S { L-L\ 2 REPORT on the SANITARY CONDITION, VITAL STATISTICS, &c, of the Parish of St. Lake, MiddleseX, FOR THE YEAR 1895, by G. E. YARROW, M.D., Barrister-at-Law, DIPLOMATE IN PUBLIC HEALTH, ROYAL COLLEGE OF PHYSICIANS AND SURGEONS, LONDON. PRESIDENT OF THE METROPOLITAN BRANCH OF THE INCORPORATED SOCIETY OF MEDICAL OFFICERS OF HEALTH. FELLOW OF THE BRITISH INSTITUTE OF PUBLIC HEALTH, OBSTETRICAL, GYNECOLOGICAL AND HUNTERIAN SOCIETIES, MEMBER OF THE HONOURABLE SOCIETY OF GRAY'S INN, Etc. MEDICAL OFFICER OF HEALTH FOR THE PARISH. LONDON: Thomas Bean & Son, Phcenix Works, 67, Golden Lane, E.C. 1890 CENSUS, 1896. Since my Annual Report has been in print I have received a return of the recent Census enumeration, which shows the population of the Parish of St. Luke to be 41,527, and a decrease upon the Census of 1891 of 913. For the several districts the figures are as follows:— 1896. 1891. City Road Registration District 29,897 29,177 Whitecross Street Registration District 7,595 8,278 Finsbury Registration District 4,035 4,985 Total 41,527 42,440 It will be seen that while the population of the City Road Registration District has increased since the Census of 1891 to the extent of 760 persons, both the other districts show a decrease. Whitecross Street to the extent of 683, and Finsbury as much as 950. LONDON The population of Registration London is given as 4,411,271; at the Census of 1891 it stood at 4,211,743, and shows an increase therefore of 199,528, but is 14,463 less than the estimate which was in use by the Registrar-General, based upon the enumerations of 1881 and 1891. G. E. YARROW, Medical Officer of Health. June, 1896. StLu 8 REPORT on the SANITARY CONDITION, VITAL STATISTICS, &C., of the Parish of St. Luke, Middlesex, FOR THE YEAR 1895, by G. E. YARROW, M.D., Barrister-at Law, DIPLOMATE IN PUBLIC HEALTH, ROYAL COLLEGE OF PHYSICIANS AND SURGEONS, LONDON. PRESIDENT OF THE METROPOLITAN BRANCH OF THE INCORPORATED SOCIETY OF MEDICAL OFFICERS OF HEALTH. FELLOW OF THE BRITISH INSTITUTE OF PUBLIC HEALTH, OBSTETRICAL, GYNECOLOGICAL AND HUNTERIAN SOCIETIES, MEMBER OF THE HONOURABLE SOCIETY OF GRAY'S INN, ETC. MEDICAL OFFICER OF HEALTH FOR THE PARISH. LONDON: Thomas Bean & Son, Ph<enix Works, 67, Golden Lane, B.C. 1896 TO THE VESTRY OF THE PARISH OF ST. LUKE, MIDDLESEX. Gentlemen, I have the honour to submit my Report on the Health, Sanitary condition, and Vital Statistics of the Parish for the fifty-two weeks ending December 28th, 1895, and which will be found to follow in much the same lines as my ten previous Annual Reports. The Sanitary District of St. Luke comprises an area of 239 acres, including open spaces and the Basin and Waterway of the Resent Canal. The number of Inhabited Houses is 3950. The statistics of Marriages, Births, and Deaths contained herein are calculated upon a population, estimated to the middle of the year, at 43,175, and divided between the three Subregistration Districts as follows:— Estimated population at Midsu,,er, 1895 Corrected Census Return, 1891. City Road 31,006 29,177 Whitecross Street 7,843 8,278 Finsbury 4,326 4,985 Total 43,175 42,440 The number of Marriages celebrated in St. Luke during the year were 118 (against 222 for the previous year), the number of persons married being in proportion to 5.4 per 1,000 of the population, or a decrease on the year 1894 of 4.9 per 1,000. The Metropolitan Marriage Rate was 17.1 per 1,000, being a slight increase upon the preceding year and contrary to the facts which govern our own district. Births. The Births registered in the Parish during the year 1895 numbered 1908, of these 479 children were born in the City of 4 London Lying-in Hospital, but as only 47 of the mothers were permanent residents of the Parish of St. Luke, a deduction of 432 has to be made from the total number, leaving 1476 as the actual number of Births to be credited to the Parish, and after allotting 47 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 1124. In the Whitecross Street Sub-registration District there were 261. and in the Finsbury Sub-registration District there were 91. In relation to the estimated population the figures stand as under:— Births per 1000 Inhabitants. For the whole Parish 34.18 City Eoad Sub-registration District 36.25 Whitecross Street „ „ 33.27 Finsbury „ „ 21.03 After a series of years during which there had been a steady decline in the number of Births, an increase took place during the year 1894, and the same occurred even to a greater extent during the past year, as is shown in the Table below. This increase is found to concern chiefly the City Road District, and in which there now exists 36 Blocks of Artizans Dwellings, accommodating 845 families, and an estimated population of 3802 persons. The number of Births belonging to the Parish tor the past five years and rate per 1,000 of the population. Births. Rate per 1000. 1891 1533 36.14 1892 1478 34.89 1893 1420 33.18 1894 1432 33.34 1895 1476 34.18 The Metropolitan Birth-rate for the year 1895 equalled 30.5 per 1,000. With the single exception of the year 1894 this is the lowest birth-rate recorded for London. The increased number of births over deaths during the year 1895 amounted to 260, a knowledge of which fact assists in forming an estimate of the population, as already indicated. 5 Deaths. The deaths from all causes registered during the year, belonging to St. Luke, numbered 1216, and includes 401 parishioners who died in Institutions outside the Parish, but is exclusive of 93 non-parishioners who died within our parochial boundary. Of the 1216 parishioners, 637 were males and 579 were females, and yield upon the estimated population a deathrate equal to 28.16 per 1000 persons living, being an increase upon our last year's death-rate of 6.2 per 1000, as shown by the following figures:— Deaths. Rate per 1000. 1892 1074 25.57 1893 1277 29.84 1894 951 22.14 1895 1216 28.16 The Metropolitan death-rate tor the year was equal to 19.8 per 1000 of the population. Infant Mortality : Of the 1216 deaths of Parishioners 591, or 48.6 per cent., occurred to infants under 5 years of age. Mortality over 65 years of age:—196 parishioners were over 65 at the time of death, being at the rate of 16.1 per cent. of the total deaths recorded. The 93 deaths of non-parishioners occurred at the following Hospitals and other places in the Parish:— Royal Hospital for Diseases of the Chest 56 City of London Lying-in Hospital 13 St. Luke's Hospital for Lunatics 16 Suicide by Drowning in a Tank 1 „ Oxalic Acid at a Workshop 1 Injuries from an Accident in a Lift 1 „ fall from a window 1 Sudden Death in the Street from Heart Disease 1 ,, at Hotels in Finsbury „ 2 „ Whitfield's Tabernacle „ 1 93 6 Hospitals, Asylums, Infirmaries, Workhouses, and other Institutions and places situated outside the Parish at which Parishioners died during the year:— Asylum for Imbeciles, Banstead 2 „ „ Caterham 2 „ „ Darenth 2 „ „ Leavesden 4 „ Lunatics, Cane Hill 1 „ „ Colney Hatch 5 „ „ Hanwell 1 „ „ Ilford 2 Cancer Hospital, Fulham 