21 HAC 39 R E P O RT THE sanitary STATE of HACKNEY DISTRICT During the year 1809; BY JOHN WILLIAM TRIPE,M.D., Licentiate of the Royal College of Physicians, Edin. &c. Medical Officer of Health fox the District, AUTHOR OF "SCARLATINA AND ITS AETIOLOGY," SCARLATINAL DROPSY," "THE RELATIVE MORTALITY OF MALE AND FEMALE CHILDREN," MEDICAL METEOROLOGY IN THE REPORTS OF B.M.S., &c. Vice President of the British Meteorological Society, &c. Printed by Order of the Board BY C. POTTER, 1G, WARWICK PLACE, KINGSLAND, N. E. June, 1860. REPORT To the Board of Works of Hackney District. Gentlemen, The Quarterly Reports which have already been printed by order of the Board, contain an account of the most important sanitary measures carried out during the year, and the statistics of the district, so that it only remains for me, with one exception, to lay before you the sanitary statistics for the year as a whole. I propose, in the first place discussing a table which shews the number of births in each sub-district during each Quarter of the Year, and the per centages for the Year. By this we see that there were 173 births or 6.7 per cent, in Stoke Newington sub-district; 157 or 6.1 per cent, in Stamford Hill ; 817 or 31'8 per cent, in West Hackney; 943 or 36.7 per cent, in Hackney; and 480 or 18.7 percent, in South Hackney sub-district. These per centages vary but little from those of 1858, the chief difference being a relative increase in the Stamford Hill sub-district, and a relative decrease (but absolute increase in number) in the West Hackney sub-district. The total number of births in the District during the year were 2570 against 2454 in the year 1858. There were also 1563 deaths in the district during 1859 against 1629 in 1858, so that whilst in 1858 the excess of births over deaths was only 825, during 1859 it was no less than 1107, or 156 births to each 100 deaths in 1858, and 164 births to each 100 deaths in 1859. This is an extremely satisfactory evidence of the good health of this District, and especially when compared with the whole 4 of London where we find the rate of births to have been only 150 to each 100 deaths during the year 1859. The birth.rate is really higher than 164 to each 100 deaths, because the whole of the mortality in the German Hospital is included in the number of deaths, while not one birth occurs there in the course of a year, the corrected numbers would be 167 births to 100 deaths. The proportion of births in eaeh 1000 for the whole. District was 67 in Stoke Newington, 61 in Stamford Hill, 318 in West. Hackney, 367 in Hackney, and 187 in South Hackney sub.districts. TABLE I. 1859.—Births in each District. Quarters Stoke Newingtn. Stamford Hill. West Hackney. Hackney. Sooth Hackney. First 49 43 206 228 102 Second 37 39 230 243 133 Third 35 33 185 229 130 Fourth 52 42 196 243 115 Total 173 157 817 943 480 Per Centage. Birth 1851 Pop. 6.7 6.1 31.8 36.7 18.7 8 4 9.6 31.7 35.7 14.6 As before stated, the total number of deaths in the District during the year was 1563, of which 108 happened in Stoke Newington, 88 in Stamford Hill sub.district, 420 in West Hackney, 692 in Hackney, and 255 in South Hackney sub.districts. These numbers include the deaths in the East London Union, the German Hospital, and the Hackney Workhouse. Now it is evident that these cannot give a correct impression of the health of the sub.districts as the deaths in the whole of these institutions are included in those registered for the Hackney sub.district If we therefore eliminate the mortality in the East London Union, and spread that in the Hackney Workhouse over the whole District in proportion to the calculated population of each sub.district, the numbers will be as follows,—in Stoke Newington sub.district 114 or 8.0 per cent, of the whole number, in Stamford Hill 96 or 6'7 per cent., in West Hackney 444 or 31'3 per cent., in Hackney 496 or 35'0 per cent., and in South Hackney 269 or 19 "0, These figures will be better understood if they be placed in a tabular form. The table also shows that the rate of death in each quarter of the year varied from that hitherto noted, inasmuch as the third quarter which has heretofore been, except in 1858, the most healthy, was, a» wo observe in most large cities, one of the mcst unhealthy. 5 TABLE II. 185 9.—Deaths in each District. Quarters. Stoke Newingtn. Stamford Hill. West Hackney. Hackney. South Hackney. Total. First 34 21 96 168 63 382 Second 14 21 105 142 62 331 Third 33 18 126 179 70 426 Fourth 27 28 93 203 70 421 Totals 108 88 420 692 256 1663 Corrected Numbers 114 96 444 496 269 1419 Per Centage. deaths 8.0 6.7 31.3 35.0 19.0 births 6.7 6.1 31.8 36.7 18.7 As I have laid before you in my quarterly reports the details of the causes of death during the past year, I now present an abstract only, so as to show the mortality from each of the great groups into which diseases are classed. TABLE III. Deaths in 1857. 1st Qr 2nd Qr 3rd Qr 4th Qr Total Percent- ages. Symotic Diseases 78 60 127 94 359 23.0 Diiseases of uncertain Seat 14 21 16 19 70 4.5 Tubercular Diseases 49 58 81 60 248 15.9 Diseases of the Nervous System 61 45 52 57 218 14.0 ,, Heart 11 13 16 20 60 3.8 Lungs, &c 77 57 23 64 221 14.1 Stomach, &c 25 22 25 19 91 5.8 Kidney, &c 5 7 12 10 34 2.2 from Childbirth. 2 3 6 5 15 1.0 of the bone joints 3 1 1 1 6 0.4 Skin 1 — 2 2 5 0.3 Malformation — — 2 — 2 0.1 Premature Birth and Debility 9 6 19 14 48 3 .1 Atrophy 1 2 3 10 1 1.0 Old Age 29 24 23 11 66 6.8 sudden Death 5 5 2 30 12 0.8 Violent Death 9 10 17 15 51 3 Not specified — — - 1 1 382 344 426 421 1563 100 6 As in former years the zymotic class of diseases has caused by far the largest mortality, for 359 deaths or 23 per cent, of the whole were registered from these causes, against 21.9 per cent, in 1858. The greater per centage of deaths from these causes arose chiefly from the enormous increase in the number of deaths from diarrhoea which was produced by the extremely hot weather. In the third quarter of 1858 the deaths from diarrhoea were 30 and the mean temperature of the quarter 611 degrees, whilst in the corresponding quarter of 1859 the deaths from diarrhoea were no less than 75, and the mean temperature 63'0 degrees The actual number of deaths from zymotic diseases in 1859 was 359 against 358 in 1858, or an increase of 1 only, but the per centage was much larger as there were only 1563 deaths in 1859 against 1629 in 1858. The chief diseases included in the zymotic class are, smallpox, measles, scarlet fever, diptheria, whooping cough, diarrhoea, and fever. The class of diseases under which the largest number of deaths were registered, next after the zymotic, was tubercular diseases, which includes consumption, mesenteric disease, water on the brain, and scrofula. The number of deaths registered were 248 or 15.9 against 239 or 14.7 per cent, in 1858. This increase is not so great as in the whole of London, for it is very remarkable that the number of deaths from consumption and diseases of the brain have increased of late. How far the system of sending children to school at an earlier age than heretofore, and the consequent earlier development of the brain to a certain extent at the expense of the rest of the body, is concerned in producing this result we cannot at present tell; but I am persuaded that in the end nothing is gained by powerful stimulation of the brain at an early age. This is scarcely the place to enter into a discussion on the important question of Education, but I cannot allow this opportunity to pass without recording my conviction that learning should be a pleasure to a child rather than a pain ; that his intellectual powers shou d be excited rather than his sensational. For it must not be forgotten that every object a child sees, feels, tastes, smells, &c., for the first time, and indeed at all times until he becomes accustomed to it, brings his sensational powers into active opeiation; whilst unless the uses of the object be explained, the intellectual powers are kept in quioscence. All parts of the brain, as well as all other parts of the body should be kept in moderate action during the whole of life, and especially during childhood, but no one portion should be unduly excited. These remarks bear reference not only to the tubercular class of diseases, but also to those of the nervous system, which were fatal to 218 persons, or 14 per cent, of the whole mortality in 1859, against 203 or 12.4 per cent, in 1858. Whilst diseases of the nervous system and tubercular affections produced an increased rate of death in 1859, diseases of the lungs caused an unusually small per centage, for only 221 deaths or 14.1 per cent, were registered iu 1850 against 263 or 16.2 per cent, in 1858. In this manner the excess of deaths from one or two of the great classes of disease is generally balanced to a certain extent by a reduction in one or 7 two of the others, for we find that in 1858, 65 4 per cent, of the total mortality was produced by these four groups of disease, viz., the zymotic class, tubercular affections, diseases of the nervous system and affections of the lungs; whilst in 1859 67.0 per cent, or an increase of 1.6 per cent, was caused by them, which is very small considering the excessive mortality from diarrhoea. The other groups of diseases produced but a small rate of death, the largest number having been registered as resulting from old age, viz, 6.8 per cent, and 5'8 per cent, from diseases of the digestive apparatus. Whilst these latter groups produced so comparatively small a mortality, one disease alone, scarlet fever, caused the deaths of 82 persons, or more than 5 per cent, of the whole mortality for the year. As this disease is much on the increase, I repeat the precautions which I would advise to be adoptsd whenever a case appears in a family,—That the person affected should bo entirely separated from the rest of the family; that no one should enter the room except for absolutely necessary purposes; that the female attendants should not wear woollen dresses; and that the patient should he placed in the top room of the house, which should be kept well ventilated. The following table shows the mortality from the chief epidemic diseases. TABLE IV. Hackney, 1859. Deaths from Epidemic Diseases. 