With Dwallan’s bemplinints - & sre<=| FORTIETH ANNUAL REPORT ON THE SANITARY CONDITION OF THE STRAND DISTRICT, LONDON. BY FRANCIS J. ALLAN, M.D., D.RH.Camb., F.R.S.Ed., medical officer of health. printed by order of the Board. London: DIPROSE, BATEMAN & CO., SHEFFIELD STREET. LINCOLN’S INN FIELD W. C. M.D.CCC.XCVI FORTIETH ANNUAL REPORT ON THE SANITARY CONDITION OF THE STRAND DISTRICT, LONDON. BY FRATsCIS J. ALLAN, M.D., D.RH.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.xcvi. A FORTIETH 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 1895, estimated on the same basis as explained in my report for 1892, stands at 24,800. The District for purposes of Registration of births, deaths, and marriages has been re-arranged by the Registrar-General. The two Sub-Districts of St. Mary and St. Clement have now been united to form the "Strand Sub-District." The population of the two divisions of the Sanitary Area is estimated to be similar in number. 1 have in previous reports pointed out the difficulties which exist in making a correct estimate of the population, and that considerable difference existed between the estimate made by the Registrar-General for purposes of Vital Statistics, and that made by him A 2 4 ON THE SANITARY CONDITION OF under the "Equalisation of Rates Act." The Census to be taken in spring of 1896 will show which of these methods is more accurate for this District. The total number of Births registered in the District was 612. This has to be corrected by the addition of 14 births in Poland Street Workhouse, and in Edmonton Workhouse, while 14 births in Bear-yard Workhouse have to be placed to the credit of St. Martin-in-the-Fields parish. The birth-rate is thus 24.91 per 1,000 inhabitants, as against 22.4 in 1894. The birth-rate in London for 1895 was 30.5 per 1,000. Table shewing the number of BIRTHS occurring in the Strand District and in each of its Registration Sub-Districts during each of the nine years ending December 29th, 1895. Year. Strand District. St. Anne Sub-District. Strand Sub-District. 1887 747 403 319 1888 735 417 318 1889 678 381 297 1890 560 321 239 1891 640 334 306 1892 590 310 280 1893 607 330 277 1894 556 288 268 1895 618 324 294 5 THE STRAND DISTRICT, LONDON. Table shewing the Number of Births (Male and Female) occurring in the Strand District, and each of its Registration Sub-Districts, in the Fifty-two Weeks of the Year ending December 29th, 1895. Male. Female. Total. Rate per 1,000 of Population in 1895. Rate per 1,000 of Population in 1894, 1. St. Anne's SubDistrict 168 156 324 26.12 23.92 2. Strand Sub-District 163 131 294 23.71 21.01 331 287 618 24.91 22.40 Deaths. The total number of deaths, after correction,* which were registered as properly belonging to this District, during the year was 5.51, as compared with 493 recorded during the preceding year. Upon the basis of the estimated population already referred to, this is equivalent to an annual death-rate of 22.2 per thousand residents throughout the District, as compared with 19.8 per thousand, the corresponding number for the whole Metropolis during the year. The death-rates in the four quarters were as follows:— 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. London 26.0 16.7 18.61 18.0 Strand 32.0 20.4 17.25 19.0 In Tables I. to V. in the Appendix are set forth the various details concerning the deaths which have taken place in the Strand and its Sub-Districts during the * 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 twelve months; 612 deaths occurred in the District; 260 of these were of persons who did not belong thereto, and 199 persons belonging to the District died outside its bounds. 157 inhabitants of the District died in Poor Law Institutions, 12 in Lunatic Asylums, 14 in Fever Hospitals, and 88 in General and Special Hospitals; thus 48.9 per cent, of the deaths of residents occurred in Public Institutions (37.9 in St. Anne, 50.7 in Strand Sub-District); 26 8 per cent of the deaths in all London were under similar circumstances. The outlying Institutions in which deaths of Strand residents took place were as follows:— Fever Hospitals (14):— Fountain 2 North-eastern 1 North-western 1 South-western 2 Western 6 South Wharf (Smallpox) 1 Hospital Ships 1 Lunatic Asylums (12):— Banstead 1 Cane Hill i Caterham 1 Colney Hatch 4 Darenth 1 Hanwell 1 Ilford 1 Leavesden 2 Parochial Institutions(137):— Central Sick Asylum 56 St. Giles Workhouse 3 Strand Union Workhouse, Edmonton 54 Westminster Workhouse, Poland Street 24 General and Special Hospitals (43):— Charing Cross 13 Children's, Great Ormond Street 2 Evelina 1 French 8 Friendenheim I German 1 Middlesex 10 St Bartholomew's 2 St. George's 1 St. Mary's 1 St. Thomas's 1 Temperance 1 University College 1 Inquests were held on the bodies of 62 persons who died in the District, of these 32 were residents, and 30 non-residents; 11 inquests were held in other parts of London in respect of deaths of inhabitants of the Strand District. The percentage of inquest cases to total deaths among Strand inhabitants was 7.8; in London, 8.6. The percentage of Inquest cases to total deaths among Strand inhabitants was 7.8, in London 8.6, 7 THE STRAND DISTRICT, LONDON. 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, 1894 and 1895 respectively. deaths. At all Ages 5 Years and under. Between 5 and 25 Years Between 25 and 65 Years Above 65 Years. Tear 1891 696 206 44 301 145 „ 1892 640 221 43 268 108 „ 1893 671 203 33 308 127 „ 1891 493 167 36 201 89 „ 1895 551 162 36 243 110 Percentage of the total Deaths:— Tear 1891 29.5 63 433 209 „ 1892 34.5 67 41.9 16.9 „ 1893 30.2 49 45.9 18.9 „ 1894 33.8 73 40.8 18.1 „ 1895 29.4 65 41.1 19.9 Deaths under 1 year of age.—105 infants died in 1895, as compared with 96 in 1894. Compared with the number of births in the year, there were therefore, 169 9 deaths, per 1,000 births. The Southern division of the Strand district being 192, compared with 148 for the Northern part (St. Anne, Soho). The London rate 8 ON THE SANITARY CONDITION OF was 165 per 1,000 births, and exceeded by 12 the average rate in the ten preceding years. Deaths under 1 year per 1,000 Births Registered. 1891. 1892. 1893. 1894. 1895. Sub-districts:— St. Anne 194 219 175 142 148 Strand 234 207 241 205 192 Sanitary District of Strand 212 211 205 172 1699 All London 167 164 164 143 165 The number of deaths of children below 5 years of age is a little less than in 1894, while between the ages of 5 and 25 the number of deaths is exactly the same in the two years. Between 25 and 65, however, there is an increase from 201 to 243, and of persons above 65 there is an increase from 89 to 110. It will be observed from Table III. in the Appendix that this increase was confined to the Southern part of the District, and that it was chiefly among females. When we come to consider the diseases which have contributed to the mortality table for 1894, we find that 27.5 per cent, of the deaths were due to influenza, and diseases of the respiratory system (excluding pulmonary phthisis), 18.2 per cent, to tubercular diseases, 13 per cent, to other zymotic or specific diseases, 10 per cent, to diseases of the nervous system, 5.8 per cent, to diseases of the digestive organs, leaving 18 per cent, attributable to all other diseases. 9 THE STRAND DISTRICT, LONDON. Influenza.—For the fifth year in succession London has been visited by this disease, and as in previous years, it was accompanied by a great increase in the number of deaths from respiratory diseases It first began to make an impression upon the death rate about the middle of February, rapidly rising to a maximum in the week ending the 9th of March, when 473 deaths were recorded, thereafter it more slowly declined to the end of April. Weekly Number of Deaths from Influenza and from RespiratoryDiseases (excluding Phthisis) in London in 1895. 10 ON THE SANITARY CONDITION OF The deaths from respiratory diseases also assumed large proportions, reaching in the week ending March 2nd, no less than 1,448, which was 945 above the corrected average for the previous ten years The effect produced by this epidemic is readily seen on the chart opposite showing the general death-rate for London and the Strand. It is to be noted that whenever respiratory diseases are becoming prevalent, that the death-rate of the Strand District, and especially of the St. Clement's portion, rises before the London rate does so. For the remainder of the year the deaths from respiratory diseases were below the average, but they produced a slight rise in the death-rate in November. In connection with the influenza epidemic in 1895, it is to be noted that it began towards the end of the long frost, and when the thaw came at the end of the first week in March the death-rate had reached its maximum. It is most probable that the absence of water from drains and sewers during several weeks, had a detrimental influence upon the public health, by preventing the proper removal, of sewage therefrom. The cold weather lasted for three months, and during that period, the longest continuous frost of this half of the century occurred, viz.—from January 21st to February 20th, 31 days. There was also a deficiency of rain during the first half of the year, the total amount which fell being less than 50 per cent, of the average. Notifiable Infectious Diseases The number of cases notified in the Strand District in 1895, was 198, the increase over last year being 11 THE STRAND DISTRICT, LONDON. chiefly of cases of scarlet fever. The total amount paid for certificates during the year was £19. 15s. 6d. Four duplicate certificates were received. Half-a-crown is paid to medical men certifying cases in their private practice; one shilling for cases which occur in connection with public appointments. The average cost per notification, for 1895, was 1s. 11d. The Metropolitan Asylums Board repay the Board these expenses. Diseases notified. Total for District. Year ending 31 Dec., 1892. Year ending 31 Dec., 1893. Year ending 31 Dec., 1894. Year ending 31 Dec., 1895. Small-pox 7 30 5 5 Diphtheria and 1 Membranous Croup J 33 79 30 36 Erysipelas 22 22 11 17 Scarlatina 111 143 52 116 Typhoid Fever 12 11 15 24 Puerperal Fever 1 1 0 0 Continued Fever 0 0 1 0 186 286 114 198 The notifications received were at the rate of 7.98 per 1,000 of the population, against 7.3, 11.3, and 4.5 in the three preceding years respectively. Throughout the Metropolis the average rate was 9.94 per 1,000 for 1895. 