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card containing clear and simple rules for the prevention of the spread of infection, such as could
be carried out without interfering with the patient's daily avocations. When the patient was
living at home, visits were paid at irregular intervals, to see that the instructions given
were carried out, and, after registration of a death, whether the case had been notified, or
had become known through the weekly returns of mortality, the house was visited and
disinfection offered. It was gladly accepted as a rule, but in 60 instances was declined as
"unnecessary." In 48 cases disinfection had already been, or was about to be, done under the
superintendence of the medical practitioner in attendance. The proportion of deaths at the
Borough Infirmary to total deaths in the borough from phthisis, was large; viz., 80 out of 212:
males 47, and females 33. Sixty-seven of these deaths were of North Kensington persons, 13 of
South Kensington persons. The notifications were 153: males 95, females 58: 114 of North
Kensington persons, and 39 of South Kensington persons; High Street, Notting Hill, and Holland
Park Avenue constituting the dividing line. A large number of cases primarily notified by District
Medical Officers were subsequently removed to the Infirmary.
INFANTILE DIARRHGEAL MORTALITY.
With the view to an effort to reduce the customary high rate of infantile mortality in
Kensington, arrangements were made in 1902, for an inquiry into the circumstances connected with
the deaths of 257 children under one year of age. The Public Health Committee authorised me to
employ the services of the lady inspectors in the delicate duty of interviewing bereaved mothers, in
order to discover to what extent the mortality might reasonably be attributed to preventable causes.
The results of the inquiry were set out in my annual report for 1902, page 60. In 1903 a similar
inquiry with respect to infantile diarrhœal mortality, was undertaken, limited to a period of twenty
weeks: July 12th—December 5th.
The Lady Inspectors' report, which was printed in my first monthly report for 1904, embraced
an account of the foods used, the condition of the homes, the status of the family, the occupation
of the male parents, and of the mothers when, as in 6 cases, the infants were illegitimate. The
deaths to which the enquiry related were 74 in number (out of a total of 97, at all ages,
in the year) : 67 in North Kensington and 7 in South Kensington. Of the deaths in North
Kensington 25 belonged to St. Charles Ward, 20 to Golborne and 18 to Norland (including 7 in the
"special area"), the aggregate population of the three wards being 72,300, that of the other six
wards in which there were 11 deaths only, being 105,700.
The summer of 1903 was cool and wet; and as usual in the circumstances, there was but a
moderate prevalence of diarrhoea at the period when, in ordinary years, the disease is most fatal. Thus
in the Metropolis, as a whole, the diarrhoeal deaths at all ages in the 12 weeks, June 21st—September
12th, were 1,284 only, and 1,271 below the corrected decennial average, whilst in the following 12
weeks, to December 5th, the deaths (1,100) were 359 in excess of the average. The deaths at all
ages in the Borough during these two successive twelve-weekly periods, were 50 and 35 respectively;
fewer than the average in the former period, and more than the average in the latter period. Of the
74 deaths, under one year, within the period of the inquiry, 64 were registered in the 13 weeks,
August 2nd—November 1st.
The information obtained led to the conclusion that the doctor but too often was called in
too late to be of service; the delay being sometimes due to the little importance so commonly
attributed to diarrhoea at the onset: it is, however, in part explained by the poverty of the people;
their inability to pay fees, and their unwillingness to make application for " medical relief."
Particular enquiry was made as to the foods used. As regards milk, it appeared that little
fresh cow's milk was given. The mothers alleged that the condensed milk used was "whole milk."
But facts ascertained in 1902, in the enquiry into infantile mortality generally, led to the inference
that large numbers of infants are fed on innutritious skimmed milk, whether liquid or condensed.
Liquid milk furnishes an admirable medium for the growth of bacteria, which multiply in it
with amazing rapidity. The milk seldom arrives to the consumer till twelve or more hours after the
"milking," and no adequate measures are taken to keep it cool, at the farm, or on the railway
journey. It is liable to be fouled with dirt at every stage, and in poor localities is stored and vended
at places where it becomes exposed to additional pollution, sustaining further contamination in the
more or less insanitary homes of the poor. Condensed milk is heavily loaded with cane sugar, and
when exposed to the air suffers bacterial infection. When one reflects on these things, and on the
conditions of infant life generally, amongst the poor; the lack, too often, of maternal care, the