NINETEENTH ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH, Being for the year 1874.

To the Vestry of the Parish of St. Mary Abbott’s, Kensington.

Gentlemen,

I propose in this, the Nineteenth Annual Report of the Medical Officer of Health, to follow the plan adopted in my previous reports: that is to say, the vital statistics will be made up to the end of the registration year (January 2nd, 1875), for the sake of comparison with the Registrar-General’s figures for the entire Metropolis: the Tables, showing the sanitary work carried out by your very competent staff of inspectors, will be made up to the end of the Vestry year (March 25th, 1875); while, with respect to other matters calling for notice, I shall bring the report down to the latest possible period, no useful purpose being served by delay; it being, moreover, in every way the better plan to refer to subjects while they are tolerably fresh in recollection, and before they have lost their interest. I shall, as usual, preface my report with some general remarks, which, I trust, will be found worthy of perusal. And I may here mention that the first Six Tables in the Appendix are given in the form settled last year by the Society of Medical Officers of Health, with a view to ensure uniformity in statistical returns. The subject was brought under the notice of the Society by myself, and a great deal of thought and labour devoted to it, in order to make the tables generally acceptable. I now pass on to observe that the public health in this Parish, as gauged by the gross mortality, was not so good during the year 1874 as in the previous year, the deaths registered (2,696) showing an increase of 260. The increase in the rate of mortality, however, was not large in proportion, for as the population increased by 5,000, 91 deaths have to be deducted on that account, while 32 deaths are accounted for by an increase in the number of deaths of non-parishioners registered at the Brompton Hospital for Consumption and the Diseases of the Chest. The real excess of mortality, therefore, was 137, and of these deaths 98 belong to the group of zymotic diseases, and were due to a severe and prolonged epidemic of measles, leaving 39 deaths to be spread over the remainder of Table 3 (Appendix); but as a matter of fact the higher rate of mortality from chest diseases, which will be referred to hereafter, more than accounts for this number. If we assume that the deaths of Kensington parishioners outside the parish were as numerous as the deaths of non-parishioners at the Brompton Hospital, which is situated within the parish, the rate of mortality during the year would be 19.5 per 1,000 persons living—a rate that compares not unfavourably with the rate for the entire metropolis, which was 22.5 per 1000. If, however, in the absence of definite information respecting deaths of parishioners taking place out of the parish, we restrict our view to the deaths of parishioners registered within the parish—deducting 125 deaths at the hospital and 36 at St. Joseph’s House—the rate of mortality was only 18.3 per 1,000. The subjoined table shows the rate in the several great divisions of the metropolis, as given by the Registrar-General in his annual summary, and in Kensington:—

DEATH RATE, 1874.

per 1,000

Kensington 19.5

All London 22.5

West Districts 20.9

North 21.8

Central 25.6

East 25.4

South 21.5

For registration purposes, Kensington [6a] is divided into two sub-districts of very unequal size and population, and which, as we shall see, are not less remarkable in other respects. The Kensington Town sub-district embraces everything north of the Kensington main road, and a good deal south of it. The Brompton sub-district completes the map of the parish, which, I may say, is exceedingly awkward in shape, being very long from north to south and very narrow from east to west, and therefore present considerable difficulties in the task of sanitary administrations. The Town sub-district comprises two wards, respectively named the Ward of St. Mary Abbott’s, Kensington, and the Ward of St. John, Notting Hill, and St. James, Norland. [6b] The latter ward contains the largest proportion of poor inhabitants. The greater number of poor comprised in this sub-district, as a whole, helps to explain the marked difference in the vital statistics of north and south, to which, I wish, in the present report, to give some prominence. The birth-rate of the parish in 1874 was 31.7 per 1,000 persons living, that of all London being 35.7, and of All England (1872) 35.8. But the birth-rate in the Town district was 33.6, and in Brompton only 24.8 per 1,000. The death-rate of the whole parish being taken at 19.5 per 1,000 (and the necessary redistribution of deaths in hospital and workhouse, in proportion to population, being made), it appears that the annual rate of mortality in the Town sub-district was 20.4 per 1,000 and in Brompton only 16.6. The above facts may be made more clear by a comparative statement. If the births and deaths in Brompton had been as numerous in proportion to population as they were in the Town sub-district, 1,122 children would have been born and 681 persons would have died; whereas, in fact, only 815 children were born, and the deaths, after correction, were only 548. Or, to put it the other way, if the births and deaths in the Town sub-district had been on the Brompton scale only 2,567 instead of 3,536 children would have been born, and only 1,726 persons, in place of 2,147, would have died. These remarkable discrepancies, quoad the birth-rate, may be in part explained by the somewhat larger proportion of females per 1,000 of the population in the Town sub-district compared with Brompton. The total estimated population in July was 138,000, viz., males 56,240, and females 81,760. In every 1,000 living, females were approximatively as 593 to males 407. In the Town sub-district there were, at the census in 1871, 587 females to 413 males; in Brompton the females were 608 and the males 392 per 1,000 persons living. We must assume, therefore, that there are fewer marriages in Brompton, and that those marriages are less fruitful than in the more densely-populated and poorer northern section of the parish. [7]

Less difficulty is experienced in accounting for the lower rate of mortality in Brompton, it being well known that the death-rate of females is considerably less than that of the male sex. Taking the whole parish, it appears that the rate of mortality was 23.9 in the male, and only 16.5 per 1,000 in the female sex. The magnitude of this difference may be illustrated by the statement that if the mortality in the entire population had been at the female rate, the deaths would have numbered only 2,208 instead of 2,696, while they would have been no fewer than 3,298 at the rate that prevailed amongst males.

The difference between the two districts is not confined merely to gross numbers of deaths. It is seen in the character of the prevalent fatal diseases, and points to a generally better state of health in Brompton, and to a better prospect of life for its inhabitants. This difference depends, no doubt, on the superior status of a large proportion of the population in the latter district, and on their possession of those necessaries and comforts of life to which the prolongation of existence is so largely due. I do not propose to enter at length upon this interesting subject now. I shall content myself for the present with putting on record the facts at which I have arrived, leaving them for the most part, to speak for themselves. The subjoined table shows the number of deaths from certain diseases in the two sub-districts, and the number that would have occurred in the Town sub-district had the mortality been on the same scale as in Brompton, due regard being had to population:—

Name of Disease Actual No. of Deaths in the Town Sub-District. Deaths in the Brompton Sub-District. Calculated No. of Deaths in Town on the Brompton scale Excess or Deficiency in Town compared with Brompton.

The Seven principal Zymotic Diseases 332 66 176 + 156

Measles 115 6 20 + 95

Diphtheria 24 2 6 + 18

Scarlet Fever 28 4 12 + 16

Typhus Fever 9 0 0 + 9

Enteric Fever 19 9 28 - 9

Simple Continued Fever 11 4 13 - 2

Hooping Cough 36 9 28 + 8

Diarrhœa 90 22 69 + 21

Puerperal Fever 18 6 19 - 1

Croup 25 1 3 + 22

Erysipelas 14 8 25 - 11

Cancer 51 16 50 + 1

Tuberculous Diseases (phthisis, scrofula, &c.) 268 59 186 + 82

Brain Disease, (Apoplexy and paralysis) 127 46 144 - 17

Convulsions 50 9 28 + 22

Heart Disease 102 33 103 - 1

Lung Diseases 461 93 292 + 169

Enteritis and Peritonitis 34 5 16 + 18

Liver Disease 30 7 22 + 8

Bright’s Disease 14 8 25 - 11

Atrophy of children 143 20 63 + 80

Premature birth 35 11 34 + 1

Childbirth 11 3 9 + 2

Teething 26 9 28 - 2

Old age 79 15 47 + 32

The greater fatality of the zymotic diseases generally, and of measles in particular, in the Town sub-district, cannot fail to be noticed; as well as the high mortality from tuberculous and lung diseases, atrophy of children, croup, &c. It is obvious, in fact, that the diseases which depend on a lowered condition of vitality, or on hereditary taint, are more prevalent in the Town sub-district than in Brompton. So are the diseases that may be correctly described as of a more or less preventable character, such, for example, as the lung diseases which are so fatal at the extremes of life, when the influences of neglect and poverty, on the one hand, and of care and comfort on the other, are so strong for evil or for good in the exposure of young and old to, or their preservation from, the predisposing causes of disease. The diseases which mark the later periods of life are, as might be expected, prominently noticeable in the Brompton mortality, such, for instance, as the brain diseases, apoplexy and paralysis, and heart disease. Cancer was equally fatal in both districts. Croup, on the other hand, was most fatal in the “Town,” and Bright’s disease, by comparison, in Brompton. I say nothing on the relative numbers of deaths attributed to “old age,” as the employment of that term generally implies failure of diagnosis rather than death without disease.

Under the heads of the various diseases, and in Tables 3 and 3a (Appendix), I have specified in detail the causes of death; but in these introductory general remarks it will not be out of place to refer to the mortality in the parish as a whole from some of the principal classes and orders of diseases. Thus the seven principal diseases of the zymotic class (or rather six, for there was no death from small-pox) were accountable for 388 deaths—a mortality equivalent to 2.8 per 1,000 persons living, and to 144 out of every 1,000 deaths. Chest diseases, other than phthisis, killed 554 persons (an increase of 71 over 1873), equivalent to 4 per 1,000 of the population, and to 208 per 1,000 deaths. Tuberculous diseases (including phthisis, scrofula, rickets, and tabes) were the causes of 326 deaths, or 2.3 per 1,000 living, and 121 per 1,000 deaths. Nearly allied to these diseases, if not identical in origin, are the wasting diseases of children, viz., those registered as marasmus, atrophy, debility, want of breast milk, and premature birth. These killed 209 children under five years of age, equal to 1.5 per 1,000 living, and to 77 per 1,000 deaths. The convulsive diseases of infants (hydrocephalus, infantile meningitis, convulsions, and teething) were fatal to 161 infants under five, or 1.1 per 1,000 living, and 59 per 1,000 deaths (vide Table 4, Appendix). Constitutional diseases caused 591 deaths = 4.2 per 1,000 living, and 232 per 1,000 deaths. Local diseases caused 1,143 deaths = 8.3 per 1,000 living, and 434 per 1,000 deaths. Developmental diseases caused 356 deaths = 2.5 per 1,000 living, and 138 per 1,000 deaths. Violent deaths (50) were equal to .3 per 1,000 living and to 18 per 1,000 deaths. The deaths of which the causes were not specified, or were ill-defined, were 22 in number = .1 per 1,000 of the population and 7 per 1,000 deaths.

