Sept.28th 1898 19,Sabile Row.W. The Librarian British Medical Association Dear sir,St. George's Aamover sg In the absence Abroad of Professor Corfield I have much Pleasure in enclosing a copy of his Report for last year, as requested. Your's faithfully J. Anderson Marks. HAN 5 PARISH OF St. George, Hanober Sqnare. REPORT of the Medical Officer of Health for the YEAR ENDED 1st JANUARY, 1898. London: WIGHTMAN & CO., "The Westminster Press," 104 & 106, Regency Street, S.W. 1 8 9 8. REPORT ON THE SANITARY CONDITION OF THE Parish of St. George, hanober Square, FOR THE YEAR 1897, BY W. H. COHFIELD, M.A., M.D. (Oxon.), F.R.C.P. (Lond.), Hon. A.R.I.B.A., and Honorary Sanitary Adviser to University College Hospital; Professor of Hygiene and Public Health in University College, London; Past President of the Society of Medical Officers of Health; Vice-President of the Sanitary Institute; "Membre d'honneur" of the Royal Society of Public Health of Belgium; Honorary Member of the Society of Hygiene of France, and of the Hungarian Society of Public Health; Honorary Corresponding Member of the Imperial Society of Medicine of Constantinople, and of the Royal Society of Hygiene of Italy; Fellow of the Medical Society of Sweden; MEDICAL OFFICER OF HEALTH. (Being his Twenty-sixth Annual Report.) To the Vestry of the Parish of St. George, Hanover Square. My Lords and Gentlemen, In my last Annual Report I gave a Table showing the Census Populations of the Parish, and of the two SubDistricts, from 1891 to 1896, and stated my reasons for believing that the populations, as enumerated at the Censuses of 1891 and 1896, were too low; estimating, however, from them, I calculate that the population of the Parish at the middle of 1897 was as follows:— Mayfair 23,850 Belgravia 56,526 Whole Parish 80,376 The total number of deaths registered in the Parish during the 52 weeks ending January 1st, 1898, was 1,577 (Table I.). Of these deaths 630 were those of NonParishioners (Table II.), leaving 947 deaths of Parishioners. To these, however, must be added 120 deaths of our 4 Parishioners in Public Institutions in the Metropolis outside of the Parish, and in the extra Metropolitan Asylums, so that the corrected total of deaths of our Parishioners during the 52 weeks was only 1,067, or 207 less than the average during the preceding ten years. This gives a corrected death-rate of 13 32 per thousand per annum on the estimated population. It will be seen from Table I. that the death-rate of the Parish during 1897 was lower than that of any former year, and nearly 2¼ per thousand lower than the average of the preceding ten years. Table I. YEAR. Gross Total of Deaths. Deaths in Public Institutions. Proportional Share of Deaths in Public Institutions Corrected Total of Deaths. Corrected Death-rate per 1,000 per annum. 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 15.82 1890 (53 weeks) 1,986 997 340 1,329 16.46 Deaths of NonParishioners in the Parish. Deaths of Parishioners in Public Institutions outside the Parish. 1891 1,877 904 144 1,312 16.22 1892 1,751 564 147 1,334 1,217 16.97 1893 1,716 654 155 15.38 1894 1,510 554 140 1,096 13.80 1895 1,675 603 113 1,185 14.98 1896(53 weeks) 1,541 569 145 1,117 13.74 Average during ten years, 1887-1896 1,726 1,274 15.54 1897 1,577 630 120 1,067 13.32 Average during ten years, 1888-1897 1,711 1,237 15.51 *Applying the correction for age and sex distribution (factor=1.10438), given by Mr. Murphy in his Annual Report to the London County Council for 1893, the death-rate of the Parish for 1896 would be 15.17. 5 Table II. Deaths in Public Institutions in the Parish. Parishioners. NonParish ioners. Mayfair. Belgravia. SubDistrict not stated. St. George's Infirmary, Fulham Road 7 71 60 240 Union Workhouse, Wallis's Yard 1 3 ... 3 St. George's Hospital 16 54 2 346 Belgrave Children's ditto ... 11 ... 21 Gordon Hospital for Cancer ... ... ... ... Other Places in the Parish 2 4 5 20 Total in the Parish 26 143 67 630 In Public Institutions in London, outside of the Parish, and in the Extra Metropolitan Asylums 24 80 16 ... Table III. Death-rates per 1,000 per annum. 1888. 1889. 1890. 1891. 1892. 1893. 1894. 1895. 1896. 1897. 28 Large English Towns. 19.2 193 21.3 22.3 *20.7 *21.6 *18.1 *20.7 *189 *19.1 London 13.5 18.3 21.5 21.4 20.6 21.3 17.8 19.9 18.6 18.2 Greater London 17.8 17.3 20.1 19.8 19.3 19.7 16.4 18.3 17.0 16.7 St. George's, Hanover sq. 16.05 14.19 14.56 14.65 16.97 15.38 13.80 14.98 13.74 13.32 *33 Towns. From Table III. we see that the death-rate of London proper, with an estimated population of 4,403,169, amounted to 18.2, the average rate in the previous ten years having been 19.9. The death-rate of Greater London, with an estimated population of 6,291,677, was 16.7, the average rate in the previous ten years having been 18.24. 6 The death-rate of the 33 largest English towns was 19.1. The death-rate of this Parish was lower than that of any one of the 33 largest English towns, except Croydon with a rate of 13.1, the others nearest to it being:— Cardiff 14.9 Brighton 15.1 West Ham 15.7 Swansea 15.8 Derby 16.0 Portsmouth 16.2 Huddersfield 16.4 Halifax 16.5 and the highest being:— Bolton 22.0 Wolverhampton 22.0 Manchester 23.1 Salford 23.9 Liverpool 24.4 Preston 24.4 The death-rate of Edinburgh was 21.3, that of Glasgow 22.0, and that of Dublin 29 0. All these rates are considerably higher than in 1896. No Colonial or Foreign city mentioned in the RegistrarGeneral's Annual Summary had a lower death-rate than this parish, the lowest death-rates among Colonial and Foreign cities being those of:— Cincinnati 13.7 Amsterdam 15.8 The Hague 15.8 St. Louis 15.9 Christiania 16.3 Brussels 16.6 Stockholm 16.7 7 and the highest being:— Moscow 28.7 St. Petersburg 29.0 Alexandria 31.8 Calcutta 32.3 Cairo 32.4 Madras 35.5 Bombay 57.5 In Berlin the rate was 17.7, in Paris 18 6, and in Vienna 209 ; all lower than in 1896. Table IV. YEAR. Registered Births. Birth-rate per 1,000 per annum. Deaths of Children under 1 Year. Total. Percentage to Registered Births. Percentage to Total Deaths of Parishioners 1891 1,610 17.96 210 13.41 16.45 1892 1,519 19.31 220 14.48 16.49 1893 1,496 18.90 204 13.64 16.76 1894 1,499 18.88 177 11.81 12.78 1895 1,470 19.02 204 13.88 17.22 1896 (53 weeks) 1,407 17.30 211 15.00 18.87 1897 1,365 17.04 183 13.40 17.24 From Table IV. we see that the number of births in the Parish was 1,365, and that the birth-rate was 17.04 per thousand per annum, as against 17.30 in 1896. The