STR 2 THIRTY-NINTH ANNUAL REPORT on the SANITARY CONDITION of the STRAND DISTRICT, LONDON (1894). by FRANCIS J, ALLAN, M.D., D.P.H.Camb., F.R.S.Ed., medical officer of health. printed by Order of the Board. LONDON: DIPROSE, BATEMAN & CO.. SHEFFIELD STREET, Lincoln's Inn Fields, W.C. m.d.ccc.xcv. THIRTY-NINTH ANNUAL REPORT on the SANITARY CONDITION of the STRAND DISTRICT, LONDON (1894). BY FRANCIS J. ALLAN, M.D., D.P.H.Camb., F.R.S.ED., medical officer of health. Printed by Order of the Board. LONDON: DIPROSE, BATEMAN & CO., SHEFFIELD STREET, Lincoln's Inn Fields, W.C. m.d.ccc.xcv. THIRTY-NINTH ANNUAL REPORT on THE SANITARY CONDITION of the STRAND DISTRICT, LONDON. TO THE STRAND DISTRICT BOARD OF WORKS. Gentlemen, The resident population of the District for the year 1894 estimated on the same basis as explained in my report for 1892, stands at 24,815, and is divided among the three registration sub-districts thus:— St. Anne 12,040 St. Mary 5,688 St. Clement 7,087 The above figures must only be taken as approximately correct; as alterations in the character of each parish are continually taking place. In the past the Census has been taken once in ten years—the last in 1891, but consequent upon the passing of the "Equalisation of Rates (London) Act," by which the RegistrarGeneral is called upon to furnish annually estimates of the populations of the various parishes of London, it has been resolved that a Census must be taken every five years, the first being in 1896. It is desirable in estimating the populations for the division of rates that allowance be made for the paupers and others belonging to any parish who are living temporarily beyond a 2 4 ON THE SANITARY CONDITION OF Its bounds as at Edmonton, Poland Street, the Central London Sick Asylum,&c. The Middle Temple now being a sanitary district, I have deducted the population from that part of it which is in the Registration Sub-District of St. Clement. The total number of Births registered in the District (inclusive of 8 in Poland Street Workhouse and 1 in Edmonton Workhouse) was 556, giving a rate of 22.40 per 1,000 inhabitants, as against 24.05 in 1894, 23.13 in 1892, and 24.5 in 1891. The birth-rate in London for 1894 was 0.8 below that of the two previous years, viz.:—30.1 per 1,000. Table shewing the number of Births occurring in the Strand District and in each of its three Registration Sub-Districts during each of the eight years ending December 29th, 1894. Year. Strand District. St. Anne. Sub-District. St. Mary. Sub-District. St. Clement. Sub-District. 1887 747 403 133 186 1888 735 417 152 166 1889 678 381 128 169 1890 560 321 113 126 1891 640 334 134 172 1892 590 310 125 155 1893 607 330 109 168 1894 556 288 118 150 DEATH RATES per 1000 of the POPULATION. 1893. DEATH RATES per 1000 of the POPULATION. 1894. 5 THE STRAND DISTRICT, LONDON. Table shewing the Number of Births (Male and Female) occurring in the Strand District, and each of its three Registration Sub-Districts, in the Fifty-two Weeks of the Year ending December 29th, 1891. Male. Female. Total. Rate per 1,000 of Population in 1894. Rate per 1,000 of Population in 1893. 1. St. Anne 143 145 288 23.92 27.05 2. St. Mary 72 46 118 20.74 18.92 3. St. Clement 89 61 150 21.12 23.09 304 252 556 22.40 24.05 Deaths. The total number of deaths, after correction,* which were registered as properly belonging to this District, during the year was 493, as compared with 671 recorded during the preceding year. Upon the basis of the estimated population already referred to, this is equivalent to an annual death-rate of 19.86 per thousand residents throughout the District, as compared with 17.4 per thousand, the corresponding number for the whole Metropolis during the year. Both these rates are much below the average of previous years, that for London having only once approached so low a rate (18.0 in 1889). The death rates in the four quarters were as follows:— 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. London 21.2 17.4 15.9 16.6 Strand 28.0 17.5 15.8 17.9 In Tables I. to V. in the Appendix are set forth *The correction above referred to consists in omitting all deaths which took place in hospitals and kindred institutions within this district of persons not properly belonging to it; and, on the other hand, of including every death of such of its inhabitants as has occurred in hospitals, infirmaries, lunatic asylums, &c. throughout the Metropolis generally, and also those of paupers belonging to the several parishes of which the district is constituted, which have happened in the workhouses of the Strand and Westminster Unions respectively. 6 ON THE SANITARY CONDITION OF various details concerning the deaths which have taken place in the Strand and its Sub-Districts during the twelve months; 527 deaths occurred in the District; 204 of these were of persons who did not belong thereto, and 170 persons belonging to the District died outside its bounds; 76 inhabitants of the District died in Poor Law Institutions, 17 in Lunatic Asylums, and 122 in Hospitals. Inquests were held in reference to the deaths of 55 persons of whom 41 were residents of this District. Two deaths were uncertified by either medical man or coroner. The ages at which death occurred in the 495 deaths belonging to this District are shewn below:— Table shewing the Number of Deaths, at Four several Periods of Life, taking place in the Strand District during the Tears 1891, 1892, 1893 and 1894 respectively. deaths at ages below. At all Ages 5 Years and under. Between 5 and 25 Years. Between 25 and 65 Years. Above 65 Years. Year 1891 696 206 44 301 145 „ 1892 640 221 43 268 108 „ 1893 671 203 33 308 127 „ 1891 493 167 36 201 89 Percentage of the total Deaths:— Year 1891 29.5 6.3 43.3 20.9 „ 1892 34.5 6.7 41.9 16.9 „ 1893 30.2 4.9 45.9 18.9 „ 1894 33.8 7.3 40.8 18.1 7 THE STRAND DISTRICT, LONDON. Deaths under 1 year of age.—96 infants died in 1894, as compared with 125 in each of the two preceding years; in other words there were 172 deaths per 1,000 births as compared with 205 in each of the two preceding years; the rate for London in 1894 was 144. Thirty per cent. of these deaths in this District were due to zymotic diseases, 27 per cent. to diseases of the respiratory system, and 17.7 to debility at birth. The only causes of death in which there was an increase, were tubercular disease and violence. The number of deaths between the ages of 1 and 5 years are slightly below those of 1893. I have on the charts appended shown in graphic form the monthly and yearly death-rates for London and the Strand for the years 1893 and 1894, with a note of the causes raising the Strand rate above that of London. While there is an improvement in the general deathrate at all ages, the deaths are attributable to the same groups of causes of death as in the preceding year, and in similar proportions; thus we find that diseases of the respiratory organs (excluding consumption) were responsible for 24.8 per cent. of the total deaths; tubercular diseases (consumption, &c.) for 18.7 per cent.; and other zymotic or specific diseases for 13.7 per cent. These three groups of diseases which are responsible for more than half (57.3 per cent.) of all the deaths in this District can be attributed in great measure to causes which may be prevented. 8 ON THE SANITARY CONDITION OF Zymotic Diseases. The number of cases notified in 1894 fell from 286 (in 1893) to 114; the decrease as shown in the subjoined Table was due to scarlet fever, diphtheria and smallpox, while there was a slight rise in the number of enteric fever cases. The total deaths from zymotic diseases were also fewer, the diminution being under the headings of influenza, scarlet fever, diphtheria and diarrhœa, while there was an increase under the headings of whooping cough, measles, and enteric fever. Diseases Notified. Total for District. Year ending 31 Dec., 1892. Year ending 31 Dec., 1893. Year ending 31 Dec., 1894. Small-pox 7 30 5 Diphtheria and Membranous Croup 33 79 30 Erysipelas 22 22 11 Scarlatina 111 143 52 Typhoid Fever 12 11 15 Puerperal Fever 1 1 0 Continued Fever 0 0 1 186 286 ll4 9 THE STRAND DISTRICT, LONDON. Disease. St. Anne. St. Mary. St. Clement. Strand District. Cases Notified in 1894. Deaths in 1894. Cases Notified in 1894. Deaths in 1894. Cases Notified in 1894. Deaths in 1894. Total Cases Notified in 1894. Total Deaths in 1894. Total Deaths in 1893. Total Deaths in 1892. Smallpox 4 0 l 0 0 0 5 0 1 0 Scarlatina 38 l 4 0 10 0 52 l 19 1 Diphtheria 11 2 9 1 10 6 30 9 21 8 Continued Fever 1 0 0 0 0 0 1 0 0 0 Enteric or Typhoid Fever 9 5 4 1 2 ... 15 6 1 3 Puerperal Fever and Pyæma 0 0 0 1 0 1 0 2 2 8 Erysipelas 7 0 2 1 2 1 11 2 3 2 Whooping Cough ... 9 ... 2 ... 9 ... 