The subjoined table shows the death-rate in the parish for 13 periods of four weeks corresponding to my monthly reports, the deaths of non-parishioners in the Brompton Hospital being excluded:—

Date of Report. Four weeks ended Rate of Mortality per 1,000 living. Mean temperature of the air.

January 31 19.8 41.6

February 28 23.2 38.7

March 28 22.0 43.0

April 25 16.8 49.5

May 23 16.8 48.2

June 20 14.1 58.4

July 18 17.5 62.8

August 15 19.9 61.1

September 12 14.7 59.4

October 10 13.7 55.3

November 7 15.3 51.6

December 5 21.4 39.1

January 2 (1875) 24.7 32.7

Average 18.4

Before concluding these general and prefatory remarks, I think it right to say a few words on the subject of certain outbreaks of disease due, it is not unreasonably believed, to a contaminated condition of that important article of diet, milk. It is true that the facts to which I am about to advert belong rather to the sanitary history of the current year than to 1874; I feel, however, that it would not be right to defer the publication of them, and the subject can be referred to again, if necessary. With reference first, then, to scarlet fever, a remarkable outbreak occurred in the month of June (1875) in South Kensington. Within sixty hours after a dinner party of sixteen in one of the most splendid streets in the metropolis, and in a house which had no sanitary defect and no infected inmates, six of the party were prostrate with scarlet fever. There was a large assemblage at the “at home” after the dinner, and four or five of the guests were stricken either with primary scarlatina or with characteristic sore throat. Some of the servants and others, likewise, were similarly affected. A vigorous enquiry excluded all suspicion of personal contagion as the cause of the outbreak. The one fact clearly proved was that all the sufferers had partaken of cream in some form or other, cream being of course more largely consumed at the dinner than at the “at home.” Many persons, doubtless, who partook of cream escaped, and their immunity may be accounted for in a variety of ways; but it is certain that every one who was attacked had partaken of cream. There were several curious not to say crucial cases, pointing to the cream as the nidus of infection. But how the contagium found its way into the milk-pot, if there, is a question that has hitherto baffled enquiry. The dairy—in town, but not in Kensington—whence the offending fluid was obtained was carefully scrutinised as to the state of health of the cows and of the employés, but no fact was elicited to explain the occurrence. [11]

As bearing on this subject, I may remark that it is not very long ago that a number of cases of sore throat, occurring in families supplied from a certain dairy, were brought under my notice; and I ascertained that illness of a similar character had prevailed in the house of the dairyman.

Referring to this subject, Professor Parkes, in his “Practical Hygiene,” states that scarlet fever has appeared to get into milk from the cuticle or throat discharges of persons affected with scarlet fever who were employed in the dairy while ill or convalescent. Remarkable cases of this kind have already been reported, and the fact that another zymotic disease—viz., enteric or typhoid fever—has been spread widely through the medium of milk, only serves to increase the importance of the subject in a sanitary point of view. It is well ascertained, however, that enteric fever has been conveyed in the foul water used in diluting milk—a double evil being thus inflicted on unwary purchasers.

At about the same time as the scarlatina outbreak my attention was again directed to milk as a probable source of disease by a leading practitioner, who gave me the particulars of a very interesting series of cases of dysentery, attributed on apparently sufficient grounds to the use of milk from diseased cows; and of a further series of cases of diarrhæa, attributed to some change in the character of milk supposed to depend on the food on which the cows were being fed. The information came too late to admit of an investigation of the subject, but the facts deserve to be put on record for future guidance.

In the first set of cases, seven in number, the symptoms were generally of a severe character. Three of the patients were young children, and the other four adults. The child first attacked, aged 2½ years, died after seventeen days’ illness. The dysenteric symptoms were sharp and constant, and marked on the first evening by a strong convulsion. The little patient sank, worn out by incessant tenesmus and exhausted brain-power. The body temperature was high throughout. This was the only fatal case. The second case was that of the child’s nurse. She was sent home showing signs of fever, and was ill a long time. In the third case the child, aged six years, had dysenteric straining of almost pure blood. There was little constitutional disturbance, and the attack soon yielded to treatment. The fourth case was that of a middle-aged gentleman attacked with diarrhæa, which assumed a dysenteric character, as many as twenty-five motions being passed in a day. The attack, which left marked debility; lasted ten days. The next case was that of an old nurse, who, ridiculing the idea of the milk being the cause of illness, drank all that was left after tea one day, and was rewarded with a violent diarrhæa that lasted a whole week. Another case was that of a child (who, however, was teething, and) who, after partaking of milk from the same source, suffered during six or seven days under a severe dysenteric attack. The seventh case was that of a lady, who after some days of bowel irritation, was prostrated with acute dysentery which was long in yielding and left great debility.

Upon enquiry being made of the dairyman who supplied the affected families with milk, he acknowledged that two, if not three, of his cows were “wrong in their quarters”—i.e., they had diseased udders; but he hoped that the small amount of bad milk they yielded would not be felt with the large quantity of good milk with which it was mixed! In each case the supply of milk from that particular dairy was cut short, and as regards the families interested, a limit was thus set to the endemic. But what mischief, if any, was done in other directions does not appear, and it is too late to enquire.

The other cases referred to were eleven of diarrhæa, which occurred at about the same period of time. The milk supply was derived in part from a dairy and in part from cows kept for private use, the one point in common between the two sheds being that “distillers’ wash” formed part of the food of the cows. There is no history of any illness or disturbance of the secretion of the cows themselves.

I regret that I had not an opportunity of investigating these cases—and especially the first series—at the time of their occurrence, as they might have thrown some light on an obscure but very important, an increasingly important subject—viz., that of disease in animals as a factor of disease in man. Professor Parkes states, inter alia, that milk contaminated with pus from an inflamed udder will give rise to stomatitis (inflammation of the mouth) in children and to apthæ (thrush) on the mucus membrane of the lips and gums. But there is no mention of these symptoms in the cases under review. Parkes also refers to the power of milk which contains large quantities of the fungus Oidium lactis, or Pennicillium, to produce dyspeptic symptoms, and even cholera-like attacks. Gastric irritation and febrile gastritis are also enumerated among the effects following the ingestion of impure milk.

But, after all the most important question is, how to prevent the occurrence of such cases? And here the difficulty is apparent of getting such regular skilled inspection of cowsheds (in Town, for it is hopeless, I fear, to attempt any supervision of the extra metropolitan sources of milk-supply!) as would suffice to detect disease in cows or employés, and secure effectual separation of diseased men and animals from the dairy. Probably nothing would have a greater effect in breeding caution in the vendors of milk than legislative enactment imposing severe penalties (not pecuniary only!) for the offence of selling for human food the milk of diseased cows.

In the case before us, it would appear that the dairyman knew that some of his cows were “wrong in their quarters,” and yet, though their milk could be of small value (for disease diminishes the yield rapidly and greatly), families were exposed to the risk of illness, and in one case the calamity of death was brought on a household, that no portion of the profits of business might be lost. We may charitably and reasonably believe that the dairyman anticipated no such consequences; but what so likely to prevent the recurrence of such a catastrophe as a consciousness of the risk incurred by vending diseased milk?

Before quitting this subject I may express my opinion that dairies are multiplied more than is desirable, and as a consequence (I have adverted to the subject in another part of this report), the sheds are often of a very unsatisfactory character. Large dairies, under careful supervision, managed with a due regard to sanitary requirements in man and animals, and situated in the suburbs or outskirts of the metropolis, would be a boon the value of which is likely to be the more appreciated as facts such as those noted above accumulate.

POPULATION, &c.

The estimated population of Kensington at the middle of the year was 138,000, an increase of 5,000 over 1873. The Town sub-district contained about 105,000, and the Brompton sub-district about 33,000 in round numbers. The males numbered about 56,240, and the females 81,760:—excess of females over males, 25,520. In every 1,000 there were approximatively 407 males and 593 females. The subjoined table shows the number of persons of each sex, arranged in groups of ages, at the Census, 1871:

AGES OF MALES AND FEMALES, 1871.

All Ages. Under 5 5 to 15 15 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 to 94 95 and upwds.

Males, 48977 7065 10198 8948 8317 5963 4339 2464 1270 378 33 2

Females 71322 7147 11527 16585 14203 9080 6241 3768 2000 667 97 7

Total, 120299 14212 21722 25533 22520 15043 10580 6232 3270 1045 130 9

From the above table it appears that there are an almost equal number of the sexes under the age of 5. Between 5 and 15 the excess of females begins, amounting to 1,329—this representing the “school” age, and the preponderance of females being explained, with probability, by the large number of girls’ schools in the parish. In the next three decades (15 to 45) there is a further large increase of females, viz., 7,637, 5,886, and 3,117 = (16,640), a considerable proportion of which doubtless consists of domestic servants. The increase is maintained throughout the table, but on a diminished scale, amounting in the three following decades (45–75) to 3,936, viz., 1,902, 1,304, and 730. Of persons above 75 years of age, 1,184 were enumerated; the excess of females being 358. The preponderance of females at middle life and in old age is probably due to the residence from choice of many independent persons, attracted by the salubrity and by the social and other advantages of Kensington; and to the greater longevity of women.

