WES 2 ANNUAL REPORT upon the PUBLIC HEALTH & SANITARY CONDITION of the united parishes of St. Margaret & John, Mestminster, FOR THE YEAR, 1894, by JOHN NORTON, M.D, D.P.H., Medical Officer of Health, member of the royal college of surgeons of england; fellow of the incorporated society of medical officers of health: fellow and member of the council of the british institute of public health. London: WIGHTMAN & CO "The Westminster Press," 104 & 106, Regency Street, S. W. 1 89 5. WES 2 ANNUAL REPORT upon the PUBLIC HEALTH & SANITARY CONDITION of the united parishes of St. Margaret & John, Mestminster, FOR THE YEAR, 1894, by JOHN NORTON, M.D, D.P.H., Medical Officer of Health, member of the royal college of surgeons of england ; fellow of the incorporated society of medical officers of health, fellow and member of the council of the british institute of public health. London: WIGHTMAN & CO "The Westminster Press," 104 & 106, Regency Street, S.W. 1 8 9 5. ANNUAL REPORT upon the PUBLIC HEALTH AND SANITARY CONDITION of the united parishes of St. Margaret & John, Mestminster, FOR THE YEAR 1894, By JOHN NORTON, M.D., D.P.H., MEDICAL OFFICER OF HEALTH, Member of the Royal College of Surgeons of England; Fellow of the Incorporated Society of Medical Officers of Health ; Fellow and Member of the Council of the British Institute of Public Health. To the Members of the United Vettry. My Lords and Gentlemen, I have the honour to place before you my Annual Report on the health, sanitary condition, and vital statistics of the United Parishes, for the year 1894. METEOROLOGICAL SUMMARY. First Quarter. The mean reading of the barometer was 29'795 inches; the mean temperature of the air 41°.4. The amount of rain measured during the quarter was 5.40 inches, and the amount of bright sunshine recorded was 237.6 hours. The first eight days of January were extremely cold, the remainder of the month was generally mild, rain being frequent. With the exception of the period from the 13th to the 23rd, the weather in February was generally fine and warm, the fall of rain being slightly above the average. In the first fortnight of March there was frequent rain, but during the rest of the month the weather was remarkably bright and genial. Second Quarter. The mean reading of the barometer was 29.769 inches; the mean temperature of the air was 53°.3; the rainfall was 5.00 inches, and the amount of bright sunshine recorded during the quarter was 386.7 hours. 4 The first half of April was genial and spring-like; the remainder of the month was mild, and there was frequent rain. The weather in May was generally dull and cold, with frequent rain. The weather during the first three weeks of June was cold and wet, but was afterwards bright and warm. Third Quarter. The mean reading of the barometer during this quarter was 29 812 inches ; the mean temperature of the air was f>8°-6 ; the rainfall measured 7 54 inches, and the duration of bright sunshine recorded was 311 hours. Th i weather during a great part of July was generally wet and dull, though in the first week and for some days at the end of the month it was fine and bright. August was generally unsettled, with very little sunshine and frequent rain. In September the weather was cold and dull, and there was frequent rain during the month. Fourth Quarter. During this quarter the mean reading of the barometer was 29'800 inches ; the mean temperature of the air was 46°.4 ; the rainfall measured 8'94 inches, and the duration of bright sunshine registered was 116 hours. The weather in October was generally dull, with frequent rain during the greater part of the month. November was a mild month, and there was much rain during the first sixteen days, after which the weather was generally fine. December was mild and generally sunless, there being frequent rain in the middle of the month. Births and Deaths. The number of births registered during the 52 weeks ended December 29th, 1894, when all the corrections have been made, was 1,219, showing a birth rate of 21.9 per 1,000 of the population. 