PAD 3 Borough of Paddington. REPORT ON VITAL STATISTICS AND SANITARY WORK FOR THE YEAR 1897, BY REGINALD DUDFIELD,M.A.,M.B.,D.P.H., Medical Officer of Health. Contents. Page. Population, Estimates of 7 Births and Birth-rates 9 Vaccinations 12 Notification of Infectious Diseases 15 Page. Deaths and Death-rates 32 Water Supply 66 Administrative Work 70 APPENDICES. A. Tables of Births, Deaths, &c. 83 B. Efficiency of Disinfection of Booms 99 C. Return Cases 116 D. Summary of Food Samples Analysed 118 SPECIAL SUBJECTS. Action to limit Infectious Disease 70 Age-group Death-rates 37 Causes of Death 41 Combined Drainage, Orders for 76 Deaths in Public Institutions 65 Delay in Removal to Hospital 29 Deaths of Infants under one year 55 Death-rates from Diphtheria 50 Food Adulteration, solutions on 81 House Drainage, tions required 75 Houses let in Lodgings, Registration of 74 Illegitimates, Births of 11 „ Deaths of 62 Infantile Diarrhœa, Deaths from 55 Infectious Disease in surrounding Parishes 27 Inquest Cases 64 Legal Proceedings 80 Manure Nuisances 78 Neglect of Vaccination 13 Return Cases of Infectious Disease 30, 116 Schools and Infectious Disease 29 Trade Supervision 77 PAD 6 TO THE CHAIRMAN & MEMBERS OF THE SANITARY COMMITTEE OF THE VESTRY OF PADDINGTON. Gentlemen, I have the honour to present to you my Fourth Annual Report dealing with the Vital Statistics of the Parish for the year 1897. The year's record would have been without special feature but for the reductions observed in the death-rates from all causes, measles, and enteric fever. In 1889 only did the death-rate (14.21 per 1,000) fall below the rate for last year (14.33). The local records extend back to 1866, and the mean death-rates from all causes have been as follows :— In periods of five years : 1866-1870 19.86 1876-1880 17.00 1886-1890 16.20 1871-1875 19.18 1881-1885 16.24 1891-1895 17.28 In periods of ten years : 1866-1875 19.52 1876-1885 16.67 1886-1895 16.74 In 1896 the death-rate was 15.3, and in 1897 14.3. The maximum rate (20.5) was recorded in 1867 and 1870. 4 A comparison of the death-rates from selected causes in 1889 and 1897 will be of interest:— Death-Rates per 1,000 of the Population. 1889 1897 Measles 0.09 0.01 Scarlet Fever 0.06 0.15 Whooping Cough 0.22 0.31 Diphtheria 0.33 0.51 Fever 0.13 0.05 Diarrhœa 0.53 0.84 Zymotic Rate 1.39 1.90 Puerperal Pever 0.08 0.01 Other Septic Diseases 0.14 0.07 Cancer 0.82 0.90 Phthisis 1.27 1.04 Other Tubercular Diseases 0.46 0.56 Bronchitis 1.65 1.59 Pneumonia 1.16 0.76 Nothing has been done yet to give effect to the Reports of the Royal Commission on Vaccination, or of the Commons' Committee on Food Products Adulteration. Amendments are very generally desired, and very needful. The varying influences brought into play make the task of the Government in drafting fresh legislation an unenviable one—that is so far as the political aspect of the case is concerned. With regard to the needs of a Disinfecting Station worked by the Vestry, and of better office accommodation, I have nothing to add to my remarks of last year. 5 In conclusion, I desire to tender my thanks to the Committee, and especially to the Chairman of the Committee, for the kindly support and co-operation I have received from them, and to express my satisfaction with the manner in which the Officials of the Department have discharged their 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, W. June, 1898. PAD 6 7 POPULATION. Six years having elapsed since the taking of the complete census in 1891, the estimates of the population have become somewhat untrustworthy. The enumeration of 1896 was from its incomplete character liable to serious error, chiefly in the direction of excess, and is therefore of little value as a check to the estimates. It has, however, been thought desirable to assume that the changes in the populations of the two sub-districts, as determined by the enumeration, have remained constant. On this basis the population of the Parish at the middle of the year, has been estimated at 126,253 inhabitants, of whom 92,788 were residents in North Paddington (St. Mary's Sub-District), and 33,465 in South Paddington (St. John's Sub-District).* The numbers of individuals estimated living in each sex-age-group have been tabulated in Table 1. The natural increment of the population of the Parish during 1897, amounted to 1,210 individuals, as compared with 1,126 in 1896 and 880 in 1895. During the decennium, 1887-96, the natural increment averaged 855 individuals a year. *The boundary line between the two sub-districts begins, at the eastern end of the Parish, in the middle of Praed Street, at its junction with Edgware Road, is continued down the centre of the Canal Basin to Bishop's Road Bridge, and passes thence down the middle of Bishop's Road and Westbourne Grove to the western limit of the Parish. 8 The population of the Metropolis at the middle of the year was estimated at 4,463,169 persons, 2,109,739 males and 2,353,430 females. The estimates of the numbers living in each sex-age-group are given in the last column of Table 1. TABLE 1. Sex-Age-Constitution of Populations estimated to middle of 1897. PERSONS. Age Groups. Paddington. St. Mary. St. John. London. All ages 126,253 92,788 33,465 4,463,169 0- 1 2,660 2,268 392 115,304 1- 5 9,321 7,739 1,582 416,607 5-15 20,950 16,928 4,022 922,380 15-25 27,006 18,716 8,290 895,792 25-65 60,380 42,849 17,531 1,936,173 65 and over 5,936 4,288 1,648 176,913 0- 5 11,981 10,007 1,974 531,911 5-65 108,336 78,493 29,843 3,754,345 5 and over 114,272 82,781 31,491 3,931,258 MALES. All ages 52,215 40,293 11,922 2,109,739 0- 1 1,304 1,114 190 57,174 1- 5 4,601 3,827 774 207,387 5-15 10,107 8,240 1,867 457,813 15-25 10,378 7,704 2,674 414,986 25-65 23,802 17,972 5,830 902,547 65 and over 2,023 1,436 587 69,832 0-5 5,905 4,941 964 264,561 6-65 44,287 33,916 10,371 1,775,346 5 and over 46,310 35,352 10,958 1,845,178 FEMALES. All ages 74,038 52,495 21,543 2,353,430 0- 1 1,356 1,154 202 58,130 1- 5 4,720 3,912 808 209,220 5-15 10,843 8,688 2,155 464,567 15-25 16,628 11,012 5,616 480,806 25-65 36,578 24,877 11,701 1,033,626 65 and over 3,913 2,852 1,061 107,081 0- 5 6,076 5,066 1,010 267,350 5-65 64,049 44,577 19,472 1,978,999 5 and over 67,962 47,429 20,533 2,086,080 9 At the date of the census the inhabitants of the Parish averaged 95.1 to the acre, 105.8 in the northern half, and 75.8 in the southern. On the estimate for 1897, these averages are 101.9, 116.7, and 75.3 respectively. In 1891 each house had an average of 8.1 occupants in the whole Parish, 8.9 in the northern half, and 6.6 in the southern. The averages for last year cannot be given, owing to the changes in the manner of making up the rate books, and the want of exact information as to the numbers of houses pulled down and constructed. The increased number of flats lately erected cannot have failed to attract a considerable number of inhabitants to the Parish, as well as to alter the density of the population. In the decennium 1841-50, each inhabitant of the Parish had an average area of 0.035 of an acre, which space had shrunk to 0'009 of an acre in 1897. Such a diminution of "elbow room" offers greatly increased facilities for the spread of infectious disease, and demands an unremitting attention to sanitary details in order to minimise those conditions inimical to health which are naturally associated with a dense aggregation of individuals. BIRTHS. During the fifty-two weeks constituting the statistical year, 3,010 births were registered in the Parish, 2,586 in North Paddington, and 424 in South. The birth-rate for the Parish was 23.84, that for North 10 Paddington 27.86, and that for South, 1266 per 1,000 inhabitants of each district. In Table 2, the numbers of births of each sex in each district are given, with the corresponding rates for 1897 and the preceding TABLE 2. Births registered. Births registered 1897. Paddington. St. Mary. St. John. Males. Females. Both Sexes. Males. Females. Both Sexes. Males. Females. Both Sexes. 1st Quarter 367 375 742 327 325 652 40 50 90 2nd ,, 370 362 732 319 309 628 51 53 104 3rd ,, 406 395 801 341 331 672 65 64 129 4th ,, 369 366 735 309 325 634 60 41 191 Year 1,512 1,498 3,010 1,296 1,290 2,586 216 208 424 Birth Rates* 1897 11.97 1.861 23.84 13.96 13.90 27.86 6.45 6.21 12.66 Mean Rates, 1892-96. 12.45 11.79 24.27 14.35 13.86 28.22 7.38 6.20 13.58 1896 13.12 11.11 24.24 15.01 13.20 28.21 7.98 5.41 13.39 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 12.67 1893 12.47 12.49 24.96 14.41 14.85 29.26 7.29 6.16 13.45 1892 12.48 12.11 24.60 14.42 14.09 28.52 7.45 6.96 14.41 * Rates per 1,000 of total population of each year. five years. The births of males in the Parish were equivalent to a rate of 11.97, 0.48 below the quinquennial mean; those of females to one of 11.86, or 0.07 above the mean, whilst the total birth-rate (23.84) was 0.43 below the same mean. Last year's birthrate was the second lowest recorded during the six years 1892-97. The mean rate for the decennium 11 1887-96 was 24.5 per 1,000, 0.8 higher than the rate for last year. (See Table 3.) With regard to the sub-districts, the rate for St. John (12.66) shows the greater diminution, being 1.92 below the mean rate for the five years 1892-96 (13.58), and 1.3 below that for the previous decennium (14.0). The birth-rate for England and Wales was 29.7, 0.9 below the decennial mean rate, and that for London 30.0, or 1.2 below the mean. (See Table 3.) Last year's rate for Paddington was 5.9 below that for England and Wales, and 6.2 below that for the Metropolis. TABLE 3. Births and Birth-rates, 1887-97. Paddington. St. Mary. St. John. Birth-rates. Regd. Rates. Regd. Rates. Regd. Rates. England and Wales. London. 1897 3,010 23.84 2,586 27-86 424 12-66 29-7 300 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 1880 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 30.1 1895 2,979 2???.3 2,526 27.9 453 14.0 30.3 30.5 1896 3,068 24.2 2,419 28.2 455 13.4 29.7 30.2 Averages 1887-96. 2,930 24.5 2,424 28.8 486 14.0 30.6 31.2 Of the 3,010 children whose births were registered in the Parish, 107 were illegitimate, equal to a rate of 12 0.84 per 1,000 of the population. (See Table 4.) The mean illegitimate rate for the decennium was 1.19, 0.35 above the rate for last year. The illegitimate births were in the proportion of 3.68 to every 100 legitimate, as compared with a decennial average of 5.13. TABLE 4. Illegitimate Births and Birth-rates. Year. Estimated Population. Births Registered. Birth-rates per 1,000 of Population. Illegitimate Births per 100 Legitimate. Legitimate. Illegitimate. Total. Legitimate. Illegitimate. Total. 1887 114,462 2,735 181 2,916 23.9 1.58 25.6 6.20 1888 115,749 2,694 149 2,843 23.3 1.28 24.6 5.24 1889 117,060 2,729 134 2,863 23.4 1.14 24.5 4.68 1890 118,736 2,741 160 2,901 23.1 1.34 24.4 5.51 1891 117,838 2,807 146 2,952 23.9 1.23 25.1 4.91 1892 119,260 2,792 142 2,934 23.4 1.18 24.6 4.77 1893 120,480 2,885 126 3,011 24.1 1.04 25.2 4.18 1894 121,500 2,686 148 2,834 22.1 1.21 23.3 5.22 1895 122,750 2,864 125 2,979 23.3 1.01 24.3 4.19 1896 124,850 2,949 119 3,068 23.3 0.94 24.2 4.03 Mean for 10 years 1887-96 119,656 2,787 143 2,930 23.29 1.19 24.48 5.13 1897 126,253 2,903 107 3,010 22.99 0.84 23.84 3.68 VACCINATION. There was a slight increase in the percentage of infants "not accounted for" during 1896 (the last year for which returns have been completed), 13 such infants forming 9.0 per cent. of those born, as against 8'8 and 8.2 in 1895 and 1894. It will be remembered that there was a slight prevalence of smallpox in the Parish in 1893 and 1894, which doubtless had some effect on the amount of vaccination in the subsequent years. TABLE 5. Vaccination Returns 1881-1896. Year. Births. Successfully vaccinated. Insusceptible of vaccination. Had Small-pox. Died unvaccinated. Vaccination postponed. Remaining (not traced, &c., &c.)* Children not accounted for (including postponed 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 2,460 13 ... 239 43 200 8.2 1885 3,019 2,489 12 ... 252 38 228 8.8 1886 2,923 2,409 7 ... 213 26 268 10.1 1887 2,915 2,440 11 ... 220 40 204 8.4 1888 2,855 2,293 22 ... 216 38 286 11.3 1889 2,870 2,275 7 ... 223 68 297 12.7 1890 2,845 2,255 7 ... 254 29 300 11.6 1891 2,968 2,172 16 ... 254 32 494 17.7 1892 2,957 2,374 7 ... 202 16 358 12.6 1893 3,015 2,421 27 ... 265 10 292 10.0 1894 2,853 2,986 2,369 24 ... 203 21 236 8.2 1895 2,378 24 ... 302 21 261 8.8 1896 3,042 2,443 28 ... 286 11 274 9.0 January to June, 1897 1,464 1,184 4 ... 113 27 136 9.2 * Gone away, false addresses, "unaccounted for." Table 6 illustrates the extent of neglect of vaccination in the country generally, in the Metropolis, and, for part of the time, in the Parish. It may be remarked that Scotland has hitherto been noted for the exceedingly small proportion of children under the "not accounted for" heading 14 the percentage of such to the births being generally from 1-2. TABLE 6. Percentages of Children born escaping Vaccination. England & Wales. Metropolis. Paddington. In the year 1872 ... 4.5 8.8 ? Averages for the Quinquennia 1873—77 4.1 8.1 ? 1878—82 4.4 6.8 ? 1883—87* 5.7 7.4 7.7 1888—92† 11.2 14.1 11.9 In the year 1891 ... 12.9 16.4 17.7 „ „ 1892† ... 14.3 18.4 12.6 „ „ 1893 ... 15.7 18.2 10.0 „ „ 1894 ... 19.0 20.6 8.2 „ „ 1895 ... Not yet published 8.8 „ „ 1896‡ ... Not yet published 9.0 * Royal Commission on Vaccination, appointed 1887. † Fifth Report of Commission, issued in 1892. ‡ Final Report of Commission, issued in 1896. To those at all familiar with the history of smallpox prior to vaccination, the increasing neglect of this valuable protection is a matter of profound regret. It is fairly generally admitted that, when the susceptible individuals constitute a certain proportion of the community (the proportion varying for each disease), the chances of an epidemic following the introduction of infection are enormous. Consider the case of Gloucester. The neglect of certain individuals to warn the authorities of the existence of smallpox among the members of their family gave the opportunity requisite for the disease to spread through a community containing a very large proportion of unprotected children. If vaccination fall 15 into general disuse, it is exceedingly improbable that the efforts of the sanitary authorities in the direction of isolation and quarantine will suffice to stay the disease. While such measures, together with general sanitation, do favour a milder form of the epidemic, vaccination alone will bring about its cessation, except the disease be allowed to run riot, attack all susceptible individuals, and thus exhaust itself. NOTIFICATION OF INFECTIOUS DISEASES. During the year 1,003 cases of infectious disease were reported, 223 fewer than the total for the previous year. The sickness-rate, calculated on the notifications, was equal to 7.94 per 1,000, or 0.2 per 1,000 above the average for the preceding seven years. In 1896 the sickness rate was 9.68 per 1,000. In the Metropolis 45,465 cases were notified, 2,367 more than the annual average for the seven preceding years, and 4,301 less than the total for 1896. The sickness-rate for 1897 was 10.18 per 1,000, that for 1896 11.10, and the septennial mean, 9.9. In comparison with the annual averages for the seven years 1890-96, the notifications of smallpox and of the fevers, enteric and continued, show reductions, all the other diseases, increases. (See Table 7.) In the Metropolis, scarlet fever, diphtheria, and cholera show increases as compared with the corresponding annual averages, all the remaining diseases 16 TABLE 7. Comparison of Returns for Paddington and London. (Corrected for duplicates.) Notifications Received. Sickness Rates. † Paddington. London. Paddington. London. 1897. Difference from Average.* 1897. Difference from Average.* 1897. 1896. 1897. 1896. Smallpox 1 -16 105 -725 0.00 0.03 0.02 0.05 Cholera 1 ... § 38 +3 0.00 o.oo 0.00 Diphtheria 312 +70 12,811 + 3,181 2.47 1.84 2.87 2.98 Membr. Croup 10 +4 388 -144 0.07 0.06 0.08 0.09 Erysipelas 136 +4 5,800 -512 1.07 0.92 1.29 1.43 Fevers. Scarlet 491 +21 22,876 +789 3.88 6.24 5.12 5.72 Typhus ... ... § 4 -17 ... ... o.oo 0.00 Enteric 45 -18 3,113 -94 0.35 0.48 0.69 0.71 Relapsing ... ... § 1 -8 ... ... o.oo 0.00 Continued ... -3 65 -94 ... 0.00 0.01 0.02 Puerperal 7 1 264 -12 0.05 0.08 0.05 0.06 Totals 1,003 +62 45,465 +2,367 7.94 9.68 10.18 11.10 * Averages for years 1890-1896 inclusive, adjusted to nearest whole numbers. † Per 1,000 of populations. ... indicates no case. 0.00, a rule under 0.01. § Only one case of each of these diseases during the seven years. diminutions. It is noteworthy that with the increase in the number of notifications of diphtheria, there has been a diminution in the notifications of membranous croup. How far such diminution is due to casesformerly described as membranous croup being now reported as diphtheria, it is impossible to say. It may, however, be 17 remarked that the past year has seen a greatly in creased proportion of cases of diphtheria removed to hospital for isolation. As the Asylums Board will not admit cases diagnosed as membranous croup, unless they be qualified as "of a diphtheritic nature," it is possible that it has become more general to describe such cases as diphtheria, for the sake of securing admission to hospital. It is almost generally accepted that the two terms describe but different manifestations of the same morbid process. In Table 8 the sickness-rates from each disease have been set out for each sub-district, and each sex, in the three age-groups, "0-5 years," "5 years and over," and "all ages." A glance over the Table will convey more than can be communicated in a short paragraph. It will suffice here to note that for the first time in the four years 1894-97, the rates from scarlet and enteric fevers, at ages under 5 years, were higher among females than males in the Parish as a whole, the greater part of such excess being due to the heavier incidence on females in North Paddington. At ages over 5 years there was not last year that marked difference between the rates for the two sexes recorded in 1896. In North Paddington at ages under 5, the incidence of diphtheria was greater on males, that from scarlet fever on females. In South Paddington, there was a greater prevalence of all diseases among males than among females. 18 TABLE 8, Comparison of Notification Rates, 1894-97. Per 1,000 estimated living in each Sex-Age-Group. District. Age-group. Year. MALES. FEMALES. Smallpox. Diphtheria and Mem. Croup. Erysipelas. Fevers. All Diseases. Smallpox. Diphtheria and Mem. Croup. Erysipelas. Fevers. All Diseases. Scarlet. Enteric & Continued. Scarlet. ???nteric & Continued. Puerperal. PADDINGTON. 0—5 1897 — 11.3 1.8 11.7 0.2 25.7 — 11.4 0.9 13.0 0.5 — 25.7 1896 — 11.1 0.8 16.9 0.1 29.1 — 7.9 0.6 16.6 — 25.1 1895 — 7.4 0.6 11.3 0.1 19.6 — 5.7 0.1 9.8 — 15.7 1894 0.5 12.6 1.2 8.6 0.8 23.9 0.3 12.8 0.5 6.5 0.1 — 20.3 5 & over. 1897 — 1.7 1.1 3.1 0.5 8.6 * 1.5 1.0 2.9 0.3 0.1 5.8 1896 * 1.1 0.5 6.3 0.9 9.0 * 1.0 1.2 4.3 0.2 0.1 7.0 1895 0.1 1.4 0.7 2.9 0.7 5.9 * 1.4 0.9 2.4 0.5 0.1 5.6 1894 0.1 1.9 1.0 1.8 0.8 5.6 0.2 2.2 1.0 1.8 0.4 * 5.8 All ages. 1897 — 2.8 1.1 4.1 0.4 8.6 * 2.3 1.0 3.7 0.3 0.1 7.5 1896 * 2.2 0.5 7.5 0.8 11.2 * 1.6 1.1 5.3 0.2 0.1 8.6 1895 o.l 2.1 0.V 3.8 0.6 7.5 * 1.8 0.9 3.0 0.4 0.1 6.4 1894 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—5 1897 — 13.2 1.2 11.9 0.2 26.5 — 12.0 1.0 13.8 06 — 27.4 1896 — 11.1 l.0 17.8 30.0 — 8.3 0.7 17.4 — — 26.5 1895 — 7.6 0.8 12.2 0.2 20.9 — 6.4 0.2 10.3 — — 16.9 1894 0.6 14.3 1.4 8.6 0.6 25.7 0.2 14 .4 0.6 7.2 0.2 — 22.6 5 & over. 18 97 — 1.8 1.2 3.5 0.5 7.0 * 1.8 1.2 3.8 0.3 0.1 7.1 1896 * 1.0 0.5 6.8 0.7 9.3 * 1.2 1.4 4.1 0.3 0.1 8.5 1895 0.1 1.7 0.8 3.1 0.7 6.6 * 1.7 1.2 2.7 0.5 0.1 6.6 1894 0.2 2.2 1.0 1.9 0.9 6.2 0.2 2.7 1.0 2.1 0.3 * 6.7 All ages. 1897 — 3.2 1.2 4.5 0.4 9.7 * 2.8 1.1 4.7 0.3 0.1 9.1 1896 * 2.2 0.5 8.2 0.6 11.8 * 1.9 1.3 6.3 0.3 0.2 10.2 1895 0.1 2.4 0.8 4.2 0.6 8.4 * 2.1 1.1 3.4 0.5 0.1 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—5 1897 — 10.4 1.0 10.4 — 21.8 — 7.9 — 8.9 — 16.8 1896 — 11.2 — 12.2 1.0 24.5 — 5.8 — 12.6 — — 18.5 1895 — 6.4 — 6.4 — 12.8 — 2.0 — 7.2 — — 9.2 1894 — 4.2 — 8.5 2.1 14.9 10 5.0 — 3.0 — — 9.1 ??? & over. 1897 1.3 (1.8 1.9 0.5 4.6 — 0.7 0.8 1.0 0-3 — 2.8 1896 — 1.5 0.5 4.6 1.2 8.0 0.6 0.6 2.3 o-i — 3.7 1895 — 0.3 0.2 2.0 0.8 3.6 * 0.8 0.4 1.8 0-4 — 3.6 1894 * 1.2 0.9 1.7 0.7 4.8 0.1 1.0 0.9 1.2 0-5 * 3.9 All ages. 1897 — 2.0 0.8 2.6 0.4 6.0 — 1.1 0.7 1.3 0-3 — 3.4 1896 — 2.3 0.4 5.2 1.2 9.5 — 0.8 0.6 2.8 0-1 — 4.4 1895 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 — No cases notified. * Rates under 0.1 per thousand. 