... ... ... ... 1 ... Puerperal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... II.—PARASITIC DISEASES. Thrush, and other Vegetable Parasitic Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... Worms, Hydatids, and other Animal Parasitic Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... III.—DIETIC DISEASES. Want of Breast Milk, Starvation 3 ... ... ... ... ... ... ... ... ... ... 3 ... Scurvy ... ... ... ... ... ... ... ... ... ... ... ... ... Chronic Alcoholism ... ... ... ... ... ... ... 3 ... ... ... 3 3 Delirium Tremens ... ... ... ... ... ... 1 ... ... ... ... 1 ... IV.-CONSTITUTIONAL DISEASES. Rheumatic Fever, Rheumatism of the Heart ... ... 1 3 ... 1 ... 1 ... ... ... 6 ... Rheumatism ... ... ... ... ... ... ... ... ... ... ... ... ... Gout ... ... ... ... ... ... ... 2 ... 3 ... 7 1 Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... Cancer, Malignant Disease ... ... ... ... 1 1 6 13 12 3 ... 36 6 Tabes Mesenterica 3 2 ... ... ... ... ... ... ... ... ... 5 ... Tubercular Meningitis, Hydrocephalus 6 9 4 ... ... 1 ... ... ... ... ... 20 ... Phthisis ... 2 1 11 26 24 16 13 ... ... ... 98 6 Other forms of Tuberculosis, Scrofula 2 ... 1 2 1 1 2 ... ... ... ... 9 ... Purpura, Hæmorrhagic Diathesis ... ... ... ... 1 1 ... ... ... ... ... 2 ... Anaemia, Chlorosis, Leucocythaemia ... ... 1 ... ... 1 ... ... ... ... ... 4 ... Glycosuria, Diabetes Mellitus ... ... ... ... ... 2 ... ... ... 1 ... 3 ... Other Constitutional Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... 143 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 6 ... ... ... 1 ... 1 ... ... ... ... 8 ... Gonorrhœa, Stricture of Urethra ... ... ... ... ... ... ... ... ... ... ... ... ... 6.—Septic Diseases. Erysipelas ... 2 ... ... ... 1 ... ... ... ... ... 3 ... Pyaemia, Septicaemia ... ... ... 1 ... ... ... 1 1 ... ... 3 1 Puerperal Fever ... ... ... 1 5 1 ... ... ... ... ... 7 ... II.—PARASITIC DISEASES. Thrush, and other V egetable Parasitic Diseases 5 ... ... ... ... ... ... ... ... ... ... 5 ... Worms, Hydatids, and other Animal Parasitic Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... III.—DIETIC DISEASES. Want of Breast Milk, Starvation 1 ... ... ... ... ... ... ... ... ... ... 1 ... Scurvy ... ... ... ... ... ... 1 ... ... ... ... 1 ... Chronic Alcoholism ... ... ... ... 1 1 1 1 ... ... ... 4 ... Delirium Tremens ... ... ... ... ... ... ... ... ... ... ... ... ... IV.—CONSTITUTIONAL DISEASES. Rheumatic Fever, Rheumatism of the Heart. ... ... ... ... ... 1 ... ... ... ... ... 1 ... Rheumatism ... ... ... ... ... ... ... ... 2 1 ... 3 ... Gout ... ... ... ... ... ... ... ... ... 1 ... 1 ... Rickets ... ... ... ... ... ... ... ... ... ... ... 4 .. Cancer, Malignant Disease ... ... ... ... 1 4 22 23 10 6 1 67 12 Tabes Meseuteriea ... ... ... ... ... ... ... ... ... ... ... 6 ... Tubercular Meningitis, Hydrocephalus 4 13 2 1 ... ... ... ... ... ... ... 20 ... Phthisis ... 2 ... 9 14 13 9 3 4 ... ... 56 2 Other forms of Tuberculosis, Scrofula ... 2 ... 5 2 ... ... ... ... ... ... 13 ... Purpura, Hæmorrhagic Diathesis ... ... ... ... ... ... ... ... ... ... ... ... ... Anæmia, Chlorosis, Leucocythæmia ... ... ... ... ... ... ... ... ... ... ... ... ... Glycosuria, Diabetes Mellitus ... ... ... 1 ... ... 1 ... ... 2 1 5 ... Other Constitutional Diseases 144 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 SI 65 65 to 75 75 to 85 85 & upwards. Totals. 55 to 60 V.-DEVELOPMENTAL DISEASES. Premature Birth 45 ... ... ... ... ... ... ... ... ... ... 45 ... Atelectasis 9 ... ... ... ... ... ... ... ... ... ... 9 ... Congenital Malformations 3 ... ... ... ... ... ... ... ... ... ... 3 ... Old Age ... ... ... ... ... ... ... 1 3 3 6 18 1 VI.—LOCAL DISEASES. 1.—Diseases of Nebvous Sistem. Inflammation of Brain or Membranes ... ... ... ... 1 ... ... 1 1 ... ... 3 1 Apoplexy, Softening of Brain, Hemiplegia, Brain Paralysis ... ... ... ... ... 5 8 16 7 9 2 47 6 Insanity, General Paralysis of the Insane ... ... ... ... ... ... 8 4 3 2 ... ... 17 ... Epilepsy 1 ... ... ... ... 5 1 1 ... ... 8 1 Convulsions 20 6 ... ... ... ... ... ... ... ... ... 26 ... Laryngismus Stridulus (Spasm of Glottis) 2 1 ... ... ... ... ... ... ... ... ... ... ... Disease of Spinal Cord, Paraplegia, Paralysis Agitans ... ... ... ... ... 1 3 4 2 ... ... 10 1 Other Diseases of Nervous System ... ... ... ... ... ... ... ... ... ... ... ... ... 2.—Diseases of Organs of Special Sense. (e.g., of Ear, Eye, Nose) ... ... ... ... ... ... ... ... ... ... ... ... ... 3.—Diseases of Circulatory System. ... ... ... ... ... ... ... ... ... ... ... ... ... Pericarditis ... ... 1 1 ... ... ... ... ... ... ... 2 ... Acute Endocarditis ... ... ... ... ... ... ... ... ... .... ... ... ... Valvular Diseases of Heart ... ... ... 1 ... 2 2 2 2 2 ... 11 ... Other Diseases of Heart ... ... ... 2 2 5 6 9 13 5 1 43 4 Aneurism ... ... ... ... ... ... 2 1 1 ... ... 4 ... Embolism, Thrombosis ... ... ... ... ... 1 ... 2 ... 1 ... 4 ... Other Diseases of Blood Vessels ... ... ... ... ... ... ... 5 2 ... ... 7 2 4. Diseases of Respiratory System. Laryngitis ... 1 1 ... ... ... ... 1 ... ... ... 3 1 Croup 1 1 ... ... ... ... ... ... ... ... ... 2 ... Emphysema, Asthma ... ... ... ... 1 ... 1 1 2 ... ... 5 ... Brunchitis. 32 22 1 2 1 6 15 23 20 13 3 138 10 Pneumonia ... ... ... ... ... ... ... ... ... ... ... ... ... Pleuriay ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of Respiratory System ... ... ... ... ... ... 1 1 ... ... ... 2 1 5. Diaseases of Digestive System. Dentition 5 6 ... ... ... ... ... ... ... ... ... 11 ... Sore Throat, Quinay ... ... ... 1 ... ... ... ... ... ... ... 1 ... Diseases of Stomach 1 ... ... ... ... .. 1 ... ... ... ... 4 ... Enteritis 21 4 ... 1 ... ... ... 1 ... ... 1 28 ... Obstructive Diseases of Intestine 1 ... ... ... ... ... 1 ... ... ... 1 3 ... 145 Table III.—Wholf. Parish.—Females (continued). Cause of Death. AGES. 0 to 1 1 to 5 5 to 15 15 to 25 25 to 3c 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 & upwards. Totals. 55 to 60 V.-DEVELOPMENTAL DISEASES. Premature Birth 26 ... ... ... ... ... ... ... ... ... ... 26 ... Atelectasis 8 ... ... ... ... ... ... ... ... ... ... 8 ... Congenital Malformations 2 1 ... ... ... ... ... ... ... ... ... 3 ... Old Age ... ... ... ... ... ... ... 1 6 32 15 54 ... VI.—LOCAL DISEASES. 1.—Diseases of Nervous System. Inflammation of Brain or Membranes ... ... ... ... ... ... ... ... ... ... ... ... ... Apoplexy, Softening of Brain, Hemiplegia, Brain Paralysis 2 1 ... ... 1 4 5 9 16 19 1 58 1 Insanity, General Paralysis of the Insane ... ... ... ... ... 3 2 ... ... 1 ... 6 ... Epilepsy ... ... ... 3 ... ... 1 2 ... ... ... 8 ... Convulsions ... 1 ... ... ... ... ... ... ... ... ... 