STR 4 ANNUAL REPORT on the STATISTICS and SANITARY CONDITION relating to STRAND DISTRICT, LONDON, FOR THE YEAR 1899. by FRANCIS J. ALLAN, M.D., C.M., D.P.IL 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.cccc. TO THE CHAIRMAN AND MKMBERS OF THE BOARD OF WORKS FOR THE STRAND DISTRICT. Gentlemen, I have the honour to submit to you my Annual Report on the Health and Sanitary Condition of the Strand District during the year 1893. It contains the Statistical Tables required by the Local Government Board, and other tables from which an idea may be formed of the position the District occupies from a health point of view, as compared with London as a whole and its various groups of districts. I have again to call attention to the great difficulty which those classes of the community who are compelled to live in Central London experience in finding accommodation. I had hoped that the buildings which the County Council promised to ercct, would have been ready for occupation before any large number of persons had been displaced from the Clare Market Area, but now some 1,300 persons have had to quit their houses without such provision having been made, with the result that overcrowding has largely increased in the neighbourhood. As the new street from Holborn to the Strand will displace many more persons, and as the want of houseroom prevents action being taken with respect to insanitary property, it is of the greatest importance that the Council should proceed to the erection of the promised dwellings without further delay. Although this is the last Annual Report that I shall have the honour of submitting to your Board, I hope to be able to present, during the present year, a supplementary report giving a resume of statistics and other matters affecting the health of the District, since the formation of the Board. I have again to express my satisfaction with the way in which the Officials of the Health Department have discharged their duties. I am, Gentlemen, Your obedient Servant, FRANCIS J. ALLAN, Medical Officer of Health. Health Department, 5, Tavistock Street, W.C. 27th January, 1900. SUMMARY OF STATISTICS. Area of the Strand District (exclusive of water) Strand portion 113 acres St. Anne's „ 53 „ 166 acres. Population, estimated to the middle of 1899:— Strand portion 11,900 St. Anne's „ 12,100 24,000 BIRTH-RATE:– For 1809. Average of 10 years, 1889-98 England and Wales 29.2 30.2 London 29.3 30.7 Strand District 21.2 23.3 Strand Sub-District 17.9 21.3 St. Anne's „ 24.4 25.5 Death-Rate:— England and Wales 18.3 18.4 London 19.7 19.7 Strand District 21.4 23.1 Strand Sub-District 25.5 26.8 St. Anne's „ 17.3 19.4 ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH of thk STRAND DISTRICT, LONDON. Population. From the changes which are taking place in this District, it is impossible to determine with accuracy the figures which best represent the population of the District. The estimate of the Registrar-General, based upon the rate of decrease in the period between the last two census years, is, for the year 1899, 23,016 ; but to this figure there must be added those persons who are resident in the various Poor-Law establishments, and who add considerably to the death rate of the District. According to the return prepared under the Equalisation of Hates Act, the Registrar-General estimates the population resident in this District as 23,872 (11,661 in St. Anne's, 12,211 in the Strand Sub-District), so that there is a difference of 856 between his two estimates. My own calculation of the population as at the middle of the year 1899, is 24,000, including inmates of the Poor-Law establishments connected with the District. This figure is divided into 11,900 for the Strand portion of the District, and 12,100 for St. Anne's portion, and may possibly be a little too high for the former, and not quite high enough for the latter. 6 ON THE SANITARY CONDITION OF Day Population.—For many years the Strand District has been becoming less a residential district and more a business one, the number of persons found sleeping in it does not therefore, represent the true population of the District. In the City o London, a day census has been taken and by bringing these into relation with the number of persons sleeping in the City, and the number of bouses used only by day, a factor is obtained, which on being applied to the conditions existing in the Strand District, gives 83,712 as the number of persons actively employed in the District during the day. This of course, does not take cognizance of the large number of persons passing through the District, or who frequent the Law Courts, Somerset House, Covent Garden Market, the theatres and music halls. Census of 1901.—It is a matter of importance to centrallysituated districts, that at the next census, the Imperial authorities should take the number of persons actively employed in the various districts. In view of the Census Bill having to be introduced into Parliament in 1900, the Board, on the recommendation of the Health Committee, passed the following resolutions on the subject:— (a) That the Census Act of 1900 should provide for an Intermediary Census in 1906. (b) That the Census be not taken on Easter or Whit- Sunday. (c) That the Census Act should be passed as early as possible, and certainly not later than Easter, 1900, in order that there may be time for proper arrangements to be made. (d) That the Census Returns should not be primarily based on Poor Law areas, but on the areas of Municipal and Sanitary Authorities; and that the age and occupation of the inhabitants of every sanitary area, and subdistricts of the larger areas, be separately tabulated and published. 7 THE STRAND DISTRICT, LONDON. (e) That, as the number of persons sleeping in the Strand District is but a small portion of the day population, the time has now arrived when provisions should be included in the Census Act whereby information shall be obtained as to the number of persons employed in the District during the day, discriminating employers from employed, sex, and nature of employment. Births. The total number of births registered in the District was 473. This has to be corrected by the addition of 9 births in Poland Street Workhouse, 10 in Edmonton Workhouse, and 24, which I am informed through the courtesy of the Secretary, occurred in the British Lying-in Hospital, Endell Street; while 6 births in Bear-yard Workhouse have to be placed to the credit of St. Martin-in-the-Fields parish, leaving a total of 510 births. The birth rate is thus 21.2 per 1,000 inhabitants, as against 2114 in 1898. The birth rate in London for 1899 was 29.3 per 1,000; the average of the previous ten years was 30.7. Table I. shewing the corrected Number of Births (Male and Female) occurriug in the Strand District, and each of its SubDistricts, in the Year ending December 31st, 1899. Male. Female. Total. Rate per 1,000 of Population in 1899. Average Rate per 1,000 in the 10 years 1889-98. 