STLU 3 REPORT ON THE SANITARY CONDITION, VITAL STATISTICS, &C., OF THE Parish of St. Luke, MiddleseX, FOR THE YEAR 1896, BY g. e. yarrow, m.d. Barrister at Law. DIPLOMATE IN PUBLIC HEALTH, ROYAL COLLEGE OF PHYSICIANS AND SURGEONS, LONDON. EX-PRESIDENT OF THE METROPOLITAN BRANCH OF THE INCORPORATED SOCIETY OF MEDICAL OFFICERS OF HEALTH. MEMBER OF THE HONOURABLE SOCIETY OF GRAY'S INN, Etc. MEDICAL OFFICER OF HEALTH FOR THE PARISH AND DEPUTY CORONER FOB NORTH-EAST LONDON. LONDON: Thomas Bean & Son, Phcenix Works, 67, Goldrn Lane, E.C. 1897 TO THE VESTRY OF THE PARISH OF ST. LUKE, MIDDLESEX. Gentlemen, I beg to present my twelfth Annual Report on the Health, Sanitary condition and Vital Statistics of the Parish for the 53 weeks ending January 4th, 1897. The Sanitary District of St. Luke comprises an area of 239 acres, including open spaces and the Basin and Waterway of the Regents Canal. The number of Inhabited Houses is 3702. Shortly after my Annual Report for the year 1895 was printed the Census enumeration of the Metropolis was published, by which our population was stated to be 41,527. The enumeration of last year was the first quinquennial census, and was taken solely for the purposes of the Equalization of Rates Act, and contains no information, therefore, beyond the crude figures of population. The decrease which has taken place since the Census of 1891 amounts to 913 persons. For the several districts into which the Parish is divided for registration purposes the figures are as follows:— 1891. City Road District 29,177 Whitecross Street District 8,278 Finsbury District 4,985 1896. 29,897 being an increase of 720 7,595 being a decrease of 683 4,035 „ „ 950 42,440 41,527 total decrease 913 It may be pointed out that the City Road Registration District comprises all that portion of the Parish which is situated 011 the north side of Old Street, while the south side of the same thoroughfare is divided into the Whitecross Street and Finsbury Districts; the population therefore has increased in the northern portion of the Parish to the extent of 720 persons, and there has been a decrease in the southern districts of 1633, and a net decrease in the Parish of 913 persons as shown above. 4 These changes have been brought about on the southern side of the Parish entirely by the demolition of dwelling houses and the erection on their sites of warehouses, factories, &c., while on the north side the same observation applies to a less extent, the extra accommodation provided by the erection of Guinness's Trust Buildings has fully compensated for the loss of dwelling houses in that district. During the past five years, in which some record has been kept, I find that 96 dwelling houses have been pulled down in the City Road District, and it is estimated that the number of persons thereby displaced amounted to 845. In the Whitecross Street District 71 houses have been demolished in the same period, whereby 598 persons were displaced, and in the Finsbury District 81 houses were pulled down and 809 persons were in the same way disturbed. Taking the two latter districts, formed from the south side of Old Street, together, the figures would be 152 houses destroyed and 1,407 persons displaced, and for the whole Parish 248 houses converted into factories, &c., whereby 2,252 persons had to find homes elsewhere. As I have already intimated the demand for accommodation has been to some extent met by the erection of Guinness's Trust Buildings in Lever Street; these dwellings consist of 14 blocks, eight of which were opened January, 1893, and six in J June, 1894, the whole providing accommodation for 1558 persons, leaving 694 persons unprovided for, being only 219 less than the total decrease in the population during the 5 years. Another indication of the change which has taken place in the Parish may be found in the fact that nearly one-fifth of the entire population now reside in the ten sets of artizans dwellings which exist in the the district, the numbers being— Peabody's Buildings ......... 3,645 Guinness'sTrust Buildings ......... 1,558 Bartholomew's Buildings ......... 1,476 Peerless Buildings ......... 315 Palmerston Buildings ......... 314 St. Clement's Buildings ......... 268 Costermonger Dwellings ......... 189 Eagle Dwellings ......... 113 Chapel Buildings ......... 31 Lever Buildings ......... 28 Total 7,937 5 As already stated, the ascertained population of the Parish at March, 1896, was 41,527, and upon this number is calculated the Statistics of Marriages, Births and Deaths, contained in this Report. The number of Marriages celebrated in St. Luke during the year was 252 (against 118 for the previous year), the number of persons married being in proportion to 12.1 per 1,000 of the population, and an increase on the year 1895 of 6.7 per 1,000, and if, as is frequently asserted, a high marriage rate is evidence of prosperity, our district is to be congratulated. The Metropolitan marriage rate was 18.0 per 1,000, and which is the highest rate recorded in any year since 1883. Births. The Births registered in the Parish during the year 1896 numbered 1,958, 1,010 being boys and 948 girls, of these 482 children were born in the City of London Lying-in Hospital, but as only 33 of the mothers were permanent residents of the Parish of St. Luke, a deduction of 449 has to be made from the total number, leaving 1,509 as the actual number of Births to be credited to the Parish, and after allotting 33 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 1,171; in the Whitecross Street Sub-registration District there were 254, and in the Finsbury Sub-registration District there were 84. In relation to the estimated population the figures stand as under:— Births per 1000 Inhabitants. For the whole Parish 36.34 City Eoad Sub-registration District 39.16 Whitecross Street „ ,, 33.44 Finsbury „ ,, 20.81 After a series of years during which there hael 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, in which 36 Block of Artizans Dwellings, accommodating 845 families, are situated. 6 The number of Births belonging to the Parish for the past six years and rate per 1,000 of the population. Births. Rate per 1000. 