STLU 1 REPORT on the SANITARY CONDITION, VITAL STATISTICS, &c., OF THE Parish of St. Luke, Middleser, FOR THE YEAR 1893, by Gr. E. YARROW, M.D., BARRISTER-AT-LAW, DIPLOMATE IN PUBI.IC HEALTH, ROYAL COLLEGE OF PHYSICIANS AND SURGEONS, LONDON. FELLOW OF THE INCORPORATED SOCIETY OF MEDICAL OFFICERS OF HEALTH OBSTETRICAL HUNTERIAN SOCIETIES, AND BRITISH INSTITUTE OF PUBLIC HEALTH. MEMBER OF THE HONOURABLE SOCIETY OF GRAY'S INN, ETC. MEDICAL OFFICER OF HEALTH FOR THE PARISH. London: THOMAS BEAN & SON, PRINTERS, 43, TABERNACLE STREET, E.C. 1894. REPORT on the SANITARY CONDITION, VITAL STATISTICS, &c., of the Parish of St. Luke, Middleser, FOR THE YEAR 1893, by G. E. YARROW, M.D., BARRISTER-AT-LAW, DIPLOMATE IN PUBLIC HEALTH, ROYAL COLLEGE OF PHYSICIANS AND SURGEONS, LONDON. FELLOW OF THE INCORPORATED SOCIETY OF MEDICAL OFFICERS OF HEALTH OBSTETRICAL HUNTERIAN SOCIETIES, AND BRITISH INSTITUTE OF PUBLIC HEALTH. MEMBER OF THE HONOURABLE SOCIETY OF GRAY'S INN, Etc. MEDICAL OFFICER OF HEALTH FOR THE PARISH. London: THOMAS BEAN & SON, PRINTERS, 43, TABERNACLE STREET, E.C. 1894. 350—9/4/94 TO THE VESTRY OF THE PARISH OF ST. LUKE, MIDDLESEX. Gentlemen, I have the honour to present my Annual Report on the Health, Sanitary Condition, and Vital Statistics of the Parish, for the year 1893. The statistics of Marriages, Births, and Deaths, contained herein, relate to the fifty-two weeks ending December 30th, 1893, and are calculated upon a population, estimated to the middle of the year, of 42,794, and divided between the three Sub-Registration Districts, as follows:— Estimated Population at Midsummer, 1893. At Census 1891. City Road 30,004 29,148 Whitecross Street 7,943 8,278 Finsbury 4,847 4,985 Total 42,794 42,411 The number of Marriages celebrated in St. Luke during the year were 241, the number of persons Married being in proportion to 11.2 per 1000 of the population, being an increase on the two previous years of 2.0 and 2.3 per 1000 respectively. The Births registered in the Parish during the year 1893 numbered 1795, of these 411 children were born in the City of London Lying-in Hospital, but as only 36 of the mothers were permanent residents of the Parish of St. Luke, a deduction of 375 has to be made from the total number, leaving 1420 as the actual number of births to be credited to the Parish, and after allotting 36 to the several districts of the Parish in which the parents resided, the Births of the respective sub-districts were as follows:— In the City Road Sub-Registration District there were 1057. In the Whitecross Street Sub-Registration District there were 256, and in the Finsbury-Sub-Registration District there Births. 4 were 107. In relation to the estimated population the figures stand as under:— Births per 1000 Inhabitants. For the whole Parish 33.18 City Eoad Sub-Registration District 35.22 Whitecross Street „ „ 32.22 Finsbury „ „ „ 24.13 By comparing the above figures with those which relate to the two preceding years, it will be seen that the number of births are gradually decreasing, due, in some measure, as might have been anticipated, from the substitution of factories and workshops for the dwellings which formerly existed in the Parish, particularly on the southern side. Births. Rate per 1000. 1891 1533 36.14 1892 1478 34.89 1893 1420 33.18 The increased number of births over deaths during the year 1893 amounted to 143, a knowledge of which fact assists in forming an estimate of the population. Deaths. The deaths from all causes registered during the year, belonging to St. Luke, numbered 1277, and includes 492 parishioners who died in institutions outside the Parish, but is exclusive of 74 non-parishioners who died within our parochial boundary. Of the 1277 parishioners, 697 were males and 580 were females, and yield upon the estimated population a death rate equal to 29.84 per 1000 persons living, being an increase upon our last year's death rate of 4.27 per 1000, as shows by the following figures:— Deaths. Rate per 1000. 1891 1277 30.11 1892 1074 25.57 1893 1277 29.84 Infant Mortality:—Of the 1277 deaths 576, or 45.1 per cent. occurred to infants under 5 years of age. Mortality over 65 years of age:—218 parishioners were over 65 at the time of death, being at the rate of 17.1 per cent. of the total deaths recorded. 5 The 74 deaths of non-parishioners occurred at the following Hospitals situated in the Parish:— Eoyal Hospital for Disease of the Chest 46 City of London Lying-in Hospital 13 St. Luke's Hospital for Lunatics 10 St. Mark's Hospital for Fistula, &c. 5 74 Hospitals, Asylums and other Institutions situated outside the Parish, at which parishioners died during the year:— Banstead Asylum 3 Cancer Hospital, Brompton 1 Cane Hill Asylum 3 Cheyne Hospital for Sick Children 1 Children's Hospital, Great Ormond Street 13 City of London Police Hospital 1 Colney Hatch Asylum 6 French Hospital, Soho 1 German Hospital, Dalston 1 Great Northern Hospital 1 Guy's Hospital 2 Hanwell Asylum 3 Holborn Union Infirmary, Archway Road 100 Holborn Union Workhouses— Shepherdess Walk, Gray's Inn Boad, and Mitcham 178 King's College Hospital 2 Leavesden Asylum 1 London Hospital 3 Metropolitan Asylums Board Fever Hospitals and Ships 41 Mildmay Hospital 1 Middlesex County Asylum, Friern Barnet 2 New Biver, Canonbury 1 Poplar Sick Asylum 1 Boyal Free Hospital 3 St. Bartholomew's Hospital 121 St. Peter's House, Kennington 1 University College Hospital 1 Total 492 Inquests. One hundred and seventeen Inquests were held on the bodies of parishioners during the year, being at the rate of 9.0 per cent, of the total deaths. Eighty-three of the inquiries 6 took place at the Coroner's Court belonging to this Parish, and the cause of death was ascertained by post-mortem examination in 24 instances. The remaining 34 inquiries were held at hospitals and institutions outside our parochial area. Of the total Inquests, the results were recorded as follows:- Infants suffocated in Bed 18 „ „ by a Caul 1 „ Hœmorrhage at Birth 1 Injuries and shock from Burns and Scalds 3 „ due to falls, blows, &c. 17 „ „ being run over 4 Suicides by Shooting 3 „ „ Cut Throat 1 „ „ Drowning 2 „ „ Poison 1 „ „ Leaping over Holborn Viaduct 1 „ „ Placing Gunpowder in the Mouth and igniting the same 1 Death due to Natural Causes 64 117 Returns of Sickness and Mortality. At the end of this Report the following tables will be found: No. I., giving the population, births, and cases of infectious disease which have come to my knowledge during the year 1893. No. II., the deaths which have been registered in the Parish, including also the deaths of parishioners in hospitals and other institutions outside the sanitary district, classified according to diseases, ages and localities. These tables are prepared in accordance with the requirements of the Local Government Board, in order to insure greater uniformity in the reports of Medical Officers of Health than has hitherto existed. Table No. III. is of a more comprehensive character, and shows the deaths registered from all causes, inclusive of the deaths of parishioners at hospitals and public institutions outside the district, but exclusive of the deaths of nonparishioners at public institutions within the Parish. 7 Table IV. is a return prepared by Mr. Neighbour, the Vaccination Officer, setting forth the number of cases of successful vaccination, so far as relates to children whose births were registered during the year ending June 30th, 1893. The figures show that those not yet found in consequence of removals, etc., number 146 out of a total of 1873, being 7'9 per cent., a deficiency somewhat less than in former years. Sickness and Deaths due to the principal Zymotic or Communicable Diseases. Small-Pox.