birth-rate for London proper was 30.0, as against 30.2 in 1896. The average birth-rate of the 33 largest English towns was 30.7, the same as in 1896, the highest being those of Salford 35.1, Wolverhampton 35.1, Liverpool 35.3, and Gateshead 35.8; and the lowest those of Croydon 25.0, Brighton 24.7, Bradford 24.6, Huddersfield 23.4, and Halifax 22.5, 8 The number of deaths of children under one year of age (Parishioners; see Table A at end of report) was 18.3; the percentage of such deaths to registered births was 1340, and to total deaths of parishioners, 17.24; thus the mortality of children under one year of age was only 134 to a thousand births, while in London generally it was 159, and the average for the 33 largest English towns was 177, the highest being Birmingham 197, Salford 219, Burnley 220, and Preston 262, deaths of children under one year of age to a thousand births. Table V. YEAR. A. b. C. D. Percentages to Gross Total of Deaths. Persons aged sixty years and upwards. Injuries Inquest Cases. Uncertified. A. b. C. d. 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 1891 627 95 144 17 33.38 5.05 7.6 0.97 1892 581 115 159 15 33.18 6.57 9.1 0.87 1893 541 98 145 15 31.53 5.42 8.4 0.87 1894 465 70 120 it 30.79 4.63 7.9 0.59 1895 586 87 147 3 34.98 5.19 8.8 0.18 1896 434 114 156 2 28.16 7.40 10.1 0.13 1897 518 97 151 4 32.85 6.15 9.6 0.25 London 1897 19,138 3,469 7,522 479 23.64 4.29 9.3 0.59 From Table V. it appears that there were 518 registered deaths of persons aged 60 and upwards, giving a percentage of 32.85 of the gross total of deaths, as against a percentage for London generally of only 23.64. There were, however (see Table VI.), only 305 deaths of parishioners of 65 years and upwards, giving a percentage of 28.58 of the corrected total of deaths. From Table V. we also see that 97 deaths from injuries were registered in the Parish, being 6.15 per cent. of the total deaths, but of the 97 deaths registered under this 9 heading only 47 were those of parishioners, and 8 parishioners died from injuries outside of the Parish, making a total of 55 deaths of parishioners from "Injuries' (see Table VI.), and giving a percentage of 5.2 of the corrected total of deaths, or somewhat higher than that of London generally, 4.29. The Inquest cases held in the parish numbered 151. They were equivalent to 9.6 per cent. of the gross total of deaths, as against 9.3 in London generally. Table VI. Non-Parishioners excluded. Year. A Persons aged sixty years and upwards. B Injuries. Percentages to corrected Total of Deaths. A B 1890 404 33 30.82 2.5 1891 405 37 30.85 2.8 1892 396 50 29.66 3.7 1893 *307 56 25.23 4.6 1894 *257 43 23.45 3.0 1895 *333 46 28.10 3.9 1896 (53 weeks) *250 48 22.36 4.3 1897 *305 55 28.58 5.2 *65 years and upwards. The number of registered deaths uncertified as to cause was only 4, and equivalent to 0.25 per cent. of the gross total of deaths, that of London generally being 0.59 per cent. Table VII. SUB.DISTRICT. Population at middle of 1897. Births. Birth-rate. Deaths of Parishioners. Deaths (corrected). Death-rate (corrected). Mayfair 23,850 261 10.98 198 223 9.8 Belgravia 56,526 1,104 19.60 786 844 14.78 Sub - district not stated ... ... ... 83 ... ... Whole Parish 80,376 1,365 17.04 1,067 1,067 13.32 10 Table VIII. birth-rates. death-rates. 1888. 1889. 1890. 1891. 1892 1893. 1894. 1895. 1896. 1897. 1888. 1889. 1890. 1891. 1892. 1893. 1894. 1895. 1896 1897. Mayfair 13.74 11.83 9.95 8.95 11.32 10.87 11.26 11.39 9.17 10.98 13.47 12.09 9.32 10.08 11.62 10.74 10.53 10.16 7.93 9.38 Belgravia 21.31 22.14 21.34 22.59 22.71 22.27 22.02 21.50 20.30 19.60 17.38 15.27 17.24 17.00 19.25 17.32 15.16 16.94 16.20 14.78 Whole Parish 18.74 18.64 17.49 17.96 19.31 18.90 18.95 18.58 16.98 17.04 16.05 14.19 14.56 14.65 16.97 15.38 13.80 14.98 13.74 13.32 11 From Tables VII. and VIII. it appears that the birthrate of the Parish was only 17.04, and that of the Mayfair Sub-District was 10.98, as against 9.17 in 1896, while that of the Belgravia Sub-District was 19.60, as against 20.30 in 1896; and that the corrected death-rate of the Mayfair Sub-District was 9.38, as against 7.93 in 1896, and that of the Belgravia Sub-District was only 14.78, as against 16.20 in 1896. From the birth and death rates in Table VII. 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 Annual Report for 1890), 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. The birth-rate in the Mayfair Sub-District is so abnormally low, and the death-rate at the same time so low, that it is of no use attempting to get any correct approximation of the mean length of life in that Sub-District. I therefore merely give it for the whole Parish, for which I calculate it was 66.69 years. Table IX. Mean Length of Life. Year. St. George's, Hanover Square. London. 1875 46.67 — 1876 47.96 — 1877 49.52 — 1878 48.03 34.24 1879 48.55 34.23 12 Table IX.—continued. Year. St. George's, Hanover Square. London N.B.—These figures for London are too high, being calculated from erroneous estimates of the population. 1880 58.01 35.17 1881 50.26 35.87 1882 52.56 36.82 1883 55.09 37.88 1884 53.78 38.08 1885 56.11 39.29 1886 54.46 39.31 1887 56.49 39.98 1888 57.71 41.77 1889 61.43 43.27 1890 62.67 41.10 1891 61.62 38.28 1892 55.27 39.58 1893 59.58 38.61 1894 66.19 43.81 1895 59.96 40.60 1896 65.49 42.03 1897 66.69 42.61 Table IX. shows the mean length of life in this parish for the last 23 years, and in London for the last 20 years, and from it we find that the mean length of life in this parish during the last 23 years has averaged 56¼ years, while during the last ten years it has averaged over 61½ years, and that the mean length of life in London has averaged over 38¾ years during the last 20 years, and over 41 years during the last 10 years. Table X. shows that the total number of Parishioners dying from the principal infectious diseases and from diarrhoea, including 17 dying in Public Institutions outside of the Parish, was only 94, a lower number than in any year since the Table was commenced (1890), which is equivalent 13 to a zymotic death-rate of only 1.17, as against 1.33 in 1896, the rate for London being 2'58, and that for the 33 largest English towns 2.87. No large town had as low a zymotic death-rate as this Parish, the nearest to it being Swansea, with 1.36. The highest zymotic death-rates in the country were those of Preston 5.63 and Salford 5.50. In 1896 Salford was highest with 4.10. Table X. Deaths of Parishioners from the principal Infectious Diseases and from Diarrhoea and Influenza:— Disease. 