10 ... Laryngismus Stridulus (Spasm of Glottis) ... ... ... ... ... ... ... ... ... ... ... ... Disease of Spinal Cord, Paraplegia, ... ... 1 ... ... 1 ... 1 2 ... ... 5 Other Diseases of Nervous System ... ... ... ... 1 ... ... 1 ... ... ... 2 ... 2.—Diseases of Organs of Special Sense. (e.g., of Ear, Eye, Nose) ... ... ... ... 1 ... ... ... ... ... ... 1 ... 3.—Diseases of Circulatory System. Pericarditis ... ... 1 l ... ... ... ... ... ... ... 2 ... Acute Endocarditis ... ... ... 1 ... ... ... ... ... ... ... 1 ... Valvular Diseases of Heart ... ... ... ... ... 3 4 2 7 3 1 23 1 Other Diseases of Heart ... ... 2 3 4 4 5 15 15 11 1 60 8 Aneurism ... ... ... ... ... ... ... 2 1 2 ... 7 ... Embolism, Thrombosis ... ... ... ... ... ... ... ... 1 ... ... 1 ... Other Diseases of Blood Vessels ... ... ... ... ... ... 1 ... 2 1 1 5 ... 4.—Diseases of Respiratory System. Laryngitis 1 ... 1 ... ... ... ... ... ... ... ... 2 ... Croup ... ... ... ... ... ... ... ... ... ... ... ... ... Emphysema, Asthma ... ... 1 ... ... ... ... 2 1 2 ... b 1 18 22 4 1 3 4 11 28 43 26 7 167 12 Pneumonia 10 9 1 ... 1 2 4 4 9 8 6 54 3 Pleurisy ... ... ... ... ... 2 ... ... ... 1 ... 3 ... Other Diseases of Respiratory System ... ... ... ... 1 1 ... ... 1 ... ... 3 ... 5.—Diseases of Digestive System. Dentition 6 2 ... ... ... ... ... ... ... ... ... 8 ... Sore Throat, Quinsy 1 ... ... ... ... ... ... ... ... ... ... 1 ... Diseases of Stomach ... ... ... 2 2 1 3 1 1 ... ... 10 ... Enteritis 22 2 ... 3 ... ... 1 ... ... 1 ... 29 ... Obstructive Diseases of Intestine ... ... ... ... ... ... 1 1 1 3 ... 6 1 146 Table III.—Whole Parish.—Males (continued). Cases of Death. AGES. 0 to 1 1 to 5 5 to 15 15 to •25 25 to 35 35 to 15 45 | to 55 55 to 65 65 to 75 76 to 85 85 Jfe upwards. Totals. 55 to 60 | LOCAL DISEASES.—Continued. 5.—Diseases of the Digestive Ststem. (Continued.) Peritonitis ... ... ... 1 ... ... ... 1 ... ... ... 2 1 Ascites ... ... ... ... ... ... ... ... ... ... ... ... ... Cirrhosis of Liver ... ... ... ... 2 ... 3 2 1 ... ... 8 2 Jaundice and other Diseases of Liver 3 ... ... ... ... 1 2 1 1 ... ... 8 1 Other Diseases of Digestive System ... ... ... ... ... ... ... ... ... ... ... ... ... 6.—Diseases of Lymphatic System. (e.g., of Lymphatics and of Spleen) ... ... ... ... ... ... ... ... ... ... ... ... ... 7 —Diseases of Gland-like Organs of Uncertain Use. (e.g., Bronchocele, Addison's Disease) ... ... ... 1 ... ... 1 1 ... ... ... 3 ... 8.—Diseases of Urinary System. Nephritis ... ... ... ... ... ... ... ... 1 ... ... 1 ... Bright's Disease, Albuminuria ... ... ... 1 2 1 4 1 4 2 ... 15 1 Disease of Bladder or of Prostate ... ... ... ... ... ... 1 3 ... 4 ... 8 1 Other Diseases of the Urinary System ... ... ... ... ... ... ... 1 ... ... ... 1 ... 9.—Diseases of Reproductive System. a. Of Organs 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 ... ... 1 ... ... ... ... ... ... ... ... 1 ... Arthritis, Ostitis, Periostitis ... ... 1 ... ... ... ... ... ... ... ... 1 ... Other Diseases of Bones and Joints ... ... ... ... ... 1 ... ... ... ... ... 1 ... 11.—Diseases of Integumentary Ststem. Carbuncle, Phlegmon ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of Integumentary System 1 ... ... ... ... ... ... ... 1 ... ... 2 ... 147 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 Si. upwards. Totals. 55 to 60 LOCAL DISEASES.—Continued. 5.—Diseases of the Digestive System. (Continued.) Peritonitis ... ... 1 ... ... ... ... ... ... ... ... 1 ... Ascites ... ... ... ... ... ... ... ... ... ... ... ... ... Cirrhosis of Liver ... ... ... ... ... ... 2 3 1 ... ... 6 2 Jaundice and other Diseases of Liver 4 1 ... ... 2 2 2 ... 4 2 1 18 ... Other Diseases of Digestive System. ... ... ... ... ... ... ... ... ... ... ... ... ... 6—Diseases of Lymphatic System. (e.g., of Lymphatics and of Spleen) ... ... ... ... 1 ... ... ... 1 ... ... 2 ... 7.—Diseases of Gland-like Organs of Uncertain Use. (e g., Bronchocele, Addison's Disease) ... ... ... ... ... ... ... ... ... ... ... ... ... 8.—Diseases of Urinary System. Nephritis ... ... ... ... ... ... ... ... 3 ... ... 3 ... Blight's Disease, Albuminuria ... 1 ... 1 ... 1 5 8 4 2 ... 22 2 Disease of Bladder or of Prostate ... ... ... .. ... ... 1 ... .. 1 ... 2 ... Other Diseases of the Urinary System ... ... ... ... ... ... ... ... ... ... ... ... ... 9.—Diseases of Reproductive System. a. Of Organs of Generation. Male Organs ... ... ... ... ... ... ... ... ... ... ... ... ... Female Organs ... ... ... ... 2 1 2 3 2 3 ... 13 ... b. Of Parturition. Abortion, Miscarriage ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Convulsions ... ... ... ... ... ... ... ... ... ... ... ... ... Placenta prævia, Flooding ... ... ... 1 2 1 ... ... ... ... ... 4 ... Other Accidents of Child-Birth ... ... ... ... 4 ... ... ... ... ... ... 4 ... 10 —Diseases of Bones and Joints. Caries, Necrosis ... ... ... ... ... ... ... 1 ... ... ... 1 1 Arthritis, Ostitis, Periostitis ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of Bones and Joints. 1 ... ... ... ... ... ... ... ... ... ... ...1... ... 11.—Diseases of Integumentary System. Carbuncle, Phlegmon ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of Integumentary System ... ... ... ... ... ... ... ... 1 ... ... 1 ... 148 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 36 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 & u pwards. Totals. 55 to 60 VII,—DEATHS FROM VIOLENCE. 1—Accident or Neoligencb. Fractures and Contusions 1 1 3 1 3 ... 3 1 ... ... 13 2 Gunshot Wounds ... ... ... ... ... ... ... ... ... ... ... ... ... Cut, Stab ... ... ... ... ... ... ... ... ... ... ... ... ... Burn, Scald ... 1 ... ... ... ... ... ... ... ... ... 1 ... Poison ... ... ... ... ... ... 2 ... ... ... ... 2 ... Drowning ... ... 1 ... ... ... ... 1 1 ... ... 3 ... Suffocation 11 ... ... ... ... ... ... ... ... ... ... 11 ... Otherwise 1 ... ... ... ... .. 1 ... ... ... ... 2 ... 2—Homicide. Manslaughter ... ... ... 1 1 ... ... ... ... ... ... 2 ... Murder ... ... ... ... ... ... ... ... ... ... ... ... ... 3.—Suicide. Gunshot Wounds ... ... ... 1 ... ... ... ... 1 ... ... 2 ... Cut, Stab ... ... ... ... ... ... ... ... ... ... ... ... ... Poison ... ... ... ... 1 1 1 ... ... ... ... 3 ... Drowning ... ... ... ... ... 1 ... ... ... ... ... 1 ... Hanging ... ... ... ... ... ... 1 ... 1 1 ... 3 ... Otherwise ... ... ... ... ... ... 1 ... ... ... ... 1 ... 4.—Execution. Hanging ... ... ... ... ... ... ... ... ... ... ... ... ... VIII—DEATHS FROM ILL-DEFINED AND NOT SPECIFIED CAUSES. Dropsy ... ... ... ... ... ... ... ... ... ... ... ... ... Debility, Atrophy, Inanition 20 1 ... ... ... ... ... ... ... ... ... 21 ... Mortification ... ... ... ... ... ... ... ... ... ... ... ... ... Tumour ... ... ... ... ... ... ... ... ... ... ... ... ... Abscess ... ... ... ... ... ... ... ... ... ... ... ... ... Hæmorrhage ... ... ... ... ... ... ... ... ... ... ... 