—Only one parishioner is certified to have died from this disease during the year, although it was again very prevalent throughout the Metropolis. The patient in question was not a resident at the time of seizure, but was an inmate of the Holborn Union Infirmary at Highgate, where he had been for several weeks suffering from rheumatism. He was 47 years of age, by trade a lithographer. No information was obtained as to vaccination, and no scars were visible. The deaths registered in London from Small-pox numbered 206, against 41 for the previous year. The total number of cases of sickness notified as Small-pox belonging to the Parish during the year was 18, and inquiries were made respecting each case with the following results:— Three cases were ascertained not to be Small-pox; in three the patients were of the migratory class, and were only credited to St. Luke from the circumstance of their having slept a night or two at the Asylum for Houseless Poor situated in Banner Street. One case was unvaccinated, nine were vaccinated, and of eight no information could be obtained. Scarlet Fever.—This disease again assumed an Epidemic Form throughout the Metropolis, twenty-six deaths are recorded as due to it in our own district, against nine in the preceding year. The cases of sickness from the same cause numbered 341. During the latter half of the year the accommodation at the disposal of the Managers of the Metropolitan Asylums Board has been quite inadequate to meet the demand for beds, and a large number of patients have consequently been treated at their own homes, much to their own 8 tage and to the dissemination of the disease; 1596 deaths were registered in London from Scarlet Fever. Diphtheria caused thirty-seven deaths, and Membranous Croup six. I have classed these diseases together, as they are regarded by many observers as identical—the term Diphtheria however being now the more frequently employed. On reference to Table I., it will be seen that the number of cases of sicknesS from Diphtheria was 136, and Croup 12, an enormous increase upon the records for the preceding year, the numbers then being, Diphtheria 45, Croup four. The deaths during the same period were, from Diphtheria 16, Croup two. The number of deaths ascribed to Diphtheria in London, amounted to 3265, being by far the largest number ever recorded for the Metropolis under this heading, and there can be but little doubt that to the prevalence of this disease may be ascribed the inability of the Asylums Board Managers to find accommodation for all the cases of Scarlet Fever requiring isolation. Fever.—Under the head of Fever 15 deaths were registered, 13 being ascribed to Enteric or Typhoid Fever and two to Puerperal Fever. Of the Enteric Fever seven of the deaths took place in institutions outside the parish, three in the City Road Sub-Registration District, two in the Whitecross Street District, and one in the Finsbury District. The Sickness Returns indicate in all 33 cases of Fever—80 being due to Enteric, two to Puerperal, and one to Continued Fever. The death returns for the Metropolis under the head of Fever are not as favourable as during the preceding year—the figures being for 1893, 719, and for 1892, 467 respectively. Whooping Cough.—Forty deaths were certified as due to this cause, a number greatly in excess of the previous year, when 29 only were registered. In the Metropolitan area, however, there has been a marked decrease in the deaths from this cause during the last three years, the figures respectively being for 1891, 2876, for 1892, 2477, and for 1893, 2330. 9 Measles.—This disease was credited with having caused 51 deaths, against 35 for the preceding year. Neither this or the malady last treated of are among the diseases which are compulsorily notifiable under the Public Health Act; the degree of prevalence, therefore, can only be judged of by the number of deaths which are ascribed to them. It is satisfactory to note that there were only 1661 deaths from Measles in London during the year, while during 1892 the number reached was 3393. Influenza.—For the fourth year in succession this disease manifested itself in the Metropolis, and although of less intensity than during the two preceding years, a large number of deaths were certified under the headings of Pneumonia and Bronchitis, which were undoubtedly due to the effects of Influenza. Ten deaths were registered as being primarily caused by it in this Parish, and in ten others it was said to have been a secondary cause. Diarrhcea caused 40 deaths, of which 35 occurred to children under five years of age. This malady also showed a marked increase in London during the summer and autumn, the total number of deaths recorded being 3446, against 2546 for the year 1892. Cholera.—In consequence of the recurrence of Cholera on the Continent the precautions taken by the Vestry against its importation during 1892 were again had resource to. Happily no case of a suspicious character occurred in the district, although a large number of passengers have continued to arrive from the Continent, and have been temporarily located at the various hotels in Finsbury and its locality, while many of the poorer class have gone into lodgings. In connection with this matter I have personally visited upwards of seventy addresses furnished by the various Port Sanitary Authorities, "being the reported destination of passengers arriving from the several infected ports, and have interviewed the passengers as to their state of health in those cases in which the addresses were correctly furnished. 10 11 TABLE I. TABLE I. Table of Population, Births, and of New Cases of Infectious Sickness, coming to the knowledge of the Medical Officer of Health, during the year 1893, in the Metropolitan Sanitary District of St. Luke, Middlesex; Classified according to Diseases, Ages and Localities. Names of Localities adopted for the purpose of these Statistics; Public Institutions being shown as separate localities. Population at all Ages. Registered Births. Aged under 5 and over 5. New Cases of Sickness in each Locality, coming to the knowledge of the medical officer of health. Number of such Cases Removed from several Localities for Treatment in their Homes in the Isolation Hospital. Census 1891. Estimated to middle of 1893. 1 2 3 4 5 6 7 8 9 10 ii 12 13 1 2 3 4 5 6 7 8 9 10 ii 12 13 Small-pox. Scarlatina. Diphtheria. Membranous Croup. Fevers. Fevers. Cholera. Erysipelas. Small-pox. 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) City Road Sub-Registration District 29,148 30,004 1029 Under 5 ... 79 36 6 ... ... ... ... ... ... ... 12 ... ... ... 57 13 2 ... ... ... ... ... ... ... ... ... 5 upwds. 10 147 65 1 ... 19 ... 1 ... 1 ... 117 ... ... 10 119 21 1 ... 7 ... ... ... ... ... ... ... Whitecross Street Sub Registration District 8278 7943 250 Under 5 ... 20 17 4 ... 1 ... ... ... ... 1 ... ... ... 17 13 ... ... 1 ... ... ... ... ... ... ... 5 upwds 1 53 8 ... ... 7 ... ... 1 ... 26 ... ... 1 45 6 ... ... 5 ... ... ... ... ... ... ... Finsbury Sub - Registration District 4985 4847 105 Under 5 ... 9 1 1 ... ... ... ... ... ... ... 2 ... ... ... 6 1 ... ... ... ... ... ... ... ... ... ... 5 upwds. 3 28 9 ... ... 2 ... ... ... ... ... 6 ... ... 3 19 6 ... ... ... ... ... ... ... ... ... ... St. Luke's Hospital for Lunatics ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... City of London Lying-in Hospital ... ... 411 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Royal Hospital for Diseases of the Chest ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... 5 ... ... ... ... ... ... ... ... ... 1 ... ... ... 5 ... ... ... ... ... ... ... ... ... ... ... St. Mark's Hospital for Fistula ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 42,411 42,794 1795 Under 5 ... 108 54 11 ... 1 ... ... ... ... ... 15 ... ... ... 80 27 2 ... 1 ... ... ... ... ... ... ... 5 upwds. 14 233 82 1 ... 29 1 ... 2 ... 150 ... ... 14 188 33 1 ... 12 ... ... ... ... ... ... ... 