1st Qr 2nd Qr 3rd Qr 1th Qr Totals Small Pox. 1 1 1 2 6 Measles 6 0 0 4 10 Scarlet Fever 17 15 19 31 82 Diptheria 9 10 1 7 27 Whooping Cough 14 12 2 8 36 Diarrhoea 2 3 75 7 87 8 11 14 22 55 Total 57 52 112 81 302 The above shows, as compared with 1858, a small increase in the mortality from small-pox, a decided decrease from Measles, an increase from scarlet fever, whooping cough and diarrhoea, also a slight increase from fever. These will be shown better by a comparison with the corrected numbers since 1855. The enormous increase in the mortality from diarrhoea from 3 deaths in the second to 75 in the third is very remarkable, and shows the prejudicial influence of high temperature in this country. The largest mortality from these diseases occurred as usual in the third quarter, The following table shows the progress of epidemic diseases since the year 1855, with corrections applied for the increase of population, which is so great in Hackney. 8 TABLE V. 1855—1859.—Corrected Deaths from certain Epidemic Diseases. Years Small Pox. Measles Scarlet Fever. Whooping Cough Diarrhoea Fever. 1855 18 7 87 58 30 76 1856 13 44 56 31 72 68 1857 1 24 45 61 75 63 1858 0 37 79 67 62 53 1859 6 10 82 36 87 55 This Table shows that small-pox was far more fatal in 1855 than in any year since, although nearly every other part of the metropolis has suffered severely from it during the last two years ; that measles was most fatal in 1856 ; scarlet fever in 1855 and 1859, so that we may expect a considerable decrease in the mortality from this disease during 1360 and 1861; whooping cough in 1857 and 1858 ; diarrhoea in 1856, 1857 and 1859; whilst fever has decreased every year except during 1859. This increased mortality from fever has been entirely caused by the outbreak in Brook Street, Victoria Street, and Albert Street, to which I shall specially refer. It is an exceedingly satisfactory proof of the increasing effect produced by sanitary measures that fever has steadily decreased since the introduction of the Metropolis Local Management Act. I now propose submitting to you a Table showing the mortality in each quarter, and the ages at death. TABLE VI. 1859.—Ages at Death. Quarter Under 1 Year. Between 1 and 20 Between 20 and4'J Between 40 and 60 Between 60 and8J Above80 Total. Pr cent. 1st 60 101 49 51 96 25 382 24.4 2nd 52 76 56 58 69 23 334 21.4 3rd 121 88 53 54 82 28 446 27.2 4th 63 128 54 64 84 28 421 27.0 Totals 296 293 212 227 331 104 1563 100 Pr. cent. 18.9 25.1 13.5 14.5 21.3 6.7 100 Out of the 1563 deaths 382 or 24.4 per cent, occurred in the first quarter, which ended on the 31st of March; 334 on the 2nd quarter, or only 21.4 per cent.; no less than 426, or 27.2 per cent, in the third quarter, which was a most unusual occurrence; and 421, or 27.0 per cent, in the last quarter. As before observed, the extreme heat during the third quarter, and the large mortality from diarrhoea and other summer diseases account for this. 9 The mortality of children under 1 year old has been most unusually small, only 296 deaths, or 18.9 per cent, having occurred at this period of life. There were 393, or 25.1 per cent, of deaths between 1 and 20 years of age, 212 or 13 5 per cent, deaths of persons who were more than 20 but under 40, .227 deaths or 14.5 per cent, between 40 and 60 years of age, 331 deaths or 21.3 per cent between 60 and 80, which is a larger proportion than usual, and no less than 104 deaths or 6.7 per cent, of persons who had attained the great age of more than 80 year3. The last statistical enquiries for the whole District to which I purpose drawing your attention are the very important ones of the mean age at death, the rate of death, that is to say the proportion of deaths to the number of living, and the expectancy of life. The mean age of death has been unusually high during this year, la great part from the small number of children who died under I year old. We have shown that 689 persons died before they attained 20 years of age, that 212 died between 20 and 40, 227 between 40 and 60, 331 between 60 and 80, and 104 above 80 years of age. Now as the deaths in the German Hospital and East London Union do not belong to this District, except of the few who resided in it before they were taken ill ; it is necessary to exclude these deaths from those of the inhabitant® in order to ascertain the true number at the different ages. On examining the returns from these institutions, I find that 26 persons died in them under 20 years of age, 33 between 20 and 40, 33 between 40 and 60, 44 between 60 and 80, and 8 above 80 years of age. Deducting these deaths from the above-mentioned numbers, we have, belonging to the District, 663 deaths under 20, 179 between 20 and 40, 194 between 40 and 60, 287 between 60 and 80, and 96 above 80, which will give a mean age at death of 35.54 years. During the years 1847-53, the mean age at death in Hackney was 34.0. If we next calculate the rate of deaths to those living, we find that if the number of the inhabitants of the District on the 30th June were 77,957, and the number of deaths 1419, the rate of deaths would be 100 in each 5493 living, or 1 in 54.93. During the years 1847-53 in Hackney, the death rate was 100 in 5170, or 1 in 51.70 inhabitants. Now, as the expectancy of life (that is to say, the time which a child born in the district during the year 1859, might be expected to live if he continued to reside in Hackney, and "the district remained as salubrious as during this year), lies between the mean age at death, and the number of living, out of which one dies annually, I have calculated according to the Registrar General's formula, that it would be no less than 48 years, 167 days, and 9 hours, against 45 years, and 292 days during the years 1847-53. This is a far greater expectancy of life than is to be found for the kingdom at large, and is probably higher than will obtain in the district for the present, except during very healthy years ; but it is very satisfactory to find that the duration of life has decidedly increased for the 10 Bhort period during which the Metropolis Local Management Act has been in operation. There is, I regret to say, one black spot in the mortality tables of the district caused by the excessive number of deaths in Albert Street, Victoria Street, and Brook Street. These deaths were in great measure caused by the effluvia from the fcecal and sewage matters which overflowed the yards and privies, and which I so frequently reported ; but which there was so much difficulty in removing partly in consequence of the opposition offered by Mr. Baker, the landlord ; partly from the want of a sewer in those streets, and from the indisposition of the Board to do the work and charge the owner. It appeared, from a house to house visitation which I made in company with Mr. Valentine, that there were 550 people living in these streets ; that during the first quarter of the year there were only 2 deaths, during the second only 2 deaths, during the third, when the effluvia was so very bad, no less than 12, and during the fourth quarter there were 9 deaths. These give an aggregate number of 25 deaths, or 1 in 22 inhabitants (whilst, as above shown in the whole of Hackney, there was only 1 death in each 54'93 inhabitants) or more than double the ordinary death rate. But this does not show the immense injury sustained so well as the age at death, for I have ascertained that no less than 8 died under 1 year old, 7 between 1 and 5 years, 6 between 5 and 20, 2 between 40 and 60, and 1 between 60 and 70. So that about 70 per cent, died under 5 years of age. The average age at death was 10 J years, and the expectancy of life would have been only 19 years 110 days, against 48 years 167 days for the whole District. A more striking proof of the injurious effects of bad drainage can scarcely be conceived. I cannot conclude my Report on these streets