316 births occurred in St.. Margaret's parish, giving a birth rate of 14.7 per 1,000; and 903 births in St. John's parish, giving a birth rate of 26.4. The number of deaths of parishioners duly corrected amounted to 1,006, showing a recorded death rate of 18.0, and a corrected death rate of 20.3 per 1,000 of the population. Of these deaths 363 occurred in St. Margaret's parish, giving a general death rate of 16.9; and 643 deaths occurred in St. John's parish, giving a general death rate of 18.8. 5 The following comparative table shows the birth and death rates per 1,000 during the past four years for the united parishes, viz. :— Birth Rate. Death Rate. Recorded. Corrected for age and sex distribution. 1891 26.8 19.7 22.2 1892 24.7 23.0 26.0 1893 24.4 23.1 26.1 1894 21.9 18.0 20.3 In calculating the above birth and death rates I have used the figures of the population of the census of 1891, which has been done in former years, as I consider this more accurate than using the population calculated to the middle of 1894. The population of St. Peter's Close is also excluded in these returns. The birth rate for London during 1894 was 301 per 1,000 of the estimated population, this is the lowest birth rate for London in any year on record. The death rate for the same period was 17.8. This rate was lower by 2.6 than the average rate in the previous ten years. With regard to Infant Mortality in London during 1894, the deaths were equal to a rate of 143 per 1,000 children born, as compared with 154, the average rate in the preceding ten years. The following table gives the distribution of the deaths of parishioners dying in various extra parochial institutions, all of which are included in the mortality statistics :— Institution. No. of Deaths. St. George's Infirmary 207 ,, Workhouse 9 Chelsea Infirmary 1 St. Thomas' Hospital 7 Western Fever Hospital 12 North Western Fever Hospital 4 South ,, „ ,, 6 London Fever Hospital 1 Queen Charlotte's Hospital 1 St. George's Hospital 18 St. Bartholomew's Hospital 1 Charing Cross „ 4 Middlesex „ 2 Throat Hospital, Great Portland Street 1 Brompton Hospital 6 Victoria „ 2 St. Peter's „ 1 Belgrave „ 2 French ,, 1 German ,, 1 6 Institution. No. of Deaths. Gordon Hospital 1 Children's „ Great Ormonde Street 1 Cancer „ 1 St. Elizabeth Hospital 1 Licensed Victuallers' Asylum 1 Hanwell Asylum 1 Banstead „ 1 Cave Hall „ 1 Darenth ,, 1 Ilford „ 1 Friedenheim ,, 1 St. Peter's House 1 Elsewhere 2 Total 301 Of the 236 deaths occurring ill Westminster Hospital 14 belonged to St. Margaret's Parish, 66 to St. John's, and 156 were strangers. Table I., giving the death rates from certain classes of disease in the districts:— Whole St. District. Margaret's. St. Johns. 1. Chief zymotic diseases ... 2.1 1.5 2.4 2. Pulmonary diseases ing phthisis 7.1 6.9 7.2 Table II.—Comparative table of deaths from the principal zymotic diseases and deaths of infants under one year of age:— Years. 1892. 1893. 1891. Deaths (Total) 1297 1290 1006 Small Pox — — — Measles 77 5 37 Scarlet Fever 18 25 8 Diphtheria 44 14 22 Whooping Cough 20 15 19 Typhus - — — Enteric Fever 3 7 4 Simple and Ill-defined Fever — 1 — Diarrhœa 22 43 11 Deaths of Infants under one year of age 233 255 180 Deaths under one year to every 1,000 Births registered 169 188 147 7 Infant Mortality. A record of the number of deaths of children under one year of age per 1,000 births is generally considered a fair indication of the healthiness of a district. The chief diseases proving fatal to children under one year of age are as follows :— More than four-fifths of the deaths in the first month are due to premature birth, congenital malformation, and feeble vitality. Diarrhceal complaints reach their maximum destructiveness from about the third to sixth month. Inherited syphilis covers mainly the first four months. Deaths from irritation of teething are most numerous in the last three months of the year. The earliest of the zymotic diseases to declare itself is whooping cough ; next comes measles, most fatal after the eighth or ninth month; whilst scarlet fever scarcely carries off any infants at all in the first year. It will readily be seen, on reference to Table III., that nearly one seventh of the deaths of infants under one year of age occur at one institution alone, and this, of course, raises the infant mortality of St. Margaret's parish very much indeed, for it must be remembered that most of the children at this institution are not born in the parish, but are imported chiefly from outside districts. 