Part 1

Transcribed from the 1875 J. Wakeham edition by David Price, email [email protected]

[Picture: Public domain cover]

THE ANNUAL REPORT ON THE HEALTH OF THE Parish of St. Mary Abbotts, KENSINGTON, DURING THE YEAR 1874.

BY T. ORME DUDFIELD, M.D., MEDICAL OFFICER OF HEALTH.

* * * * *

KENSINGTON: J. WAKEHAM, PRINTER, 4, BEDFORD TERRACE, CHURCH STREET.

1875.

CONTENTS.

PAGE Prefatory Remarks 5–13 Mortality, higher rate of, in 1874, accounted for 5 Death Rate, Metropolitan and Local 6 Kensington “Registration District”—what it comprises 6 „ Parish of, division into Wards 6 „ Town and Brompton “Sub-registration Districts,” 7 contrast in the vital statistics of Sexes, relative rate of mortality in the 7 Sub-districts, character of the prevalent fatal diseases in 8 the Kensington Town, greater fatality of Zymotic, Tubercular 9 and Lung diseases in Deaths, (whole Parish) numbers of, from classes and orders 9 of diseases Death Rate and Mean Temperature, monthly record of 10 Scarlet Fever, outbreaks of, supposed to depend on 10 Contamination of Milk Dysentery and Diarrhœa, supposed to be due to the use of 11 the Milk of diseased Cows Dairies, undesirable Multiplication of 13 Population 13 Males and Females, ages of, living at the Census, 1871 13 „ great disproportion in the relative numbers of 13 Parish, area of, density of Population, number of inhabited 14 houses, &c. „ growth of Population: increase in Rateable Value of 14 Property Marriages and Marriage-rate 14 Births and Birth-rate 15 Deaths and Death-rates of sexes and in Sub-districts 15 Death Rates at all Ages, the true method of calculating 17 „ Special causes of 17 Zymotic Diseases, deaths from 17 Measles, Epidemic of 18 Scarlet Fever 18 Puerperal Mortality 22 Public Institutions, Deaths in 24 Inquests, facts in relation to, requiring explanation 25 Deaths, “not certified” 28 Death, Certificates of the cause of, abuse of 29 Vaccination 30 Meteorology 30 Sanitary Work 31 Boiling offal for pigs’ food, nuisances from 31 Swine, convictions for keeping, on prohibited premises 32 Diseased Animal, conviction for allowing carcase of, in a 32 Licensed Slaughter House Diseased Animal in slaughter house, no offence under 33 certain circumstances Blood, Conviction for allowing offensive accumulation of, 33 in a Licensed Slaughter House Diseased Meat, seizure of 33 Iron Foundry, nuisance at an 33 Slaughter Houses 34 Cow Sheds 38 Bakehouses 39 Dust Removal 39 Water Storage, domestic 40 Mortuary 41 Disinfecting Chamber 42 Baths and Wash-houses 43 Sewer Ventilation 43 Water Supply 44 Gas 49 Mortality, weekly returns of, services of the Sub-district 51 Registrars, in connection with the Conclusion 51 TABLES, Statistical (Appendix) 55

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

_To the Vestry of the Parish of St. Mary Abbott’s_, _Kensington_.

GENTLEMEN,

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

DEATH RATE, 1874.

per 1,000 Kensington 19.5 All London 22.5 West Districts 20.9 North 21.8 Central 25.6 East 25.4 South 21.5

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

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

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

Name of Actual No. Deaths in Calculated Excess or Disease of Deaths the No. of Deficiency in the Town Brompton Deaths in in Town Sub- Sub- Town on the compared District. District. Brompton with scale Brompton. The Seven 332 66 176 + 156 principal Zymotic Diseases Measles 115 6 20 + 95 Diphtheria 24 2 6 + 18 Scarlet 28 4 12 + 16 Fever Typhus 9 0 0 + 9 Fever Enteric 19 9 28 - 9 Fever Simple 11 4 13 - 2 Continued Fever Hooping 36 9 28 + 8 Cough Diarrhœa 90 22 69 + 21 Puerperal 18 6 19 - 1 Fever Croup 25 1 3 + 22 Erysipelas 14 8 25 - 11 Cancer 51 16 50 + 1 Tuberculous 268 59 186 + 82 Diseases (phthisis, scrofula, &c.) Brain 127 46 144 - 17 Disease, (Apoplexy and paralysis) Convulsions 50 9 28 + 22 Heart 102 33 103 - 1 Disease Lung 461 93 292 + 169 Diseases Enteritis 34 5 16 + 18 and Peritonitis Liver 30 7 22 + 8 Disease Bright’s 14 8 25 - 11 Disease Atrophy of 143 20 63 + 80 children Premature 35 11 34 + 1 birth 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. Rate of Mortality Mean temperature Four weeks ended per 1,000 living. 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.