without mentioning the enormous amount of labour sustained by the Officers of the Board. There were frequent house to house visitations of the streets made by myself and Mr. Valentine, or of the individual houses in which deaths occurred, or in which nuisances existed. The Surveyor had to examine the drains, and eventually carry out the work in accordance with the orders of the Magistrate and the Board. There were no less than 13 attendances before the Magistrates, of which 3 were to obtain summonses, 7 to have the summonses adjudicated on, and 3 for orders. At most of these all the Officers attended. I have repeated in each Quarterly Report the number of nuisances stated, and therefore now present the numbers as a whole. It appears from these that Mr. Valentine was successful in 1224 cases, which may be classed as follows :— 11 TABLE VII. Privies and Cesspools Emptied, Filled up, and Drained into the Sewer 447 Privies and Cesspools Emptied 160 Stable and other Refuse removed 173 Privies Limewhited and Repaired 47 Filthy Premises, &c., Cleaned and Purified 85 Pigstyes Cleansed and Repaired 80 Choked Drains Cleansed and Repaired 138 Ditches Cleansed 3 Other Nuisances abated 101 1224 To obtain the removal of these nuisances it has been necessary to summons a larger number of persons than usual, viz., 24. These with Mr. Baker's cases, have involved a much greater number of attendances at the Police Courts during the past year than usual. The meteorology of the year having been pointed out in each quarter, I shall state only the summaries. During the first quarter the mean temperature was in excess by no less than 5 degrees, during the second 0.8 of a degree, during the third by 3.2 of a degree, whilst during the fourth it was below the average 1.2 degrees, so that the mean for the whole year was 4()½ degrees, or about 2½ degrees above the average. TABLE VIII. Temperature at the Town Hall. Quarter Degrees Highest Lowest Ranges, º º º º 1st +5.0 63 0 28.6 34.4 2nd +0.8 812 25.0 56.2 3rd +3.2 94.6 42.2 52.4 4th -1.2 80.6 15.0 65.6 The range of the thermometer during the year was nearly 80 degrees. I remain, Gentlemen, Your obedient Servant, J. W. TRIPE. 19 HAC 39 REPORT ON THE SANITARY STATE of HACKNEY DISTRICT, For the Quarter ending April 7th,1859, BY JOHN W. TRIPE, M. D., Medical Officer of Health to the District. Member of the Council of the Meteorological Society. Printed by Order of the Board, by JOHN COVENTRY, CHURCH STREET, HACKNEY. 1859. REPORT To the Board of Works for the Hackney District. Gentlemen, The mortality during this quarter has been remarkably small; 382 deaths only having been registered against 452 in the corresponding quarter of last year. The extreme severity of the weather last year, and the unusual mildness of it this, will account, in some measure, for the marked decrease in the mortuary rate, but this cannot be the only cause, as the improved rate in Hackney District has been in excess of that for the whole of London. During the quarter ending April 3rd, 1858, no less than 100 children died in this District who were under one year of age ; whilst only 60 died during the corresponding period now under consideration : further, the death rate in 1858 was larger at all periods of life, excepting only amongst persons above 80 years old. Now, this, at first sight, appears very singular ; but we find that the death rate of persons who have attained above the ordinary age of man, is not so dependent on alternations of temperature as we might suppose, provided they are able to protect themselves from the weather and procure abundant comforts; but, that next after the very young, those who are above 00 and under 80 years of age suffer to the greatest extent from severe weather. The rate of death from the different groups of diseases was somewhere about an average during the last quarter, except as regards inflammatory diseases of the lungs and consumption : the number of deaths from the zymotic class, and diseases of the stomach, digestive organs, and kidney, were but little altered. The high rate of death from zymotic diseases which has obtained all over London during the last four or five years, has arisen in great part from the prevalence of scarlet fever, diptheria, and hooping-cough; which produced an aggregate mortality of nearly oneninth of the total number of deaths in Hackney, and yet has not been nearly so fatal as in many other localities. 4 I have again to call your attention to the state of the water supply at High Hill Ferry, and in the vicinity of the river Lea, generally. Nearly eighteen months since I reported that more than one hundred- houses in these localities were without a proper water supply ; that there were wells on some of the premises ; but that, in the majority of cases, the inhabitants were compelled to obtain their water from the river Lea, which is totally unfitted for use. My report was referred to the Churchwardens, but nothing has been done in the matter. It is one of the defects of the Metropolis Local Management Act, that the Board of Works has no power to enforce a water supply, except in localities where there is a sewer, and then only in an indirect manner. The number of births registered in the District during the quarter were 628 ; of which 332 were males and 296 females : the total deaths were 382; of which 192 were males, and 183 females. The excess of births over deaths were, consequently, 246, against 206 in the corresponding quarter of last year, but the total number of births was 30 less than last year. Of the 382 deaths, 37 were registered in the East London Union and German Hospital, so that the number belonging to the District was 345. Of the 382 deaths, '34 were registered in Stoke Newington ; 21 in Stamford Hill; 96 in West Hackney; 168 in Hackney; and 63 in South Hackney Sub-districts. The real mortality for the Hackney Sub-district is much lower, as 37 deaths occurred in the East London Union and German Hospital, and several in the Workhouse. Of the 628 births, 49 were registered in the Stoke Newington Sub-district; 43 in Stamford Hill; 206 in West Hackney ; 228 in Hackney; and 102 in South Hackney Sub-district. The ages at death were as follows :—60 children died during the first year of life; 101 died who were above 1 year but less than 20 years of age ;. 49 died between 20 and 40 ; 51 between 40 and 60 ; no less than 96 who were above 60 and below 80 years of age; and 25 who so far exceeded the ordinary duration of life as to be above 80 years of age at their death. Of the 382 deaths, 78 arose from epidemic diseases; 14 from mortification, cancer, and other diseases of uncertain seat; 49 from tubercular diseases, including 29 from consumption ; 64 from diseases of the brain and nerves ; 11 from diseases of the heart and blood-vessels; 77 from diseases of the lungs and organs of respiration ; 25 from diseases of the stomach and digestive organs ; 9 from premature birth ; 29 from old age ; and 9 from violent deaths. Of the 9 deaths from violence, no less than 4 arose from burns. Now, as the simple precaution of spaking the inflammable materials worn by 5 females in a strong solution of alum will prevent them from taking fire, I think it much to be regretted that these accidents so frequently occur, and so often prove fatal. I would also advise the sacking attached to your fire escapes to be protected against fire, in a similar manner, The total number of new cases treated at the German Hospital during the quarter, was 1396 ; out of which there were but 3 cases of small-pox, and but 6 of erysipelas ; only 1 of fever, and 16 of diarhcea. The total number of nuisances abated by Mr. Valentine during the quarter, was 251 : which may be divided as follows— Privies and Cesspools emptied, filled up, and drained in the Sewer 107 Privies and Cesspools emptied 30 Stable, Pig, and other Refuse removed 36 Roads in a filthy state cleansed and repaired 12 Drains cleansed and repaired 30 Other Nuisances abated 36 Total 251 The meteorology of the quarter was somewhat unusual ; the temperature having been in excess of the average by 5 degrees. For several weeks the temperature was every day above the mean, on many occasions by as much as 10 or 12 degrees, and on some from 13 to 15 degrees. As before mentioned, this extremely mild winter has been accompanied in this District by a less amount of illness and death than usual, although there has been an excess in London as a whole, 25 deaths having been registered in each 1000 inhabitants against an average of 24½ I remain, Gentlemen, Your obedient Servant, JOHN W. TRIPE. May 12th, 1859. 6 TABLE. Deaths Registered in the District of Hackney during the Thirteen Weeks ending Saturday, April 2nd, 1859. Causes of Death. Ages. Total. Under 1 and under 20 20 and under 40 40 and under 6o 60 and under 80 80 and above I. Zymotic: Smallpox .. 1 .. .. .. .. 1 Measles .. 6 .. .. .. .. 6 Scarlatina 3 14 .. .. .. .. 17 Hooping Cough 2 12 .. .. .. .. 14 Croup .. 2 .. .. .. .. 2 Thrush .. 1 .. .. .. .. 1 Diarrhoea (Bowel Complaint) 1 1 .. .. .. .. 2 Dysentery .. .. .. .. 