WES ANNUAL REPORT ON THE SANITARY CONDITION OF THE PARISHES OF St. Margaret & St. John, Westminister, Ending December, 1893, By BARNARD HOLT, F.R.C.S., Medical Officer of Health. Westminster : WIGHTMAN & CO., Printers and Stationers, 104 & 106, Regency Street, S.W. 1894. - WES 1 ANNUAL REPORT ON THE SANITARY CONDITION OF THE PARISHES OF St. Margaret & St. John, Westminister, Ending December, 1893, By BARNARD HOLT, F.R.C.S., Medical Officer of Health. Westminster: WIGHTMAN & CO., Printers and Stationers, 104 & 106, Regency Street, S.W. 1894. ANNUAL REPORT on the SANITARY CONDITION OF THE PARISHES of St. Margaret and St. John, Westminster, Ending December, 1893, By BARNARD HOLT, F.R.C.S., Medical Officer of Health. To the Members of the United Vestry. Gentlemen, Following my usual custom I shall commence with recording the number of births and deaths that have occurred during the year, and afterwards place before you various interesting details and an account of the work and sanitary improvements that have been effected during the past twelve months. The number of births registered in the parish during the year has been 687 males, and 663 females, or a total of 1,350 births; while the deaths have numbered 580 males, and 474 females, or a total of 1,054 deaths. From these, however, must be deducted 293 as the result of accident, or occurring in persons not belonging to the parish, which reduces the actual number to 761. At the same time, to this 761 must be added 484 deaths of parishioners occurring in extra-parochial institutions, so that during the past year 1,245 deaths of inhabitants of the united parishes have been recorded. The deaths during 1892 were 1,095, but a comparison is impossible, as this method of excluding strangers dying in the parish, and including parishioners dying out of it, has not hitherto been adopted. The following deaths occurred at the undermentioned ages, viz.:— Above sixty, 159; above seventy, 149; above eighty, 57; above ninety, 7. 3 The following deaths occurred at the undermentioned places, viz.:— Hospitals. Barracks. Westminster 255 Hyde Park 5 Station 15 Wellington 2 Convent 14 Knightsbridge 1 Grosvenor 4 Wellington House 4 Victoria House 4 Grenadiers 2 Almshouses 7 305 8 The following is the table of deaths occurring in the district during the past three years:— 1891. 1892. 1893. Small Pox 0 0 0 Measles 39 73 3 Scarlet Fever 0 2 6 Whooping Cough 22 19 15 Diarrhœa 43 33 49 Dysentery 0 0 1 Cholera 0 0 1 Fever 10 2 9 114 129 84 The above table shows a decrease in reference to the previous year of 45 deaths from zymotic causes, which is eminently satisfactory considering the severe outbreaks of measles, scarlet fever, and diphtheria, which have taken place during the year. The vigilant and strict measures that were taken during the threatened epidemic of cholera in July, August, and September, 1892, were again enforced in 1893, with the result that the single death which occurred was shown to be rather the effect of some food of which the patient had partaken, and not due to any of the surrounding circumstances. It is impossible to too highly estimate the great benefit that follows the compulsory notification of disease, and it is mainly owing to the promptitude of the medical gentlemen in reporting cases, and the immediate attention given by the inspectors to the reports, and, whenever possible, removing the patients to the hospitals, that so few deaths in comparison with the number of cases have occurred from zymotic causes. The following table is a copy of the tabular returns of deaths, taking each parish separately, in accordance with the form prescribed by the Local Government Board:— 4 5 (A) TABLE OF DEATHS during the year 1893 in the Metropolitan Sanitary District of St. Margaret's, Westminster, classified according to Diseases, Ages, and Localities. Localities. Mortality from all causes, at subjoined Ages. Mortality from subjoined causes, distinguishing Deaths of Children under Five Years of Age. At all Ages. Under 1. 