~\ i THE VESTRY OF THE Parish of Saint George, HANOVER SQUARE. Medical Officer's Report FOR The Year ended 25th March, 1891. JUNE, 1891. London PRINTED BY HAMILTON BROS., BUCKINGHAM PALACE ROAD, LONDON, S.W. 1891. REPORT THE SANITARY CONDITION of the Parish of Saint George, Hanover Square, FOR THE YEAR, 1890. BY W. H. CORFIELD, M.A., M.D. (OXON), F.R.C.P. (LOND.) Professor of Hygiene and Public Health in University College, London; Past President of the Society of Medical Officers of Health; Honorary Corresponding Member of the Royal Society of Public Health of Belgium; of the Imperial Society of Medicine of Constantinople; of the Royal Society of Hygiene of Italy ; and of the Society of Hygiene of France. medical officer of health, (BEING HIS NINETEENTH ANNUAL REPORT) To the Destun of the Parish of St. George HANOVER SQUARE. My Lords and Gentlemen, The total number of deaths registered in the Parish during the 53 weeks ending January 3rd, 1891, was 1986, a larger number than any registered in the Parish during the preceding ten years, and 124 more than the annual average during those ten years. Of these deaths 997 occurred in Public Institutions in the Parish, whereas . the deaths of our Parishioners in Public Institutions in the Metropolis and those in the extra Metropolitan Asylums only amounted to 340, so that the total of deaths of our Parishioners (corrected for 52 weeks) was only 1304, or 146 less than the average during the preceding 10 years, I and equivalent to a corrected death-rate of only 14.56 per 2 thousand per annum, which is nearly 2½ per thousand per annum lower than the average annual death-rate during the preceding 10 years. The decennial census of the population was taken on Sunday, April 5th, 1891, and I considered it necessary to make the following observations with regard to it in my monthly Report for June, 1891. The Census population of the Parish in 1871 was 89,758, and that in 1881 was 89,573 i I have no reason to believe that there was any serious inaccuracy in either of these enumerations, so that the population of the Parish was practically stationary during the ten years from 1871 to 1881. The enumerated population in 1891 was only 78,362, showing an apparent decrease of 11,211 (or one eight of the population) since 1881. I know of no reason whatever for any such decrease, and I do not believe it has taken place. The Census was taken of the persons sleeping in the Parish on the night of Sunday, April 5th, a day which had two serious disadvantages, the first being that it was a Sunday, a day on which many people in this Parish are out of town, and the second that it was the Sunday after Easter, and that large numbers of people had not returned to town from their Easter Holidays. I therefore consider that the enumeration of the population of the Parish this year is of no value for statistical purposes, and in estimating the birth-rates and death-rates, shall continue to use the Census population of 1881, until a fresh and more correct enumeration shall have been made, which will, I hope,be in 1896. I should add that I think the beginning of April, (provided it is not too near Easter, and that a I Saturday or Sunday is not selected), is a very fair time for I the enumeration to take place, so far as St. George's, I Hanover Square is concerned, as the Parish is then neither I too full of people nor too empty. 3 Table I. year. Gross Total of Deaths Deaths in Public Institutions Proportional Share of Deaths in Public Institutions Corrected Total of Deaths (52 weeks) Corrected Death-rate per 1,000 per annum (52 weeks) 1880 1,855 713 347 1,489 16.64 1881 1,932 812 394 1,514 16.91 1882 1,867 730 361 1,498 16.73 1883 1,845 829 390 1.406 15.70 1881 (53 weeks) 1,873 769 384 1.460 16.30 1885 1.773 766 *436 1,443 16.11 1886 1.900 797 *435 1,538 17.17 1887 1.727 762 *473 1,438 16.05 1888 1.817 861 *482 1.438 16.05 1889 1,664 756 *363 1,271 14.19 Average during ten years, 1880-1889 1,823 780 407 1.450 16.19 1890 (53 weeks) 1,986 997 *340 1,304 14-56 Average during ten years. 1881-1890. 1,838 836 405 1,425 1516 •Actual Numbers (not calculated as in former years.) Deaths of Parishioners in Public Institutions. Mayfair Belgravia SubDistrict not stated Total Fulham Road Workhouse 1 3 1 5 St. George's Union Workhouse 17 97 11 125 St. George's Hospital 13 62 1 76 Belgrave Children's ditto — 5 - 5 St. Gabriel's ditto - 7 - 7 Other Places in the Parish — 1 — 1 Total in the Parish 31 175 13 219 In Public Institutions in London, outside of the Parish 19 84 1 104 In Extra Metropolitan Asylums (up to August 9th, after which date they are included in the deaths in Public Institutions outside the Parish) ... ... ... 17 340 4 Table Ia. Death-rates per 1,000 per annum. 