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77
reference to increase of population. Since 1871, when the hospitals became available, in one year
only (1880) in this parish, have the deaths exceeded 100; whereas in the three consecutive years
1868-69-70, the numbers were 170, 106, and 198, respectively. Had the deaths from scarlet fever
in 1900 been as numerous in proportion to population as in 1870, not four persons would have died
from this cause, but 294.
Diphtheria* during the last twelve or thirteen years, has given the greatest concern to all
engaged in public health work in the Metropolis; having previously been regarded rather as a rural
disease, of late years it has fastened upon town populations. The deaths from this cause, happily,
are now declining, largely as the result of antitoxic serum treatment carried out extensively at the
hospitals of the Asylums Board, to which sufferers from the disease were first admitted in 1889.
"Fever," in the Registrar-General's classification, includes typhus, enteric, and simple
continued fevers; these diseases were not separately classified before 1871. During the seventeen
years 1884-1900, typhus, in a fatal form, occurred but once in this parish, viz., in 1898,
when a group of cases occurred at "fiats" at North Kensington, under circumstances set out in
the report for that year: two deaths were registered. Most of the cases had occurred before the
disease was recognised and notified—some weeks after its first appearance. Enteric (or typhoid)
fever, during the last fifteen years, exhibits a mortality reduced by more than one-half, as compared
with that in the years 1856-1870, and without correction for increase of population. It
is probable that some of the deaths certified as "simple continued fever" between 1871-1885,
were really due to enteric fever.
The appended tables B, C, and D (pages 85 and 86), exhibit in a compendious form
statistical information regarding the various matters dealt with in the preceding pages.
Public Health and Sanitary Work.—Notable work, of more than local interest and
importance, was undertaken and carried through by the late Vestry during many years, from 1871
onwards. Detailed account of the said work is set out in the successive annual reports of the
medical officer of health: in this place only brief reference can be made to the several matters
referred to, the most important being that of—
Hospital Accommodation for Infectious Disease.—In 1871 small-pox was raging, the
most serious epidemic of modern times having begun in 1870, in which year the first hospitals,
for small-pox and "fever," established by the Metropolitan Asylums Board, were brought into
use—at Hampstead (N.W. district), at Stockwell (S.W. district), and at Homerton (E. district)
respectively. Strictly, these hospitals were pauper institutions, intended for persons in receipt
of, or entitled to " relief." But this class of persons never furnished a tenth part of the patients,
many boards of guardians wisely assisting the sanitary authorities by affording facilities for the
admission of any sick person, on the certificate of their medical officer and the order of their
relieving officer. In this parish the good offices of the guardians and their officers were never
wanting, and, so far as accommodation allowed, the hospitals were accessible to all whom the
vestry desired to isolate. Difficulty occasionally arose from the demand of payment for smallpox
patients, who, not seldom, had been induced to go to hospital for the protection of the
public, and so as not to endanger the spread of disease, being themselves too slightly indisposed
to require medical treatment, or even confinement to the house. At my request, the guardians
instructed the relieving officers to cease making such applications; and not only so, but they
tacitly allowed these officers to accept the certificate of any medical man as evidence of the
nature of the infectious illness, thus doing away with the necessity of a visit by the "parish
doctor" (held to be objectionable in the case of non-paupers), and so removing the appearance
of pauperisation, which had been a let and hindrance to isolation in hospital of persons, often
indeed in poor circumstances but not of the pauper class. Thus we got on very well for several
years, after the epidemic of small-pox ceased in 1872, there being thereafter a restricted demand
for isolation, and, in fact, a somewhat general unwillingness to make use of the hospitals,
accommodation being in excess of the demand for scarlet fever and enteric fever: diphtheria
cases were not admissible. But in 1876, small-pox having again become epidemic, and
sufferers and their friends being only too glad to make use of the hospitals, available accommodation
speedily became exhausted. The Local Government Board, thereupon, in a communication
dated 2nd January, 1877 (having defined "the classes for which the hospitals were
intended") enquired—What provision the Vestry (and other local authorities) had made, or
proposed to make for non-paupers under the provisions of the 37th section of the Sanitary Act,
1866? It became my duty to report on the subject, and on the 10th January, and again subsequently
in a communication (by way of reply) to the Asylums Board, whilst deprecating the
* Prior to 1859, diphtheria deaths were classified to scarlet fever. During the last few years the Registrar-General
has classified deaths from membranous croup to diphtheria. Deaths classified to croup are now few ; in the earlier years of
the period under consideration they were numerous, and nearly all of them, probably, might properly have been classified to
diphtheria.