$TL-LL S REPORT ON THE SANITARY CONDITION, VITAL STATISTICS, &c„ OF THE Parish of St. Luke, Middlesex, FOR THE YEAR 1897. 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 FOR NORTH-EAST LONDON. LONDON: Harmer & Harley, Ltd., 39 to 44, Cowper Street, E.C. 1898. STLU 5 TO THE VESTRY OF THE PARISH OF ST. LUKE, MIDDLESEX. Gentlemen I have the honour to present my thirteenth Annual Report dealing with the Health, Sanitary condition, Vital and other Statistics of the Parish for the year 1897. The Sanitary District of St. Luke comprises an area of 239 acres, including Open Spaces and the Basin and Waterway of the Regent's Canal. The number of Inhabited Houses is 3,647. The statistics of Marriages, Births and Deaths contained in this Report relate to the fifty-two weeks ending January 1st, 1898, and are calculated upon a population estimate'! to the middle of the year of 41,272, being a decrease upon the ascertained population at 1896 of 255 persons, and divided between the three Sub-Registration Districts as follows:— Estimated population at Midsummer, 1897. Population at Census, 1896 City Road District 30,079 29,897 Whitecross Street District 7,327 7,595 Finsbury District 8,866 4,035 41,272 41,527 It will be seen from the above figures that while the total decrease has again affected the south side of Old Street, there has been a slight increase in the northern portion of the Parish. Marriages. The number of Marriages celebrated in St. Luke during the year was 290, the number of persons married being in proportion to 14.0 per 1,000 of the population. The number of Marriages for the two previous years were 252 and 118 respectively. The Metropolitan Marriage.rate for 1897 was 18*5, being the highest recorded for any year since 1878. Births. The Births registered in the Parish during the year numbered 1,860, 935 being boys and 925 girls; of the total number 483 were born in the City of London Lying.in Hospital, but as only 47 of the mothers were permanent residents in the Parish of St. Luke, a deduction of 436 has to be made from this number, leaving 1,424 as the actual figures which represent the 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 1,106 ; in the Whitecross Street Sub.Registration District there were 239, and in the Finsbury Sub.Registration District there were 79. In relation to the estimated population the figures stand as under :— Births per 1,000 Inhabitants. For the whole Parish 34.50 City Eoad Sub.Registration District 86.76 Whitecross Street ,, „ 32.61 Finsbury ,, ,, 23.02 The following table shows 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. 1892 1478 34.89 1893 1420 33.18 1894 1432 33.34 1895 1476 34.18 1896 1509 36.34 1897 1424 34.50 The number of Births in excess of the Deaths during the year 1897 amounted to 377: 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 5 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 1,047, and includes 396 parishioners who died in Institutions outside the Parish, but is exclusive of 128 non.parishioners who died within our parochial boundary. Of the 1,047 parishioners, 528 were males and 519 were females, a number which yields upon the estimated population a Death.rate equal to 25.36 per 1,000 persons living, being a slight decrease upon our last year's Death.rate, as shown by the following figures:— Deaths. Rate per 1000. 1892 1074 25.57 1898 1217 29.84 1894 951 22.14 1895 1216 28.16 1896 1055 25.40 1897 1047 25.36 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 1,047 deaths of parishioners, 458, or 43'7 per cent., occurred to infants under 5 years of age. Mortality over 65 years of age:—177 parishioners were over 65 at the time of death, being at the rate of 16.8 per cent. of the total deaths recorded. The 128 deaths of non.parishioners occurred at the following Hospitals and other places in the Parish Royal Hospital for Diseases of the Chest 88 City of London Lying.in Hospital 17 St. Luke's Hospital for Lunatics 13 St. Mark's Hospital for Fistula .. 4 Sudden Death in the Street from Heart Disease 1 ,, „ at Hotels in Finsbury 3 ,, ,, in an Omnibus from Apoplexy 1 ,, ,, in Sailing Barge on Canal 1 128 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 ,, ,, ,, Caterliam 4 ,, ,, ,, Darenth 8 ,, ,, Lunatics, Cane Hill 1 „ „ „ Colney Hatch 1 ,, ,, „ Ilford 8 Bethnal Green Workhouse 1 City of London Hospital for Diseases of the Chest 1 " Freidheim," St. John's Wood 1 German Hospital, Dalston 1 Gray's Inn Road 1 Guy's Hospital 1 H.M. Prison, Wormwood Scrubs 1 Holborn Union Infirmary, Archway Road 151 „ ,, Workhouses, Shepherdess Walk and Mitcham 98 Hospital for Sick Children, Great Ormond Street 7 ,, ,, Women, Euston Road 1 Hostel of God 1 King's College Hospital 1 London Hospital 2 Metropolitan Hospital 2 ,, Asylums Board Hospitals 26 Middlesex Hospital 1 Poplar Hospital for Accidents 1 River Thames 2 Royal Free Hospital, Gray's Inn Road 3 St. Bartholomew's Hospital 78 St. George's Hospital >.. 1 St. Joseph's Home 1 St. Luke's House, Osnaburgh Street 1 Society for Prevention of Cruelty to Children 1 University College Hospital 1 Victoria Hospital 1 396 Inquests. One hundred and fifteen Inquests were held ou the bodies of parishioners during the year, being at the rate of 10*7 per cent, of the total deaths. Eighty-five inquiries (three being as to the cause of death of non-parishioners) took place at the Coroner's 7 Court belonging to this Parish, and the cause of death was ascertained by post-mortem examination in 50 instances. The remaining 30 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 50 Accident or Neglect— Deaths due to Injuries the result of blows, falls, &c. 12 ,, ,, from burns 6 ,, „ „ being run over 6 ,, Strangulated Hernia 1 ,, Tetanus following injury to Foot 1 Suffocation—accidental Drowning 8 ,, while in bed with parents 19 ,, a Fit Hemorrhage from Varicose Veins 1 Alcoholic excess 5 Suicide by Hanging 4 ,, Drowning 1 „ Poison 1 Still-born 4 115 In the early part of the year, the Medical Officer of Health of the London County council made a report dealing with the deathrate of the Parish of St. Luke, which report was followed later by comments in the medical and lay press upon the high birth and death-rates of the parish, and by way of reply I had the honour of submitting the following observations and report for the consideration of your Vestry. " Referring to the Annual Report of the Medical Officer of Health tor the County of London for 1895, I wish to make the following observations:— " The corrected death-rate is stated to be 31-9 per 1,000 of the persons living, is estimated upon a population of 41,676, and is the highest death-rate of the 43 Metropolitan Sanitary Districts. My estimate of the population for the year under consideration was 43,175, which gave a death-rate of 28.1, but the Census of 1896 enabled a more correct result to be arrived at, and the figures contained in Mr. Shirley Murphy's Report are no doubt, the more correct. 8 " The birth-rate of St. Luke is also highest of the 43 Sanitary Districts, viz., 45'8 per 1,000 living ; the next- highest being St. George's-in-the-East with 41.9, Whitechapel with 40-2, while the Parishes adjacent to our own are considerably lower, Clerkenwell yielding a birth-rate of 31 5, Shoreditch 33.6 and Islington 29-7 per 1,000 persons living. Now, it is a pretty well recognised fact that the higher the birth-rate in a locality the higher the death-rate, nearly 50 per cent. of children born dying before they attain the age of live years ; during the year 1895, 591 children died under the age mentioned out of a total of 1,216 deaths, being at the rate of 48.6 per cent. "Mr. Murphy's report dealt with the deaths of Infauts under one year only, which are stated to have numbered 351 or 184 per 1,000 births. In Clerkenwell there were 399 or 192 per 1,000, in Shoreditch 864 or 199 per 1,000, in Holborn 174 or 212 per 1,000 births ; so that in this respect St. Luke's will bear favourable comparison with the surrounding Sanitary Districts. " I may further point out that of the 1,216 deaths recorded in St. Luke, 196 or 16.1 per cent, were of persons above 65 years of age, also of the total number 401 or nearly one-third died in Institutions outside the Vestry's area, and evidence is not wanting to show that many bad been so located a number of years. " Iu reference to the prevalence of Infectious Diseases, especially those affecting young children, it must be borne in mind that about 8,000 persons or nearly one-fifth of our entire population are boused in artizans' dwellings, such conditions being eminently favourable for the spread of Infectious Diseases." 9 Report on the Birth-rate and Death-rate of the Parish, for the ten years 1887 to 1896 inclusive. To the Public Health Committee. Gentlemen, The comments which have recently been made upon the high birth and death-rates of the Parish of St. Luke for the year 1896 have induced me to compare the statistics with those of previous years, in order that we may judge whether or no there is justification for assuming that the Parish is less healthy than formerly, and if the criticisms are just, to endeavour to ascertain the causes upon which they are founded. The first table annexed hereto shows the results of the several Censuses of 1871, 1881, 1891, and 1896, and the decrease in the population during each interval, also the number of births and deaths, and the rates per 1,000 of the population for the years named. The several Districts into which the Parish is divided for the purposes of registration of births and deaths is shown in this table, and the enormous decrease which has taken place in the southern portion of the Parish is made apparent. The second series of tables relate to the ten years from 1887 to 1896 inclusive, and give the ascertained population for each year. These figures are arrived at by dividing the decrease at each Census by the number of years intervening (viz., 10 or 5) and deducting the result from the preceding year's population. The last table is a summary of the foregoing, and shows at a glance the number of births and deaths with the rates per 1,000 of the population living during each of the ten years mentioned. In dealing with the birth-rate permit me again to refer to a fact to which I have from time to time called attention in my Annual Reports, namely, that the number of births registered in the Parish, and upon which the data of the Registrar-General is formed, should not be taken as the basis upon which to estimate the birth-rate, because it includes from 400 to 500 infants born in the City of London Lying-in Hospital, while only 7 to 8 per cent, of the parents of the said children are permanent residents of the Parish. It is not, therefore, strictly accurate to state, as 10 did a recent writer to a medical journal, that "the birth.rate of St. Luke last year reached the enormous number of 46.7 per 1,000 for, after making the deduction of non.resident persons, the actual rate stood at 36'3 per 1,000. This rate is undoubtedly high enough, and, in my opinion, supported by the tables annexed, has much to do with the high death.rate, and, strange to say, that the number of births last year belonging to the Parish exceeded either of the previous four years, and this notwithstanding the decreasing population, while the rate per 1,000 was higher than any year since 1889, at which time the population numbered nearly 2,000 more than last year. I believe the cause of this may be fairly ascribed to the circumstances of the large number of artizans' dwellings now existing in the Parish, and the fact of their being occupied for the most part by married people below the middle period of life. (About 8,000 persons, or nearly one.fifth of the population, reside in the artizans' dwellings.) Dr. Drysdale, in a letter to the British Medical Journal on the subject of " High and low death rates in London Districts in 1896," and to which I have already referred, says :—" St. Luke is an example of a district with a heavy death.rate (25.1 per 1,000 in 1896), and St. George's.in.the.East had a similar death. rate of 24.5 per 1,000 last year. It would, I submit, be a very instructive discussion if some of your correspondents would suggest why the death.rate of Hampstead is just about half that of St. Luke or St. George's, Southwark ? If I might be allowed to give my opinion on the matter, it would be that Hampstead is peopled by educated and rather well.to.do inhabitants ; and, that, on the contrary, St. Luke is peopled by less educated and far poorer folks. " There is another, and perhaps a more fundamental cause of the difference of the death.rate of our poorer and richer districts in London. Hampstead had last year a modest birth rate of 19 per 1,000 inhabitants ; St. Luke had an enormous birth.rate of 46.7 (? 