60 1 per cent, of the Strand cases were removed to hospitals, as shown in detail in Table II. (Form B.) 12 ON THE SANITARY CONDITION OF All the small-pox cases, 77.5 per cent, of the scarlet fever, 63.8 „ „ diphtheria, 62.5 „ „ enteric fever, and 23.5 „ ,, erysipelas cases, were treated in hospital. During the third and fourth quarters, considerable difficulty was experienced by the Metropolitan Asylums Board, in finding beds for the persons who desired to have the advantage of hospital treatment. This difficulty was due partly to an attempt to raise the cubic space allotted per bed from 1,200 to 2,000 cubic feet, it having been shown that better results in treatment are thereby obtained, and partly to the discontinuance of the use of the Gore Farm Hospital for the reception of convalescing scarlet fever patients. The reason given for this by the Asylums Board was that the beds at Gore Farm (800 in the Upper Hospital, 200 in the Lower Hospital), might be required for smallpox cases. Except in a few cases in which there was delay of several days, no great difficulty was experienced in this District in obtaining the removal of patients unable to be isolated in their homes In other districts, however, the matter was felt more acutely, and as a result, a conference of Metropolitan Sanitary Authorities was called. The following is the report submitted by your Delegates to that Conference:— "We beg to report that we attended the Conference "on December 3rd, 1895, at Marylebone Court House, in "company with the representatives from twenty-nine "other Metropolitan Vestries and District Boards 'to 13 THE STRAND DISTRICT, LONDON. ''consider the position of the Metropolitan Asylums " 'Board in regard to its inability to provide sufficient " 'accommodation for the infectious sick.' "The following Resolutions were passed after con"siderable discussion:— "1. That a communication be addressed to the "Metropolitan Asylums Board, strongly urging "that Board to take steps to immediately open "the vacant beds of the Gore Farm Hospital "at Darenth, for the purpose of providing the "temporary accommodation required by the "London Local Authorities for the cases of "Scarlet Fever urgently requiring removal "from the crowded families and houses in "which they are spreading the disease. "2. That, in the opinion of this Conference, the "Authorities making the Rate to raise the "Funds for the requirements of the Metro"politan Asylums Board should be entitled to "be directly and adequately represented upon "that Board. "3. That the President of the Local Government "Board be asked to receive a deputation in "support of the foregoing Resolutions. "4. That a copy of the foregoing Resolutions be "forwarded to the Local Government Board, "the Metropolitan Asylums Board and the "several Vestries and District Boards of the "Metropolis, who have appointed Delegates "to attend this Conference, and that each of "those Vestries and District Boards be asked "to appoint one Representative to attend the 14 ON THE SANITARY CONDITION OF "proposed deputation to the President of the "Local Government Board. "We recommend that the Board appoint a Repre'sentative to attend the proposed deputation. "R. C. Gamble. "Langton Geo. Vere. "Farq. Matheson. "Francis J. Allan. "Medical Officer of Health." The Asylums Board at once took steps to comply with the first resolution. It will be noticed, in the subjoined table, that the scarlet fever cases notified in London, were considerably fewer in number than were notified in either 1892, or 1893, but the epidemic in 1895, was confined to the latter half of the year, and thus made itself felt more severely. The rate per 1,000 inhabitants, of cases of scarlet fever, was, London, 4.7 Strand, 4.6. TOTAL NOTIFICATIONS IN LONDON. Year. Small Pox. Scarlet Fever. Diphtheria and Croup. Enteric Fever. Typhus Fever. Other Con. tinued Fevers. Puerperal Fever. Erysipelas Cholera. Relapsing Fever. Totals. 1890 60 15,330 5,420 2,877 35 237 206 4,598 25 7 29,795 1891 114 11,398 6,412 3,372 27 152 221 4,764 23 39 26,552 1892 423 27,096 8,356 2,465 20 147 347 6,934 54 7 45,849 1893 2,813 36,901 13,694 3,663 22 205 397 9,700 86 4 67,485 1894 1,192 18,440 11,190 3,360 21 162 253 6,080 21 2 40,925 1895 1,076 20,654 11,887 3,710 15 107 249 5,994 30 4 43,722 IEDINFECTIOUS DISEASES NOTIF—In the Year ending 31st December, 1895. Disease. St. Anne, Soho. Strand Sub-District. Total for District. Quarter ending 30 March. Quarter ending 29 June. Quarter ending 28 Sept. Quarter ending 31 Dec. Total. Quarter ending 30 March. Quarter ending 29 June. Quarter ending 28 Sept. Quarter ending 31 Dec. Total. Quarter ending 30 March. Quarter ending 29 June. Quarter ending 28 Sept. Quarter ending 31 Dec. Total. Small-pox ... 1 2 ... 3 ... 2 ... ... 2 ... 3 2 ... 5 Diphtheria and Membranous Croup 7 8* 3 4 22 2 3 2 7 14 9 11 5 11 36 Erysipelas 1 1 5 4 11 1 1 3 1 6 2 2 8 5 17 Scarlatina 5 5 39 23 72 4 2 18 20 44 9 7 57 43 116 Typhoid Fever 1 *3 5 9 5 1* 2 7 15 6 1 5 12 24 Totals 14 15 52 36 117 12 9 25 35 81 26 24 77 71 198 * Two cases notified as Enteric Fever and five cases notified as Diphtheria, were found later in the course of the disease not to be infectious cases. 16 ON THE SANITARY CONDITION OF Small-pox.—1,076 notifications of this disease were made during 1895 to metropolitan authorities. Five cases occurred in this District, the source of infection in each case being traceable. Two deaths occurred, one a woman aged 51, who had been vaccinated in infancy, received infection from her unvaccinated son, who was sent home ill; the disease (a malignant type) not having been recognised. A sister, age 14, also developed the disease in a very mild form. The other fatal case was that of a tramp (unvaccinated), who contracted the disease in Whitechapel. Of the two other cases, one contracted the disease in Boulogne, the other in Holborn; in neither case did the disease spread to any person employed in the same places of business. Several persons living in other districts, who contracted small-pox, worked in this district, but in only one instance did they communicate the disease to their fellow-workers. The person thus affected appears to have been the only one in the offices in which he was employed who was not protected by vaccination. Diphtheria and Membranous Croup.—There were 11,887 notifications of this disease in London, as compared with 11,190 in 1894, being at the rate of 2.7 per 1,000 inhabitants. 36 were notified in the Strand District, but five eventually proved not to be of an infectious nature. The corrected rate for this District was, therefore, 1.2 per 1,000 inhabitants; 12 of the cases proved fatal. The death-rate for London per 1,000 inhabitants was 053, for this District 0.48, for the Northern Registration Sub-district (St. Anne, Soho) 0.40, and for the Southern Sub-district (Strand) 0.56. 2 of the cases were under 1 year of age. 7 „ „ between 1 and 2 years „ THE STRAND DISTRICT, LONDON. 17 4 of the cases were between 2 and 5 years of age 4 „ „ „ 5 and 6 „ 4 ,, ,, ,, 7 and 8 ,, ,, 4 ,, ,, 9 and 15,, „ The ages of the remaining 5 cases varied from 17 to 32. 11 cases were males, 20 females. In 13 cases the source of infection was not traceable. There were conditions of overcrowding associated with 4 cases; of defective drains, stopped closets, &c., with 14 of the cases. In two families second cases occurred; inclusive of these direct infection was traced in 7 cases. Towards the end of the severe frost in the month of March, it was found that the water-closets were stopped up in a number of the poorer-class houses from the want of water; while the frost lasted no great nuisance arose, but when the thaw set in I was apprehensive that danger to the public health might arise therefrom. Under these circumstances it was deemed advisable to thoroughly flush out the drains in such houses with the hose. This was much appreciated by the inmates of the houses in question, and it is interesting to note that in only one of these houses has infectious disease of any kind appeared during the year. In the excepted house the closet and drain were several times wilfully obstructed during the year. I believe that defective drainage has a direct influence in the production of certain throat affections. Enteric Fever.—3,710 cases were notified in London in 1895, with 614 deaths, being 17 below the corrected average of the last 10 years. The death-rate was 014 per 1,000 inhabitants. In the Strand district, 9 cases B 18 ON THE SANITARY CONDITION OF were notified in St. Anne's parish, 15 in the Strand subdistrict. One case in both proved eventually not to be enteric fever. The number of deaths were 2 and 4 respectively, equal to a rate of 0.24 per 1,000 inhabitants of the district. Six of the cases occurred in the early part of the year, and were part of the previous year's outbreak. 7 of the cases contracted the disease out of the district; in 4 no source was traceable; in 9 cases, defective conditions of drainage were discovered in the houses in which the cases then were; in 3 cases, the disease was attributed to eating shell-fish. 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 District were 2 64 and 2'01 respectively per 1,000 of the population. Compared with the averages in the ten preceding years, the mortality from small-pox, measles, scarlet fever, whooping-cough, and "fever" throughout London, was below the average, while that from diphtheria and from diarrhoea showed an excess. Measles was prevalent in the District in the early part of the year, but the deaths were fewer than the average throughout London, being 0.24 in the Strand, 0.60 in London. Whooping Cough caused only three deaths in 1895, in this District. The London death rate of 0.34 per 1,000 living is the lowest ever recorded, the nearest approach thereto being 0.41 in 1883. THE STRAND DISTRICT, LONDON. 19 Diarrhoea.—12 deaths were attributed to this complaint, 8 being in children under 1 year of age. In addition, 10 deaths were certified in the months of August, September, and October, as due to enteritis, 9 of them being children. DEATHS FROM ZYMOTIC DISEASES. Disease. St. Anne SubDistrict. Strand SubDistrict. Strand District. Deaths in 1895. Deaths in 1895. Total Deaths in 1895. Total Deaths in 1894. Total Deaths in 1893. Total Deaths in 1892. Smallpox l l 2 ... 1 ... Measles 3 3 6 16 2 54 Scarlatina 4 5 4 1 19 1 Diphtheria 5 7 12 9 2L 8 Whooping Cough 2 1 3 20 11 12 Diarrhoea and English Cholera 6 6 ... 7 13 8 Chickenpox ... ... ... ... 1 ... ... Tnfluenza 3 5 8 ... 6 15 Entcric or Typhoid Fever ... 2 4 6 6 1 3 Erysipelas and Pyæmia 1 5 6 4 5 10 Totals 27 37 47 61 79 111 Infantile diarrhoea depends, to a large extent, upon climatic conditions, being more prevalent when the temperature is high in the summer months, less so D 2 20 ON THE SANITARY CONDITION OF when it is low. Thus, since 1887, the average temperature of the air in the third, or summer quarter, has been below the average, except in 1893 and 1895, when it was respectively 2.3 and 2.7 degrees above the average. In these years, the diarrhoea, as measured by the mortality, was equal to an annual rate of 2 03 and 2.41 per 1,000 respectively, whereas during the six colder summers, it averaged only T58 per 1,000. The occurrence of diarrhoea does not depend, however, so much upon the temperature of the air as upon the temperature of the earth, otherwise we should have experienced an outbreak in the warm weather of May, 1895. This statement is founded upon observations which show that diarrhoea appears as soon as the earth at a depth of 4 feet, reaches a temperature of 56 ° F., This is, of course, assisted or retarded by other conditions, such as the amount of rain-fall. In London, as a whole, the diarrhoea produces a maximum effect on the death-rate in July, but in the Strand district this effect is not attained till August. Disinfection. During the twelve months ending 31st December, 1896, 150 premises were purified and cleansed after infectious disease, and 3606 articles were disinfected in your Board's apparatus: 48 articles were burnt in your destructor at the request of the owners. 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 cases of measles. Thorough cleansing of rooms, and in some cases disinfection by steam has been resorted to after all deaths from phthisis. THE STRAND DISTRICT, LONDON. 21 The Temporary Shelter was made use of during the time when their dwellings were being disinfected by 5 families comprising 15 persons ; 9 were sheltered during the day only, 6 during the night also. The shortest period during which the shelter was made use of was 12 hours, the longest 30 hours. Public Library.—During the year, your Board resolved that as the parish of St. Paul, Covent Garden, is served by the St. Martin's Free Library, intimation be made to the Librarian of cases of infectious diseases occurring in that parish with a view to prevent the issue of books to infected persons, or the reception of books into the Library from such persons without proper disinfection. Vaccination in the District. I am indebted to Mr. J. H. Penfold 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.* 1895. Births. Successfully Vaccinated. Insusceptible. Died Unvaccinated. Vaccination Postponed. Removed and Address not known. Remaining. St. Anne Sub-District 308 223 1 25 9 21 29 Strand Sub-District 305 207 — 27 17 32 22 Totals G13 430 1 52 20 53 51 * 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. 22 ON THE SANITARY CONDITION OF Distribution of Deaths in Sub-Districts and Parishes. From the Tables in the Appendix may be seen the manner in which the deaths were distributed in the two Registration Districts. Thus, while the death rate was 22.2 for the whole District, it was only 16'3 in the parish of St. Anne, Soho, but in the Strand Sub-District it reached 28 0 per 1,000 inhabitants. The death rates of the parishes composing the district appear to be :— 16.37 for St. Anne, Soho. 31.67 „ St. Clement Danes. 