1891 1533 36.14 1892 1478 34.89 1893 1420 3318 1894 1432 33.34 1895 1476 34.18 1896 1509 36.34 shown by the following figures Deaths. Rate per 1000 1892 1074 25.57 1893 1277 29.84 1894 951 2214 1895 1216 28.16 1896 1055 25.40 The Metropolitan Death.rate for the year was equal to 18.2 per 1,000 of the population, being one of the lowest London Death rates hitherto recorded. Infant Mortality: Of the 1,055 deaths of Parishioners 483, or 45.8 per cent., occurred to infants under 5 years of age. Mortality over 65 years of age:—171 parishioners were over 65 at the time of death, being at the rate of 16.2 per cent. of the total deaths recorded. The number of Births in excess of the Deaths during the year 1896 amounted to 454. The number of Births registered in London amounted to 135,796 giving a rate of 30.2 per 1,000 of the population. This is the lowest London Birth-rate on record, still the excess of Births over Deaths was 52,285, the average increment for the previous 10 years having been 48,024 per annum. Deaths. The Deaths from all causes registered during the year, belonging to St. Luke, numbered 1,055, and includes 410 parishioners who died in Institutions outside the Parish, but is exclusive of 83 non-parishioners who died within our parochial boundary. Of the 1,055 parishioners, 540 were males and 515 were females, a number which yields upon the estimated population a Death-rate equal to 25.40 per 1,000 persons living, being a decrease upon our last year's Death-rate of 2.76 per 1,000, as 7 The 83 deaths of non-parishioners occurred at the following Hospitals and other places in the Parish:— Royal Hospital for Diseases of the Chest 57 City of London Lying-in Hospital 11 St. Luke's Hospital for Lunatics 12 St. Mark's Hospital for Fistula 1 Sudden Death in the Street from Heart Disease 1 ,, at an Hotel in Finsbury ,, 1 83 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 „ ,, Leavesden 4 ,, Lunatics, Cane Hill 1 ,, ,, Colney Hatch 2 „ „ Hanwell 3 ,, ,, Ilford 2 Butcher's Almshouses 1 City of London Hospital for Diseases of the Chest 1 Convent Hospital 1 " Freidheim," St. John's Wood 2 German Hospital, Dalston 2 Gresham Almshouses 1 Guy's Hospital 1 Holborn Union Infirmary, Archway Boad 156 ,, Workhouses, Shepherdess Walk and Mitcham 92 Hospital for Consumption, Brompton 1 Hospital for Sick Children, Great Ormond Street 6 Licensed Victuallers' Asylum 1 London Hospital 4 Metropolitan Asylums Board Hospitals 28 Police Station, Rochester Bow 1 Begents Canal, Hoxton 1 ,, Kentish Town 1 River Lea 1 Eoyal Free Hospital, Gray's Inn Boad 2 St. Bartholomew's Hospital 90 St. Elizabeth's Hospital, Great Ormond Street 1 St. Luke's House, Osnaburgh Street 1 Wimpole Street, 29 1 410 8 Inquests. One hundred and seventeen Inquests were held on the bodies of Parishioners during the year, being at the rate of 11.0 per cent of the total deaths. Eighty-three inquiries (three being as to the cause of death on 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 44 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:— Deaths due to Natural Causes 58 Accident or Neglect— Deaths due to Injuries the result of blows, falls, etc. 9 ,, ,, from burns 6 „ ,, being run over 5 „ improper feeding 1 „ Drowning 2 Suffocation—accidental 1 „ while in bed with parents 24 „ „ Drink 1 From neglect at birth 1 Alcjiolic excess 4 Suicide by Hanging 1 „ Drowning 1 ,, Poison 2 Still-born 1 117 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 1896. 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 ensure greater uniformity in the reports of Medical Officers of Health than has hitherto existed. 9 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 No. 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, 1896. The figures show that those not yet found in consequence of removals, etc., number 194 out of a total of 1,900, being 10.2 per cent., a deficiency somewhat less than in former years. Sickness and Deaths due to the Principal Zymotic or Communicable Diseases. Small-pox: I am again in a position to be able to report that no deaths from this cause occurred to any parishioner of St. Luke during the year. The Metropolis furnished only 9 deaths from the disease against 55 for the year 1895 and 89 for 1894. Two cases of sickness were notified as Small-pox during the year, and were removed to the Wharf of the Metropolitan Asylums Board for trasmission to the Hospital Ships. In both instances the patients were found to be suffering from Chickenpox, and after vaccination were returned to their own homes. Scarlet Fever was the registered cause of deaths in London in 942 instances, being, with the exception of the year 1895 (when the number of deaths was 829), the smallest number recorded from this disease for 5 years. Of the 942 deaths 644, or 68 per cent., occurred in public institutions. Belonging to our own district 21 deaths were certified, 16 of which took place in the Metropolitan Asylums Board Hospitals. These figures are largely in excess of the previous two years, the deaths in 1895 being five and 1894 nine. The returns of sickness from the same cause shaw, as may be supposed, an increase upon the previous 3 years, the number being 259 for 1896, 145 for 1895 and 124 for 1894. 10 Diphtheria caused the deaths of 25 parishioners, against 18 for the year 1895; although an increase, these figures will bear favourable comparison with those relating to the surrounding sanitary districts, and also the Metropolis as a whole. The rate for St. Luke being 0.62 per 1,000 persons living, Islington yielding 0.74, Clerkenwell 0.62, and Shoreditch 0.60 per 1,000. The total deaths in the Metropolis amounted to 2,683, being at the rate of 0.60 per 1,000, against 2,316, or 0'54 per 1,000, for the previous year. The number of cases of sickness from Diphtheria notified in the Parish was 131, and from Membranous Croup 3. Fever.