36.3). Well, it seems to me that, in London at least, death.rates are high when birth.rates are high, and that if the mortality is to be lowered in St. Luke births must be reduced. Phthisis is about thrice as prevalent in St. Luke as it is in Hampstead." Dr. Drvsdale's view of the subject I fully endorse. In tabulating the deaths, I have, during the years 1887 to 1891 11 inclusive, added the deaths of persons dying in Institutions, &c., outside the Parish boundary to the districts to which the deceased are reported to have originally belonged, bnt in consequence of the increasing number of such deaths registered " as late of St. Luke's Parish " merely, I have abandoned the practice mentioned for the last five years, and given the number of such deaths separately, but I have added the percentage of such mortality and also that of children under five years of age for each year for the whole ten years. It has been pointed out that the death.rate of St. Luke last year was exceedingly high, but it will be seen by the tables appended that, with the exception of the years 1889 and 1894, the number of deaths was less and the death rate lower than any of the ten years under consideration. While the Infant mortality which, for the year 1881, stcod at 54.2, and 1891 at 51.3 percent. of the total number respectively, shows the smallest percentage of either of the ten years, viz., 36.3. On the other hand, the number of deaths in Institutions outside the Parish registered as belonging to St. Luke was greater during the last two years than had ever been the case previously. That the Infant mortality is the main cause of our heavy death. rates is proved beyond doubt. Taking my Annual Reports for the past four years it may be seen that the deaths of children under 5 years of age have exceeded by 50 per cent. the total number occurring in the Parish. The figures are for the year 1893 Adults 891 under 5 years 468 189 4 ,,308 „ 320 189 5 453 „ 455 189 6 322 „ 406 The question naturally arises why this should occur, and the a iswer is found mainly in the recorded causes of death. Taking. last year as an example (and I again confine my observations to deaths occurring in the Parish), it will be seen that out of 44 persons certified as dying from Diarrhoea, 40 were infants under 5 years of age ; from Bronchitis, Pneumonia, &c., 81 out of 135 total ; from Suffocation, 24 out of 27 (L need hardly say that the said suffocations occurred for the most part while the infants were in bed with their parents, really overlain, an accident (?) almost unknown among persons of better social position). Measles, a disease which, with proper care and attention, is rarely fatal, was 12 certified as the cause of death in 32 instances. With reference to Bronchitis and Pneumonia, neglect and exposure are the main factors in the majority of instances. While as to Diarrhoea, improper feeding stands as the primary cause. In this connection I would especially mention deprivation of breast milk and the substitution in lieu thereof of preserved milk and farinaceous foods in its various forms, while the use of unclean feeding bottles and tubes are a frequent cause of pollution of the food and consequent gastric irritation in the infant. Resort to artificial feeding and its attendant evils are, of course, necessitated by the absence oi the mothers, who are engaged in various occupations away from their homes for many hours at a time, not infrequently, however, the infants are left in the care of older children who themselves are not far removed from infancy. I am, Gentlemen, Yours obediently, G. E. YARROW, Medical Officer of Health. October 26^, 1897. 13 TABLE A. Population of the Parish according to the Census of 1871, 1881, 1891 and 1896, showing the average annual decrease during each interval; also the number of Births and Deaths and the rates per 1,000 of the population. Registration Districts 1871. 1881. 1891. 1896. City Road & Old Street combined Old Street 12,156 11,541 12,039 29,897 City Road 18,291 18,628 17,138 Whitecross St. 13,790 9,217 8,278 7,595 Finsbury 10,732 7,463 4,985 4,035 54,969 46,849 42,440 41,527 being a decrease upon being a decrease being a decrease being a decrease upon the the census of 1861 of upon last cen. upon the pre. previous census of 913 = 2,104—No. of Births, sus of 8,120= vious census of 182.3 per annum. Births, 2,026 = 36.1 per 1,000 to 812 per an. 4,409 = 440.9 1,509 = 36.3 per 1,000; of the population; num. Births, per annum. Deaths, 1,055 = 25.4 per Deaths 1,186 = 21.5 per 1,760 = 37.5 Births, 1,533= 1,000. Under 5 years, 1,000; Deaths under 5 per 1,000. 36.1 per 1,000 ; 483 = 45.8 per cent, of the years of age, 603—being Deaths, 1,000 Deaths, 1,277 total deaths. Deaths in at the rate of 54.2 per =21.3 per = 30.1 per Institutions outside the cent, of the total deaths. 1,000. Under 1,000. Under Parish boundary, 410 = 5 years, 547 = 5 years, 537 = 38.8 per cent, of the popu. 54.7 percent, of 42.0 percent.of lation. the total deaths, the total deaths. TABLE B. 1887. District. Births. Deaths. Population, 1881 46,849 Old .Street 445 265 Six years at 441 = 2,646 City Road 725 465 44,203 Whitecross St. 340 248 Finsbury 175 128 1,685 = 1,106 = 38.1 per 1000 25.0 per 1000. Deaths under 5 years of age, 482 = 43.5 per cent. of the whole. Deaths in outlying Institutions, 275 = 24.8 per cent. 14  1888. District. Births. Deaths. Population, 1887 44,203 Old Street 506 254 Decrease 441 City Road 701 445 43,762 Whitecross St. 321 282 Finsbury 166 150 1,694 = 1,131 = 38.9 per 1000 25.8 per 1000. Deaths under 5 years of age, 538 = 47.5 per cent. of the whole. Deaths in outlying Institutions, 316 = 27.9 per cent. 1889. District. Births. Deaths. Population, 1888 43,762 Old Street 420 238 Decrease 441 City Road 692 407 43,321 Whitecross St. 303 198 Finsbury 139 105 1,554 = 948 = 35.8 per 1000 22.7 per 1000. Deaths under 5 years of age, 407 = 42.9 per cent, of the whole. Deaths in outlying Institutions, 304 = 32.0 per cent. 1890. District. Births. Deaths. Population, 1889 43,321 Old Street 478 316 Decrease 441 City Road 673 543 Whitecross St. 312 307 42,880 Finsbury 112 111 1,575= 1,277 = 36.7 per 1000 29.7 per 1000. Deaths under 5 years of age, 536 = 41.9 per cent.of the whole. Deaths in outlying Institutions, 377 = 29.5 per cent. .1891. District. Births. Deaths. Population, 1890 42,880 City Road 1,120 874 Decrease 440 Whitecross St. 292 268 Finsbury 121 135 Census return 42,440 1,533= 1,277 = 36.1 per 1000 30.0 per 1000. Deaths under 5 years of age, 537 = 42.0 per cent. of the total. Deaths in outlying Institutions, 404 = 31.6 per cent. *During this year the two Registration Districts hitherto known as the Old Street and City Boad were united under the latter name. 15 1892. District. Births. Deaths. Census return 1891 42,440 City Road 1,095 552 Annual decrease 182 Whitecross St. 263 129 — Finsbury 120 64 42,258 1,478 745 34.9 per 1000 Deaths in outlying Institutions 329 = 30.6 per cent. of the total Total 1,074 = 25.6 per 1000 Deaths under 5 years of age, 551 = 51.3 per cent. 1893. District. Births. Deaths. Population, 1892 42,258 City Road 1,057 560 Decrease 182 Whitecross St. 256 153 Finsbury 107 72 42,076 1,420= 785 33.7 per 1000 Deaths in outlying Institutions 492 = 38.5 per cent. 1,277 = 30.3 per 1000 Deaths under 5 years of age, 576 = 45.1 per cent. 1894. District Births. Deaths. Population, 1893 42,076 City Road 1,077 406 Annual decrease 182 Whitecross St. 258 96 Finsbury 97 55 41,894 1,432= 557 34.1 per 1000 Deaths in outlying Institutions 394 = 41.5 per cent. 951 = 22.7 per 1000 Deaths under 5 years of age, 876 = 39.5 per cent. 16 1895. District. Births. Deaths. Population, 1894 41,894 City Road 1,124 618 Annual decrease 182 Whitecross St. 261 142 Finsbury 91 55 41,712 1,476= 815 35.3 per 1000 Deaths in outlying Institutions 401 = 82.9 per cent. 1,216 = 291 per 1000 Deaths under 5 years of age, 591 = 48.6 per cent. 1896. District. Births. Deaths. Population, 1895 41,712 Old Street & Decrease 185 City Road 1,171 475 Whitecross St. 254 124 Ascertained pop. 41,527 Finsbury 84 46 1,509= 645 36.3 per 1000 Deaths in outlying Institutions 410 = 38.3 per cent. 1,055 = 25.4 per 1000 Deaths under 5 years of age, 483 = 36.3 per cent. 17 TABLE C. SUMMARY of Population, Births and Deaths, with Rates per 1,000 of the Population for Ten years. Population. Births Rate per 1000. Deaths. Rate per 1,000. No. of Deathd under 5 years. Deaths in outlying Institutions. 1887 44,208 1,685 38.1 1,106 25.0 482 equal to 43.5 per cent. 275 equal to 24.8 per cent. of the whole 1888 43,762 1,694 38.9 1,131 25.8 538 „ 47.5 „ 316 „ 27.9 „ 1889 43,321 1,554 35.8 948 22.7 407 „ 42.9 „ 304 „ 820 ,, 1890 42,880 1,575 36.7 1,277 29.7 536 „ 41.9 „ 877 „ 29.5 „ 1891 42,440 1,533 361 1,277 300 537 „ 42.0 „ 404 „ 81.6 „ 1892 42,258 1,478 34.9 1,074 25.6 551 „ 51.8 329 „ 30.6 „ 1893 42,076 1,420 83.7 1,277 30.3 576 „ 45.1 492 „ 88.5 „ 1894 41,894 1,432 34.1 951 22.7 876 „ 39.5 „ 894 „ 41.5 „ 1895 41,712 1,476 35.1 1,216 29.1 591 „ 48.6 401 „ 32.9 „ 1896 41,527 1,509 36.3 1,055 25.4 488 „ 36.3 „ 410 „ 38.3 „ 18 Returns of Sickness and Mortality. On pages 22 to 33 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 1897. 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. 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. 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, 1897. The figures show that those not yet found in consequence of removals, etc., number 197 out of a total of 1,84U, being 10'7 per cent., a deficiency somewhat greater than in former years. Sickness and Deaths due to the Principal Zymotic or Communicable Diseases. Small-pox.—For the third successive year I am in a position to report that no death from this cause has occurred to any parishioner of St. Luke, nor has any case of sickness from the disease been notified. The Metropolis furnished 16 deaths from this cause against 9 for the year 1896, and 55 for 1895. Scarlet Fever was the registered cause ot deaths in London in 780 instances, being the smallest number recorded from this disease since 1891, and being at the rate of 0-18 per 1,000 of the population living as compared with 0*25, the average rate in the 19 10 years immediately preceding; of these 780 deaths, 592 or 76 per cent. occurred in public institutions. Belonging to our own district 13 deaths were certified, all of which took place in the Metropolitan Asylums Board Hospitals. This is a more favourable return than for the year 1896, when the deaths numbered 21. The returns of sickness from the same cause were also less, the numbers being 234 for 1897 and 259 for 1896. Diphtheria caused the deaths of 21 parishioners against 25 for the year 1896. Although only a slight decrease, these figures will bear favourable comparison with those relating to some of the surrounding Sanitary Districts, and even to the Metropolis as a whole. The rate for St. Luke being 0'51 per 1,000 persons living, Clerkenwell yielding 0-73, Shoreditch 0*64, and Hackney (>•62 per 1,000. The total deaths in the Metropolis amounted to 2,261, being equal to a rate of 0'51 per 1,000 against 2,683 or 0-60 per 1,000 for the previous year. The number of cases of sickness from Diphtheria notified in the Parish was 183, and from Membranous Croup 1. Fever.