19 Smallpox. Paddington. London. Cases reported in 1897 1 105 Average annual number, 1896-97 17 830 Case-rate*, 1897 0.00 0.03 This disease was, in fact, absent from the Parish throughout the year, the single case reported in the Northern Sub-District in the third quarter of the year being erroneously so diagnosed. The patient, an adult female, was removed to hospital only to be sent home again next day. In the Metropolis 105 cases were notified, the smallest total for any year since 1890, when 60 cases were recorded. No information is available as to the number of cases erroneously diagnosed. The Reports of the Ambulance Committee of the Metropolitan Asylums Board indicate that a very considerable proportion of the cases sent to the Smallpox Wharves are erroneously diagnosed. Cholera. Paddington. London. Cases reported in 1897 1 38 Average annual number, 1890-96 0 35 Case-rat.*, 1897 o.oo o.oo The single case reported as "cholera" was not one of true cholera, but of severe diarrhoea with vomiting, apparently due to poisoning by drain emanations. The patient was a domestic groom resident in South Paddington. There were other illnesses of an indefinite character among the members of his family. An * In all cases the rates are calculated per 1,000 of the estimated population, unless otherwise stated. 20 account of the series will be found in the Report for the Second Quarter of the Year. Diphtheria and Membranous Croup.* Paddington. London. Cases reported in 1897 322 13,199 Average annual number, 1890-90 248 10,162 Case-rate, 1897 2.54 2 95 With the exception of 1894, when 382 cases were reported, last year's total is the highest recorded since the introduction of notification. The following are the figures for each year :— 1890. 1891. 1892. 1893. 1894. 1895. 1896. North Paddington 199 160 134 237 340 209 195 South „ 25 24 39 57 42 28 47 Paddington 224 184 173 294 382 237 242 Last year 275 cases were reported from North Paddington (64 in excess of the seven years' average), and 47 from South Paddington (10 in excess of the average). In the first quarter of the year 66 cases were recorded in the whole Parish, 82 in the second, 89 in the third, and 85 in the last. Whilst the cases were fairly equally distributed over the four quarters in North Paddington (the totals for each quarter were 62, 71, 66, and 76), there was a special incidence on the second and third quarters in the South (the figures were 4, 11, 23, and 9). The cases in the two minor outbreaks indicated in the figures were reported from streets to the west of Queen's Road, the greater proportion from Salem Gardens. A •Throughout the Report, unless otherwise stated, "diphtheria" includes "membranous croup." 21 able number of the patients were scholars at St. Matthew's Schools. The chief streets affected were Moscow Road (3 cases in 3 houses), Salem Gardens (10 cases in 6 houses), and York Mews (4 cases in 3 houses). In North Paddington there were some excess of the disease in the following streets :— Bravington Rd. 21 cases in 13 houses Kilburn Pk. Rd. 8 cases in 3 houses Harrow Road 15 „ 10 „ Barnsdale Road 7 „ 4 „ Ashmore Road 13 „ 8 „ Waverley Road 7 ,, 5 „ Shirland Road 9 „ 5 „ Kensal Road 7 „ 6 „ Clarendon Street 9 „ 6 „ Cirencester Street 7 „ 7 „ In 54 houses in various parts of the Parish, 127 cases were recorded, the number of cases in any house varying from 2 to 6. These secondary cases were increased in frequency through failure to recognise the primary, and occasionally, it is feared, through neglect to secure medical advice for the patients. In 18 instances (40 attacks) two or more cases were reported simultaneously, the recorded dates of attack not being identical. In each of 14 of the 18 instances, two cases were so reported, and in each of the remaining four, three. Particulars of the 54 groups here dealt with will be found in Appendix B (see page 114). In at least five instances, the notification was received on the day on which the patient died, and in one other case the notification was not received until the day after the death of the patient. In one group of four cases reported from one 22 house, the infection appears to have been conveyed from the first patient (treated at home in Paddington) to relations in the country. Certain of the relatives were removed to the local isolation hospital. One of the patients, discharged from that hospital, came to Paddington, and there infected other members of the family. (See Group 26, Appendix B, p. 114). Two groups, one of five and the other of six cases, were intimately associated. The source of infection of the first patient (Group 37, p. 114), an inmate of Victoria Orphanage, could not be traced. He appears to have infected three other children, at varying intervals, and after his apparent recovery, was sent to Hampstead to recover his health. From the Branch Home in Hampstead, six children, including the patient already mentioned, were some two months later removed to this Parish, all ill with diphtheria. The first patient succumbed to this his second attack. The children were brought into the Parish as soon as they were taken unwell, and no diagnosis was made until they were in Paddington. (See Groups 37 and 31, Appendix B, page 114.) Although the bulk of the cases of diphtheria were reported from houses occupied by more than one family, in five instances only did the infection spread to other families. Of the 322 cases reported, 206 were removed to hospital, equal to 60.8 per cent. In 1896, 50.0 per cent. of the cases were removed, in 1895, 53.0, and in 23 1894, 56.2. Last year 61.1 per cent. of the children under five went to hospital, and 66.2 per cent. of persons aged five years and upwards. Scarlet Fever. Paddington. London. Cases reported, 1897 491 22,876 Average annual number, 1890-96 470 22,087 Case-rate, 1897 3.88 5.12 The cases of scarlet fever (491) reported last year were 299 fewer than the number reported in 1896 (790). In 1893, 776 cases were reported, and in 1892 539. In each of the remaining years since 1890 the cases have varied in number, from 212 in 1890 (notification probably incomplete) to 416 in 1895. The diminution in the local case rate from this disease from 6.24 in 1896 to 3.88 in 1897, is in satisfactory contrast with the slight reduction in the Metropolis generally, viz., from 5.72 in 1896 to 5.12 in 1897. In North Paddington 431 cases were reported, or 48 more than the annual average for the seven years 1890-96, and in South Paddington 60, or 27 fewer than the average. In the former district the following streets had excessive numbers of cases :— Bravington Rd. 24 cases in 18 houses Shirland Road 21 „ 14 „ Woodchester???t.l9 „ 12 „ Ashmore Road 19 „ 13 „ Fernhead Road 12 „ 11 „ Harrow Road 12 ,, 11 „ Portnall Road 11 cases in 10 houses Canterbury Terrace 10 „ 4 „ Brindley St. 10 „ 6 „ Clarendon St. 10 „ 7 „ Saltram Cres. 10 7 „ In south Paddington the largest number in any one street was 7 in Craven Terrace. 24 The largest number of cases reported during the year from any one house was 5. There were two such groups (Nos. 11 and 50, Appendix B, p. 113). In the first group (No. 11), three of the patients were found to be peeling when the first notification was received, and the fifth case in the house followed the return of a patient from hospital. In the second group (No. 50), the cases followed each other at such close intervals as to make it evident that the infection was passed directly from patient to patient. In each group the patients were removed to hospital as soon as the disease was reported. It would be beyond the scope of this Report to deal with all the instances of multiple infection in the houses, and it must suffice to direct attention to the paragraphs on the causes of such secondary cases, and to the analysis of the reputed cause of each group, contained in Appendix B. (See page 108, et seq.) In 22 instances, two or more cases were reported simultaneously, in sixteen, two cases, and six, three. In thirteen out of the twenty-two instances, the disease in the first patient appears to have been unrecognised—probably through want of medical attendance in many cases—until the secondary cases occurred In eight instances the disease spread to a second family living in the same house. Of the 491 cases, 380 were removed to hospital, equal to 77.3 per cent., as compared with 76.8 per 25 cent. in 1896, 65.3 in 1895, and 82.3 in 1894. The proportion of cases removed depends, to some extent, on the "pressure" experienced by the hospital authorities. There was little or no such "pressure" in 1894. Of the patients aged under five years, 80.4 were removed last year, of those over five years, 76.0. Enteric and Continued Fevers.* Paddington. London. Cases reported, 1897 45 3,178 Average annual number, 1890-96 66 8,366 Case-rate, 1897 0.35 0.70 Having regard to the general prevalence of this disease throughout the country, and to the local epidemics reported from certain towns during the autumn, a record for the year showing a diminution of approximately one-third of the average annual number, may be deemed very satisfactory. The local case rate for the year (0.35) was just one-half that for the Metropolis (0.70), and 0.13 below the local rate for 1896 (0.48). In 1896 the rate for the Metropolis was 0.73—showing a reduction last year of 0.03 only, just one-fourth of the reduction in the local rate. In North Paddington 34 cases were recorded in the year, 14 below the annual average for 1890-96. In 1892, 32 cases were recorded, but with this exception, the total for each of the seven years was higher than that for last year. The highest total (57) was recorded in 1891. *Throughout the Report, unless otherwise stated, Enteric (or Typhoid) Fever is considered to include Continued Fever. 26 In South Paddington 11 cases were recorded in 1897, 7 below the annual average, and the smallest total recorded since the date of notification. The highest number for any year has been 23, recorded in 1890, and the lowest (prior to 1897) 13, recorded in 1893. In North Paddington four cases in four houses were reported from Shirland Road, and two in two houses (one a nursing home) from Clifton Gardens. The remaining 28 cases were reported from as many streets and houses. In South Paddington three cases were reported among the Nursing Staff of St. Mary's Hospital, and two (taken ill on the same day) in a house in Edgware Road. The other six cases occurred singly in streets and houses. In no house or family was there a secondary attack—the three cases in St. Mary's Hospital having independent origins. The origin of infection in sporadic cases of enteric fever is a matter of speculation rather than of knowledge. Of the 45 cases recorded during the year, three appeared to have been due to the patients nursing other cases, and two to eating oysters (origin unknown). In two cases there were histories of consumption of ice cream and mussels, but the information was too unreliable to be accepted without reservation. Of the 45 cases, 23 were removed to hospital, equal to 51.1 per cent., as compared with 51.6 per cent. in 1896, 37.1 in 1895, and 43.8 in 1894. Of 27 the patients under 5 years of age, 25 per cent. were removed to hospital, and of those aged over five years, 53.6. Puerperal Fever. Paddington. London. Cases reported, 1897 7 264 Average annual number, 1890-96 8 276 Case-rate, 1897 0.05 0.05 The whole of the cases of this disease were reported in North Paddington, in which district 60 cases have been reported in the eight years 1890-97, as compared with four cases in South Paddington. In the former district 17,394 births were registered in the eight years, and in the latter 3,285, so that the cases of puerperal fever (as notified) have been just about three times as frequent in the former as in the latter district. In at least three of the seven cases reported last year, the patient had no medical attendance at the time of labour. Inasmuch as the amount of infectious disease in a district depends, to some extent, on the prevalence of such disease in the adjacent districts, Table 9 has been prepared to compare the local prevalence of disease with those of the districts co-terminous with the Parish. The Table contains the number of cases of each disease reported in each quarter and in the whole year, with the rates per 1,000. The figures have been taken from official sources, viz., the Weekly Returns of the Local Government and the Metropolitan Asylums Boards. 28 The subjoined tabulated scheme indicates the varying degrees of prevalence of the more important diseases—the bottom of the list being the most satisfactory position for a district to occupy. Diphtheria and Membranous Croup. Chelsea 3.23* Willesden 3.06 Paddington 2.54 Kensington 1.92 St. Marylebone 1.56 St. George, Hanover Square 1.49 Scarlet Fever. Willesden 5.44 Chelsea 5.05 Kensington 4.36 Paddington 3.89 St. Marylebone 2.81 St. George, Hanover Square 2.20 Enteric and Continued Fevers. Kensington 0.70 St. Marylebone 0.62 Willesden 0.58 Chelsea 0.53 St. George, Hanover Square 0.51 Paddington 0.33 Puerperal Fever. Kensington 0'09 Willesden 0.09 Paddington 0.09 Chelsea 0-05 St. Marylebone 0.03 St. George, Hanover Square 0 01 * Rates per 1,000 of population. Attention has already been called to the spread of infection through neglect of the first case in any family, and some note should now be made of other factors favouring the spread of infection. As one result of the inquiries made after every notification, it appeared that 50 cases of infectious illness reported during the twelvemonth, were due to infection brought into the Parish, either through the patient coming here whilst incubating the disease, or through his infecting other persons after his arrival in the district. The cases included 23 of scarlet fever, 12 29 of diphtheria,* and 15 of enteric fever. No cases were reported from outside districts of infection taken from this Parish, but it is probable that such cases occurred. In speaking of the prevalence of diphtheria, allusion was made to a series of cases in the area west of Queen's Road, many of the sufferers being scholars of St. Matthew's Church School. (See page 21, supra). This was the only instance during the twelvemonth of any special spread of disease among the children of any one school, and even in this case there were so many other factors to be considered that it is not certain that the school should be indicted. It might almost be said that there was no evidence of any school being a special means of spreading infection, and no action was required beyond the customary notices required by the Public Health (London) Act, 1891. Inquiries were made as to milk supplies, laundries, etc., but no conveyance of infection was indicated thereby. It is the practice of the Department to secure the removal of the largest possible proportion of cases to hospital, both with a view to prevent the spread of infection, and for the better nursing of the sick. The success achieved has been indicated in speaking of each disease. There was during certain months of the year a considerable strain on the accommodation * If the secondary cases in Groups 26 and 31 (vide page 114) be included, 21 cases of diphtheria have been due to importations, and the total of such imported cases becomes 59. 30 available. There resulted a longer or shorter delay in removing some of the patients, 139 patients not being removed within twenty-four hours of the application for removal. The cases thus delayed comprised 113 of scarlet fever, and 26 of diphtheria. The appended statement shows the extent of the delay :— Days of delay. Scarlet Fever. Diphtheria. One 53 13 Two 24 7 Three 14 3 More than three 22 3 113 26 If hospital isolation is to be real and efficient, the patients requiring such isolation should be removed within the shortest possible time after diagnosis. The above record is to that extent unsatisfactory, but it should in fairness be remarked that the delay indicated appears to have caused practically no harm. In the case of scarlet fever, the delay extended in one case to 23 days, and in another to 24, but the system of daily application by the Department, with statement of the circumstances making each removal urgent or otherwise, has worked well, and no case that could be described as in real need of immediate hospital isolation was kept at home more than twenty-four hours after application. In the Reports for 1895* and 1896† attention has * p. 41. † pp. 59 and 144. 31 TABLE 9. Notifications of Infectious Disease in Districts coterminous with Paddington. District Pop., 1897. 1897. Smallpox. Cholera. Diphtheria. Membr. Croup. Erysipelas. Fever. Scarlet. Typhus Enteric. Relap???in g Continued. Puerperal. Total. PADDINGTON.* 126,161* 1st Qr. ... ... 61 5 37 97 ... 8 ... ... 2 210 2nd ,, ... 1 80 2 33 94 ... 9 ... ... 1 220 3rd „ 1 ... 89 ... 38 133 ... 11 ... ... 2 274 4th „ ... ... 82 3 28 167 ... 17 ... ... 2 292 Year l 1 312 10 136 421 ... 45 ... ... 7 1,003 Rate † 0.00 0.00 2.47 0.07 1.07 3.89 ... 0.35 ... ... 0.05 7.95 KENSINGTON. 171,427 1 st Qr. ... ... 73 4 59 117 ... 21 ... 3 3 280 2nd „ ... ... 63 2 54 146 ... 18 ... 1 5 289 3rd „ 1 ... 81 2 62 248 ... 31 ... ... 2 427 4th „ ... ... 165 2 62 238 ... 47 ... 1 6 461 Year 1 ... 322 10 237 749 ... 117 ... 5 16 1457 Rate † 0.00 ... 1.87 0.05 1.38 4.36 ... 0.68 ... 0.02 0.09 8.49 CHELSEA. ‡ 96,692 1st Qr. ... ... 77 1 24 98 ... 17 ... ... 1 218 2nd „ ... ... 81 2 21 135 ... 5 ... ... 244 3rd ,, ... ... 66 ... 22 145 ... 16 ... ... 1 250 4th „ ... ... 83 3 31 111 ... 14 ... ... 3 245 Year ... ... 307 6 98 489 ... 52 ... ... 5 957 Rate † ... ... 3.17 0.06 1.01 5.05 ... 0.53 ... ... 0.05 9.89 St. GEORGE, Hanover Square. 80,330 1st Qr. ... ... 15 ... 16 41 ... 7 ... ... 1 80 2nd „ ... ... 24 ... 12 41 ... 9 ... 2 ... 88 3rd ,, 1 ... 29 ... 8 45 ... 10 ... ... ... 93 4th „ ... ... 52 ... 15 50 ... 14 ... ... ... 131 Year l ... 120 ... 51 117 ... 40 ... 2 1 392 Rate † 0.01 ... 1.49 ... 0.63 2.20 ... 0.49 ... 0.02 0.01 4.87 St. MARYLE- BONE. 140,808 1st Qr. 1 ... 41 1 63 60 ... 17 ... ... ... 183 2nd „ 2 ... 34 ... 54 93 ... 11 ... 1 1 196 3rd „ 1 2 68 ... 70 113 ... 22 ... ... 2 278 4th „ ... ... 76 2 67 131 ... 38 ... ... 2 315 Year 4 2 218 3 254 397 ... 88 ... 1 5 972 Rate † 0.02 0.01 1.54 0.02 1.80 2.81 ... 0.62 ... 0.00 0.03 6.90 WILLESDEN. 1 92,605 1st Qr. 1 ... 63 1 26 117 ... 14 ... 1 3 225 2nd „ ... 1 40 3 19 89 ... 10 ... ... 1 163 3rd „ ... 1 56 1 27 121 ... 17 ... ... ... 223 4th „ ... ... 120 ... 35 177 ... 12 ... ... 6 319 Year 1 2 279 5 106 604 ... 53 ... 1 9 960 Rate † 0.01 0.02 3.01 0.05 1.14 5.44 ... 0.57 ... 0.01 0.09 10.36 * The estimate given here is taken from the some source as the estimates for the other districts and differs somewhat from the estimate arrived at by the Department's calculations † Rates per 1,000 of the estimated population. ‡Chelsea detached, otherwise Kensal New Town, is the only part co-terminous with Paddington. 32 been directed to the occurrence of fresh cases of infectious disease following the return of patients from hospital. During the past year 41 such "return" cases have been noted, 33 of scarlet fever and 8 of diphtheria. Particulars of 14 of the cases of scarlet fever, giving rise to 19 other cases, will be found in the Appendix C, page 116. These cases were specially inquired into, as there appeared to be a probability in each case that the returning patient was the cause of the subsequent cases. The cases not dealt with did not present such indication of cause and effect. With regard to diphtheria, the occurrence of return cases can only be noted. It is impracticable to make satisfactory inquiries concerning such cases until bacteriological examination be available. DEATHS. During the year 1,941 deaths were registered in the Parish, 991 of males and 950 of females, equal to an uncorrected death-rate of 15.37 per thousand, as compared with rates of 16.57, 18.32, and 15.78, in the years 1896, 1895, and 1894 respectively. The deaths were due to the following among other causes:— diseases of the zymotic class 261, including measles 2, scarlet fever 3, diphtheria 36, whooping cough 44, enteric fever 8, simple continued fever 1, diarrhœa 109, puerperal fever 4, and other septic diseases 15. The deaths due to the principal zymotic diseases numbered 203, and were equal to a zymotic rate of 33 1.60 per 1,000. The deaths from cancer numbered 124, those from phthisis 133, and those from other forms of tuberculosis 93. Bronchitis and pneumonia were certified as causing 318 deaths, viz., 212 from the former, and 106 from the latter disease. The foregoing figures include the deaths of 294 non-parishioners, and do not take into account the 163 deaths of parishioners registered in other parts of the Metropolis. By the exclusion of the former and the inclusion of the latter, a nett total of 1,810 deaths of parishioners is obtained, equal to a death rate of 14.33 per 1,000. This constitutes the commonly called "corrected" total of deaths and death-rate, but, as will be shortly explained, the latter requires further a correction before it can be used for comparison with the rates of other districts. If Table 10 be referred to, it will be seen that the death-rate for last year (14.33) was the lowest for the six years, 1892-97, and 2.27 below the mean rate for the five years 1892-96. Table 11 shows that last year's rate was 2.19 below the decennial mean rate, and that the rate for 1889 (14.21) was the only one below that for last year. An examination of the recorded rates since 1866 shows that the years 1889 and 1897 have been the only occasions when corrected deathrates under 15.0 per 1,000 have been recorded. The 1,810 deaths of parishioners comprised 906 of males and 904 of females, equal to rates of 17.35 and 12.20 per 1,000 of each sex. (See Table 10.) These 34 TABLE 10. Deaths of Parishioners. Deaths recorded 1897. Paddington. St. Mary. St. John. Males. Females. Both Sexes. Males. Females. Both Sexes. Males. Females. Both Sexes. 