12 13 TABLE II. TABLE II. Table of Deaths, during the Year 1893, in the Metropolitan Sanitary District of St. Luke, Middlesex, Classified according to Diseases, Ages and Localities. Names of Localities adopted for the purpose of these Statistics; Public Institutions being shown as separate localities. Mortality from all Causes, at subjoined ages. Mortality from subjoined Causes, distinguishing Deaths of Children under Five Years of Age. At all Ages. Under 1 Year. 1 and under S. 5 and under 15. 15 and under 25. 25 and under 65. 65 and upwards. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 Small-pox. Scarlatina. Diphtheria. Membranous Croup. 1 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. Coutinued. Relapsing. J Puerperal. ( a ) (b) (c) (d) (e) (f) (g) (h) (i) City Road Sub-Registration District 553 202 125 18 13 143 52 Under 5 ... 2 4 4 ... ... ... ... ... ... 1 32 25 21 ... ... 3 80 4 19 129 324 5 upwds. ... 3 ... ... ... 3 ... ... 1 ... 4 1 1 1 1 ... 40 69 19 6 80 229 Whitecross Street SubRegistration District 151 49 45 7 3 34 13 Under 5 ... ... ... ... ... ... ... ... ... ... ... 12 10 7 ... ... 1 27 ... 5 32 94 5 upwds. ... ... ... ... ... 2 ... ... i ... ... ... ... ... ... ... 13 19 5 1 16 57 Finsbury Sub-Registration District 71 17 19 4 1 21 9 Under 5 ... ... ... 1 ... 1 ... ... ... ... ... 2 3 2 ... ... ... 10 1 1 14 35 5 upwds. ... ... 2 ... ... ... ... ... ... ... ... ... ... 1 ... ... 4 11 4 ... 14 36 St. Luke's Hospital for Lunatics 10 ... ... ... 1 1 8 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 1 ... 5 10 City of London Lying-in Hospital 16 15 ... ... ... 1 ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 2 ... 12 15 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 Royal Hospital for Diseases of the Chest 53 ... ... 2 15 35 1 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 39 4 8 1 1 53 St. Mark's Hospital for Fistula 5 ... ... ... ... 4 1 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 5 Totals 859 283 189 31 33 239 84 Under 5 ... 2 4 5 ... 1 ... ... ... ... 1 46 38 30 ... ... 4 118 7 25 187 468 5 upwds. ... 3 2 ... ... 5 ... ... 2 ... 4 1 1 2 1 ... 96 107 37 8 122 391 The subjoined numbers have also to be taken into account in judging of the above records of Mortality. Deaths occurring outside the District among persons belonging thereto 492 35 84 25 24 181 1431 Under 5 ... 15 26 1 ... 1 ... ... ... ... ... 4 1 5 ... ... 3 24 ... 1 39 120 5 upwds. 1 6 5 ... ... 6 ... ... ... ... 4 ... ... 3 1 ... 41 108 23 23 151 372 Deaths occurring within the District among persons not belonging thereto 74 12 ... 2 13 37 10 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 9 11 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 33 8 9 1 12 63 14 TABLE III. Deaths registered from all Causes, inclusive of the Deaths of Parishioners at Hospitals and Public Institutions outside the District, but exclusive of the Deaths of Non-Parishioners at Public Institutions within the Parish. CAUSES OF DEATH. AGES. Total under 5 years of age. Grand Total all Ages. 0 to 1 1 to 5 5 to 15 15 to 25 25 to 65 65 and upwds CLASSES. I. Specific Febrile or Zymotic Diseases 55 121 21 4 24 8 176 233 II. Parasitic Diseases ... ... ... ... ... ... ... ... III. Dietic Diseases 5 ... ... 1 ... ... 5 6 IV. Constitutional Diseases 33 19 7 13 111 11 52 194 V. Developmental Diseases 29 ... ... ... 2 55 29 86 VI. Local Diseases 121 113 22 22 229 133 234 640 VII. Deaths from Violence 21 4 4 3 16 7 25 55 VIII. Deaths from Ill-defined and not specified Causes 53 2 ... 1 3 4 55 63 317 259 54 44 385 218 576 1277 I Specific Febrile or Zymotic Diseases. 1. Miasmatic Diseases Small Pox, Vaccinated ... ... ... ... ... ... ... ... „ Unvaccinated ... ... ... ... ... ... ... ... ,, No Statement ... ... ... ... 1 ... ... 1 Measles 12 38 1 ... ... ... 50 51 Scarlet Fever 1 16 7 2 ... ... 17 26 Typhus ... ... ... ... ... ... ... ... Whooping Cough 12 27 1 ... ... ... 39 40 Diphtheria 2 27 8 ... ... ... 29 37 Simple Continued or Ill-defined Fever ... ... ... ... ... ... ... ... Enteric or Typhoid Fever ... 3 3 2 5 ... 3 13 Other Miasmatic Diseases ... ... ... ... ... ... ... ... 15 TABLE III.—continued. CAUSES OF DEATH. AGES. Total under 5 years of age. Grand Total all Ages. 0 to 1 1 to 5 5 to 15 15 to 25 25 to 65 65 and upwds Specific Febrile or Zymotic Diseases—continued. 2. Diarrhceal Diseases. Simple Cholera ... ... ... ... ... ... ... ... Diarrhœa, Dysentry 26 9 ... ... 3 2 35 40 3. Malarial Diseases. Remittent Fever ... ... ... ... ... ... ... ... Ague ... ... ... ... ... ... ... ... 4. Zoogenous Diseases. Cow-pox and effects of Vaccination ... ... ... ... ... ... ... ... Other Diseases (e.g., Hydrophobia, Glanders, Splenic Fever) ... ... ... ... ... ... ... ... 5. Venereal Diseases. Syphilis 1 1 ... ... ... ... 2 2 Gonorrhœa, Stricture of the Urethra ... ... ... ... ... ... ... ... 6. Septic Diseases. Erysipelas 1 ... ... ... 5 3 1 9 Pyæmia, Septicæmia ... ... ... ... 2 ... ... 2 Puerperal Fever ... ... ... ... 2 ... ... 2 Influenza ... ... 1 ... 6 3 ... 10 55 121 21 4 24 8 176 233 II. Parasitic Diseases. Thrush and other Vegetable Parasitic Diseases ... ... ... ... ... ... ... ... Worms, Hydatids, and other Animal Parasitic Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 16 TABLE III.—continued. CAUSES OF DEATH. AGES. Total under 5 years of Age. Grand Total all Ages. 0 to 1 1 to 5 5 to 15 15 to 25 25 to 65 65 and upwds III. Dietic Diseases. Want of Breast Milk, Starvation 5 ... ... ... ... ... 5 5 Scurvy ... ... ... ... ... ... ... ... Chronic Alcoholism ... ... ... ... ... ... ... ... Delirium Tremens ... ... ... 1 ... ... ... 1 5 ... ... 1 ... ... 5 6 IV. Constitutional Diseases. Rheumatic Fever, Rheumatism of the Heart ... ... ... 1 1 ... ... 2 Rheumatism ... ... ... ... 2 3 ... 5 Gout ... ... ... ... ... 2 ... 2 Rickets ... 1 ... ... ... ... 1 1 Cancer, Malignant Disease 1 ... ... ... 19 4 1 24 Tabes Mesenterica 16 5 ... ... ... ... 21 21 Tubercular Meningitis, Hydrocephalus 6 4 2 ... ... ... 10 12 Phthisis 3 4 5 10 87 2 7 111 Other Forms of Tuberculosis, Scrofula 6 6 ... 2 1 ... 11 14 Purpura, Hæmorrhagic Diathesis ??? ... ... ... ... ... 1 1 Anæmia, Chlorosis, Leutocythæmia ... ... ... ... ... ... ... ... Glycosuria, Diabetes Mellitus ... ... ... ... 1 ... ... 1 Other Constitutional Diseases ... ... ... ... ... ... ... ... 33 19 7 13 111 11 52 194 17 TABLE III.—continued. CAUSES OF DEATH. AGES. Total under 5 years of Age. Total all Ages. 0 to 1 1 to 5 5 to 15 15 to 25 25 to 65 65 and upwds V. Developmental Diseases. Premature Birth 26 ... ... ... ... ... 26 26 Atelectasis ... ... ... ... ... ... ... ... Congenital Malformation 3 ... ... ... ... ... 3 3 Old Age ... ... ... ... 2 55 ... 57 29 ... ... ... 2 55 29 86 VI. Local Diseases. 1. Diseases of Nervous System. Inflammation of Brain or Membranes 11 9 4 ... ... 1 20 25 Apoplexy, Softening of Brain, Hemiplegia, Brain Paralysis ... 1 1 ... 22 20 1 44 Insanity, General Paralysis of the Insane ... ... ... ... 3 7 ... 10 Epilepsy ... 1 ... ... 4 2 1 7 Convulsions 23 5 ... ... 1 ... 28 29 Laryngismus Stridulus (Spasm of Glottis) 2 ... ... ... ... ... 2 2 Disease of Spinal Cord, Paraplegia, Paralysis Agitans ... ... ... ... 5 5 ... 10 Other Diseases of Nervous System ... 1 ... ... ... ... 1 1 2. Diseases of Organs of Special Sense. Diseases of Organs of Special Sense, e.g., of Ear, Eye, Nose 1 1 1 ... ... ... 2 3 3. Diseases of Circulatory System. Pericarditis ... 1 ... ... ... ... 1 1 Acute Endocarditis ... ... ... ... ... ... ... ... Valvular Diseases of Heart ... ... ... ... 4 ... ... 4 Other Diseases of Heart ... 4 1 4 6 29 11 5 55 Aneurism ... ... ... ... ... ... ... ... Embolism, Thrombosis ... ... ... ... ... ... ... ... Other Diseases of Blood Vessels ... ... ... ... ... ... ... ... 18 TABLE III.—continued. CAUSES OF DEATH. AGES. Total under 5 years of Age. Grand Total all Ages. 0 to 1 1 to 5 5 to 15 15 to 25 25 to 65 65 and upwds Local Diseases —continued. 4. Diseases of Respiratory System. Laryngitis 2 1 ... ... ... ... 