2 Cholera .. .. .. .. .. Influenza .. .. .. .. .. 2 6 Scurvy and Purpura .. .. .. .. .. .. Ague .. .. .. .. .. .. Remittent Fever .. .. .. .. .. .. Infantile Fever .. .. .. .. .. Typhus Fever .. 3 3 1 1 .. 8 Puerperal Fever (Metria) .. .. .. .. .. .. Rheumatic Fever .. .. 3 .. .. .. 7 Erysipelas (Rose) 1 .. .. .. .. .. .. Syphilis 1 .. •• .. .. .. 1 Noma (canker) .. .. •• .. .. .. .. Diptheria 1 7 •• .. 1 .. 9—78 II. Dropsy, &c.: Hæmorrhage .. .. .. 1 .. 1 Dropsy .. 1 .. 2 .. 3 Abscess .. .. .. 1 .. 1 Ulcer .. .. .. .. .. .. Fistula .. .. .. .. .. .. Mortification .. .. 2 1 1 4 Cancer .. 1 2 2 .. 5—14 Gout .. .. .. .. .. .. III. Tubercular: Scrofula .. .. .. 1 .. .. 1 Tabes Mesenterica 5 7 .. .. .. 12 Phthisis (Consumption) .. 4 19 6 .. .. 29 Hydrocephalus (Water on Brain) 1 6 •• •• .. .. 7—49 IV. Brain and Nerves : Meningitis 3 2 .. •• 1 •• 6 Cerebritis .. I .. 1 2 .. 4 Apoplexy .. .. 1 4 6 •• 12 Palsy (Paralysis) .. .. .. 3 7 4 14 Delirium Tremens .. .. .. .. Epilepsy .. 1 1 1 .. .. 3 Insanity .. .. .. 1 1 .. 2 Convulsions 15 2 .. .. .. .. 17 Disease of Brain, &c. .. 2 .. 1 4 •• 7—64 Carried forward 33 76 29 23 37 7 205 7 T A B L E—(continued.) Causes of Death. Ages. Total. Under 1 and under 20 20 and under 40 40 and under 60 60 and under 80 80 and above Brought forward.. 33 76 29 23 37 7 205 V. Heart and Blood Vessels: Pericarditis .. .. .. .. .. .. Endocarditis .. .. .. .. .. .. Aneurism .. .. .. .. .. .. Disease of Heart. &c .. .. 1 3 7 .. 11 — 11 VI. Respiratory Organs: Laryngismus Stridulus 1 .. l .. .. .. 1 Larygitis .. 4 .. .. .. .. 5 Bronchitis 4 4 .. 7 19 3 37 Pleurisy .. .. .. .. .. .. Pneumonia 8 7 2 5 4 1 27 Asthma .. .. .. 1 2 .. 3 Disease of Lungs .. .. .. 2 1 I 4—77 VII. Digestive Organs:. Teething .. 2 .. .. .. .. Quinsey .. .. .. .. .. .. 2 Gastritis .. .. 1 1 .. .. 2 Enteritis .. 1 1 .. .. .. 2 Peritonitis .. 1 .. .. .. .. 1 Ascites .. .. .. .. .. .. Ulceration of Intestines .. 1 .. .. .. .. 1 Hernia (Rupture) .. .. .. .. 1 .. 1 Disease of Bowels .. .. .. .. .. .. Abdominal Tumour .. .. .. .. .. .. Stricture of Intestinal Canal .. .. 1 .. .. .. 1 Disease of Stomach, &c .. .. 1 .. 1 .. 2 Disease of Pancreas .. .. .. 1 .. .. 1 Inflammation of Liver (Hepatitis) .. .. .. 1 2 .. 3 Jaundice .. .. .. 1 .. .. 2 Disease of Liver .. .. 2 3 2 .. 7—25 Disease of Spleen .. .. .. .. .. .. VIII. Kidneys, &c Nephritis .. .. .. .. .. .. Nephria (Bright's Disease) .. .. 1 .. 1 .. 2 Diabetes .. .. 1 .. .. •• 1 Cystitis .. .. .. .. .. Stricture of Uretha .. .. .. .. .. .. Disease of Prostrate Gland .. .. .. .. .. .. Disease of Kidneys .. .. .. 1 I .. 2—5 IX. Childbirth : Paramenia .. .. .. .. .. .. Childbirth (see Metria) .. .. 2 .. .. .. 2—2 Disease of Uterus, &c .. .. .. .. .. .. Ovarian Disease .. .. •• •• .. •• Carried forward 47 96 43 49 78 12 325 8 T A B L E—(continued.) Causes of Death. Ages. Total. Under 1 ! and | under 20 20 and under 40 40 and under 60 60 and under80 80 and above Brought forward 47 96 43 49 78 12 325 X. Joints, Bones, &c: Chronic Rheumatism •• •• 1 •• •• •• 1 Disease of Joints •• .. •• 1 1 •• 2—3 Disease of Bones .. .. .. .. .. •• Disease of Spine •• •• •• •• •• •• XI. Skin, Cellular Tissue, &c.: Carbuncle and Boils •• •• •• •• 1 •• 1—1 Phlegmon •• •• •• •• •• •• Disease of Skin, &c •• •• •• • • •• .. XII. Malformation: Spina Bifida Other Malformations •• •• •• •• •• •• •• XIII. Premature Birth and De- Bility 9 •• •• •• •• •• 9—9 XIV. Atropy 1 •• •• •• •• •• .1 — 1 XV. Old Age •• •• •• •• 16 13 29—29 XVI. Sudden Deaths 3 1 •• 1 •• •• 5—5 XVII. Violent Deaths: Intemperance .. •• •• •• •• •• Privation of Food •• •• •• •• •• •• Want of Breast Milk .. •• •• •• •• •• Neglect •• •• •• •• •• •• Amputation of Leg .. •• •• •• •• •• Poisoned Wounds .. •• •• •• •• •• Burns and Scalds •• 3 1 •• •• •• 4 Hanging (Suicide) .. •• •• •• •• •• Suffocation •• •• •• •• •• •• Drowning (Suicide) •• •• •• •• •• •• 2 Fracture and Contusions .. 1 •• •• •• •• 1 Wounds •• •• •• •• •• •• other Violence •• •• 2 •• •• •• 2—9 XVIII. Not Specified •• •• •• • • .. .. total 60 101 49 51 96 25 382 Under 1 0 and under 20 20 and under 4q 40 and under 60 60 and under 80 80 and above Total. HAC 39 REPORT on the SANITARY STATE of HACKNEY DISTRICT, For the Ouarter euding july 2nd, 1859, JOHN W. TRIPE, M.D., Medical Offices of Health to the Disteict. Member of the Council of the Meteorological Society, &c. Printed by Order of the Board, by JOHN COVENTRY, CHURCH STREET, HACKNEY, 1859. REPORT. To the Board of Works for the Hackney District. Gentlemen, The mortality of the District during this quarter has been singularly small, 334 deaths only having been registered against 366—the corrected average for the last three years ; or against 398—the correct average for 1853, 1854, and 1855. The corrected numbers for the corresponding quarters since my appointment are 394 for 1856; 344 for 1857 ; 361 for 1858, against 334 for 1859; so that the deaths are 10 less than they would have been in 1857 (one of the most healthy quarters on record) had the number of inhabitants been the same then as now. The number of births also are equally satisfactory, 521 having been registered in the corresponding quarter of 1856; 565 in 1857; 580 in 1858; and no less than 682 in 1859. These figures are very satisfactory, as they show that the population of the District must be rapidly increasing. I do not mean to assert that the number of births is to be taken as a criterion of the number of inhabitants in any given district, or is to be considered an index of the rate of increase by immigration, for on the contrary I have ascertained that it is not so, but adduce these numbers as collateral proof of the salubrity of the District. If the population of the District has increased at the same rate as in the year 1841—51 (as the increase in the number of deaths as well as of new houses rated to the parishes indicate) the population in the middle of the quarter would be 77,613. Now as the number of deaths, exclusive of those in the East London Union and German Hospital, were 301, the rate of death would be only one in each 257.8 inhabitants; or at the rate of one in 64.2 inhabitants per year. This is an extraordinarily low death rate, as it is only in the ratio of 15.5 per 1000 living, annually: whilst in the whole of London it was at the rate of 20 per 1000 living. In Anglesey it was 13 per 1000 living per annum ; in Bath and Hastings, 14 per 1000 ; 3 in Hackney, as before stated, 15.5; in the Isle of Wight and Lowestoft, 16 per 1000; in Tunbridge, Dover, Eastbourne, and Barnstaple, 17 per 1000; in Thanet and Weymouth, 18 per 1000; in Scarborough, Kendal, Brighton, Worthing, and Warwick, 19 per 1000.* I have not assigned any number for the sub-districts of Hackney, as it is impossible to ascertain their populations with any approach to accuracy. From the reading of the last Quarterly Report of the Medical Officer of Health to the City, and the article in the "Times" newspaper thereon, (which has been commented on at this Board), it might be considered that the low death rate during this quarter had been almost, if not entirely, the result of sanitary measures, and that a similar rate might be expected for the future. This, however, must not be looked for, unless our climate should so far change as to have the frequent recurrence of such favourable meteorological conditions as obtained during the quarter under consideration. There is no doubt but that proper sanitary supervision of a district will materially reduce the death rate, but it will not do so suddenly; nor will it change, although it will modify, the mortality which belongs to each season, and which is the result, in great part, of the average temperature. I state this again, that disappointment may not result from too high an estimate being placed on the results obtainable from the Metropolis Local Management Act. The mortality at the different ages is more satisfactory even than the aggregate mortality, for only 52 infants died out of the total 334 deaths; of the remainder, 76 died above 1 year of age but under 20; 56 between 20 and 40; 58 between 40 and 60; 60 between 60 and 80; and 23 above 80. The percentage of death at these ages are as follows: 15.3 per cent. in children under 1 year old; 22.8 per cent between 1 and 20 years; 16.8 per cent. between 20 and 40; 17.4 per cent. between 40 and 60; 20.8 per cent. between 60 and 80; and 6.9 per cent. above 80. The small number of infants and the large proportion of elderly and old people who died, and therefore the unusual duration of life, may be shewn by comparing them with the returns from the City for the same period, and for Hackney during the year 1858. RATE OF DEATH AT DIFFERENT AGES. 2nd Quarter, 1859. City, 2nd Quarter, 1859. Hackney, Year 1858. Hackney, per cent. per cent. per cent. Under 1 year 38.9 15.3 24.4 Between 1 and 20 years 6.1 22.8 22.4 „ 20 and 40 years 15.9 16.8 13.5 „ 40 and 60 years 18.3 17.4 14.3 Above 60 20.8 27.7 25.4 *These figures are taken from the last Quarterly Return of the Registrar General of births, &c., and are calculated on the populations of 1851, and are therefore not absolutely correct. 