—Under this heading 7 deaths were registered n the Parish, all being ascribed to Enteric or Typhoid Fever. Three of the deaths occurred in the Royal Hospital for Diseases of the Chest, neither of the deceased persons belonged to the Parish. The other four belonged to the City Road District, three of whom died in their own homes, and one in the Metropolitan Asylums Board Hospital. There were 566 deaths classed as " Fever " within the Metropolitan area during the year, being 43 less than the previous year, and equal to a rate of 0.13 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 43 cases of Enteric Fever and 2 of Puerperal Fever. During the year 1896, 38 cases were certified, and for 1895, 32 cases. Admissions and deaths at the Metropolitan Asylums Board Hospitals, the Highgate Smallpox Hospital, and the London 20 Fever Hospital of persons suffering from Smallpox, Scarlet Fever, Diphtheria and Enteric Fever, 1888-1897:— Years. Smallpox. Scarlet Fever. Diphtfieria. Enteric Fever. Admissions. Deaths. Admissions. Deaths. Admissions. Deaths. Admissions. Deaths. 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 1,330 399 759 108 1892 366 38 13,686 850 2,021 584 430 65 1893 2,546 190 15,312 918 2,853 866 544 110 1894 1,226 108 11,892 725 3,691 1,041 538 96 1895 971 65 11,800 601 3,688 824 661 119 1896 211 8 16,627 674 4,580 956 600 96 1897 73 13 15,550 628 5,726 993 664 124 Whooping Cough was the cause of 27 deaths, being a slight increase upon the previous year, when 23 deaths were certified as due to this cause. The deaths from this disease in London numbered 1,842, being equal to a death-rate of 041 per 1,000 living, and, with a single exception, below the rate in any year since 1883. The mean rate for the ten years 1887-96 having been 0.59 per 1,000. This not being a notifiable disease, I am unable to state the amount of sickness due to it during the year. Measles.—For the same cause as that mentioned in respect to the last disease, the degree of prevalence of Measles can only be judged by the number of deaths ascribed to it, but it is satisfactory to note that it is credited with having caused only 34 deaths, against 32 for 1896 and 99 for 1895. The Registrar-General's Report shows that Measles was the 21 certified cause of 1,929 deaths in the Metropolis, against 3,697 deaths for the preceding year, and when it was more fatal than any previous year on record, with the exception of 1864. The Metropolitan death.rate of Measles last year was 0.43 per 1,U00, as compared with 0.64, the decennial average rate. Diarrhcea was certified as the cause of death in 51 instances, of which 49 related to children under 5 years of age, and to which subject I have referred in a report on the high birth.rate and death.rate of the Parish. ■ The above number of deaths, although in excess of our usual record, compares favourably with the deaths certified from the same cause throughout the Metropolitan area, the number during the year being 4,089, equal to a death.rate of 092 per 1,000, and the highest since the year 1887. For the two preceding years the number of deaths were 3,223 and 3,600 respectively. Influenza.—Nine deaths were ascribed to Influenza during the year, against three for the preceding year. This increase corresponds with the experience in London as a whole, the returns for which show that 671 deaths were referred to this cause, whereas the number for 1896 was 491 ; nevertheless, with this exception, there were fewer deaths from Influenza last year than in any other year since 1890, the first year of the epidemic in London. Phthisis. St. Luke occupies an uuenviable position in the list of Metropolitan sanitary areas with respect to deaths from consumption, the rate being 3.11 per 1,000, and is only exceeded by St. Saviour, Southwark, with 3.22 and the Strand District with a rate of 3.36 per 1,000. The actual number of deaths which took place in the Parish from this disease was 103; 48 of these occurred at the Royal Hospital for Diseases of the Chest, and being of non.residents, may therefore be deducted. On the other hand, 71 parishioners died from the malady in Institutions outside our parochial boundary, making a total of 126 deaths of parishioners from this cause. 22 23 No.1 Table of Population, Births, and of new cases of Infectious Sickness, coming to the knowledge of the Medical Officer of Health, during the year 1897, in the St. Luke, Middlesex, Sanitary District ; classified according to Diseases, Ages and Localities. Names oh 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 knowledge of the each Locality coming to the Medical Officer of Health. Number of such Cases Removed from their Homes in the several Localities for Treatment in Isolation Hospital. Last Census. Estimated to middle of 1897. i 2 3 4 5 6 1 8 5 io » 12 13 1 2 3 4 5 6 7 8 9 io 11 13 Small-Pox. Scarlatina. Diphtheria. Membranous Croup Fevkrs. Fevers. Erysipelas. Small-Pox. Scarlatina. Diphtheria. Membranous Croup Fevers. Cholera. Erysipelas. Typhus. Enteric or Typhoid. Continued. Relapsing. Puerperal. Cholera. Typhus. Enteric or Typhoid. Continued. Relapsing. Puerperal. O) (b) (O (d) (e) City Road Sub-Registration District 29897 30079 1071 Under 5 ... 66 54 1 ... 1 ... ... ... ... 5 ... ... ... 59 35 ... ... 1 ... ... ... ... ... ... ... 5 upwds ... 110 66 ... ... 33 ... ... 1 ... 51 ... ... ... 101 38 ... ... 16 ... ... ... ... ... ... ... Whitecross Street SubRegistration District 7595 7327 229 Under 5 ... 9 18 ... ... 1 ... ... ... ... 2 ... ... ... 9 14 ... ... ... ... ... ... ... ... ... ... 5 upwds ... 27 26 ... ... 3 ... ... 1 ... 18 ... ... ... 26 22 ... ... 1 ... ... ... ... ... ... ... Finsbury Sub-Registration District 4035 3866 77 Under 5 ... 4 7 ... ... ... ... ... ... ... ... ... ... ... 4 6 ... ... ... ... ... ... ... ... ... ... 5 upwds ... 8 11 ... ... 3 ... ... ... ... ... ... ... ... 4 8 ... ... 1 ... ... ... ... ... ... ... St. Luke's Hospital for Lunatics ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds ... 10 ... ... ... ... ... ... ... ... ... ... ... 3 ... ... ... ... ... ... ... ... ... ... ... City of London Lying-in Hospital ... ... 483 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Royal Hospital for Diseases of the Chest ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds ... ... 1 ... ... 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... St. Mark's Hospital for Fistula, &c. ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 41527 41272 1860 Under 5 ... 72 79 1 2 ... ... ... 7 ... ... ... 72 55 ... ... 1 ... ... ... ... ... ... ... 5 upwds ... 155 104 ... 42 ... 2 ... 79 ... ... ... 134 68 ... ... 18 ... ... ... ... ... ... ... 24 25 No. 2. Table of Deaths, during the YeUr 1897, 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 agf.s. (i) mortality from subjoined causes, distinguishing deaths of children under Five Years of age. At all Ages. Under i Year. i and under 5. 5 and under 15 15 and under25 25 and under65 65 and upward i 2 3 4 5 6 7 8 ' io 11 13 ■4 15 16 17 18 19 20 21 22 Small-Pox. Scarlatina. Diphtheria. Membranous Croup Fevers. Cholera. Erysipelas. Measles. Whooping Cough. Diarrhoea and Dysentery. > V lire B 3 * Phthisis. 1 Bronchitis, I 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) City Road Sub-Registration District 500 196 108 16 10 125 45! Under 5 ... ... ... ... ... ... ... ... ... ... 1 24 23 32 ... 5 88 ... 2 18 107 304 5 upwds ... ... ... ... ... 3 ... ... ... ... 2 1 2 ... 37 49 21 1 9 ... ... Whitecross Street SubRegistration District 98 34 18 1 1 29 151 Under 5 ... ... ... ... ... ... ... ... ... ... ... 3 3 5 ... 1 14 ... ... 3 23 52 5 upwds ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 10 14 8 ... ... 14 46 Finsbury Sub-Registration District 51 14 7 2 ... 14 14 Under 5 ... ... 1 ... ... ... ... ... ... ... ... 1 ... 4 ... ... 5 ... ... ... 10 21 5 upwds ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 2 4 4 ... ... 18 30 St. Luke's Hospital for Lunatics 13 ... ... ... ... 9 4 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 1 ... 2 7 13 City of London Lying-in Hospital 18 15 ... ... 1 2 ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 14 15 5 upwds ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 3 Royal Hospital for Diseases of the Chest I 95 ) 1 ... 5 14 71 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 5 upwds ... ... ... ... ... 3 ... ... ... ... ... ... ... ... 1 48 17 13 1 ... 11 94 St. Mark's Hospital for Fistula, &c. 1 4 1 ... 3 ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 5 upwds ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 3 Totals 779 261 133 24 26 253 821 Under 5 ... ... ... ... ... ... ... ... ... 1 28 26 41 ... 6 109 ... 2 22 154 394 5 upwds ... 1 ... ... 6 ... ... ... ... ... 2 1 2 2 97 87 47 2 11 127 385 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 396 34 46 16 22 174 104 8 13 ... ... ... ... ... ... ... ... 4 ... 8 ... 1 7 ... 1 5 33 80 5 upwds 5 2 ... ... 1 ... ... ... ... 1 ... ... ... ... 70 53 30 3 16 135 316 Deaths occurring within the District among persons not belonging thereto 128 16 0 5 13 84 10 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... 1 13 16 5 upwds ... ... 3 ... ... ... ... ... ... ... ... 1 48 IV 14 1 2 26 112 26 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 to1 1 to 5 5 to 15 15 to 25 25 to 65. 65 and upwards. CLASSES. I. Specific Febrile or Zymotic Diseases 63 78 13 3 8 2 141 167 II. Parasitic Diseases ... ... ... ... ... ... ... ... III. Dietic Diseases ... ... ... ... 3 ... ... 3 IV. Constitutional Diseases .. 16 22 6 16 131 19 38 210 V. Developmental Diseases 32 ... ... ... ... 41 32 73 VI. Local Diseases 114 72 14 14 182 106 186 502 VII. Deaths from Violence 18 8 3 ... 14 6 26 49 VIII. Deaths from ill-defined and not specified Causes 34 1 ... ... 5 3 35 43 277 181 36 33 343 177 458 1047 I. Specific Febrile or Zymotic Diseases. 1. Miasmatic Diseases. Small Pox, Vaccinated ... ... ... ... ... ... ... ... ,, Unvaccinated ... ... ... ... ... ... ... ... ,, No Statement ... ... ... ... ... ... ... ... Measles 4 28 2 ... ... ... 32 34 Scarlet Fever 1 7 5 ... ... ... 8 13 Typhus ... ... ... ... ... ... ... ... Whooping Cough 16 10 1 ... ... ... 26 27 Diphtheria 2 16 2 1 ... ... 18 21 Simple Continued or Ill-defined Fever ... ... ... ... ... ... ... ... Enteric or Typhoid Fever ... ... 1 3 ... ... 4 Other Miasmatic Diseases ... ... ... ... ... ... ... ... TABLE III.—continued. CAUSES OF DEATH. ages. Total under 5 years of age. Grand Total all Ages. o to x. 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 84 15 ... ... 1 1 49 61 8. Malarial Diseass. Remittent Fever ... ... ... ... ... ... ... ... Ague ... ... ... ... ... ... ... ... ... 4. Zoogenous Diseases. Cowpox, and effects of Vaccination ... ... ... ... ... ... ... ... Other Diseases (e.g., Hydrophobia, Glanders, Splenic Fever) 5. Venereal Diseases. Syphilis 8 ... 1 ... 1 ... 8 5 Gonorrhcea, Stricture of the Urethra ... ... ... ... ... ... ... ... 6. Septic Diseases. Erysipelas 1 ... ... 1 ... ... 1 2 Pyaemia, Septicemia 1 ... 2 ... ... ... 1 8 Puerperal Fever ... ... ... ... ... ... ... ... Influenza 1 2 ... ... 