1881 1882 1883 1884 1885 1886 1887 1888 1889 1890 28 large English Towns *21.7 22.3 21.6 21.6 20.6 20.9 20.8 19.2 19.3 21.3 London 21.2 21.4 20.4 20.4 19.8 19.9 19.6 18.5 17.4 20.3 St. George's Hanover sq. 16.91 16.73 15.70 16.30 16.11 17.17 16.05 16.05 14.19 14.56 *Twenty towns. From Table Ia we see that the death-rate of London proper amounted to 20.3, and was higher than in any year since 1884, and almost 3 per thousand higher than in 1889. The death-rate of greater London with a population of 5,758,500, was (for 53 weeks) 19.4, or almost 3 per thousand higher than the preceding year, and nearly 5 per thousand higher than the death-rate of this parish. The death-rate of the 28 largest English towns was 21.3 for 53 weeks, or 2 per thousand higher than it was in 1889. As usual the death-rate of this Parish was lower than that of any one of the 28 largest English towns, the nearest to it being— Nottingham 16.5 Brighton 17.8 Leicester 17.9 Derby 18.5 Huddersfield 19.0 Bristol 19.2 Hull 19.2 Portsmouth 19.6 Birkenhead 19.7 and the highest being— Sheffield 24.9 Bolton 25.8 Newcastle 25.9 Preston 27.4 Manchester 30.6 5 The death-rate of Edinburgh was 20.0 (or 2 per thousand higher than in 1889), that of Glasgow 25.3, and that of Dublin 26.4, the two latter being higher than in 1889. As usual the lowest death-rates in foreign cities are much higher than the death-rate of this Parish, the nearest to it being those of— St. Louis 18.7 Stockholm 19.6 Philadelphia 20.5 Christiania 21.1 and the highest being- Budapest 31.4 Alexandria 39.6 Moscow 40.3 Madras 42.9 Cairo 44.8 Table II. YEAR. Registered Births. Birth-rate per l,000 per ann. (52 weeks). DKATHS OF CHILDREN UDER 1 YEAR. Total (uncorrected). Percentage to Registered Births, Percentage to Total Deaths (uncorrected.) 1879 (53 weeks) 2.168 23.26 298 13.75 14.48 1880 2,140 23.91 310 14.49 16.71 1881 2,092 23.36 280 13.38 14.49 1882 1,935 21.61 271 14.01 14.52 1883 1,878 20.97 287 15.28 15.56 1884 (53 weeks) 1,933 21.18 259 13.40 13.83 1885 1,767 19.73 219 12.39 12.35 1886 1,761 19.66 269 15.28 14.16 1887 1,749 19.53 275 15.72 15.92 1888 1,679 18.74 236 14.05 12.98 1889 1,670 18.64 234 14.01 14.06 1890 (53 weeks) 1,596 17.49 267 16.73 13.44 6 From Table II. we see that the number of births in the Parish still decreases, and that the birth-rate (corrected for 52 weeks) was only 17.49 per thousand per annum, being the lowest yet recorded. The birth-rate for London proper was 29.1, also the lowest yet recorded, that of greater London being 29.5, and that of the outer ring 30.9 (all for 53 weeks). The average birth-rate of the 28 largest English Towns was 30, or 1 per thousand lower than that of 1889, the highest being those of Sunderland, 35.5; Preston, 36.7 , Cardiff, 38.7; and Newcastle, 39.8; and the lowest those of Bradford, 25.6 : Nottingham, 24.9; Brighton, 23.2 ; and Huddersfield, 22.6. The number of deaths of children under one year of age registered in the Parish was 267 in the 53 weeks ; the percentage of such deaths to registered births was 16.41 (which is the highest percentage yet recorded), and to total deaths 13.44; thus the mortality of children under one year of age was 164 to a thousand births, or 24 more than in 1889, while in London generally it was 163; and the average for the 28 largest English Towns was 172, the highest being Liverpool, Sheffield, and Leicester with 195 each, Salford with 199, and Preston with 241 deaths of children under one year of age to a thousand births. The number of deaths of children (of Parishioners) was 251, or 15.73 percent of the registered births, and 19.15 per cent, of the corrected deaths. 7 Table III. year. A. Persons aged sixty years and upwards B. Violence. C. Inquest Cases. D. Uncertified Percentages to Gross Total of Deaths. a. B. C. D. 1879 625 89 120 - 30.37 4.32 5.8 - 1880 531 97 126 — 28.63 5.23 6.8 — 1881 582 107 129 31 30.12 5.54 6.7 1.60 1882 525 80 102 29 28.12 4.29 5.5 1.55 1883 537 93 126 27 29.11 5.05 6.8 1.46 1884 543 106 132 31 28.99 5.66 7.0 1.66 1885 557 79 106 22 31.42 4.46 6.0 1.25 1886 604 79 135 41 31.79 4.16 7.1 2.15 1887 521 88 122 20 30.17 5 09 7.0 1.15 1888 541 90 124 22 29.77 4.95 6.8 1.21 1889 523 77 116 30 31.43 4.63 7.0 1.80 1890 650 94 130 22 32.73 4.73 6.5 1.10 London 1890 21,885 3,088 6,631 821 23.99 3.38 7.3 0.9 From Table III. it appears that there were 650 registered deaths of persons aged 60 years and upwards, giving a percentage of 32.73 of the gross total of deaths, as against a percentage for London generally of only 23.99. There were, however, (see Table IIIa) only 404 deaths of Parishioners of 60 years and upwards, giving a percentage of 30.82 of the corrected total of deaths, or a proportion of only 45.1 to a thousand persons living, as against 77.5 in London generally and 81.8 in the 28 largest English Towns, the lowest being Norwich, 71.5, Leicester, 69.7, and Brighton, 61.4; and the highest, Blackburn, 103.0, Bolton, 110.9, and Manchester, 121.9. From this Table we also see that 94 Violent Deaths were registered in the Parish, being 4.7 per cent. of the total deaths, but of the 94 deaths registered under this heading, only 33 were those of Parishioners (see Table IIIa), giving a per-centage of only 2.5 of the corrected total of deaths, which is nearly 1 per cent. below that of London generally. 