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.
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
|
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.
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
|
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.
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.
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
|
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.
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.
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.
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.
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.
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.
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.
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
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.
Next to the unwholesomeness of houses arising from the
neglected state of dust bins—to whatever cause the neglect
may be attributable—no subject, perhaps, so often engages
the attention of Sanitary Inspectors as that of water supply and
the neglected state of cisterns. It would almost seem as if
many householders thought that the water supply needed no more
attention than that of gas, which is usually comprised in a
quarterly settlement with the collector. Months and
probably years elapse in some cases without any attention being
paid to the condition of cisterns which, I need hardly say, ought
to be cleaned out periodically, and not less frequently than once
a month. It is true that the inconvenient position in which
the cisterns are sometimes placed occasions difficulties in
getting at them, which may in some measure account for the
neglect. But in other cases where no such difficulty exists
the result is the same. One among the “water
regulations” by which the Companies are almost constituted
a sanitary authority, and which might be enforced with public
advantage, relates to the position of cisterns which are required
to be placed in accordance with their views. This
regulation is of a retrospective character, but so far as I know
it is not carried out. Another valuable regulation would
abolish the “waste pipe”—a fertile and
unsuspected cause of foul water, and, in many cases of illness,
being often untrapped and then serving as a ventilator to the
drains, giving exit to noxious gases which the water absorbs
freely. But I cannot say that I have heard of any instance
in which the Companies have exercised their powers in this
respect—powers, be it understood, claimed by and conceded
to them, not on sanitary grounds, but simply to prevent the waste
of water. It is one of my most often repeated instructions
to the Inspectors to view the apparatus for water supply when
making a house inspection, and to abolish waste pipes whenever
practicable. Another regulation has for its object, to
prevent waste of water, by the intervention of a service box for
the supply of the water closet, thus limiting the discharge at
each elevation of the lever to a maximum of two gallons.
This regulation I have no doubt is carried out in the case of new
houses; but it is perhaps of even more importance in old ones, in
which, as too often happens, the domestic and the closet service
are drawn from one and the same cistern. In a special
report (November 20, 1872) I referred to all these points, and to
many others, and I have seen no reason to modify the expressions
of regret with which I then had occasion to speak of the
stringency of the regulations, which is, I apprehend, the main,
if not the sole cause of our being still without the constant
system of water supply which it was supposed the Act of 1871
would give us. The stringency to which I allude has reference
principally to the costliness of the apparatus and fittings on
which the companies insist as a condition of constant service;
and not to the exercise of the powers they possess, but do not as
a rule employ, to improve the present system by insisting on the
due carrying out of the really useful and valuable regulations
quoted above. The adoption of this constant system would
enable us to get rid of our cisterns, if not altogether, yet so
far as the supply of water for culinary use and drinking is
concerned. The neglect of cisterns to which I referred
above, would then be a matter of less moment; and as the pipes
would be always charged, we should be less liable, than we are
now, to the contamination of water, for such an accident as I am
about to mention would be almost impossible.
Complaint was made that the first portion of water entering
certain cisterns in a street and mews at Notting Hill, each time
the water was turned on, was of a disgusting character; and this
happened at a time when there was an obstruction of the sewer in
the mews, the effect being to saturate the ground and flood the
surface with sewage and surface drainage. I surmised that
the main was defective, and that when the water was turned off
the sewage was sucked into the pipe to fill the vacuum, and then
forced through the service pipes so soon as the water was turned
on. It turned out, so I was informed by the Company, that
the defect really existed in a service pipe of one of the houses;
the effect, however, was the same, and dangerous nuisances of
this kind may occur at any time, or in any locality, under
similar circumstances, so long as the intermittent system of
water supply is continued. In the present instance several
cases of illness were traced to this fouling of the water, and
had the sewer contained typhoid excreta, the results might have
been lamentable in the extreme, and of the same kind as at Over
Darwen, and at Lewes during the recent epidemics of Enteric
Fever. As I have remarked in another place, we seem as far
off as ever from the constant system, the only gleam of hope in
respect of it being that the companies have made, and are making
extensive preparations, so as to enable them to supply their
districts when called on to do so. They are enabled to give
a constant supply even though it should not be required of them
by the Metropolitan authority, and they would be gainers by so
doing, if the prevention of waste is really of any moment to
them, which may be reasonably doubted. The Metropolitan
authority is the Metropolitan Board of Works, a body which it is
well known are unwilling to execute the authority conferred on
them by the Act, strongly disapproving, as they do, of the
regulations, the stringency of which they did their utmost, but
in vain, to modify.