1st Quarter 245 218 463 189 172 361 56 46 102 2nd „ 209 194 403 164 151 315 45 43 88 3rd „ 241 248 489 204 204 408 37 44 81 4th „ 211 244 455 163 208 371 48 36 84 Year 906 904 1810 720 735 1455 186 169 355 Death Rates * 1897 17.35 12.20 14.33 17.86 14.00 15.68 15.60 7.84 10.60 Mean Rates 1892—1896. 19.11 14.84 16.60 19.73 16.64 17.98 17.06 10.58 12.87 Death Rates * 1896 18.58 13.06 15.34 19.82 15.00 17.09 14.46 8.41 10.67 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 1893 19.87 16.44 17.86 19.87 18.58 19.14 19.87 11.42 14.43 1892 20.32 15.82 17.68 20.99 17.40 18.96 18.20 12.33 14.35 * Rates per 1,000 individuals in each case. rates were 1.76 and 2.64 per 1,000 lower than the corresponding means for the preceding five years. Of the residents of North Paddington, 1,455 deaths were recorded, equal to a rate of 15.68 per 1,000 of the inhabitants of the district, and of the residents of South Paddington, 355 deaths, equal to a rate of 10.60. The latter rate would be considered a very good record in a health resort. The differences between the rates for last year and those for the quinquennium 1892-96 will be found in Table 10. The rate for North Paddington (15.68) was 2.32 per 1,000 below the decennial mean rate (18.00), that for 35 TABLE 11. Deaths and Death-rates, 1887-1897. Years. Paddington. St. Mary. St. John. Death-rates. Regd. Rates. Regd. Rates. Regd. Rates. England and Wales. London.* 1897 1,810 14.33 1,455 15.68 355 10.60 17.4 18.2 1887 1,785 15.59 1,346 17.35 439 11.90 19.1 20.3 1888 1,916 16.55 1,472 18.64 444 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 17.86 1,680 19.14 473 14.43 19.2 21.3 1894 1,831 15.06 1,449 16.29 382 11.73 16.6 17.8 1895 2,099 17.09 1,671 18.44 428 13.30 18.7 19.9 1896 1,942 15.34 1,583 17.09 359 10.57 17.1 18.6 Averages 1887-96. 1,974 16.52 1,529 18.00 445 12.93 18.5 19.9 South Paddington (10.60), 2.33 below its mean (12.93). The figures contained in Table 11 show differences of 3.1 and 3.9 (in favour of the Parish) between last year's rates for Paddington and England and Wales, and London respectively. The mean rate for the Parish (16.5) was 2.0 per 1,000 below the mean for England and Wales (18.5), and 3.4 below that for London (19.9). All the rates mentioned in the foregoing paragraphs take no account of the differences in the constitutions of the various populations as regards sex and age. Factors to adjust such differences have been calculated and applied to the rates of the dis- 36 tricts given in Table 12. The rates there given are TABLE 12. Comparison of "Corrected" Death-rates, 1897. Standard Death.rate. Sex-age Factor. Rates for 1897. Middle of 1897. Infantile Mortality* per 1,000 births. Record. Corrected. Population. Acres per Person England and Wales 1915 17.4 17.4 31055355 156 London 17.96 1.06626 17.7 18.87 4463169 0.015 158 West— Paddington 17.72 1.08070 14.4 15.56 126,161 0.009 149 Kensington 17.38 1.10184 15.7 17.29 171,427 0.012 166 Hammersmith. 18.05 1.06094 16.7 17.71 105,959 0.021 171 Fulham 18.27 1.04817 17.0 17.81 120,040 0.014 162 Chelsea 17.95 1.06685 17.8 18.98 96,692 0.008 161 St. George, Hanover Sq. 17.34 1.10438 13.2 14.57 80,330 0.013 133 North— Marylebone 17.82 1.07464 18.3 19.66 140,808 0.010 136 Hampstead 16.63 1.15153 11.8 13.58 77,275 0.029 127 St. Pancras 17.89 1.07043 18.7 20.01 242,255 0.011 168 Islington 17.90 1.06983 15.8 16.90 341,134 0.009 136 Hackney 18.23 1.05047 16.5 17.33 216,698 0.018 147 East— Shoreditch 18.45 1.03794 21.6 22.41 121,883 0.005 183 Bethnal Green 18.39 1.04133 21.4 22.28 129,098 0.005 171 Whitechapel 17.74 1.07948 20.4 22.02 79,724 0.004 148 St. George in the East 18.43 1.03907 26.4 27.43 47,917 0.005 197 Mile End, Old Town 18.58 1.03068 18.7 19.27 111,883 0.006 149 Poplar 18.49 1.03569 19.8 20.50 169,811 0.013 170 South — Newington 18.32 1.04531 21 2 22.16 122,191 0.005 177 Lambeth 18.24 1.04989 17.5 18.37 300,048 0.013 151 Battersea 17.80 1.07584 16.2 17.42 168,877 0.012 162 Wandsworth 17.93 1.06804 13.4 14.31 195,612 0.047 135 Camberwell 18.10 1.05801 16.6 17.56 257,575 0.017 159 * From the Registrar-General's Annual Summary for 1897. The mortality among infants obtained from the local register is somewhat less than that given by the Registrar-General. 37 fully corrected and strictly comparable, save that no account is taken of the varying influences of overcrowding, poverty, &c., which cannot be reduced to mathematical formulae. Of the Metropolitan Districts mentioned in the Table, Hampstead had the lowest death-rate (13.58) last year, Wandsworth the next lowest (14.31), and St. George, Hanover Square, the next (14.57). These were the only districts with rates below the fully corrected rate for the Parish (15.56). It will be seen that last year's rate for England and Wales was 1.8 below the "standard rate," whilst that for London was approximately 0.9 above the standard. The rates prevailing in the districts included in the Western Area of the Metropolis were all below the standard rates, to the following extents :—Paddington 1.16, Kensington 0.09, Hammersmith 0.34, Fulham 0.46, Chelsea 0.97, and St. George, Hanover Square, 2.77. AGE-GROUP DEATH-RATES. Tables 13 and 13a contain the death-rates prevailing in the six age-groups used in these reports for each sex and each sub-district, as well as the whole Parish, the rates being calculated on the total deaths recorded in each age-group. Tables 14 and 14a give the numbers of deaths recorded at ages under one year, and in each year of life under five. With regard to infants under one year of age, the mortality rates in the latter tables are more trustworthy than those in the former. 38 TABLE 13. Death-rates per 1,000 estimated living in each group. Males. Age Groups. 1892. 1893. 1894. 1895. 1896. Mean Rates 1892.96. 1897. Paddington. 0-1 198.03 190.47 173.32 211.18 215.57 197.71 180.21 1-5 33.11 28.80 28.26 21.42 31.92 28.70 21.29 5-15 4.31 3.95 3.60 2.64 3.26 3.55 4.05 15-25 3.67 3.63 4.70 3.86 2.88 3.75 3.08 25-65 15.00 16.08 13.75 16.32 13.50 14.93 14.15 65 & over 105.01 97.30 64.66 95.62 78.39 88.20 80.57 All ages 20.32 19.87 17.22 19.58 18.58 19.11 17.35 0-5 69.49 64.48 60.27 63.31 72.43 65.99 56.39 5-65 9.91 10.39 9.31 10.28 8.67 9.71 9.25 5 & over 14.08 14.20 11.74 14.00 11.72 13.15 12.37 St. Mary. 0-1 196.32 205.12 182.58 211.59 216.03 202.33 186.71 1-5 33.78 28.75 29.98 24.08 33.51 30.02 21.69 5-15 4.44 3.59 3.03 2.73 3.52 3.46 4.00 15-25 4.05 3.56 4.73 3.72 3.25 3.86 2.98 25-65 15.46 14.65 13.34 16.47 14.27 14.84 14.57 65 & over 105.85 98.74 63.95 98.50 83.08 90.02 77.29 All ages 20.99 19.87 17.73 20.26 19.82 19.73 17.86 0-5 70.43 68.52 64.39 66.34 74.64 68.86 58.89 5-65 10.19 9.45 8.98 10.23 9.44 9.66 9.37 5 & over 14.08 13.07 11.21 13.82 12.16 12.87 12.13 St. John. 0-1 207.44 107.52 119.56 208.79 212.88 171.24 142.10 1-5 30.02 29.02 19.92 8.06 24.18 22.24 19.37 5-15 3.78 5.47 5.50 2.22 2.11 3.81 4.28 15-25 2.64 3.81 4.61 4.27 1.84 3.43 3.36 25-65 13.67 20.31 14.63 15.87 10.90 15.07 12.86 65 & over 103.09 93.91 66.54 88.49 67.11 83.83 88.58 All ages 18..20 19.87 15.52 17.27 14.46 17.06 15.60 0-5 6.49 44.49 39.38 47.51 61.33 39.84 43.56 5-65 9.05 13.39 10.40 10.43 7.12 10.08 8.87 5 & over 14.09 17.70 13.41 14.61 10.34 14.03 13.14 39 TABLE 13A. Death-rates per 1,000 estimated living in each group. Females. Age Groups. 1892. 1893. 1894. 1895. 1896. Mean Rates 1892-96. 1897. Paddington. 0-1 138.36 166.79 128.93 168.05 144.41 149.31 157.08 1-5 23.92 25.83 29.32 23.49 29.63 26.44 15.46 5-15 3.72 4.06 4.68 3.31 4.05 3.96 3.41 15-25 2.34 3.01 2.49 2.47 2.21 2.50 1.62 25-65 11.16 11.78 9.48 9.99 8.80 10.24 7.73 65 & over 98.70 88.62 64.25 90.43 58.63 80.12 69.25 All ages 15.82 16.45 13.55 15.34 13.06 14.84 12.20 0-5 49.44 57.27 51.54 55.77 55.33 53.87 47.07 5-65 7.61 8.20 6.85 8.51 6.28 7.49 6.97 5 & over 12.85 12.82 10.16 13.23 9.29 11.67 9.09 St. Mary. 0-1 135.26 173.99 136.40 173.91 151.84 154.28 168.97 1-5 25.06 27.58 30.40 25.92 81.25 28.04 17.12 5-15 3.44 4.26 5.04 3.53 3.57 3.97 3.10 15-25 2.93 3.74 2.65 2.97 2.63 2.98 2.08 25-65 13.16 13.14 10.56 11.03 10.67 11.71 8.64 65 & over 94.44 91.98 64.74 89.43 57.61 79.64 72.93 All ages 17.40 18.60 15.18 17.06 15.00 16.64 14.00 0-5 50.19 60.96 54.56 59.62 58.74 56.81 51.71 5-65 8.75 9.08 7.53 7.58 7.30 8.05 5.94 5 & over 8.22 14.07 10.97 12.50 10.33 11.22 9.97 St. John. 0-1 155.00 126.90 86.73 134.02 102.56 121.04 89.10 1-5 18.72 17.67 24.16 11.58 21.95 18.81 7.42 5-16 4.68 3.31 3.33 2.41 5.94 3.93 4.64 15-25 1.25 1.63 2.19 1.48 1.04 1.52 0.71 25-65 7.16 8.98 7.20 7.73 4.88 7.19 5.81 65 & over 109.41 79.88 63.08 93.13 61.31 81.36 59.37 All ages 12.33 11.42 9.64 11.10 8.41 10.58 7.84 0-5 45.95 39.43 36.65 36.04 38.05 39.22 28.76 5-66 5.18 6.24 5.33 5.34 3.99 5.21 4.21 5 & over 10.57 10.04 8.31 9.87 6.95 9.15 7.06 40 TABLE 14. Males. Deaths at ages under 5 years. St. Mary. St. John. Paddington. 1892. 1893. 1894. 1895. 1896. 1897. 1892. 1893. 1894. 1895. 1896. 1897. 1892. 1893. 1894. 1895. 1896. 1897. Births Registered 1242 1264 1240 1269 1390 1296 247 239 213 246 271 216 1489 1503 1453 1515 1661 1512 Deaths at Ages Under 1 day 12 20 16 21 22 19 6 2 2 4 3 3 18 22 18 25 25 22 1-7 days 19 19 17 22 12 22 5 4 1 4 4 3 24 23 18 26 16 25 1-4 weeks 22 27 26 30 39 18 4 1 2 3 10 1 26 28 28 33 49 19 1-12 months 150 150 136 157 167 149 24 13 17 27 24 20 174 163 153 184 191 169 Total under 1 yr. 203 216 195 230 240 208 39 20 22 38 41 27 242 236 217 268 281 235 1-2 years 75 46 55 56 65 38 14 8 6 3 8 5 89 54 61 59 73 43 2-3 „ 17 27 26 13 29 18 2 5 5 2 2 4 19 32 31 15 31 22 3-4 „ 15 20 14 15 16 18 5 5 2 1 5 3 20 25 16 16 21 21 4-5 „ 13 11 15 6 18 9 2 4 2 ... 4 3 15 15 17 6 22 12 Total 1-5 years 120 104 110 90 128 83 23 22 15 6 19 15 143 126 125 96 147 98 Grand Total under 5 yrs. 323 320 305 320 368 291 62 42 37 44 60 42 385 362 342 364 428 333 * Infantile Mortality 163 170 157 181 172 160 158 83 103 154 151 125 162 157 149 176 169 155 * Deaths at ages under 1 year per 1,000 births registered. 41 TABLE 14 a. Deaths at ages under 5 years. Females. St. Mart. St. John. Paddington. 1892. 1893. 1894. 1895. 1896. 1897. 1892. 1893. 1894. 1895. 1896. 1897. 1892. 1893. 1894. 1895. 1896. 1897. Births Registered 1214 1303 1183 1257 1223 1290 231 202 198 207 184 208 1445 1505 1381 1464 1407 1498 Deaths at Ages Under 1 day 10 12 11 19 9 19 4 2 2 8 5 2 14 14 13 22 14 21 1-7 days 14 14 16 17 13 12 4 3 1 2 1 2 18 17 17 19 14 14 1-4 weeks 18 26 11 29 30 25 1 4 2 2 2 3 19 30 13 31 32 28 1-12 months Total under 1 yr. 103 138 113 131 123 139 22 16 12 19 13 11 125 154 125 150 136 150 145 190 151 196 175 195 31 25 17 26 21 18 176 215 168 222 196 213 1-2 years 49 45 43 49 59 31 7 3 10 9 6 2 56 48 53 58 65 33 2-3 „ 23 23 27 26 27 14 3 5 5 ... 5 1 26 28 32 26 32 15 3-4 „ 12 23 28 9 20 13 4 2 ... ... 5 1 16 25 28 9 25 14 4-5 „ 7 11 16 15 16 9 1 4 4 ... 2 2 8 15 20 15 18 11 Total 1-5 years 91 102 114 99 122 67 15 14 19 9 18 6 106 116 133 108 140 73 Grand Total under 5yrs. 236 292 265 295 297 262 46 39 36 35 39 24 282 331 301 330 336 286 * Infantile Mortality 119 145 127 155 143 151 134 123 85 125 114 86 121 142 121 151 139 142 * Deaths at ages under 1 year per 1,000 births registered. 42 TABLE 15. Death-rates from Groups of Diseases per 1,000 individuals. 1892. 1893. 1894. 1895. 1896. Mean. 1892 to 1896. 1897. I.— Specific Febrile, or Zymotic Diseases 3.01 3.37 2.79 2.91 3.01 3.01 2.29 1. Miasmatic Diseases ,, 2.24 2.41 2.21 1.89 2.24 2.19 1.29 2. Diarrhœal ,, 0.62 0.53 0.37 0.74 0.52 0.56 0.87 3. Malarial ,, — 0.01 * * 0.02 — 4. Zoogenous ,, — * * * — 5. Venereal ,, 0.08 0.12 0.10 0.10 0.08 0.09 0.03 6. Septic „ 0.06 0.27 0.09 0.15 0.14 0.14 0.08 II.— Parasitic Diseases 0.01 — 0.04 0.04 — 0.01 * III.— Dietic Diseases 0.05 0.09 0.11 0.10 0.13 0.09 0.12 IV.— Constitutional Diseases 3.27 3.25 3.10 2.99 2.86 3.09 2.81 V— Developmental Diseases 1.18 1.05 1.09 1.35 1.31 1.19 1.14 VI.— Local Diseases 8.92 8.88 6.82 8.35 7.02 7.99 7.06 1. Nervous System 1.41 1.71 1.31 1.64 1.54 1.52 1.37 2. Organs of Special Sense 0.02 0.04 0.03 * 0.01 0.03 3. Circulatory System 1.43 0.13 1.18 1.38 1.11 1.04 1.32 4. Res-piratory System 4.10 4.10 2.60 3.65 2.47 3.38 2.51 5. Digestive System 1.16 1.05 0.97 1.09 1.16 1.08 1.11 6. Lymphatic System * * * 0.01 0.02 * • 7. Gland-like Organs of Uncertain Use 0.02 0.01 0.02 0.02 0.01 0.01 — 8. Urinary System 0.46 0.40 0.45 0.42 0.49 0.44 0.51 9. Reproductive System 0.16 0.09 0.15 0.17 0.13 0.14 0.12 (a) Organs of Generation 0.09 0.03 0.05 0.10 0.03 0.06 0.03 (A) Parturition 0.07 0.05 0.09 0.06 0.10 0.07 0.08 10. Bones and Joints 0.07 0.06 0.04 0.04 0.03 0.04 0.03 11. Integumentary System 0.04 0.02 0.02 0.02 0.02 0.02 0.02 VII.— Violence 0.56 0.67 0.64 0.62 0.46 0.67 0.45 1. Accident or Negligence 0.39 0.45 0.52 0.47 0.38 0.42 0.37 2. Homicide 0.04 0.01 — 0.03 — 0.01 0.02 3. Suicide 0.12 0.09 0.12 0.12 0.07 0.10 0.05 4. Execution — — — — — — — VIII.— Ill-Defined & not Specified Causes 0.68 0.63 0.45 0.48 0.52 0.54 0.42 Total Death-rates 17.68 17.87 15.06 17.09 15.34 17.40 14.33 * Indicates a rate of less than 0 01 per 1,000. — Indicates no deaths recorded. 43 TABLE 16. Birth-rate * Death-rates* from Infantile Mortality (0-1 year) per 1,000 births registered. All Causes. Principal Zymotic Diseases. Small-Pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Fever. † Diarrhoea. Phthisis. England & Wales 1897 29.7 17.4 2.15 0.00 0.40 0.14 0.24 0.35 0.16 0.86 ? 156 1887.96 30.7 18.6 2.11 0.01 0.44 0.20 0.22 0.41 0.16 0.60 1.50 148 33 Great Towns 1897 30.7 19.1 2.87 0.00 0.55 0.18 0.31 0.41 0.18 1.24 ? 177 1887.96 ? 20.6 2.38 0.02 0.62 0.27 0.29 0.14 0.20 0.84 ? 167 67 Large Towns 1897 30.1 17.2 2.41 0.00 0.43 0.15 0.24 0.38 0.16 1.05 ? 169 Rest of England & Wales 1897 ? 16.4 1.62 o.oo 0.29 012 0.19 0.31 0.14 0.57 ? 138 Registration London 1897 30.0 17.7 2.68 o.oo 0.43 0.17 0.50 0.41 0.13 0.92 1.76 158 1887.96 31.3 19.9 2.76 0.00 0.64 0.25 0.45 0.59 0.15 0.67 1.88 155 PADDINGTON 1897‡ 23.8 14.4 1.94 ... 0.02 0.17 0.51 0.35 0.08 0.81 1.13 149 1887.96 24.5 16.5 2.06 0.00 0.40 0.13 0.43 0.39 0.11 0.54 1.35 145 * All rates per 1,000 of population. † Includes Typhus, Enteric (or Typhoid), and Simple Continued Fevers. 0.00 indicates a rate of under 0.01 per 1,000. ... indicates no deaths recorded. ‡ From Registrar-General's Annual Summary. § From local registers. 44 Of the rates prevailing among males, the chief reduction occurred among those aged from 1-5 years and 65 and upwards. At the former ages the rate in the whole Parish was 21.29, as compared with a quinquennial mean of 28.70, last year's rate being the lowest recorded in the six years dealt with. The reduction in the rate at this age was not so marked (2.87) in St. John's Sub-district as in St. Mary's (8.33). At ages of 65 years and upwards the rate for 1897 (80.57) was 7.63 below the mean (88.20), in the Parish, the rate in North Paddington being 12.73 below the mean, that in South Paddington 4.65 above. Among females similar reductions may be observed at the ages mentioned, that recorded in South Paddington at age 1-5 years (11.39 per 1,000) being the largest reduction of the whole series. The mortality among infants was 168.4 per 1,000 estimated living, 180.2 among males, and 157.0 among females. The rate prevailing among males was slightly below the mean for the five preceding years, that among females above. The mortality measured by the births registered was 148, 155 among males and 149 among females. The decennial mean rate (Table II., Appendix A) was 145, 3 below the rate for last year. The causes of this increase will be dealt with later on. It will be seen from Table 12 that the infantile mortality rate for the Parish (149) was lower than that for any district included in the Western Area of the 45 Metropolis, with the exception of St. George, Hanover Square (133). In Wandsworth the rate was 135, and in Hampstead 127 per 1,000 births registered. The official returns show that the local rate was 9 per 1,000 below that for the Metropolis (Table 16) and 7 below that prevailing in England and Wales. In the "Rest of England and Wales," chiefly made up of rural and small urban districts, only was the rate (138) lower than that of the Parish. CAUSES OF DEATH. The numbers of deaths from the various diseases at various ages are given in Table III., Appendix A, on which table the rates given in Table 15 have been calculated. Table 17 shows the variations in the numbers of deaths from certain selected causes, from the quinquennial and decennial averages (corrected for changes in population), and Table 18 gives the rates obtained from the figures in Table 17. These tables tell their own tale so clearly that it will suffice to briefly direct attention to a few points only. Measles. No. of Cases Fatality* Not known. No. of Deaths 1897 2 1896 103 Mortality† „ 0.01 „ 0.81 * By "fatality" is meant the number of deaths per cent. of the cases reported. * By "mortality" is meant the number of deaths per 1,000 of the population of all ages, unless otherwise specified. 46 TABLE 17. Average annual number of Deaths compared with record for 1897. (Averages corrected for changes in population, and adjusted to nearest whole numbers.) Principal Zymotic Diseases. ST. MARY'S. ST. JOHN'S. PADDINGTON. 1897. Averages. 1897. Averages. 1897. Averages. 1887 to 1891. 1892 to 1896. 1887 to 1896. 1887 to 1891. 1892 to 1896. 1887 to 1896. 1887 to 1891. 1892 to 1896. 1887 to 1896. Smallpox 0 1 1 0 0 0 1 1 Measles 2 40 56 49 4 6 4 2 44 62 53 Scarlet Fever 16 15 17 16 4 1 4 3 20 16 21 19 Whooping Cough 36 51 38 44 4 8 3 6 40 59 41 50 Diphtheria* 65 50 65 58 8 12 12 12 73 62 77 70 Fever 5 9 13 11 2 6 4 5 7 15 17 16 Diarrhœa 96 61 63 62 11 7 8 7 107 68 71 69 Totals 220 226 253 241 29 38 37 37 249 264 290 278 Puerperal Fever Diseases of Parturition 2 5 4 5 1 1 1 2 6 5 6 7 8 6 7 3 1 2 1 10 9 8 8 Other Septic Diseases 7 12 10 11 2 3 3 3 9 15 13 14 Epidemic Influenza 19 19 52 36 11 6 19 12 30 25 71 48 Alcoholism Cirrhosis of Liver 9 6 7 7 2 2 3 2 11 8 10 9 15 10 12 11 5 7 6 6 20 17 18 17 Malignant Disease 84 75 83 79 30 29 33 30 114 104 116 109 Phthisis Other Tubercular Diseases 104 156 135 146 28 28 28 28 132 184 163 174 62 61 65 64 9 13 11 12 71 74 76 76 Apoplexy 64 75 70 73 22 24 23 23 85 99 93 96 Bronchitis Pneumonia 173 189 204 198 28 50 53 50 201 239 257 248 78 145 112 128 18 41 32 36 96 186 144 164 Suicides 6 11 10 11 1 4 4 4 7 15 14 15 0 indicates an average less than 1. — no deaths. * Includes Diphtheria, Quinsy, Croup, Sore Throat, and Laryngitis. † „ Typhus, Enteric (Typhoid), and Simple Continued Fevers. ‡ ,, Diarrhoea and Dysentery. § ,, Tabes Mesenterica, Tubercular Meningitis, Hydrocephalus, Scrofula, and other forms of Tuberculosis, except Phthisis. The two deaths recorded in the Parish were 51 below the decennial average; 42 below that for 1886-91, and 60 below that for 1892-96. In North Paddington (where both deaths occurred) the corresponding averages were 49, 40, and 56, and the 47 TABLE 18. Calculated from Figures of Table 17. Death Rates per 1,000 of Populations. St. Mary. St. John. Paddington. 1897. Mean 1887-96. 1897. Mean 1887-96. 1897. Menu 1887-96. Piincipal Zymotic Diseases. Smallpox 0.00 ... 0.00 ... 0.00 Measles 0.02 0.52 ... 0.13 0.01 0.40 Scarlet Fever 0.17 0.16 0.11 0.07 0.16 0.14 Whooping Cough 0.38 0.47 0.11 0.17 0.31 0.39 Diphtheria* 0.70 0.62 0.23 0.34 0.57 0.54 Fever* 0.05 0.11 0.06 0.14 0.05 0.12 Diarrhoea* 1.03 0.66 0.32 0.21 0.84 0.63 Totals 2.37 2.59 0.86 1.09 1.97 2.15 Puerperal Fever Diseases of Parturition 0.02 0.04 ... 0.03 0.01 0.04 0.07 0.07 0.08 0.03 0.08 0.06 Other Septic Diseases 0.07 0.11 0.06 0.09 0.07 0.11 Epidemic Influenza 0.20 0.39 0.32 0.36 0.23 0.38 Alcoholism Cirrhosis of Liver 0.09 0.07 0.0i 0.05 0.08 0.06 0.16 0.12 0.14 0.18 0.15 0.14 Malignant Disease 0.90 0.85 0.89 0.89 0.90 0.86 Phthisis Other Tubercular Diseases* 1.12 1.67 0.83 0.82 1.04 1.35 0.66 0.68 0.26 0.36 0.56 0.59 Apoplexy 0.68 0.78 0.65 0.67 0.68 0.75 Bronchitis Pneumonia 1.86 2.13 0.82 1.50 1.59 1.94 0.84 1.38 0.53 1.06 0.76 1.28 Suicides 0.06 0.11 0.02 0.10 0.05 0.11 * See foot-notes to Table 17. 0.00 indicates a rate under 0.01. mortality last year was 0.02, as compared with a mean rate of 0.52. The deaths were recorded in the second half of the fourth quarter of the year. Of the prevalence of nonfatal cases in the Parish nothing is known. The local rate last year was the lowest of the rates given in Table 16. 