1 his 8 shows the importance of reckoning only the deaths of Parishioners under this heading, which I am now able to do. The Inquest cases held in the Parish numbered 130, or more than in either of the three preceding years. They were equivalent to 6.5 per cent. of the gross total deaths as against 7.3 in London generally. The number of deaths uncertified as to cause was 22, or 8 less than in 1889, and equivalent to 1.1 per cent. of the gross total of deaths, as against only 0.9 per cent. in London generally. Table IIIa. Non-Parishioners excluded. Year. a Persons aged sixty years and upwards. Violence. Percentages to corrected Total of Deaths. a b 1890 404 33 30.82 2.5 9 Table IV. SUB-DISTRICT. Population at middle of 1890. Births. (53 weeks). Birth-rate (52 weeks). Total Deaths (53 weeks). Deaths of Parishioners (53 weeks). Deaths (corrected) (52 weeks). Death-rate (corrected). Hanover Square Mayfair Mayfair 30,353 308 9..95 717 278 283 9.32 Belgravia 59,220 1,288 21.34 1,269 1,019 1,021 17.24 Sub-district not stated 15 Whole Parish 89,573 1,596 17.49 1,986 1,312 1,304 14.56 There were also 17 deaths of Parishioners in extra Metropolitan Asylums, which (with those of which the Sub-district was not stated), I have distributed to the Sub-districts in proportion to population. Table IVa. Hanover Sq. Mayfair birth-rates. death-rates. 1880. 1881. 1882. 1883. 1884. 1885. 1886. 1887. 1888. 1889. 1890. 1880. 1881. 1882. 1883. 1884. 1885. 1886. 1887. 1888. 1889. 1890. 19.45 20.84 17.85 19.12 17.26 l6.83 17.08 16.61 16.46 15.20 15.36 14.16 14.00 14.45 113.67 13.74 11.83 9.95 16.90 12.39 17.44 11.79 15.84 11.87 14.65 11.34 15.54 12.44 15.18 11.19 15.42 11.49 12.75 13.47 12.09 9.32 Belgravia 25.87 25.89 23.3 23.07 23.87 22.24 22.46 22.53 21.31 2214 21.34 17.53 17.92 18.09 16.99 17.40 17.49 18.79 17.75 17.38 15.27 17.24 Whole Parish 23.91 23.36 21.61 20.97 21.18 19.73 19.66 19.53 18.74 18.64 17.49 16.64 16.91 16.73 15.70 16.30 16.11 17.17 16.05 16.05 14.19 14.56 11 From Table IV it appears that the birth-rate (corrected for 52 weeks) of the Mayfair Sub-district was only 9.95, as against 11.83 in 1889, while that of the Belgravia Subdistrict was 21.34, as against 22.14 in 1889; and that the corrected death-rate of the Mayfair Sub-district was only 9.32, as against 12.09 in 1889, and that of the Belgravia Sub-district 17.24, as against 15.27 in 1889 and 17.38 in 1888, the death-rate of the Mayfair Sub-district being, as shewn in Table IVa, the lowest yet recorded, while the death-rate of the Belgravia Sub-district was lower than in any year since 1879, with the exception of the years 1883 and 1889. From the birth and death rates in Table IVa I have calculated, as usual, "the mean length of life." I use the term "mean length of life" instead of "mean duration of life" (as I explained in my last Annual Report) in order to prevent confusion, as the term " mean duration of life" is a technical expression, which means the length of life as calculated by the life-table method. The "mean length of life " stated in this report is calculated by means of Dr. Bristowe's formula. Mean Length of Life. Mayfair Sub-District 104.15 Belgravia 52.35 Whole Parish - 62.67 The extraordinary figure calculated for the Mayfair Subdistrict is due to the abnormally low birth-rate (9.95) and this is caused partly by the fact that there are a very large number of unmarried domestic servants, and partly because so many of the children of the inhabitants are born in the country. The calculated mean length of life in this Parish during the last 16 years has been as follows:— 12 In 1875 it was 46.67 years. „ 1876 „ 47.96 „ „ 1877 " 49.52 „ „ 1878 „ 48.03 „ „ 1879 „ 48.55 „ „ 1880 „ 58.01 „ „ 1881 „ 50.26 „ „ 1882 „ 52.56 „ „ 1883 „ 55.09 „ „ 1884 „ 53.78 „ „ 1885 „ 56.11 „ „ 1886 „ 54.46 „ „ 1887 „ 56.49 „ „ 1888 „ 57.71 „ „ 1889 „ 61.43 „ „ 1890 „ 62.67 " So that the mean length of life in this Parish during those 16 years has averaged nearly 54 years. The mean length of life in London during the last 13 years has been, according to my calculation, as follows:In 1878 it was 34 -24 years „ 1870 „ 34.23 " „ 1880 „ 35.17 „ „ 1881 „ 35.87 „ „ 1882 „ 36.82 „ „ 1883 „ 37.88 „ „ 1884 „ 38.08 „ „ 1885 „ 39.29 „ „ 1886 „ 39.31 „ „ 1887 „ 39.98 „ „ 1888 „ 41.77 „ „ 1889 „ 43.27 „ „ 1890 „ 41.10 „ It will thus be seen that the calculated mean length of life in this Parish was higher than in any previous years, while that of London generally was lower than it was in either 1888 or 1889, but higher than in any year before 1888, 13 Table V. Showing the number of deaths registered in the Parish in each of the ten years, 1880 to 1889, from the principal infectious Diseases and Diarrhœa, and the number in 1890. DISEASE. 1880. 1881. 1882. 1883. 1884. 1885. 1886. 1887. 1888. 1889. Annual Average of ten years, 1880-1889 Proportion of Deaths to 1,000 Deaths in ten years. 1880-1889. 