Part 2

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

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

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

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

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

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

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

POPULATION, &c.

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

AGES OF MALES AND FEMALES, 1871.

All Under 5 5 to 15 15 to 25 to 35 to 45 to 55 to 65 to 75 to 85 to 95 and Ages. 25 35 45 55 65 75 85 94 upwds. Males, 7065 10198 8948 8317 5963 4339 2464 1270 378 33 2 48977 Females 7147 11527 16585 14203 9080 6241 3768 2000 667 97 7 71322 Total, 14212 21722 25533 22520 15043 10580 6232 3270 1045 130 9 120299

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

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

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

The Year. Population. Rateable Value. The Year. 1801 8,556 £75,916 1823 1821 14,428 93,397 1833 1841 26,834 142,772 1843 1851 44,053 257,103 1853 1861 70,108 375,333 1860 1871 120,299 590,711 1865 1874 (estmtd.) 138,000 817,326 1870 £1,119,442 (April) 1875

MARRIAGES.

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

In Churches 1077 At Nonconformist Places of Worship 71 At Roman Catholic 70 At the Superintendent-Registrar’s Office 93 Total 1311

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

BIRTHS.

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

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

KENSINGTON TOWN BROMPTON Sub-District. Sub-District. Males. Females. Total. Males. Females. Total. Grand Total. 1st 484 475 959 94 111 205 1164 Quarter 2nd 464 409 873 102 95 197 1070 3rd 435 405 840 84 103 187 1027 4th 448 416 864 105 121 226 1090 Total 1831 1705 3536 385 430 815 4351

DEATHS.

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

KENSINGTON TOWN BROMPTON Sub-District. Sub-District. Males. Females. Total. Males. Females. Total. Grand Total. 1st 295 307 602 63 64 127 729 Quarter 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 Actual Deaths per Population. number 1,000 of deaths. persons living. Under 1 3,762 762 202.8 1 and under 2 3,153 223 70.9 2 „ 5 9,413 203 21.6 (0 „ 5) (16,328) (1,188) (73.) 5 „ 15 24,910 105 4.2 15 „ 25 29,262 105 3.6 25 „ 35 25,822 148 5.7 35 „ 45 17.267 151 8.7 45 „ 55 12,145 198 16.3 55 „ 65 7,154 199 27.8 65 „ 75 3,754 232 62.1 75 „ 85 1,199 183 153.8 85 „ 95 149 54 400 95 and upwards 10 8 138,000 2571

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

Place. Age. 0–5 15–25 25–35 55–65 65–75 England & Wales (10 years) 68.5 7.3 .. .. .. London ( 1861–70) 81.9 6.3 9.8 38.8 75.4 Kensington (1874) 73.0 3.6 5.7 26.8 62.1

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

SPECIAL CAUSES OF DEATH.

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

_Deaths from the seven principal Zymotic Diseases_.

Town. Brompton. Total. Per 1,000 deaths. Small Pox 0 0 0 0 Measles 115 6 121 45 Scarlet Fever 28 4 32 11.8 Diptheria 24 2 26 9.6 Whooping Cough 36 9 45 16.7 Fever 39 13 52 19.3 Diarrhœa 90 22 112 41.6 Total 332 56 388 144.0

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

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