26.92 „ St. Mary-le-Strand. 16.97 " St. Paul, Covent garden. and 23.3 for the Liberty of the Rolls and Precinct of the Savoy. Based, however, on the estimate of the RegistrarGeneral under the "Equalisation of Rates Act," the population is greater in St. Anne's and less in St. Clement's than my figures. On his figures with outlying paupers added, the death rates are for:— St. Anne, Soho 15'86 per 1,000 inhabitants. St. Clement Danes 33.39 „ ,, „ About one-third of the population of the District is in St. Clement's parish, and nearly half the deaths. As the Quinquennial Census takes place in 1896 we shall be able to obtain more exact figures, and to correct the estimated rates of the last five years. Mortuaries in the District. During the year, the number of dead bodies received THE STRAND DISTRICT, LONDON. 23 into the mortuaries in the Strand District were as follows: — Total number of Bodies. After Infectious Disease. Post-mortem examinations made. Strand Mortuary 54 4 12 St. Anne's 20 — 3 Savoy Deadhouse 8 — 4 Total 82 4 19 I am pleased to be able to report that steps are now being taken by the Duchy of Lancaster to obtain an alteration of coroner's districts, which will render it unnecessary in future to use the Savoy dead-house for the reception of bodies, a purpose for which the building is quite unsuited. Sanitary Work. The following list summarises the work carried out under the supervision of the Department during the year:— Dwelling Houses inspected* 1,175 Number of visits paid by Sanitary Inspectors 5,998 Preliminary notices served 507 Orders made by the Board ("Public Health London Act") 60 Premises in which works have been carried out 507 Workshops:— Cleansed and Whitewashed 225 Over-crowding abated 3 Ventilation improved 6 * Exclusive of special inspection of houses in area represented under the "Housing of the Working Classes Act," 24 ON THE SANITARY CONDITION OF Houses:— Overcrowding abated (by written notice) 46 Throughout 47 Cleansed and Whitewashed Partially 187 Ventilation improved, walls, ceilings and floors repaired 33 Roofs made water tight 44 Water closets:— Reconstructed and repaired 159 Additional provided 16 Water re-instated 114 Flushing apparatus repaired 17 Obstructions removed from 158 New pans and traps provided 25 Pans and traps cleansed 44 Drainage :— New drains constructed 90 Drains repaired 27 Sink and lavatory waste pipes disconnected and trapped 1ll Rain water pipes repaired 25 Obstructions removed from drains 71 Paving required or repaired :— In yards 36 In basements 19 Dust and dung removal:— Sanitary Bins provided* 68 Offensive refuse removed from premises 26 * Under the Board's system of dust collection, fixed bins are gradually being disused and abolished. THE STRAND DISTRICT, LONDON. 25 Water supply:— New service pipes laid on direct from main* 6 Cisterns repaired and cleansed 67 Re-instatement of water after being cut off by Water Company 55 Certificates granted under " Public Health (London) Act," Section 48 2 Under-ground rooms:— Use prevented as separate dwellings 7 In addition to the ordinary notices for the abatement of nuisances, 618 letters have been written during the year. The street 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. 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 Systematic inspection of houses has gone on regularly throughout the year. Some re-arrangement of duties of the staff was rendered necessary by the resignation of one of the Inspectors in the Spring of last year. Mr. Inspector Strutt has now charge of the whole district so far as it relates to dwelling houses, disinfection and the execution of the Food and Drugs Acts. Mr. Inspector * Constant supply being laid on to every house, water is recommended to be drawn direct from the Water Company's Mains. 26 ON THE SANITARY CONDITION OF Martinson devotes himself to workshops and outworkers, Avhile the weekly inspection of houses let in lodgings has been placed upon Mr. F. Chamberlain, as Assistant Sanitary Inspector who also has charge of the temporary shelter. These arrangements have proved to be satisfactory. Smoke Consumption.—During the year much good has been done in the District by abating nuisances caused by smoke. Those coming under Sub-section A, of Section 24 of the "Public Health Act," have been dealt with by your Surveyor; those under Subsection B, have had statutory notices served upon them through the Health Department. Such orders have been made in regard to chimneys sending forth black smoke in such quantity as to be a nuisance, and in each case have been complied with. Water Inquiry.—At the request of the Board, I attended an inquiry held by Col. Ducat, one of the Inspectors of the Local Government Board, under Section 19 of the "Metropolis Water Act, 1871," as to the sufficiency of the present supply of water for flushing closets. The evidence adduced by the London County Council went to show the water companies that in a large number of instances cisterns were employed which cannot hold two gallons of water, and a still larger number do not discharge two gallons at each flush. The evidence supported the view previously taken by your Board (on 24th April, 1895), on the recommendation of your Health Committee. "That the London County Council be informed that "this Board are of opinion that the provision in the " Regulations made under the 'Metropolis Water Act, THE STRAND DISTRICT, LONDON. 27 "1871,' to the effect that the waste-preventing appa"ratus of a water-closet shall not be capable of "discharging more than two gallons of water at each "flush, should be altered so that the discharge shall be "not less than two nor more than three-and-a-half "gallons, and that the Council be requested to take "steps with the view of obtaining an amendment of "the Regulations accordingly." It was pointed out that a 2-gallon flush is sufficient to cleanse a properly constructed pan, but the benefit of a proper flush is not infrequently interfered with by the introduction of badly shaped basins, by insufficient height of the cistern, and by obstructions in the bore of the pipe from the cistern to the basin. Apparently it is not generally known that the Metropolitan Water Companies have it in their Acts that a supply of water for domestic purposes shall not include a supply of water for flushing the drains of houses. Houses let in Lodgings.—Since these bye-laws came into operation, in 1894, your Board has resolved to register 77 premises. Five of these premises have since been closed. The houses are inspected every week, with satisfactory results. This regular inspection tends to stimulate both owner and occupier to keep things in good order. In most cases, there is a desire to comply with the bye-laws, and in only one instance was it necessary to have recourse to magisterial intervention. I am sure that the careful enforcement of these bye-laws will lead to greater care being taken of house property by the tenants, who, in their turn, participate in the benefit of more comfort, cleanliness and better health. Artisans' Dwellings.—Appended are some statistics relating to the Artisans' Dwellings in the Strand District. Statistics relating to Artisans' Dwellings in the Strand District in 1895. Name of Dwellings. Deaths. Number of deaths from Infectious Diseases notified. Population. Births. Birth-rate per 1,000. Under 5 years. 5 years to 65 years. Above 65 years. Total. Deathrate per 1,000. Previous Deathrate. Tubercular Diseases. Other Zymotic Diseases. Bespiratory Diseases. Sandringham Buildings 1,290 50 38.75 1 4 1 6 4.65 Average of 9 years. 9.25 3 0 1 Scarlet Fever 5. Enteric Fever 1. Newport Dwellings 1,229 52 42.3 11 5 0 16 1304 Average of 2 years. 17.72 2 3 8 Scarlet Fever 8. Diphtheria 1. Erysipelas 2. Eversley Buildings From 140 4 28.35 2 3 0 5 35.7 Average of 2 years. 48 23 0 1 0 Scarlet Fever 4. THE STRAND DISTRICT, LONDON. 29 HOUSING OF THE WORKING CLASSES ACT. With reference to the Insanitary Area which 1 represented to the London County Council under this Act in November, 1894, the Public Health and Housing Committee of the Council reported as follows:— "For some years past our attention has from time "to time been called to the insanitary condition of an "area lying immediately north of the Strand, adjoining "Clare Market and the southern end of Drury Lane. "This is the largest and worst of those crowded collec"tions of courts and alleys which remain to disgrace "central London. The property is held by a large "number of small owners who are powerless of them"selves to effect any adequate improvement, and it is "clearly one of those cases which Part I. of the Housing "Act was designed to meet. We are satisfied that "the narrowness, closeness, and bad arrangement and "bad condition of the houses, courts, and alleys within "the area, and the want of light, air, and ventilation "are injurious to the health of the inhabitants, and ''that the evils connected with these houses, courts, or "alleys, and the sanitary defects of this area cannot "be effectually remedied otherwise than by an improve"ment scheme." The Committee therefore prepared a scheme and submitted it to the Council, and the Council, being satisfied of the truth of the representation, approved of their Committee's recommendation, and ordered the scheme to be advertised during three consecutive weeks in the month of October, as required by the Act. For the purposes of the Scheme, known as "The " London (Clare Market, Strand) Improvement 30 ON THE SANITARY CONDITION OF "Scheme, 1895," the Council have included the houses on the land between the parish boundary and Kemble Street, with the Dispensary in Stanhope Street. It is proposed to remove all the buildings on the Area, and to erect new dwellings upon the ground for the accommodation of 500 persons. House room for 1,269 other persons will be provided on part of the site of Millbank Penitentiary. The remaining land in the Area may be disposed of, as the Council may think fit. It is estimated that the cost will be as follows:— Cost of land, &c. £379,150 „ roads 2,250 381,400 Less estimated value of building sites 164,900 Total net cost £216,500 Appended hereto will be found a copy of the Representation with my Report thereon. Workshops. The importance of apportioning the inspection of work-places to a special officer, has again been emphasised during the past year. 496 work-places have been inspected separately from dwelling houses, 1,272 visits have been paid, and orders requiring cleansinghave been served in reference to 225 of them. In 6, the ventilation has been improved; and in 3, overcrowding has been abated by notice. But, as I reported last year, good in many respects, results from 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 THE STRAND DISTRICT, LONDON. 31 closet 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:— Work connected with— Iron, steel, tin, lead, &c. 32 Printing and stationery 106 Gold, silver and jewels 62 Leather 37 Clothing and upholstery 77 Wood 45 Instrument making 14 Engravers 37 Food 34 Laundries 25 General offices 20 Soap and perfumes 4 Scene painters &c. 3 Laundries.— These places have been frequently visited; each has been cleansed and limewashed once, and in 3 cases more often. Bakehouses.— Twenty-nine bakehouses now exist in the Strand District.* These have been frequently and systematically inspected. Each has been cleansed and limewashed twice during the year, and, more frequently, when necessary. * The bakehouses here referred to comprise the following, viz.: — Bread Bakers 23 Pastry Cooks 3 Confectioners 2 Muffin Baker 1 32 ON THE SANITARY CONDITION OF In one case it was necessary to commence legal proceedings to prevent a place connected with the bakehouse being used for sleeping purposes. The "Eag-and-bone" shops have also been inspected from time to time.* In one instance an attempt was made to utilise the street and footway for purposes of this business. This appeared to your Surveyor and myself, to be a most objectionable practice, especially in the middle of a street market. Discontinuance of it was obtained by the removal of various goods to the Greenyard. Corent Garden Market.