1890. Proportion of Deaths to 1,000 Deaths in 1890. Small-pox 0 9 1 0 2 2 0 0 0 0 1.4 0.8 0 0 Measles 16 21 30 13 40 21 20 30 12 49 25.2 13.8 49 24.6 Scarlet Fever 40 18 13 11 7 10 2 16 8 1 12.6 6.9 1 0.5 Diphtheria 18 14 15 27 25 35 32 22 52 36 27.6 15.1 29 14.6 Whooping Cough 50 15 63 21 43 19 40 23 28 31 33.3 18.2 48 23.6 Typhus Fever 1 3 0 0 1 0 0 0 0 0 0.5 0.3 0 0 Enteric (Typhoid) Fever 15 20 21 21 22 8 12 15 5 18 15.7 8.2 12 6.0 Simple Continued Fever 2 1 0 8 1 2 1 2 1 1 1.9 10 2 1.0 Diarrhœa 39 33 34 27 44 37 45 58 27 31 37.5 20.5 29 14.6 Cholera 1 2 2 1 0 2 1 0 0 0 0.9 0.5 1 0.5 Total 182 136 179 129 185 136 153 166 133 167 156.6 85.3 171 849 14 From Table V it will be seen that the total number of deaths from infectious diseases and diarrhœa (viz. 171), is somewhat higher than the average of the previous 10 years, this being due to an excess of deaths from Measles and Whooping Cough, the deaths from the other infectious diseases being in every case (with the exception of Diphtheria, which is slightly above the average), below the average of the previous 10 years. The 171 deaths from these diseases is equivalent to a zymotic death-rate of 1.88, as against 1.86 in 1889, the rate for London being 2.73, and that for the 28 largest English towns 2.77. If, however, we only consider the deaths of our Parishioners from the principal zymotic diseases, they amount (as will be seen from Tables Va and Vb,) to only 143, equivalent to a zymotic death-rate of only 1.6. The only towns with a lower zymotic death-rate than this are Huddersfield, 1.19; Halifax, 1.37; and Nottingham, 1.58. The highest zymotic death-rates in the country are furnished by Salford, with 3.84; Manchester, 4.01; and Preston, 4.28. These rates are much lower than the highest rates for 1889, in which year the zymotic death-rate of Preston was as high as 7.70. Table Va. Deaths of Parishioners from the principal Infectious Diseases in the May-fair Sub-district. Disease.  Small Pox 0 Measles 10 Scarlet Fever 0 Diphtheria 0 Whooping Cough 8 15 Typhus Fever 0 Enterie (or Typhoid) Fever 1 Simple continued Fever 0 Diarrhoea 3 Cholera 0 Total 22 Table Vb. Deaths of Parishioners from the principal Infectious Diseases in the Belgravia Sub-District. Disease. 1890. Small Pox 0 Measles 35 Scarlet Fever 2 Diphtheria 12 Whooping Cough 40 Typhus Fever 0 Enteric (or Typhoid) Fever 4 Simple continued Fever 2 Diarrhoea 26 Cholera 0 Total 121 There were also 8 deaths from Influenza. Taking these diseases separately according to the order in which they are placed in Table V., we find that:— Small-Pox: caused no death in the Parish, and no deaths of our Parishioners in Public Institutions outside of the Parish. Measles: no less than 49 deaths, exactly the same number as that recorded in 1889, and nearly twice the 16 average number of the previous 10 years, were registered in the Parish during 1890; 4 of these, however, were deaths of Non-Parishioners. Scarlet Fever: only one death from this disease was registered in the Parish during the year, and that was one of a Non-Parishioner. There were, however, 2 deaths of our Parishioners from this disease in Public Institutions outside the Parish. Diphtheria: 29 deaths were registered in the parish from this disease, being 7 less than in 1889, and only a little above the annual average for the previous 10 years. Among the 29 deaths registered in the Parish, there were however, no less than 20 deaths of Non-Parishioners, leaving only 9 deaths of Parishioners from this disease. On the other hand there were 3 deaths from Diphtheria of Parishioners in Public Institutions outside the Parish. One death was also registered as from "Membranous Croup," and another from "Ulceration of throat, Diphtheroid." I must remark that Diphtheria is still exceedingly prevalent in London, and seems to be taking a hold of London and some of our great towns, as mentioned in my last two reports, for reasons that have not yet been explained. Thus in the 28 largest English towns, including London, the diphtheria death-rate in 1890, was one third as high again as the death-rate for the previous 10 years, including of course the year 1889, when the rate was no less than half as high again as the rate for the previous 10 years. In Norwich it was twice as high, in Sheffield more than twice, in Newcastle 2½ times, in Manchester more than 2½ times, in Derby nearly 4 times, in Blackburn 4 times, and in Salford more than 4½ times, as high as in the previous 10 years. The increase was not so great in London, where it 17 was only half as high again as in the previous 10 years. The Towns that have shewn a notable decrease in their deathrates from this disease, are Portsmouth, Bristol, Wolverhampton, Nottingham, Oldham, Huddersfield and Cardiff. Whooping Cough: no less than 47 deaths were registered as against 31 in 1888, and an average of 33.3 during the previous 10 years. Typhus Fever was not, so far as I am aware, present in the parish during the year, and only one death from it has been recorded in the