4 The above shows the immense number of infant deaths in the City as compared with Hackney, both in this quarter and in 1858, and also the much smaller proportion of deaths of aged people. The death rate of infants in this District, and also of old people, would be slightly increased by eliminating the deaths in the German Hospital, as they are chiefly of persons under 20 and in the prime of life; but the numbers would not be materially changed. The births during the quarter have been very large, no less than 682 having been registered, or an excess of 100 over those of the corresponding quarter last year. Of the 682, 351 were of males and 331 of females. The numbers registered in each District are as follows, 37 in Stoke Newington; 39 in Stamford Hill; 230 in West Hackney; 243 in Hackney; and 133 in South Hackney sub-district. As the births were 682 in number, and the deaths only 334, there were more than 200 births (205) to each 100 deaths. In the City there were only 797 births to 630 deaths, or 121 births to each 100 deaths. This small proportion of births to deaths, and the large number of infantile deaths, (which are incompatible with a good sanitary state of a district) assure me that the death rates assigned by the Medical Officer of Health for the City are erroneous; and that there are not so many residents in the City now as in 1851, although Dr. Letheby calculates their number to have increased. The following are the numbers of deaths registered in the sub-districts, 14 in Stoke Newington; 21 in Stamford Hill; 105 in West Hackney; 142 in Hackney (including the 33 in the German Hospital and East London Union); and 52 in South Hackney. During this quarter, I have made sanitary inspections in the following localities, and have obtained your orders for improvements to be made therein, viz:— Wellington Street; Shacklewell Lane; Holly Street; Caroline Cottages, Caroline Street; Richmond Road; Wood Street, Clapton; Conduit Place; King'sRoad, Homerton; Water Lane; Chatham Place; several houses in High Street, Stoke Newington; Union Street and John Street, West Hackney; Enfield Road; Silk Mill Road; Coronation Place; Prospect Place; Caledonian Cottage, Brunswick Cottage, and other houses in Stoke Newington Road; Albert Grove; Twemlow Terrace; White Post Lane, Hackney Wick; Hertford Road; Bentley Crescent; Larter's Yard; Elizabeth Cottage, Ridley Road; Mare Street and St. Thomas's Square; also the Birkbeck Schools; the South Hackney National Schools; the Lancasterian Schools, West Hackney, and the Schools in Brook Street, Upper Clapton. The particulars of these inspections have been laid before you in my Weekly Reports; I have also made special Reports on the 5 Congreve Manufactory at Hackney Wick, and the Fish Curing Premises, at Albert Grove, Victoria Park; also numerous Reports on the state of Mr. Winn's Dust Yard. The new nuisances which have been discovered during the quarter, and have been removed, or are being abated, by Mr. Valentine, may be classed as follows:— Foul Cesspools emptied and drained into the Sewer 110 Cesspools emptied 66 Houses cleansed and repaired 8 Drains cleansed 47 Other Nuisances abated 60 Total 291 I have also to Report that in consequence of the proceedings against Mr. Robins, he has removed his Manufactory of Japanned Cloth from Homerton, so that the District is now free from what the inhabitants stated to be "an abominable nuisance." The meteorology of the quarter has not presented anything very unusual, except the extremely high temperature on the 6th and 7th April, when the mean heat was respectively 16° and 17½ degrees above the average. The mean temperature for the quarter was nearly one degree in excess of the average, having been above the ordinary temperature in each month of the quarter. The pressure of the air, as shewn by the barometer, was a little less than usual, but only to a slight extent, and the rain-fall was more than 6 inches, which is a little over the average, but not nearly enough to supply the great deficiency in the first quarter of the year. Mr. Glaisher remarks, in connection with this subject, "that the rain-fall in this country has been gradually diminishing since 1815, and there appears but little reason to anticipate that the deficiency in 1854—58, amounting to no less than 25 inches, will be made up in future years." If there should be a gradual decrease in the rain-fall around London, it must become a question of some importance as to how the greatly increased demand for water can be supplied, especially as the drainage of London will be diverted from the Thames. I remain, Gentlemen, Your obedient Servant, JOHN W. TRIPE. August 25th, 1859. 6 TABLE. Deaths Registered in the District of Hackney during the Thirteen Weeks ending Saturday, July 2nd, 1859. Causes of Death. Ages. Total. Under 1 and under20 20 and under 40 40 and under 60 60 and under 80 80 and above I. Zymotic: Smallpox .. 1 .. .. .. .. 1 Measles .. .. .. .. .. .. .. Scarlatina .. 14 1 .. .. .. 15 Hooping Cough 4 8 .. .. .. .. 12 Croup .. .. .. .. .. .. .. Thrush .. .. .. .. .. .. .. Diarrhœa (Bowel Complaint) 1 1 .. .. 1 .. 3 Dysentery .. .. .. .. 1 .. 1 Cholera .. .. .. .. .. .. .. Influenza .. .. .. .. .. .. .. Scurvy and Purpura .. .. .. .. .. .. .. Ague .. .. .. .. .. .. .. Remittent Fever .. 2 .. .. .. .. 2 Infantile Fever .. .. .. .. .. .. .. Typhus Fever .. 3 3 1 4 .. 11 Puerperal Fever (Metria) .. .. .. 1 .. .. 1 Rheumatic Fever .. .. 2 .. .. .. 2 Erysipelas (Rose) .. .. 1 .. .. .. 1 Syphilis 1 .. .. .. .. .. 1 Noma (Canker) .. .. .. .. .. .. .. Diptheria 1 7 1 1 .. .. 10—60 II. Dropsy, &c.: Hæmorrhage .. .. 1 1 .. .. 2 Dropsy .. .. .. 1 2 .. 3 Abscess .. .. .. .. .. .. .. Ulcer .. .. .. .. .. .. .. Fistula .. .. .. .. .. .. .. Mortification .. .. .. .. 1 1 2 Cancer .. .. 1 6 6 l 14—21 Gout .. .. .. .. .. .. .. III. Tubercular: Scrofula 2 .. .. .. .. .. 2 Tabes Mesenterica 2 1 .. .. .. .. 3 Phthisis (Consumption) .. 5 27 12 1 .. 45 Hydrocephalus (Water on Brain) 4 4 .. .. .. .. 8—58 IV. Brain and Nerves: Meningitis 2 2 .. .. .. .. 4 Cerebritis .. 1 1 .. 3 .. 5 Apoplexy .. .. 2 5 2 2 11 Palsy (Paralysis) .. .. .. .. 11 1 12 Delirium Tremens .. .. .. .. .. .. .. Epilepsy .. .. 1 1 .. .. 2 Insanity .. .. 3 .. .. .. 3 Convulsions 7 .. .. .. .. .. 7 Disease of Spinal Cord, &c. .. .. .. 1 .. .. 1—45 Carried forward 24 49 44 30 32 5 184 7 TABLE— (continued.) Causes of Death. Ages. Total. Under 1 and under 20 20 and under 40 40 and under 60 60 and under 80 80 and above Brought forward 24 49 44 30 32 5 184 V. Heart and Blood Vessels: Pericarditis .. .. .. 1 .. .. 1 Endocarditis .. .. .. .. .. .. .. Aneurism .. .. .. .. .. .. .. Disease of Heart, &c. .. 1 1 4 6 .. 12—13 VI. Respiratory Organs: Laryngismus Stridulus 1 2 .. .. .. .. 3 Larygitis 2 2 .. .. .. .. 4 Bronchitis 3 10 1 6 7 3 30 Pleurisy .. .. .. 2 .. .. 2 Pneumonia 6 3 3 1 1 .. 14 Asthma .. .. .. 1 2 .. 3 Disease of Lungs .. .. .. .. 1 .. 1—57 VII. Digestive Organs: Teething 2 2 .. .. .. .. 4 Quinsey .. 1 .. .. .. .. 1 Gastritis .. .. .. 2 .. .. 2 Enteritis 1 .. .. 1 .. .. 2 Peritonitis .. Ascites .. .. .. .. .. .. Ulceration of Intestines .. .. .. .. .. .. .. Hernia (Rupture) .. .. .. .. 1 .. 1 Intussusception 1 .. .. .. .. .. 1 Disease of Bowels .. .. .. .. .. .. .. Abdominal Tumour .. .. .. .. .. .. .. Stricture of Intestinal Canal 1 .. .. .. .. .. 1 Disease of Stomach, &c. .. .. .. .. .. .. .. Disease of Pancreas .. .. .. .. .. .. .. Inflammation of Liver (Hepatitis) .. .. .. 1 .. .. 1 Jaundice .. .. .. .. .. .. .. Disease of Liver .. 1 .. 3 2 2 8 Disease of Spleen .. .. 1 .. .. .. 1—22 VIII. Kidneys, &c.: Nephritis .. .. .. .. .. .. .. Nephria (Bright's Disease) .. .. 1 .. 2 .. 3 Diabetes .. .. .. 1 .. .. 1 Cystitis .. .. .. .. .. .. .. Stricture of Uretha .. .. .. .. 1 .. 1 Disease of Prostrate Gland .. .. .. .. .. .. .. Disease of Kidneys .. .. 1 .. 1 .. 2—7 IX. Childbirth: Childbirth (see Metria) .. .. 1 .. .. .. 1 Disease of Uterus, &c. .. .. .. 1 .. .. 1 Ovarian Disease .. .. .. 1 .. .. 1—3 Carried forward 41 71 53 55 56 10 286 8 TABLE— (continued.) Causes of Death. Ages. Total. Under 1 and under 20 20 and under 40 40 and under 60 60 and under 80 80 and above Brought forward 41 71 53 55 56 10 286 X. Joints, Bones, &c: Chronic Rheumatism .. .. .. .. .. .. .. Disease of Joints .. 1 .. .. .. .. 1—1 Disease of Bones .. .. .. .. .. .. .. Disease of Spine .. .. .. .. .. .. .. XI. Skin, Cellular Tissue, &c.: Carbuncle and Boils .. .. .. .. .. .. .. Phlegmon .. .. .. .. .. .. .. Disease of Skin, &c. .. .. .. .. .. .. .. XII. Malformation: Spina Bifida .. .. .. .. .. .. .. Other Malformations .. .. .. .. .. .. .. XIII. Premature Birth and Debility 6 .. .. .. .. .. 6-6 XIV. Atropy 2 .. .. .. .. .. 2—2 XV. Old Age .. .. .. .. 11 13 24—24 XVI. Sudden Deaths 2 .. 1 .. 2 .. 5—5 XVII. Violent Deaths: Intemperance .. .. .. 1 .. .. 1 Privation of Food .. .. .. .. .. .. .. Want of Breast Milk 1 .. .. .. .. .. 1 Neglect .. .. .. .. .. .. .. Amputation of Leg .. .. .. .. .. .. .. Poisoned Wounds .. .. .. .. .. .. .. Burns and Scalds .. 