1 "Freidheim," St. John's Wood 1 German Hospital, Dalston 1 Great Northern Hospital 1 Guy's Hospital 2 Holborn Union Infirmary, Archway Road 137 ,, Workhouses, Shepherdess Walk and Mitcham 103 Home and Infirmary for Sick Children 1 Hospital for Sick Children, Great Ormond Street 11 Hoxton House Asylum 1 King's College Hospital 3 London Hospital 3 Metropolitan Asylums Board Hospitals 11 Middlesex Hospital 5 Pond, Hampstead Heath 1 Prison, Wormwood Scrubbs 1 River Lea 1 River Thames, Lambeth 1 Royal Free Hospital, Gray's Inn Road 3 Royal Orthopaedic Hospital 1 Shoreditch Workhouse Infirmary 1 St. Bartholomew's Hospital 88 St. Luke's House, Osnaburgh Street 2 St. Peter's House 1 University College Hospital 1 401 7 Inquests. One hundred and twenty-nine Inquests were held on the bodies of Parishioners during the year, being at the rate of 10.6 per cent. of the total deaths. One hundred and eight inquiries (8 being as to the cause of death of non-parishioners) took place at the Coroner's Court belonging to this Parish, and the cause of death was ascertained by post-mortem examination in 55 instances. The remaining 29 inquiries were held at Hospitals and Institutions outside our Parochial area. Of the total Inquests the results were recorded as follows:— Deaths due to Natural Causes 67 Accident or Neglect— Deaths due to Injuries the result of blows, falls, etc. 14 „ ,, from burns 1 „ ,, being run over 1 ,, „ to bladder 1 „ „ hand 1 ,, ,, from being crushed between railway trucks 1 ,, Poisoning by carbolic acid 1 ,, Drowning 2 Suffocation while in bed with parents 31 Haemorrhage from neglect at birth 1 Alcoholic excess 8 Suicide by Hanging 1 ,, Drowning 3 ,, Poison (Carbolic acid, 1; Oxalic acid, 1) 2 ,, Cut throat 1 Murder by Stabbing 1 137 8 Return 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 1895. 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 non-parishioners at public institutions within the Parish. 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, 1895. The figures show that those not yet found in consequence of removals, etc., number 197 out of a total of 1961, being 10.0 per cent., a deficiency greater than in former years, and may fairly be ascribed to the following reasons—First, a growing opposition to the operation of vaccination, encouraged by the delay in the Report of the Royal Commission, and a vague belief that the said Report will be condemnatory of the practice. Sickness and Deaths due to the Principal Zymotic or Communicable Diseases. Small-Pox.—There were no deaths certified from this cause during the year belonging to the Parish of St. Luke. The Metropolis furnished 55 deaths, against 93 for 1894, and 206 for the year 1893. The total number of cases of sickness notified as Small-pox during the year was three. The first was that of a man 75 years of age, who, after being in the City Road Workhouse three days developed the disease, he was described as a "travelling 9 tailor" in the habit of sleeping in common lodging-houses, shelters, etc., and had lately been sleeping at the Salvation Army Shelter, Clerkenwell, but gave an address in St. Luke in order to obtain admission to the Workhouse. The second was that of a man 25 years old, a shoemaker by trade, employed at a factory in Mount Street, Whitechapel, in which district there existed at the time quite an epidemic of Small-pox. The third case was a child six years old, who, upon arrival at the Wharf belonging to the Asylum Board, was found not to be suffering from Small-pox, and was returned home forthwith. Besides the foregoing I have made inquiries and advised the necessary precautionary measures iu a case in which the patient was employed in this parish, but resided in Shoreditch, and have also visited three suspected cases at the request of the Medical Attendants, but which cases proved not to be Small-pox. There were only 55 deaths due to Small-pox registered in the Metropolis during the year, against 206 for the year 1894. Scarlet Fever was the registered cause of death in London in 829 instances, being the smallest number recorded for the past four years, the figures being 962 for 1894, 1596 for 1893, and 1174 for 1892 respectively; of the 829 deaths 69 per cent. occurred in Public Institutions. In our own district 5 deaths were certified, as against 9 for the previous year. The cases of sickness from the same cause numbered 145, against 124 for the year 1894, 341 for 1893, and 224 for 1892. Diphtheria caused 18 deaths to Parishioners. This disease, which had assumed an epidemic form throughout the Metropolis during the years 1893 and 1894, showed some signs of abatement during the past year. Nevertheless, the number of deaths was considerably above the average, amounting to 2316. During 1894 there were 2473, and in 1893, 3265 deaths, the latter being the largest number ever recorded under this heading. The number of cases of sickness from Diphtheria notified in the Parish during the year was 92, and from Membranous Croup, 6. Fever.—Under this heading 7 deaths were registered, 6 being ascribed to Enteric or Typhoid, and one to Puerperal Fever— of the Enteric three died in Institutions outside the Parish, one died at the Royal Hospital for Diseases of the Chest, one in the 10 City Road District, and one in the Finsbury District. The case of Puerperal also died in the City Road District. There were 629 deaths registered from Fever within the Metropolitan area during the year, being a slight decrease upon the numbers of the two preceeding years. The table of Infectious Sickness gives a much less favourable account under this head than that of the previous year, there being 32 cases notified against 17 during 1894. Whooping Cough was the cause of 20 deaths in the Parish, being about half the average number. The number of deaths registered from Whooping Cough in London was 1483, showing a death-rate of 0.34 per 1000 living, being the lowest rate on record from this disease, the average for the preceding 10 years having been 0.63. This not being among the notifiable diseases, I am unable to record the amount of sickness due to it during the year. Measles.—This disease was credited with having caused 99 deaths, against 13 for the preceding year; the degree of prevalence of this malady, like the last, can only be judged of by the number of deaths ascribed to it, because it also is not notifiable under the Public Health (London) Act. The returns of the Registrar-General show that although the number of deaths ascribed to Measles in London amounted to 2633 during the year, the fatality was much less than in the preceding year, when the number reached 3292. The deaths, however, showed an increase each quarter: during the first, 300 occurred, 564 during the second, 753 during the third, and 1015 during the fourth quarter. Diarrhœa caused 63 deaths, 62 of which occurred to children under five years of age. This number is far in excess of our usual record, and is, in fact, the largest number registered since the year 1886. At the same time it is not out of proportion to the deaths from the same cause throughout the Metropolitan area, in which the smallest number occurred during the first quarter of the year, viz. 166, the second quarter the number rose to 316, during the third quarter as many as 2655 deaths were registered, after which the number fell to 462 during the fourth quarter, making a total for the year of 3600 cases, against 1780 for the preceding year, and being in the proportion 11 of 0.83 per 1000 living, a rate of 0.15 per 1000 above the average for 10 years, and higher than any year since 1887. Influenza.