Parish since 1881. Enteric (or Typhoid) Fever: 12 deaths were registered, or 6 less than in 1889, and nearly 4 less than the corrected average for the previous 10 years. Of these 12 deaths, however, 9 were those of Non-Parishioners in St. George's Hospital, leaving only 3 deaths of Parishioners. On the other hand two of our Parishioners died of this disease in public institutions outside the Parish, making 5 parishioners altogether. Simple Continued Fever: two deaths were registered from this disease. There was, however, also a death of an infant from "Infantile Remittent Fever." Diarrhoea: 29 deaths were registered, being 2 less than in 1889, and against an average of 37.5 during the previous 10 years. They were all deaths of Parishioners. I may note that the temperature of the autumn quarter was 40.8, was no less than 2.9 degrees below the average of the previous 119 years, and no less than 3.6 degrees below the average of the previous 49 years, and that the temperature of the summer quarter 59.4 was slightly below the average. The mean temperature of the year was 48.6 degrees, being the same as the average of 119 years, but 0.7 below the average of the previous 49 years. 18 One death from English Cholera was registered (under the name of Cholerine). Influenza: no less than 27 deaths were registered in the Parish from this disease, and of these, 25 were those of persons over 20 years of age, and 7 of them over 60. The large number of deaths from diseases of the lungs is no doubt attributable to a certain extent, to the results of attacks of this disease. Upon this point the Registrar General remarks as follows:— "The increased mortality from discases of the respiratory system was most remarkable. In 1889, as shewn in the Annual Summary for that year, there had been a saving under this heading of 4,376 lives, when the years mortality was compared with the average of the previous decennium; but in 1890, this saving was transformed into a loss of 2,143 lives. This striking change was entirely due to the enormous mortality from Lung diseases, in the first and the last months of the year. In January, there was a sharp, though not very lengthy, outbreak of Influenza, and though the deaths" directly ascribed to this epidemic influence, only numbered 303 in the month, and were not classified among diseases of the respiratory organs, but separately in the zymotic class, there can be 110 doubt that the much larger excess of deaths concomitantly attributed to respiratory diseases were, in reality, cases of Influenza. For, in the first place, the enormous and sudden increase in these deaths occurred at a time when the ordinary cause of increased mortality from lung diseases, namely, severe cold, was conspicuously absent, the mean temperature in January having, in fact, been no less than 70. I. Fahr. above the average for that month. Secondly, the usual winter rise in the mortality from Lung diseases takes place under the heading Bronchitis, in a much greater degree than under the 19 heading Pneumonia; whereas, the reverse was the case in the first month in 1890, for, while the mortality under Bronchitis only rose 64 per cent. above the January average, the mortality under Pneumonia rose 97 per cent. And thirdly, while the ordinary rise of mortality in cold seasons is mainly among the very aged, the increased mortality in this fatal month was mainly among persons between 20 and 60.'' "The excessive mortality, then, from Lung diseases in the first month of 18 go, was due to the same cause as were the deaths ascribed to Influenza. The excess in the last month of the year, 011 the other hand, which, though not so great as the earlier excess had been, was nevertheless sufficiently formidable, inasmuch as the mortality from Lung diseases was 44 per cent. above the average for the ten previous Decembers, was doubtlessly in the main due to the usual cause of such excess, namely, prolonged cold, the mean temperature in the month having been 90. 3 Fahr. below the December average, and accompanied moreover by a succession of dense fogs; and accordingly the excess was no longer higher under Pneumonia than under Bronchitis as had been the case in January, but in almost equal proportions under the two headings ; the death-rate from the former having been 48, and from the latter 47 per cent. above the December average. Even in this month, however, a comparison of the figures just given with those in Table C., will show that Pneumonia increased as compared with Bronchitis, in far more than the usual winter or cold season proportion ; and this fact suggests the suspicion that even in last December there was some unhealthy influence at work beyond ordinary cold weather." " The effects then of the epidemic influence in January 1890, must not be measured simply by the number of deaths ascribed to Influenza. The excess of mortality 20 from Lung diseases in that month at least must also be included in the account; and there is much reason to suspect