3 3 Croup 1 3 ... ... ... ... 4 4 Emphysema, Asthma ... ... ... 1 ... 7 ... 8 Bronchitis 50 44 1 1 73 56 94 225 Pneumonia 8 30 6 7 44 10 38 105 Pleurisy ... 1 ... 1 3 1 1 6 Other Diseases of Respiratory System ... ... ... ... 1 ... ... 1 5. Diseases of Digestive Organt. Dentition 7 6 ... ... ... ... 13 13 Sore Throat, Quinsey ... ... ... ... ... ... ... ... Diseases of Stomach 2 ... ... ... 6 2 2 10 Enteritis 5 3 ... ... 3 ... 8 11 Obstructive Diseases of Intestines 3 1 ... ... 3 3 4 10 Peritonitis ... 2 2 ... 4 1 2 9 Ascites ... ... ... ... ... ... ... ... Cirrhosis of Liver ... ... ... ... 6 2 ... 8 Jaundice, and other Diseases of Liver 1 ... ... ... 1 ... 1 2 Other Diseases of Digestive System ... 1 ... ... ... ... 1 1 6. Diseases of Lymphatic System. e.g., of Lymphatics and of Spleen ... ... ... ... ... ... ... ... 7. Diseases of Glandlike Organs of Uncertain Use. e.g., Bronchocele, Addison's Disease ... ... ... ... ... ... ... ... 8. Diseases of Urinary System. Nephritis ... 1 2 1 6 2 1 12 Bright's Disease. Albuminuria ... ... ... 1 6 ... ... 7 Disease of Bladder or of Prostate ... ... ... ... 1 2 ... 3 Other Diseases of the Urinary System ... ... ... ... ... ... ... ... 19 TABLE III.—continued. CAUSES OF DEATH. AGES. Total under 5 years of Age. Grand Total all Ages. 0 to 1 1 to 5 5 to 15 15 to 25 25 to 65 65 and upwds Local Diseases—continued. 9. Diseases of Reproductive System. Male Organs ... ... ... ... ... 1 ... 1 Female Organs ... ... ... 1 1 ... ... 2 Abortion, Miscarriage ... ... ... ... ... ... ... ... Puerperal Convulsions ... ... ... ... 1 ... ... 1 Placenta Prævia, Flooding ... ... ... ... 1 ... ... 1 Other Accidents at Childbirth ... ... ... ... 1 ... ... 1 10. Diseases of Bones and Joints. Caries, Necrosis ... ... 1 2 ... ... ... 3 Arthritis, Ostitis, Periostitis ... ... ... ... ... ... ... ... Other Diseases of Bones and Joints ... ... ... 1 ... ... ... 1 11. Diseases of Integumentary System. Carbuncle, Phlegmon ... ... ... ... ... ... ... ... Other Diseases of Integumentary System 1 ... ... ... ... ... 1 1 121 113 22 22 229 133 234 640 VII.—Deaths from Violence. 1. Accident or Negligence. Fractures and Contusions 1 1 3 3 7 5 2 20 Gunshot Wounds ... ... ... ... ... ... ... ... Cut, Stab ... ... ... ... ... ... ... ... Burn, Scald ... ... ... ... ... 2 1 3 Poison ... ... ... ... 1 ... ... 1 Drowning ... ... ... ... 1 ... ... 1 Suffocation 20 2 ... ... ... ... 22 22 Otherwise ... ... 1 ... ... ... ... 1 20 TABLE III.—continued. CAUSES OF DEATH. AGES. Total under 5 years of Age. Grand Total all Ages. 0 to 1 1 to 5 5 to 15 15 to 25 25 to 65 65 and upwds Deaths from Violence— continued. 2. Homicide. Manslaughter ... ... ... ... ... ... ... ... Murder ... ... ... ... ... ... ... ... 3. Suicide. Gunshot Wounds ... ... ... ... 2 ... ... 2 Cut, Stab ... ... ... ... 1 ... ... 1 Poison ... ... ... ... 1 ... ... 1 Drowning ... ... ... ... 1 ... ... 1 Hanging ... ... ... ... ... ... ... ... Otherwise ... ... ... ... 2 ... ... 2 4. Execution. Hanging ... ... ... ... ... ... ... ... 21 4 4 3 16 7 25 55 VIII. Deaths from Ill-defined and not specified Causes. Dropsy ... ... ... ... 1 ... ... 1 Debility, Atrophy, Inanition 51 2 ... ... 1 ... 53 54 Mortification ... ... ... ... ... 4 ... 4 Tumour ... ... ... ... ... ... ... ... Abscess 1 ... ... 1 ... ... 1 2 Hæmorrhage 1 ... ... ... 1 ... 1 2 Sudden Death (cause not ascertained) ... ... ... ... ... ... ... ... Causes not Specified or Ill-defined ... ... ... ... ... ... ... ... 53 2 ... 1 3 4 55 63 TABLE IV. Return respecting the Vaccination of Children whose Birth were Registered between July 1st, 1892, and June 30th, 1893, in the Parish of St. Luke, Middlesex. REGISTRATION SUB - DISTRICTS. Registered. Vaccinated. Certified as Insusceptible. Had Small-Pox. Died unVaccinated. Postponed by Medical Certificate. Removal to Districts, the Vaccination Officer of which has been duly apprized. Removal to Places Unknown, and Cases not yet Found. Outstanding Cases. City Road 1472 976 l 0 179 26 *163 124 3 Whitecross Street 265 215 0 0 30 7 0 13 0 Finsbury 100 74 0 0 13 4 0 9 0 Totals 1837 1265 l 0 222 37 *163 146 3 * These are Children born in the Lying-in Hospital, the Parents of whom belong to other Districts, the Officers of which have been furnished with the necessary information for enforcement of the Law. 21 22 HOUSING OF THE WORKING CLASSES ACT. Under the provisions of this Statute notices were served upon the owner of two houses in Little Arthur Street, Golden Lane, to make the same fit for human habitation. The age and faulty construction of the buildings, however, were such that the owner found himself unable to comply with the notices. Nevertheless, he resisted the Vestry's action, and closing orders were applied for. The case came before Mr. Rose at Clerkenwell Police Court, who, after two adjournments, to enable the owner to obtain legal assistance, granted closing orders, which have been duly complied with. PUBLIC HEALTH (LONDON) ACT, and WORK OF THE SANITARY DEPARTMENT. Notification of Infectious Disease. The following Table gives the number and nature of the cases notified under secs. 55 and 56 of the Public Health Act during the 52 weeks ended December 30th, 1893, and indicates also where the same received treatment:— Total Number of Certificates from each cause. Treated at the Metropolitan Asylums Board Hospital. Treated at General Hospital. Treated at their own homes. Small-Pox 14 14 0 0 Scarlet Fever 341 269 0 72 Diphtheria 144 64 21 80 Typhus Fever 0 0 0 0 Enteric Fever 30 13 3 14 Continued Fever 1 0 0 0 Membranous Croup 12 3 2 7 Puerperal Fever 2 0 0 2 Erysipelas 165 0 23 142 Total Number from all the causes 709 363 59 318 23 The amount paid to the Medical Practitioners for furnishing the above Certificates amounted to £58 9s. 6d. For the year 1892 the sum of £33 0s. 6d. was paid. The Vestry is recouped for this expenditure by the Metropolitan Asylums Board (out of the Metropolitan Common Poor Fund), to which Board a copy of each certificate is sent within 12 hours of the receipt of the same. REGENT'S CANAL. The condition of that portion of the Regent's Canal which is situated in this Parish, has formed the subject of inquiry and discussion both by your Public Health Committee and the London County Council, and the Medical Officer of the latter has furnished an exhaustive Report upon the matter, confirming the views expressed in the Report I submitted December, 1892. In December last, in company with the Chairman of your Public Health Committee, I attended a Conference at the Offices of the London County Council, at which, besides Members of the Council, Representatives of the several Local Authorities interested in the subject were present. The difficulties surrounding the question of taking proceedings against the Canal Company, to compel them to cleanse the Canal, were fully recognised by the Members of the Council and the Representatives of the several Sanitary Authorities, and after hearing the views of the various delegates—The Chairman stated, that when the Sanitary Authorities had taken steps to abate all nuisances along the banks of the Canal, the Council would then, if applied to, see what measures it could adopt to effect the cleansing and other evils existing in the Water Way. LOCAL WELLS AND INFECTIOUS DISEASE. The following is the substance of a Report presented to the Public Health Committee in September last, on the above subject:— Last October, in response to an application of the Medical Officer of the London County Council, I furnished a list of wells situated in this Parish, three of which were found to be supplying water for drinking and domestic purposes. Since furnishing the list, I have narrowly watched the returns of Infectious Disease, with the view to ascertain if any such could be traced to the use of water obtained 24 from either of the sources indicated, with the result that I am now able to connect