—Under this heading four deaths were registered, all being ascribed to Enteric or Typhoid Fever. Two died in St. Bartholomew's Hospital and two in their own homes, but all belonged to the City .Road Registration District. There were 609 deaths classed as "Fever" within the Metropolitan area during the year, being 20 less than the previous year, and equal to a rate of 0.14 per 1,000, and slightly below the average rate (0.15) in the previous 10 years. The table of Infectious Sickness shows a considerable increase under the head of Fever compared with the two previous years, there being notified 38 cases of Enteric Fever, 2 of Continued Fever and 2 of Puerperal Fever. During the year 1895, 32 cases in all were certified, and for 1894, 17 cases. Whooping Coush was the cause of 23 deaths in the Parish, a number considerably below the average. The deaths from this disease in London amounted to 2,937, equal to a deathrate of 0.65 per 1,000 living, and far in excess of the rate for several years, the mean rate for 10 years having been 0.60 per 1,000. This not being among the notifiable diseases, I am unable to state the amount of sickness due to it during the year. Measles.— 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, but it is satisfactory to note that it is credited with having caused only 32 deaths, against 99 for the preceding 11 year, more especially in view of the fact that the Registrar General reports 3,697 deaths from this cause, against 2,633 for the preceding year, being equal to a death-rate of 0.82 per 1,000 as compared with 0.61, the average rate for 10 years. The Registrar-General remarks that in London, Measles appears to have been more fatal last year than in any previous year on record, with the single exception of 1864. Diarrhcea was certified as the cause of death in 49 instances, of which 45 related to children under 5 years of age. This number, although in excess of our usual record, is more favourable than that for the year 1895, when 63 deaths were so registered; further, the number 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., 129, the second quarter the number rose to 269, during the third quarter as many as 2,624 deaths were registered, after which the number fell to 201 during the fourth quarter, making a total for the year of 3,223 cases, against 3,600 cases for 1895, and 1,780 for 1894. Influenza.—Only three deaths were ascribed to Influenza during the year, whereas during the preceding year nine deaths were so recorded. This decrease corresponds with the experience throughout London, the returns for which show that 496 deaths were referred to the same cause, a number smaller than any year since 1890, the first year of the epidemic in London. Phthisis—Although not the highest in point of numbers; St. Luke occupies an unenviable position in the list of Metropolitan sanitary areas with respect to deaths from Consumption. During the past year 89 deaths took place within the Parish from this cause—33 of these occurred at the Royal Hospital for 12 Diseases of the Chest, and being of non-residents, may therefore be deducted. On the other hand, 62 parishioners died from the disease in Institutions outside our parochial boundary, making 118 deaths of parishioners from this disease. Admissions and deaths at the Metropolitan Asylums Board Hospitals, the Highgate Smallpox Hospital, and the London Fever Hospital of persons suffering from Smallpox, Scarlet Fever, Diphtheria, and Enteric Fever, 1887-1896:— 13 Years. Smallpox. Scarlet Fever. Diphtheria Enteric Fever. Admissions. Deaths. Admissions. Deaths. Admissions. Deaths. Admissions. Deaths. 1887 59 3 6662 516 18 4 458 62 1888 66 8 4881 514 111 50 461 73 1889 7 — 4837 370 740 278 311 42 1890 25 4 6991 521 965 317 518 95 1891 67 8 5601 360 1330 399 759 108 1892 366 38 13686 850 2021 584 43° 65 1893 2546 190 15312 918 2853 866 544 no 1894 1226 108 11892 725 3691 104I 538 96 1895 971 65 11800 601 3688 824 661 II9 1896 211 8 16627 674 4580 956 600 96 14 15 No. l Table of Population, Births, and of new cases of Infectious Sickness, coming to the knowledge of the Medical Officer of Health, during the year 1896, 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. Population at all Ages. Registered Births. Aged under 5 or 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 their Homes in the several Localities for Treatment in Isolation Hospital. Census 1891. Estimated to middle of 1896. l 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 29897 1152 Under 5 ... 49 33 1 ... 1 ... ... ... ... 7 ... ... ... 42 14 ... ... 1 ... ... ... ... ... ... ... 5 upwds ... 143 62 1 ... 26 1 ... 2 ... 95 ... ... ... 123 31 ... ... 14 1 ... ... ... ... ... ... Whitecross Street Sub Registration District 8278 7595 243 Under 5 ... 25 13 ... ... ... ... ... ... ... 3 ... ... ... 21 7 ... ... ... ... ... ... ... ... ... ... 5 upwds ... 21 16 ... ... 4 ... ... ... ... 20 ... ... ... 21 8 ... ... 2 ... ... ... ... ... ... ... Finsbury Sub-Registration District 4985 4035 81 Under 5 ... 7 2 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 5 upwds ... 11 5 ... ... 7 1 ... ... ... 9 ... ... ... 11 5 ... ... 4 1 ... ... ... ... ... ... St. Luke's Hospital for Lunatics ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... City of London Lying-in Hospital ... ... 482 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Royal Hospital for Diseases of the Chest ... ... ... Under 5 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 5 upwds ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... St. Mark's Hospital for Fistula, &c. ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... Totals 42440 41527 1958 Under 5 ... 82 48 2 1 ... ... ... ... 10 ... ... ... 70 22 ... ... 1 ... ... ... ... ... ... ... 5 upwds ... 177 83 1 ... 37 2 ... 2 ... 125 ... ... ... 157 44 ... ... 20 2 ... ... ... ... ... ... 16 17 No. 2. Table of Deaths, during the year 1896, 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. (a) Mortality from all Causes, AT SUBJOINED AGES. (1) mortality from subjoined causes, distinguishing deaths of children under five years of age. At all Ages. (b ) Under 1 Year. ( c ) 1 and under 5. (d) 5 and under 1. (e) 1 15 and under 25 (f) 25 and under 65 (g) 65 and (h) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 is 19 20 21 22 Small-Pox. Scarlatina. Diphtheria. Membranous Croup Typhus. FRVKIIS. Puerperal. Cholera. Erysipelas. Measles. Whooping Cough. Diarrhoea and Dysentery. Rheumatic Fever. Phthisis. Bronchitis, Pneumonia, and Pleurisy. Heart Disease. Influenza. Injuries. All other Diseases. Total. Enteric or Typhoid. Continued. Relapsing. City Road Sub-Registration District 47I 222 81 1 5 106 46 Under 5 ... 