8 1 8 7 63 78 18 8 8 2 141 167 II. Parasitic Diseases. Thrush, and other Vegetable Parasitic Diseases ... ... ... ... ... ... ... ... Worms, Hydatids and other Animal Parasitic Diseases ... ... ... ... ... ... ... ... 27 28 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. III. Dietic Diseases. Want of Breast Milk, Starvation ... ... ... ... ... ... ... ... Scurvy ... ... ... ... ... ... ... ... Chronic Alcoholism ... ... ... ... 2 ... ... 2 Delirium Tremens ... ... ... ... 1 ... ... 1 ... ... ... ... 3 ... ... 3 IV. Constitutional Diseases. Rheumatic Fever ... ... ... ... ... 1 ... 1 Rheumatism ... ... 1 ... 1 1 ... 3 Gout ... ... ... ... 1 ... ... 1 Rickets 1 2 ... ... ... ... 3 3 Cancer, Malignant Disease ... ... ... ... 24 12 ... 36 Tabes Mesenterica 4 2 ... ... ... ... 6 6 Tubercular Meningitis, Hydrocephalus 1 8 3 ... ... ... 9 12 Phthisis 3 3 2 14 101 4 6 127 Other Forms of Tuberculosis, Scrofula 6 7 ... 1 2 ... 13 16 Purpura, Hæmorrhagic Diathesis ... ... ... ... ... ... ... Antemia, Chlorosis, Leucocythsemia ... ... ... 1 ... ... ... 1 Glycosuria, Diabetes Mellitus ... ... ... ... 1 1 ... 2 Other Constitutional Diseases 1 ... ... ... 1 ... 1 2 16 22 6 16 131 19 38 210 29 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 27 ... ... ... ... ... 27 27 Atelectasis 1 ... ... ... ... ... 1 1 Congenital Malformation 4 ... ... ... ... ... 4 4 Old Age ... ... ... ... ... 41 ... 41 32 ... ... ... ... 41 32 73 VI. Local Diseases. 1. Diseases of Nervous System. Inflammation of Brain or Membranes 2 6 1 ... 2 ... 8 11 Apoplexy, Softening of Brain, Hemiplegia, Brain Paralysis ... 3 ... 1 18 14 3 36 Insanity, General Paralysis of the Insane ... ... ... ... ... 2 ... 2 Epilepsy ... ... 3 1 1 1 ... 6 Convulsions 19 6 ... ... ... ... 25 25 Laryngismus Stridulus (Spasm of Glottis) ... ... ... ... ... ... ... ... Disease of Spinal Cord, Paraplegia, Paralysis Agitans ... 2 ... ... 5 ... 2 7 Other Diseases of Nervous System ... 1 ... ... 2 ... 1 3 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 ... ... ... ... ... ... ... ... Acute Endocarditis ... ... ... ... 1 ... ... 1 Valvular Diseases of Heart ... ... 1 1 3 3 ... 8 Other Diseases of Heart 3 ... 2 2 41 10 3 58 Aneurism ... ... ... ... 4 ... ... 4 Embolism, Thrombosis ... ... ... ... 1 1 ... 2 Other Diseases of Blood Vessels ... ... ... ... 1 1 ... 2 30 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 to 65. 65 and upwards. Local Diseases—continued. 4. Diseases of Respiratory System. Laryngitis ... ... ... ... ... ... ... ... Croup ... ... ... ... ... ... ... ... Emphysema, Asthma ... ... ... ... 1 1 ... 2 Bronchitis 54 25 ... 1 45 44 79 169 Pneumonia 16 22 4 2 22 8 38 74 Pleurisy ... ... ... ... ... ... ... ... Other Diseases of Respiratory System ... ... ... ... ... ... ... ... 5. Diseases of Digestive Organs. Dentition 2 1 ... ... ... ... 3 3 Sore Throat, Quinsey ... ... ... ... ... ... ... ... Diseases of Stomach ... ... 1 ... 4 3 ... 8 Enteritis 13 4 ... ... 1 1 17 19 Obstructive Diseases of Intestines ... ... ... 1 4 3 ... 8 Peritonitis 1 ... 1 ... 1 ... 1 3 Ascites ... ... ... ... ... ... ... ... Cirrhosis of Liver ... ... ... ... 5 ... ... 5 Jaundice, and other Diseases of Liver ... ... ... 2 1 ... ... 3 Other Diseases of Digestive System 2 ... ... ... ... 1 2 3 6. Diseases of Lymphatic System. e.g., of Lymphatics and of Spleen ... ... ... 1 ... ... ... 1 7. Diseases of Glandlike Organs of Uncertain Use. e.g., Bronchocele, Addison's Disease ... ... ... ... 1 ... ... 1 8. Diseases of Urinary System. Nephritis ... 1 ... ... 4 1 1 6 Bright's Disease, Albuminuria ... ... 1 ... 5 3 ... 9 Disease of Bladder or of Prostate ... ... ... ... ... 4 ... 4 Other Diseases of the Urinary System ... ... ... ... 2 ... ... 2 31 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. 9. Diseases of Reproductive System. Male Organs ... ... ... ... 1 ... ... 1 Female Organs ... ... ... ... 1 ... ... 1 Abortion, Miscarriage ... ... ... ... ... ... ... ... Peurperal Convulsions ... ... ... ... ... ... ... ... Placenta Prævia, Flooding ... ... ... ... ... ... ... Other Accidents at Childbirth ... ... ... ... 4 ... ... 4 10. Diseases of Bones and Joints. Caries, Necrosis 1 ... ... 1 1 1 1 4 Arthritis, Ostitis, Periostitis ... ... ... ... ... 4 ... 4 Other Diseases of Bones and Joints ... ... ... 1 ... ... ... 1 11. Diseases of Integumentary System. Carbuncle, Phlegmon ... ... ... ... ... ... ... ... Other Diseases of Integumentary System 1 1 ... ... ... ... 2 2 114 72 14 14 182 106 186 502 VII. Deaths from Violence. 1. Accident or Negligence. Fractures and Contusions ... 3 1 ... 6 6 3 16 Gunshot Wounds ... ... ... ... ... ... ... ... Cut, Stab ... ... ... ... 1 ... ... 1 Burn, Scald ... 4 1 ... 1 ... 4 6 Poison ... ... ... ... ... ... ... ... Drowning ... ... 1 ... 1 ... ... 2 Suffocation 18 1 ... ... ... ... 19 19 Otherwise ... ... ... ... ... ... ... 32 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 ... ... ... ... ... ... ... ... 3. Suicide. Gunshot Wounds ... ... ... ... ... ... ... ... Cut, Stab ... ... ... ... ... ... ... ... Poison ... ... ... ... ... ... ... ... Drowning ... ... ... ... 2 ... ... 2 Hanging ... ... ... ... 3 ... ... 3 Otherwise ... ... ... ... ... ... ... ... 4. Execution. Hanging ... ... ... ... ... ... ... ... 18 8 3 ... 14 6 26 49 VIII. Deaths from Ill-defined & not specified Causes. Dropsy ... ... ... ... ... ... ... ... Debility, Atrophy, Inanition 29 1 ... ... ... ... 30 30 Mortification ... ... ... ... 1 2 ... 3 Tumour 1 ... ... ... 2 ... 1 3 Abscess 4 ... ... ... 1 1 4 6 Hæmorrhage ... ... ... ... 1 ... ... 1 Sudden Death (cause not ascertained) ... ... ... ... ... ... ... ... Causes not Specified or Ill-defined ... ... ... ... ... ... ... ... 34 1 ... ... 5 3 35 43 33 TABLE IV. Return respecting the Vaccination of Children whose Births were Registered between July 1st, 1896, and June 30th, 1897, 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 1526 878 1 - 178 33 *226 173 37 Whitecross Street 232 174 1 — 81 6 — 16 4 Finsbury 82 59 - - 9 3 - 8 3 Totals 1840 1111 2 — 218 42 *226 197 44 * 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. 34 The following Report by Dr. Young, Assistant Medical Officer of Health to the London County Council, was received by the Vestry in November, and was afterwards referred to me by the Public Health Committee for my observations thereon, a copy of which latter are also appended, and which, together with the Report, were duly considered by the Committee, but their recommendations were not dealt with by the Vestry during the period covered by this Report. LONDON COUNTY COUNCIL. Sanitary Condition and Administration of the Parish of St. Luke. Public Health Department, Spring Gardens, S.W., November, 1897. Dr. YOUNG'S REPORT. The district under the jurisdiction of the Vestry of St. Luke is one of the smallest in area in the County of London. It is situated in the central part of the Metropolis and adjoins the City of London, which forms its southern boundary. On the east and north it is bounded by Shoreditch and Islington respectively, and on the west by Clerkenwell and the Charterhouse, while, for a short extent of boundary at the south-western corner, it is in juxtaposition with the district under the jurisdiction of the Holborn Board of Works. The sanitary district of St. Luke corresponds with the civil parish of the same name. The soil throughout the district is composed of gravel and sand overlying the London clay. The area of the district is 237 acres, including about three acres of water, which consists of that portion of the City Road basin of the Regent's Canal situated in the northern part of St. Luke. The ratable value of the parish in April, 1896, was £347,192. During the year April 1st, 1896, to March 31st, 1897, the contribution of St. Luke to the Equalisation of Rates Fund exceeded the grant made from the fund by £286 3s. 4d. For statistical purposes St. Luke forms part of the registration district of Holborn, which also includes the whole of the sanitary district under the Vestry of Clerkenwell and the greater part of that under the jurisdiction of the Holborn Board of Works. St. Luke is now divided into three sub-districts, known as City Road, Whitecross Street and Finsbury, the first being the northern, the second the southwestern, and the third the south-eastern part of the parish. 35 The following table shows the acreage, number of inhabited houses, and population of each sub-district, and of the whole parish at the date of each census since 1871— Acres. Inhabited Houses. Population. 1871. 1881. 1891. 1871. 1881. 1891. 1896. City Road 127 3.5 acres of which are water. 3,199 3,154 2,917 30,462 30,169 29,177 29,897 Whitecross Street 32 1,430 830 558 13,792 9,217 8,278 7,595 Finsbury 78 1,227 817 475 10,741 7,463 4,985 4,035 Whole district 237 5,856 4,801 3,950 54,995 46,849 42,440 41,527 These figures show that during the interval since 1871 a marked decrease has been taking place both in the population and in number of inhabited houses in the district, although the results of the last census in 1896 point to a lessened rate of decrease, and in the City Road sub-district there was a small increase in the number of residents. The decrease has at each census been most marked in the two subdistricts adjoining the City of London, and is doubtless largely accounted for by the substitution of business premises for inhabited houses. The clearances made in connection with the widening of Golden Lane in and after 1877 must have displaced a number of residents from this part of the district, but decrease in the population from this cause has probably been counterbalanced by the erection of the large number of blocks of artizans' dwellings now existing in the streets at either side of Whitecross Street. The average number of residents to each acre in 1871, 1881, 1891 and 1896 was 232, 198, 179 and 175 respectively; in London the corresponding number in 1896 was 59. The average number to each inhabited house in St. Luke in 1871, 1881 and 1891 was 9.3, 9.7 and 107 respectively, and in the County of London 7'7 persons. The resident population is almost entirely made up of the labouring class, artizans and small shopkeepers. There is a small proportion of people better off in the neighbourhood of Finsbury Square and King's Square, while towards the western end of the district south of King's Square are to be found some of the very poor classes. In 1891 the 36 population was made up of 20,746, or 48.9 per cent., males, and 21,694, or 51.1 per cent., females, the relative proportion of the sexes having remained practically the same since 1871. In London generally the proportion was 47.8 per cent. males and 52.7 per cent. females. The age constitution of the population at the date of the 1891 census was as follows:— Age period. 0- 5— 10— 15— 20— 25— 85— 45— 55— 75— St. Luke— Males, per cent. of population 6.33 5.71 5.20 5.09 4.54 7.96 6.24 4.19 2.37 1.02 .24 Females, do. 6.70 5.88 5.30 5.21 4.85 7.77 6.37 4.19 2.88 1.48 .48 London— Males, per cent. of population 5.92 5.36 4.90 4.69 4.61 7.92 5.85 4.11 2.35 1.20 .37 Females, do. 5.99 5.42 4.99 5.21 5.56 9.11 6.49 4.64 2.92 1.72 .69 Compared with London there is in St. Luke a greater proportion of persons under 20 years of age, the excess being most marked at the younger ages; above 20 years the proportion is less than in London generally. In the following table the rates of births and deaths per 1,000 persons in St. Luke are given for recent years. For the purpose of comparison the corresponding rates in the adjoining districts of Clerkenwell and Holborn, as well as in London generally, are also given:— Birth-Rate. Death-Rate. London. St. Luke. Holborn. Clerkenwell. London. St. Luke. Holborn. Clerkenwell. 