—The number of deaths certified from this cause during the year amounted to 9, whereas during the year 1894 only two deaths were so recorded. The deaths due to Pneumonia and Bronchitis numbered 326, against 248 for the preceding year, and in a notable number of instances Influenza was said to be a secondary cause of death amongst the cases certified under these headings. 12 13 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 1895, in the St. Luke, Middlesex, Sanitary District; classified according to Diseases, Ages and Localities. population at all ages. Registered Births. Aged under 5 or over 5. New Casks ok Sickness in knowledge of the each Locality, coming to the Medical Officer of Health Number of such Cases Removal from their Homes in the several Localities for Treatment in Isolation Hospital. Names of Localities adopted for the purpose of these Statistics; Public Institutions being shown as separate localities. Census 1891. Estimated to middle of. 1895. 1 2 3 4 5 6 7 8 9 10 11 12 13 1 2 3 4 5 6 7 8 9 10 11 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 29177 31006 1082 Under 5 36 19 3 ... 4 ... ... ... ... 5 ... ... ... 29 9 ... ... 4 ... ... ... ... ... ... ... 5 upwds 1 71 45 1 ... 22 ... ... 2 ... 51 ... ... 1 62 23 ... ... 10 ... ... ... ... ... ... ... Whitecross Street SubRegistration District 8278 7843 258 Under 5 12 9 ... ... 1 ... ... ... ... 1 ... ... ... 9 5 ... ... ... ... ... ... ... ... ... ... 5 upwds 1 16 11 1 ... 4 ... ... ... ... 20 ... ... 1 14 3 1 ... 3 ... ... ... ... ... ... ... Finsbury Sub-Registration District 4985 4326 89 Under 5 ... 2 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds ... 12 5 ... ... ... 1 ... ... ... 4 ... ... ... 8 3 ... ... ... ... ... ... ... ... ... ... St. Luke's Hospital for Lunatics ... ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... City of London Lying-in Hospital ... ... 479 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Royal Hospital for Diseases of the Chest ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... St. Mark's Hospital for Fistula, &c. ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 42440 43175 1908 Under 5 ... 50 31 3 ... 5 ... ... ... ... 6 ... ... ... 38 14 ... ... 4 ... ... ... ... ... ... ... 5 upwds 2 99 01 2 ... 26 1 ... 2 ... 76 ... ... 2 84 29 1 ... 13 1 ... ... ... ... ... ... 14 15 TABLE II. TABLE II. Table or Deaths, during the Year 1895, in the St. Luke, Middlesex, Sanitary District; 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 Fives Years of Age. At ail Ages. Under 1 Year. 1 and under 5. 5 and under 15 15 .and under 25 25 and under 65 65 and upward. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 81 22 Small-Pox. Scarlatina. Diphtheria. Membranous Croup Fevers. Cholera. Erysipelas. Measles. Whooping Cough. Diarrhoea and Dysentery. Rheumatic Fever. Phthisis. Bronchitis, Pneumonia, and Pleurisy. Heart Disease. Influenza. Injuries. All other Diseases. Total. Typhus. Enteric or Typhoid. Continued. Relapsing. Puerperal. (a) (b) (C) (d) (e) (f) (g) ( h) (i) City Road Sub-Registration District 620 252 147 14 15 121 71 Under 5 ... 1 1 ... ... ... ... ... ... ... ... 78 12 44 ... 2 82 ... ... 29 151 400 5 upwds ... ... 4 ... ... 1 ... ... 1 ... ... I I 1 I 31 79 18 2 2 78 220 Whitecross Street SubRegistration District 143 46 28 7 6 41 15 Under 5 ... ... ... ... ... ... ... ... ... ... ... 12 1 9 ... 1 24 1 ... 2 23 73 5 upwds ... 1 ... ... ... ... ... ... ... ... 2 1 ... ... I 10 21 6 2 4 22 70 Finsbury Sub-Registration District 58 20 8 ... 3 17 10 Under 5 ... ... ... ... ... ... ... ... ... ... ... 5 5 2 ... 1 ... ... ... 2 10 28 5 upwds ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 4 7 4 ... 3 11 30 St. Luke's Hospital for Lunatics 17 ... ... ... 1 12 4 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 11 ... ... ... 5 17 City of London Lying-in Hospital 14 12 ... ... 1 1 ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 11 12 5 upwds ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 2 Royal Hospital for Diseases of the Chest 56 ... ... 4 14 38 ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 32 9 7 ... ... 7 56 St. Mark's Hospital for Fistula, &c. ... ... ... ... ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 908 330 183 25 40 230 100 Under 5 ... 1 1 ... ... ... ... ... ... ... ... 95 13 55 4 127 1 33 125 455 5 upwds ... 1 4 ... ... 3 ... ... 1 ... 2 2 6 1 2 78 110 35 4 9 195 453 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 401 40 49 13 22 176 101 Under 5 ... 3 11 ... ... 1 ... ... ... ... ... 2 1 7 2 24 3 37 91 5 upwds ... ... 2 ... ... 2 ... ... ... ... 2 57 65 25 5 17 135 310 Deaths occurring within the District among persons not belonging thereto 93 11 ... 4 17 56 5 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 9 10 5 upwds ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 33 18 9 ... 4 18 83 16 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 upwards. CLASSES. I. Specific Febrile or Zymotic Diseases 88 108 l6 3 l6 5 196 236 II. Parasitic Diseases ... ... ... ... ... ... ... ... III. Dietic Diseases 4 ... ... ... 4 3 4 11 IV. Constitutional Diseases 17 29 4 18 115 11 46 194 V. Developmental Diseases 33 ... ... ... ... 37 33 70 VI. Local Diseases 122 79 16 19 251 138 201 575 VII. Deaths from Violence 33 3 2 5 10 3 36 56 VIII. Deaths from ill-defined and not specified Causes 69 4 ... ... ... 1 73 74 366 223 38 45 346 198 589 1216 I. Specific Febrile or Zymotic Diseases. 1. Miasmatic Diseases. Small Pox, Vaccinated ... ... ... ... ... ... ... ... „ Unvaccinated ... ... ... ... ... ... ... ... „ No Statement ... ... ... ... ... ... ... ... Measles 22 75 2 ... ... ... 97 99 Scarlet Fever ... 4 1 ... ... ... 4 5 Typhus ... ... ... ... ... ... ... ... Whooping Cough 10 4 6 ... ... ... 14 20 Diphtheria 1 12 5 ... ... ... 13 18 Simple Continued or Ill-defined Fever ... ... ... ... ... ... ... ... Enteric or Typhoid Fever ... 1 ... 1 3 ... 1 5 Other Miasmatic Diseases ... ... ... ... ... ... ... ... 17 TABLE III.—continued. CAUSES OF DEATH. AGES. Total under 5 years of age. Grand Total all Agea. 0 to 1. 1 to 5. 5 to 16. 15 to 25. 25 to 65. 65 and upwards. Specific Febrile or Zymotic Diseases—continued. 2. Diarrhœl Diseases. Simple Cholera ... ... ... ... ... ... ... ... Diarrhœa, Dysentery 51 12 ... ... ... ... 63 63 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 4 ... ... ... ... ... 4 4 Gonorrhœa, Stricture of the Urethra ... ... ... ... ... ... ... ... 