48 Prior to 1897, the smallest number of cases of this disease recorded in any year was 7 in 1891, when there were six deaths in North and one in South Paddington. In no other year has the total fallen below 11. The largest number in any year was 103 in 1896. Whooping Cough. No. of Cases Fatality Not known. No. of Deaths 1897 40 1896 47 Mortality „ 0.31 „ 0.37 The deaths recorded were ten below the average for 1887-96, 19 below that for 1887-91, and 1 below that for 1892-96. In North Paddington the deaths were 8, 15, and 2 below the corresponding averages, and in South 2 and 4 below, and 1 above. The mortality in North Paddington was 0.08 below the mean, and 0.06 below in South. Fever.* No. of Cases 1897 45 1896 62 No. of Deaths „ 7 „ 16 Fatality „ 15.5 „ 25.7 Mortality „ 0.05 „ 0.12 The deaths in the Parish were nine below the average for 1887-96, in North Paddington 6, and in South Paddington 3. The mortality in the Parish was 0'07 below the mean, in North Paddington 0.06, and in South, 0.08. So small a number of deaths has not been recorded since 1892. The local rate was the lowest of all the rates mentioned in Table 16. * See footnote to Table 17. 49 Diarrhoea. No of Cases Fatality ) Not known. No. of Deaths 1807 107 1896 66 Mortality 0.84 0.52 The deaths were 38 in excess of the average for the ten years, 39 above the average for 1887-91, and 36 above that for 1892-96. In North Paddington the deaths were 34, 35, and 33 above the corresponding averages, and in South Paddington 4, 4, and 3. The mortality last year was 0.29 in excess of the mean, 0.37 in North Paddington, and 0.11 in South. This subject will be reverted to in speaking of the causes of death among infants. Scarlet Fever. No. of Cases 1897 491 1896 790 No. of Deaths „ 20 „ 22 Fatality „ 4.0 „ 2.7 Mortality „ 0.15 „ 0.17 The fatality of this disease varies greatly in different epidemics, and is dependent chiefly on the virulence or mildness of the morbific element, on the season of the year in which the disease occurs, and on the hygienic surroundings of the patients. As a rule it has been observed that with an excessive number of attacks there is a diminished fatality. The 20 deaths were one in excess of the ten years' average, four in excess of the average for 1887-91, and one below that for 1892-96. In North Paddington 16 deaths were recorded, a total equal to the decennial average, one above that for 1887-91, and one 50 below that for 1892-96. The four deaths in South Paddington were one in excess of the decennial average, three above that for 1887-91, and equal to that for 1892-96. The mortality last year was in excess of the mean in each case, being most so in South Paddington—0.11 as compared with 0.07. Diphtheria. No. of Cases 1897 322 1896 242 No. of Deaths „ 65 „ 67 Fatality „ 20.1 „ 27.6 Mortality „ 0.51 „ 0.52 In comparison with 1896, there was a slight diminution in the mortality from this disease, and a satisfactory reduction in its fatality. In four out of the ten years, 1887-96, higher totals of deaths have been recorded, viz., in 1888 (75), 1893 (69), 1894 (92), and 1896 (67). Owing to the changes in the methods of classification of causes of deaths, and to the improved means of diagnosis, it has been thought desirable to include under the term "Diphtheria" in Tables 17 and 18, the deaths classified under the headings "Diphtheria," "Quinsy," "Croup," "Sore-throat," and "Laryngitis." The total deaths from these causes in 1897 numbered 73, three in excess of the ten years' annual average, 11 in excess of that for 1887-91, and four below that for 1892-96. The mortality based on the total of 73 was 0.57, 0.03 above the mean. In North Paddington 65 deaths were recorded, 15 in excess of the annual average for 1887-91, equal to 51 that for 1892-96, and seven in excess of that for the ten years. The mortality 0.70, was 0.08 above the mean. In South Paddington eight deaths were recorded, four less than each of the three annual averages. The mortality, 0.23, was 0.11 below the mean. The rate for diphtheria alone in 1897 (0.51), was 0.01 above the rate for the Metropolis, 0.27 above that for England and Wales, 0.20 above that for the 33 "Great Towns," 0.27 above that for the 67 "Large Towns," and 0.32 above that for the " Rest of England and Wales." (Table 16.) The mortalities from this disease at ages under five years have been calculated for each sex in the Parish and its two sub-districts, for the years 1892-97 (Table 19). It will be noticed that no death has occurred in South Paddington from diphtheria at ages under one year during the period under review. In this age-group the great increase took place in the mortality among females in North Paddington. In the age-group 1-5 years there was an increase in the mortality among males, and a considerable diminution in that among females. In the last group the mortality increased in both sexes. A fatality of 17.9 per cent, prevailed last year among the patients removed to hospital, as compared with 27.6 in 1896. Among the patients kept at home the fatality was 24.1, as compared with 27.2 in 1896. 52 TABLE 19. Death-rates from Diphtheria. Rates per 1,000 individuals in each Sex-age-group. Age. Paddington. St. Mary. St. John. M. F. M. F. M. F. 0-1 years. 1897 0.76 2.95 0.89 3.46 — — Mean-rate, 1892-6 2.06 0.75 2.41 0.89 — — 1896 2.30 2.21 2.70 2.60 — — 1895 1.57 — 1.83 — — — 1894 2.39 — 2.80 — — — 1893 3.22 1.55 3.79 1.84 — — 1892 0.81 — 0.96 — — — 1-5 years. 1897 4.78 2.33 4.70 2.81 5.16 — Mean rate, 1892-6 4.40 4.11 4.43 4.55 4.18 1.99 1896 5.64 4.44 5.75 4.86 5.09 2.43 1895 3.57 3.04 3.74 3.66 2.68 — 1894 4.97 7.05 6.72 8.26 1.32 1.27 1893 4.34 4.23 3.59 4.32 7.91 3.78 1892 3.47 1.80 3.37 1.65 3.91 2.49 5-15 years. 1897 1.18 1.19 1.33 1.15 0.53 1.39 Mean rate, 1892-6 0.59 1.04 0.60 1.03 0.54 1.03 1896 0.29 0.64 0.24 0.57 0.52 0.91 1895 0.60 0.94 0.74 0.94 — 0.96 1894 0.72 2.30 0.63 2.30 1.10 1.90 1893 0.83 1.16 0.89 1.21 0.54 0.94 1892 0.52 0.19 0.52 0.12 0.54 0.46 Pea'lis at ages above 15 years, not included in above:— 1892 2 1895 1 1893 5 1896 4 1894 3 1897 2 53 The foregoing diseases are known as the " Princi- pal Zymotic Diseases," and the total deaths ascribed to them numbered 241, equal to a death-rate of 1.90 per 1,000. In 1896, 332 deaths were recorded from these causes, equal to a rate of 2.54. Last year's rate for Paddington compares favourably with the rates prevailing in the districts mentioned in Table 16. The diseases in this group can be divided into two groups:— (а) Those which are notified, and to the direct controlling of which much time and energy are devoted; and (б) Those which are subjected to no direct controlling influence. The former class includes smallpox, diphtheria, scarlet fever, and "fever," to which diseases 92 deaths were attributed during the year, equal to a death-rate of 0.728 per 1.000. The remaining diseases, constituting the second class, caused 149 deaths, equal to a rate of 1.180. In 1896 the rates from the diseases in each class were 0.837 and 1.706. In 1867, thirty years ago, the rates were 0.989 and 2.093, but the year was marked by the commencement of an epidemic of measles, and by the absence of any considerable amounts of dinhtheria and diarrhoea. Puerperal Fever. No. of Cases 1897 7 1896 11 No. of Deaths „ 2 „ 4 Fatality „ 28.5 „ 36 3 Mortality* „ 0.02 „ 0.05 * Per 1,000 females living at all ages. 54 The deaths from this cause were well below the annual averages. The fatality was high, but there is more than a suspicion that the number of cases reported understates the prevalence of the disease. The last "Nomenclature of Diseases" issued by the Royal College of Physicians, directs that the term "Puerperal Fever" should no longer be used. The Legislature thus directs the notification of a disease under a name which the highest medical authority declares to be out of use and so affords an excuse for the non-performance of an exceedingly unpleasant duty. Grouping puerperal fever with diseases of parturition, a total of twelve deaths is obtained, equal to a fatality of 0.4 per cent, of the births registered in the year. In North Paddington there were nine deaths (0.34 per cent, of the births), and in South three (0.70 per cent.) The deaths during the year from all the other diseases mentioned in Tables 17 and 18 were below their respective annual averages, with the exception of those from Malignant Disease. The 114 deaths from this cause were 5 in excess of the ten years' annual average, and 10 in excess of that for 1887-91, but 2 below that for 1892-96. The mortality last year was 0.90, as compared with a mean rate of 0.86. The increase occurred entirely in North Paddington, where 84 deaths were recorded, 5 in excess of the annual average for 1887-96, 9 in excess of that for 55 1887-91, and 1 in excess of that for 1892-96. The mortality (0.90) was 0.05 above the mean. DEATHS OF INFANTS UNDER ONE YEAR OF AGE. In Table 20, the deaths of these children have been classified under the principal causes, and set out in comparison with the averages for the preceding deceunium and the two quinquennia therein included. The total of such deaths during the year was 448— 24 in excess of the annual average for the preceding decennium, and 43 in excess of the annual average for the five years 1887-91. If the decennial averages be multiplied by the factor 1.027 to correct for the difference between the annual average number of births during 1887-96 (2,930) and the number recorded last year (3,010), the "corrected" annual averages given in the last column but one of Table 20 will be obtained. On this basis, last year's deaths (448) were twelve in excess of the annual average, whilst the infantile mortality, calculated per 1,000 births registered, was 4 above the decennial mean (144). Infantile Diarrhoea.—A good deal was written on this subject in the Annual Report for 1895 (pages 92 et seq.), and it will suffice here to deal only with the special phenomena of the year to supplement what was written in the Report mentioned. 56 TABLE 20. Deaths of Infants under One Year. (Averages adjusted to nearest whole numbers.) Uncorrected Averages. Corrected Ave) ages, 1887-96.* 1897. 1887-91. 1892-96 1887-96. Measles 8 13 11 11 1 Scarlet Fever 0 1 1 1 ... Whooping Cough 20 16 18 18 20 Diphtheria 3 4 3 3 5 Diarrhoea 49 56 52 54 83 Principal Zymotics 80 90 85 87 109 Syphilis 13 8 10 10 2 All other Zymotics 2 4 4 4 5 Total Zymotics 95 102 99 101 116 Want of Breast Milk 3 3 3 3 5 Tubercular Diseases 30 27 29 30 28 Premature Birth 60 69 54 56 57 Malformations 10 19 14 14 23 Convulsions 38 28 33 34 24 Bronchitis and Pneumonia 65 74 69 72 83 Dentition 9 7 8 8 6 Enteritis 4 19 12 12 27 Suffocation (overlaid) 11 12 11 11 7 Other Forms of Violence 5 3 4 4 5 Atrophy and Debility 56 55 56 58 45 All other Causes 29 34 32 33 22 Grand Total 405 412 424 436 448 Infantile Mortality per) 1,000 births 139 149 144 144 148 * Obtained by factor 3010/2930= 1.027 57 The deaths registered as due to "diarrhoea" do not account for all the deaths caused by those morbid conditions which give rise to the high mortality of infants during the summer months. "Diarrhoea" is, after all, only a symptom of disease, and not a disease per se, and many practitioners prefer to attribute* the deaths to whatever conditions they may deem to have caused the diarrhoea. Hence, in dealing with the question, it is necessary to take note of deaths classified as "enteritis," "atrophy and debility," &c.—terms of but vague signification, and denoting pathological processes with which diarrhoea and wasting are most commonly associated. From these three causes there were 155 deaths in the course of the year—viz., 83 from diarrhoea, 27 from enteritis, and 45 from atrophy and debility— a total of 35 in excess of the annual average for the ten year 1887—97 . The records for each of the ten years are here set out:— 1887. 1888. 1889. 1890. 1891. 1892. 1893. 1894. 1895. 1896. 1897. Diarrhoea 51 25 51 50 64 62 54 38 72 54 83 Enteritis 7 0 5 4 5 13 11 6 43 25 27 Atrophy and Debility 39 53 47 69 73 73 62 38 48 55 45 Totals 97 78 106 123 142 148 127 81 163 134 155 *There is also a certain amount of "fashion" influencing the certification of deaths which has undoubtedly caused the transference of a considerable number of deaths from " atrophy and debility," and " diarrhoea " to " enteritis." This probably will account in part for the diminution in the number of deaths under " convulsions." 58 The mortality from diarrhoeal affections is well known to be highest in the third quarter of the year, and, of the 155 deaths recorded last year, 111 were recorded in that quarter. Further, the prevalence of the disease varies somewhat with the temperatures recorded. The variations in the mean temperature of the air in each week of the three months, July, August, and September, with the corresponding variations in the temperature of the ground at a depth of three (3) feet, are set out in Table 21, together with TABLE 21. Week ending Greenwich Observations. Deaths registered in the Parish (not corrected). Mean Temp, of Air. Diff. from Average for 50 years. Mean Temp, of Earth at 3 ft. Diarrhoea All Ages. Enteritis. Under 1 yr. Atrophy Under 1 yr. July 3 64.4 + 30 61.87 0 0 0 „ 10 61.5 -0.5 61.89 1 0 0 „ 17 65.5 +2.6 63.12 4 1 0 „ 24 66.9 + 4.0 64.75 6 0 0 „ 31 64.6 +2.3 64.65 11 3 1 Aug. 7 68.1 + 5.8 65.45 21 2 1 „ 14 63.6 + 1.1 65.63 18 3 2 „ 21 62.0 +0.4 64.29 17 4 1 „ 28 59.6 -1.2 62.74 2 0 3 Sept. 4 56.8 -3.0 61.54 5 2 0 „ 11 54.2 -4.5 59.39 4 1 1 „ 18 54.6 -3.0 58.55 1 1 1 „ 25 55.4 -0.1 57.55 4 3 1 Oct. 2 56.5 + 2.0 58.01 2 1 0 the deaths registered in the Parish in each week from the three causes dealt with in these paragraphs. The 59 numbers given under these last headings are not corrected for non-parishioners. The table shows that the mortality follows the rise and fall of the temperatures, but that temperature alone is not the efficient cause of the mortality is shown by Table 22, which compares the chief meteorological elements for the last four years (third quarters), and the deaths from diarrhoea only at four age-groups under one year of life. TABLE 22. Third Quarters of 1894. 1895. 1896. 1897. Greenwich Observations. Mean Temperature (F°) 55.5 62.3 63.0 59.5 „ Daily Range „ 16.5 20.5 17.9 18.7 „ Humidity of Air(Saturation=100) 81 73 74 73 Total Rainfall, inches 7.56 6.50 8.60 6.34 Bright Sunshine, percentage of "possible" recorded 23.5 30.6 25.4 43.9 Mean Velocity of Wind in miles per hour 10.3 11.0 10.6 11.0 Deaths of Parishioners. Deaths from Diarrhoea, 0—3 months 7 12 9 21 ,, 3—6 „ 9 19 20 31 ,, 6—9 „ 12 14 10 18 ,, 9— „ 6 6 6 8 Total under 1 year 34 51 45 78 * A new globe fixed to recorder in January. Results in former years found to be too low. Of the infants dying of diarrhæal affections, 77 were males and 78 females; whilst, of the 60 whole, no fewer than 139 (out of 155) were residents in North Paddington, and only 16 of South. This will be better appreciated in the form of rates per 1,000 children born in each district, the rate for North Paddington being 53.7, that for South 37.7. TABLE 23. Deaths recorded at ages under One Year from Diarrhoeal Affections. 1892-97, third quarter of each year. Under 7 dys. Weeks. Months. Totals under 1 year. 1- 2- 3- 1- 2- 3- 4- 5- 6- 7- 8- 9- 10- 11- 1892. Diarrhoea ... 1 ... 2 4 6 11 9 2 4 3 2 ... 4 2 50 Enteritis 1 ... ... 1 4 ... 1 ... 1 ... 1 ... ... ... 9 Atrophy 2 1 ... 1 3 3 2 2 2 2 ... 1 2 ... ... 21 1893. Diarrhoea ... ... 2 6 8 6 4 4 2 3 2 2 1 4 44 Enteritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Atrophy ... 2 2 3 ... 6 1 3 2 1 1 1 ... 1 ... 23 1894. Diarrhoea ... 1 ... ... 3 3 3 3 3 5 6 1 4 1 1 34 Enteritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Atrophy ... ... ... 2 3 2 3 1 1 ... 1 1 1 ... ... 16 1895. Diarrhoea ... 1 ... ... 8 3 4 8 7 5 5 4 1 3 2 51 Enteritis ... 3 2 ... 5 4 2 2 1 l 3 1 1 ... ... 25 Atrophy ... 1 ... 1 6 1 ... 2 1 ... ... ... ... ... ... 12 1896. Diarrhoea ... 1 2 ... 5 1 12 4 4 2 5 3 1 2 3 45 Enteritis 1 1 ... ... 2 2 4 ... 4 ... 3 1 ... ... 1 19 Atrophy 2 2 3 2 3 3 1 3 2 1 ... ... ... ... ... 22 1897. Diarrhoea ... ... 4 1 6 10 6 16 9 2 8 8 3 3 2 78 Enteritis ... ... 1 ... 1 3 7 3 3 3 1 ... ... ... ... 22 Atrophy 1 ... 1 1 2 2 1 ... 2 1 ... ... ... ... 11 * Not taken out. The ages at which summer diarrhoea is moat fatal are shown by the figures in Table 23, which 61 deals with the third quarter of each of the six years 1892-97. Taking the deaths from diarrhoea alone, it appears that, at ages under six months, the number dying in each year from 1892 onwards was 35, 30, 16, 31, 29, and 52; whilst the numbers at ages above six months were 15, 14, 18, 20, 16, and 26. This shows the heavier incidence on the younger children, and also the smaller range of mortality among children in the older group, among whom a fairly constant mortality from this cause appears to have prevailed. As it has not been possible to get out information as to the social status of the parents of the deceased, that part of the subject must be left for future consideration. The streets in which the deaths from diarrhoea occurred were given in the Appendices to the Reports for the third quarters of the. years (q.v.). What, then, is the cause of this mortality? The answer may be given in one word—"Dirt." Dirt in the soil, in the streets, in the house, on the person, and last, and perhaps most important of all, in the food. It has been shown on many occasions that nearly all infants dying of diarrhæal affections are "hand" (i.e., "bottle") fed, and therein lies the causa causans of the mortality. Sour neglected bottles will suffice to kill children under conditions otherwise favourable to life, and when to such poisoning by the bottle there is added starvation by the use of condensed milks of the cheaper sort— 62 many deprived of as much as 95 per cent, of the natural fat (cream)—the marvel is rather that so many children survive their trials than that so many die. Sanitary supervision can do much towards mitigating this scourge, but more must be done by the individual parent. The most effective means of obviating the annual loss of life from diarrhoea are the instruction of girls in the need of real cleanliness in the home, and the abandonment of artificial feeding. DEATHS OF ILLEGITIMATES. The deaths of 47 illegitimate children were registered during the year, 36 under 1 year of age, 9 at ages between 1 and 5 years, and 2 at ages exceeding 5 years. Of the 47 deaths, 38 were registered in North Paddington, and 9 in South. The mortality among illegitimate children under 1 year was at the rate of 336 per 1,000 illegitimate births, as compared with a rate of 141 among legitimate children. The appended statement shows the numbers of deaths due to certain causes, and the occupations of the mothers of the children. The death of one infant was registered without certificate from medical practitioner or coroner's inquest. 63 TABLE 24.—Deaths of Illegitimate Children. 1897. Paddington. 0-1 1-5 5 & over. M. F. M. F. M. F. Quarter 1st 4 2 3 1 ... ... „ 2nd 2 2 1 1 1 ... „ 3rd 7 9 2 ... 1 ... „ 4th 5 5 1 ... ... ... Year 18 18 7 2 2 ... Causes of Death. 0—1. 1—6. 5 & over M. F. M. F. M. F. Measles 1 0 0 0 0 0 Whooping cough 0 0 1 0 0 0 Diphtheria 0 0 0 0 1 0 Diarrhoea 4 6 0 0 0 0 Dietic Diseases 1 0 0 0 0 0 Tubercular Diseases 1 1 1 2 0 0 Developmental Diseases 2 3 0 0 0 0 Bronchitis and Pneumonia 3 3 3 0 0 0 Gastro-enteritis 3 2 0 0 0 0 Accident and Violence 1 1 0 0 0 0 III-de6ned Causes 1 1 0 0 0 0 All other Causes 1 1 2 0 1 0 Totals 18 18 7 2 2 0 64 Occupations of Mothers. Domestic Employment 35 Servant 14 General Servant 7 Cook 6 House-maid 7 Charwoman 1 Laundry Workers 2 Laundress 2 Commercial Employees 6 Tailoress 1 Sliopwoman 1 Dressmaker 3 Barmaid 1 No occupation, or occupation not stated 4 INQUEST CASES. During the year, 133 deaths were registered on the Coroner's certificate after inquest. The deaths included 75 from "natural causes," 6 "by misadventure," 36 from accidents, 7 from suicide, and with respect to 6 the findings were "open." (See Table 25.) TABLE 25. Inquests on Parishioners, 1897. . Finding of Jury. Paddington. St. Mary. St. John Natural Causes 75 58 17 By Misadventure 6 5 1 Accidental Death 36 26 10 Manslaughter — — — Wilful Murder 3 2 1 Suicide 7 6 1 Open 6 4 2 Totals 133 101 32 65 The accidental deaths were attributed to the following causes:— Vehicular Traffic 6 Falls, not exactly specified 6 Railway do 3 Overlaid in bed 5 Fires, not conflagrations 5 Drowned in Canals 2 Accidents at Birth 2 and one from each of the following miscellaneous causes:— Mishandling a revolver. Injury to foot by boot. Upsetting boiling water. Nutshell in windpipe. Kick from horse. Window cleaning. Suffocation in a fit. DEATHS IN INSTITUTIONS. In the local institutions there were 519 deaths, including 269 of non-parishioners; and, in institutions beyond the limits of the Parish, 163 deaths of parishioners occurred. In all, 401 deaths of parishioners took place during the year in public institutions, equal to 22.l per cent, of all deaths. Local Institutions. Paddington Workhouse & Infirmary 192, including 16 non-parishioners. Lock Hospital 2, „ 2 „ Children's Hospital, Paddington Green 63, „ 45 „ St. Mary's Hospital 262, „ 206 „ Outlying Institutions. Hospitals of the Metropolitan Asylums Board 54 Scarlet fever 17 Diphtheria 87 General Hospitals 35 Cancer 10 Tubercular diseases 1 Other diseases, 24. Special Hospitals 14 Cancer 3 Tubercular diseases 6 Other diseases, 5. "Homes" 7 Cancer 4 Tubercular diseases . 