1. St. Anne's SubDistrict 160 136 296 24.4 25.53 2. Strand Sub-District 114 100 214 179 21.32 Strand District 274 236 510 21.2 23.38 8 ON THE SANITARY CONDITION OF TABLE II. Births in the Strand District in each of the ten years, 1890-99 Year. Strand District. St Anne Sub-District Strand Sub-District. 1890 560 321 239 1891 640 334 306 1892 590 310 280 1893 607 330 277 1894 556 288 268 1895 618 324 294 1896 578 292 286 1897 580 314 266 1898 *542 290 252 1899 *510 296 214 * Corrected as fully as possible. Deaths. The total number of deaths, after correction,† which were registered as properly belonging to this District, during the year was 5 L4. was 514. This is nearly up to the average number (519) recorded in the preceding five years, as shown in Table III. Parish. 1891. 1895. 1896. 1897. 1898. 1899. St. Anne, Soho 202 203 231 185 205 210 St. Clement Danes 201 254 216 220 241 232 St. Mary-le-Strand 49 42 45 35 47 33 St. Paul,Covent Garden 33 37 38 40 23 32 Precinct of the Savoy 2 8 3 5 2 2 Liberty of the Holls ... G 7 4 6 2 5 Strand District 493 551 537 491 523 514 † 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. 9 THE STRAND DISTRICT, LONDON. Upon the basis of the estimated population already referred to, the death.rate for 1899 is 21.41 per thousand persons as compared with 23.18 per thousand, the average rate for the preceding ten years. The death.rates in the four quarters were as follows:— 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. London 20.1 16.2 20.1 20.9 Strand 22.3 18.83 18.83 25.6 The London rate for the year was 19.7 per 1,000, being the same as the decennial average. TABLE IV. Death Rates in the Groups of Metropolitan Districts in 1899, compared with those in the Strand. ANNUAL KATE FEB 1,000 PERSONS LIVING. Deaths under 1 year to 1,000 Births Districts. All Causes. Deaths from Principal Zymotic Diseases. Small.Fox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Fever. Diarrhœa Phthisis. London 19.7 2.46 0.00 0.47 0.08 0.43 0.37 0.17 0.92 1.81 167 West 18.0 1.91 – 0.22 0.10 0.26 0.33 0.15 0.80 1.65 174 North 17.7 2.17 0.00 0.40 0.09 0.35 0.38 0.15 0.78 1.63 155 Central 23.0 2.20 – 0.45 0.11 0.27 0.26 0.22 0.90 2.75 172 East 22.9 3.17 0.00 0.72 0.06 0.47 0.45 0.24 1.23 2.18 180 South 19.0 2.62 0.00 0.53 0.09 0.54 0.36 015 0.94 1.75 164 Strand Sub.Dists. 21.41 1.37 – 0.16 0.04 0.25 – 0.04 0.87 2.75 180 St. Anne 17.35 1.40 – 0.08 0.08 0.4l – 0.08 0.74 1.40 135 Strand 25.54 1.34 – 0.25 – 0.08 – – 1.00 3.27 243 Note.—Where the deaths under any heading are too few to express as a rate per 1,000 within two places of decimals, 0.00 is inserted; where no deaths have occurred, it is expressed thus — 10 ON THE SANITARY CONDITION OF The Strand District forms one of the Central Group. Appended to this Report are Tables A and B required by the Local Government Board, together with Tables showing the causes of death in the Strand District, and in each of its SubDistricts at various groups of ages, and distinguishing males and females Tables Y, VI, and XII. From these Tables it may be seen that 544 deaths occurred in the District; 241 of these were of persons who did not belong thereto, and 211 persons belonging to the District died outside its bounds. 147 inhabitants of the District died in Poor Law Institutions, 15 in Lunatic Asylums, 0 in Fever Hospitals and 88 in General and Special Hospitals; thus 48.6 per cent. of the deaths of residents occurred in Public Institutions (41.9 in St. Anne, 53.2 in Strand Sub-District); 28.1 per cent. of the deaths in all London were under similar circumstances. TABLE V. Deaths in the Strand District, 1899. Showing Locality at time of Death. Registration Sub-District. SubDistricts. Workhouses and Infirmaries. General and Special Hospitals. Fever Hospitals. Lunatic Asylums. Totals. Males. Females. 1 Males. Females. Males. Females, j Males. Females. ; Males. Females. Males Females. Males and Females. St. Anne Soho 52 70 17 26 23 16 – – 4 2 96 114 210 Strand 83 59 59 45 27 22 – – 5 4 174 130 304 Strand District 135 129 76 71 50 38 – – 9 6 270 244 514 Table VI. shows the death rates per 1,000 persons at various groups of ages, as estimated from the number of persons living at these ages at the census. It also shows the deaths of males and females in the sub-districts, and gives the rates for the preceding 10 years for comparison. 11 THE STRAND DISTRICT, LONDON. TABLE VI. Age Groups. Strand District. Strand Sub.District. ' St. Anne, Soho. 10 years. 1899. • 10 years. 1899. 10 years. 1899. 0 to 1 year * 196 182 217 247 179 135 1 to 5 years 39.6 21.8 49.0 20.3 31.0 18.2 5 to 15 years 3.7 3.3 4.2 2.7 3.4 3.8 15 to 25 years 4.3 5.4 4.8 6.9 3.79 3.9 25 to 65 years 20.3 20.0 23.8 24.2 16.1 15 6 65 years and over 97.0 100.0 102.0 101.4 84.3 97.7 0 to 5 years 81.3 50.0 94.6 73.8 69.9 47.1 5 years and over 17.4 17.6 20.9 21.2 13.7 14.0 At all Ages:— Persons 23.2 21.4 26.8 25 5 19.5 17.3 Males 24.5 22.2 28.3 28.8 20.05 15.6 Females 21.9 20.5 25.2 22 1 18.3 19.4 * Deaths under 1 year of age are per 1,000 births. Causes of Death.—As in former years, deaths from diseases due to Tubercle (phthisis, scrofula, &c.), and from other diseases affecting the Respiratory System occupy a prominent place. The Tubercular rate, however, shows some improvement over that of the preceding year; but the Respiratory rate is a little worse, due, doubtless, to the Influenza which appeared at the close of the year; 10 deaths attributable directly to this cause are included under " other causes," in the next Table. TABLE VII. Death Rates from Groups of Diseases per l, 000 persons living in 1891 Diseases. London. Strand District. St. Anne's Sub.District. Strand Sub.District. Principal Zymotic 2.46 1.37 1.40 1.34 Tubercular 2.48 3.41 2.64 4.20 Respiratory 3.89 5.08 4.13 6.05 Nervous 1.81 1.95 1.40 2.52 Heart and Blood vessels 1.69 2.08 1.32 2.85 Constitutional 1.27 1.29 1.48 1.09 Digestive System 1.52 0.33 0.16 0.50 Debility at Birth 0.72 1.00 0.74 1.26 Old Age 0.64 0.91 0.74 1.09 Urinary Organs 0.57 1.00 0 66 1.34 Violence 083 0.83 0.99 0.67 Dietic 0.18 0.79 0.66 0.92 Septic 0.11 0.37 0.24 050 Other Causes 1.53 0.90 0.74 1.17 All Causes 19.7 21.41 17.35 25.54 12 ON THE SANITARY CONDITION OF Notifiable Infectious Diseases. 126 certificates were received in 1899, relating to 121 cases of infectious disease. The amount paid for certificates during the year was £11. 17s., which is refunded to this Board by the Metropolitan Asylums Board. TABLE VIII. Cases notified per 1,000 population in 1899. Disease. London. Strand. St. Anne Sub-District. Strand Sub-District. Smallpox 0.00 – – – Scarlet Fever 3.98 2.29 3.14 1.42 Diphtheria & Membranous Croup 3.02 1.54 2.56 0.50 Typhus Fever 0.00 – – – Enteric Fever 0.98 0.50 0–49 0.50 Continued 0.01 – – – Relapsing „ 0.00 – – – Puerperal ,, 0.07 – – – Cholera 0.00 – – – Erysipelas 1.23 0.70 0.66 0.75 Total 9.32 5.01 6.85 3.19 Although the notifications were more in number than last year, they were as a whole below the average of previous years both in London and the Strand. Table X. shows the ratio of cases of each disease notified in the various Metropolitan Sanitary Districts. It will be seen that some of the Southern districts suffered heavily from both Scarlet Fever and Diphtheria, while Enteric Fever was proportionately most felt in the City and in the Eastern group, and to a less extent in some of the Central and Southern Districts. During 1899, no difficulty was experienced in obtaining admission of patients to hospital from the Strand District. 