1 3 ... ... ... ... ... ... ... ... 19 15 15 ... 7 61 1 1 20 I40 303 5 upwds ... 1 1 1 ... 2 ... ... ... ... ... 2 ... 4 ... 27 44 14 1 68 168 Whitecross Street SubRegistration District 124 42 30 4 5 33 I0 Under 5 ... 3 2 ... ... ... ... ... ... ... ... 3 2 3 ... 3 18 ... ... 4 34 72 5 upwds ... ... 1 ... 1 ... 12 13 4 1 4 16 52 Finsbury Sub-Registration District 46 12 7 4 1 13 9 Under 5 ... ... 2 1 ... ... ... ... ... ... ... 2 1 2 ... 2 2 ... ... 7 19 5 upwds ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 6 6 ... ... 13 27 St. Luke's Hospital for Lunatics 14 ... ... ... 4 9 1 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 3 6 ... ... 3 14 City of London Lying-in Hospital 1 9 9 ... ... ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 9 9 5 upwds ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Royal Hospital for Diseases of the Chest 63 1 2 2 9 45 4 U nder 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 2 3 5 upwds ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 8 9 ... ... 10 60 St. Mark's Hospital for Fistula, &c. 1 ... ... ... ... 1 ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 Totals 728 286 I20 21 24 207 701 Under 5 ... 4 7 1 ... ... ... ... ... ... ... 24 18 40 ... 13 81 1 1 24 192 406 5 upwds ... 1 1 1 2 ... ... ... ... 1 2 1 4 ... 76 74 39 2 7 11 322 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 410 32 56 24 12 180 106 Under 5 ... 10 13 ... ... ... ... ... ... ... 1 6 4 5 ... 2 14 1 2 30 88 5 upwds ... 6 4 ... ... 2 ... ... ... ... ... ... ... 2 ... 60 58 16 3 20 151 322 Deaths occurring within the District among persons not belonging thereto 83 11 ... 3 13 51 5 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 10 11 5 upwds ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 32 11 15 ... ... 14 72 18 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 66 70 14 5 10 5 136 I70 II. Parasitic Diseases ... ... ... ... ... ... ... ... III. Dietic Diseasee ... ... ... ... 8 1 ... 9 IV. Constitutional Diseases 20 29 9 12 112 7 49 189 V. Developmental Diseases 33 ... ... ... 2 49 33 84 VI. Local Diseases 104 72 14 8 176 108 176 482 VII. Deaths from Violence 25 4 7 2 12 3 29 53 VIII. Deaths from ill-defined and not specified Causes 59 3 ... ... 5 1 62 68 307 178 44 27 325 74 485 155 I. Specific Febrile or Zymotic Diseases. ... ... ... ... ... ... ... ... 1. Miasmatic Diseases. ... ... ... ... ... ... ... ... Small Pox, Vaccinated ... ... ... ... ... ... ... ... „ Unvaccinated ... ... ... ... ... ... ... ... „ No Statement ... ... ... ... ... ... ... ... Measles 5 ... 2 ... ... ... 30 32 Scarlet Fever 3 11 6 ... ... ... 4 21 Typhus ... ... ... ... ... ... ... ... Whooping Cough 10 12 1 ... ... ... 22 23 Diphtheria 2 18 3 ... 2 ... 20 25 Simple Continued or Ill-defined Fever ... ... ... ... ... ... ... ... Enteric or Typhoid Fever ... ... ... ... 3 ... ... 4 Other Miasmatic Diseases ... ... ... ... ... ... ... ... 19 TABLE III.—continued. CACSES or DEATH. AGES. Total under 5 years 0 age. Grand Total all Age. 0 to 1. 1 to 5. 5 to 15. 15 to 25 25 to 65 65 and upwards Specific Febrile or Zymotic Diseases—continued. 2. Diarrheal Diseases. Simple Cholera ... ... ... ... ... ... ... ... Diarrhoea, Dysentery 40 4 2 3 2 1 44 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 Gonorrhoea, Stricture of the Urethra ... ... ... ... ... ... ... ... 6. Septic Diseases. ... ... ... ... ... ... ... ... Erysipelas 1 ... ... ... 1 ... 1 2 Pyaemia Septicaemia ... ... ... ... 2 ... ... 2 Puerperal Fever ... ... ... ... ... ... ... ... Influenza 1 ... ... ... 2 3 1 6 66 70 14 5 1O 5 136 170 II. Parasitic Diseases. Thrush, and other Vegetable Parasitic Diseases ... ... ... ... ... ... ... ... Worms, Hydatids and other Animal Parasitic Diseases ... ... ... ... ... ... ... ... 20 TABLE III.—continued. CAUSES OF DEATH. ages. 0to 1 1to 5 5 to 15 15 to 25 25 to 65 65 and upwards Total under 5 years of age. urand Total All Ages. III. Dietic Diseases. Want of Breast Milk, Starvation ... ... ... ... ... ... ... ... Scurvy ... ... ... ... ... ... ... ... Chronic Alcoholism ... ... ... ... 4 1 ... 5 Delirium Tremens ... ... ... ... 4 ... ... 4 ... ... ... ... 8 1 ... 9 IV. Constitutional Diseases. Rheumatic Fever, Rheumatism of the Heart ... ... ... ... ... ... ... ... Rheumatism ... ... ... ... • •• 1 ... 1 Gout ... ... ... ... 1 1 ... 2 Rickets 1 2 ... ... ... ... 3 3 Cancer, Malignant Disease ... ... ... ... 16 2 ... 18 Tabes Mesenterica 5 3 ... ... ... ... 8 8 Tubercular Meningitis, Hydrocephalus 3 10 i ... 1 ... 13 15 Phthisis 5 9 4 9 89 2 ... 118 Other Forms of Tuberculosis, Scrofula 5 5 4 3 3 ... 10 20 Purpura, Hemorrhagic Diathesis ... ... ... ... ... ... ... ... Anaemia, Chlorosis, Leucocythaemia ... ... ... ... ... 1 ... 1 Glycosuria, Diabetes Mellitus ... ... ... ... 1 ... ... 1 Other Constitutional Diseases 1 ... ... ... 1 ... 1 2 20 29 9 12 112 7 49 189 SI TABLE III.—continued. causes of death. , ages. 65 and upwards. 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. V. Developmental Diseases. Premature Birth 25 ... ... ... ... ... 25 25 Atelectasis 5 ... ... ... ... ... 5 5 Congenital Malformation 3 ... ... ... ... ... 3 3 Old Age ... ... ... 2 49 ... 51 33 ... ... ... 2 49 33 84 VI. Local Diseases. 1. Diseases of Nervous System. Inflammation of Brain or Membranes 6 6 i i 1 12 14 Apoplexy, Softening of Brain, Hemiplegia, Brain Paralysis ... i i 24 16 ... 42 Insanity, General Paralysis of the Insane ... 5 6 ... 11 Epilepsy ... i 2 1 1 ... 5 Convulsions 13 2 ... ... ... ... ... 15 Laryngismus Stridulus (Spasm of Glottis) ... ... ... ... ... ... ... ... Disease of Spinal Cord, Paraplegia, Paralysis Agitans ... ... ... ... 2 ... ... 2 Other Diseases of Nervous System ... ... ... ... 2 ... ... 