6 LON 21 REPORT on THE SANITARY CONDITION of the CITY OF LONDON, FOR THE YEAR 1853-4, by JOHN SIMON, F.R.S., medical officer of health to the city. of london, and svbgeon to st. thohas's hospital. london: c. dawson, printer, 148½, fenchurch street. 1854. At a Meeting of the Commissioners of Sewers of the City of London, held at the Guildhall of the said City, on Tuesday, November the 21 st, 1854:— The Medical Officer of Health laid before the Court his Annual Report, which was ordered to be printed, and a Copy to be sent to every member of this Court and the Court of Common Council. JOSEPH DAW, Principal Clerk. THE SANITARY CONDITION of the CITY OF LONDON. SIXTH ANNUAL REPORT. To the Hon. the Commissioners of Sewers of the City of London. Upper Grosvenor Street, Michaelmas, 1854. Gentlemen, I beg to lay before your Hon. Court the mortuary Tables of the past year. They are arranged, as usual, so as to display the local distribution of deaths in your several districts and sub-districts, the influence of seasons, the ages of chief mortality, and the proportionate prevalence of certain important diseases. 6 For convenience of comparison I prefix to them those Tables of my last Annual Report, in which I had compiled the results of five years' previous experience in the several matters referred to. Such inferences as I am able to draw from these pathological statistics of the City, you have allowed me on former occasions to submit with so much detail, that any renewed analysis of their meaning would seem superfluous. The epidemic prevalence of Cholera is the only fact to require exceptional notice; but since our new experience of this disease will claim to be separately spoken of, I need not at present trespass on your time by any comment on the figures which I subjoin. I have the honour to remain, Gentlemen, Your obedient faithful Servant, JOHN SIMON. NOTE TO TABLE, No. I. In calculating the Death-Rates given in the last lines of this Table, I have proceeded as follows :— First, I have counted all Workhouse-Population and Workhouse-Deaths as forming part of the aggregate population and aggregate mortality of that Union to which the particular Workhouse legally belongs. Next, I have distributed among the several sub-districts the population and the mortality of their Union Workhouses, in the ratio of the general sub-district population ; so as to prevent the high Workhouse-Mortality from telling unjustly against that sub-district in which the Workhouse happens to have been erected. Thus, for instance, the East London Union has its male Workhouse placed in the territory of the West London Union ; but I have reckoned it as belonging to the East London Union, in respect both of its population and its deaths. Similarly, the City of London Union has its Workhouse situate at Bow ; but, not the less, I have considered its 794 inmates and 526 deaths as belonging to the population and the mortality of our central Union. Thus again for the sub-district death-rates—for instance, in the two sub-districts of the East London Union : reckoning the Workhouse-Population not as exclusively due either to Cripplegate or to St. Botolph, but as furnished by these sub-districts jointly, in the ratio of their populations, I have distributed 576 between them in the proportion 23435 : 20582. The WorkhouseDeaths of the period (802) have been similarly distributed ; and the rates, given in the last line of the table, are finally deduced from a comparison of these sums, viz:— 23435 + 306.66 : 2458 + 426.991 1000 : 121.515 which, divided by 5 (to show an annual, instead of a quinquennial, result) gives 24.30 as the annual death-rate for St. Botolph; and, in like manner, 20582 269.33 : 2483 -(- 375.008 gives 137.065 as the quinquennial, and 27.41 as the annual deathrate per thousand for the sub-district of Cripplegate. Hospital-Deaths have been distributed, as far as possible, according to the previous residence of the patients. Thus the north sub-district of the West London Union, in which St. Bartholomew's Hospital is situated, is made to retain only its just proportion of deaths. On the same principle I have reckoned to the death-lists of other sub-districts those cases in which I could ascertain that the residents of such sub-districts had gone to die either in St. Bartholomew's or in other Metropolitan Hospitals. No. I.—Quinquennial Synopsis of City Mortality, with Death-rates calculated per thousand on the Population of 1851. Population according to the Census of 1851. Entire City of London, 129,922. East London Union. 44,593 West London Union. 28,603 City of London Union. 56,726 Saint Botolph. 23,435 Cripplegate. 20,582 Workhouses. 576 North. 12.350 South. 15,844 Workhouse. 409 s. w. 9,204 N. W. 11,847 South. 11,461 S. E. 10,594 N.E. 12,826 Workhouse. 794 Mortality of Five Years, from Michaelmas 1848 to Michaelmas 1853. 1848-9 3763 519 574 179 372 598 126 293 245 263 214 262 103 1849-50 2752 396 444 125 324 290 108 176 168 218 183 219 101 1850-1 2978 493 471 167 317 313 68 191 169 258 217 213 101 1861-2 3064 534 460 176 266 379 129 196 198 203 171 235 117 1852-3 3040 516 534 155 289 309 164 170 188 223 164 224 104 - V 2458 2483 802 1568 1889 595 1026 968 1165 949 1153 526 Total 15,597 5743 4052 5787 Yearly Death-rate per thousand of the living Population 24.00 25.75 28.33 20.40 24.30 27.41 * 29.19 27.66 * 23.83 17.96 21.90 19.52 19.58 * N.B. The first year's total (3763) includes 15 deaths, which, by reason of their imperfect registration, it has been impossible to refer correctly to the Unions where they occurred. No. II.—Comparative Mortality in different seasons of the Year ; namely, in the Autumn Quarters (Oct., Nov., Dec.) in the Winter Quarters (Jan., Feb., March J in the Spring Quarters (April, May, June) and in the Summer Quarters (July, Aug., Sept.) of the Five Years from Michaelmas 1848 to Michaelmas 1853. East London Union. West London Union. City of London Union. Total for entire City. Deaths in the different seasons of five years, as follows:— Saint Botolph. Cripplegate. Workhouses. North. South. Workhouse. S. w. n. w. South. S. £. N. E. Workhouse. In five Autumn Quarters 616 613 201 357 392 129 245 236 272 227 271 119 3678 1430 878 1370 In five Winter Quarters 641 623 223 371 464 183 248 274 347 265 360 153 4152 1487 1018 1647 In five Spring Quarters 519 583 195 402 471 159 226 230 273 255 262 137 3712 1297 1032 1383 In five Summer Quarters 682 664 183 438 562 124 307 228 273 202 260 117 4040 1529 1124 1387 No. III.—Mortality of the Five Years, 1848-53, classified by Age, first for the entire City, next for the Three Unions severally. Deaths in the Population of the City of London. Under 5 Years of Age. From 5 to 10 From 10 to 15 From 15 to 20 From 20 to 30 From 30 to 40 From 40 to 50 From 50 to 60 From 60 to 70 From 70 upwards. Age not reported. Total. Year by year, dating from Michaelmas to Michaelmas. 