89 per cent. of the Scarlet Fever; 89.1 per cent. of the Diphtheria; 58.3 per cent. of the Enteric Fever; and 23.5 of the Erysipelas cases were so treated. A recent decision of the High Court (in "Warwick v. Graham") has settled that where a person suffering from an infectious disease, is liable to 13 THE STRAND DISTRICT, LONDON. municate and spread the malady to others, he has not "proper lodging and accommodation " and the Sanitary Authority may obtain a Magistrate's Order for his compulsory removal. TABLE IX. Infectious Diseases notified, 1890—1899. In London. Year. Small Pox. Scarlet Fever. Diphtheria and Croup. Enteric Fever. Typhus Fever. Other Continued Fevers. Puerperal Fever. Erysipelas Cholera. Relapsing Fever. Totals. 1890 60 15,330 5,870 2,877 35 237 206 4,598 25 7 30,245 1891 114 11,398 6,412 3,372 27 152 221 4,764 23 39 26,552 1892 423 27,095 8,356 2,465 20 147 347 6,934 54 7 45,848 1893 2,813 36,901 13,694 3,666 2,2 205 397 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 979 19,757 11,223 3,506 14 105 236 5,660 29 3 41,512 1896 225 25,647 13,941 3,190 6 103 279 6,438 13 3 49,845 1897 104 22,848 13,199 3,103 4 65 264 5,800 38 1 45,361 1898 32 16,894 11,855 3,024 16 55 247 5,169 23 1 37,316 1899 29 18,089 13,684 4,452 13 69 326 5,607 15 1 42,285 In the Strand District. 1890 – 60 10 13 – – – 10 – – 93 1891 – 33 13 19 – 1 1 12 – – 79 1892 7 111 33 12 – – 1 22 – – 186 1893 30 143 79 11 – – 1 22 – – 286 1894 5 52 30 15 – 1 – 11 – – 114 1895 5 116 36 24 – – – 17 –– – 198 1896 – 130 36 9 – – 1 11 – – 187 1897 8 122 41 18 – – – 17 – – 206 1898 – 45 50 9 – – – 11 – – 115 1899 – 55 37 12 – – – 17 – – 121 Scarlet Fever.—This disease was somewhat more prevalent in London than in 1898. 38 cases were notified in St. Anne's, with 1 death; 32 families had 1 case each, 2 families had 3 cases each; 5 cases occurred in Sandringham Buildings ; 10 in Newport Dwellings; in the rest of St. Anne's Parish a second case occurred in only one house. 17 cases occurred in the Strand Sub-District, with no deaths; 10 families had 1 case each, 2 had 2 cases each, and 1 had 3 cases. No cases occurred in any of the houses among the members of families other than those first attached. TABLE X. Cases of Infectious Disease notified in the several Sanitary Districts of the Metropolis, in the year 1899 stated as per 1,000 of Population. Name of District. Small.pox. Scarlet Fever. Diphtheria. Enteric Fever. Typhus Fever. Other Continued Fevers Puerperal Fever. Erysipelas. Cholera. Totals. West Districts. Paddington ... 2.97 1.58 0.76 0.00 0.00 0.05 1.14 ... 6.5 Kensington ... 2.56 1.48 0.61 0.00 0.09 0.06 1.21 ... 6.0 Hammersmith ... 4.05 1.76 1.06 0.00 ... 0.11 1.05 ... 7.9 Fulham 0.00 6.50 4.00 0.82 ... 0.00 0.08 1.54 0.03 12.9 Chelsea ... 2.91 2.46 0.60 ... 0.04 0.08 0.85 0.00 7.0 St. George, Hanover Sq. ... 2.44 1.12 0.56 ... ... 0.02 0.91 ... 5.0 Westminster ... 3.81 1.91 0.86 ... 0.01 ... 1.07 ... 7.7 V8t James, Westminster ... 2.24 1.69 1.55 ... ... ... 1.00 ... 6.5 North Districts St. Marylebone 0.01 2.85 1.39 0.84 ... 0.00 0.04 1.42 ... 6.5 Hampstead ... 3.60 1.44 0.56 ... ... 0.06 0.64 ... 6.3 St. Pancras ... 3.52 2.30 0.98 ... ... 0.05 1.25 0.00 8.1 Islington 0.00 4.31 2.04 1.03 ... 0.00 0.09 102 0.00 8.5 Stoke Newington ... 5.17 0.85 0.48 ... ... 0.19 0.99 ... 7.7 Hackney 0.00 4.44 3.19 1.20 ... 0.02 0.09 1.35 ... 10.3 Central Districts. St. Giles, Bloomsbury ... 2.04 0.80 0.64 ... ... 0.02 1.47 ... 5.0 St. Martin.in.the.Fields ... 2.55 1.40 0.57 ... ... 0.08 0.73 ... 5.4 Strand ... 2.29 1.54 0.50 ... ... ... 0.70 ... 6.0 Holborn 0.03 3.94 2.16 1.21 ... 0.06 0.03 1.48 ... 8.9 Clerkenwell ... 4.87 3.03 1.37 ... 0.01 0.09 1.07 ... 10.4 St. Luke, Middlesex ... 3.96 2.52 0.88 ... ... ... 1.58 ... 8.9 City of London ... 2.64 2.03 3.42 ... 0.03 ... 0.75 ... 8.9 Shoreditch 0.00 3.00 3.09 1.39 ... 0.01 0.08 1.66 0.00 9.2 East Districts. Bethnal Green ... 3.34 2.67 1.57 ... ... 0.14 2.52 0.00 10.2 Whitechapel 0.02 2.57 2.48 1.70 0.04 ... 0.06 1.53 ... 8.4 St. George.in.the.East 0.02 2.04 2.12 1.48 ... ... 0.10 1.60 ... 8.3 Limehouse 0.03 2.90 2.24 2.29 ... ... 0.05 1.32 ... 8.8 Mile End ... 2.61 3.30 1.22 ... 0.01 0.06 1.31 ... 8.5 Poplar 0.01 2.46 2.48 1.62 ... 0.02 0.08 1.34 ... 8.0 South Districts. St. Saviour, South wark ... 3.76 5.04 0.4.3 ... ... 0.12 1.40 ... 10.7 St. George, Southwark 0.01 3.93 7.40 0.92 0.01 0.01 0.03 1.25 ... 13.6 Newington ... 4.10 5.87 0.88 ... ... 0.04 1.62 ... 12.5 St. Olave, Southwark ... 5.76 2.88 1.00 ... ... 0.09 0.27 ... 10.0 Bermondsey ... 4.68 6.32 1.18 0.08 0.01 0.03 1.03 ... 12.2 Rotherhithe ... 6.24 3.90 1.31 0.02 ... 0.04 2.04 ... 13.5 Lambeth 0.00 3.29 3.64 0.72 0.00 0.03 0.09 1.09 0.00 8.8 Battersea ... 4.13 3.47 0.92 ... ... 0.08 1.18 ... 9.8 Wandsworth ... 4.34 2.94 0.64 ... 0.00 0.06 1.13 ... 9.1 Camberwell 0.01 4.32 4.69 0.66 0.00 0.01 0.07 0.97 ... 10.8 Greenwich 0.00 6.62 3.75 0.91 ... 0.01 0.07 1.49 0.00 12.8 Lewisham 0.01 6.37 5.28 0.63 ... 0.01 0.07 0.92 ... 13.3 Woolwich 0.02 4.02 3.15 0.65 ... ... 0.12 0.35 ... 8.6 Plumstead ... 10.9 2.84 0.39 ... 0.01 0.06 1.01 ... 15.3 Lee ... 4.85 3.35 0.52 ... ... 0.05 0.72 ... 9.5 The Metropolis * 0.00 3.98 3.02 0.98 000 0.01 0.07 1.23 0.00 9.3 * Includes 39 cases notified to the Port of London Sanitary Authority. 15 THF, STRAND DISTRICT, LONDON. Diphtheria and Membranous Croup.—31 cases (1 case not being Diphtheria) were notified in St. Anne's with 5 deaths, 24 houses were attacked and 25 families; 1 case occurred in a hospital outside the district, in which the patient was being treated for phthisis; 6 cases were notified in 5 families in 5 houses in the Strand Sub-District, with 1 death. In several instances, cases of Scarlet Fever had occurred in members of the same family, so that possibly some of the cases may have been preceded by an unrecognised attack of Scarlet Fever. In St. Anne's the cases were spread over the whole year, but in the Strand, they were confined to March, June, and July. Mr. Cribb, the bacteriologist appointed by your Board, reports that during the year 1899 he has examined 9 specimens taken from the throats of persons suspected of suffering from Diphtheria, or desirous of knowing that they were free from infection after having been exposed thereto. In two instances the result was doubtful, and on a second trial one case proved to be Diphtheria, the other not. In the remaining cases, the Diphtheria organism was not found. It is desirable where Diptheria occurs in a tenement house, that the persons living therein, especially the children, should be carefully examined, with a view to discover if any have been infected, so that prompt measures may be taken for isolation, and for treatment. The experience gained from the use of Antitoxin shows that the best results are obtained by early treatment. Enteric Fever.