8 9 Table III.—DEATHS during the year 1894 in the Metropolitan Sanitary District of St. Margaret's, Westminster, classified according to Diseases, Ages, and Localities. Localities. ST. MARGARET. 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. 55 & upwards. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 Smallpox. Influenza. Scarlatina. Diphtheria. Membranous Croup. Typhus. Fevers. Cholera. Erysipelas. Measles. Whooping Cough. Diarrhœa and Dysentery. Rheumatic Fever. Ague. Phthisis. Bronchitis, Pneumonia and Pleurisy. Heart Disease. Injuries. All other Diseases. Total. Enteric. or Typhoid. Continued. Repulsing. Puerperal. (a) (b) (c) (d) (e) (f) (g) (h) (i) Westminster Hospital 236 22 41 17 21 125 10 Under 5 ... ... ... 8 ... ... ... ... ... ... ... 1 4 2 4 ... ... 1 12 2 3 26 63 5 upwds. ... ... ... 2 ... ... 5 ... ... ... ... ... ... ... ... ... ... 23 28 25 12 78 173 Convent 9 7 2 ... ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... 3 ... 1 ... ... ... 2 ... ... 3 9 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Rest of Parish. 197 32 15 12 10 82 46 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... 5 3 ... ... ... ... 18 ... 1 20 47 5 upwds. ... 4 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 20 36 26 8 55 150 Net Total 363 46 31 15 17 141 113 Under 5 ... ... 2 5 ... ... ... ... ... ... ... ... 9 3 4 ... ... ... 22 1 2 29 77 5 upwds. ... 5 ... 1 ... 2 ... ... ... ... 1 ... ... 1 ... ... 50 78 35 13 100 286 The subjoined numbers have also to be taken into account in judging of the above records of Mortality. Parishioners Dying outside Parish 141 5 12 2 5 52 65 Under 5 ... ... 2 5 ... ... ... ......... ... ... ... ... 1 ... 3 ... ... ... 2 ... ... 4 17 5 upwds. ... 1 ... 1 ... ... ... ... ... ... ... 1 ... ... 1 ... ... 26 40 7 3 44 124 Nou-Parishioners dying in parish. 220 20 39 16 19 118 8 Under 5 ... ... ... 8 ... ... ... ... ... ... ... 1 4 2 4 ... ... 1 12 1 2 24 59 5 upwds. ... ... ... 2 ... ... 4 ... ... ... ... ... ... ... ... ... ... 19 26 23 10 77 161 No death occurred from Small Pox in this District during the year. 10 11 Table IV.—DEATHS during the year 1894 in the Metropolitan Sanitary District of St. John's, Westminster, classified according to Disease Ages, and Localities. Localities. ST.JOHN. Mortality from all causes, at subjoined Ag.es. Mortality 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 18 19 20 21 22 23 Smallpox. Influenza. Scarlatina. Diphtheria. Membranous Croup. Typhus. Fevers. Cholera. Erysipelas. Measles. Whooping Cough. Diarrhœa and Dysentery. Rheumatic Fever. Ague. Phthisis. Bronchitis, Pneumonia, and Pleurisy. Heart Disease. Injuries. All other Diseases. Total. Enteric (or Typhoid). Continued. Relapsing. Puerperal. (a) (b) (c) (d) (e) (f) (g) (h) (i) Grosvenor Hospital 2 ... ... ... ... 2 ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 2 Station Hospital 10 ... ... ... ... 7 3 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... ... 7 10 Rest of Parish 402 115 67 12 13 ' 128 67 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... 25 15 3 ... ... 1 62 2 8 66 182 5 upwds ... 7 ... 1 ... ... ... ... ... ... ... ... 2 ... ... ... ... 36 59 28 5 82 220 Net Total 643 134 104 24 28 252 101 Under 5 ... ... 4 12 ... ... ... ... ... ... ... ... 26 16 6 ... ... 1 74 3 11 85 238 5 upwds ... 9 2 4 ... ... 2 ... ... ... ... 1 2 ... ... ... ... 82 90 37 16 160 405 The subjoined numbers have also to be taken into account in judging of the above records of Mortality. Parishioners dying outside parish. 