1 ... Sudden Death (cause not ascertained) ... ... ... ... ... ... ... ... ... ... ... ... ... Causes not Specified or Ill-defined 2 ... ... ... ... ... ... ... ... ... ... 2 ... Not Certified ... ... ... ... 1 ... ... ... ... ... ... 1 ... 149 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 86 & upwards. Totals. 55 to 60 VII.—DEATHS FROM VIOLENCE. 1.—accident of Negligence. Fractures and Contusions ... 1 1 ... ... ... 6 1 ... ... ... 9 1 Gunshot Wounds ... ... ... ... ... ... ... ... ... ... ... ... ... Cut, Stab ... ... ... ... ... ... ... ... ... ... ... ... ... Burn, Scald ... ... 1 ... 1 ... ... 1 ... ... ... 3 1 Poison ... ... ... ... ... ... 2 ... ... ... ... 2 ... Drowning ... ... ... ... ... ... ... ... ... ... ... ... ... Suffocation 7 ... ... ... ... 1 ... ... ... ... ... 8 ... Otherwise 3 ... ... ... ... ... ... ... ... ... ... 3 ... 2.—Homicide. Manslaughter ... ... ... ... ... ... ... ... ... ... ... ... ... Murder 1 ... ... ... 1 ... ... ... ... ... ... 2 ... 3.—Suicide. Gunshot Wounds ... ... ... ... ... ... ... ... ... ... ... ... ... Cut, Stab ... ... ... ... 1 ... ... ... ... ... ... 1 ... Poison ... ... ... 1 ... 1 ... ... ... ... ... 2 ... Drowning ... ... ... 1 ... ... ... ... ... ... ... 1 ... Hanging ... ... ... ... ... ... ... ... ... ... ... ... ... Otherwise ... ... ... ... ... ... 1 ... ... ... ... 1 ... 4.—execution. Hanging ... ... ... ... ... ... ... ... ... ... ... ... ... VIII.—DEATHS FROM ILL-DEFINED AND NOT SPECIFIED CAUSES. Dropsy ... ... ... ... ... ... ... ... ... ... ... ... ... Debility, Atrophy, Inanition 28 2 1 ... ... ... ... ... ... ... ... 31 ... Mortification ... ... ... ... ... ... ... ... ... ... ... ... ... Tumour ... ... ... ... ... ... ... ... ... ... ... ... ... Abscess 1 ... ... ... ... ... ... ... ... ... ... 1 ... Hæmorrhage 1 ... ... ... ... ... ... ... ... ... 1 ... Sudden Death (cause not ascertained) 1 ... ... ... ... ... ... ... ... ... ... 1 ... Causes not Specified or Ill-defined ... ... ... ... ... ... ... ... ... ... ... ... ... Not Certified 1 ... ... ... ... ... ... ... ... ... ... 1 ... 150 TABLE IV. Showing the Number of Deaths at all ages in 1895, 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. Deaths per 1,000 of Population, at all ages. Deaths per 1,000 of Total Deaths, at all ages. 1. Principal Zymotic ) Diseases 207 1.68 98.61 2. Pulmonary Diseases 449 3.65 218.67 3. Principal Tubercular) Diseases 231 1.88 110.05 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 123 41.29 251.02 5. Convulsive Diseases 50 16.78 102.04 NOTICE. 1. Includes Smallpox, Measles, Scarlet Fever, Diphtheria, Whooping Cough, Typhus, Enteric (or Typhoid), and Simple Continued Fevers, and Diarrhoea. 36 of the deaths occurred in Hospitals situated beyond the limits of the District. 3. Includes Phthisis, Scrofula, Tubercular Meningitis, Tuberculosis, Rickets, and Tabes. 4. Includes Marasmus, Atrophy, Debility, Want of Breast Milk, and Prema ture Birth. 5. Includes Hydrocephalus, Infantile Meningitis, Convulsions, and Teething. 151 TABLE V. Table showing the Number of Deaths from the principal Zymotic Diseases in the Ten Years 1885 to 1894, and in the Year 1895. DISEASE. 1885. 1886. 1887. 1888. 1889. 1890. 1891. 1892. 1893. 1891. Annual Averages, 1885—94. Total Deaths in 1895. Smallpox 11 ... ... 1 ... ... ... ... 4 3 1.9 1.9 ... Measles 63 66 33 66 11 77 7 81 30 66 50.0 52.5 18 Scarlet Fever 8 11 35 14 8 6 7 17 30 13 14.9 15.6 14 Diphtheria 25 28 27 75 39 45 27 32 69 92 45.9 48.1 49 Whooping Cough 59 55 19 74 26 82 67 29 59 44 51.4 54.0 20 Fever. Typhus 1 ... ... ... ... ... ... ... ... ... 0.1 0.1 ... Enteric 17 15 10 15 16 10 17 7 19 23 14.9 15.6 15 Simple Continued 3 1 ... ... ... 1 ... ... ... ... 0.5 0.5 ... Diarrhœa 65 92 63 38 63 62 76 82 65 45 65.1 68.4 91 L 2 TOTALS. Paddinqton 252 268 187 283 163 283 201 248 276 286 244.8 257.2 207 London 11,261 11,121 12,684 10,803 9,709 12,279 9,675 11,983 13,223 11,544 11,428.2 12,061.3 11,545 England & Wales 57,726 62,859 64,676 50,684 61,027 59,698 53,221 58,824 84,433 52,765 60,591 3 64,287.3 64,901 152 TABLE VI. Report of the Works of the Sanitary Department completed during the Year 1895. No. of Complaints received. Inspections of Dwelling Houses. Houses Let in Lodgings. Sanitary Works completed in Dwelling Houses. To Regulate Keeping of Animals. Trade Supervision. Foods. Canal Boats. Drainage, &c. 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. Services 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. Yards and Areas Paved and Drained. Manure Receptacles Reconstructed, &c. Accumulations Removed. Improperly kept Removed. Slaughterhouses. Cowhouses. Bakehouses. Offensive Trades. Seizure of Unsound Food. Samples taken for Analysis. Registered. Inspected. Quarters. 1 387 356 825 .. 2723 ... ... 102 45 14 21 37 12 11 75 .. 2 ... 3 1 12 3 ... 6 22 2 .. 2 1 7 . 1 90 .. 56 2 356 186 1026 .. 3049 .. .. 92 39 19 20 78 41 27 75 .. 2 1 3 3 31 5 1 5 53 43 1 7 2 77 .. 1 99 1 51 3 270 85 .886 .. 3039 .. .. 105 38 27 24 48 31 28 24 11 4 .. 4 1 16 2 .. 6 30 28 1 3 1 5 .. 1 81 1 45 4 196 44 632 1 2998 .. .. 109 52 24 23 70 30 32 15 2 6 1 8 .. 10 2 .. 8 5 6 4 8 3 76 .. .. 93 2 22 Year 1209 671 3369 1 11809 .. .. 408 174 84 88 233 114 98 189 13 14 2 18 5 69 12 1 25 110 79 6 20 7 165 .. 3 363 4 174 153 Meteorological observations at Greenwich. From Weekly Reports of the Registrar-General. Quarters. Year 1895. Year 1894. 1 2 3 4 Totals. Means. Totals. Means. Barometer.—Mean 29-655 29.844 29.805 29.675 - 29.745 - 29.796 Total Oscillation 20.14 13.73 15.34 22.37 71.58 — 73.05 — Thermometer—Mean 35.2 54.8 62.3 45.9 - 49.5 - 491 Absolute Maximum 63.0 86.2 87.3 78.0 87.3 6.9 Absolute Headings 86.0 Absolute Readings ,, Minimum 6.9 31.4 41.2 25.5 12.8 Mean Daily Range 11.5 20.8 20.5 11.8 — 16.1 14.8 Sunshine.—Hours recorded . 143.2 457.8 503.2 121.2 1,225.4 — 1,051.6 — "Possible'' Record 907.6 1,387.8 1,316.0 835.7 4,447.1 — 4,446.2 Per cent, of "Possible") recorded 15.7 32.9 38.2 14.5 275 — 23.6 — No. of days of record 58 83 86 48 275 268 — Humidity.—Mean 79 72 73 85 — 77 — 81 Rainfall, &c.—Total 3.21 2.01 6.50 7.76 19.48 — 26 44 — No. of days of fall 42 26 37 51 156 — 194 — ,, ,, Snow 25 — — 3 28 — 5 — with Fog 16 5 9 22 52 — 55 — „ ,, Thunder 1 6 8 — 15 — 19 — „ „ Lightning. 3 2 8 4 17 — 9 — ,, ,, Hail 1 1 1 1 4 — 7 — Hoar frost observed 11 1 — 17 29 — 23 — Wind.—Mean direction N.W. S.W. S.W. S.W. - S.W. S.W. Mean Hourly Velocity 12.3 102 11.0 13.4 - 11.7 — 12.3 No. of observations of calm 12 7 11 9 39 — 1 — 154 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-st. 