—6 cases were notified in St. Anne's parish (with 1 death), in the months of August (2), October (2), and November (2). Six cases also were notified in the Strand SubDistrict, in the months of January (1), April (1), June (2), September (1), and October (1). The number of cases of this disease notified in London as a whole, largely exceeded that of any previous year since notification was introduced. This increase is doubtless ascribable 16 ON THE SANITARY CONDITION OF to the favourable conditions produced by a larger amount of hot weather experienced, together with the lessened rainfall, which has characterised recent years. Table X. shows that the cases were by no means evenly distributed, and a weekly survey of the notifications shows clearly that in the week ending 14th October (41st week), a very sudden and rapid rise took place in the number of cases notified in the Eastern and Southern Districts. The Northern and Western Districts were much less affected, and the Central scarcely, if at all. The sharpness of the rise is suggestive of the introduction of the poison into those districts by some extensively used vehicle, as milk or water. More extensive enquiry than is possible here, is necessary to determine the mean3 by which the poison was diffused, but it is of interest to note that if the water supplied by any one of the companies is not maintained constantly at the highest standard of filtration, the water supplied by the other companies may be contaminated thereby, as in order to prevent a diminished supply on the part of any company, a general scheme of intercommunication between the companies has been instituted under Act of Parliament. Thus, the New River Company, which supplies this District, during 1899, has been receiving water from the Grand Junction and West Middlesex Companies, to make up that portion of its supply derived from the river Lea, which it had given up for the benefit of East London. Erysipelas.—8 cases were notified in St. Anne's parish, all in the second half of the year. 9 cases were notified in the Strand Sub-District (with 1 death), 2 of these occurred in King's College Hospital. Smallpox and Vaccination.—No case of Smallpox has occurred in this District since 1897. I am indebted to Mr. J. H. Penfold and Mr. W. C. Hasted, Vaccination Officers respectively of Westminster Union and Strand Union, for the subjoined details relating to the per- 17 THE STRAND DISTRICT, LONDON. fo rmance of Vaccination in those parts of the above Unions included in the Strand District for the year 1898. 1898. Births. Successfully Vaccinated. Insusceptible. Died Unvaccinated. Vaccination Postponed. Removed and Address not known. Removed and V. 0. informed. Conscientious Objection. Remaining. St. Anne 259 199 1 23 – 25 4 7 – Strand 236 140 3 28 14 34 3 3 11 Totals 495 339 4 51 14 59 7 10 11 Principal Diseases of the Zymotic Class. The Registrar-General classifies small-pox, scarlet fever, measles, diphtheria, whooping-cough, "fever" (typhus, enteric and continued), and diarrhoea under this heading. The Zymotic death-rates for London and the Strand District were 2.46 and 1.37 respectively per 1,000 of the population (See Tables IV. and "VII.) Compared with the averages in the ten preceding years, the mortality in London from small-pox, diphtheria, whooping-cough, scarlet fever and "measles" was below the average, while that from enteric fever and diarrhoea was above it. Schools and Infectious Disease.— Certificates have been forwarded to me by most of the school teachers in the District, relating to children who have been excluded from school on account of infectious disease existing in their homes, and chiefly from this source I have ascertained the existence of 38 cases of Measles, 1 of Whooping Cough, 7 of Mumps and 3 of Chickenpox. It is desirable, in the interest alike of the ratepayers, the teachers and school managers, that the Medical Officer should be kept informed of the existence of infectious disease. Measles.—No cases came to my knowledge till the middle of 1899; then the following appeared during the rest of the year:— B 18 ON THE SANITARY CONDITION OF 1899. St. Anne. Strand Sub-District. District. June – 2 2 July 5 2 7 September 2 1 3 October 2 6 8 November 3 2 5 December – 13 13 Total 12 26 38 Towards the end of the year this complaint became prevalent in adjoining parishes, and was doubtless introduced into the District by children attending schools in these parishes. With the view of checking its spread, the St. Clement Danes Infant School was closed for a period of three weeks from 8th December, on my recommendation. During that time the schoolroom was disinfected, and thoroughly cleansed. Three deaths occurred in the Strand Sub-District in June, July and September; 1 death in St. Anne's in November. Whooping Cough.—Only one case came to my knowledge, in St. Anne's, in January. Ghickenpox.—3 cases occurred in January, 1 in Strand, 2 in St. Anne's. Mumps.—7 cases occurred in January. All went to the same school, and 6 of them were in families living on the same staircase in Newport Buildings. Influenza became prevalent towards the end of the year, and added largely to the death-rate, especially through its effects on the respiratory system; as on former occasions, many elderly people were carried off. Diarrhceal Disease.—21 deaths occurred from Acute or Infantile Diarrhoea, 9 of the deaths being in St. Anne's, 12 in the Strand. Several deaths were registered as due to this cause, but on enquiry being made into the conditions, it was found that diarrhoea had been only a symptom of some other complaint 19 THE STRAND DISTRICT, LONDON. Enquiries were also made as to the cause of death of children under 1 year of age, and some of these ascribed to other causes were found due to diarrhoea. In a number of instances, several other cases were found in the same house, and in 13 houses, insanitary conditions were found, such as overcrowding, w.c. stopped, offensive accumulations, &c. Disinfection. During the twelve months ending 31st December, 1899, 97 premises were purified and cleansed after infectious disease, and 2,231 articles were disinfected in your Board's apparatus; 40 articles were burnt in your Destructor at the request of the owners. The use of formic aldehyde as a gas, or in the form of spray, has now been substituted in place of sulphur fumigation, and has given satisfactory results. One important result has been the great reduction in the time inmates of rooms undergoing process of disinfection, have been kept out of them. With the present methods, the "Temporary Shelter" is less likely to be made use of, and during 1899 no person was admitted thereto. A man (a foreigner), who was found removing some infected bedding for purpose of disinfection, in an improper manner, was cautioned by the Board. Cleansing of Persons Act.