2 Other diseases, 1. 66 Outlying Institutions.—Continued. Lunatic Asylums 37 Tubercular diseasos 4 Cancer 2 Other diseases, 31. Poor Law Institutions 4 Tubercular diseases 1 Other diseases 3 "Elsewhere" ... 12 Tubercular diseases 1 Other diseases 11 Of the 163 deceased persons, 27 were residents of South Paddington. WATER SUPPLY. The water supplied to the district by the West Middlesex and Grand Junction Waterworks Companies has maintained its excellence, that of the former Company being on the whole the better. Table 26 shows the amount of, and range of variation in, the purification effected by the settlement and filtration which the water undergoes before distribution, and Table 27 compares the mean results of last year with those of the three preceding years. Valuable as are the results and information obtained by the chemical analysis of a water of known composition, especially when such analysis is made at frequent intervals, it is necessary to supplement it by biological examination and inspection of, and supervision over, the area whence the water is derived. The biological examination of water is as yet but imperfectly understood, and usually consists in an enumeration of the number of "colonies" which may be developed from a minute standard quantity of water. On special occasions a careful search will be made for such micro-organisms as are known to be 67 TABLE 26. Comparison of Analyses of Thames Water and the Water Supplied to Paddington. (From the Registrar-General's Annual Summary.) 1897. Thames (unfiltered water.) From Mains of West Middlesex Co. Grand Junction Co. Temperature (decrees Centi- grade) mean 10.4 9.8 11.6 max. 20.0(8)* 18.1(8)† 20.8(8) min. 3.8(2) 6.5(2) 5.7(2) Parts per 100,000 of water. mean 29.81 27.50 29.02 Total Solids max. 34.00(1) 31.86(1) 33.14(1) min. 27.60(9) 23.74(7) 25.32(9) mean 0.274 0.159 0.162 Organic Carbon max. 0.602(2) 0.280(1) 0.302(2) min. 0.158(11) 0.093(6) 0.108(6) mean 0.043 0.019 0.020 Orgnnic Nitrogen max. 0.0760 0.032(1) 0.031(1) (2) min. 0.027(4) 0.010(9) 0.011(6) mean 0.009 — — Ammonia max. 0.014(11) — — min. 0.004(8)(9) — — mean 0.223 0.223 0.251 Nitrogen as Nitrites and Nitrates max. 0.294(1) 0.291(2) 0.321(11) min. 0.142(8) 0.125(8) 0.136(8) mean 1.8 1.8 1.8 Chlorine max. 2.0(12) 1.8 ‡ 1.9 § min. 1.7(2-5) 1.71 l.7(2)(4-6) Degrees of Hardness mean 20.1 19.5 19.1 max. 22.7(1) (4) 22.7(1) 23.3(1) min. 16.3(8) 16.6(8) 16.9(8) (9) *The figures shown thus ( ) indicate months of observation, †No record for September. ‡ 1.8 during Jan., Mar., June, and Aug.-Dec. 1.7 during other months. § 1.9 during Jan. and Oct.-Dec. 68 the cause of disease, whose presence in a given sample might be expected by reason of the occurrence of epidemic disease. Very little is at present known of those microbes which may be called indigenous to water supplies, or of the significance of their presence. Some waters, such as those derived from deep wells, are entirely free from microbes. For some time past, Sir Edward Frankland, the Water Examiner, has collated the gaugings of the volume of water flowing through the bed of the Thames, and the number of microbes present in each c.c. of water at the time of the gauging. His observations show that the microbes are most numerous in flood times. He has also enumerated the microbes present in the water at various stages of settlement and filtration, and when it is Dumped iuto the mains. The purification (quâ micro-organic life) effected by the two Companies supplying the Parish last year was as follows:— 1897. West Middlesex. Grand Junction. Amount of storage, days' supply 19.4 3.4 Average thickness of sand on filters, in feet 2.76 2.25 Average rate of filtration, gall, per sq. ft per hour 1.33 1.8 Percentage of microbes removed. Maximum 99.89 99.92 Minimum 97.52 89.33 Average 99.40 98.46 Having regard to the observation of the excess of microbes in the river water during flood time, it is satisfactory to note that the West Middlesex Company have already increased their storage capacity from 5.6 69 (in 1896) to 19.4 days, and that the two Companies have initiated magnificent schemes of storage which will, it is hoped, enable them to avoid taking water from the river during floods. TABLE 27. Comparison of mean results of analyses, 1894-97. Mean Temperature C°. Parts per 100,000 pts. of Water. (Means of alt Analyses.) Total Solids. Organic. Ammonia. Nitrogen as Nitrites and Nitrates. Chlorine. Hardness degree = 1 pt. Ca CO3. Carbon. Nit'g'n. West Middlesex Water Co. 1897 9.8 27.50 0.159 0.019 0.000 0.223 1.8 19.5 1896 11.1 28.54 0.161 0.024 0.000 0.205 1.9 19.8 1895 9.8 28.57 0.159 0.021 0.000 0.233 1.8 19.3 1894 10.9 28.12 0.207 0.24 0.000 0.216 1.9 18.4 Grand Junction Water Co. 1897 11.6 29.02 0.162 0.020 0.000 0.251 1.8 19.1 1896 1895 12.7 11.8 28.46 28.74 0.163 0.147 0.022 0.019 0.000 0.000 0.217 0.239 1.9 1.8 19.8 19.6 1894 12.3 28.96 0.202 0.024 0.000 0.226 1.9 18.9 It is not pleasant to recall the fact that the bulk of the water supplied to the Metropolis has already passed, more than once, through the systems of various animals, not excluding man, but it cannot be denied that the existing supply has hitherto proved to be a safe one. There has been no epidemic of disease since 1866 traceable to the water-supply, and each year the condition of the river is being improved, and 70 the theory and practice of filtration becoming better understood. A demand that the water-supply of the Metropolis shall be beyond all chances of pollution rests on something more than theory, but it is unfortunately only too often necessary to reduce the demand for the ideal to the limits of the practicable. The question is, therefore, whether the existing supply, heretofore found safe, and calculated to suffice for the needs of the population for many years, should be abandoned in favour of a new source from some distant part such as Wales. The latter water may well be purer at its source than the existing supply, but the chances of dangerous pollution in transit would be enormous. It seems more rational to extend the work of purifying the river by compelling all riparian residents to so deal with their waste products that no living organism shall pass into the river, and to perfect the system of filtration and storage. The control of the water beyond the waterworks requires more attention to eliminate the risks incurred in the mains and in the house cisterns. ADMINISTRATIVE WORK. In so far as statistics can indicate the work accomplished by the Department, the year's record will be found in Table VI. in Appendix A (page 97). Infectious Disease.—During the year, 1,124 visits of inquiry have been made with respect to 71 tious diseases, 791 rooms have been disinfected, and 36 tons of bedding, &c., removed for steam disinfection and purification. Under Sections 62 and 65 of the Public Health (London) Act, 1891, notice of the provisions of the said sections and of the penalties incurred for infringement thereof must be served on the " master of the house or part of the house...in which . . . there is a person suffering from a dangerous infectious disease." The service of such notice is now effected under cover of "letter of advice" from the Medical Officer of Health, with which are enclosed a sheet of precautions suggested for the prevention of spread of infection, and blank certificate of freedom of infection. It is satisfactory to be able to report that in one case only since the introduction of this system has a medical practitioner refused to sign the certificate of recovery, and that in nearly every case the disinfection required is carried out by the Vestry Officials, and not done privately. It is somewhat anomalous that the Legislature should provide for the local authority being promptly informed of the onset of infection, but leave the matter of certification of recovery or freedom from infection—by which alone can the patient or his guardian be relieved of his responsibilities under the sections of the Public Health (London) Act, 1891, dealing with infectious diseases— to the willingness of the medical profession to co-operate with the Sanitary Officials. In all cases of puerperal 72 fever, the midwives and nurses are specially warned not to attend further cases until efficient disinfection shall have been carried out. During the year a system of inter-notification has been inaugurated by the Department, and Medical Officers of Health of other districts are now advised of the occurrence of cases in this Parish due to infection acquired elsewhere, of cases imported from outside districts, &c. Duplicates of all notices sent to teachers of schools situated in other districts are sent to the Medical Officers of those districts. At present there is no provision for the bacteriological diagnosis of diphtheria and enteric fever. Such examination is useful for the decision of doubtful cases, for the detection of cases which might otherwise remain unknown and lead to the dissemination of disease, and for the safe determination of freedom of infection on recovery of the patients. There can be little doubt that systematic bacteriological examination effects an economy in expenditure for hospital isolation, saves much anxiety to the relatives of patients, and conduces to the general health of the inhabitants of the district by the elimination of possible foci for the spread of infection. In accordance with the provisions of the 60th Section of the Public Health (London) Act, 1891, the Vestry has provided temporary accommodation for persons excluded from the use of their homes during the processes of disinfection. The "Family Shelter" 73 has been opened since September, 1895, and has been most useful. During 1897, 144 individuals were accommodated, comprising 92 adults and 52 children, in 52 families. The stay in each instance has ranged from one night to three days. The house has on more than one occasion been used to receive members of families of patients needing isolation in hospital, but for whom accommodation could not be immediately obtained. The annual expenditure is very trifling, under £50. Messrs. Armfield, the Contractors for the disinfection of bedding, &c., have done their work satisfactorily. During the year a total of £1,109 was paid for this work, as compared with £ 1,284 and £881 in 1896 and 1895. It is hoped that the work of erecting the new Disinfecting Station will be almost complete, if not finished, before the end of the current year. The fumigation of rooms is still effected with sulphur di-oxide gas, evolved from the combustion of cake sulphur or (occasionally) of carbon bisulphide. A report on the results of the process of disinfection, will be found in Appendix B (page .99). During the twelve months, £88 have been expended on disinfectants—viz., £43 for sulphur and carbon bisulphide, and £45 for soap, powder, &c., for free distribution. There is an increasing need of a reception-house for the bodies of persons dying in small tenements, 74 both from infectious or other maladies. A scheme for new mortuary, &c., is before the Vestry, and it is hoped that a mortuary chapel—separate and distinct from the buildings set apart for inquest purposes—will find a place among the proposals adopted by the Vestry. Houses let in Lodgings.—The registration of such houses in pursuance of Section 94 of the Public Health (London) Act, 1891, was commenced at about the middle of the year, an additional Inspector being • appointed temporarily for the work. Inasmuch as this was the first occasion of putting these provisions into effect, some opposition was expected, but happily not experienced. The work up to the end of the year had gone on smoothly, and, on the whole, had the co-operation of the house owners. It is too early to say anything of the effect of such registration, but a good result may confidently be expected to follow the reduction in aggregation of population which has taken place, and still more, perhaps, from the annual cleansing required. Even better results would be obtained, could painted and distempered walls be accepted for living rooms; but there seems to be a prejudice against such decoration, cheap papers being preferred. It was noticed, in going through the second street selected for registration, that many families displaced from the first street had migrated to the second, some to make a further move on, as the houses in the second street were registered. 75 Between the commencement of the work in June and the end of the year, 311 houses were visited for the purposes of registration, 168 demands for particulars issued, and 1,235 rooms measured up, and their cubic contents calculated. At the end of the year 86 houses were on the Register. From an examination of the Register, it appears that there was not that amount of overcrowding in Woodchester and Clarendon Streets which was commonly reputed to exist. This means that, as a rule, the tenements were not occupied to the fullest extent permissible under the Bye-laws, which prescribe 400 cubic feet for adults, and 200 cubic feet for children under ten years of age, for the inhabitants of rooms used for the double purpose of living and sleeping. Such an extreme aggregation of individuals as is permissible under these conditions is by no means desirable, although legal. With very few exceptions, the water-closet accommodation was insufficient for the inhabitants of the houses. House Drainage.—Regulations governing the redraining of houses have not yet been adopted by the Vestry. The lack of such regulations makes the work of securing good drainage difficult, inasmuch as owners do not know what they have to do, and are inclined to think that the proposals of the Vestry's Officers are in excess of their legal powers. The London County Council have not yet issued Bye-laws under the 202nd Section of the Metropolis Local 76 Management Act, 1855, a draft of which was sent to the Vestry in January of last year. During the year several systems of combined drainage have been dealt with. Orders were made under Section 74 dealing with combined systems of drainage:— (NEW DRAINAGE WORKS) Workshop and Stable in Hormead Road. The Flats, St. Mary's Terrace. The Drill Hall, 207, Harrow Road. 23 and 24, London Street. 346, 348, and 350, Harrow Road. 46, Westbourne Terrace North and 29, Ranelagh Road. (OLD DRAINAGE WORKS) 2 and 3, Polygon Mews. 13 and 14, Church Place. 25 and 26, Pickering Placc. 286, Elgin Avenue, and 166, Portsdown Road. 20 and 22, Westbourne Park Road. 20 and 21, Devonshire Terrace. 97 and 99, Westbourne Park Road. In each case of old work, application for consent of the Vestry was made in the first place. A complete examination has been made of the building plans in the care of the London County Council, as successors to the Metropolitan Commissioners of Sewers. The work involved the examination of— 16 Vols, of Petitions or Applications from 1847 to 1855 ; 67 „ Court Papers; 31 „ Court Minutes: 1 Vol. of General Orders; and 25 Vols, of Minutes of General and Works Committee. There were discovered 145 Petitions for combined drainage works, relating to 1,040 houses or premises, and 88 plans accompanying the Petitions, relating to somewhere about 888 houses. Copies were made of all the petitions and plans, and are now in the custody of the Vestry's Surveyor. 77 An examination of the Acts of Parliament* under which the Commissioners of Sewers acted shows that there was no provision for combined drainage at all, and that it was intended that each house should have its own independent drain. No formal order as to construction of drainage was made by the Commissioners prior to October, 1851, but the production of the petition and plan has hitherto been deemed sufficient for the requirements of the definition included in Section 112 of the Metropolis Management Act, 1862. Trade Supervision.—All the cowsheds, slaughterhouses, and bake-houses in the Parish have been systematically inspected at the end of each half-year, and at such other times as appeared necessary. The premises occupied by milk-vendors and bakers were specially inspected during the year and detailed Registers are in course of compilation. Under the 26th Section of the Factory and Workshop Act, 1891, the District Inspector of Factories forwards to the Sanitary Authority notices of new workshops opened in the Parish. During the year seven such notices have been received, the workrooms being duly inspected and entered on the Register. When a workroom is first inspected, it is measured, a report on it entered in a Register, and a card issued to the proprietor indicating how many persons may * 11 and 12 Vic. c. cxii.; 12 and 13 Vic. c. xciii.; 14 and 15 Vic. c. lxxv; 15 and 16 Vic. c. lxiv.; 16 and 17 Vic. c. cxxv.; and 17 and 18 Vic c. cxi. 78 be employed in it, the card to be hung in the room. The total number of rooms so inspected, measured, and entered in the Register during the year was 42. The District Inspector of Factories forwarded five complaints of insanitary conditions in workrooms, including 3 cases of dirty premises, one of overcrowding, and one of defective sanitary fittings. The matters complained of were remedied as soon as brought to the notice of the occupiers of the workrooms. The total number of inspections under the Factory Acts was 158, excluding bake-houses, &c. The working of the Factory and Workshop Acts can hardly be called satisfactory. There is good reason to believe that the seven new workrooms reported through the Home Office do not represent all the rooms opened in the course of the year, and it is desirable that more inspections should be made by the local officials. It has, however, been found impracticable to do this, the time of the Vestry's Staff being fully occupied with other work. Manure Nuisance.—There was the usual recurrent difficulty in connection with the manure during the summer months, hay-harvest time. With that exception, there was no cause for complaint, except of effluvia from the removal of peat-moss manure. There is no doubt that the use of this litter should be put under more restrictive regulation. It is saturated with urine and dung when removed from the stall(the excremental matters forming a far larger 79 portion of peat than of straw manure), and emits a particularly nauseating odour when turned over. The manure should be removed from metropolitan stables daily, or, if kept on the premises for more than twenty-four hours, should be loaded direct from the stall into covered carts for removal without further handling. It is said that, if the stored peat manure be sprinkled with a dilute solution of vitriol (sulphuric acid), less smell is given off; but this has not, so far as is known, been tried in this district. The County Council have recently taken the views of the various Metropolitan Local Authorities as to the desirability of obtaining legislation to provide for the making a charge for removal of manure under Section 36 of the Public Health (London) Act, 1891. Under Sub-section 1 of that section the Vestry has the option to make an agreement with horse owners for the removal of manure by the Vestry; but, as the sub-section now reads, there is no provision for making a charge or rate for such work, or for the speedy recovery of any expenses incurred. It would facilitate the removal of manure from the Parish, were the work done by the Vestry, but it is probable that the difficulty of the final disposal of the manure would be increased. Legal Proceedings.—The notices issued during the year numbered 1,060, and included 861 written intimations pursuant to Section 3 of the Public Health (London) Act, 1891; 99 notices under the 80 4th and other Sections of the Act; and 100 notices of infringement of Bye-laws made under the same Act. Only 5 summonses were issued, under the Act, that number, however, not representing the total number of instances in which legal proceedings were authorised. In all cases, other than the five in question, the works necessary were carried out without the issue of a summons. The cases heard before the Magistrate were:— 2, Elgiu Mews, North Order agreed to No costs. 