6. Septic Diseases. Erysipelas ... ... ... ... 1 3 ... 4 Pyaemia Septicaemia ... ... 1 2 5 ... ... 8 Puerperal Fever ... ... ... ... 1 ... ... 1 Influenza ... ... i ... 6 12 ... 9 88 108 16 3 16 5 196 236 II. Parasitic Diseases. Thrush, and other Vegetable Parasitic Diseases ... ... ... ... ... ... ... ... Worms, Hydatids and other Animal Parasitic Diseases ... ... ... ... ... ... ... ... 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 IS. 15 to 25. 25 to 65. 65 and upwards. III. Dietic Diseases. Want of Breast Milk, Starvation 4 ... ... ... ... ... 4 4 Scurvy ... ... ... ... ... ... ... ... Chronic Alcoholism ... ... ... ... 4 3 ... 7 Delirium Tremens ... ... ... ... ... ... ... ... 4 ... ... ... 4 3 4 11 IV. Constitutional Diseases. Rheumatic Fever, Rheumatism of the Heart ... ... ... ... 2 ... ... 2 Rheumatism ... ... ... ... 2 1 ... 3 Gout ... ... ... ... 1 1 ... 2 Rickets ... 5 ... ... ... ... 5 5 Cancer, Malignant Disease ... ... ... ... 26 5 ... 3i Tabes Mesenterica 4 1 ... ... ... ... 5 5 Tubercular Meningitis, Hydrocephalus 7 7 1 1 1 ... 14 17 Phthisis 2 4 1 16 8l 4 6 108 Other Forms of Tuberculosis, Scrofula 4 12 2 1 1 ... 16 20 Purpura, Hæmorrhagic Diathesis ... ... ... ... ... ... ... ... Anæmia, Chlorosis, Leucocythæmia ... ... ... ... ... ... ... ... Glycosuria, Diabetes Mellitus ... ... ... ... 1 ... ... 1 Other Constitutional Diseases ... ... ... ... ... ... ... ... 17 29 4 18 115 11 46 !94 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 upwards. V. Developmental Diseases. Premature Birth 26 ... ... ... ... ... 26 26 Atelectasis 6 ... ... ... ... ... 6 6 Congenital Malformation 1 ... ... ... ... ... 1 1 Old Age ... ... ... ... ... 37 ... 37 33 37 33 70 VI. Local Diseases. 1. Diseases of Nervous System. Inflammation of Brain or Membranes 3 7 ... 1 3 ... 10 14 Apoplexy, Softening of Brain, Hemiplegia, Brain Paralysis ... ... ... 1 12 24 ... 37 Insanity, General Paralysis of the Insane ... ... ... ... 7 7 ... 14 Epilepsy ... ... 1 2 1 1 ... 5 Convulsions 14 3 ... ... ... ... 17 17 Laryngismus Stridulus (Spasm of Glottis) I ... ... ... ... ... 1 1 Disease of Spinal Cord, Paraplegia, Paralysis Agitans ... 1 ... ... 2 ... 1 3 Other Diseases of Nervous System i 1 ... 2 1 ... 2 5 2. Diseases of Organs of Special Sense. Diseases of Organs of Special Sense, e.g., of Ear, Eye, Nose ... ... 1 ... ... ... ... 1 3. Diseases of Circulatory System. Pericarditis ... ... ... ... 1 ... ... 1 Acute Endocarditis ... ... ... ... ... ... ... ... Valvular Diseases of Heart ... ... 4 ... 16 4 ... 24 Other Diseases of Heart 3 1 ... 1 19 10 4 34 Aneurism ... ... ... ... 2 ... ... 2 Embolism, Thrombosis ... ... ... ... ... ... ... ... Other Diseases of Blood Vessels ... ... ... ... ... ... ... ... 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 upwards. Local Diseases—continued. 4. Diseases of Respiratory System. Laryngitis ... 4 ... ... ... ... 4 4 Croup ... ... ... ... ... ... ... Emphysema Asthma 1 ... ... ... ... 11 1 12 Bronchitis 47 30 4 1 62 62 77 206 Pneumonia 28 29 2 2 30 5 57 96 Pleurisy ... ... 1 ... 5 1 ... 7 Other Diseases of Respiratory System ... ... ... 1 ... ... ... 1 5. Diseases of Digestive Organs. Dentition 7 ... ... ... ... ... 7 7 Sore Throat, Quinsey ... ... ... ... 1 ... ... 1 Diseases of Stomach 1 ... ... 1 4 1 1 7 Enteritis 12 ... ... ... ... ... 14 14 Obstructive Diseases of Intestines 2 ... ... ... 1 4 2 7 Peritonitis ... ... ... 2 3 1 ... 6 Ascites ... ... ... ... ... ... ... ... Cirrhosis of Liver ... ... ... ... 5 1 ... 6 Jaundice, and other Diseases of Liver ... ... ... ... 3 ... ... 3 Other Diseases of Digestive System 1 1 ... ... ... 1 2 3 6. Diseases of Lymphatic System. e.g., of Lymphatics and of Spleen 1 ... 1 1 2 7. Diseases of Glanlike Organs of Uncertain Use. e.g., Bronchocele Addison's Disease ... ... ... ... ... ... ... ... 8. Diseases of Urinary System. Nephritis ... ... ... ... 6 1 ... 7 Bright's Disease, Albuminuria ... ... 2 2 8 1 ... 13 Disease of Bladder or of Prostate ... ... ... 1 ... ... ... 1 Other Diseases of the Urinary System ... ... ... ... 1 ... ... 1 21 TABLE III.—continued. CAUSES OF DEATH. AGES. Total under 5 years of age. Grand Total all Agea. 0 to 1. 1 to 5. 5 to 15. 15 to 25. 25 to 65. 65 and upwards. Local Diseases—continued. 9. Diseases of Reproductive System. Male Organs ... ... ... ... ... ... ... ... Female Organs ... ... ... ... 3 ... ... 3 Abortion, Miscarriage ... ... ... ... ... ... ... ... Puerperal Convulsions ... ... ... ... ... ... ... ... Placenta Prævia, Flooding ... ... ... ... ... ... ... ... Other Accidents at Childbirth ... ... ... 1 ... ... ... 1 10. Diseases of Bones and Joints. Caries, Necrosis ... ... 1 1 2 1 ... 5 Arthritis, Ostitis, Periostitis ... ... ... ... 3 1 ... 4 Other Diseases of Bones and Joints ... ... ... ... ... ... ... ... 11. Diseases of Integumentary System. Carbuncle, Phlegmon ... ... ... ... ... ... ... ... Other Diseases of Integumentary System ... ... ... ... ... ... ... ... 122 79 16 19 201 138 20i 575 VII. Deaths from Violence. 1. Accident or Negligence. Fractions and Contusions ... 2 1 2 5 3 2 13 Gunshot Wounds ... ... ... ... ... ... ... ... Cut, Stab ... ... ... ... ... ... ... ... Burn, Scald ... ... 1 ... ... ... ... 1 Poison ... 1 ... ... ... ... 1 1 Drowning ... ... ... 1 ... ... ... 1 Suffocation 32 ... ... ... ... ... 32 32 Otherwise 1 ... ... ... ... ... 1 1 22 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 upwards. Deaths from Violence—continued. 2. Homicide. Manslaughter ... ... ... ... ... ... ... ... Murder ... ... ... ... 1 ... ... 1 3. Suicide. Gunshot Wounds ... ... ... ... ... ... ... ... Cut, Stab ... ... ... ... 1 ... ... 1 Poison ... ... ... ... 1 ... ... 1 Drowning ... ... ... 2 1 ... ... 3 Hanging ... ... ... ... 1 ... ... 1 Otherwise ... ... ... ... ... ... ... ... 4. Execution. Hanging ... ... ... ... ... ... ... ... 33 3 2 5 IO 3 36 56 VIII. Deaths from Ill-defined and not specified Causes. Dropsy ... ... ... ... ... ... ... ... Debility, Atrophy, Inanition 68 4 ... ... ... ... 72 72 Mortification ... ... ... ... ... ... ... ... Tumour ... ... ... ... ... ... ... ... Abscess 1 ... ... ... ... 1 1 2 Hæmorrhage ... ... ... ... ... ... ... ... Sudden Death (cause not ascertained) ... ... ... ... ... ... ... ... Causes not Specified or Ill-defined ... ... ... ... ... ... ... ... 69 4 ... ... ... 1 73 74 23 TABLE IV. Return respecting the Vaccination of Children whose Births were Registered between July 1st, 1894, and June 30th, 1895, 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 1614 1015 4 — 187 28 °207 158 15 Whitecross Street 258 192 — — 28 4 — 30 4 Finsbury 89 65 — — 10 3 — 9 2 Totals 1961 1272 4 — 225 35 °207 197 21 *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. 