an outbreak of Enteric Fever with the use of polluted water from one of the wells, and to show that the water obtained from a second well is so contaminated with sewage or surface drainage, as to render it unfit for the purposes for which it has been used. Well No. 1 is situated in a factory known as 25, Richmond Street, which extends along the rear of 19, 20, 21, 22, 23, and 24, in that street. The ground floor is in the occupation of a firm of Zinc Workers, who also furnish steam power to the floors above, and which are occupied respectively by the proprietors of Decorative Glass Works, a Surgical Instrument Maker, a Hollow Razor Grinder, and a Glass Embosser on the first floor, an Engineers on the second floor, and a Cycle Manufacturer and a Whalebone Polisher on the third floor. About 67 persons are as a rule employed on the premises. The well is described as a Tube Well about 35 feet deep, and the water, besides being used to supply the boilers to obtain steam power, was, at the time of my visit, used also for drinking purposes by all the employes, in fact there was no other source of Water on the premises. It further supplied the houses Nos. 19, 20 and 25, Richmond Street, 17 persons reside in these houses, making a total of 84 persons who were using the Water from the same source. About 20 feet distance from the well there are three Waterclosets and a large Urinal, and about ten feet distant a second Water-closet, these are the only Sanitary conveniences on the premises. On July 3rd, a case of Typhoid Fever was notified, occurring in a lad 14 years of age, residing at 15, Wellesley Street; July 29th, a man aged 26, also of 15, Wellesly Street, was certified to be suffering from Continued Fever, inquiries showed that both these patients were employed on the upper floor of the Factory, 25, Richmond Street, also that two other men were absent from work through illness, the nature of which was not then ascertained, as their places of residence were unknown. On August 3rd, I obtained a sample of the water from a draw tap on the ground floor and sent it to Mr. Stokes for analysis. On the 5th he furnished the accompanying certificate:— Analytical Laboratory, Vestry Hall, Paddington Green, W., August 5th, 1893. On August 4th I received from you a sample of Well Water marked 100a, August 3rd. I find this to contain in grains per gallon, as follows:— 25 Total solid matter 99. Containing— Chlorine 7.3 Equal to common salt 11.9 Nitrites Plentiful Ammonia 0.017 And yielding— Albuminoid Ammonia 0.019 Of the total solid matter 15 grains were volatilizable by heat. The Oxygen required in 15 minutes to oxidize the organic matter was 0 033 grains. The Oxygen required in 3 hours to oxidize the organic matter was 0.106 grains. The Water had a yellow tint. The Microscope showed it to be swarming with living animalculæ. On consideration of these facts, I am of opinion that the water has become contaminated with surface drainage, and that it is not safe water for drinking purposes. It would be advisable to prohibit such water being used for drinking. ALE. W. STOKES, Public Analyst. Notice was thereupon served on the owners of the premises to discontinue the use of the water for drinking purposes, and the work necessary for obtaining a supply of water from the New River Company's Mains was at once proceeded with and completed August 20th. In the meantime, the lad 14 (first case notified) died, the cause being certified as Typhoid Fever. On August ]6th, case No. 2 was removed from his home to St. Bartholomew's Hospital, it was then certified as a case of Enteric Fever, and the patient died August 24th. I have seen the two men whose addresses could not at the time of my visit to the factory be ascertained. One of them was absent from work four weeks and the other about ten days. The Medical man who attended the former, informs me that although he was unable to identify the illness with Enteric Fever, he has no doubt it was in great measure caused by the use of water from a polluted source; in the second of these cases the man was treated at his home for Febrile Catarrh. On the Wednesday last, September 6th, I received a Certificate, notifying that a girl 14 years old, residing at 19, Richmond Street (one of the houses supplied from the well in question), was suffering from Enteric Fever, upon inquiry I learned that the patient had been ill for four weeks, but the Medical men under whose care she has been were unable to 26 satisfy themselves as to the nature of the complaint until after a consultation which took place on the 5th inst. In view of the result of the analysis of the water in the last case I caused samples to be obtained from the two other wells mentioned in the first part of this report, and forwarded the same to Mr. Stokes, and his certificate is as follows:— Analytical Laboratory, Vestry Hall, Paddington Green, W., 30th August, 1893. On the 25th of August I received from you two samples of. well water. These I have now carefully analyzed, and I find them to contain in grains per gallon:— Sample 101a. Sample 102a Total solid matter 32 151 Containing Chlorine 1.52 17.86 Equal to common salt 415 28.63 Nitrites None Abundant Ammonia 0.007 0.859 and yielding— Albuminoid Ammonia 0.022 0.026 Of the total solid matter there were in sample 101a 10 grains, in sample 102a 17 grains of volatile matter. The oxygen required to oxidise the organic matter in sample 101a in three hours was 0.033 grains. The oxygen required to oxidize the organic matter in sample 102a in three horn's was 0126 grains. The microscope showed sample 101a to be fairly free from living animalculæ, while sample 102a was swarming with anirralculæ. On consideration of these facts I am of opinion that the water 101a is a moderately good sample of drinking water. In its present state no ill effect could be anticipated from the use of such a supply. There is no evidence of any sewage contamination. Sample 102a is quite unfit for drinking purposes; it is evidently largely contaminated with sewage or surface drainage, and should certainly not be used at all for drinking purposes or for cleaning out any vessels that may be used to contain food. ALF. W. STOKES, Public Analyst. The sample identified in the certificate as 101a was obtained from No. 2 well, said to be a tube well, depth unknown. It is situated on the premises of a cloth worker's, &c., 136, Old Street. It is the only source of water supply on the premises, where about 20 persons are employed. All the water, however, from the well passes through a filter before it can be used. 27 Sample 102a, of which such a bad report appears in the certificate, was obtained from well No. 3. This is also said to be a tube well about 25 feet deep. It is situated at 138 Lever Street, in the occupation of a tripe dresser, etc. On my visit to the premises I was informed that the well water was only used for "cooling" the various articles after cooking, the water for the latter purpose being obtained from the New River Company, and from which source there was an ample supply on the premises. On receipt of Mr. Stokes' certificate in this case I also caused a notice to be served on the owners to forthwith discontinue the use of the water from the polluted well for drinking purposes or the preparation of any article of food, and am informed that since the receipt of the notice all dressing, cooking, etc., has been done at other premises belonging to the firm. Nevertheless, seeing the nature of the business and that they have a supply of pure water, I strongly recommended the Vestry to proceed, if necessary, with steps to obtain an order for closing this well, and in accordance with the Vestry's resolution the well has since been filled in. Since furnishing the list of wells to the County Council last October, I have learned of the existence of four other wells in the Parish, two being situated on premises