20 11 12 Measles ... 5 ... 7 ... 4 ... 16 2 54 Diarrhœa and English Cholera ... 3 ... 2 ... 2 ... 7 13 8 Chickenpox ... 0 ... 0 ... 1 ... 1 0 0 Influenza ... ... ... ... ... ... ... 0 6 15 Totals 70 25 20 15 24 24 114 64 79 111 10 ON THE SANITARY CONDITION OF The notifications received were at the rate of 4.5 per 1,000 of the population, against 11.3, 7.3 and 3.4 in the three preceding years respectively. Throughout the Metropolis the average rate was 9.7 per 1,000 for 1894. 80 of the Strand cases (71 per cent.) were removed to fever hospitals, as shown in detail in Table II. (Form B). The amount paid for 118 certificates notifying the existence of 114 cases of infectious disease was £10. 9s. 6d. Smallpox.—1,391 notifications of this disease were made during 1894 in the Metropolis, 417 of which were in Marylebone Parish. Several persons from infected families worked in the Strand District, but no cases appear to have arisen through them. Five cases did occur in the District in two families, one child (unvaccinated) in St. Mary-le-Strand Parish, 4 adults in one house in St. Anne's Parish, the source of infection was untraceable; no deaths occurred. Two other cases were notified, but the medical men subsequently withdrew their certificates on finding that the disease as it developed was not smallpox. Scarlet Fever.—52 cases were notified against 143 in 1893, 38 of these resided in St. Anne's, Soho. In 6 instances 2 cases occurred in the same house, and in 3 instances, 3 cases. Most of the cases were of children of school age, and several cases were traced to a pupil attending a private school in the District. Only 1 case proved fatal. Diphtheria and Membranous Croup.—2,300 fewer notifications were received by the various Metropolitan Sanitary Authorities in 1894 than in 1893 and the deaths registered from this cause were 2,673 as compared Avith 3,625. In the Strand District the 11 THE STRAND DISTRICT, LONDON. tions fell from 79 (in 1893) to 30 in 1894 with 9 deaths. In my report for 1893, I ventured to draw the attention of your Board to the importance of early and accurate diagnosis in this disease, and pointed out that this could only be accomplished when medical men had placed at their disposal the means for making a bacteriological culture from suspected throat cases. The increase of diphtheria together with the introduction of a new method of treatment has led to much attention being paid to the subject and especially to the point I urged, namely, that the Metropolitan Asylums Board was the proper authority to take this matter up. I was enabled as your delegate to bring the subject before the Congress of the British Institute of Public Health held at King's College, where a resolution was carried calling upon the central authorities to provide the means for making such diagnosis. I am pleased to be able to report that the Metropolitan Asylums Board have now made arrangements in connection with their, hospitals so that all cases admitted will have the diagnosis confirmed in this way, and equally important, no case will be discharged until the throat and nose have been found free from infective germs. If the results are satisfactory after six months' trial, the scheme will be extended to cases treated at home. In the Strand District the cases were distributed thus:— Sub-Registration Districts. Cases. Deaths. St. Anne, Soho 11 2 St. Mary-le-Strand 9 1 St. Clement Danes 10 6 12 ON THE SANITARY CONDITION OF One case in St. Clement's was afterwards determined not to be diphtheria, but another case not notified proved fatal. Making this correction, there were 15 persons of each sex attacked; 11 of each were under 15 years of age (2 being under 1 year, and 6 between 1 and 3 years of age). In one-third of the cases death ensued. There is a considerable amount of evidence pointing to school life as an important agent in the spread of this disease. Without a complete list of all the children attending the schools in or near the District with particulars of the classes in which they were, and of those away ill belonging to other districts, no satisfactory conclusions can be formed as to the part played by the schools in regard to the cases in this District. Only 8 children affected attended school, and half of these (two families) attended the same school, the others attended each a different school. In 8 cases the source of infection was traceable—two children had previously suffered from what was supposed to be ordinary sore throat, when a third one developed the disease in more malignant form it was recognised; a nurse engaged in attending diphtheritic patients became infected herself; a father and mother received the complaint from a daughter whose illness was believed to be "simple tonsilitis'' so that isolation had not been resorted to. Of the 30 cases, 2 came direct from other districts, 9 were in houses with defective drainage arrangements (in one was a large circular cesspool 17 feet deep 10 feet across with an overflow and waste water drain ending several feet from the sewer and discharging its contents in the ground beneath an unpaved vault) in at least 2 cases the houses 13 THE STRAND DISTRICT, LONDON. were overcrowded, and in several others the ventilation and cleanliness of the rooms occupied left much to be desired. Cholera and Diarrhœa.— Cholera reappeared upon the Continent in 1894 and as its advent is usually preceded by diarrhoea of a milder form the Local Government Board suggested that during the autumn months the latter disease might be made notifiable in persons over 1 year of age. In place of this, however, the requirements for the time were met by asking the medical men practising in the District to give me private intimation of any marked increase in the number of diarrhœa cases they were called upon to treat and of any severe cases of diarrhoea (Choleraic Diarrhoea or British Cholera) which might come under their care in the District. I have to thank these gentlemen for their co-operation. Fortunately the cases were not numerous; in each case coming to my knowledge the general surroundings were examined, disinfectants supplied, and the water-closets, drains and sinks flushed. Dr. Klein was charged by the Local Government Board to enquire into the relationship, if any, existing between those cases known as British Cholera, and cases of true or Asiatic Cholera, and he desired to render assistance where the diagnosis was doubtful, but no cases demanding this occurred in the District. Enteric Fever.—15 cases were notified in 1894, being 4 more than in 1893. In 9 of them the complaint proved fatal. With two exceptions all the cases were notified in the last quarter of the year. Throughout London there has been in the last few months of the year an increase in this disease traceable in 14 ON THE SANITARY CONDITION OF some cases to the eating of oysters which had been laid in some "fattening ground" contaminated with typhoid sewage. It is also possible that the floods in the Thames in late autumn by washing down the deposits in its bed together with the contents of numerous cesspools on its banks may have exercised some influence on this disease. The chemists of the Water Companies claim that the "efficiency of filtration, "as regards the security of the public against any "possibility of water pollution, is proved by the bac"teriological examinations of the waters." Dr. E. Frankland, who analyses the water on behalf of the Local Government Board, reports as follows:— "The Thames at Hampton was, on November the "5th, owing to heavy floods, in an extremely bad condi"tion; it was very turbid and brown in colour and con"tained a very large proportion of organic matter in "solution, most of it, however, of vegetable origin. "Bacterially it was also of very inferior quality, contain"ing more than five times as many microbes per cubic "centimetre as on the 10th of October. As delivered "by the five Companies drawing from this river, it was "greatly improved in quality. Owing to the command "of large storage, the Chelsea Company sent out water "of quality almost as good as that delivered in October, "but the remaining Companies could not exclude flood "water, and their supplies contained much more organic "matter than usual; nevertheless, the excess appears "to have been wholly of vegetable origin, or nearly so. "It was, in every case but one, efficiently filtered; the "exception was the water sent out by the Southwark "Company, which was, however, only very slightly "turbid." 