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 it 29 Oct, 1888 155 SLAUGHTER-HOUSE S. NORTH. Wim. Spink George James Ariss Joseph Hall Hagger Alfred Stanbridge Ginger Henry Anness Win. J. Sack Lewis Eleazor White John Joseph Cridlan 14 Celbridge Mews. 275 Edgware Road. Hero Place, Edgware Road. Portsdown Mews. 18 Chippenham Mews. Jonson's Mews. 125 Harrow Road. Bishop's Mews. SOUTH. Frank Pain 15 Southwick 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. BAKEHOUSES. District No. 1. Underground Bakehouses in use: 27 Amberley Eoad 8 Bristol Gardens 60 Carlton Yale 17 Clifton Road 237 Elgin Avenue 14 Formosa Street 37 Kilburn Park Road 227 Maida Vale 57 Shirlaud Road 125 Shirland Road 195 „ District No. 2. Underground Bakehouses in use: 102 Church Street 7 Praed Street 72 Hall Place 53 „ 189 Edgware Road 17-19 Chilworth Street 819 „ 9 London Street 3 Spring Street 86 Praed Street 90 Harrow Road 47 Cambridge Street 349 Edgware Road 57 „ 401 „ 91 Star Street 29 Harrow Road 156 Underground Bakehouses not in use: 77 Harrow Road 46 Connaught Street Above-ground Bakehouses in use: 377 Edgware Road 143 Harrow Road District No. 3. Underground Bakehouses in use: 94 Bishop's Road 16 Craven Terrace 67 Moscow Road 24 Porchester Road 80 Queen's Road 32 Chilworth Street 56 Westbourne Grove 72 Princes Square 157 Queen's Road 46 Craven Road 5 Norfolk Road 70 Queen's Road 68 Ledbury Road 24 Hereford Road 10 Richmond Road 76 34-35 Alexander Street Underground Bakehouses not in use: 3 Coburg Place 8 Coburg Place Above-ground Bakehouse in use: 75 Queen's Road District No. 4. Underground Bakehouses in use: 23 Chichester Street 113 Cirencester Street 52 Clarendon Street 67 Cornwall Road 241 Harrow Road 265 292 23 Westbourne Terr. North 37 43 Waverley Road 62 Alfred Road 20 Woodchester Street 135 Westbourne Park Road 99 „ „ Villas Underground Bakehouses not in use: 14 Cirencester Street 41 Taviatock Crescent 43 Ranelagh Road 157 District No. 5. Underground Bakehouses in use: 27 Kensal Road 55 Elgin Avenue 4 Carlton Bridge 1 Chippenham Road 41 99 59a Fernhead Road 75 365 Harrow Road 360 500 „ 560 „ 534 436 „ 117 Walterton Road Underground Bakehouse not in use: 303 Harrow Road Above-ground Bakehouses in use: 339 Harrow Road 2 Mozart Street 10 Kensal Road 158 Appendix B. FACTORY AND WORKSHOP LEGISLATION. The Factory and Workshop Act, 1895, amends, without codifying, the earlier Acts, dating from 1878, which regulate factories and workshops as regards sanitation, employment, &c. The new Act increases the complexity, if not confusion, which existed prior to its being added to the Statute roll, and it is to be regardod more as a "stop-gap" pending the drafting of a "code," rather than a serious attempt to amend factory legislation. The officers of local authorities have nothing to do with factories, with one exception to be presently noted, unless their intervention is called for by the factory inspector, but by Sec. 3 of the Factory and Workshop Act, 1891, all workshops are placed, for sanitary supervision, under the local authorities.* A "workshop" is defined by Sec. 93, "Definitions" of the Factory and Workshop Act, 1878, as follows:— The expression " workshop " in this Act means :— (1) Any premises or places named in Part Two of the Fourth Schedule to this Act, which are not a factory within the meaning of this Act.† (2) Also any premises, room, or place not being a factory within the meaning of this Act, in which premises, room, or place, or within * Section 3 is as follows: —(1) Sections three and thirty-three of the Factory and Workshop Act, 1878 (which relates to cleanliness, ventilation and overcrowding in, and limewashing of, factories and workshops) shall cease to apply to workshops. (2) For the purpose of their duties with respect to workshops (not being workshops to which the Public Health (London) Act, 1891, applies), a sanitary authority and their officers shall, without prejudice to their other powers, have all such powers of eutry, inspection, taking legal proceedings, or otherwise, as an inspector under the principal Act. †Part Two of the Fourth 8chedule specifies hut works, rope works, bakehouses, lace warehouses, shipbuilding yards, quarries, and pit.banks. 159 the close or curtilage or precincts of which premises, any manual labour is exercised by way of trade or for purposes of gain in or incidental to the following purposes or any of them; that is to say,— (o) In or incidental to the making of any article or part of an article; or (4) In or incidental to the altering, repairing, ornamenting, or finishing of any article ; or (c) In or incidental to the adapting for sale of any article, and to which or over which premises, room, or place, the employer of the persons working therein has the right of control or access The practical distinction between a factory and a workshop is the use of mechanical power, steam or other, in the former. Laundries are, under Sec. 22 of the Act of 1895, to be deemed to be workshops, if no mechanical power be employed, for the enforcement of certain specified regulations, and places where work is given out are workshops for the purposes of Sec. 6 of the same Act. The fact that a portion of a work-place is in the open air, does not remove that place from the category of a workshop, if it be otherwise within the definition.* Local authorities have the following powers under the Public Health (London) Act, 1891:— Sec. 2 (g), which is as follows:— Any factory, workshop, or workplace, which is not a factory subject to the provisions of the Factory and Workshop A.ct, 1878 (41 •"The provisions of this Act which relate—(1) To the cleanliness (in"eluding liinewashing, painting, varnishing, and washing) or to the freedom " from effluvia, or to the overcrowding, or ventilation of a factory or work- "shop shall not apply—(a) where persons are employed at home, that is "to say, to a private house, room, or place, which, though used as a dwelling, "is by reason of the work carried on there a factory or workshop within the "meaning of this Act, and in which neither steam, water, nor other me"chanical power, is used, and in which the only persons employed are "bers of the same family dwelling there; Nothing in this section shall "exempt a bakehouse from the provisions of this Act with respect to cleanli"ness (including limewashiug, painting, varnishing, and washing) or to free"dom from effluvia."