24 PUBLIC HEALTH (LONDON) ACT, and WORK OF THE SANITARY DEPARTMENT. Notification of Infectious Diseases. The following Table gives the number and nature of the cases notified under Sections 55 and 56 of the Public Health Act during the 52 weeks ended December 28th, 1895, 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 and Infirmaries. Treated at their own Homes. Duplicate Certificates. Erroneously Diagnosed. Small-Pox 3 2 — — — 1 Scarlet Fever 160 122 — 23 12 3 Diphtheria 107 43 22 27 15 — Typhus Fever — — — — — — Enteric Fever 35 17 9 5 4 — Continued Fever 1 1 — — — — Membranous Croup 6 1 1 3 — 1 Puerperal Fever 2 — — 2 — — Erysipelas 92 — 10 72 10 — Total number from all causes 406 186 42 132 41 5 The amount paid to the Medical Practitioners for furnishing the above Certificates amounted to £37 10s. 6d. For the year 1894 the sum of £30 15s. 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. During the year I have visited and reported upon 5 Slaughterhouses, 2 Cowsheds, and 36 Bakehouses, situated in the Parish, with the result that notices to cleanse, whitewash, and remedy 25 other sanitary defects were served upon the owners of 2 Slaughter-houses, 2 Cowsheds, and 16 Bakehouses. Although the condition of some of the Bakehouses cannot be regarded as wholly satisfactory, improvement is gradually taking place. The number in which water is drawn direct from the main instead of through objectionably situated cisterns has increased from 3 in 1893 to 21 in 1895. Out of a total of 36, 19 are situated underground, and are for the most part indifferently lighted and ventilated. It is satisfactory to know that in future it will be illegal to continue the objectionable practice of constructing Bakehouses underground. By the Factory and Workshop Act, 1895, Bakehouses are classed as Workshops, and Sec. 27 (3) provides that: "A Place underground shall not be used as a Bakehouse, unless it is so used at the commencement of this Act, and if any place is so used in contravention of this Act it shall be deemed to be a Workshop not kept in conformity with the principal Act," and the owner will become liable to be proceeded against accordingly. Besides the before-mentioned, I have visited all new premises requiring a Certificate under Public Health Act, 1891, also a large number of Dwelling-houses, Factories, and Workshops, of which complaints have been received, and in every instance in which the Vestry's Notice to abate a Nuisance has not been complied with. In those cases in which summonses have been granted, I have attended the Police Courts in support of the same. I have made numerous Reports on the various matters which have occupied the attention of your Public Health Committee during the year; among the most important of which were the Workshop and Factory Bills and Act (copy of this latter is appended to this report). Sanitary Registration Bill. Nuisance arising from Fried Fish Shops. THE FACTORY AND WORKSHOPS ACT, 1895. To the Public Health Committee. Gentlemen, I reported upon this Act in March last, when it was introduced to the House of Commons, and while in its Bill stage; and I propose in this report to refer mainly to those 26 sections of the Act which relate to the protection of the life and health of the persons whom this class of legislation is specially intended to benefit. Section 1. Fixes the amount of air space to be allotted to each worker in a factory or workshop at 250 cubic feet at least during the usual working hours, and at 400 cubic feet during any period of overtime: but power is reserved for the Secretary of State by an order to modify this portion for any time during which artificial light, other than electric light, is employed, and also as regards any particular manufacturing process or handicraft. And in order to facilitate the carrying out of these provisions, sub-Section 3 provides that a notise shall be affixed specifying the number of persons who may be employed in each room of the factory or workshop, and in this matter Section 78 of the principal Act shall apply to this Act; so that in the event of any contravention of this provision, the occupier of a workshop will be liable to a fine not exceeding forty shillings. Section 3. Provides that where notice of an act, neglect, or fault is given by a Factory Inspector to a Sanitary Authority, it shall be the duty of the latter to inform the Inspector within one month of the proceedings taken in consequence of such notice. (The alternative which the Bill provided, of giving power to the Inspector to take the necessary proceedings in the event of the Sanitary Authority failing to do so, and to recover the cost of so doing from the Sanitary Authority, has been eliminated.) Section 6 This section has also been amended. In the Bill it provided that a penalty not exceeding £20 should be incurred by the owner of a workshop or factory who permitted wearing apparel to be made, cleaned, or repaired, in any building in which an inmate was suffering from small-pox or scarlet fever. In the Act as it now stands, occupiers of laundries or any place from which work is given out, and any contractor employed by any occupier, shall be liable to a penalty which is now reduced to £10 for infringement of this Section. The liability will not, however, be incurred if the occupier, &c., proves that he was not aware of the illness, and could not reasonably have been expected to have become aware of it. Section 22 Places laundries for the first time under the Factory and Workshop Acts; those in which steam, water, or other mechanical power is used in aid of the laundry process being classed as factories, and every other laundry as a workshop. 27 In the first class provision must be made by means of a fan or other construction for regulating the temperature of the ironing-room and for carrying away the steam in every washhouse. All stoves for heating irons must be separated from any ironing-room, and gas-irons emitting noxious fumes must not be used. Tenement Factories. Where mechanical power is supplied to different parts of the same building occupied by different persons, such parts constituting different factories, the owner, and not the occupier, shall be liable for the observance of certain provisions ; amongst them, their Sanitary condition, the fencing of machinery, the limewashing of any engine-house, staircase, or room let to more than one tenant, also the removal of dust, and affixing of the required notices in the same. Section 24. Relates to bakehouses, and repeals certain Sections of the older Acts which limit their operations to places having a population of more than 5,000 persons; and, what is of greater importance, this Clause provides for the repeal of Section 15 of the Act of 1883, limiting the power of the Sanitary Authorities over bakehouses occupied as such prior to June, 1883, and which has reference to the existence of water-closets, drains, and cisterns in bakehouses. The Section also prohibits the construction of any further underground bakehouses. Section 27. By this Section power is given to the Secretary of State to prohibit or restrict the employment of persons in any process or labour which he considers dangerous or injurious to health, life, or limb. Section 28. Extends the system of notification by medical practitioners to cases of sickness from lead, phosphorous, or arsenical poisoning, or from carbuncle contracted in any factory or workshop, the said notification to be forwarded to the Chief Inspector of Factories, Home Office. The Secretary of State may, by order, extend the provisions of this Clause to other diseases, and he is responsible for the expenses incurred in carrying out this Section, and medical men are liable for non-compliance with it. Section 29. Provides for the supply of suitable washing conveniences for the use of workers employed in factories or workshops in which poisonous substances are used. Section 30. Provides for the maintenance of a "reasonable" temperature, limit of humidity, and prevention of excessive quantity of gas vapour or other impurity being inhaled by workers. Fans and arrangements for ventilation are to be provided for these purposes. Section 32 and 33. 