15 THE STRAND DISTRICT, LONDON. Of the 15 cases notified in this District, 9 (with also a case of "simple continued fever") were in St. Anne's parish. Three of the cases came directly from other towns to this district, and one patient complained of bad smells at the shop where he was employed in another parish. In connection with the oyster theory, it is of interest to note that no less than 7 of the above cases were persons employed in hotels and restaurants, one of them being also an oyster merchant. In 8 premises insanitary conditions existed. I have had information of cases of enteric fever occurring in persons employed in Somerset House, and complaints have been made from time to time of the bad smells experienced therein ; one case of enteric fever occurred in a person employed there in the end of 1893, and 2 others in another department at the end of 1894, one of these being resident on the premises. Somerset House is not under the sanitary jurisdiction of your Board, but I brought the matter under the attention of the proper authorities, and understand that considerable improvements are being carried out. Two cases were notified from another Government building, viz.:—Bow Street Police Section House, the second case apparently having taken the infection from the first patient who was treated in a room occupied by eight other men until the nature of the disease was recognised. I have suggested certain improvements in the sanitary arrangements, and also that a room be set apart for men who are sick. Principal Diseases of the Zymotic Class.—The Registrar-General classifies small-pox, scarlet fever, measles, diphtheria, whooping-cough, fevers (typhus, enteric and continued), and diarrhoea under this heading. The zymotic death-rates for London and the Strand 16 ON THE SANITARY CONDITION OF District may be seen in Table V. (in the Appendix). The Strand rate is 0.3 below that for London. Measles was prevalent in St. Anne's parish in the first quarter of the year, in St. Mary and St. Clement's Sub-Registration Districts in the second quarter, while whooping-cough prevailed somewhat extensively in St. Clement's district during the first quarter, appearing in Soho in the second quarter and continuing there throughout the rest of the year. The death rates from these two diseases and from enteric fever are the only ones above the London zymotic rates. In the Metropolis the mortality from measles and diphtheria showed a marked increase compared with the average of the previous ten years, while that of the other principal zymotic diseases showed a decline. Disinfection. During the twelve months ending 31st December, 1894, 101 premises were purified and cleansed after infectious disease, and 3,253 articles were disinfected in your Board's apparatus. In addition to disinfecting after cases of small-pox, scarlet fever, diphtheria, enteric fever and other notifiable diseases, disinfection has also been effected on the certificates of medical men that it was requisite after one case of measles and one case of chicken pox. Thorough cleansing of rooms and in some cases disinfection by steam has been resorted to after all deaths from phthisis. Shelters.—Under Section 60 of the Public Health, London, Act, the Sanitary Authority shall provide, free of charge, temporary shelter or house accommodation for the members of any family in which dangerous 17 THE STRAND DISTRICT, LONDON. infectious disease has appeared, who have been compelled to leave their dwellings for the purpose of enabling such dwellings to be disinfected. Your Board has now a house at all times available for this purpose, but it is a general experience that persons do not care to make use of such accommodation. Vaccination in the District. I am indebted to Mr. Geo. J. Milford and Mr. C. B. Snell, Vaccination Officers respectively of Westminster Union and Strand Union, for the subjoined details relating to the performance of Vaccination in those parts of the above Unions included in the Strand District.* 1894. Births. Successfully Vaccinated. Insusceptible. Died Unvaccinated. Vaccination Postponed. Removed and Address not known. Remaining. St. Anne 291 172 10 15 12 25 57 St. Clement and St. Mary 273 198 1 34 9 31 — Totals 564 370 11 49 21 56 57 Distribution of Deaths in Sub-Districts and Parishes. From the Tables in the Appendix may be seen the * The Vaccination Officers do not make their Reports to the Local Government Board until a later date, by which time those infants who were not old enough, or whose vaccination was postponed, would probably have been vaccinated. B 18 ON THE SANITARY CONDITION OF manner in which the deaths were distributed in the three Registration Districts. Thus, while the death rate was 19.86 for the whole district, it was only 16.76 in the parish of St. Anne, Soho, but in St. Mary-le Strand Sub-district (which includes St. Paul, Covent Garden, the Precinct of the Savoy, as well as the Holywell Ward of St. Clement Danes parish), it rose to 20.74, and in St. Clement Danes Sub-District it reached 24.41. These figures are much below the rates of the last two years but still exhibit the same relationship to one another. As in last year's Report I have divided out the deaths among the parishes composing the District in contra-distinction to the Registration Sub-divisions, and have calculated out their respective death-rates. Parishes. Estimated population No. of Deaths. Rate per 1000. St. Anne 12,040 202 16.76 St. Clement Danes 8,438 201 23.82 St. Mary-le-Strand 1,560 49 31.41 St. Paul, Covent Garden 2,154 33 15.32 Liberty of the Rolls 427 6 14.05 Precinct of the Savoy 196 2 10.20 The Strand District 24,815 493 19.86 The part of the Temple in the Registration SubDistrict of St. Clement, is now included in the Sanitary District of the Middle Temple. In respect of 56 persons placed to the credit of the Strand, I have been unable to ascertain the exact addresses, most of them dying in an infirmary and only 19 THE STRAND DISTRICT, LONDON. the parish being recorded. Some of these are relics of streets and courts long since swept away. One had been a pauper inmate since 1863. In the Special Report which I have made under the Housing of the Working Classes Act, I have dealt with the causes of the high death-rates prevailing in parts of St. Mary and St. Clement's parishes. The estimate of the Registrar General (made under the "Equalisation of Rates Act") with the additions of the inmates of outlying Poor Law institutions, nearly agrees with my own on the whole population, but in respect of the individual parishes we differ in our estimate of St. Anne, Soho, and St. Clement Danes. The estimates are made on the basis of a comparison of the number of houses on the rate books in 1891 and 1894. According to this estimate, St. Anne's has a population (with paupers) of 12,788, and St. Clement Danes 7,518. This would alter the death-rate to 15.7 for St. Anne, and 26.7 for St. Clement's parish. The Registrar-General, however, working on his usual basis (viz. on the increase or decrease shown at each Census period), produces a different estimate of the popularion, whereon he calculates births and deathrates, so that probably the truth lies somewhere between the three estimates. If fewer houses be rated in St. Clement's Parish, those which are occupied now hold more people than formerly, while in St. Anne's Parish the new buildings occupied since the Census have been chiefly constructed in flats, each containing fewer than the average number of occupants. Mortuaries in the District. During the year, the number of dead bodies received B 2 20 ON THE SANITARY CONDITION OF Into the mortuaries in the Strand District were as follows:— Total number of Bodies. After Infectious Disease. Post-mortem examinations made. Strand Mortuary 55 6 28 St. Anne's „ 13 — 9 Savoy Deadhouse 4 — 2 Total 72 6 39 SANITARY WORK. The following list summarises the work carried out under the supervision of the department during the year:— Houses and workshops inspected* 3,103 Number of visits paid by Sanitary Inspectors 8,815 Preliminary notices served 576 Orders made by the Board ("Public Health London Act") 60 Premises in which works have been carried out 610 Workshops:— Cleansed and Whitewashed 149 Over-crowding abated 4 Ventilation improved 12 Houses:— Cleansed and Whitewashed Throughout 14 Partially 190 Ventilation improved, walls, ceilings and floors repaired 35 * Exclusive of special inspection of houses in area represented under the " Housing of the Working Classes Act." 21 THE STRAND DISTRICT, LONDON. Roofs made water tight 33 Water closets:— Reconstructed and repaired 246 Additional provided 18 Water re-instated 18 Flushing apparatus repaired 23 Obstructions removed from 41 New pans and traps provided 31 Pans and traps cleansed 65 Drainage:— New drains constructed 144 Drains repaired 37 Sink and lavatory waste pipes disconnected and trapped 338 Rain water pipes repaired 24 Obstructions removed from drains 14 Paving required or repaired:— In yards 46 In basements 61 Dust and dung removal:— Sanitary Bins provided* 46 Offensive refuse removed from premises 24 Water supply:— New service pipes laid on direct from main† 29 Cisterns repaired and cleansed 10 Re-instatement of water after being cut off by Water Company 5 Certificates granted under "Public Health (London) Act," Section 48 8 * Under the Board's system of dust collection, fixed bins are gradually being disused and abolished. † Constant supply being laid on to every house, water is recommended to he drawn direct from the Water Company's Mains. 