I cannot allow the subject of a mortuary to pass without a
brief reference, and an expression of my great regret that the
parish is still unprovided with one. As I have stated in
former reports, the burials, at the public expense, of poor persons,
occupants in life of single rooms, are reckoned by hundreds every
year; and I cannot doubt that in a large proportion of these
cases the survivors would avail themselves of the privilege of
depositing their dead in a public mortuary of suitable
construction, and in a suitable locality. Poor persons in
somewhat similar circumstances, but above the pauper class,
would, in all probability, also use the mortuary. The law
provides for the removal of the bodies of those who have died of
an infectious disease, viz., on medical certificate and by
Justice’s order. Bodies of persons found dead or
accidentally killed, and not identified, would be received as a
matter of course. A properly-designed mortuary would
embrace a room for conducting post-mortem examinations,
which are now often made under painful and distressing
circumstances, to say nothing of the inconvenience to which the
operator is put—and there were 154 such examinations last
year by coroner’s order. It should also embrace a
suitable Court for the due and proper execution of the
coroner’s office.
No progress in this matter has been made since my last report,
a conference with a Committee of the Board of Guardians, with a
view to the appropriation of a portion of the stone yard at the
Dispensary Buildings, Mary Place, Potteries, having proved
abortive. I cannot say I regret this result, as I do not
consider the site a desirable one. The mortuary should be
quite distinct from any association with pauperism, and though
privacy of site is desirable, I hold that it should be placed in
the most respectable and the most central locality that can be
obtained, in order to ensure its being used. I am still of
opinion that the
should, if possible, be so far associated with the mortuary as
to enable one and the same person to have the charge of both
establishments. Proceedings in respect of both are alike at
a standstill, because we have not been able to procure a
site. Fortunately, during a considerable portion of the
year there has not been very much need of a chamber, so far as
need depends on the prevalence of infectious disease; but I am of
opinion that a great amount of good sanitary work might be done
with an efficient chamber, if only in purifying by heat the often
foul and otherwise offensive bedding and clothing of the
poor. Latterly, owing to the increased prevalence of
scarlet fever, and also during the latter period of 1874, a good
deal of disinfection has been satisfactorily carried out for your
Vestry by Messrs. Wellan & Co., of Manchester Mews, Walmer
Road, Notting Hill, by chemical agents and heat combined.
As to the value of disinfection properly done there can be no
doubt and I am not acquainted with a single instance in which
clothing, bedding, &c., that has been properly submitted to
the process, has been the medium of contagion.
No steps were taken during the year to supply the parish with
these valuable institutions. I hope, however, that the
subject will be taken up again before long, your Vestry having
already expressed an opinion favourable to the principle. I
have no doubt that in a few years, and at whatever reasonable
cost, Baths and Wash-houses will be regarded as indispensable
parts of a well-regulated system of sanitary administration.
The subject of sewer ventilation has made little or no
progress during the year, and, as usual, numerous complaints have
been received of noxious smells emanating from the gullies and
ventilators. Each case has been dealt with as far as
possible; and in many of the cases charcoal filters have been
introduced, with the result of putting a stop to
complaints. I am, nevertheless, somewhat sceptical as to
the value of this plan, as I cannot divest my own mind of the
suspicion that they impede ventilation, and may prove effectual
only by preventing the escape of foul air. The subject was
brought very prominently before your Vestry during the current
year, in consequence of numerous complaints by inhabitants of
Elsham-road of bad smells, not only in the roadway, but also in
the houses. I made an exhaustive report on the locality,
and advised measures for diminishing pressure in the sewers, by
opening up blind ends, and so allowing the gas to circulate, or,
at least, to escape innocuously into the open air, rather than
into the houses. I described the sanitary defects which
existed in the houses, and recommended ventilation of the house
drains by independent pipes carried from the highest point of the
drain to some distance above the parapets of the houses, and I
pointed out that this remedy alone would go far to remove the
cause of complaint. To what extent the plans have been
carried out I have not yet ascertained, but it is certain that a
long period had since elapsed without any communication on the
subject having been received in my department.