1 .. .. .. .. 1 Hanging (Suicide) .. .. .. .. .. .. .. Suffocation .. .. 1 .. .. .. 1 Drowing (Suicide) .. 1 .. 1 .. .. 2 Fracture and Contusions .. 2 .. .. .. .. 2 Wounds .. .. 1 1 .. .. 2—10 Other Violence .. .. .. .. .. .. .. XVIII. Not Specified .. .. .. .. .. .. .. Total 52 76 56 58 69 23 334 Under 1 0 and under 20 20 and under 40 40 and under 60 60 and under 80 80 and above Total. HAC 39 REPORT on the SANITARY STATE of HACKNEY DISTRICT, for the Quarter ending October 1st, 1859, BY JOHN W. TRIPE, M.D., Medical Officer of Health to the District. Member of the Council of the Meteorological Society, &c. Printed by Order of the Board, by john coventry, church street, hackney. 1859. REPORT. To the Board of Works for the Hackney District. Gentlemen, In my last Quarterly Report I had the pleasure of laying before you the mortuary statistics of the District, by which it was shewn that the public health of Hackney had been unprecedently good during that quarter. I then stated that we must not look for so low a mortality in other quarters, unless our climate should so far change as to have the frequent recurrence of such favourable meteorological conditions as obtained in the quarter under consideration. There is no doubt that proper sanitary supervision of a District will materially reduce the death rate, but it will not do so suddenly; nor will it change, although it will greatly modify, the mortality that belongs to each season, which is the result, in great part, of the average temperature. The observations I have just quoted have been singularly and unfortunately verified by the temperature and mortality of the past quarter; for whilst the temperature was nearly 3½ degrees above the average of the last 88 years, the mortality was 426 against 334 in the quarter ending July 2nd. The mortality might have been expected to have been above the average during the quarter ending October 2nd, even if there had not been any unusual meteorological causes of death, inasmuch as after a period of very low, we usually get a period of somewhat increased mortality; but the unusual temperature must be considered as the chief cause of the great increase in the death rate. I have no doubt when sanitary measures are more generally and more efficiently carried out, than the state of the sewerage of this District has hitherto allowed, that an increase in the mean temperature of a few consecutive weeks, or of a quarter, will not be attended with so great a proportionate increase in the death rate as during this quarter. In seasons which have passed, the rate of death has not varied very materially during the second and third quarters of the year,—the mortality of the third having been, except in hot summers, below rather than above that of the second. This order is likely now to be inverted, for in all large cities and densely populated places the death rate of the third quarter is 3 always in excess of that of the second, chiefly from the prevalence of diarrhoea and other diseases of the zymotic class. As Hackney therefore becomes more densely populated, the more its inhabitants are likely to suffer and die during unusually hot weather. The number of deaths during this quarter have not been so large proportionately as for the whole of London; for whilst 104,339 persons died in the whole of London, or at the rate of 2.09 per cent., there were only 426 in Hackney, or excluding the German Hospital and East London Union, 383, which is at the rate of 1.99 per cent. per annum on the total population. As regards the diseases which produced death in the Metropolis, the Registrar-General observes "that the deaths in London exceeded the average; the high temperature facilitated the decomposition of the impure refuse under the houses, in the streets, and in the river; diarrhoea was unusually fatal all over the London area; scarlatina and diphtheria were epidemic; in the surrounding divisions the mortality was also above the average—as there the same diseases prevailed with variable degrees of severity." These remarks precisely apply to Hackney, with the exception of diphtheria; for there was a very great increase in the mortality of children under 1 year old from diarrhœa, also in a less degree amongst older persons; and from scarlatina between the ages of 1 and 20. The deaths from fever were however less than usual, as they were only 14 against 19 in the corresponding quarter of last year. The deaths from consumption were greatly in excess of those in the corresponding quarter of 1858, having been 54 against 37, and against 45 in the quarter ending July 2nd, 1859. The chief causes of the fatality of diarrhœa in the District appear to have been the extensive disturbance of the soil in carrying out the Drainage Works in the District, and the unusual heat of the weather. I have during the very hot weather stayed, as far as possible, the emptying and filling up of privy cesspools, so that the returns for the quarter show a a smaller number than usual; and as the Main Drainage scheme is progressing so speedily towards completion, at least so far as this District is concerned, I do not think it advisable to compel the owners of property to make these alterations now, except in urgent cases. The mortality at the different ages was as follows :—of children under 1 year of age 121; of those between 1 and 20 years of age 88; between 20 and 40 years 53; between 40 and 60 years 54; between 60 and 80 years no less than 82; and of persons above 80 years 28. Of the 426 deaths, 127 were caused by zymotic diseases; 16 by maladies of uncertain 4 seat—as dropsy; 81 by tubercular affections; 52 by diseases of the brain and spinal cord; 16 from affections of the heart; 23 only from diseases of the lungs—exclusive of consumption; 25 from diseases of the stomach; 12 from renal affections; 19 from premature birth and debility; 23 from old age; and 17 were from violence, or were sudden. There were 612 births against 426 deaths; so that, exclusive of immigration, the increase of the inhabitants of the District was 186. Of the 612 births, 306 were of males, and precisely the same number of females; whilst of the 426 deaths, 200 were of males, and no less than 226 were of females. Of the 612 births, 35 were registered in Stoke Newington; 33 in Stamford Hill; 185 in West Hackney; 229 in Hackney; and 130 in South Hackney. Of the 426 deaths, 33 occurred in Stoke Newington; 18 only in Stamford Hill; 126 in West Hackney; 179 in Hackney; and 70 in South Hackney sub-districts. Of the 426 deaths, 43 happened in the East London Union or German Hospital; so that the real mortality for the Hackney sub-district was only 136, instead of 179. I have also to report that there have been as many as 12 deaths during the quarter in Albert Street, Brook Street, and Victoria Street; of these no fewer than 6, being one-half, were under 1 year old. I propose in my Annual Report to ascertain the rate of death in these streets during the year, as it will show the influence of poverty and bad drainage in producing an unnecessary number of deaths. Of the 12 deaths in these streets, 1 was occasioned by fever, 1 by remittent fever, 1 by stomatitis or ulceration of the mouth and chest, 3 by diarrhoea, 1 by convulsions, 1 by water in the brain, 1 by atrophy, 1 by peritonitis, 1 by cancer, and 1 from a stone in the gall-bladder and diseased liver. From this analysis we find that the majority of the deaths were caused by diseases which are aggravated, and in many instances caused by want of proper food and by filth. One great cause for congratulation is the continued decrease in the fever cases which have occurred throughout the whole District. There have been occasionally a few cases, as at Homerton, from certain local circumstances which it has been difficult to remove, but the testimony of the medical practitioners as well as of the death registers, certainly shows that the disease is being gradually reduced in intensity and frequency. I do not believe that sanitary arrangements, however perfect, will entirely prevent the occurrence of typhoid fever, far less of typhus, but I do expect that the annual proportion of deaths from these diseases will be gradually and steadily reduced. 