2 2. Diseases of Organs of Special Sense. ... ... ... ... ... ... ... ... Diseases of Organs of Special Sense, e.g., of Ear, Eye, Nose ... ... ... ... ... ... ... ... 3. Diseases of Circulatory System, ... ... ... ... ... ... ... ... Pericarditis ... ... ... ... 1 ... ... 1 Acute Endocarditis ... ... ... ... ... ... ... ... Valvular Diseases of Heart ... ... i ... 2 2 ... 5 Other Diseases of Heart ... 2 4 ... 25 8 ... 39 Aneurism ... ... ... ... 4 ... ... 4 Embolism, Thrombosis ... ... ... ... ... ... ... ... Other Diseases of Blood Vessels ... ... ... ... ... ... ... ... 22 TABLE III.—continued. CAUSES OF DEATH. AGES Total under 5 years 0 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 ... ... ... ... ... ... ... ... Croup 1 2 1 ... ... ... 3 4 Emphysema Asthma ... ... ... ... I 6 ... 7 Bronchitis 27 24 56 44 51 151 Pneumonia 19 24 I I 15 4 43 64 Pleurisy ... ... ... 2 1 3 Other Diseases of Respiratory System 2 ... ... ... 2 ... 2 4 5. Diseases of Digestive Organs. ... ... ... ... ... ... ... ... Dentition 5 4 ... ... ... 9 9 Sore Throat, Quinsey ... ... ... ... ... ... ... ... Diseases of Stomach ... ... ... ... I ... ... 1 Enteritis 24 4 2 ... 2 1 28 33 Obstructive Diseases of Intestines ... ... ... I ... 3 ... 4 Peritonitis 1 I I 2 1 1 6 Ascites ... ... ... ... ... ... ... ... Cirrhosis of Liver ... ... ... ... 4 ... ... 4 Jaundice, and other Diseases of Liver 3 ... ... ... 3 2 3 8 Other Diseases of Digestive System 1 ... I ... ... ... 1 2 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 ... 3 ... ... 7 2 3 12 Bright's Disease, Albuminuria ... ... ... ... 6 2 ... 8 Disease of Bladder or of Prostate ... ... ... ... 1 3 ... 4 Other Diseases of the Urinary System ... ... ... ... ... ... ... ... 23 TABLE III.—continued. CAUSES OF DEATH. AGES. 0 to 1. 1 to S. 5 to 15. 15 to 25. 25 to 65. 65 and upwards. Total under 5 years of age. Grand Total all Ages. Local Diseases—continued. 9. Diseases of Reproductive System. Male Organs 1 ... ... ... ... ... 1 1 Female.Organs ... ... ... ... 1 ... ... 1 Abortion, Miscarriage ... ... ... ... ... ... ... ... Puerperal Convulsions ... ... ... ... ... ... ... ... Placenta Praevia, Flooding ... ... ... ... 2 ... ... 2 Other Accidents at Childbirth ... ... ... 1 4 ... ... 5 10. Diseases of Bones and Joints. Caries, Necrosis ... ... ... ... ... ... ... ... Arthritis, Ostitis, Periostitis ... 1 ... ... 1 4 1 6 Other Diseases of Bones and Joints ... ... ... ... ... ... ... ... 11. Diseases of Integumentary System. Carbuncle, Phlegmon ... ... ... 1 ... ... ... 1 Other Diseases of Integumentary System 1 ... ... ... ... 1 1 2 104 72 14 8 176 108 176 482 VII. Deaths from Violence. 1. Accident or Negligence. Fractsxa and Contusions ... 1 2 ... 6 2 1 11 Gunshot Wounds ... ... ... ... ... ... ... ... Cut, Stab ... ... ... ... ... ... ... ... Burn, Scald ... 1 4 1 ... ... 1 6 Poison ... ... ... ... ... ... ... ... Drowning ... ... ... ... ... ... ... Suffocation 22 2 ... ... 2 1 24 27 Otherwise 3 ... ... ... ... ... 3 3 to 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. Deaths from Violf.nce—continued. 2. Homicide. Manslaughter ... ... ... ... ... ... ... ... Murder ... ... ... ... ... ... ... ... 3. Suicide. Gunshot Wounds ... ... ... ... ... ... ... ... Cut, Stab ... ... ... ... ... ... ... ... Poison ... ... ... ... 2 ... ... 2 Drowning ... ... ... ... 2 ... ... 3 Hanging ... ... ... 1 ... ... ... 1 Otherwise ... ... ... ... ... ... ... ... 4. Execution. ... ... ... ... ... ... ... ... Hanging ... ... ... ... ... ... ... ... 25 4 7 2 12 3 29 53 VIII. Deaths from Ill-defined and not specified Causes. Dropsy ... ... ... ... ... ... ... ... Debility, Atrophy, Inanition 59 3 ... ... 3 ... 62 65 Mortification ... ... ... ... ... ... ... ... Tumour ... ... ... ... ... 1 ... 1 Abscess ... ... ... ... 2 ... ... 2 Haemorrhage ... ... ... ... ... ... ... ... Sudden Death (cause not ascertained) ... ... ... ... ... ... ... ... Causes not Specified or Ill-defined ... ... ... ... ... ... ... 59 3 ... ... 5 1 62 68 25 TABLE IV. Return respecting the Vaccination of Children whose Births were Registered between July 1st, 1895, and June 30th, 1896, 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 1571 930 1 I70 20 0257 156 37 Whitecross Street 244 186 I — 24 4 — 27 2 Finsbury 85 61 — — 8 2 — 11 3 Totals I9OO 1177 2 — 202 26 0257 194 42 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. 26 PUBLIC HEALTH (LONDON) ACT, and WORK OF THE SANITARY DEPARTMENT. Notification of Infections Diseases. The following Table gives the number and nature of the cases notified under Sections 55 and 56 of the Public Health Ac1 during the 53 weeks ended January 2nd, 1897, and indicates also where the same received treatment : Total Number of ( Vri t float— from each cnusc. Treated at the Metropolitan Asylums Board Hospital. Treated at General Hospitals and Infirmaries. Treated at their own Homes. Duplicate Certificates. Erroneously Diagnosed. Small-Pox 2 2 — — — 2 Scarlet Fever 277 224 — 36 17 2 Diphtheria 142 66 10 55 11 — Typhus Fever - - - - - - Enteric Fever 41 21 7 11 2 1 Continued Fever 2 2 — — — — Membranous Croup 3 — 1 2 — — Puerperal Fever 2 — — 2 — — Erysipelas 155 - 20 115 20 — Total number from all causes 624 315 38 221 50 5 The amount paid to the Medical practitioners for tarnishing the above Certificates amounted to £.58 15s. 0d. For the year 1895 the sum of £37 10s. 6d. was paid. The Vestry is recouped for this expenditure by the Metropolitan Asylums Hoard (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. Disinfection of Infected Articles. Representations of the unsatisfactory nature of the disinfection performed by the Apparatus belonging to your Vestry having been made on several occasions, I was requested 27 by the Public Health Committee to furnish a report upon the matter, which I did in the following terms:— TO THE PUBLIC HEALTH COMMITTEE. Report on the advantages of steam for the purpose of disinfection, with special reference to the apparatus known as Thresh's Patent Current Steam Disinfector. Gentlemen, The advantages of steam over dry heat are first the power it possesses of penetrating into