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.
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: