CLE 4 MEDICAL OFFICER'S REPORT. TO THE VESTRY OF ST. JAMES & ST. JOHN, CLERKENWELL. Gentlemen, The following Report upon the Sanitary state of Clerkenwell for the year 1857, contains a summary of the weekly reports which I have had the honour of laying before you, together with some remarks upon the causes of the mortality, and suggestions for its diminution. On referring to the appended tables, it will be seen that 1406 deaths were registered in Clerkenwell during the year. The number of deaths registered in 1856, was 1313; so that the mortality of the past year has been greater than that of the preceding by 93 A certain number of deaths of the inhabitants of Clerkenwell takes place annually in General and Special Hospitals and Lunatic Asylums; these amounted in 1856 to 101, and in 1857 to 103. Hence we have a total of 1509 deaths for the past, against 1414 for the preceding year. But it must be borne in mind, that the mortality of 1856 was considerably below the average; and below that of any of the last ten years, excepting 1850. The average mortality for the last ten years (1847—1856) corresponds to 1418, uncorrected for increase of population, and exclusive of the deaths in hospitals, &c. So that, although the mortality is greater than in 1856, it is less than the average of the last ten years, even when considered independently of the increase of population. On looking again at the tables, it is seen that the total number of deaths from zymotic diseases of all kinds, was 348; that from the principal zymotic diseases 301. Among these we have, 6 18 from small-pox, all in unvaccinated subjects or infants; 52 from measles, 45 from scarlet fever, 84 from hooping-cough, 66 from diarrhoea, and 48 from typhus. On comparing these deaths with those of 1856, the number from small-pox is the same; that from measles 22 more than in the latter; from scarlet fever 10 less; from hooping-cough 20 more; from diarrhoea 22 more; and from typhus 3 less. Hence, the excess of deaths from measles and hooping-cough nearly corresponds to the total excess of deaths from the entire class of diseases. 663 of the total number of deaths occurred in children under five years of age—nearly one-half: and 297 in persons sixty or more years of age. 274 deaths arose from consumptive diseases or those of the tubercular class. The births during the year were 2,219, those of 1856 being 2,579. The mean temperature of the year was higher, and the movement of the wind slower than the average. It will be presently seen that a great deal has been done during the year in the removal of cesspools, making of drains, &c., and yet the mortality from zymotic diseases is greater than in the preceding year. It must be remembered, however, that the noxius influences have been under removal, and the agency of death resulting from the previous action of malaria, have been at work nearly at the same time; so that no material benefit can be expected to have resulted from these important proceedings at present. It is evident, however, that unfavourable influences have been at work in promoting the propagation and increased fatality of zymotic diseases; and I may remark, that in most instances, where death from zymotic disease has occurred, I have visited the houses, and it has been but very rarely that I have not found some striking cause for the production of disease and death. A high temperature and slow wind are undoubtedly favourable to the production and spread of zymotic diseases, and tend to bring into full play the action of unfavourable sanitary conditions, which otherwise might have remained inert, or exerted but a feeble influence. To these unfavourable influences, may probably be referred the large increase in the number of deaths from diarrhœa; although when it is considered that two deaths only are registered as having arisen from "want of breast-milk," we may be sure that many of the deaths referred to diarrhoea have arisen from the latter cause, as explained in my former Report, page 18. Water supply.—The water supplied by the New River Company continues satisfactory in quality. It is even purer than it 19 was, containing 15.92 grains of inorganic, and .80 grains of organic matter per gallon. But there is room for vast improvement in the increase of quantity, which is still very deficient in the courts and alleys. A great source of evil lies in the existence of underground cisterns, in which the water is stored in some of the courts, being pumped up as required. In two instances, the contents of these cisterns were most foul and offensive, and actually contained portions of human excrement recognizable by the microscope. So long as these are allowed to exist, tbere can be no certainty of the water not becoming contaminated with the contents of surcharged, obstructed, or imperfect drains; and those who drink it, run great risk of suffering severely from cholera, diarrhoea, and other zymotic diseases. Cow-houses.—During the year, there have been great complaints regarding nuisances arising from the cow-houses; and it is to be regretted that these establishments are not removed into more open spots, beyond the metropolis, or that their management is not under control and regular supervision. Slaughter-houses.—The condition of the slaughter-houses is good, and the improvements effected preparatory to the granting of the licenses, have been considerable. TJrinals.—A great deficiency of these exists in the district, and several are required. These should not be placed in out-of the way situations, but where they could easily be seen by persons looking for them; nor should they be placed against houses, where the urine would soak through the walls. They could be kept sweet by daily flushing and white-washing with chloride of lime and water, without incurring the enormous expense of a constant flushing with simple water. Nuisances removed.