85, Cirencester Street Order made Costs, 16s. 6d. 41, Do. do do. do. 32, Portnall Road do do. 25s. 0d. 6, Thorugate Road do do. 21s. 0d. Under the Sale of Food and Drugs Acts, 20 summonses were taken out, the results of the same, being set out below :— FOR YEAR 1897. Sample Adulterated. Extent of Adulteration. Fine Imposed Costs Impost d. £. s. d. £. s. d. Milk 30% Cream abstracted 10 0 0 0 12 6 do. 6% added Water 3 0 0 0 12 6 do. 9% do. 0 10 0 0 12 6 Butter 45% Margarine 3 0 0 0 12 6 do. 50% do. 2 0 0 0 12 6 Milk 17% added Water 2 0 0 0 12 6 do. 7% do. 1 0 0 0 12 6 do. 10% do. 1 0 0 0 12 6 do. 15% Cream abstracted 1 0 0 0 12 6 do. 7% added Water 2 0 0 0 12 6 do. 6% do. 1 0 0 1 1 0 Butter 85% Margarine 1 0 0 0 12 6 Milk 7% added Water 3 0 0 1 3 0 Butter 80% Margarine — 1 3 0 do. 70% do. 1 0 0 1 3 0 do. 98% do. 5 0 0 1 5 0 Coffee 5 % Chicory 1 0 0 1 5 0 Butter 80% Margarine — 0 12 6 Milk 7% added Water 3 0 0 1 3 0 do. 12% do. 2 0 0 1 0 0 81 No new legislation has been effected during the year, but two Bills based on the Report of the Food Products Committee were brought before the House of Commons, one in the early part of the session by Mr. Kearley and others as a private measure, and the second in the last weeks of the session by the Government. The former measure, although not entirely acceptable, was a fairly successful attempt to give effect to the Report of the Committee, the latter a perfunctory fulfilment of a pledge given earlier in the session. Both Bills were included in the "slaughter of the innocents." The subject of the amendment of existing legislation was referred to the Sanitary Committee by the Vestry, and ultimately the Committee presented a full Report on the reference, together with the following recommendations, which were adopted by the Vestry nem. con.:- (a.) That all receptacles, trucks, &c , used for distributing food stuffs, should be marked with the name and address of the owner, and that penalties should be prescribed for failure to so mark or for falsely marking. (b.) That mixtures should be labelled as such in letters of minimum size, either on a separate label to be attached to the package after making up, or printed on the wrapper in such a position that they shall be conspicuously visible when the package is made up. That the composition of mixtures sold under registered trade marks should be disclosed and recorded at the time of registration and entered on the certificate of registration, and the proportions of the ingredients of other mixtures should be set out on the label. Mixtures sold under registered trade marks to be sold in the manufacturers' packages only. (c.) That where a sample has been referred to Somerset House by the magistrate, the Government analyst and the public analyst should be liable to be called as witnesses for cross examination, as to methods of analysis and interpretations of results, at the adjourned hearing. 82 (d.) That the sample should be divided on all occasions into four parts, one to be given to the vendor, one to the public analyst, and two to be retained by the local authority for future use, if required (e.) That the retailer should notify the local authority within teven days of service of summons of his intention to rely on the warranty of the wholesale vendor ; and that the invoice of the wholesale vendor, if established in the United Kingdom, should be deemed a warranty. In such case one of the reserved portions of the sample should be forwarded to the wholesale vendor, and a summons be issued forthwith against him, returnable on the same day as the summons against the retailer. In the event of the retailer proving that he sold the sample in the same state as he received it from the wholesale vendor, the summons should be dismissed against the retailer and the wholesale vendor bear the costs of the prosecution of the retailer as well as his own. On the other hand, should the summons against the wholesale vendor be dismissed, and the retailer be convicted, the latter should pay the costs of the proceedings against the former. No defence to stand with respect of a warranty on the part of any wholesale or retail vendor not established within the United Kingdom. (f.) That a minimum fine should be prescribed for the second offence, and imprisonment without the option of a fine, at the discretion of the magistrate, to be prescribed for third and subsequent offences. (g.) That all convictions, subsequent to the first, whether for the same form of adulteration or otherwise, should be advertised by the defendant in such papers and on so many occasions as the Court may direct at the expense of the defendant, the Court to have the power to direct the local authority to insert the advertisements and to recover the expenses from the defendant. 83 Appendix A. TABLE I. Year. Estimated Populations at Middle of each Year. Births Registered. Deaths of Parishioners St. Mary. St. John. St. Mary. St. John. St. Mary. St. John.. 1897 92,788 33,465 2,586 424 1,455 355 1896 91,350 33,500 2,613 455 1,583 359 1895 90,577 32,173 2,526 453 1.671 428 1894 88,949 32,551 2,423 411 1,449 382 1893 87,708 32,772 2,567 444 1.680 473 1892 86,111 33,149 2,456 478 1,632 510 1891 84,156 33,682 2,420 532 1,590 620 1890 82,091 36,645 2,389 512 1,602 502 1889 80,824 36,786 2,346 517 1,266 398 1888 78,939 36,810 2,331 512 1,472 444 1887 77,578 36,884 2,368 548 1,346 439 Averages for 1887-96 84,464 35,192 2,443 486 1,529 445 84 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 all ages. Paddington Workhouse and Infirmary. St. Mary's Hospital. Lock Hospital. Children's Hospital, Paddington Green. Outlying Institutions. 1897 23 .84 14.33 148 263 396 192 262* 2 63 163 1896 24.2 15.3 155 245 398 188 334 2 48 160 1895 24. 3 17.1 164 233 330 204 332 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 24.2 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 15.6 122 200 316 181 847 6 50 67 Averages for 1887-1896. 24.53 16.53 145 215 336 199 352 4 52 (7 years) 122 * Hospital closed for some weeks for repairs, &c. * * Hospital recommenced work in 3rd quarter of the year. † Closed during re-construction. 85 TABLE IV. Showing the Number of Deaths at all ages in 1897, 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 registered. Deaths per 1,000 of Population, at all ages. Deaths per 1,000 of Total Deaths, at all ages. 1. Principal Zymotic ) Diseases 274 2.17 151.3 2. Pulmonary Diseases 318 2.51 175.6 3. Principal Tubercular Diseases 172 1.36 95.0 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 111 36.8 247.7 5 Convulsive Diseases 72 23.9 160.7 NOTICE. 1. Includes Smallpox, Measles, Scarlet Fever, Diphtheria, Whooping Cough, Typhus, Enteric (or Typhoid), and Simple Continued Fevers, and Diarrhoea. 55 of the deaths occurred in Hospitals situated beyond the limits of the District. 3. Includes Phthisis, Scrofula, Tuberculosis, Rickets, and Tabes Mesenterica. 4. Includes Marasmus, Atrophy, Debility, Want of Breast Milk, and ture Birth. 5. Includes Hydrocephalus, Infantile Meningitis, Convulsions, and Teething. 86 TABLE III males. whole parish. Deaths Registered from all Causes (luring the Year 1897. 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. All Ages. 0- 1- 5- 15- 25- 35- 46- 55- 65- 75- 85- Classes. I. Specific Febrile, or Zymotic Diseases 58 51 14 3 5 2 9 6 4 3 .. 155 II. Parasitic Diseases ... ... ... ... ... ... ... ... ... ... ... ... III. Dietic Diseases 3 ... ... ... 3 3 2 1 ... ... ... 12 IV. Constitutional Diseases 16 13 11 12 23 23 36 21 9 6 ... 170 V. Developmental Diseases 40 ... 1 ... ... ... ... 1 4 11 7 64 VI. Local Diseases 92 33 12 13 22 33 56 72 77 32 4 446 VII. Deaths from Violence 4 1 a 4 3 5 4 7 4 1 1 37 VIII. Deaths from Ill-defined and Not Specified Causes 22 ... ... ... ... ... ... ... ... ... ... 22 Totals 235 98 41 32 56 66 107 108 98 53 12 906 I.—SPECIFIC FEBRILE, OR ZYMOTIC DISEASE. 1.—Miasmatic Diseases. Smallpox a. Vaccinated ... ... ... ... ... ... ... ... ... ... ... ... b Unvaccinated ... ... ... ... ... ... ... ... ... ... ... ... c. No Statement' ... ... ... ... ... ... ... ... ... ... ... ... Measles 1 ... ... ... ... ... ... ... ... ... ... 1 Scarlet Fever ... 9 1 ... ... ... ... ... ... ... ... 10 Typhus ... ... ... ... ... ... ... ... ... ... ... ... Epidemic Influenza 3 ... ... ... 2 2 3 3 1 2 ... 16 Whooping Cough 11 13 ... ... ... ... ... ... ... ... ... 24 Diphtheria 1 22 12 ... 1 ... ... ... ... ... ... 36 Simple Continued and Ill-defined Fever ... ... ... ... ... ... 1 ... ... ... ... 1 Enteric or Typhoid Fever ... ... ... 3 ... ... 1 ... ... ... ... 4 Other Miasmatic Diseases ... ... ... ... ... ... ... ... ... ... ... ... 2.—Diarrhœal Diseases. Simple Cholera ... ... ... ... 1 ... ... ... 1 ... ... 2 Diarrhœa, Dysentery 39 6 1 ... 1 ... 3 1 2 1 ... 54 87 table III whole parish. females. Deaths Registered from all Causes during the Year 1897. 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. All Ages. 0- 1- 5- 15- 25- 35- 45- 55- 65- 75- 85- I. Specific Febrile, or Zymotic Diseases 58 30 18 2 5 2 2 7 6 5 135 II. Parasitic Diseases 1 ... ... ... ... ... ... ... ... ... .. 1 III. Diktic Diseases 2 ... ... ... ... 1 ... 1 ... ... ... 4 IV. CoNSTITOTIONAL DIsEA8ES 15 11 6 9 14 31 33 30 21 13 3 186 V. Developmental Diseases 40 1 ... ... ... ... ... ... 7 18 14 80 VI. Local Diseases 63 27 12 14 23 33 35 56 95 70 18 446 VII. Deaths from Violence 8 1 1 2 1 3 1 2 1 ... ... 20 VIII. Deaths from Ill-Defined and Not Specified Causes 26 3 ... ... 1 ... ... 2 ... ... ... 32 Totals 213 73 37 27 44 70 71 98 130 106 35 904 I.—SPECIFIC FEBRILE, OR ZYMOTIC DISEASES. 1.—Miasmatic Diseases. Smallpox a. Vaccinated ... ... ... ... ... ... ... ... ... ... ... ... b. Unvaccinated ... ... ... ... ... ... ... ... ... ... ... ... c. No Statement ... ... ... ... ... ... ... ... ... ... ... ... Measles ... 1 ... ... ... ... ... ... ... ... ... 1 Scarlet Fever ... 6 3 1 ... ... ... ... ... ... ... 10 Typhus ... ... ... ... ... ... ... ... ... ... ... ... Epidemic Influenza ... 1 ... ... 1 1 2 3 2 4 ... 14 Whooping Cough 9 5 1 ... ... ... ... 1 ... ... ... 16 Diphtheria 4 11 13 1 ... ... ... ... ... ... ... 29 Simple Continued and Ill-defined Fever ... ... ... ... ... ... ... ... ... ... ... ... Enteric or Typhoid Fever ... ... 1 ... 1 ... ... ... ... ... ... 2 Other Miasmatic Diseases ... ... ... ... ... ... ... ... ... ... ... ... 2.—Diarrhœal Diseases. ... ... ... ... ... ... ... ... ... ... ... ... Simple Cholera ... ... ... ... ... 1 ... ... ... ... ... 1 Diarrhoea, Dysentery 44 ... ... ... ... ... ... 1 ... ... ... 53 88 Males. Table III. (continued). Cause of Death. AGES. All Ages. 0- 1- 5- 15- 25- 35- 45- 55- 65- 75- 85- SPECIFIC FEBRILE, OR ZYMOTIC DISEASE (continued). 3.—Malabial Diseases. Remittent Fever ... ... ... ... ... ... ... ... ... ... ... ... Ague ... ... ... ... ... ... ... ... ... ... ... ..... 4.—Zoogenous Diseases. ... ... ... ... ... ... ... ... ... ... ... Cowpox and effects of Vaccination ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases (e.g. Hydrophobia,Glanders, Splenic Fever) ... ... ... ... ... ... ... ... ... ... ... ... 5.—Venebeal Diseases. Syphilis 1 1 ... ... ... ... ... ... ... ... ... 2 Gonorrhoea, Stricture of Urethra ... ... ... ... ... ... ... 1 ... ... ... 1 6. —Septic Diseases. ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas 2 ... ... ... ... ... ... 1 ... ... ... 3 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 ... ... ... ... ... ... ... ... ... ... 8 Scurvy ... ... ... ... ... ... ... ... ... ... ... ... Chronic Alcoholism ... ... ... ... 1 3 2 ... ... ... ... 6 Delirium Tremens ... ... ... ... 2 ... ... 1 ... ... ... 3 IV— CONSTITUTIONAL DISEASES. Rheumatic Fever, Rheumatism of the Heart ... ... 1 ... ... ... ... ... 1 ... ... 2 Rheumatism ... ... ... ... 1 ... ... 1 ... ... ... 2 Gout ... ... ... ... ... ... ... 3 ... ... ... 4 Rickets 2 ... ... ... ... ... ... ... ... ... ... 2 Cancer, Malignant Disease ... ... ... ... 1 2 8 11 5 4 ... 33 Tabes Mesenterica 5 2 1 ... ... ... ... ... ... ... ... 8 Tubercular Meningitis, Hydrocephalus 8 8 4 ... ... ... ... ... ... ... ... 20 Phthisis. ... 1 1 10 18 17 25 4 ... ... ... 78 Other forms of Tuberculosis, Scrofula 1 2 3 2 2 ... 1 ... ... ... 13 Purpura, Hæmorrhagic Diathesis ... ... ... ... ... ... ... ... ... ... ... ... Anaemia, Chlorosis, Leucocythæmia. ... ... 1 ... ... ... ... ... ... ... ... 1 Glycosuria, Diabetes Mellitus ... ... ... ... 1 2 ... 1 ... 1 ... 7 Other Constitutional Diseases ... ... ... ... ... ... ... ... ... ... ... ... 89 Table III. (continued). Females. Cause of Death. AGES. All Ages. 0- 1- 5- 15- 25- 35- 45- 55- 65- 75- 85- SPECIFIC 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.—Venebeal Diseases. Syphilis 1 ... ... ... 1 ... ... ... ... ... ... 2 Gonorrhoea, Stricture of Urethra ... ... ... ... ... ... ... ... ... ... ... ... 6- Septic Diseases Erysipelas ... ... ... ... ... ... ... 2 2 ... ... 4 Pyaemia, Septicaemia ... ... ... ... ... ... ... ... ... 1 ... 1 Puerperal Fever ... ... ... ... 2 ... ... ... ... ... ... 2 II.—PARASITIC DISEASES. Thrush, and other Vegetable Parasitic Diseases 1 ... ... ... ... ... ... ... ... ... ... 1 Worms, Hydatids, and other Animal sitic Diseases ... ... ... ... ... ... ... ... ... ... ... ... III.—DIETIC DISEASES. ... ... ... ... ... ... ... ... ... ... ... ... Want of Breast Milk, Starvation 2 ... ... ... ... ... ... ... ... ... ... 2 Scurvy ... ... ... ... ... ... ... ... ... ... ... ... Chronic Alcoholism ... ... ... ... ... 1 ... ... ... ... ... 1 Delirium Tremens ... ... ... ... ... ... ... 1 ... ... ... 1 IV.—CONSTITUTIONAL DISEASES. Rheumatic Fever, Rheumatism of the Heart. ... ... ... ... ... 1 ... 1 ... ... ... 2 Rheumatism ... ... ... ... ... ... ... ... 1 ... ... 1 Gout ... ... ... ... ... ... ... ... ... 1 ... 1 Rickets ... 1 ... ... ... ... ... ... ... ... ... 1 Cancer, Malignant Disease ... 1 ... ... 3 7 23 21 14 10 ... 81 Tabes Mesenteria 6 2 1 ... ... ... ... ... ... ... ... 9 Tubercular Meningitis, Hydrocephalus 8 4 2... ... ... ... ... ... ... ... ... 14 Phthisis ... 1 1 ... 10 19 6 4 3 ... 1 54 Other forms of Tuberculosis, Scrofula ... 2 1 ... 1 1 1 1 ... ... ... 7 Purpura, Hæmorrhagic Diathesis 1 ... ... ... ... ... 1 ... ... ... ... 2 Anaemia, Chlorosis, Leucocytbæmia ... ... 1 ... ... 2 1 1 1 ... ... 6 Glycosuria, Diabetes Mellitus ... ... ... ... ... 1 1 2 2 2 ... 8 Other Constitutional Diseases ... ... ... ... ... ... ... ... ... ... ... 90 Males. Table III. (continued). Cause of Death. ages. All Ages. 0- 1- 5- 15- 25- 35- 45- 55- 65- 75- 85- V.-DEVELOPMENTAL DISEASES. Premature Birth 27 ... ... ... ... ... ... ... ... ... ... 27 Atelectasis 9 ... ... ... ... ... ... ... ... ... ... 9 Congenital Malformations 4 ... 1 ... ... ... ... ... ... ... ... 5 Old Age ... ... ... ... ... ... ... 1 4 11 7 23 VI.-LOCAL DISEASES. 1.—Diseases of Nervous System. Inflammation of Brain or Membranes ... 2 ... 1 ... ... 1 ... ... ... ... 4 Apoplexy, Softening of Brain, Hemiplegia, Brain Paralysis ... ... ... ... 1 1 7 10 10 4 2 35 Insanity, General Paralysis of the Insane ... ... ... 1 2 4 2 2 ... 1 ... 12 Epilepsy ... 1 ... ... 2 1 ... ... 1 ... ... 5 Convulsions 17 2 ... ... ... ... ... ... ... ... ... 19 Laryngismus Stridulus (Spasm of Glottis) 1 2 ... ... ... ... ... ... ... ... ... 3 Disease of Spinal Cord, Paraplegia, Paralysis Agitans ... ... ... ... 2 ... 1 2 2 ... ... 7 Other Diseases of Nervous System 1 2 1 ... ... ... ... ... ... ... ... 4 2.—Diseases of Organs of Special Sense. (e.g., of Ear, Eye, Nose) ... 1 1 ... ... ... ... ... ... ... ... 2 3.—Diseases of Circulatory System. Pericarditis ... 1 1 ... ... ... ... ... ... ... ... ...2 Acute Endocarditis ... ... ... ... 1 1 ... ... 1 ... ... 3 Valvular Diseases of Heart ... ... 2 ... ... 2 2 4 4 ... ... 14 Other Diseases of Heart ... ... 2 1 1 2 8 9 11 6 ... 40 Aneurism ... ... ... ... ... 2 1 2 ... ... ... 5 Embolism, Thrombosis ... ... ... ... ... ... 1 ... ... ... ... l Other Diseases of Blood Vessels ... ... ... ... ... 4 2 ... 1 ... 7 4.—Diseases of Respiratory System. Laryngitis ... 2 1 ... ... ... ... ... ... 1 ... 4 Croup ... ... ... ... ... ... ... ... 1 ... ... 1 Emphysema, Asthma 86 5 ... ... 1 3 4 14 16 11 ... 91 Bronchitis 36 0 ... 1 1 ... ... ... ... ... ... ... Pneumonia 12 5 1 3 5 8 9 8 4 2 1 58 Pleurisy ... ... 1 1 2 ... 1 ... 1 ... ... 6 Other Diseases of Respiratory System ... ... ... ... ... ... ... ... ... ... ... ... 6.—Diseases of Digestive System. Dentition 3 5 ... ... ... ... ... ... ... ... ... 8 Sore Throat, Quinsy ... ... ... ... ... ... ... ... ... ... ... ... Diseases of Stomach 2 ... 1 ... ... ... 4 1 1 ... ... 4 Enteritis 18 3 1 2 1 ... ... ... i ... ... 30 Obstructive Diseases of Intestine. 1 ... ... ... ... ... ... 3 l 2 ... 7 91 Table III. (continued). Females. Cause of Death. AGES. All Ages. 0- 1- 5- 15- 25- 35- 45- 55- 65- 75- 85- V.-DEVELOPMENTAL DISEASES. Premature Birth 30 ... ... ... ... ... ... ... ... ... ... 30 Atelectasis 8 ... ... ... ... ... ... ... ... ... ... 8 Congenital Malformations 2 1 ... ... ... ... ... ... ... ... ... 3 Old Age ... ... ... ... ... ... ... ... 7 18 14 39 VI.—LOCAL DISEASES. 1.—Diseases of Nervous System. Inflammation of Brain or Membranes 1 ... 2 1 ... ... ... ... ... 1 ... 5 Apoplexy, Softening of Brain, Hemiplegia, Brain Paralysis 1 ... ... ... ... 1 9 6 21 10 3 51 Insanity, General Paralysis of the Insane ... ... ... 1 2 3 2 1 ... 2 1 12 Epilepsy ... ... ... 1 ... ... ... ... ... ... ... 1 Convulsions ... 1 ... ... ... ... ... ... ... ... ... 8 Laryngismus Stridulus (Spasm of Glottis) ... 1 ... ... ... ... ... ... ... ... ... 1 Disease of Spinal Cord, Paraplegia, Paralysis Agitans ... ... ... ... 1 1 1 ... 1 1 ... 5 Other Diseases of Nervous System ... ... ... ... ... 1 ... 1 ... ... ... 2 2.—Diseases of Organs of Special Sense. (eg., of Ear, Eye, Nose) ... ... ... 1 1 ... 1 ... ... ... ... 3 3. —Diseases of Circulatory System. ... ... ... ... ... ... ... ... ... ... ... Pericarditis ... ... ... ... ... 1 ... ... ... ... ... 1 Acute Endocarditis ... ... 1 ... 1 ... ... ... ... ... ... 2 Valvular Diseases of Heart ... ... ... ... 1 ... 2 5 6 4 ... 18 Other Diseases of Heart ... ... 3 2 2 2 6 12 16 16 4 63 Aneurism ... ... ... ... ... 1 ... 1 Embolism, Thrombosis 1 1 ... ... ... 2 1 1 1 ... 7 Other Diseases of Blood Vessels .. ... ... ... ... ... ... ... ... 3 ... ... 3 4.—Diseases of Respiratory System. Laryngitis ... 1 ... ... ... ... ... ... ... 1 Croup ... ... 2 ... ... ... ... ... ... ... 2 Emphysema, Asthma ... ... ... ... ... ... 1 2 1 1 ... 5 Bronchitis . 26 12 1 1 ... ... 4 15 27 18 6 110 Pneumonia 9 7 1 1 ... ... 2 2 7 7 2 38 Pleurisy ... ... ... ... ... 1 ... ... ... 1 ... 2 Other Diseases of Respiratory System ... ... ... ... ... ... ... ... ... ... ... ... 5.—Diseases of Digestive System. Dentition 3 ... ... ... ... ... ... ... ... ... ... 3 Sore Throat, Quiosy ... ... 1 ... ... ... ... ... ... ... ... 1 Diseases of Stomach 1 1 1 2 1 3 ... 9 Enteritis 9 2 1 3 2 1 0 1 ... 21 Obstructive Diseases of Intestine ... ... ... 1 ... 2 1 ... 1 1 ... 6 92 Males. Table III. (continued). Cause of Death. AGES. All Ages. 0- 1- 5- 15- 25- |35- 45- 55- 65- 75- 85- LOCAL DISEASES.—Continued. 5.—Diseases of the Digestive System. (Continued.) Peritonitis ... ... ... ... 1 1 ... ... ... 1 ... 3 Ascites ... ... ... ... ... ... ... ... ... ... ... ... Cirrhosis of Liver ... ... ... ... ... 4 2 2 1 ... ... 9 Jaundice and other Diseases of Liver ... ... ... ... ... ... 2 2 4 ... ... 8 Other Diseases of Digestive System ... ... ... ... ... ... ... 1 ... ... ... 1 6.—Diseases of Lymphatic System. (e.g., of Lymphatics and of Spleen) ... 1 ... 1 ... ... ... ... ... ... 1 3 7.—Diseases of Gland-like Organs of Uncertain Use. (e.g., Bronehocele, Addison's Disease) ... ... ... ... ... ... ... ... ... ... ... ... 8.—Diseases of Urinary System. Nephritis ... ... ... ... ... 1 2 1 ... ... ... 4 Bright's Disease, Albuminuria ... 1 ... ... 3 3 4 8 8 3 ... 30 Disease of Bladder or of Prostate ... ... ... 1 ... ... ... ... 10 ... ... 11 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 1 ... ... ... ... ... ... ... ... ... ... 1 10.—Diseases of Bones and Joints. Caries, Necrosis ... ... ... 1 ... ... 1 ... ... ... ... 2 Arthritis, Ostitis, Periostitis ... ... ... ... ... ... ... 1 ... ... ... 1 Other Diseases of Bones and Joints ... ... ... ... ... ... ... ... ... ... ... 11.—Diseases of Integumentary System. Carbuncle, Phlegmon ... ... ... ... ... ... ... ...... ... ... ... ... Other Diseases of Integumentary System ... ... ... ... ... ... ... ... ... ... ... ... 93 Table III. (continued). Females. Cause or Death. ages. All Ages. 0- 1- 5- 15- 25- 35- 45- 55- 65- 75- 85- LOCAL DISEASES.—Continued. 5.—Diseases op the Digestive System. (Continued.) Peritonitis ... 1 ... 1 ... 1 ... ... 1 ... ... 4 Ascites ... ... ... ... ... ... ... ... ... ... ... ... Cirrhosis of Liver ... ... ... ... 1 3 1 5 ... 1 ... 11 Jaundice and other Diseases of Liver 1 ... ... ... ... 2 3 3 ... ... 1 10 Other Diseases of Digestive System 2 ... ... 1 ... ... ... ... ... ... 1 4 6.—Diseases op Lymphatic System (e.g., of Lymphatics and of Spleen) ... ... ... ... ... ... ... ... ... ... ... ... 