—Section 61, Factory and Workshop Act, 1878. The exemption to domestic workshops conferred in this section is now non-existent, as all workshops are dealt with under the Public Health (London) Act. 160 and 42 Vict., cap. 16) relating to cleanliness, ventilation, and overcrowding, and (i.) Is not kept in a cleanly state and free from effluvia arising from any drain, privy, earth closet, water closet, urinal, or other nuisance, or (ii.) Is not ventilated in such a manner as to render harmless any gases, vapours, dust, or other impurities generated in the course of the work carried on therein that are a nuisance or injurious or dangerous to health, or (iii.) Is so overcrowded while work is carried on as to be injurious to the health of those employed therein, shall be a nuisance liable to be dealt with summarily under this Act. Sec. 25 (1), for the limewasbing and washing of workshops when certified by the officers of the authority to be necessary. (2) For the same in factorios not subject to the Factory Acts. Sec. 26 (1) For securing cleanliness, ventilation, and other sanitary conditions in bakehouses which are workshops. (2) Powers of entry into bakehouses to the same extent as for nuisances, with penalty for any refusal to admit. Sec. 27, Notice by the Medical Officer of Health to the inspector of factories of any employment of women, young persons and children which the Medical Officer may become aware of. Sec. 38 (1) for the provision of sufficient and suitable watercloset accommodation in factories and workshops. (2) For enforcing the provision of such accommodation with special penalties for non-conpliance. The powers of entry are those conferred in Sec. 115 of this Act. It is to be noted that under Sec. 38, the local authority can initiate action in a factory without waiting for the factory inspector to call attention to the want of accommodation, which would presuppose that the local authority has power to inspect factories for this purpose. The Factory and Workshop Act, 1895, extends and modifies the powers under the Public Health Act, in the following particulars 161 Section 1.—The standard cubic space to be provided is fixed at 250 cubic feet per person, during ordinary work hours, and 400 cubic feet during overtime. The Home Secretary is empowered to modify the spaces given above to meet the use of artificial light, other than electric. A notice is to be affixed (not stated where) specifying the number of workers who may be employed in each room of the workshop.* It is not settled who is to determine the cubic contents of the work-rooms, but the most satisfactory plan will be for the local authority to do so. The notice issued by the Home Office specifying the number of workers, is to contain on one sheet the numbers for every room in the building. It would probably be fixed up near the entrance to the workplace where the other notices are fixed. A preferable plan will be to provide a card for each room, which card should be hung in a conspicuous position in its proper room. No order has as yet been issued for determining the space to be deducted for artificial light. Section 2.—This section gives power to a court of summary jurisdiction to prohibit the use of a factory or workshop, or part of either, which cannot be used as such without "danger to health, or to life or limb." Complaint is to be made by an inspector of factories, but no proceedings are to be taken under this section, where a local authority can deal with the case under the Public Health Act, unless such authority make default in so dealing with the case. Section 3.—When the factory inspector notifies a local authority of any " act, neglect, or default," the authority must report what action has been taken to the factory inspector. The time allowed for acting on the notice from the factory inspector is limited to "within one month." Section 5.—This provides for a penalty in the case of any occupier continuing to use a workshop (or place for distribution of work) after the expiration of one month from the receipt of a notice from an 'inspector' that his workplace is injurious or dangerous to the health of the persons employed there. The *Throughout this consideration of the Act workshop regulations only will be dealt with, irrespective of any provisions applying to factories as well. 162 section is not in force until such time as the Home Secretary issues an order for its application by reason "of the number and distribution of the population or the conditions under which work is carried on, there are special risks of injury or danger to the health of the persons employed and of the district." This section appears to have been framed to deal with the "sweating dens" in densely crowded districts. The inspector to act under such conditions would be the inspector of factories. Section 6.—This is one of the most important provisions in the Act. It is as follows:— If any occupier of a factory, or workshop, or laundry, or of any place from which any work is given out, or any contractor employed by any such occupier, causes or allows wearing apparel to be made cleaned or repaired in any dwelling-house or building occupied therewith, whilst an inmate of the dwelling-house is suffering from scarlet fever or smallpox, then, unless he proves he was not aware of the existence of the illness in the dwelling-house, and could not reasonably have been expected to become aware of it, he shall be liable to a fine not exceeding ten pounds. Two new principles are embodied in this section, one that of preventing work which may spread disease, being done in the same house as that occupied by a patient sick with an infectious disease, and the other the introduction of the words "could not reasonably have been expected to become aware of." It is to be noted that there is no proviso covering the case of a patient the member of another family who is kept at home in isolation. The section says that no work shall be done in the same house or building. The burden of proof that the defendant did not know or could not be expected to become aware of any case would lie with the defendant himself, and the latter clause would be very difficult to substantiate in the two diseases mentioned. When the Bill was before the House of Commons, endeavours were made to have the principle extended to other diseases, but it was on the whole, better to wait and to learn how the clause as it now stands will operate. There is no provision for any compensation, although the stoppage of work may act very hardly in certain instances, notably when in a tenement house, there is a case of either disease in a family of which the worker is not a member, 163 and the patient declines to go to the hospital, or where the hospitals are full and accommodation cannot be secured. This clause would affect out-workers. Section 22.