231 19 37 12 15 117 31 Under 5 ... ... 4 12 ... ... ... ... ... ... ... ... 1 1 3 ... ... ... 12 1 3 19 56 5 upwds ... 2 2 3 ... ... 2 ... ... ... ... 1 ... ... ... ... ... 46 28 9 11 71 175 Strangers dying in parish. 2 ... ... ... ... 2 ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 2 No death occurred from Small Pox in this District during the year. 12 13 Table V.—POPULATION, BIRTHS, AND OF NEW CASES OF INFECTIOUS SICKNESS, coming to the knowledge of the Medical Officer of Health, during the 52 Weeks ended 29th December, 1894, in the Sanitary District of St Margaret and John, Westminster, classified according to Diseases, Ages, and Localities. Localities. Population at all Ages. Registered Births. Ages. New Cases of Sickness in a each locality. Number of such cases removed from home to hospitals. 1 2 3 4 5 6 7 8 9 10 11 Totals. 1 2 3 4 5 6 7 8 9 10 11 Totals. Census 1891. Estimated to Middle of 1894. Smallpox. Scarlatina. Diphtheria. Membranous Croup. Fevers. Fevers. Cholera. Erysipelas. Smallpox. Scarlalina. Diphtheria. Membranous Croup. Fevers. Cholera. 1 Erysipelas. Typhus, Enteric (or Typhoid). Continued. Relapsing. Puerperal. Typhus. Enteric (or Typhoid). Continued. Relapsing. Puerperal. (a) (b) (c) (d) (e) st. margaret. Westminster Hospital. ... ... ... Under 5 ... 1 ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... 1 5 upwards ... 4 ... ... ... 1 ... ... ... ... ... 5 ... 4 ... ... ... 1 ... ... ... ... ... 5 Convent ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwards ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Rest of Parish ... ... ... ... ... 9 12 ... ... 1 ... ... ... ... ... 22 ... 9 12 ... ... ... ... ... ... ... ... 21 5 upwards ... 36 18 ... ... 20 ... ... ... ... 7 81 ... 33 12 ... ... 9 ... ... ... ... ... 54 Total 21,433 20,761 316 Under 5 ... 10 12 ... ... 1 ... ... ... ... ... 23 ... 10 12 ... ... ... ... ... ... ... ... 22 5 upwards ... 40 18 ... ... 21 ... ... ... ... 7 86 ... 37 12 ... ... 10 ... ... ... ... ... 59 st. john. Grosvenor Hospital ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwards ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Station Hospital ... ... ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwards ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Rest of Parish ... ... ... Under 5 ... ... 22 ... ... 3 ... ... ... ... 3 63 ... 35 22 ... ... 3 ... ... ... ... ... 60 5 upwards 1 66 20 ... ... 18 1 ... ... ... 24 130 1 65 17 ... ... 17 ... ... ... ... 6 106 Total 34,106 33,689 903 Under 5 ... 35 22 ... ... 3 ... ... ... ... 3 63 ... 35 22 ... ... 3 ... ... ... ... ... 60 5 upwards 1 66 20 ... ... 18 1 ... ... ... 24 130 1 65 17 ... ... 17 ... ... ... ... 6 106 " Notification of Infectious Disease" has been compulsory in the District since October 31st, 1889. The Isolation Hospitals arc the Hospitals of the Metropolitan Asylums Board, and occasionally the London Fever Hospital and the London Small Pox Hospital. 14 Remarks on Infectious Diseases. Small-Pox.—No death was registered in either of the parishes during the year. One case, however, was notified in St. John's parish, at an eating house, and upon investigation the patient was found to be a girl of seven years of age, whose parents had both been very recently removed to the Small-pox hospital at Dartford, and who resided in Flint-street, Walworth. Before obtaining the removal of the patient, I, however, took the precaution of vaccinating both her and her brother, and had the remaining occupants of the house removed to the Vestry's rooms at the Public Mortuary, whilst the place was thoroughly disinfected, and the sale of refreshments stopped. The child attended St. John's National School, Walworth, and an intimation of the case was sent to the Medical Officer of Health for Walworth. No further cases occurred in the parishes, but one doubtful case was notified, which however proved to be one of Papular Syphilide. Scarlet Fever.