With respect to the question of circulation of air in sewers,
plus ventilation, I may mention that a striking
illustration of the value of this plan was afforded in the
locality of Notting Hill Square. At one of the houses at
the southern, or loftiest side of the square, there had been
numerous cases of fever, and there was clear evidence of the
escape of sewer gas into the house in question. Upon
careful enquiry into the drainage of the locality, 1 ascertained
that the sewer which received the house drainage originated in a
dead or blind end, and that the ventilation was
insufficient. Your Vestry directed a communication to be
made between the blind end in question and another very near to
it, thus setting up a free circulation in the system; and at the
same time freely ventilated the sewer near the junction.
The effect was everything that could be desired: for certain
improvements in respect of the trapping and ventilation of the
house drains having been carried out, the evil complained of
was effectually removed, and no farther illness has been
reported.
It is much to be wished that some effectual plan may be soon
discovered for ventilating sewers; and, although I do not profess
myself competent to decide what direction such a discovery is
likely to take, the most promising idea I have yet heard proposes
the extraction of foul air by the action of fans placed in
suitable localities, the present ventilators being retained in
the capacity of inlets for pure air, instead of outlets for foul
air; acting, in fact, like the down draught in a mine. We
all know, by reading, what great lengths of galleries in mines
deep below the surface of the earth are ventilated, and very
efficiently, in this manner, and it seems not unreasonable to
hope that the system may be found applicable to the purpose under
consideration. Certainly, there seems no reason to doubt
the almost illimitable power of steam fans to induce currents in
any direction; and leaving the question to be worked out by those
who are making a practical study of it, I can but wish them every
success, believing an effectual system of sewer ventilation to be
one of the chief sanitary desiderata of the present
day.
The Report, by Professor Frankland, on the analysis of the
waters supplied by the Metropolitan Water Companies during the
several months of the year, is, on the whole, somewhat more
favourable than usual. As regards
“temperature,” he notices the wide variation in the
waters derived from riverian sources, as compared with the narrow
range in the deep well water of the Kent Company, derived from
the chalk. The temperature of the Thames water varied from
36° Fahr. in February to 68°–9 in June, a range of
34°; while the range in the water of the Kent Company was
only 7°–9 Fahr., viz., from 51–l° in May to
59° in September and October. The total solid
impurities—composed of a great variety of substances, some
of which are organic and very objectionable, and at times
eminently noxious, while others are either entirely or
comparatively harmless—was rather less than in previous
years, the progressive increase in the quantity which had been
noticed during the years 1871–2–3 having apparently
ceased. The maximum was observed in January, and the
minimum in July. The character of the Thames water, in
respect of organic impurity—as represented by its two most
important constituents, carbon and nitrogen—was practically
the same as in the previous years. The maximum pollution
occurred in March, April, and December, when the river was in a
very objectionable condition. In December the Chelsea
Company supplied this foul water in an unfiltered condition, and
contaminated with fœcal matter. The subjoined table
shows the maximum, minimum, and average quantity of organic
matter in the water, the amount of organic element (organic
carbon and
organic nitrogen) in the Kent Company’s water being taken
as unity, or the standard of comparison:—
Name of Company.
|
Maximum.
|
Minimum.
|
Average.
|
Kent
|
1.0
|
1.0
|
1.0
|
West Middlesex
|
4.3
|
2.0
|
3.0
|
Grand Junction
|
4.9
|
2.4
|
3.3
|
Chelsea
|
7.1
|
2.3
|
3.7
|
Professor Frankland remarks that the water of the Thames is at
its source as free from pollution as the chalk well water, but on
its downward course becomes largely and progressively
contaminated by sewage and the washings of cultivated land,
especially during winter.
The average hardness of the Thames water—or the weight
of carbonate of lime, or its equivalent of other soap-destroying
substances, found in 100,000 parts of water was 21° or parts
in 1873, and 19.7° in 1874. Large quantities of soap or
soda are required to soften the water before it is used for
washing; but this process could be accomplished for a small
portion of the expense by substituting lime for soap or soda, as
practised on similar waters at Aylesbury, Canterbury, Caterham,
and Tring. The following table exhibits the degree of
efficiency of filtration of the waters:—
Name of Company.
|
No. of occasions
when clear and
transparent.
|
No. of occasions
when slightly
turbid.
|
No. of occasions
when turbid.
|
No. of occasions
when very
turbid.
|
Chelsea
|
6
|
5
|
0
|
2
|
West Middlesex
|
12
|
1
|
0
|
0
|
Grand Junction
|
7
|
5
|
1
|
0
|
The exceptional occasion on which the water supplied by the
West Middlesex Company was slightly turbid was in December, when
the condition of the Thames was bad for a lengthened time, so
that even the large storage of the Company proved insufficient to
render them independent of flood water; it being impossible,
moreover, to separate by filtration the whole of the finely
divided clay to which the turbidity of the water was due.