—Two persons applied during 1899. They were given a warm bath while their clothing was purified by being passed through the disinfecting apparatus. Mortuaries in the District. During the year, the number of dead bodies received into the mortuaries in the Strand District were as follows:— 1899. Total number of Bodies. After Infectious Disease. Post-mortem examinations made. Strand Mortuary 70 3 26 St. Anne's ,, 28 – 19 Total 98 3 45 B 2 20 ON THE SANITARY CONDITION OF Sanitary Work. The following list summarises the work carried out under the supervision of the Department during the year:— Number of visits paid by Sanitary Inspectors* 3,733 Preliminary notices served 318 Orders made by the Board (" Public Health London Act") 39 Dwelling Houses:— Inspections* 798 Premises in which works have been carried out 344 Letters written 670 Overcrowding abated (by written notice) 60 Cleansed and Whitewashed Throughout 27 Partially 134 Ventilation improved, walls, ceilings and floors repaired 41 Roofs made water-tight 53 Water closets:— Reconstructed and repaired 134 Additional provided 14 Water re-instated 19 Flushing apparatus repaired 23 Obstructions removed from 18 New pans and traps provided 13 Pans and traps cleansed 64 Drainage:— New drains constructed 44 Drains repaired 23 Sink and lavatory waste pipes disconnected and trapped 65 Rain water pipes repaired 45 Obstructions removed from drains 18 * Exclusive of the weekly inspection of Registered Houses. 21 THE STRAND DISTRICT, LONDON. Paving required or repaired:— In yards 46 In basements 42 Dust and dung removal:— Sanitary bins provided* 33 Offensive refuse removed from premises 32 Water supply:— Cisterns repaired and cleansed 66 Re-instatement of water after being cut off by Water Company 3 Certificates granted under " Public Health (London) Act," Section 48 3 Under-ground rooms:— Use prevented as separate dwellings 6 The stables and mews, 42 in number, have been regularly inspected, more particularly in regard to the periodical removal of manure. There are no cowsheds or slaughter-houses in this district. Smoke Consumption.—Smoke nuisances coming under Subsection A, of Section 24 of the "Public Health Act," have been dealt with by your Surveyor; those under Sub-section B, have had three statutory notices served upon them through the Health Department. Orders made in regard to chimneys sending forth black smoke in such quantity as to be a nuisance, have in each case been complied with. Systematic Inspection of houses has gone on regularly throughout the year as required by the "Public Health Act." Houses so dealt with are situated in the following streets:—Bateman Street, Bateman's Buildings, Clement's Inn Passage, Craven Buildings, Drury Court, Greek Street, Little Dean Street, Little Essex Street, Leicester Square, New Inn Passage, Newcastle Street, St. Anne's Court, Spur Street, and Whitcomb Street. * Under the Board's system of dust collection, fixed bins are being abolished. 22 ON THE SANITARY CONDITION OF Plans of Drainage Works.—A Bill promoted by the London County Council requiring the deposit with Sanitary Authorities of plans and notices of drainage works, received the Royal Assent under the title of the "Metropolis Management Acts Amendment (By-laws) Act, 1899." The principal section of the Act is as follows:— "2. The powers of the London County Council for making "by-laws under Section Two hundred and two of the Metropolis "Management Act, 1855, shall extend and apply to authorise "the Council to make By-laws for the following purpose. "Requiring persons about to construct, re-construct, or alter "the pipes, drains, or other means of communicating with sewers, "or the traps and apparatus connected therewith, to deposit with "the Sanitary Authority of the District such plans, sections, and "particulars of the proposed construction, re-construction, or "alteration as may be necessary for the purpose of ascertaining "whether such construction, re-construction, or alteration, is in "accordance with the statutory provisions relative thereto, and "with any By-laws made under the said section. "Provided that any such By-laws shall not require the "deposit of any plan or section in the case of any repair which "does not involve the alteration or the entire re-construction of "any such pipe, drain or other means of communicating with "sewers, or the traps and apparatus connected therewith. "Provided that any such By-laws shall not require the "deposit of plans, sections, and particulars before the work is "commenced in any case in wbich the alteration of the drains "must be carried out at once, but the By-laws may require such "deposit to be made within a limited time from the commencement "of the work." Draft by-laws have been prepared, but some doubt exists as to the power of Local Authorities under the "Metropolis Management Act" to enforce such by-laws, the present ones being under the "Public Health (London) Act." Public Health Act.—At the request of the County Council, the Board submitted an extensive series of amendments desired in connection with the " Public Health (London) Act." An Act to consolidate all the Health Acts relating to London is required. 2'3 THE STRAND DISTRICT, LONDON. Overcrowding.—In my report for 1898 I pointed out that many persons displaced from the Insanitary Area were finding accommodation in adjoining houses which were quite unsuitable for letting out in tenements. During the past year, a large number of cases of overcrowding have had to be dealt with. I also pointed out that if the County Council did not proceed at once with the scheme for a new street from Holborn to the Strand it would be necessary to take further action under the Housing of the Working Classes Acts. Holbom to Strand Netv Street.—Fortunately the Council were able to obtain the sanction of Parliament to their scheme, and in a few years the insanitary conditions existing in St. Clement Danes and St. Mary-le-Strand parishes will be removed. Meanwhile the urgent cry is for house-room. I had hoped that the Council would have erected buildings on the sites acquired by them for the purpose, before the end of 1899, but with the exception of one block of dwellings at Millbank, none of the others are ready. Until that is done a large number of people must continue to struggle on in the dwellings they at present occupy, as to close their houses under present circumstances would only tend to overcrowd adjoining districts. Houses in the following streets will be removed under this Act:—Bear Yard, Craven Buildings, Denzell Street, Drury Court, Houghton Street, Sardinia Street, Sheffield Street, Stanhope Street, Twining Street and Yere Street. In these streets I find that there are 111 premises used for dwelling purposes. In these are accommodated 534 families comprising 1,726 persons who occupy 833 rooms. 754 persons occupy one roomed tenements, 768 two-roomed tenements, 74 three-roomed tenements, and 130 persons living in 23 houses have more than three rooms at their disposal. During the last six years 390 deaths have occurred among the residents of these houses, giving an average death-rate of 32.2 per 1000; 21.5 per cent. of these deaths were due to tubercular disease and 15 per cent. to zymotic disease. In the respective streets the death-rate varied from 24 to 41 per 1,000. In the above calculations, the Receiving Ward in Bear Yard and four common lodging houses have been excluded. 