- Previous to the passing of this section, laundries were included in factory legislation in a very indirect manner. They were first mentioned in Sec. 2 of the Act of 1891, as one of the places in which any "act, default, or neglect" in relation to drainage, water supply, nuisance, &c., coming under the notice of a factory inspector, was to be notified by him to the local authority. Even now, their position is peculiar. They are not classed as factories or workshops, except for the purposes set out in the 4th sub-section, which is decidedly vague. It seems, however, as if such laundries as do not employ power, may be deemed to be workshops, and regulated under the Public Health (London) Act, 1891. As already mentioned, the special provisions with reference to infectious diseases included in Sec. 6 apply to laundries. Section 27.—The prohibition of the use of an underground bakehouse, which was not in use at the commencement of the Act, i.e., 1st day of January, 1896, is the only addition to the enactments embodied in the Public Health (London) Act, 1891.* Section 32.—This clause requires that a "reasonable temperature" should be secured and maintained in each room of a workshop. It is not stated whether this comes under the head of a sanitary measure, and there is no guidance as to the temperature to be maintained, or the officer to see that the provision is enforced. It is almost impracticable to fix a limit as to the higher temperatures, as they must necessarily follow the temperature of the air, but in winter it is reasonable to expect the workrooms to be adequately warmed. A temperature 55o.0 Fahrenheit, has been suggested. Some further legislation is needed as the manner in which the temperature is to be taken, i.e., where the thermometer is to be fixed by which the reasonable temperature is to be gauged. *The local authority control only retail bakehouses, which are defined in the 18th Sec. of the Factory and Workshop Act, 1883, to be 'bakehouses or places, the bread, biscuits, or confectionery baked in which are not sold wholesale but by retail in some shop or place occupied together with such bakehouse.' If machinery be used the bakehouse would be a factory. 164 Section 33.—This section extends the 36th section of the Act of 1878, which requires factories and workshops where certain dusts, &c., are given off, to be ventilated by the use of a fan or other artificial means, to any workshop "where any process is carried on by which any gas, vapour, or other impurity is generated and inhaled by the workers' to an injurious extent." This provision is one which must be deemed vital to health, but there is no statement that the local authorities are to see to its enforcement. It would not be unduly stretching the clause to make it apply to a workshop where much gas was burned, but it is doubtful if such were the intention of the legislature. Section 35.—This section is practically the same as Section 38 of the Public Health (London) Act, 1891, and deals with the provision of sufficient and suitable water-closet accommodation. Section 41. —Under Sec. 26 of the Act, 1891, it was enacted that notice should be sent to the factory inspector of the district of any workshop opened in the district, such notice to be sent within one month of opening. These notices are sent to the local authorities by the factory inspector. By the 41st Sec. of the Act of 1895, all persons occupying workshops, who have not sent notices under 26th Sec. of the Act of 1891, must send notice of occupation in the course of the year 1896, and the factory inspector is to forward the notices on to the local authority. The district inspector of factories has been approached with a view to obtaining a list of all the workshops in Paddington. Section 42.—Pursuant to the 27th Sec. of the Act of 1891, the Home Secretary issued an order, known as the " Outworkers' Order," requiring the occupiers of certain workshops to make and keep lists of all the persons employed by them outside the workshop or factory, together with the addresses of the places where they worked, such lists to be open to inspection by the factory inspector and the officials of the local authority. By the 42nd Sec. of the Act of 1895, it is prescribed that such lists shall be made up and sent to the district factory inspector on the first days of March and September of each year, showing the names of all persons directly employed as workmen or as contractors outside the workshop and the addresses where they are employed. 165 There is no provision for copies of the lists to be sent to the local authorities, but the factory authorities will do so. These outworkers will require to be looked up and inspected at their places of work much the same as if each place were a workshop. By an order dated January 27th, 1896, the Home Secretary decreed that such lists should be furnished by the occupiers of workshops carrying on the trade of clothes making, electro-plating, cabinet and furniture making and upholstery, and the making of files, and by every contractor employed by the occupiers of such workshops, and by the occupiers of every place where such work is given out. Under Sec. 77 of the Act of 1878, a register "in the prescribed form" has to be kept of various matters "under this Act," including the periodical limewashing of the workshop, and by the 43rd Sec. of the Act of 1895, failure to make an entry of such lime-washing, is to be prima fade evidence of failure to observe the requirements of the Factory Acts with respect to lime-washing. It is doubtful whether this applies to workshops, as the lime-washing there is under the Public Health Acts, but such a provision would be very useful. 166 LONDON BUILDING ACT, 1894. This Act codifies and amends the legislation dealing with the erection of buildings of all classes, previously scattered throughout some twenty acts, public and private. Although the whole Act cannot fail to have some influence on the salubrity of dwellings, yet there are certain particulars to which the designation " sanitary " is more specially applicable, and attention will be confined to them on this occasion. They will be considered under the headings of (a) site, (b) air spaces, and (c) the dwelling. Site. —The Act gives the Council no control over the choice of site except as regards land below the Trinity high-water mark. Sec. 122 et seq. In this case building of dwelling-houses can only be sanctioned " with the permission of the Council and subject to and in accordance with such regulations as the Council may from time to time prescribe." The regulations may forbid the erection of houses on such land, may regulate the erection of the same, and prescribe the level at which the under-surface of the bottom floor of any such dwelling-house shall be built, and the provision to be made for the efficient drainage of the buildings. A special court of appeal is constituted by the Act to hear any objections to the ruling of the Council in this matter. Under Sec. 164 (1), the Council is empowered to make bye laws