belonging to Messrs. Le Grand Sutcliffe, of Bunhill Row, Well Sinkers, etc., and two on those of Messrs. Allen & Sons, Drug Grinders, 7, Cowper Street. These are all artesian wells, from 175 to 345 feet in depth, and although the water is used by the employes of each firm for drinking purposes, its chief use is that of supplying power for machinery, and having in view the depth of the borings and the comparatively recent construction in each case, I have not thought it necessary to have the water analyzed. During the year I have visited and reported upon the five slaughter-houses, three cow-sheds, and the 37 bakehouses situated in the Parish, and with reference to the latter, furnished the following observations:—Of the total number, 21 of the bakehouses are situated in the basements, and for the most part inefficiently ventilated ; the remaining 16 are in the rear of the shops, on the same level, being really constructed over the yards. Although a constant water supply now exists throughout the Parish, in only three instances is the water used for bread-making drawn direct from the Mains. In all other cases it is taken from cisterns, many of which are situated over water-closets and are inaccessible for the purpose of thorough and frequent cleansing, several of them were very dirty. 28 In 19 cases, Notices were served to carry out Whitewashing, Cleansing, and to remedy other Sanitary defects. I consider it would be a very desirable reform to compel all bakehouses to be situated on the ground level, and in cases in which the water is not drawn direct from the main, to cause it to be received into a receptacle of small dimensions and used only for the purposes of the trade, and so situated that it can be easily cleansed at frequent intervals. Besides the foregoing, I have made numerous Reports to your Public Health Committee on the various matters which have occupied its attention during the year ; among the most important of which were on :— The Public Health (London) Bill. The Bye-Laws made by the London County Council under the Public Health (London) Act. And the Bye-Laws made by the Vestry under the Public Health (London) Act, a copy of the latter is herewith appended. I have visited the premises in every instance in which the Vestry's Notice has not been carried out, and in those cases in which Summonses were granted have attended the Police Court in support of the same. It will be seen by the foregoing and by reference to the Sanitary Inspectors'Report annexed, that a very large increase in the amount of work has been performed during the past year. The number of houses inspected and reported upon numbered 2384 against 1963 for the previous year, nevertheless there are several matters which the Public Health Act requires should receive attention remaining untouched, but which I hope means will shortly be found to deal with satisfactorily. I have the honour to be, Gentlemen, Your obedient Servant, G. E. YARROW, M.D., D.P.H., Lond., etc., etc. Vestry Hall, City Road, March 6th, 1894. 29 PUBLIC HEALTH (LONDON) ACT, 1891. Bye-Laws Made by the Vestry of the Parish of St. Luke, in the County of London, being the Sanitary Authority for the said Parish with respect to the Cleansing of Cisterns. Interpretation of Terms. 1. Throughout these Bye-laws the expression " Sanitary Authority " means the Vestry of the Parish of St. Luke, in the County of London. For securing the Cleanliness and Freedom from Pollution of Tanks, Cisterns, and other Receptacles used for storing of Water used or likely to be used by Man for Drinking or Domestic Purposes, or for manufacturing Drink for the use of Man. 2. The owner of any premises who shall provide thereon a tank, cistern, or other receptacle to be used for storing of water used or likely to be used by man for drinking or domestic purposes, or for manufacturing drink for the use of man, shall cause the same to be so constructed and placed that it may conveniently be cleansed. Construction and Situation of Cistern. 3. The owner of any premises on which a tank, cistern, or other receptacle not provided by the occupier of such premises is used for storing of water used or likely to be used by man for drinking or domestic purposes, or for manufacturing drink for the use of man, shall cause every such tank, cistern, or other receptacle which is erected outside a building or which being erected inside a building is not placed in a suitable chamber or otherwise constructed or placed so as to prevent the pollution of the water therein, to be provided with a proper cover. Owner in certain cases to provide Cover to Cistern. 4. The occupier of any premises on which a tank, cistern, or other receptacle is used for storing of water used or likely to be used by man for drinking or domestic purposes, or for manufacturing drink for the use of man, shall empty and cleanse the same, or cause the same to be emptied and cleansed, once at least in every six months, and at such other times as may be necessary to keep the same in a cleanly state and free from pollution. Occupier to Cleanse Cistern periodically He shall cause every such tank, cistern, or other receptacle which is erected outside a building, or which, being erected inside a building, is not placed in a suitable chamber, or otherwise constructed or placed so as to and in certain cases to keep Cistern Covered. 30 prevent the pollution of the water therein, to be kept at all times properly covered. Provided that in every case where any tank, cistern, or other receptacle used for storing of water used or likely to be used by man for drinking or domestic purposes, or for manufacturing drink for the use of man, is used for supplying water to persons occupying two or more separately occupied premises, the foregoing requirements shall apply to the owner of such premises instead of to any occupier thereof. Premises separately occupied. Premises let in Lodgings. The person in occupation of, or having the charge, management, or control of the premises, or if there is no such person, then any person in occupation of or having the charge, management, or control of any part of the premises, and in the case of any premises the whole of which is let to lodgers, the person receiving the rent payable by the lodgers, either on his own account, or as the agent of another person, shall, for the purposes of this Bye-law be deemed to be the occupier. Occupier not to obstruct Owner. 5. The occupier of any premises, or any other person shall not obstruct or interfere with the owner of such premises, or with any person duly authorised by him in that behalf, in the execution of any work to which the foregoing Bye-laws relate. Penalties. Penalties. 6. Every person who shall offend against any of the foregoing Bye-laws shall be liable for every such offence to a penalty of five pounds, and in the case of a continuing offence to a further penalty of forty shillings for each day after written notice of the offence from the Sanitary Authority. Mitigation by Justices. Provided, nevertheless, that the justices or court before whom any complaint may be made or any proceed ings may be taken in respect of any such offence may, if they think fit, adjudge the payment as a penalty of any sum less than the full amount of the penalty imposed by this Bye-law. Dated this 6th day of June, 1893. Sealed by order. (Signed) G. W. PRESTON, Clerk of the Vestry. Allowed by the Local Government Board, this tenth day of August, 1893. (Signed) HENRY H. FOWLER, President. HUGH OWEN, Secretary. 31 PUBLIC HEALTH (LONDON) ACT, 1891. Bye-laws Made by the Vestry of the Parish of St. Luke, in the County of London, being the Sanitary Authority for the said Parish, with respect to the keeping of Water-closets supplied with sufficient Water for their effective action. Interpretation of Terms. 