1—5. 5—15. 15—25. 25—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. Croup. Typhus. Enteric. Continued. Relapsing. Puerperal. Cholera. Erysipelas. Measles. Whooping Cough. Diarrhœa and Dysentery. Rheumatic Fever. Ague. Phthisis. Bronchitis, Pneumonia and Pleurisy. Heart Disease. Injuries. All other Diseases. Total. Westminster Hospital 255 31 24 24 37 128 11 Under 5 ... ... 5 ... ... ... ... ... ... ... ... 1 ... 6 ... ... ... 14 2 3 24 55 5 upwds. ... ... 4 ... ... 1 ... ... ... ... 3 ... ... 1 ... ... 16 53 12 11 99 200 Convent 14 13 ... ... ... 1 ... Under 5 ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... 2 ... ... 9 13 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 Wellington Barracks 2 ... ... ... ... 2 ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 2 Hyde Park Barracks 5 1 ... 1 2 1 ... Under 5 ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... 1 3 Knightsbridge Barracks 1 1 ... ... ... ... ... Under 5 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Wellington House 4 4 ... ... ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 2 ... ... 1 4 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Victoria House 4 4 ... ... ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 9 ... ... 1 4 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Rest of Parish 240 42 14 13 13 88 70 Under 5 ... 1 1 1 ... ... 1 ... ... ... ... 1 2 5 ... ... ... 16 ... 3 25 56 5 upwds. ... 1 1 ... 1 2 ... ... ... ... ... ... ... 3 1 ... 22 40 18 14 81 184 Total 525 96 38 38 52 220 81 Under 5 ... 1 6 5 ... ... 1 ... ... ... ... 2 2 14 ... ... ... 36 2 6 60 135 5 upwds. ... 2 5 ... 1 3 ... ... 1 ... 3 ... ... 4 2 ... 39 94 30 25 181 390 The subjoined numbers have also to be taken into account in judging of the above records of Mortality. Parishioners Dying outside Parish 161 2 6 2 10 60 81 Under 5 ... 4 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 7 5 upwds. ... ... 1 ... ... 2 ... ... ... ... 2 ... ... 2 ... ... 23 47 8 4 65 154 Strangers Dying in Parish 230 24 24 12 30 100 40 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 20 3 ... 25 48 5 upwds. ... ... 4 ... ... 3 ... ... ... ... ... ... ... ... ... ... ... 60 ... 20 95 182 6 7 (A) TABLE OF DEATHS during the year 1893 in the Metropolitan Sanitary District of St. John's, Westminster, classified according to Diseases, Ages, and Localities. Localities. Mortality from all causes, AT SUBJOINED AGES. (i) Mortality from subjoined causes, distinguishing deaths of children under five. At all ages. Under 1. 1-5. 5—15. 15-25. 25—65. 65 & upwards. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 IS 19 20 21 22 Smallpox. Scarlatina. Diphtheria. Membranous Croup. Fevers. Cholera. Erysipelas. Measles. Whooping Cough. Diarrhœa and Dysentery. Rheumatic Fever. Ague. Phthisis. Bronchitis, Pneumonia, and Pleurisy. Heart Disease. Injuries. A11 other Diseases. Total. Typhus. Enteric (or Typhoid). Continued. Relapsing. Puerperal. (a) (b) (c) (d) (e) (f) (g) (h) Station Hospital 15 ... ... ... 11 4 ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 5 I ... 7 15 Almshouses 7 ... ... ... ... ... 7 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 5 7 Grenadier Guards Hospital 2 ... ... ... 2 ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 2 Grosvenor Hospital 4 1 ... ... ... 3 ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 5 upwds ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 3 Rest of Parish 501 159 54 24 15 184 65 Under 5 ... ... 3 ... ... ... ... ... ... ... ... ... 11 29 ... ... 1 55 1 6 98 204 5 upwds ... 3 ... 1 ... ... ... ... 2 ... 1 1 1 6 1 ... 53 90 20 15 103 297 Total 529 160 54 24 28 191 72 Under 5 ... ... 3 ... ... ... ... ... ... ... ... ... 11 29 ... ... 1 55 1 6 99 205 5 upwds ... 3 1 1 1 ... ... ... 2 ... 1 1 1 6 2 ... 53 96 22 17 11 7 324 The subjoined numbers have also to be taken into account in judging of the above records of Mortality. Parishioners dying outside parish. 