—Complaints have been made from time to time in respect of waggons, loaded with manure, standing for considerable periods in the market, and adjoining streets. Steps have been taken to prevent them remaining there, but there is no power to hinder the owners of such waggons carrying back to the country, on the top of the manure, empty fruit and vegetable baskets. The Bye-laws of the County Council do not apply to the carriage of horse-dung manure; but it is clearly necessary that the method by which manure is removed from London should receive consideration. At one time farmers were glad to pay for manure, but now stable-keepers have sometimes to pay in order to obtain its removal. The practice is for the farmer or market gardener sending up produce to take back manure in the empty wagons. This method is open to * 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). THE STRAND DISTRICT, LONDON. 33 grave objections, especially where the produce sent up consists of food, mostly to be eaten in a raw state. No great hardship would ensue were the County Council to prohibit this practice, for under the "Public Health Act, 1891 Section 36, each Metropolitan Sanitary Authority may collect and remove the manure and other refuse matter from any stables and cow-houses within their district, the occupiers of which signify their consent in writing to such removal. 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, cabinetwork, 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 Hoard, and a list has been made of 269 persons so employed in this District, most of them being engaged in making wearing apparel. Their homes and work-places 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. Legal Proceedings. A number of persons have during the year been reported to the Board for infractions of the "Public Health Act" and its Bye-laws. In cases, however, where c 34 ON THE SANITARY CONDITION OF these were inadvertent,the Board has accepted apologies; but in the following cases further proceedings were deemed necessary:— Nature op Complaint. Resblt. Defective Drainage (New Church Court) Work done after several adjournments. DefectiveDrainage(St. Anne's Court) Order made. Wilful exposure of a servant suffering from Scarlet Fever ("Public Health Act, 1891," section 68 b) Fine, 40s. and costs. Illegal use of Bakehouse ("Factory and Workshop Act, 1878," section 35) Illegal use discontinued and cost* paid. Infringement of Bye-law, No. 14 (Bye-laws under "Public Health Act, 1891," section 39 (1). Failing to give notice before fixing w.c. apparatus Fine, 20s. and costs. Infringement of Bye-law, No. 8 (Bye-laws for Houses let in Lodgings under "Public Health Act, 1891," section 94). Failing to maintain drainage in good order and efficient action Fine, 10s. and costs. Inspection and Analysis of Food. Subjoined is a list of food stuffs which have been condemned as unfit for food during the year :— Apples 6½ cwt. Asparagus 16 lbs. Bananas 154 ,, Onions 2 cwt. Cherries 33 ,, Potatoes 4 ,, Chestnuts 15 ½ ,, Radishes ¼ „ Damsons 7½ „ Savoys 1 „ Grapes 2½ „ Tomatoes 23 ,, Oranges 9 ,, Vegetable Marrows 2 ,, Peaches 1 „ Plums ½ ,, Raspberries ½ ,. Rabbits, Ostend 6 cases. This does not represent all the food-stuffs disposed 35 the strand district, london. 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 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. During the past year the Board thought it desirable that the Medical Officer should undertake a greater measure of responsibility in regard to the work of the Health Department, and I cannot conclude this Report without expressing my sincere thanks for the handsome manner by which the Board marked its sense of appreciation of my services; and I have to thank the members of the staff for their assistance in carrying on the work of the Department. 1 have the honour to be, Gentlemen, Your obedient Servant, FRANCIS J. ALLAN, M.D., Medical Officer of Health APPENDIX to the FORTIETH ANNUAL REPORT. OF THE MEDICAL OFFICER OF HEALTH. APPENDIX to the FORTIETH ANNUAL REPORT. Page Table I. Deaths in the Strand District during the year ending December 29th, 1895, classified according to Form A of the Local Government Board 39 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 40 Table III. Deaths at several Periods of Life in the Strand District, showing those in Infirmaries, Hospitals and Asylums, and distinguishing Males and Females 11 Table IV. Causes of Death in the Strand District and in each Sub-District in 1895 42 Table V. Analysis of the Births and Deaths in London, the Strand, and in each of the Strand SubDistricts for the 52 weeks of 1895 44 Report on Area represented under Part I of the Housing of the Working Classes Act 45 Local Government Board. Form A. TABLE 1. Table of DEATHS during the Year 1895. in the Metropolitan Sanitary District of STRAND, classified according to Disease Ages, and Localities. Names ok Localities adopted for the purpose of these Statistics; Public Institutions being shown as separate localities. (Columns for Population and Births are in Form B.) 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 15 and 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 Fevers. Cholera. Erysipelas. Measles. Whooping Cough Diarrhoea and Dysentery. | Rheumatic Fever. Ague. Phthisis. Bronchitis, Pneumonia, and Pleurisy. Heart Disease. Injuries. All other Diseases. TOTAL. Typhus. Enteric or Typhoid. Continued Relapsing Puerperal. (a) (b) (c) (d) (e) (f) (g) (h) (i) Strand District 289 79 31 6 7 117 49 Under 5 3 1 5 2 12 — — 2 27 6 52 110 — 2 5 - 1 - 2 — — 30 63 24 5 47 179 Strand Union Casual Wards, Beak Yard 26 2 — - — 19 5 Under 5 - 2 2 5 upwds 1 3 9 5 - 6 24 King's College Hospital 254 29 31 14 30 135 15 Under 5 1 - - 4 - - 1 18 1 4 26 60 5 upwds 8 - - 2 23 20 28 15 98 194 Hospital for Women, Soho Square 19 - - - 2 16 1 Under 5 — — 5 upwds 1 18 19 St. Peter's Hospital 10 8 2 Under 5 - - 5 upwds 10 10 Lock Hospital, Dean Street 1 1 - Under 5 5 upwds 1 1 St. John's Hospital .. 2 1 1 _ Under 5 - - 5 upwds 1 1 2 Home Hospital, Dean Street 1 1 Under 5 - 5 upwds 1 1 Hospital for Diseases of the Heart, Soho Square 9 — — 2 7 Under 5 — 5 upwds 1 6 - 2 9 Royal Ear Hospital 1 - 1 Under 5 1 1 5 upwds - — TOTALS 612 110 63 21 42 304 72 Under 5 - 8 - - 1 - - - - 1 5 12 16 — — 3 46 1 11 85 179 5 upwds - - 2 - - 13 - - - - - 1 - 4 2 - 66 113 70 20 221 511 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 199 12 14 5 9 101 58 Under 5 — 7 2 - - - - - - - - - 1 2 - - — 3 1 10 26 5 upwds 2 2 - — — — - — - — 1 - - 1 - - 36 35 8 6 81 173 Deaths occurring within the district among persons not belonging there to 260 17 20 12 29 162 20 Under 5 - — 2 — — 1 - — — — — — — 2 — - 1 11 1 3 16 37 5 upwds - - - - - 7 - - - - - - - - 2 - 17 19 35 18 12 223 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 1895, in the Metropolitan Sanitary District of STRAND, classified according to Diseases, Ages, and Localities. Names of Localities adopted for the purpose of these Statistics; Public Institutions being shown as separate localities. Population at all Ages. Registered Births. Aged under 5 or over 5. New Cases of Sickness in each Locality, coming to the knowledge of the Medical Officer of Health Number of such cases removed from their homes in the several Localities for Treatment in Isolation Hospital Census 1891. Estimated to middle of 1895. 1 2 3 4 5 B 7 8 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. j Typhus. Enteric or Typhoid. Continued. Relapsing. Puerperal Typhus. Enteric or Typhoid Continued. Relapsing. Puerperal. (a) (b) (c) (d) (e) SUB - DISTRICTS- 125,824 24,800 Under 5 - 24 8 - - 1 33 - 16 4 — - 20 St. Anne, Soho 310 5 upwds 3 48 13 9 — — 10 83 31 35 9 6 — 2 55 Strand 257 Under 5 - 9 5 1 15 — 8 5 — 13 5 upwds 2 33 10 15 3 65 2 29 5 9 2 47 Westminster Workhouse, Poland Street 14 Under 5 5 upwdS Strand Union Workhouse, Edmonton Under 5 - - 6 5 upwds Do. do. Casual Wards, Bear Yard Under 5 — — 45 5 upwds - - King's College Hospital Under 5 — — - - - — 5 upwds 1 1 1 — 1 St. Peter's Hospital Under 5 - - - 5 upwds 1 — 1 1 — 1 TOTALS 25,824 24,800 632 Under 5 - 33 13 - - - - - - - 2 48 - 24 9 - - - - - - - 33 5 upwds 5 83 23 — — 24 — — — — 15 150 5 66 14 — — 15 — — — — 4 104 TABLE III. Mortality of the STRAND DISTRICT during the Year (52 weeks) ending December 28th, 1895. Registration Sub-Districts. SubDistricts LOCALITY AT TIME OF DEATH. age at time of death as below. Workhouses : Metropolitan Infirmaries, Hospital, &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 65 55 to 65 65 to 75 75 to 85 85 and upwards. M. F. M. F. M. F. M. F. M. F. M. F. M.F 1. St. Anne Soho 52 74 10 14 ... ... 34 16 1 2 97 106 203 48 22 7 5 17 26 18 17 29 10 4 2. Strand 75 79 ... ... 32 22 71 60 4 5 182 166 348 57 35 7 17 19 33 56 47 39 22 6 Strand District. 127 153 10 14 32 22 105 76 5 7 279 272 551 105 57 14 22 36 69 74 64 68 32 10 280 78 181 12 162 36 243 110 42 APPENDIX 43 APPENDIX. TABLE IV. SUMMARY OF CAUSES OF DEATH. CAUSES OF DEATH. AGES. deaths in each Sub-District. 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. Strand. Total. I.— SPECIFIC FEBRILE, OR ZYMOTIC DISEASES - 1. MIASMATIC— Small-pox - - - 1 - - - - - - - 1 1 2 Measles - 5 1 — — - - — — — — 3 3 6 Scarlet Fever - 7 9 - - - - - - - - 4 5 9 Whooping Cough 2 1 - — - - - - - - - 2 1 3 Diphtheria 3 5 3 - 1 - — — — — — 5 7 12 Enteric Fever — — - 1 3 1 - — — — 2 4 6 Influenza — — - - — - - 2 2 — 1 3 5 8 2. Diarrhœl Diseases 8 - - - — - - 1 2 1 - 6 6 12 3. Malarial „ — — — - - — — — — — — — 4. Zoogenous „ 1 - - - - - - - - - - 1 — 1 5. Phthisis ,, - 1 - 7 12 27 18 8 — - - 23 50 73 Other Tubercular Diseases 15 12 - - — 1 - — - — — 12 19 31 6. Venereal ,, 7 - - - - - - — - — — 2 5 7 7. Septic „ 2 - - - - - - — - - — 1 5 6 II.—PARASITIC DISEASES 1 - - - - - - - - - — 1 — 1 III—D1ETIC DISEASES 1 - - - 1 2 - 1 - 1 — 1 6 7 IV.—CONSTITUTIONAL DISEASES Malignant Disease — - - - - 2 - 5 6 - — 6 11 17 Acute Rheumatism — - - - - - - - - - - — — — Rheumatism and Gout — - - - — - - 2 1 — — — 4 4 Other Constitutional Diseases - - - - - - - - 1 — — 1 1 2 V.—LOCAL DISEASES 1. Convulsions and Dentition 7 2 - - - - - - - - - 5 4 9 Other Diseases of Nervous System 2 3 1 2 4 - 9 6 2 10 36 46 2. Diseases of Circulatory System - - - 8 4 7 11 4 1 14 28 42 3. Diseases of Respiratory System 18 17 < 6 15 2 20 30 9 3 51 94 145 4. Diseases of Digestive System 11 2 - 9 2 3 4 - 5 1 - 14 18 32 5. Diseases of Urinary System - - - - 3 3 - - 1 1 - 7 7 14 6. Diseases of Reproductive System - - - - 1 1 - — — - - 1 1 2 VI—DEVELOPMENTAL— Debility at Birth 15 - - - - - - - - - - 8 8 16 Old Age - - - - - - - - 5 8 3 9 7 16 VII.—ACCIDENT AND VIOLENCE 6 2 1 1 1 2 2 - - 1 - 9 7 16 VIII.—ILL-DEFINED 6 - - - - - - - - - - 1 6 6 Totals 105 57 14 22 36 69 74 61 68 32 10 203 348 551 TABLE V.— Analysts and Comparison of London and Strand Births and Deaths, for the Fifty-two "Weeks ending 28th December, 1895. Districts. ANNUAL RATE PER 1,000 PERSONS LIVING. Deaths under 1 year to 1,000 Births. Districts. Births. Total Deaths (Corrected). Deaths fom Principal Zymotic Diseases Small-Pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Fever. Diarrhoea. Violence. Tubercular Diseases. 1892 1893 1894 1895 London 30.5 20.64 21.3 17.79 19.8 2.64 0.01 0.60 0.19 0.53 0.34 0.14 0.83 0.78 2.62 166 London. Strand 24.91 25.09 26.59 19.86 22.2 2.01 0.08 0.24 0.36 0.48 0.12 0.24 0.48 0.64 4.19 169 Strand. Registration Sub-Districts Sub-Districts. St. Anne 26.12 21.15 23.60 16.76 16.3 1.85 0.08 0.24 0.32 0.40 0.16 0.16 0.48 0.72 2.82 148 St. Anne. Strand 23.71 29.0 30.1 22.7 28.0 2.17 0.08 0.24 0.40 0.56 0.08 0.32 0.48 0.56 5.56 192 Strand. 44 APPENDIX. Strand District Board of Works REPORT on an Area in the Strand District REPRESENTED TO THE LONDON COUNTY COUNCIL under The Housing of the Working Classes Act, PART 1. by FRANCIS J. ALLAN, M.D., F.R.S.E., Medical Officer of Health, Strand District Board of Works REPORT OF THE MEDICAL OFFICER OF HEALTH ON THE AREA Represented to the London County Council under THE HOUSING OF THE WORKING CLASSES ACT.