The superficial area of the parish is 2,190 acres, viz., 1,497 in the Town sub-district, and 639 in Brompton. Some 300 or 400 acres are still uncovered by buildings. The density of the population is about 74 persons to an acre. The total number of houses, including empties and those in course of erection, slightly exceeds 20,000. The inhabited houses at the middle of the year were about 17,667, an increase of 747 over the previous year. There were about 7.8 persons to each house on an average throughout the parish; but at the census, 1871, it appeared that the average in the Brompton Sub-district was only seven.

The subjoined table is of interest, showing as it does the remarkable growth of the parish in wealth and population during the present century:

The Year. Population. Rateable Value. The Year.

1801 8,556 £75,916 1823

1821 14,428 93,397 1833

1841 26,834 142,772 1843

1851 44,053 257,103 1853

1861 70,108 375,333 1860

1871 120,299 590,711 1865

1874 (estmtd.) 138,000 817,326 1870

£1,119,442 (April) 1875

MARRIAGES.

The marriages celebrated during the year were 1,311; one marriage to 105.2 of the population. Nineteen persons were married out of every 1,000 living. The marriage rate in all England in 1872 (last year of publication) was 17.5. The marriages in Kensington were celebrated as follows:

In Churches 1077

At Nonconformist Places of Worship 71

At Roman Catholic 70

At the Superintendent-Registrar’s Office 93

Total 1311

The marriages in the three previous years were: 1871, 1,131; 1872, 1,132; 1873, 1,241.

BIRTHS.

The births registered—registration not being compulsory—were 4,351. The annual birth rate in Kensington was 31.7 per 1,000 persons living, and in the Metropolis 35.7. The births in the Town sub-district were 3,536, and in Brompton 815: 2,216 males and 2,135 females were born. The males formed about 51, and the females 49 per cent of the births—104 males being born to 100 females: about the same proportion as in all England. One child was born to 31.6 of the population. The birth rate in the Town sub-district was 33.6, and in Brompton 24.8 per 1,000. The deficient birth rate, as compared with that of the Metropolis and England, is the result of the great disproportion in the relative number of the sexes already alluded to; the rate, however, is slightly increasing, as may be seen by reference to Tables 1 and 2 (Appendix.)

The subjoined table shows the quarterly number of births in each sub-district:

Kensington Town Sub-District. Brompton Sub-District.

Males. Females. Total. Males. Females. Total. Grand Total.

1st Quarter 484 475 959 94 111 205 1164

2nd 464 409 873 102 95 197 1070

3rd 435 405 840 84 103 187 1027

4th 448 416 864 105 121 226 1090

Total 1831 1705 3536 385 430 815 4351

DEATHS.

The deaths registered in 1874 were 2,696, viz., 2,102 in the Town sub-district and 594 in Brompton. After re-distribution of the deaths in the Workhouse and Hospital (the deaths in the latter institution remaining as a compensation allowance for the deaths of parishioners occurring outside the parish), the numbers in the respective districts stand thus: Town, 2,147; Brompton, 548. The death rate was 19-5 per 1,000 (all London 22.5), the death rate in the Town sub-district being 20.4, and in Brompton 16.6. Thirteen hundred and forty-seven males died, and 1,349 females; the deaths of females being only two above the males, although the females exceed the males in the population by no fewer than 25,520. The death rate of males was 23.9, of females 16.5 per 1,000. The general death rate in the parish, excluding the deaths of non-parishioners at the Brompton Hospital and the deaths at St. Joseph’s House, Notting-hill, was 18.3 per 1,000. The subjoined table shows the number of deaths in each quarter and in each district, excluding the deaths of non-parishioners in the Hospital at Brompton:

Kensington Town Sub-District. Brompton Sub-District.

Males. Females. Total. Males. Females. Total. Grand Total.

1st Quarter 295 307 602 63 64 127 729

2nd 218 227 445 55 53 108 553

3rd 238 245 483 49 56 105 588

4th 294 278 572 58 71 129 701

Total 1045 1057 2102 225 244 469 2571

The deaths under one year of age (762) bear the proportion of 17.5 per cent. on the registered births (London 15.5), and they were equal to 28.5 per cent. of the total deaths (London 24.6.) The deaths under five (1,188) were equal to 27.7 per cent. on the number of births, and to 45.4 per cent of the total deaths; the relative proportions in all London being 26.3 and 41.6. The deaths at 60 years of age and upwards (582) formed 21.7 per cent. of the total mortality in Kensington, the relative proportion in all London being 21.6.

Impressed with the imperfections of mere general death rates and proportional relations as given above, I have, at considerable labour, estimated the population in groups of ages, and worked out the death rate for each group—showing the number of deaths per 1,000 persons living, as follows:

Age. Estimated Population. Actual number of deaths. Deaths per 1,000 persons living.

Under 1 3,762 762 202.8

1 and under 2 3,153 223 70.9

2 „ 5 9,413 203 21.6

(0 „ 5) (16,328) (1,188) (73.)

5 „ 15 24,910 105 4.2

15 „ 25 29,262 105 3.6

25 „ 35 25,822 148 5.7

35 „ 45 17.267 151 8.7

45 „ 55 12,145 198 16.3

55 „ 65 7,154 199 27.8

65 „ 75 3,754 232 62.1

75 „ 85 1,199 183 153.8

85 „ 95 149 54 400

95 and upwards 10 8

138,000 2571

Since the preceding Table was worked out I have become acquainted with an interesting and valuable paper by Mr. Thomas A. Welton, F.S.S., on “The Effect of Migrations upon Death Rates,” read before the Statistical Society on the 15th June, 1875, and which enables me to supplement it by the following Table, in which are contrasted the death rates at certain ages in England and Wales, and in the Metropolis during the 10 years 1861–70, and in the Parish of Kensington in 1874, calculated on the number of deaths per 1,000 persons living at the several ages.

Place. Age.

0–5 15–25 25–35 55–65 65–75

England & Wales (10 years) 68.5 7.3 .. .. ..

London ( 1861–70) 81.9 6.3 9.8 38.8 75.4

Kensington (1874) 73.0 3.6 5.7 26.8 62.1

It must be obvious that the truest mode of calculating death rates is that used in the above Tables, and the result of such calculations is by no means unfavourable to the character for salubrity of the parish of Kensington. Did time permit of following out the method for the sexes, and in the two sub-districts, the results would, I doubt not, be very much more favourable for Brompton, and for the female sex, than they are for the entire parish, and for both sexes.

SPECIAL CAUSES OF DEATH.

Zymotic Diseases.—The deaths from the seven principal diseases of the zymotic class, named below, were 388 in number, viz.: 332 in the Town sub-district and 56 in Brompton, an increase of 98 over the previous year: 96 of the additional deaths belonging to the Town sub-district. Nevertheless, the mortality from these maladies was little above the average of the previous 10 years (380), and considerably below the corrected number, after due allowance for the increase of population. The deaths were equivalent to 2.8 per 1,000 persons living, and to 144 per 1,000 deaths, as against an average of 178 in the 10 years 1864–73. The deaths in London in 1874 from the same diseases were 147 per 1,000 deaths, and in all England in 1872 (the latest year of publication), 188.

Deaths from the seven principal Zymotic Diseases.

Town. Brompton. Total. Per 1,000 deaths.

Small Pox 0 0 0 0

Measles 115 6 121 45

Scarlet Fever 28 4 32 11.8

Diptheria 24 2 26 9.6

Whooping Cough 36 9 45 16.7

Fever 39 13 52 19.3

Diarrhœa 90 22 112 41.6

Total 332 56 388 144.0

It will be observed that there was no fatal cases of small-pox during the year: the first time during the decade of such immunity. But, on the other hand, the year was marked by an epidemic of measles of extraordinary severity, and confined entirely to the Town sub-district. During the year 1873 the deaths from this affection were 38, of which 31 occurred during the months of November and December, the commencement of the epidemic. Of these 38 deaths, 28 belong to the Town sub-district. The mortality in Brompton was 10 during the whole of 1873 but fell to 6 last year; while the deaths in the Town Sub-district rose to 115. Of the total of 121 deaths, 119 occurred under the age of 5 years. The highest total in the previous 10 years was noted in 1864, when 100 children died of this complaint (vide Table 5 Appendix). The total mortality during the last epidemic was 148, viz., 16 in November and 15 in December 1873, and 107 during the first five months of 1874, viz., January, 25; February, 31; March, 25; April, 16; and May, 10. Measles is always more fatal when it occurs as an epidemic, and especially during the winter months, the immediate cause of death being, in the majority of cases, some intercurrent complication affecting the lungs. The brunt of the epidemic fell on the poorer classes in the northern parts of the parish.

Scarlet Fever was fatal in 32 cases—an increase of 22 over the mortality of the previous year. 28 of the deaths took place in the Town sub-district, and 4 in Brompton—21 of the victims being under 5 years of age. The disease was, to a certain extent, epidemic in the Autumn, and, fears being entertained that it might spread, through the agency of the Board Schools, precautions were taken by the London School Board, acting on the suggestions I laid before your Vestry, to prevent children attending school from infected houses. The evil blew over as the winter advanced; but, in accordance with the usual course of epidemic scarlet fever, a more severe outbreak may be looked for during the current year, the signs of which are not wanting at the present writing.