7.—Diseases of Gland-like Organs op Uncertain Use. (e.g., Bronchocele, Addison's Disease) ... ... ... ... ... ... ... ... ... ... ... ... 8.—Diseases op Urinary System. Nephritis ... ... ... ... ... 1 ... ... 1 ... ... 2 Bright's Disease, Albuminuria ... ... ... ... 3 4 2 2 4 1 ... 16 Disease of Bladder or of Prostate ... ... ... ... ... ... ... ... ... 1 ... 1 Other Diseases of the Urinary System ... ... ... ... ... ... ... ... ... ... ... ... 9.—Diseases of Reproductive System. A. Of Organs of Generation. Male Organs ... ... ... ... ... ... ... ... ... ... ... ... Female Organs ... ... ... 1 3 ... ... ... 1 ... ... 5 B Of Parturition. Abortion, Miscarriage ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Convulsions ... ... ... ... ... ... ... ... ... ... ... ... Placenta previa, Flooding ... ... ... ... 1 2 ... ... ... ... ... 3 Other Accidents of Child- Birth 1 ... ... 1 4 1 ... ... ... ... ... 7 10.—Diseases of Bones and Joints. Caries, Necrosis ... ... ... ... ... ... ... ... ... ... ... ... Arthritis, Ostitis, Periostitis 1 ... ... ... ... ... ... ... 1 ... ... 2 Other Diseases of Bones and Joints ... ... ... ... ... ... ... ... ... ... ... ... 11.—Diseases of Integumentary System. Carbuncle, Phlegmon ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of Integumentary System ... ... ... ... ... ... ... ... ... ... ... ... 94 Males. Table III. (continued). Cause of Death. AGES. All Ages. 0- 1- 5- 15- 26- 35- 45- 56- 65- 75- 85- VII.-DEATHS FROM VIOLENCE. ' 1.—accident or Negligence. Fractures and Contusions ... ... ... 2 3 3 2 3 3 1 1 18 Gunshot Wounds ... ... ... ... ... ... ... ... ... ... ... 1 Cut, Stab ... ... ... ... ... ... ... ... ... ... ... ... Burn, Scald ... 1 1 ... ... ... ... ... ... ... ... 2 Poison ... ... ... ... ... ... ... ... ... ... ... 1 Drowning ... ... 2 ... ... ... 1 1 1 ... ... 5 Suffocation 2 ... ... ... ... ... ... 1 ... ... ... 3 Otherwise 1 ... ... ... ... ... ... ... ... ... ... 1 2. —Homicide. Manslaughter ... ... ... ... ... ... ... ... ... ... ... ... Murder ... ... ... 1 ... ... ... ... ... ... ... 1 3.—Suicide Gunshot Wounds ... ... ... ... ... ... ... ... ... ... ... ... Cut, Stab ... ... ... ... ... 1 1 ... ... ... ... 2 Poison ... ... ... ... ... 1 ... 1 ... ... ... 2 Drowning ... ... ... ... ... ... ... 1 ... ... ... 1 Hanging ... ... ... ... ... ... ... ... ... ... ... ... Otherwise ... ... ... ... ... ... ... ... ... ... ... ... 4.—Execution. Hanging ... ... ... ... ... ... ... ... ... ... ... ... VIII.—DEATHS FROM ILL- DEEFINED AND NOT SPECIFIED CAUSES. Dropsy ... ... ... ... ... ... ... ... ... ... ... ... Debility, Atrophy, Inanition 20 ... ... ... ... ... ... ... ... ... ... 20 Mortification ... ... ... ... ... ... ... ... ... ... ... ... Tumour ... ... ... ... ... ... ... ... ... ... ... ... Abscess ... ... ... ... ... ... ... ... ... ... ... ... Haemorrhage ... ... ... ... ... ... ... ... ... ... ... ... Sudden Death (cause not ascertained) ... ... ... ... ... ... ... ... ... ... ... ... Causes not Specified or Ill-defined 1 ... ... ... ... ... ... ... ... ... ... 1 Uncertified Death 1 ... ... ... ... ... ... ... ... ... ... 1 95 Table III. (continued). Females. Cause or Death. AGES. All Ages. 0- 1- 5- 15- 25- 35- 45- 55- 65- 75- 85- VII.—DEATHS FROM VIOLENCE. 1.—Accident of Negligence. Fractures and Contusions 1 ... ... ... ... ... ... 1 ... ... ... 2 Gunshot Wounds ... ... ... ... ... ... ... ... ... ... ... ... Cut, Stab ... ... ... ... ... ... 1 ... ... ... ... 1 Burn, Scald ... ... 1 2 ... ... ... ... 1 ... ... 4 Poison ... ... ... ... 1 ... ... 1 ... ... ... 2 Drowning ... ... ... ... ... ... ... ... ... ... ... ... Suffocation 5 1 ... ... ... 1 ... ... ... ... ... 7 Otherwise ... ... ... ... ... ... ... ... ... ... ... ... 2.—Homicide. Manslaughter ... ... ... ... ... ... ... ... ... ... ... ... Murder ... ... ... ... ... ... ... ... ... ... ... 2 3.—Suicide, Gunshot Wounds ... ... ... ... ... ... ... ... ... ... ... ... Cut, Stab ... ... ... ... ... ... ... ... ... ... ... ... Poison ... ... ... ... ... 1 ... ... ... ... ... 1 Drowning ... ... ... ... ... ... ... ... ... ... ... ... Hanging ... ... ... ... ... ... ... ... ... ... ... ... Otherwise ... ... ... ... ... 1 ... ... ... ... ... 1 4.—Execution. Hanging ... ... ... ... ... ... ... ... ... ... ... ... VIII.—DEATHS FROM ILL-DEFINED AND NOT SPECIFIED CAUSES. Dropsy ... ... ... ... ... ... ... 1 ... ... ... 1 Debility, Atrophy, Inanition 25 3 ... ... 1 ... ... ... ... ... ... 29 Mortification ... ... ... ... ... ... ... ... ... ... ... ... Tumour ... ... ... ... ... ... ... 1 ... ... ... 1 Abscess ... ... ... ... ... ... ... ... ... ... ... ... ... Haemorrhage ... ... ... ... ... ... ... ... ... ... Sudden Death (cause not ascertained) ... ... ... ... ... ... ... ... ... ... ... ... Causes not Specified or Ill-defined ... ... ... ... ... ... ... ... ... ... ... ... Uncertified Deaths 1 ... ... ... ... ... ... ... ... ... ... 1 96 TABLE V. Table showing the Number of Deaths from the principal Zymotic Diseases in the Ten Years 1887 to 1896, and in the Year 1897. DISEASE. 1887. 1888. 1889. 1890. 1891. 1892. 1893. 1894. 1895. 1896 (53wks.) Annual Averages, * 1887—96. Total Deaths in 1897. Deathrates, 1897. Uncorrected. Corrected. Smallpox ... 1 ... ... ... ... 4 3 ... 1 0.9 1 ... ... Measles 33 66 11 77 7 81 30 66 18 103 49.2 52 2 0.01 Scarlet Fever 35 14 8 6 7 17 30 13 14 22 16.6 18 20 0.15 Diphtheria 27 75 39 45 27 32 69 92 49 67 52.2 55 65 0.51 Whooping Cough 19 74 26 82 67 29 59 44 20 47 46.7 49 40 0.31 Fever. Typhus ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric 10 15 16 10 17 7 19 23 15 14 14.6 15 6 0.04 Simple Continued ... ... 1 ... ... ... ... ... ... 2 0.3 0 1 0.00 Diarrhoea 63 38 63 62 76 82 65 45 91 66 65.1 69 107 0.84 Totals 187 283 163 283 201 248 276 286 207 322 245.6 259 241 1.90 * See also Tables 17 and 18 supra. 97 TABLE VI. Report of the Works of the Sanitary Department completed during the Year 1897. 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, Ac. Water Supply. Dust Receptacles. Miscellaneous. "House-to-House." On Complaint or after illness. Cellar Dwellings. Re-inspections of all kinds. Houses placed on Register Registered Houses Inspected. Entire Reconstruction. Drains trapped and (or) ventilated. Waste-pipes disconnected. Rain-water-pines disconnected. W.C. New provided, repaired, &c. 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. Quartern. 1 194 .. 698 .. 2949 .. .. 87 46 15 24 59 26 6 18 6 3 .. 4 2 10 1 .. 8 1 26 1 1 .. 44 365 .. 93 2 61 2 210 26 808 .. 3142 .. .. 108 27 13 19 49 23 4 15 10 1 13 .. 5 .. .. 17 .. 66 .. 2 2 33 312 .. 94 1 59 3 238 59 722 .. 3050 .. .. 125 19 14 19 67 40 15 10 8 3 .. 9 .. 8 .. .. 9 4 64 .. 11 2 30 187 .. 91 1 47 4 162 .. 605 3160 86 3 120 20 27 20 66 34 19 13 6 9 .. 7 .. 14 2 .. 19 4 6 1 .. 24 41 347 .. 90 1 52 Year 804 86 2833 .. 12301 86 3 440 112 69 82 241 123 44 56 30 16 .. 33 2 37 3 .. 53 9 162 2 14 28 148 1211 .. 368 5 219 98 TABLE VII. Meteorological Observations at Greenwich. From the Weekly Returns of the Registrar-General. Quarters. 1897. Years. 1 2 3 4 1897. 1896. 1895. 1894. Barometer. —Mean 29.690 29.776 29.778 29.919 29.790 29.836 29.745 29.796 Total Oscillation 24.54 18.45 15.69 19.12 77.80 72.96 71.58 73.05 Thermometer—Mean 41.1 53.0 59.5 45.8 49.8 49.79 49.5 49.1 Absolute Maximum 62.2 90.2 89.5 67.2 90.2 91.1 87.3 86.0 ,, Minimum 23.8 29.9 38.2 28.3 23.3 24.3 6.9 12.8 Mean Daily Range 9.6 18.4 18.7 11.5 14.5 14.6 16.1 14.8 Sunshine.—Hours recorded 179.0 583.8 570.4 201.9 1,535.1 1,018.4 1,225.4 1,051.6 "Possible'' Record 927.0 1,402.0 1,296.5 820.5 4,446.0 4,504.0 4,447.2 4,446.2 Per cent. of "Possible" recorded 19.3 41.6 43.9 24.6 34.5 22.6 27.5 23.6 No. of days of record 60 82 88 64 294 264 275 268 Humidity. —Mean 83 73 73 84 78 79 77 81 Rainfall, &c.—.Total 7.38 4.73 6.34 3.69 22.14 22.77 19.48 26.44 No. of days of fall 48 38 42 40 168 163 156 194 „ ,, Snow 1.2 — — 1 13 7 28 5 „ „ with Fog 10 7 8 36 61 43 52 55 „ „ Thunder 2 7 14 1 24 17 15 19 „ „ Lightning 3 5 13 1 22 16 17 9 ,, ,, Hail 2 2 1 2 7 4 4 7 Hoar frost observed 7 2 - 15 24 40 29 23 Wind.—Mean direction S.W. S.W. S.W. S.W. S.W. S.W. S.W. S.W. Mean Hourly Velocity 14.0 12.0 11.0 10.8 11.9 11.2 11.7 12.3 No. of observations of calm 2 3 1 14 20 36 39 † 99 Appendix B. An Examination as to the efficiency of Sulphur Dioxide Gas for the Disinfection of Rooms. The object of disinfection is to check the spread of infection both in the family or household, and in the surrounding district. Of the success achieved in the latter direction no reliable evidence is either available, or likely to be obtainable, in a district of such complex relations as a Metropolitan Parish. On the other hand the success in limiting the spread of infection in the household can be gauged with some degree of certainty by examining the conditions under which subsequent cases occur in such household or family. Before, however, proceeding to do this, it will be necessary to clearly set out certain considerations material to the inquiry, which must be carefully weighed before any reliable conclusions can be arrived at. The term "primary" and "secondary," as used in this Report, refer respectively to the first and each and all subsequent cases notified in 1897, from any given house or tenement. The circumstances nected with the primary cases will, for the present purposes, be ignored, except in a few special instances. Disinfection of the sick-room is done as a matter of routine after smallpox, diphtheria, membranous 100 croup, and scarlet, enteric (or typhoid), and puerperal fevers. In the case of erysipelas, such disinfection is not deemed necessary, and the other diseases included in the schedule of notification are so rare that they may for present purposes be ignored. Disinfection would naturally be carried out after the occurrence of any of them. Disinfection is occasionally carried out after other infectious diseases, such as measles, whooping cough, phthisis, chicken pox, &c., but no records exist of the results of such disinfection. Practically, scarlet fever and diphtheria (iucluding membranous croup) are the only diseases which can be dealt with here. There were 45 cases of enteric fever during the year, but in only one instance was there more than a single case in a house, and in that instance the two patients were taken ill on the same day. The circumstances attending the spread of scarlet fever differ so much from those attending the spread of diphtheria that no comparison can be safely made between the results of disinfection for the two diseases. Were it desired to discredit any method of house disinfection, all secondary cases might be attributed to failure of such process. This would manifestly be as unfair as would be an assumption that such method never broke down and that all secondary cases were due to other sources of infection. The truth is that such secondary cases may be due to one, or other of the following conditions:— 101 (a.) Simultaneous infection of the secondary and primary patients, the later development of the secondary case being due to a longer incubation period by reason of some personal idiosyncrasy of the patient; (6.) Infection derived from the primary case at some time between the onset of the illness and the inception of isolation, or removal to hospital, or, when the primary patient is kept at home, to imperfect isolation; (c.) The release of the primary patient from isolation, or his return from hospital, before all infection has left him; (d.) Failure of the method of disinfection, either through inefficiency of the process or material used, or the omission to disinfect some particular article; and (e.) Independent sources of infection. In an inquiry such as this, the three first and last possibilities ought to be excluded before any particular case of spread of infection is assigned to the operation of the fourth. A standard period of time for the incubation of each disease must, therefore, be determined upon, and such standard should include the longest periods recorded with some frequency, but not what may be called exceptional cases of prolonged incubation. Without discussing the varying lengths of incubation periods, it will suffice to say that the incubation period of scarlet fever is frequently as 102 long as fourteen days, but more commonly from one to three days. In the case of diphtheria, the frequent discovery of the living bacillus diphtheria in the throats of persons presenting no clinical symptoms of the disease, greatly complicates the question of incubation. In the absence of any systematic bacteriological examination of the throats of the patients and the other members of the household, it is impossible to eliminate errors due to the conveyance of infection by persons apparently quite well. As, however, a working standard is requisite, a period not exceeding three weeks will be taken as the incubation period of diphtheria, and the possibility of conveyance of infection by the method already alluded to set aside for the present. In connection with diphtheria and diphtheritic membranous croup, there is one other circumstance having a very important relation to this inquiry. As has already been stated, systematic bacteriological examination of the throats of patients is not carried out. The result is that as regards the majority of the patients treated at home, the medical attendants have to rely on the indications visible to the naked eye in deciding as to the freedom of their patients from infection. It is almost universally agreed that the throats of such persons, while presenting no indications of diphtheritic inflammation, may still contain the bacillus diphtherice in an active and 103 virulent form. The bacillus may, in the absence of further treatment, give rise to a second attack of the disease in the patient, and can infect any with whom the patient may be allowed to come into contact. The want of a bacteriological test of freedom from infection renders the fixing of a period of quarantine for patients treated at home a very difficult matter. The practice of the Department is to accept the certificate of recovery sent in by the medical attendant without demur, even if such certificate be forwarded within (say) three days after notification. With scarlet fever, on the other hand, it is easier to define the infective period, by reason of the commonly accepted view that the patient is infectious so long as desquamation persists. As a rule six to seven weeks are required for the completion of desquamation, and should a certificate of freedom from infection be received after a period of isolation much shorter than that standard, the circumstances of the case are specially inquired into before disinfection is carried out. The processes available for the disinfection of living rooms, apart from the furniture, etc., are:— (1.) Fumigation by chlorine gas, evolved from chloride of lime, sulphurous acid gas (S02), nitrous acid gas, etc. (2.) Washing of walls, ceiling, woodwork, etc., with various disinfectant solutions, such as 1% sol. chloride of lime. 104 (3.) Fumigation with formaldehyde vapour:— (a.) By liberation under pressure of the gas from an aqueous solution of calcium chloride charged with formaldehyde. (6.) By volatilisation of "formalin"— paraform tablets—in limited supply of moist air. (4.) Spraying walls, etc., with antiseptic solutions—those most used being solutions of mercuric chloride (corrosive sublimate) and formaldehyde. On general principles, disinfection is more likely to be efficacious if the disinfectant be applied in solution rather than in the gaseous form, but in the application of such liquid to walls, ceiliugs, etc., there is always the risk of missing small areas of the surfaces to be disinfected. The risk can be diminished to very insignificant proportions if the surfaces be gone over more than once. The ideal disinfection of a living room would include its perflation for one or more days, the stripping off of all paper, and the destruction of all paint, with subsequent re-papering, re-painting, and white-washing. Such process, superadded to a thorough cleansing of the floor boards, and removal of all dust from every corner, crack, and crevice, should free the room from all infection. Such ideal is rarely obtainable—partly on the score of expense and partly by the reason of the time the room would be out of use, a serious consideration in a 105 tenement of perhaps 2 rooms. The chief aims of official disinfection are reliability and speed of work. It will be convenient to describe here the present method of house disinfection, before proceeding to inquire into its efficiency. The room to be fumigated is first roughly measured up and its cubic contents approximately ascertained. All openings, such as the fireplace, crevices round the window frames, ventilators, etc., are then sealed up by pasting paper over them. Any boxes, drawers, or other closed receptacles in the room, are opened and their contents opened spread out to allow the fumes to come into contact therewith as freely as possible. The disinfectant used is Sulphur Dioxide gas (S02), which is obtained by the combustion of either cake sulphur, in the form of "candles," or of Carbon Bisulphide (CS2). A few years ago the latter was almost exclusively used, but now the former. The tin containing the candle, or the vessel containing the Carbon Bisulphide, is set in a second vessel containing water, mainly as a precaution against fire, but the water which is vaporised by the heat of the burning sulphur assists in the process of disinfection. As soon as the sulphur is lighted, the door of the room is shut, locked, and the cracks round the frame carefully closed up from the outside by pasting on paper, not forgetting the keyhole. The rule is to keep the room shut up for 24 hours, after which it is freely ventilated until the sulphur fumes have entirely disappeared. The only 106 advantage Carbon Bisulphide has over the "candle" is that, with the amounts usually used, the former is completely volatilised in about twenty (20) minutes, whereas the candle requires some two (2) hours or more. The disadvantages of the bisulphide are that it is an explosive liquid, that there is always the risk of breaking the bottles containing it in the course of transport, and that copper pans, which are heavy and expensive, are necessary. The fumes from the carbon bisulphide are peculiarly unpleasant and persistent, in both respects more so than those from the candle. When cake sulphur is used, 1 lb. of sulphur is allowed for every 1,000 cubic feet, or fraction of that quantity, of air space to be fumigated. If carbon bisulphide be used, a trifle over one pint is used as the equivalent of 1 lb. of sulphur. Theoretically, about 8 fluid ounces of the bisulphide should give as much S02 in the gaseous form as 1 lb. of sulphur. The general instruction is in all cases to use an excess of the standard rather than err in the direction of false economy. In the point of expense, there is very little difference between the two materials. Hitherto it has not been the practice of the Department to require re-papering of the walls, whitewashing of the ceilings, or re-painting of the woodwork of the room, unlets the state of the room as regards dirt and dilapidation be such as would favour the harbouring of disease germs under conditions 107 which might prevent the proper destruction of the infective particles. In by far the larger number of cases, the patients are removed to hospital, so that there is but a slight probability of any infective particle becoming attached to the walls, ceilings, etc. When the patients are treated at home, the following extra precautions are recommended:— "After the room has been disinfected by the Vestry's Officer, it should be left with the windows open (top and bottom) for several hours—24 if possible. At the end of that time, all woodwork, including furniture, floor-boards, doors, etc., should be washed with a disinfecting solution, and the wallpaper cleaned or stripped off. For cleaning wallpaper, use crumb of bread, and burn all the dirtied bread and bread crumbs. Every article in the room, not removed by the Vestry's Officials, should be washed, or, if washing be impossible, wiped over with a cloth damped with a disinfectant. "Very special care should be taken to remove all dust from the room, using plenty of water for this purpose." The methods of dealing with the bedding, clothes, etc., removed from the room, will not be dealt with here. Tables A and B appended hereto contain complete lists of houses in which more than one case of scarlet fever or diphtheria occurred during 1897. For convenience of reference, the addresses of the houses 108 have been omitted and the groups of eases numbered consecutively. Any group can be identified by reference to the preliminary tables which have been preserved. Scarlet Fever. —During 1897, 490 cases of this disease were notified from 366 houses, distributed as follows:— From 281 houses, 1 case ,, 56 ,, 2 cases „ 21 „ 3 „ „ 6 „ 4 „ and „ 2 ,, 5 ,, In 56 of the 85 groups of cases,* the spread of infection was apparently due to the operation of causes (a) and (or) (b). The groups are:—Nos. 2-4, 8-12, 15, 17-19, 23, 25-28, 33, 34, 36-44, 47-60, 62, 66, 68, 69, 71, 74, 76-79, and 81-84. In 18, cause (c) appears to have been operative, viz.:- Nos. 1, 6, 11†, 16, 21, 24, 30-32, 35, 61, 64, 65, 67, 70, 73†, 80, and 85. In 13 groups, none of the three causes already specified appeared to have operated, viz.:—Nos. 5, 7, 13, 14, 20, 22, 29, 45, 46, 63, 72, 73†, and 75. In these cases it was impossible to eliminate the possibility of independent fresh sources of infection. For the present purpose they may be assumed as due to failure of the process of disinfection. * By a "group of cases" is meant the cases occurring in any one house. † Groups 11 and 73 are mentioned twice owing to differences in the circumstances attending certain of the secondary cases in each group. 