— PART I. In February, 1894, I reported to the Strand Board of Works that I had carefully examined during the previous twelve months a large number of houses in the District, and that I had found many in such a state as to be unfit for habitation. This report was considered at a meeting of the Health Committee; and I was specially authorized to take such steps as might be necessary to obtain rectification of sanitary defects or closure of the houses, and for that purpose to put in force the provisions of the Housing of the Working Classes Act, 1890, and the Public Health (London) Act, 1891. A number of premises have been dealt with, but there are serious difficulties in the way of carrying out those instructions unless some scheme for the reconstruction of certain areas and for re-housing of the people can be devised. The owners of many of the houses in the neighbourhood of Drury Lane are willing to do their best to render their houses more fit for habitation, but they are precluded from doing this by the fact that the space of ground occupied is already so covered over that no improvement in the way of providing more air and light can be effected, while if they pull down with a view to re-build, the space at their IV APPENDIX. disposal is too small for the purpose. On the other hand, the closure of a large number of dwellings, without the possibility of their being rebuilt would deprive a large number of people, whose work is in the neighbourhood, of a home. Recently the pulling down of the premises between Drury Lane and Catherine Street in the parish of St. Martin-in-the-Fields, as well as the closing of houses in this District, has led to the persons displaced crowding into the adjoining courts and alleys; thus the population of the Area marked A on the plan appended has increased from 1,605 in 1889 to 1,811 in the middle of 1895. This has been effected partly by the displacement of families who were able to rent several rooms each, by the addition of others only able to rent one or at most two rooms, and partly by overcrowding, which has constantly occupied the attention of your Sanitary staff, with the result that while it was abated in one part it re-appeared in another. The Strand Board of Works having no power to provide now and healthy dwellings for those displaced, or to re-arrange the streets, alleys and courts so as to provide for more air and light, it appeared to me that the proper course to pursue was to bring the matter under the attention of the London County Council, who have the power to deal with it in a permanent and satisfactory manner. In order, therefore, to bring the question officially before that body, I have prepared the following statement (called the "Official Representation") under Part I. of the Housing of the Working Classes Act, which, having reported to the Strand Board, I forwarded to the County Council on the 23rd November, 1894, with a map showing the parts of the District to which the Representation relates:— Housing of the Working Classes Act, 1890. LONDON (STRAND DISTRICT) IMPROVEMENT, 1894. To The London County Council. I, Francis John Allan, of 5, Tavistock Street, Covent Garden, in the County of London, Doctor of Medicine and Master in Surgery of the University of Edinburgh, Diplomate in Public Health of the University of Cambridge, Medical Officer of appendix. V Health of the Strand District, in the said county, do hereby, with reference to a certain area within the said Strand District, which is delineated and coloured red on the plan hereunto annexed and signed by me and which is bounded— As regards Sub-Area A: On the North by the part of the boundary of the District lying between Drury Lane and Stanhope Street; On the South by Blackmoor Street; On the East by Stanhope Street; On the West by Drury Lane. As regards Sub-Area B: On the North by Clare Street; On the South by the backs of the houses on the north side of Houghton Street; On the East by Clare Market; On the West by Stanhope Street. As regards Sub-Area C : On the North by White Hart Street; On the South by the backs of houses in the Strand ; On the East by Drury Lane and Drury Court; On the West by Helmet Court, make an Official Representation within the meaning of Section 4 of the Housing of the Working Classes Act, 1890, to the effect following, that is to say:— 1. That houses, courts and alleys, within the said area are unfit for habitation. 2. That the narrowness, closeness and bad arrangement of the streets and houses, the want of light, air and ventilation and other sanitary defects, or one or more of such causes, are dangerous or injurious to the health of the inhabitants of the buildings in the said area and of the neighbouring buildings. 3. That the evils connected with such houses, courts or alleys, and the sanitary defects in such area cannot be effectually remedied otherwise than by an Improvement d VI APPENDIX. Scheme for the re-arrangement and re-construction of the streets and houses within such area or of some of such streets or houses. Dated this Twenty-third day of November, 1894. The Area (which for convenience in dealing with, I have divided into three Sub-Areas, A, B and C), contains about acres and is situated in the parishes of St. Clement Danes and of St. Mary-le-Strand; Sub-Areas A and B being in the former, C in the latter. The District is divided by the Registrar-General for Census and Death Registration purposes other than by parishes, so that Sub-Area A is in the Registration Sub-District of St. Clement, and Sub-Areas B and C in the Registration Sub-District of St. Mary. The arrangement of the streets, courts, and alleys does not appear to have undergone much change in position from the time they were originally planned in the first half of the 17th century. During the last hundred years the whole district has deteriorated in every respect. Besides being inhabited by the lowest classes, the streets and courts themselves, in many cases, have been narrowed and encroached upon by extension of buildings, and houses which formerly had a fair amount of space to the rear now stand practically back to back. Other causes have however accentuated the process of degeneration. During the last forty years the owners and occupiers in these parishes have had almost continuously the prospect held before them of the demolition of their houses for the purposes of a new street from Holborn to the Strand. Within the first year of the Strand Board of Works' existence the Central Authority was memorialised to make such a roadway, which would have opened up this congested neighbourhood. Soon after and throughout the sixties, schemes were under discussion for the acquisition of a large site for the Law Courts and for providing proper means of access thereto, and had these schemes been carried out in their entirety these insanitary areas would have been swept away with the other courts and alleys upon the site of which the Law Courts and other buildings now stand. The minutes of the Strand Board show that new plans for dealing with this part of the district were con- appendix. VII tinually being produced and discussed, and in the latest Bill (that of the County Council in 1893) dealing with this matter, powers were sought to improve the Area now represented. But the result of these protracted attempts has been a serious one to the district interested and especially to the poorer parts thereof. Owners of property and others have hesitated to spend money in rebuilding, or in remodelling the district, in case that in doing so they might throw greater obstacles in the way of the Central Authority, and in the hope that some plan for opening up the district would shortly ensue. Certain owners of a number of houses in Sub-Area A writing to the Strand Board in 1885 said they were desirous of dealing with their houses in such a way as would make them fit homes for persons of the labouring class, without diminishing the number of such persons at present housed on the site. Plans had been prepared several years before, but the owners after mature consideration, were convinced that owing to the confined nature of the area and the probability of interference with ancient lights, no satisfactory plan could be devised by them without including properties other than those belonging to them. The condition of this area and the difficulties of dealing with it are not unknown to the London County Council. Almost at its first meeting in April, 1889, it had the question of a new road through this district under its consideration, and the matter has engaged the attention of one or more of its Committees ever since. In a report (dated 22nd June, 1892), the Improvements Committee of the Council stated in the scheme recommended by it for improving the communication between the Strand and Holborn as one of the aims of the scheme. " (d) To open and improve one of the most insanitary and decaying quarters of London." In describing the course of the proposed new or widened streets the Committee said :— "From this central circus, the new street would pass in a "perfectly straight line to the Strand exactly opposite to St. Mary"le-Strand Church, crossing Vere Street, Clare Street, Stanhope ''Street, Wych Street and Drury Court, a large part of which is "a most insanitary area with houses only fit to be pulled down. d 2 VIII APPENDIX. "The district generally, is described in Mr. C. Booth's book on "Labour and Life of the People as having 'a crowded and very "mixed population," and much of it is marked in his map with the "dark colours of 'poor' and 'very poor.' Ultimately the bulk of "this districtlying between Drury Lane and King's College Hospital "must be rebuilt if only because the houses cannot stand much "longer, since they are amongst the oldest left in London. Many "of the persons who now occupy them are compelled by their work "to live in the district, and it is a question whether the formation "of a new thoroughfare might not afford an opportunity for the "Council to undertake a comprehensive scheme for re-housing the "people displaced. This very difficult question should be at once "undertaken by the Public Health Committee." On the 11th July, 1892, the Council instructed "the Public Health and Housing Committees to consider whether any portions of the area lying centrally between the Strand and Sardinia Street should be made the subject of a scheme under Part 1 of the Housing Act, 1890." Apparently this joint Committee agreed that such a course was necessary, for eventually the Parliamentary Committee recommended that the Council should deal with the matter by substituting in a Bill the more favourable provisions of the Housing Act for those of the Lands Clauses Consolidation Act, where property was shown to be insanitary, and in doing so the Committee stated (13th October, 1892):— "The re-housing under more sanitary conditions of large "numbers of labouring people displaced by any improvement, is one "of the public functions of the Council. And thus the new street "scheme will have the double purpose of giving to the metropolis a "line of communication most urgently needed, and at the same "time of dealing with insanitary areas by removing a considerable "and very poor population from houses and alleys which afford "them no healthy means of habitation." "The London Improvements Bill," subsequently introduced into Parliament in Session 1893, states in the Preamble as one of the reasons for passing the Bill into law: "And whereas there is "included within the limits of land which may be required for APPENDIX. IX " the purposes of the New Central Street and Subsidiary Streets " considerable areas which would form unhealthy areas within " the meaning of The Housing of the Working Classes Act, 1890, " and a considerable number of overcrowded and insanitary " dwellings, and it is expedient that the Council should be " empowered in connection with the said New Central Street " and Subsidiary Streets to rearrange and improve the neiglibour" ing streets courts and alleys, and that powers for the acquisition " of property of this class should he conferred upon them as in "this Act set forth." The above recommendation of the Parliamentary Committee was carried out in the Bill. Within the limits of the land which might be required as stated in the Preamble