1891 31.8 45.5 27.7 33.6 22.4 32.8 33.6 27.8 1892 30.9 45.2 27.1 32.9 21.6 27.9 29.9 27.2 1893 31.0 42.2 26.8 31.9 22.4 330 29.9 29.2 1894 30.1 450 26.2 33.0 18.6 24.9 22.6 20.8 1895 30.6 45.8 26.2 31.5 20.8 31.8 28.1 25.0 1896 30.2 46.7 28.1 33.7 19.3 27.1 25.7 23.2 The rates have been corrected by exclusion of non-residents dying in 37 the district, and inclusion of deaths of residents dying in outlying institutions, as well as for age and sex distribution. Dr. Yarrow, the Medical Officer of Health, in his Annual Reports to the Vestry, points out that a number of mothers of children born in the City Road Lying-in Hospital are not permanent residents in the parish; if allowance be made for these the birth-rates are considerably lowered, but still remain higher than those prevailing in London generally. The deaths from the principal zymotic diseases, and of children under one year of age, give the following rates * Zymotic Death-Rate per 1,000 Living. Deaths under One Year Old per 1,000 Births. London. St. Luke. Holborn. Clerkenwell. London. St. Luke. Holborn. Clerkenwell. 1891 2.27 2.82 4.36 4.35 153 159 228 170 1892 2.80 3.09 3.00 2.86 154 142 211 172 1893 3.04 5.53 3.38 4.83 163 174 214 202 1894 2.65 2.08 2.55 2.63 143 123 180 145 1895 2.62 5.39 2.87 3.80 165 184 212 192 1896 3.14 3.82 3.21 3.78 160 154 194 184 The inhabitants of St. Luke are housed in premises consisting chiefly of two and three storeys, situated in fairly wide streets, which form the main thoroughfares of the district, and in narrower side streets off these. The district is entirely built over, there being no open space except in the centre of King's Square and in the neighbourhood of Finsbury Square, where there is a small amount of land unbuilt on in connection with militia barracks, and a disused burial ground. The two-storey houses are to be found in the side streets and alleys; they are mostly old cottages, showing signs of decay, though at the time of inspection they were, on the whole, in a fair state of repair, owing to the fact that they are constantly receiving attention from the officers of the authority. Each house generally contains two rooms, one on the ground floor and the other on the top floor, the staircase affording communication between the two being situated in the ground floor room, into which also the door from the street directly opens. They mostly have small back-yards, and some have in addition a small room at the rear of the ground floor room, which is used as a kitchen or washhouse. These premises are mostly occupied by single families, but in some cases by two, though from their arrangement they are not adapted for this purpose. The houses three storeys in height are situated chiefly in the larger thoroughfares; they generally contain an entrance passage and have two rooms, one behind the other * Smallpox, Measles, Scarlet Fever, Diphtheria, Whooping Cough, Fever, Diarrhœa. 38 on each floor, but in some cases there are but three rooms in the house, one on each floor. These premises are in nearly all instances occupied by members of more than one family, this being so even in many cases where the ground floor is used as a shop. In the better class streets the whole house is rented by one tenant, who sublets unfurnished one or more of the rooms, while in the poorer class of street it is usually found that the rooms are let separately to each tenant, there being no one person resident who has any control over the house generally, unless the landlord arranges with one of the tenants to act as caretaker and to see that those parts of the house used in common are kept in a proper and cleanly condition. In addition to the above-mentioned housing accommodation considerable provision has been made for the inhabitants of the district by the erection of blocks of model dwellings, especially in the neighbourhood of Whitecross Street. These dwellings, it is stated by Dr. Yarrow, the Medical Officer of Health of St. Luke, in his Annual Report for 1896, are inhabited by as much as one-fifth of the total resident population. Many of these blocks of dwellings were visited during the inquiry, and were found to be well arranged in respect to the means of light and ventilation of the living rooms, and the provision made for washhouses and water-closets, and they were clean and in good repair. In all instances the blocks are in charge of a resident superintendent. There are no houses in the district built back to back with the exception of a small block known as Baltic Place and Baltic Court. There are a few narrow courts and alleys, some of which are approached by an archway from the adjoining street, and in some of which the houses having no backyards are provided with water-closets and washhouses for common use in the space in front of the houses. For the most part, however, the houses in such cases being but two storeys high, and having but one room on each floor, the evils arising from absence of open space at the rear of the premises is somewhat diminished. The majority of premises have small yards. Some of these houses appear to be of considerable age, and show signs of decay. During the inquiry I visited 432 houses, and in these defective conditions of sufficient import to require the attention of the officers of the Authority were noted as follows:—Defective or insufficient paving of yards in 63 instances; defective or dirty condition of water-closets in 88 instances; dilapidated dustbins or absence of proper covers in 66 instances; and undue accumulations of house refuse in 13 instances. Domestic cisterns were found to be insufficiently covered or in a dirty state in 34 cases, and animals kept so as to be a nuisance were met with on nine occasions. Dampness of walls was noticed in 23 cases; but in a large number of the older houses matchboarding of walls exists, and it is possible that in some of these after wet weather dampness would also be present. Inlets to drains, which, in the large majority of cases, are placed outside the dwellings, were found to be in 39 good repair, in only 13 instances were they found defective or choked; defective stack pipes and gutters were noticed in 10 cases. But the conditions requiring remedy and most frequently met with relate to the interior of dwellings: thus, in 146 tenements, the rooms and staircases and passages were in need of cleansing, while walls, ceilings and floors were dilapidated or defective in 71 cases, notwithstanding the fact stated by the Sanitary Inspector that the rooms in many cases had been cleansed after inspection made within the previous 18 months. These conditions were most marked in the poorer class of tenement houses referred to above as houses in which rooms are let out separately. Inadequate water-closet accommodation for the number of residents in houses was noticed on two occasions, and illegal occupation of basement rooms in three instances. Overcrowding of rooms, judged by the standard adopted in the bye-laws of the authority as to houses let in lodgings, was noted in as many as 49 cases. There are in the district 19 houses let in lodgings which have been registered. They are situated in the following streets Lever Street, four houses; Bastwick Street, five houses; Featherstone Street, two houses; and Honduras Street, eight houses. Some of these were visited, and found for the most part in compliance with the bye-laws. There are four registered common lodging-houses in St. Luke, three for the accommodation of male lodgers, and one for both males and females. One of the lodging-houses consists partly of a building formerly used as a mission room, and is not well adapted for its present purpose, and although improvements were effected upon the occasion of its transfer to the present keeper, the day room accommodation is still unsuitable. Two of the houses are old premises, and frequently in need of repair. The fourth house has lately been transferred, and is at the present time undergoing improvement. The Sanitary Authority have not a complete list of the workshops in the district. During the inquiry 91 of these premises were visited, and for the most part they were satisfactory, but detective conditions, or the need for cleansing were noted as regards 43, while the watercloset accommodation for the number of workers was insufficient in two instances. No effectual attempt has been made to carry out the section of the Factory and Workshop Act relating to outworkers. Of the 35 bakehouses in St. Luke 30 were inspected and found to be maintained in a satisfactory condition, except in the case of three, which were in need of some slight repairs. The means of light and ventilation are unsatisfactory in the case of eight, and 16 of the bakehouses visited are situated underground. The cowsheds, milkshops and slaughter-houses were found at the date of inspection in compliance with the regulations. One slaughter-house, although satisfactory in other respects, is open to objection, owing to the situation of a watercloset in relation to it, and at one cowshed the dung and grain pits communicate with the shed when the doors of the pits are open. 40 There are two registered tripe-boiling premises in St. Luke, one of these (as to which complaint was made to me during the inspection) is not at present in use. The second is undergoing alterations with a view to improvement. The water supply of the district is furnished by the New River Company, and a constant supply is provided throughout. A few houses obtain their water from the rising main, but in the majority of cases storage cisterns exist. These cisterns are in nearly all houses situated in the back yard, and in many instances they are not provided with adequate covers, and from inquiries which I made of householders it does not appear that the bye-law as to periodical cleansing is carried out. The scavenging of the streets and the collection and removal of house refuse is carried out by the sanitary authority. As regards the collection of house refuse, the dustmen call at all houses once in each week in order to remove the contents of the ashpit, but inquiries made of householders during the inspection appear to show that collection depends to some extent upon whether the householder considers there is or is not sufficient accumulation for removal at the time that the dustmen call, the result being that in some cases the refuse, only small in amount and probably filling only part of the receptacle, is allowed to remain on the premises till the next week. At the time of my visit to two houses in one street 1 found that the dustmen had just made their weekly call, but had been told there was no refuse for collection; but upon examining the dust-bins it was found that each contained refuse which had collected since removal a week previously. In the main thoroughfares the collection of refuse is made daily. The refuse at the present time is taken to a wharf on the City Road basin of the Regent's Canal, and thence removed by barge; but this method of disposal will shortly cease on the completion of the dust destructor which is being erected for the use of the district. For the disinfection of articles of clothing and bedding after the occurrence of cases of infectious disease in the families of residents in the district, the Vestry has recently provided a steam disinfecting oven. This is situated at the Mortuary buildings, and is in charge of and worked by the caretaker of the Mortuary and Coroner's Court. Rooms in which cases of infectious disease have occurred are fumigated with sulphur by an assistant. The Shelter for the use of persons during the time that their room or rooms are undergoing disinfection is not yet ready for use. It is proposed to utilise for this purpose six rooms on the top floor of the building which is being erected in connection with the Vestry's new wharf and dust destructor buildings. These rooms are over and approached by the same staircase as the rooms to be occupied by the Wharf Superintendent. It is not proposed to fit up a bath-room in connection with the Shelter. 