22 ON THE SANITARY CONDITION OF Under-ground rooms:— Use prevented as separate dwellings 6 In addition to the above-mentioned work, the street and other markets have been regularly inspected every day (including Sundays). The Stables and mews, 62 in number, have been regularly inspected, more particularly in regard to the periodical removal of manure. Occupiers of stables have all complied with the requirements of the County Council's bye-laws relating to the provision, situation and cleansing of receptacles for dung. The "Rag-and-bone" shops have also been inspected from time to time.* The number of works of sanitary improvement carried out include a number of extensive and complicated schemes of re-drainage and re-construction which have been carried out in a satisfactory manner under the supervision of your Inspectors. They include the re-drainage of the Gaiety and Lyceum Theatres, the Royal Italian Opera House,several important restaurants, clubhouses and schools. Combined Drainage.—The law in regard to that part of the drains liable to be constructed and kept in repair by the owners of houses and that part under the control of the Local Authority is in a confused state, and considerable trouble has arisen in many metropolitan districts. * Those at present in the district are situate as follows, viz.:— 8, St. Anne's Court (Soho); 12, Moor Street (Soho); 18, Vere Street (St Clement Danes); 19, Clare Street (St. Clement Danes); 23 THE STRAND DISTRICT, LONDON. In the cases carried to the Court of Appeal the opinion of the Judges has not been unanimous and the decisions somewhat conflicting. It has been suggested by a deputation from London Sanitary Authorities to the County Council that a Bill should be introduced to remedy the anomalous condition existing. Fortunately in the Strand District little trouble has arisen, probably from the fact that owners can not build or rebuild over a public sewer. Houses let in Lodgings.—On the 12th July, 1894, the Local Government Board sanctioned bye-laws for the Strand District under the "Public Health (London) Act, 1891," section 94, relating to houses let in lodgings or occupied by members of more than one family. In two essential points do these bye-laws differ from those suggested by the Local Government Board. That body was of opinion that all houses under a certain rental which are let in the manner referred to should be placed upon the Register; on the other hand, your Board has contended for many years that the bye-laws should apply only in such cases as in the discretion of your Board appeared to require the application of the bye-laws for their more effectual control. Eventually, the view of your Board has been adopted. The other alteration refers to the amount of air space to be allotted to children in such houses; in the bye-laws in force in the Strand District no distinction is drawn between children and adults in this respect. The objects of the bye-laws, are— For fixing the Number of Persons who may occupy a House, or part of a House, which is let in 24 ON THE SANITARY CONDITION OF Lodgings or occupied by Members of more than One Family. For the Registration of Houses so let or occupied. For the Inspection of such Houses. For enforcing drainage for such Houses, and for promoting cleanliness and ventilation in such Houses. For the cleansing and lime-washing at stated times of the premises. For the taking of precautions in case of any infectious disease. Since these bye-laws came into force your Board has resolved that 62 premises should be placed upon the Register. These are inspected every week with satisfactory results. Overcrowding and carelessness on the part of the occupiers has been kept in check thereby and written notices to abate overcrowding have only had to be served in 21 cases. Landlords, also appear to have paid more attention to the conditions existing in their properties and to have themselves taken steps to remedy irregularities. Artisans' Dwellings. Appended are some statistics relating to the Artisans' Dwellings in the Strand District. During the year, improvements have been carried out at both Sandringham and Newport Buildings. At the former, dry areas have been constructed in the rear of several blocks, in the latter the whole of the sinks and gulleys (to the number of 294) have been re-fitted. 25 THE STRAND DISTRICT, LONDON. Statistics relating to Artisans' Dwellings in the Strand District in 1894. Name of Dwellings. Population. Births. Birth-rate per 1,000. Deaths. Deathrate per 1,000. Previous Deathrate. Number of deaths from Infectious Diseases notified. Under 5 years. 5 years to 65 years. Above 65 years. Total. Tubercular Diseases. Other Zymotic Diseases. Respiratory Diseases. Sandringham Buildings 1,295 29 22.4 7 5 1 13 10.03 Average of 8 years. 4 2 3 Scarlet Fever 2. 10.20 Newport Dwellings 1,212 60 49.5 8 6 3 17 14.00 1893. 2 1 5 Scarlet Fever 4. Enteric Fever 1. Diphtheria 1. 21.45 Eversley Buildings From 128 to 140 4 28.35 2 3 2 7 49.64 1893. — 1 4 - 46.83 26 ON THE SANITARY CONDITION OF Common Lodging Houses. During the year, works of sanitary improvement, have been carried out at several of the Common Lodging Houses in this District. Considerable attention has also been directed to the class of persons frequenting these houses and other unlicensed shelters, as it has been found to be largely due to them that infectious disease especially smallpox has been carried from one town to another. The London County Council on the 19th July, "thought it desirable to "convene a Conference, with a view to considering "whether means can be adopted to prevent the spread "of infectious diseases by the class of persons referred "to." Delegates from your Board attended the Conference, and the following resolutions were adopted:— (1.) That common shelters which are not subject to the law relating to common lodging houses should be made subject to such law. (2.) That there should be power to the local authority to require medical examination of all persons entering common lodging houses and casual wards, and that, each inmate should on admission have a bath of fresh water. (3.) That the local authority should have power to order the keeper of a common lodging house in which there has been infectious disease, to refuse fresh admissions for such time as may be required by the authority. (4.) That the local authority should have power to require the temporary closing of any common lodging house in which infectious disease has occurred. 27 THE STRAND DISTRICT, LONDON. (5.) That the local sanitary authorities should have power to require the detention of any inmate of a common lodging house or casual ward who may reasonably be suspected of being liable to convey infectious disease. (6.) That means should be provided for the detention and isolation of any vagrant found wandering in a public place, if reasonably suspected of being liable to convey infectious disease. (7.) That the local sanitary authority should have power to require the disinfection of the person and clothing of any person in a common lodging house or casual ward, whether infected or exposed to infection. (8.) That arrangements should be made by which the occurrence of infectious disease in common lodging houses or casual wards should be made known by the local authority of the district to the local authorities of other districts. (9.) That local authorities should have power to require the vaccination or re-vaccination of persons in common lodging houses or casual wards who are exposed to the infection of smallpox. The supervision of the common lodging houses in London has now been undertaken by the County Council, and a staff of 11 inspectors has been appointed for this purpose Appended is a list of the common lodging houses which were on the Register of the Police during 1894. They afforded accommodation for 136 women and 608 men. During the year, this use of the houses No. 12, 28 ON THE SANITARY CONDITION OF Holies Street, Nos. 112 and 113, Drury Lane was discontinued, the first named house being pulled down, and the latter two subsequently closed under the "Public Health (London) Act"; so that there is now accommodation of this class for 624 persons. For women:— 12, Holies Street (now closed) 21 beds. 25, Stanhope Street 34 „ 14, White Horse Yard 35 „ 15, „ „ „ 46 „ For men:— 112 & 113, Drury Lane (now closed) 99 „ 1 & 2, St. Mary's Buildings, Wych Street 92 „ 27 & 28, Vere Street 48 „ 29, Vere Street 63 „ 30, „ 113 „ 22, „ 48 „ 13, Sardinia Street 55 „ 15, „ „ 35 „ 26, Litchfield Street 55 „ There are also a Salvation Army Shelter accommodating 116 men, and a number of smaller unlicensed lodging houses. Legal Proceedings. The following is a summary of the cases in which it was necessary to lay a complaint before a magistrate. Public Health (London) Act: — Summons applied for and granted 15 Result:— Board's Order complied with before magistrate heard case 2 29 THE STRAND DISTRICT, LONDON. Magistrate's Order granted,— (a.) To do works required 3 (b.) To close premises*— From want of water 3 From unsanitary conditions 5 Fines inflicted,— For illegal interference with water supply, £5 and costs. For selling oranges in a condition unfit for food (section 47 (3), £10 and costs. Appeal to Quarter Sessions, conviction upheld. For non-compliance with Bye-laws 1 and 14 under section 39 (1), 10s. and costs. Food and Drugs Acts:— Summons taken out 7 Convictions 6 Dismissed (on production of warranty) 1 Housing of the Working Classes Act:— Number of inhabited houses represented to London County Council under Part I. 238 Number of houses represented to the Strand Board of Works under Part II. 10 Result:— Closed without magisterial intervention 3 Improved without magisterial intervention 5 Subsequently dealt with and closed under Public Health Act 2 Nine of the 10 houses represented under Part II. are situated in the insanitary area which forms the * In respect of two houses the closing order was subsequently revoked on restoring the premises to a sanitary condition. 30 ON THE SANITARY CONDITION OF subject of the representation under Part I. of the Act. The remaining house is included in the scheme which your Board has undertaken to open up the entrance to Clare Market through Gilbert's Passage. Another improvement (from a sanitary point of view) undertaken by agreement between your Board and the Ecclesiastical Commissioners and now in progress, is the widening of Chichester Rents, Chancery Lane. WORKSHOFS. The Strand District includes within its bounds so many and so varied industries that it is of extreme importance that your Board should see that the work is carried out in premises sanitarily fit for the purpose. The Labour Commissioners have recommended that with a view to the improvement, or, where that should prove impossible, the gradual extinction of the lowest class of workplaces in which the "sweated" industries are carried on, legislation to the following effect is desirable:— "That within the industries or districts affected "by the proposed legislation, or by administrative "orders under it, all occupiers of workshops (ex"cluding domestic Avorkshops, which we do not "think can be dealt with at present), and, perhaps, "also of factories, shall be required under penalties to "obtain a certificate from a competent public authority "to the effect that the premises used by them are in "all respects in an efficient sanitary condition, and "contain sufficient cubic space for the number of "persons employed therein, such certificate to be with"drawn at any time if it were found that the conditions "were no longer complied with. The occupiers should 31 THE STRAND DISTRICT, LONDON. "be primarily liable, but that immediate owners, who "receive the rents of workshops, should also be liable "for penalties which could not be recovered from "occupiers in case of such workshops being carried on "without the certificate having been obtained, or after "it had been withdrawn. That all contractors and "shopkeepers in the industries or districts in question "who should employ outworkers should keep lists of "such outworkers, and should be bound to take all "reasonable precautions that work so given out was, if "done in workshops, only done in those which had a "proper certificate." Your Board is one of the few Sanitary Authorities who have appointed an officer to deal with the inspection of workshops, and the result of his first year's work has been satisfactory. Many workplaces are, also, inspected by the other sanitary officers in the course of their work. During the year, 509 workplaces have been inspected separately from dwelling houses, and orders requiring cleansing have been served in reference to 149 of them. In 12, the ventilation has been improved; and in four, overcrowding has been abated by notice. But considerable effect in many respects is obtained by the visit of the inspector, and in most cases improvements are at once effected by employers of labour on hearing what is required of them. Proper and sufficient watercloset and urinal accommodation has been provided in a number of instances which are included in the total of the sanitary work executed during the year. The following is a summary of the employments carried on in a number of the workplaces inspected:— 32 ON THE SANITARY CONDITION OF Work connected with— Iron, steel, tin, lead, &c. 17 Printing and stationery 103 Gold, silver and jewels 79 Leather 36 Clothing and upholstery 87 Wood 41 Instrument making 16 Engraving 36 Food 40 Laundries 24 General offices 13 Soap and perfumes 4 Scene painting, &c. 3 Laundries.—These places have received special attention during the past year. In one case the whole of the articles on the premises were taken possession of and disinfected in your disinfecting apparatus before being sent out from the laundry to their owners, on account of a case of scarlet fever having occurred in the same house in a member of the family of a woman employed in the laundry. The laundries have been cleansed and limewashed when deemed necessary on periodical inspection, and in three cases an impervious floor has replaced defective ones of wood. Bakehouses.—Considerable interest has been aroused into the conditions under which bread is made in the bakehouses of London. On the 22nd May, 1894, the Local Government Board addressed a circular letter to the several Sanitary Authorities drawing their attention to the duties devolving upon them in this matter. The Public Health Committee of the County Council had a report on the subject from their medical officer, and 33 THE STRAND DISTRICT, LONDON. concluded that the law with reference to bakehouses should be amended, and that the Council should be empowered to make regulations which might deal with the following points:— "The position and structure of workshops and workplaces used as bakehouses and of rooms or places used in connection therewith. "The lighting, ventilation (including air-space) cleansing, drainage and water supply of such premises. "The provision and situation of water-closets and urinals in connection with bakehouses. "The prohibition of the use of the bakehouses for other purposes than the preparation of food. "The use of any room adjoining or opening into any bakehouse. "The conduct of the business and the prevention of the contamination upon the premises of any articles of food prepared in any bakehouse or of any materials to be used in the preparation of food. "The mode of making application for licence to use any premises as a bakehouse." Later in the year (15th October), the Rev. L. G. Vere and I attended as your delegates, a Conference of Metropolitan Sanitary Authorities, convened by the Vestry of St. George-the-Martyr, Southwark, to consider the question of the regulation of bakehouses, when the following resolutions were adopted:— " That the present state of the law relating to bakehouses requires amendment by the addition of the following clauses to the 'Public Health (London) Act, 1891':— c 34 ON THE SANITARY CONDITION OF (a.) That uniform Metropolitan bye-laws regulating bakehouses be made by the London County Council, and be confirmed by the Local Government Board, and that the duty of enforcing these bye-laws shall devolve upon the various Local Authorities. (b.) That the portions of the bye laws regulating the structure of bakehouses do not apply to existing bakehouses. (c.) That the London County Council be empowered to frame bye-laws for the construction of underground bakehouses, and that all bakehouses erected after the passing of such byelaws shall conform thereto." Twenty-nine bakehouses now exist in the Strand District,* one having been rebuilt and come into use again during the year. These have been frequently and systematically inspected. Each has been cleansed and limewashed twice during the year, and six more frequently. A small sweetstuff manufactory was found newly established in the basement of a house at the end of an unhealthy court, but the owner, who sold the sweets on the streets, promptly vacated the cellar on being informed that the surrounding conditions were unsuitable for such a business. Covent Garden Market.