was the Area which I have represented, and which also was almost specifically referred to in the report already quoted, of the Improvements Committee. I therefore venture to think that no question can arise either as to the necessity for dealing with such an area, or as to the procedure to effect the same, being that of the Housing of the Working Classes Act. In the two years which have elapsed since the various Committees of the Council thus reported, the general conditions have not improved except that a number of houses have been closed, and some pulled down, nor could one expect improvement, but rather the reverse. My predecessor, the late Dr. Conway Evans, writing of another area, describes what happens when plans for improving a district are being considered. He said: " Meanwhile, however, the fact that the houses are doomed to " come down for the formation of the new street has operated " most disadvantageously so far as the structural and sanitary " condition of the property is concerned, both upon their owners " and occupiers. In the former it has naturally induced an " indisposition to incur any outlay which can possibly be avoided " upon dwellings expected very shortly to be pulled down; while, " in the latter, it has brought about feelings of callousness and " indifference, frequently degenerating into neglect, in respect of " the cleanliness and healthfulness of abodes from which the " inmates expect almost weekly to be ejected This X APPENDIX. "apathy of the inmates in association with, in many instances, "most objectionable habits, lead to their permitting the dirt to "accumulate on their floors and staircases, their drains and water"closets to become obstructed from their mode of use, or rather "of abuse, and the basements of the houses to become so filthy "as to justify the assertion that they are scarcely fit, in some "instances, for human habitation."* It is to be remembered, moreover, that this influence has possibly been telling upon the owners and occupiers in the represented Area for many years. Moreover, not only has the district as a whole degenerated, but the clearances in the Clare Market area, have acted prejudicially on the remaining parts especially in the matter of overcrowding, as was predicted by Mr. Charles Booth,† who states "that the clearances "made are being and will be paid for by the further degradation of the "district towards the Strand," and the patches of 'very poor' "will tend to become the quarters of the lowest grade of occasional "labourers, loafers." Hence the decline in the general condition of the overcrowded houses. "They must then in their turn," he adds, "be scheduled and pulled down." In order to facilitate appreciation of the condition of the represented Area and consideration of any schemes which may be formed for its improvement, I have prepared information of a detailed and statistical nature respecting areality, number of houses, population, mortality rates, causes of deaths, comparative death rates, &c. Before, however, proceeding to these details it may be desirable to roughly describe the three sub-areas into which I have divided the whole represented district. Sub-area A. This is a rectangular area bounded as before mentioned on the north by the houses in Kemble Street (not included in the Representation); on the east by Stanhope Street, on the west by Drury Lane and on the south by Blackmoor Street, and includes within that limit, six courts in addition to Eversley Buildings. Although amongst the 130 buildings contained therein * Twenty-sixth Annual Report to the Board of Works for the Strand District, 1881-82; Appendix, p. 15. † "Labour and Life of the People." Charles Booth. Vol. II., p. 296. APPENDIX. XI there are some in fair condition and structural repair, the vast majority are old, worn, ill-ventilated and unfit for habitation. Without entering into a minute description, a few short notes may be added respecting each street or court. In Stanhope Street (350 ft. by 35 ft.), of which only the western side is within the sub-area, some of the houses are fair and a few of them by virtue of possessing a back yard have somewhat better ventilation than others. The interiors, however, are far from satisfactory. Drury Lane is in some degrees comparable to Stanhope Street, being the same length and breadth, but owing to the temporary clearances on the western side of the street obtains a freer access of air and light. The houses are in worse repair and sanitary condition than those of Stanhope Street. All are without exception used in various trades having shops on the ground floor. A number have been altered for business accommodation and in such a manner as to be detrimental to their hygienic condition. The water supply and closets are frequently in the basements or much crowded at the back. The back ventilation is generally extremely deficient. Blachnoor Street on the southern limit is a narrow market thoroughfare less than 20 feet wide. The dozen houses are old, most of them are without ventilation; all of them are dark. The ground floors are occupied for business purposes. The six courts included in the square are with two exceptions, blind alleys, having only one entrance, they are as follows :— Nag's Head Court, is approached by an archway 40 feet long and 3 feet 4 inches wide. The court is about 8J feet wide and contains seven houses, three of which are solely business establishments (1 and 2 a fruit warehouse, 7, and 8 a patent medicine factory). All the inhabited houses are extremely poor, with narrow staircases, dark, dirty rooms, small cramped yards, and defective sanitary arrangements in each case. The water-supply and closet are in immediate proximity to each other in the yard ; the former is fair, the latter invariably bad. The light is shut out from the inhabited houses by Eversley Buildings. Harford Place is 18 feet wide, but is obstructed at its entrance by a house in Drury Lane and reduced to 9 feet. All the eight XII APPENDIX. houses are similar, all are let in tenements, and there is no business establishment in the court. Each house has a small back yard, in which the water supply and closet are situated. The houses on the north side are somewhat better than those on the south, but both sets are in an area too overbuilt to afford sufficient air. Granby Place is entered by an archway 8 feet wide and 35 long. At the eastern end a small passage leads to White Horse Yard, it is therefore in some degree a thoroughfare. The light is poor. Fortytwo out of the forty-eight families live in one room. The height of most of the rooms in the top floors is rarely above 7½ feet, Nos. 5 and 6 are 6½. Practically there is no back ventilation in any of the houses. All the yards are very small, mere wells, and the water supply, etc., are necessarily much cramped. White Horse Yard (250 feet long, 10 to 12 broad) is undoubtedly the worst part of this sub-area, in regard to structural conditions. The court is a thoroughfare between Stanhope Street and Drury Lane, and is entered at the latter end by an arch 8 feet wide The houses are with only one or two exceptions, much dilapidated, and have no back ventilation. The stairs are dark and narrow. The closet and drinking water arrangements are situated in the cellars and are deficient. The ground floor of most of the houses is used as a shop and storeroom. Nos. 3, 6, 16, 17, 18 and 21 are already closed. Nos. 14 and 15 form a registered lodging house for women (81 inmates). Nos. 11 and 12 (now unlet) are used solely for business purposes. Of the 66 families, 55 live in one-room dwellings. Clare Court (200 feet long and 13 broad) is not a through passage, though it has two narrow passages for exit, the one into White Horse Yard, a covered passage 3 feet 8 inches broad, the other into Blackmoor Street, 5 feet 4 inches wide. The houses are practically without means for through ventilation. Nos. 9 and 10 are warehouses, and a Salvation Army station is situated at the corner of the passage into Blackmoor Street. Half Moon Court was in old days a garden at the back of some of the houses in Stanhope Street. Since then it opened into Harford Place and so formed a connection between Stanhope Street and Drury Lane. Eventually it was closed as a thoroughfare and has been for some time a small cul de sac containing three houses, one of APPENDIX. XIII which was last year converted for business purposes. The other two were in every way unfit for habitation and were closed for that reason on January 14th, 1896. The court is entered by a covered passage 2 feet 10 inches wide. JEversley Buildings are structurally good. They are, however, placed in such a position that they are hemmed in on every side by other buildings. They are approached by a narrow covered passage (3 ft. wide) under No. 30, Stanhope Street. There is an open space front, back, and at one end, about 10 feet wide, but this is curtailed in front by overhanging balconies. The end of the yard is blocked up by the houses in Harford Place, and the front of the buildings is overshadowed by the walls of the tannery. The half of the buildings next Stanhope Street are thus extremely dark, as are also the ground floor rooms in the west half. The building consists of five floors, with 20 single and 24 double tenements. The Sub-area B includes both sides of Holies Street, the south side of Clare Street and one house in Clare Market and three in Stanhope Street. The general characteristics of the sub area are similar to the neighbouring Sub-area A, but are perhaps more acute. Of the twenty-seven houses in Holies Street (250 feet long and 30 feet broad) nine are already closed and one is exclusively used for trade purposes. In the remaining seventeen, 309 people live. All the houses are poor, worn out and dilapidated; some have yards and slight back ventilation, but in others even this is absent. Clare Street is a "market" street. All the eleven houses are devoted to business on the ground floor. The population is 164, of which half live in single rooms. The houses are back to back with those on the north side of Holies Street, and the fresh air and light are very little. The third Sub-area C comprises seven courts at the back of the Strand, lying between the Strand on the south and White Hart Street on the north, and bounded on the west by Angel Court and on the east by Drury Lane and Drury Court. It includes more than 60 houses and a total population of 841. Drury Court is a direct continuation of the Lane towards the Strand. The houses are old, dilapidated and out of repair, with the drinking water and closets in immediate proximity to each other. XIV APPENDIX. Denham Yard is a small cul de sac at the back of Drury Court, containing three dwelling houses, with a population of 41, all of whom live in single rooms. The houses are thoroughly bad. Windsor Court is another blind court opening into the Strand. The general sanitary conditions are bad in the extreme. The water supply, &c. are generally situated together in dirty, foul, ill-paved basements. There is little or no ventilation and poor light. New Church Court.—This is a through court from the Strand to White Hart Street. All the houses without exception are insanitary. Many have no back ventilation. The western side of the court is mostly occupied by a wood store. The last two houses at the Strand end of the same side have been recently (October, 1895) destroyed by an explosion and two others have been closed in consequence thereof. The basements in many of the houses are in a filthy condition. Angel Court is the most westerly portion of this sub-area. It is entered by an archway from the Strand, and from the entrance to the steps is 140 feet; there it becomes Eagle Court (in St. Martin's Parish) and opens thus into White Hart Street. Angel Court contains twelve inhabited houses with a total population of 201, only twenty-seven of whom live in one-room dwellings. With one or two exceptions the houses in the court are sanitarily deficient. Several of the houses have small yards at the back, but these like the basements are ill-paved and damp. The ventilation is indifferent. In While Hart Street there are several of the houses included in the representation. Fifty-four out of the eighty-seven inhabitants live in one-room dwellings. The ground floors are used as business places. All the houses are worn out except No. 32 (where a fire occurred in January, 1894). Nos. 29 and 30 are closed under a Magistrate's order. There is total absence of through ventilation. Feathers Court is a cul de sac opening out of Drury Lane, containing a population of 147 in 11 houses. The houses arc old, dilapidated, without through ventilation: they are practically backto-back houses. Area. The represented Area comprises about 153,000 square feet or 3½ XV APPENDIX. acres, of which about 30,000 feet are streets, alleys or courts ; this is made up as follows :— TABLE I. A B C Whole Area. Sq. Feet. Sq. Feet. Sq, Feet. Sq. Feet. Ground built over. 75,500 23,700 23,800 123,000 Streets, Alleys and Courts. 