—From, this disease eight deaths were registered, viz., six in St. John's parish and two in St. Margaret's. One hundred and fifty-one cases were notified, 101 in St. John's parish, and 50 in St. Margaret's. It will be seen on reference to Table II. that the number of deaths was only eight compared with twenty-five last year, and on reference to Table V. that the number of cases notified during the same period was 410, against 151 this year. It will be interesting to note that five cases occurred at the Newport Market Industrial School, Coburg-row. A sharp look-out, however, was kept for any latent cases which might have developed, and this was done with great success. Whilst dealing with Scarlet Fever, it may here be well to state that proceedings were instituted against a medical practitioner for non-notification of a case in Victoria-street, with the result that the Magistrate inflicted the full penalty of the law. Diphtheria.—Twenty-two deaths occurred from this disease against fourteen last year, this heading includes all cases of Membranous Croup. The total number of cases notified in the parishes was seventy-two, compared with eighty-two last year. Great care has been taken to examine and enquire into every case with special attention as to school attendance, and forms for the purpose were printed, and as eases occurred, these were filled up and sent to the Medical Officer of Health of the London County Council, who issued a memorandum upon the increase of this disease in London in 1894. It is reasonable to believe that the spread of the disease is largely due to school attendance; in fact there has been a great increase in the mortality from this disease in children between the ages of three and ten years, since the Education Act came into operation in 1870. A letter was also received from the Medical Officer of the School Chart Shewing Week by Week the Number of Cases of Scarlet Fever Diphtheria and Enteric Fever Notified by Medical Practitioners as having occurred in the Parish of St. Margaret, Westminster, during the year ended 29th December, 1894. Chart Shewing Week by Week the Number of Cases of Scarlet Fever Diphtheria and Enteric Fever Notified by Medical Practitioners as having occurred in the Parish of St. John the Evangelist, Westminster, during the year ended 29th December, 1894. , i-.v L'-rr^x 15 Board for London in April, enquiring whether the Vestry would grant a certificate stating when the premises in which an infectious disease had occurred have been disinfected, so that the head teacher of the school attended by the children from the house in question may have some guarantee upon their re-admission. In reply the Vestry stated that upon enquiry being made by the head teacher of any elementary school, the sanitary officers would answer the same according to the facts of the case, on the understanding that the Vestry incur no responsibility by so doing. In November last the Managers of the Metropolitan Asylums Board entered into an arrangement with the Royal College of Physicians with the idea of affording their medical officers opportunities for the early recognition and accurate diagnosis of diphtheria by means of bacteriological examination. Reference must also be made as to the anti-toxic serum treatment of diphtheria, which seems to have been very successful in Germany, France, &c. On the 8th of December last the Board accepted the offer of the Laboratories' Committee of the Royal Colleges of Physicians and Surgeons for supplying serum for the treatment of cases of diphtheria in their hospitals. Fevers.—Under this heading forty-four cases were notified, forty-three being cases of typhoid fever, and one a case of continued fever. Last year the number of cases notified was fortyfive. Four deaths were registered this year against seven last year. It may be interesting to note from statistics that the male sex is more liable to be attacked by enteric fever, but its fatality is greater amongst the female sex. Measles.