that a very large number of deaths under other headings should also be similarly included; inasmuch as otherwise inexplicable rises occurred under them Thus the mortality from Phthisis suddenly shot up in the first week of January, and remained far above the average for ten weeks in succession, although the death-rate from this disease in London had been declining for years past, and was below the average in almost every week of 1890, excepting these first ten. A similarly sudden increase occurred among deaths from diseases of the organs of circulation, which during the month of January were as much as 55 per cent. above the usual January average, and although it is true that the mortality from this group of diseases has long been increasing, the suddenness and the extent of the increase in January was far in excess of this gradual rise. In short it would probably not be far from the truth if the whole increase of mortality from all causes in the aggregate during the mild month of January were attributed to Influenza ; in which case that disease would have to be credited with having caused 2,258 deaths in London, in the first four weeks of the year alone." Notification of cases of Infectious Diseases. The following Table shows the number of cases viz:— 294, certified under this heading from January 1st to December 31st 1890. Table Vc. Name of Disease. No. of cases certified, Scarlet Fever 145 Enteric Fever 40 Continued Fever 5 21 Diphtheria 64 Erysipelas 37 Membranous Croup 1 Total 292 Two other cases of Scarlet Fever were notified by householders and one by the Metropolitan Asylum Board, but were not certified by Medical Attendants. The Act continues to work quite satisfactorily and none of the friction that was foretold by its opponents has occured. As I said last year I was from the first opposed to the principle of "dual notification" as it is called, that is to say, of notification by the householder, as well as certification by the medical attendant, as I consider that an unnecessary complication was thereby introduced, and the event has justified my anticipation, for, as a matter of fact, the Act is now made effective entirely through the certificates given by the medical attendants, as we scarcely ever receive any notifications from householders, nor do we want them. So far from cases being concealed owing to the operation of the Act, we hear of numbers of cases that we should not have heard of if it were not for the operation of the Act. Sanitary Legislation. The following important Acts relating to Sanitary matters were passed during the year 1890. "The Customs and Inland Revenue Act," by Section 26, of which Medical Officers of Health are required to furnish certificates to the owners of Artizan's Dwellings, if the rents do not exceed 7s. 6d. per week, and if each dwelling is so constructed as to afford suitable accommodation for each of the families 22 or persons inhabiting it, and that due provision is made for their sanitary requirements. This Act has been since amended, so as to make the maximum rental of each dwelling, £20 per annum, instead of 7s. 6d. per week. Where such certificate is granted, the Assessment of such a dwelling to inhabited house duty, is to be discharged by the Commissioners of the Inland Revenue. The "Housing of the Working Classes Act," which gives extensive powers for dealing with unhealthy Areas, with Insanitary buildings, and with buildings which obstruct the free access of light and air to other buildings, (compensation to the owners being provided for) and the "Infectious Disease Prevention Act," which provides for the inspection of Dairies, giving power to prohibit the supply of Milk in certain cases, for the cleansing and disinfecting of premises, bedding, &c., for punishing persons who cease to occupy infected houses without disinfecting them or giving notice to the owners, or who give false answers to persons negociating for the hire of such houses, and for the disposal of the bodies of persons who have died of Infectious Diseases, and for the disinfection of Public Conveyances, &c., &c. Sanitary Work. For the year ending March 31.57, 1891. The following table has been compiled for me by Mr. Joseph Snook, your Senior Sanitary Inspector, from the Report Book:— Table VI. Various kinds of Complaints oj Nuisances, &c., from 1 si April, 1890, to 3lst March, 1891. Total number of Complaints 640 Notices served 189 23 Houses and premises limewhited 62 Houses disinfected after infectious diseases 161 Old brick drains abolished, and pipes substituted 31 New drains constructed 40 Drains unstopped and repaired 42 Drains trapped and ventilated, sinks disconnected, &c. 113 Closets supplied with water and repaired 44 Closets unstopped and repaired 41 New Closets provided 28 Roofs repaired 3 New dustbins provided 8 Dustbins renewed, repaired, new covers, &c. 30 New Cisterns provided 16 Cisterns repaired, new covers, &c. 18 Waste Pipes disconnected 36 Removal of animals improperly kept 0 