I have already referred (p. 10, ante) to a curious outbreak of scarlet fever following on a dinner-party at South Kensington, and it may be here mentioned that a report of the occurrence having found its way, with more or less inaccuracy, into some of the papers, a good deal of alarm was created, and an impression got abroad that the disease was very prevalent in Kensington, his impression was not confined to the immediate locality, and the effect of it was to cause a considerable exodus of the wealthier classes at a prematurely early period of the “season,” as well as more or less consequent injury to trade. Some suspicions connected with the state of the Knightsbridge Barracks and the health of the soldiers’ families, including those that lived outside, added fuel to the fire, if indeed they did not kindle it. I had no reason, myself, to suspect any extensive prevalence of scarlet fever, for I knew that the deaths though rather above the average were still few in the aggregate, and I was aware, after repeated enquiry, that the cases under treatment at the three charitable dispensaries and by the five district Poor Law Medical Officers were astonishingly few. In fact, on several occasions when enquiry was made, it turned out that only one or two, or at the most three cases, were under the care of the Medical Officers, although they have many thousand cases of sickness among the poorest classes under their care during the year. I also ascertained from many medical men that they had very few cases under their care, most of them none at all. I stated these facts in my June report, but as the alarm was really great I thought it well to address a circular letter to the two hundred and fifty medical men whose names appear in the Medical Directory as residents in Kensington, asking for information and stating all I knew as to the actual dimensions of the epidemic, if it could be so called, and the comparative abeyance of scarlet fever in dispensary and parochial practice. To this letter I had fewer than fifty replies, including those that were viva voce. As I had asked for positive information only, it is probable that many of those who did not favor me with any reply were silent for the best of reasons, viz., that they had nothing to communicate. Of those gentlemen to whose courtesy I am indebted for their replies only six had any cases under treatment. The testimony of all my correspondents excepting two was unanimous in this—that the disease generally assumed a mild form, and the correctness of this view was supported by the fact that although adults formed a large proportion of the cases, the few deaths that occurred were those of young children. The exceptions referred to went to prove the rule. The first-named was a group of seven cases in one house of a person in good circumstances, in which it was subsequently discovered that the cistern was not only in untrapped connection with the drains but was also in a disgusting condition of filthiness, to which cause my informant attributed the outbreak. This fact, however, may perhaps with greater probability be the explanation of the severity of the disease, and the sharp sequelœ in all the cases. There were no deaths. In the second group of cases, eleven in number, occurring in three families of 21 persons occupying rooms in two small houses in a street at Notting Hill, there were five deaths, but, as I stated in my July report the causes of the severity and the fatality of the outbreak were to be found in the circumstances of the people and in their dwellings, “The fatality of the disease,” I remarked, “has been great in proportion to the number of cases . . . and this I attribute to the want of proper accommodation, etc., for the sick, the spread of the disease being the direct and necessary result of the retention for home treatment of first cases. It is practically impossible to isolate the patients in the crowded houses of the poor, and the parents are generally unwilling to allow their children to be removed to the hospital, the prejudice against which, however rarely survives actual experience.” In the same report I alluded to the concealment of cases, and to the fact that the registration of a death is oftentimes the first clue to the existence of the disease, and the information then comes too late for practical, i.e., preventive purposes. It is obvious, also, after repeated experience that some of the poor who can ill afford to pay a doctor, employ the services of private medical men for fear that if they applied for Parish relief the sick child, or children, will be sent to the hospital. Private practice, is, under such circumstances, conducted under great disadvantages, for the payment of the small fees with which the medical man is content in such cases, deprives the poor of the means of purchasing those comforts, not to say necessaries, of the sick chamber, on which, inter alia, recovery so largely depends. It is heart-breaking to see the wan faces of little sick children in their miserable rooms, especially when the contrast is mentally made between the condition prevailing “at home,” and the well-ordered hospital, with its staff of doctors and nurses, and all requisites for every stage of illness and convalescence. Another case that came under my notice in the course of the enquiry may be mentioned. The child was attended by a non-qualified practitioner; the parents, however, believing him to be a duly qualified medical man, for how should a poor ignorant Irish labourer know the difference between “Doctors”?

“The child died at the end of the second week, and the existence of scarlet fever in the house became known to us only on the registration of the death: too late, in fact, for the mischief was done. The two rooms occupied by this family contained seven persons, viz., the parents and five children. Successively the father and two more children fell sick, and were removed to the hospital, where they are all doing well. The rooms and clothing were disinfected, and the mother and two remaining children were reluctantly compelled to leave the house; but no sooner had they done so than the elder child fell sick, and was sent to the hospital. The mother and her infant are at present well. The day following the burial of the deceased child another family of nine persons left the house. They have been traced, and two children found to be ill. They are tolerably well isolated, however, and seem likely to do well. I am trying, nevertheless, for the sake of the rest of the family, to have them removed. The lessons taught by this story are too obvious to need recapitulation; I will only observe, therefore, what the facts have strongly suggested to my own mind, viz., that among the many requirements in sanitary legislation, none is more needed than power to provide quarantine for the apparently healthy members of poor families in which infectious disease has broken out.”

The other cases that have occurred up to the present time are too few, and otherwise offer nothing to call for special notice. All the fatal cases occurred in streets wholly occupied by the poorer classes. But, as I observed in my report,—

“A principal source of danger in the future lies in the carelessness or ignorance which leads to the premature exposure of convalescents, to which cause several cases have been referred by my correspondents. A case of this kind occurred a short time ago. I ascertained that a boy, who had been ill only a few days and whose skin was actively peeling, had not only, by inadvertence, attended at the waiting room of a public dispensary, but had also been to one of the largest and most crowded of our parochial schools, while other members of the same family, and out of the same room, had been in the other departments of the same school, which moreover I found on inspection to be in a very unsanitary condition. I am doing what I can to prevent the recurrence of such a case by putting the teachers of schools on their guard; and, mindful of the steps which the School Board for London took, on our suggestion last year, with a view to prevent the spread of the malady through the medium of Board Schools, I addressed the Clerk to the Board lately, stating the facts as they are known in this parish, and urging a repetition of the precautions adopted last year; and I have had the satisfaction of receiving a communication from that gentleman to the effect that ‘the notices on the subject of scarlet fever, issued to the respective teachers in the autumn of last year, will be re-issued to the teachers by the time the various schools commence their work, after the summer holidays.’”

Before concluding my remarks on this subject, I may mention that I availed myself of the opportunity afforded by sending the circular letter to medical men to place in their hands the “Suggestions for preventing the spread of infectious diseases,” and other sanitary notices, pointing out that copies were always available for the use of their patients; asking their co-operation in aid of the efforts which it is at all times my duty to make, with a view to arrest the spread of infectious diseases, urging the importance of isolation of the sick, and the propriety of sending patients to the hospital when the home accommodation does not allow of isolation; offering the services of your sanitary staff in all such cases, and explaining the arrangements made for the disinfection of clothing, etc., in the absence of a public disinfecting chamber. It, of course, remains to be seen to what extent the epidemic will grow, and judging by past experience the disease may during this year and the next be expected to prove fatal above the average, but come what may I have the satisfaction of knowing that no means have been spared, or will be, which it is in the power of your Vestry to adopt with a view to arrest its progress.

Diphtheria.—This disease was the cause of 26 deaths (Town, 24; Brompton, 2), an increase of 15 over 1873—entirely in the Town sub-district. The deaths under five years were 14.

Whooping Cough.—The mortality from this complaint was 45, in the Town sub-district 36, and in Brompton 9. The deaths under five were 44.

Fever.—Typhus, was fatal in 9 cases, all in the Town sub-district. The number in the previous year was 6—all likewise in the Town.

Enteric Fever.—The registered deaths from this disease were 28—viz., 19 in the Town and 9 in Brompton. The numbers in 1873 were 19 and 8 respectively. The term Typhoid is often employed to designate this disease, and leads to error in the tabulation of the mortality returns. I have good reason to believe that some of the cases returned by the Registrar-General as typhoid fever were not cases of enteric fever, the word typhoid having been employed in medical certificates of the cause of death to describe a condition of the patient in the last stages of fatal illness of a nature entirely distinct from enteric fever.

Simple continued fever caused 15 deaths (8 under five years), viz., 11 in the Town sub-district and 4 in Brompton. The deaths in 1873 were 7 and I respectively in the two districts.

Diarrhœa was less fatal than in 1873, the deaths being in that year 145, and in 1874 only 112. The annual average number in ten years was 111, without allowances for increase of population. The deaths last year in the two sub-districts were 90 and 22; in the previous year 121 and 24. The large majority of fatal cases occurred in infancy, viz., 100 under one year and 8 between one and five. Above 65 years of age the deaths were 4. At intermediate ages there was no death. The principal mortality was experienced in the warm summer weather, viz., in July 38, and in August 31. Five deaths from Cholera were registered, viz., 3 in the Town and 2 in Brompton.

Other Zymotic Diseases.—Croup was the cause of 26 deaths, 25 under five years, and all save one in the Town sub-district. The deaths in the previous year were 20.

Erysipelas caused 21 deaths, viz., 13 and 8 in the Town and Brompton respectively. The deaths in 1873 were 24.

Puerperal Mortality.—Some difficulty is experienced in procuring a correct record of the deaths arising out of or connected with childbed, owing to the fact that reference to the previous occurrence of childbirth is sometimes omitted in the medical certificate of the cause of death. Some of the deaths, therefore, registered as Peritonitis, Pyæmia, Erysipelas, and even under less suggestive headings, may have been connected with the puerperal state. The deaths actually ascribed to childbed diseases were 24, other 14 being set down to the various accidents incident to that critical period. These numbers together represent a mortality somewhat below one per cent. (0.87) on the births registered. Dr. Matthews Duncan, the successor of Sir James Simpson at the University of Edinburgh, has promulgated an opinion that the true average mortality of the puerperal state is one per cent., i.e., one death in every hundred confinements; an estimate which a practitioner in this parish, who has a most extensive midwifery practice, tells me coincides with his personal experience. The causes of death as registered were:—Puerperal fever, 4; Puerperal peritonitis, 9; Pyæmia, 5; Septicæmia, 1; Metritis, 4; Pelvic cellulitis, 1. Eighteen of the deaths occurred in the Town sub-district, the mortality being pretty evenly spread over the parish, and none of the cases being traceable to contagion. They occurred in the four quarters respectively as follows—9, 6, 5, and 4. The ages at death were: 20–30 years, 18; 30–40 years, 4; 40 years and upwards, 2.