—This disease caused 37 deaths compared with five last year. Measles was very prevalent in London during the year, and almost double the number of deaths occurred compared with that of the previous year. On and after the 1st April, 1894, the Vestry decided to abandon the notification of this disease, and up to that date 227 cases were notified. Diarrhoea.—Eleven deaths were registered from this disease, ten of which were in children under five years of age. Fortythree deaths were registered in 1893. Cholera.—No deaths occurred from, and no cases were notified of this disease. With regard to cholera, a circular letter was received from the Local Government Board, dated 16th July, 1894, its object being that of encouraging Sanitary Authorities to attach more importance to the prevalence of diarrhoea and to obtain the classification of the disease until the end of September. I accordingly reported on this letter to the Vestry, the Local Government Board rightly assuming that diarrhoea is often a prelude to other diseases. With a view of 16 enjoining on the public the necessity for strict attention with regard to sanitary matters, I drafted a circular giving hints as to . the prevention of diarrhoea, which was approved of by the Vestry, and a copy was accordingly sent to every householder in the parishes. This undoubtedly proved very effectual. Whooping Cough.—During the year there were nineteen deaths from this cause against fifteen last year, showing a slight increase. The appended charts will show at a glance the incidence of the three principal zymotic diseases, viz., Scarlet Fever, Diphtheria, and Enteric Fever. Of the 302 cases of infectious diseases notified, 247 were removed to the various fever hospitals. A list of the streets, with the number of cases of infectious diseases occurring in such streets, is given below :— St. Margaret.s .Parish. Street or Place. Scarlet Fever. Diphtheria. Typhoid Fever. Carlisle-mansions 1 ... ... Caxton-street 1 ... ... Charles-street 3 ... ... Cobourg-row 7 1 ... Ennismore-gardens 1 ... ... Francis-street 2 1 ... Hill-street ... ... 1 Hyde Park-barracks 3 ... ... Hyde Park-court 1 1 2 Hyde Park-house ... ... 2 King's Head-court 1 1 ... Knightsbridge-barracks 5 ... 1 Lewisham-street 1 ... ... Peabody-buildings, James-street 2 7 1 James-street ... ... 1 St. Andrews-terrace 3 1 ... Parliament-street ... ... 1 Stafford-place 1 ... ... Trevor-square 1 .. ... Victoria-house 3 ... ... Victoria-street 3 1 4 Willow-street 1 ... ... York-street 1 1 1 Castle-buildings ... l ... Horseshoe-alley ... l ... Queen Anne's-gate ... l 3 Montpelier-square ... 1 ... Dartmouth-street ... l ... Raphael-street ... l ... Parker-street ... 5 ... Greencoat-mansions ... 1 ... Rutland-gate ... 1 1 Catherine-street ... 1 ... Spencer-buildings ... 1 ... Artillery-row ... 1 ... Kensington-place ... 1 ... Westminster Hospital 5 ... 1 Kensington Palace-gardens ... ... 1 17 St. John's Parish. Street or Place. Scarlet Fever. Diphtheria. Typhoid Fever. Small-pox. Bessborough-gardens 2 .. ... ... Bessborough-place 3 2 1 ... Bessborough-street ... ... ... ... Bull's Head-court 1 ... ... ... Benuett's-yard 1 ... ... ... Church-street 1 ... ... ... Cobourg-row 2 ... 1 ... Cowley-street 1 ... ... ... Chadwick-street 3 ... ... ... Carey-place 1 ... ... ... Chapter Chambers, Chapter-st. 1 1 ... ... Charlwood-street 1 ... ... ... Douglas-street 1 1 ... ... Dean's-place 4 ... ... ... Dorset-street 5 ... 1 ... Edward-street 1 ... ... ... Elizabeth-place ... l ... ... Esher-street ... ... 1 ... Frederick-street 1 l ... ... Grosvernor-road 1 ... ... ... Grosvenor-street 1 ... ... ... Great Smitl-street ... ... 1 ... Great Peter street 3 ... 1 ... Greycoat-place ... 1 2 ... York-buildings, Grub-street ... 2 ... ... Horseferry-road 3 1 2 1 Little College-street ... 1 ... ... Lillington-street 5 3 ... ... Lower Garden-sereet ... ... 1 ... Little Smith-street ... 1 ... ... Marsham-street ... ... 1 ... Moreton-street 1 ... ... .. Medway-street 2 4 ... ... Monck-street ... 1 ... ... Millbank-street 1 ... ... ... North-street 1 ... ... ... Page-street 3 ... 