The Kent Company’s deep well water, having already
undergone natural filtration through an enormous thickness of
chalk, is always clear and transparent, without artificial
filtration. The appliances of the Companies supplying river
water are, excepting in the case of the West Middlesex Company,
unequal to the filtration work required of them. The
microscope is called into use in the examination of potable
water, and it always reveals numbers of living and moving
organisms in the sediment deposited by turbid water on
standing. The annexed table exhibits the results of such
microscopic examinations during the past six years:—
Name of Company.
|
Number of occasions
when living
organisms were found.
|
|
1869.
|
1870.
|
1871.
|
1872.
|
1873.
|
1874.
|
Chelsea
|
3
|
2
|
2
|
3
|
2
|
5
|
West Middlesex
|
0
|
0
|
0
|
0
|
0
|
0
|
Grand Junction
|
4
|
1
|
1
|
2
|
3
|
5
|
To
Professor Frankland’s valuable report, the main features of
which I have thus summarised, are appended numerous tables
setting forth, in detail, the various information condensed in
the text. I subjoin, as of greatest general interest, Table
M, which exhibits the
Averages
for 1874.
(The numbers in this Table relate to 100,000 parts of each
Water.)
Names of Companies.
|
Temperature in Centigrade
Degrees.
|
Total Solid Impurity.
|
Organic Carbon.
|
Organic Nitrogen.
|
Ammonia.
|
Nitrogen, as Nitrates and
Nitrites.
|
Total Combined Nitrogen.
|
Previous Sewage or Animal
Contamination. (Estimated.)
|
Chlorine.
|
Total Hardness.
|
Proportionate Amount of organic
Elements, that in the Kent Company’s Water being taken as
1.
|
Thames.
|
Chelsea
|
11.8
|
26.46
|
.211
|
.039
|
.001
|
.155
|
.196
|
1250
|
1.87
|
19.3
|
3.7
|
West Middlesex
|
12 5
|
26.62
|
.176
|
.028
|
.001
|
.124
|
.153
|
930
|
1.83
|
19 4
|
3.0
|
Southwark
|
12.7
|
26.68
|
.192
|
.030
|
.001
|
.125
|
.155
|
940
|
1.83
|
20.0
|
3.3
|
Grand Junction
|
11. 4
|
27.00
|
.186
|
.033
|
.001
|
.129
|
.164
|
990
|
1.83
|
20 0
|
3.3
|
Lambeth
|
12.0
|
27.88
|
.196
|
.037
|
.001
|
.144
|
.181
|
1120
|
1.87
|
20.0
|
3.4
|
Other Sources.
|
New River
|
12.2
|
26.02
|
.087
|
.015
|
.001
|
.146
|
.162
|
1150
|
1.67
|
20.1
|
1.5
|
East London
|
11.8
|
27.13
|
.153
|
.027
|
.001
|
.076
|
.104
|
560
|
2.04
|
19.3
|
27
|
Kent
|
12.4
|
40.36
|
.057
|
.012
|
.000
|
.371
|
.383
|
3 40
|
2.48
|
28.1
|
1.0
|
But it is not to Professor Frankland alone that we are now
indebted for information respecting the water we drink, many very
interesting facts being supplied by Major Bolton, R.E., the water
examiner appointed by the Board of Trade, under the provisions of
the Metropolis Water Act, 1871. Major Bolton’s
reports, which, by his courtesy, I receive every month, afford
information on all points relative to the machinery for water
supply, and to the provisions already made, or in progress, for
giving a constant supply, the main object of the Act; and which,
I suppose, we may, at some remote future, hope to obtain.
As the information in question is not generally accessible, I
make no apology for presenting a resumé of it on
this occasion. And, first, with respect to the constant
service, we learn that the West Middlesex Company are giving
constant supply to a number of houses, on the application of the
owners, and are fully prepared to extend the supply when called
upon. Extensive works and additional engine power of 120
horse power are in course of construction at Hampton.
