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.