15,000 12,000 6,200 34,000 Totals 90,500 35,700 30,000 157,000 Acres 2077 0.819 0.688 3.584 Houses.—The following premises are included in the Representation :— Area A. Drury Lane: Nos. 101, 102, 103, 104, 105, 106, 107, 108, 109,110, 111,112, 113, 114, 115, 116, 117, 118, 119, 120, 121. White Horse Yard: Nos. 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 12,13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24. 25, 26. Harford Place: Nos. 1, 2, 3, 4, 5, 6, 7, 8. Nag's Head Court: Nos. 1, 3, 4, 5, 6, 7, 8. Clare Court: Nos. 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11 12, 13, 14, 15, 16, 17. Granby Place: Nos. 1, 2, 3, 4, 5, 6, 7, 8, 10, 11, 12, 13, 14 15, 16, 17, 18. Half Moon Court: Nos. 1, 2, 3. Eversley Buildings: (44 sets of Booms). Stanhope Street: Nos. 15, 16, 17, 18, 20, 21, 22, 23, 24, 25, 26, 27, 28, 30, 31, 32, 33, 34, 35. Blackmoor Street: Nos. 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 21, 25. Area B. Holies Street: Nos. 2, 3, 4, 5, 5½, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26. XVI appendix. Clare Market: No. 3. Clare Street: Nos. 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25. Stanhope Street: Nos. 56, 57, 58. Area C, Drury Court: Nos. 18, 19, 20, 21, 22, 23. Windsor Court: Nos. 1, 2, 3, 4, 5, 6. Denham Yard: Nos. 1, 2, 3, 4. White Hart Street: Nos. 29, 30, 31, 32, 33, 34, 35. Angel Court: Nos. 2, 3, 4, 5, 6, 7, 8, 9,10, 11, 12,13, 14. New Church Court: Nos. 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 24, 25, 26, 27. Feathers Court: Nos. 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11. There are thus 234 premises in all, being in A Sub-Area, 130; in B Sub-Area, 42; and in C Sub-Area, 62. Of these:— In A. In B. In C. Total. Are used as dwellings only 51 8 37 96 „ for business only 11 1 3 15 „ conjointly 60 23 14 97 Are closed or demolished 8 10 8 26 The premises used both for business and residential purposes consist of shops on the ground-floor, part of the house being occupied by the shopkeeper, and the rest let off. Those used for business purposes only, include a tannery, a button factory (closed), fruit and green-grocery stores, patent medicine factory, old clothes shops. In addition to the premises included in my Representation, the County Council have specified certain other premises, eighteen in number, required by them for their scheme of reconstruction. These coloured blue on the map appended are:— The Dispensary, No. 59, Stanhope Street. Drury Lane: Nos. 122, 123. Stanhope Street: No. 36. Kemble Street: Nos. 2, 4, 6, 8, 10, 12, 14, 16, 18, 20, 22, 24, 26, 28. APPENDIX. XVII Population. In its details the population appears to be constantly changing and varying in many respects week by week. It is therefore difficult to accurately measure it, but from notes made from time to time, I believe the figures given in Table II. hereto appended are as approximately accurate as it is possible to obtain them. TABLE II. Total Population of Represented Area (Exclusive of Inmates of Poor Law Establishments). 1891. 1892. 1893. 1894. 1895. Area 3,217 3,264 3,187 3,100 3,147 Sub-Area A* 1,689 1,731 1,773 1,815 1,811 Sub-Area B 700 687 574 463 495 Sub-Area C 828 846 840 822 841 Distribution of Papulation.—The following Table exhibits the average number of persons per acre living in the Area in each of the past five years:— TABLE III. 1891. 1892. 1893 1894. 1895. Area 919 932 910 885 898 Sub-Area A 816 836 857 876 905 Sub-Area B 933 916 765 617 663 Sub-Area C 1,200 1,225 1,216 1,191 1,222 The density of population per acre for the whole of London in 1895 * In Sub-Area A, there are three Common Lodging-Houses and a Home for Girls capable of accommodating 131 persons. XVIII APPENDIX. was 58.8; for the Strand District 145. In Sub-Area B., if the Area occupied by houses now closed or in ruins be taken into account, the density figure for 1895 should be 770. While the figures just stated represent the probable density of the Area in regard to persons sleeping in it, the fact must not be lost sight of, that though these figures are excessive, such overcrowding means more in this part of the Strand District than it would in most other portions of the Metropolis. Not only is there a large additional day population in and around this Area, but there is also a succession of extra populations throughout the whole of the twenty-four hours.* I would again quote from another of Dr. Conway Evans' Reports (the 32nd), in which on this very point, he said, "Though this 'vicarious' "overcrowing is obviously beyond the control of legislation, neverthe"less, when its influence is regarded in conjunction with the evil effects "of the 'home' overcrowding which is dealt with at almost every "meeting of your Board, it can scarcely be doubted that the combi"nation tends to operate prejudicially upon the public health, or that "allowance ought to be made in respect of this influence whenever "the general rate of mortality of such a district as this is being com"pared with that of localities in which their forms of overcrowding "are slight and unknown." The conjunction of these two forms of overcrowding while influencing the resident population, must tell more or less also upon the localities in which reside the crowds who frequent the district for business or pleasure. One may say with confidence that in more ways than one the proximity of a crowded and poor district to an important thoroughfare like the Strand, to the Law Courts, to Cove nt Garden Market, &c., is a standing danger to the rest of London, and that the improvement of such conditions is one of metropolitan value and importance. Families and Persons per House.— The number of inhabited houses has slightly decreased during 1895, but the number of People doing business in shops, offices, Law Courts, Somerset House, &c.; people attending theatres and other places of amusement; people engaged during the night in printing establishments and in Covent Garden Market, besides people passing through the District to other parts. In 1890, a census taken on several occasions by Mr. Arthur Ventris, Surveyor to the Strand Board, showed that upwards of 80,000 persons passed daily along the Strand on foot. APPENDIX. XIX families per house, and of persons per house, has increased in each of the Sub-Areas. The figures are given below:— TABLE IV. Inhabited Houses. Number of Families. Families per House. Persons per House. 1894. 1895. 1894. 1895. 1894. 1895. 1894. 1895. Area 207 201 836 849 4.0 4.2 14.9 15.0 Sub-Area A 116 113 490 477 4.2 4.2 15.6 14.8 Sub-Area B 33 31 138 147 41 4.7 14.0 15.9 Sub-Area C 58 57 208 225 3.5 3.9 14.1 14.7 In calculating these figures Eversley Buildings have been reckoned as one house with 33 families; excluding these the Table would read as follows for 1895:- Area 200 816 4.0 14.4 Sub-Area A 112 444 3.9 13.7 Three Common Lodging Houses and a Home for Girls, with their inmates, have net been included. At the census of 1881 and at that of 1891 the average number of persons occupying one house in the Strand District, was 11.6. This was the highest average of any district in London. Number of Rooms per Family.— The following Table shows the number of families occupying tenements of one, two, three, or more rooms:— TABLE V. Occupying 1 room. Occupying 2 rooms. Occupying 3 rooms. Occupying more than 3 rooms. 1894. 1895. 1894. 1895. 1894. 1895 1894. 1895. Represented Area 423 571 338 230 33 20 42 28 Sub-Area A 264 356 180 96 16 7 30 18 Sub-Area B 66 105 60 33 8 4 4 5 Sub-Area C 93 10 98 101 9 9 8 5 XX APPENDIX. Thus 67.25 per cent. of the families occupy 1 room tenements. 27.1 „ „ „ „ 2 „ „ 2 3 „ „ „ „ 3 „ „ and 3.3 „ „ „ „ tenements of more than 3 rooms, as compared with 50.6 per cent. 40.4 per cent., 3.9 per cent. and 5 per cent. respectively in 1894. This hears out the statement that the neighbourhood is degenerating and becoming more and more a poor-class one. The number of persons in these families are as follows:— TABLE VI. Number of Persons living— A B. c. Total. In 1 room tenements 1068 286 323 1667 In 2 „ „ 466 159 437 1062 In 3 „ „ 35 25 49 109 In more than 3 room tenements 111 25 32 168 (Common Lodging-Houses are not included.) Thus 55.6 per cent. of the population live in 1-room tenements. 35.2 „ „ „ „ 2 „ „ 3.6„ „ „ „ 3 „ „ and 5.6 „ „ „ „ tenements of more than 3 rooms. At the Census of 1891 it was found that 59.1 per cent. of the resident population in the Strand District, lived in tenements of three rooms or under (18.1 per cent. in 1 room tenements, 24.2 per cent. in two-room tenements, 16.8 per cent. in 3 room tenements) but in the Area in 1895, no less than 94.4 per cent. occupy such tenements. Table VII. shows the average number of occupants per room:— TABLE VII. Average Number of Occupants per Room. Tenements with In the Strand District. In Area. In A. In B. In C. 1 Room 2.45 2.93 3.00 2.72 2.93 2 Rooms 1.95 2.31 2.42 2.4 2.16 3 Rooms 1.43 1.81 1.66 2.08 1.81 APPENDIX. XXI In only one district of London, viz.: Whitechapel, is there any approach to such overcrowding. Moreover in Whitechapel, there are large numbers of model buildings in which it may be presumed the sanitary arrangements are good and proportioned to the needs of the people, whereas, in the represented Area, the houses were for the most part constructed for the use of one family only, and are unfitted for the purposes to which they are now put. It has been pointed out by Dr. Newsholme, in his discussion of the vital statistics of the Peabody Fund Dwellings, that the number of persons to a room should be considered in preference to the density per acre. In the Area, however, we have overcrowding per acre, per house and per room, in each case to an excessive amount. Mortality. The mortality of the Strand District compares unfavourably with that of London as a whole. That this is due to the influence of certain parts and not to the condition of the whole district can readily be shown by the following table : — TABLE VIII- Death-rate per 1,000 of the Population. 1891. 1892- 1893. 1894. 1895. Average of 6 years. London 21-4 20-fi 20-9 17-4 19-8 200 Strand District 2C-7 25-0 2G-5 19-8 22-2 24-1 Registration Sub Districts St. Anne 23-3 21-1 23-6 16-7 16-3 20-2 Strand 30-3 29-0 30-1 22-7 280 28-0 Thus, while the average for the St. Anne's half of the District is nearly that of London, the southern part has an average rate of 28 per 1,000. Having kept a record of the houses given as the addresses of persons who have died, I have been able to locate certain areas wherein this high rate has occurred ; I have thus been able to single out St. Clement Danes and St. Mary-le-Strand as the parishes having e XXII APPENDIX. the highest death rates, and in these parishes the areas which formed the subject of the representation, thus:— TABLE IX. Death-rate per 1,000 estimated Population. Parish. 1893. 1894. 1895. Average. St. Clement Danes 32.75 23.8 31.67 29.4 St. Mary-le-Strand 39.24 31.4 26.9 32.5 From the subjoined Table X, it will be seen that the average deathrate in the Represented Area during the five years ending 1895 is 3771 per 1,000, being 13.6 above the average for the whole Strand Sanitary District and 17.7 above that for all London. It also exceeds the average rate for the southern part of the Strand District by 9.7. Moreover, on an analysis of the population and a comparison of the numbers who have died at each group of ages with the numbers dying in the same periods in all London, it appears that the actual number of deaths in the district are double the number which ought to take place. TABLE X.