Syphilis nominally caused 12 deaths—a number we may well believe below the actual mortality from this Protean disease.

Constitutional Diseases.—Cancer was the cause of 67 deaths, viz., 51 in the Town and 16 in Brompton. Fifty-four of the deaths took place between the ages of 45 and 75.

The Tubercular Diseases caused 408 deaths, viz., 325 in the Town and 73 in Brompton. Scrofula was the registered disease in 27 cases, Tabes mesenterica in 53, Phthisis in 245, and Hydrocephalus or Meningitis in 82 cases. The numbers of deaths in the several quarters were—1st, 113; 2nd, 104; 3rd, 88; and 4th, 103:—216 in the winter and 192 in the summer quarters. One hundred and fifty-seven of the deaths were those of children under the age of five years. This mortality is exclusive of those brain affections, Convulsions, &c., and those diseases called developmental which, under the names of Atrophy and Premature birth, are nearly allied to the tubercular diseases specially so-called.

Local Diseases.—The diseases of the nervous system were fatal in 256 cases, viz., 199 in the Town and 57 in Brompton. Eighty-five of the deaths occurred under five years of age. Apoplexy was fatal in 64 cases, Paralysis in 47, Epilepsy in 13, Convulsions in 59, and Brain disease in 62. Apoplexy and Paralysis are diseases of old age; Convulsions, as a rule, of infancy. The deaths from this order of diseases were very equally spread over the whole year, the quarterly numbers being 66, 63, 61, and 66 respectively

The Diseases of the Organs of Circulation caused 149 deaths, viz., in the Town district 115, and in Brompton 34. Nine only of these deaths occurred under the age of five years. Pericarditis was the registered cause in 5 cases, Aneurism in 7, and “Heart disease” in the remainder, 137.

Diseases of the Respiratory Organs.—The deaths from this important order of diseases were 554, viz., 462 in the Town sub-district, and 92 in Brompton. Under five years of age the deaths were 244. The mortality from these affections is greatly influenced by season, more deaths occurring in winter than in summer, and a higher mortality prevailing in proportion as the winter is severe. These facts are illustrated by the subjoined figures, which show the mortality to have been in the four quarters of the year respectively 189, 80, 58, and 227. Thus in the winter quarters the deaths were 416, and in the summer quarters only 138. The deaths in the summer quarters of 1874 were seven less than in 1873; but there was an excess of 78 in the winter quarters of the former year, due to the long-continued cold weather that prevailed in the latter months. The several diseases of this order were the registered causes of death as follows:—Laryngitis 6, Bronchitis 300, Pleurisy 10, Pneumonia 176, Asthma 12, and Lung disease 41. The increased fatality of Bronchitis and Pneumonia helps to explain the higher mortality of 1874 as compared with 1873.

Diseases of the Digestive Organs were fatal in 118 cases (18 under five years), viz., 93 in the Town and 25 in Brompton. They include Enteritis 19, Peritonitis 20, and Liver disease 37.

Diseases of the Urinary Organs were fatal in 51 cases, including Kidney disease 12, Blight’s disease 22; Cystitis 7, and Diabetes 5.

Diseases of the Organs of Generation caused 7 deaths, 6 of them registered as Uterus disease, &c. These deaths are exclusive of malignant affections of the organs included under the head of Cancer.

The Diseases of Children were fatal in 75 cases, including Premature birth 46, Teething 25, and Malformations 4.

The Diseases of Adults include 14 deaths returned as Child-birth, these deaths being irrespective of those already alluded to under the head of Puerperal Fever.

Diseases of Old People (so described) were returned under the head of Old Age as the cause of 94 deaths.

Diseases of Nutrition, viz., Atrophy and Debility, were the cause of 163 deaths, all under five years of age, (153 in the first year of life) viz., 143 in the Town sub-district and 20 in Brompton.

Violent Deaths, 48 in number, were registered, including 10 due to fractures and contusions, 17 (all under one year) to suffocation, and four to drowning.

Causes not Specified or Ill-defined.—Twenty deaths registered came under this description.

DEATHS IN PUBLIC INSTITUTIONS.

The Hospital for Consumption and Diseases of the Chest. At this important institution 131 persons died, viz., 80 males and 51 females. All the deaths, with the exception of eight, were due to that hitherto incurable malady phthisis, or as it is popularly known, consumption. Five deaths were caused by heart disease, one by aneurism, and two by lung disease. The deaths in the four quarters respectively were 26, 30, 30, and 45. Six only of the deaths properly belong to the parish. Seventy-five of the deceased came from other parishes in London and the suburbs, and 50 from other than metropolitan counties. If the truth were known, it is not improbable that some few deaths from phthisis outside the hospital properly belong to other districts, the patients having come to town for medical treatment attracted by the fame of the institution, and being attended as out-patients.

St. Joseph’s House.—This large charitable establishment of the Roman Catholics, situated in Portobello Road, Notting Hill, is not classed as a public institution, although its inmates (about 200) are drawn from all parts. The deaths last year numbered 36—males 21 and females 15—all above 60 years of age, and due to the more common diseases of senility, as Brain disease 8, Lung and Heart disease 16, Cancer 3, Intestinal diseases 3, “Old Age” 2, other diseases 4.

The Parish Infirmary.—At this large and important hospital there were 221 deaths, viz., in the four quarters respectively 61, 40, 44, and 76; males 117, females 104. The deaths included 37 of infants under one year of age, and 86 of persons above 60 years of age, viz., between 60 and 70, 36; 70–80, 38; 80–90, 11; at 97, 1. Inquests were held in three cases, the verdicts returned being (1) “Sudden, apoplexy, natural causes,” (2) “Fall from a window, accidental,” (3) “Fall from a ladder, accidental.”

The causes of death may be summarised thus:—

Brain disease, Apoplexy, Paralysis, &c. 26

Lung diseases 37

Heart disease 7

Scrofulous or Tuberculous diseases, Phthisis, &c. 41

Wasting diseases, Debility, &c., of Children 21

Atelectasis (Imperfect expansion of lungs at birth) 5

Cancer 8

Enteric fever 2

Measles 4

Diarrhœa 3

Intestinal diseases, &c. 13

Kidney disease 4

Uterine diseases 2

Ulcer 3

Childbirth, &c. 3

Violent 2. Privation 1. 3

Old Age 23

Various 16

Total 221

INQUESTS.

A large proportion of deaths form the subject of enquiry in the Coroner’s Court. Last year the number was 172, viz., 152 in the Town sub-district and 20 in Brompton, equal to 6.4 per cent. of the total deaths. One hundred of the subjects of enquiry were below the age of five years, 80 being less than a year old, mostly in fact infants of a few hours, days, or weeks. Forty-eight inquests were held on persons between the ages of 5 and 60, and 24 on persons above the age of 60. The great majority of the deaths were due to disease. Thus of the 99 sudden deaths the causes of death as found by post mortem examination (and post mortem examinations were made in 154 out of the total of 172 cases) were as follows:—

Brain, Diseases of the 13

Apoplexy 11

Lungs, Diseases of the 24

Heart „ „ 20

Scrofula 4

Convulsions 4

Spasm of the Glottis 7

Diarrhœa 3

Diphtheria 2

Syphilis 2

Premature birth and infantile debility 3

Visceral diseases (of Liver, Kidneys, &c.) 3

“Fever” 1; Thrush 1; “Sudden” 1 3

Total 99

Various diseases were specified in other six cases in which the deaths were not returned as “sudden.” Death was found to be caused by disease in many of the cases in which the deceased were “found dead,” either in bed or otherwise, viz., from

Lungs, Diseases of the 6

Heart „ „ 6

Convulsions 4

Brain, Diseases of the, 2; Apoplexy 1 3

Laryngitis 1; Spasm of the Glottis 1; Scrofula 1 3

“Found Dead,” &c. 4

Total 26

The accidental and violent deaths were caused as follows:—

Falls 7

Barns 1

Drowned 4

Suffocation 16

Cut throat 2

Pistol shot 2

Hanging 2

Run over by railway train 1

Wilful Murder 4

“Accident,” “Violence” 2

Total 41

With respect to the accidental or violent deaths it may be remarked that the 16 from suffocation were of infants and due to “accident.” One of the newly born infants was found in a box and another up a chimney; these being, as were some of the others, the children of single women. On four newly-born children the verdict of “murder” was found. In one case there had been “exposure,” in a second the child was found dead, and in the other cases the verdict was simply “wilful murder.” Of the four drowning cases one was suicidal. By hanging, cut-throat, and pistol-shot all the deaths recorded (two from each cause), were suicidal, making a total of seven suicidal deaths during the year. The remaining deaths by violence were accidentally caused.