41 A Mortuary has been provided in connection with the Coroner's Court near Whitecross Street. It contains one mortuary chamber and a post-mortem room. There is no separate mortuary chamber for the bodies of persons dying of infectious complaints. The Sanitary Authority for the district is the Vestry of St. Luke. For the purpose of carrying out the duties relating to the sanitary condition of the district the Vestry has appointed the following officers—a medical officer of health, two sanitary inspectors, and a clerk for the sanitary department. The Medical Officer of Health is not allowed to engage in the practice of his profession. He controls and supervises the work of the Public Health Department, and attends daily during certain hours in the morning and afternoon at the offices of the Vestry in the City Road. Each Inspector has a part of the district allotted to him, and in this part he carries out all duties arising under the Public Health (London) Act, 1891, and under the Food and Drugs Act. As regards, however, the sections of the former Act relating to the seizure of food unfit for human consumption, the existence of a public street market in Whitecross Street throws additional duties in this respect on the Sanitary Authority, and in order that inspection of the market may be made twice in each day the duty is equally borne by the two Inspectors. In addition to these Acts the Vestry is an inspecting authority under the Canal Boats Act, and one of the Inspectors has been appointed under the Act for the purpose of visiting boats in the City Road basin, and is expected to visit a certain number during each month, though up to the present time it has not been possible to inspect this number of boats in the period owing to the Inspector's time being engaged in other duties. The register of these inspections is kept by the Sanitary Inspector. Office accommodation for the Inspectors is provided at the Vestry Hall, and they attend there daily in the morning in order to keep appointments and to give information to builders, complainants, and others, and in the latter part of the afternoon to consult the Medical Officer and to fill up their diaries, in which are recorded the result of inspections made during the day time. These diaries are supervised by the Medical Officer of Health, and are presented at each meeting of the Committee. The Clerk is occupied entirely with duties arising out of the work of the Department. He keeps the complaint and report book, and prepares the intimation and statutory notices from notes supplied by the Inspectors. He also fills up the certificates forwarded to the School Board and to the Metropolitan Asylums Board relating to cases of infectious diseases notified to the Medical Officer of Health, and carries out any other clerical duties of the Department. In addition to the above-mentioned officers there is a General Assistant, who is engaged to assist the Sanitary Inspectors in draintesting and in the collection of samples; to fumigate rooms after the 42 occurrence of cases of infectious disease; to convey articles of clothing and bedding requiring disinfection to and from the disinfecting oven, and to serve notices. The Mortuary Keeper is also under the control of the Medical Officer of Health, and he, in addition to duties arising out of the use of Mortuary and Coroner's Court, disinfects articles of clothing in the disinfecting oven. The Vestry, as Sanitary Authority for the District, have made Bye-laws under the Public Health (London) Act, 1891, for securing the periodical cleansing of drinking-water cisterns and the proper flushing of waterclosets; for the prevention of nuisances arising from various causes, including the keeping of animals; for securing the paving of open spaces in connection with dwelling-houses; and for the registration of houses occupied by members of more than one family. These Bye-laws have been confirmed by the Local Government Board, and are similar to those made by other Metropolitan authorities. As regards the lastmentioned Bye-laws, the amount of cubic space required in registered rooms is 300 cubic feet for each adult in the case of sleeping rooms, and 400 cubic feet in rooms used both as living and sleeping rooms; for persons under 10 years of age only half these amounts are required. Provision is also made for the exemption of houses as follows:— (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 a 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 the rate of five shillings and sixpence per week or upwards. This inquiry into the sanitary administration of St. Luke, and the inspection of the conditions existing in the district at the present time, the results of which are set out in the foregoing part of this Report, show that the population is almost entirely composed of the labouring and the poorer class, and that the houses in the district are in most instances occupied by more than one family, the majority occupying one and two rooms. The notes as to the condition of premises made during the inspection show that it is most markedly in respect to conditions of a recurring nature, such as a dirty and dilapidated state of rooms and overcrowding of tenements that attention should be directed. It is for remedyingand preventing the recurrence of conditions such as these that Byelaws as to tenement houses are specially useful, and it is necessary therefore that the Authority should enforce in a thorough manner the powers which they possess under their Bye-laws as to houses let in 43 lodgings. The Bye-laws of the Authority were confirmed by the Local Government Board in 1895, and I understand that since that date an attempt has been made to enforce them, and notices were served upon the owners of 48 houses, but upon the return of these notices with particulars as to occupation and rent of tenements, it was found that owing to the low limit of exemption, namely, three shillings a week, only 16 houses came within the scope of the Bye-laws, although other houses in the same and other streets are substantially the same as regards their occupation as those which have been registered. Inquiries made of tenants as to rent during my inspection confirm this experience, that the present limit of exemption renders the Bye-laws inoperative in this district; thus, out of a total of 177 tenements, which appear to be of the class for which these Bye-laws are intended, 145 were let at three shillings or more per week, and would therefore escape registration. There is little doubt that much benefit would be derived from the periodical inspection and cleansing of the majority of houses let in lodgings in the district, some needing both inspection and cleansing more frequently than others. In view of the experience already gained as to the practicability of using the Bye-laws, the Authority should take steps to amend the exemption clauses. It has been customary to have house-to-house inspections made by the Inspectors of those parts of the district which are known to require most attention, and, as the result of this, many of these premises were found in respect to conditions other than those referred to above in a satisfactory state. These inspections, together with inspection on complaint, re-inspection after completion of works, and duties relating to food, and the collection of samples, is sufficient to take up the time of the present Staff; and it has not been possible to undertake a systematic house-to-house inspection throughout the whole district, with a view to obtaining a record of the conditions of, and the mode of use of all premises in the district, although the Vestry have passed a resolution that each Inspector shall devote two days in each week to this purpose. The result is that many insanitary defects exist in houses, and the sanitary authority has not yet a complete knowledge as to all the workshops and workplaces in the parish and the requirements of such premises, although a number have been visited and particulars relating to them entered in the Vestry's register of factories and workshops. In order to carry out this house-to-house inspection, and to visit periodically as often as may be considered necessary houses let in lodgings when registered, it will be necessary to make an increase in the number of Inspectors at present engaged by the Authority. The increase necessary in the staff will depend to some extent upon the number of houses which it is found should be registered, when the Bye-laws are so amended as to make them practically useful in the district. In arriving at this conclusion of need of increase in the Sanitary Staff, the following facts, to which my attention was directed 44 by the Chairman of the Vestry's Public Health Committee when I commenced the inquiry, have been kept in mind, namely— 1. That since the reorganisation of the work of the department some twelve months ago, and the appointment of two new Inspectors, an increased amount of work has been effected in the district. 2. That at least one-fifth of the total population reside in blocks of artisans' dwellings which, having resident superintendents and being let to tenants subject to certain regulations, require less supervision on the part of the Sanitary Authority than other premises. 3. That much small property in the district is being replaced by commercial premises, and that the consequent decrease in population will lead to a less amount of work being necessary under the Food and Drugs Act. These points, however, do not affect the fact that the Staff is at present inadequate to deal with conditions now existing in the district and requiring action by the Vestry. Further, the substitution of commercial premises for houses and a possible decrease in the resident population does not necessarily mean a lessened amount of inspectorial duties if these premises comprise a large number of work-places. The conditions enumerated in the earlier part of the Report are mostly such as can be readily dealt with under the Public Health Act; but it may be desirable to resort to the powers which the Vestry possess under the Housing of the Working Classes Act in the case of some of the older houses in the parish, as well as in such cases as Baltic Place and Court and Beckford Square, where there is an absence of rear space. The method of collection of house refuse in the parish requires to be further improved, so as to secure the cleansing of ashpits at all premises once in each week. The Shelter which is being provided for the use of persons during the disinfection of their rooms is, as at present proposed, open to objection in being approached by the entrance and staircase, which also leads to apartments reserved for the Vestry's Wharf Superintendent, and it is desirable that one room should be set apart for use as a bath-room. The addition of a separate chamber to the Mortuary for the bodies of persons dying of infectious complaints is also desirable. C. W. F. YOUNG, Assistant Medical Officer of Health. 