the substance of materials exposed to its influence to an extent far beyond that possessed by dry heat. The temperature of it is more rapidly raised, and is uniform throughout the apparatus. It has been shown that a thermometer placed in the middle of 16 folds of blanket will register a temperature exceeding 212 degrees Fahrenheit in 15 minutes in a Steam Disinfector, the temperature in the chamber being 220 degrees Fahrenheit, while to obtain a like result in a Hot Air Chamber a temperature of 280 degrees Fahrenheit would have to be reached within the chamber, and that temperature maintained for two or three hours, causing discoloration and frequently destruction of the articles exposed, the heat not being uniform throughout the chamber and the penetration doubtful. It has been demonstrated that Bacillus exposed to saturated steam at a temperature of 212 degrees Fahrenheit for five minutes is killed although enveloped in 16 folds of blanket, or placed in the centre of a flock mattress, both of which are non-conductors of heat. To accomplish the same object by dry heat a temperature of 280 degrees Fahrenheit would have to be maintained for three hours or more. The full heat is obtained in a steam apparatus in 30 minutes, while the Dry Heat Oven belonging to the Vestry takes two hours to register a temperature of 220 degrees Fahrenheit. Great economy is therefore effected in the consumption of fuel by a steam apparatus. The Local Government Board are so convinced of the advantages of Steam over Dry Heat as a Disinfector that they will only grant loans to Sanitary Authorities for the construction of the former. The advantages claimed for the Machines known as Thresh's over other Steam Disinfectors are: 1st, Its relative prime cost. A suitable machine can be fixed at the Vestry's station for the sum of £168, whereas the cost of fixing a Washington Lyon's Machine (the form of machine mostly hitherto used in England), including the necessary alterations, has been estimated by your Surveyor at £479, the cost of the machine alone being £276 10s. 28 2nd, No separate boiler is required, as is the case with other steam apparatus. The steam is generated from a jacket around the chamber. 3rd, The steam not being worked under pressure no valves are required, and no danger from explosion is likely to occur. The machine is simple in construction and can be worked by an unskilled person. 4th, The cost of working is small, the consumption of coal being about 1 cwt. for six hours' continual working. It effects economy therefore in its cost in the time occupied for disinfection, in labour, and in the amount of the fuel consumed. I may further add that all articles are effectually dried before being removed from the apparatus, this is done by diverting the steam into the chimney and drawing air into the coil of tubes which, being heated, thoroughly dries the articles in the chamber, and unless exposed to the hot air process such articles as horsehair and india-rubber mackintosh are not injured by the process. Lastly, the site of your present Disinfecting Oven is sufficiently large to receive a suitable Thresh's machine. A new shaft will not be required, the present chimney lending itself for the purpose. The following extract is from a report of the Lancet Special Commission on Disinfection :— " To sum up, it will be seen that in no single particular have we found the invention of Dr. Thresh to come short of the requirements which we have laid down as essential in a machine intended for practical disinfection. In the first place, it is of moderate cost, the expense of working it is small, it requires no special management, and yet is free from the risks attending the use of steam under pressure. Next, and above all, it is efficient as a steriliser, since it is shown in the bacteriological experiments above described that the machine is able to render innocuous the disease organisms therein mentioned. Even the resistant spores of bacillus anthracis were rendered completely inert, so that it may be concluded with safety that this apparatus would act effectively on all infective material which in every-day practice would be submitted to its action. Not less important is it that the process of disinfection by steam is effected by it not only without injury to the articles and fabrics which commonly require disinfecting, but it leaves them absolutely unwetted, and, indeed, in many instances in a drier condition than they were previously to treatment. In short, the machine fulfils the conditions of a really efficient disinfector for all practical purposes; and seeing how difficult a task it has hitherto 29 been to satisfactorily comply in every particular with these conditions, the fact that such an appliance is now at the disposal of those responsible for the maintenance of the Public Health will be welcomed by all interested in sanitary advance." I expect to be supplied with a list of places where this machine is in use in the course of a few days. I remain, Yours obediently, G. E. YARROW, Medical Officer of Health. July lst, 1896. The above Report having been considered, a Committee was thereupon appointed to visit one or two places at which Thresh's Apparatus was in use, and the Report of the said Committee being favourable, your Vestry agreed to substitute a Steam Disinfector for the Apparatus hitherto relied upon for the purpose, and the work was ultimately carried out by Messrs. Slater & Owen, Engineers, of Great George Street, Westminster, and after 4 months use of the Steam Chamber I am in a position to certify that it fulfils all the promises made for it by its makers. Supply of Disinfectants. A large quantity of Carbolic Acid and Disinfecting Powder has been supplied to parishioners from the Mortuary upon presentation of orders for the same issued from this department. The Mortuary and Coroner s Court. During the twelve months under consideration 289 bodies have been received into the Mortuary. Eighty-three Inquests were held in the Coroner's Court belonging to the Vestry and forty-four Post-mortem Examinations were made in the Postmortem