1848—9 1243 202 92 90 292 345 396 355 366 367 15 3763 1849—50 1032 83 44 70 166 200 251 254 318 334 0 2752 1850—1 1194 124 48 60 169 227 248 261 303 342 2 2978 1851—2 1197 113 57 84 196 253 267 260 287 350 0 3064 1852—3 1135 94 37 59 179 258 268 297 320 393 0 3040 Sum of Five Years 5801 616 278 363 1002 1283 1430 1427 1594 1786 17 15597 Local Distribution. East Londan Union 2471 215 80 105 338 432 488 444 551 619 0 5743 Wast Londan Union 1416 141 75 122 305 376 405 393 420 398 1 4052 City of London Union 1914 260 123 136 359 475 537 590 623 769 1 5787 Uncertain Address * * * * * * * * * * 15 15 No. IV.—Number of Deaths occasioned, during the Five Years, 1848-53, by certain Acute Diseases, chiefly Epidemic, Infectious, Endemic. In the successive years terminating severally as follows :— Fever. Acute Diarrhœa (not of infants) Dysentery, and Cholera. Scarlet-Fever. and Cynanche maligna. Small-Pox. Erysipelas, Pyœmia, and Puerperal Fever. Diarrhoea, Bronchitis and Pneumonia of infants under 3 year6 of age. Measles, Hoopingcough and Croup. Hydrocephalus and Convulsions of infancy. Total of preceding columns. At Michaelelmas,1849 166 825 135 17 44 285 196 264 1932 „ „ 1850 118 54 32 33 40 243 124 219 863 „ „ 1851 107 23 46 41 17 340 272 282 1128 „ „ 1852 165 37 86 96 24 330 132 308 1178 „ „ 1853 145 43 85 15 26 304 190 289 1097 Total Number of such Deaths in the Five Years 1848-5.3 701 982 384 202 151 1502 914 1362 6198 Average 140 196 77 40 30 301 183 272 1240 Year ending at Michaelmas, 1854 146 233 149 9 15 278 231 307 1368 No. V.—Sixth Annual Enumeration of Deaths, relating to the fifty-two weeks dating from September 25th, 1853, to September 23rd, 1854. East London Union. West London Union. City of London Union.[v###] Deaths in the four quarterly periods, terminating as follows :— Saint Botolph. Cripplegate. Workhouses. North. South. Workhouse. s. w. N. W. South. S. E. N. E. Workhouse. M. F. M. F. M. F. M. F. M F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. I. In the quarter ending Dec. 24th 777 69 64 54 69 24 24 54 34 44 35 18 14 30 32 21 19 29 16 27 18 36 20 11 15 133 123 48 88 79 32 62 40 45 45 56 26 II. In the quarter ending March 25th 895 79 68 62 65 31 45 33 32 55 51 26 21 23 24 22 25 25 30 30 23 38 36 22 29 147 127 76 65 106 47 47 47 55 53 74 51 III. In the quarter ending June 24th 798 73 57 74 42 15 30 38 39 38 53 23 20 23 35 26 20 24 14 33 16 39 25 21 20 130 116 45 77 91 43 58 46 38 49 64 41 IV. In the quarter ending Sept. 23rd 865 75 92 77 96 14 15 28 26 49 42 17 13 22 21 33 23 28 18 38 30 37 41 16 14 167 173 29 54 91 30 43 56 46 68 78 30 Sum of the four quarters 3335 296 281 267 272 84 114 153 131 186 181 84 68 98 112 102 87 106 78 128 87 150 122 70 78 577 539 198 284 367 152 210 189 184 215 272 148 1314 803 1218 Total for the Year 3335 No. VI.—Classification of 3,335 Deaths, which occurred in the fifty-two weeks, dating from September 25th, 1853, to September 23rd, 1854. Total of Deaths. AT WHAT AGES ? FROM WHAT CAUSES? 0 to 5 5 to 10 10 to 15 15 to 20 20 to 30 30 to 40 40 to 50 50 to 60 60 to 70 70 and over. Violence and Poison. Fever. Acute Diarrhoea (not of infants) Dysentery and Cholera. Scarlet-Fever and Cynanche Maligna. Small-Pox. Erysipelas, Pyaemia, and Puerperal Fever. Diarrhoea, Bronchitis and Pneumonia of infants under 3 years of age. Measles, Hooping-cough and Croup. Hydrocephalus and Convulsions of infancy. Other Diseases, chiefly chronic. East London Union 1314 576 63 26 25 80 82 116 90 127 129 23 67 109 90 3 6 135 88 117 676 West London Union 803 325 34 15 16 45 73 57 70 75 93 18 42 41 20 4 1 66 80 75 456 City of London Union 1218 369 47 26 33 59 107 115 146 130 186 52 37 83 39 2 8 77 63 115 742 Sum for xntire City 3335 1270 144 67 74 184 262 288 306 332 408 93 146 233 149 9 15 278 231 307 1874