—Complaint having been made that the watercloset and urinal accommodation were deficient in the market, a special enquiry and examination was made. I found that the persons using * The bakehouses here referred to comprise the following, viz.:— Bread Bakers 24 Pastry Cooks 2 Confectioners 2 Muffin Baker 1 35 the strand district, london. the market might be divided into various groups, viz.,— (1.) Auctioneers and others occupying shops and offices. (2.) Their clerks and assistants. (3.) The regular and casual porters. (4.) Railway and carriers' employes. (5.) The general public who attend as buyers, &c. For each class separate and sufficient accommodation is provided by the owner of the market or by your Board. Certain improvements which I have suggested, have been or are in process of being carried out in respect of the construction of certain of the conveniences. Effluvia Nuisances.—In four instances has it been necessary to take steps to abate a nuisance arising from offensive emanations from business premises (" Public Health Act" section 21). Two of these arose from cooking (fried fish in one instance, ham beef and vegetables in the other) in eating houses, and one from a cellar in which foreign cheese was stored ; each of these was remedied by improved ventilation. The fourth case was in a restaurant kitchen from melting fat, which was put a stop to. Outworkers.—Under the Order of the Home Secretary dated 31st October, 1892, the occupiers of factories and workshops engaged in the manufacture of articles of wearing apparel, electro-plate, files, cabinet, furniture and upholstery work are bound to prepare lists showing the persons employed by them to do work outside the factory or workshop. These lists are open to the inspection of any officer of your Board, and a list has been made of 244 persons c 2 36 on the sanitary condition of so employed in this District, most of them being engaged in making wearing apparel. Their homes and workplaces have been frequently visited and when occasion required, the rooms have been ordered to be cleansed. In addition, many names of persons employed in this District but living elsewhere have been sent to the sanitary authorities in whose district they reside; and similar returns have been received from a few other authorities. Protected Persons.—The Medical Officer is required to give notice to H.M. Inspectors of Factories and Workshops (" Public Health Act," section 27) when he becomes aware of any child (under 14 years of age), young person (between 14 and 18 years of age), or woman employed in a workshop. During the year such notice has been sent in respect of 1,105 individuals, 39 of whom were children and young persons, the remainder women. This number will not be so large in the future, as there was at first some overlapping with the work of the assistants of H.M. Superintending Inspector of Workshops, but now they have their list of protected persons almost complete. The Superintending Inspector, Mr. Lakeman, sends me notice of any insanitary conditions he discovers, and they are at once attended to by your Inspectors. Inspection and Analysis of Food. Subjoined is a list of food stuffs which have been destroyed as unfit for food during the year:— Apples 61 cases. Broccoli 13 dozen. Cherries 22 bushels. Cucumbers 2 dozen. Currants 173 baskets. Damsons 2½ bushels. Grapes 3 barrels. Onions 12 bushels. Oranges 25 boxes. Peaches 16 boxes. Pears 20 boxes. Peas 10 sacks. Pineapples 4 Plums 7 bushels. Pomegranates 1 case. Potatoes 10 sacks. Tomatoes 30 boxes. Walnuts 4 bags. Sausages (Italian) 5 lbs. Salmon 160 lbs. the strand district, london. 37 This does not represent all the food-stuffs disposed of by your Board, as much refuse fruit and vegetables are collected in Covent Garden Market in the special carts provided for the purpose. The custom is for inferior varieties of various food stuffs to be sold with the intention that only what is good in it should be retailed to the public; the rest the buyer is expected to pick out and throw into your Board's carts. If the retailer fails to do this, he is liable to have the food in his possession seized and destroyed, and no action results against the wholesale seller. But if any article has been sold to the retailer for food, the person who so sold the same is liable, on conviction, to fine and imprisonment, unless he proves that at the time he sold the said article he did not know, and had no reason to believe, that it was in such condition. In the end of 1893, a summons was taken out by your Board against a Covent Garden firm, who had sold by auction to a costermonger two boxes of oranges, the contents of one box being entirely bad, and a fine of £10 and costs was ultimately imposed by the magistrate. An appeal was taken to the County of London Sessions and dismissed, as it was proved that the boxes of oranges had been technically marked as being of good quality by the defendants' servants, who must, therefore, have first examined the contents of the box. Another case on somewhat similar lines in another district was brought before 11 judges sitting as a Court for Consideration of Crown cases Reserved. The appeal was upheld, a decision in which 10 of the judges concurred. This case, however, differs from that taken up by your Board, in that it was not proved that the defendant had sold the walnuts as good and fit for food. 38 on the sanitary condition of the strand district. The decision, however, relieves the wholesale seller of much responsibility (if he takes certain precautions), and it remains for the buyer to insist upon a proper opportunity for viewing the goods before he makes his purchase. The Acts relating to the sale of food and drugs have been systematically enforced throughout the district as in former years, under the supervision of your Health Committee, and from the report of your Board's Analyst it will be seen that a varied number of articles have been examined by him. Your Board has endeavoured to check the fraudulent practice pursued by certain restaurant keepers of substituting margarine for butter but has not been encouraged in this course by one Magistrate who expressed the opinion that the statute was not meant for this purpose. Your Health Committee has, however, been advised to the contrary, and intends to persevere in the endeavour to protect the public and honest traders. I have the honour to be, Gentlemen, Your obedient Servant, FRANCIS J. ALLAN, M.D., Medicnl Officer of Health. February, 1895. APPENDIX to the THIRTY-NINTH ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH. APPENDIX to toe THIRTY-NINTH ANNUAL REPORT. page Table I. Deaths in the Strand District during the year ending December 29th, 1894, classified according to Form A. of the Local Government Board... ... ... ... .. ... 43 Table II. Population, Births, New Cases of Infectious Disease, and removals thereof to Isolation Hospitals, classified according to Form B of the Local Government Board 44 Table III. Deaths at several Periods of Life in the Strand District, showing those in Infirmaries, Hospitals and Asylums, and distinguishing Males and Females 45 Table IV. Causes of Death in the Strand District and in each Sub-District in 1894 46 Table V. Analysis of the Births and Deaths in London, the Strand, and in each of the Strand SubDistricts for the 52 weeks of 1894 51 Local Government Board. Form A. TABLE 1. Table of DEATHS during the Year 1894, in the Metropolitan Sanitary District of STRAND, classified acccording to Diseases, Ages, and Localities. Names of Localities adopted for the purpose of these Statistics ; Public Institutions being shown as separate localities. Mortality from all causes, at subjoined Ages. Mortality from subjoined causes, distinguishing Deaths of Children under Five Years of Age. At all ages. Under 1 year. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 65. 65 and upwards. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 Smallpox. Scarlatina. Diphtheria. Membranous Croup. Fevers. Cholera. Erysipelas. Measles. Whooping Cough. Diarrhoea and Dysentery. Rheumatic Fever. Ague. Phthisis. Bronchitis, Pneumonia, and Pleurisy. Heart Disease. Injuries. All other Diseases. TOTAL. {Columns for Population and Births are in Form B.) |Typhus. Enteric or Typhoid. Continued Relapsing Puerperal. (a) (b) (c) (d) (e) (f) (g) (h) (i) Strand District 289 76 54 12 10 95 42 Under 5 1 1 - 16 16 3 - - - 34 - 5 54 130 5 upwds - 1 1 1 - - 30 48 17 6 55 159 Strand Union Casual Wards, Bear Yard 12 2 - - - 6 4 Under 5 - 2 2 5 upwds 2 2 1 1 4 10 King's College Hospital 192 29 34 11 18 90 4 Under 5 7 - 2 2 2 - - - 22 - 2 26 63 5 upwds 2 6 - 2 - - - 15 9 18 9 68 129 Hospital for Women, Soho Square 9 - - - 1 7 1 Under 5 - - 5 upwds 1 8 9 St. Peter's Hospital 11 - - - - 6 5 Under 5 - - 5 upwds 11 11 Lock Hospital, Dean Street 2 2 - Under 5 5 upwds 2 2 St. John's Hospital 2 1 1 - Under 5 - - 5 upwds 2 2 Home Hospital, Dean Street 2 1 1 Under 5 - - 5 upwds 2 2 Hospital for Diseases of the Heart, Soho Square 8 - - 2 1 4 1 Under 5 - 5 upwds 1 - 7 - - 8 TOTALS 527 107 88 26 30 218 58 Under 5 - 1 8 - - - - - - - - 18 18 5 - - - 56 - 7 82 195 5 upwds - — 3 - - 6 - - - - - - 3 1 - - 48 59 44 18 152 332 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 170 9 8 4 8 96 45 Under 5 - - 3 - - - - - - - - 1 2 - - - 4 - - - 7 17 5 upwds - - - - - 5 - - - - - - - - - - 35 27 13 8 65 153 Deaths occurring within the district among persons not belonging thereto 204 20 25 12 20 113 14 Under 5 — — 5 -- — — — — - — — 2 1 1 — — — 3 - 1 22 45 5 upwds - - - - - 5 - - - - - - 1 - - - 14 9 27 8 95 159 Local Government Board. Form. B. TABLE II. Table of POPULATION, BIRTHS, AND OF NEW CASES OF INFECTIOUS SICKNESS, coming to the knowledge of the Medical Officer of Health, during the year 1894, in the Metropolitan Sanitary District of STRAND, classified according to Diseases, Ages, and Localities. Names or Localities adopted for the purpose of these Statistics; Public Institutions being shown as separate localities. Population at all Ages. Registered Births. Aged under 5 or over 5. New Cases of Sickness in each Locality, coming to the knowledge of the Medical Officer of Health. Number of such Cases removed from their Homes in the several Localities for Treatment in Isolation Hospital. Census 1891. Estimated to middle of 1893. 1 2 3 4 5 6 7 8 9 10 11 1 2 3 4 5 6 7 8 9 10 11 Smallpox Scarlatina. Diphtheria. Membranous Croup. Fevers. Cholera. Erysipelas. TOTALS. Smallpox. Scarlatina. Diphtheria. Membranous Croup. Fevers. Cholera. Erysipelas. TOTALS. Typhus. Enteric or Typhoid. Continued. Relapsing. Puerperal Typhus. Enteric or Typhoid. Continued Relapsing. Puerperal. (a) (b) (c) (d) (e) SUB-DISTRICTS— St. Anne, Soho 280 Under 5 - 9 4 1 1 15 - 8 2 1 1 12 5 upwds 4 29 6 8 1 - 7 55 4 20 5 7 1 1 38 St. Mary 118 Under 5 1 3 - 4 1 - 2 — 3 5 upwds - 4 6 4 2 16 — 3 2 3 8 St. Clement 25,824 24,815 149 Under 5 — 2 3 — 5 — 2 3 — 5 5 upwds - 6 5 1 2 2 16 — 5 4 1 2 12 St. Anne's Workhouse, Poland Street 8 Under 5 5 upwds Strand Union Workhouse, Edmonton 1 Under 5 - - 5 upwds Do. do. Casual Wards, Bear Yard Under 5 - - 5 upwds - - King's College Hospital Under 5 - - - - - - 5 upwds 2 1 3 2 — 2 St. Peter's Hospital Under 5 - - - - 5 upwds - - — Hospital for Diseases of the Heart, Soho Square Under 5 5 upwds - - - TOTALS 25,824 24,815 556 Under 5 1 11 10 1 - 1 - - - - - 24 1 10 7 1 - 1 - - - - -- 20 5 upwds 4 41 18 1 14 1 - - - 11 90 4 30 11 1 — 12 1 - - - 1 60 45 appendix. TABLE III. Mortality of the STRAND DISTRICT during the Year (52 weeks) ending December 29th, 1894. Registration Sub-Distbicts. SubDistricts LOCALITY AT TIME OF DEATH. age at time of death as below. Workhouses : Metropolitan Infirmaries, Hospitals, &c. Lunatic Asylums. totals. Westminster Union (St. Anne's Poland Street). Strand Union (Edmonton) and Bear Yard. Under 1 1 to 5 5 to 15 15 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 and upwards. m. f. m. f. m. f. m. f. m. f. m. f. 1. St. Anne Soho 64 55 9 7 ... ... 33 28 3 3 109 93 202 41 26 8 9 10 23 25 19 28 10 3 2. St. Mary-le-Strand 45 32 ... ... 7 6 19 5 3 1 74 44 118 25 14 4 5 8 11 15 14 9 12 1 3. St. Clement Danes 42 40 ... ... 8 12 33 31 4 3 87 86 173 30 31 6 4 6 22 20 26 15 11 1 Strand District. 151 127 9 7 15 18 85 64 10 7 270 223 493 96 71 18 18 27 56 60 58 51 33 5 278 49 149 17 493 167 36 201 89 TABLE IV Deaths from all causes in the STRAND DISTRICT, and in each Note.—The Deaths of Non-Residents occurring in Hospitals, &c., in the District, are beyond the limits of the CAUSES OF DEATH. ages. Deaths in each SobDistrict. Under 1 1 to 5 5 to 15 15 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 and upd. j St. Anne, Soho. St. Mary-le-Strand (with St Paul, Covent Garden). St. Clement Danes. Total. I—ZYMOTIC DISEASES. 1.—Miasmatic. Smallpox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 1 15 ... ... ... ... ... ... ... ... ... 5 7 4 16 Scarlet Fever (Scarlatina) ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... 1 Diphtheria (including Membranous Croup) 1 5 3 ... ... ... ... ... ... ... ... 2 1 6 9 Whooping Cough 4 15 1 ... ... ... ... ... ... ... ... 9 2 9 20 Chickenpox 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 1 Enteric or Typhoid Fever ... ... ... 3 2 ... 1 ... ... ... ... 5 1 ... 6 Simple Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2.—Diarrhceal Diseases. Diarrhcea and Dysentery 6 ... ... ... ... ... ... ... ... 1 ... 3 2 2 7 Simple Cholera (Choleraic ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhoea) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Asiatic Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3.—Malarial Diseases. Ague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Remittent Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4.—Zoogenous Diseases. Hydrophobia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Glanders ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cowpox and effects of Vaccination ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5.—Tubercular Diseases. Tabes Mesenterica 5 2 ... ... ... ... ... ... ... ... ... 3 3 1 7 Phthisis ... ... 2 7 11 25 10 13 1 ... ... 2G 22 21 69 Tubercular Meningitis, Hydrocephalus l 4 1 ... ... ... ... ... ... ... ... 2 2 2 6 General Tuberculosis, Scrofula, &c 4 2 2 2 ... 1 ... ... ... ... ... 4 3 4 11 6—Venereal Diseases. Syphilis 4 ... ... ... ... ... ... ... ... ... ... 4 ... ... 4 Gonorrhoea, Stricture of Urethra ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 7.—Septic Diseases. Erysipelas 2 ... ... ... ... ... ... ... ... ... ... ... 1 1 2 Pyæmia. Septicemia ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 1 Puerperal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cellulitis ... ... ... ... 1 ... ... ... ... ... ... 1 ... 1 TABLE IV. (continued). Sub-District, during the year ending 29th December, 1894. excluded; and the Deaths of Residents occurring in Hospitals, &c., situated in London District, are included. CAUSES OF DEATH. ages. Deaths in each SubDistrict. Under 1 1 to 5 5 to 15 15 to 25 25 to 35 35 to 15 45 to 55 55 to 65 65 to 75 75 to 85 85 and upd St. Anne, Soho. St. Mary-le-Strand (with St. Paul, Covent Garden), St. Clement Danes. Total. II.—PARASITIC DISEASES Thrush, and other Vegetable Parasitic Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Worms, Hydatids and other Animal Parasitic Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... III.—DIETIC DISEASES. Privation ... ... ... ... ... ... ... ... 1 ... ... ... l ... 1 Want of Breast Milk ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scurvy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Alcoholism a. Del. Tremens ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... b. Intemperance ... ... ... ... ... ... 1 ... ... ... ... l ... ... 1 IV.—CONSTITUTIONAL DISEASES. Gout ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Rheumatic Fever and Rheumatism of the Heart ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Rheumatism ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... 1 Cancer, Malignant Disease ... ... ... ... 1 1 2 3 1 1 ... 4 1 4 9 Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Anaemia, Chlorosis, &c. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diabetes Mellitus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Purpura, Hæmorrhagic Diathesis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Constitutional Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... V.—LOCAL DISEASES 1.—Diseases of the Nervous System. Inflammation of the Brain or Membranes 1 2 1 ... ... ... ... ... ... ... ... 2 l l 4 Apoplexy and Brain Paralysis ... ... ... ... ... 1 3 4 6 2 l 6 2 9 17 Insanity ... ... ... 1 ... 5 4 1 3 1 ... 3 5 7 15 Chorea ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Epilepsy ... ... ... 1 1 ... 1 ... ... ... ... 2 ... 1 3 Convulsions 8 ... ... ... ... ... ... ... ... ... ... 3 3 2 8 Laryngismus Stridulus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Teething ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Disease of Spinal Cord ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Nervous Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2.