Room adjoining the Court. By arrangement with the London County Council the sum of £50 per annum is now received by the Vestry for the accommodation afforded by the Coroner's Court in lieu of payment by fees as was wont to be the case. During the year I have visited and reported upon 4 Slaughterhouses, 2 Cowsheds, and 35 Bakehouses, situated in the Parish, with the result that notices to cleanse, whitewash, and remedy other sanitary defects were served upon the owners of 2 Cowsheds, and 30 Bakehouses, 30 In consequence of so large a proportion of the Bakehouses being found in an unsatisfactory condition, the Public Health Committee adopted my suggestion that a set of Rules, based upon the Factory and Workshops Act, 1878, be printed and furnished to every baker in the Parish, and the following were accordingly duly circulated. :— PARISH OF ST. LUKE, MIDDLESEX. Rules made by the Vestry for the Sanitary Regulation of Bakehouses, in accordance with the several Statutes governing the same. 1. Every bakehouse shall be kept in a cleanly state, and free from effluvia arising from any drain, watercloset, or other nuisance. The floors shall be carefully swept at least once every twenty-four hours, and the sweepings shall he immediately placed in an impermeable covered receptacle, and removed from the bakehouse at not longer intervals than seven days. 2. All the inside walls of the rooms of the bakehouse, and all the ceilings or tops of such rooms, and all the passages and staircases of the bakehouse, shall either be painted with oil, or varnished, or limewashed. Where painted with oil or varnished there shall be three coats of paint or varnish, and the paint or varnish shall be renewed once at least in every seven years, and shall be washed with hot water and soap once at least in every six months. Where lime-washed the lime-washing shall be renewed once at least in every six months. The cleansing shall be done in the months of April and October. 3. The troughs and all the utensils used in the making of bread and pastry shall be kept scrupulously clean. 4. A place underground shall not be used as a bakehouse, unless so used prior to January 1st, 1896. 5. A place on the same level with the bakehouse, and forming part of the same building, shall not be used as a sleeping place : (a) Unless it is effectually separated from the bakehouse by a partition extending from floor to ceiling. (b) Unless there be an external glazed window of at least nine superficial feet of area, of which at least four-and-a-half superficial feet are made to open for ventilation. 6. No watercloset or ashpit shall be within or communicate directly with the bakehouse. 7. Any cistern for supplying water to the bakehouse shall be separate and distinct from any cistern for supplying water to a watercloset. 31 8. No drain or pipe for carrying off faecal or sewage matter shall have an opening within the bakehouse ; and every sink-waste, or other pipe used for carrying off surface water within the bakehouse, shall be efficiently trapped and disconnected from any drain. 9. Every bakehouse shall be efficiently lighted, shall be ventilated so as to render harmless all gases and dust, and shall not be overcrowded while work is carried on therein. 10. Every bakehouse shall be used for the purposes of the trade only. 11. No animal shall be kept in the bakehouse on any pretence whatever. 12. No person suffering, or who has recently suffered, from any infectious disease, shall be permitted to enter the bakehouse, or take part in the manufacture or sale on the premises, of bread, biscuits or confectionery. 13. The owner or occupier of a bakehouse shall give immediate notice to the Medical Officer of Health of any case of infectious disease occurring on the same premises as the bakehouse. Penalties. Every bakehouse in which there is a contravention of Sections 3, 33 and 34 of the Factory and Workshops Act, 1878, which provide for the sanitary condition and cleansing of the bakehouse, shall be deemed not to be kept in conformity with the Act, and the occupier thereof is liable for default to a fine not exceeding ten pounds. The use of a bakehouse for sleeping purposes, or of a room on the same level as the bakehouse, insufficiently separated from it, and insufficiently ventilated and lighted, is punishable under the 35th Section of the same Act by a fine not exceeding twenty shillings for the first offence, and of a sum not exceeding five pounds for every subsequent offence. An infringement of the loth Section of the Factory and Workshops Act, 1883, which prohibits :— A direct communication between a watercloset, earthcloset, privy or ashpit with the bakehouse; The supply of water to a bakehouse from a cistern also supplying a watercloset; The opening into a bakehouse of a drain carrying off faecal or sewage matter; is punishable by a fine not exceeding forty shillings, and a further fine not exceeding five shillings for every day during which the infringement is continued after a conviction, October, 1896. 32 Houses let in lodgings which are registered under the Byelaws relating to the same Bastwick Street, 16, 17, 18, 34, 58. Featherstone Street, 19, 20. Honduras Street, 2, 4, 5, 6, 8. Lever Street, 15, 43, 47, 51. The above are the only houses at present on the Vestry's Register, although a very large number exist in the Parish which the Bye-laws were intended to include and which in my opinion should be registered. The amount of rent paid, however (3s. per week) excludes them from the operation of the Bye-laws. The following is a list of the fines and costs incurred under the several Acts, also the nature and amount of adulteration where analyses were made • Public Health (London) Act, 1891. Fines. costs. For non compliance with Magistrate's order £4 and 21s. For having diseased beef on premises £5 and 2s. On owner of same £5 and 2s. Exposing unsound rabbits for sale 10s. and 4s. For selling and having in possession hams unfit for food £25 and 4s. Food and Drugs Acts. Article. Extent of Adulteration. Fines and Costs. Milk 18% added water 10s. and 2s. Mustard 40% added flour 