The Grand Junction Company have formed a high service
reservoir near Kilburn, to contain 6,000,000 gallons, for
constant service, and are completing the line of main pipes to
connect up this reservoir with the works at Campden-hill; they
are likewise erecting boilers and works at Hampton, for which
place an additional 70-inch engine of 125 horse power is being
constructed, and an extra 30-inch main from Hampton to Kew has
been ordered to be laid down. The Chelsea Company does not
appear to have taken, as yet, any steps in this matter, having,
as we shall see, other and more pressing work in hand. The
Act of 1871 provides power to compel the companies to give a
constant supply as and when the “public authority”
may see fit to move. The authority (Metropolitan Board of
Works) has not seen fit to move in respect of the companies
supplying this parish, nor is it probable that any steps will be
taken until the stringency of the water regulations, to which I
have already referred, has been modified.
The number of miles of streets in the Metropolis which contain
mains constantly charged, and upon which hydrants could at once
be fixed, is 666—including 67 in the West Middlesex,
41½ in the Grand Junction, and 50 in the Chelsea
Company’s district. The companies are prepared to
affix hydrants thereon when required by the authorities; but, in
fact—although hydrants might be used for street
watering—of 2,531 hydrants already erected, 1,996 are for
private purposes, and only 535 for public purposes, including 267
for street watering, in the entire Metropolis.
The companies supplying this parish obtain water exclusively
from the Thames, viz., the West Middlesex and Grand Junction
Companies at Hampton, and the Chelsea Company at Ditton.
The bad state of the water supplied by the last-named company in
December appears to have been caused by the intake being
“below the filthy outflow of the rivers Mole and
Rye.” The total volume which may be supplied daily by
each company is 20,000,000 gallons. The average daily
supply during the month of December was—West Middlesex,
8,600,000; Grand Junction, 10,200,000; and Chelsea, 7,200,000
gallons—eleven to fourteen per cent. of the water
(exclusive of waste, an enormous but unknown quantity!) being
delivered for other than domestic purposes. The number of
houses supplied in the several districts is—West Middlesex,
46,404; Grand Junction, 35,144; and Chelsea, 28,395. Only
401 houses in the West Middlesex district have a constant
supply. The estimated population supplied is—West
Middlesex, 348,000; Grand Junction, 316,000; Chelsea,
210,000. The West Middlesex Company possess eleven engines
of 1,341 horse power; the Grand Junction, eleven of 1,820 horse
power; and Chelsea, eight of 1,025 horse power. The number
of miles of mains possessed by these companies in the Metropolis
is—West Middlesex, 248; Grand Junction, 200; Chelsea,
170. The West Middlesex Company have three subsiding and
storage reservoirs for unfiltered water—area, 20½
acres; available capacity, 57,000,000 gallons: and three covered
reservoirs for storing filtered water, of an aggregate capacity
of 10,922,000 gallons. This company, by means of its large
reservoir capacity, avoids taking in water during floods.
The Grand Junction Company have four subsiding and storage
reservoirs for unfiltered water—area, 7 acres; available
capacity, 19,500,000 gallons: the number of covered reservoirs
for filtered water being three, their capacity 18,000,000
gallons. This company requires additional impounding and
subsiding reservoirs. The Chelsea Company have no
reservoirs for unfiltered water, and only two (capacity,
11,000,000 gallons) for storing filtered water. The filter beds
of the several companies are as follows:—West Middlesex,
five in number, area 8 acres, depth 5 feet, viz., Harwich sand
1ft. 9in., Barnes sand 1ft., and gravel (screened to different
sizes and arranged in layers) 2ft. 3in. The average rate of
filtration per square foot of area was, during December,
1½ gallons per hour. (It may be here observed that
the quality of the water is improved by a slow rate of
filtration—the rate should not exceeded 2½ gallons
per square foot of filter bed per hour: this will give 540
gallons per square yard each 24 hours, and at this rate
filtration should be effectual.) Grand Junction: Number of
filter beds, 4; area in acres, 7¾; depth, 5ft.