28 Section 41. Provides that every person who is in occupation of a workshop at the commencement of this Act shall furnish the Factory Inspector with a notice giving the name and situation of the workshop, nature of the work, and other particulars of a like nature; and further directs that any notice so served shall be forthwith forwarded to the Sanitary Authority of the district in which the workshop is situated; the intention, no doubt, being to enable the Authority to carry out the duties imposed upon it by the Act without unnecessary delay. Section 43. By this Section failure to enter in the Begister particulars as to white-washing is to be regarded as prima facie evidence of the non-observance of the requirements of Section 77 of the principal Act. The Act will come into operation on January 1st, 1896. It consists of 56 Sections, but, as stated at the outset of this Beport, I have only thought it necessary to call attention to those Sections which will require the supervision of the Public Health Department, the work of which must necessarily be much increased by the new enactment. I am, yours obediently, G. E. YARROW, Medical Officer of Health. The following Bye-laws made by the Vestry and approved by the Local Government Board complete the series necessary to be made by the Vestry under PUBLIC HEALTH (LONDON) ACT, 1891. Bye-laws. Made by the Vestry of the Parish of St. Luke, Middlesex, in the Administrative County of London, being the Sanitary Authority for the said Parish, with respect to Houses let in Lodgings, or occupied by Members of more than one Family. Interpretation of Terms. 1. In these bye-laws, unless the context otherwise requires, the following words and expressions have the meaning hereinafter respectively assigned to them ; that is to say— " Sanitary Authority " means the Vestry of the Parish of St. Luke, Middlesex, in the Administrative County of London. 29 "Lodging-house" means a house or part of a house which is let in lodgings or occupied by members of more than one family. "Landlord," in relation to a house or part of a house which is let in lodgings or occupied by members of more than one family means the person (whatever may be the nature or extent of his interest in the premises) by whom or on whose behalf such house or part of a house is let in lodgings or for occupation by members of more than one family, or who for the time being receives, or is entitled to receive the profits arising from such letting. "Lodger," in relation to a house or part of a house which is let in lodgings or occupied by members of more than one family, means a person to whom any room or rooms in such house or part of a house may have been let as a lodging or for his use and occupation. Exempted Houses. 2. In either of the following cases a lodging-house shall be exempt from the operation of these bye-laws; that is to say— (i) Where the landlord resides upon the premises and the letting by such landlord is to not more than one lodger. (ii) Where the rent or charge payable by each lodger, and exclusive of any charge for the use by such lodger of any furniture, is at the rate of three shillings per week or upwards. (iii) Where the rent or charge payable by each lodger, and inclusive of any charge for the use by such lodger of any furniture, is at a rate of five shillings and sixpence per week or upwards. (a) For fixing the nimber o f persons who may occupy a house or part of a house which is let in lodgings or occupied by members of more than one family. (b) For the registration of houses so let or occupied. (c) For the inspection of such houses. (d) For enforcing drainage for such houses, and for promoting cleanliness and ventilation in such houses. (e) For the cleansing and lime-washing at stated times of the premises. (f) For the taking of precautions in case of any infectious disease. 3. The landlord of a lodging-house or a lodger therein shall not knowingly cause or suffer a greater number of persons than will admit of the provision of three hundred cubic feet of free air space for 30 each person of an age exceeding ten years, and of one hundred and fifty cubic feet of free air space for each person of an age not exceeding ten years to occupy, at any one time, as a sleeping apartment, a room which is used exclusively for that purpose, and which is under the control of such landlord, or which has been let to such lodger respectively, as the case may be. 4. The landlord of a lodging-house, or a lodger therein, shall not knowingly cause or suffer a greater number of persons than will admit of the provision of four hundred cubic feet of free air space for each person of an age exceeding ten years, and of two hundred cubic feet of free air space for each person of an age not exceeding ten years to occupy, at any one time, as a sleeping apartment, a room which is not used exclusively for that purpose, and which is under the control of such landlord, or which has been let to such lodger respectively, as the case may be. 5. The landlord of a lodging-house, within a period of fourteen days after he shall have been required by a notice in writing, signed by the Clerk to the Sanitary Authority, and duly served upon or delivered to such landlord, to supply the information necessary for the registration of such house by the Sanitary Authority, shall, himself, or. by his agent duly authorised in that behalf, sign and furnish to the Sanitary Authority a true statement of the following particulars with respect to such house ; that is to say— (a) The total number of rooms in the house. (b) The total number of rooms let in lodgings or occupied by members of more than one family. (c) The manner of use of each room. (d) The number, age, and sex of the occupants of each room used for sleeping. (e) The Christian name and surname of the lessee of each room ; and (f) The amount of rent or charge per week payable by each lessee. 