1890. 1891 1892. 1893. 1894. 1895. 1896. Average from 1890 to 1896. 1897. Small Pox 0 0 0 3 1 1 0 1 0 Measles 45 13 48 2 29 10 32 25 18 Scarlet Fever 2 6 12 24 10 8 11 10 7 Diphtheria 12 19 23 26 18 23 24 20 20 Whooping Cough 48 21 19 12 20 25 16 23 13 Typhus Fever 0 0 0 0 0 0 0 0 0 Enteric (Typhoid) Fever 5 9 8 11 8 8 9 8 11 Simple Continued Fever 2 1 0 2 2 1 0 1 0 Diarrhœa 29 31 21 28 10 33 16 24 25 Cholera 0 0 1 0 0 0 0 0 0 Total 143 100 132 108 98 109 108 112 94 Influenza 27 46 75 13 15 67 7 40 17 Taking these diseases separately, according to the order in which they are placed in Table X., we find that:- Small Pox caused no death in the Parish. Measles caused 18 deaths of Parishioners, or decidedly less than the average of the last seven years. Scarlet Fever caused only 7 deaths of Parishioners, being 3 below the annual average. It also caused 1 death of a Non-Parishioner in the Parish. 14 Diphtheria: 20 deaths were caused by this very fatal disease, as against 24 in 1896, and an annual average of 20 during the preceding 7 years. Diphtheria also caused 11 deaths of Non-Parishioners in the Parish. This disease is still exceedingly prevalent in London and in some of the other great towns, the average death-rate from it in the 33 largest English towns in 1897 being, however, only about 7 per cent. above the average of the preceding 10 years, and that of London 13 per cent. above its average for the same period. Whooping Cough: 16 deaths of Parishioners were registered, the annual average of the previous 7 years having been 23. This disease also caused 6 deaths of Non-Parishioners in the Parish. Typhus Fever was not, so far as I am aware, present in the Parish during the year, and no death from it has been recorded in the Parish since 1884. Enteric (Typhoid) Fever: 11 deaths of Parishioners were recorded, Being 1 more than the annual average. Eight Non-Parishioners died of this disease in the Parish. Simple continued Fever: No death from this disease was registered. Diarrhœa: This disease caused 25 deaths of Parishioners, as against only 16 in 1896, and an annual average of 24. It also caused 10 deaths of Non-Parishioners in the Parish. I may note that the mean temperature of each quarter of the year was above the average. The mean temperature of the year was 50.3° F., or 1.6° F. above the average of 126 years, and 1.0° F. above the average of the last 56 years. 15 A Non-Parishioner died of Dysentery in the Parish. No death from English Cholera was registered. Influenza: 17 deaths of Parishioners were recorded from this disease, as against 7 in 1896. No Non-Parishioners died from it in the Parish. As there is no special column for this disease in the table (A), ordered by the Local Government Board to be used, the deaths from it are entered under other headings according to the information given in the certificates; but in future, I propose to enter the deaths from this disease in a separate column. Cases of Infectious Diseases. The following Table shows the number of cases certified by Medical Attendants in the years 1890 to 1897:— Table XI. Name of Disease. Number of Cases certified. 1890. 1891. 1892. 1893. 1894. 1895. 1895. 1897. Scarlet Fever 145 122 318 567 255 298 339 178 Enteric Fever 40 26 42 62 65 37 52 39 Conttinued Fever 5 2 1 2 4 3 1 2 Diphtheria 64 74 118 111 97 92 119 119 Erysipelas 37 41 57 76 45 67 56 50 Membranous Croup 1 2 1 7 3 4 0 0 Small Pox 0 0 1 21 10 2 1 0 Puerperal Fever 0 2 2 3 3 1 0 3 1 English Cholera 0 0 1 2 0 0 0 292 269 541 851 482 504 571 389 Of the above 389 cases certified last year, only 8 were also notified by householders. There was also a case of Scarlet Fever of which I received no certificate, as the Medical Attendant gave his certificate to the person in charge of the Ambulance. 16 Twelve of the cases of Enteric Fever were contracted outside of the Parish, 3 of them at Maidstone. Of the 39 cases of Enteric Fever, only 6 were certified in November and December, and 16 in the three previous months, so that the monthly average for the last two months of the year (3.0) was lower than that of the three previous months (5.3). Cases of Enteric Fever. YEAR. Aug., Sept. and Oct. November and December. No. of Cases. Average per month. No. of Cases. Average per month. 1891 6 2.0 12 6.0 1892 15 5.0 15 7.5 1893 16 5.3 18 9.0 1894 14 4.6 29 14.5 1895 11 3.7 10 5.0 1896 15 5.0 15 7.5 1897 16 5.3 6 3.0 It will be seen from the Table that this is the first time since 1891 that the average per month of cases of Enteric Fever in November and December has been less than during the three previous months. As, however, some of the cases were traced to the Maidstone epidemic, I have ascertained the number of cases contracted outside of the Parish during the months in question and found them to be no less than 7 during August, September and October, and only 2 during November and December, so that the number of cases among Parishioners was 9 during August, September and October, and 4 during November and December, giving a monthly average of 3 during the first three months and 2 during the last two months, and thus showing that the general rule for this Parish has been reversed during 1897. 17 Another case was certified as Diphtheria, but turned out not to be a case of that disease. Five of the 14 cases of Diphtheria, which occurred in the month of June, were in the nursery at Fulham Road Workhouse, the disease having been introduced by one of the children who was frequently taken out by its mother. The children attacked were all sent to hospital, and on visiting the building, I ascertained that the Resident Medical Officer was taking all necessary precautions. I advised that a steam disinfecting apparatus be provided, instead of the hot-air stove then on the workhouse premises. A case which was certified as Small Pox was returned from one of the hospitals of the Metropolitan Asylums Board as not being a case of that disease. In January, 1897, I submitted to you the following Special Report on the Notification of Measles:— "As you will no doubt remember, I made a Special Report on this subject at the request of your Committee of Works in May, 1892, when I came to the conclusion that it was not expedient for the Committee to recommend the compulsory notification of Measles, chiefly on the ground 'that in several places where this ha3 been done it has been afterwards abandoned, having been found