with respect to (inter alia) "foundations and sites of buildings and other erections; the mode in which and the materials with which such foundations and sites are to be made, excavated, filled up, prepared, and completed for securing stability and for purposes of health; . It may be possible to prohibit the use of sites which are entirely unfit for the erection of dwelling-houses under such bye-laws. By Sec. 216 of the Act, the bye-laws made under Sec. 16 of the Metropolis Management and Building Acts Amendment Act, 1878, are continued in force. Bye-law No. 2 of that series deals with "Foundations and Sites of Buildings," and provides that "no house, building, or other erection," shall be constructed on any place which has been "filled up and covered'' with refuse, i.e., with "any material impregnated or mixed with any fecal animal or vegetable matter" or with "dust or slop" until the refuse, &c., shall have been excavated and the site made good with 167 "hard brick or dry rubbish or concrete or other suitable materia]" where such excavation is not required for the foundations, &c., of the building. It is further prescribed that the whole site shall be covered with good concrete at least six inches thick and that the foundations shall be bedded in at least nine inches of concrete, projecting four inches beyond the lowest course of the footings. On a natural bed of gravel the concrete under the footings may be omitted with the approval of the district surveyor. Air Space.—Ample air space should be secured for new buildings, or buildings re-constructed (with certain reservations), by the provisions dealing with the width of streets and the laying out thereof, and with the lines of frontage and the height of buildings; by the compulsory provision of open spaces in rear of all dwelling-houses, and the limit of "the angle of construction"; and by the limitations to the formation of shafts and to the depth of offsets from the main building. There is no express statement as to the minimum width of a new street, but the Council have the power to refuse to sanction the plans of any new street for carriage traffic of a width under 40 feet, and they may, under certain circumstances, demand that the width be 60 feet, and in the case of a road for foot traffic only, the implied minimum is 20 feet. Any street of 60 feet length, or of a length greater than the width, must be open at both ends from the ground upwards and must communicate with a street at either end. The line of frontage is to be at least 20 feet distant from the centre of a roadway for carriage traffic and 10 from the centre of a roadway for foot passengers only. The distance is to be measured from the centre of the roadway to the front wall of the house, if there be no forecourt, or to the front boundary of any forecourt or garden. The Council are empowered under special circumstances to allow the line of frontage to be advanced, or they may demand that it shall be set back, but not farther than 30 feet from the centre of the road. The height of a building is to be measured from the surface of the street or ground previous to excavation, to the top of the parapet, or of the external wall or to base of gable, as the case M 2 168 may be. The maximum height fixed by Sec. 47 is 80 feet, but two storeys may be built in addition in the roof, and turrets and other architectural ornaments are not included in the height. In the case of dwelling-houses to be occupied "by persons of the working class" erected within the "prescribed distance," the height of such building is not to exceed "the distance of the front or nearest external wall of such building from the opposite side of " the street. Where there is a habitable basement to a dwelling-house, there must be in rear of the house an open space reserved for such basement of at least 100 square feet, on which nothing may be erected. It is not necessary that the rear boundary of such space should be at the rear boundary of the curtilage. To every house there must be in the rear, an open space of at least 150 square feet, which space must extend along the whole width of the house, and for 10 feet from the back wall of the building. Under certain circumstances, this space may be occupied by buildings not exceeding 9 feet in height. For fixing the height of the building in reference to the open space in rear, Sec. 41 prescribes certain rules with regard to the manner of setting oft a ''diagonal line,'' which is to make an angle of 63.5 with a "horizontal line" at a distance of 10 feet from the rear wall of the building. Both the lines are defined and their manner of setting off described in the 41st Sec. No part of the building, except dormers, chimneys, and ornaments, are to be constructed outside the limits of the diagonal line. Sec. 45 prohibits the construction of shafts in the centre of a building for lighting habitable rooms, except under certain conditions, (i) if the depth of the court from the parapet to the ceiling of the ground storey exceeds the length or breadth of the shaft, an opening for purposes of ventilation must be made in the basement of the building connecting the shaft with the external air; and (ii) the width of the shaft at the level of the windowsill of any room, must be equal to at least one half the length of the diagonal line from such window-sill to the opposite parapet. In the case of any offsets built from the rear wall of a dwelling house, the interval between any two offsets must be equal to at 169 least one half the length of such offset measured from the rear wall of the dwelling-house. The Dwelling.—The matter of preventing the rising of exhalations and damp from the site has been dealt with in part under the heading of "Site.'' The Bye-laws under Sec. 16 of the Metropolis Management and Building Acts Amendment Act, 1878, prescribe the rules as to the materials to be used in walls, the provision of a damp course (at least six inches below the level of the lowest floor), and the protection of walls, against which the soil abuts, from the effects of percolation, &c. Sec. 70 of the Act of 1894 prescribes that every habitable room, not being in the roof, shall be at least 8 ft. 6 in. high in every part, and that a room in the roof shall be at least 8 ft. high to the extent of at least one half of its area. Every habitable room is to have window provision, measured clear of the sash frames, equal to one-tenth of the floor area of the room, and such window, or windows, must open to at least one-twentieth of the floor space. In a room lighted from the roof, the window opening must be at least onetwelfth of the floor area and the efficient opening one-twentyfourth of the floor area. If a lantern light be used, the portion opening must be at least one-twentieth of the floor area. In any room not lighted from the roof, the part of the window which opens must reach to seven feet from the floor of the room. A basement room,* whose floor is not bedded in concrete, must have a space between the wooden floor and the soil sufficient to allow of free ventilation. In the case-of tenements over stables, the floor between the living rooms and the stable is to be so constructed that no smell can penetrate it, and the staircase to the upper parts of the stables, when to living rooms, are to be separated off with a nine inch brick wall. By Sec. 69 it is prescribed that the staircase of a tenementhouse shall be ventilated upon every storey above the ground storey by window or sky-light, to the external air. The administration of the Act is entirely in the hands of the London County Council. * These rooms are specially dealt with under Sec. 96 of the Public Health (London) Act, 1891. 