6. In any case where the landlord of a lodging-house occupies or resides in any part of the premises, or retains a general possession or control of the premises, such landlord, and in any case where the landlord of a lodging-house does not occupy or reside in any part of the premises, or retain a general possession or control of the premises, every lodger who is entitled to have or to exercise the control of the outer door of the premises shall, at all times when required by the Medical Officer of Health, the Sanitary Inspector, or any other officer specially appointed or authorised by the Sanitary Authority in that behalf, afford any such officer free access to the interior of the premises for the purpose of inspection. 31 7. Every lodger in a lodging house shall, at all times when required by the Medical Officer of Health, the Sanitary Inspector, or any other officer specially appointed or authorised by the Sanitary Authority in that behalf, afford any such officer free access for the purpose of inspection to the interior of any room or rooms which may have been let to such lodger. 8. Where the Medical Officer of Health, the Sanitary Inspector, or any other officer specially appointed or authorised by the Sanitary Authority in that behalf, has, for the purpose of inspection, obtained access to the interior of a lodging-house, or to the interior of any room or rooms in such house, a person shall not wilfully obstruct any such officer in the inspection of any part of the premises, or, without reasonable excuse, neglect or refuse, when required by any such officer, to render him such assistance as may be reasonably necessary for the purpose of such inspection. 9. In any case where a lodger in a lodging-house is entitled to the exclusive use of any court, court-yard, area, or other open space within the curtilage of the premises, such lodger, and in any case where two or more lodgers in a lodging-house are entitled to the use in common of any court, court-yard, area, or other open space within the curtilage of the premises, the landlord shall cause such court, court-yard, area, or other open space to be thoroughly cleansed from time to time, as often as may be requisite for the purpose of keeping the same in a cleanly condition. 10. The landlord of a lodging-house shall cause every drain or means of drainage with which any water-closet belonging to such house may communicate to be maintained at all times in good order and efficient action. He shall also cause all such means of ventilation as may be provided in or in connection therewith to be maintained at all times in good order. 11. Every lodger in a lodging-house shall cause all solid or liquid filth or refuse to be removed once at least in every day from every room which has been let to him, and shall once at least in every day cause every vessel, utensil or other receptacle for such filth or refuse to be thoroughly cleansed. 12. In every case where a lodger in a lodging-house is entitled to the exclusive use of any staircase, landing or passage in such house, such lodger shall cause every part of such staircase, landing, or passage to be thoroughly cleansed from time to time as often as may be requisite. 13. A lodger in a lodging-house shall not cause or suffer any animal to be kept in any room which has been let to such lodger, or elsewhere upon the premises in such a manner as to render the condition of such room or premises filthy. 32 14. The landlord of a lodging-house shall cause every common passage or staircase in such house to be thoroughly cleansed from time to time as often as may be requisite. 15. The landlord of a lodging-house shall, in the first week of the month of April in every year, cause every part of the premises to be cleansed. He shall at the same time, except in such cases as are hereinafter specified, cause every area, the interior surface of every ceiling, and wall of every water-closet belonging to the premises, and the interior surface of every ceiling and wall of every room, staircase, and passage in the house to be thoroughly limewashed. Provided that the foregoing requirement with respect to the limewashing of the internal surface of the walls of rooms, staircases, and passages shall not apply in any case where the internal surface of any such wall is painted, or where the material of or with which such surface is constructed or covered is such as to render the limewashing thereof unsuitable or inexpedient, and where such surface is thoroughly cleased, and the paint or other covering is renewed, if the renewal thereof be necessary for the purpose of keeping the premises in a cleanly and wholesome condition. 16. The landlord of a lodging-house shall provide adequate means of ventilation in or in connection with every common passage or staircase in such house, and shall cause such means of ventilation to be maintained at all times in good order. 17. The landlord of a lodging-house shall cause all such means of ventilation as may be provided in or in connection with any room in such house to be maintained at all times in good order. 18. In every case where, in pursuance of any statutory provision in that behalf, an order of a justice has been obtained for the removal from a lodging-house to a hospital of a person who is suffering from any dangerous infectious disease and is without proper lodging or accommodation, the landlord of such house, and the lodger to whom any room whereof such person may be an occupant has been let shall, on being informed of such order, forthwith take all such steps as may be requisite on the part of such landlord and of such lodger respectively, to secure the safe and prompt removal of such person in compliance with such order, and shall, in and about such removal, adopt all such precautions as, in accordance with any instructions which such landlord and such lodger, respectively, may receive from the Medical Officer of Health of the Sanitary Authority, may be most suitable for the circumstances of the case. Penalties. 19. Every person who shall offend against any of the foregoing bye-laws shall be liable for every such offence to a penalty of five 33 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 : 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. Repeal of Bye-laws. From and after the date of the confirmation of these Bye-laws the regulations as to houses let in lodgings or occupied by members of more than one family, which were confirmed on the second day of January, in the year one thousand eight hundred and eighty-five, by the Local Government Board, shall be repealed. The Seal of the Vestry of the Parish of St. Luke, Middlesex, in the Administrative County of London, affixed by Order this 10th day of September, 1895. (Signed) M. MANNS, Churchwarden. G. W. PRESTON, Clerk of the Vestry. Allowed by the Local Government Board this twenty-ninth day of October, 1895. (Signed) HENRY CHAPLIN, President. HUGH OWEN, Secretary. PUBLIC HEALTH (LONDON) ACT, 1891. Bye-laws. Made by the Yestry of the Parish of St. Luke, in the County of London, being the Sanitary Authority for the said Parish for the Management of the Mortuary. 1. Throughout these Bye-laws the expression "The Sanitary Authority" means the Vestry of the Parish of St. Luke, in the County of London. 