6in.—viz., Harwich sand, 2ft. 6in.: Hoggin, 6in.: fine
gravel, 9in.: coarse gravel, 9in.: boulders, 1ft.: average rate
of filtration, 1⅓ gallons per square foot of area per
hour. Chelsea: Filter beds, 7; area, 6¾ acres;
depth, 8ft.—viz., Thames sand, 3ft. 3in.: shells, &c.,
3in.: gravel, 4ft. 6in.; rate of filtration, 2⅓ gallons per
square foot per hour. It will be observed that
notwithstanding the greater depth of the filter beds of the
Chelsea Company, the water supplied by the Company in all times
of difficulty arising from a flooded state of the river is unfit
for drinking, although the rate of filtration is slower than that
deemed sufficient by the water examiner. This is due to the
total absence of impounding and storage reservoirs for unfiltered
water, to the exceptionally bad quality of the water taken in by
the Company, owing to the improper situation of the intake at
Ditton, and to the impossibility of filter beds removing
suspended matter when in any large quantity; that, moreover,
being a principal object of the subsiding reservoirs. The
disgusting condition in which the water of the Company was sent
out during parts of the months of November and December formed
the subject of many complaints, both in the public press and in
communications addressed to myself, and was referred to in my
reports, dated December 16th, 1874, and January 13th, 1875.
I had, on former occasions, reported specially on the subject,
and particularly in February, 1872. The dissatisfaction
which the condition of the water at the latter date gave rise to
induced the Company to take steps to improve their means of
supply by enlarging their storage. The scheme submitted to
Parliament in the Session of 1873 included the embanking of the
Thames at Hampton Court, and was defeated by a strong public
opposition, on what I described at the time as æsthetical
grounds. No further attempt appears to have been made by
the Company to put their supply on a proper footing until the
great outcry referred to arose. On the 18th December,
however, at a special meeting of the proprietors, a resolution to
the following effect was passed:—
“That the directors be authorised to take
such steps as in their judgment may be necessary or expedient to
obtain a fresh intake, with reservoirs and other works connected
therewith, and lay the necessary main pipes from the site of such
proposed intake to the works at Seething Wells, with the least
possible delay.”
The measures taken by the directors to secure the
land—an area of 50 acres, near Molesey—for the
construction of impounding reservoirs, were approved and adopted,
and the directors were authorised to apply to Parliament in the
now current Session for the necessary powers. This they
have done, and there is every probability that their Bill will
pass, and that with the completion of the contemplated additions
to their works this Company will be able, at no distant time, to
supply its customers with water as clear and transparent as any
derived from the River Thames.
During the first half of the year the parish was supplied with
cannel gas of 20 candle lighting power, and at the increased
price of six shillings and threepence per thousand cubic
feet. Since July common coal gas of 16 candles has been
exclusively supplied at a charge of five shillings per
thousand. The subjoined table, taken from the quarterly
returns of the chief gas examiner, shows the results of the daily
testings of the gas supplied by the Gas Light and Coke Company,
at the testing station at 123, Ladbroke Grove, Notting
Hill:—
Month.
|
Illuminating power in Sperm
Candles.
|
Amount of Impurity.
|
Number of Examinations.
|
|
|
Sulphuretted Hydrogen.
|
Ammonia per 100 feet
Grains.
|
Sulphur per 100 feet
Grains.
|
|
January
|
21.28
|
|
4.11
|
21.92
|
25
|
February
|
21.76
|
|
1.15
|
18.46
|
23
|
March
|
21.47
|
|
0.86
|
15.63
|
26
|
April
|
22.04
|
|
0.56
|
17.37
|
22
|
May
|
21.53
|
|
0.39
|
17.97
|
23
|
June
|
21.28
|
|
0.48
|
17.93
|
20
|
July
|
17.13
|
|
0.50
|
18.76
|
26
|
August
|
16 70
|
|
0.37
|
17.79
|
23
|
September
|
16.83
|
|
0.15
|
17.17
|
25
|
October
|
16.53
|
(Present 3 times)
|
0.19
|
16.44
|
26
|
November
|
16.67
|
|
0.19
|
17.02
|
24
|
December
|
16.68
|
(Present 3 times)
|
|
19.01
|
25
|
The next table shows the maxima, minima, and averages of
lighting power stated quarterly:—
Period.
|
Maximum.
|
Minimum.
|
Average.
|
1st Quarter (Cannel Gas)
|
22.9
|
19.6 [49a]
|
21.50
|
2nd do. do.
|
23.0
|
20.3
|
21.62
|
3rd do. (Common Gas)
|
17.6
|
16.1
|
16.89
|
4th do. do.
|
18.2
|
15.5 [49b]
|
16.63
|
As
regards sulphur impurity, the amount was in excess of the
permitted quantity (25 grains in 100 cubic feet of gas), on one
occasion only during the year, viz., 26.4 grains on 30th
July. Sulphuretted hydrogen was found on three
occasions—in the months of October and December
respectively.