to be of little use on account of the fact that the disease is so highly infectious before the appearance of the characteristic rash, and also because it is found quite impracticable to carry out the measures of isolation that are necessary to prevent the spread of such diseases.' I then quoted from Dr. Harvey Littlejohn's Report on 'Ten Years' Compulsory Notification of Infectious Disease in Edinburgh,' which Report shows that although the Town Council 'has cheerfully paid over £3,500 for the notification of Measles alone,' instead of diminishing, the 18 epidemics there are becoming larger, the number of cases in the five epidemics during those ten years having increased from 2,791 to over 5,600, and this in spite of the fact that in Edinburgh they are able to remove a number of cases to hospital, a thing which we certainly should not be able to do. I have recently received information from the best source, that no less than seven different Sanitary Authorities in Lancashire, which had adopted notification of Measles, have given it up, no advantage having apparently accrued from it. One of the Medical Inspectors of the Local Government Board, Dr. Theodore Thomson, has investigated this question and his Report has been issued. From this Report it appears that as regards the 33 places visited by him, compulsory notification of Measles was in force in seven Urban and five Rural Districts at the times he visited these districts, that in seven Urban and three Rural Districts trial had in the past been made of compulsory notification of Measles, but that this measure had been revoked before he visited those Districts; and that in the instance of one Urban District twice visited by him, Measles, which was compulsorily notifiable on his first visit, had ceased to be so before the date of his second visit. Dr. Thomson's Report does not show that satisfactory results have followed the compulsory notification of Measles, either in reducing the number of cases or in lowering the death-rate, but he endeavours to account for this by stating that all the measures he considers necessary as supplementary to compulsory notification have not been thoroughly carried out in any District that he has examined. The reasons why compulsory notification of Measles has failed wherever it has been tried, are, in the first place, as already mentioned, the infectiousness of the 19 disease before it can be recognized, and then the fact that in large numbers of cases a Medical man is not called in to attend, and that it is frequently impossible, even when the case is certified, to procure isolation either at home or in a hospital. To make the notification of Measles of any real use it would have to be as complete as it is now, I believe, in the case of Scarlet Fever (a thing which is absolutely impossible for the reasons stated above), Isolation Hospitals would have to be provided, and parents persuaded to allow their children to be sent to them, which, especially considering that Measles is most fatal during the second year of life, they certainly would not in the vast majority of instances consent to do, and the sanitary staff would have to be very considerably increased, especially during the prevalence of epidemics, in order to make the necessary investigations, to secure the isolation or removal of the patients when consent was obtained, and to carry out disinfection, etc. A measure that I have often found useful in controlling epidemics of this disease is the closure of the Infants' Departments of Schools in which outbreaks have occurred, and I am satisfied that this is a most important method of checking the disease, if adopted soon enough. The idea is prevalent in some quarters that the closure of Schools is of little use, because if the children are not in School they are playing about in the court-yards and streets, as if an infected person were as dangerous to those around him in the open air as in a crowded Schoolroom. The absurdity of such an idea is at once obvious. I may add that the simple precaution of taking care of children who are recovering from Measles, so as to prevent them catching cold, will do more to reduce the mortality from this disease than anything else. I have said nothing as yet about the additional cost which would be incurred by you, as the Sanitary 20 Authority of this Parish, if you adopted the compulsory notification of Measles, as if it could be shown that any real advantage to the health of the community would accrue from it, I have not the slightest doubt that you would be willing to incur the necessary expense; but as I am quite satisfied that no benefit, in any way commensurate with the enormous expense that would have to be incurred, would result, I cannot recommend you to petition the Local Government Board to add Measles to the list of notifiable diseases." The following "Joint Report by the Medical Officer of Health and the Surveyor, on the By-laws [proposed to be] made by the London County Council for regulating the dimensions, form, and mode of construction and the keeping, cleansing and repairing of the pipes, drains and other means of communicating with sewers and the traps and apparatus connected therewith," was submitted to your Vestry in January, 1897, by Mr. Livingstone and myself:— "We have carefully considered the proposed By-laws and beg to suggest that the following alterations be recommended by the Vestry:— Rain water pipes. By-law 2.—We consider that the waste-pipes of sinks (other than slop-sinks), baths and lavatory basins, should be allowed to be connected with rain-water pipes and open channels, especially as the model By-laws of the Local Government Board require such waste-pipes to be discharged over open channels (By-laws with respect to new streets and buildings, No. 66); a By-law forbidding the connection of the waste-pipes of baths and lavatory basins, at any rate, with rain-water pipes, would certainly tend to discourage the use of baths and lavatories in small houses. By-law 3. (Concrete.)—We consider that a stoneware pipe drain need only be covered with 4-in. of concrete. 21 Drains to be trapped from sewer. By-law 4.—From this By-law it would appear that the disconnecting-chamber must be constructed under the vault, where there is one between the front area and the sewer. We consider it far preferable to construct the disconnecting-chamber in the front area as being more convenient of access, vaults being frequently used as coal-cellars, etc., and we think that the proposed By-law should be altered to meet this point. Ventilation of drains. By-law 6 (i).—A third arrangement for the purpose of securing efficient ventilation of the drains should be permitted (as it is often impossible to carry out either of the two arrangements provided in the By-law), viz. : the provision of two suitable ventilating pipes, one from the upper end of the drain and one from the lower part near to the trap, both carried up above the ridge of the roof. By-law 6 (ia).* —The words 'Such opening shall also in every case be situated on that side of the trap which is the nearer to the building,' should be 'The point at which such opening communicates with the drain shall also in every case, etc.' By-law 6 (ib).*—The same alteration is required as in 6 (ia). By-law 6 (iii).—It is not clear whether, for instance, a 6-in. drain must have a 6-in. pipe to ventilate it, or whether it may be ventilated by means of a 4-in. branch drain with a 4-in. ventilating pipe. Soil-pipes. By-law 8.—After the words ' he shall construct such soil-pipe so that there shall not be any trap in such soil-pipe or between the soil-pipe and any drain with which it is connected,' we suggest that the words *With reference to Air-Inlets. 22 'unless such trap is provided with an air-inlet' be added, as it is somtimes desirable to disconnect soil-pipes from the drains and to ventilate the drains separately." In June, 1897, I submitted to you the following Special Report on Open Spaces about buildings:— "I have considered the Report made by Dr. Sykes to the Health Committee of the Vestry of St. Pancras, and referred to me for consideration and report, and I now beg to report as follows:— As Dr. Sykes points out, by Section 29 of the Metropolis Building Act, 1855, it was provided that at the rear or side of any dwelling-house (unless all the rooms can be lighted and ventilated from a street or alley adjoining), an open space of at least 100 square feet, exclusively belonging to that building, should be left unbuilt over. By Section 14 of the Metropolis Management and Building Acts (Amendment) Act, 1882, a space of 150 square feet or more, up to 450 square feet, was required, but the open space might be entirely covered in up to the level of the ceiling of the ground floor storey. In the London Building Act, 1894, Section 41 (2), it is provided that in new houses, abutting upon old streets, the open space to be provided may be entirely covered in up to the level of 16 feet above the adjoining pavement, and this applies to all London streets existing when the Act came in force in 1895. You will thus see that the Legislature has, apparently deliberately, gradually sanctioned more and more the covering in of open spaces, so that there is now nothing to prevent the areas on which houses are built being entirely covered to the height of 16 feet above the ground level, that is to say, there need be no open areas to the basement, nor to the ground floor, nor perhaps, 23 even as Dr. Sykes points out, to an 'entresol' so long as the whole is not more than 16 feet above the adjoining pavement. This, you will at once see, is a very serious state of things, as, if it is allowed to continue, basements, at any rate, and ground floors to a considerable extent, will be built without proper means of access for fresh air, and the whole of the drainage arrangements will be included within the building, there being no proper means for efficiently disconnecting the various wastepipes. It may be thought perhaps that the by-laws of the London County Council, made under Section 39 (1) of the Public Health Act, 1891, and providing that every water-closet shall be constructed with one of its sides, at least, against an external wall, abutting 'immediately upon the street, or upon a yard or garden, or open space of not less than 100 square feet of superficial area, measured horizontally at a point below the level of the floor of such closet,' will suffice to prevent this entire covering up of open spaces around houses; but this, in my opinion, is not so. It cannot be for a moment supposed that the Legislature intended that no watercloset should be permitted on the basement floor (nor even on the ground floor, except against the front wall) of a dwelling house constructed according to the Building Act of 1894, and I doubt very much if since the passing of that Act the By-law I have quoted (and several others also, for instance the one requiring soil-pipes to be outside the house) could be enforced. To ascertain this, however, it would be necessary to consult some eminent Legal Authority, or even to get a decision on a test case, and I think it desirable that the attention of the London County Council should be called to the matter without delay." 24 During a correspondence on this subject in The Timet, the following letter of mine appeared: — "The last paragraph of Dr. Poore's letter in The Times of the 23rd inst., gives me the opportunity of pointing out that there is a more serious danger to the health of Londoners than any inadequate provision of By-laws with regard to the curtilage of houses, and that is that by the London Building Act of 1894, anyone whore-builds a house abutting on an old street (i.e., on any street existing in London at the time of the passing of that Act) may cover in the whole area of the site to a height of 16 feet above the level of the adjoining pavement, that is to say so as to include the Basement and the Ground Floor, and perhaps a low Mezzanine Floor as well, thus making it impossible for these floors to be adequately ventilated and rendering nugatory several of the By-laws of the London County Council made under the Public Health (London) Act, 1891, in order to ensure proper sanitary arrangements in houses. One cannot contemplate without dismay the prospect of the closing in of all open areas, both in front of and behind houses in London streets, and I trust it is not too much to hope that the London Building Act may be amended in this respect before many years are over." In December, 1897, I submitted to you the following Report on the admission of Diphtheria and Scarlet Fever Patients into the wards of general hospitals:— "I have considered the question which you have referred to me as to whether it is desirable or not that patients suffering from Diphtheria and Scarlet Fever, should be admitted into the general hospitals 'not specially constructed and conducted with a view to isolating and treating infectious diseases.' 