Having carefully analysed the facts relating to these deaths as they appear in the weekly returns of mortality, I submit the results, which are, I think, worthy of attention. Of course the primary cause of an inquest being held is the absence of a medical certificate showing the cause of death. The reasons why certificates are not forthcoming, and therefore why inquests become necessary, may be inferred from certain particulars which appear in the returns, and may be summed up as follows:—

Sudden Death 99

Found dead in bed (22) or otherwise (26) 48

Accident 3

Violence 15

Doubtful (none of the above reasons stated) 7

Total 172

It is to the deaths from disease that I would draw particular attention, the bare facts appearing to point to a large amount of neglect of the sick, which, without explanation, would seem to border on the criminal. Fatal visceral diseases, it need hardly be said, present symptoms which the most ignorant cannot altogether overlook—fever, pain, exhaustion, &c.; and each disease has a more or less prolonged course, varying with the importance of the organ affected, and with the amount of care bestowed on the sufferer. It is not credible that any medical man would be unable to diagnose the existence of such a disease, e.g. as pneumonia, or would refuse to certify the cause of death of a patient who had died under his care. We are driven to the conclusion, therefore, that, in a great number of cases of disease, many of the victims being infants, no effort is made to obtain medical advice for the sufferers, and hence, when death ensues, an inquest becomes necessary, as there is no medical certificate to show the cause of death. A post-mortem examination is made, and then it becomes known that death was caused by a disease that might have been cured, and that certainly must have had a well-defined and often a lengthened course. Passing over such maladies as apoplexy and heart disease, it is only necessary to mention, in support of this view, such diseases as pneumonia, &c. (30 deaths); brain diseases (15); convulsions—a symptom rather than a disease (8); scrofula (5); syphilis (2); diarrhœa, diphtheria, &c. The question then arises, in connection with such cases as these, whether it is sufficient to record the cause of death? whether, in fact, some one should not be made responsible for the neglect to provide medical advice for a child who ultimately dies “suddenly” or is “found dead” as a consequence of an attack of pneumonia, that may have extended over one, two, or three weeks, or even a longer time? Not many weeks before this present writing one of the “Peculiar People” was found guilty of manslaughter, having neglected to provide medical attendance for his child, who died of pneumonia, although it was admitted that every care, otherwise, had been bestowed on the patient; and, notwithstanding the well-known fact that with such care a very large proportion of the cases, especially if one lung only is affected, will recover. It need scarcely be added that the parents’ neglect had its origin in conscientious motives, however mistaken and absurd. Can such a plea be made in all or many of the cases to which I have here alluded: and should negligent parents escape without punishment—without censure even?

True, the facts I have thus briefly brought under notice may be explained—and they certainly need explanation; for as they baldly appear in the returns of mortality they would seem to indicate an indifference to life which is not only shocking, but may be in some degree the cause of that terrible infantile mortality which all thinking persons deplore. I will only add that it is notorious that medical men are constantly called in to see children sick beyond the hope of recovery, in order that no fuss may arise after death—the death certificate being all-sufficient. No doubt in many cases, where the diagnosis is quite clear, the certificate is given, although the practitioner may be conscious of the neglect of the parents in applying for assistance when “too late;” and, I dare say, that in some at least of the cases which come before the Coroner the inquest has been brought about by the judicious refusal of medical men to give certificates under such circumstances. I venture to think, however, that a certificate should not be given in any such case, and that not only should an inquest be held, but that the mere fact of the responsible person in charge of the infant having failed to obtain that medical advice and assistance which the poor may have for the asking, should be regarded as establishing a prima facie charge of neglect, for which he or she should appear and answer at another tribunal in the absence of exculpatory evidence.

DEATHS “NOT CERTIFIED.”

The number of deaths “not certified,” that is, of persons who were attended in their last illness by non-qualified practitioners—generally professing to hold unregisterable foreign degrees, often obtained by purchase, in absentia, was 33. The numbers in the two previous years were 30 and 21. In my annual report for 1872 I mentioned that I had some time previously called the attention of the Registrar-General to the desirability of an addition to the form of certificate of death provided for the use of medical men, whereby it would be made clear whether the subscriber was or was not duly qualified, i.e., registered. The Registrar-General approved the suggestion, and his attention having, at my instance, been again directed to the subject by the Society of Medical Officers of Health last year, he has, in the new form of certificate brought into use at the commencement of the current year, added a line immediately below the place for signature on which the subscriber is required to enter his “registered qualification.” It is not probable that any unregistered practitioner would venture to use the certificate, should he inadvertently become possessed of it, as might happen through the almost unavoidable ignorance in which the sub-district registrars are left, from the want of an official list of registered practitioners. Not long ago I ventured to direct the attention of the Registrar-General and the Registrar to the General Medical Council to the importance of these officers being supplied with the Medical Register, issued annually by the Council; but these gentlemen, while appreciating the suggestion, were unable to hold out any hope that it would or could be carried into effect, inasmuch as the Government are unwilling to incur the necessary expense, and as the Register is too inaccurate to be implicitly relied on in doubtful cases. But now that medical men are required, under a penalty for neglect, to give certificates of the cause of death, some means ought to be found of restricting the use of them in any form, to registered practitioners. The sub-district Registrars do not knowingly accept a certificate from a non-qualified practitioner, but in some cases where a medical title is used by a stranger, “invalid” certificates obtain currency. In all other irregular cases the registrar returns the death as “not certified,” making use, nevertheless, of the information as to the cause of death contained in the certificate! If it were made an offence at law for any unregistered practitioner to give a certificate of death, the difficulty would probably be met. At present I do not know what course would be best to adopt, unless to hold inquests on the bodies of all persons who die under the treatment of non-qualified practitioners. This course was adopted in some cases in the northern part of the parish last year, and it led, in at least one instance, to the unsatisfactory, not to say discreditable result, of the Philadelphian M.D. who attended a sick child, calling in a registered practitioner at the last gasp, so that he might certify to the cause of death. An inquest, however, was held on the body, and the death was found to be due to quite a different disease to that entered in the certificate. I may add that the Board of Guardians, laudably anxious to put a stop to the scandal, took proceedings at the Hammersmith Police Court against an unregistered practitioner for signing a vaccination certificate, and thus “falsely pretending to be registered.” The case was dismissed, however, and no further steps have been taken in the matter. But something should be done for the protection of the poor, who are almost exclusively the patients of the unqualified man, being unable to realize the distinction; and action is rendered the more necessary by the fact that children—infants of tender age—are most commonly the victims of the practice. Thus, of the 33 cases of uncertified deaths referred to, 25 were children, of whom 18 were less than one year old. The causes of death returned included such diseases as typhus fever, scarlet fever, measles, diarrhœa, inflammation of the lungs and of the brain, and scrofulous maladies.

METEOROLOGY.

The mean temperature of the air at Greenwich during the registration year was 49.4° F., the average of 35 years being 49.3°. The averages of the four quarters were 41.6°, 53.5°, 60.6°, and 41.8°. The hottest week was that which ended on the 11th of July, mean temperature 66.8°; and the coldest week was that ended on the 2nd of January, 1875, mean temperature 28.8°. The highest reading of the thermometer was on the 9th of July, 92.0°, and the lowest on the first day of the current year 18.2°. The dryness of the atmosphere (i.e., the difference between the dew point temperature and air temperature) was 5.6 (average in 30 years 5.5.) The rainfall was 24.1 inches.

VACCINATION.

I am indebted to Mr. Shattock, the energetic Vaccination Officer, for the interesting particulars contained in Table IX, (Appendix), on the important subject of Vaccination. From it we learn that during the year 4,357 births were returned to him by the sub-district registrars, and that the successful vaccinations numbered 3,588. Twenty-three infants were certified as insusceptible of successful vaccination; in 74 cases the postponement of vaccination was sanctioned by medical certificate on account of the state of health, &c.; 27 children were removed to other districts, the vaccination officer of each district being duly apprized of such removal; 9 cases were still under proceedings (at the date of the report), by summons or otherwise; while 464 children died unvaccinated. The cases unaccounted for—either through the removal of the children to places unknown, or which cannot be reached, and cases not having been found—amounted in all to only 172, or a fraction below 4 per cent. of the total births—a result that must be considered very satisfactory, highly creditable to the vaccination officer, and, I would add, to the Board of Guardians; while I can hardly believe it has been surpassed in any other district of the Metropolis.

The Guardians have lately (August, 1875) prosecuted successfully a non-qualified practitioner for signing Vaccination Certificates. A penalty of Ten pounds was inflicted; the offence with which the defendant was charged being that of “falsely pretending to be registered” under the Medical Act, none but registered practitioners being qualified to sign Vaccination Certificates.

SANITARY WORK.

Table 6 (Appendix) contains a summary of the principal items of sanitary work accomplished during the Vestry year ended 25th March, 1875. The number of complaints received and entered in the complaint book was 1,482; viz., 820 in the North, and 662 in the South Sanitary District. Seven thousand two hundred and eighty-six houses were inspected—viz., 3,229 in the North, and 4,057 in the South district, besides mews, of which there are about 140 in the parish. The number of sanitary notices served for the amendment of houses, premises, &c., was 1,438, viz., 756 in the North and 682 in the South: 1,477 houses and premises were cleansed, &c.: 68 were disinfected after infectious diseases. The drains of 442 houses were cleansed and repaired; and trapped and ventilated in 341 other cases: 463 privies and water-closets were repaired and supplied with water; and 6 new water-closets were provided: 31 new dust-bins were erected, and 41 old ones covered, repaired, &c.: 8 water-cisterns were constructed, and 75 cleansed, covered and repaired—a very inadequate number it would seem, so far as regards cleansing, only that in a great number of cases this operation—so commonly neglected—was directed and carried out without formal notice: 115 accumulations of dung, stagnant water, animal and other refuse were removed, and in 58 cases animals improperly kept, or kept in unfit localities (swine especially), were removed.

The number of inspections in each district, and in each period of four weeks, covered by my monthly reports, may be seen, in Table 6A. Legal proceedings were had recourse to in 100 cases, viz., 82 in the North, and 18 in the South district, and generally with a successful result. A few of the cases deserve special notice.