Meat, Fish, &c., condemned (cases of) 2 Overcrowding abated 4 Cesspools abolished 12 Accumulation of dung, straw, &c., removed 33 Various nuisances removed 110 No cause for complaint 26 Legal proceedings taken 0 Cases could not assist 7 Cases referred to Surveyor 21 Cases referred to Police 2 Licensed Cow-houses 3 Licensed Slaughter-houses 5 Cases removed to Hospitals 111 Inspection of houses after cases of infectious diseases, 161, viz:— Small Pox ??? Scarlet Fever 75 24 Typhoid, and Simple continued Fever 36 Typhus Fever 0 Diphtheria 49 Puerperal Fever 1 Mr. Snook has also prepared the following Table showing the number of cases of these diseases removed to Hospital, and the number treated at home, during the twelve months ending March 31st, 1891. Description of Case. Removal to Hospital Treated at Home. Total Recovered Died Small Pox 0 0 0 0 Scarlet Fever 65 10 0 75 Enteric (Typhoid) Fever 15 13 7 35 Diptheria 31 5 13 49 Puerperal Fever 0 0 1 1 Continued Fever 0 0 1 1 Totals 111 28 22 161 The articles disinfected in the hot-air disinfecting chamber belonging to the Parish were as follows:— 61 Beds 141 Sheets 82 Mattresses 71 Bolsters 39 Palliasses 184 Pillows 116 Quilts 33 Dresses 231 Blankets 24 Shawls 10 Waistcoats 27 Coats 25 Trousers 46 Towels 46 Carpets 69 Cushions 26 Hearthrugs 31 Table Covers 42 Curtains 10 Rugs 16 Suits of Clothing and a quantity of Sundry Articles. 25 The total number of complaints attended to, and also that of notices served was considerably greater than in 1889; it Was not, however, necessary to take legal proceedings in any case to enforce compliance with the notices served, this being the strongest argument that could possibly be given to show that the notices were not served without good reason. The markets have been regularly inspected and kept in good order, so that it has been only necessary to condemn articles exposed for sale in two instances, viz:- One of Oranges and one of Cucumbers and Cauliflowers. The slaughter-houses and cowsheds have also been regularly inspected and kept in good condition. There are however, now, only five licensed slaughter-houses and three licensed cowsheds in the parish, the license of one of the four cowsheds mentioned in my last Report, not having been renewed. The bake-houses, which are now again placed under our Supervision, have been inspected twice during the year and found in a sufficiently satisfactory condition. The number of articles of clothing, etc., disinfected, has been rather more than it was in the previous year, owing to the increased number of cases reported in consequence of the Infectious Disease Notification Act. The following is the return of the number of bodies received in the Mortuary during the twelve months ending 31st March, 1891, as furnished to me by the Mortuary Keeper, Mr. Coles. Table VII. Return showing the number of bodies received into the Mortuary, EburD Bridge, from 1st April, 1890, to 31st March, 1891. Cause of Death. Number Post Mortems. Inquests. Deaths from Scarlet Fever 0 0 0 Ditto Diptheria 0 0 0 Found Drowned 8 8 8 Found Dead 15 14 14 Born Dead 1 1 1 Murder 0 0 0 Suicide 18 18 18 Deaths from Natural Causes 47 37 34 Deaths from Accident 20 20 20 Totals 109 98 95 26 Houses Let in Lodgings. There are now only 42 houses upon the Register, against 74 in 1888, as many of these houses have been pulled down and turned into workshops and so taken the list. They have all been inspected and the limewhiting and cleansing properly carried out. from April 1890, to March. 1890. Date of Collection April 21. May 23. June 25. July 24. Aug. 21. Sept. 30. Oct. 31. Nov. 29. Dec. 31. Jan. 30. Feb. 27. Mar. 20. Average. Grand Jnnction Co.'s Water. Total Solid Matters 36 22 28 30 32 36 24 38 38 30 36 38 32.3 a. Volatile 16 8 14 12 12 22 10 18 16 12 16 16 14.3 b. Fixed 20 14 14 18 20 14 14 20 22 18 20 22 18.0 Chlorine 1.8 1.8 1.8 1.8 1.8 1.8 1.8 1.8 1.8 1.8 1.8 1.8 1.8 Equivalent to Common Salt 2.96 2.96 2.96 2.96 2.96 2.96 2.96 2.96 2.96 2.96 2.96 2.96 2.96 Nitrogen as Nitrates 0.12 0.078 0.10 0.10 0.116 0.175 0.156 0.25 0.212 0.25 0.218 0.155 0.161 Saline Ammonia 3.0 2.2 1.5 1.6 1.4 2.2 0.8 2.2 4.8 14.6 0.8 1.4 3.0 Organic Ammonia 11.6 13.2 12.6 16.4 11.2 9.8 7.0 12.6 10.6 23.4 13.0 15.4 13.1 Chelsea Company's Water. Total Solid Matters 34 28 29 28 28 28 22 34 36 30 38 34 30.7 a. Volatile 16 12 15 8 10 14 12 16 12 8 14 12 12.4 b. Fixed 18 16 14 20 18 14 10 18 24 22 24 22 18.3 Chlorine 1.8 1.8 1.8 1.8 1.8 .1 1.8 1.8 1.8 1.8 1.8 1.8 1.8 1.8 Equivalent to Common Salt 2.96 2.96 2.96 2.96 2.96 2.96 2.96 2.96 2.96 2.96 2.96 2.96 2.96 Nitrogen as Nitrates 0.12 0.078 0.10 0.07 0.087 0.175 0.156 0.25 0.156 0.233 0.28 0.233 0.161 Saline Ammonia 2.4 2.2 1.5 0.8 0.8 2.0 0.8 0.8 1.6 4.6 0.8 0.8 1.6 Organic Ammonia 10.8 12.8 11.6 9.2 9.6 10.8 7.4 10.8 10.6 9.8 12.2 11.8 10.6 27 28 Table VIII. shows the results of the analyses of the water supplied to the Parish by the two companies during each of the twelve months. The average quality of the water