25 I would first remark that it is not so very long ago that cases of all infectious diseases were received into the general wards of hospitals both in this country and on the Continent, and that Scarlet Fever cases were received into the general wards of St. George's Hospital, until about 12 years ago, when you, at my suggestion, protested against the custom, and it was abandoned. Diphtheria and Enteric (Typhoid) Fever patients are still received into most, if not all, of the general hospitals in London, but the Diphtheria cases are now, I believe, generally treated in separate wards. Enteric Fever cases are, however, mixed up with the other patients in the medical wards. I have seen cases of both these diseases communicated in hospitals to Medical Attendants, Nurses, and other patients, and I have long been of opinion that cases of these diseases should not be admitted into the wards of general hospitals. The argument so often used that Students would not have an opportunity of studying cases of these diseases if they were not admitted to the Hospitals connected with the Medical Schools is now very much weakened by the fact that the General Medical Council has induced the Metropolitan Asylums Board to allow Medical Students to study these diseases at the hospitals for infectious diseases under their direction. I therefore quite agree with the suggestion made by the Vestry of St. Pancras on account of the recent outbreak of Enteric fever at University College Hospital, that your Vestry, as the Sanitary Authority of the Parish, should inform the Authorities of the Hospitals in the Parish that in your opinion it is undesirable to admit patients suffering from Diphtheria and Enteric Fever into a hospital not specially constructed and conducted with a view to treating and isolating infectious diseases.' " 26 My object in writing the above Report was to insist on the importance of preventing the admission of patients suffering from Diphtheria or Enteric Fever into the General Wards of Hospitals along with patients not suffering from infectious diseases. Provision should be made in every General Hospital for the treatment in a separate Ward of urgent cases of Diphtheria I have received and answered a number of communications from the Medical Officer of Health of the London County Council, and from other Medical Officers of Health, on various sanitary matters connected with the Parish. Legislation during the Year. The following Acts connected with sanitary administration were passed during the year 1897:— 1. "An Act to permit Local Authorities to provide Cleansing and Disinfection for Persons infested with Vermin." Otherwise "The Cleansing of Persons Act, 1897." This provides that the Local Authority may permit any person who shall apply to it, on the ground that he is infested with vermin, to have the use, free of charge, of the apparatus which the authority may possess for cleansing the person and his clothing from vermin, and it provides that the use of such apparatus shall not be considered to be parochial relief. It also gives Local Authorities the power to expend any reasonable sum on buildings, appliances, and attendants that may be required for the carrying out of the Act, and to defray those expenses out of any rate or fund applicable by the authority for general sanitary purposes, or for the relief of the poor. 27 2. "An Act to amend the Law respecting the Metropolitan Water Companies." The Metropolis Water Act, 1897. This Act provides that any Water Consumer or Local Authority may make complaint to the Railway and Canal Commission that any of the Metropolitan Water Companies has failed to perform some statutory duty, and it gives the Commissioners power to hear and determine any such complaints and to impose penalties for failure to fulfil such duty. It also gives Local Authorities power to aid Water Consumers in obtaining the determination of any question with respect to the rights, duties, and liabilities of any of the Metropolitan Water Companies in reference to the quantity or quality of the water supplied, or the charges made by them. And 3. "An Act to amend the Law for the better protection of Infant Life." The Infant Life Protection Act, 1897. This repeals the Infant Life Protection Act, 1872 (35 and 36 Vict., c. 38). It is for the purpose of controlling Baby-farming, and the Local Authority for it in the County of London is the London County Council. Sanitary Work For the Year ending December 31st, 1897. The following tables, prepared by Mr. Albert Taylor, your Chief Sanitary Inspector, show the amount of sanitary work done. I have added the figures for 1896 for comnarison:— Table XII. 1896. 1897. Houses and Premises inspected 1,949 1,794 „ ,, re-inspected 4,294 4,193 References to Surveyor 16 14 Notices issued (preliminary) 1,040 753 „ „ (statutory) 42 54 Summonses taken out 15 13 Convictions obtained 15 13 28 Table XIII. Nuisances dealt with: - - 1896. 1897. Soil pipes ventilated 264 298 Bath, Sink, and other Waste Pipes disconnected 441 517 Drains unstopped or repaired 118 151 Defective Drains re-constructed 372 387 Trapped Gullies fixed 540 631 Water Closet apparatus cleaned and repaired 169 195 Water Closets fixed 290 304 Water Waste Preventer Cisterns fixed 298 299 Drinking Water Cisterns cleaned and repaired 132 140 Houses provided with water 12 10 Water Supply of W.C.'s separated from drinking water 36 24 Dustbins repaired 13 5 ,, provided 108 62 Yard surfaces paved or repaired 47 15 Cesspools abolished 8 5 Overcrowding abated 37 30 Houses and premises cleansed 154 123 Roofs and rain-water pipes repaired 29 11 Offensive accumulations removed 58 65 Wire manure cages provided 31 20 Nuisances from the keeping of animals 7 7 Underground rooms discontinued for use as sleeping apartments 10 3 Smoke nuisances 3 10 Removal of Hog's Wash in unsuitable receptacles 16 10 Miscellaneous nuisances 76 33 3,219 3,355 20 Examination of Drains:— 1896. 