24 ON THE SANITARY CONDITION OF Housing of the Working Glasses Act.—During 1899, the Arbitrator appointed by the Home Secretary, held enquiries as to the compensation to be paid by the Council in respect of those claims which had not been settled by agreement, and practically the Council have now acquired most of the property under the Clare Market Scheme. At the end of 1899, 99 houses were entirely closed and many others were only partially inhabited, probably about 1,000 persons have been displaced during the year. The death-rate for the Area estimated on the population as calculated to the middle of 1899, is 36 per 1,000, which is also the average of the preceding eight years. Of the 84 deaths, 18 were due to Consumption. Houses Let in Lodgings.—At the end of 1899, 112 premises had been placed upon the Register (51 in St. Anne's, 61 in the Strand). Of these 8 are at present closed. Those occupied contain 967 rooms, and accommodate 2,015 persons. Several owners of registered houses have been cautioned during the year, and in one instance an owner was summoned and fined £2 and 2s. costs, for failing to maintain the drainage of a registered house in good condition, whereby the basement was flooded for several days with sewage. Many of the tenants have been cautioned for neglecting to keep their places clean. Inspection of the houses has been made, on several occasions, early in the morning, and on one occasion, by myself, in regard to suspected cases, late at night. Legal Proceedings have been taken:— (1.) To close premises No. 104, Drury Lane, unfit for habitation (order and costs); (2.) To enforce an order of the Board in respect of defective drainage at No. 6, Yere Street (order to do work, and costs); (3.) Against a builder for failing to give notice of intention to construct a water-closet, and for improperly constructing the same. Penalty inflicted, £3 and 2s. costs. 25 THE STRAND DISTRICT, LONDON. Infringements of by-laws were brought under the notice of the Board in other instances, apologies being accepted where the work had been satisfactorily executed but where the failure to give notice had been due to an oversight. Common Lodging Houses.—By a decision of the Court of Queen's Bench, Salvation Army Shelters are found to come under the Acts governing common lodging houses. The action was taken in regard to the premises, 9, Stanhope Street, with reference to which your Board has, in the past, had to take action to abate overcrowding, &c. During 1899, 46 deaths occurred in connection with the Common Lodging Houses in this District, and 14 of them were from Consumption. On an average about one-third of the deaths among the inmates of these houses are due to Tubercle. House Record.—I explained a scheme in my last Report for keeping a record of each house in the District. I have now been able to carry this out for St. Anne's Parish, and for a considerable portion of the rest of the District, and benefit has already been found from it. It takes, however, some time to abstract the information scattered through the various books for past years, but I hope to have a record prepared for the whole District before it is merged into the City of Westminster. Clerical Assistance.—The appointment of Mr C. A. Mudge as Clerk in the Health Department, has proved of great assistance, and has enabled the work of the Department to be conducted more satisfactorily and expeditiously. Workshops. The inspection of workplaces is the special duty of Inspector Martinson, and the nature of the employments chiefly carried out in the District are set out in the list prepared by him of the work done under this heading during the year 1899. From the way in which dwellings and workplaces are united in the same building, it follows not infrequently, that the house as a whole has been inspected by Chief Inspector Strutt, so that works of 26 on the sanitary condition of re-drainage and such like may be included in the general list rather than under that of "Workshops." Number of inspections 771 ,, visits 1,746 Letters written 76 Extra W.C. accommodation provided 3 Overcrowding abated 4 Premises cleansed 241 Ventilation improved 2 Number of outworkers 304 Premises notified to H.M. Inspector 10 „ ,, from „ 4 Complaints from Home Office 3 There are now on the Register 267 Workshops, containing 761 workrooms, in which 2,628 males and 995 females are employed. These numbers are exclusive of shops, offices and Covent Garden Market, and show an increase on preceding years. Bakehouses.—The bakehouses have been regularly inspected. The number in the District has been reduced from 27 to 24. Laundries.—There are 18 in the District, and they have been inspected from time to time. Printing Offices have increased to 117. Tailors' workshops, to the number of 90, are on the Register, but this is a constantly varying number, as those engaged in this class of work in a small way, frequently change their place of abode. Legal Proceedings.—Your Inspector co-operated with the Home Office Inspector in regard to a prosecution against a firm of theatrical costumiers who were employing more women in their workroom during overtime. The cubic area of the room was 3,825 feet, giving space for 15 workwomen during the day and for 9 during overtime; the Inspectors found that 19 were working in the room. The defence was that it was just before the pantomime season when work had to be done under great pressure; but as the defendant had already been cautioned, a fine of 40s. and Costs was imposed. the strand district, london. 27 Inspection and Analysis of Food. The street markets have been inspected every day (including Sundays) and the following list shows the kind and quantity of the food-stuff which has been condemned during the year :— Apples 15 bushels Plums 270½ bushels Bananas 909 crates Raspberries 7 cwt. Cherries 21½ bushels Strawberries 10 boxes Currants, Black 96 „ Currants, Red 6 „ Cabbages 96 Damsons 20 ,, Onions 18 bags Figs 12 boxes Potatoes 32 cwt. Grapes 7 birrels Tomatoes 494 boxes Greengages. 