And first I will mention the subject of boiling food for pigs. A greater nuisance than this is, it would be difficult to imagine in a parish like Kensington. The effluvia given off from the boiling of a quantity of animal and vegetable refuse, collected from the wash-tubs, and often in a semi-putrid state before cooking, is sickening and offensive to the last degree. It constitutes by far the greater part of the nuisance arising from the keeping of swine in an improper locality; and the efforts persistently made during the last four years to improve the condition of the Potteries have been sadly marred by the continuance of the process of food collection and preparation, which still goes on to some extent, although nearly all the swine have been removed. As no means were ever adopted to prevent the escape into the air of the noxious effluvia resulting from the cooking, we resolved to attack the nuisance under the 27th section of the Nuisances Removal Act, which enacts, in effect, that

“If any building, or place for boiling offal . . . or used for any trade, business, &c., causing effluvia, be at any time certified to the local authority by any Medical Officer to be a nuisance or injurious to the health of the inhabitants of the neighbourhood, and that the person carrying on such business shall not have used the best practicable means for abating such nuisance, or preventing or counteracting such effluvia, the person so offending shall, upon a summary conviction for such offence, forfeit and pay a sum of not more than Five Pounds nor less than Forty Shillings, and upon a second conviction for such offence the sum of Ten Pounds, and for each subsequent conviction a sum double the amount of the penalty imposed for the last preceding conviction, but the highest amount of such penalty shall not in any case exceed the sum of Two Hundred Pounds.”

Several prosecutions were undertaken successfully—fines varying from Forty Shillings to Five Pounds (including costs) being inflicted. The steps already taken will, it is hoped, prove sufficient, and render unnecessary any further appeal to the law, especially as a notice of your Vestry’s intention to proceed against offenders in every case has been widely distributed in the Potteries.

Twenty-four convictions were obtained against old offenders for keeping swine in an improper locality, and Mr. Bridge, one of the magistrates at the Hammersmith police-court, announced his intention of throwing on the defendants in any future cases that might be brought before him, the onus of proving that the pigs were not on the premises on days intervening between the days for which the defendants might be summoned for the offence of keeping pigs in a place under the ban of a “prohibitory order,” the penalty for this offence being Ten Shillings a day. Hitherto we have been required to prove the presence of swine on each day, so that, for example, to obtain in one week penalties to the amount of three pounds, it was necessary to visit the prohibited premises every day in the week. But if Mr. Bridge should feel justified in carrying out his views, it would only be necessary to visit the premises on Monday and Saturday to obtain the same amount of penalties which would be imposed, unless the defendant should be able to prove that the pigs were not on the premises on the intervening days, viz., Tuesday, Wednesday, Thursday, and Friday.

The proprietor of a licensed slaughter-house in the Potteries, Notting-hill, was fined in the sum of Ten pounds and costs for having on the premises the carcase of a cow, diseased and unfit for human food. The cow had been brought dead from another place, and after seizure it was stated that the carcase was not intended for food. But it was dressed in the usual way, and the meat having been condemned by Mr. Ingham, proceedings were taken before Mr. Bridge, with the result above stated, the magistrate ruling that the fact of the carcase being in the slaughterhouse was sufficient evidence of the intention to pass it off as food for man. The cow, it may be added, having died, or been killed, at a licensed cow-shed in the same locality, I pointed out to the licensee the great impropriety of his proceedings, and the risk he would run of losing his license, to say nothing of other consequences, on a repetition of his indiscretion. Subsequently, I received notice from the proprietor of a licensed slaughter-house that the carcase of another cow that had been killed in the last stage of the “lung disease” (pleuro-pneumonia) was awaiting my opinion of the fitness, or otherwise, of the meat for human food. I condemned the meat, which was removed to a knacker’s yard. No proceedings were taken in this case, but I cautioned the licensee not to admit diseased animals—living or dead—on his premises at any future time. Some time after the occurrence of this case I learnt, to my great surprise, that the instructions issued by the Metropolitan Board of Works, to the district veterinary cattle inspectors under the provisions of the Contagious Diseases (Animals) Act authorised the removal of diseased cows from cowsheds to a licensed slaughter-house for the purpose of being killed; or if killed at the shed, of being dressed, there to await the fiat of the inspector as to the fitness, or otherwise, of the meat for human food. This instruction seems to be at variance with the slaughter-house bye-laws, to say nothing on the question of the propriety of using for food the flesh of diseased animals. In the provinces it is the practice, I believe, to destroy and bury animals affected with pleuro-pneumonia; and I am under the impression that heavy fines have been inflicted on persons for selling or exposing for sale the flesh of such animals. In London cowkeepers are required, under a penalty for neglect, to give notice to the Metropolitan Board of Works of the occurrence of cases of pleuro-pneumonia; and they are entitled to compensation from the Board to the extent of a moiety of the value of any animals that may be killed with a view of “stamping out” the disease. It follows that the larger the amount realized by the sale of the carcase, for whatever purpose, whether for the food of man or of cats, the less is the amount payable to the owner in the way of compensation.

The proprietor of the slaughter-house in the Potteries first referred to above, was fined Five pounds and costs for allowing a large accumulation of putrid blood, &c., to remain on the premises after his attention had been repeatedly called to the necessity of properly storing and regularly removing all such matters before they became offensive.

A seizure of meat unfit for human food was made at Norfolk Terrace—at a mis-called “co-operative” store—and the defendant was fined Twenty pounds and costs.

A person who had formerly kept a licensed cow-shed was fined Forty shillings and costs for keeping cows for dairy purposes without a license.

A somewhat serious nuisance having been complained of, arising at an iron foundry at Notting Hill, from the escape of noxious fumes and grit from the low but capacious chimney above the melting furnaces, I gave a certificate to the effect necessary to found legal proceedings, which, however, were not had recourse to, the proprietors of the foundry having expressed their willingness to adopt any measures I might advise, with a view to remove the cause of complaint. They have done this by carrying up the shaft some 20 feet, and by the interposition of diaphragms to intercept the fine grit carried up by the draught; and I hope that in the result these measures will be found adequate for the purpose.

LICENSED SLAUGHTER HOUSES.

The licensed slaughter-houses—49 in number—viz., 28 in the North Sanitary District, and 21 in the South, have been duly inspected. In my last annual report I gave some account of the Slaughter Houses (Metropolis) Act, 1874, under which the Metropolitan Board of Works, as the “local authority,” were empowered to frame bye-laws, for regulating the conduct of the business of a slaughterer of cattle, and the structure of the premises in which the business is carried on. As it was impossible to get the bye-laws framed and confirmed by the Local Government Board previous to the annual licensing day in the month of October (as a matter of fact they were not confirmed until the 27th of May in the present year), your Vestry, on the recommendation of the Sanitary Committee, unanimously resolved that certain conditions were essential in order to fit a slaughter-house for the business, and decided to oppose the renewal of licenses in every case that did not come up to the standard. The conditions were as follows:

1. A slaughter-house should have an independent entrance, so that the cattle may not have to pass through the house or shop; and it should be at a reasonable distance from other buildings, particularly inhabited houses.

2. It should be open to the roof; or, at least, should have no inhabited rooms over it.

3. It should be well ventilated and properly lighted, so that the slaughtering may be done, as it always should be, with closed doors.

4. It should have walls and floor of smooth and impervious materials—the flooring being laid on concrete.

5. It should be well drained, with stone ware pipes, and the drains should be permanently trapped.

6. It should have attached to it ample and separate lairage, constructed with a due regard to sanitary and other requirements.

7. It should be effectually separated from any lair, stable, dung-pit, w.c., &c., so that the meat may not be exposed to any offensive effluvia.

8. It should be of adequate size, and should not be used for any other purpose than that for which it is licensed, and particularly it should not be used as a stable, a lair, or a cow-shed.

Upon viewing the several slaughter-houses by this standard, so many were found defective in one or other respect that it was thought best to give the formal notice of opposition required by the Act, in every case, but your Clerk and myself were directed to oppose the renewal of the license in those cases only that did not come up to the standard. We did this, but the justices overruled our objection in every case, on the ground that the premises, however faulty, had been licensed in former years, and time must be allowed to put them in proper order. At the same time, the justices gave the assembled licensees notice that at the next licensing day (in October of the current year, namely) they would not renew the license in any case that was not up to the standard. With reference to the decision of the magistrates, and the ground on which it was based, it is, perhaps, hardly necessary for me to state the fact, so well known already, that the existing slaughter-houses, were, without exception, licensed before I entered upon the duties of my appointment, and that the reason your Vestry did not oppose the renewal of the licenses in either of the subsequent years was that, in common with myself, you believed that the private slaughter-houses would be finally closed in 1874, under the operation of the Building Act, 1844. It only remains to add that the slaughter-houses will now have to be judged by the standard of the bye-laws; and it may therefore be useful to state in what respect the bye-laws differ—either in excess or defect—from the standard adopted by your Vestry in 1874. As regards new slaughter-houses, the requirements of the “local authority” are fully up to that standard; and, as regards existing slaughter-houses, the only material differences between the bye-laws and the standard relate to the points dealt with in clauses 1 and 6 (supra). The bye-laws do not require that a slaughter-house shall have an independent entrance, or be at all removed from other buildings; and they do not require provision to be made for housing cattle previous to slaughtering; but it is enacted that no animal shall be detained on the “premises” for a longer time than “absolutely necessary” previous to slaughtering, and that the “slaughter-house” (which is only a part of the “premises”) shall not be used for “any other purpose than that for which it is licensed,” viz., killing. It follows, then, that the slaughter-house itself may not be used as a lair, and the question arises—Where shall the animals be kept, if there be no lairage? It appears to me that the existence of lairage is assumed, and that the absence of this necessary accommodation would form a reasonable cause for opposition even under the bye-laws. But whether this is so or not, I venture to think that your Vestry would be fairly entitled to oppose the renewal of a license in the case of premises so obviously defective, and that you would be fully justified in taking the opinion of the justices as to the suitability of premises for a slaughter-house to which there is no access save through a butcher’s shop or dwelling-house.