1897. Drains tested and found defective 490 474 „ ,, satisfactory 183 255 Drains of New Buildings, or Premises undergoing alteration, superintended and tested 244 272 It was necessary to take legal proceedings in 13 cases to enforce the abatement of nuisances, and for contravening By-laws ; a conviction was obtained in each case. There are 95 registered houses let in lodgings. They have been inspected, and the regulations as to cleansing complied with. The total number of applications for the removal of house refuse were:—In the In-Wards, 969; in Grosvenor Place District, 889; and in South Belgravia District, 1,924. I had improvements carried out at several of the Model Dwellings in the Parish, in connection with the issuing of my certificates under Section 26 of the Customs and Inland Revenue Act, 1890. With regard to the Factory and Workshop Acts, Mr. Taylor reports that:— "A house-to-house inspection has been made of all business premises in Dering, Pollen, Westbourne, Eccleston, Lower Belgrave, and Passmore Streets, also Eaton Terrace and Belgrave Mews East, which come within the operation of these Acts, while a number of inspections have been made in various parts of the district as the result of special complaints." "The number of workshops and work-places inspected was 92; of these, the sanitary arrangements of 58 were found defective, the drains of 29 having to be reconstructed." 30 "These 92 premises contained 164 work-rooms, 22 of which were overcrowded, and 30 in a dirty and unwholesome condition. There were 964 persons found employed in these workrooms, or 50 in excess of the accommodation, taking 250 cubic feet as the minimum amount of cubic space allowed for each person in such places." Notices have been served where necessary, to prevent overcrowding, and to enforce the provisions as to cleanliness, ventilation, drainage, &c. There are 47 bakehouses on the register, of which 46 are in use; these have been inspected twice each during the year, and the regulations as to cleansing observed. The Factory and Workshop Act of 1895 contains important sanitary provisions, especially with regard to the amount of space to be allowed for each person employed ; the Act also applies to Laundries and to Bakehouses, and prohibits the use of any "place underground" as a Bakehouse. "unless it is so used at the commencement of this Act." Cards showing the number of persons who may be employed in each factory or workshop, and in each room, have been distributed and hung up in conspicuous places in the factories and workshops, and in each room where work is carried on. There are now no cowsheds in the Parish. There is now only one licensed slaughterhouse in the Parish, and this has been regularly inspected and found to be satisfactorily conducted. The street stalls and butchers' shops have been frequently visited, but it has not been necessary to seize any article of food as unfit for human consumption. 31 The Mewses in the Parish have been regularly inspected, and are generally satisfactory, except daring the summer months, when there is great difficulty in getting rid of the dung, because the farmers are too busy to fetch it away. Table XIV. Infectious Diseases and Disinfection. 1895. 1896. 1897. Infectious cases reported 504 571 389 Medical certificates received 567 650 456 Certificates of infectious cases sent to School Teachers 294 262 261 Houses in which infectious disease occurred 453 482 335 Visits made to infected houses 1,158 1,246 982 Patients removed to the Hospitals 373 400 279 Houses disinfected 370 464 279 Rooms disinfected 404 457 337 Articles of clothing, bedding, &c., disinfected 6,183 6,769 7,010 Certificates have been sent to the Head Teachers of Schools after disinfection has been carried out in houses where there are children who go to school, so that the Head Teachers may know when to re-admit the children from those houses, and to the Chief Librarian of the Public Libraries belonging to the Vestry to prevent the issue of books to infected houses. The Public Shelter, provided by the Vestry for housing families temporarily displaced during the disinfection of their homes and bedding, has not been occupied during the year. Disinfectants have been distributed to the public when required, and personal instructions given as to their proper use. 32 The preparations made by me in 1892, in case of an invasion of cholera, were described in my annual report for that year; the arrangements made still hold good and could be set to work at any time. The following Table shows the number of bodies received in the Mortuary during the 12 months ending December 31st, 1897, as compiled from the returns furnished to me monthly by the Mortuary-keeper, Mr. Birch. Table XV. Return showing the number of bodies received into the Mortuary, Ebury Bridge, during the 12 months ending December 31st, 1897. Cause of Death. Number. Post Mortems. Inquests. Found Drowned 4 4 4 Found Dead 7 7 7 Born Dead 4 4 4 Murder 5 5 5 Suicide 17 17 17 Natural Causes 190 134 60 Accidents 63 63 63 Infectious Diseases 0 0 0 Totals 290 234 160 Of the 290 bodies, 23 were brought to the Mortuary because there was insufficient accommodation for them at home, and 107 were sent from St. George's Hospital during the re-building of the Post-mortem Room there. The results of the analyses of the water supplied to the Parish by the two companies during each of the twelve months have been submitted to me by your Public Analyst, Mr. Charles E. Cassal, and I have reported on them monthly. (See the Report of the Public Analyst.) 33 Your Committee of Works passed the following resolutions with regard to the work of the Inspectors on November 16th, 1897:— 10. That the present division of the work among the Sanitary Inspectors, as settled by Dr. Corfield, be approved, viz.:— Mr. Taylor for the Sanitary work of the In-Wards; Mr. Aris for the Sanitary work of the Out-Ward, except the part assigned below to Mr. Whipp; Mr. Whipp for the Sanitary work of the Knightsbridge Ward, and the northwest part of the Out-Ward, including both sides of Buckingham Palace Road and Commercial Road, and for the Workshops and Bakehouses of the Knightsbridge and Out-Wards; and Mr. Temple for the Clerical work of the department, and for the Workshops of the InWards, and any other work that may be assigned to him by Dr. Corfield. Mr. Taylor as Chief Sanitary Inspector to superintend generally the Sanitary work of the whole Parish, under the direction of the Medical Officer of Health. 11. That Mr. Taylor conduct the correspondence of the tary Department and sign all Notices, that he appear in Court to prosecute in all cases, and that he be relieved of his duties under the Sale of Food and Drugs Acts so that he can devote the whole of his time to Sanitary Work. 12. That Mr. Aris, Mr. Whipp, and Mr. Temple be employed under the Sale of Food and Drugs Acts, and that they work the Wards of the Parish on the interchange system as the Sale of Food and Drugs Acts Committee may direct. 