2. Every person who has caused the body of one who has died of an Infectious Disease to be deposited in the Mortuary, shall cause the body to be removed therefrom for the purpose of interment, within a period of three days from the date of death. 3. Every person who has caused the body of one who has died of Non-infectious Disease to be deposited in the Mortuary, shall 34 Cause the body to be removed therefrom for the purpose of interment, within a period of five days from the date of death. 4. Every person for the time being employed in depositing a body in the Mortuary, or in removing a body therefrom, shall, while so employed, conduct himself in all respects with decency and propriety. 5. Every person who has been admitted for the purpose of viewing a body which has been deposited in the Mortuary, shall, while on the premises, conduct himself with decency and propriety. 6. No person shall remove from the Mortuary a Shell or Coffin in which a body has been received into the Mortuary, except for the burial of the body contained therein, or except with the written permission of the Medical Officer of Health, and after such disinfection of the said Shell or Coffin as the Medical Officer of Health may deem expedient. Penalties. 7. 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. 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. The Seal of the Vestry of the Parish of St. Luke, Middlesex, in the Administrative County of London, affixed by Order, this 25th day of October, 1895. (Signed) M. MANNS, Churchwarden. G. W. PRESTON, Clerk of the Vestry. Allowed by the Local Government Board this seventeenth day of December, 1895. (Signed) HENEY CHAPLIN, President. HUGH OWEN, Secretary. In order to meet the continued increase of work in the Public Health Department, the Vestry during the past year appointed a Disinfecter and general Assistant to the Sanitary Inspectors, which appointment has had the effect of considerably relieving the Inspectors of many minor matters of detail, much, however, remains to be done if the Vestry desires the Acts relating to 35 Public Health to be thoroughly carried out, and to this end I have no hesitation in saying it is the desire of every member of the Staff to do his very best. Trusting that upon the whole the work of the past year has been satisfactory to your Vestry, and in the hope of having your continued support, 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, April 20th, 1896. 36 Public Health Department. To the Vestry of the Parish of St. Luke, Middlesex. Gentlemen, The works carried out by order of the Public Health Committee, between the 1st January and 31st December, 1895, in the Parish, are as follows :— Houses Inspected 2286 Houses cleansed, whitewashed and repaired 380 Dust-bins provided and repaired 165 Yards to houses paved or amended 246 Traps provided to yards and house drains 277 Water receptacles cleansed and provided with covers 70 Water supply re-instated 155 Drains amended and obstructions removed 255 Houses provided with new pipe drains 37 Rain-water pipes disconnected from drains 140 "Waste pipes of sinks 95 Water-closets re-constructed 113 ,, ,, ventilation improved 47 ,, ,, water supply re-instated 217 ,, pans cleansed 122 ,, additional provided 30 Overcrowding in rooms abated 73 Underground rooms illegally occupied as dwellings 27 Eoofs of houses repaired 91 Nuisances arising from accumulations of manure and refuse, etc. 123 Ventilation of houses improved 5 Dung-pits abolished and proper receptacles provided 15 Miscellaneous nuisances abated 200 Booms fumigated 356 Cab „ 1 Lots of bedding disinfected 264 No. of articles of bedding, clothing, &c., destroyed 15 37 List of Streets, Courts, and other places inspected under systematic house-to-house visitation during the year :— Baltic Court James Street Baltic Place Old Street Beckford Square Macclesfield Place Belward Avenue Mason's Place Collingwood Street Osman's Place Church Row Eed Lion Market Clarence Place Richard's Place Dean's Court Roby Street Elizabeth Place Three King Court French Alley Thomas' Place Garden Court Westmoreland Place Gt. Arthur Street Willow Row Henry Street Wither's Place Honduras Street York Road Hull's Place Young's Buildings Notices served for enforcing Sanitary Works, etc. :— Written Imitations 1288 Statutory Notices 483 Notices of Summonses 53 Thirty-six bakehouses were visited, and the necessary notices to cleanse, limewash, and trap the drains on the premises were served, and the work done in 16 instances. Five slaughter-houses were inspected, three were found to be in good sanitary condition. On the owners of two notices were served to limewash and amend the paving. Two cow-sheds were also visited and notices given to limewash and amend the paving. 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:— 2 boxes of oranges 1 box of eggs 2 cwt. pork 2 bags mussels 1¼ cwt. beef 3 cwt. fish 2¾ cwt. mutton ½ cwt. tomatos 1¾ cwt. rabbits 38 Sale of Food and Drugs Act. The Fines and Costs imposed by the Magistrates under this Act amounted to £27 9s. 6d., which has been recovered and paid into the Vestry's Account. Eight Summonses were taken out under the Public Health (London) Act, 1891, for non-compliance with the Vestry's Notices. Four cases related to drainage works and general repairs. The necessary work was executed after the granting of the Summonses, and they were accordingly withdrawn upon payment of Costs by the defendants. For improperly keeping dogs in a dwelling room the defendant was also ordered to pay the costs, the nuisance having been abated. For exposing unsound food for sale (oranges) defendant was fined 5s. and 2s. costs. The other two cases were adjourned in order that the required works might be carried out within a time specified by the Magistrate. One still remains unfinished, while in the other a second summons was granted, and the defendant was fined £4 and 21s. for non-compliance with the Magistrate's order. The Mortuary and Coroner s Court. During the twelve months under consideration, 240 bodies were received into the Mortuary. One hundred and eight Inquests were held during the same period, and the sum of £19 12s. paid to the Vestry for the accommodation afforded by the Coroner's Court. Fifty-five Post-mortem examinations were held in the Post-mortem Room adjoining the Coroner's Court. A large quantity of Disinfecting Powder and Carbolic Acid has been given away to the Parishioners. JOHN E. RUGG, Sanitary FRED. A. BARTH, Inspectors. Vestry Hall, City Road, E.C. ANNUAL REPORT upon the Public Health & Sanitary Condition of the UNITED PARISHES of St. Margaret & St. John,Mestminster, FOR THE YEAR 1895, by JOHN NORTON, M.D., D.P.H.. Medical Officer of Health, member of the royal college of surgeons of england ; fellow of the incorporated society of medical officers of health ; fellow of the british institute of public health. London Wightman & Co., "The Westminster Press," 104 & 106, Regency Street, S.W. 189 6