—Showing Death Kates of Area and Sub-Areas compared with London and Strand District. General Death-rate. Average of 5 years. 1891 1892 1893 1894 1895 London 21.4 20.4 20.9 17.7 19.8 20.00 Strand District 26.75 25.09 26.59 19.87 22.2 24.10 The Area 34.18 35.84 44.83 39.03 34.67* 37.71 Sub-Area A 41.40 32.92 38.92 41.32 38.1* 38.53 Sub-Area B 22.85 39.5 50.52 25.91 30.3 33.77 Sub-Area C 30.17 40.18 47.62 41.36 30.9 38.05 * Omitting population and deaths in connection with Common Lodging-Houses, the Death-rate for 1895 would be 33.2 for the whole Area and 37.5 for Sub-Area A. From the above Table, an average of 15 deaths per year are omitted of persons whose exact residence in the Area is unknown. appendix. xxiii Appended to this Report are Summaries of the Causes of Death for the years 1891, 1892, 1893, 1894 and 1895. Infant Mortality.— Throughout the central districts of the Metropolis the death-rates of children have for many years been higher than in any other group of districts. In my Annual Report for 1892, I pointed out that 211 infants in each 1,000 born in the Strand District died before they were one year old, against 154 in all London, and I added, "this large mortality among infants (the "highest of any district in London) is apparently not confined to "1892, for 1 find the same rate prevailed exactly 10 years ago and "that in the interval it has averaged 220." Being unable to ascertain the Birth-rate in the represented Area with accuracy, I cannot present figures for comparison. The birthrate in the Registration Sub-districts containing the Area have not been high, averaging only 22.1 per 1,000 population during the last five years, while the average for all London during the same period was 30.8. Undoubtedly, however, the birth-rate in the Area would be higher than that of the remaining portion of the Registration Sub-district. In the Registration Sub-districts of St. Mary and St. Clement (now united into the Sub-district of "Strand") the deaths of children under 1 year of age have always been excessive. Table XI exhibits the rates during the last three years in London and in the southern part of the Strand Sanitary Area. TABLE XI. Deaths of Infants under 1 year of age per 1,000 Births. 1893. 1894. 1895. London 164 143 165 Registration Sub-District of "Strand" 241 205 192 e 2 xxiv Appendix. It has been estimated that there are 312 children under 5 years of age in the represented Area; were the death-rate the same as the average for London for that age-group during the decade 1881-90 (Annual Report of the Medical Officer of Health for the County of London for 1893, p. 8) the expected number of deaths would be 20, instead of that however 39 were registered in 1895, and the average for the last five years is 49.8. I have in my Annual Reports drawn attention to the fact that a certain amount of poverty exists in this part of the district, and it might be assumed that this of itself might be sufficient to cause an increase in the death and sickness rates, but while a certain degree of this may be admitted it cannot be denied that the general arrangement of the streets and courts, with the want of air and light, accentuates the tendency to ill-health, which exposure, deficient food and intemperance has initiated. But, at the same time, it must be remembered that many of the inhabitants endeavour to make the best of their surroundings so far as these will admit, and conditions existing are not all to e placed to the credit of the careless habits of the people. The same factors which produce the high infant death-rate also affect the health of the older members of the community and lead to a gradual deterioration of the constitution, rendering them susceptible to disease and unable to withstand it. While the course of all diseases is aggravated by such conditions it is found that persons living in crowded, insanitary, and badly ventilated houses, suffer especially from diseases affecting the respiratory system and from tubercular disease (as Pulmonary Consumption).* In the represented Area nearly half (46.3 per cent) the deaths in the last five years were due to these causes. The average death-rate for the five years in the represented Area from Respiratory Diseases (exclusive of Phthisis) is 12 per 1,000 inhabitants. This is double the average rate for the Strand District and three times that for all London. The average death-rate for the five years in the Area from Phthisis and other Tubercular disease is 6.5 per 1,000 inahabitnts, while for London and the Strand District it is 2.6 and 4.1 respectively. * Barry and Gordon Smith: Report on Back-to-Back Houses, 1888. APPENDIX. XXV Zymotic Disease.— Insanitary conditions affect zymotic disease in two ways; they afford suitable ground for the introduction of infection, and they render less the chance of recovery in those affected. Table XII discloses a comparison of the Zymotic deathrate in the Area, Sub-Areas, Strand and London. TABLE XII. Death-rate from the Principal Zymotic Diseases. 1891. 1892. 1893. 1894. 1895. Average 5 years. London 2.30 2.80 3.07 2.70 2.65 2.70 Strand 2.00 3.46 2.69 2.36 2.01 2.56 Area 1.86 4.59 6.27 7.09 3.81 4.72 Sub-Area A 2.30 4.04 5.07 7.71 3.31 4.48 Sub-Area B 0.00 4.36 3.48 4.31 6.06 3.64 Sub-Area C 1.21 7.08 8.26 7.29 3.56 5.48 XXVI APPENDIX. the whole area—summary of causes of death. CAUSES OF DEATH. 1891. ages. 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 Totals. I.— SPECIFIC FEBRILE, OR ZYMOTIC DISEASES— 1. Miasmatic Diseases 1 2 1 ... ... ... ... 1 1 ... ... 6 2. Diarrhœal „ 1 1 ... ... ... ... ... ... ... ... ... 2 3. Tubercular „ 3 3 1 ... 5 3 3 1 ... ... ... 19 4. Venereal „ 3 ... ... ... ... ... ... ... ... ... ... 3 5. Septic „ ... ... ... ...... ... ... ... ... ... ... ... ... 11.—D1ETIC DISEASES 1 2 ... ... ... ... ... ... ... ... ... 3 III.— CONSTITUTIONAL DISEASES ... ... ... ... 1 1 ... ... 1 ... ... 3 IV.— LOCAL DISEASES— 1. Diseases of Nervous System 6 3 ... ... ... ... ... 2 ... ... ... 11 2. Diseases of Circulatory System ... ... 1 ... ... ... 1 ... 2 ... ... 4 3. Diseases of Respiratory System 11 2 ... ... 3 4 5 11 3 ... ... 39 4. Diseases of Digestive System 1 ... ... 1 ... ... 1 ... ... ... ... 3 5. Diseases of Urinary System ... ... ... ... ... 2 1 2 ... ... ... 5 6. Diseases of Reproductive System ... ... ... ... ... ... ... ... ... ... ... ... 7. Diseases of Bones and Joints ... ... ... ... ... ... ... ... ... ... ... ... 8. Diseases of Integumentary System ... ... ... ... ... ... ... ... ... ... ... ... V— DEVELOPMENTAL DISEASES 3 ... ... ... ... ... ... ... 1 ... ... 4 VI— VIOLENCE 4 ... ... ... 2 1 1 ... ... ... ... 8 Totals 34 13 3 1 11 11 12 17 8 ... ... 110 1892. I.— SPECIFIC FEBRILE, OR ZYMOTIC DISEASES— 1. Miasmatic Diseases 1 8 2 1 ... ... ... ... ... ... ... 12 2. Diarrhœal „ 2 ... ... ... ... ... ... ... 1 ... ... 3 3. Tubercular „ ... 4 1 3 5 4 4 ... ... ... ... 21 4. Venereal „ 2 ... ... ... ... ... ... ... ... ... ... 2 5. Septic „ 1 1 ... 1 ... 1 ... ... ... ... ... 4 II.— DIETIC DISEASES ... ... ... ... ... ... ... ... ... ... ... ... III.— CONSTITUTIONAL DISEASES ... ... ... ... ... ... ... 2 ... ... ... 2 IV.— LOCAL DISEASES— 1. Diseases of Nervous System 2 ... ... ... 1 2 2 ... ... ... ... 7 2. Diseases of Circulatory System ... ... 3 ... 1 2 2 ... ... ... ... 8 3. Diseases of Respiratory System 7 8 ... ... 2 6 5 9 2 ... 1 40 4. Diseases of Digestive System ... ... ... ... ... 1 1 ... ... ... ... 2 5. Diseases of Urinary System ... ... ... ... ... 2 3 1 ... ... ... 6 6. Diseases of Reproductive System ... ... ... ... ... 1 ... ... ... ... ... 1 7. Diseases of Bones and Joints ... ... ... 1 ... ... ... ... ... ... ... 1 8. Diseases of Integumentary System ... ... ... ... ... ... ... ... ... ... ... ... V.- DEVELOPMENTAL DISEASES 5 ... ... ... ... ... ... ... ... ... 1 7 VI.— VIOLENCE ... ... ... ... ... ... ... l ... ... ... 1 Totals 20 21 6 6 9 19 17 13 3 1 2 117 xxvii appendix. THE WHOLE AREA—SUMMARY OF CAUSES OF DEATH—Continued. CAUSES OF DEATH. 1893. ages. 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 Totals. I.— SPECIFIC FEBRILE. OR ZYMOTIC DISEASES— 1. Miasmatic Diseases 5 8 3 ... ... ... ... ... ... ... ... 16 2. Diarrhœal „ 3 1 ... ... ... ... ... ... ... ... ... 4 3. Tubercular „ 2 3 2 2 2 1 3 1 ... ... ... 16 4. Venereal „ ... ... ... ... ... ... ... ... ... ... ... ... 5. Septic „ ... ... ... ... 1 ... ... ... 1 ... ... 2 II— DIETIC DISEASES 1 1 ... ... 1 2 ... ... ... ... ... 5 III.— CONSTITUTIONAL DISEASES 1 ... ... 1 ... 1 ... 5 2 ... ... 10 IV.— LOCAL DISEASES- 1. Diseases of Nervous System 5 3 ... ... ... ... ... 1 1 ... ... 10 2. Diseases of Circulatory System ... ... ... 1 1 2 ... 5 ... ... ... 9 3. Diseases of Respiratory System 11 4 1 ... 5 4 7 6 3 ... ... 41 4. Diseases of Digestive System 1 1 ... ... 1 2 1 ... ... ... ... 6 5. Diseases of Urinary System ... ... ... ... ... 4 ... 1 ... ... ... 5 6. Diseases of Reproductive System ... ... ... ... ... ... ... ... ... ... ... ... 7. Diseases of Bones and Joints ... 1 1 ... ... ... ... ... ... ... ... 2 8. Diseases of Integumentary Sytem 1 ... ... ... ... ... ... ... ... ... ... 1 V.— DEVELOPMENTAL DISEASES 7 ... ... ... ... ... ... ... 1 ... ... 8 VI.— VIOLENCE ... ... ... ... ... ... 3 ... 1 ... ... 4 Totals 37 22 7 4 11 16 14 19 9 ... ... 139 1894. I.— SPECIFIC FEBRILE, OR ZYMOTIC DISEASES— 1. Miasmatic Diseases 6 13 ... ... ... ... ... ... ... ... ... 19 2. Diarrhœal „ 3 ... ... ... ... ... ... ... ... ... ... 3 3. Tubercular „ 3 2 1 3 1 7 1 2 1 ... ... 21 4. Venereal „ 2 ... ... ... ... ... ... ... ... ... ... 2 5. Septic „ 1 ... ... ... 1 ... ... ... ... ... ... 2 II.— DIETIC DISEASES ... ... ... ... ... ... ... ... 1 ... ... 1 III.— constitutional disEASEs ... ... ... ... ... ... ... 2 ... ... ... 2 IV.— LOCAL DISEASES— 1. Diseases of Nervous System 3 ... ... ... ... 1 1 ... ... ... ... 5 2. Diseases of Circulatory System ... ... ... ... ... 3 1 3 ... 1 ... 8 3. Diseases of Respiratory System 12 9 1 ... ... 5 2 2 3 2 ... 36 4. Diseases of Digestive System l 2 1 ... 1 1 ... ... ... ... ... 6 5. Diseases of Urinary System ... ... ... 1 1 1 1 1 ... ... ... 5 6. Diseases of Reproductive System ... ... ... ... ... ... ... ... ... ... ... ... 7. Diseases of Bones and Joints ... 1 ... ... ... ... ... ... ... ... ... 1 8. Diseases of lntegumentary System ... ... ... ... ... ... ... ... ... ... ... ... V.- DEVELOPMENTAL DISEASES 3 ... ... ... ... ... ... ... ... 1 ... 4 VI.— VIOLENCE ... 1 ... ... ... ... 2 1 ... ... ... 4 vii.— ILL-DEFINED 1 ... ... ... 1 ... ... ... ... ... ... 2 Totals 35 28 3 4 5 18 8 11 5 4 ... 121 xxviii apPEnDIx. THE WHOLE AREA.— SUMMARY OF CAUSES OF DEATH—Continued. CAUSES OF DEATH. 1895. ages. 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 Totals. I.— SPECIFIC FEBRILE, OR ZYMOTIC DISEASES— 1. Miasmatic Diseases ... 3 2 1 ... ... 1 1 1 ... ... 9 2. Diarrhœal „ 5 ... ... ... ... ... ... 1 ... ... ... 6 3. Tubercular „ ... 4 ... 2 3 4 1 ... ... ... ... 14 4. Venereal „ 3 ... ... ... ... ... ... ... ... ... ... 3 5. Septic „ ... 1 ... 1 ... ... ... ... ... ... ... 2 II— DIETIC DISEASES ... ... ... ... ... ... ... ... ... ... ... ... III.— CONSTITUTIONAL DISEASES 1 ... 1 1 ... 1 1 2 2 ... ... 9 IV— LOCAL DISEASES— 1. Diseases of Nervous System 6 2 ... ... 1 1 1 1 ... 1 ... 13 2. Diseases of Circulatory System 1 ... ... 2 ... ... ... 2 ... ... ... 5 3. Diseases of Respiratory System 5 2 1 1 2 4 3 3 6 5 ... 32 4. Diseases of Digestive System ... ... ... 2 ... ... ... ... ... ... ... 2 5. Diseases of Urinary System ... ... ... ... ... 1 ... ... ... ... ... 1 6. Diseases of Reproductive System ... ... ... ... ... ... ... ... ... ... ... ... 7. Diseases of Bones and Joints ... ... ... ... ... ... ... ... ... ... ... ... 8. Diseases of Integumentary System ... ... ... ... ... ... ... ... ... ... ... ... V— DEVELOPMENTAL DISEASES 7 1 ... ... ... ... ... 2 2 ... ... 12 VI— VIOLENCE 1 ... 2 ... ... ... ... ... ... 1 ... 4 Totals 26 13 6 10 6 11 7 12 11 7 ... 109