45 Observations on the recent Report made by the Medical Officers of the London County Council on the Sanitary Condition and Administration of the Parish of St. Luke. To the Public Health Committee. Gentlemen, The first subject contained in the above Report calling for comment is the difference in the birth and death-rates therein from those set out in the Report which I have recently submitted for your consideration, and I think the explanation is to be found in the fact that Dr. Young has obtained his figures from the Returns of the Registrar-General, and which, for reasons I have given, are not strictly reliable. This observation applies also to the Zymotic Death-Rate. With respect to the deaths of infants under one year of age, the number appears to be much less than occurs in the adjoining districts of Holborn aud Clerkenwell, which are given for comparison, and while in four of the six years quoted it was slightly above that of London as a whole, in the other two years it was less, but it must not be forgotten that these figures are based upon the assumption that the total number of births which take place in the parish belong to St. Luke, whereas nearly 500 do not so belong, consequently when death occurs to any of these the record is made in another district. The three subjects, however, which call for the special consisideration of your Committee are:— First, the necessity for the amendment of the Bye-laws relating to houses let in lodgings or occupied by more than one family. Second, the desirability of increasing the number of your Sanitary Inspectors; and Thirdly, the provision of further accommodation at the Mortuary. In reference to the first of these I may mention that the matter has been under the consideration of the Vestry from time to time since 1874, and Bye-laws were first made by the Vestry in 1884, but it was not found practical to put them in force, and as doing so was then permissive the subject was allowed to remain in abeyance until by the Public Health (London) Act the making and enforcing of the Bye-laws became compulsory. 46 The present Bye-laws were adopted by the Vestry, September 3rd, 1895, and approved by the Local Government Board, October 29th following, but when put into operation were found to be inefficient in two particulars; first, by reason of the rent limit which is 3s. per week, and which prevents houses it is desirable to register being so dealt with, while it embraces others with which it is not necessary to interfere, for example, an aged person occupying a single room at 2s. 6d. per week renders the house liable to be registered, while the same sized room occupied by a family at 3s. per week is not registerable. The second defect arises from the fact that before proceeding to deal with any premises under the Bye-laws a resolution of the Vestry is required to the effect that it is necessary to do so, but the Vestry naturally decline to pass such resolution until they are furnished with the facts in each case, and which the officers have no authority to obtain. The subject of the alteration of these Bye-laws was last considered by your Committee, November 10th, 1896, when it was resolved to recommend the Vestry to make alterations in the direction referred to, but the Vestry declined to endorse the Committee's recommendation and the Bye-laws have since remained inoperative. In connection with this subject permit me to refer to a recent Report of the Public Health Committee of the London County Council, who, in urging the necessity of Bye-laws being made and put into operation in districts where the matter had hitherto been neglected, conclude their Report to the Council in the following terms "In view of the fact that the statutory requirement that the Bye-laws relating to houses let in lodgings should be enforced is still so much neglected in many districts in London, we think the Council should make a complaint, to the Local Government Board. The Sanitary Authority with regard to which we think that course should in the first instance be taken is Bethnal Green, as that Authority does not seem to have attempted to take any action with regard to houses let in lodgings. We will, if necessary, make recommendations with regard to other districts later." With respect to an increase in the Sanitary Staff, a suggestion in this direction is frequently met with the observation that twelve years ago or so one officer was sufficient to meet all requirements of the district, and without endorsing this view 47 permit me to point out some of the increased duties devolving upon Sanitary Authorities by recent legislation—the carrying out of the Bye-laws made by the London County Council, and those by the Vestry under the Public Health (London) Act, the Notification and Prevention of Diseases Act (now incorporated in the Public Health Act), the Workshops and Factory Acts, Housing of the Working Classes Act, Canal Boats Act, Food and Drugs Act, and the Margarine Act, all of which involves a large amount of detail work not required by the Sanitary and Nuisance Removal Acts of former days. When the subject of the necessary Staff required to carry out the Public Health Act was under the consideration of the Special Committee appointed to report on the matter in 1892, I recommended that a third Inspector should be appointed, even if temporarily, to bring the work to the requirements, but the Committee then thought the necessity might be obviated by an alteration of the duties of the Staff. Since that time the duties have gone on increasing and the work has never been overtaken. The matter has been urged upon the attention of the Vestry by the London County Council from time to time since the foregoing, the last occasion being October, 1896, when it was decided to inform the Council that the Vestry were of opinion that the "Sanitary Staff is sufficient and compares favourably with other districts of like circumstances." The subject of the required increased accommodation at the Mortuary has also been under the consideration of the Public Health Committee on several occasions, the last time being in 1892. I then suggested that the matter might be met by conversion of the small apartment, known as the waiting room for females, into a Post-Mortem Room, and the present Post-Mortem Room being used as a general Mortuary, the old Mortuary at the extreme end of the premises being divided into two apartments, the inner one to be used for depositing bodies of persons dying of infectious disease, and the outer one as a store for shells, implements, &c. This scheme was reported upon by the Surveyor and rejected by the Committee on the ground of expense. There is only one other matter dealt with in the Report which requires consideration, namely, property in the parish which it would be desirable for the Vestry to deal with under the Housing of the Working Classes Act. Of the first of these mentioned a representation was made by me to the Vestry in 1892 upon which 48 the necessary proceedings were taken to obtain closing orders, and after some delay and considerable expense had been incurred the magistrate visited the premises and declined to make the order asked for, on the ground that he thought by giving the owner a mouth in which to make the necessary alterations the property would then be in a satisfactory condition. Beckford Square was at that time on the list for consideration of the Committee with the object of similar proceedings being taken, but in view of the failure attending the above, which, in the opinion of the Committee was in much worse condition, it was decided not to proceed with the matter. Other property has since been closed under the statute, but my own view of the matter is that the same object can be achieved more expeditiously under the provisions of the Public Health (London) Act, 1891. In conclusion, I beg respectfully to say that the opinions I have expressed in the past with reference to the several matters referred to in Dr. Young's Report have been fully justified by time and the abortive attempts which have been made to deal with them. I consider it desirable that the Bye-laws for the registration of houses let in lodgings should be made practicable and be put into operation as soon as possible, because the class of houses to which it is desirable to apply them are of necessity subject to recurring nuisances of a nature which can be more expeditiously dealt with in the mode proposed than by any other which has hitherto been suggested. If this is conceded it is in itself a justification for the appointment of another Sanitary Inspector, as at starting one man's time would be fully occupied by the work involved, and after the register is completed any time he might have undisposed of by the inspection of the registered houses could be devoted to factory, house-to-house inspection, or any of the other matters which are constantly falling into arrears. With regard to the Mortuary I have pointed out how the defect can be remedied, and that it is a real defect calling for remedy will, I am sure, not be gainsaid when I remind you that the bodies of persons dying of infectious disease are placed in the same chamber as those dying from accident and from the result of illness of non-infectious character, and that these are visited by large numbers of relatives, friends, and jurymen at considerable risk ; the same observation applies to your own servants, who have to use the said Mortuary for the purposes of storing shells and other necessary articles. Yours obediently, December 14th, 1897. G. E. Yarrow. 49 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 January 1st, 1898, 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 Hospitals and Infirmaries. Treated at the London Fever Hospital. Treated at their own Homes. Duplicate Certificates. Erroneously Diagnosed. Small-Pox ... ... ... ... ... ... ... Scarlet Fever 255 195 ... 11 28 21 ... Diphtheria 205 121 23 2 37 20 2 Typhus Fever ... ... ... ... ... ... ... Enteric Fever 46 19 14 ... 10 3 ... Continued Fever ... ... ... ... ... ... ... Membranous Croup 1 ... ... ... 1 ... ... Puerperal Fever 2 ... ... ... 2 ... ... Erysipelas 95 ... 16 ... 70 9 ... Total number from all causes 604 335 53 13 148 53 2 The amount paid to the Medical practitioners for furnishing the above Certificates amounted to £57 3s. For the year 1896 the sum of £58 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. Temporary Shelter. In accordance with the provisions of the Act, house accommodation, with necessary attendants, has been provided at 41, 50 Macclesfield Street, where the members of any family in which any dangerous infectious disease has appeared, who are compelled to leave their dwellings for the purpose of enabling such dwellings to be disinfected, can be received, and the following Regulations for the management of the said Shelter-house have been approved by your Yestry. VESTRY OF ST. LUKE, MIDDLESEX. Regulations for persons occupying the temporary Shelter-house. 1. Persons shall occupy the temporary Shelter-house only during the period that their rooms are undergoing disinfection; when this process has been completed, the Caretaker will inform them of the fact and they shall immediately vacate the Shelter-house. 2. No person not being a temporary occupant shall be permitted to visit the Shelter on any pretence whatever, except with the written permission of the Medical Officer of Health. 3. Occupants shall at all times keep their rooms and all articles in them in an orderly and cleanly condition. 4. Every person occupying the temporary Shelter-house shall at all times behave in a decent. orderly, and sober manner, and every person not so behaving, shall be liable to instant discharge by the Caretaker, who has received instructions to rigidly enforce this rule. VESTRY OF ST. LUKE, MIDDLESEX. Duties of the Caretaker of the temporary Shelter-house. 1. He shall at all times keep the building in a cleanly state, and shall prepare the rooms for the reception of cases. 2. As soon as convenient, after the departure of a family, he shall see that the rooms are washed, that the bedding and other clothing used by them is properly disinfected and washed, and that all articles are put away in a cleanly condition. 