20s. and 2s. Pepper 60% rice powder 10s. and 2s. Milk 19% added water £3 and 2s. „ 16% „ £2 and 2s. „ 12% £2 and 2s. ,, 20% „ £5 and 2s. „ 12% 10/6 and 2s. „ 13% £2 and 2s. Coffee 25% chicory 3s. Milk 17% added water 12s. 6d. „ 20% cream abstracted 12s. 6d. „ 35% l2s.6d. 12% added water „ 10% „ 12s. 6d. Butter 70% margarine 2s. Coffee 70% chicory £1 and 2s. Milk 44% added water 12s. 6d. Butter 95% margarine £1 and 2s. Milk 17% added water £1 and 12s. 6d 33 Margarine Act. Margarine not labelled £2 „„ 10s. and 2s. „„ 10s. and 2s. „„ 10s. „„ £1 „„ 12s. 6d. „„ 19s. 6d. „„ 1s. and 2s. In consequence of resignations two new Sanitary Inspectors have been appointed during the year at salaries commencing at £120, rising by annual increments of £10 to £150 per annum, the maximum salary having previously been £120 per annum. A General Assistant and Disinfecter has also been appointed in lieu of the plan of employing a person to fumigate infected rooms by contract. At the same time the opportunity was taken to substitute covered trucks for the old horse ambulance used for the removal of infected bedding, clothing, &c., to and from the Disinfecting Chamber. By this arrangement a saving of £75 per annum was made towards the increased expenditure (the average cost of horsing ambulance being £45 and fumigating rooms £30 per annum), and the advantage was also gained of having another officer in the Department without, as had been recommended, appointing a third Sanitary Inspector. Besides those already mentioned I have made numerous Reports to your Public Health Committee on the various matters which have occupied its attention during the year, and have also visited 135 dwelling-houses, factories, and workshops of which complaints have been received, and in every instance in which the Vestry's Notice has not been complied with. In those cases in which summonses have been granted I have attended the Police Court in support of the same, and with the hope that the work of the Public Health Department has been on the whole satisfactory to your Vestry, I have the honour to be, Gentlemen, Your obedient servant, G. E. YARROW, M.D.., D.P.H., &c. Vestry Hall, City Road, April 30th, 1897. 34 Public Health Department. To the Vestry of the Parish of St. Luke, Middlesex, Gentlemen, We beg to present the following report of the work of the Public Health Department during' the year ending December 31st, 1896 :— Premises inspected 2433 Houses cleansed and repaired 514 Dustbins provided and repaired 225 Yards to houses paved and amended 168 Traps provided to yards and house drains 63 Water receptacles cleansed and provided with covers... 56 Water supply re-instated 34 Drains amended and obstructions removed 227 Houses provided with new pipe drains 94 Rainwater pipes disconnected from drains 53 Waste pipes of sinks ,, ,, 41 Waterclosets reconstructed 15 ,, ventilation improved 25 „ water supply re-instated 204 ,, pans cleansed 107 Overcrowding in rooms abated 57 Underground rooms found illegally occupied as dwellings 9 Roofs of houses repaired 106 Nuisances arising from accumulations of manure and refuse abated 52 Ventilation of houses improved 4 Dungpits abolished and proper receptacles provided 7 Miscellaneous nuisances abated. 153 Rooms fumigated 428 No. of articles of bedding, clothing, &c., disinfected 3246 No. of articles of clothing, &c , destroyed 5 Dust complaints reported to Surveyor 119 35 Factory and IVorkshojts Acts, 1895. No. of Workshops inspected 90 No. of Workshops found in satisfactory condition 30 No. of Workshops found to have foul waterclosets and urinals 48 No. of Workshops found to have defective drains 52 No. of Workshops found to require additional water- closet accommodation 28 No. of Workrooms inspected 151 No. of Workrooms requiring additional ventilation 10 No. of Workrooms required cleansing 60 No. of Workrooms measured 40 No. of Workrooms found overcrowded 2 Total No. of Sanitary Notices served. Written intimations 1242 Statutory notices 524 Notices of Summons 91 Thirty-five bakehouses were visited, notices were served for cleansing, limewashing, &c., where necessary, and the work done in all cases. Two cowsheds and four slaughter-houses were also visited and notices to limewash and amend paving served upon owners of the former. List of Streets and Courts inspected under systematic house to house visitation :— Ironmonger Row Macclesfield Place Hall Street Macclesfield Street Clarence Street Clarence Place Garden Court Garden Bow Charles Court Mason's Place York Place John's Place Whitby Court Roby Street Europia Place George Yard Anchor Yard Ludlow Street Lewen's Court Parr's Place Church Eow Wellington Place Cottage Lane Bastwick Street Peerless Street Little Arthur Street Baltic Street Great Arthur Street Wither's Place Belward Avenue Murton Street 36 Inspection of Food, &c. The meat, fish, fruit, &c., exposed for sale in Whitecross Street and other parts of the Parish have been kept under observation, and the following were seized and destroyed :— 120 lbs. of beef 62 lbs. pork 1 fore quarter mutton 6 sheeps livers 7 fowls 4½ cwt. fish 25 hams 69 bushels fruit 51 rabbits 200 lbs. bread 70 lbs. walnuts 177 lbs. jam Public Health (London) Act, 1891. Fourteen summonses were taken out under this Act, eleven of them being for exposing for sale or selling unsound food. Of these eleven, nine resulted in convictions, the fines and costs imposed amounting to £38 6s. ; one was withdrawn on the advice of the Vestry's Solicitor, and the other was dismissed, the proceedings having been commenced in the wrong court. Three summonses were taken out for the abatement of nuisances, resulting in each case in an order being made for the work to be done and payment of costs. Sale of Food and Drugs and Margarine Acts. Thirty-five summonses were taken out under these Acts. Of these twenty-nine resulted in convictions, the fines and costs imposed amounting to £33 12s. 6d.; two were withdrawn on the advice of the Vestry's Solicitor, and four were dismissed. We are, Gentlemen, Your obedient servants, A. W. MARTIN, Sanitary R. ADAMS, Inspectors. April, 1897.