1 ... Peabody-buildings 19 8 ... ... Ponsonby-terrace 3 2 ... . Pousouby-place 1 .. ... ... Rochester-row 1 ... ... ... Romney-street 2 ... ... ... Regency-street 8 ... ... ... Smith-sq.,St John's Chambers 1 ... .. ... St. Matthew's-street ... 1 .. ... Tufton-street 1 l l ... Techbrook-street 4 ... l ... Upper Garden-street ... .. l ... Vincent-street 2 2 ... ... Vineent-square 1 1 ... ... Vauxhall-bridge-road 5 3 3 ... Westminster-buildings 2 ... ... ... Winchester-terrace 1 3 1 ... Wood-street ... 1 ... ... 18 Table VI.—Vaccinations during the Year 1894. Primary Vaccination. Re-Vacination by Public Vaccinator. Public Vaccination. Private Practitioners. Total. 13 477 364 841 The following is a record of the Sanitary Work done in the United Parishes throughout the year 189-1:— Coroner's Court and Mortuary. Articles disinfected 6,875 Rooms disinfected 411 Number of families removed to the Vestry's Reception Rooms, Horseferry-road, during the disinfection of their dwellings 24 Number of bodies removed to Mortuary 133 Number of Inquests held at the Coroner's Court 97 Sale of Food and Drugs Act. The following is a statement respecting the samples of food taken for analysis during the year:— Article. No. of Samples. Genuine. Adulterated. Fines. Costs. £ s. d. £ s. d. Butter 33 26 7 18 0 0 4 7 6 Milk 39 37 2 2 0 0 1 5 0 Cocoa 3 Nil. 3 2 0 0 1 17 6 Coffee 9 9 — 2 0 0 Ice Cream 6 6 — 1 0 0 Unsound Food. The carcases of seven sheep were examined and found to be putrid and were consequently destroyed. Large quantities of fruit, fish and vegetables have been condemned. In nearly all these cases the goods were brought to the Town Hall for examination. 19 Housing of the Working Classes Act, 1890. The following houses were closed under the above Act, being unfit for human habitation, viz. :— 2 to 16, Ship-court. 1 to 7, Taylor's-buildings. 5 and 6, Bull's-head-court. 44, Tufton-street. 10 and 11, Vincent-place. 1 to 12, George's-place. 6, Gulston's-cottages. The houses in Ship-court, George's-place, Vincent-place, and Taylor's-buildings have since been demolished. In addition to this property, five houses Nos. 13 to 19, Francis street, and 37, Albert-gate were closed tinder the Public Health (London) Act, 189.1, and over fifty small houses have been closed or demolished voluntarily on the part of the owners in the neighbourhood of Francis-street and Willow-street. Lewisham street.—The houses on the south side of this street have been thoroughly repaired and cleansed throughout; the old wooden water-closets removed and good brick closets built in their place, the cellars have been closed and boarded up to prevent access thereto, and in most cases the back areas have also been filled in and cemented over, thereby enlarging the yards. Bake-houses. It will be within the recollection of the Vestry that I made a special report in June, giving full details with regard to the complete inspection of the bake-houses in the district. During the year in one instance only was it found necessary to serve a statutory notice. Cow-sheds and Slaughter-houses. These have all been inspected and in only one case, a cow-shed, which was in an insanitary condition, was it found necessary to oppose the renewal of the license. Works were eventually carried out, and the license renewed. Stables and Mews. A large number of stables has been inspected, and the regulations of the London County Council for the provision of proper manure receptacles, &c., were carried out with exceptionally good results. 20 Milk-shops. The whole of the milk shops in St. John's Parish, numbering seventy-two, were examined, and in a large number of instances it was found that paraffin oil was kept close to the milk vessels, and in several cases houses were discovered carrying on the sale of milk which were not duly registered. Information was accordingly given to the London County Council. Workshops. A large number of these has been examined, but it has been found impossible to carry out a systematic inspection, owing to the pressure of other and more important work. Outworkers.