—During the year the large number of 386 cesspools have been destroyed, and the closets properly panned and trapped, and 150 houses have been properly drained. In addition, a few (far too few) houses have been cleansed and lime-whited, some water-butts cleansed, and several accumulations of refuse, foul bones, (fee. removed. One manufactory, both a nuisance and the cause of injury to health, has been removed from the district; two others, at least nuisances, have also been removed; and improvements, sometimes at a great cost, have been effected in others, which were the source of great complaint and injury. It deserves to be mentioned, that with very few exceptions, the nuisances have been removed simply under the serving of the notices issued by the Vestry, and without the employment of legal proceedings. The detailed manner in which I noticed the causes of injury to health and increased mortality in my last Report, renders it unnecessary to dwell upon them here. Although great improvements 20 Lave taken place in the district during the year, and others are still in progress, yet there are some most important noxious influences which have been allowed to proceed unchecked. These arise from the want of facilities for washing and purifying the foul linen, bedding, &c. of the poor. All who are in the habit of visiting the poor, must have perceived the offensive effluvia filling the rooms in which they dwell; often defeating the efforts of the medical practitioner, and increasing the mortality and diffusion of zymotic diseases. The want of Baths and Wash-houses is greatly felt in the district, and their supply would truly be a vast benefit to the poorer classes. In conclusion, I may congratulate the Vestry upon the extent of the improvements which have been effected, and express a hope that their continued efforts may be still urged, and as successfully. The mortality of the district is below the average, even when the increase of population is excluded from consideration; this is satisfactory.* But the Vestry in their visitations of the dwellings of the poor, must feel that there is yet room for vast improvement, find that the present average mortality should really belong to a population very much larger than that now inhabiting the district, 1 have the honour to remain, Gentlemen, Your obedient Servant, J. W. Griffith, M.D. * On comparing the present mortality of the districts of the Metropolis in general, with that of ten years ago, it is curious to observe that in what may be called the old established districts, the present mortality is the same or less than it was; whilst in the newer districts it is often amazingly on the increase, as shown by a few examples. Thus Districts. Mortality in 1848. Mortality in 1857. Hampstead 195 280 Islington 1745 2631 Lewishara 582 801 Holborn 1215 1144 Clerkenwell 1441 1406 St. Luke's 1335 1330 London City 1024 877 Surely the enormous increase in the mortality of the first three districts does not depend simply upon increase of population. Probably the real explanation is, that in the latter districts, sanitary improvements are progressing faster than the evils connected with increase of population are augmenting; whilst in the former, the reverse is the case. 21 DEATHS REGISTERED IN CLERKENWELL DURING 1857. Under 5 years 5 and under 20 20 and under 40 40 and under 60 60 and under 80 80 and upwards Totals. Zymotic Diseases. Small Pox. 6 6 Measles 48 4 52 Scarlat 32 10 2 1 45 Hooping C 83 1 84 Croup 11 2 13 Thrush 2 2 Diarrh. 57 1 2 5 1 66 Dysentery 1 1 2 Cholera Influen. 2 1 2 5 Purpura 1 1 Ague 1 Remitt. F. 1 1 Infan. F. 1 1 Typhus 14 16 7 4 7 48 Metria 4 1 5 Rheum. F. 3 2 5 Erysip. 1 1 1 2 5 Syphilis 7 7 Noma Hydrophob 348 Dropsy, Cancer, and others of u ncertain seat. Hæmorr 1 1 1 3 Dropsy 3 1 3 5 11 23 Abscess 1 1 2 Ulcer Fistula 1 1 Mortif 1 1 Cancer 1 1 9 7 1 19 Gout 1 4 5 54 Tubercular Class. Scrofula 8 1 1 1 11 Table M. 48 2 50 Phthisis 11 15 90 52 10 178 Hydroceph 34 1 35 274 Diseases of Brain, Nervous Syst., &c. Cephal. 1 1 1 1 4 Apoplex 1 9 14 2 26 Paralys. 5 6 1 12 Delir. Tr. Chorea 2 2 Epilep 2 2 1 5 Tetanus 1 1 Insanity 2 2 1 5 Convul. 37 37 115 Brain 7 4 3 5 3 1 23 417 63 118 105 81 7 791 22  Under 5 years. 5 and under 20 20 and under 40 40 and under 60 60 and under 80 80 and upwards Total. Diseases of Heart, &c. Pericar 1 1 2 Aneuris. Heart 3 3 5 14 17 42 44 Diaeases of Respiratory System. Laryng. 8 1 9 Broochi. 29 1 7 33 39 4 113 Pleurisy 1 1 2 Pneumo 57 2 5 5 4 1 74 Asthma 2 5 10 17 Lungs 3 2 1 2 2 10 225 Diseases of Digestive Organs. Teeth 40 40 Quinsy 1 1 Gastri 3 1 1 1 6 Enteri 2 1 1 3 7 Perito 1 1 1 3 Ascites Ulcera: Intest. Hernia 2 1 3 Ileus 2 1 3 Intuss 1 1 2 Strict. In. 1 1 2 Stom 2 1 3 1 1 8 Pane Hepat. 3 2 5 Jaundice 1 1 2 Liver 1 1 1 6 3 12 Spleen 94 Diseases of Kidneys, &c. Nephrit Nephria 4 4 Ischur 1 1 Diabet 1 1 2 Stone 1 1 Cystit 1 1 Strict. Ur. 1 1 2 Kidn. 2 3 5 16 Diseases of Uterus, Puerperal, &c. Param Ovar. Dr. 2 1 3 Childb. 1 2 1 4 Uter. 2 1 1 4 11 Diseases of Joints, Bones, &c. Arthri Rheuma 2 2 Joint 2 Diseases of Skin. Carbun 1 2 2 5 Phlegmon. 1 1 Skin 6 152 13 39 93 94 8 398 23  Under 5 years 3 and under 20 20 and under 40 40 and under 60 60 and under 80 80 and upwards Totals. Malformation. Cyanos 2 2 Spina. Bif. Oth. Malf 1 1 3 Debillity from Prematr Birth. Prema. B. 38 38 51 Debility 13 13 Atrophy, Age, &c. Atrophy 19 2 21 Age 2 58 44 104 Sudden 125 Deaths from Violence, Privation, &c. Intemp 1 2 1 4 Priva 1 1 Want Milk 2 2 Neglect Cold Poison 1 1 Burns, &c Hanging, &c. 1 1 2 Drown Fracture 2 2 Wounds Oth. Viol. C. 16 16 28 Not Sp 3 1 4 4 94 2 3 6 62 44 211 791 Births 2219 398 1406 Uncertain 6 Excess 813 Total Deaths 1 406