13. That all communications be addressed to the Chief tary Inspector, Vestry Hall, Mount Street, except letters making appointments to inspect work-in-hand in the Out-Ward, which should be addressed to the Assistant Sanitary Inspector, No 7, Commercial Road. 34 35 (A)TABLE OF DEATHS during the Year 1897, in the Metropolitan Sanitary District of St. George's, Hanover Square, classified according to Diseases, Ages, and Localities. Localities. Mortality from all causes, at subjoined ages. Mortality. from subjoined causes, distinguishing deaths of children under five. At all ages. Under 1. 1—5. 5—15. 15—25. 25—65. 65 & upwards. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 Smallpox. Scarlatina. Diphtheria. Membranous Croup. Fevers. Cholera. Erysipelas. Measles. Whooping Cough. Diarrhoea and Dysentery. Rheumatic Fever. Ague. Phthisis. Bronchitis, Pneumonia, and Pleurisy. Heart Disease. Injuries. All other Diseases. Total. Typhus. Enteric or Typhoid. Continued. Relapsing. Puerperal. (a) (b) (c) (d) (e) (f) (g) (h) (i) Mayfair 148 13 8 3 3 72 49 Under 5 ... ... 1 ... ... ... ... ... ... ... 1 ... 1 ... ... ... 2 3 1 1 11 21 5 upwds ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 12 29 17 4 64 127 Belgravia 563 132 55 13 21 188 154 Under 5 ... ... 3 ... ... 2 ... ... ... ... 1 14 12 18 ... ... 12 25 3 11 86 187 5 upwds ... ... 4 ... ... 3 ... ... ... ... 1 3 ... 3 1 ... 45 88 44 11 173 376 St. George's Infirmary (Fulham Road) 138 7 4 ... 1 55 71 Under 5 ... ... ... ... ... ... ... ... ... ... ... 1 ... 2 ... ... 1 4 ... ... 3 11 5 upwds ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 26 25 11 6 58 127 Union Workhouse 4 3 ... ... ... ... 1 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 3 5 upwds ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 St. George's Hospital 72 4 5 3 7 44 9 Under 5 ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 2 ... ... 4 9 5 upwds ... ... 2 ... ... 5 ... ... ... ... 1 ... ... ... ... ... 6 6 6 5 32 63 Belgrave Children's Hospital 11 7 3 1 ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 2 1 ... 4 10 5 upwds ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 Other places in the Parish 11 4 ... 1 ... 5 1 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 ... 4 5 upwds ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 5 ... 7 Net Total 947 170 75 21 32 364 285 Under 5 ... ... 5 ... ... 2 ... ... ... ... 2 15 13 21 ... ... 19 36 5 16 111 245 5 upwds ... ... 6 ... ... 8 ... ... ... ... 2 3 ... 4 2 ... 90 148 80 31 328 702 The subjoined numbers have also to be taken into account in judging the above records of mortality. Parishioners dying outside parish 120 13 8 11 12 56 20 Under 5 ... 6 2 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 2 1 1 8 21 5 upwds ... 1 7 ... ... 1 ... ... ... ... 1 ... ... ... 1 ... 14 11 13 7 43 99 Non-Parishioners dying in parish. 630 41 42 22 36 377 112 Under 5 ... ... 8 ... ... ... ... ... ... ... ... 2 6 7 ... ... 13 11 2 1 33 83 5 upwds ... ... 3 ... ... 8 ... ... ... ... 2 ... ... 3 2 ... 106 80 65 52 226 547 36 37 "Notification of Infectious Disease" has been compulsory in the District since October 31st, 1889. The Isolation Hospitals are the Hospitals of the Metropolitan Asylums Board, and occasionally the London Fever Hospital and the London Small Pox Hospital. Cases of Diphtheria and Enteric (Typhoid) Fever are also received into St. George's Hospital. (B) TABLE OF POPULATION, BIRTHS, AND OF NEW CASES OF INFECTIOUS SICKNESS, coming to the knowledge of the Medical Officer of Health, during the year 1897, in the Metropolitan Sanitary District of St. George, Hanover Square, classified according to Diseases, Ages, and Localities. Names of Localities Population at all Ages. Registered Births. Ages. New Cases of Sickness in each Locality. Number of such Cases removed from Home to Hospitals, 1 2 3 4 5 6 7 8 9 10 11 Totals. 1 2 3 4 5 6 7 8 9 10 11 Totals. Census 1891. Estimated to middle of 1892. Smallpox. Scarlatina. Diphtheria. Membranous Croup Fevers. Fevers. Cholera. Erysipelas. Smallpox. Scarlatina. Diphtheria. Membranous Croup. Fevers. Cholera. Erysipelas. Typhus. Enteric or Typhoid. Continued. Relapsing. Puerperal. Typhus. Enteric or Typhoid. Continued. Relapsing. Puerperal. (a) (b) (c) (d) (e) Mayfair 23,827 23,900 261 Under 5 ... 5 5 ... ... ... ... ... ... ... 2 12 ... 4 5 ... ... ... ... ... ... ... ... 9 5 upwards ... 28 9 ... ... 2 1 ... 1 ... 12 53 ... 21 6 ... ... 2 ... ... ... ... 1 30 Belgravia 56,140 57,694 1,104 Under 5 ... 41 31 ... ... 2 ... ... ... ... 1 75 ... 36 30 ... ... ... ... ... ... ... ... 66 5 upwards ... 100 67 ... ... 33 1 ... ... ... 30 231 ... 92 51 ... ... 23 1 ... ... ... 8 175 Fulham Rd. Workhouse ... ... ... Under 5 ... ... 3 ... ... ... ... ... ... ... ... 3 ... ... 3 ... ... ... ... ... ... ... ... 3 5 upwards ... ... 3 ... ... 1 ... ... ... ... 2 6 ... ... 2 ... ... ... ... ... ... ... 1 3 Buckingham Palace Rd. Workhouse ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwards ... 1 ... ... ... ... ... ... ... ... 3 4 ... 1 ... ... ... ... ... ... ... ... 3 4 St. George's Hospital ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwards ... a 2 ... ... 1 ... ... ... ... ... 6 ... 2 ... ... ... ... ... ... ... ... ... 2 | Belgrave Children's Hospital ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwards ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... St. Gabriel's do. ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwards ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Orthopædic Hospital (Hanover Square) ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwards ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Gordon Hospital for Cancer ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwards ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Total 79,967 81,594 1,365 Under 5 ... 46 39 ... ... 2 ... ... ... ... 3 90 ... 40 38 ... ... ... ... ... ... ... ... 78 5 upwards. ... 132 81 ... ... 37 2 ... 1 ... 47 300 ... 116 59 ... ... 25 1 ... ... ... 13 214 38 For the information of the Parishioners, I may mention that the ambulance belonging to the Metropolitan Asylums Board is kept at Seagrove 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. Also that a refuge has been provided at No. 1, Pimlico Road, for the use of persons during the disinfection of their rooms. I have the honour to be, My Lords and Gentlemen, Your obedient Servant, W. H. CORFIELD. 19, Savile Row, London, W.