11 boxes „ Preserved 10 lbs. Oranges 126 cases Pineapples 496 Pork 1 head This does not represent all the damaged food-stuffs disposed of by your Board, as much refuse fruit and vegetables are collected in Covent Garden Market in the special carts provided for the purpose. The extreme heat experienced during the month of July, led to considerable difficulty in the fruit trade. It was almost impossible to get such fruit as raspberries to London without some degree of fermentation being set up, and this led to a great deal of extra work being thrown upon the officers of the Health Department, to decide whether the fruit was fit for food. Where the fruit was sound when picked, a slight degree of fermentation in no way interferes with its value as a food, and although a peculiar frothy appearance (which may mislead inexperienced persons into the belief that the food is rotten) is produced by the process, yet the products are entirely innocuous, and are at once dissipated on the application of a slight amount of heat. Such fruit is of course, not suitable for dessert purposes, but is quite good and wholesome for stewing, preserving, or for use in tarts or pastry. The head of Pickled Pork, mentioned in the above list, was sold without proper care having been taken by the salesman to examine it in the maimer usual among butchers as instructed 28 on the sanitary condition ok to do by his master. A part of it was eaten by one person only, and it made him ill. I secured the remainder of the head and the smell on cutting into it was quite sufficient to show that decay had set in. I submittcd the meat to Dr. Newman of the Bacteriological Department, King's College, who was good enough to examine it, and he informed me that the pork was full of organisms, principally proteus vulgaris and bacillus coli communis with a number of saprophytic bacteria. The butcher compensated the man who had bought it. In 1897, on the initiative of your Board, a resolution was sent to the Local Government Board and County Council by 21 of the Sanitary Authorities of the Metropolis expressing the view that it was desirable that by-laws should be made, giving power to the Authorities to control places where food was prepared, stored, or sold, and to prevent the use of places unsuitable for the purpose. During that year some further communications were made to the Council on the subject and the matter was under the consideration of one of the Council's Committees. With the view of obtaining some information which might guide them, Dr. Hamer, one of the Assistant Medical Officers was directed to visit various districts, and he issued a lengthy report detailing his investigations to the Council. He agreed with your Board in the opinion that more systematic and thorough inspection of places where food is prepared and sold is required, and that the law needed amendment in order to deal with cases in which places used for the storage and preparation of food are used as sleeping apartments, or communicate directly with water-closets, or are otherwise liable to contamination by impurity. The Public Health Committee reported to the Council on 7th March, 1899, that they would shortly have under consideration the question of amendments which it is desirable should be made in the " Public Health (London) Act" and they would consider Dr. Hamer's report in that connection. Sale of Food and Drugs Acts.—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 the strand district, london. 29 Health Committee, and from the report of your Board's Analyst it will be seen that a large and varied number of articles have been examined by him. During 1899, Parliament has had under consideration a Bill amending previous Acts in several particulars. Your Board made several representations to the President of the Board of Agriculture with reference to several matters, and several members of the Health Committee attended on a deputation to Mr. Long to give their views with respect to the sale of condensed, separated or skimmed milk. The Bill eventually became law to come into operation on January 1st, 1900. The new Act which makes certain alterations in procedure, requires any person selling milk in the street to have his name and address conspicuously inscribed on the vehicle or milk receptacle; that every tin containing condensed, separated, or skimmed milk, shall bear a label clearly visible to the purchaser, on which the words "Machine Skimmed Milk "or "Skimmed Milk" as the case may require are printed in large legible type. The penalties which may be inflicted under the Acts are made heavier. 30 INDEX TO PREVIOUS REPORTS OF THE MEDICAL OFEICER OF HEALTH. ANNUAL REPORT. Census Figures and Enumeration Districts 5,15,27,30 Cholera.—Hospital Accommodation in District 10,11,29,37 Circular on " Consumption and its Prevention" 43 Covent Garden Market:— Sale of Fruit and Vegetables 15,18,38,39,42 Sanitary Conveniences 39 Common Lodging Houses and Infectious Disease 38,39 Craven or Pest-House Charity 14 Diphtheria.—Bacteriological Examination 38, 43 Disinfecting Apparatus:— Regulations 37 Legal Proceedings 28 Disinfection of Rooms 43 Enteric Fever Outbreak from Milk 34 Food—Sale of Food in District, with Map 43 Health Missioners 42 House Record 43 Housing of the Working Classes:— Chapel Court, Clement's Lane Scheme 20,21 Clare Market Scheme 10, 41 Measures for dealing with Measles 41 Mortuary Accommodation 14,29 Newport Market, Sanitary Condition 20 Population, On the Character of the 32 Overcrowding 3, 4, 10, 32 Preserved Green Peas 21 Sewer Emanations 41 Slaughterhouses 2,17 Small Pox Outbreaks 4, 15 St. Mary-le-Strand Burial Ground, Russell Court 43 APPENDIX. 1. Local Government Board Returns. 2. Summary of Causes of Death. Local Government Board. Form A. TABLE XI. SUMMARY OF TABLES and showing DEATHS during the Year 1899, in the Metropolitan Sanitary District of STRAND, classified acccording to Diseases, Ages, and Localities. Names of Localities adopted for the purpose of these Statistics; Public Institutionsbeing shown as separate localities. (Columns for Population and Birth. 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 under 15. 15 and under 25. 25 and under 65. 65 and upwards. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 Smallpox. Scarlatina. Diphtheria. Membranous Croup. Typhus. Fevers. Puerperal. Cholera. |Erysipelas. |Measles. Whooping Cough. Diarrhoea and Dysentery. | Rheumatic Fever. Ague. Phthisis. Bronchitis, Pneumonia, and Pleurisy. Heart Disease. Injuries. All other Diseases. TOTAL. Enteric or Typhoid. Continued Relapsing (a) (b) (c) (d) (e) (f) (g) (h) (i) Strand District 279 66 27 4 13 122 47 Under 5 1 1 3 16 24 4 44 93 5 upwds 1 1 1 5 32 55 22 7 62 186 In Hospitals, &c., in District 265 22 23 13 29 153 25 Under 5 1 2 1 4 12 1 3 21 45 5 upwds 1 5 1 4 17 29 21 16 126 220 TOTALS 544 88 50 17 42 275 72 Under 5 1 2 5 17 4 36 1 7 65 138 5 upwds 2 6 1 1 9 49 84 43 23 188 406 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 211 19 9 4 12 110 57 Under 3 1 5 1 2 16 28 5 upwds 1 1 1 31 33 22 12 82 183 Deaths occurring within the district among persons not belonging thereto 241 15 21 8 27 149 21 Under 5 1 2 2 3 10 3 15 36 5 upwds 1 5 1 3 15 23 20 17 120 205 Local Government Board. Form A. TABLE XIa. Table of DEATHS during the Year 1899, in the STRAND Sub-District, classified according to Diseases, Ages and Localities. Names of Localities adopted for the purpose of these Statistics; Public Institutions being shown as separate localities. (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 under 15. 15 and under 25. 25 and under 65. 65 and upwards. 