5 Another most important preventive measure to which I would refer is re-vaccination, and the early vaccination of children. In the notices which have been printed by your authority, I have pointed out the necessity for re-vaccination of every person in the house being above 7 years of age, when a case of this disease occurs. I would also now dwell upon the advisability of every person being re-vaccinated who is above 7 years of age, and has not proper marks upon his or her arm. The indications by which we recognize protective marks I have pointed out in the hand-bills, and it is most important that we should satisfy ourselves on the point, for a person may think himself safe against the disease, when the previous vaccination had ceased to exert any beneficial influence. It must also be remembered that vaccination can, under no circumstances, be relied on as a certain protection against small-pox, any more than an attack of small-pox itself. But it is certain, from the statistics of the Small-pox Hospital, that the fatality of small-pox is far greater in those who have not been vaccinated, or in whom the vaccination has not left proper marks; and that those who have only one mark die more frequently than those who have two, and those who have two more often pro rata than those who have three marks. The nuisances abated by Mr. Valentine during the quarter have been as follows :— Privies emptied, filled up, and drained into the Sewer 135 Privies and Cesspools emptied 33 Stable, Pig, and Cow-dung, and other refuse removed 48 Premises repaired and Lime-whited 18 Gulleys trapped, Roads cleansed, &c. 12 Pigs removed, and Pig-sties repaired and cleansed 35 Choked Drains cleansed 28 Other Nuisances 77 Total 386 The meteorology of the quarter has been most unusual —the mean temperature having been 63 degrees, or more than 3 degrees in excess of the mean temperature of the season during the last 88 years. In making this calculation I have allowed for the difference of elevation of Hackney and that of the places at which the observations have been made. The thermometer exceeded a heat of above 90 degrees in the shade on 4 days, and for 10 successive days and nights the mean temperature of each 24 hours was above 70 degrees, a thing quite unheard of since accurate records have been kept. The rain-fall amounted to nearly 8 inches, which is above the average. I remain, Gentlemen, Your obedient servant, JOHN W TRIPE. November, 1859. 6 TABLE. Deaths Registered in the District of Hackney during the Thirteen Weeks ending Saturday, October lst, 1859. Causes of Death. Ages. Total. Under 1 1 and under 20 20 and under 40 40 and under 60 60 and under 80 80 and above I. Zymotic: Smallpox .. .. 1 .. .. .. 1 Measles .. .. .. .. .. .. .. Scarlatina .. 19 .. .. .. .. 19 Hooping Cough 1 1 .. .. .. .. 2 Croup .. .. .. .. .. .. .. Thrush .. .. .. .. .. .. .. Diarrhœa (Bowel Complaint) 48 12 .. 2 9 4 75 Dysentery .. .. 3 2 .. .. 5 Cholera .. .. .. .. .. .. .. Influenza .. .. .. .. 1 .. 1 Scurvy and Purpura .. .. .. .. .. .. .. Ague .. .. .. .. .. .. .. Remittent Fever .. 2 1 1 .. .. 4 Infantile Fever .. .. .. .. .. .. .. Typhus Fever .. 5 4 4 .. 1 14 Puerperal Fever (Metria) .. .. .. .. .. .. .. Rheumatic Fever .. .. .. .. .. .. .. Erysipelas (Rose) 1 .. .. .. 2 .. 3 Syphilis 2 .. .. .. .. .. 2 Noma (Canker) .. .. .. .. .. .. .. Diptheria 1 .. .. .. .. .. 1—127 II. Dropsy, &c.: Hæmorrhage 1 .. .. .. .. .. 1 Dropsy .. .. .. .. 2 .. 2 Abscess .. .. .. .. .. .. .. Ulcer .. .. .. .. .. .. .. Fistula .. .. .. .. .. .. .. Mortification .. .. .. .. .. 1 1 Cancer .. 1 2 1 6 1 11 Gout .. .. .. .. 1 .. 1—16 III. Tubercular: Scrofula .. .. 1 1 .. .. 2 Tabes Mesenterica 10 3 .. .. .. .. 13 Phthisis (Consumption) .. 15 23 14 2 .. 54 Hydrocephalus (Water on Brain) 6 6 .. .. .. .. 12—81 IV. Brain and Nerves: Meningitis .. 2 .. .. .. .. 2 Apoplexy .. .. 2 3 2 1 8 Palsy (Paralysis) .. 1 .. 5 10 .. 16 Delirium Tremens .. .. 1 .. .. .. 1 Epilepsy .. .. .. 1 2 .. 3 Insanity .. .. 2 .. .. .. 2 Convulsions 5 2 .. .. .. .. 7 Disease of Brain 1 3 1 2 4 1 12 Disease of Spinal Cord, &c. 1 .. .. .. .. .. 1—52 Carried forward 77 72 41 ?6 41 9 276 7 TABLE— (continued.) Causes of Death. Ages. Total. Under 1 l and under 20 20 and under 40 40 and under 60 60 and under 80 80 and above Brought forward 77 72 41 36 41 9 276 V. Heart and Blood Vessels: Pericarditis .. .. .. .. .. .. .. Endocarditis .. .. .. .. .. .. .. Aneurism .. .. .. 1 .. .. 1 Disease of Heart, &c. 1 .. 1 3 7 3 15—16 VI. Respiratory Organs: Laryngismus Stridulus .. .. .. .. .. .. .. Larygitis .. 3 .. .. .. .. 3 Bronchitis .. 1 1 3 2 .. 7 Pleurisy .. 1 1 .. 1 .. 3 Pneumonia 2 4 1 .. .. .. 7 Asthma .. .. .. 1 .. .. 1 Disease of Lungs .. 1 .. .. .. 1 2—23 VII. Digestive Organs: Teething 3 1 .. .. .. .. 4 Quinesy .. .. .. .. .. .. .. Gastritis .. .. .. .. 1 .. 1 Enteritis .. .. .. .. .. .. .. Peritonitis .. 1 .. 2 1 .. 4 Ascites .. .. .. .. .. .. .. Ulceration of Intestines .. .. .. .. .. .. .. Hernia (Rupture) .. .. .. .. .. .. .. Ileus .. .. 1 .. .. .. 1 Intussusception .. .. .. .. .. 1 1 Abdominal Tumour .. .. .. .. .. .. .. Stricture of Intestinal Canal .. .. .. .. 1 .. 1 Disease of Stomach, &c. .. .. .. .. 1 .. 1 Disease of Pancreas .. .. .. .. .. .. .. Inflammation of Liver (Hepatitis) .. .. 1 .. .. .. 1 Jaundice 2 .. .. .. 1 1 4 Disease of Liver .. .. 1 2 4 .. 7—25 Disease of Spleen .. .. .. .. .. .. .. VIII. Kidneys, &c.: Nephritis .. .. .. .. .. .. .. Nephria (Bright's Disease) .. .. .. 1 .. .. 1 Diabetes .. .. 1 1 .. 1 3 Cystitis .. .. .. .. 1 1 2 Stricture of Uretha .. .. .. .. .. .. .. Disease of Prostrate Gland .. .. .. .. 2 1 3 Disease of Kidneys .. .. .. 2 1 .. 3—12 IX. Childbirth: Childbirth (see Metria) .. .. 1 1 .. .. 2 Disease of Uterus, &c. .. .. .. .. 2 .. 2 Ovarian Disease .. .. 1 .. .. .. 1—5 Carried forward 85 84 51 53 66 18 357 8 TABLE— (continued.) Causes of Death. Ages. Total. Under 1 1 and under20 20 and under 40 40 and under 60 60 and under80 80 and above Brought forward 85 84 51 53 66 18 357 X. Joints, Bones, &c: Chronic Rheumatism .. .. .. .. .. .. .. Disease of Joints .. .. .. .. 1 .. 1—1 Disease of Bones .. .. .. .. .. .. .. Disease of Spine .. .. .. .. .. .. .. XI. Skin, Cellular Tissue, &c.: Carbuncle and Boils .. .. .. 1 .. .. 1 Phlegmon .. .. .. .. .. .. .. Disease of Skin, &c. .. .. .. .. 1 .. 1—2 XII. Malformation: Spina Bifida 1 .. .. .. .. .. 1 Other Malformations 1 .. .. .. .. .. 1—2 XIII. Premature Birth and bility 19 .. .. .. .. .. 19—19 XIV. Atropy 3 .. .. .. .. .. 3—3 XV. Old Age .. .. .. .. 13 10 23-23 XVI. Sudden Deaths 2 .. .. .. .. .. 2—2 XVII. Violent Deaths: Intemperance .. .. .. .. 1 .. 1 Privation of Food .. .. .. .. .. .. .. Want of Breast Milk 8 .. .. .. .. .. 8 Neglect .. .. .. .. .. .. .. Amputation of Leg .. .. .. .. .. .. .. Poisoned Wounds .. .. .. .. .. .. .. Burns and Scalds 1 .. .. .. .. .. 1 Hanging (Suicide) .. .. .. .. .. .. .. Suffocation .. .. .. .. .. .. .. Drowing (suicide) .. 3 1 .. .. .. 4 Fracture and Contusions .. .. .. .. .. .. .. Wounds .. .. .. .. .. .. .. Other Violence 1 1 1 .. .. .. 3—17 XVIII. Not Specified .. .. .. .. .. .. .. Total 121 88 53 54 82 28 426 Under 1 1 and under 20 20 and under 40 40 and under 60 60 and under 80 80 and above Total. HAC 39 REPORT on the SANITARY STATE of HACKNEY DISTRICT, for the Quarter ending December 31st, 1859, BY JOHN W. TRIPE, M.D., Medical Officer of Health to the District, Member of the Council of the Meteorological Society, &c. Printed by Order of the Hoard, BY john coventry, church street, hackney. 1860. REPORT. To the Board of Works for the Hackney District. Gentlemen, The Registrar General of Births and Deaths stated, in his last Quarterly Report, that 109,450 deaths were registered in the whole of the Metropolis during the three months ending December 31st, or at the rate of 2.189 per cent. per annum. The mortality for the Hackney District was 421, of which 31 deaths occurred in the East London Union and the German Hospital; so that 390 deaths of the inhabitants took place, or 1.91 per cent. per annum, if the number of the inhabitants was 81,524 as calculated. The Registrar General also stated that the mortality of the town districts in England during the last quarter of 1859 was 25 per 1000, and of the country 19 per 1000, so that Hackney, as a suburban district, was far more healthy than the average. During the corresponding quarter in 1858 there were 475 deaths in the whole district, against 421 in the last quarter, so that there were 54 deaths less this quarter than in 1858. A comparison between the births of the two quarters is equally satisfactory, as in the last quarter of 1858 there were only 610 registered against 648 in 1859. The excess of births over deaths has also been larger than usual, as there were only 421 deaths against 648 births, or 154 births to each 100 deaths. Of the 648 births, 329 were of males, and 319 of females; whilst of the 421 deaths, 210 were of males, and 211 of females. This is contrary to the usual death rate, as more males die than females, especially at the early period of life. The number of births registered in each of the subdistricts was as follows:— 52 in Stoke Newington, 42 in Stamford Hill, 196 in West Hackney, 243 in Hackney, and 115 in South Hackney. The deaths registered were as follows:— 29 in Stoke Newington, 28 in Stamford Hill, 93 in West Hackney, 203 in Hackney, and 70 in South Hackney sub-district. Of the 421 deaths, 63 were of children under one year of age, or 15 per cent. only; 128 were above 1 but under 20; 54 were above 20 and under 40; 64 were above 40 and under 60; no less than 84 were more than 60 but less than 80; and 28 were above 80 years of age. The mortality of 4 the young has considerably decreased since my appointment, so that we may conclude that the sanitary measures carried out have been productive not only of an increased duration of life, but also of diminished sickness. This is chiefly shewn