Ammonia was in excess on 19 occasions in the month of January,
but of a total of 25 testings: the average for the entire month
being 4.11 grains (maximum 7.5.) This excess above the
maximum allowance (2.5 grains in 100 feet of gas) was due to
unavoidable causes, in connection with alterations being then
made in the purifying machinery, which, having since been
perfected, the ammonia has sunk to an almost infinitesimal
quantity.
In the Appendix I have given the quarterly returns of the
chief examiner, showing the results of the daily
testings—for which I am indebted to the courtesy of Mr.
Wakefield, the Clerk to the Metropolitan Board of Works.
These returns show in detail the facts above stated, and prove
that the gas has been up to the Parliamentary standard, as
estimated by the prescribed tests. Nevertheless, complaints
have been made by persons living in various parts of the parish,
of the deficient lighting power of the gas. It must be
assumed, therefore, that in some cases the burners in use have
been in fault. There can, indeed, be no doubt that many
consumers fail to obtain a proper light, owing to the habitual
use of bad burners, or to the neglect to cleanse good ones.
Burners that were of sufficient capacity for the cannel gas, with
which the parish was supplied during the first half of the year,
are inadequate, and are not adapted to burn common gas so as to
produce a good light. Some consumers who have reported the
sufficiency of the light when proper burners have been employed,
have complained of the great increase in the amount of their gas
bills, and in a few instances, I understand, the dissatisfaction
has been so great as to lead to a discontinuance of the use of
gas. It is a remarkable fact, often observed—a fact
that makes us almost despair of ever getting “cheap
gas”—that the bills seem always to increase when the
price is lowered! How this is brought about I do not
pretend to explain; but, so far as my experience goes, it would
seem that gas bills never were lower than when the price per
thousand feet was at its highest. I do not think that
extravagance in consumption—as a result of decrease in
price—can be admitted to be a sufficient explanation of the
phenomenon. There are mysteries in gas manufacture and
supply, which may be revealed hereafter, and the discovery may
both enlighten us on the point now mentioned, and also explain
the occurrence of complaints of bad light, concurrently with the
satisfactory results of the nightly examinations of the gas at
the appointed testing station.
During some portion of the year the supply was scarce.
The Company, when applied to for an explanation, attributed the
scarcity to the refusal of a “sister Vestry” to allow
the roads in their parish to be broken up for the purpose of
laying down a larger main from the works at Horseferry Road, to
supplement the supply from the Kensal Works, which are inadequate
for the large district hitherto dependent on that source. I
am not without hope that when the new 24-inch main is completed
some of the causes of dissatisfaction to which I have adverted
may be removed, and that a sufficient and well-regulated
pressure, with a full supply of gas, will be obtained.
The dissatisfaction with the gas led your Vestry to adopt a
curious experiment during the current year, viz., that of burning
mineral oil with the Silber light in a certain number of street
lamps in the Kensington Road. I offer no opinion at present
on the comparative value of the two sources of light; but I may
mention the fact already well known, and referred to in my
monthly reports, that the lighting of the streets in this parish
is very unsatisfactory, inasmuch as we are still using burners
adapted to consume three feet per hour, as in the days of cannel
gas, whereas 4½ feet burners, at the least, should be
employed. A suggestion has been made that the average meter
system should be adopted in this parish, and it has my cordial
approval—already expressed in my monthly reports—as
it is only fair and proper that public bodies should pay for the
gas they consume and no more. The average meter system has
been adopted in the parishes of Paddington and St. Pancras.
It has given entire satisfaction, and in a very short space of
time the first cost of applying the meters to every twelfth lamp
will have been defrayed by the saving in expenditure on
gas. In Paddington the Vestry have undertaken all the
necessary work of lighting and repairing the lamps. The gas
has been burned for a somewhat shorter average period nightly,
and a further large saving in expenditure has thus been
effected. With reference to the cost of gas in this parish,
I may be permitted to mention that during the year the revenue of
the Company was many thousand pounds more than necessary to pay
the ten per cent. dividend—which, in fact, might have been
paid without the increase in the price of the gas, sanctioned by
the Commissioners appointed by the Board of Trade, in the month
of January. If, however, the price had not been raised
during 1874, it is probable that the price charged in 1873 would
have been maintained. But, in the face of the enormous
over-taxation of gas consumers in 1874, and the reduced cost of
coal, the Company could not apply to the Board of Trade for a
revision of the price in 1875, the result being that the charge
reverted on the 1st of January to the Parliamentary price of
three shillings and ninepence per 1,000 cubic feet.