1. Throughout these Bye-laws the expression " the Sanitary Authority " means the Vestry of the Parish of St. Luke, in the County of London. With respect to the keeping of Water-closets supplied with sufficient Water for their effective action. 2. The occupier of any premises in or for which any water-closet is for the time being provided, shall cause such water-closet to be at all times properly supplied with a sufficient quantity of water for securing its effective action. Occupier to supply Closet with Water. Where, however, any water-closet is provided for the use of persons occupying twoor more separately occupied premises, and there is a person having the care and control of such water-closet, the foregoing requirement shall apply to such person. Premises separately occupied. The person in occupation of or having the charge, management, or control of the premises, or if there is no such person, then any person in occupation of or having the charge, management, or control of any part of the premises, and in the case of any premises, the whole of which is let to lodgers, the person receiving the rent payable by the lodgers, either on his own account or as the agent of another person, shall for the purposes of this Bye-law be deemed to be the occupier. Premises let in Lodgings. Penalties. 3. Every person who shall offend against the foregoing Bye-law shall be liable for every such offence to a penalty of five pounds, and in the case of a continuing offence to a further penalty of forty shillings for each day after written notice of the offence from the Sanitary Authority. Penalties. Provided, nevertheless, that the justices or court before whom any complaint may be made, or any proceedings may be taken in respect of any such offence, Mitigation by Justices. 32 may, if they think fit, adjudge the payment as a penalty of any sum less than the full amount of the penalty imposed by this Bye-law. Dated this 6th day of June, 1893. Sealed by order. (Signed) G. W. PRESTON, Clerk of the Vestry. Allowed by the Local Government Board, this tenth day of August, 1893. (Signed) HENRY H. FOWLER, President. HUGH OWEN, Secretary. PUBLIC HEALTH (LONDON) ACT, 1891. Bye-laws Made by the Vestry of the Parish of St. Luke, in the County of London, being the Sanitary Authority for the said Parish for the Prevention of Nuisances. Interpretation of Terms. 1. Throughout these Bye-laws the expression " the Sanitary Authority " means the Vestry of the Parish of St. Luke, in the County of London. For the Prevention of Nuisances arising from any Snow, Ice, Salt, Dust, Ashes, Rubbish, Offal, Carrion, Fish, or Filth, or other Matter or Thing in any Street. Occupier to Remove Snow from Footways. 2. The occupier of any premises fronting, adjoining, or abutting on any street not repairable by the inhabitants at large shall, as soon as conveniently may be after the cessation of any fall of snow, remove or cause to be removed from the footways and pavements adjoining such premises and forming part of such street, all snow fallen or accumulated on such footways and pavements, in such a manner and with such precautions as will prevent any undue accumulation in any channel or carriageway or upon any paved crossing. Occupier defined where Premises let in Lodgings. The person in occupation of or having the charge, management, or control of the premises, or if there is no such person, then any person in occupation of or having the charge, management, or control of any part of the premises, and in the case of any premises the whole of 33 which is let in tenements or to lodgers, the person receiving the rent payable by the tenants or lodgers, either on his own account or as the agent of another person, shall for the purposes of this Bye-law be deemed to be the occupier. 3. Every person who shall remove any snow from any premises on to any carriageway shall deposit the same in such a manner and with such precautions as to prevent any accumulation thereof in any channel or upon any paved crossing. Channel and Crossing to be kept clear. If in the process of such removal any snow be deposited upon any footway or pavement in any street, he shall forthwith remove such snow from such footway or pavement. 4. Every person who shall throw any salt upon any snow on the footway of any street shall do so in such quantity and in such manner as effectually to dissolve the whole of such snow, and he shall forthwith effectually remove from the footway the whole of the deposit resulting from the mixture of the salt with the snow. He shall not place any part of such deposit on the carriageway of such street elsewhere than in proximity to any channel at the side of such carriageway, and he shall not remove any part of the same into any such channel unless it is sufficiently liquid to flow along such channel. If Salt used for dissolving Snow, deposit to be forthwith removed. No person shall throw any salt upon any snow on the carriageway of any street unless it shall be practicable forthwith effectually to remove the whole of the deposit resulting from the mixture of the salt with the snow. Every person who shall throw any salt upon any snow on any such carriageway shall forthwith effectually remove the whole of the deposit, but he shall not place any part thereof on the footway of such street or on any paved crossing or on the carriageway, in such a manner as to interfere with the carriage traffic, nor shall he place any part thereof in the channel at the side of the carriageway unless it is sufficiently liquid to flow along such channel. Salt not to be used in certain circumstances. 5. A person shall not throw, cast, or lay, or cause to be thrown, cast or laid, any dust, ashes, rubbish, offal, carrion, fish, or filth, or other like matter or thing, in or upon any part of a street. Throwing Refuse in Street prohibited ; Provided always that this Bye-law shall not apply to any act which is for the time being an offence within the meaning of any public general statute, or of any 34 Bye-law made by the London County Council, and in force in the place where such act is done. but not in case of Frost. Provided also that it shall not be an offence against this Bye-law to lay any ashes or other suitable material in any street in time of frost to prevent accidents. If Litter used to be removed when necessity for use ceases. 6. Every person who shall lay or cause to be laid in any street any litter or other matter in case of sickness to prevent noise, shall lay the same so that it may be evenly distributed over the surface of the part of the street intended to be covered, and shall, when the occasion ceases, within forty-eight hours thereafter remove or cause to be removed from such street the litter or other matter so laid in such street. For Preventing Nuisances arising from any offensive matter running out of any Manufactory, Brewery, Slaughter-House, Knacker s yard, Butcher's or Fishmonger's Shop, or Dunghill, into any uncovered place, whether or not surrounded by a wall or fence. Occupier of certain premises not to allow Refuse to run therefrom 7. The occupier of a manufactory,brewery,slaughterhouse, knacker's yard, butcher's or fishmonger's shop, or of any premises comprising a dunghill, shall not cause or suffer any offensive matter to run out of such manufactory, brewery, slaughter - house, knacker's yard, butcher's or fishmonger's shop, or dunghill, into any uncovered place, whether or not surrounded by a wall or fence, so as to be likely to become a nuisance. For the Prevention of the Keeping of Animals on any premises in such place or manner as to be a Nuisance or Injurious or Dangerous to Health. Occupier not to keep Animal so as to pollute Water Supply. 