by a comparison of the corresponding quarter of 1857, when there were 79 deaths of children under one year old out of 395 deaths, or about 20 per cent. There were 94 deaths from the zymotic class of diseases, viz.:— 2 from small pox, 4 from measles, 31 from scarlet fever, 8 from hooping cough, 1 from thrush, 7 from diarrhœa, 3 from dysentry, 1 from influenza, 22 from the various kinds of fever, 2 from erysipelas, 2 from syphilis, and 7 from diptheria. There were also 19 from diseases of uncertain seat, of which 8 were from cancer, 60 from tubercular affections, including 48 from consumption, and 6 from water on the brain. No less than 57 deaths arose from diseases of the brain and spinal cord, of which 13 were registered as from insanity, 11 from apoplexy, 11 from palsy, and 6 from inflammatory diseases of the brain. There were also 20 deaths from diseases of the heart, 64 from inflammatory affections of the lungs and respiratory organs, 19 from diseases of the stomach and digestive organs, 10 from diseases of the kidneys, 5 from childbirth, 14 from premature birth and debility, 10 from atrophy, 30 from old age, and 10 were sudden or from violence. Of the 16 sudden deaths, 5 were caused by suffocation of children under one year of age, 3 from intemperance, and 2 from drowning. The nuisances which have been removed by Mr. Valentine, to a great extent under my immediate superintendence, are as follows:— Cesspools emptied, filled up, and drained into the sewer 95 Cesspools emptied 31 Horse, Cow, Pig, and Vegetable refuse removed 60 Houses limewashed and purified, houses repaired 19 Filthy places and roads cleansed and purified 11 Pigsties purified, repaired, or removed 24 Foul and offensive drains cleansed or re-constructed 33 Other nuisances 7 Total 280 There were 18 owners of property required to attend before the Board in consequence of their neglect to obey notices which had been served on them to abate nuisances existing on their property. Of these four only neglected to perform the work after they had been so required, the whole of whom were summonsed to the Worship Street or Clerkenwell Police Courts, and ordered by the Magistrates to abate the nuisances, in each case, within fourteen days. 5 In my last Quarterly Report I pointed out the necessity of revaccinating a considerable proportion of the inhabitants of the District, as, in my opinion, the protective influence of vaccination ceases at a much earlier period than is generally believed. I pointed out in that Report the advisability of performing the operation a second time in children above 7 years of age who had not proper marks on their arms. The steps which have been taken by the Board of Guardians, at the instance of Dr. Seaton, the Government Inspector, have been such as to carry out in the most efficient manner the suggestion I then made. The result of my inspection of the children in the public schools prove the correctness of my opinion, as about 30 per cent. were not properly protected. I shall lay the statistics before you as soon as the lists I furnished to the District Vaccinators have been returned to me; but in several instances the whole of those who were re-vaccinated had the cow-pock in its ordinary and unmodified form. The meteorology of the quarter ending December 31st, was very unusual, the temperature having been very largely in excess during the first three weeks of October, when a very sudden and severe cold set in—the mean temperature on the 21st and 22nd having been nearly 12 degrees below the average, on the 23rd 15 degrees, and on the 21 th nearly 16 degrees below the average. The weather then became a little warmer, especially during the first nine days of November, after which we had very cold weather to the 23rd day of December. From the 16th to the 19th day of December, the temperature varied from 15 degrees to 17 degrees below the average. The range of temperature was extremely large both in October and December; in October it was above 55 degrees—the lowest having been 25.4° and the highest 80.6°; in December it was 42 degrees—the highest temperature having been 56° and the lowest 14°. The rain-fall was considerably above the average, having been more than 8 inches. Very little ozone was noted. I remain, Gentlemen, Your obedient Servant, JOHN W. TRIPE. March, 1800. 6 TABLE. Deaths Registered in the District of Hackney during the Thirteen Weeks ending Saturday, December 31st, 1859. Causes of Death. Ages, Total. Under 1 1 and under 20 20 and under 40 40 and under 60 60 and under 80 80 and above I. Zymotic: Smallpox .. 2 .. .. .. .. 2 Measles .. 4 .. .. .. .. 4 Scarlatina .. 31 .. .. .. .. 31 Hooping Cough 3 5 .. .. .. .. 8 Croup .. .. .. .. .. .. .. Thrush 1 .. .. .. .. .. 1 Diarrhœa (Bowel Complaint) 4 1 .. .. 2 .. 7 Dysentery .. 1 .. .. 2 .. 3 Cholera .. .. .. .. .. .. .. Influenza .. .. .. .. .. 1 1 Scurvy and Purpura .. .. .. .. .. .. .. Ague .. .. .. .. .. .. .. Remittent Fever .. 1 .. .. .. .. 1 Infantile Fever .. .. .. .. .. .. .. Fever 1 14 3 2 2 .. 22 Puerperal Fever (Metria) .. .. 2 .. .. .. 2 Rheumatic Fever .. .. .. .. .. 1 1 Erysipelas (Rose) 1 .. 1 .. .. .. 2 Syphilis 1 .. 1 .. .. .. 2 Diptheria .. 7 .. .. .. .. 7—94 II. Dropsy, &c.: Hæmorrhage .. .. .. 2 .. .. 2 Dropsy .. .. .. 2 3 .. 5 Abscess .. .. .. 1 .. .. 1 Ulcer .. .. .. .. .. .. .. Fistula .. .. .. .. .. .. .. Mortification .. .. .. .. .. 1 1 Cancer .. 2 1 1 4 .. 8 Gout .. .. .. .. 1 1 2—19 III. Tubercular: Scrofula .. .. .. 1 .. .. 1 Tabes Mesenterica 1 4 .. .. .. .. 5 Phthisis (Consumption) .. 5 25 15 3 .. 48 Hydrocephalus (Water on Brain) 1 5 .. .. .. .. 6—60 IV. Brain and Nerves: Meningitis .. 2 .. .. .. .. 2 Cerebritis .. 3 .. .. 1 .. 4 Apoplexy .. 1 .. 4 5 1 11 Palsy (Paralysis) .. 1 .. 2 6 2 11 Delirium Tremens .. .. 1 .. .. .. 1 Epilepsy .. 2 .. 1 1 .. 4 Insanity .. .. 1 1 .. .. 2 Convulsions 10 3 .. .. .. .. 13 Disease of Brain, &c. .. 1 .. 3 2 .. 6 Disease of Spinal Cord .. 1 .. 2 .. .. 3—57 Carried forward 23 96 35 37 32 7 230 7 TABLE— (continued.) Causes of Death. Ages. Total. Under 1 l and under20 20 and under40 40 and under 60 60 and under 80 80 and above Brought forward 23 96 35 37 32 7 230 V. Heart and Blood Vessels: Pericarditis .. .. .. .. 1 .. 1 Endocarditis .. .. .. .. .. .. .. Aneurism .. .. .. .. .. .. .. Disease of Heart, &c. .. 1 4 6 8 .. 19—20 VI. Respiratory Organs: Laryngismus Stridulus .. .. .. .. .. .. .. Laryngitis .. 6 .. .. .. .. 6 Bronchitis 3 7 1 7 14 3 35 Pleurisy .. 2 .. .. .. .. 2 Pneumonia 6 6 1 2 1 .. 16 Asthma .. .. .. .. 3 .. 3 Disease of Lungs .. .. .. 1 1 .. 2—64 VII. Digestive Organs: Teething 2 .. .. .. .. .. 2 Quinsey .. 1 .. .. .. .. 1 Gastritis .. .. .. .. .. .. .. Enteritis .. 2 1 1 1 .. 5 Peritonitis .. 1 .. 1 1 .. 3 Ascites .. .. .. .. .. .. .. Ulceration of Intestines .. .. .. .. .. .. .. Hernia (Rupture) .. .. .. .. 1 .. 1 Ileus .. .. .. .. .. .. .. Intussusception .. .. .. .. .. .. .. Abdominal Tumour .. .. .. .. .. .. .. Stricture of Intestinal Canal 1 .. .. .. .. .. 1 Disease of Stomach, &c. .. .. .. 1 1 .. 2 Disease of Pancreas .. .. .. .. .. .. .. Inflammation of Liver (Hepatitis) .. .. .. .. .. .. .. Jaundice .. .. .. 1 .. .. 1 Disease of Liver .. .. .. .. .. .. .. Disease of Spleen .. 1 1 .. .. 1 3—19 VIII. Kidneys, &c.: Nephritis .. .. .. .. .. .. .. Nephria (Bright's Disease) .. .. 1 .. 1 .. 2 Diabetes .. .. .. .. .. .. .. Cystitis .. .. 1 .. 2 .. 3 Stricture of Urethra .. .. .. .. .. .. .. Disease of Prostrate Gland .. .. .. .. .. 1 1 Disease of Kidneys .. .. 1 2 1 .. 4—10 IX. Childbirth: Childbirth (see Metria) .. .. 3 2 .. .. 5— 5 Disease of Uterus, &c. .. .. .. .. .. .. .. Ovarian Disease .. .. .. .. .. .. .. Carried forward 35 123 49 61 68 12 348 8 TABLE— (continued.) Causes of Death. Ages. Total. Under 1 1 and under20 20 and under 40 40 and under 60 60 and under 80 80 and above Brought forward 35 123 49 61 68 12 348 X. Joints, Bones, &c: Chronica Rheumatism .. .. .. .. .. .. .. Disease of Joints .. 1 .. .. .. .. 1—1 Disease of Bones .. .. .. .. .. .. .. Disease of Spine .. .. .. .. .. .. .. XI. Skin, Cellular Tissue, &c.: Carbuncle and Boils .. .. .. .. .. 1 1 Phlegmon .. .. .. .. .. .. .. Disease of Skin, &c. 1 .. .. .. .. .. 1—2 XII. Malformation: Spina Bifida .. .. .. .. .. .. .. Other Malformations .. .. .. .. .. .. .. XIII. Premature Birth and Debility 14 .. .. .. .. .. 14—14 XIV. Atrophy 8 2 .. .. .. .. 10 — 10 XV. Old Age .. .. .. .. 15 15 30—30 XVI. Sudden Deaths .. .. .. .. .. .. .. XVII. Violent Deaths: Intemperance .. .. 1 1 1 .. 3 Privation of Food .. .. .. .. .. .. .. Want of Breast Milk .. .. .. .. .. .. .. Neglect .. .. .. .. .. .. .. Amputation of Leg .. .. .. .. .. .. .. Poison .. .. 1 .. .. .. 1 Burns and Scalds .. 2 .. .. .. .. 2 Hanging (Suicide) .. .. .. .. .. .. .. Suffocation 5 .. .. .. .. .. 5 Drowning (Suicide) .. .. 1 1 .. .. 2 Fracture and Contusions .. .. 1 1 .. .. 2 Wounds .. .. .. .. .. .. .. Other Violence .. .. .. .. .. .. .. XVIII. Not Specified .. .. 1 .. .. .. 1-16 Total 63 128 54 64 84 28 421 Under 1 1 and under 20 20 and under 40 40 and under 60 60 and under 80 80 and above Total.