Gentlemen,

I propose in this, the Nineteenth Annual Report of the Medical Officer of Health, to follow the plan adopted in my previous reports: that is to say, the vital statistics will be made up to the end of the registration year (January 2nd, 1875), for the sake of comparison with the Registrar-General’s figures for the entire Metropolis: the Tables, showing the sanitary work carried out by your very competent staff of inspectors, will be made up to the end of the Vestry year (March 25th, 1875); while, with respect to other matters calling for notice, I shall bring the report down to the latest possible period, no useful purpose being served by delay; it being, moreover, in every way the better plan to refer to subjects while they are tolerably fresh in recollection, and before they have lost their interest. I shall, as usual, preface my report with some general remarks, which, I trust, will be found worthy of perusal. And I may here mention that the first Six Tables in the Appendix are given in the form settled last year by the Society of Medical Officers of Health, with a view to ensure uniformity in statistical returns. The subject was brought under the notice of the Society by myself, and a great deal of thought and labour devoted to it, in order to make the tables generally acceptable. I now pass on to observe that the public health in this Parish, as gauged by the gross mortality, was not so good during the year 1874 as in the previous year, the deaths registered (2,696) showing an increase of 260. The increase in the rate of mortality, however, was not large in proportion, for as the population increased by 5,000, 91 deaths have to be deducted on that account, while 32 deaths are accounted for by an increase in the number of deaths of non-parishioners registered at the Brompton Hospital for Consumption and the Diseases of the Chest. The real excess of mortality, therefore, was 137, and of these deaths 98 belong to the group of zymotic diseases, and were due to a severe and prolonged epidemic of measles, leaving 39 deaths to be spread over the remainder of Table 3 (Appendix); but as a matter of fact the higher rate of mortality from chest diseases, which will be referred to hereafter, more than accounts for this number. If we assume that the deaths of Kensington parishioners outside the parish were as numerous as the deaths of non-parishioners at the Brompton Hospital, which is situated within the parish, the rate of mortality during the year would be 19.5 per 1,000 persons living—a rate that compares not unfavourably with the rate for the entire metropolis, which was 22.5 per 1000. If, however, in the absence of definite information respecting deaths of parishioners taking place out of the parish, we restrict our view to the deaths of parishioners registered within the parish—deducting 125 deaths at the hospital and 36 at St. Joseph’s House—the rate of mortality was only 18.3 per 1,000. The subjoined table shows the rate in the several great divisions of the metropolis, as given by the Registrar-General in his annual summary, and in Kensington:—

DEATH RATE, 1874.

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 Disease Actual No. of Deaths in the Town Sub-District. Deaths in the Brompton Sub-District. Calculated No. of Deaths in Town on the Brompton scale Excess or Deficiency in Town compared with Brompton.
The Seven principal Zymotic Diseases 332 66 176 + 156
Measles 115 6 20 + 95
Diphtheria 24 2 6 + 18
Scarlet Fever 28 4 12 + 16
Typhus Fever 9 0 0 + 9
Enteric Fever 19 9 28 - 9
Simple Continued Fever 11 4 13 - 2
Hooping Cough 36 9 28 + 8
Diarrhœa 90 22 69 + 21
Puerperal Fever 18 6 19 - 1
Croup 25 1 3 + 22
Erysipelas 14 8 25 - 11
Cancer 51 16 50 + 1
Tuberculous Diseases (phthisis, scrofula, &c.) 268 59 186 + 82
Brain Disease, (Apoplexy and paralysis) 127 46 144 - 17
Convulsions 50 9 28 + 22
Heart Disease 102 33 103 - 1
Lung Diseases 461 93 292 + 169
Enteritis and Peritonitis 34 5 16 + 18
Liver Disease 30 7 22 + 8
Bright’s Disease 14 8 25 - 11
Atrophy of children 143 20 63 + 80
Premature birth 35 11 34 + 1
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.