supplied by the Chelsea Company was better than, but that supplied by the Grand junction Company not so good as, during the twelve months ending March, 1890. The average quality of the Chelsea Company's water was, as then, decidedly better than that of the Grand Junction Company's water. This is no doubt owing to the fact that the Chelsea Company has much larger storage reservoirs than the Grand lunction Company, and so need only take in water when the river is in a good condition. All the samples when seen through a depth of two feet were clear and had a slight greenish tint; they were all free from copper, lead, and iron. For the information of the Parishioners, I may mention that a hospital carriage for removing persons suffering from infectious diseases (including Diphtheria) is kept at the Workhouse in Wallis's Yard, Buckingham Palace Road, and that the Ambulance belonging to the Metropolitan Asylums Board is kept at Seagrave Road, Fulham; but those who are in a position to bear the expenses of their support should apply at the London Fever Hospital, Liverpool Road, Islington; (or, in case of small-pox, at the Highgate Small-pox Hospital), where they can be accommodated on favourable terms. I have the honour to be, My Lords and Gentlemen, Your obedient Servant, W. H. CORFIELD, M.A., M.D. (Oxon), F.R.C.P. (London). 19, Savile Row, London, W., June 1891, X.B The deaths of Non-Parishioners occuring in the public Institutions in the Parish are excluded; those of Parishioners in t h# Other public Institutions in London and in the Extra-Metropolitan Asylumsare included. Table IX Deaths of Parishioners of St. George, Hanover Square, during the 53 weeks ending Saturday, January 3rd, 1891. causes of death. mayfair. belgravia. All Ages Under 1. 1-5. 5-20 20-60. 60 & over. All Ages. Under 1 1-5. 5-20. 20-60. 10 & over. All causes 278 43 30 12 103 90 1019 207 132 51 333 296 Zyotic Small Pox ... ... ... ... ... ... ... ... ... ... ... ... Measles 10 2 7 1 ... ... 35 3 27 5 ... ... Searlet Fever ... ... ... ... ... ... 2 ... ... 2 ... ... TyPhus Fever ... ... ... ... ... ... ... ... ... ... ... ... Relapsing-Fever ... ... ... ... ... ... ... ... ... ... ... ... Influenza 8 1 ... ... 5 2 19 1 ... ... 13 5 Whooping Cough 8 2 5 1 ... ... 40 14 25 1 ... ... Diphtheria ... ... ... ... ... ... 12 ... 11 1 ... ... Simple Continued and III- ... ... ... ... ... ... ... ... ... ... ... ... defined Fever ... ... ... ... ... ... 2 ... 1 ... ... 1 Enteric Fever 1 ... ... ... 1 ... 4 ... ... 2 2 ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... Diarrhosa, Dysentery 3 2 1 ... ... ... 26 17 3 ... 2 4 Remittent Fever ... ... ... ... ... ... ... ... ... ... ... ... Hydrophobia ... ... ... ... ... ... 1 ... ... 1 ... ... Glanders ... ... ... ... ... ... ... ... ... ... ... ... Cowpox and Effects of Vac- ... ... ... ... ... ... ... ... ... ... ... ... Cination ... ... ... ... ... ... ... ... ... ... ... ... Ceneral Affections 1 1 ... ... ... ... 7 5 2 ... ... ... ErysiPelas ... ... ... ... ... ... 2 ... ... ... 1 1 Pyæand and septicœmia 5 ... ... ... 4 1 10 1 ... 1 4 4 PuerPeral Fever ... ... ... ... ... ... 1 ... ... ... 1 ... Other Zymotic Diseases ... ... ... ... ... ... 1 1 ... ... ... ... Parasitic Thrush and other Vegetable Worksites ... ... ... ... ... ... ... ... ... ... ... ... Worms and other Animal Parasites ... ... ... ... ... ... ... ... ... ... ... ... ???Etic. Starvation, Want of Breastmilk debility from Birth 5 4 1 ... ... ... 24 23 1 ... ... ... ???Memt Alcoholism 2 ... ... ... 2 ... 4 ... ... ... 3 1 Gheumatic Diseases 2 ... ... ... 1 1 6 1 ... 2 ... 3 Gout 1 ... ... ... ... 1 5 ... ... ... 1 4 Rickets 2 1 1 ... ... ... 4 ... 1 1 1 1 Cancer 15 ... ... ... 7 8 45 ... ... 1 24 20 Phthisis and Scrofula 36 5 3 3 18 7 139 20 9 7 94 9 Diabetes 2 ... ... ... 1 1 4 ... ... ... 4 ... Other constitutional Diseases ... ... ... ... ... ... 2 1 ... ... 1 ... Premature Birth, &c 7 7 ... ... ... ... 36 30 ... ... ... ... Accidents of Child-birth 1 ... ... ... 1 ... 3 ... ... ... 3 ... Local Old Age 12 ... ... ... ... 12 44 ... ... ... ... 44 Diseases Of Brain, &C. 25 5 ... 1 9 10 96 11 11 8 25 41 " Heart, &c. 32 ... 1 3 20 8 72 1 1 6 32 32 " Lungs, &c. 73 10 9 3 20 31 243 46 31 4 66 96 " Stomach, Liver, &c. 13 2 1 ... 5 5 48 8 3 5 21 11 " Kidneys, &c. 9 ... ... ... 5 4 24 1 ... ... 13 10 Violent. "Other Organs 1 ... ... ... ... 1 23 4 5 4 6 4 Fractures, Constusions ... ... ... ... ... ... 5 ... ... ... 3 2 Gunshot Wounds 2 ... ... ... 2 ... 2 ... ... ... 2 ... Cut. Stab ... ... ... ... ... ... 1 ... ... ... 1 ... Scald Burn ... ... ... ... ... ... 2 ... 1 ... ... 1 Poison ... ... ... ... ... ... 4 ... ... ... 3 1 Drowning ... ... ... ... ... ... 3 ... ... ... 2 1 Hanging ... ... ... ... ... ... 2 ... ... ... 2 ... Suffocation 1 1 ... ... ... ... 10 7 ... ... 3 ... Doutful ... ... ... ... ... ... 2 2 ... ... ... Causes III-defined ... ... ... ... ... ... 3 3 ... ... ... ... Couses Not Specified ... ... ... ... ... ... 1 1 ... ... ... ... .