3. He shall see that the Regulations of the temporary Shelter-house are rigidly observed by the inmates, and any breach thereof shall be reported to the Medical Officer of Health. 4. He shall keep a book, provided by the Vestry, in which he shall enter the names and ages of all persons who shall become occupants of the Shelter, the hour and date of their arrival and of their final departure. 51 Disinfection of Infected Articles. A Thresh's Current Steam Disinfector has been in use by the Vestry during the past twelve months, and has been found to fulfil all the conditions promised by its makers. It has been put to a very severe test by reason of having, for considerable periods, performed all the disinfections not only of our own, but also that of two other adjoining sanitary districts. This, according to the view of the makers, has been the cause of some defects arising in the apparatus which, however, have been remedied at the expense of the firm who supplied the machine. The number of articles disinfected by the apparatus during the year amounted to 7,190. Another improvement in this Department has been made by the provision of two specially constructed trucks for conveyance of articles to and from the Disinfecting Chamber, one being used before, and the other after, the articles of Bedding, Clothing, &c., have been disinfected. They are in substitution for the old covered van, formerly used as a Fever Ambulance, and which was the only means of conveying articles to and from the apparatus. The number of rooms fumigated after the occurrence in them of cases of infectious disease amounted to 452. Supply of Disinfectants. 926 persons were supplied with Carbolic Acid and Disinfecting Powder 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 264 bodies have been received into the Mortuary. Eighty-five Inquests were held in the Coroner's Court belonging to the Vestry and fifty Postmortem Examinations were made in the Post-mortem 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. Houses let in lodgings which are registered under the Byelaws relating to the same:— 52 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 the opinion of the Vestry should be registered. The amount of rent, however, named in the existing Bye-laws (3s. per week) excludes them from the operation of the Act, and an amendment has been made with a view to remedying the defect, and the amended Bye-laws are awaiting the sanction of the Local Government Board. 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. Exposing unsound jam 42s. „ „ fruit 2s. Insufficient W.C. accommodation 40s. and 2s. Insanitary premises 21s. and 21s. „ „ 6s. „ „ 6s. „ „ 6s. Exposing fowls unfit for food £10 and 40s. Accumulation of manure 23s. Contravention of L.C.C. Bye-laws 5s. and 23s. „ „ „ 10s. and 2s. „ „ „ 20s. and 2s. „ „ „ 60s. and 2s. „ „ „ 21s. Accumulation of manure 40s. and 2s. Insanitary premises 21s. Exposing unsound meat £20 and 2s. Insanitary premises 21s. „ „ 21s. Exposing unsound rabbits for sale 22s. The following premises being in such a condition as to be unfit for human habitation, Closing Orders were made by the magistrate:— Nos. 7 and 8, Red Lion Market. 53 At the suggestion of Her Majesty's Chief Inspector under the Canal Boats Act, the Sanitary Inspector having charge of the Northern District of the Parish has, with the approval of the Local Government Board, beeu appointed an Inspector under the said Act, and the result of his inspections of the boats which have come into that portion of the Regent's Canal situated within the Parish will he found in the Inspector's Report on page 59. Besides those already mentioned, I have made numerous Reports to your Public Health Committee on the various matters which have occupied its attention, and twice during the year I have visited and reported upon four slaughter-houses, two 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 two cowsheds and 26 bakehouses. Food and Drugs and Margarine Acts. Article. Extent of Adulteration. Fines. Costs. Butter 85% margarine 10s. 6d. and 2s. „ 90% „ 20s. and 12s. 6d. Milk 12% added water 20s. and 12s. 6d. Butter 90% margarine 5s. and 12s. 6d. Milk 15% added water 10s. and 12s. 6d. Butter 98% margarine 10s. and 12s. 6d. „ 85% „ 10s. and 2s. Margarine Exposing without label Is. and 2s. Milk 90% cream abstracted 20s. and 12s. 6d. Butter 95% margarine 10s. and 14s. 6d. Cheese 30% foreign fat 3s. and 12s. 6d. Butter 70% margarine 10s. and 14s. 6d. Milk 12% added water £5 and 12s. 6d. Margarine Exposing without label 12s. 6d. „ „ „ „ 12s. 6d. Butter 85% margarine 20s. and 12s. 6d. Milk 15% added water £5 and 12s. 6d. „ 9% „ 80s. and 22s. 6d. „ 12% „ 10s. and 12s. 6d. Butter 95% margarine 20s. and 14s. Milk 8% added water 10s. and 12s. 6d. „ 22% „ 40s. and 12s. 6d. „ 11% „ 20s. and 12s. 6d. Butter 98% margarine 20s. and 12s. 6d. Milk 8% added water £5 and 12s. 6d. „ 18% „ 10s. 6d. and 2s. 54 I have also visited 215 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 1 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 hth, 1898. 55 Sanitary Inspectors' Reports. 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, 1897 : Premises inspected 2074 Houses cleansed and repaired 487 Dustbins provided and repaired 256 Yards to houses paved and amended 191 Traps provided to yard and house drains 149 Water receptacles cleansed and provided with covers 84 Water supply re-instated 19 Drains amended and obstructions removed 271 Houses provided with new pipe drains 242 Rainwater pipes disconnected from drains 169 Waste pipes to sinks „ „ 100 Waterclosets reconstructed 208 ,, water supply re-instated 228 ,, soilpipes re-instated and ventilated 72 ,, pans cleansed 189 Overcrowding in rooms abated 107 Underground rooms found illegally occupied as dwellings 28 Roofs and guttering to houses repaired 141 Nuisances arising from accumulations of manure and refuse abated 71 Dungpits abolished and proper receptacles provided 5 Damp walls remedied 83 Miscellaneous nuisances 127 Dust complaints referred to Surveyor 113 Thirty-four bakehouses, two cowsheds, and four slaughterhouses were visited. Notices were served for cleansing, limewashing, &c., where necessary, and the work done in all cases. 56 List of Streets and Courts inspected under systematic houseto-house visitation :— Macclesfield Place Garden Court Hull Street Wellington Place Bastwick Street Mason's Place Whitby Court Wither's Place Gastigny Place G Block, Roscoe Street Shrewsbury Court Beckford Square Baltic Court New Court Memel Street King Street Thomas Place Hull's Place Charles Court Anchor Yard Ludlow Street John's Place Garden Row Europia Place Elizabeth Place Waterloo Place H Block, Roscoe Street Red Lion Market Young's Buildings Baltic Place Dean's Court Honduras Street Oliver's Yard Regent Street Inspection of Food, &'c. The meat, fish, fruit, &c., exposed for sale in Whitecross Street aud other parts of the Parish have been kept under observation, and the following were seized and destroyed :— 17 lbs. of beef. 204 lbs. of pork. 7 lbs. of liver. 30 lbs. of tripe. 268 fowls. 4 rabbits. 868 lbs. bacon and hams. 13 cwt. preserved food. l½ cwt. conger eels. ½ barrel herrings. 2 boxes oranges, 1½ bushel lemons. 28 boxes strawberries. 2 barrels apples. £ bushel tomatoes. 50 lbs. mixed fruit. London County Council Bye-Laws. Owing to the large improvements taking place within the Parish and the erection of new buildings, we beg to state that the sanitary requirements of such have been kept well under observation, and the necessity for strict attention was justified by the large number of contraventions of Bye-laws discovered, entailing an extra amount of vigilance and, in some cases, police court proceedings. Fines and costs were inflicted in six instances for contravening the London County Council Bye-laws, 57 Factory and Workshops Act, 1895, and Public Health (London) Act, 1891. Under the afore-mentioned Acts a systematic inspection is being carried on, thus entailing a large amount of time in the endeavour to compile a complete register of the factories and workshops within the Parish, and we are pleased to state that every assistance is given by the various employers of labour with reference to the provision of sanitary appliances required in accordance with the Acts. The following shows the work done by your Sanitary Inspectors during the past year Number of visits to workshops 269 ,, workshops found correct 113 ,, ,, ,, with defective drains 24 ,, ,, ,, ,, foul water-closets and urinals 120 „ ,, „ requiring additional water-closets 36 ,, additional waterclosets provided 135 ,, visits to workrooms 660 ,, workrooms requiring cleansing 408 ,, ,, found satisfactory 252 ,, „ measured 50 „ ,, requiring ventilation 8 ,, ,, found overcrowded 10 ,, proceedings taken in respect of water-closet accommodation 2 ,, references to Her Majesty's Inspector of Factories relating to overcrowding, young persons and dangerous machinery, and provision for fire 15 Total Number of Sanitary Notices. Written intimations 1,583 Statutory notices 734 Notices of summons 115 Public Health (London) Act, 1891. Twenty-five summonses were taken out under this Act, four of them being for exposing or selling unsound food, 13 for the abatement of nuisances, two for failing to provide sufficient watercloset accommodation, and six for contravening the Bye-laws of the London County Council. Of these, 23 resulted in convictions, one was withdrawn and one dismissed, the fines and costs imposed amounting to £51 8s. 58 Sale of Food and Drugs Act. This year 193 samples of Food and Drugs have been taken for analysis. The following table shows the number of samples, with fines and costs :— Articles submitted to Public Analyst. Number of Samples. Number Adulterated. Number of Proceedings. Number in which Proceedings were not taken. Number Certified as of Poor Quality. Fines. Costs. £ s. d. £ s. d. Milk 90 19 13 6 9 22 10 6 6 17 0 Butter 42 13 12 1 ... 5 16 0 5 3 6 Cheese 1 1 ... ... ... 0 3 0 0 12 6 Filled Cheese 1 ... ... ... ... ... ... Lard 5 ... ... ... ... ... Margarine 5 ... ... ... ... ... Coffee 9 ... ... ... ... ... Demerara Sugar 3 ... ... ... ... ... Pepper 7 ... ... ... ... ... Cocoa 1 ... ... ... ... ... Coffee Mixture 2 ... ... ... ... ... Ground Ginger 2 ... ... ... ... ... ... Condensed Milk 2 ... ... ... ... ... ... Cod Liver Oil 1 ... ... ... ... ... ... Epsom Salts 1 ... ... ... ... ... Tincture of Rhubarb 1 ... ... ... ... ... Castor Oil 1 ... ... ... ... ... Oatmeal Soap 1 ... ... ... ... ... Curry Powder 1 ... ... ... ... ... Sweets 1 ... ... ... ... ... Brandy 4 ... ... ...... ... ... Whisky 5 ... ... ... ... ... Gin 8 ... ... ... ... ... Port Wine 1 ... ... ... ... ... Sherry 1 ... ... ... ... ... Water 1 ... ... ... ... ... Ice Cream 1 ... ... ... ... ... 193 33 25 7 9 £28 9 6 £12 13 0 Margarine Act. Proceedings. Fines. Costs. Exposing for sale, unlabelled ... 7 ... £10 0 ... £2 14 0 In one case vendor absconded, and in most of the other cases proceedings were also taken under the sale of Food and Drugs Act. STTLU 5 59 Canal Boats Acts. Under the above, 28 boats lying in the City Road basin were visited and notices served in three cases for contraventions of Bye-laws of Local Government Board. The work in the past year has been of an exceptionally heavy character, owing to the large number of premises which have been redrained and rebuilt, and the inquiry made by the London County Council's Medical Officer into the sanitary condition ot the Parish. This has necessitated our staying late in office during a large part of the year in order to cope with the excess of work. With the hope that the work of the Department has been carried out to your satisfaction, We are, Gentlemen, Your obedient servants, A. W. MARTIN,] R. ADAMS, Sanitary Inspectors.