109 Altogether, disinfection was carried out 429 times after scarlet fever, and, if the classification given above be correct, "the breakdowns" were equivalent to 3'0 per cent, of the whole. The cases following such breakdowns numbered 15, or 3.0 per cent. of the total number of cases recorded. Diphtheria.—The cases of diphtheria and membranous croup recorded during 1897 numbered 322 in all from 249 houses, the cases being distributed as follows:— From 195 houses 1 case each „ 43 „ 2 cases „ 6 „ 3 „ „ 3 ,, 4 ,, „ 1 house, 5 „ and „ 1 „ 6 „ In 44 out of the 54 groups of cases tabulated, causes (a) and (or) (b) were operative. The groups referred to are:—Nos. 1-11, 13-15, 18-23, 25, 27-30, 32, 34, 35, 39-54. In 2, cause (c) was apparently operative, viz., in Nos. 12 and 16. Of the remaining cases, 5 require some special mention, namely, Nos. 17, 26, 31, 37, and 38. In group 17, the first patient was subsequently certified not to have had diphtheria at all. Of the four cases in group 26, the first had an origin in this Parish, but the remaining three cases were attributable to imperfect measures of isolation and disinfection in another district. There were 110 reasons for thinking that the cases in the other district, giving rise to the three secondary cases of this group, may have been due to the primary, and local, case of the group. It was ascertained that there had been communication between the household in this Parish and that in the other district during the course of the illness of the primary cause of the group. In any case, it was concluded that the three secondary cases of this group were in no way attributable to imperfect methods of disinfection practised in this Parish. Groups 31 and 37 were intimately associated, the patients in each group being orphans under the care of the Sisters of the Church Extension Association. The cases in group 37 appeared to have been due to direct personal infection, with in all probability some laxity in the matter of disinfection. Disinfection was done by the Department after the primary case of this group only, the other children being at the date of their attacks at the Sanatorium, where any disinfection performed was carried out privately. The whole of the cases in group 31 were transferred from Hampstead, being children taken ill at a branch establishment of the Sisterhood and brought to the Sanatorium in this Parish. There were reasons for thinking that this group was due to persistence of infection in the throats, or elsewhere, of one or more of the patients in group 37, the fifth case in group 1ll 31 being one of the patients in group 37. At the close of the sequence of cases in group 31 disinfection of the premises, &c., was carried out by the Department. From the date of the official disinfection up to the time of writing, no further cases have occurred. The two cases included in group 38 were two notifications with regard to the same patient. The boy was removed to hospital when first notified to be ill with diphtheria, was detained there for about a month, and within a week of his return home had a relapse of the disease, was re-admitted, and died. The foregoing remarks dispose of 51 out of the 54 groups of cases tabulated. The remaining three groups, viz., Nos. 24, 33, and 36, could not be explained on any of the before-mentioned grounds. Of these groups, No. 24 may be eliminated from present consideration, inasmuch as the disinfection after the primary case was done privately, and certified to by the medical attendant. There remain, therefore, but two groups which, supposing all independent sources of infection be excluded, an exclusion which cannot be demonstrated, were due to breakdown in the process of disinfection. During the year, disinfection of the sick room was carried out by the Department 257 times after diphtheria and membranous croup. The two breakdowns would, therefore, be equivalent to 0.7 per cent. of the total disinfections. The cases secondary to 112 such breakdowns numbered 2, or 0.6 per cent. of the cases notified. It may be noted here that the secondary case in group 33 occurred in the same house but in another family and tenement. So far it appears that in 3.0 per cent. of the disinfections after scarlet fever, and in 0.7 per cent. of those after diphtheria, the process of disinfection may have been inefficient. In a communication to the British Medical Association, read at the Annual Congress of 1896, Dr. Kenwood reported that he had collected statistics from 6 sanitary areas in and around London with reference to 1,330 disinfections of premises after scarlet fever and diphtheria. Taking the view that all cases occurring within fourteen days after such fumigation—a view which he stigmatises as "extreme and unjustifiable"—he found that there had been 55 cases so attributable to defective disinfection, equal to 4.1 per cent. of the total disinfections performed. The 55 cases included cases of both scarlet fever and diphtheria. For the purpose of making some comparison with Dr. Kenwood's result, the number of times secondary cases occurred within fourteen days of disinfection have been determined. During the year 686 disinfections were carried out, and after 58 operations, secondary cases were reported within fourteen days—giving a percentage of "breakdowns" on Dr. Kenwood's supposition of 8.4. For reasons already set out, no value is attached to this mode of examining the question. 113 TABLE A.—SCARLET FEVER, 1897. Group No. Dates of Group No. Dates of Sickening. Disinfection. Sickening. 1 '^infection. 45 /■ 4 4 May 6 May 2 f. 2 10 Sept. ... 13 Sept. ... m. 5 9 J une 16 J une ... in. 30 14 Sept. 20 Sept. 46 m. 2 8 Nov. 19 Nov. ... 3 /• 4 21 Aug. ... 22 Sept. ... /• 1 7 Dec. 8 I'ec. f. 31 3 Sept. ... 22 Sept. ... 1 47 m. 12 1 April ... 7 June /■ 6 14 Sept. ... 22 Sept. ... | m. 18 6 April ... 7 June ... 4 m. * 30 Sept. 8 Oct. ... 1 48 m. 8 30 Aug. 1 Sept. ... m. 2 30 Sept. 8 Oct. ... I /• 4 6 Sept. 9 Sept. ... 5 /■ 7 30 Aug. 4 Sept. 49 m. 4 23 Jan. 27 Jan. ... 1 27 Jan. ... / /■ 3 21 Oct. ... 29 Oct. ... /• 2 23 Jan. 6 m. 15 14 May. ... IS May 50 m. 4 12 Dec. ... 17 Dec. ... m. 43 13 July 15 July E. m. 3 18 Dec. 20 Dee. 7 m. 5 28 Jan. 14 April ... f. 4 23 Dec. ... 27 Dec. m. « 3 Mar. 14 April ... m. 1 23 Dec. ... 27 Dec. ... m. 3 1 May 9 June ... m. 6 24 Dec. 27 Dec. 8 /• 1 20 Aug. ... 29 Aug. ... 1 51 m. 2 11 July 13 July /• 3 27 Aug. ... 29 Aug. ...} m. 1 14 July 16 July 9 /• 2 13 Mar. ... 10 May ... 52 f- 4 12 July ... 16 July m. 34 29 Mar. 10 May /• 2 16 July 17 July ... /■ 7 1 April ... 1 April ... Second family 53 . /• 4 15 April ... 21 ADril ..." 10 /• 7 8 Oct. ... 16 Oct. ... / 6 21 April ... 21 April ... - m. 3 19 Oct. ... 22 Oct. ... /• 10 21 April ... 21 April ... , ]1 /■ 16 ? 23 July ...) 54 /• 11 16 Nov. ... 12 Jan. m. 12 ? 23 July ... I Home again, Ml. 13 19 Nov. ... 12 Jan. /• 8 ? 23 July ... [ 11, 28, & 30 Sept. 55 /• 7 25 Oct. ... 20 Dec. ... m. 9 13 July 21 July ...) /• 9 3 .Nov. 20 Dee. /■ 8 26 Sept. 4 Oct. ... Second family ,b. /. 13 10 Nov. ... 20 Dec. ... 12 /• 4 25 Oct. 29 Oct. ...) 56 in. 7 7 Dec. 10 Dec. ... m. 2 26 Oct. ... 29 Oct. ...} in. 2 9 Dec. 11 Dec. ... | 11 Dec. ... j 13 /■ 6 30 Not. 1 Dec. m. 4 9 Dec. m. 12 20 Dec. 20 Dec. /. 11 Dec. ... 30 Dec. ... m. 4 20 Dec. ... 23 Dec. ... 57 f. 2 1 Nov. 5 Nov. 14 m. 7 26 Oct. ... 2 Nov. f. 3 6 Nov. 9 Nov. /■ 3 15 Dec. 15 Dec. f. 26 8 Nov. 9 Nov. 15 /• 5 7 Oct. ... 12 Nov. ... 58 /• 4 2 May 9 July m. 11 12 Nov. ... 17 Nov. ... [8 Oct. m. 15 19 May 9 July 16 /■ 6 12 Aug. 17 Aug. ... Home again 59 m. 7 16 Oct. ... 0 Dec. ...\ r. 7 16 Oct. 22 Oct. B. m. 4 16 Oct. ... 6 Doc. ...| 17 in. 12 17 Dec. 20 Doc. ...) 60 f. 11 12 Nov. 24 Nov. ... /■ 14 18 Dec. 20 Dec. ...J f. 8 30 Nov. ... 2 Dec. [June 18 in. 2 15 Dec. 18 Dec. ...) 61 f- 6 13 April ... 16 April ... Home again 15 m. 4 16 Dec. 18 Dec. ... f f. 16 1 July 2 July B. 19 /■ 16 30 Oct. ... 10 Nov. m. 5 28 Dec. 1 Jan. /■ 20 1 Nov. ... 10 Nov. 62 f. 3 25 Sept. 5 Nov. in. 9 2 Nov. ... 10 Nov. f. 6 28 Sept. ... 5 Nov. /• 12 5 Nov. 10 Nov. 63 f. 7 6 March ... 6 March ... 20 /• 11 10 June 15 June ... f. 5 20 Nov. 12 Jan. [15 Sept. Home again m. 5 11 Sept. ... 18 Sept. 64f f. 3 25 July 28 July f 18 17 Dec 20 Dec. [25 Aug. f. 8 22 Sept. 24 Sept. ... B. 21 /• 11 7 July 9 July Home again 65+ in. 10 1 Oct. 6 Oct. B. /• 8 4 Sept. ... 7 Sept. "... B. m. 7 7 Oct. 13 Oct. ... B. 22 /• 4 18 May ... 22 May ... j Home again 16 66 /• 10 23 Oct. ... 29 Oct. ... July. /. 35 30 Oct. .. 2 Nov. [16 Oct. 23 /• 2 19 Sept. ... 22 Sept. ... 67 /• 8 7 Aug. 10 Aug. ... Home again /• 8 6 Mar. 18 Mar. ... 1 f. 3 27 Oct. ... 30 Oct. ... B. /• 9 15 Mar. 18 Mar. ...j 68 f. 14 4 Feb. 22 March ... /• 6 20 Mar. 24 Mar. [14 S«pt. /. 16 4 Feb. 22 March ... 24 m. 8 10 July 12 July Home again /. 17 18 Feb. ... 22 March ... m. 19 25 Sept. ... 25 Sept. B. 69 m. 3 ? 2 Dee. m. 43 26 Sept. 27 Sept. ... b. m. 2 27 Nov. ... 30 Nov. ... 25 /■ 8 18 June 23 June m. A 1 Dec. 6 Dec. [of Nov. 26 /■ ]2 24 June ... 26 June ... 70 m. 20 10 Sept. ... 15 Sept. ... Home again end /■ 6 P 12 Oct. ...) f. 20 4 Dec. 7 Feb. ... b. (?) 27 /• 3 ? 12 Oct. ... j" 71 f. 7 1 J uly 2 July / 5 25 Oct. 1 Nov. 1 .Nov. /• 12 11 July 12 July A second family 28 m. 24 5 Nov. 72 in. 2 15 May ... 18 May /• 5 ZS Uct. ... 15 Nov. ... 30 Oct. ... f 5 10 July ... 13 July ... A second family m. 29 JNov. ... 73 f 8 11 T mn on TIITIA i 29 /• /• m. 4 27 June ... 13 July Died in hospital. J. m 10 ix j une 14 June ou j une ... I 30 June ... f 30* 5 4 19 JNov. ... 4 Jan. 23 Nov. ... 9 Jan. Second family. k. in. 7 31 July 3 Aug. ... j Another family Home ag. 7 Oct. First family, b. 31* m. 2 7 Jan. ... 9 Jan. Second family b. f- 5 10 Oct. ... 12 Oct. ... /• 8 9 Feb. 10 Feb. ... b. 74 m. 6 4 June 8 June 32 /• 34 15 Feb. 17 Feb. ... b. /. 9 7 June 10 June m. 4 29 May 29 May Home ag. 21 Oct. /. 12 10 June ... 10 June ... /■ 2 27 Oct. 2 Nov. ... b. 75 m. 14 28 June 1 July 33 /• 1 31 Oct. 2 Nov. ... b. / 9 28 Oct. ... 30 Oct. ... A second family /• 6 19 July 20 J uly 76 f. 14 17 Nov. 6 Jan. ... "j m. 8 21 July 22 July f. 7 19 Nov. 6 Jan. ... > /• 4 21 July 26 July in. 4 19 Nov. 6 Jan. ... J 34 m. 12 22 July 26 July '/7 m. 8 22 April ... 30 April ... 1 /• 6 28 Nov. 30 Nov. in. 6 25 April ... 30 April ... j 35 /• 11 2 Dec. 4 Dec. [8 May. 78 f. 5 10 April ... 15 April ... /• 15 18 Feb. 22 Feb. ... Home again. in, 4 11 April ... 15 April ... 36 /• 3 10 May 14 May b. m. 2 18 April ... 2J April ... /• /■ 6 2 19 June ... 22 J une ... 23 June 26 J une ... 79 m. /. 12 7 21 April ... 26 August... 22 April ... 12 Oct. ... 37 in. 10 10 2 28 Junj ... 2 July /• 10 1 Sept. 12 Oct. ... [19 Oct. m. m. 14 Nov. 19 .Nov. ... 25 Nov. ... 23 Nov. ... 80 in. m. 12 6 11 August... 1 Nov. 17 Aug. ... 11 Nov. Home again E. 38 m. 5 24 Nov. 26 Nov. /. 17 11 Nov. 16 Nov. ... R. in. 9 9 Feb. 31 Mar. ... /■ /. 9 2 Nov. 11 Nov. B. 39 in. 11 14 Feb. 31 Mar. ... 81 7 29 Dec. 22 Feb. /• 8 1 Feb. 25 Feb. ...| in. 4 6 Jan. 22 Feb. ... 40 m. m. 10 14 13 Feb. 20 July 25 Feb. ... | 21 July ... 82 fin. 4 5 3 J uly 3 J uly 19 Aug. ... "j 19 Aus*. ... [- 41 /• 11 28 J uly 30 J uly /. 7 3 July 19 Aug. ... J ? 1 ? ^ in. 6 17 J uue 21 June ... | 83 m. & 11 Sept. 11 Sept. 42 /■ 3 18 June 21 June ... J f. 2 m. f- 5 4 April ... 6 April ... in. 31 11 Sept. 2 July ? J 9 July 43 2 16 April ... 18 A pril ... 81 f. 6 in. f 1 3 12 Mar. 12 Mar. ... 16 Mar. ... 1 16 Mar. ... > 85 in. f. 4 9 16 July(?)... 2 Feb. 27 July 5 Feb. [24 Ap. Home again B. m. 4 12 Mar. 16 Mar. ...) in. 2 27 April ... 30 April ... OILS. Where two or more cases are bracketed together, the cases were notified simultaneously. w " R " indicates " return " cases. rom patients removed to hospital in 1393. f These groups had common origin from discharged patient. 114 TABLE B.—DIPHTHERIA, 1897. Group No. Sex & Age of Patient. Dates of Notes. Group No. Sex & Age of Patient. Dates of Notes. Sickening. Disinfection. Sickening. Disinfection. 1 m. 4 14 April 21 April D.-N. 15 April. 28 m. 4 18 Dec. 1 Jan., '98 (D. 14 Jan. UN. 15 „ m. 6 15 May 17 May f. 29 18 Dec. 1 Jan., '98 2 f. 7 15 Mar. 23 Mar. 29 m. 2 11 Jan. 15 Jan. m. 3 22 Mar. 23 Mar. 3 m. 5 14 Jan. 19 Jan. m. 1 18 Jan. 21 Jan. f. 3 14 Jan. 20 Jan. 30 f. 4 16 Sept. 17 Sept. 4 f. 5 13 April 20 April f. 7 21 Sept. 23 Sept. m. 9 21 April . 23 April 31 f. 5 30 Aug. 5 Nov. 6 m. 6 23 Jan. 26 Jan. f. 4 4 Sept. 5 Nov. m. 2 23 Jan. 26 Jan. m. 4 4 Sept. 5 Nov. 6 f. 4 30 Mar. 30 Mar. f. 4 4 Sept. 5 Nov. m. 32 8 April 24 May m. 4 18 Sept. 5 Nov. 7 m. 2 18 Feb. 24 Feb. D.-N. 22 Feb. m. 4 22 Sept. 5 Nov. f. 11 22 Feb. 24 Feb. 32 f. 1 11 Nov. 23 Nov. D.-N. 22 Not. m. 4 22 Feb. 24 Feb. f. 2 25 Nov. 25 Nov. 8 f. 2 21 Jan. 30 Jan. 33 m. 2 9 Jan. 11 Jan. f. 7/12 24 Jan. 30 Jan. m. 4 16 July 21 July A second famil 9 f. 6 24 Jan. 30 Jan. 34 m. 13 6 Aug. 23 Aug. f. 3 26 Jan. 30 Jan. f 3 6 Aug. 23 Aug. 10 f. 5 31 Jan. 2 Feb. 35 f 11 13 Nov. 17 Nov. m. 4 4 Feb. 15 Feb. f 15 13 Nov. 17 Nov. f. 34 22 Feb. 27 Feb. 36 m. 9 18 Feb. 19 Feb. f. 7 6 Mar. 19 Mar. Second family Third family f.5 30 July 9 Aug. f. 1 6 April 1 May 37 m. 3 3 Mar. 3 Mar. 11 m. 9 23 Oct. 5 Nov. f. 4 26 Mar. d. p. f. 8 1 Nov. 5 Nov. m. 4 6 May d. p. f 10 1 Nov. 5 Nov. m. 4 19 June d. p. 12 m. 4 13 Jan. 18 Jan. Returned home 16 March. 38 m. 3 20 Sept. 25 Sept. Same patient. m. 3 28 Oct. 29 Oct. m. 3 2 A pril 9 April R. 39 f 11 1l Sept. 14 Oct. ..'."I 13 m. 5 15 Nov. 23 Nov. D.-N. 19 Nov. f. 12 15 Sept. 14 Oct. ...} m. 6 18 Nov. 23 Nov. 40 f. 11 18 June 24 J une ... \ f. 8 18 Nov. 23 Nov. f. 36 19 June 24 J une ... 1 m. 6 22 Nov. 22 Nov. Another family, 41 f. 8 4 Aug. 9 Aug. ..."] 14 m. 6 29 May 12 June m. 4 7 Aug. 9 Aug. ... J- f. 4 4 J une 12 June f. 2 8 Aug. 9 Aug. ...J f. 1 8 June 12 June 42 m. 14 3 June 5 June ... 15 f. 15 8 Aug. 10 Aug. m. 14 9 June 10 June ... f. 6 11 Aug. 13 Aug. 43 f 4 13 July 26 July ... 16 f. 5 20 June 24 June Home again 15 Oct. f. 29 20 July (?) 26 July 44 m. 14 28 April 5 May m. 1 19 Oct. 21 Oct R. f.. 1 5 May 8 May 17 f. 1 3 Mar. Certified not diphtheria. 45 f . 2 19 Jan. 22 Jan. ...) f 10/12 2 Aug. 13 Aug. Another family. f. 4 20 Jan. 22 Jan. ... ) 18 m. 2 29 May 1 June 46 m. 1 14 Nov. 9 Dec. f. 29 1 J une 4 June f. 9 24 Dec. Jan., '98 19 f. 2 7 Dec. 12 Dec. 47 f. 7 2 July 5 July m. 6 13 Dec. 14 Dec. f. 3 23 July 26 July 20 f. 3* 30 Juine 5 July R. 48 f. 10 19 April 80 April ... f. 5 6 July 7 July R. f. 2 8 May 10 May 21 m. 3 1 Dec. 6 Dec. f. 3 11 May 3 June ... A second famil_ D.-N. 23 July. m. 5 7 Dec. 9 Dec. 49 f. 7 21 July 24 J uly 22 m 1 5 July 24 J uly f 5 30 July 2 Aug. m 27 14 July 24 July 50 f. 5 1 July 5 J uly ,., 23 f. 3 19 Jan. 11 Feb. m. 11 14 July 16 July ... f. 12 27 Jan. 11 Feb. 51 f. 2 17 Sept 23 Sept. ... 24 m. 11 27 Nov. d p. m. 6 27 Sept 28 Sept. ... f. 7 23 Dec. 24 Dec. f. 1 10 Oct. 10 Oct. ... 25 f. 16 16 Oct. 23 Nov. 52 m. 4 15 July 16 July f. 12 17 Oct. 23 Nov. f. 1 19 July 20 July 26 f. 4 9 Aug. 27 Aug. 53 m. 3 6 July 20 July ... ) f. 10 20 Sept. 6 Oct. f. 4 13 July 20 J uly ... J m. 13 21 Sept. 6 Oct. 54 m. 11 25 May 28 May ... 1 27 m. 5 ? 6 Oct m. 1 23 May 28 May ... / f. 33 28 Nov. 22 Dec. m. 1 3 Dec. 22 Dec. Came home, after treatment for Scarlet JJever, 28th June. NOTES.—" D " indicates Death, and " N " Notification, thus " D. N. 15 April" means patient's case was notified on 15th April, and that death took place on the same day. 115 As the conditions under which bacteriological investigations touching methods of disinfection are carried on in the laboratory differ so greatly from those attending the every-day use of such methods, it has been thought preferable to consider the matter on the basis of statistical results obtained from the year's work. Unfortunately whilst the published results of the laboratory investigations are voluminous (and many contradictory), the only known communication based on statistics is that of Dr. Kenwood, of which mention has already been made. On this occasion no comparison can be made with the results of other methods, but should any fresh information be obtained from other sources the same will be communicated to the Committee. It may be mentioned that whilst this Report was in preparation, formaldehyde, both as gas and as spray, has been adopted by the Department to be used alternately with sulphur, and the results will be carefully noted. It seems reasonable to conclude that the results of disinfection by sulphur during 1897 were satisfactory, although it is desirable that the margin of 3'0 per cent. of breakdowns should be eliminated. 116 Appendix C. RETURN CASES, 1897— No. First Patients. Hospital. Subsequent Cases. Interval (days). Initials. Sex Age. Removed to. Discharged from. Initials. Sex Age. Date of Sickening. 1 J. P. f., 7 Nov. 18, '96 Dec. 31, '96 C. P. m. 4 Jan. 4, '97 4 7 or 8 w. s. m. 2 Jan. 7 2 T. W. m. 8 Dec. 2, '96 Jan. 20, '97 A. w. f. 6 Feb. 1 19 or 12 W. W. m. 4 Jan. 13, '97 3 A. S. m. 7 Dec. 3, '96. Feb. 3, '97 C. S f. 8 Feb. 9 6 11 or 5 L. S. f. 34 Feb. 14 4 L. W f. 9 Feb. 5. April 24 D. W. m. 2 April 27 3 5 T. H. m 5 April 6 June 11 W. H. f. 2 June 14 3 6 W. H f. 2 June 18 Sept. 4 M. H. f 4 Sept. 13 9 7 G. A. m. 4 June 23 Aug. 4 D. P. f. 2 Aug. 26 22 8 A. R. f. 11 July 9 Aug. 25 E. R. f. 8 Sept. 4 10 9 M. D f. 11 June 15 Aug. 21 L. D m. 5 Sept. 11 21 10 D. O f. 3 July 28 Sept. 15 H. W. f. 1 Sept. 19 4 7 or 3 L. G. f. 8 Sept. 22 11 J. C. m. 8 July 12 Sept. 14 W. H. m. 19 Sept. 25 11 13 or 12 J. C. m. 43 Sept 27 12 A.E.s. m. 7 Aug. 3 Oct. 7 E S. f. 5 Oct. 10 3 13 E. P f. 6 Aug. 17 Oct. 8 N. P. f. 7 Oct. 16 8 14 P. C. m. 4 May 29 Oct. 21 J. C. f. 2 Oct. 27 6 10 or 14 E. C. f. 1 Oct. 31 117 SCARLET FEVER. Notes. J.P., seen Jan. '98, presented no abnormal symptoms. Efficiency of disinfection suspected room full of odds and ends. T.W. & W.W., seen Feb. 4th. T.W. desquamation on soles of feet; reported to have had scurf about ears; slept with A.W. after his return from Hospital Mother of A.S. had sore throat about Feb. 12th. A.S, seen Feb. 10th. History of discharging sore on wrist; nasal catarrh; enlarged glands; unhealthy throat; probably albuminuria; had been kept apart from Feb. 3rd to Feb. 6th. L.W., seen May 1st. Apparently well except for cold. Skin rough, not desquamating. History of foul linen sent home, disinfected, not washed. M.H. (f., 4), sickened with Diphtheria June 14th. T.H., seen June 19th. Mucous discharge from nose; cracked nostrils; nasopharyngeal catarrh; enlarged glands of neck. W.H., seen Sept. 16. Only noted some scurf in head and cracks behind ears. (Same family as Case 5, but in another house.) C.A. (m. 1), removed with Diphtheria Aug. 2nd, came home Aug. 9th. No school attendance. G.A., not seen.* A.R., not seen.* M.D., not seen.* D.G., seen Sept. 24th. No cause assignable. J.C., junr., at home Sept. 14th to 20th, then to Country. M.O.H. called to see him Sept. 26th. A.E.S., seen Oct. 13th Nasal discharge; cracked nostrils; enlarged tonsils; congested throat; probably adenoid growths in pharynx. E.D. seen Oct. 20th. Nasal discharge; cracked nostrils; dryness and roughness of skm. ??? attending school. P.C. seen Nov. 2nd. Purulent nasal discharge; cracked nostrils; throat apparently normal. Has been kept quarantined from Oct. 2nd to 24th. Special Bath Oct. 23rd. No School attended for over six months. Fresh home since first case. * Occurred during vacation. 118 Appendix D. tabulated list of food and drugs analysed During the Year ending March 31st, 1898. Article analysed. Total number. Number adulterated. Percentage adulterated. Milk 193 11 5.7 Butter 56 8 14.3 Coffee 24 2 8.3 Bread and Flour 12 0 0 Spirits 12 0 0 Sweets 12 0 0 Lard 9 0 0 Cheese 6 0 0 Oatmeal 6 0 0 Lemon Squash 6 0 0 Glycerine 6 0 0 Cocoa 5 0 0 Pepper 5 0 0 Mustard 4 0 0 Arrowroot 3 0 0 Tapioca 3 0 0 Bice 2 0 0 Potted Meat 2 0 0 Condensed Milk 1 0 0 367 21 5.7 Total of Fines imposed £26 0 0 „ „ Costs „ £13 10 0 Average of Fines imposed £1 4 9 „ „ Costs „ 12 10 ALF. W. STOKES, F.C.S., F.I.C., (Public Analyst.) 8 Laboratory, Vestry Hall, Paddington Green, W.