8. The occupier of any premises shall not keep nor allow to be kept any animal on such premises in such a place or in such a manner as to pollute or to be likely to pollute, any water supplied for use or used or likely to be used by man for drinking or domestic purposes, or for manufacturing drink for the use of man, or any water used or likely to be used in any dairy. Deposit of Dung, etc. 9. Every occupier of a building or premises wherein or whereon any horse or other beast of draught or burden, or any cattle may be kept, shall deposit or cause to be deposited in a suitable receptacle, all dung, manure, soil, filth, or other offensive or noxious matter other than urine and other liquid filth which may, from time to time, be produced in the keeping of any such animal in such building or upon such premises. 35 He shall likewise provide in connection with such building or premises a sufficient drain, constructed in such a manner and of such materials, and maintained at all times in such a condition as effectually to carry away all urine and liquid filth or refuse therefrom. Provision of Drain. Except where the Sanitary Authority by notice duly given under the statutory provision in that behalf shall have otherwise required, he shall, once at least in every week, remove or cause to be removed from such building or premises all dung, manure, soil, filth, or other offensive or noxious matter produced in or upon such building or premises, and deposited in a receptacle as hereinbefore required. Provided that this requirement shall not apply to the occupier of any stable or cowhouse from which the Sanitary Authority remove or contract for the removal of manure and other refuse matter. Removal of Dung periodically. Where for the purpose of preventing the keeping of any horse or other beast of draught or burden or any cattle on any premises so as to be a nuisance or injurious or dangerous to health, it is necessary that the floor of the building in which such animal is kept should be impervious to liquid matter, no person shall keep any animal in such building unless or until the floor thereof shall have been paved with a hard and impervious pavement evenly and closely laid and so sloped as to effectually carry off all liquid matter therefrom to a properly trapped inlet to the drain hereinbefore required to be provided. Impervious Floor to be provided for Stables, etc. As to the Paving of Yards and Open Spaces in connection with Dwelling-Houses. 10. The owner of every dwelling-house in connection with which there is any yard or open space shall, where it is necessary for the prevention or remedy of insanitary conditions that all or part of such yard or open space shall be paved, forthwith cause the same to be properly paved with a hard, durable, and impervious pavement, evenly and closely laid upon a sufficient bed of good concrete, and so sloped to a properly constructed channel as effectually to carry off all rain or waste water therefrom ; and he shall cause such pavement to be kept in proper repair. Owner to Pave Yard Penalties. 11. Every person who shall offend against any of the foregoing Bye-laws shall be liable for every such Penalties. 36 offence to a penalty of five pounds, and in the case of a continuing offence to a further penalty of forty shillings for each day after written notice of the offence from the Sanitary Authority. Mitigation by Justices. Provided, nevertheless, that the justices or court before whom any complaint may be made or any proceedings may be taken in respect of any such offence may, if they think fit, adjudge the payment as a penalty of any sum less than the full amount of the penalty imposed by this Bye-law. Dated this 6th day of June, 1893. Sealed by order. (Signed) G. W. PRESTON, Clerk of the Vestry. Allowed by the Local Government Board, this tenth day of August, 1893. (Signed) HENRY H. FOWLER, Presichnt. HUGH OWEN, Secretary. 37 Public Health Department. To the Vestry of the Parish of St. Luke, Middlesex. Gentlemen, The works carried out by the order of the Public Health Committee, between the 1st January and 31st December, 1893, in the Parish, are as follows:— Houses Inspected 2384 Houses cleansed, whitewashed and repaired 510 Dust-bins provided 119 ,, repaired Ill Yards to houses paved or amended 282 Traps provided to yards and house drains 457 Water receptacles cleansed 37 ,, ,, provided with covers 48 Drains amended and obstructions removed 218 Houses provided with new pipe drains 117 Rain-water pipes disconnected from drains 209 Waste pipes of sinks ,, ,, 229 Water-closets reconstructed 186 „ ,, ventilation improved 16 ,, „ water supply reinstated 163 ,, ,, pans cleansed 119 Overcrowding in rooms abated 71 Underground rooms illegally occupied as dwellings 36 Roofs of houses repaired 46 Nuisances arising from accumulations of manure and refuse 137 Ventilation of houses improved 28 Wells closed 2 Miscellaneous nuisances abated 241 Rooms disinfected 635 Lots of bedding fumigated 512 38 List of Streets, Courts, and other places inspected under systematic house-to-house visitation during the year Anchor Yard Apple Yard Baltic Court Baltic Place Bath Buildings Belward Avenue Charles Court Church Row Clarence Street Collingwood Street Dean's Court Elizabeth Place Europa Place Garden Court Garden Row George Yard Gastigny Place Hull's Place Hull's Street James Street John Place Little Arthur Street Macclesfield Place Mason Place M'urton Street Mount Mills New Court Osman's Place President Place Red Lion Market Richard's Place Waterloo Place Westmoreland Place Whitby Court Wither s Court Willow Row Notices served for enforcing Sanitary Works, etc. Written Intimations 1121 Statutory Orders 467 Thirty-seven bakehouses were visited, and the necessary notices to cleanse, limewash, and trap the drains on the premises were served, and the work done. Five slaughter-houses were inspected and found to be in good sanitary condition. Three cow-sheds were also visited and found to be in a good sanitary condition. Inspection of Food, etc. The Meat, Fish, Fruit, etc., exposed for sale in Whitecross Street and other parts of the Parish, have been kept under observation, and the following were seized and destroyed:— 79 fowels 4½ sacks shell fish 28 boxes of oranges 120 boxes dried herrings 13/4 cwt. pork 61/4 cwt. fish 3¼ cwt. beef 2 cwt. (foreign) hams 1¼ cwt. mutton 21/4 cwt. bacon 148 rabbits 3 cwt. fruit 62 sheep plucks 39 Adulteration of Food and Drug Acts. The Fines and Costs imposed by the Magistrates under this Act amounted to £12 15s., which has been recovered and paid into the Vestry's Account. Housing of the Working Classes Act, 1890, and Public Health (London) Act, 1891. Eighteen Summonses were taken out under the above Acts, with the following results :— In three cases the Magistrate granted closing orders and ordered costs to be paid by the defendants. In nine instances the Summonses were withdrawn, the works having been done to the satisfaction of the Vestry ; and in one case of overcrowding the nuisance was ordered to be abated within fourteen days. In two cases the Magistrate made an order for the works to be done within fourteen days and ordered costs, in one of which the order was not complied with, further proceedings were taken and the owner was fined £5 and costs. In another case the owner was fined £5 and costs under Section 61 of the Public Health (London) Act, for refusing to deliver infected clothing to the Sanitary Authorities. Proceedings were also taken against two tradesmen for obstructing the Sanitary Officers, one was fined £2 and costs, and the other Is. and costs. The Mortuary and Coroner's Court. During the twelve months under consideration, 297 bodies were, on sanitary grounds, received into the Mortuary. Eightyseven Inquests were held during the same period, and the sum of £15 15s. paid to the Vestry for the accommodation afforded by the Coroner's Court. Twenty-four Post-mortem examinations were held in the Post-mortem Room adjoining the Coroner's Court. A large quantity of Disinfecting Powder and Carbolic Acid have been given away to Parishioners. JOHN E. RUGG, Sanitary FRED. A. BARTH, Inspectors. Vestry Hall, City Road, E.C.