323 24 38 7 10 183 61 Under 5 ... 8 4 ... ... ... ... ... ... ... ... ... 1 2 ... ... 8 ... ... 40 63 5upwds ... 5 ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... 54 37 12 9 141 260 Strangers dying in parish. 17 1 ... ... 9 7 ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 5 upwds ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... 6 3 1 4 16 8 It is interesting to notice in the foregoing tables how many of those deaths, mentioned as occurring in various "Localities," do not belong to the parish wherein they take place ; for instance, in the Westminster Hospital, where there were 255 deaths, 139 of them belonged to entirely outside parishes, 91 to St. John's, and only 25 to St. Margaret's, where the Hospital is situated. And though there is no institution of corresponding magnitude in St. John's, yet the same thing may be observed on a smaller scale—three out of the four deaths at the Grosvenor Hospital came from other parishes, and 13 out of 15 occurring at the Station Hospital were from Chelsea, Battersea, the Tower of London, &c. The Table also shows in a very satisfactory way how few deaths, comparatively, have occurred from zymotic causes, both inside and outside the parishes, to the inhabitants of St. Margaret's and St. John's. The following Table (B) deals with the Births and cases in the same way as (A) has with the Deaths:— 10 11 (B) TABLE OF POPULATION, BIRTHS, AND OF NEW CASES OF INFECTIOUS SICKNESS, coming to the knowledge of the Medical. Officer of Health, during the year, 1893, in the Metropolitan Sanitary District of St. Margaret's, Westminster, classified according to Diseases, Ages, and Localities. Localities. Population at all Ages. Registered Births. Ages. New Cases of Sickness in each locality. Number of such cases removed from home to hospital. Census 1891. Estimated to Middle of 1893.* 1 2 3 4 5 6 7 8 9 10 11 12 Totals. 1 2 3 4 5 6 7 8 9 10 11 Totals. Smallpox. Scarlet Fever. Diphtheria. Membranous Croup. Fevers. Fevers. Cholera. Erysipelas. Measles Smallpox. Scarlatina. Diphtheria. Croup. Fevers. Cholera. Erysipelas. Typhus. Enteric (or Typhoid). Continued. Relapsing. Puerperal. Typhus. Enteric (or Typhoid). Continued. Relapsing. Puerperal. (a) (b) (c) (d) (e) 21,668 21,668 382 Under 5 ... 26 11 ... ... ... ... ... ... ... 3 61 101 ... 22 7 ... ... ... ... ... ... ... 1 30 5 upwards 2 104 28 ... ... 19 ... ... 3 ... 21 28 205 2 77 20 ... ... 9 ... ... 1 ... 5 114 Total 21,668 21,668 382 Under 5 ... 26 11 ... ... ... ... ... ... ... 3 61 101 ... 22 7 ... ... ... ... ... ... ... 1 30 5 upwards 2 104 28 ... ... 19 ... ... 3 ... 21 28 205 2 77 20 ... ... 9 ... ... 1 ... 5 114 (B) TABLE OF POPULATION, BIRTHS, AND OF NEW CASES OF INFECTIOUS SICKNESS, coming to the knowledge of the Medical Officer of Health, during the year, 1893, in the Metropolitan Sanitary District of St. John's, Westminster, classified according to Diseases, Ages, and Localities. Localities. Census 1891. To Middle of 1893.* Births. Ages. New Cases of Sickness in each locality. Number of such casus removed from home to hospitals. 1 2 3 4 5 6 7 8 9 10 11 12 Totals. 1 2 3 4 5 6 7 8 9 10 11 Totals. Smallpox. Scarlet Fever. Diphtheria. Croup. Typhus. Enteric. Continued. Relapsing, Puerperal. Cholera. Erysipelas. Measles. Smallpox. Scarlet Fever. Diphtheria. Croup. Typhus. Enteric. Continued. Relapsing. Puerperal. Cholera. Er sipelas. 34,092 34,092 968 Under 5. 3 83 18 ... ... ... ... ... ... ... 2 80 186 3 6 15 ... ... ... ... ... ... ... 24 5 upwards. 42 197 25 1 ... 21 ... ... 2 2 56 54 400 42 147 18 ... ... 18 ... ... ... ... 15 240 Total 34,092 34,092 968 Under 5. 8 83 18 ... ... ... ... ... ... ... 2 80 186 3 6 15 ... ... ... ... ... ... ... ... 24 5 upwards. 42 197 25 1 ... 21 ... ... 2 2 56 54 400 42 147 18 ... ... 18 ... ... .. ... 15 240 * In my opinion this is the fairest way to estimate the population of these parishes instead of adding the average rate of increase for London generally, as I did in last year's report. 12 The places where the greatest number of measles have occurred have been Cobourg-row, Willow-street, and Vauxhall-bridge-road; the outbreak has, however, only been severe during November and December, and has spread more or less, over the entire district; but out of the 223 cases there have only been 3 deaths. Scarlet fever has been more or less prevalent throughout the whole year, and reached its highest in September, when there were 66 cases, but out of the 410 cases that have been reported altogether, only 23 have proved fatal, 6 in the parish and 17 outside ; the streets where the greatest number has occurred have been Peabody-buildings, Regency-street, and Willow-street, but this has also spread over the entire parish. Diphtheria has been much less than last year, there being 82 cases instead of 143, and out of these 82, 15 died in the parish, and 16 in the outlying hospitals to which they were conveyed, and the disease has not shown itself at any one particular spot more than another. In the first six months of the year 42 cases of Small-pox occurred. Another case was notified in August, three more in September, and one in October, making 47 cases in the year. Of these, 31 occurred in March, April, and May—16 at a common lodging-house in Great Peter-street, 14 at a Salvation Army Shelter in the Horseferry-road, and 3 among the employes of a licensed victualler carrying on business near the lodginghouse above-named. There are upwards of 600 beds in the lodging-house, and 200 in the Salvation Army Shelter; but the separate beds are not distinguished by any mark or number, and the name of the man sleeping in any particular bed on any one night is not taken. It is easy to see, therefore, what obstacles presented themselves both in obtaining the satisfactory disinfection of the bedding and in tracing the individual sufferers in order to ascertain their condition with respect to vaccination. The authorities supervising the lodging-house are the police, whose officers assisted the Vestry's inspectors with every information in their power, as, in fact, did the persons in charge of the Salvation Army Shelter. From this place, while the men were in bed, their clothes were taken to the disinfecting oven by the Vestry's inspectors and returned in time for the men's use on their rising in the early morning. All the sufferers were removed for treatment to the hospital ships of the Metropolitan Asylums Board, lying off Greenhithe, and in many instances it became necessary for me to communicate with the patients, with the assistance of the officers of the Asylums Board, before the position of the bed they had occupied could be ascertained for disinfection purposes. Meanwhile, as there were signs of the disease spreading, the closing of the places was insisted upon, 13 in order to admit of the thorough disinfection and fumigation of the rooms and other parts of the building, by which means anything like a serious outbreak was effectually checked. By means of a troublesome correspondence, and by the willing co-operation of the medical sttaff of the Asylums Board, I was enabled to ascertain that of the 44 adults, not one had been revaccinated since infancy; and of the 3 children, two had not been vaccinated at all. Under these circumstances, I consider it fortunate that not one of these cases terminated fatally. Erysipelas was in excess of last year, being 82 cases, and 4 deaths in the parish and 2 outside, instead of 77 cases and 7 deaths which took place in 1892. The following is a table of cases notified each month, and also the deaths that occurred in the parishes of the undermentioned diseases:— Scarlet Fever. Diphtheria. Small Pox. Croup. Enteric Fever. Puerperal Fever. Cholera. Erysipelas. Measles. Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths January 9 ... 7 2 3 ... ... ... 1 ... 1 ... ... ... 3 ... 2 ... February 13 ... 5 ... 4 ... ... ... 1 ... 1 1 ... ... 5 ... 5 ... March 19 ... 5 ... 11 ... ... 1 1 ... ... l ... ... 