—The Factory and Workshops Act, 1891, requires the occupiers of factories and workshops to keep a list of persons in their employ who are engaged in any of the following occupations at their own homes, viz.:—(1) Making of wearing apparel, (2) electro-plate, (3) cabinet furniture and upholstering work, (4) files. The names and addresses of a large number of such persons resident in the parish have been obtained, but no case of infectious disease has been known to arise at any of their homes during the year. Urinals in Connection with Public-Houses. On June 19th the Sanitary Committee instructed the Inspectors to examine and report upon the urinal accommodation upon public-house premises in the parish, owing to numerous complaints having been received of nuisances committed in public thoroughfares in various parts of the parish. Of the fifty public-houses in St. Margaret's parish, ten were without any urinal accommodation whatever, and fourteen of the sixty-eight licensed houses in St. John's parish were in a similar condition. In many instances there was no water supply whatever to the urinals. The usual notices were served on the owners or occupiers to keep the same in a proper sanitary condition, and at the same time the Committee recommended that all those urinals which were accessible from the highway and in which the structures were suitable, and where the owners or occupiers were willing, that the Vestry undertake the lighting, flushing and cleansing of the same. Black Smoke. In all but one instance the service of an " intimation " that a nuisance existed from this cause has been sufficient to abate the same, the exception referred to being that of the Royal Palace Hotel, Kensington, in which legal proceedings were taken, the defendants being fined £5 and three guineas costs. 21 Water Supply, &c., to Newly-erected Houses. The examination of sanitary fittings, made necessary by the Bye-laws of the London County Council, resulted in the inspection of over 100 new water-closets and their connections to soil pipes, and in addition 101 certificates under section 48 of the Public Health (London) Act, 1891, have been granted to the owners of newly-erected houses. Underground Rooms. Section 96, Public Health (London) Act, 1891. A great deal of good is being done by the inspection of these rooms, and, up to the present, it has only been found necessary to serve one notice for the illegal occupation of such rooms. Registration of Houses Let in Lodgings. From the 1st April, 1894, Inspector J.W. Kirk (assisted by Mr. J. Foster) has been specially engaged in this work, with the following results, viz. :— St. Margaret. St. John. Houses registered 52 352 Comprising tenements 294 2,471 Return forms served 52 353 Registration notices served 52 198 The following is a summary of the work executed by the three sanitary inspectors during the year 1894 :— Inspections made 2,995 Defects found 4,071 Notices served 2,265 Work completed 1,951 Police proceedings 57 In forty-six other cases legal proceedings were ordered for works to be carried out in St. Margaret's parish, but the work being completed on the service of the formal notices the summonses were abandoned. In conclusion, it is satisfactory to be able to state that the health of the inhabitants of the united parishes has been exceptionally good during the year 1894, as will be seen on reference to the death statistics, the death-rate being especially low, when compared with that of previous years. 22 In consequence of the constant increase in the many and varied duties cast upon the Public Health Department, I must offer my best thanks for the able help which has been accorded me by the Sanitary Inspectors and Sanitary Clerk during the past year. I regret that this report has not been sent in before, owing to the fact that I have been suffering, since the beginning of January, 1895, from a severe attack of Typhoid Fever, from which I am, even now, only just convalescing. I have the honour to be, My Lords and Gentlemen, Your obedient Servant, JOHN NOKTON, Medical Officer of Health. Town Hall, Caxton Street, Westminster. 13th May, 1895.