—Diseases of Circulatory System. Pericarditis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Valvular Diseases of Heart ... ... 1 1 1 ... 1 1 ... ... ... 3 2 ... 5 Other Diseases of Heart ... ... ... 1 ... 4 10 4 6 1 ... 12 7 7 26 Aneurism ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 l Embolism, Thrombosis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of Blood Vessels ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... TABLE IV. (continued). CAUSES OF DEATH. ages. Deaths in each SubDistrict. Under 1 1 to 5 6 to 15 15 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 and upd. St. Anne. Soho. St. Mary-le-Strand (with St. Paul. Covent Garden). St. Clement Danes. Total. 3.—Respiratory Organs. Laryngitis ... 1 1 ... ... ... ... ... ... ... ... 2 ... ... 2 Bronchitis 16 9 2 ... 2 5 6 13 14 9 2 33 15 30 78 Pleurisy ... ... ... 1 ... 1 ... 1 1 1 ... 1 3 1 5 Pneumonia . 10 10 1 ... 1 3 5 3 3 ... ... 10 6 20 36 Asthma, Emphysema ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... 1 Other Lung Diseases ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 1 4.—Digestive Organs. Quinsy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diseases of Gullet & Stomach 1 1 1 ... ... ... ... 1 1 ... ... ... 2 3 5 Enteritis 2 ... ... ... ... ... ... 1 ... ... ... ... ... 1 3 Peritonitis ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... 1 Hernia ... ... ... ... ... ... 1 ... ... ... 1 ... ... 1 Obstruction of Intestines ... 1 ... 1 1 ... 1 1 ... ... ... 2 ... 3 5 Disease of Pancreas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cirrhosis of Liver ... ... ... ... l 2 3 3 2 ... ... 5 2 4 11 Other Liver Diseases ... ... ... ... ... 1 1 ... 1 ... ... 2 1 ... 3 5.—Urinary Organs. Bright's Disease (Nephritis) ... ... ... ... 3 3 2 2 1 ... ... 4 4 3 11 Calculus of Kidney or Bladder ... ... ... ... ... ... 1 1 ... ... ... 1 1 ... 2 Other Kidney Diseases ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... 1 Other Diseases of Bladder or Prostate ... ... ... ... ... ... ... 1 1 ... ... 1 1 ... 2 6.—Diseases of Reproductive System. Abortion ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Child-birth ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... 1 7.—Diseases of Bones and Joints. Synovitis (Arthritis) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Caries and Necrosis ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 1 Other Diseases of Bones and Joints ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 8.—Diseases of Integumentary System. Ulcer ... ... ... ... ... ... ... ... ... ... ... ... ... . ... Other Skin Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 9.—Diseases of Organs of Special Sense. Ear 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 Eye ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Nose ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... TABLE IV. (continued) ages. Deaths in each SubDistrict. CAUSES OF DEATH. 1 Under 1 1 to 5 6 to 15 15 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 and npd. St. Anne, Soho. St. Mary-le-Strand (with St. Paul, Covent Garden). St. Clement Danes. Total. 10.—Diseases of Glandular Organs. Bronchocele ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Addison's Disease ... ... ... ... ... 1 ... ... ... ... ... ... ... l 1 Other Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 11.—Diseases or Lymphatic System. Diseases of Lymphatics .. ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diseases of Spleen ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... VI.—DEVELOPMENTAL DISEASES. Premature Birth (Debility at Birth) 15 ... ... ... ... ... ... ... ... ... ... ... 4 4 15 Malformations 2 ... ... ... ... ... ... ... ... ... ... 2 ... ... 2 Old Age ... ... ... ... ... ... ... ... 7 16 2 10 6 9 25 VII —VIOLENT DEATHS, &c. 1.—Accident or Negligence. By Falls ... ... 1 ... ... l ... 1 1 ... ... 2 ... 2 4 By Railways ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... By Horses and Vehicles ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 In Building Operations ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... In Conflagrations ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 By Burns and Scalds ... 1 ... ... ... ... ... ... ... ... ... ... 1 ... 1 By Wounds—Gunshot ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... By Wounds—Cut, Stab ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Poison ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Drowning ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Suffocation (in bed) 4 ... ... ... ... ... ... ... ... ... ... 2 2 ... 4 By Negligence at Birth 2 ... ... ... ... ... ... ... ... ... ... 2 ... ... 2 Otherwise ... ... ... ... ... l ... ... ... ... ... 1 ... ... 1 2.—Homicide. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Murder and Manslaughter ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... 1 3.—Suicide. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Wounds—Gunshot ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Wounds—Cut, Stab ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 1 Poison ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 1 Drowning ... ... ... ... ... ... 2 ... ... ... ... ... 1 ... 2 Hanging ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Otherwise ... ... ... ... 1 l ... ... ... ... ... 2 ... ... 2 4.—Execution. Hanging ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... VIII.—CAUSES NOT SPECIFIED OR ILL-DEFINED. Not specified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ill-Defined. Marasmus 5 ... ... ... ... ... ... ... ... ... ... 2 1 2 5 Decubitus ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 1 Totals 96 71 18 18 27 56 60 58 51 33 5 202 118 173 493 d 50 appendix. TABLE IV. (continued.) SUMMARY OF CAUSES OF DEATH. AGES. deaths in each Sub- distkict. CAUSES OF DEATH. Under 1 1 to 5 5 to 15 15 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 & up St. Anne. St. Mary. St. Clement. Total. I.—SPECIFIC FEBRILE, OR ZYMOTIC DISEASES 29 44 10 12 14 26 11 13 1 1 - 64 45 52 161 1. Miasmatic Diseases 7 36 4 3 2 - 1 - - - - 22 11 20 53 2. Diarrhoeal ,, 6 - - - - - - - - 1 - 3 2 2 7 3. Malarial „ - - - - - - - - - - - - - - - 4. Zoogenous „ - - - - - - - - - - - - - - - 5. Tubercular „ 10 8 5 9 11 26 10 13 1 - - 35 30 28 93 6. Venereal „ 4 - - - - - - - - - - 4 - - 4 7. Septic „ 2 - 1 - 1 - - - - - - - 2 2 4 II.—PARASITIC DISEASES - - - - - - - - - - - - - - - III.—DIETIC DISEASES - - - - - - 1 - 1 - - 1 1 — 2 IV.—CONSTITUTIONAL DISEASES - - - - 1 1 2 4 1 1 - 5 1 4 10 V.—LOCAL DISEASES 39 25 7 6 10 26 41 40 40 15 3 99 56 97 252 1. Diseases of Nervous System 9 2 1 2 1 6 8 5 9 3 1 10 11 20 47 2. Diseases of Circulatory System - - 1 2 1 4 11 5 6 2 - 15 9 8 32 3. Diseases of Respiratory System.. 26 20 4 1 3 9 12 17 19 10 2 47 24 52 123 4. Diseases of Digestive System 3 2 1 1 2 3 6 7 4 - - 12 6 11 29 5. Diseases of Urinary System - - - - 3 3 4 4 2 - - 7 6 3 16 6. Diseases of Reproductive System - - - - - - - 1 - - - 1 - - 1 7. Diseases of Bones and Joints - 1 - - - - - - - - - - - 1 1 8. Diseases of Integumentary System - - - - - - - - - - - - - - - 9. Diseases of Organs of Special Sense 1 - - - - - - - - - - 1 - - 1 10. Diseases of Gland-like Organs - - - - - - - - - - - - - 1 1 11. Diseases of Lymphatic System - - - - - - - - - - - - - - - VI.—DEVELOPMENTAL DISEASES 17 - - - - - - - 7 16 2 19 10 13 42 VII.—VIOLENCE 6 2 1 - 1 3 5 2 1 - - 12 4 5 21 VIII.—ILL DEFINED AND NOT SPECIFIED CAUSES 5 - - - 1 - - - - - - 2 1 3 6 Totals 96 71 18 18 27 56 60 58 51 33 5 202 118 173 493 51 appendix. TABLE V.—Analysts and Comparison of London and Strand Births and Deaths, for the Fifty.two Weeks ending 29th December, 1894. Districts. ANNUAL RATE PER 1,000 PERSONS LIVING. Deaths under 1 year to 1,000 Births. Districts. Births. Total Deaths (Corrected). Deaths from Principal Zymotic Diseases Small.Pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Fever. Diarrhoea. Violence. Tubercular Diseases. 1891 1892 1893 1894 London 30.1 21.4 20.64 20.9 17.4 2.66 0.02 0.73 0.22 0.66 0.48 0.14 0.40 0.72 ... 143 London. Strand 22.40 26.75 25.09 26.59 19 80 2.36 — 0.64 0.04 0.36 0.80 0.24 0.28 0.84 3.73 172 Strand. Registration Sub.Districts. Sub.Districts. St. Anne 23.92 23.37 21.15 23.60 16.76 2.07 — 0.41 0.08 0.16 0.75 0.41 0.25 0.99 2.90 142 St. Anne. St. Mary 20.74 23.01 24.08 29.51 20.74 2.28 — 1.22 — 0.17 0.35 0.17 0.35 0.70 5.27 210 St. Mary. St. Clement 21.12 35.66 32.47 30.66 24.41 2.95 — 0.56 - 0.84 1.26 — 0.29 0.70 3.95 200 St. Clement. Note.—Where the deaths under any heading are too few to express as a rate per 1,000 within two places of decimals, 0.00 is inserted ; where no deaths have occurred, it is expressed thus —. .