170 ABSTRACT OF THE QUARTERLY REPORTS OF THE PUBLIC ANALYST For the Year ending March 25th, 1896. A total of 383 samples of food were analyzed. These consisted of Milk (fresh and condensed) 218 samples, Butter 62, Lard 16, Groceries 43, Spirits 23, Ices 7, Beer 5, Potted Meats 5, and Bread 4. Of these, 16 samples of Milk, 4 of Butter, 2 of the Groceries, and 3 of the Spirits, proved to be adulterated. A review of these articles shows:— Milk to be adulterated to the extent of 7⅓ per cent. This is only half of the adulteration that was experienced last year. Through the mildness of the winter there has been a plentiful supply of milk, so that there has been less than usual a temptation to make up the quantity with water. Comparing the samples taken this year from the railway stations, street sellers, and shops, on week-days and Sundays, it is found that most of the adulterated samples were obtained on Sundays, at the smaller shops. Condensed milk, from its handiness and good 171 keeping qualities, is coming very largely into use, especially amongst the poor. In London there are over 50 different brands of condensed milk sold, and new brands are constantly coming before the public. Quite nine-tenths of these are made from skimmed milk, though this fact is not very obvious on the label. Several inquests have been held on children fed on such milks who have, however, died from lack of sufficient nutriment. It should be obligatory to label such tins of skimmed milkwith a notice that they are unfit for feeding infants. At present some are actually labelled " recommended for feeding infants." Butter shows this year an adulteration of 6| samples per 100, consisting usually of an admixture of 80 per cent, of beef-fat, known as margarine. Most of this margarine is imported from abroad, so that the British buyer of " butter" who may wish to help the unfortunate English farmer, too often finds his cash going into the pockets of the foreign grease merchants. Groceries, though of great variety, showed a marked freedom from adulteration, the only article adulterated being coffee. Here, again, the adulterators force us to support the foreign chicory growers rather than the British capital expended in coffee plantations. So long as chicory is one-fifth of the price of coffee, the temptation to find that the customer prefers a mixture, even when he asks for "coffee," is likely to prevail with the unscrupulous. 172 Unluckily such a mixture usually contains about 70 per cent, of chicory. Spirits.—Of these, 13 per cent, proved to be below the legal limit, containing from 2 to 4 per cent, of water beyond what the Act allows. This dilution may seem small, but when the high price charged is considered, and the very large quantity that is sold, it will be seen that this represents a large extra profit. As it is, gin may legally contain in 100 parts by weight G9 parts of water; other spirits may contain only 64 parts of water. Luckily, the older forms of adulteration of spirits by means of deleterious ingredients have been entirely put a stop to by the working of the Adulteration Act; nothing worse than water is now to be found in spirits. Ices prove to be made of water, milk, and flour paste, with sugar. Occasionally there is some innocuous flavouring and coloring matters present. So far, no metal from the vessels used nor any deleterious ingredients have been detected. What is most to be feared is the want of cleanliness and the insanitary condition of the storage of the material. It would be well if the vendors and their premises were licensed and inspected so as to guard against any possible spread of infection. Beer.—This continues to be of the same wholesome character as in former years. As the law allows of the use of any harmless bittering material, and does not 173 insist on the use of malt, it frequently happens now that beer contains neither malt or hops. Legislation insisting on the use of both of these would vastly benefit British agriculture and improve beer. Potted Meats consisted of German Sausage and of Brawn. The former contained about one-third of their weight of bread; the latter were free from bread. None of these contained any deleterious or unwholesome materials, nor could any horseflesh be detected. Fines for adulteration, ordered to be paid into the Vestry's account, amounting to £43 : 5s ; this was the result of 18 prosecutions, so that the average fine was £2 : 8s. The benefit of the working of the Act is not however to be measured by the fines inflicted. If the Adulteration Act were not carried out it would be almost impossible for the honest trader to live; he would be so surrounded by those who could undersell him by means of adulterated articles that he must needs starve or else take to adulteration in sheer defence. The result to the buyer would be disastrous. Thanks to the enforcement, by the Sanitary Committee, of this Act, the mass of traders in this Parish are able to earn an honest living, the adulterators are not allowed to increase and are after all but few in number. Though this Parish stands well much remains to be done throughout the country. In to-day's "Times," Sir James Blyth estimates that twenty millions of money arc sent out annually from this country for Dairy and 174 Agricultural produce which this country itself could well supply. A stricter enforcement of the Adulteration Act on our imports would do much to remedy this. ALP. W. STOKES, F.C.S., P.I.C., (Public Analyst.) Laboratory, Vestry Hall, Harrow Road, June 15 th, 1896. TABULATED LIST OF ARTICLES ANALYSED During the Year ended 31st March, 1896. Articles analyzed. Total number Number adulterated. Milk & Condensed Milk 218 16 Butter 62 4 Lard 16 0 Groceries 43 2 Spirits 23 3 Bread & Pastry 4 0 Ices 7 0 Ale 5 0 Potted Meat 5 0 383 25