(The Vestry subsequently adopted these views. I here subjoin a synopsis of the bye-laws, which I have prepared for the guidance of the Sanitary Inspectors.)

Objects of the Bye Laws:—To regulate the conduct of the business of a slaughterer of cattle, and the structure of the premises on which such business is carried on, and the mode in which application is to be made for sanction to establish such business anew.

Definitions.—The Metropolitan Board of Works, as the “Local Authority,” is styled the “Board.” “The premises” include the Slaughter House and all the premises used for the business of a slaughterer of cattle. The “Slaughter House” means the portion of the premises used for the slaughtering and dressing of cattle. The “Occupier” means the occupier of premises where the business of a slaughterer of cattle is carried on; and “Slaughterer of cattle” means a person whose business it is to kill any kind of cattle for the purpose of its flesh being used as Butchers’ meat.

Bye-Laws as to the Structure of the Premises, (Nos. 15 to 21 inclusive.)—The slaughter house to be well paved with asphalte or flagstone set in cement, laid with a proper slope and channel towards a gulley, and effectually drained by an adequate drain of glazed pipes communicating with the public sewer. The gulley to be trapped by an appropriate trap and covered with a grating, the bars of which to be not more than ⅜ of an inch apart (16).

The inner walls of the Slaughter House to be covered with hard, smooth impervious material, to the height of four feet at the least, and to be always kept clean, and in good order, and repair (17).

No room or loft to be built by owner or occupier over any Slaughter House (20).

An adequate tank or other proper receptacle for water and water supply to be provided, and so placed that the bottom of the same shall not be less than 6 feet above the floor level (15).

The Slaughter House to be well and thoroughly ventilated (15).

No water closet, privy, cesspool, urinal, or stable to be within, or to communicate directly with the Slaughter House (19).

The occupier to cause all needful works and repairs to the premises to be forthwith done and executed, as and when the same shall become requisite, and not to make any alteration in respect of the paving, drainage, ventilation, or water supply, to, or in the premises, without the consent of the “Board” (18).

Penalties.—For breach of any of the bye-laws, 15 to 20 inclusive, whether by omission, commission, or neglect, £5; and in the case of a continuing offence, the sum of £1 for every day during which such offence is continued after a conviction for the first offence (21).

Bye-Laws as to the Conduct of the Business Nos. 1 to 14 Inclusive:—The inner walls of the Slaughter House to be always kept clean and in good order and repair; and the internal surface of the roof and upper portions of the walls to be washed with quick-lime at least once in every three months (6).

The Slaughter House to be thoroughly washed and cleansed within three hours after the slaughtering is completed (7).

A sufficient number of tubs, boxes, or vessels, formed out of proper non-absorbent materials, with tight and close fitting covers thereto, to be provided for the purpose of receiving and carrying away all manure, garbage, offal and filth, and these products to be placed in the tubs, &c., immediately after the killing and dressing of any cattle. Blood to be put into similar but separate tubs, &c., and all such tubs, &c., with their contents to be removed from the premises within 24 hours (5).

The fat of any animal slaughtered to be kept freely exposed to the air until its removal from the premises; and all such fat, and also hides, skins, and tripes to be removed within 24 hours after the slaughtering is completed (9). Carcase, bone, hide, skin, and all meat, fat, offal, blood, garbage, and other articles, to be removed before the same have become putrid or offensive (10).

Every covered and other receptacle used in the Slaughter House to be kept cleansed and purified so as to avoid any offensive smell (8).

Cattle not to be kept in the “premises” except for the time absolutely necessary previous to slaughter (1). The Slaughter House not to be used for any purpose other than that for which it is licensed; and slaughtering not to be conducted within public view (4).

No animal that is not intended or fit for human food to be slaughtered in the premises (1); and if any diseased cattle should be brought to the Slaughter House, the occupier to give information thereof, forthwith, to the “Board,” and to the cattle inspector for the district, with all particulars in his knowledge as to where, from whom, and from what place it was received (11).

No fowl, pig, or other animal used for human food (except cattle about to be slaughtered), and no dog to be kept in or about the premises (2).

No room situated over the Slaughter House to be inhabited under any pretence whatsoever (3).

All persons lawfully entitled to admission to have free access to the premises during the times of slaughter and at all reasonable hours (12).

Penalties.—For breach of any of the Bye-laws, 1 to 12 inclusive, whether by omission, commission, or neglect, £3; and in the case of a continuing offence, £1 for every day during which such offence is continued after a conviction for the first offence; and every Court of Summary Jurisdiction, having Jurisdiction to hear and decide complaints of the breach of the Bye-laws, may by Summary Order suspend or deprive any occupier of a Slaughter House altogether of the right of carrying on any such business, as a penalty for the breach of any one of these Bye-laws (13–14).

As to the mode in which Application is to be made for sanction to Establish anew the Business of a Slaughterer of Cattle.—The Applicant to furnish the “Board” with a plan of the premises and sections of the building in which it is proposed to carry on such business, drawn to a scale of a quarter of an inch to the foot, and showing the provision made, or proposed to be made, for the drainage, lighting, ventilation, and water supply of the same; and also to furnish a key plan of the locality, showing the buildings and streets within 100 yards of the premises, drawn to a scale of five feet to the mile (22).

Notes.—It is required that the Slaughter House, in respect of structure, be brought into conformity forthwith with the Bye-laws (15 to 20); when this has been done, the Bye-laws, (1 to 12), which relate to the conduct of the business, will principally engage attention. The points to which attention will have more especially to be given are those that apply to—

1. The daily and quarterly cleansing.

2. The provision and condition of impermeable and covered vessels for the reception and removal of blood, offal, &c.

3. The exposure to air of fat, and the regular removal of all parts of animals, including blood, offal and manure, before the same become putrid or offensive.

4. The exclusive use of the Slaughter House for slaughtering. (It may not be used as a lair, or as a stable, or as a cart shed).

5. The exclusion from the “premises” of fowls, pigs, dogs, &c.

6. The detention in the premises for so long only as absolutely necessary of animals about to be slaughtered. The “Occupier,” it may be added, is the party responsible for the due execution of the Bye-laws.

LICENSED COW-SHEDS.

The licensed cow-sheds, 33 in number—viz., 17 in the North and 16 in the South district—have been regularly inspected. Your Vestry, after a careful consideration of the subject, and after making enquiries as to the practice adopted in other districts, have adopted a standard of capacity to be complied with in respect of cow-sheds, viz., an allowance of 800 cubic feet of space for each cow, no height of shed above 16 feet to be reckoned in the computation of cubic space; each single stall to be 4 feet, and a double stall for two cows, 7½ feet in width. It is to be desired that steps should be taken to obtain powers to frame bye-laws for regulating the structure of cow sheds, the same as slaughter-houses. Great improvements are necessary in many of the cow-sheds; some of the sheds are, in fact, ill-adapted for the purpose, and in the category I would include those that are not open to the roof—being, in fact, imperfectly ventilated stables. The importance of properly constructed—which means well drained, well paved, well lighted, and well ventilated—cow-sheds, is becoming better understood every year, and events to which reference has already been made (p. 10 ante) are likely to give an impetus in the direction of bringing cow sheds under much more strict supervision, as to construction and management than heretofore. It is not uncommon to hear complaints of offensive smells from cow-sheds, even where the premises are very well kept, and where the smell is really not greater than must needs be expected, regard being had to the number of cows kept, and the removal of manure, &c. Should cow-sheds become the subject of legislation, and precise regulation thereunder, it would be desirable to provide for a notice being posted, outside the premises, some days before the annual licensing day, the same as is done in the case of public-houses, and as ought to be done in respect of slaughter-houses, so that householders in the vicinity might, if necessary, attend and show cause against the renewal of the license.

BAKEHOUSES.

The bakehouses, 108 in number—viz., 60 in the North and 48 in the South district—have been regularly inspected during the year, and the provisions of the Act relating to them carried out as efficiently as circumstances would admit.

Complaints arising out of the neglect of Contractors to fulfil the duty of

DUST REMOVAL

occupied, as usual, an inordinate amount of time in the way of inspection, correspondence and clerical work, the letters, and other communications received during the year being 5,891, viz., 2,560 in the North, and 3,331 in the South district. The actual number of complaints was 1,010, viz., 357 in the North, and 653 in the South contract district; while the orders issued for the removal of dust were 10,177, viz., 3,868 in the North District, and 6,309 in the South. The vexatious difficulties attending this important question led your Vestry to consider again the possibility of dispensing with the assistance of contractors; but no result has hitherto come out of the trouble that was taken by a Committee and by the Clerk of the Vestry to solve the difficulty. The same as with respect to the mortuary and the disinfecting chamber, the lack of a suitable site for the storing of the dust in the intermediate stage between the dust-bins and the final disposition of their contents, has practically rendered nugatory all the labour bestowed on the question. Towards the close of the contract year the complaints became so numerous that your Vestry not only employed a staff of horses, carts, and men to make up for the deficiencies of the contractor (and at his expense) but, also, imposed heavy pecuniary penalties. A somewhat curious result of this strictly equitable and, in fact, unavoidable severity was, that the new contractors for the North district expressed unwillingness to sign the contract, and did not sign it for a period of three months, during which time, as they preferred to set about their work in their own way, which only brought matters right after a considerable interval, the complaints in this district became very numerous, and the difficulty experienced in the first quarter of 1875 in the South district, was, in the second quarter, transferred to the North. But as not seldom happens, so in this case—out of evil came good, for your Vestry temporarily appointed, at my request, a Dust Inspector, whose services having given satisfaction, and proved very useful, have been permanently retained, thus affording a very much needed accession to the strength of the sanitary staff at my disposal.