I cannot conclude my report without special acknowledgment of
the assistance rendered to me by the sub-district registrars of
births, deaths, &c., during the past year, which has been one
of crisis. For many years the Registrar-General had
presented to the several Medical Officers of Health of the
Metropolis the original manuscript returns of the causes of all
deaths registered within their districts during the previous
week, these returns being forwarded by the sub-district
registrars to Somerset House, and forming the basis of the
Registrar-General’s “Weekly Return.” For
this duty the sub-district registrars received no
remuneration. The necessity of similar information being
supplied to Provincial Medical Officers of Health arose out of
the passing of the Public Health Act, 1872, but no such returns
being in existence, the information was not forthcoming.
Hence many difficulties, into which I need not enter.
Suffice it to say that in the Public Health Amendment Act
provision was made for the payment of the sub-district registrars
by Provincial Sanitary Authorities for information of a precisely
similar character to that which had hitherto reached the
Metropolitan Medical Officers without expense to the Local
Boards. On the passing of the last-named Act, the London
registrars, feeling themselves entitled to remuneration for the
“secondary use,” by the Medical Officers of their
manuscript returns, applied to the Registrar-General on the
subject, and he, in turn, requested the Society of Medical
Officers of Health to bring the question of payment on a proposed
scale before the several Vestries and District Boards. The
Society, however, declining the somewhat invidious task, the
Registrar-General addressed a similar application to the Local
Boards. In the result very few of them consented to the
requisition of the Registrar-General, who thereupon gave notice
to the Medical Officers that after an appointed day in October he
should no longer forward the weekly returns; and he was as good
as his word. Greatly to their credit, Messrs. Barnes and
Hume spontaneously put themselves in communication with me,
promising to send me a duplicate copy of the returns as before;
and this they did, until, some time afterwards, a fair and
mutually satisfactory arrangement was completed between your
Vestry and these gentlemen. The upshot is that I obtain the
returns early on Monday morning instead of on Wednesday evening,
and I am thus enabled to tabulate the vital statistics up to a
period within four days of the date of my monthly reports,
instead of eleven days, as under the former arrangement.
Additional information of value is also supplied by the
registrars, and they continue to forward from day to day, on
special forms, notice of any deaths that may have been registered
from small-pox, scarlet fever, diphtheria, typhus, enteric, and
simple continued fevers, and puerperal fever, &c., so that no
time is lost in taking the necessary steps after fatal
cases of these infectious diseases.
I have to express my obligations to the officers of the Board
of Guardians for information of cases of infectious diseases,
&c.; and I am happy to testify my sense of the cordial
support I invariably receive from the Sanitary Inspectors, and of
the efficient manner in which their onerous, often delicate, and
always important duties have been performed. Some
portion of the time of Messrs. Wood and Langman has been taken up
in attending to the new duties imposed on them under the
Adulteration of Food, &c., Act—especially in attending
the police court to conduct prosecutions. Much of the work
of general inspection is still done in a desultory way, owing to
the magnitude and inconvenient configuration of the parish, and
to the necessity of attending to complaints as they arise from
day to day—a necessity that impedes, more or less, the
important duty of systematic inspection of the houses in streets,
&c., inhabited by the poorer classes of the population.
It is desirable that the 35th clause of the Sanitary Act, 1866,
should be adopted, in order to the registration and regular
inspection of all houses which are let out in tenements. No
doubt this would involve much additional work for a time, but the
benefits would be commensurate, for the risk of overcrowding
would be diminished, ventilation would be improved, and the
cleansing of the rooms, staircases, &c., would be
systematically carried out. It seems to me that this is the
direction sanitary improvement should take in the future; and the
staff having been increased by the appointment of an additional
officer, I am not without hope of being able to bring the subject
under the notice of your Vestry at an early date, with reasonable
prospect of success. A principal difficulty in connection
with sanitary administration is that of securing an efficient
record of work done—a difficulty which has been much
lessened in this parish by the conspicuous care and ability with
which Mr. Rudman has performed the clerical duties of the
department.
I am, Gentlemen,
Your very obedient Servant,
T. ORME DUDFIELD, M.D.,
Medical Officer of Health.
Vestry Hall, Kensington,
August,
1875.