1 2 3 4 5 6 1 7 1 8 1 9 10 11 12 13 14 15 16 17 18 19 20 21 22 Smallpox. Scarlatina. Diphtheria. Membranous Croup. Fevers. Cholera. Erysipelas. | Measles. Whooping Cough. Diarrhoea and Dysentery. Rheumatic Fever. J 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 Sub-District 151 29 14 1 7 73 27 Under 5 2 8 8 25 43 5 upwds 1 1 4 16 28 15 5 38 108 Strand Union Casual Wards, Bear Yard 18 1 2 12 3 Under 5 5 upwds 1 9 4 4 18 King's College Hospital 187 22 23 9 21 100 12 Under 5 1 2 1 4 12 1 3 21 45 5 upwds 1 5 1 16 15 11 7 86 142 St. Peter's Hospital 19 1 9 9 Under 5 5 upwds 4 15 19 River Thames 7 7 Under 5 5 upwds 7 7 TOTALS 382 51 37 11 31 201 51 Under 5 1 4 9 4 20 1 3 46 88 5 upwds 2 5 1 1 4 33 56 30 19 143 294 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 15 5 7 63 33 Under 5 1 3 1 2 13 20 5 upwds 1 19 24 14 5 40 103 Deaths occurring within the district among persons not belonging thereto 201 14 21 6 21 119 20 Under 5 1 2 1 3 10 3 15 35 5 upwds 1 5 1 15 20 11 16 97 166 Local Government Board. Form A. TABLE Xlb. Table of DEATHS during the Year 1899. in the ST. ANNE'S Sub-District, classified according to Diseases, Ages and Localities. Names of Localities adopted for the purpose of these Statistics; Public institutions being shown as separate localities. (Columnsfor 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 under 15. 15 and under 25. 25 and under 65. 65 and upwards. 1 2 3 4 5 6 7 8 1 9 10 11 12 13 14 15 10 17 18 19 20 21 22 Smallpox. Scarlatina. Diphtheria. Membranous Croup. Fevers. Cholera. Erysipelas. Measles. Whooping Cough. Diarrhoea and Dysentery. Rheumatic Fever. Ague. Phthisis. Bronchitis, Pneumonia and Pleurisy, Heart Disease. Injuries. All other Diseases. total. Typhus. Enteric or Typhoid. Continued. Relapsing. Puerperal. (a.) (b) (c) (d) (e) (f) (g) (h) (i) St. Anne's Sub-District 128 37 13 3 6 49 20 Under 5 1 1 1 8 16 4 19 50 5 upwds 1 1 16 27 7 2 24 78 Hospital for Women, Soho Square 17 1 16 Under 5 5 upwds 17 17 Hospital for Diseases of the Heart, Soho Square 15 3 3 8 1 Under 5 5 upwds 4 6 2 3 15 Lock Hospital 2 1 1 Under 5 5 upwds 1 1 2 TOTALS 162 37 13 6 11 74 21 Under 5 1 1 1 8 16 4 19 50 5 upwds 1 5 16 28 13 4 45 112 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 88 4 4 4 5 47 24 Under 5 3 2 3 8 5 upwds 1 1 12 9 8 7 42 80 Deaths occurring within the district among persons not belonging thereto 40 1 2 6 30 1 Under 5 1 1 5 upwds 3 3 9 1 23 39 Local Government Board. Form B. TABLE XII. Table of POPULATION, BIRTHS, AND OF NEW CASES OF INFECTIOUS SICKNESS, coming to the knowledge of the Medical Officer of Health, during the year 1899, (52 weeks) in the Metropolitan Sanitary District of STRAND, classified according to Diseases, Ages, and Localities. Names ok 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 1806. Estimated to middle of 1899. 1 2 3 4 5 6 7 8 9 10 11 1 2 3 4 5 6 7 8 9 10 11 Smallpox Scarlatina. Diphtheria. Membranous Croup. Fevers. Cholera. Erysipelas. TOTALS. Smallpox. Scarlatina. Diphtheria. Membranous Croup. Fevers. Cholera. Erysipelas. TOTALS. Typhus. Enteric or Typhoid. Continued. Relapsing. Puerperal Typhus. Enteric or Typhoid. Continued Relapsing. Puerperal. (a) (b) (c) (d) (e) SUB-DISTRICTS— St. Anne, Soho 12,048 12,100 271 Under 5 16 13 29 14 11 25 5 upwds 22 18 6 8 54 20 17 4 41 Strand 11,734 11,900 178 Under 5 7 1 1 9 6 1 7 5 upwds 10 5 6 6 27 9 4 3 2 18 Westminster Workhouse, Poland Street 158 9 Under 5 5 upwds Strand Union Workhouse, Edmonton 774 10 Under 5 5 upwds Do. do. Bear Yard 24* Under 5 5 upwds King's College Hospital Under 5 5 upwds 2 2 2 2 TOTALS 24,714 24,000 492† Under 5 23 14 1 38 20 12 32 5 upwds 32 23 12 16 83 29 21 7 4 61 *6 of these Births belong to the Parish of St. Martin-in-the-Fields. 24 Births belonging to this District took place in the British Lying-in Hospital, Endell Street. 36 APPENDIX. APPENDIX. 37 TABLE XIII. SUMMARY OF CAUSES OF DEATH IN THE STRAND DISTRICT IN 1899. CAUSES OF DEATH. Total Deaths AGE AT TIME OF DEATH. REGISTRATION SUB-DISTRICTS Totals. Under 1 year. 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 and up. St. Anne. Strand. Males Females. Males. Females. Males. Females. Males. Females. Malev Females. Males. Females. Males. Females. Males. Females. Males. Females. Males. Females. Males. Females. Males. Females. Males. Females. I.—SPECIFIC FEBRILE, OR ZYMOTIC DISEASES- 1. MIASMATIC— Small-pox - - - - - - - - - - - - - - - - - - - - - - - - - - - Measles 4 - - 2 2 - - - - — — — - - - - - - - - - 1 - -1 2 2 2 Scarlet Fever 1 1 - - - - - - - - - - - - - - - - - - 1 — - - 1 - Whoolping Cough - - - - - - - - — — — — — - - - - - - - - - - - - - - Diphtheria 6 - 1 - 3 1 — — — — — — — — 1 — — — — — — — 4 — - 1 5 Enteric Fever 1 - - - - - - - - - - - - - - - - - - - - - - — - - - Influenza 10 - - - - - - - - 1 1 1 - 2 - 1 - - - - 1 1 3 4 2 5 5 Other Miasmatic Diseases - - - - - - - - - - - - - - — - — — - — - - - - - - - 2. Diarrhceal Diseases 21 9 8 2 1 - - - - - - - - - - - - - 1 - 5 4 7 5 12 9 3. Malarial ,, - - - - - - - - - - - - - - - - - - - - — - - - - - - 4. Zoogenous ,, - - - - - - - - - - — — — — — — — — -— — — — — — — — - 5. Phthisis ,, 66 1 - 1 1 2 2 9 1 3 7 7 12 6 5 2 5 1 1 — — 12 15 20 19 32 34 Other Tubercular Diseases 16 3 1 5 2 1 1 1 - - - - - - - - - - - — — 4 1 7 4 11 5 6. Venereal 6 3 2 - - - - - - - - - - - - 1 - - - - - 2 1 2 1 4 2 7. Septic 9 1 - - - 1 - 1 - - 2 -— — 2 — - — 1 — - — 2 1 4 2 6 3 11.—PARASITIC DISEASES - - - - - - - - - — - — — - - — — - — — — - - - - - - III DIDTIC DISEASES (Alcoholic) 19 - - - - - - - - - — 4 6 1 5 2 — 1 — — — 1 7 7 4 8 11 IV—CONSTITUTIONAL DISEASES Malignant Disease 19 - - - - - - - - - 1 - 1 1 5 5 3 - 1 1 1 5 7 2 5 7 12 Acute Rheumatism 6 - - - - - 1 1 - — 1 — - 3 - - - — - - - 1 - 3 1 4 2 Rheumatism and Gout 2 - - - - - - - - - 1 - - 1 - 1 - - - - - 1 - 1 - 2 - Diabetes 2 - - - - - - - - - — — 1 - — 1 — — — — — 1 — I 1 1 1 Rickets 2 1 - - 1 - - - - — - - - - - - - - - - - 1 1 - - 1 1 V.—LOCAL DISEASES— 1. Convulsions and Dentition 7 3 2 1 1 - - - - - - - - - - - - - - - - - - 4 3 4 3 Other Diseases of Nervous System 40 2 1 1 2 - 1 3 - 2 2 2 1 3 2 4 2 3 6 1 2 8 — 13 10 21 19 2. Diseases of Circulatory System 50 - - - - - - - - 2 - 3 3 2 4 10 11 3 3 - 4 4 12 17 17 21 29 3. Diseases of Respiratory System 122 14 7 5 4 - 2 3 - 5 1 7 4 6 6 12 7 12 9 8 10 20 30 52 20 72 50 4. Diseases of Digestive System 8 1 2 1 1 - - - 1 - - - - - - - 1 - 1 - - - 2 2 4 2 6 5. Diseases of Urinary System 24 - - - - — - — - 2 - 2 1 1 2 5 2 2 - 4 1 6 2 10 6 16 8 6.Diseases of Reproductive System 3 - - - - - - - 1 - - - - - 1 1 - - - - - - - 1 2 1 2 7. Diseases of Bones and Joints 1 - - - - - - — - — — — — — - - — — — — 1 - - - 2 1 - 8. Diseases of Integumentary System - - - - - - - - - - - - - - - - - - - - - - - - - - - 9. Diseases of Organs of Special Sense - - - - - - - - - - - - - - - - - - - - - - - - - - - 10.Diseases of Gland like Organs - - - - - - - - - - - - - - - - - - - - - - - - - - - 11. Diseases of Lymphatic System - - - - - - - - - - - - - - - - - - - - - - - - - - - VI.—developmental— Debility at Birth 24 15 9 - - - - - - - - - - - - - - - - - - 6 3 9 6 15 9 Old Age 22 - - - - - - - - — — — — -— — — — 4 2 4 12 3 6 5 8 8 14 VII.—ACCIDENT AND VIOLENCE 20 1 2 1 - - - - 1 - 2 4 — — — 3 2 2 - - 2 8 4 3 5 11 9 VIII.—ILL-DEFINED (Marasmus) 3 2 - - 1 — — — - — - - — — — - - - - - - 2 - - 1 2 1 Totals 514 57 35 19 19 5 8 19 8 15 19 30 30 29 32 48 33 29 26 19 34 96 114 174 130 270 244