7 ... 14 ... April 11 ... ... ... 11 ... ... ... 1 ... ... ... ... ... 8 ... 9 ... May 37 1 10 1 9 ... 1 1 4 1 1 1 ... ... 9 ... 4 ... June 42 ... 3 ... 4 ... ... ... 9 ... ... ... ... ... 5 ... 4 ... July 50 2 14 2 ... ... ... 1 2 ... ... ... ... ... 9 1 5 ... August 31 1 3 ... 1 ... ... ... 4 ... ... ... ... ... 3 1 5 ... September 66 1 6 ... 3 ... ... ... 2 ... ... ... ... ... 12 ... 3 ... October 48 1 9 1 1 ... ... ... 5 ... ... ... ... ... 8 ... 2 ... November 55 ... 13 6 ... ... ... 2 9 2 1 ... ... ... 10 2 78 ... December 29 ... 7 3 ... ... ... 1 1 2 1 ... ... ... 3 ... 92 3 410 6 82 15 47 ... 1 6 40 5 5 3 2 1 82 4 223 3 It will be seen that apparently the deaths from croup exceed the number of cases notified, but they occurred in young children after very short illnesses, and were not cases of membranous croup. It is a matter of congratulation that the Sanitary Committee and Vestry have now a most excellent mortuary completed in the parish, where post-mortem examinations can be held in a large room provided for the purpose, without any of the former 14 unavoidable crowding of witnesses, &c., so extremely prejudicial to health. Dead bodies of parishioners can also be removed there during the period awaiting interment, which prevents the necessity of a corpse remaining in a room inhabited by the rest of the family. All clothing, bedding, &c., where an infectious case has occurred is now taken by the Vestry's workmen to the disinfecting station at the rear of this mortuary, and there either destroyed or properly and thoroughly purified in an apparatus provided for the purpose, as the occasion necessitates; and there is a set of rooms to which whole families can be removed, and be accommodated with gas and firing found them during the time that their own premises are whitewashed and fumigated after a case of infectious disease. The whole of this institution is a great benefit to the parish, and thoroughly desirable in every way. With the exception of the premises Nos. 13, 15, 17 & 19, Chadwick-street, where houses closed by order of the Magistrate in December, 1892, have since been put into thorough repair and re-inhabited, most of the improvements during the past year have consisted in demolishing buildings unfit for human habitation. For instance, on my reporting in January that 77, Monck-street, was in this condition, the house was thereupon closed and subsequently demolished. Nos. 1, 2, 8 & 4, Bull's Head-court, and ATos. 1, 2, 3, 4, 5 & 6, Anns-place— These premises were closed early this year, without it being necessary for the Vestry to obtain closing orders, and I am informed the land is now to let for building purposes. These premises Were referred to in my report of last year. As were also Nos. 32, 34 & 36, Ship court— Notices were served by order of the Vestry on February 18th of this year, and on the 20th April an order was made requiring the closing of the premises, which was done, and the same have since been demolished. Nos. 26, 28, 30, 34 & 36, Garden-street— Being reported as unfit for human habitation, notices under the provisions of the "Housing of the Working Classes " Act were served on 16th October, and on the 10th November they were closed by order of the Police Magistrate. 15 And 10, Vandon-street — The insanitary condition of this house having been reported to the Committee on the 19th of September; in accordance with their instructions, I, in conjunction with the Surveyor, reported on the 20th of that month the desirability of closing it under the provisions of the Act, and as a result a Magistrate's order was formally obtained on the 20th November, but the house had been voluntarily closed then for a month. The following is a summary of the Inspector's work done during the year:— St. Margaret's. St. John's. Houses examined 1,282 2,006 Defects found 1,730 2,848 Notices served 913 1,350 Work completed 836 1,262 I have the honour to be, Gentlemen, Your faithful Servant, BARNARD HOLT. mmmk WES 1